[House Report 108-808]
[From the U.S. Government Publishing Office]



                                     

                                                 Union Calendar No. 493

108th Congress, 2d Session -  -  -  -  -  -  -  -  -  - House Report 
108-808

                           ACTIVITIES REPORT

                                 of the

                     COMMITTEE ON VETERANS' AFFAIRS

                        HOUSE OF REPRESENTATIVES

                      ONE HUNDRED EIGHTH CONGRESS

                               __________

                             first session

                        Convened January 7, 2003

                       Adjourned December 8, 2003

                             second session

                       Convened January 20, 2004

                       Adjourned December 7, 2004

                                     



 January 3, 2005--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed
?

                                     
For Sale by the Superintendent of Documents, U.S. Government Printing Office
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                     COMMITTEE ON VETERANS' AFFAIRS

               CHRISTOPHER H. SMITH, New Jersey, Chairman

MICHAEL BILIRAKIS, Florida           LANE EVANS, Illinois
TERRY EVERETT, Alabama               BOB FILNER, California
STEVE BUYER, Indiana                 LUIS V. GUTIERREZ, Illinois
JACK QUINN, New York                 CORRINE BROWN, Florida
CLIFF STEARNS, Florida               VIC SNYDER, Arkansas
JERRY MORAN, Kansas                  CIRO D. RODRIGUEZ, Texas
RICHARD H. BAKER, Louisiana          MICHAEL H. MICHAUD, Maine
ROB SIMMONS, Connecticut             DARLENE HOOLEY, Oregon
HENRY E. BROWN, Jr., South Carolina  TED STRICKLAND, Ohio
JEFF MILLER, Florida                 SHELLEY BERKLEY, Nevada
JOHN BOOZMAN, Arkansas               TOM UDALL, New Mexico
JEB BRADLEY, New Hampshire           SUSAN A. DAVIS, California
BOB BEAUPREZ, Colorado               TIM RYAN, Ohio
GINNY BROWN-WAITE, Florida           STEPHANIE HERSETH, South Dakota
RICK RENZI, Arizona
TIM MURPHY, Pennsylvania

           Patrick E. Ryan, Chief Counsel and Staff Director

-------------

    \1\ February 5, 2003--Rep. Michael H. Michaud was 
appointed to the Committee.
    \2\ February 12, 2003--Rep. Jim Gibbons resigned from 
the Committee to serve on the Select Committee on Homeland Security.
    \3\ February 13, 2003--Rep. Darlene Hooley, Rep. 
Silvestre Reyes, Rep. Ted Strickland, Rep. Shelley Berkley, Rep. Tom 
Udall, Rep. Susan A. Davis, and Rep. Tim Ryan were appointed to the 
Committee.
    \4\ February 25, 2003--Rep. Tim Murphy was appointed to 
the Committee.
    \5\ June 16, 2004--Rep. Silvestre Reyes resigned from 
the Committee.
    \6\ June 16, 2004--Rep. Stephanie Herseth was appointed 
to the Committee.

                                     


                                     


                                  (ii)


                                     
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                               __________

                         SUBCOMMITTEE ON HEALTH

                   ROB SIMMONS, Connecticut, Chairman

JERRY MORAN, Kansas                  CIRO D. RODRIGUEZ, Texas
RICHARD H. BAKER, Louisiana          BOB FILNER, California
JEFF MILLER, Florida                 VIC SNYDER, Arkansas
JOHN BOOZMAN, Arkansas               TED STRICKLAND, Ohio
JEB BRADLEY, New Hampshire           SHELLEY BERKLEY, Nevada
BOB BEAUPREZ, Colorado               TIM RYAN, Ohio
GINNY BROWN-WAITE, Florida           LUIS V. GUTIERREZ, Illinois
RICK RENZI, Arizona                  CORRINE BROWN, Florida
CLIFF STEARNS, Florida               DARLENE HOOLEY, Oregon
TIM MURPHY, Pennsylvania
                               __________

                        SUBCOMMITTEE ON BENEFITS

             HENRY E. BROWN, Jr., South Carolina, Chairman

JACK QUINN, New York                 MICHAEL H. MICHAUD, Maine
JEFF MILLER, Florida                 SUSAN A. DAVIS, California
JEB BRADLEY, New Hampshire           CORRINE BROWN, Florida
GINNY BROWN-WAITE, Florida           STEPHANIE HERSETH, South Dakota
                               __________

              SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

                     STEVE BUYER, Indiana, Chairman

MICHAEL BILIRAKIS, Florida           DARLENE HOOLEY, Oregon
TERRY EVERETT, Alabama               LANE EVANS, Illinois
JOHN BOOZMAN, Arkansas               BOB FILNER, California
Vacancy                              TOM UDALL, New Mexico

                                     

                                     

                                     

                                     

                                 (iii)

  
?

                                     

                            Committee Staff

           Patrick E. Ryan, Chief Counsel and Staff Director

Charles M. Durishin, Democratic Staff Director (January 3, 2003-May 17, 
                                 2003)

       James H. Holley, Democratic Staff Director (May 18, 2003)

                Kingston E. Smith,* Deputy Chief Counsel

  Arthur K. Wu, Deputy Staff Director/Staff Director, Subcommittee on 
                      Oversight and Investigations

    Leah M. Booth, Democratic Executive Assistant, Subcommittees on 
                          Benefits and Health

        John M. Bradley,* Staff Director, Subcommittee on Health

   Geoffrey K. Collver, Democratic Counsel, Subcommittee on Benefits

 Veronica Crowe, Professional Staff Member, Subcommittee on Oversight 
                           and Investigations

              Peter A. Dickinson, Communications Director

                  Bernadine N. Dotson, Office Manager

    Dolores Dunn, Professional Staff Member, Subcommittee on Health

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

          Kevin J. Gash, Democratic Professional Staff Member

  Kathleen S. Greve, Professional Staff Member, Subcommittee on Health

       Darryl W. Kehrer, Staff Director, Subcommittee on Benefits

 Sarah Keller-Likins, Democratic Executive Assistant, Subcommittee on 
                                 Health

          Steven R. Kirkland, Director of Information Systems

             Summer L. Larson, Staff Assistant, Legislative

Ruth J. Mahnken, Democratic Professional Staff Member, Subcommittee on 
                      Oversight and Investigations

   Mary Ellen Mc Carthy, Democratic Staff Director, Subcommittee on 
                                Benefits

 Mary Stevens McDermott, Administrative and Financial Assistant/Chief 
                                 Clerk

   Jonathan M. McKay, Staff Assistant, Subcommittee on Oversight and 
                             Investigations

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

               Jeanne M. McNally, Legislative Coordinator

             Holly M. Palmer, Staff Assistant, Legislative

Virginia E. Richardson, Democratic Executive Assistant, Subcommittee on 
                      Oversight and Investigations

      Devon E. Seibert, Staff Assistant, Subcommittee on Benefits

  Leonard A. Sistek, Jr., Democratic Staff Director, Subcommittee on 
                      Oversight and Investigations

            Tanya J. Skypeck, Staff Assistant, Front Office

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

                    Jeremiah B. Tan, Printing Clerk

     Stacy H. Zelenski, Research Assistant, Subcommittee on Health

-------------

    * On November 19, 2004, John M. Bradley was named Staff Director 
and Kingston E. Smith was named Chief Counsel.

                                     


                                  (v)


                                     
                          LETTER OF SUBMITTAL

                              ----------                              

                          House of Representatives,
                            Committee on Veterans' Affairs,
                                    Washington, DC, January 3, 2005

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.

                                      Christopher H. Smith,
                                                           Chairman
                                FOREWORD

                              ----------                              

    The 108th Congress made substantial progress in 
strengthening and reforming federal programs benefiting 
veterans and their families. With the War on Terror being 
fought every day in Iraq, Afghanistan and other locations 
around the world, the 108th Congress continued to fulfill our 
Nation's obligations to provide health care services, 
compensation, and transition benefits to servicemembers, 
veterans, and their families.
    In the past two years, veterans health care services became 
more comprehensive, accessible, and timely. Compensation 
benefits for disabled veterans were expanded and increased. 
Civil, legal and job protections for servicemembers and 
veterans were strengthened. Education, training, employment, 
and entrepreneurship programs for transitioning veterans were 
improved. The national cemetery system honoring our veterans 
was authorized to further expand to meet future needs.
    Through steady oversight of the Department of Veterans 
Affairs (VA), there have been measurable reductions in fraud, 
waste, and mismanagement, as well as record increases in third 
party collections that go directly back into VA to fund 
veterans' health care.

    Major Committee Legislation--The Veterans Benefits 
Improvement Act of 2004 (Public Law 108-454) strengthens VA 
education, training and employment programs; enhances VA 
disability and compensation programs; expands VA's home loan 
programs; and strengthens veterans' and servicemembers' legal 
protections. Major provisions of Public Law 108-454, as 
enacted:

     LIncrease VA's monthly MGIB educational assistance 
for apprenticeship and on-the-job training programs;
     LAuthorize VA to pay benefits for competency-based 
apprenticeships, which are predicated upon the mastery of job 
skills rather than a set time period for training;
     LProvide an additional $250 in dependency and 
indemnity compensation (DIC) paid monthly to surviving spouses 
with one or more children under age 18 for a two-year 
transition period;
     LIncrease the maximum VA home loan guaranty to 25 
percent of the Freddie Mac conforming loan amount for a single-
family residence (currently from $240,000 to $333,700) and 
annually index it to Freddie Mac.

    The Veterans Health Programs Improvement Act of 2004 
(Public Law 108-422) strengthens VA's homeless, long term care, 
and nursing programs; authorizes new and expanded VA outpatient 
clinics; and establishes new research and education centers for 
veterans with multi-traumatic combat injuries. Major provisions 
of Public Law 108-422, as enacted:

     LAuthorize 16 leases totaling $24,420,000 for VA 
community-based outpatient clinics;
     LIncrease authorization for the Grant and Per Diem 
homeless veterans assistance program from $75 million to $99 
million in FY 2005;
     LProvide payments to States to assist them in 
hiring and retaining nurses to work in State veterans' homes;
     LAuthorize a new pilot program to improve 
recruitment of qualified nurses using outside agencies, 
advertising, and interactive online technologies;
     LAuthorize new research and education centers for 
treating veterans with complex multi-trauma injuries associated 
with combat.

    The Department of Veterans Affairs Health Care Personnel 
Enhancement Act of 2004 (Public Law 108-445) reforms VA's 
physician pay and nurse employment systems to provide 
additional flexibility to recruit and retain highly qualified 
medical personnel. Under Public Law 108-445, a new physician 
and dentist pay system will be established, to be comprised of 
three elements: a 15-step Physician and Dentist Base and 
Longevity Pay Schedule; a market pay band for clinical 
specialties and subspecialties set by the Secretary; and 
incentive bonuses up to $15,000 for physicians or dentists who 
meet established performance goals set by the Department.
    The Veterans Benefits Act of 2003 (Public Law 108-183) 
expands and strengthens numerous compensation and transition 
benefits for veterans. Major provisions of Public Law 108-183, 
as enacted:

     LExpand the Montgomery GI Bill program to cover 
self-employment training programs and entrepreneurship courses 
at approved institutions;
     LAllow federal agencies to create sole-source 
contracts for disabled veteran-owned small businesses and to 
restrict certain contracts to disabled veteran-owned small 
businesses;
     LRestore dependency and indemnity compensation 
(DIC), home loan, education, and burial benefit eligibility for 
spouses remarried after age 57;
     LIncrease the specially adapted automobile grant 
from $9,000 to $11,000, and increase the specially adapted 
housing grants from $48,000 to $50,000 for the most severely 
disabled veterans and from $9,250 to $10,000 for less severely 
disabled veterans;
     LIncrease monthly educational benefits for spouses 
and dependent children of disabled;
     LEliminate the 30-day requirement for prisoners of 
war (POWs) to qualify for presumptions of service-connection 
for certain disabilities: psychosis, any of the anxiety states, 
dysthymic disorder, organic residuals of frostbite, and post-
traumatic osteoarthritis;
     LProvide full compensation and DIC to members of 
the new Philippine Scouts if the individual resides in the 
United States as a citizen or permanent resident, and also 
extend eligibility for burial in a national cemetery.

    The Servicemembers Civil Relief Act (Public Law 108-189), 
rewrote the Soldiers' and Sailors' Civil Relief Act, 
modernizing and expanding the law to meet today's civil, legal, 
and financial arrangements. Important provisions of Public Law 
108-189, as enacted:

     LUpdate eviction protections for families of 
servicemembers on active duty to reflect the increase in the 
cost of rental housing;
     LStrengthen protections for servicemembers from 
losing life insurance coverage while on active duty;
     LProvide coverage for all motor vehicles and other 
personal property by the Act's installment contract 
protections, so that the creditor must obtain a court order 
before repossessing the motor vehicle;
     LClarify that the Act's rights and protections 
apply to civil administrative proceedings, such as license and 
zoning matters, which are far more common today than they were 
in 1940;
     LImprove protection of servicemembers against 
default judgments;
     LExpand the professional liability protections to 
include legal services.

    The Veterans Health Care, Capital Asset, and Business 
Improvement Act of 2003 (Public Law 108-170), authorized $276.6 
million for major medical construction projects, and enhanced 
and expanded numerous VA heath care benefits. Other major 
provisions of Public Law 108-170, as enacted:

     LEliminate the 90-day requirement for former POWs 
to qualify for VA outpatient dental care and eliminate 
prescription drug copayments for former POWs;
     LAuthorize VA to provide health care services to 
certain Filipino World War II veterans who permanently reside 
in the United States;
     LAuthorize VA to appoint chiropractors as clinical 
practitioners;
     LIncrease yearly earmarked funding for specialized 
mental health care services to severely and chronically 
disabled veterans from $15,000,000 to $25,000,000;
     LExtend VA's authority to transfer housing 
properties recovered through foreclosure of GI home loans to 
community-based homeless veterans assistance providers;
     LAuthorize premium pay for Saturday duty to 
additional VA health care workers;
     LAuthorize VA to carry out major construction 
projects proposed by the Capitol Asset Realignment for Enhanced 
Services (CARES) initiative only after submitting a report to 
Congress listing each project in order of priority as 
established in this legislation.

    The National Cemetery Expansion Act of 2003 (Public Law 
108-109) directed the Secretary of Veterans Affairs to 
establish, not later than four years after the date of 
enactment, six new national cemeteries in southeastern 
Pennsylvania; Birmingham, Alabama; Jacksonville, Florida; 
Bakersfield, California; Greenville/Columbia, South Carolina; 
and Sarasota, Florida.

    Oversight--The Committee continued aggressive oversight of 
the federal veterans programs and laws. The tone was set early 
in the 108th Congress when the Committee held a series of 
hearings to investigate fraud, waste, abuse, and mismanagement 
in the Department of Veterans Affairs. Detailed testimony from 
both the Office of Inspector General and the Government 
Accountability Office (GAO) documented progress made, as well 
as areas where significant improvement was needed. Among the 
major areas covered were mismanagement of part-time physicians, 
erroneous benefits paid to fugitive felons, and ongoing efforts 
to improve VA's third party insurance collections to the 
Medical Care Collections Fund.
    Other oversight topics examined in Committee hearings 
included VA's CARES (Capital Asset Realignment for Enhanced 
Services) process; VA-DOD sharing of medical resources; VA's 
preparedness to meet national medical emergencies; and VA's 
ability to provide a seamless delivery of benefits and services 
to servicemembers as they transition from the military to 
civilian life.

    Budget and Appropriations--Funding for veterans programs 
has increased significantly in each of the past four years. 
Overall funding for the Department of Veterans Affairs has 
risen $23 billion from approximately $48 billion in fiscal year 
2001 to over $71 billion in the fiscal year 2005 budget, almost 
a 50 percent increase in four years. Veterans medical care 
funding has risen from $20.2 billion in the fiscal year 2001 
budget to $27.8 billion in the fiscal year 2005 budget. The 
fiscal year 2005 Consolidated Appropriations Act (Public Law 
108-447) contained $1.2 billion more in veterans medical care 
funding than had been requested by the Administration in the 
budget submission.
    As a result of these funding decisions made by Congress, as 
well as aggressive oversight by the Committee, the number of 
veterans who received VA medical care services in 2004 topped 5 
million, over one million more than had received medical care 
services four years prior. At the same time, using new 
resources provided through the budget and appropriations 
process, as well as increased focus upon management 
initiatives, VA has been able to reduce the number of veterans 
on long waiting lists by more than 98 percent in two years, 
from over 300,000 in 2002 to less than 6,000 today.

    Acknowledgements--The successes achieved for veterans in 
the 108th Congress are the result of dedicated, bipartisan work 
by the Members and staff of the Committee. I want to thank 
Honorable Lane Evans of Illinois, the Ranking Minority Member 
of the Committee, for his dedication and cooperation in 
improving the lives of all veterans and their loved ones. I 
want to thank the Chairmen and Ranking Minority Members of the 
Subcommittees for all of their highly effective work: Honorable 
Henry Brown and Honorable Michael Michaud of the Benefits 
Subcommittee; Honorable Rob Simmons and Honorable Ciro 
Rodriguez of the Health Subcommittee; and Honorable Steve Buyer 
and Honorable Darlene Hooley of the Oversight and 
Investigations Subcommittee. I also want to thank Honorable 
Mike Bilirakis, the Vice Chairman of the Committee, for his 
years of advocacy on behalf of veterans.
    Our legislative success was only possible due to the 
cooperation of our counterparts in the Senate, Honorable Arlen 
Specter, Chairman, and Honorable Bob Graham, Ranking Member, of 
the Senate Veterans' Affairs Committee. I want to thank them 
and their expert professional staff for their work to better 
the lives of veterans.
    I especially want to thank the entire Majority and Minority 
professional staffs of our Committee. The countless 
contributions made by each of them throughout the 108th 
Congress are responsible for truly historic progress made on 
behalf of veterans and their families.
    The Committee notes with sadness the June 20, 2003, death 
of one of its most distinguished former members, Honorable Bob 
Stump. Born and raised in Arizona, he served our country with 
distinction, from his enlistment in the U.S. Navy during World 
War II at the age of 16, to his extraordinary 26 years in the 
United States Congress. From 1995-2000, he chaired the 
Committee, and was its ranking minority member for the two 
previous years. With an impressive record of legislative 
accomplishments resulting in immeasurable good for veterans, 
servicemembers, and their families, Bob Stump was a true 
American hero.
    The 108th Congress continued to build upon the legacy of 
the 107th and prior Congresses. The course has been set, the 
orders given, and there will be no retreat from the mission to 
ensure that all of America's veterans are honored, cared for, 
and given all of the benefits they earned through their 
service.

                                      Christopher H. Smith,
                                                           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...........................     2
            Medical care.........................................     3
            Medical and prosthetic research......................     4
        Veterans Benefits Administration.........................     5
            Compensation and pension.............................     5
            Insurance............................................     5
            Education............................................     6
            Home loan assistance.................................     6
        National Cemetery Administration.........................     6
    Department of Labor..........................................     7
    American Battle Monuments Commission.........................     7
    Arlington National Cemetery..................................     8

Legislation enacted into law:
    Public Law 108-109, National Cemetery Expansion Act of 2003, 
      11/11/2003.................................................     8
    Public Law 108-147, Veterans' Compensation Cost-of-Living 
      Adjustment Act of 2003, 12/03/2003.........................     9
    Public Law 108-170, Veterans Health Care, Capital Asset, and 
      Business Improvement Act of 2003, 12/06/2003...............    10
    Public Law 108-183, Veterans Benefits Act of 2003, 12/16/2003    14
    Public Law 108-189, Servicemembers Civil Relief Act, 12/19/
      2003.......................................................    18
    Public Law 108-363, Veterans' Compensation Cost-of-Living 
      Adjustment Act of 2004, 10/25/2004.........................    20
    Public Law 108-422, Veterans Health Programs Improvement Act 
      of 2004, 11/30/2004........................................    21
    Public Law 108-445, Department of Veterans Affairs Health 
      Care Personnel Enhancement Act of 2004, 12/3/2004..........    24
    Public Law 108-454, Veterans Benefits Improvement Act of 
      2004, 12/10/2004...........................................    26

Activities of the Committee......................................    32

Activities of the subcommittees:
    Subcommittee on Health.......................................    47
    Subcommittee on Benefits.....................................    64
    Subcommittee on Oversight and Investigations.................    73

Summary of action by the Committee...............................    83
Hearings and Executive Sessions..................................    84
Committee web site...............................................    89
Oversight Plan for 108th Congress................................    91
Report on the budget proposed for fiscal year 2004...............    99
Report on the budget proposed for fiscal year 2005...............   120
Messages from the President and other Executive Branch 
  communications.................................................   140
Statistical data--war veterans and dependents....................   152
                                     

                                                 Union Calendar No. 493
108th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     108-808

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



 
ACTIVITIES OF THE COMMITTEE ON VETERANS' AFFAIRS FOR THE 108TH CONGRESS

                                _______
                                

 January 3, 2005--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

   Mr. Smith of New Jersey, for 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 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.

    The Committee on Veterans' Affairs 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. The 
Committee during the 108th Congress had 31 members, 17 in the 
majority and 14 in the minority.

                           VETERANS PROGRAMS


                     Department of Veterans Affairs

    President Herbert Hoover issued an executive order on July 
21, 1930, creating the Veterans Administration. At that time, 
the Veterans Administration had 54 hospitals and 31,600 
employees to serve 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 families.
    The veteran population was approximately 24.7 million on 
September 30, 2004. Over 74 of every 100 veterans have served 
during defined periods of armed hostilities. Altogether, 
approximately 65 million veterans, dependents and survivors of 
deceased veterans, over 20 percent of the Nation's population, 
are potentially eligible for VA benefits and services.
    To serve these veterans, their dependents and survivors, VA 
carries out its veterans programs nationwide in three 
administrations. The Veterans Health Administration (VHA) is 
responsible for veterans' health care programs. The Veterans 
Benefits Administration (VBA) is responsible for compensation, 
pension, vocational rehabilitation, education assistance, home 
loan guaranty and insurance programs. The National Cemetery 
Administration (NCA) is responsible for the operation of 120 
national cemeteries. The Board of Veterans' Appeals (BVA) 
provides final decisions for the Secretary on appeals of 
veterans benefits claims.
    As of September 30, 2004, VA had 236,427 employees. Among 
all the departments and agencies of the Federal government, 
only the Department of Defense (DOD) has a larger work force. 
Of the total number of VA employees, the Veterans Health 
Administration has 214,580, the Veterans Benefits 
Administration has 12,972, the National Cemetery Administration 
has 1,542, and the Veterans' Canteen Service has 3,238. The 
remaining 4,095 employees are in staff offices, including the 
office of the Inspector General. VA is a leading employer of 
veterans with about 25.2 percent of VA's employees being 
veterans.
    Since the formation of the Department, the Secretaries of 
Veterans Affairs have been: Honorable Edward J. Derwinski, 
1989-1992; Honorable Jesse Brown, 1993-1997; Honorable Togo D. 
West, Jr., 1998-2000; and the current Secretary, Honorable 
Anthony J. Principi.

                     VETERANS HEALTH ADMINISTRATION

    VA's largest and most visible component is the Veterans 
Health Administration (VHA). It has 157 hospitals, 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 at military treatment facilities in Alaska and 
Hawaii. VHA is divided into 21 Veterans Integrated Service 
Networks (VISNs) that provide its basic management structure. 
VHA is headed by the Under Secretary for Health, who is 
appointed by the President for a four-year term.
    In addition to its 157 hospitals, VA operates 696 
community-based outpatient clinics, 134 nursing homes and 42 
domiciliary care facilities.

Medical Care

    In 2003, with about 19,000 average operating acute hospital 
beds, VA treated 604,093 inpatients, 92,516 veterans in nursing 
home care units or in community nursing facilities at VA 
expense, and 24,413 veterans in home care and other community-
based health programs sponsored by VA. The Department's 
outpatient clinics registered over 46 million visits by 
veterans in 2003. Altogether, over 4.5 million veterans 
received care under VA auspices in 2003.
    Over the past decade, VA has transformed its health care 
system through a structural and organizational change, with 
improved resource allocation, better measurements of 
accountability for quality and value, and development of an 
information infrastructure to support the needs of patients, 
clinicians, and administrators. VA has experienced 
unprecedented growth in demand for medical care for the last 
several years. Between 2000 and 2003, the number of veterans 
treated through the VA health care system grew by 1.1 million, 
or 31 percent. During the same period, the VA health care 
budget increased by more than $6 billion (33 percent). This 
growth resulted in long waiting lists. More than 175,000 new 
enrollees waited six months or more for their first primary 
care appointments in July 2002. Due to management initiatives, 
VA was able to reduce the number of patients waiting for a 
first appointment to less than 4,000 as of May 15, 2004.
    Across the Nation, VA is currently affiliated with 107 
medical schools, 54 dental schools, and over 1,000 other 
schools offering students allied and associated education 
degrees or certificates in 40 health profession disciplines. 
More than one-half of all practicing physicians in the United 
States received at least part of their clinical educational 
experiences in the VA health care system. In 2003, over 83,000 
health care professionals received training in VA medical 
centers. The Department is also the largest employer of 
registered nurses in the United States, with 34,464 nurses on 
its rolls in 2003.
    VA's efforts to provide clinical services for veterans 
suffering from post-traumatic stress disorder (PTSD) were 
inaugurated with the establishment of the Vet Center program in 
1979.
    VA's Vet Center program consists of 206 community-based Vet 
Centers. The Vet Center program provides a mix of professional 
readjustment counseling for war trauma, family-related services 
and community-based service functions to include outreach, 
education, case management and referral activities. The Vet 
Centers make over 200,000 veteran referrals each year to VA 
medical facilities and regional offices.
    The Department conducts a variety of specialized programs, 
including compensated work therapy to provide disabled veterans 
with job skills, training, and rehabilitative residences. 
Often, these programs assist homeless veterans. VA also 
provides targeted services for homeless veterans, including 
outreach, case management, clinical care, residential treatment 
and rehabilitation, care for serious mental illnesses and 
substance-use disorder, and supported housing.
    In operating its health care facilities, the Department 
benefits from the contributions of time and energy by more than 
133,000 volunteers from all walks of life. Many veterans 
themselves and family members of veterans volunteer through 
VA's Voluntary Service. Volunteers donate nearly 13 million 
hours of service each year to bring companionship, faith, hope 
and comfort to hospitalized veterans and to the millions of 
veterans who visit VA outpatient clinics.

Medical and Prosthetic Research

    Some of the most recent advances from VA research include:

    Establishment of a new center for limb loss care. 
Researchers at the Providence VAMC have established a new 
Center for Rebuilding, Regenerating and Restoring Function 
After Limb Loss in collaboration with Brown Medical School and 
the Massachusetts Institute of Technology. The Center will 
provide state-of-the-art care for veteran amputees, foster the 
development of new prosthetic devices, and advance research in 
such areas as tissue engineering and robotics. VA expects the 
Center to significantly improve outcomes for veterans with 
recent combat injuries and other VA patients who have suffered 
amputation.

    Neuropsychological measures of military personnel. DOD has 
permitted VA scientists access to military personnel prior to 
deployment to establish baseline neuropsychological measures. 
Once they return from Operation Iraqi Freedom, these soldiers 
will be reassessed on the same neuropsychological measures, 
allowing comparison of pre- and post-deployment health, and 
providing valuable insight into the effects of traumatic 
exposure.

    Discovery that a harmless virus helps HIV infected 
patients. A study at the Iowa City VAMC and University of Iowa 
showed that a harmless virus, GBV-C, boosts immune proteins and 
helps slow the progression of HIV to prolong survival for many 
patients.

    Studies related to multiple-sclerosis nerve damage. 
Scientists with VA, Yale and University College, London, have 
found alterations in the appearance of two sodium channel 
molecules during nerve-fiber degeneration in multiple 
sclerosis. This landmark finding provides, for the first time, 
important clues about the molecular basis for the permanent and 
irreversible damage caused by MS.

    Clinical Trial using Deep Brain Stimulation to treat 
refractory Parkinson's disease. VA, in collaboration with the 
National Institute for Neurological Disorders and Stroke, is 
conducting an investigational trail of two promising 
neurosurgical techniques utilizing implantation of electrical 
stimulation devices to assess the impact on symptoms and 
functioning of Parkinson's patients, and to compare the effects 
of the techniques.

    Functional electrical stimulation (FES). VA researchers at 
the Cleveland FES Center are focusing on the application of one 
of the most advanced electrical currents technology to generate 
and suppress activity in the nervous system. This application 
can be used to control the movement of otherwise paralyzed 
limbs to stand and hand grasp, activate bowel and bladder 
function, create perceptions such as skin sensibility and 
suppress pain and spasm. The original technology for the 
diaphragm stimulator system, used by the late actor Christopher 
Reeve to help him breathe for extended periods without a 
ventilator, was developed at the Cleveland FES Center.

                    VETERANS BENEFITS ADMINISTRATION

    The Veterans Benefits Administration (VBA) is responsible 
for administering and delivering benefits and services to 
eligible veterans, as well as certain survivors and dependents. 
VBA operates 57 regional offices throughout the United States, 
Puerto Rico and the Republic of the Philippines. In 2002, the 
regional offices were realigned into four area offices which 
set goals, monitor performance and share responsibility for 
mission accomplishment within their geographic area. VBA 
programs include disability compensation, pension, education, 
vocational rehabilitation and employment, home loan guaranty, 
life insurance, and burial. VBA is headed by the Under 
Secretary for Benefits, who is appointed by the President for a 
four-year term.

Compensation and Pension

    More than 2.5 million veterans receive disability 
compensation and another 342,000 receive pension payments from 
VA. Additionally, over 340,000 individual widows, children and 
parents of deceased veterans are paid survivor compensation or 
death pension benefits. VA disability and death compensation 
and pension payments amounted to more than $29.6 billion in 
fiscal year 2004.

Insurance

    VA operates the tenth largest insurance program in the 
United States, based on total amount of coverage provided. VA-
administered and supervised insurance programs provide $750 
billion of coverage to more than 7.5 million veterans, 
servicemembers and their families. Six of the programs are 
administered directly by VA. Two others, the Servicemembers' 
Group Life Insurance (SGLI) and the Veterans' Group Life 
Insurance (VGLI) programs, are supervised and overseen by VA 
but are contracted to the Prudential Insurance Company of 
America. SGLI and VGLI represent 97 percent of the coverage 
amount and insure approximately 5.8 million lives for a total 
of $729 billion, to include more than 2.8 million veterans, 
active duty servicemembers, reservists and Guardsmen, plus 3.1 
million spouses and children.
    In 2003, the VA life insurance programs returned $569 
million in dividends to 1.5 million veterans who hold some of 
these VA life insurance policies, and paid an additional $2.42 
billion in death claims and other disbursements. The 
Philadelphia VA Insurance Center was selected from among 22 
organizations as recipient of the 2004 Government Customer 
Support Excellence Award, and was also named the recipient of 
the 2004 Leo C. Wurschmidt, Jr. Customer Service Team Award, 
VBA's highest award for customer service.

Education

    Since 1944, when the first GI Bill became law, more than 21 
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 
(MGIB). Approximately 59 percent of veterans eligible for the 
MGIB have used it through fiscal year 2004. Over 17,400 more 
claimants received education benefits during fiscal year 2004 
than during fiscal year 2003. Almost 68 percent of the 490,417 
beneficiaries who used VA education benefits during fiscal year 
2004 qualified under the provisions of the MGIB. Reservists 
accounted for about 18 percent, and the Survivors' and 
Dependents' Educational Assistance program for certain eligible 
dependents of veterans accounted for almost 14 percent.

Home Loan Assistance

    More than 16.8 million veterans and their dependents have 
benefited from VA's loan guaranty program. From this program's 
establishment as part of the original GI Bill in 1944 through 
the end of fiscal year 2002, VA home loan guaranties totaled 
more than $740 billion. In fiscal year 2002, VA guaranteed 
317,000 loans valued at $40 billion. Since 1948, VA has 
assisted 35,000 disabled veterans with grants totally more than 
$537 million for specially adapted housing.

                    NATIONAL CEMETERY ADMINISTRATION

    VA assumed responsibility for the National Cemetery 
Administration (NCA) in 1973. As of March 2004, NCA maintains 
almost 2.5 million gravesites at 120 national cemeteries in 39 
states and Puerto Rico. NCA also oversees 33 soldiers' lots, 
monument sites, and confederate cemeteries. Currently, 60 VA 
cemeteries in 34 states are able to provide both casket and 
cremation burials, and an additional 23 provide burial for 
family members of those already buried and can also accommodate 
cremated remains. Thirty-seven are closed to new interments but 
can accommodate family members in already-occupied gravesites. 
Total acreage in NCA has increased from 4,260 in 1973 to 14,200 
in 2004. More than 3 million people, including veterans from 
every war and conflict--from the Revolutionary War to Operation 
Iraqi Freedom--are honored by burial in VA's national 
cemeteries.
    Since 1973, annual interments in VA national cemeteries 
have increased from 36,400 to 89,750 in fiscal year 2003. 
Interments are expected to increase annually until 2008. In 
1999 and 2003, Congress directed VA to establish 12 new 
national cemeteries. One of those, Fort Sill National Cemetery 
in Oklahoma, opened in November 2001. The others, one in 
Alabama, two in California, three in Florida, one in Georgia, 
one in Michigan, two in Pennsylvania, and one in South 
Carolina, will be located near large populations of veterans 
who currently do not have access to burial in a veterans' 
cemetery.
    The Department of Veterans Affairs State Cemetery Grants 
Program was established in 1978 to complement VA's National 
Cemetery Administration. The program assists states with 
building or improving state veterans cemeteries. VA will pay 
for the construction costs in exchange for states providing the 
land and operating the cemeteries. More than $175 million has 
been awarded for 54 operational veterans cemeteries in 30 
states and Guam. Five state cemeteries are under construction. 
In 2003, state cemeteries that received VA grants buried 18,192 
eligible veterans and family members. Owing to the success of 
the State Cemetery Grants Program, Congress made the program, 
set to expire in fiscal year 2004, permanent with Public Law 
108-183.

                          Department of Labor


                   VETERANS' EMPLOYMENT AND TRAINING

    The Veterans' Employment and Training Service (VETS) of the 
Department of Labor provides employment and training services 
to eligible veterans through a non-competitive Jobs for 
Veterans State Grants Program. Under this grant program, funds 
are allocated to State Workforce Agencies in direct proportion 
to the number of veterans seeking employment within their 
state. On December 14, 2004, the Department of Labor granted an 
additional $3.78 million in grants above the annual 
appropriations for Veterans' Employment and Training to be 
divided among 17 communities in 15 states. Over 2,220 veterans 
will benefit from these grants in the form of new job 
placement, career counseling, classroom or on-the-job training, 
and obtaining or retaining licenses and certifications.

                  American Battle Monuments Commission

    The American Battle Monuments Commission (ABMC), created by 
an Act of Congress in 1923, is a Federal agency responsible for 
the construction and permanent maintenance of military 
cemeteries and memorials on foreign soil, as well as 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. government agencies and private individuals and 
organizations to maintain adequately the monuments and markers 
erected by them on foreign soils. ABMC also provides 
information and assistance, on request, to relatives and 
friends of the war dead interred or commemorated at its 
facilities.
    In performance of its functions, ABMC administers, operates 
and maintains 24 permanent American military cemetery memorials 
and 22 monuments, memorials, markers and separate chapels in 
fourteen foreign countries, the Commonwealth of the Northern 
Mariana Islands, Gibraltar, and three memorials in the United 
States. When directed by Congress, ABMC develops and erects 
national military monuments in the United States, such as the 
Korean War Veterans Memorial and most recently, the World War 
II National Memorial. A decade in the making, the World War II 
Memorial is located on the National Mall in Washington, DC and 
was dedicated on May 29, 2004. It is the first national World 
War II Memorial built to honor the 16 million servicemembers 
who served in the Armed Forces of the United States, the more 
than 400,000 who died, and the millions who supported the war 
effort at home.

                      Arlington National Cemetery

    Arlington Mansion and 200 acres of ground immediately 
surrounding it were designated as a military cemetery on June 
15, 1864, by Secretary of War Edwin M. Stanton. With more than 
200,000 people buried, Arlington National Cemetery has the 
second largest number of people buried of any national cemetery 
in the United States. Arlington National Cemetery is 
administered by the Department of the Army.
    Veterans from all the Nation's wars and conflicts are 
buried in the cemetery, from the American Revolution through 
Operation Iraqi Freedom. Since the War on Terror began, 121 
servicemembers have been interred at Arlington National 
Cemetery; 15 from Operation Enduring Freedom in Afghanistan and 
106 from Operation Iraqi Freedom. The cemetery conducts 
approximately 6,452 burials each year. In addition to in-ground 
burial, the cemetery has a large columbarium for cremated 
remains. Seven courts are currently in use, each with 5,000 
niches. Arlington is the site of many non-funeral ceremonies, 
and approximately 3,700 such ceremonies are conducted each 
year. Arlington is expected to continue to provide burials 
through the year 2060 with its recently approved capital 
investment plan.
    More than 4 million people visit the cemetery annually, 
many coming to pay final respects at graveside services, of 
which nearly 125 are conducted each week. Also, more than 3,800 
former slaves are buried there. The Tomb of the Unknowns and 
the grave of President John F. Kennedy are among the most 
visited sites at the cemetery.

                      LEGISLATION ENACTED INTO LAW

                                ------                                


                           Public Law 108-109


                National Cemetery Expansion Act of 2003


                        (H.R. 1516, AS AMENDED)

    Title: An Act to provide for the establishment by the 
Secretary of Veterans Affairs of additional cemeteries in the 
National Cemetery Administration.

    H.R. 1516, as amended, will:

    1.  Direct the Secretary of Veterans Affairs to establish, 
not later than four years after the date of enactment, six new 
national cemeteries in the following areas: southeastern 
Pennsylvania; Birmingham, Alabama; Jacksonville, Florida; 
Bakersfield, California; Greenville/Columbia, South Carolina; 
and Sarasota, Florida.
    2.  Direct the Secretary to use Advance Planning Funds for 
the establishment of the new cemeteries.
    3.  Direct the Secretary, in determining the specific sites 
for the new cemeteries, to solicit the advice of 
representatives of State and local veterans' organizations and 
other individuals as the Secretary considers appropriate.
    4.  Require the Secretary to submit a report to Congress 
within 120 days of enactment setting forth the six areas where 
those cemeteries will be established, a schedule for 
establishment, the estimated cost associated with 
establishment, and the amount of Advance Planning Funds 
obligated for this purpose.
    5.  Require the Secretary to submit to Congress an annual 
report that updates the information included in the initial 
report until the six cemeteries are completed.

    Effective Date: Date of enactment.

    Cost: The Congressional Budget Office (CBO) estimates that 
implementing the bill would cost $11 million in 2004 and $93 
million over the 2004-2008 period, assuming appropriation of 
the necessary amounts. The bill would not affect direct 
spending or receipts.

    Legislative History:

    June 26, 2003: H.R. 1516 ordered reported amended favorably 
            by the Committee on Veterans' Affairs.
    July 10, 2003: H.R. 1516 reported amended by the Committee 
            on Veterans' Affairs. H. Rept. 108-199.
    July 21, 2003: Passed the House amended under suspension by 
            vote of 408-0 (Roll No. 399).
    July 22, 2003: Referred to the Senate Committee on 
            Veterans' Affairs.
    September 30, 2003: Senate Committee on Veterans' Affairs 
            ordered reported favorably with an amendment in the 
            nature of a substitute.
    October 14, 2003: Senate Committee on Veterans' Affairs 
            reported with amendments and an amendment to the 
            title, with written report number 108-164.
    October 17, 2003: Passed the Senate with amendments and an 
            amendment to the title by unanimous consent.
    October 20, 2003: Message on Senate action sent to the 
            House.
    October 29, 2003: House agreed to the Senate amendments 
            under suspension by vote of 412-0 (Roll No. 577).
    November 11, 2003: Signed by the President, Public Law 108-
            109.
                                ------                                


                           Public Law 108-147


      Veterans' Compensation Cost-of-Living Adjustment Act of 2003


                              (H.R. 1683)

    Title: An Act to increase, effective as of December 1, 
2003, the rates of disability compensation for veterans with 
service-connected disabilities and the rates of dependency and 
indemnity compensation for survivors of certain service-
connected disabled veterans, and for other purposes.

    H.R. 1683 will:

    Provide effective December 1, 2003, a cost-of-living 
adjustment to the rates of disability compensation for veterans 
with service-connected disabilities and to the rates of 
dependency and indemnity compensation for survivors of certain 
service-connected disabled veterans. The percentage amount 
would be equal to the increase for benefits provided under the 
Social Security Act, which is calculated based upon changes in 
the Consumer Price Index.

    Effective Date: December 1, 2003.

    Cost: The COLA is assumed in the baseline, and would have 
no budgetary effect relative to the baseline. Relative to 
current law, the Congressional Budget Office estimates that 
enacting this provision would increase spending for these 
programs by about $420 million in 2004. (The annualized cost 
would be about $560 million in subsequent years.) This estimate 
assumes that the COLA effective on December 1, 2003, would be 
2.2 percent.

    Legislative History:

    May 15, 2003: H.R. 1683 ordered reported favorably by the 
            Committee on Veterans' Affairs.
    May 19, 2003: H.R. 1683 reported by the Committee on 
            Veterans' Affairs. H. Rept. 108-108.
    May 20, 2003: Considered under suspension of the rules. At 
            the conclusion of debate, the Yeas and Nays were 
            demanded and ordered. Pursuant to the provisions of 
            clause 8, rule XX, the Chair announced that further 
            proceedings on the motion would be postponed.
    May 22, 2003: Passed the House under suspension by vote of 
            426-0 (Roll No. 209).
    May 22, 2003: Referred to the Senate Committee on Veterans' 
            Affairs.
    November 21, 2003: Senate Committee on Veterans' Affairs 
            discharged by unanimous consent.
    November 21, 2003: Passed the Senate by unanimous consent.
    December 3, 2003: Signed by the President, Public Law 108-
            147.
                                ------                                


                           Public Law 108-170


 Veterans Health Care, Capital Asset, and Business Improvement Act of 
                                  2003


                         (S. 1156, AS AMENDED)

    Title: An Act to amend title 38, United States Code, to 
improve and enhance provision of health care for veterans, to 
authorize major construction projects and other facilities 
matters for the Department of Veterans Affairs, to enhance and 
improve authorities relating to the administration of personnel 
of the Department of Veterans Affairs, and for other purposes.
    S. 1156, as amended, will:

          TITLE I--HEALTH CARE AUTHORITIES AND RELATED MATTERS

    1.   Authorize former prisoners of war to receive 
outpatient dental care from VA, irrespective of the number of 
days detained in captivity.
    2.   Eliminate copayments for pharmaceuticals administered 
to former prisoners of war.
    3.   Authorize VA to provide veterans who participated in 
tests conducted by the Department of Defense (DOD) Deseret Test 
Center from 1962 through 1973 higher priority for hospital 
care, medical services and nursing home care without 
requirement for proof of service-connection through December 
31, 2005.
    4.   Authorize VA to provide hospital and nursing home care 
and medical services to certain Filipino World War II veterans 
of the Philippines Commonwealth Army and former Philippines 
``New Scouts'' who permanently reside in the United States, in 
the same manner as provided to U.S. veterans.
    5.   Expand VA authority to provide rehabilitative work 
skills training and development services, employment support 
services and job development and placement services.
    6.   Authorize VA to enter into ``provider agreements'' 
with non-VA entities to provide veterans with institutional 
nursing care or non-institutional extended care in a manner 
similar to such agreements permitted under the Social Security 
Act.
    7.   Extend VA's authority to provide a range of non-
institutional extended care services as set forth in Public Law 
106-117 through December 31, 2008.
    8.   Extend the mandate to provide medically necessary, 
institutional nursing care services to severely service-
connected disabled veterans through December 31, 2008.
    9.   Expand and extend VA authority to conduct a pilot 
program on assisted living for veterans.
    10.  Increase funding authorization for each of fiscal 
years 2004 through 2006 from $15,000,000 to $25,000,000 for the 
provision of specialized mental health services to veterans.

             TITLE II--CONSTRUCTION AND FACILITIES MATTERS

    1.   Increase from $4,000,000 to $7,000,000 the threshold 
that classifies a medical facility construction project as 
``major construction.''
    2.   Streamline the process and notification requirements 
in title 38, United States Code, when the Veterans Health 
Administration (VHA) proposes an enhanced-use lease of VA 
properties no longer needed for the delivery of care to 
veterans
    3.   Authorize individual VHA facilities to be reimbursed 
for expenses incurred in the development and execution of 
enhanced-use leases.
    4.   Simplify the reporting of the Annual Report on Long-
Range Health Planning.
    5.   Authorize $14,500,000 for the construction of a long-
term care facility in Lebanon, Pennsylvania.
    6.   Authorize $20,000,000 for the construction of a long-
term care facility in Beckley, West Virginia.
    7.   Authorize $98,500,000 for the construction of a new 
bed tower in Chicago, Illinois.
    8.   Authorize $48,600,000 for the correction of seismic 
deficiencies in San Diego, California.
    9.   Authorize $50,000,000 for medical care and research 
renovations in West Haven, Connecticut.
    10.  Authorize $45,000,000 for the construction of a VA-
Navy outpatient medical care facility in Pensacola, Florida.
    11.  Authorize a lease in the amount of $3,000,000 for an 
outpatient clinic in Charlotte, North Carolina.
    12.  Authorize a lease in the amount of $2,879,000 for an 
outpatient clinic extension in Boston, Massachusetts.
    13.  Authorize advance planning in the amount of 
$26,000,000 for a major medical facility project in Denver, 
Colorado.
    14.  Authorize advance planning in the amount of $9,000,000 
for a major medical facility project in Pittsburgh, 
Pennsylvania.
    15.  Authorize advance planning in the amount of 
$25,000,000 for a major medical facility project in Las Vegas, 
Nevada.
    16.  Authorize advance planning in the amount of $9,000,000 
for a major medical facility project in Columbus, Ohio
    17.  Authorize advance planning in the amount of 
$17,500,000 for a major medical facility project in East 
Central, Florida.
    18.  Authorize a total of $276,600,000 for fiscal year 2004 
for the construction of the projects designated in Section 211.
    19.  Authorize a total of $86,500,000 for the advance 
planning authorized in Section 213.
    20.  Authorize VA to carry out major construction projects 
in connection with the Capitol Asset Realignment for Enhanced 
Services (CARES) initiative no sooner than 45 days or 30 days 
of continuous session of Congress following the submission of a 
one-time report to Congress by February 1, 2004, that lists 
each proposed major construction project in order of priority, 
with such priority established in Section 221(2).
    21.  Require VA to notify Congress in writing of actions 
proposed under the CARES initiative that would result in 
medical facility closures, significant staff realignments or 
medical facility consolidations and prohibit such actions from 
occurring until 60 days following the notification or 30 days 
of continuous session of Congress.
    22.  Express the sense of Congress of the difficulties that 
veterans residing in rural areas encounter in gaining access to 
VA health care facilities and require VA to report actions to 
be taken to improve rural access to care.
    23.  Require VA to develop a plan for meeting the future 
inpatient hospital care needs of veterans who reside in 
southern New Jersey.
    24.  Require VA to develop a plan for meeting the future 
hospital care needs of veterans who reside in southern Texas.
    25.  Require VA to develop a plan for meeting the future 
hospital care needs of veterans who reside in north central 
Washington.
    26.  Require VA to develop a plan for meeting the future 
hospital care needs of veterans who reside in the Panhandle 
area of Florida.
    27.  Require VA to submit a report on each plan developed 
under Section 231(a) to the Senate and House Committees on 
Veterans' Affairs by April 15, 2004.
    28.  Require VA to conduct a feasibility study in 
coordination with the Medical University of South Carolina and 
in consultation with DOD to consider establishing a joint 
health-care venture to deliver inpatient, outpatient and/or 
long-term care to veterans, DOD, and other beneficiaries who 
reside in Charleston, South Carolina, with a report to the 
Committees by April 15, 2004.
    29.  Authorize VA to name the VA Medical Center in 
Prescott, Arizona, the Bob Stump Department of Veterans Affairs 
Medical Center.
    30.  Authorize VA to name the VA Medical Center (West Side 
Division) in Chicago, Illinois, the Jesse Brown Department of 
Veterans Affairs Medical Center.
    31.  Authorize VA to name the VA Medical Center in Houston 
Texas, the Michael E. DeBakey Department of Veterans Affairs 
Medical Center.
    32.  Authorize VA to name the VA Medical Center in Salt 
Lake City, Utah, the George E. Wahlen Department of Veterans 
Affairs Medical Center.
    33.  Authorize VA to name the outpatient clinic in New 
London, Connecticut, the John J. McGuirk Department of Veterans 
Affairs Outpatient Clinic.
    34.  Authorize VA to name the outpatient clinic in Horsham, 
Pennsylvania, the Victor J. Saracini Department of Veterans 
Affairs Outpatient Clinic.

                      TITLE III--PERSONNEL MATTERS

    1.   Modify the authorities on appointment and promotion of 
certain personnel in the Veterans Health Administration.
    2.   Authorize VA to appoint chiropractors as clinical 
practitioners in the Veterans Health Administration under title 
38, United States Code, and set various conditions and 
requirements associated with these appointments.
    3.   Authorize premium pay for Saturday duty to additional 
Veterans Health Administration health care workers with direct 
patient-care responsibilities.
    4.   Allow employees of the Veterans' Canteen Service to be 
considered for appointment in VA positions in the competitive 
service in the same manner as VA employees in the competitive 
service are considered for transfer to a Canteen Service 
position.

                        TITLE IV--OTHER MATTERS

    1.   Establish within the Veterans Health Administration 
(VHA) an Office of Research Oversight to monitor, review and 
investigate matters of medical research compliance and 
assurance in the Department of Veterans Affairs (VA), including 
matters relating to the protection and safety of human subjects 
and VA employees participating in VA medical research programs. 
Require various reports to the Congress concerned with this new 
office.
    2.   Cover employees of Nonprofit Research Corporations 
under the Federal Tort Claims Act.
    3.   Extend authority to establish Nonprofit Research 
Corporations through December 31, 2008.
    4.   Authorize DOD to purchase medical equipment, services 
and supplies through VA's revolving supply fund, and require 
DOD to reimburse VA's supply revolving fund for any DOD 
purchases using DOD appropriations.
    5.   Extend VA's authority to provide certain housing 
assistance for homeless veterans through December 31, 2008.
    6.   Change the reporting date requirements on several 
reports VA is required to make to Congress.

    Effective Date: Date of enactment except the following 
sections:

    Sec. 301: Shall take effect 180 days after date of 
            enactment.
    Sec. 303: Shall apply with respect to the first pay period 
            beginning on or after January 1, 2004.

    Legislative History:

    May 23, 2003: Referred to the Senate Committee on Veterans' 
            Affairs.
    July 29, 2003: Hearing. Senate Committee on Veterans' 
            Affairs.
    September 30, 2003: Senate Committee on Veterans' Affairs 
            ordered reported favorably with an amendment in the 
            nature of a substitute.
    November 10, 2003: Senate Committee on Veterans' Affairs 
            reported with an amendment in the nature of a 
            substitute and an amendment to the title, with 
            written report number 108-193.
    November 19, 2003: Passed the Senate with an amendment and 
            an amendment to the title by unanimous consent. 
            (Note: consists of certain provisions from S. 1815, 
            H.R. 1720, H.R. 2357, H.R. 2433, H.R. 3260, and 
            H.R. 3387.)
    November 21, 2003: Passed the House under suspension by 
            vote of 423-2 (Roll No. 658).
    December 6, 2003: Signed by the President, Public Law 108-
            170.
                                ------                                


                           Public Law 108-183


                     Veterans Benefits Act of 2003


                        (H.R. 2297, AS AMENDED)

    Title: An Act to amend title 38, United States Code, to 
improve benefits under laws administered by the Secretary of 
Veterans Affairs, and for other purposes.

    H.R. 2297, as amended, will:

                       TITLE I--SURVIVOR BENEFITS

    1.  Provide that remarriage of the surviving spouse of a 
veteran after attaining age 57 would not result in termination 
of dependency and indemnity compensation (DIC), home loan, or 
education benefits eligibility.
    2.  Expand benefits eligibility to those children with 
spina bifida who were born to Vietnam-era veterans who served 
in an area of Korea near the demilitarized zone between 
September 1, 1967 and August 31, 1971.
    3.  Permit VA to make payment proceeds from National 
Service Life Insurance and United States Government Life 
Insurance policies to alternate beneficiaries should a primary 
beneficiary not be located.
    4.  Repeal current law restricting a surviving spouse or 
dependent children to receiving no more than two years of 
accrued benefits if the veteran dies while a claim for VA 
periodic monetary benefits is being processed.

  TITLE II--BENEFITS FOR FORMER PRISONERS OF WAR AND FILIPINO VETERANS

    1.  Add cirrhosis of the liver to the list of presumed 
service-connected disabilities for former prisoners of war, and 
eliminate the requirement that a POW be held for 30 days or 
more to qualify for presumptions of service-connection for 
certain disabilities: psychosis, any of the anxiety states, 
dysthymic disorder, organic residuals of frostbite, and post-
traumatic osteoarthritis.
    2.  Provide the full amount of compensation and DIC to 
eligible members of the new Philippine Scouts, as well as the 
full amount of DIC paid by reason of service in the organized 
military forces of the Commonwealth of the Philippines, 
including organized guerilla units, if the individual to whom 
the benefit is payable resides in the United States and is 
either a citizen of the U.S. or an alien lawfully admitted for 
permanent residence.
    3.  Extend eligibility for burial in a national cemetery to 
new Philippine Scouts, as well as eligibility for VA burial 
benefits, to those who lawfully reside in the United States.
    4.  Extend the authority of the Secretary of Veterans 
Affairs to maintain a regional office in Manila, Philippines, 
through December 31, 2009.

   TITLE III--EDUCATION BENEFITS, EMPLOYMENT PROVISIONS, AND RELATED 
                                MATTERS

    1.  Expand the Montgomery GI Bill program by authorizing 
educational assistance for on-job training in certain self-
employment training programs.
    2.  Increase monthly educational benefits for spouses and 
dependent children of veterans who have permanent and total 
disabilities or who have died as a result of service-related 
causes to $788 for full-time study, $592 for three-quarter time 
study, and $394 for half-time study.
    3.  Extend the delimiting date for survivors' and 
dependents' education benefits when the eligible individual is 
involuntarily ordered to full-time National Guard duty under 
title 32, United States Code.
    4.  Round down to the nearest dollar the annual cost-of-
living adjustments to educational assistance benefits.
    5.   Authorize the use of VA education benefits to pay for 
non-degree/non-credit entrepreneurship courses at approved 
institutions.
    6.   Repeal VA's education loan program authorization.
    7.   Extend the Veterans' Advisory Committee on Education 
through December 31, 2009.
    8.   Furnish federal agencies discretionary authority to 
create ``sole-source'' contracts for disabled veteran-owned 
small businesses--up to $5 million for manufacturing contract 
awards and up to $3 million for non-manufacturing contract 
awards.
    9.   Furnish federal agencies discretionary authority to 
restrict certain contracts to disabled veteran-owned small 
businesses if at least two such concerns are qualified to bid 
on the contract.
    10.  Mandate that the Department of Labor place staff in 
veterans' assistance offices at overseas military installations 
90 days after date of enactment.

             TITLE IV--HOUSING BENEFITS AND RELATED MATTERS

    1.   Extend VA's specially adapted housing grant to 
severely disabled servicemembers prior to separation from 
active duty service.
    2.   Increase the specially adapted automobile grant from 
$9,000 to $11,000, and increase the specially adapted housing 
grants from $48,000 to $50,000 for the most severely disabled 
veterans and from $9,250 to $10,000 for less severely disabled 
veterans.
    3.   Make permanent the VA home loan program for members of 
the Selected Reserve.
    4.   Reinstate the Department of Veterans Affairs' vendee 
loan program.
    5.   Adjust the funding fee charged to Selected Reserve 
home loan applications and make certain increases in home loan 
fees.
    6.   Extend for one year the procedures on liquidation 
sales of defaulted home loans guaranteed by the Department of 
Veterans Affairs.

                        TITLE V--BURIAL BENEFITS

    1.   Permit states to receive burial plot allowances for 
burial of all eligible veterans.
    2.   Allow a remarried surviving spouse to retain 
eligibility for burial in a national cemetery based on the 
prior marriage to a deceased veteran.
    3.   Make permanent the State Cemetery Grants Program.

               TITLE VI--EXPOSURE TO HAZARDOUS SUBSTANCES

    1.   Require independent oversight of the Department of 
Defense radiation dose reconstruction program.
    2.   Require an independent study on the disposition of the 
Air Force Health Study on ``Operation Ranch Hand'' veterans.
    3.  Authorize funding of medical follow-up agency of 
Institute of Medicine of National Academy of Sciences for 
epidemiological research on members of the Armed Forces and 
veterans.

                        TITLE VII--OTHER MATTERS

    1.  Make clarifying amendments relating to the Veterans' 
Claims Assistance Act.
    2.  Clarify the current prohibition on the assignment of 
veterans' benefits.
    3.  Extend for six years the Advisory Committee on Minority 
Veterans.
    4.  Authorize a nationwide, five-year contract medical 
examination pilot program.
    5.  Expand the list of serious federal criminal offenses a 
conviction of which would result in a bar to all VA benefits.
    6.  Extend for two years the requirement to round down to 
the nearest dollar compensation cost-of-living adjustments.

    Effective Date: Date of enactment except the following 
sections:

    Sec. 101: Subsections (a) and (b) shall take effect on 
            January 1, 2004; no benefit may be paid prior to 
            that date. Those surviving spouses who remarried 
            after attaining age 57 but prior to the date of 
            enactment have one year to apply for reinstatement.
    Sec. 103: Subsections (a) and (b) shall take effect on 
            October 1, 2004.
    Sec. 104: Shall apply with respect to deaths occurring on 
            or after date of enactment.
    Sec. 211: Shall apply to benefits paid for months beginning 
            after date of enactment.
    Sec. 212: Shall apply to deaths occurring on or after date 
            of enactment.
    Sec. 301: Shall take effect on the date that is six months 
            after date of enactment and shall apply to self-
            employment on-job training approved and pursued on 
            or after that date.
    Sec. 302: Shall take effect on July 1, 2004, and shall 
            apply with respect to educational assistance 
            allowances payable under chapter 35 and section 
            3687(b)(2) of title 38, United States Code, for 
            months beginning on or after that date.
    Sec. 303: September 11, 2001.
    Sec. 305: Shall apply to courses approved by State 
            approving agencies after date of enactment.
    Sec. 306: Subsection (d) shall take effect on date of 
            enactment. Subsections (e), (f), and (g) shall take 
            effect 90 days after date of enactment.
    Sec. 309: Amendment made by paragraph (1) shall apply with 
            respect to offices established after date of 
            enactment. Section 309(b) shall take effect not 
            later than 90 days after date of enactment.
    Sec. 402: Shall apply with respect to assistance furnished 
            on or after date of enactment.
    Sec. 405: January 1, 2004.
    Sec. 502: Shall apply with respect to deaths occurring on 
            or after January 1, 2000.
    Sec. 701: Shall take effect as if enacted on November 9, 
            2000, immediately after the enactment of the 
            Veterans Claims Assistance Act of 2000 (P.L. 106-
            475; 114 Stat. 2096).
    Sec. 705: Shall apply to claims filed after date of 
            enactment.

    Legislative History:

    June 26, 2003: H.R. 2297 ordered reported amended favorably 
            by the Committee on Veterans' Affairs.
    July 15, 2003: H.R. 2297 reported amended by the Committee 
            on Veteran's Affairs. H. Rept. 108-211.
    October 8, 2003: Passed the House amended under suspension 
            by vote of 399-0 (Roll No. 536).
    October 14, 2003: Referred to the Senate Committee on 
            Veterans' Affairs.
    November 19, 2003: Passed the Senate with an amendment by 
            unanimous consent. (Note: consists of certain 
            provisions from H.R. 1257, H.R. 1460, and S. 1132.)
    November 20, 2003: House agreed to the Senate amendment 
            under suspension by voice vote.
    December 16, 2003: Signed by the President, Public Law 108-
            183.
                                ------                                


                           Public Law 108-189


                    Servicemembers Civil Relief Act


                         (H.R. 100, AS AMENDED)

    H.R. 100, the Servicemembers Civil Relief Act, is a 
comprehensive restatement of the Soldiers' and Sailors' Civil 
Relief Act of 1940 that would clarify and strengthen the rights 
and protections it provides to persons in military service.
    The Act's coverage includes servicemembers' financial 
obligations and liabilities, such as rent, mortgages, 
installment contracts and leases; civil (but not criminal) 
legal proceedings; life insurance; taxes; and rights in public 
lands.

    H.R. 100, as amended, includes:

      Clear guidance that a tax jurisdiction may not 
use the military compensation of a non-resident servicemember 
to increase the tax liability imposed on other income earned by 
the non-resident servicemember or spouse subject to tax by the 
jurisdiction.
      Clear guidance that the 6 percent interest rate 
cap for obligations and liabilities of servicemembers incurred 
before military service results in a reduction of monthly 
payments and that any interest in excess of the cap is 
forgiven, consistent with the Act's objective of reducing 
monthly obligations for servicemembers, including mobilized 
National Guard or Reserve members who may have a reduced 
income.
      A right for any active duty servicemember who has 
permanent change of station orders or who is being deployed for 
more than 90 days to terminate a housing lease. Currently, a 
servicemember can be obligated to pay rent for housing he or 
she is unable to occupy because of a government required move.
      Updated eviction protection to reflect the 
increase in the cost of rental housing. The current Act only 
applies to leases of less than $1,200 per month; H.R. 100 would 
increase that amount to $2,400, and the amount would increase 
each year in accordance with a housing rental index. It would 
also require the Secretary of Defense to publish the rental 
amount annually in the Federal Register.
      An increase in the coverage level for protection 
against the lapse of life insurance policies when an individual 
enters military service from $10,000 to $250,000 or the SGLI 
maximum, whichever is greater.
      Termination of a motor vehicle lease without 
penalty when a servicemember is called up or deployed for not 
less than 180 days, or ordered to make a permanent change of 
station outside of the continental United States.
      Coverage of all motor vehicles and other property 
by the Act's installment contract protections, so that in the 
case of a servicemember who, for example, has fallen behind on 
motor vehicle lease payments, the lessor must obtain a court 
order before repossessing the motor vehicle.
      Clarification that the Act's rights and 
protections apply to civil administrative proceedings, such as 
license and zoning matters, which are far more common today 
than they were in 1940.
      Protection of assets of a servicemember from 
attachment to satisfy business debts for which the 
servicemember is personally liable, as long as the assets 
sought to be attached are not held in connection with the 
business.
      Improved protection of servicemembers against 
default judgments.
      A minimum 90-day stay of proceedings at any stage 
before final judgment in a civil action for a servicemember who 
is serving on active duty or is within 90 days after 
termination of active duty and who has received notice of such 
proceedings, upon proper application.
      An expansion of the professional liability 
protections to include legal services.

    Legislative History:

    April 3, 2003: H.R. 100 ordered reported favorably with an 
            amendment in the nature of a substitute by the 
            Committee on Veterans' Affairs by voice vote.
    April 30, 2003: H.R. 100 reported amended by the Committee 
            on Veterans' Affairs. H. Rept.108-81.
    May 7, 2003: Passed the House amended under suspension by 
            vote of 425-0 (Roll No. 163).
    May 8, 2003: Referred to the Senate Committee on Veterans' 
            Affairs.
    November 21, 2003: Senate Committee on Veterans' Affairs 
            discharged by unanimous consent.
    November 21, 2003: Senate struck all after the enacting 
            clause and substituted the language of S. 1136 
            amended.
    November 21, 2003: Passed the Senate with an amendment by 
            unanimous consent.
    December 8, 2003: House agreed to the Senate amendment by 
            unanimous consent.
    December 19, 2003: Signed by the President, Public Law 108-
            189.
                                ------                                


                           Public Law 108-363


      Veterans' Compensation Cost-of-Living Adjustment Act of 2004


                        (H.R. 4175, AS AMENDED)

    Title: An Act to increase, effective as of December 1, 
2004, the rates of disability compensation for veterans with 
service-connected disabilities and the rates of dependency and 
indemnity compensation for survivors of certain service-
connected disabled veterans, and for other purposes.

    H.R. 4175, as amended, will:

    1.  Provide effective December 1, 2004, a cost-of-living 
adjustment to the rates of disability compensation for veterans 
with service-connected disabilities and to the rates of 
dependency and indemnity compensation for survivors of certain 
service-connected disabled veterans. The percentage amount 
would be equal to the increase for benefits provided under the 
Social Security Act, which is calculated based upon changes in 
the Consumer Price Index.

    Effective Date: Date of enactment

    Legislative History:

May 19, 2004: H.R. 4175 ordered reported favorably amended by 
            the Committee on Veterans' Affairs.
June 3, 2004: H.R. 4175 reported amended by the Committee on 
            Veterans' Affairs. H. Rept. 108-524.
July 20, 2004: Considered under suspension of the rules. At the 
            conclusion of debate, the Yeas and Nays were 
            demanded and ordered. Pursuant to the provisions of 
            clause 8, rule XX, the Chair announced that further 
            proceedings on the motion would be postponed.
July 22, 2004: Considered as unfinished business. On motion to 
            suspend the rules and pass the bill, as amended, 
            agreed to by the Yeas and Nays: 421-0 (Roll No. 
            408).
September 7, 2004: Referred to the Senate Committee on 
            Veterans' Affairs.
October 5, 2004: Senate Committee on Veterans' Affairs 
            discharged by unanimous consent.
October 5, 2004: Senate struck all after the enacting clause 
            and substituted the language of S. 2483.
October 5, 2004: Passed the Senate in lieu of S. 2483 with an 
            amendment by unanimous consent. (Please note: 
            Sections 4 and 5 of H.R. 4175 were dropped when 
            passed by the Senate with an amendment.)
October 8, 2004: House agreed to the Senate amendment under 
            unanimous consent.
October 25, 2004: Signed by the President, Public Law 108-363.
                                ------                                


                           Public Law 108-422


            Veterans Health Programs Improvement Act of 2004


                        (H.R. 3936, AS AMENDED)

    Title: An Act to amend title 38, United States Code, to 
increase the authorization of appropriations for grants to 
benefit homeless veterans, to improve programs for management 
and administration of veterans' facilities and health care 
programs, and for other purposes.

    H.R. 3936, as amended, will:

                TITLE I--ASSISTANCE TO HOMELESS VETERANS

    1.   Increase the authorization for the grant and per diem 
program for homeless veterans from $75 million to $99 million 
for fiscal year 2005.

               TITLE II--VETERANS LONG-TERM CARE PROGRAMS

    1.   Direct the Secretary to make payments to States to 
assist them in hiring and retaining nurses in State veterans' 
homes; makes a State home eligible for such payments if it has 
an employee incentive program and is receiving per diem 
payments from VA; limit the amount of payment a State home may 
receive each year; require a State home receiving such payment 
to provide an annual report to VA; and require VA to implement 
the assistance program so that eligible States would begin to 
receive payments no later than June 1, 2005.
    2.   Clarify that per diem payments made by VA for the care 
of veterans in State veterans homes shall not be used to offset 
or reduce other payments made to assist veterans.
    3.   Extend until December 31, 2005, VA's authority to 
provide care to veterans participating in certain long-term 
care demonstration projects previously authorized in the 
Veterans Millennium Health Care and Benefits Act.
    4.   Eliminate copayments for hospice care furnished by VA.

                        TITLE III--MEDICAL CARE

    1.   Make permanent the authority of the Secretary to 
provide sexual trauma counseling to veterans.
    2.   Establish centers for research, education and clinical 
activities that specialize in treating complex multi-trauma 
associated with combat injuries.
    3.   Reduce the amount authorized to establish four 
National Medical Emergency Preparedness Centers from $20 
million to $10 million per year.

       TITLE IV--MEDICAL FACILITIES MANAGEMENT AND ADMINISTRATION

               Subtitle A--Major Medical Facility Leases

    1.   Authorize leases (all requested by the Department of 
Veterans Affairs (VA)) to be paid from the medical care account 
for outpatient clinics or other health care facilities which VA 
currently operates or plans to operate in: Wilmington, North 
Carolina, in the amount of $1,320,000; Greenville, North 
Carolina, in the amount of $1,220,000; Norfolk, Virginia, in 
the amount of $1,250,000; Summerfield, Florida, in the amount 
of $1,230,000; Knoxville, Tennessee, in the amount of $850,000; 
Toledo, Ohio, in the amount of $1,200,000; Crown Point, 
Indiana, in the amount of $850,000; Fort Worth, Texas, in the 
amount of $3,900,000; Plano, Texas, in the amount of 
$3,300,000; San Antonio, Texas, in the amount of $1,400,000; 
Corpus Christi, Texas, in the amount of $1,200,000; Harlingen, 
Texas, in the amount of $650,000; Denver, Colorado, in the 
amount of $1,950,000; Oakland, California, in the amount of 
$1,700,000; San Diego, California (two sites), in the amounts 
of $1,300,000 and $1,100,000, respectively.

    2.   Authorize appropriations of $24,420,000 for the leases 
in the preceding paragraph.

    3.   Authorize VA to enter into a long-term lease of up to 
75 years for land to construct a new medical facility on the 
Fitzsimons Campus of the University of Colorado, in Aurora, 
Colorado.

                   Subtitle B--Facilities Management

    4.   Provide the Secretary with additional authority to 
transfer unneeded VA real property and retain the proceeds from 
the transfer.

    5.   Require VA to receive fair market value for any 
transfer of real property, except when transferred to providers 
of homeless veterans' services receiving grants under section 
2011 of title 38, United States Code.
    6.   Establish a new ``Capital Asset Fund'' for deposit of 
proceeds from transfers of real property to be used to defray 
VA's cost of such transfers, including demolition, 
environmental remediation, maintenance, repair, establishment 
of new and improved facilities, historic preservation and 
administrative expenses.
    7.   Authorize an appropriation of $10,000,000 for the 
Capital Asset Fund.
    8.   Terminate the Nursing Home Revolving Fund and transfer 
unobligated balances from the fund to the Capital Asset Fund 
subsequent to the Secretary's certification that VA facilities 
maintain long-term care capacity as required by law.
    9.   Require an inventory and two subsequent annual reports 
to Congress on the status of, and plans for, VA properties 
listed on the National Register of Historic Properties.
    10.  Authorize VA to acquire and transfer certain real 
property in the District of Columbia for use for homeless 
veterans.
    11.  Require VA to notify Congress of the impact of actions 
proposed for health facilities specified in this Act that may 
result in a facility closure, consolidation, or administrative 
reorganization, and prohibit such actions from occurring until 
60 days following the notification or 30 days of continuous 
session of Congress as specified.
    12.  Authorize the use of project funds to construct or 
relocate surface parking incidental to an authorized major 
medical facility construction project.
    13.  Provide the Secretary flexibility in using funds to 
develop advance planning for major construction projects 
previously authorized by law.
    14.  Exempt VA from state and local land use laws under the 
enhanced-use lease authority.
    15.  Allow the Commonwealth of Kentucky the first option on 
the further use of the VA Medical Center in Louisville, 
Kentucky for a State veterans' home upon any proposed VA 
disposal of the medical center.
    16.  Transfer to VA certain property in Boise, Idaho, 
currently administered by the General Services Administration, 
for the provision of veterans' benefits.

                 Subtitle C--Designation of Facilities

    17.  Authorize VA to name the VA Medical Center in 
Amarillo, Texas, the Thomas E. Creek Department of Veterans 
Affairs Medical Center.
    18.  Authorize VA to name the VA Medical Center in the 
Bronx, New York, the James J. Peters Department of Veterans 
Affairs Medical Center.
    19.  Authorize VA to name the outpatient clinic in Peoria, 
Illinois, the Bob Michel Department of Veterans Affairs 
Outpatient Clinic.
    20.  Authorize VA to name the outpatient clinic in Lufkin, 
Texas, the Charles Wilson Department of Veterans Affairs 
Outpatient Clinic.
    21.  Authorize VA to name the outpatient clinic in 
Sunnyside, Queens, New York, the Thomas P. Noonan, Jr. 
Department of Veterans Affairs Outpatient Clinic.

                   TITLE V--PERSONNEL ADMINISTRATION

    1.   Establish a pilot program within the Department of 
Veterans Affairs (VA) to study the use of outside recruitment, 
advertising and communications agencies and interactive and 
online technologies, to improve VA's program for recruiting 
nursing personnel.
    2.   Add blind rehabilitation personnel to the category of 
positions VA is permitted to hire through use of a hybrid 
appointment authority.
    3.   Repeal the requirement for VA's Under Secretary for 
Health to be a medical doctor.

                        TITLE VI--OTHER MATTERS

    1.   Extend and codify VA's authority to recover 
overpayments made for fee and contract health care services for 
veterans.
    2.   Require VA to establish an inventory of medical waste 
management activities at VA health care facilities and submit a 
report to Congress by June 30, 2005, concerning such 
activities.
    3.   Clarify that veterans enrolled in VA health care are 
eligible to use the Veterans' Canteen Service (VCS).
    4.   Require VA to submit annual reports through 2007 to 
Congress on veterans' waiting times for VA specialty care 
appointments.

    Effective Date: Date of enactment

    Legislative History:

    May 19, 2004: H.R. 3936 ordered reported favorably by the 
            Committee on Veterans' Affairs.
    June 25, 2004: H.R. 3936 reported by the Committee on 
            Veterans' Affairs. H. Rept. 108-574, Part I.
    June 25, 2004: Committee on Armed Services discharged.
    July 20, 2004: Passed the House under suspension by voice 
            vote.
    July 21, 2004: Received in the Senate.
    September 7, 2004: Referred to the Senate Committee on 
            Veterans' Affairs
    October 9, 2004: Senate Committee on Veterans' Affairs 
            discharged by unanimous consent.
    October 9, 2004: Senate struck all after the enacting 
            clause and substituted the language of S. 2485, as 
            amended.
    October 9, 2004: Passed the Senate in lieu of S. 2485 with 
            an amendment and an amendment to the title by 
            unanimous consent. (Note: consists of certain 
            provisions from H.R. 1318, H.R. 2786, H.R. 4231, 
            H.R. 4248, H.R. 4317, H.R. 4608, H.R. 4658, H.R. 
            4768, H.R. 4836, S. 2485 and S. 2596.)
    November 17, 2004: House agreed to the Senate amendments 
            under suspension by voice vote.
    November 30, 2004: Signed by the President, Public Law 108-
            422.
                                ------                                


                           Public Law 108-445


Department of Veterans Affairs Health Care Personnel Enhancement Act of 
                                  2004


                         (S. 2484, AS AMENDED)

    Title: An Act to amend title 38, United States Code, to 
simplify and improve pay provisions for physicians and dentists 
and to authorize alternate work schedules and executive pay for 
nurses, and for other purposes.

    S. 2484, as amended, will:

    1.  Establish a reformed compensation system for physicians 
and dentists appointed in the Veterans Health Administration 
(VHA) of the Department of Veterans Affairs (VA). The 
compensation system would require VA to determine the rate of 
pay for a physician or dentist on the basis of three elements 
as follows: (1) a 15-step Physician and Dentist Base and 
Longevity Pay Schedule established in law; (2) a market pay 
band for clinical specialties and subspecialties set by the 
Secretary of Veterans Affairs; and (3) an incentive bonus not 
to exceed the lower of $15,000 or 7.5 percent of the combined 
base and market pay of a physician or dentist who meets 
established performance goals set by the Department.
    2.  Require the Under Secretary for Health to be 
compensated at the annual rate of base pay for positions at 
Level III of the Executive Schedule, and permit the Under 
Secretary who is also a physician or dentist to be paid the 
market pay element of the reformed compensation system.
    3.  Require the Secretary to submit a series of reports to 
Congress on the effectiveness of the reformed compensation 
system and include an assessment of its impact on recruitment 
and retention.
    4.  Establish the effective date of the reformed 
compensation system to be the first day of the first pay period 
that begins on or after January 1, 2006.
    5.  Provide a transition pay authority for physicians and 
dentists appointed before the effective date of the revised 
compensation system and guarantee that current physician pay 
rates would be held harmless.
    6.  Authorize VA to offer two additional options for 
alternative tours of duty for nurses working in VA health care 
facilities as follows: (1) three 12-hour tours of duty in a 
week would be paid as 40 hours; and (2) nine months of work 
with three months off in a year that would be paid over a 12-
month period.
    7.  Authorize VA to provide nurse executives employed in VA 
health care facilities and VA's Central Office special pay 
allowances of not less than $10,000 or more than $25,000.

    Effective Date: Date of enactment except the following 
section:

    Sec. 3: Shall apply on the first day of the first pay 
            period that begins on or after January 1, 2006.

    Legislative History:

    June 1, 2004: Referred to the Senate Committee on Veterans' 
            Affairs.
    June 22, 2004: Hearing. Senate Committee on Veterans' 
            Affairs.
    July 20, 2004: Senate Committee on Veterans' Affairs 
            ordered reported favorably with amendments.
    September 23, 2004: Senate Committee on Veterans' Affairs 
            reported with an amendment in the nature of a 
            substitute and an amendment to the title, with 
            written report number 108-357.
    October 5, 2004: Passed the Senate with an amendment and an 
            amendment to the Title by unanimous consent. (Note: 
            consists of similar provision from H.R. 4231.)
    October 6, 2004: Received in the House.
    October 6, 2004: Message on Senate action sent to the 
            House.
    October 6, 2004: Held at the desk.
    November 17, 2004: House agreed to the Senate amendments 
            under suspension by voice vote.
    December 3, 2004: Signed by the President, Public Law 108-
            445.
                                ------                                


                           Public Law 108-454


               Veterans Benefits Improvement Act of 2004


                         (S. 2486, AS AMENDED)

    Title: An Act to amend title 38, United States Code, to 
improve and enhance education, housing, employment, medical, 
and other benefits for veterans and to improve and extend 
certain authorities relating to the administration or benefits 
for veterans, and for other purposes.

    S. 2486, as amended, will:

                  TITLE I--VETERANS EARN AND LEARN ACT

    1.   Modify VA on-job training and apprenticeship benefit 
entitlement rates under the Vietnam-era and survivors' and 
dependents' programs to be consistent with the entitlement 
rates for the Montgomery GI Bill-Active Duty and Selected 
Reserve programs and the Post-Vietnam Era Veterans' Educational 
Assistance Program. The modification would charge benefits 
entitlement usage based on ``dollars used'' rather than ``time 
spent'' in training, to help the trainee conserve entitlement. 
This provision would take effect as of October 1, 2005.
    2.   Increase by 10 percent the percentage of the full-time 
VA monthly educational assistance allowance payable to 
individuals pursuing a full-time apprenticeship or on-job 
training program. For the first six months of training, the 
percentage of the monthly benefit would increase from 75 
percent to 85 percent; for the second six months of training, 
from 55 percent to 65 percent; and for subsequent months, from 
35 percent to 45 percent. These percentage increases would 
apply to the Montgomery GI Bill Active Duty and Selected 
Reserve programs, the Post-Vietnam Era Veterans' Educational 
Assistance program, and the Survivors' and Dependents' 
Educational Assistance program. This provision would take 
effect from October 1, 2005 through December 31, 2007.
    3.   Authorize VA to pay benefits for competency-based 
apprenticeships, in addition to time-based apprenticeships, and 
require State approving agencies to consider the recommendation 
of the Secretary of Labor regarding the approximate term and 
standards for such registered apprenticeship programs. 
Competency-based apprenticeships are completed upon 
demonstration of mastery of job skills rather than a set time 
period.
    4.   Extend eligibility for Survivors' and Dependents' 
Educational Assistance from 10 years to 20 years for a 
surviving spouse of any person who died on active duty.
    5.   Authorize VA to provide educational assistance 
benefits to reimburse eligible beneficiaries for the cost of 
certain national tests required for admission to institutions 
of higher learning or graduate schools, and for national tests 
that can qualify veterans for receipt of college credit.
    6.   Require coordination of information among the 
Departments of Veterans Affairs, Defense, and Labor with 
respect to on-job training or registered apprenticeships 
pursued by servicemembers while serving in the military and 
their receipt of appropriate credit for such training in 
civilian training programs.
    7.   Provide the Secretary of Veterans Affairs the 
discretion to establish a pilot program that furnishes on-job 
training benefits under VA educational assistance programs to 
claims adjudicators training in its disability compensation, 
dependency and indemnity compensation, and pension programs.
    8.   Permit the Secretary of Defense (or, in cases 
involving the activation of Coast Guard personnel, the 
Secretary of Homeland Security) to collect an activated 
Selected Reserve member's $1,200 payment for use of Active Duty 
Montgomery GI Bill educational assistance benefits under 
Chapter 30 of title 38, United States Code, not later than 1 
year after completion of 2 consecutive years of active duty.

                      TITLE II--EMPLOYMENT MATTERS

             Subtitle A--Employment and Reemployment Rights

    1.   Increase from 18 months to 24 months the maximum 
period of employer-sponsored health coverage that an employee 
covered by USERRA may elect to continue, beginning with the 
date the absence from the position of employment begins; and 
providing that the effective date of the increased coverage 
would be the date of enactment.
    2.   Reinstate the requirement for comprehensive annual 
reports from the Secretary of Labor to Congress on the 
disposition of cases filed under USERRA; such reports would 
begin no later than February 1, 2005.
    3.   Require employers to provide notice to employees of 
the rights, benefits and obligations of employers and employees 
that apply under USERRA, and require the Department of Labor to 
make available to employers the text of the notice to be 
provided within 90 days after date of enactment.
    4.   Establish a demonstration project for the referral of 
federal employee complaints under USERRA to the Office of 
Special Counsel for investigation and resolution, and require 
the Secretary of Labor and the Office of Special Counsel to 
carry out the demonstration project. The Comptroller General is 
required to evaluate and report on the project.

                       Subtitle B--Other Matters

    5.   Direct the Secretary of Veterans Affairs to contract 
for a report on placement, retention, and advancement of 
recently separated servicemembers in private sector employment 
for the purpose of determining ways to improve their employment 
opportunities.

                      TITLE III--BENEFITS MATTERS

    1.   Provide an additional $250 in dependency and indemnity 
compensation (DIC) paid monthly to the surviving spouse with 
one or more children below the age of 18. The additional 
benefit would be paid for months occurring during the 2-year 
period beginning on the date on which entitlement for DIC 
commenced.
    2.   Permit a radiation-exposed veteran who received 
payment under the Radiation Exposure Compensation Act (RECA), 
administered by the Department of Justice, to be eligible for 
VA compensation. A survivor who received a payment under RECA 
would be entitled to dependency and indemnity compensation 
(DIC). VA compensation and DIC would be reduced by any amounts 
received under RECA.
    3.   Exclude life insurance proceeds paid upon the death of 
a veteran from consideration as income for death pension 
benefits.
    4.   Provide specially adapted automobile and adaptive 
equipment benefits to veterans who are injured in a VA hospital 
due to negligence, carelessness, or similar reasons, and to 
veterans who are injured because of VA-sponsored rehabilitation 
or training, and specify that such veterans are eligible for 
specially adapted housing grants.
    5.   Make an award of death pension effective the first day 
of the month in which the death occurred if the claim is 
received within one year from the date of the veteran's death.
    6.   Codify VA regulations establishing cancer of the bone, 
brain, colon, lung and ovary as diseases for which a 
presumption of service connection is made for a veteran exposed 
to ionizing radiation. In addition, specify that the definition 
of ``radiation-risk activity'' includes service in a capacity 
that, if performed as an employee of the Department of Energy, 
would qualify the individual for the Energy Employees 
Occupational Illness Compensation Program Act of 2000, as 
amended (42 U.S.C. '7384 et. seq.).
    7.   Codify the current dollar amounts of disability 
compensation and dependency and indemnity compensation provided 
for in Public Law 108-147.

                       TITLE IV--HOUSING MATTERS

    1.   Extend eligibility for specially adapted housing 
grants to veterans with permanent and total service-connected 
disabilities due to the loss, or loss of use, of both arms at 
or above the elbows.
    2.   Allow volunteers to provide services in connection 
with the construction, alteration, or repair of multi-family 
transitional housing. Permit commercial activities other than 
neighborhood retail services and job training programs to be 
performed by a multi-family transitional housing project.
    3.   Increase the maximum VA home loan guaranty to 25 
percent of the Freddie Mac conforming loan amount for a single 
family residence and annually index the maximum amount of VA's 
home loan guaranty for construction or purchase of a home to 
the Freddie Mac limit. In 2004, the increase is expected to 
raise from $240,000 to $333,700 the maximum amount for a home 
loan guaranteed by VA.
    4.   Reinstate the program of VA-guarantees for adjustable 
rate mortgages (ARMs) through fiscal year 2008. The program 
expired at the end of fiscal year 1995.
    5.   Extend the authority of VA to guaranty hybrid 
adjustable rate mortgage loans through fiscal year 2008, and 
make additional improvements to the program. This program is 
set to expire at the end of fiscal year 2005. A hybrid ARM 
offers lower interest rates (like most adjustable rate loans) 
after a fixed payment for a longer period of time than most 
traditional ARMs.
    6.   Terminate the collection of home loan fees from 
veterans rated eligible for compensation at pre-discharge 
rating examinations.
    7.   Extend the Native American Home Loan program through 
December 31, 2008.

                TITLE V--MATTERS RELATING TO FIDUCIARIES

    1.   Define a fiduciary as a guardian, curator, 
conservator, committee or person legally vested with the 
responsibility or care of a claimant (or the estate) or of a 
beneficiary (or the beneficiary's estate), or any other person 
appointed in a representative capacity to receive money paid by 
VA.
    2.   Require VA to conduct an inquiry or investigation as 
to the fitness of a fiduciary, prior to certification. Such 
inquiry or investigation would include, to the extent 
practicable, a face-to-face interview, a copy of a credit 
report within one year of appointment, in addition to the 
furnishing of any bond that may be required by the Secretary.
    3.   Require the Secretary, as a part of the inquiry or 
investigation, to request information about whether the 
potential fiduciary has been convicted of any offense under 
Federal or State law.
    4.   Permit a less rigorous inquiry or investigation of the 
parent of a minor beneficiary; spouse or parent of an 
incompetent beneficiary; person appointed by a court of 
competent jurisdiction; or appointed to manage an estate where 
the annual amount of veterans' benefits to be managed does not 
exceed $3,600.
    5.   Give the Secretary the authority to appoint a 
temporary fiduciary for a period not to exceed 120 days, if 
needed to protect the assets of the beneficiary when a 
determination of incompetence is being made or appealed, or a 
fiduciary is appealing a determination of misuse.
    6.   Prohibit the Secretary from continuing the temporary 
fiduciary beyond 120 days if a final decision has not been made 
on the competence of the beneficiary or fiduciary, unless the 
Secretary has obtained a court order for a guardian, 
conservator or similar legal fiduciary.
    7.   Prohibit a fiduciary from collecting a fee from the 
beneficiary for any month when the Secretary or a court has 
determined the fiduciary has misused some or all of the 
veterans' benefits.
    8.   Require the Secretary to repay misused benefits if the 
misuse is due to the Secretary's failure to investigate or 
monitor a fiduciary; when the fiduciary is not an individual; 
or is an individual who, for any month during a period when 
misuse occurs, serves 10 or more individuals who are 
beneficiaries.
    9.   Require the Secretary to conduct periodic on-site 
reviews of any person or agency located in the United States 
that serves as a fiduciary to more than 20 beneficiaries and 
the total annual amount of benefits exceeds $50,000.
    10.  Authorize the Secretary to require a fiduciary to 
personally appear at a VA regional office to receive payments.
    11.  Authorize federal courts to issue judicial orders of 
restitution when sentencing a fiduciary who is a defendant in a 
criminal matter arising from the misuse of benefits.
    12.  Require the Secretary to include in annual reports 
information on the fiduciary program including the number of 
beneficiaries, the types of benefits being paid, the number of 
cases in which the fiduciary was changed by the Secretary 
because of a finding that benefits had been misused, and other 
information concerning actions taken in cases of misuse.

                   TITLE IV--MEMORIAL AFFAIRS MATTERS

    1.   Designate a memorial currently under construction at 
the Riverside National Cemetery in Riverside, California, as: 
Prisoner of War/Missing in Action National Memorial.
    2.   Authorize the Secretary of Veterans Affairs to lease 
any undeveloped land and unused or underutilized buildings 
belonging to the United States and part of the National 
Cemetery Administration (NCA). The term of any lease would be 
limited to 10 years. Proceeds from the lease of land or 
buildings and proceeds from agricultural licenses of NCA lands 
would be deposited in a National Cemetery Administration 
Facilities Operation Fund. Fund proceeds would be available to 
cover costs incurred by NCA in the operation and maintenance of 
national cemeteries.
    3.   Expand the authority of the Secretary of Veterans 
Affairs to acquire additional lands for national cemeteries by 
exchanges of existing land.

   TITLE VII--IMPROVEMENTS TO SERVICEMEMBERS CIVIL RELIEF ACT (SCRA)

    1.   Add to the definitions in the general provisions of 
SCRA that the term ``judgment'' would mean ``any judgment, 
decree, order or ruling, final or temporary.''
    2.   Clarify that waivers by servicemembers of rights and 
protections under SCRA must be in writing and must be executed 
in a separate instrument; and require that certain written 
waivers must be in at least 12-point type.
    3.   Provide that plaintiffs as well as defendants may 
under SCRA request stays of civil proceedings.
    4.   Clarify that dependents as well as servicemembers are 
covered by SCRA's residential and motor vehicle lease 
termination provisions on joint leases.
    5.   Provide that SCRA's lease termination provisions also 
apply when the servicemember residing in a State outside the 
continental United States receives permanent change of station 
orders to any location outside that State, for example, from 
Hawaii or Alaska to the 48 contiguous States or a foreign 
country.
    6.   Define for the purposes of SCRA's lease termination 
provisions that the term ``military orders'' would mean with 
respect to a servicemember, ``official military orders, or any 
notification, certification, or verification from the 
servicemember's commanding officer, with respect to the 
servicemember's current or future military duty status.''
    7.   Define for the purposes of SCRA's lease termination 
provisions that the term ``continental United States'' would 
mean ``the 48 contiguous States and the District of Columbia.''
    8.   Clarify that SCRA's lease termination provisions also 
cover individual deployments, as well as military unit 
deployments.

                       TITLE VIII--OTHER MATTERS

    1.   Authorize the principal office of the United States 
Court of Appeals for Veterans Claims to be located at any 
location in the Washington, D.C., metropolitan area, rather 
than only in the District of Columbia.
    2.   Extend the requirement for the Advisory Committee on 
Former Prisoners of War to report to the Secretary of Veterans 
Affairs through 2009.
    3.   Provide a veteran separated from the Armed Forces 
under honorable conditions after 3 years or more of active 
service with administrative and judicial redress for alleged 
violations of his or her rights under section 3304(f)(1) of 
title 5, United States Code, which grants veterans preference 
to compete for vacant positions in the Federal government.
    4.   Direct the Secretary of Veterans Affairs to submit a 
report to Congress, not later than 1 year after date of 
enactment of this Act, detailing the Department's outreach 
efforts to make veterans and servicemembers aware of VA 
benefits and services to which they may be entitled.

    Effective Date: Date of enactment except the following 
sections:

    Sec. 102: Shall apply with respect to months beginning 
            after September 30, 2005.
    Sec. 103: Shall apply with respect to months beginning on 
            or after October 1, 2005, and before January 1, 
            2008.
    Sec. 202: The Secretary of Labor shall submit a report no 
            later than February 1, 2005, and annually 
            thereafter.
    Sec. 203: Not later than the date that is 90 days after the 
            date of enactment, the Secretary of Labor shall 
            make available to employers the notice required 
            under section 4334 of title 38, United States Code.
    Sec. 204: The demonstration project shall be carried out 
            during the period beginning on the date that is 60 
            days after the date of enactment and ending on 
            September 30, 2007.
    Sec. 211: Not later than 180 days after the date of 
            enactment, the Secretary of Veterans Affairs shall 
            enter into a contract.
    Sec. 301: Shall take effect with respect to payments for 
            the first month beginning after the date of the 
            enactment of this Act.
    Sec. 302: Paragraph (4) of section 1112(c) of title 38, 
            United States Code, as added by subsection (a), 
            shall take effect with respect to compensation 
            payments for months beginning after March 26, 2002. 
            Subsection (c) of 1310 of such title, as added by 
            subsection (b), shall take effect with respect to 
            dependency and indemnity compensation payments for 
            months beginning after March 26, 2002.
    Sec. 306: Shall take effect as of March 26, 2002.
    Sec. 405: Shall not be construed to affect the force or 
            validity of any guarantee of hybrid adjustable rate 
            mortgages under section 3707A of title 38, USC, as 
            in effect on the day before the date of the 
            enactment of this Act.
    Sec. 507(a): Except as otherwise provided, this title and 
            the amendments made by this title shall take effect 
            on the first day of the seventh month beginning 
            after the date of enactment.
    Sec. 802: December 27, 2001.
    Sec. 805: Not later than one year after the date of 
            enactment of this Act, the Secretary of Veterans 
            Affairs shall submit the report to Congress.

    Legislative History

    June 1, 2004: Referred to the Senate Committee on Veterans' 
            Affairs.
    June 6, 2004: Senate Committee on Veterans' Affairs 
            hearing.
    July 20, 2004: Senate Committee on Veterans' Affairs 
            ordered reported favorably with amendments.
    September 20, 2004: Senate Committee on Veterans' Affairs 
            reported with an amendment in the nature of a 
            substitute and an amendment to the Title, with 
            written report number 108-352.
    October 8, 2004: Passed the Senate with an amendment and an 
            amendment to the Title by unanimous consent. (Note: 
            consists of certain provisions from S. 1132, S. 
            2485, H.R. 1716, H.R. 3936, H.R. 4175, H.R. 4345 
            and H.R. 4658.)
    October 9, 2004: Referred to the House Committee on 
            Veterans' Affairs.
    November 17, 2004: House agreed to the Senate amendments 
            under suspension by voice vote.
    December 10, 2004: Signed by the President, Public Law 108-
            454.

                      ACTIVITIES OF THE COMMITTEE


                         LEGISLATIVE ACTIVITIES

First Session

Business Meeting to Approve the Committee's Views and Estimates 
on the Administration's Proposed Budget for the Department of 
Veterans Affairs for Fiscal Year 2004

    On February 27, 2003, the Committee met to consider a 
report to the Committee on the Budget from the Committee on 
Veterans' Affairs on the Administration's proposed budget for 
VA for fiscal year 2004.
    The Committee voted 20-1 to send the report as proposed to 
the Committee on the Budget. The Committee report recommended 
$64 billion in budget authority for fiscal year 2004. The 
Committee recommended $30.7 billion in discretionary 
appropriations. (See Report on the Budget Proposal for Fiscal 
Year 2004, p. 99)
Full Committee Markup of H.R. 100 and H.R. 1297

    On April 3, 2003, the Committee met and marked up two 
bills: H.R. 100 (see House Report 108-81), and H.R. 1297 (see 
House Report 108-62). H.R. 100 was ordered reported, as 
amended, favorably to the House. H.R. 1297 was also ordered 
reported favorably to the House.
    On May 7, 2003, the House passed H.R. 100 by a vote of 425-
0 (Roll No. 163).
    On December 8, 2003, the House agreed to the Senate 
amendment to H.R. 100 by unanimous consent.
    On December 19, 2003, H.R. 100 was enacted as Public Law 
108-189, the Servicemembers Civil Relief Act (see summary, p. 
18).
    H.R. 1297 was incorporated as Title III of S. 762, the 
Fiscal Year 2003 Supplemental Appropriations Act, as passed by 
the Senate on April 7, 2003.
    On April 16, 2003, H.R. 1559 was enacted as Public Law 108-
11, the Emergency Wartime Supplemental Appropriations Act, 
2003.

Markup of H.R. 1460, H.R. 1683, H.R. 1257, H.R. 1562, H.R. 1715 
and H.R. 1911

    On May 15, 2003, the Committee met and marked up six bills: 
H.R. 1460, as amended, (see House Report 108-142); H.R. 1683 
(see House Report 108-108); H.R. 1257, (see House Report 108-
107); H.R. 1562, as amended, that included H.R. 1832 and H.R. 
1908 (see House Report 108-114); H.R. 1715; and H.R. 1911 (see 
House Report 108-115, Part I). H.R. 1911 was also referred to 
the House Committee on Armed Services. H.R. 1460, as amended, 
H.R. 1683, H.R. 1257, H.R. 1562, as amended, H.R. 1715 and H.R. 
1911 were ordered reported favorably to the House.
    On May 21, 2003, the House passed H.R. 1911 by a vote of 
426-0 (Roll No. 204).
    On November 7, 2003, the House agreed to the Conference 
Report to H.R. 1588, as amended, the National Defense 
Authorization Act for fiscal year 2004, which included text 
identical to H.R. 1911, by a vote of 362-40, 2 Present (Roll 
No. 617); (see Conference Report 108-354).
    On November 24, 2003, H.R. 1588, as amended, became Public 
Law 108-136, the National Defense Authorization Act for Fiscal 
Year 2004.
    On December 16, 2003, H.R. 2297, as amended, became Public 
Law 108-183, the Veterans Benefits Act of 2003 (see summary, p. 
14).

Markup of H.R. 1516, H.R. 2297, H.R. 116, H.R. 1720, H.R. 2433, 
H.R. 2595 and H. Con. Res. 159

    On June 26, 2003, the Committee met and marked up seven 
bills: H.R. 1516, as amended, (see House Report 108-199); H.R. 
2297, (see House Report 108-210); H.R. 116, as amended, (see 
House Report 108-200); H.R. 1720, as amended, (see House Report 
108-210); H.R. 2357, as amended, (see House Report 108-198); 
H.R. 2433, as amended, (see House Report 108-213); H.R. 2595, 
(see House Report 108-197); and H. Con. Res. 159, (see House 
Report 108-196). H.R. 1516, as amended, H.R. 2297, as amended, 
H.R. 116, as amended, H.R. 1720, as amended, H.R. 2357, as 
amended, H.R. 2433, as amended, H.R. 2595 and H. Con. Res. 159 
were ordered reported favorably to the House.
    On July 21, 2003, the House passed H.R. 2357, as amended, 
by voice vote.
    On September 10, 2003, the House passed H.R. 2433, as 
amended, by voice vote.
    On September 30, 2003, the House agreed to H. Con. Res. 159 
by voice vote.
    On October 29, 2003, the House passed H.R. 1720, as 
amended, (included provisions of H.R. 116, as amended,) by a 
vote of 417-0 (Roll No. 339).
    On November 21, 2003, the House passed S. 1156 (included 
provisions from H.R. 116, H.R. 1720, and H.R. 2433) by a vote 
of 423-2 (Roll No. 658).
    On December 6, 2003, S. 1156, as amended, became Public Law 
108-170, the Veterans Health Care, Capital Asset, and Business 
Improvement Act of 2003 (see summary p. 10).

Second Session

Markup of H.R. 4231, H.R. 4248, H.R. 3936, H.R. 4345, H.R. 1716 
and H.R. 4175

    On May 19, 2004, the Committee met and marked up six bills: 
H.R. 4231, as amended, (see House Report 108-538); H.R. 4248, 
as amended, (see House Report 108-534); H.R. 3936, (see House 
Report 108-574); H.R. 4345; H.R. 1716, as amended, (see House 
Report 108-572); and H.R. 4175, as amended, (see House Report 
108-524). H.R. 4231, as amended, H.R. 4248, as amended, H.R. 
3936, H.R. 4345, H.R. 1716, as amended and H.R. 4175, as 
amended, were ordered reported favorably to the House.
    On September 30, 2004, the House passed H.R. 4231, as 
amended, by a vote of 411-1 (Roll No.483).
    On October 7, 2004, the House passed H.R. 4248, as amended, 
by voice vote.
    On October 8, the House agreed to the Senate amendment to 
H.R. 4175.
    On October 25, 2004, H.R. 4175, as amended, was enacted as 
Public Law 108-363, the Veterans' Compensation Cost-of-Living 
Adjustment Act of 2004 (see summary, p. 20).
    On November 17, 2004, the House agreed to the Senate 
amendments to H.R. 3936 (included H.R. 4248 and provisions of 
H.R. 4231), by voice vote.
    On November 30, 2004, H.R. 3936, as amended, became Public 
Law 108-422, Veterans Health Programs Improvement Act of 2004 
(see summary p. 21).

Markup of H.R. 4768, H.R. 4658, H.R. 1318 and H.R. 4836

    On July 21, 2004, the Committee met and marked up four 
bills: H.R. 4768, as amended, (see House Report 108-663); H.R. 
4658, as amended, (see House Report 108-683); H.R. 1318; and 
H.R. 4836. H.R. 4768, as amended, H.R. 4658, as amended, H.R. 
1318 and H.R. 4836 were ordered reported favorably to the 
House.
    On September 13, 2004, the House passed H.R. 1318 and H.R. 
4836 by voice vote.
    On September 29, 2004, the House passed H.R. 4768, as 
amended, by voice vote.
    On October 7, 2004, the House passed H.R. 4658, as amended, 
by voice vote.
    On November 17, 2004, the House agreed to the Senate 
amendments to H.R. 3936 (included H.R. 4768) by voice vote.
    On November 30, 2004, H.R. 3936, as amended, became Public 
Law 108-422, the Veterans Health Programs Improvement Act of 
2004 (see summary p. 21).

Hearing on Protecting the Rights of Those Who Protect Us: 
Public Sector Compliance with the Uniformed Services Employment 
and Reemployment Rights Act and Improvements to the 
Servicemembers Civil Relief Act

    On June 23, 2004, the Committee held a hearing on H.R. 
4477, the Patriotic Employer Act of 2004, introduced by 
Honorable James P. McGovern of Massachusetts, Honorable Jeb 
Bradley of New Hampshire and Honorable Lane Evans of Illinois 
on June 2, 2004; H.R. 3779, the Safeguarding Schoolchildren of 
Deployed Soldiers Act of 2004, introduced by Honorable Louise 
McIntosh Slaughter of New York and Honorable Ginny Brown-Waite 
of Florida on February 4, 2004; a draft bill, the USERRA Health 
Care Coverage Extension Act of 2004, subsequently introduced as 
H.R. 4659 by Honorable Henry E. Brown Jr. of South Carolina, 
Honorable Michael H. Michaud of Maine and Honorable Christopher 
H. Smith of New Jersey on June 23, 2004; a draft bill, the 
Servicemembers and Veterans Legal Protections Act of 2004, 
subsequently introduced as H.R. 4658, by Honorable Christopher 
H. Smith of New Jersey and Honorable Lane Evans of Illinois on 
June 23, 2004. H.R. 4477, H.R. 4659, and H.R. 4658 were 
subsequently incorporated into H.R. 1716 and S. 2486 (see 
Summary, p. 26). The Committee also received testimony that 
examined compliance with the Uniformed Services Employment and 
Reemployment Rights Act (USERRA) and the Servicemembers Civil 
Relief Act (SCRA).
    Witnesses included: Honorable James P. McGovern of 
Massachusetts, Honorable Jeb Bradley of New Hampshire, 
Honorable Louise McIntosh Slaughter of New York, and Honorable 
Ginny Brown-Waite of Florida who testified on behalf of their 
legislation. Ms. Tammy Kimmel, Mr. Jason Burris, and Judithe 
Hanover Kaplan, Ph.D., J.D., M.S.N., RN, also testified about 
their experience with USERRA and SCRA protections.
    Testifying for the Administration were: Honorable Scott J. 
Bloch, Special Counsel for the U.S. Office of Special Counsel; 
Honorable Dan G. Blair, Deputy Director for the Office of 
Personnel Management; Honorable David C. Iglesias, United 
States Attorney for the District of New Mexico, Department of 
Justice; Mr. Charles S. Ciccolella, Deputy Assistant Secretary, 
Veterans' Employment and Training Service, Department of Labor; 
Mr. Craig W. Duehring, Principal Deputy Assistant Secretary of 
Defense for Reserve Affairs, Department of Defense; and Colonel 
Brarry Cox, Director, Military Member Support and Ombudsman 
Services for the National Committee for Employer Support of the 
Guard and Reserve.
    Testifying on behalf of their respective organizations 
were: Honorable Pat Quinn, Lieutenant Governor of Illinois, for 
the Council of State Governments; Harry A. Van Sickle, Union 
County Commissioner (PA), for the National Association of 
Counties; Colonel Robert F. Norton, USA (Ret.), Deputy 
Director, Government Relations, Military Officers Association 
of America; Ms. Kathleen Moakler, Deputy Director, Government 
Relations, National Military Family Association; and Margot 
Saunders, Esq., Managing Attorney, National Consumer Law 
Center.
    Ms. Tammy Kimmel, an Army spouse, testified about the 
difficulties she encountered when she and her husband attempted 
to use their right under the SCRA to terminate their 
obligations under a residential joint lease. He had permanent 
change of station orders to go overseas.
    The DOD representative, Mr. Craig Duehring, presented the 
Department's views in support of the draft amendments to SCRA, 
which were developed in cooperation with DOD. Mr. Duehring did 
not offer DOD support for H.R. 3779.
    The Committee's examination of USERRA compliance in the 
public sector was a follow-up to the July 24, 2003, hearing on 
private sector employees. The hearing also explored the merits 
of expanding the jurisdiction of the Office of Special Counsel 
(OSC) over USERRA enforcement cases for Federal employees. 
Honorable Scott J. Bloch, Special Counsel, testified regarding 
OSC's USERRA enforcement activities and also testified 
favorably regarding expanded jurisdiction for OSC. Mr. Jason 
Burris and Dr. Judith Kaplan, both former members of the 
reserve components and former Federal employees, testified 
about their USERRA cases and praised the work of the OSC in 
resolving their cases.
    The Committee also considered a draft bill, the USERRA 
Health Care Coverage Extension Act of 2004, to extend from 18 
months to 24 months the maximum period of employer-sponsored 
health care coverage that a member of the reserve components 
could elect to continue. The draft bill also contained a 
provision to reinstate the reporting requirements for the 
Department of Labor in consultation with the Department of 
Justice and OSC on USERRA cases reviewed by or referred to 
them. When USERRA was originally enacted, the reporting 
requirements ended on February 1, 1996. The draft bill included 
a requirement for a report on USERRA enforcement activities on 
February 1, 2005 and annually thereafter. Witnesses testifying 
on behalf of the Administration supported this proposed 
legislation, and it was included in H.R. 4658.

                          OVERSIGHT ACTIVITIES

First Session

Hearing on VA Health Care System

    On January 29, 2003, the Committee held an oversight 
hearing on the current state of VA health care system, with a 
focus on its capacity to meet the current demand for health 
care and on the degree to which VA is fulfilling its statutory 
mission to care for veterans.
    The witnesses at this hearing were Honorable Robert H. 
Roswell, Under Secretary for Health, VA; Mr. Dennis Cullinan, 
Director, National Legislative Service, Veterans of Foreign 
Wars; Mr. Peter S. Gaytan, Principal Deputy Director, Veterans 
Affairs and Rehabilitation Commission, The American Legion; Mr. 
Joseph Violante, National Legislative Director, Disabled 
American Veterans; Mr. Richard Fuller, National Legislative 
Director, Paralyzed Veterans of America; Mr. Richard Jones, 
National Legislative Director, AMVETS; and Dr. Linda Spoonster 
Schwartz, Chair, Health Committee, Vietnam Veterans of America.
    Under Secretary Roswell testified that VA had made 
adjustments, given its sustainable capacity to meet veterans' 
health care needs, and shifted priorities to ensure that 
service-disabled veterans have the first claim on VA health 
care resources. He described a recent moratorium on 
establishing any new clinics and discussed co-payments policy, 
recruitment of new enrollees, a reorganized headquarters 
leadership and further described the Capital Asset Realignment 
for Enhanced Services (CARES) process to examine VA's capital 
needs in the future.

Hearing on the State of Veterans' Employment

    On February 5, 2003, the Committee held an oversight 
hearing on veterans' employment issues. The hearing explored 
the performance of government programs in three areas: the 3 
percent contracting goal set forth in Public Law 106-50, the 
Veterans Entrepreneurship and Small Business Act of 1999; the 
implementation of Public Law 107-288, the Jobs for Veterans 
Act; and the Transition Assistance Program (TAP) as 
administered by the Department of Labor for servicemembers and 
spouses transitioning to civilian life.
    Witnesses included Mr. Richard Weidman, Vietnam Veterans of 
America; Mr. John Lopez, Association for Service Disabled 
Veterans; Mr. Blake Ortner, Paralyzed Veterans of America; Mr. 
Joseph K. Forney, VetSource; Chief Master Sergeant Elizabeth S. 
Schouten, Deputy Director of Operations for the United States 
Air Force Band; Ms. Angela B. Styles, Administrator, Office of 
Federal Procurement Policy in the Office of Management and 
Budget, accompanied by Mr. Fred C. Armendariz, Associate Deputy 
Administrator for Government Contracting and Business 
Development for the Small Business Administration and Ms. Linda 
G. Williams, Associate Administrator for Government Contracting 
for the Small Business Administration; Mr. Kevin Boshears, 
Director, Office of Small Business Development for Department 
of Treasury; and Honorable Frederico Juarbe, Jr., Assistant 
Secretary for Veterans' Employment and Training Service for the 
Department of Labor, accompanied by Honorable Charles S. 
Ciccolella, Deputy Assistant Secretary for Veterans' Employment 
and Training Service and Mr. Ron Bachman, Regional 
Administrator Chicago/Denver for the Veterans' Employment and 
Training Service.
    Mr. Weidman, Mr. Lopez, and Mr. Ortner thanked the 
Committee for its work on Public Law 107-288 and testified that 
it was a first step. Mr. Forney joined them by testifying that 
the Federal government does not achieve the 3 percent 
procurement goals of Public Law 106-50 for veteran-owned small 
businesses.
    Chief Master Sergeant Schouten, a transitioning 
servicemember, testified about the excellent instruction she 
received while attending her TAP classes.
    Ms. Styles testified for the Administration on Public Law 
106-50. She stated that she considered the procurement numbers 
with regard to service-disabled veteran-owned small businesses 
unacceptable. In her oral testimony, she stated, ``I can convey 
to you a commitment from my office to do a better job, to pay 
more attention to this program.''
    Secretary Juarbe testified for the Administration on the 
implementation of Public Law 107-288 and the TAP program as 
administered by the Department of Labor. Mr. Juarbe 
specifically addressed concerns regarding TAP sites at overseas 
locations and how the Department provides informal services to 
servicemembers at these locations through the service branches. 
Mr. Juarbe also discussed the implementation plan for Public 
Law 107-288.

Hearing on Proposed Fiscal Year 2004 Budget for Veterans 
Programs

    On February 11, 2003, the Committee held a hearing on the 
fiscal year 2004 budget for veterans programs. The principal 
witness for the Administration was Honorable Anthony J. 
Principi, Secretary of Veterans Affairs. The Secretary was 
accompanied by five Department officials including Honorable 
Robert H. Roswell, M.D., Under Secretary for Health, and 
Honorable Vice Admiral Daniel L. Cooper, Under Secretary for 
Benefits.
    The Administration requested $25.2 billion in discretionary 
funding for veterans medical care, a $1.3 billion increase over 
the Administration's fiscal year 2003 request.
    Veterans service organization representatives presented 
their Independent Budget proposal for fiscal year 2004. 
Additionally, veterans service organizations representatives 
advocated mandatory funding for veterans' health care.
    The Committee expressed support for the President's 
proposal to reduce the pharmacy co-payment burden for Priority 
2-5 veterans by raising the income threshold at which such 
payments would be required. However, the Committee questioned 
the Administration's proposals to assess a $250 enrollment fee 
for higher-income veterans; raise the prescription drug co-
payment from $7 to $15 for veterans making $24,000 or more a 
year; and restrict institutional long-term care services to 
those with service-connected disability rated 70 percent or 
greater.

Hearing on Past and Present Efforts to Identify Fraud, Waste, 
Abuse, and Mismanagement in Veterans Programs

    On May 8, 2003, the Committee held the first in a series of 
hearings on congressional efforts to eliminate waste, fraud, 
abuse, and mismanagement within VA, and to improve the timely 
delivery of quality health care and benefits for veterans and 
their families.
    Witnesses at the hearing included: Honorable. Richard 
Griffin, Inspector General, Department of Veterans Affairs; and 
Ms. Cynthia Bascetta, Director, Healthcare--Veterans' Health 
and Benefits Issues, General Accounting Office.
    The IG testified about ways to improve health care delivery 
for veterans and summarized a recent audit of VA physician time 
and attendance, which had been requested by the Secretary of 
Veterans Affairs. He also stated that VA does not have 
effective procedures to align staffing levels with workload 
requirements, and that savings in excess of $209 million could 
be realized as a direct result of the establishment of VA's 
Fugitive Felon program, which stops improper payments of 
veterans benefits to fugitive felons.
    GAO testified about VA's health care and disability 
benefits. Their witness also testified about excessive waiting 
times for VA outpatient care, VA's large and aged 
infrastructure, which is not well aligned to meet veterans' 
needs, and about the need to consolidate duplicative care 
provider locations serving the same populations. GAO concluded 
that VA had made significant progress in the timeliness of its 
claims processing, but VA's disability criteria are outmoded.

Hearings to Receive the Final Report of the President's Task 
Force to Improve Health Care Delivery for Our Nation's Veterans

    On June 3, 2003, the Committee held the first in a series 
of two hearings on the final recommendations of the President's 
Task Force to Improve Health Care Delivery for Our Nation's 
Veterans, entitled President's Task Force to Improve Health 
Care Delivery for Our Nation's Veterans, Final Report 2003. The 
witness was Dr. Gail R. Wilensky, Co-Chair of the President's 
Task Force.
    The President's Task Force was established in May 2001 to 
make recommendations on improving coordination between the 
Departments of Defense and Veterans Affairs' health care 
systems. The President's Task Force issued its Final Report on 
May 26, 2003. Dr. Wilensky testified that the President's Task 
Force recommended changing the veterans' health care funding 
process through ``modifications to the current budget and 
appropriations process, by using a mandatory funding mechanism, 
or by some other changes in the process that achieve the 
desired goal.'' She emphasized that the view of the President's 
Task Force was that improved coordination between VA and DOD 
could not be fully realized until the VA health care funding 
problem is satisfactorily resolved.
    Additionally, Dr. Wilensky stated that it was ``vital that 
the field-level managers of the two Departments come to 
understand the commitment of the top leadership to improved 
collaborative efforts between VA and DOD.'' Further, Dr. 
Wilensky discussed the President's Task Force recommendations 
to achieve a seamless transition from active duty military to 
veteran status. She said that the current transition process is 
often cumbersome, slow, and overly bureaucratic and that ``the 
development and use of electronic medical records that could 
share data would not only foster collaboration in the delivery 
of health care services but also reduce medical errors and 
attendant costs.''
    On June 17, 2003, the Committee held a follow-up hearing 
concerning the President's Task Force. Witnesses included: 
Honorable Leo S. Mackay Jr., Ph.D., Deputy Secretary, VA; 
Honorable David S. C. Chu, Ph.D., Under Secretary of Defense 
for Personnel and Readiness, DOD; and the following 
Commissioners to the President's Task Force to Improve Health 
Care Delivery for Our Nation's Veterans: Charles R. Anthony, 
Ph.D.; Mr. Mack G. Fleming; Ms. Susan M. Schwartz; Mr. Robert 
W. Spanogle; and Mr. Harry N. Walters. Testifying on behalf of 
the veterans service organizations and military associations 
were Mr. Dennis M. Cullinan, National Legislative Director, 
Veterans of Foreign Wars; Mr. Richard Fuller, National 
Legislative Director, Paralyzed Veterans of America; Mr. 
Richard Jones, National Legislative Director, AMVETS; Colonel 
Robert F. Norton, USA (Ret.), Deputy Director, Government 
Relations, Military Officers Association of America; Mr. Steve 
Robertson, Director, National Legislative Commission, The 
American Legion; Mr. Joseph A. Violante, National Legislative 
Director, Disabled American Veterans.
    The testimony of the witnesses largely related to the 
central recommendation of the President's Task Force that the 
veterans' health care funding process be overhauled in order to 
achieve the necessary funding to meet demand within established 
access standards.

Second Hearing on Past and Present Efforts to Identify Fraud, 
Waste, Abuse, and Mismanagement in Programs

    On June 10, 2003, the Committee held a second hearing on 
congressional efforts to eliminate waste, fraud, abuse, and 
mismanagement within VA. The purpose of the second hearing was 
to receive testimony from VA and to highlight the Committee's 
oversight of VA's efforts to streamline and improve 
efficiencies in its management of benefit delivery systems. The 
hearing also examined what still needed to be accomplished to 
further improve the timely delivery of all veterans benefits.
    Witnesses included: Honorable Leo S. Mackay, Jr., Ph.D., 
Deputy Secretary, VA, who was accompanied by Honorable Robert 
H. Roswell, MD, Under Secretary for Health, Honorable Vice 
Admiral Daniel L. Cooper, Under Secretary for Benefits, and 
Honorable William H. Campbell, Assistant Secretary for 
Management.
    Dr. Mackay testified about efforts underway at the 
Department to prevent fraudulent behavior by employees within 
the Veterans Benefits Administration and outlined safeguards 
that had been established to prevent future problems. Dr. 
Mackay also discussed recommendations made by the VA 
Procurement Reform Task Force of 2001, and stated that 25 of 
the 60 task force recommendations had already been implemented. 
Legislation to change the result of the decision in Allen v. 
Principi, 268 F. 3d 1340 (Fed. Cir. 2001), which allows 
veterans to receive additional compensation for secondary 
substance abuse caused by a veteran's disability, was cited by 
VA as one of its major legislative proposals. This prompted 
many questions by members of the Committee. Dr. Mackay also 
noted problems with the computation and processes used to 
report activities related to some competitive outsourcing 
activities.

Hearing to Evaluate the Status of VA and DOD Efforts to Provide 
Seamless Health Care Coverage to Transitioning Veterans

    On October 16, 2003, the Committee held an oversight 
hearing to evaluate availability of medical care for 
servicemembers immediately following deployments, including 
Guard and Reserve members, and the transition between DOD and 
VA of servicemembers being discharged.
    The following witnesses testified from VA: Honorable Robert 
H. Roswell, MD, Under Secretary for Health, accompanied by 
Michael J. Kussman, MD, Deputy Chief Patient Care Officer, 
Veterans Health Administration, Mr. William D. Stinger, Deputy 
Under Secretary for Benefits, Veterans Benefits Administration; 
and Harold Kudler, MD, Chairman, Under Secretary for Health's 
Special Committee on Post-Traumatic Stress Disorder (PTSD).
    Mr. Edward Wyatt, Jr., Principal Deputy Assistant Secretary 
of Defense for Health Affairs, accompanied by Lieutenant 
General James B. Peake, MD, The Surgeon General, U.S. Army; 
Vice Admiral Michael L. Cowan, MD, Surgeon General of the Navy; 
Lieutenant General George Peach Taylor, Jr., MD, Surgeon 
General of the U.S. Air Force; Mr. Tom Bush, Director, Program 
Integration, Office of the Secretary Defense Reserve Affairs 
Manpower and Personnel; and Chaplain Gary Mauck, Lieutenant 
Colonel, U.S. Army Reserve, Fort Stewart, Georgia, accompanied 
by Colonel John Kidd, Fort Stewart Garrison Commander; 
presented statements for DOD.
    Mr. Neal P. Curtin, Director, Defense Capabilities and 
Management, accompanied by Mr. Clifton Spruill, Assistant 
Director, Defense Capabilities and Management, provided 
testimony for the General Accounting Office (GAO).
    Colonel Robert T. Frame, DDS, U.S. Army Reserve; Senior 
Master Sergeant Robbin Halcomb, Air National Guard; Mr. Nelson 
Villegas, U.S. Army veteran; and Mrs. Arvilla Stiffler, mother 
of Mr. Jason Stiffler, U.S. Army veteran testified about their 
experiences with the transition between DOD and VA health care 
systems.
    This hearing included personal accounts and analysis of 
individual experiences of separating servicemembers 
transitioning from DOD to VA programs following a serious 
illness or injury while on active duty. GAO reported its most 
recent findings concerning DOD pre- and post-deployment health 
screenings, health records maintenance and in-theater health 
tracking of troops. The Committee heard testimony from health 
care executives from both Departments, including the Surgeons 
General of the U.S. Army, Navy and Air Force and a Reserve 
Affairs official.
    Additional witnesses provided a view of what occurs beyond 
the metropolitan Washington, DC area, for both DOD and VA and 
their patients. Chaplain Mauck, an Army Reserve Lieutenant 
Colonel from Fort Stewart, Georgia, testified about the 
pastoral programs the Army has established to assist returning 
troops with post-traumatic stress disorder (PTSD) and about the 
general stresses of returning from deployment. Dr. Kudler, the 
Chairman of the VA Advisory Committee on PTSD, also testified 
about VA's ``Iraq War Clinicians Guide'' and the sixteen 
clinical practice guidelines developed jointly by VA and DOD 
for the management of PTSD.

Second Session

Hearing on VA's Long-Term Care Policies

    On January 28, 2004, the Committee held a hearing to 
examine existing VA long-term care programs and VA's strategy 
for addressing future long-term care needs of aging and 
disabled veterans. GAO also presented testimony based on its 
reported findings in VA Long-Term Care: Changes in Service 
Delivery Raise Important Questions, GAO-04-425T, January 28, 
2004.
    Government witnesses included: Honorable Robert H. Roswell, 
MD, Under Secretary for Health, VA, accompanied by James F. 
Burris, M.D, Chief Consultant for Geriatrics and Extended Care 
Strategic Healthcare Group; John D. Daigh, Jr., MD, Assistant 
Inspector General for Health Care Inspections, Office of 
Inspector General, VA, accompanied by Ms. Victoria Coates, 
Director, VA Atlanta Regional Office of Healthcare Inspections, 
Office of Inspector General; and Ms. Cynthia A. Bascetta, 
Director, Veterans' Health and Benefits Issues, General 
Accounting Office (GAO), accompanied by Mr. Jim Musselwhite, 
Assistant Director, Health Care.
    Other witnesses included: Joel Streim, MD, President, 
American Association for Geriatric Psychiatry; Ms. Jade Gong, 
RN, FAACN, Member of VA Geriatrics and Gerontology Advisory 
Committee, Health Strategy Associates; Ms. Linda Sabo, 
Executive Director, Alzheimer's Association Western New York 
Chapter; Mr. Phillip Jean, President, National Association of 
State Veterans Homes, and Administrator of the Maine Veterans 
Home in Scarborough.
    Statements for the record were submitted by Ms. Carol 
Rutherford, Director, Veterans Affairs and Rehabilitation 
Division, The American Legion; Mr. Richard Jones, National 
Legislative Director, AMVETS; Mr. Adrian M. Atizado, Assistant 
National Director, Disabled American Veterans; Mr. Fred Cowell, 
Health Policy Analyst, Paralyzed Veterans of America; Mr. Paul 
A. Hayden, Deputy Director, National Legislative Service, 
Veterans of Foreign Wars; Mr. Richard Weidman, Director of 
Government Relations, Vietnam Veterans of America; Charles H. 
Roadman II, MD, CNA, President and Chief Executive Officer, 
American Health Care Association.
    The Committee learned that VA's long-term care services 
have undergone some positive changes in recent years, but VA's 
commitment to long-term care has not kept pace with veterans' 
needs, and access to VA care and the basic availability of 
these programs remain variable from network to network.
    Many of the concerns expressed at the May 22, 2003, 
Subcommittee hearing on long-term care remained unresolved. 
Issues related to VA's role in meeting the long-term health 
care needs of aging veterans, and the challenge to improve its 
management and direction of long-term care policies will 
require continued Committee oversight.

Hearing on the President's Proposed Fiscal Year 2005 Budget for 
the Department of Veterans Affairs

    On February 4, 2004, the Committee held a hearing on the VA 
budget for fiscal year 2005. The Administration requested $64.9 
billion in new appropriations in the VA budget. Of this total, 
$35.2 billion was for entitlement programs such as disability 
compensation and Montgomery GI Bill payments, and $29.7 billion 
in discretionary funding was for health care, medical research 
and administration of the benefits and cemetery systems.
    VA witnesses testifying at the hearing included: Honorable 
Anthony J. Principi, Secretary of Veterans Affairs, accompanied 
by Honorable Robert H. Roswell, MD, Under Secretary for Health; 
Honorable Daniel L. Cooper, Under Secretary for Benefits; 
Honorable John W. Nicholson, Under Secretary for Memorial 
Affairs; Honorable Tim S. McClain, General Counsel; and 
Honorable William H. Campbell, Assistant Secretary for 
Management.
    Testifying on behalf of military and veterans service 
organizations were the following witnesses: Mr. Dennis 
Cullinan, Director, National Legislative Service, Veterans of 
Foreign Wars; Mr. Richard Fuller, National Legislative 
Director, Paralyzed Veterans of America; Mr. Richard Jones, 
National Legislative Director, AMVETS; and Mr. Joseph A. 
Violante, Disabled American Veterans; Mr. Peter S. Gaytan, 
Principal Deputy Director of the Veterans Affairs and 
Rehabilitation Division, The American Legion; Mr. Richard C. 
Schneider, National Director, Veterans and State Affairs, Non 
Commissioned Officers Association; Colonel Robert F. Norton, 
USA (Ret.), Co-Chair, Veterans Committee, The Military 
Coalition; Mr. Morgan Brown, Co-Chair, Veterans Committee, The 
Military Coalition; and Mr. Richard Weidman, Director of 
Government Relations, Vietnam Veterans of America.
    Secretary Principi presented the Administration's fiscal 
year 2005 budget requirements for veterans programs, and 
representatives of the veterans service organizations presented 
their Independent Budget proposal, with varying perspectives on 
the levels of funding for VA programs.

Hearing on Employing Veterans of Our Armed Forces

    On March 24, 2004, the Committee held an oversight hearing 
on employing veterans of our armed forces. Witnesses included 
Mr. Joseph J. Grano, Jr., Chairman, UBS Financial Services 
Inc.; Mr. Steven A. Wohlwend, Senior Division Manager, 
Industrial Relations, Deere & Company; Mr. Robert W. Smith III, 
Global Controller, Service Engineering Operations, Ford Motor 
Company; Mr. Joseph Keith Kellogg, Senior Vice President, 
Homeland Security Solutions, Oracle Corporation; Mr. Wesley 
Poriotis, Chief Executive Officer, The Center for Military and 
Private Sector Initiative, Inc., Veterans Across America; Mr. 
Harold A. Scott, Vice President, Human Resources, Harley-
Davidson Motor Company; Mr. Kevin M. Horigan, Group Vice 
President, Public Services, PeopleSoft; Mr. Brad L. Champlin, 
Executive Vice President, Union Planters Corporation; and Mr. 
Robert C. Crawford, Vice President, Staffing, Prudential 
Financial.
    The witnesses from business and industry uniformly 
testified that former servicemembers as a class of individuals 
are valued business assets for several reasons, including their 
loyalty, work habits, self-discipline, dependability, and 
commitment. Witnesses generally expressed a lack of knowledge 
as to how to have a job within their company approved for 
veterans' training in the form of an on-job training or 
apprenticeship program administered by VA. Mr. Poriotis 
testified to a ``deselective bias'' that can exist in private-
sector hiring practices because relatively few chief human 
resources officers have served in the military. Mr. Grano spoke 
to language and other terminology barriers private companies 
encounter in understanding how military occupational 
specialties can translate to civilian jobs.

Hearing on Homeless Assistance Programs for Veterans

    On May 18, 2004, the Committee held an oversight hearing on 
Federal homeless assistance programs for veterans, and VA's 
coordination with community-based providers and other Federal 
agencies, principally the Departments of Health and Human 
Services (HHS) and Housing and Urban Development (HUD). The 
purpose of this hearing included a review of Public Law 107-95, 
the Homeless Veterans Comprehensive Assistance Act of 2001, and 
VA's progress in implementing this law and the transitional 
housing authority of Public Law 105-368, the Veterans Programs 
Enhancements Act of 1998.
    Witnesses who testified at this hearing included: Honorable 
Gordon H. Mansfield, Deputy Secretary of Veterans Affairs, 
accompanied by Mr. Peter H. Dougherty, Director, Office of 
Homeless Veterans Programs; Ms. M. Gay Koerber, Associate Chief 
Consultant, Health Care for Homeless Veterans; Mr. Claude B. 
Hutchison, Jr., Director, Office of Asset Enterprise 
Management; Ms. Patricia Carlile, Deputy Assistant Secretary 
for Special Needs Programs, HUD; Mr. Don Winstead, Deputy 
Assistant Secretary for Planning and Evaluation, Office of 
Human Services Policy, HHS; Mr. John Kuhn, LCSW, MPH, Homeless 
Program Coordinator, VA New Jersey Health Care System, 
accompanied by Mr. Robert Valentino, Mr. Ralph Owens, and Mr. 
Thaddeus McNair; Richard McCormick, Ph.D., Hudson, Ohio; Ms. 
Linda Boone, Executive Director, National Coalition for 
Homeless Veterans, Washington, DC; Mr. William G. D'Arcy, 
Catholic Charities of the Archdiocese of Chicago, Chicago, 
Illinois; Mr. James W. Manning, Commissioner, Housing Authority 
of the Township of Neptune, Neptune, New Jersey; Mr. Carlos 
Martinez, President and CEO, American GI Forum, National 
Veterans Outreach Program, Inc., San Antonio, Texas.
    At this hearing, the Committee heard testimony about 
successes of the program in Lyons, New Jersey. In rebuilding 
their lives, three formerly homeless veterans are helping other 
veterans by outreach, example, training and mentoring, 
operating businesses, and developing a website.

Follow-up Hearing on Eliminating Waste, Fraud, and Abuse in 
Veterans' Programs

    On June 17, 2004, the Committee held its third hearing on 
congressional efforts to eliminate waste, fraud, abuse, and 
mismanagement within VA. The purpose of the hearing was to 
review how VA has addressed ongoing problems that were reviewed 
in previous hearings held on May 8, 2003 and June 10, 2003.
    Witnesses included: Honorable Gordon H. Mansfield, Deputy 
Secretary, VA; Mr. McCoy Williams, Director, Financial 
Management and Assurance Team, General Accounting Office; and 
Honorable Richard Griffin, Inspector General (IG), VA.
    Deputy Secretary Mansfield focused the first part of his 
testimony on the problems encountered with the implementation 
of the Core Financial and Logistics System, which is an 
integration of financial and management information systems, at 
Bay Pines VA Medical Center, FL. He also testified that the IG, 
the House Committee on Appropriations, and Carnegie Mellon 
University were conducting investigations and would issue 
reports later in the year on their findings. Deputy Secretary 
Mansfield also provided an update on several areas discussed in 
previous hearings and discussed how the Department intended to 
address the problems outlined, including part-time physicians 
and attendance, staffing levels, and improvements in the 
collections process.
    The IG indicated during the Committee's June 17, 2004, 
hearing on VA's efforts to curtail waste, fraud, abuse, and 
mismanagement that additional funding was critical to maintain 
a current level of return of investment for the Fugitive Felon 
Program. A hearing outcome was that on June 18, 2004, the 
Committee requested that the Appropriations Committee provide 
an additional $7.8 million to fully fund VA's Office of 
Inspector General (OIG), in its efforts mandated by Public Law 
107-103 to eliminate payments to fugitive felons.

Hearing on the Evolution of VA-DOD Collaboration in Research 
and Amputee Care for Veterans of Current and Past Conflicts and 
on Needed Reforms in VA Blind Rehabilitation Services

    On July 22, 2004, the Committee held an oversight hearing 
on the evolution of VA-DOD collaboration in research and 
amputee care for veterans of current and past conflicts, and on 
needed reforms in VA blind rehabilitation services.
    Witnesses from VA included: Michael J. Kussman, MD, Acting 
Deputy Under Secretary for Health; Mindy L. Aisen, MD, Deputy 
Chief Research and Development Officer; Mr. Frederick Downs, 
Jr., Chief Consultant, Prosthetic and Sensory Aids Service 
Strategic Healthcare Group; Rory A, Cooper, Ph.D., Director, 
Center of Excellence on Wheelchairs and Associated 
Rehabilitation Science and Engineering, VA Healthcare System, 
Pittsburgh, Pennsylvania; Ms. Penny L. Schuckers, MSW, Chief, 
Eastern Blind Rehabilitation Center and Clinic, VA Medical 
Center, West Haven, Connecticut; Mr. Bruce W. Davis, MSW, 
Visual Impairment Services Team Coordinator, North Florida/
South Georgia VA Medical Center, Gainesville, Florida; and Ms. 
Nancy J. Strohm, MSW, VISOR Coordinator, VA Medical Center, 
Lebanon, Pennsylvania.
    Testifying for DOD were the following witnesses: Brett P. 
Giroir, MD, Deputy Director, Defense Sciences Office, Defense 
Advanced Research Projects Agency; Paul F. Pasquina, MD, Chief, 
Physical Medicine and Rehabilitation, Walter Reed Army Medical 
Center; Mr. Chuck Scoville, Program Manager, U.S. Army Amputee 
Patient Care, Walter Reed Army Medical Center; Sergeant David 
Sterling, United States Army; and Staff Sergeant Ryan Kelly, 
United States Army.
    Testimony was provided by Ms. Cynthia A. Bascetta, 
Director, Veterans' Health and Benefits Issues, Government 
Accountability Office (GAO), and formerly known as the General 
Accounting Office.
    Mr. Thomas H. Miller, Executive Director, Blinded Veterans 
Association; Mr. John Fales, President, Blinded American 
Veterans Foundation; Ms. Joy J. Ilem, Assistant National 
Legislative Director, Disabled American Veterans; Mr. Richard 
B. Fuller, National Legislative Director, Paralyzed Veterans of 
America presented testimony on behalf of veterans service 
organizations.
    Other witnesses included: Mr. Bert Harman, President and 
CEO, Otto Bock Healthcare; and Mr. Robert Conetta, United 
States Army veteran.
    The Committee considered testimony affecting 157,000 
legally blind veterans, 44,000 of whom are enrolled in VA 
health care. According to the testimony, more than 2,000 of 
these blinded veterans have received treatment in the VA's 
Blind Rehabilitation Centers. One focus of the hearing was the 
degree to which changes may be needed in VA's approach to 
caring for blinded and visually-impaired veterans.
    GAO found that, as a consequence of the growing number of 
veterans in need of blind rehabilitation services and VA's 
reliance on ten regional centers of excellence to provide that 
care, the average waiting time is excessive for a veteran to be 
admitted to a blind rehabilitation center. GAO reported to the 
Committee, and VA agreed, that waiting time management for 
blind rehabilitation needs to be improved. Also, GAO testified 
on the need for VA to reform its program management. The 
Committee expressed its view that VA should advance its 
planning to make visual-impairment services more available to 
veterans where they live, rather than requiring veterans to 
report to specialized centers for these services.
    A second focus of the hearing was to learn more about 
recent efforts on the part of VA and DOD to improve care for 
servicemembers and veterans suffering the effects of recent 
traumatic amputations in the war on terrorism. The hearing 
examined several aspects of the treatment being provided to 
these survivors, and how this treatment improves the lives of 
those who are wounded.

Three Years After 9/11: Is VA Prepared to Fulfill Its Roles in 
Homeland Security?

    On August 26, 2004, the Committee held a hearing to address 
the findings of the National Commission on Terrorist Attacks 
Upon the United States (also known as the 9/11 Commission) and 
to examine VA's role in the National Response Plan and other 
homeland security contingency plans; VA's preparations to 
fulfill those obligations and duties; VA's coordination and 
collaboration with other Federal agencies charged with homeland 
security functions; and VA's integration into both national and 
local emergency prevention and response plans.
    Witnesses included: Honorable Gordon H. Mansfield, Deputy 
Secretary, VA, accompanied by Honorable Robert N. McFarland, 
Assistant Secretary for Information and Technology; Jonathan B. 
Perlin, MD, Acting Under Secretary for Health, VA; Mr. Robert 
J. Epley, Associate Deputy Under Secretary for Policy and 
Program Management, VBA; Major General Lester Martinez-Lopez, 
Commanding General, U.S. Army Medical Research and Materiel 
Command and Fort Detrick, DOD; Honorable Stewart Simonson, 
Assistant Secretary for Public Health Emergency Preparedness, 
Department of Health and Human Services; Neil C. Livingstone, 
Ph.D, Chief Executive Officer, Global Options, Inc.; Jerry L. 
Mothershead, MD, Former Senior Medical Consultant, Navy 
Medicine Office of Homeland Security, Physician Advisor, 
Medical Readiness and Response Group, Batelle Memorial 
Institute; and Karl Y. Hostetler, MD, VA San Diego Healthcare 
System.
    VA testified that funding for its initiative relating to 
Homeland Security rose from $84.5 million in fiscal year 2002 
to $271 million in fiscal year 2004, and its budget request for 
fiscal year 2005 was $297 million. VA also described its 
partnership in the National Disaster Medical System, 
specifically its role in the aftermath of Hurricane Charley. VA 
reiterated that one of its major roles in the National Disaster 
Medical System is the management of four pharmaceutical and 
medical supply caches for the Department of Homeland Security 
and Federal Emergency Management Agency and two additional 
special caches for other Federal agencies. Secretary Mansfield 
restated his support for the Committee's efforts to secure 
funding for VA emergency preparedness centers.
    General Martinez-Lopez discussed the work carried out at 
Fort Detrick, MD, in training first responders, and military 
and civilian care providers to treat exposure to chemical and 
biological agents. He also testified about VA's role in the 
development of an oral smallpox vaccine. General Lopez 
addressed the collaboration between VA, DOD and NIH on 
neurodegenerative diseases research. Mr. Simonsen testified 
about HHS' interagency working group and efforts to develop 
recommendations to address availability of health care 
providers to respond to a mass casualty event.
    Dr. Mothershead stated that most medical facilities are 
able to return to normal or near normal operation within 48 
hours of an event. Dr. Mothershead further stated that while 
500 hospitals or 10 percent of the total hospitals in the 
country and 25 percent of the medical emergency departments 
have closed, the demand has not declined. He expressed concern 
that there are no national standards to effectively measure the 
Nation's ability to handle a significant terrorist attack.

                    ACTIVITIES OF THE SUBCOMMITTEES


                         Subcommittee on Health

    The Subcommittee on Health has legislative, oversight and 
investigative jurisdiction over veterans' hospitals, medical 
care, and treatment of veterans (see Oversight Plan for 108th 
Congress, p. 91).

                         LEGISLATIVE ACTIVITIES

First Session

Subcommittee Markup of H.R. 1562, H.R. 1715, H.R. 1832, H.R. 
1908, and H.R. 1911

    On May 6, 2003, the Subcommittee on Health met and marked 
up five bills: H.R. 1562, H.R. 1715, H.R. 1832, H.R. 1908, and 
H.R. 1911. All five bills were reported favorably to the Full 
Committee (see Full Committee Markup, p. 33).

Hearing on H.R. 1720, H.R. 116, H.R. 2307, and H.R. 2349

    On June 11, 2003, the Subcommittee on Health held a 
legislative hearing to consider the following four bills: H.R. 
1720, the Veterans Health Care Facilities Capital Improvement 
Act, introduced by Honorable Rob Simmons of Connecticut on 
April 10, 2003; H.R. 116, Veterans' New Fitzsimons Health Care 
Facilities Act of 2003, introduced by Honorable Joel Hefley of 
Colorado on January 7, 2003; H.R. 2307, introduced by Honorable 
David L. Hobson of Ohio on June 3, 2003, to establish new VA 
medical facilities in the area of Columbus, Ohio and in south 
Texas; and H.R. 2349, introduced by Honorable Lane Evans of 
Illinois on June 5, 2003, to authorize construction of a new 
bed tower at the VA West Side facility in Chicago and certain 
other major medical facility projects.
    Witnesses included: Honorable Robert H. Roswell, MD, Under 
Secretary for Health, VA, who was accompanied by Mr. D. Mark 
Catlett, Principal Deputy Assistant Secretary for Management 
and Mr. Robert L. Neary, Jr., Associate Chief Facilities 
Management Officer for Service Delivery; Ms. Cathleen C. 
Wiblemo, Deputy Director, Health Care, Veterans Affairs and 
Rehabilitation Division, The American Legion; Mr. Richard 
Jones, National Legislative Director, AMVETS; Mr. Adrian M. 
Atizado, Associate National Legislative Director, Disabled 
American Veterans; Mr. Carl Blake, Associate Legislative 
Director, Paralyzed Veterans of America; and Mr. Paul A. 
Hayden, Deputy Director, National Legislative Service, Veterans 
of Foreign Wars.
    Statements for the Record were received from Honorable Joel 
Hefley of Colorado; Honorable David L. Hobson of Ohio; 
Honorable Solomon P. Ortiz of Texas; Honorable Deborah Pryce of 
Ohio; and Honorable Lane Evans of Illinois.
    VA supported H.R. 1720 and H.R. 116. VA also supported 
Sections 1, 2, and 3 of H.R. 2349, but expressed opposition to 
Section 4 of the bill, which would prohibit VA from spending 
funds to dispose of VA's Lakeside property until a contract is 
awarded to construct a new bed tower on VA's West Side campus. 
Regarding H.R. 2307, VA agreed that the need for an expanded 
replacement outpatient clinic in Columbus was appropriate, but 
stated that it was premature to endorse a proposed new facility 
in south Texas. VA also requested that the Subcommittee 
consider additional project leases included in the President's 
fiscal year 2004 budget for Boston, MA; Pensacola, FL; and for 
a Health Administration Center in Denver, CO. Authorization for 
VA seismic projects listed in the President's 2003 budget at 
facilities in Palo Alto, San Francisco, and West Los Angeles 
remained a high priority for the Department.
    All of the veterans service organizations representatives 
testified in support of the four bills and the Subcommittee's 
efforts to improve the capital infrastructure of VA's health 
care system, with one exception. The Disabled American Veterans 
expressed some concern about H.R. 1720, asserting that whatever 
option is approved for the Denver area, VA should maintain a 
separate identity with direct line authority in all areas 
involving care of veteran patients.

Subcommittee Markup of H.R. 116, H.R. 1720, H.R. 2357, and H.R. 
2433

    On June 24, 2003, the Subcommittee on Health met and marked 
up four bills: H.R. 116, with an amendment; H.R. 1720, with an 
amendment; H.R. 2357, with an amendment; and H.R. 2433, with an 
amendment. All four bills were favorably reported to the Full 
Committee (see Full Committee Markup, p. 33).

Hearing on H.R. 1585

    On Tuesday, July 15, 2003, the Subcommittee on Health held 
a legislative hearing to consider H.R. 1585, a bill to 
establish an office to oversee research compliance and 
assurance within VHA, and to provide for a Director of such 
office, introduced by Honorable Steve Buyer of Indiana on April 
3, 2003.
    Witnesses included: Honorable Robert H. Roswell, MD, Under 
Secretary for Health, VA, accompanied by Mindy L. Aisen, MD, 
Deputy Chief Research and Development Officer, David A. Weber, 
Ph.D., Acting Chief of the Office of Research Oversight, and 
Lynn Cates, MD, Assistant Chief Research and Development 
Officer; and John Clarkson, MD, Senior Vice President for 
Medical Affairs and Dean of the University of Miami School of 
Medicine, on behalf of the Association of American Medical 
Colleges (AAMC).
    Dr. Roswell testified that the legislation was unnecessary 
because actions approved by the Secretary and undertaken by VA 
to realign human research protection responsibilities and 
activities within the Office of Research and Development 
achieved the objectives of H.R. 1585. Additionally, he outlined 
criticisms of certain other provisions of H.R. 1585. On behalf 
of the AAMC, Dr. Clarkson supported the principle and intent of 
the legislation.

Hearing on H.R. 2379 and H.R. 3094

    On September 30, 2003, the Subcommittee on Health held a 
hearing to consider two bills to improve veterans' access to 
health care: H.R. 2379, the Rural Veterans Access to Care Act 
of 2003, introduced by Honorable Tom Osborne of Nebraska on 
June 5, 2003, and H.R. 3094, the Veterans Timely Access to 
Health Care Act, introduced by Honorable Ginny Brown-Waite of 
Florida on September 16, 2003.
    Witnesses included: Honorable Tom Osborne of Nebraska; 
Honorable Jon C. Porter of Nevada; Honorable Robert H. Roswell, 
MD, Under Secretary for Health, VA; Mr. Arthur L. Johnsen, 
Franklin County Veterans Service Officer, Nebraska; Mr. John J. 
Kenney, Citrus County Veterans Service Officer, Florida; Ms. 
Cathleen Wiblemo, Deputy Director for Health Care, Veterans 
Affairs and Rehabilitation, The American Legion; Mr. Dennis 
Cullinan, National Legislative Director, Veterans of Foreign 
Wars; Mr. William Carl Blake, Associate Legislative Director, 
Paralyzed Veterans of America; Mr. Adrian M. Atizado, Assistant 
National Legislative Director, Disabled American Veterans; Mr. 
Rick Weidman, Director, Government Relations, Vietnam Veterans 
of America; and Mr. Richard Jones, National Legislative 
Director, AMVETS.
    Representative Osborne testified that H.R. 2379 would allow 
enrolled veterans who live in highly rural areas to seek health 
care and receive medical treatment closer to their homes. 
Representative Brown-Waite stated that H.R. 3094 would ensure 
that veterans have swift and speedy access to necessary health 
care. Under Secretary Roswell presented the Administration's 
view that both H.R. 2379 and H.R. 3094 would be harmful to VA's 
existing efforts to improve overall access to VA health care.
Second Session

Hearing on H.R. 4020, H.R. 4231, H.R. 3849, and H.R. 4248

    On May 6, 2004, the Subcommittee on Health held a hearing 
to consider the following legislation: H.R. 4020, State 
Veterans' Home Nurse Recruitment and Retention Act of 2004, 
introduced by Honorable Christopher H. Smith of New Jersey on 
March 23, 2004; H.R. 4231, Department of Veterans Affairs Nurse 
Recruitment and Retention Act of 2004, introduced by Honorable 
Rob Simmons of Connecticut on April 28, 2004; H.R. 3849, 
Military Sexual Trauma Counseling Act of 2004, introduced by 
Honorable Ciro Rodriguez of Texas on February 26, 2004; H.R. 
4248, Homeless Veterans Assistance Reauthorization Act of 2004, 
introduced by Honorable Christopher H. Smith of New Jersey on 
April 29, 2004; and a draft bill to reform the qualifications 
and selection requirements for the position of the Under 
Secretary for Health.
    VA witnesses included: Honorable Gordon H. Mansfield, 
Deputy Secretary, who was accompanied by Honorable Tim S. 
McClain, General Counsel, Jonathan B. Perlin, MD, Acting Under 
Secretary for Health, VA, and Mr. Thomas J. Hogan, Deputy 
Assistant Secretary for Human Resources Management.
    Additional witnesses included: Linda S. Schwartz, RN, 
Dr.PH, Commissioner of the Connecticut Department of Veterans 
Affairs; Andrea Mengel, Ph.D., R.N., Head, Department of 
Nursing, Community College of Philadelphia, representing the 
American Association of Community Colleges; Ms. Marsha Four, 
RN, Chair of VA Advisory Committee on Women Veterans; Mr. 
Robert Van Keuren, Chair of VA Advisory Committee on Homeless 
Veterans; Ms. Cathleen C. Wiblemo., Deputy Director, Health 
Care, The American Legion; Mr. Rick Weidman, Director, 
Government Relations, Vietnam Veterans of America; Mr. Richard 
Jones, National Legislative Director, AMVETS; Mr. Richard 
Fuller, National Legislative Director, Paralyzed Veterans of 
America; Mr. Dennis Cullinan, National Legislative Director, 
Veterans of Foreign Wars; and Mr. Adrian M. Atizado, Assistant 
National Legislative Director, Disabled American Veterans.
    VA testified in support of H.R. 4248, H.R. 3849 and the 
intent of the draft bill to amend the procedures for 
appointment and qualifications of the Under Secretary for 
Health. VA opposed H.R. 4020, arguing that the Department 
already contributes to the cost of nurse recruitment with the 
per diem amount VA pays states for the care of veterans in 
State homes, and that the legislation would reduce available 
medical care funds for other programs. VA generally accepted 
the provisions of H.R. 4231, but opposed Section 4 of the bill 
to provide that a registered nurse applying for a VA 
appointment may not be denied appointment solely because the 
nurse applicant does not have a baccalaureate degree. Deputy 
Secretary Mansfield expressed VA's belief that the provision 
was unnecessary because it is not VA's policy to deny 
appointment based on the lack of baccalaureate degree.
    However, Dr. Andrea Mengel, representing community 
colleges, testified in support of H.R. 4231, asking: ``With 
hundreds of choices of workplace opportunities, why would new 
RN graduates from associate degree programs choose to work at 
the VHA where the hiring and promotion policy will hold them 
back? Community colleges across the Nation report that their 
graduates are not choosing the VHA.'' Also, Dr. Linda S. 
Schwartz, Commissioner of the Connecticut Department of 
Veterans Affairs, stated ``. . . I would just ask the 
rhetorical question, which is better, no nurse or a nurse from 
an associate degree program? And to me the answer is a nurse 
from an associate degree program. . . .'' Ms. Marsha Four, 
Chair of VA Advisory Committee on Women Veterans, testified in 
strong support of H.R. 3849, and Mr. Robert Van Keuren, Chair 
of the VA Advisory Committee on Homeless Veterans testified in 
strong support of H.R. 4248.
    All of the veterans service organizations testified in 
support of H.R. 3849 and H.R. 4248 and generally supported H.R. 
4020 and H.R. 4231. However, Ms. Wiblemo, on behalf of The 
American Legion, expressed concern that Congress should 
appropriate sufficient funding to allow VA to carry out the 
intent of H.R. 4020 and did not take a position on Section 4 of 
H.R. 4231. All of the veterans service organizations raised 
questions about the draft bill to reform the qualifications and 
selection requirements for the position of the Under Secretary 
for Health.

Subcommittee Markup of H.R. 4231 and H.R. 4248

    On May 13, 2004, the Subcommittee met and marked up two 
bills: H.R. 4231, with an amendment; and H.R. 4248, with an 
amendment. Both bills were reported favorably to the full 
Committee (see Full Committee Markup, p. 34).

Hearing on Draft Legislation Pertaining to Major Medical 
Facility Leases and Capital Asset Management within VA

    On June 24, 2004, the Subcommittee on Health held a hearing 
to consider a draft bill to authorize 17 VA major medical 
facility leases, establish a new procedure for transferring 
excess VA properties and a new fund into which proceeds from 
such transfers would be deposited, and for other purposes.
    Witnesses included Honorable Anthony J. Principi, Secretary 
of Veterans Affairs, who was accompanied by Honorable Tim S. 
McClain, General Counsel, Honorable William H. Campbell, 
Assistant Secretary for Management, Mrs. Laura Miller, Deputy 
Under Secretary for Health for Operations and Management, and 
Mr. James M. Sullivan, Deputy Director, Office of Asset 
Enterprise; Mr. Lawrence A. Biro, Network Director, VA Veterans 
Integrated Service Network 19: Rocky Mountain Network; 
Honorable Everett Alvarez, Jr., Former Chairman, Capital Asset 
Realignment for Enhanced Services (CARES) Commission; Mr. 
Dennis Brimhall, President and Chief Executive Officer, 
University of Colorado Hospital; Mr. John L. Nau, III, 
Chairman, Advisory Council on Historic Preservation; Mr. Dennis 
Samic, Treasurer, American Veterans Heritage Center, Inc.; Mr. 
Richard Jones, National Legislative Director, AMVETS; Mr. John 
F. Sommer, Jr., Executive Director, The American Legion; Mr. 
Robert Wallace, Executive Director, Veterans of Foreign Wars; 
Mr. Thomas H. Corey, President, Vietnam Veterans of America; 
Ms. Joy J. Ilem, Assistant National Legislative Director, 
Disabled American Veterans; and Mr. Richard Fuller, National 
Legislative Director, Paralyzed Veterans of America. Mr. 
Richard Moe, President, National Trust for Historic 
Preservation, submitted a statement for the record.
    The draft bill was subsequently introduced as H.R. 4768, 
the Veterans Medical Facilities Management Act of 2004, by 
Honorable Rob Simmons of Connecticut on July 7, 2004.
    Secretary Principi testified in support of the draft 
legislation and discussed VA's CARES plan, to improve both 
access and quality for veterans' medical care. Mr. Nau and Mr. 
Samic testified in support of giving VA authorization to use 
the proceeds from the transfer of real property for maintenance 
and adaptive re-use of historic properties, but expressed 
concern that the legislation lacked established priorities to 
ensure that some of the funds would be used for historic 
preservation. All of the veterans service organizations 
endorsed the establishment of a Capital Asset Fund and the 
CARES concept, but cautioned that the proper oversight would be 
needed to make certain that VA would use the authority 
appropriately.

Subcommittee Markup of H.R. 4768

    On July 8, 2004, the Subcommittee on Health met and marked 
up H.R. 4768, the Veterans Medical Facilities Management Act of 
2004. The bill was reported favorably to the full Committee 
(see Full Committee Markup, p. 34).

                          OVERSIGHT ACTIVITIES

First Session

Staff Site Visit to VA's Conference on Home as the Site of 
Care, St. Petersburg, Florida

    On February 5, 2003, a majority staff member of the 
Subcommittee on Health attended VA's Conference on Home as the 
Site of Care. The purpose of the conference was to advance the 
use of telemedicine in the VA in the areas of long-term care; 
chronic disease management; and mental health.
    Under Secretary Robert Roswell stated VA's strategic plan 
for long-term care was to triple the number of veterans 
receiving home and community based care by 2006. Also, at the 
Conference it was announced that a new Office of Care 
Coordination would be established at VA's Central Office in 
Washington, DC.

Hearing on the Availability and Eligibility for Pharmaceutical 
Services Provided by VA

    On March 19, 2003, the Subcommittee on Health held an 
oversight hearing to examine new proposals for a veterans' 
prescription drug benefit to improve access and shorten waiting 
times for veterans enrolled in the VA health care system. The 
following bills related to this subject were discussed during 
the hearing: H.R. 709, the Veterans Prescription Access 
Improvement Act, introduced by Honorable Roger F. Wicker of 
Mississippi on February 11, 2003; H.R. 372, to authorize 
pharmacies of the Department of Veterans Affairs to fill 
prescriptions for drugs and medicines written by private 
physicians, introduced by Honorable Stephen F. Lynch of 
Massachusetts on January 27, 2003; H.R. 240, the Veterans 
Prescription Drug Equity Act, introduced by Honorable John L. 
Mica of Florida on January 8, 2003; and a draft bill, the 
Veterans Prescription Drug Benefits Act of 2003.
    Hearing witnesses included: Honorable Lane Evans of 
Illinois and Ranking Democratic Member, Committee on Veterans 
Affairs; Honorable Stephen F. Lynch of Massachusetts; Honorable 
John L. Mica of Florida; Honorable Roger F. Wicker of 
Mississippi; and Honorable Anthony J. Principi, Secretary of 
Veterans Affairs. Honorable Nancy L. Johnson of Connecticut 
submitted testimony for the record.
    Under current law, VA does not offer prescription drugs as 
a direct benefit, but rather as a part of its overall health 
care benefits package to enrolled veterans. Current VA policy 
requires veterans to be evaluated first by a VA health care 
provider before a medication may be dispensed. According to VA, 
these policies and practices for providing prescription drugs 
to enrolled veterans are necessary for patient safety and 
quality care. The VA Office of Inspector General questioned 
these restrictions in a report, Audit of Veterans Health 
Administration (VHA) Pharmacy Co-Payment Levels and 
Restrictions on Filling Privately Written Prescriptions for 
Priority Group 7 Veterans, OIG Report Number 99-00057-4, 
December 20, 2000.
    The Committee examined the decision issued by Secretary 
Principi on January 17, 2003, ending enrollment of new Priority 
8 veterans for the remainder of fiscal year 2003. The Secretary 
explained his decision to restrict Priority 8 veterans from 
enrolling as a consequence of a budget shortfall, the pressures 
of greater demand for VA health care from higher-income 
veterans and the lack of a meaningful drug benefit for many 
senior citizens.
    Secretary Principi testified that the Department would work 
closely with the Committee to find a solution to the problem of 
waiting lists and offered a limited program under which VA 
would fill prescriptions written for veterans by non-VA 
physicians. Under this limited program, enrollees could have 
prescriptions filled if they were unable to obtain timely 
services from VA. On July 24, 2003, subsequent to this hearing, 
VA announced a short-term policy to allow certain veterans to 
receive a transitional pharmacy benefit.

Hearing on the Status of the Implementation of Public Law 107-
287, the Department of Veterans Affairs Emergency Preparedness 
Act of 2002; and Deployment Health Care for Veterans

    On March 27, 2003, the Subcommittee on Health held a 
hearing to review the status of VA and DOD readiness roles to 
meet the challenges presented by bioterrorism, weapons of mass 
destruction, combat injuries and combat-related illnesses. VA's 
requirement to provide DOD with wartime casualty back-up and 
post-deployment health care services was also a topic.
    Witnesses who testified at this hearing included: Honorable 
Robert H. Roswell, Under Secretary for Health, VA, accompanied 
by Susan Mather MD, M.P.H., Chief Officer, Public Health and 
Environmental Hazards; Honorable William Winkenwerder Jr. MD, 
M.B.A., Assistant Secretary of Defense for Health Affairs, DOD, 
accompanied by Michael E. Kilpatrick M.D., Deputy Director, 
Deployment Health Support Directorate Office of the Deputy 
Assistant Secretary of Defense for Force Health Protection and 
Readiness; John D. Shanley, MD, Director Division of Infectious 
Disease, University of Connecticut Health Center, Connecticut 
State Chair in Infectious Disease; Laurence A. Feldman, Ph.D., 
Vice President, University of Medicine and Dentistry of New 
Jersey; Harold J. Timboe, MD, M.P.H., Director, Center for 
Public Health and Biomedical Research, University of Texas 
Health Science Center at San Antonio; and Thomas E. Turndrup, 
MD, F.A.C.E.P., Director, Center for Disease Preparedness, 
Department of Emergency Medicine, University of Alabama at 
Birmingham.
    Also, the Subcommittee received testimony from Mr. Peter S. 
Gaytan, Principal Deputy Director Veterans Affairs and 
Rehabilitation Commission, The American Legion; Mr. Adrian M. 
Atizado, Associate National Legislative Director, Disabled 
American Veterans; Mr. Carl Blake, Associate Legislative 
Director, Paralyzed Veterans of America; Mr. Richard Weidman, 
Director of Government Relations, Vietnam Veterans of America; 
and Mr. Dennis Cullinan, Director of National Legislative 
Service, Veterans of Foreign Wars; and Mr. Richard Jones, 
National Legislative Director, AMVETS, submitted a statement 
for the record.
    Dr. William Winkenwerder testified that military personnel 
are trained and equipped to operate in a contaminated 
environment and to deploy medical capabilities to evacuate and 
treat casualties. The Subcommittee heard testimony about pre- 
and post-deployment health screening, and the continuum of 
medical services from active duty through transition to veteran 
status.
    Dr. Robert Roswell testified on matters relating to medical 
recordkeeping and environmental surveillance. Both Dr. 
Winkenwerder and Dr. Roswell testified that there is a need for 
VA and DOD to work together to ensure proper health and troop-
movement records are kept and shared for departing service-
members. They both supported the establishment of the four 
Medical Emergency Preparedness Centers authorized by Public Law 
107-287, the Department of Veterans Affairs Emergency 
Preparedness Act of 2002. This law established authority for 
four geographically dispersed National Medical Emergency 
Preparedness Centers under VA jurisdiction. The law was 
intended to ensure that VA programs include expertise in the 
care of injuries and illnesses from exposures to the hazards of 
combat. The war on terrorism includes possible enemy uses of 
biological, chemical, incendiary and nuclear weapons. The 
enacted authority for these centers is consistent with VA's 
``fourth mission,'' to provide health care and contingency 
support to DOD in times of war and national emergencies.
    Veterans' service organizations that testified unanimously 
agreed on the need to fund and operate the centers. Witnesses 
representing academic institutions from New Jersey, Alabama, 
and Texas, specializing in biomedical research and medicine 
each concurred that funding the Medical Emergency Preparedness 
Centers was critical.

Hearing on Medical and Prosthetic Research Programs in VA

    On Thursday, April 10, 2003, the Health Subcommittee held a 
hearing to assess the status of medical and prosthetic research 
programs in VA.
    Witnesses appearing before the Subcommittee included 
Honorable James R. Langevin of Rhode Island; Nelda P. Wray, MD, 
MPH, Chief Research and Development Officer, Office of Research 
and Development, Veterans Health Administration (VHA), 
accompanied by Mindy Aisen, MD, Director, Rehabilitation 
Research and Development; John G. Demakis, MD, Director, Health 
Services Research and Development; and Fred S. Wright, MD, 
Associate Chief of Staff for Research, VA Connecticut 
Healthcare System; Eileen Lennon, Ph.D., Chairman, National 
Association of Veterans' Research and Education Foundations 
(NAVREF), accompanied by Ms. Barbara West, Executive Director; 
Ira R. Katz, MD, Ph.D., Professor of Psychiatry, Director, 
Section on Geriatric Psychiatry, University of Pennsylvania 
Health System; and Kevin C. Dellsperger, MD, Ph.D., Chief of 
Staff, Associate Dean for Veterans Affairs, Iowa City VA 
Medical Center. Mr. Christopher Reeve, Christopher Reeve 
Paralysis Foundation, submitted a letter of support for the 
record.
    According to VA witnesses, the Department conducts most of 
its medical and prosthetic research programs as a complement to 
affiliations with medical and health professions schools and 
colleges nationwide. While VA research focuses primarily on the 
special needs of veterans, it benefits all Americans. VA's 
current areas of emphasis include research into aging, chronic 
diseases, mental illnesses, substance-use disorders, sensory 
losses, trauma-related illnesses, rehabilitation, and health 
systems and services improvement.
    Representative Langevin testified how VA research in the 
area of spinal cord injuries is transferring to the larger 
community in the area of cardiovascular technologies to help 
improve muscle tone through electrode research. He also noted 
VA's record in rehabilitation and employment services for 
disabled veterans.
    The Subcommittee received testimony from Dr. Katz on the 
added value of the eight Mental Illness Research Education and 
Clinical Centers (MIRECCs) to their host Networks and the VA 
system as a whole. Also, the NAVREF witnesses presented 
testimony about their ongoing programs and initiatives, 
responded to oversight issues and provided legislative and 
policy recommendations for consideration by the Subcommittee.

Staff Site Visit to VA Connecticut Health Care System

    On April 14, 2003, majority staff members of the 
Subcommittee on Health made a site visit to the VA Connecticut 
Health Care System facilities at West Haven, New London, and 
Newington. Additionally, staff attended and participated in a 
fact-finding meeting at the VA Medical Center (VAMC) in West 
Haven, organized by The American Legion for National Commander 
Ron Conley. Attendance included representatives from all major 
veterans service organizations in Connecticut, and senior staff 
from the West Haven VAMC.

Staff Site Visit to VA New England Health Care System

    On April 23, 2003, majority staff members of the 
Subcommittee on Health made a site visit to the VA New England 
Health Care System facilities in Jamaica Plain, West Roxbury, 
and Bedford, MA; Portsmouth, NH; and Augusta, ME. The purpose 
of the visit was to observe the status of the consolidation of 
the West Roxbury and Jamaica Plain facilities, activities of 
the Geriatric Research Education and Clinical Center in 
Bedford; and the Portsmouth, New Hampshire community-based 
outpatient clinic, which is situated at Pease Air Force Base. 
This facility is unique in that the VA staff shares this space 
with operations units of the New Hampshire National Guard.
    The staff visited the Togus VAMC in Augusta, Maine, and 
toured its National Cemetery. Two themes raised during visits 
to all the major facilities were patient waiting times and 
unmet construction needs.

Hearing on Long-Term Care Programs in VA

    On Thursday, May 22, 2003, the Subcommittee on Health held 
an oversight hearing to examine existing VHA long-term care 
programs and expenditures and assess VHA's strategy for 
addressing future long-term care needs of aging and disabled 
veterans.
    Testifying were: Honorable Robert H. Roswell, M.D., Under 
Secretary for Health, VA, accompanied by James F. Burris, M.D., 
Chief Consultant for Geriatric and Extended Care; and Ms. 
Cynthia A. Bascetta, Director, Veterans' Health and Benefits 
Issues, U.S. General Accounting Office (GAO), accompanied by 
Mr. Jim Musselwhite, Assistant Director, Health Care.
    Testifying on behalf of the veterans service organizations 
were Mr. Peter S. Gaytan, Principal Deputy Director, The 
American Legion; Mr. Thomas H. Miller, Executive Director, 
Blinded Veterans of America; Ms. Joy J. Ilem, Assistant 
National Legislative Director, Disabled American Veterans; Mr. 
Richard B. Fuller, National Legislative Director, Paralyzed 
Veterans of America; and Mr. Paul A. Hayden, National 
Legislative Service, Veterans of Foreign Wars.
    The veterans service organizations representatives 
submitted testimony for the record. Additionally, Mr. Stephen 
McConnell, Vice President, Advocacy & Public Policy, 
Alzheimer's Association; Mr. Richard Weidman, Director, 
Government Relations, Vietnam Veterans of America; and Mr. 
Jeremy Chwat, Director of Legislation, Eastern Paralyzed 
Veterans Association, submitted statements for the record.
    GAO presented testimony based on a report released at the 
hearing entitled VA LONG-TERM CARE: Service Gaps and Facility 
Restrictions Limit Veterans' Access to Noninstitutional Care, 
GAO-03-815T, May 22, 2003. The GAO study revealed that VA's 
lack of emphasis on increasing access to noninstitutional long-
term care services continues to contribute to service gaps, and 
that individual facility restrictions and practices 
inconsistent with Congressional intent serve to further limit 
access to VA long-term care.

Staff Site Visit to University of Colorado Fitzsimons Campus 
and Denver VA Medical Center

    On May 28, 2003, Committee staff of the Subcommittees on 
Health and Oversight and Investigations accompanied Honorable 
Bob Beauprez of Colorado to meet with representatives of VA, 
the United States Air Force, veterans organizations, the 
University of Colorado Hospital and Health Sciences Center, and 
the State of Colorado to explore the feasibility of sharing 
facilities and resources between VA, DOD, and the University on 
the Fitzsimons Campus.
    The staff also visited the VA Health Administration Center 
and met with Colorado State Representative John Witwer, and 
Colorado State Senator Bill Owen, to discuss the status of 
financing the University's plans at Fitzsimons. The staff also 
reviewed the CHAMPVA operations at the VA Health Administration 
Center. (CHAMPVA is a health care benefits program for the 
spouse or survivor and for the children of a veteran who meets 
specific eligibility criteria.)

Staff Oversight of Capital Asset Realignment for Enhanced 
Services (CARES) Briefings and CARES Commission Hearings

    Throughout the 108th Congress, Committee staff attended 
briefings by various officials of VA and its Capital Asset 
Realignment for Enhanced Services (CARES) Commission, as well 
as public hearings of the CARES Commission, all of which 
focused on progressing phases of the CARES process. CARES was a 
VA-initiated review of plans to realign its infrastructure to 
(a) enhance access to services over the next 20 years and (b) 
redirect the cost of maintaining obsolete facilities to 
providing additional care to veterans.
    On August 11-12, 2003, Health Subcommittee staff attended 
the CARES Commission hearing in Baltimore, MD. On August 18-19, 
2003, Subcommittee staff reviewed the CARES National Draft Plan 
for the consolidation of Wade Park and Brecksville campuses in 
Cleveland, toured the facilities, met with key personnel and 
attended the CARES Commission hearing in Columbus, OH. Other 
staff visits and CARES Commission hearings included: Exton and 
Pittsburgh, PA hearings on August 26-28, 2003, and an Orlando, 
FL hearing on September 10-11, 2003; CARES Commission 
discussions about the results of its site visits, hearings and 
written comments received from stakeholders and the public in 
Washington, DC, on October 14-16, 2003; and follow-up sessions 
of the CARES Commission on November 19-21, 2003, in Washington, 
DC.

Staff Site Visit to Salina and Clay Center, Kansas

    On September 14, 2003, a majority staff member visited the 
VA Outpatient Clinic in Salina, KS, and provided staff 
assistance to Honorable Jerry Moran of Kansas at a veterans 
health care forum in Clay Center, KS. Attendees included Mr. 
Tom Sanders, Director of Wichita Veterans Affairs Medical and 
Regional Office Center; Mr. Robert Malone, Director of 
Leavenworth and Topeka Veterans Affairs Medical Center; The 
American Legion and Post Commanders from ten Kansas counties; 
and State officers of the major veterans service organizations.

Hearing on VA Physician and Dentist Compensation Issues

    On October 21, 2003, the Subcommittee on Health held a 
hearing on VA physician and dentist compensation issues, 
including reforms being sought for the current pay system and 
consideration of a draft bill proposed by the Secretary in a 
letter to the Speaker of the House, dated July 18, 2003.
    Witnesses testifying at the hearing were Honorable Robert 
H. Roswell, MD, Under Secretary for Health, VA, accompanied by 
Ms. Mari A. Horak, Associate Chief Patient Care Services 
Officer, Veterans Health Administration; Thomas Joseph Lawley, 
MD, Dean, Emory University School of Medicine, representing the 
Association of American Medical Colleges; Lactancio D. 
Fernandes, MD, F.C.C.P., President Local 1045, American 
Federation of Government Employees; Stephen Rosenthal, MD, 
President, National Association of VA Physicians and Dentists; 
Jacqueline Parthemore, MD, F.A.C.P., Chief of Staff and Medical 
Director, VA San Diego Health Care System; Richard Bauer, MD, 
Chief of Staff, South Texas Veterans Health Care System; Ms. 
Sheila M. Cullen, Medical Director, San Francisco VA Medical 
Center; Michael H. Ebert, MD, Chief of Staff, VA Connecticut 
Health Care System; Mr. Michael M. Lawson, Director, VA Boston 
Health Care System; Michael S. Simberkoff, MD, Executive Chief 
of Staff, VA New York Harbor Health Care System.
    In addition, the following individuals submitted statements 
for the record: Mr. James B. King, Executive Director, AMVETS; 
Mr. Delatorro L. McNeal, Executive Director, Paralyzed Veterans 
of America; Mr. Robert Wallace, Executive Director, Veterans of 
Foreign Wars; and Mr. Thomas H. Corey, President, Vietnam 
Veterans of America.
    At the hearing, the Subcommittee learned of the problems VA 
is facing with increased demand for VA health care, nearly 
1,000 vacant physician and dentist positions and an outdated 
pay system. The problems and the need for pay reform were 
addressed at a national level by Under Secretary Roswell, and 
anecdotally by the medical executives from various VA medical 
centers and professional organizations.

Second Session

Staff Site Visit to East Orange Campus of the VA New Jersey 
Health Care System

    On January 15, 2004, majority staff members visited the 
East Orange, NJ VA Medical Center. The purpose of the visit was 
to discuss maintenance or improvement the medical center's 
physical plant, which houses the only VA tertiary care health 
care facility in New Jersey.
    East Orange is a medical and surgical tertiary care 
facility. While some areas of the hospital have been 
modernized, the age and design of the facility would make 
renovation expensive. However, a clinical addition could 
address a number of the problems noted during this visit. VA 
officials were encouraged to consider modernization of the East 
Orange facility to make it comparable to other VA facilities 
with similar missions.

Staff Site Visit to Explore the Feasibility of a Joint Venture 
with the Ralph H. Johnson VA Medical Center (VAMC), the Medical 
University of South Carolina and the Naval Hospital Charleston

    On Monday, February 23, 2004, a majority staff member 
accompanied Honorable Henry E. Brown, Jr., Chairman of the 
Benefits Subcommittee to a meeting he requested in Charleston, 
South Carolina, to explore the feasibility of the Charleston VA 
Medical Center (VAMC) sharing facilities and resources with 
Medical University of South Carolina, in consultation with the 
Naval Hospital Charleston.
    Attending the meeting were: Mr. William Mountcastle, 
Director of the Charleston VAMC and Ms. Linda Watson; Medical 
University of South Carolina representatives included: Dr. Jack 
Feussner, Chairman of the Department of Medicine, Dr. John 
Raymond, Vice President for Academic Affairs and Dr. Jerry 
Reeves, Dean of the College of Medicine (Mr. Layton McCurdy, a 
member of the CARES Commission); DOD: Captain Greg Hall, the 
Executive Officer of the Naval Hospital Charleston. The 
discussions revealed that the Medical University of South 
Carolina is proceeding with plans for a major redevelopment of 
the site for its own purposes, but it remained to be determined 
if VA would have a role.

Hearing on the Status of VA Post-Traumatic Stress Disorder 
(PTSD) Programs

    On March 11, 2004, the Subcommittee on Health held a 
hearing on the status of VA post-traumatic stress disorder 
(PTSD) programs for veterans and on the role of chaplains in 
providing pastoral care for veterans with mental health 
problems.
    The witnesses who testified at the hearing included: 
Honorable Robert H. Roswell, MD, Under Secretary for Health, 
VA, accompanied by Alfonso R. Batres, Ph.D., MSW, Chief 
Officer, Readjustment Counseling Service, and Laurent S. 
Lehmann, MD, Chief Consultant, Mental Health Strategic Health 
Care Group; Thomas Horvath, MD, Chief of Staff, Michael E. 
DeBakey Veterans Affairs Medical Center; Terence Keane, Ph.D., 
Director, Behavioral Science Division, National Center for 
PTSD; Harold Kudler, MD, Co-Chair, Under Secretary for Health's 
Special Committee on PTSD, Durham VA Medical Center; Chaplain 
Robert W. Mikol, Clinical Chaplain, Lyons Campus of the VA New 
Jersey Health Care System; and Father Philip G. Salois, 
Veterans Integrated Service Network 1, Chaplain Program 
Manager, VA Boston Health Care System; Lieutenant Colonel 
Kenneth Brown, Chaplain, United States Army; Lieutenant Charles 
E. Hodges, Chaplain Corps, United States Naval Reserve; 
Commander Mark Andrew Jumper, Staff Chaplain, United States 
Coast Guard Academy; and Sally Satel, MD, Resident Scholar, The 
American Enterprise Institute.
    Submitting statements for the record were: Matthew J. 
Friedman, MD, Ph.D., Executive Director, National Center for 
PTSD; Mr. Richard Jones, National Legislative Director, AMVETS; 
Mr. David Gorman, Executive Director, Disabled American 
Veterans; Mr. Delatorro L. McNeal, Executive Director, 
Paralyzed Veterans of America; Mr. Robert Wallace, Executive 
Director, Veterans of Foreign Wars; and Mr. Thomas H. Corey, 
President, Vietnam Veterans of America.
    VA witnesses testified that PTSD is a mental health 
disorder that may occur from exposure to a traumatic event 
involving the threat of imminent death or injury. In the 
military, it is the most prevalent mental disorder arising from 
combat, peacekeeping and humanitarian missions, and acts of 
terrorism.
    The witness panels indicated that the toll of PTSD on the 
individual often results in many problems including 
unemployment, family violence, broken marriages, substance 
abuse, homelessness and incarceration. The Veterans Benefits 
Administration reported 214,546 unique veterans with a PTSD 
diagnostic code as of December 2003. Of that total, 200,146 
were in receipt of VA compensation and 14,400 were in receipt 
of pension.
    One expert witness, Dr. Sally Satel, cautioned that as we 
try to help the soldiers of Operation Iraqi Freedom meld back 
into society, it would be a mistake to rely too heavily on the 
conventional wisdom about Vietnam. Dr. Satel's testimony 
acknowledged that some soldiers will return from Iraq and 
Afghanistan with severe psychological problems and require 
appropriate care. She also pointed out that receiving 
disability payments can provide an economic incentive to 
maintain dysfunction and could be the route to further 
disability and isolation, when a return to work might offer the 
best therapy.
    The Subcommittee also heard personal accounts from a panel 
of chaplains, who provide pastoral care to veterans and active 
duty members, helping them to deal with the stress and 
psychological trauma that may result from combat. Chaplains 
serve as key members of treatment teams in VA health care 
delivery programs. In the military services, chaplains serve on 
the front lines and are often first responders in order to 
provide pastoral care.

Hearing on VA Providing Certain Veterans with A Prescription-
Only Health Care Benefit

    On March 30, 2004, the Subcommittee on Health held a 
hearing on VA providing certain veterans with a prescription-
only health care benefit. The Subcommittee received testimony 
on the results of VA's survey of veterans concerning a 
potential prescription-only health benefit and a status report 
on the implementation of VA's ``transitional pharmacy benefit'' 
announced on July 24, 2003.
    Witnesses included: Jonathan Perlin, MD, Deputy Under 
Secretary for Health, VA, accompanied by Mr. Michael A. 
Valentino, Chief Consultant, Pharmacy Benefits Management, and 
Ms. Barbara Manning, Veterans Health Administration Policy and 
Forecasting Service; Cornelio R. Hong, MD, F.A.C.P., Norwich 
Internal Medicine; Mr. Edward S. Banas, Sr., National 
Commander, Veterans of Foreign Wars; Mr. Rick Weidman, 
Director, Government Relations, Vietnam Veterans of America; 
Mr. Carl Blake, Associate Legislative Director, Paralyzed 
Veterans of America; Ms. Joy J. Ilem, Assistant National 
Legislative Director, Disabled American Veterans; Mr. Peter S. 
Gaytan, Principal Deputy Director Veterans Affairs and 
Rehabilitation Division, The American Legion; Jr.; Mr. Richard 
Jones, National Legislative Director, AMVETS. Submitting for 
the Record: Mr. John Gage, National President, American 
Federation of Government Employees.
    Public Law 108-199, the Consolidated Appropriations Act, 
2004, authorized VA to dispense prescription drugs to enrolled 
veterans with privately written prescriptions based on 
requirements established by the Secretary, provided the 
implementation of the program incurs no additional cost to VA. 
The Conference Report accompanying the law, House Report 108-
401, further directed the Secretary to collect and 
independently verify data on the costs and benefits of this new 
drug benefit and submit a report to the Committee on 
Appropriations by March 2, 2004, detailing the number of 
veterans who would utilize such benefit, as well as costs or 
savings to the VA. As directed by Congress, VA conducted a 
survey to assess the potential demand and cost of a 
prescription-only health care benefit. The survey was completed 
in February 2004. VA testified at this hearing on its results.
    The Subcommittee received testimony about providing 
veterans with a new cost-neutral prescription drug benefit that 
would provide medications to veterans at cost with a marginal 
administrative markup in price. The cost to the government 
would be offset by veterans, who would benefit from VA's large 
scale purchasing power by paying VA costs for medications 
rather than drug store prices. The VFW Pharmacy Fairness Act, a 
draft bill presented by the Commander in Chief of the Veterans 
of Foreign Wars, Mr. Edward S. Banas, Sr., was another approach 
discussed at the hearing. This bill proposed to ease waiting 
times, reduce redundancy and improve access to veterans with a 
change in VA's outpatient prescription benefit by requiring VA 
to fill prescriptions written by licensed, non-VA physicians 
for Medicare-eligible veterans.

Field Hearing on the Status of Military and VA Health Care 
Coordination, including Post-Deployment Health Care of Recently 
Discharged Veterans

    On April 13, 2004, the Subcommittee on Health held a field 
hearing in San Antonio, Texas. The hearing focused on the 
status of coordinating efforts between the military and VA 
health care, including the post-deployment health care of 
recently discharged veterans.
    Witnesses at the hearing included: Mr. Jose R. Coronado, 
Director, VA South Texas Veterans Health Care System, 
accompanied by Richard Bauer, MD, Chief of Staff of the VA 
South Texas Veterans Health Care System; Ms. Janeth Del Toro, 
NP, VA South Texas Veterans Health Care System; Raul Aguilar, 
MD, Chief Medical Officer, McAllen Outpatient Clinic, VA South 
Texas Veterans Health Care System; Brigadier General C. William 
Fox, Jr., Commander, Brooke Army Medical Center, accompanied by 
Colonel Bernard L. DeKoning, Commander, Darnall Army Community 
Hospital, Fort Hood, TX; Lieutenant Colonel Lee Cancio, M.D., 
Chief, Burn Center, Brooke Army Medical Center; Brigadier 
General Charles B. Green, Commander, 59th Medical Wing, Wilford 
Hall Medical Center, Lackland AFB, TX, and Lead Agent, TRICARE 
Region 6; Lieutenant Colonel Brian J. Masterson, MD, Chief 
Information Officer, Wilford Hall Medical Center, Lackland AFB, 
Texas; Stephen L. Holliday, Ph.D., ABPP, President, Association 
of VA Psychologist Leaders; Mr. Ignacio Leija, American GI 
Forum, National Veterans Outreach Program; Mr. Douglas Herrle, 
Disabled American Veterans, accompanied by Mr. William Morin; 
and Mr. Richard Holloway, The American Legion.
    According to witnesses, the large concentration of military 
and VA health resources in the area afford San Antonio a 
promising setting for coordination between DOD and VA. The 
delivery of post-deployment health care to veterans was 
discussed at this hearing.
    Among four medical facilities in the San Antonio area (the 
Audie L. Murphy Memorial Veterans Hospital, the Kerrville VA 
Medical Center, and their associated community clinics), almost 
1,200 casualties of the global war on terrorism had been 
treated as of the date of the hearing. One such casualty, Staff 
Sergeant Canady, accompanied the Commander of Brooke Army 
Medical Center, Brigadier General C. William Fox, Jr., to give 
a first-hand account about the services that have been 
coordinated and rendered between DOD and VA on his behalf.

Site Visit to Northern Arizona Health Care System

    On April 16, 2004, majority staff members visited the 
Prescott VA Medical Center and attended the ceremony to name 
the facility in honor of the late Bob Stump, who served as 
Chairman of the Veterans' Affairs Committee from 1995-2000. The 
Secretary of Veterans Affairs, Honorable Anthony J. Principi, 
spoke at the dedication ceremony, among other officials and 
guests.

Staff Participation in a VA-DOD Conference on the Sharing of 
Medical Resources: VA and DOD Explore New Partnerships, New 
Orleans, LA

    On April 21, 2004, Committee staff participated in a panel 
discussion entitled ``Lessons Learned.'' Other conference 
participants included VA, DOD, OMB and GAO staff. The purpose 
of the conference was to provide a forum for discussion of the 
status of VA-DOD health resources sharing under Public Law 97-
174, Veterans' Administration and Department of Defense Health 
Resources Sharing and Emergency Operations Act. Staff members 
offered their perspectives on changes made to that basic 
mandate by Public Law 107-314, the Bob Stump National Defense 
Authorization Act for Fiscal Year 2003, and discussed 
Congressional expectations for further progress.

Staff Site Visit to the VA Outpatient Clinics in Twin Ports and 
Chippewa Falls, Wisconsin and the Minneapolis VA Medical Center

    On May 26, 2004, a majority staff member, along with staff 
from Honorable Russell D. Feingold of Wisconsin's Wausau 
district office and Honorable David R. Obey of Wisconsin's 
Superior district office, participated with the Minneapolis VA 
Medical Center director and several other staff in a site visit 
to the Twin Ports, (Superior) WI outpatient clinic.
    The itinerary also included a site visit to the Chippewa 
Falls outpatient clinic and meetings with the Deputy Director 
of Veterans Integrated Service Network 23, VA Midwest Health 
Care Network; and Mr. Jimmie L. Coulthard, President of the 
Veterans Outreach for the Minnesota Assistance Council for 
Veterans, and the private sector initiator of several enhanced-
use leases with VA to build housing projects for homeless 
veterans in Minneapolis and St. Cloud, Minnesota.

Field Hearing on Optimizing Facilities and Improving Health 
Care and Benefit Services to Veterans in the State of 
Connecticut

    On June 7, 2004, the Subcommittee on Health conducted a 
field hearing at the VA Connecticut Healthcare System, 
Newington Campus, in Newington, CT. The purpose of the hearing 
was to examine VA health care and other benefits provided to 
Connecticut veterans.
    The following witnesses testified before the hearing: 
Jeannette Chirico-Post, MD, Network Director, VA New England 
Healthcare System; Mr. Roger Johnson, Director, VA Connecticut 
Veterans Healthcare System; Mr. Ricardo Randle, Director, VA 
Regional Office, Hartford, CT; Fred Wright, MD, Associate Chief 
of Staff for Research, VA Connecticut Veterans Healthcare 
System; Karin T. Thompson, APRN, BC, President AFGE 
Professional Nurses Union, Local 2138; Colonel William Sobota, 
Director of Manpower and Personnel (JI), Connecticut Army 
National Guard; Captain J. A. Bashford, Deputy Naval Health 
Care New England, Naval Ambulatory Care Center; Mr. Rick Sapp, 
VA Legal Instruments Examiner, Fort Drum, New York; Mrs. 
Michelle Will, Enrollment Coordinator, VA Connecticut 
Healthcare System; Mr. Edmund J. Burke, Secretary/Treasurer, 
Connecticut Veterans Coalition Forum; Mr. Paul J. Pobuda, 
Department Service Officer, The American Legion Department of 
Connecticut, Mr. Donald Johnson, National Service Officer, 
AMVETS Department of Connecticut; Mr. Allen Gumpenberger, 
National Service Officer Disabled American Veterans Department 
of Connecticut; Mr. Glen Tewksbury, Department Service Officer 
Veterans of Foreign Wars Department of Connecticut. Dr. Linda 
Spoonster Schwartz, R.N., Dr.PH, Commissioner, Connecticut 
Department of Veterans Affairs also testified at the hearing.
    Honorable Ciro Rodriguez, Ranking Member of the 
Subcommittee, Honorable Christopher Shays of Connecticut and 
Mr. Eliott Ginsberg, representing Honorable John Larson of 
Connecticut, joined Honorable Rob Simmons, Chairman of the 
Subcommittee, at this hearing.
    The hearing focused on the ``Connecticut Model'' of 
delivering VA health care and benefit services. Witnesses 
testified about the developing relationships among VA, the 
Connecticut Department of Veterans Affairs, local military 
facilities and State veterans organizations, the importance of 
working together, and sharing facilities and resources to 
benefit Connecticut veterans. The collocation of the VA 
Regional Office in Hartford to the Newington campus and the 
collaboration between VA Connecticut and the Rocky Hill State 
Veterans' Home were also discussed at the hearing.

Staff Site Visit to the Grand Opening of the Community Hope 
Transitional Housing Program at the Lyons Campus of the VA New 
Jersey Health Care System

    On December 3, 2004, Community Hope, Inc., a private non-
profit organization celebrated the grand opening of its Hope 
for Veterans, the largest and most comprehensive transitional 
housing and recovery program for homeless veterans in New 
Jersey. This 75-bed facility is located in a newly renovated, 
once-vacant Building 53 on the Lyons campus of the VA New 
Jersey Health Care System. A majority staff member participated 
in the opening ceremonies, along with more than 100 attendees, 
including Honorable Rodney P. Frelinghuysen of New Jersey; 
Federal, state and county officials; financial supporters of 
the project and various veterans' organizations.

                        Subcommittee on Benefits

    The Subcommittee on Benefits has legislative, oversight and 
investigative jurisdiction over compensation, general and 
special pensions of all the wars of the United States, life 
insurance issued by the Government on account of service in the 
Armed Forces, 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, burial benefits, education of 
veterans, vocational rehabilitation, veterans' housing 
programs, readjustment of servicemen to civilian life, and 
soldiers' and sailors' civil relief (see Oversight Plan for 
108th Congress, p. 91).

                         LEGISLATIVE ACTIVITIES

First Session

Hearing on H.R. 241, H.R. 533, H.R. 761, H.R. 850, H.R. 966, 
and H.R. 1048

    On April 10, 2003, the Subcommittee held a legislative 
hearing on the following bills: H.R. 241, the Veterans 
Beneficiary Fairness Act of 2003, introduced by Honorable 
Christopher H. Smith of New Jersey on January 8, 2003; H.R. 
533, the Agent Orange Veterans' Disabled Children's Benefits 
Act of 2003, introduced by Honorable Lane Evans of Illinois on 
February 5, 2003; H.R. 761, the Disabled Servicemembers Adapted 
Housing Assistance Act of 2003, introduced by Honorable Lane 
Evans of Illinois on February 13, 2003; H.R. 850, the Former 
Prisoners of War Special Compensation Act of 2003, introduced 
by Honorable Michael K. Simpson of Idaho on February 13, 2003; 
H.R. 966, the Disabled Veterans Return-to-Work Act of 2003, 
introduced by Honorable Henry E. Brown, Jr., of South Carolina 
on February 27, 2003; and H.R. 1048, the Disabled Veterans 
Adaptive Benefits Improvement Act of 2003, introduced by 
Honorable Henry E. Brown, Jr., of South Carolina on March 4, 
2003.
    Witnesses included Honorable Michael K. Simpson; Honorable 
Daniel L. Cooper, Under Secretary for Benefits, Veterans 
Benefits Administration, accompanied by Mr. John Thompson, 
Deputy General Counsel, Department of Veterans Affairs, and Mr. 
Ron Henke, Director, Compensation and Pension Service, Veterans 
Benefits Administration; Mr. Peter S. Gaytan of The American 
Legion; Mr. Rick Surratt of the Disabled American Veterans; Mr. 
Paul Hayden of the Veterans of Foreign Wars; Mr. Leslie Jackson 
of the American Ex-Prisoners of War; and Mr. Carl Blake of the 
Paralyzed Veterans of America.
    Representative Simpson testified in support of his bill, 
H.R. 850. The veterans service organization witnesses supported 
the legislation before the Subcommittee, except section 3 of 
H.R. 850, which would overturn the decision in Allen v. 
Principi, 268 F. 3d 1340 (Fed. Cir. 2001) by prohibiting VA 
from allowing secondary service-connected compensation for 
disabilities associated with substance abuse caused by a 
primary service-connected condition. This legislative proposal 
was included in the President's 2004 budget submission. The 
Administration supported H.R. 241 and H.R. 761, but opposed or 
otherwise had reservations about the other bills on the agenda.

Hearing on H.R. 1460, H.R. 1712, and H.R. 1716

    On April 30, 2003, the Subcommittee held a legislative 
hearing on the following bills: H.R. 1460, the Veterans 
Entrepreneurship Act of 2003, introduced by Honorable Rick 
Renzi of Arizona on March 27, 2003; H.R. 1712, the Veterans 
Federal Procurement Opportunity Act of 2003, introduced by 
Honorable Lane Evans of Illinois on April 10, 2003; and H.R. 
1716, the Veterans Earn and Learn Act, introduced by Honorable 
Christopher H. Smith of New Jersey and Honorable Lane Evans of 
Illinois on April 10, 2003.
    Witnesses included Honorable Rick Renzi; Honorable Leo S. 
Mackay, Jr., Ph.D., Deputy Secretary, VA, accompanied by 
Honorable Tim S. McClain, VA General Counsel, Mr. Scott F. 
Denniston, Director, Office of Small & Disadvantaged Business 
Utilization, Honorable William Campbell, Assistant Secretary 
for Management, and Mr. Robert Epley, Associate Deputy Under 
Secretary for Policy and Program Management, Veterans Benefits 
Administration; Mr. George H. Bliss, III, United Association of 
Plumbers and Pipefitters; Mr. William D. Stephens, National 
Association of State Approving Agencies; Mr. Chad Schatz, 
National Association of State Approving Agencies; and Ms. Ann 
Sullivan, Women Impacting Public Policy , Inc; Ms. Angela B. 
Styles, Administrator, Office of Federal Procurement Policy, 
Office of Management and Budget, accompanied by Mr. William D. 
Elmore, Associate Administrator, Office of Veterans Business 
Development, Small Business Administration, and Mr. Fred C. 
Armendariz, Associate Deputy Administrator, Government 
Contracting and Business Development, SBA; Major General 
Charles R. Henry (USA, Retired), President and CEO, National 
Veterans Business Development Corporation; Mr. John K. Lopez, 
Association for Service Disabled Veterans; Mr. Donald T. 
Wilson, Association of Small Business Development Centers; Mr. 
James R. Krempasky, Western Fire, Inc.; Mr. Robert G. Hesser, 
HI Tech Services, Inc; Mr. Blake Ortner, Paralyzed Veterans of 
America; Mr. Brian E. Lawrence, Disabled American Veterans; Mr. 
Peter S. Gaytan, The American Legion; and Mr. Richard Jones, 
AMVETS.
    Representative Renzi testified in support of his bill, H.R. 
1460. The veterans service organizations supported all three 
bills. The building and construction trades represented by Mr. 
Bliss and the National Association of State Approving Agencies 
testified on H.R. 1716, with general support for the bill. Mr. 
Wilson, Mr. Krempasky, Mr. Hesser, and General Henry testified 
in support of H.R. 1460 and H.R. 1712. The Administration 
witnesses testified in support of H.R. 1460 and H.R. 1716 but 
expressed concerns over cost implications, and opposed certain 
provisions contained in H.R. 1712.

Subcommittee Markup of H.R. 241, H.R. 761, H.R. 1257, H.R. 
1460, H.R. 1683, and H.R. 1949

    On May 7, 2003, the Subcommittee met and marked up six 
bills: H.R. 241; H.R. 761; H.R. 1257; H.R. 1460, with an 
amendment; H.R. 1683; and H.R. 1949. All six bills were 
reported favorably to the full Committee (see Full Committee 
Markup, p. 33).

Hearing on H.R. 886, H.R. 1167, H.R. 1500, H.R. 1516, H.R. 
2163, H.R. 2164, H.R. 2285, and H.R. 2297

    On June 11, 2003, the Subcommittee held a legislative 
hearing on the following bills: H.R. 886, to provide for the 
payment of dependency and indemnity compensation to the 
survivors of former prisoners of war who died on or before 
September 30, 1999, introduced by Honorable Tim Holden of 
Pennsylvania on February 23, 2003; H.R. 1167, to permit 
remarried surviving spouses of veterans to be eligible for 
burial in a national cemetery, introduced by Honorable Heather 
Wilson of New Mexico on March 6, 2003; H.R. 1500, the Veterans' 
Appraiser Choice Act, introduced by Honorable Adam Smith of 
Washington on March 27, 2003; H.R. 1516, to direct the 
Secretary of Veterans Affairs to establish a national cemetery 
for veterans in southeastern Pennsylvania, introduced by 
Honorable Jim Gerlach of Pennsylvania on March 31, 2003; H.R. 
2163, to exclude the proceeds of life insurance from 
consideration as income for purposes of determining veterans' 
pension benefits, introduced by Honorable Jeb Bradley of New 
Hampshire on May 20, 2003; H.R. 2164, to provide for an 
extension in the period of eligibility for survivors' and 
dependents' education benefits for members of the National 
Guard who are involuntarily ordered to full-time National Guard 
duty, introduced by Honorable Jeb Bradley of New Hampshire on 
May 20, 2003; H.R. 2285, to require the Secretary of Labor to 
provide staffing at military installations overseas under the 
Transition Assistance Program, introduced by Honorable Michael 
K. Simpson on June 2, 2003; and H.R. 2297, to modify and 
improve certain benefits for veterans, introduced by Honorable 
Christopher H. Smith of New Jersey and Honorable Lane Evans of 
Illinois on June 2, 2003.
    Witnesses included Honorable Michael K. Simpson; Honorable 
Tim Holden; Honorable Jeb Bradley; Honorable Jim Gerlach; 
Honorable Rick Larsen of Washington, on behalf of Honorable 
Adam Smith; Honorable Heather Wilson; Honorable John Molino, 
Deputy Assistant Secretary of Defense, Military, Community and 
Family Policy; Honorable Frederico Juarbe, Jr., Assistant 
Secretary for Veterans' Employment and Training Service, 
Department of Labor, who was accompanied by Mr. Gordon Banks, 
Director of Operations, Veterans' Employment and Training 
Service; Mr. Robert Epley, Associate Deputy Under Secretary for 
Policy and Program Management, Veterans Benefits 
Administration, who was accompanied by Mr. John Thompson, 
Deputy General Counsel, Department of Veterans Affairs, and Mr. 
Dick Wannamacher, Senior Advisor, National Cemetery 
Administration.
    The Members of Congress testified in support of their 
respective bills before the subcommittee. Mr. Juarbe of the 
Veterans' Employment and Training Service opposed H.R. 2285 as 
not necessary at this time; he stated that the Department of 
Labor was in the process of establishing a presence at military 
installations. Mr. Molino of the Department of Defense deferred 
to the Department of Labor, but stated that a meeting was 
scheduled to discuss establishing a Transition Assistance 
presence overseas. Mr. Epley of the Veterans Benefits 
Administration supported the bills under consideration, except 
H.R. 1500 and H.R. 886. Mr. Epley testified that H.R. 1500 
would inhibit the ability of the Department to maintain an 
independent appraisal process, and under current law veterans 
have the ability to select another appraiser if they are not 
satisfied with the valuation performed by the VA-selected 
appraisal; the Administration did not support H.R. 886 because 
the proposal was not included in the President's 2004 budget.

Subcommittee Markup of H.R. 1516 and H.R. 2297

    On June 25, 2003, the Subcommittee met and marked up two 
bills: H.R. 1516, with amendments; and H.R. 2297, with 
amendments. Each bill was reported favorably to the full 
Committee (see Full Committee Markup, p. 33).

Second Session

Hearing on H.R. 348, H.R. 843, H.R. 1735, H.R. 2206, H.R. 2612, 
H.R. 3936, H.R. 4065, H.R. 4172, H.R. 4173, and a Draft Bill

    On April 29, 2004, the Subcommittee on Benefits held a 
hearing on H.R. 348, the Prisoner of War Benefits Act of 2004, 
introduced by Honorable Michael Bilirakis of Florida on January 
27, 2003; H.R. 843, the Injured Veterans Benefits Eligibility 
Act of 2003, introduced by Honorable Silvestre Reyes of Texas 
on February 13, 2003; H.R. 1735, to increase the maximum VA 
home loan guarantee introduced by Honorable Susan A. Davis of 
California on April 10, 2003; H.R. 2206, the Prisoner of War/
Missing in Action National Memorial Act, introduced by 
Honorable Ken Calvert of California on May 22, 2003; H.R. 2612, 
the Veterans Adapted Housing Expansion Act of 2003, introduced 
by Honorable Michael H. Michaud of Maine on June 26, 2003; H.R. 
3936, to authorize the principal office of the United States 
Court of Appeals for Veterans Claims to be at any location in 
the Washington, DC, metropolitan area, introduced by Honorable 
Christopher H. Smith of New Jersey and Honorable Lane Evans of 
Illinois on March 11, 2004; H.R. 4065, the Veterans Housing 
Affordability Act of 2003, introduced by Honorable Ginny Brown-
Waite of Florida on March 30, 2004; H.R. 4172, to codify 
certain diseases as a presumption of service-connection for 
veterans exposed to ionizing radiation introduced by Honorable 
Lane Evans of Illinois on April 20, 2004; H.R. 4173, to direct 
the Secretary of Veterans Affairs to contract for a report on 
employment placement, retention, and advancement of recently 
separated servicemembers, introduced by Honorable Michael H. 
Michaud of Maine and Honorable Henry E. Brown, Jr., on April 
20, 2004; and a draft bill to create an open period for active 
duty servicemembers who declined to participate in the Post-
Vietnam Era Veterans' Educational Assistance Program to elect 
to participate in the program of basic educational assistance 
under the Montgomery GI Bill.
    Witnesses included: Honorable Kenneth B. Kramer, Chief 
Judge, United States Court of Appeals for Veterans Claims; 
Honorable Michael Bilirakis; Honorable Ken Calvert; Honorable 
Michael H. Michaud; Honorable Ginny Brown-Waite; Honorable 
Susan A. Davis; Honorable Silvestre Reyes; Mr. Robert Epley, 
Associate Deputy Under Secretary for Policy and Program 
Management, Veterans Benefits Administration, accompanied by 
Mr. John Thompson, Deputy General Counsel, VA; Mr. William 
Carr, Acting Deputy Undersecretary of Defense for Military 
Personnel Policy, DOD; Mr. F. Paul Dallas, American Ex-
Prisoners of War; Mr. Richard Jones, AMVETS; Mr. Carl Blake, 
Paralyzed Veterans of America; Mr. John McNeill, Veterans of 
Foreign Wars; Mr. Brian Lawrence, Disabled American Veterans; 
and Ms. Cathleen Wiblemo, The American Legion.
    The Members of Congress testified in support of their 
respective bills. Chief Judge Kramer testified in support of 
H.R. 3936. Mr. Epley testified in support of many of the bills 
on the agenda, but opposed H.R. 843. Mr. Epley testified that 
while the Department of Veterans Affairs supported the concepts 
of H.R. 1735 and H.R. 4065, they were reserving opinion on 
these two bills until VA could conclude a review of the results 
of an independent evaluation of the VA Home Loan program. The 
veterans service organization representatives either supported 
or did not oppose the bills on the agenda.

Subcommittee Markup of H.R. 1716, H.R. 3936, H.R. 4175, and 
H.R. 4345

    On May 13, 2004, the Subcommittee met and marked up four 
bills: H.R. 1716, with amendments; H.R. 3936; H.R. 4175, with 
amendments; and H.R. 4345 (see Full Committee Markup, p. 34).

Hearing on H.R. 4032 and a Draft Bill

    On June 16, 2004, the Subcommittee held a hearing on H.R. 
4032, the Veterans Fiduciary Act of 2004, introduced by 
Honorable Susan A. Davis of California on March 25, 2004; and a 
draft bill, the Veterans Self-Employment Act of 2004.
    Witnesses included Mr. Jack McCoy, Director, Education 
Service, Veterans Benefits Administration, accompanied by Mr. 
Robert Epley, Associate Deputy Under Secretary for Policy and 
Program Management at the VA, and Mr. John Thompson, Deputy 
General Counsel, Department of Veterans Affairs; Mr. John H. 
Pickering, Former Chair, Commission on Law and Aging, American 
Bar Association, accompanied by Ms. Nancy Coleman, Director, 
Commission on Law and Aging, American Bar Association; Mr. John 
Gay, Vice President, Government Relations, International 
Franchise Association, accompanied by Mr. James Amos, Jr., 
Chairman Emeritus, Main Boxes Etc. and managing partner of 
Eagle Alliance Partners; and Beth Buehlmann, Ph.D., Vice 
President and Executive Director, Center for Workforce 
Preparation, U.S. Chamber of Commerce.
    Mr. McCoy testified that VA has not experienced any 
significant problems carrying out the activities of the 
Fiduciary Program, and viewed H.R. 4032 as imposing 
restrictions and requirements on the program that might be too 
broad to warrant VA's unqualified support. Mr. McCoy opposed 
the draft bill because, among other things, in his view there 
was no record to support expanding veterans' education benefits 
for the cost of starting a business. Mr. Pickering supported 
the concepts of H.R. 4032, and Mr. Gay and Dr. Buehlmann 
supported the draft bill.
                          OVERSIGHT ACTIVITIES

First Session

Hearing on Troops-to-Teachers Program

    On April 9, 2003, the Subcommittee held an oversight 
hearing on the Troops-to-Teachers program as administered by 
the Department of Defense (DOD) and funded by the Department of 
Education (DOE). Troops to Teachers assists program 
participants find employment in high-need local educational 
agencies or public charter schools. These schools have a 
poverty rate of at least 20 percent or serve at least 10,000 
poor children and have a high percentage of teachers teaching 
outside their specialty or with emergency credentials. A high 
percentage of these school districts are found in inner cities. 
The hearing highlighted the program's successes and challenges 
since it began in 1994, as well as identified issues for future 
actions.
    Witnesses included Ms. Nina Rees, Deputy Under Secretary 
for Innovation and Improvement, Department of Education, 
accompanied by Dr. John Gantz, Director, Defense Activity for 
Non-Traditional Educational Support, DOD; Dr. Deno Curris, 
President, American Association of State Colleges and 
Universities; Dr. Nancy Dunlap, Associate Director, School of 
Education, Clemson University, accompanied by Dr. Kathy Brown, 
Professor, The Citadel; Mr. Don Sweeney, National Association 
of State Approving Agencies and Troops to Teachers New England; 
Dr. William Harner, Superintendent, Greenville County Schools 
(Troops-to-Teachers graduate); and Ms. Sandra Sessoms-Penny, 
Assistant Principal, Yorktown, VA (Troops-to-Teachers 
graduate).
    Ms. Nina Reese testified for the Administration that the 
Troops-to-Teachers program ``promotes high standards by 
identifying and bringing these talented men and women, and 
their top-notch skills and abilities, into our Nation's public 
schools.'' However, Ms. Reese stated that many states have 
barriers that keep talented individuals from the Troops-to-
Teachers program out of the classroom; DOE and DOD are working 
together to try and break down these barriers.
    Mr. Don Sweeney suggested, in his testimony, that the 
program does not address the needs of the rural areas of 
America. Mr. Sweeney offered a legislative proposal to address 
this problem.

Hearing on Department of Veterans Affairs' Fiduciary and Field 
Examination Activity

    On July 16, 2003, the Subcommittee held an oversight 
hearing on the Department of Veterans Affairs' Fiduciary 
Program, and what improvements have been or need to be made to 
protect the incomes and estates of beneficiaries from fraud and 
abuse. When VA monetary benefits are payable to an individual 
who is incapable of managing his or her own financial affairs, 
a third party payee who acts as a fiduciary, is required. 
Through the Fiduciary and Field Examination Activity, VA's 
Compensation and Pension Service is responsible for protecting 
the incomes and estates of these beneficiaries. This includes 
monitoring the third party payee and scheduling periodic visits 
to the beneficiary to ensure his or her needs are being met. As 
of May 31, the Veterans Benefits Administration personnel 
supervised the management of funds valued at over $2.7 billion 
for 100,157 beneficiaries, to include veterans, widows, adult 
helpless children, and minors.
    Honorable Richard Griffin, the VA Inspector General, 
testified on his office's past audits and reviews of the 
Fiduciary and Field Examination Activity; Mr. Ronald Henke, 
Director of the Compensation and Pension Service, testified on 
the purpose of the program, how it is administered, and 
improvements being made as a result of the Inspector General's 
findings. Mr. John Pickering, a member of the American Bar 
Association and former Chair of the Commission on Law and 
Aging, explained the representative payee system at the Social 
Security Administration and detailed many of the problems that 
exist in both the Social Security Representative Payee program 
and VA's Fiduciary Program.

Hearing on the Uniformed Services Employment and Reemployment 
Rights Act

    On July 24, 2003, the Subcommittee held an oversight 
hearing on the Department of Labor's administration of the 
Uniformed Services Employment and Reemployment Rights Act 
(USERRA). The hearing examined the effect that the law has on 
National Guard and Reserve members and their employers.
    Witnesses included Second Lieutenant Taylor Adams, 315th 
Airlift Wing, Maintenance Squadron, U.S. Air Force Reserve, a 
recently returned reservist; Mrs. Michelle Comeau-Dumond, the 
wife of a currently-mobilized National Guard member and a 
disabled Gulf War veteran; Colonel Robert F. Norton, (USA, 
Retired), Co-Chairman of the Veteran's Committee of The 
Military Coalition; Mr. John Ryan, Senior Vice President for 
Human Resources, Schering-Plough Corporation; Mr. Jim Rouse, 
Vice President, Washington Office, ExxonMobil Corporation; Ms. 
Susan LaChance, Manager of Selection, Evaluation, and 
Recognition, United States Postal Service; Mr. Peter Perez, 
Senior Vice President, Human Resources, W.W. Grainger, Inc.; 
Lieutenant General Normand Lezy, (USAF-Ret), Vice President, 
National Government Relations, Wal-Mart Stores, Inc.; and 
Honorable Frederico Juarbe, Jr., Assistant Secretary for 
Veterans' Employment and Training Service at the Department of 
Labor, accompanied by Colonel Alan R. Smith, Director, Military 
Member Support for the National Committee for the Employer 
Support of the Guard and Reserve.
    Lieutenant Adams testified that he was able to easily make 
a smooth transition from active duty to civilian life with the 
help of his employer. Mrs. Comeau-Dumond testified that her 
family has faced many difficulties since her husband has been 
mobilized to Kuwait. Colonel Norton made suggestions on how 
USERRA could be improved. The witnesses representing employers 
testified about how their corporations or services go beyond 
the requirements of the law for their employees who are members 
of the Guard and Reserve, including making up any pay 
deferential and continuing benefits while the employees are 
mobilized.
    Secretary Juarbe testified for the Administration and 
discussed how the Department of Labor and the National 
Committee for the Employer Support of the Guard and Reserve, a 
division of the Department of Defense, work closely together as 
stewards of the program to assist National Guard and Reserve 
Members and employers during times of mobilization.

Hearing on Department of Veterans Affairs' Life Insurance 
Program

    On September 25, 2003, the Subcommittee held an oversight 
hearing on the administration of Department of Veterans Affairs 
life insurance programs and operational or policy issues the 
Department faces in administering the program.
    Mr. Thomas Lastowka, Director, VA Regional Office and 
Insurance Center, presented testimony on behalf of the 
Department of Veterans Affairs. Mr. Lastowka was accompanied by 
Mr. Stephen Wurtz, Deputy Assistant Director for Insurance, and 
Mr. Mike Tarzian, Chief, Actuarial Staff. Colonel Virginia 
Penrod (USAF), Director of Compensation, Military Personnel 
Policy, testified on behalf of the Department of Defense. The 
veterans service organizations were represented by Mr. Brian 
Lawrence, Assistant National Legislative Director, Disabled 
American Veterans; Mr. Donald Mooney, Assistant Director for 
Resource Development, The American Legion; Mr. Richard Jones, 
National Legislative Director, AMVETS; and Mr. Carl Blake, 
Associate Legislative Director, Paralyzed Veterans of America.
    The Administration witnesses explained the mechanisms in 
administering the seventh largest insurance program in the 
United States, and detailed their efforts to make the programs 
even more successful. The Insurance Center received an 
exemplary score of 90 on the American Customer Satisfaction 
Index. The veterans service organization witnesses praised the 
insurance programs, and offered legislative recommendations for 
enhancing the Service-Disabled Veterans Insurance program and 
the Veterans' Mortgage Life Insurance program.

Second Session

Hearing to Receive the Report of the VA Vocational 
Rehabilitation and Employment Service Task Force

    On April 1, 2004, the Subcommittee held an oversight 
hearing to receive the report of the VA Vocational 
Rehabilitation and Employment Service Task Force. Honorable 
Dorcas R. Hardy, Chairman of the 12-member Task Force, 
presented its findings and recommendations.
    Chairman Hardy testified that the Task Force proposed more 
than 100 recommendations in four board categories-program, 
organization, work process, and integrating capacities. Some 
program recommendations included: (1) development of new 
policies and procedures to implement a new, five-track 
employment-driven service delivery system with priority given 
to Guard and Reservists in the tracks for reemployment and 
rapid access to jobs; (2) acceleration of the delivery of 
Chapter 31 rehabilitation services to those veterans in most 
critical need; and (3) creation of new staff positions and 
staff for an Employment Readiness Specialist and a Marketing 
and Placement Specialist to facilitate implementation of a five 
track employment-driven service delivery system, as designed by 
the Task Force.
    The Task Force recommended setting goals and measures of 
success to improve the administration of VA's responsibilities 
in the Transition Assistance Program and Disabled Transition 
Assistance Program (DTAP). The Task Force also recommended VA 
reorganize to include dedicated staff in planning and 
implementation of VA's responsibilities in the DTAP, and in 
executing a consistent, national DTAP program at all DOD 
installations and Military Treatment Facilities.
    Finally, the Task Force recommended initiating a study of 
other Federal, state and private-sector vocational 
rehabilitation service organizations to benchmark outcomes, 
performance measures, and quality assurance practices.

Hearing on Federal Department and Agency Initiatives to use 
Discretionary Set-Aside and Restricted Authorities in 
Contracting with Service-Disabled Veteran-Owned Small 
Businesses

    On July 15, 2004, the Subcommittee held a joint hearing 
with the Subcommittee on Workforce, Empowerment, and Government 
Programs of the Committee on Small Business, on Federal 
department and agency initiatives that would use discretionary 
set-aside and restricted authorities established in Public Law 
108-183 for contracting with service-disabled veteran-owned 
businesses.
    Witnesses included Ms. Allegra McCullough, Associate Deputy 
Administrator for Government Contracting & Business 
Development, U.S. Small Business Administration; Mr. Frank 
Ramos, Director for the Office of Small and Disadvantaged 
Business, Office of the Secretary of Defense, DOD; Mr. Brad 
Scott, Regional Administrator for Region 6, Heartland Region, 
General Services Administration; Mr. Scott Denniston, Director 
for the Office of Small Business & Center for Veterans 
Enterprise, VA; and Ms. Nina Rose Hatfield, Deputy Assistant 
Secretary for the Business Management and Wildland Fire, 
Department of the Interior, testified on behalf of the 
Administration.
    Mr. John Lopez, Co-Chairman for the Task Force for Veterans 
Entrepreneurship; Mr. Rick Weidman, Chairman for the Task Force 
for Veterans Entrepreneurship; Dr. Steven L. Schooner, Co-
Director for the Government Procurement Law Program at The 
George Washington University Law School; Mr. Joseph Forney, 
President, VetSource, Inc.; and Mr. James Hudson, Marketing 
Director for Austad Enterprises, Inc., testified regarding 
their experiences with contracting laws and regulations.
    Federal departments and agencies now have additional tools 
to contract with service-disabled veteran-owned small 
businesses. The Subcommittees heard testimony by the agencies 
and departments about the steps they are taking to aggressively 
use these new contracting tools and their effect together to 
develop and implement the regulations for Public Law 108-183 in 
an expeditious manner.
    Ms. McCullough reported to the Subcommittees that the 
percentage of prime contracting dollars that goes to these 
businesses is only 0.25 percent. She testified that only three 
agencies met or exceeded the 3 percent goal: the National 
Endowment for the Arts with 25.27 percent; the Consumer 
Products Safety Commission with 4.35 percent; and the Railroad 
Retirement Board with 3.44 percent.
    The private-sector witnesses representing the veterans' 
community testified on the effect of this new law on service-
disabled veteran-owned small businesses and the difficulties 
they continue to face. Mr. Hudson, who operates the Veterans 
Business Newswire, an e-newsletter sent to more than 25,000 
veteran-small business owners, called for more outreach by the 
Federal government toward service-disabled veteran-owned small 
businesses to encourage more veterans to contract with the 
Federal government.

              Subcommittee on Oversight and Investigations

    The Subcommittee on Oversight and Investigation has 
authority over matters that are referred to the subcommittee by 
the Chairman of the full Committee for investigation and 
appropriate recommendations (see Oversight Plan for 108th 
Congress, p. 91).

                          OVERSIGHT ACTIVITIES

First Session

Hearing on Weapons of Mass Destruction: Is Our Nation's Medical 
Community Ready?

    On April 10, 2003, the Subcommittee held a follow-up 
hearing to assess VA's progress in the development of the 
medical education program mandated by Section 3 of Public Law 
107-287, the Department of Veterans Affairs Emergency 
Preparedness Act of 2002. The hearing also reviewed what role 
VA should play in the continuing medical education of current 
and future health care professionals. This hearing was a 
follow-up to a hearing on November 14, 2001, by the 
Subcommittee on Oversight and Investigations to examine what 
roles VA and DOD should play in providing our Nation's medical 
students with the education and training programs necessary to 
diagnose and treat casualties when exposure to biological, 
chemical, or radiological agents is suspected.
    Witnesses included: Robert H. Roswell, MD, VA Under 
Secretary for Health; Mr. Jerome M. Hauer, Acting Assistant 
Secretary for the Office of Public Health Emergency 
Preparedness, HHS; Mr. Eric Tolbert, Director, Emergency 
Preparedness and Response Directorate, Department of Homeland 
Security (DHS); John Nelson, MD, Member of the Board of 
Trustees, American Medical Association (AMA); and Colonel Maria 
Morgan, Deputy Adjutant General, State of New Jersey.
    Mr. Hauer stated VA's assistance has been invaluable to the 
creation and ongoing maintenance of the Strategic National 
Stockpile. The Centers for Disease Control has established 
collaborative relationships with other specialty organizations 
in an effort to disseminate constituent specific information on 
bio-terrorism and other threats. The AMA discussed the idea of 
a public-private entity to bridge the gap between medical 
community and the public, which would be comprised of key 
participants, including DVA and DOD. DHS explained VA's role in 
National Disaster Medical System in maintaining the weapons of 
mass destruction pharmaceutical caches. DHS also expressed 
hopes of being an active partner in the development of 
education and training programs in response to weapons of mass 
destruction. The Subcommittee also received testimony from the 
Deputy Adjutant General of the New Jersey National Guard on its 
role in natural and man made disasters.

Hearing on VA's Progress on Third Party Collections

    On May 7, 2003, the Subcommittee held its third oversight 
hearing on the VA's third party collections process. The 
purpose of the hearing was to examine a number of issues facing 
VA as it seeks to improve its collections under the Medical 
Care Collection Fund program, including the progress it has 
made in implementing the Veterans Health Administration's 2001 
Revenue Cycle Improvement Plan.
    Witnesses included: Leo S. Mackay, Ph.D., Deputy Secretary, 
VA; Mr. Robert A Perrault, Director, Veterans Health 
Administration Business Office; Ms. Cynthia A. Bascetta, 
Director, Veterans' Health and Benefits Issues, GAO, 
accompanied by Mr. Michael T. Blair, Assistant Director of 
Health Care, GAO; Mr. Joseph Glorioso, Director, Government 
Subscriber Relations, Digital Healthcare Inc; Mr. Donald N. 
Blanding, Healthcare Information Technology Consultant; and Ms. 
Cathy C. Wiblemo, Deputy Director for Health Care, Veterans 
Affairs and Rehabilitation Division, The American Legion.
    GAO provided an update on VA's third-party collections 
since September 2001. According to GAO, VA does not 
consistently bill third parties for services it provides to 
veterans. Further, GAO stated VA should ensure that veterans 
file appropriate and accurate medical insurance claims, and 
that all insurance claims are supported by medical record 
documentation. The Subcommittee was also informed the VHA 
should continue to reduce errors in coding, which lead to 
delays or non-payment. VA stated it was implementing the 
Patient Financial Services System project in Cleveland, which 
would be a comprehensive integration of business processes and 
information technology improvements. The Subcommittee should 
continue its oversight of third party collections.

Human Subjects Protections in VA Research

    On June 18, 2003, the Subcommittee held its fifth oversight 
hearing on human subject protection in VA's medical research 
programs. The purpose of the hearing was to review three 
concerns: (1) the strength of the human subject protections at 
VA; (2) the necessity of maintaining an independent oversight 
entity that reports directly to the Under Secretary for Health; 
and (3) the adequacy of H.R. 1585 in addressing these concerns.
    Witnesses included: Ms. Cynthia Bascetta, Director, 
Veterans' and Benefits Issues, GAO; Greg Koski, Ph.D., MD, 
Senior Scientist, Institute for Health Policy; Robert H. 
Roswell, M.C., VA Under Secretary for Health; accompanied by: 
Nelda P. Wray, MD, Chief Research and Development Officer; John 
H. Mather, MD, Special Assistant to the Under Secretary for 
Health; and David A. Weber, Ph.D.
    GAO testified that the VA had taken insufficient actions to 
strengthen its human subjects protection systems since GAO 
originally made recommendations in September of 2000. GAO was 
critical of VA's reorganization of its headquarters research 
offices which lacked adequate planning and notification. Dr. 
Koski emphasized the need to create an autonomous oversight 
office within VA as an important step toward ensuring the 
integrity of its human research programs. Under Secretary 
Roswell discussed actions taken since a VA research stand-down 
ordered on March 6, 2003. As a result, the Program for Research 
Integrity Development and Educations within the Office of 
Research was established. Under Secretary Roswell also stated 
that the newly established Office of Research Oversight would 
be responsible for oversight of compliance with policy, 
regulations, law, and ethics.

Hearing on Force Protection: Lesson Learned and Applied from 
the First Gulf War.

    On July 9, 2003, the Subcommittee on Oversight and 
Investigations held a hearing on medical protections for 
deployed DOD personnel. The purpose of the hearing was to 
review the pre-and post-deployment medical protection of troops 
deployed to Afghanistan and the Persian Gulf Region. 
Specifically, the hearing provided an assessment of what health 
protections were provided to troops deployed to the Gulf Region 
and what measures the DOD took to protect service-members from 
possible exposure to biological, chemical, and environmental 
agents. The Subcommittee also was interested in learning what 
medical data was collected by DOD because such information 
assists VA in making its future determinations of eligibility 
for benefits.
    Witnesses included: Dr. William Winkenwerder, Assistant 
Secretary of Defense for Health Affairs; Dr. Jonathan B. 
Perlin, Deputy Under Secretary for Health, VA; and Dr. Marjorie 
E. Kanof, Director, Health Care-Clinical and Military Health 
Care Issues, GAO.
    During the hearing, a lengthy discussion ensued regarding 
the definition of medical examinations. DOD stated that its 
interpretation of the law is that a medical screening fulfills 
the requirements of Public Law 105-85, the National Defense 
Authorization Act for Fiscal Year 1998. Public Law 105-85 also 
requires pre- and post-deployment medical examinations. The 
Subcommittee believes these health assessments should include: 
reviews of required immunizations and other medications, 
personnel protective and medical equipment, DNA and serum 
samples, dental classification, and briefings on possible 
health threats and countermeasures. The Subcommittee also 
believes the intent of the requirement was for an actual 
physical evaluation. GAO also testified that DOD's health care 
examination requirements differ for active duty versus National 
Guard and Reserve member.

Rx for VA's Nursing Shortage: Is There More Than One Antidote?

    On October 2, 2003, the Subcommittee held a hearing to 
review the impact of the nursing shortage on the Department of 
Veterans Affairs. The purpose of the hearing was to examine 
programs and initiatives that offer solutions for recruitment 
and retention of VA's nursing work force.
    Witnesses included: Cathy J. Rick, RN, CNAA, FACHE, Chief 
Nursing Officer, VA; Sandra K. Janzen, MS, RN, CNAA, Associate 
Chief of Staff/Nursing, James A. Haley Hospital, Tampa, FL; 
Mary Raymer, RN, MA, CNAA, Nursing Education Program Manager, 
Health Care Staff Development & Retention Office, VA, New 
Orleans, LA. Barbara Blakeney, MS, APRN, BC, ANP, President, 
American Nurses Association (ANA); Sarah Myers, Ph.D., RNC, 
Nurses Organization of Veterans Affairs; Julie Cowan Novak, 
DNSc, RN, MA, CPNP, Head, School of Nursing, Purdue University; 
and Regina Foley, MBA, RN, CNAA, Vice President/Chief Nurse 
Executive, Ocean Medical Center, NJ.
    VA witnesses testified that the VA has experienced 
difficulties in recruiting nursing staff, that one-third of the 
VA's registered nurses, licensed practical nurses, and nursing 
assistants are eligible to retire in 2005, and that different 
strategies must be employed to attract nursing graduates to VA. 
The Tampa VA Medical Center, FL, has had great success 
recruiting and retaining health care professionals, especially 
its nursing staff. The Subcommittee learned that 17 percent of 
the eligible residency scholarship participants were hired by 
VA facilities in 2002.
    VA and the ANA cited a study conducted by Dr. Linda H. 
Aiken (April 1998-November 1999), which concluded that in 
hospitals with higher proportions of nurses educated at the 
baccalaureate level or higher, surgical patients experienced 
lower mortality rates. These assertions were disputed in 
written testimony submitted by the American Association of 
Community Colleges. VA and ANA also expressed their strong 
enthusiasm and support for the Magnet Accreditation Program. 
Magnet Status is the highest level of recognition that the 
American Nurses Credentialing Center can extend to health care 
organizations. The program has been beneficial to the hospital 
in retaining and recruiting nursing staff. Private sector 
witnesses also discussed the success rate in their hospitals 
since receiving Magnet Status.

VA-DOD Shared Medical Records--20 Years and Waiting

    On November 19, 2003, the Subcommittee held a hearing to 
review the progress being made by the DOD and the VA in the 
last 10 years with the sharing of medical information and 
development of a seamless electronic medical record.
    Witnesses included: Linda Koontz, Director, Information 
Management Issues, GAO; Major General Kenneth L. Farmer, Jr., 
Deputy Surgeon General, U.S. Army, DOD, Ms. Jeanne B. Fites, 
Deputy Under Secretary for Military Health System, DOD, Frances 
M. Murphy, M.D., MPH, Deputy Under Secretary for Health Policy 
Coordination, VA, Edward F. Meagher, Acting Chief Information 
Officer, VA; and Kem Clawson, Director of Advanced Technology 
Solutions, EMC Corporation, McLean, VA.
    GAO testified that VA and DOD are making progress but full 
implementation of a joint strategy is years away. GAO also 
stated that VA and DOD have achieved a measure of success in 
sharing data, as evidenced by VA clinicians now having access 
to military health records for veterans through the Federal 
Health Information Exchange. However, a virtual medical record 
based on a two-way exchange of data between VA and DOD is far 
from being achieved with DOD and VA presenting differing 
perspectives of progress achieved.
    The Subcommittee learned from Ms. Fites that it takes an 
average of 60 days for the DD Form 214 to be available through 
Defense Personnel Information Systems after a servicemember 
separates from the military. VA stated that it needs such 
information in order to process claims and determine what is 
service connected. Questioning of VA and DOD witnesses revealed 
that the two departments continue to purchase equipment that is 
not compatible or interoperable, which defeats the goal of 
achieving shared medical records.

Second Session

Staff Site Visit to Augusta, GA

    On January 15-16, 2004, minority Staff traveled to both 
campuses of the Augusta, GA VAMC, associated grounds, and two 
contract nursing homes. A primary focus was on the function of 
the textile care processing facility institutional laundry and 
the need to seek alternative methods of accomplishing this 
vital service due to the disrepair of the current laundry. 
Tours of the medical centers were also accomplished.

Staff Site Visit to Bay Pines VAMC, FL

    On February 22-23, 2004, minority staff traveled to Bay 
Pines VAMC, FL to review the status of the Core Financial and 
Logistics System (CoreFLS) information technology project and 
to meet with principal parties to the project. A brief no-
notice tour of the VAMC and nursing home was also conducted.

Hearing VI on VA's Information Technology Programs

    On March 17, 2004, the Subcommittee held its sixth 
oversight hearing on VA's information technology programs. The 
purpose of the hearing was to receive an update from the VA and 
the DOD concerning their efforts to share medical information 
and develop a seamless medical record. The Subcommittee 
examined the advantages of electronic medical records, 
including capturing insurance information for third party 
collections and the reduction of medical errors.
    Witnesses included: Dr. John Halamka, CIO of CareGroup 
Healthcare System and Harvard Medical School; Dr. John R. 
Clarke, Professor of Surgery, Drexel University, and Adjunct 
Professor of Computer and Information Science, University of 
Pennsylvania; Ms. Linda Koontz, Director, Information 
Management Issues, GAO; Mr. James C. Reardon, CIO, Military 
Health System, Office of the Assistant Secretary of Defense 
(Health Affairs), DOD; Dr. Robert H. Roswell, MD, Under 
Secretary for Health, VA; Robert M. Kollodner, Acting Chief 
Information Officer for Health, Veterans Health Administration; 
Mr. Robert N. McFarland, Assistant Secretary for Information 
and Technology, Department of Veterans Affairs; and Mr. Edward 
C. Davies, Managing Partner, Federal Civilian Agencies, Unisys 
Corporation.
    The Subcommittee received testimony from Dr. Halamka and 
Dr. Clarke about the importance of moving away from paper 
medical records towards electronic medical records. Dr. Halamka 
stated that the medical group he manages has electronically 
converted nine million records. Dr. Clarke provided valuable 
information concerning the potential of electronic records to 
offer improvement in the safety, quality, and efficiency of 
health care in the United States, as called for in previous 
Institute of Medicine reports. The Subcommittee also reviewed 
the CoreFLS and the Patient Financial Services Systems. Both 
had cost overruns and numerous delays.

Hearing on Department of Veterans Affairs Employment Screening 
Practices and Procedure for Background Checks and Credentialing

    On March 31, 2004, the Subcommittee held a hearing to 
examine serious lapses and vulnerabilities in the Department of 
Veterans Affairs screening process of applicants for positions 
within the Veterans Health Administration. .
    Witnesses included: Ms. Cynthia Grubbs, Director Office of 
Policy and Planning, HHS; Ms. Cynthia Bascetta, Director, 
Health Care--Veterans' Health and Benefits Issues, GAO; and Dr. 
Frances M. Murphy, Deputy Under Secretary for Health Policy 
Coordination, Veterans Health Administration, VA.
    GAO testified that it had identified key VA screening 
requirements that include verifying state licenses and national 
certificates; completing background investigations, and 
checking databases for practitioners who have been 
professionally disciplined or excluded from Federal health care 
programs. GAO stated that it found mixed compliance with the 
key requirements in the four facilities they visited. GAO 
recommended expansion of VA's verification process, its query 
of national data banks and finger printing of all practitioners 
who have direct patient care access.
    The Subcommittee also learned that the Federal 
Credentialing Program which was intended to develop electronic 
credentialing for vetting of VA heath care professionals was 
disbanded in 2003. Dr. Murphy stated that VA intended to create 
systematic credentialing and oversight processes and would 
verify all existing licenses and certificates with the issuing 
organization for both applicants and employee renewals.

Site Visit to San Diego, CA

    On April 19-22, 2004, majority staff from the Oversight and 
Investigations and Benefits Subcommittees conducted a site 
visit in the San Diego, CA area. Staff met with the VA Regional 
Office and received an update on its efforts in hiring veterans 
and disabled veterans. Staff also met with representatives 
involved in Operation Transition from the TAP program, 
organized labor, local businesses, SBA, One-Stop Career 
Centers, non-profit organizations, and the San Diego Chamber of 
Commerce to review efforts to assist veterans with employment, 
and starting small businesses. Staff attended TAP classes and 
DTAP at Point Loma Naval Base, Miramar Marine Base, and Camp 
Pendleton Marine Base.
    On April 22, 2004, majority staff met with Rear Admiral 
John Mateczun, Commander, Naval Medical Center San Diego and 
his staff to discuss VA-DOD sharing, separation physicals, VA-
DOD coordination on transition matters, physician 
credentialing, and third party billing. Staff also learned that 
the Naval Medical Center is continuing to fill its 
prescriptions through Consolidated Mail Order Pharmacy, even 
though the pilot has finished. The Center has also used VA as a 
business partner to develop their East County Clinic Project 
concept with VA Medical Center Outpatient Center in San Diego, 
and has used VA's safety model as its prototype to develop 
their own safety protocols. In the afternoon, staff met with VA 
Medical Center Director Gary Rossio and his staff to discuss 
part-time physicians time and attendance, the research program, 
third party collections, and the pharmacy program.

Hearing on VA Research on Alzheimer's Disease, Parkinson's 
Disease and Diabetes.

    On April 28, 2004, the Subcommittee held a hearing to 
review current research being conducted by VA and National 
Institutes of Health (NIH) on Alzheimer's disease, diabetes and 
Parkinson's disease. The hearing provided VA with an 
opportunity to highlight the important biomedical research that 
is being conducted by the VA in these areas.
    Witnesses at the hearing included: Dr. Judith A. Salerno, 
Deputy Director, National Institute on Aging, NIH; Dr. Michael 
J. Kussman, Acting Deputy Under secretary for Health, Veterans 
Health Administration; Dr. Franklin K. Zieve, Associate Chief 
of Staff, Richmond VAMC; Dr. Robert Ferrante, Director, 
Experimental Neuorpathology, Bedford VAMC; and Dr. Mary Sano, 
Associate Chief of Staff, Bronx VAMC.
    During the hearing, the Subcommittee received testimony 
from NIH about its many collaborations with VA, and how NIH 
conducted clinical trials in which veterans participate in 
studies on diseases that afflict veterans such as diabetes, 
Parkinson's and Alzheimer's. The Subcommittee also received an 
update from VA on its ongoing research. VA provided the 
Subcommittee with a video on deep brain stimulation which 
showed how effective this treatment could be in alleviating 
symptoms caused by Parkinson's disease. The Subcommittee also 
heard from researchers in the field on projects currently 
underway in their respective fields.

Hearing on the VA' Role in the Development of Interoperable 
Electronic-Medical Records Systems in the Federal Government.

    On May 19, 2004, the Subcommittee held a hearing to receive 
an update from VA and DOD about their collaboration with HHS 
over the past two years and how it was instrumental in laying 
the groundwork for the Federal government's Health Information 
Technology (IT) initiative.
    Witness included: Dr. Jonathan J. Javitt, Potomac Institute 
for Policy Studies, Member, Subcommittee on Health Care 
Delivery and Information Technology, President's Information 
Technology Advisory Committee; Ms. Linda Koontz, Director, 
Information Management Issues, GAO; Jonathan B. Perlin, MD, 
Acting Under Secretary for Health, VA; and Mr. James C. 
Reardon, Chief Information Officer for Military Health System, 
DOD.
    The Subcommittee learned about the future role of VA and 
DOD in developing and implementing the health IT initiative. 
The hearing also examined the advantages of electronic medical 
records, which include lower cost, fewer errors, and higher 
quality. The Subcommittee received testimony from DOD and VA 
about the progress they are making with the sharing of medical 
information and development of a seamless electronic medical 
record, which they have been working on since 1998.
    GAO provided an update on the progress being made by VA and 
DOD toward a two-way exchange of patient health care 
information. Ms. Koontz stated that GAO found that the 
departments have achieved a measure of success in sharing 
through the one-way transfer of health information from DOD to 
VA health care facilities but they have been severely 
challenged in their pursuit of the longer term objective of a 
two way transfer of health information between the two 
departments. Dr. Javitt testified that when modern computer 
technology is added to the practice of medicine, medical errors 
are prevented and hospital costs are avoided and lives are 
saved.

Staff Site Visit to James A. Haley Veterans Hospital, Tampa, 
Florida

    On July 1-2, 2004, majority staff members of the 
Subcommittee on Oversight and Investigations made a site visit 
to the Medical Center in Tampa, FL to review the facility's 
third party collections and found that outpatient billing takes 
longer because the facility is understaffed and does not have 
enough medical coders. The biggest collection obstacles 
appeared to be lack of integrated billing and current medical 
data software systems. Staff also met with the facility's 
research department to review its policy and implementation 
concerning background checks, verification of degrees and 
research misconduct.
     On July 2, 2004, majority staff met with hospital and 
nursing leadership to learn about its Magnet Recognition 
Program. After the briefing on Tampa's Magnet Program, staff 
toured the hospital and visited several units: spinal cord 
injury, ambulatory care, and nursing home.

Oversight hearing on VA's Third Party Collections

    On July 21, 2004, the Subcommittee held a hearing to 
examine a number of issues facing VA as it seeks to improve its 
third party collections, including implementation of its pilot 
Patient Financial Services System. The pilot project is 
currently underway at the Cleveland VA Medical Center. The 
pilot project is designed to demonstrate how integrated, 
commercial management and patient financial software will 
improve VA's third party collections.
    Witnesses included: Mr. Michael L. Staley, Assistant 
Inspector General for Auditing, VA; Ms. Cynthia A. Bascetta, 
Director, Health Care--Veterans' Health and Benefits Issues, 
GAO; Mr. McCoy Williams, Director, Financial Management and 
Assurance Team, GAO; Honorable Robert N. McFarland, Assistant 
Secretary for the Office of Information and Technology, VA; Mr. 
Kenneth Ruyle, Chief Business Officer, Veterans Health 
Administration; Mr. Ken Ray, VISN 8 Chief Financial Officer; 
and Mr. Edward C. Davies, Managing Partner, Unisys Corporation.
    VA testified that collections had increased $129 million 
above last fiscal year's collections. Considerable improvement 
had been made toward automated billing and collections 
activities. Improvements have been made to the VHA's Revenue 
Action Plan, which includes targeted completion of the Medicare 
Remittance Advice project, and its Consolidated Patient Account 
Centers. VA also testified that it was using lessons learned 
from a previous integration project and would utilize 
independent consultants to perform a thorough risk analysis.
    GAO's testimony focused on internal control activities over 
third party billings and collections at three selected medical 
centers. GAO found continuing weaknesses that affected billing 
timeliness. These weaknesses included not billing insurance 
companies in a timely manner, verifying and updating patients' 
third-party insurance, and inadequate documentation to support 
billings. GAO also found inconsistency in compliance with 
follow-up procedures, especially for Medicare secondary 
insurance companies. The IG provided a summary of Combined 
Assessment Program reviews. Mr. Staley's testimony was similar 
to GAO's regarding weaknesses in the collections process. The 
IG also cited a 2002 audit showing that clearing the backlog of 
unissued bills totaling over $1 billion would net $368.4 
million in additional collections.

Staff Site Visit to Western VA Facilities

    On August 9-14, 2004, Minority staff traveled to Dugway, 
UT; Salt Lake City, UT; Sacramento, CA; Martinez, CA; Oakland, 
CA; San Francisco, CA; Mare Island, CA; and Reno, NV. A general 
review of management flexibility and standardization with VA 
Central Office policies was the objective for this trip. The 
visit included a number of both scheduled and no-notice visits. 
At the medical centers, patient care was a principal focus of 
the review, but issues including staffing, contracting, and 
part-time physician attendance were also reviewed. At the 
Regional Offices (VBA) and (NCA), staffing concerns and 
performance were discussed. The VISN 21 Office visit focused on 
contract nursing homes and nursing home quality. The trip 
included a tour of the East Bay Stand-Down and also a day-long 
visit to the classified technical library at the US Army's 
Dugway Proving Ground in Utah to review chemical and biological 
exposure reports involving US military and civilian personnel 
circa 1948-1970s.

Site Visit to Nashville and Murfreesboro, TN

    On August 27-18, 2004, Minority Staff conducted no-notice 
visits of VA facilities at Nashville and Murfreesboro, TN, 
which included a review of one medical center, a BVA Regional 
Office and a national cemetery. The focus of the visit to the 
Medical Center included general patient care, long-term 
psychiatric care, and the laundry.

Hearing on Department of Veterans Affairs' Smart Card Projects

    On October 6, 2004, the Subcommittee held a hearing to 
receive an update from the VA concerning its Smart Card 
projects.
    Witnesses included: Honorable Benjamin H. Wu, Deputy Under 
Secretary for Technology, Technology Administration, Department 
of Commerce; Ms. Linda Koontz, Director, Information Management 
Issues, GAO, accompanied by: Ms. Valerie C. Melvin, Assistant 
Director, Information Management Issues, GAO Mr. Neville 
Pattinson, Director of Business Development, Technology and 
Government Affairs, Axalto; Honorable Robert N. McFarland, 
Assistant Secretary for Information and Technology, VA; and Mr. 
Robert J. Brandewie, Director, Defense Manpower Data Center, 
Office of the Secretary of Defense for Personnel and Readiness, 
DOD.
    Under Secretary Wu addressed the development of the 
Government's Smart-Card Interoperability Specification and the 
efforts of the National Institute of Standards and Technology 
standardize the specifications both nationally and 
internationally. The Subcommittee also received testimony about 
VA's efforts related to the development of its Smart Card and 
biometric technologies, and its VA Authentication and 
Authorization Infrastructure Project. Secretary McFarland 
stated that its VA Smart Card project will be completed in 18 
months.
    During the hearing, the Subcommittee learned about the 
benefits of using Smart Card technology to ensure VA 
infrastructure security, cyber security, employee 
accountability and fraud prevention in the compensation and 
pension delivery system. DOD has issued approximately six 
million cards to its employees without any major problems. GAO 
testified that since VA is using the General Services 
Administration's standard contracting vehicle to purchase 
commercial Smart Card products from vendors and is 
participating in government-wide initiatives, it should be in a 
better position to be successful with its efforts.

                                                                          SUMMARY OF VETERANS' AFFAIRS COMMITTEE ACTION
                                                           BILLS AND RESOLUTIONS REFERRED AND HEARINGS / EXECUTIVE SESSIONS CONDUCTED

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                 Congress
                                         -------------------------------------------------------------------------------------------------------------------------------------------------------
                                           90th    91st     92d     93d    94th    95th    96th    97th    98th    99th    100th   101st   102d    103d    104th   105th   106th   107th   108th
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bills and resolutions referred..........     685     740     693     839     719     709     339     273     229     198     147     194     215     174     128     134     146     194     253
Hearing sessions........................      46      43      37      44      58      72      84      89      71      76      44      72      67      71      39      56      66      58      65
Meetings and mark-up sessions...........      13      27      21      16      30      26      19      18      16      20      16      26      20      23      19      18      13      14      16
Bills reported..........................  \3\ 19      34      26  \4\ 14      23      32      11      16      15      17      14      33      21      25      15      15      10      14      22
Bills in House..........................       4       1       4       1  ......       1       1       1       3       3       1       4       3      11  ......  ......       1  ......  ......
Pending in Senate committees............       3       9       7       2   \5\ 9      17       3       6       6       8       9      23       7      11      10       1       1      10       7
Bills on Senate Calendar or in Senate...  ......  ......  ......  ......  ......       1       1       1  ......       1       3       1       3       3  ......  ......       1  ......       4
Recommitted.............................  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......
Bills vetoed............................  ......  ......       2       1  ......  ......       1  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......
Bills passed over veto..................  ......  ......  ......       1  ......  ......       1  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......  ......
Laws enacted............................      15      24      15      15      15      13       6       8       8       6       4       8      24      15       6       6      11      13       9
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------


1    Including 4 bills enacted as amendment to 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.
10 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.
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.)

    January 29, 2003. OPEN. 1:00 p.m. Full Committee. Meeting. 
Organizational.

    January 29, 2003. OPEN. 1:30 p.m. Full Committee. Hearing. 
Department of Veterans Affairs Health Care System. (Serial No. 
108-1)

    February 5, 2003. OPEN. 2:00 p.m. Full Committee. Hearing. 
The State of Veterans' Employment. (Serial No. 108-2)

    February 11, 2003. OPEN. 10:00 a.m. Full Committee. 
Meeting. Oversight Plan.

    February, 11,2003. OPEN. 10:00 a.m. Full Committee. 
Hearing. Department of Veterans Affairs Budget Request for 
Fiscal Year 2004. (Serial No. 108-3)

    February 25, 2003. OPEN. 2:00 p.m. House and Senate 
Veterans Affairs Committees. Joint Hearing. Room 345 Cannon 
HOB. The legislative priorities of the Disabled American 
Veterans.

    February 27, 2003. OPEN. 2:00 p.m. Full Committee. Meeting. 
To approve Committee's views and estimates for the FY 2004 
budget for submission to the Budget Committee.

    March 6, 2003. OPEN. 10:00 a.m. House and Senate Veterans 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
Legislative Priorities of the Military Order of the Purple 
Heart, Paralyzed Veterans of America, Jewish War Veterans, 
Blinded Veterans Association and Non Commissioned Officers 
Association.

    March 12, 2003. OPEN. 10:00 a.m. House and Senate Veterans 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
Legislative Priorities of the Veterans of Foreign Wars.

    March 13,2003. OPEN. 10:00 a.m. House and Senate Veterans 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
Legislative Priorities of The Retired Enlisted Association, 
Gold Star Wives, Fleet Reserve Association and Air Force 
Sergeants Association.

    March 19, 2003. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. Oversight Hearing on the Availability and Eligibility 
for Pharmaceutical Services Provided by the Department of 
Veterans Affairs. (Serial No. 108-4)

    March 20, 2003. OPEN. 10:00 a.m. House and Senate Veterans 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
Legislative Priorities of AMVETS, American ExPrisoners of War, 
Vietnam Veterans of America, Military Officers Association of 
America and the National Association of State Directors of 
Veterans Affairs.

    March 27, 2003. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. Bioterrorism Research and Post-Deployment Health Care 
for Veterans. (Serial No. 108-5)

    April 3, 2003. OPEN. 9:30 a.m. Full Committee. Markup. H.R. 
100 and H.R. 1297.

    April 9, 2003. OPEN. 2:00 p.m. Subcommittee on Benefits. 
Hearing. Troops-to-Teachers. (Serial No. 108-6)

    April 10, 2003. OPEN. 9:30 a.m. Subcommittee on Benefits. 
Hearing. H.R. 241, H.R. 533, H.R. 761, H.R. 850, H.R. 966, and 
H.R. 1048. (Serial No. 108-7)

    April 10, 2003. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. 340 Cannon HOB. Weapons of Mass 
Destruction: Is Our Nation's Medical Community Ready? (Serial 
No. 108-8)

    April 10, 2003. OPEN. 1:00 p.m. Subcommittee on Health. 
Hearing. Medical and Prosthetic Research in the Department of 
Veterans Affairs. (Serial No. 108-9)

    April 30, 2003. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Hearing. H.R. 1460, the Veterans Entrepreneurship Act of 2003; 
H.R 1712, the Veterans Federal Procurement Opportunity Act of 
2003; and H.R. 1716, the Veterans Earn and Learn Act. (Serial 
No. 108-10)

    May 6, 2003. OPEN. 1:00 p.m. Subcommittee on Health. 
Markup. H.R. 1562, H.R. 1715, H.R. 1832, H.R. 1908 and 
H.R.1911.

    May 6, 2003. OPEN. 1:30 p.m. Subcommittee on Health. 
Hearing. Homeless Assistance Programs in VA. (Serial No. 108-
11)

    May 7, 2003. OPEN. 11:30 a.m. Subcommittee on Benefits. 
Markup. H.R. 241, H.R. 761, H.R. 1257, H.R. 1460, H.R. 1683 and 
H.R. 1949.

    May 7, 2003. OPEN. 2:00 p.m. Subcommittee on Oversight and 
Investigations. Hearing. To Review the Progress of the 
Department of Veterans Affairs Regarding the Collection of its 
Medical Care Collection Fund (MCCF). (Serial No. 108-12)

    May 8 and June 10, 2003. OPEN. 10:00 a.m. Full Committee. 
Hearings. Past and Present Efforts to Identify and Eliminate 
Fraud, Waste, Abuse, and Mismanagement in Programs Administered 
by the Department of Veterans Affairs. (Serial No. 108-13)

    May 15, 2003. OPEN. 10:00 a.m. Full Committee. Markup. H.R. 
]257, H.R. 1460, H.R. 1562, H.R. 1683, H.R. 1715 and H.R. 1911.

    May 22, 2003. OPEN. 1:30 p.m. Subcommittee on Health. 
Hearing. Oversight Hearing on Long-Term Care Programs in VA.

    June 3 and June 17, 2003. OPEN. 10:00 a.m. Full Committee. 
Hearing. Hearings on the Report of the President's Task Force 
to Improve Health Care Delivery for our Nation's Veterans. 
(Serial No. 108-15)

    June 11, 2003. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Hearing. H.R. 886, H.R. 1167, H.R. 1500, H.R. 1516, H.R. 2163, 
H.R. 2164, H.R. 2285, and H.R. 2297.

    June 11, 2003. OPEN. 2:00 p.m. Subcommittee on Health. 
Hearing. H.R. 116, H.R. 1720, H.R. 2307, and H.R. 2349. (Serial 
No. 108-17)

    June 18, 2003. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Human Subjects Protections in VA 
Research.

    June 24, 2003. OPEN. 11:00 a.m. Subcommittee on Health. 
Markup. H.R. 116, H.R. 1720, H.R. 2357 and H.R. 2433.

    June 25, 2003. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Markup. H.R. 1516 and H.R. 2297.

    June 26, 2003. OPEN. 10:00 a.m. Full Committee. Markup. 
H.R. 116, H.R.1516, H.R. 1720, H.R. 2357, H.R. 2433, H.R. 2595 
and H. Con. Res. 159.

    July 9, 2003. OPEN. 2:00 p.m. Subcommittee on Oversight and 
Investigations. Hearing. Force Health Protection: Lessons 
Learned and Applied From the First Gulf War. (Serial No. 108-
19)

    July 15, 2003. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. H.R. 1585, a bill to establish an office to oversee 
research compliance and assurance within the Veterans Health 
Administration of the Department of Veterans Affairs.

    July 16, 2003. OPEN. 10:30 a.m. Subcommittee on Benefits. 
Hearing. Department of Veterans Affairs' Fiduciary Program. 
(Serial No. 108-21)

    July 24, 2003. OPEN. 9:30 a.m. Subcommittee on Benefits. 
Hearing. Hearing on the Uniformed Services Employment and 
Reemployment Rights Act.

    September 16, 2003. OPEN. 10:00 a.m. House and Senate 
Veterans' Affairs Committees. Joint Hearing. Room 216 Hart SOB. 
The Legislative Priorities of The American Legion.

    September 25, 2003. OPEN. 10:30 a.m. Subcommittee on 
Benefits. Hearing. Oversight Hearing on the Department of 
Veterans Affairs' Life Insurance Program. (Serial No. 108-23)

    September 30, 2003. OPEN. 2:30 p.m. Room 340 Cannon HOB. 
Subcommittee on Health. Hearing. H.R. 2379, the Rural Veterans 
Access to Care Act of 2003; and H.R. 3094, the Veterans Timely 
Access to Health Care Act. (Serial No. 108-24)

    October 2, 2003. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Rx for VA's Nursing Shortage: Is 
There More Than One Antidote?

    October 8, 2003. OPEN. 1:30 p.m. Subcommittee on Health. 
Markup. H.R. 1585.

    October 16, 2003. OPEN. 10:00 a.m. Full Committee. Hearing. 
Handoff or Fumble? Are DOD and VA Providing Seamless Health 
Care Coverage to Transitioning Veterans? (Serial No. 108-26)

    October 21, 2003. OPEN. 2:00 p.m. Subcommittee on Health. 
Hearing. Hearing on Veterans Affairs Physician and Dentist 
Compensation Issues. (Serial No. 108-27)

    November 19, 2003. OPEN. 10:30 a.m. Subcommittee on 
Oversight and Investigations. Hearing. Hearing on VA-DOD Shared 
Medical Records--20 Years and Waiting.

    January 28, 2004. OPEN. 10:00 a.m. Full Committee. Hearing. 
Hearing on the Department of Veterans Affairs Policies 
Affecting the Millions of Veterans Who Will Need Long-Term Care 
in the Next Ten Years. (Serial No. 108-29)

    February 4, 2004. OPEN. 10:00 a.m. Full Committee. Hearing 
on the Department of Veterans Affairs Budget Request for Fiscal 
Year 2005. (Serial No. 108-30)

    February 24, 2004. OPEN. 2:00 p.m. House and Senate 
Veterans' Affairs Committees. Joint Hearing. Room 216 Hart SOB. 
The Legislative Priorities of the Disabled American Veterans.

    March 4, 2004. OPEN. 10:00 a.m. House and Senate Veterans' 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
Legislative Priorities of the Non Commissioned Officers 
Association, Military Order of the Purple Heart, Paralyzed 
Veterans of America, Jewish War Veterans and Blinded Veterans 
Association.

    March 10, 2004. OPEN. 10:00 a.m. House and Senate Veterans' 
Affairs Committees. Joint Hearing. 216 Hart SOB. The 
Legislative Priorities of of the Veterans of Foreign Wars.

    March 11, 2004. OPEN. 9:30 a.m. Subcommittee on Health. 
Hearing. Oversight Hearing on the Status of Department of 
Veterans Affairs' Post-Traumatic Stress Disorder Programs.

    March 17, 2004. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Hearing VI on the Department of 
Veterans Affairs Information Technology Programs.

    March 18, 2004. OPEN. 10:00 a.m. House and Senate Veterans' 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
Legislative Priorities of the Air Force Sergeants Association, 
The Retired Enlisted Association, Gold Star Wives and Fleet 
Reserve Association.

    March 24, 2004. OPEN. 11:00 a.m. Full Committee. Hearing. 
Hearing on Employing Veterans of Our Armed Forces.

    March 25, 2004. OPEN. 10:00 a.m. House and Senate Veterans' 
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The 
Legislative Priorities of the National Association of State 
Directors of Veterans Affairs, AMVETS, American Ex-POWs, 
Vietnam Veterans of America and the Military Officers 
Association of America.

    March 30, 2004. OPEN. 10:00 a.m. Subcommittee on Health. 
Hearing. Hearing on the Department of Veterans Affairs 
Providing Certain Veterans with a Prescription-Only Health Care 
Benefit.

    March 31, 2004. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Hearing on VA's Current Procedures 
for Background Checks and Credentialing.

    April 1, 2004. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Hearing. Hearing to Receive the Report of VA's Vocational 
Rehabilitation and Employment Service Task Force.

    April 13, 2004. OPEN. 8:30 a.m. Municipal Plaza Building, 
City Hall Complex, City Council Chambers, San Antonio, Texas. 
Subcommittee on Health. Hearing. Oversight Hearing on the 
Status of Military and VA Health Care Coordination, Including 
Post-Deployment Health Care of Recently Discharged Veterans.

    April 28, 2004. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Hearing on VA Research on 
Alzheimer's Disease, Parkinson's Disease, and Diabetes.

    April 29, 2004. OPEN. 10:00 a.m. Subcommittee on Benefits. 
Hearing. Hearing on H.R. 348, H.R. 843, H.R. 1735, H.R. 2206, 
H.R. 2612, H.R. 3936, H.R. 4065, H.R. 4172, H.R. 4173 and a 
draft bill.

    May 6, 2004. OPEN. 9:30 a.m. Subcommittee on Health. 
Hearing. Hearing on H.R. 4020, State Veterans' Homes Nurse 
Recruitment and Retention Act of 2004; H.R. 4231, Department of 
Veterans Affairs Nurse Recruitment and Retention Act of 2004; 
H.R. 3849, Military Sexual Trauma Counseling Act of 2004; H.R. 
4248, Homeless Veterans Assistance Reauthorization Act of 2004; 
and a draft bill to reform the qualifications and selection 
requirements for the position of the Under Secretary for 
Health.

    May 13, 2004. OPEN. 9:30 a.m. Subcommittee on Health. 
Markup. H.R. 4231 and H.R. 4248.

    May 13, 2004. OPEN. 11:00 a.m. Subcommittee on Benefits. 
Markup. H.R. 1716, H.R. 3936, H.R. 4175 and H.R. 4345.

    May 18, 2004. OPEN. 10:30 a.m. Full Committee. Hearing. 
Oversight Hearing on Homeless Assistance Programs for 
Veterans--Implementation of Public Law 107-95, the Homeless 
Veterans Comprehensive Assistance Act of 2001, and Status of 
the National Goal to End Chronic Homelessness by 2011.

    May 19, 2004. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Department of Veterans Affairs 
Role in the Future of Electronic Health Records.

    May 19, 2004. OPEN. 2:30 p.m. Full Committee. Markup. H.R. 
1716, H.R. 3936, H.R. 4175, H.R. 4231, H.R. 4248 and H.R. 4345.

    June 7, 2004. OPEN. 9:30 a.m. Newington VAMC, Connecticut. 
Subcommittee on Health. Hearing. Oversight Hearing on 
Optimizing Facilities and Improving the Delivery of Health Care 
and Services to Veterans in the State of Connecticut.

    June 16, 2004. OPEN. 11:00 a.m. Subcommittee on Benefits. 
Hearing. Room 340 Cannon HOB. Hearing on H.R. 4032, and draft 
bill, the Veterans Self-Employment Act of 2004.

    June 17, 2004. OPEN. 10:00 a.m. Full Committee. Follow-up 
Hearing on Efforts to ldenti1)r and Eliminate Fraud, Waste, 
Abuse, and Mismanagement in Programs Administered by the 
Department of Veterans Affairs.

    June 23, 2004. OPEN. 10:00 a.m. Full Committee. Hearing. 
Hearing on Protecting the Rights of Those Who Protect Us: 
Public Sector Compliance with the Uniformed Services Employment 
and Reemployment Rights Act and Improvement of the 
Servicemembers Civil Relief Act. Testimony also heard on H.R. 
3779 and H.R. 4477; and two draft bills, the USERRA Health Care 
Coverage Extension Act of 2004; and the Servicemembers Legal 
Protection Act of 2004.

    June 24, 2004. OPEN. 9:30 a.m. Subcommittee on Health. 
Hearing. Hearing on a draft bill, the Department of Veterans 
Affairs Real Property and Facilities Management Improvement Act 
of 2004.

    July 8, 2004. OPEN. 9:30 a.m. Subcommittee on Health. 
Markup. H.R. 4768.

    July 15, 2004. OPEN. 2:00 p.m. Subcommittee on Benefits and 
Subcommittee on Workforce Empowerment, and Government Programs, 
Committee on Small Business. Joint Hearing. Room 311 Cannon 
HOB. Excellence in Action: Government Support of Disabled 
Veteran-Owned Business.

    July 21, 2004. OPEN. 10:00 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Fourth Hearing on the VA's 
Progress in the Third Party Collections Program and 
Implementation of the Patient Financial Services System.

    July 21, 2004. OPEN. 1:15 p.m. Full Committee. Markup. H.R. 
1318, H.R. 4658, H.R. 4768 and H.R. 4836.

    July 22, 2004. OPEN. 9:30 a.m. Full Committee. Hearing. 
Hearing on the Evolution of VA-DOD Collaboration in Research 
and Amputee Care for Veterans of Current and Past Conflicts, as 
well as Needed Reforms in VA Blind Rehabilitation Services.

    August 26, 2004. OPEN. 10:00 a.m. Full Committee. Hearing. 
Ten Years After 9/11: Is VA Prepared to Fulfill Its Roles in 
Homeland Security?

    September 21, 2004. OPEN. 10:00 a.m. House and Senate 
Veterans' Affairs Committees. Joint Hearing. 345 Cannon HOB. 
The legislative priorities of The American Legion.

    October 6, 2004. OPEN. 9:30 a.m. Subcommittee on Oversight 
and Investigations. Hearing. Hearing on the Department of 
Veterans Affairs Smart Card Projects.

                           COMMITTEE WEB SITE


                         WWW.VETERANS.HOUSE.GOV

    The Committee on Veterans' Affairs operates, maintains, and 
updates a web site (veterans.house.gov) containing 
comprehensive and timely information on Committee activities, 
federal actions, and other news of interest to veterans. The 
web site contains thousands of pages of information, organized 
into nine sections: About the Committee; About the Chairman; 
Committee News; Committee Hearings; Committee Documents; 
Veterans' Legislation; VA Benefits; VA Health Care; and 
Veterans Links.
    The website was redesigned and re-launched in the 107th 
Congress in order to make it more functional, informative, and 
aesthetically pleasing. Subsequently, in March of 2003, the web 
site was honored by the Congress Online Project as one of the 
very best web sites among all 610 congressional web sites 
reviewed. The Committee web site received a grade of ``A'', 
making it one of only 26 web sites to receive a ``Silver Mouse 
Award'' in 2003.
    The transformation of the Committee's web site continued 
during the 108th Congress with a redesigned section on 
veterans' benefits, and a major new Committee Spotlight feature 
on the 60th anniversary of the GI Bill. Both of these expanded 
sections provide web site visitors with a wealth of 
information, both historical and current. Throughout the 108th 
Congress, the Committee continued to enhance the web site with 
additional links and information of interest to our target 
audiences: veterans, Congress, and other individuals and 
organizations interested in public policy concerning veterans.

                   OVERSIGHT PLAN FOR 108th CONGRESS


    In accordance with clause 2(d)(1) of Rule X of the House of 
Representatives, the Committee on Veterans' Affairs on February 
11, 2003, adopted its oversight plan for the 108th 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 
108th Congress, the Committee and its subcommittees will 
undertake additional oversight activities as the need arises.

    1.   VA-administered Insurance Program. The Department of 
Veterans Affairs (VA) administers six life insurance programs 
under which two million policies with a value of $20 billion 
remained in force at the end of fiscal year 2002. The committee 
will examine policy and operational issues VA faces in 
operating the seventh largest insurance program in the United 
States.

    2.   Non-Service-Connected Pension Program. The non-
service-connected disability pension program provides financial 
assistance to more than 348,000 low-income veterans. Veterans 
must have at least 90 days of military service, including at 
least one day of wartime service, and be totally and 
permanently disabled for employment purposes as a result of 
disability not related to their military service, or over age 
65. The committee will examine the administration of this 
program.

    3.   Improvements in Timeliness of Claims Processing. VA 
provides over $22 billion a year in disability compensation and 
pension benefits to more than 2.4 million veterans. The 
Veterans Benefits Administration (VBA) has made many 
improvements to its operations, including realigning its field 
offices to improve control of claims and shifting its focus 
from resource management to workload management. The committee 
will focus on the General Accounting Office's December 2002 
report, Veterans Benefits: Claims Processing Timeliness 
Performance Measure Could be Improved (GAO-03-282).

    4.   State of Veterans' Employment and Training. From May 
1997 to June 2001, the General Accounting Office (GAO) issued 
eight reports criticizing the Veterans' Employment and Training 
Service, Department of Labor, for deficiencies in performance, 
management, and strategic planning. Public Law 107-288, the 
Jobs for Veterans Act, reformed the nationwide veterans' 
employment and training delivery system, focusing on 
accountability, flexibility, incentives, and results. Further, 
Public Law 106-50, the Veterans Entrepreneurship and Small 
Business Development Act of 1999, increased small business 
opportunities for veterans and disabled veterans by improving 
their access to capital, information, and markets. The 
committee will examine implementation of these two laws.

    5.   Troops-To-Teachers. The Troops-To-Teachers program 
services as an alternative route to teacher certification for 
military servicemembers and retirees who seek a second career 
as a public school teacher. The program is funded by the 
Department of Education. The committee plans a joint hearing 
with the Committee on Education and the Workforce. The 
committees expect to examine the skills and experience that 
veterans bring to teaching, as well as the administration of 
the program.

    6.   Role of the Board of Veterans' Appeals in the 21st 
Century. The Board of Veterans' Appeals (BVA) is the component 
of the VA responsible for making the final Departmental 
decision on behalf of the Secretary in appeals of veterans' 
benefits claims. Since the advent of judicial review of appeals 
of veterans' claims in 1988, the essential mission of BVA has 
remained relatively unchanged. The committee will examine how 
to most effectively use the Board's expertise and resources in 
serving veterans.

    7.   Quality Assurance for Disability Claims at the Board 
of Veterans' Appeals. Veterans who are dissatisfied with a 
decision made by a VA regional office may appeal that decision 
to BVA. During fiscal years 1999 and 2000, BVA decided an 
average of 35,000 appeals per year. GAO reviewed the quality 
assurance program at the Board and the Board's collection of 
data to improve the quality and consistency of its decisions on 
veterans' claims. The committee will focus on the GAO's August 
2002 report, Veterans' Benefits: Quality Assurance for 
Disability Claims and Appeals Processing Can Be Further 
Improved. (GAO-02-806).

    8.   Vocational Rehabilitation and Employment. VA's 
Vocational Rehabilitation and Employment (VR&E) program 
provides services and assistance to enable veterans with 
service-connected disabilities to obtain and maintain suitable 
employment, and to enable certain other disabled veterans to 
achieve independence in daily living. The committee will 
examine VR&E's focus on suitable employment, assistance to the 
most seriously disabled veterans, succession planning, 
contracted services, claims processing, employer outreach and 
quality assurance.

    9.   Office of Federal Contract Compliance Programs. The 
Office of Federal Contract Compliance Programs (OFCCP) is an 
enforcement agency within the Department of Labor. In addition 
to other equal employment laws, OFCCP enforces the Vietnam Era 
Veterans' Readjustment Assistance Act of 1974 (VEVRAA). The law 
requires that employers with Federal contracts of $100,000 or 
more provide equal opportunity and affirmative action for 
certain veterans. The Federal government awards prime contracts 
worth approximately $200 billion per year. The committee will 
examine OFCCP's recent investigatory and enforcement actions 
related to VEVRAA, staffing matters, and the general complaint 
process.

    10.  Fiduciary Activities. When a probate court or VA 
rating board determines an adult VA beneficiary is incompetent, 
VBA personnel assess the need for a fiduciary, appoint an 
appropriate person or entity to manage the beneficiary's funds, 
and monitor the management of those funds. As of December 31, 
2002, VBA personnel supervised the management of funds for more 
than 100,000 incompetent beneficiaries. VA's Inspector General 
has begun conducting Combined Assessment Program reviews at VBA 
regional offices. The most recent summary report (Report No. 
02-01811-38) indicates that improvement with regard to 
Fiduciary and Field Examination activities is needed at more 
than 50 percent of the regional offices reviewed between June 
2000 and September 2002. The committee will determine the 
extent of problems with VBA's fiduciary program and 
recommendations for improvements.

    11.  Meeting the Health Care Needs of Veterans. Despite 
record budget increases, the growing demand for health care is 
outpacing the resources allotted to VA for veterans' health 
care. The committee will evaluate factors that contribute to 
the loss of current services, long waiting times and delayed or 
denied care. The committee will also review the recommendations 
of the President's Task Force to Improve Health Care Delivery 
for Our Nation's Veterans and any plans to implement the Task 
Force's recommendations.

    12.  Infrastructure Maintenance in VA Health Care and 
CARES. The VA health care system capital asset planning 
process, known as Capital Assets Realignment for Enhanced 
Services (CARES) II, is underway, with a scheduled date of 
completion during the 108th Congress. The committee is 
concerned about the cumulative effects of years of insufficient 
resources to adequately maintain VA's aging health care 
facilities. Many need significant maintenance, repair and 
modernization. The committee will review these needs and the 
implementation of CARES and its next phases.

    13.  Veterans Equitable Resource Allocation System. The 
Veterans Health Administration (VHA) adopted this system of 
allocating funds to its field health activities in April 1997. 
During the past year, the allocation model was revised. The 
committee will review the implementation, operation and 
effectiveness of the new Veterans Equitable Resource Allocation 
(VERA) model and its impact on veterans.

    14.  Management Improvements. The VA's plans in fiscal year 
2003 included saving $298 million by making management 
improvements, with an additional $800 million in savings 
proposed for fiscal year 2004. The committee will review the 
business practices, scope and success of VA management 
improvements.

    15.  VA and DOD Health Resources Sharing. Sections 721 
through 726 of Public Law 107-314 provided the most significant 
changes to VA-DOD sharing authority in its 20-year history. 
With new opportunities and incentives in place to conserve 
scarce federal health care resources and improve the delivery 
of services to the military-veteran community, the committee 
intends to continue its close oversight of VA-DOD resource 
sharing, especially implementation of the new legislation.

    16.  Status of VA Medical, Biological, Chemical and 
Radiological Research. VA medical research, in affiliation with 
the nation's leading schools of medicine, has been remarkably 
successful in curing human disease and advancing biomedicine. 
The committee has monitored VA research for a number of years 
and will continue to review it. Public Law 107-287 expanded the 
VA's role in homeland security and created new research centers 
to counter biological, chemical, and radiological terrorism and 
threats against active duty service members, veterans and the 
general public. Implementation of the new law will be carefully 
monitored.

    17.  Mental Health and Substance-Use Disorder Programs. 
Reported reductions in capacity of VA programs to care for the 
most seriously mentally ill veterans, especially those with 
psychoses and with substance-use disorders, continue to be a 
matter of concern. The committee will explore the state of VA's 
mental health programs and the effectiveness of chronic mental 
illness treatment programs in VA's institutional, contract, 
community-based, case-management and aftercare programs.

    18.  Follow-up on Millennium Act. Public Law 106-117, the 
Veterans Millennium Health Care and Benefits Act, was the most 
significant health care legislation Congress has enacted for 
veterans in a number of years. Since the law was enacted, VA 
has implemented many of its provisions. The committee will 
continue to give attention to the remaining steps VA must take 
to comply fully with its mandates and will provide oversight to 
those programs already implemented, including the effectiveness 
of pilot programs and the maintenance of capacity in VA's long-
term care programs.

    19.  Rural Health Care Matters. The committee is concerned 
about the health of veterans who live in rural and remote 
regions, particularly whether they have adequate access to VA 
health care and services. The emergence of VA telemedicine 
holds promise to extend VA services beyond major VA medical 
centers. The committee will examine the role of telemedicine in 
VA's efforts in rural care. Also, VA has promoted improved 
access through its community-based clinics, primary care 
outlets now numbering in the hundreds. The committee will 
explore geographic distribution of these clinics to determine 
if VA has adequately responded to rural veterans' needs, 
including investigation of the availability of mental health 
services in rural clinics.

    20.  Women Veterans' Programs. An Advisory Committee on 
Women Veterans was established in 1983 under Public Law 98-160 
to assess the health care, outreach, and benefits needs of 
women veterans and make recommendations to the Secretary of 
Veterans Affairs and Congress. VA medical centers have been 
mandated to designate women veterans' coordinators, in addition 
to providing specialized health services and outreach. The 
committee will continue to review VA policies and programs for 
women veterans.

    21.  Scarce Medical Specialty Contracting. The committee is 
concerned about medical specialty services obtained through 
government contracts. Some of these contracts are expensive 
compared to average costs for government-employed physicians. 
The committee will explore options for obtaining such physician 
specialty services in a cost-effective manner.

    22.  Personnel Legislation. Congress made significant 
changes in VA practitioner pay systems in Public Law 106-419, 
the Veterans Health Care Personnel and Benefits Act of 2000. 
The committee will examine VA's implementation of these changes 
and consider the need for additional legislation.

    23.  Prescription Drugs. The committee will examine VA's 
pharmaceutical program, including practices, costs and 
copayments for veterans, in order to assess the pharmaceutical 
services veterans receive.

    24.  Force Protection. The committee will continue to 
actively monitor DOD force protection practices and policies 
(especially those actions being taken by DOD in advance of 
military deployments overseas), and review measures taken by 
DOD to ensure VA will be able to appropriately identify and 
care for service-connected conditions of returning veterans in 
the event of war with Iraq. In addition, VA has announced it 
will double its research investment for Persian Gulf War 
Illnesses. The committee will continue to investigate issues 
linked to war-related illnesses and injuries.

    25.  The Deseret Test Center Project 112 and Shipboard 
Hazards and Defense Program. In the last session of the 107th 
Congress, the committee held a hearing to investigate potential 
health consequences to veterans involved in tests conducted 
through DOD's Deseret Test Center, known as Project 112, and 
Shipboard Hazards and Defense (SHAD). The committee will 
continue to monitor information from DOD and review whether 
active duty forces are being adequately protected and 
appropriately informed regarding their potential exposures.

    26.  Hepatitis C Programs. The committee will examine VA's 
response to the incidence of hepatitis C virus (HCV) infection 
among its patient population and the methods by which VA 
allocates and monitors funding for education, screening and 
treatment of HCV.

    27.  Medical Care Collection Fund/Medicare Remittance 
Advice. VA collects over $680 million per year from third party 
insurers for medical care provided to veterans with health care 
insurance. The committee will examine what progress has been 
made by the VA since the September 20, 2001, hearing on this 
issue. The committee will review improvements in collection 
procedures, cost of collections, cost of care provided to 
veterans, and outsourcing initiatives.

    28.  Fugitive Felon Program. Prior to 2002, veterans and 
dependents wanted by United States law enforcement authorities 
for committing felony criminal acts were eligible to receive VA 
benefits while fleeing from justice. Based on a legislative 
proposal presented by the VA Inspector General, the 107th 
Congress enacted Public Law 107-103, prohibiting specified VA 
benefits to be paid or provided to fugitive felons and 
dependents. The committee will review the implementation of 
this program.

    29.  Cemetery Standards of Appearance. The committee will 
examine what steps the National Cemetery Administration should 
take to ensure the appearance of the cemeteries it maintains 
meets the standards defined in the Logistics Management 
Institute's 2002 report, Cemetery Standards of Appearance.

    30.  National Personnel Records Center. The National 
Personnel Records Center (NPRC) is responsible for maintaining 
the official military personnel records of discharged members 
of the Armed Forces. The committee will examine NPRC's external 
role in VBA's processing of veterans claims and what 
improvements are needed to ensure timely retrieval of records.

    31.  Hearing on VA's Biomedical Research Program. The 
committee will review VA research developments, with a 
particular focus on Parkinson's disease, Alzheimer's disease 
and diabetes research.

    32.  VA Research. The committee will examine the 
relationship between the Office of Research Compliance and 
Assurance (ORCA) and the Office of Research and Development. 
The committee will also conduct a follow-up review of ORCA's 
report on the accreditation of human subject protections, and 
related issues including the indirect costs associated with the 
National Institute of Health (NIH) research at VA. The 
committee will examine the impact of VA coverage of all 
indirect costs associated with research on VA healthcare.

    33.  VA Information Technology Programs. The committee will 
continue its oversight of VA's IT programs to review progress 
being made with implementation of its integrated enterprise 
architecture plan and efforts to improve its internal and 
external cyber security.

    34.  Nursing Shortages. VA continues to have a difficult 
time retaining and recruiting registered nurses. The committee 
will examine short-term and long-term implications of this 
nationwide problem and what actions VA should take to address 
this nursing shortage.

    35.  VHA's 4th Mission, Preparedness and Capacity. The 
events of September 11th, 2001, raised the national awareness 
of the role of the Federal Government in times of emergency or 
disaster. The committee will review VA's role and 
responsibilities in emergency and disaster response.

    36.  VA Contract Nursing Home Safety. The various states 
have differing standards for inspecting nursing homes. The 
committee will review VA's role in oversight of nursing homes 
with VA contracts.

    37.  Prioritization of Veterans Health Care. VA has 
established a new "Category 8" classification for veterans who 
have higher incomes and do not suffer from military service 
related disabilities or health problems. In 2002, over half the 
830,000 veterans who enrolled for VA health care were 
classified as Category 8. The committee will examine the effect 
that Category 8 veterans have on VA's budget and health care 
delivery.

    38.  VA Physicians' Duty Assignments and Timekeeping. The 
VA Inspector General's Combined Assessment Program Reviews have 
cited the need for VA medical centers to do a better job of 
monitoring their part-time physicians who hold a joint 
appointment with the VA and an affiliated university. The 
committee will examine VHA physician accountability.

    39.  VA Senior Executive Service Bonuses. The committee 
will examine VA's bonus practices for its Senior Executive 
Service employees. The committee will review GAO's September 
2002 report, Results-Oriented Cultures, Using Balanced 
Expectations to Manage Senior Executive Performance (GAO-02-
966), which used VBA as a case study. The examination will 
focus on discrepancies between rewards and performance.

    40.  VA Sourcing Decisions. The President's Management 
Agenda encourages government agencies to outsource work that 
can be accomplished commercially. The committee will hold a 
hearing to examine VA's efforts to comply with this goal.

    41.  Veterans Preference/VETS-100 Report. The Department of 
Labor's Office of the Assistant Secretary for Policy (OASP) and 
Veterans' Employment and Training Service (VETS) developed a 
system designed to help veterans determine the type of Federal 
employment preferences to which they are entitled, the benefits 
associated with the preferences and the steps necessary to file 
a complaint due to the failure of a Federal agency to provide 
those benefits. The committee will review the enforcement of 
the veterans' preference laws by the Department of Labor. The 
committee will also review the VETS-100 Report, which companies 
must file showing the number of targeted veterans in their work 
force by job category, hiring location and number of new hires. 
The committee will evaluate the VETS-100 report to determine 
employer compliance with veterans preference laws.

    42.  The Civilian Health and Medical Program of the 
Department of Veterans Affairs. There are approximately 160,000 
Civilian Health and Medical Program of the Department of 
Veterans Affairs (CHAMPVA) beneficiaries who generate over 1.7 
million medical claims. Annual program expenditures are 
approximately $160 million, with claims totaling around $145 
million. The committee will review the effectiveness of program 
management controls for duplicate claims payments, eligibility 
verification, and recovery for fraudulent claims payments. The 
committee will also review how the recently authorized CHAMPVA 
for Life program is being implemented.

    43.  Controlled Substances Security. The VA IG's Combined 
Assessment Program Reviews have consistently cited material 
weaknesses in VA medical center security for controlled 
substances. Weak security increases the potential for waste, 
fraud, abuse, and drug diversion. The committee will examine VA 
efforts to address this issue.

    44.  The Uniformed Services Employment and Reemployment 
Rights Act. Under the Uniformed Services Employment and 
Reemployment Rights Act (USERRA), reserve component service 
members called up active duty have the right to return to their 
employment upon leaving active duty. In light of the current 
mobilizations of the reserve components, the committee will 
examine the effectiveness of USERRA for returning service 
members.
 REPORT TO THE COMMITTEE ON THE BUDGET FROM THE COMMITTEE ON VETERANS' 
AFFAIRS, SUBMITTED PURSUANT TO SECTION 301 OF THE CONGRESSIONAL BUDGET 
ACT OF 1974, ON THE BUDGET PROPOSED FOR FISCAL YEAR 2004, MARCH 7, 2003


                         LETTER OF TRANSMITTAL

                              ----------                              

                          House of Representatives,
                            Committee on Veterans' Affairs,
                                  Washington, DC, February 28, 2003
Hon. Jim Nussle,
Chairman, Committee on the Budget
House of Representatives, Washington, DC

    Dear Mr. Chairman: Enclosed with this letter is the report of the 
Committee on Veterans' Affairs on the fiscal year 2004 budget for 
veterans' benefits and services.
    The Committee has carefully reviewed the Administration's budget 
proposal for the Department of Veterans Affairs (VA). On February 11, 
2003, the Committee held a hearing to receive the testimony of the 
Secretary of Veterans Affairs and veterans service organizations on the 
Administration's proposed budget, as well as views on the Independent 
Budget proposed by four major veterans organizations. While the 
Administration has again proposed a substantial increase in the budget 
for veterans' affairs, there remains a gap between the level of 
resources it would provide and that needed to meet unprecedented growth 
in demand for VA health care. There is also a serious backlog of 
maintenance and repair projects necessary to transform many of our 
National Cemeteries from neglected graveyards to national shrines.
    The Administration's proposed fiscal year 2004 budget requests 
total resources for the medical care business line of $27.5 billion, a 
net increase of $2 billion over the fiscal year 2003 level for 
equivalent accounts; of this $2 billion, only $1.5 billion is 
appropriated funds. Of the total increase requested in the 2004 budget, 
about $525 million would come from increased collections. Payments by 
veterans for VA health care are projected to increase by $187 million 
due to several proposed policy changes; increased collections from 
third parties account for $349 million of the $525 million projected 
increase, with proposed legislative changes accounting for $69 million 
of this amount. Adoption of these policies would result in a 
significant reduction in demand for VA health care from veterans who do 
not have a compensable service-connected disability and who are not 
poor.
    The VA's ability to provide long-term care would be severely 
impaired by the Administration's proposal to close about 5,000 of its 
12,000 nursing home beds. Given the expected number of elderly veterans 
from World War II and the Korean War who are expected to seek nursing 
home care over the next ten years, the Committee is strongly opposed to 
any proposal that would result in the closure of even a single VA 
nursing home bed.
    The Administration's health care budget also is predicated on 
achieving ``management efficiencies'' totaling $950 million. Previous 
VA budgets contained similar proposals, and while the Committee does 
not wish to discourage efforts to make VA health care more efficient, 
there is little evidence that such savings have been or will be 
achieved. Thus, the Committee is reluctant to rely on projections of 
this magnitude as a substitute for funding veterans' health care.
    The Committee observes that funding for veterans' health care has 
become one of the most contentious topics year after year, and that it 
is nearly impossible to manage veterans' health care on a rational, 
business-like basis with the current unreliable funding situation. The 
Committee is convinced that veterans' health care funding must be put 
on a more firm foundation that matches funding with the actual number 
of veterans who seek care from VA. Consequently, the Committee believes 
that Congress should make a commitment to funding VA health care for 
enrolled veterans on a fiscally responsible and guaranteed basis, and 
the Committee recommends that the Budget Committee provide for this 
funding change in the budget resolution.
    For veterans' entitlement benefits, the Administration proposes 
$33.4 billion in entitlement programs for compensation, pensions, 
education, vocational rehabilitation and employment, housing, insurance 
and burial. The Committee recommends legislation that would permit 
surviving spouses of veterans killed on active duty to retain their VA 
benefits if they remarry after age 55. Every other Federal survivor 
benefit permits the continuation of benefits to spouses who remarry 
after a certain age.
    College Board data show the current $900 Montgomery GI Bill monthly 
rate would need to be $1,496 for a veteran-student to attend a four-
year public college as a commuter student. The Committee recommends an 
incremental increase in basic monthly benefits to $1,200, and 
elimination of the initial $1,200 participation fee servicemembers must 
pay. The total first-year cost of these and other benefit enhancements 
is estimated by the Committee to be $701 million, and the Committee 
strongly recommends that these benefit improvements be accommodated in 
the 2004 budget resolution.
    The Administration budget also requests $422 million to pay burial 
benefits to veterans' families, operate 121 National Cemeteries, 
develop new national cemeteries, expand existing cemeteries, and 
establish or expand state veterans' cemeteries. The Committee welcomes 
this initiative, but believes that an additional $65 million is needed 
to address the $279 million in recently identified cemetery maintenance 
and restoration projects.
    Although the VA has made considerable progress in implementing a 
number of recommendations made by a task force that studied the 
benefits claim backlog, the Administration's budget inexplicably does 
not provide any additional funding to continue implementation of a 
number of recommendations. The Committee recommends a modest increase 
of $12 million to implement these recommendations, as well as $17 
million to retain existing staffing in VBA's various programs.
    We believe the increases recommended by the Committee and more 
fully justified in the accompanying views and estimates for fiscal year 
2004 are necessary to adequately fund veterans programs. We 
particularly wish to reiterate that Congress must find a better way to 
fund veterans' health care in order to meet the obligation to care for 
those who have answered the Nation's call to duty.
    We thank the Committee on the Budget for considering our 
recommendations and look forward to continued discussion on these 
important issues.

                                        Sincerely,

Christopher H. Smith,            Lane Evans,
Chairman                         Ranking Democratic Member

                                 ______
                                 

                BACKGROUND AND COMMITTEE RECOMMENDATIONS


                     Department of Veterans Affairs


                     VETERANS HEALTH ADMINISTRATION

    The Status of VA Health Care.--Beginning in the mid-1990s, 
the Department of Veterans Affairs accelerated internal reforms 
of its health care delivery system for veterans, greatly 
emphasizing primary and managed care, while expanding sites of 
clinical service. Today, VA health care is widely available to 
millions of veterans in 1,300 locations, ranging from major 
urban academic medical centers to rural storefront clinics. VA 
health care is recognized for its world-class patient safety 
program and provides veterans a measurable advantage in quality 
of care. As provided by law, VA manages veterans' access to 
care through a formal enrollment system. Through outreach VA 
has enrolled nearly seven million veterans, about five million 
of whom are regular patients.
    While the number of veterans enrolled in VA medical care 
has increased dramatically, appropriated funding is not keeping 
pace with the growth in enrollment or the increased needs of 
elderly veterans. Further, much of VA's capital infrastructure 
(hospitals and clinics) is outdated or not receiving adequate 
maintenance. Many VA health care structures are subject to 
severe seismic risk and some, in fact, have been damaged by 
earthquakes in recent years. Some obsolescent facilities need 
complete replacement.
    In July 2002, VA reported to Congress that it estimated 
that 310,000 veterans were waiting more than six months for 
initial appointments. By December 2002, that number had been 
reduced to 236,000, but two-thirds of these were new enrollees, 
not respondents to the initial data review from July.
    The Secretary of Veterans Affairs, the Honorable Anthony J. 
Principi, on February 11, 2003, presented the VA's budget 
request for fiscal year 2004 to the Committee. In his 
testimony, the Secretary observed: ``[t]he demand for VA health 
care has risen dramatically in recent years. From 1996 to 2002, 
the number of patients to whom we provided health care grew by 
54 percent. Among veterans in Priority Groups 7 and 8 alone, 
the number treated in 2002 was about 11 times greater than it 
was in 1996.''
    The Department has confirmed to the Committee that in the 
current fiscal year, it projects a shortfall in resources of 
$1.9 billion to meet the anticipated needs for medical services 
of those already enrolled. At the Committee's hearing on the 
state of the VA health care system on January 29, 2003, the 
Under Secretary for Health, the Honorable Robert H. Roswell, 
testified that to adequately meet the needs of VA's core 
constituency of service-disabled and poor veterans, the 
Veterans Health Administration would require annual budgetary 
increases of 13 to 14 percent. The Department received a record 
health care funding increase of 11 percent from the omnibus 
appropriations bill signed by the President on February 20, 
2003, Public Law 108-7. This increase, however, did not address 
the reported $1.9 billion shortfall.
    The FY 2004 budget proposes closing 5,000 VA nursing home 
beds at a time when older veterans' needs for nursing home care 
are growing. VA would substitute non-institutional 
alternatives, as well as state and community nursing home beds 
for these VA nursing home beds, but does not request sufficient 
resources to match the level of capability eliminated by 
removing these beds from service. VA also proposes that 
Congress double VA's prescription copayment for some veterans. 
The Secretary of Veterans Affairs already has the authority to 
increase copayments when necessary without intervening action 
by Congress, provided the copayment does not exceed the actual 
cost for these drugs. In February 2002, VA more than trebled 
the prescription copayment amount. The Committee does not 
recommend additional increases.
    The Administration proposes that Congress impose an annual 
enrollment fee of $250 on Category 7 and 8 veterans. The 
Committee is concerned about ramifications of such a policy and 
is opposed to its enactment as a solution to VA's recurring 
financial problems. Other alternatives to resolving VA's 
funding deficits should be exhausted before imposing this 
additional cost on veterans. Proposals designed to discourage 
veterans' use of services could prove unnecessary, for example, 
with passage of a meaningful drug benefit. The Committee 
recommends an additional $773 million to account for needs 
associated with retention of nursing home beds, expansion of 
alternative programs and maintaining veterans' access to care.
    The Committee notes that the Secretary of Veterans Affairs 
has announced an agreement in principle with the Secretary of 
Health and Human Services to execute an agreement under the 
Medicare Part C program so that VA facilities with available 
capacities may participate in a ``VA+Choice'' managed care plan 
for a small number of Priority 8 veterans now temporarily 
excluded from direct enrollment in VA health care. Also, over a 
quarter million veterans currently enrolled in VA care are 
simultaneously enrolled participants in the military TRICARE 
program; the VA should actively seek greater cooperation from 
the Department of Defense in coordinating benefits for military 
retirees who are enrolled as veterans in the VA health care 
system.
    If a private or other public health insurance plan covers a 
veteran, whether through a private employer or the Federal 
government, VA should have access to that information. The 
Committee supports the Administration's proposal to make 
accurate insurance disclosure a requirement and expects to 
report legislation providing this authority along with other 
measures, such as deeming VA a preferred provider for purposes 
of receiving payment from managed care organizations. These new 
authorities would aid VA's collections program.

    Inflation.--The medical care component of the Consumer 
Price Index (CPI) continues to escalate, outpacing all other 
items in the CPI for the past seven years. The Bureau of Labor 
Statistics (BLS) released inflation rate data in December 2002 
that showed the overall health care inflation rate was 5 
percent for calendar year 2002. Within that level, hospital 
care inflation was the highest single component at 10.2 
percent, followed by prescription drugs and medical supplies at 
6 percent. An experimental price index Congress directed BLS to 
develop also reveals that persons 65 years of age and over are 
spending more than twice as much on health care as the total 
population. During the Committee hearing on January 29, 2003, 
Dr. Roswell testified as follows:

          One of the things that we have determined is that in 
        a typical year, our expenses increase 6 to 7 percent by 
        new enrollment in Priorities 1 through 7. In addition 
        to that [enrollment growth], increased utilization, 
        because the veteran population ages, and health care 
        expenditures and health care utilization increase. With 
        every increasing year of age, particularly in an 
        elderly population, we have another 2 to 3 percent 
        incremental cost every year. So a 7 percent increase 
        associated with enrollment in our highest priority 
        groups, coupled with another 2 to 3 percent of 
        increased utilization costs, coupled with a 
        conservatively estimated health care inflation rate of 
        4.5 or 5 percent, yields a 13 or 14 percent per year 
        increase in the money available to take care of just 
        our core population of veterans.

    Rising Pharmaceutical Costs.--VA expects to spend about 
$4.4 billion this year on its pharmaceutical programs. VA's 
budget for prescription drugs has nearly doubled over the past 
three years and, at the current rate of growth, will exceed $7 
billion by the end of fiscal year 2008. A budget growth of such 
magnitude stems from both higher utilization of the program by 
veterans and increased use of new drugs. From December 2000 to 
December 2002, the Veterans Health Administration reported that 
enrolled veterans increased from 4.7 million to 6.7 million, 
with about 4.7 million expected to be active consumers of VA 
health care services. VA should request adequate funding to 
ensure that it remains capable of providing state of the art 
pharmaceutical drug treatment.

    Capacity and Demand for Long-term Care Services.--Public 
Law 106-117, the Veterans Millennium Health Care and Benefits 
Act of 1999, expanded VA's mission to provide and maintain 
specialized capacities to care for aging veterans. The 
Committee has been in regular communication with the Secretary 
concerning a noted decline in VA nursing home beds 
(approximately 2,000 beds). On May 8, 2002 the Secretary made a 
commitment to restore these beds to their prior level, provided 
that Congress appropriates an increase in VA's medical care 
appropriation for fiscal year 2003. In the omnibus 
appropriation approved by Congress on February 13, 2003, VA 
received $1.1 billion more than what was requested by the 
President for the period.
    The Committee is disappointed by the Secretary's proposal 
in this budget to close thousands of additional VA nursing home 
beds. VA's own long-term care model, based on the medical needs 
of its users, indicated a need for 17,000 new nursing home beds 
by 2020. The Committee does not believe that VA can replace 
5,000 nursing home beds with outpatient programs for elderly, 
chronically ill veterans.
    VA has never fulfilled the promise of its landmark mid-
1980's study, Caring for the Older Veteran. That study 
recommended large increases in both inpatient and alternative 
programs, such as respite, hospice, adult-day and home-based 
care, so that VA could approach the needs of World War II 
veterans with meaningful, health and end-of-life care programs, 
on both institutional and non-institutional bases. This has not 
been achieved.
    In order to aid the Department in maintaining its current 
nursing home bed level, the Committee recommends that VA's 
budget request be augmented by an additional $297 million. 
Furthermore, VA should fund effective alternatives to long-term 
care and reopen long-term care nursing beds which have been 
closed.

    Health Care for World War II Filipino Veterans.--Last year, 
the House approved legislation to authorize VA to provide 
health care to certain Filipino World War II veterans now legal 
residents or citizens of United States. The Administration 
supported this provision and the Secretary stated that VA would 
absorb the $12 million estimated cost of implementation in the 
Departments budget. The Committee recommends an additional $12 
million to support this proposal.

    Mental Health Programs for Disabled Veterans.--Over the 
past five years, the Department has shifted resources and 
programs away from institutional mental health care. However, 
as VA planned new community-based intensive case management 
programs, it was understood that sufficient resources would be 
preserved to provide an appropriate level of care for VA's 
chronically mentally ill patients.
    The VA Advisory Committee on Seriously Mentally Ill 
Veterans estimates the shift in resources from mental health 
programs may be as much as $600 million. VA has dramatically 
expanded its primary care clinics. While the Committee 
certainly supports the primary care clinics, VA should 
partially restore lost support for mentally ill veterans. Again 
this year the budget request does not address this need. The VA 
Program Evaluation Resource Center maintains a registry of 
veterans suffering with psychosis and bipolar disorder that 
contains 200,000 individuals. These veterans cannot be 
sustained medically without intensive efforts. Due to the 
nature of their illnesses, most cannot speak for themselves. 
Accordingly, the Committee recommends a number of funding 
adjustments in the following areas:

          1. Mental health intensive case management teams--The 
        Committee understands that VA presently operates about 
        50 intensive case management teams assigned to 
        aftercare of VA patients with serious and chronic 
        mental illness. Some of these teams that already had a 
        minimal staffing complement have recently suffered 
        reductions in staff. A fully functioning team's annual 
        average direct cost (primarily in staffing) is 
        approximately $400,000. The Committee recommends an 
        additional $40 million for fiscal year 2004 to fund 100 
        additional teams for a total of 150 Mental Health Care 
        Intensive Care Management teams to provide vulnerable 
        veterans better follow-up care and improved 
        coordination of community based services.
      22. Mental health in community primary care--The 
Department operates approximately 650 community based 
outpatient clinics nationwide. When VA made the decision to 
provide better access to community-based primary care, it did 
not sufficiently provide for mental health needs in these 
clinics. Approximately half of these facilities offer dedicated 
mental health services, but the remaining sites do not. The 
addition of qualified mental health staff to support effective 
professional services in these settings is a way to ensure that 
mental health care becomes more accessible and convenient. 
Adding a small cadre of mental health professionals at 
approximately 200 locations (according to their need) would 
provide a more complete service in VA community-based clinics. 
A $40 million enhancement to mental health capacity would also 
give VA better options to care for not only the de-
institutionalized chronically mentally ill, but also to provide 
new services to veterans with acute mental health needs who may 
not otherwise receive adequate care.
      3. Substance-abuse programs--VA Currently cares for 
130,000 veterans with substance abuse problems. Over the past 
decade, VA shifted its drug treatment programs from residential 
care to ambulatory-based programs. VA has acknowledged in its 
report under section 1706 of Title 38, United States Code, that 
capacity in the substance-abuse disorder programs is declining. 
The Committee believes these programs should be restored. 
Opioid-substitution programs are insufficiently available in VA 
facilities and some metropolitan areas do not provide enough 
care to meet the needs of the veteran population. The Committee 
recommends $20 million in additional funds to address these 
shortcomings.

    Medical Care Collections Fund.--VA is authorized to bill 
health care insurers for covered non-service-connected care 
provided to veterans. The Department projects medical care 
collections for 2004 to be $2.1 billion. This would be the 
largest one-year increase in collections in the program since 
Congress authorized it in 1986--32 percent above the estimated 
end-of-year collections for 2003. The Department is attempting 
to achieve this remarkable goal by implementing a revenue cycle 
improvement plan and collecting better, verifiable insurance 
information sooner in the process of patient care. VA also is 
pilot testing a business plan to reconfigure the revenue 
collection program with contracted efforts and commercial 
collections systems using standard practices.
    The Committee supports the Department's efforts at 
improving performance in first- and third-party collections, 
but the Committee remains skeptical that VA can achieve all it 
promises in fiscal year 2004. If VA fails to achieve its goal 
of such a significant one-year increase, veterans will be 
denied care to the extent of that failure. The Committee is 
unwilling to assume VA will be successful in increasing 
collections as promised. Assuming the Department can accomplish 
a 10 percent increase in collections in fiscal year 2004 over 
the current estimate for this year, the Committee recommends 
that $363 million be restored to Medical Care to account for 
the difference between VA's budget level and the practical 
effect of its actions.

    Management Improvements and Efficiencies.--The Department's 
2004 budget proposes to achieve management savings of $950 
million, three times the level of savings projected for fiscal 
year 2003, from management efficiencies and improvements. VA's 
plans include implementing a competitive out-sourcing plan, 
reforming the health care procurement process, increasing 
employee productivity, increasing health resources sharing with 
the Department of Defense, and continuing the trend of shifting 
patients from inpatient to outpatient levels of care.
    The Committee concludes that VA will be able to achieve 
only about a quarter of the management savings it has proposed 
in this budget. Therefore, the Committee recommends an 
additional $625 million for veterans' medical care.

    Homelessness Among Veterans.--With the passage of the 
Homeless Veterans Comprehensive Assistance Act of 2001, the 
Committee enunciated a goal of ending chronic homelessness in 
the veteran population within a decade. More than a year since 
enactment of this law, the Committee is not satisfied with VA's 
responsiveness to the mandates of this Act. Among some of the 
most effective activities that need additional funding are VA 
homeless domiciliaries; VA's grant and per diem program for 
community providers; and the so-called ``Health Care for 
Homeless Vets' initiative.'' VA also funds several programs in 
mental health and coordinates with other Federal agencies 
(principally the Departments of Housing and Urban Development, 
and Labor) to address veterans' homelessness. VA has yet to 
implement a prison and institutional outreach-transition 
initiative and a special needs authority provided in the Act.
    The Department has made a $5 million commitment to provide 
health care services and case management in a VA-HUD-HHS joint 
venture that would open 300-400 new beds in sites yet to be 
announced. VA is prepared to commit $10 million to provide 
dental services to homeless veterans as authorized in the Act. 
The Department has not made a transitional housing loan as 
authorized by 1998 legislation despite a commitment to do so. 
The Committee rejects the VA proposal that Congress convert the 
transitional housing loan program to a grant program.
    The Act authorized funding of $75 million for the several 
in-house homeless assistance programs for fiscal year 2003, but 
VA is requesting no funding in its budget. Also, the Act 
authorized $5 million for homeless domiciliaries in fiscal year 
2003, and an additional $5 million in 2004. VA made no request 
for these funds. The Committee recommends that $75 million be 
added to the VA's budget to address the still unmet needs of 
about one-quarter million homeless veterans.

    Medical and Prosthetic Research.--The Department carries 
out an extensive array of research and development as a 
complement to its affiliations with medical and allied health 
professional schools and colleges nationwide. While these 
programs are specifically targeted to the needs of veterans, VA 
research has defined new standards of care that benefit all 
Americans. Among the major emphases of the program are aging, 
chronic diseases, mental illnesses, substance-use disorders, 
sensory losses, and trauma-related illnesses. VA's research 
programs are internationally recognized and have made important 
contributions in virtually every arena of medicine, health, and 
health systems.
    The Secretary has requested a 2004 budget for VA Medical 
and Prosthetic Research of $408 million, an increase of $8 
million or 2 percent over the fiscal year 2003 level. The 
Committee strongly supports an increase in the research account 
to $460 million (15 percent) in 2004, as recommended by both 
the Independent Budget as well as the Friends of VA Research 
coalitions. The Committee believes this additional funding is 
needed in VA's research programs to keep pace with funding 
developments in the Federal biomedical research community. A 16 
percent funding increase was provided in the 2003 omnibus 
appropriations bill for the National Institutes of Health. 
Additional funding of $52 million in VA biomedical research in 
fiscal year 2004 would provide coverage for inflation and 
permit a small program expansion.

    Emergency Preparedness in Bio-Terrorism.--The Department of 
Veterans Affairs Emergency Preparedness Act of 2002 mandated VA 
to establish four national emergency preparedness centers and 
an educational curriculum for medical students and 
professionals for response to weapons of mass destruction. The 
Act authorized $20 million per year for the support of the 
centers. Due to unavailability of funds, the Department has yet 
to proceed with establishment of the centers. These centers are 
critical to enable VA to aid the Department of Defense and 
other Federal agencies to contend with the war on terrorism, 
and even more importantly, to aid VA in preparing itself to 
deal with the effects of the use of weapons of mass 
destruction. The Committee urges the Committee on the Budget to 
include $20 million to support the establishment of these new 
bio-terrorism research centers. The Act also authorized the 
establishment of an education program to be carried out through 
VA. The education and training curriculum would include a 
program to teach current and future health care professionals 
how to diagnose and treat casualties who have been exposed to 
chemical, biological, or radiological agents. The Committee 
also urges the Committee on the Budget to include an additional 
$5 million to support the requirement.

    Medical Administration and Miscellaneous Operating 
Expenses.--For national program administration, the Secretary 
proposed an increase in the Medical Administration and 
Miscellaneous Operating Expenses (MAMOE) account of $9.4 
million in fiscal year 2004. The budget requests a total of 
$87.5 million in MAMOE to provide improved corporate leadership 
and support to VHA. Specifically, by providing VHA a basis to 
increase staffing in national program administration from the 
fiscal year 2003 estimated level of 545 to a planned 588, this 
increase will have a beneficial effect on the development and 
implementation of policies, plans, and broad program 
activities. The increased funds are intended to help complete 
the restructuring of the Office of the Under Secretary for 
Health which began in 2002. Part of this restructuring is 
focused on the Capital Assets Realignment for Enhanced Services 
(CARES) process and the creation of a new Deputy Under 
Secretary for Health Policy to better coordinate federal health 
care benefits between various agencies, and to enhance the 
prospects for VA-DOD sharing. The Committee supports $87.5 
million as requested for MAMOE.

    CARES and the Continuing Needs of Veterans.--VA is 
continuing its initiative to identify the most effective and 
efficient use of its infrastructure in health care delivery to 
veterans. The Committee held a number of hearings during the 
107th and earlier Congresses dealing with VA's capital assets. 
VA hospitals were primarily built or converted after World War 
II to rehabilitate and care for wounded, sick and traumatized 
soldiers, sailors, airmen, and marines. For the past thirty 
years VA has gradually changed its health care approach from an 
institutional provider of physical medicine and rehabilitation, 
long-term psychiatry, and restorative care to that of an 
outpatient and acute primary care provider to serve an older 
population with chronic illnesses. The capital infrastructure 
built for its previous approach does not easily lend itself to 
VA's new delivery model.
    Even though VA's CARES process will take several years to 
complete, the Committee strongly believes that VA's most 
pressing capital infrastructure needs must be addressed. Due to 
the CARES process, in recent years VA has proposed few 
construction projects.
    Outside consultants and VA's own reports show a growing 
need and rising backlog of major and minor projects. For 
example, a 1998 Price Waterhouse report suggested VA, in 
proportion to the value of its $35 billion infrastructure, 
should be investing in the range of $700 million to $1.4 
billion annually on replacement and modernization projects. A 
second consultant report disclosed dozens of VA patient care 
buildings at the highest level of risk for earthquake damage or 
even collapse. Another report revealed $57 million in needed 
projects to protect women's privacy in VA health facilities.

    Major Construction Projects.--In the 107th Congress, the 
Committee authorized nearly $800 million in major medical 
facility construction needs, but little of this funding was 
appropriated. Last year, the Department advised Congress of its 
major construction priorities, as follows:

          1. Palo Alto, CA: This project would include seismic 
        corrections, correction of patient privacy 
        deficiencies, correction of fire safety deficiencies, 
        and functional improvements for the Mental Illness 
        Research, Education and Clinical Center.
          2. Cleveland, OH: This project would include the 
        replacement of all mechanical, electrical, and 
        architectural systems installed in this facility built 
        in 1961.
          3. San Francisco, CA: This project would seismically 
        upgrade the main inpatient building at the San 
        Francisco VA Medical Center.
          4. Anchorage, AK: This project would consolidate the 
        Alaska Veterans Affairs Health Care System and Regional 
        Office at Elmendorf Air Force Base, Alaska.
          5. West Los Angeles, CA: The upgrade of Building 500 
        would strengthen braced frames below the second floor, 
        strengthen collector plate connections to the braced 
        frames, and add new collector plates to transfer loads 
        in the central core area to the braced frames located 
        at the wings.
          6. West Haven, CT: This project would renovate three 
        inpatient wards to correct for patient privacy 
        inadequacies as well as consolidate associated support 
        services.
          7. Long Beach, CA: Building 7 of the VA Long Beach 
        Medical Center would be seismically upgraded and 
        retrofitted.
          8. Palo Alto, CA: Renovations would include seismic 
        corrections, correction of fire safety deficiencies, 
        and functional laboratory improvements in areas 
        formerly occupied by inpatient psychiatric wards. 
        Building 205, Menlo Park campus, would be demolished. 
        Most research personnel would be relocated.
          9. Tampa, FL: This project would relocate three 
        Spinal Cord Injury (SCI) inpatient wards and ancillary 
        support functions to a new SCI building.
          10. VISN 4 (PA, WV, NJ, DE, OH): This multi-facility 
        project would renovate and expand outpatient clinics at 
        seven different medical centers. Six of the eight 
        projects would renovate and expand primary and 
        specialty care clinic areas. The other two projects 
        would expand outpatient ambulatory surgery and 
        outpatient day programs.
          11. Beckley, WV: This project would consist of design 
        and construction of a nursing home care unit with 120 
        beds.
          12. Lebanon, PA: This project would reconfigure two 
        floors at the VAMC which is currently unfit to house 
        inpatients. A new elevator shaft and entrance would be 
        built to meet the needs of the patients.
          13. San Diego, CA: This project would seismically 
        strengthen the Medical Center by adding two new 
        exterior unbonded braced frames at the end of each 
        building wing, replacing the braces in all of the 
        existing braced frames with new unbonded braces, and 
        adding new collector elements.
          14. Hines, IL: A blind rehabilitation center 
        (authorized and appropriated in fiscal year 2002) would 
        be relocated and modernized.
          15. San Juan, PR: The air conditioning would be 
        repaired and overhauled in conjunction with asbestos 
        abatement and further seismic protections in three 
        areas in the existing basement, first, and second 
        floors.
          16. VISN 6 (WV, VA, NC): This multi-facility project 
        would renovate five VAMCs' Mental Health and Spinal 
        Cord Injury/Dysfunction Units. The project includes 
        privacy improvements, hazardous materials abatement, 
        window replacement, and HVAC and utilities upgrading.
          17. VISN 4 (PA, WV, NJ, DE, OH): This multi-facility, 
        VISN-wide project would renovate and upgrade seven 
        major VA medical centers for patient safety and 
        patient/employee welfare.
          18. Atlanta, GA: The renovations would correct 
        patient privacy issues, improve staff efficiencies, 
        improve the functional layout, and meet ADA 
        requirements and female patient issues.
          19. Tampa, FL: This project would provide 
        approximately 1,170 additional parking spaces for the 
        Tampa VA Medical Center.
          20. Washington, DC: This project would allow for 
        three new clinics to improve patient flow between 
        primary care and specialty care clinics.

    While the House passed an authorization measure supporting 
the completion of many of these high-priority projects, only 
the Hines, IL project on the above list received appropriations 
in fiscal year 2002. No funds for any of the other projects 
were appropriated in fiscal year 2003.
    The Committee understands that the sale of the 
underutilized VA Lakeside hospital in Chicago was expected to 
be a direct source of funding to improve the West Side VA 
facility as a key acute inpatient facility for the veterans of 
Chicago. VA indicates in the budget that CARES will provide the 
funding for the project which is now estimated at $98.5 
million, considerably less than the previous estimate.
    The Colorado University School of Medicine plans a major 
relocation of all its facilities to the site of the closed 
Fitzsimons Army Hospital. VA is considering whether to 
recommend replacement of the Denver VA Medical Center, a 50-
year-old structure now co-located with the Colorado medical 
school as a part of that relocation. These two meritorious 
projects alone, the West Side tower and the new Denver VA 
Medical Center, are estimated to cost nearly $500 million.
    In addition, there are many other worthy projects high on 
VA's established priority list that lack funds. Many are 
medical centers that will not be affected significantly by 
CARES and that are needed to continue providing good health 
care to veterans. The Committee will further explore these 
needs and will recommend projects to meet them. Consequently, 
the Committee recommends an additional amount of $500 million 
for the major medical facilities construction account in fiscal 
year 2004.

    State Home Grants Programs.--In 47 states, 114 homes for 
veterans provide nursing, domiciliary care, and adult day care 
to over 21,300 veterans whose care is coordinated with the 
Department of Veterans Affairs. States commit to pay 35 percent 
of the construction costs of projects for state home 
facilities, and to bear most of the cost of facilities 
operations and health care that exceeds amounts contributed by 
VA. Fiscal year 2003 applications totaling $287 million for new 
construction and renovation grants to state veterans homes are 
pending in the Department. A new round of requests will be 
solicited in April 2003 for fiscal year 2004 awards.
    Congress revised the state home program in Public Law 106-
117 to provide a higher priority for critically needed 
renovations in existing state homes, especially those projects 
involving fire and life safety improvements. Prior to enactment 
of P.L. 106-117, these long-delayed projects were given a lower 
priority for funding than grants for constructing new state 
home beds. Although VA has implemented the provisions of the 
Act affecting the ranking criteria for funding projects, 
renovation projects remain 63 percent of the overall backlog of 
unfunded projects. The budget requests $102 million to support 
the grant program, a two percent increase over the fiscal year 
2003 appropriated level. The Committee recommends additional 
funding of $30 million to support a more adequate VA response 
to the growing demand for long-term care facilities and to 
modernize and renovate existing facilities in the states' 
inventories. Provision of these funds will support the 
establishment of approximately 360 new nursing home and 
domiciliary beds in state veterans' homes.

                    VETERANS BENEFITS ADMINISTRATION

    Compensation and Pension Service.--The ability of VA to 
provide accurate, timely and quality benefits delivery is 
dependent on a number of factors, including an adequate number 
of properly trained staff, effective business process and 
computer modernization initiatives, accountability measures, 
inter-departmental cooperation between the various VA 
administrations and military service departments, including the 
National Personnel Records Center and the Center for Unit 
Records Research, and assistance from the veterans service 
organizations. Entitlement benefits are provided to 2.5 million 
veterans, more than 316,000 survivors, and 1,115 children.
    The President is requesting $29.9 billion and 8,586 FTEE to 
support the compensation and pension entitlement benefits 
programs. This represents a $3.4 billion dollar increase over 
the enacted fiscal year 2002 level, but a decrease of 190 FTEE 
is also proposed. The Committee is concerned that a decrease in 
FTEE could detract from continued improvements in claims 
processing. The Committee notes that a number of VBA employees 
have been called to active military service and that additional 
activations may adversely impact claims processing.
    Both the President and the Secretary have made timeliness 
and quality in claims adjudication a top priority, and have set 
a goal of adjudicating claims within 100 days by the summer of 
2003. In December 2002, the average days pending for a rating-
related claim were 168, reduced from a high of 203 days in 
January 2002. Additionally, the reported national accuracy rate 
increased from 78 percent in 2001 to 80 percent in fiscal year 
2002, with a target of 90 percent in 2004. VBA decreased its 
claims workload from 344,183 rating-related claims at the end 
of September 2002 to 328,566 as of December 2002.
    In October 2001, the VA Claims Processing Task Force made 
34 recommendations to improve claims processing. Of the 66 
action items, 38 have been implemented--28 completely and 10 
which are being monitored to ensure that the goals of the 
recommendations are being met. The Committee recommends $12 
million for VBA to implement the medium and long-term 
recommendations, to include hiring nurses and other medically-
trained individuals, including veterans who have worked as 
medical corpsmen or in similar military specialties, to work on 
compensation and pension claims, to establish a more permanent 
claims adjudication training cadre, and to out-base rating 
specialists at 70 of the largest VA medical centers.

    VBA Staffing for all Business Lines.--The Committee 
commends VBA for its recent improvements in claims 
adjudication; however, the Committee remains concerned that 
FTEE levels across the board are actually below the fiscal year 
2002 level. The Committee recommends an additional $17 million 
to sustain employment and other critical operational process 
improvements within VBA's major business lines: compensation, 
pensions, education, housing, vocational rehabilitation and 
employment, insurance and burial.

    Regional Office Staffing.--The Committee is concerned about 
the apparent lack of a long-term strategy for addressing the 
claims needs of veterans served by poorly performing regional 
offices. The Committee expects that VA will clearly articulate 
a plan for addressing this critical problem and will 
effectively use any funding for additional personnel to improve 
performance. The Committee also expects that VA would closely 
monitor the quality and productivity of any regional office 
that receives additional funding or staff.

    Homeless Veterans Coordinators.--Public Law 107-95 requires 
the Secretary to ensure that there is at least one full-time 
employee assigned to oversee and coordinate homeless veterans 
programs at each of the 20 regional offices that the Secretary 
determines have the largest homeless populations within the 
regions of VBA. The Committee understands that, although the 
offices have been designated and personnel nominally assigned 
as coordinators, some of these employees have multiple 
responsibilities and are not able to devote full-time efforts 
to addressing the needs of homeless veterans. The Committee 
expects that employees will be assigned to perform the 
oversight and coordination activities mandated by Public Law 
107-95 on a full-time basis and that general operating expense 
funding for fiscal year 2004 will be used to support the 
positions.

                    NATIONAL CEMETERY ADMINISTRATION

    The President is requesting $156 million for (1) National 
Cemetery Administration (NCA) operation and maintenance of 124 
national cemeteries and 33 soldiers' and sailors' lots in 
private or municipal cemeteries, monument sites and confederate 
cemeteries, and (2) VBA adjudication of veterans' death 
benefits. The President's budget request supports 1,588 FTEE in 
NCA--an increase of 69 FTEE from the Fiscal Year 2003 request--
and 177 FTEE in VBA, an increase of two FTEE over last year's 
request.
    The President is requesting $108.9 million to develop new 
national cemeteries, create additional gravesites at existing 
national cemeteries, and establish/expand state veterans 
cemeteries. The funds would be used to develop and/or expand 
cemeteries in the following locations:

      Detroit area, phase one development of a new 
national cemetery;
      Ft. Snelling, Minnesota, expansion of and 
improvements to national cemetery; and
      Barrancas National Cemetery, Florida, expansion 
of and improvements to national cemetery.

    The President's request does not provide funding for 928 
full-scale cemetery restoration and repair projects, estimated 
to cost $279 million, or funding for development of new 
national cemeteries beyond those currently in development in 
Pittsburgh, Sacramento, Southern Florida, and Atlanta. A study 
mandated by Public Law 106-117 of future burial needs 
determined that based upon 1990 census data, NCA would need to 
develop 31 new cemeteries by 2020 to meet the burial needs of 
veterans and their survivors. NCA is currently reevaluating 
that recommendation with recently available data from the 2000 
census.
    The National Cemetery Administration (NCA) maintains almost 
2.5 million gravesites at 124 national cemeteries in 39 states, 
the District of Columbia and Puerto Rico. Of these, 61 have 
available, unassigned gravesites for burial of both casketed 
and cremated remains; 26 will only accept cremated remains and 
the remains of family members for interment in the same 
gravesite as a previously deceased family member; and 33 are 
closed to new interments, but may accommodate family members in 
the same gravesite as a previously deceased family member.
    Occupied graves maintained by NCA are projected to increase 
from 2,380,500 in fiscal year 2000 to over 2,998,100 in 2008. 
VA is continuing to develop new cemeteries in areas not 
presently served by NCA: Atlanta, Georgia; Detroit, Michigan; 
Fort Sill, Oklahoma; Miami, Florida; Pittsburgh, Pennsylvania; 
and Sacramento, California. However, an independent study--
mandated in Public Law 106-117--of veterans' burial needs based 
on VA planning guidelines found that VA should establish 31 
additional cemeteries through 2020 to provide service to 90 
percent of veterans within 75 miles of their homes. This 
assumed a veteran population threshold of 170,000. This study 
was based upon data from the 1990 census. The Committee 
understands that the report is being updated to reflect 2000 
census data. Upon completion of that update, the Committee may 
direct the Secretary to begin the planning phase for the 
construction of seven new veterans' cemeteries in those areas, 
with a veteran population threshold of 150,000, that are deemed 
most in need between 2005 and 2020.
    The Committee recommends a five-year, $300 million 
restoration and improvements project at existing cemeteries. 
The Committee recommends an initial, first-year appropriation 
of $65 million for fiscal year 2004 to address this problem.

                       BOARD OF VETERANS' APPEALS

    The President is requesting $50.4 million and 448 FTEE to 
support its operations at the Board of Veterans' Appeals (the 
Board). In fiscal year 2002, the Board received 28,158 appeals 
and decided 17,231 appeals: 27.7 percent were granted in the 
veterans' favor, 19.3 percent were remanded to a regional 
office for further development, and 49.9 percent were denied. 
The Committee recognizes that due to a number of factors, 
including the large number of remands following enactment of 
legislation mandating the VA's ``duty to assist'' claimants, 
the number of appeals decided during fiscal year 2002 was 
unusually low. Based upon new appeals filed during 2002, the 
Committee expects that the number of decisions will return to 
more historic levels (between 30,000 and 40,000), assuming 
adequate staffing at the Board during future fiscal years.
    During the past year, the Board has begun to assist in 
developing some claims rather than remanding all of them to the 
regional offices. The Board has converted 31 attorney positions 
to support staff positions to staff the Evidence Development 
Unit. It appears the loss of these attorneys has had a 
significant impact on the Board's capacity to produce final 
decisions in a timely manner. According to the Fiscal Year 2002 
Report of the Board Chairman and the Administration's budget 
request, without additional FTEE, the Board will not be able to 
keep pace with the additional appeals it receives. With current 
staffing and a 25 percent productivity increase projected in 
the budget request, the Board is expected to develop a backlog 
of 6,000 to 8,000 appeals per year. However, no additional 
funding has been requested. The Committee expects that the 
Board will manage its operations to fulfill its primary 
function of deciding administrative appeals without developing 
an unacceptable backlog.

                          Department of Labor


               VETERANS' EMPLOYMENT AND TRAINING SERVICE

    The Jobs for Veterans Act, Public Law 107-288, redesigned 
the nationwide delivery system of veterans' employment and 
training services based on themes of incentives, results, 
accountability, and flexibility. In early December 2002, the 
Department of Labor (DOL) established a comprehensive work 
group of state and federal representatives to draft a broad 
plan for implementing the new law. The Committee commends this 
prompt action.
    The states reported an average Entered Employment Rate 
(percentage who register for work with the Job Service or a 
One-Stop Career Center and gain employment) for veterans for 
the first three quarters for fiscal year 2002 (October 1, 
2001--June 30, 2002) of 41 percent. For fiscal years 1999, 
2000, and 2001, the Entered Employment Rate for veterans 
averaged about 30 percent. The Committee views the improvement 
in Entered Employment Rate as a promising start.
    The most recent DOL-published unemployment rate data are as 
follows:

                          Average 2002 Unemployment Rates for Male and Female Veterans
----------------------------------------------------------------------------------------------------------------
                Age                             Male Veterans                         Female Veterans
----------------------------------------------------------------------------------------------------------------
All Ages                             4.7%                                 5.0%
20-24                                10.8%                                13.3%
25-34                                5.7%                                 5.5%
35-44                                5.3%                                 5.0%
45-54                                4.6%                                 3.4%
55-64                                4.2%                                 2.5%
----------------------------------------------------------------------------------------------------------------


                                             Average 2002 Unemployment Rates for Black and Hispanic Veterans
--------------------------------------------------------------------------------------------------------------------------------------------------------
                 Male/Female              Black/Hispanic
                                                                                         All Ages                                 20-24

--------------------------------------------------------------------------------------------------------------------------------------------------------
Black Male                                                                7.0%                                   17%
Black Female                                                              6.6%                                   23.9%
Hispanic Male                                                             4.7%                                   8.7%
Hispanic Female                                                           9.9%                                   21.6%
--------------------------------------------------------------------------------------------------------------------------------------------------------


    Further, according to the Bureau of Labor Statistics, 50.7 
percent of all disabled male veterans were in the labor force 
in August 2001. The unemployment rate for disabled male 
veterans was 4.4 percent. The unemployment rate for ``special'' 
disabled male veterans (rated at least 30 percent disabled by 
VA) was 8.5 percent. The Committee notes Public Law 107-288 
authorizes the Secretary of Labor to create a ``weighted'' 
placement system that provides greater job placement credit for 
harder-to-place veterans, such as those who are disabled or 
have other unique needs.
    The Administration is requesting $219,993,000 for VETS for 
fiscal year 2004: $162.415 million for state grants for 
Disabled Veterans Outreach Program Specialists and Local 
Veterans Employment Representatives, $29.028 million for 
federal program administration, $2 million for the National 
Veterans' Employment and Training Services Institute (NVESTI), 
$19 million for the Homeless Veterans' Reintegration Program 
(HVRP), and $7.55 million for the Veterans Workforce Investment 
Program. The fiscal year 2003 appropriation for VETS is 
$214,212,000. The Committee recommends an additional $1 million 
for the NVESTI. Congress authorized funding of $50 million for 
HVRP in Public Law 106-117.
    The Committee believes that the HVRP is one of the most 
cost effective job placement programs in the Federal 
government. During fiscal year 2002, DOL competitively awarded 
102 grants: 43 to non-profit organizations, 11 to faith-based 
organizations, and the remainder to state and local agencies. 
These grants resulted in the enrollment of 12,142 homeless 
veterans in the program. Of those enrolled, 6,605 successfully 
entered employment, despite in many cases having to overcome 
major obstacles to being employable. The Committee accordingly 
recommends an additional $31 million for HVRP.

 LEGISLATION THE COMMITTEE MAY REPORT WITH DIRECT SPENDING IMPLICATIONS

    Montgomery GI Bill.--The current Montgomery GI Bill (MGIB)-
Active Duty basic benefit is $900 per month, effective October 
1, 2002. This benefit increases to $985 per month effective 
October 1, 2003, per Public Law 107-103, enacted December 27, 
2001. The Committee recommends an increase in the MGIB to 
$1,200 per month effective October 1, 2004. Against the current 
baseline, the Committee estimates this measure would cost about 
$405 million in 2004, and $2.63 billion over five years. This 
increase would represent an interim step toward implementing 
the bipartisan Servicemembers and Veterans Transition 
Assistance Commission recommendation for an MGIB that pays 
tuition, fees, and a monthly subsistence allowance, thus 
allowing veterans to pursue enrollment in any educational 
institution in America limited only by their aspirations, 
abilities, and initiative.
    Based on data from the College Board's ``Trends in College 
Pricing for the 2002-2003 Academic Year,'' the Committee 
concludes that the current monthly basic MGIB benefit would 
need to be $1,496 per month for a veteran-student to be able to 
pay the average tuition and expenses as a commuter student at a 
four-year public college for academic year 2002-2003. The 
College Board's 2002-2003 academic year statistics reflect that 
average annual tuition and fees, books and supplies, room and 
board, transportation and other expenses for attending a four-
year public college amount to $13,463 for a commuter student 
and $12,841 for a student who lives on campus. Four-year 
private institutions cost $27,695 and $27,677, respectively. 
With the current basic MGIB annual benefit of $8,100, however, 
a veteran is expected to pay tuition, fees, room and board, and 
other living expenses during the academic year. The disparity 
between these ever increasing costs and a veteran's ability to 
pay for them using the MGIB benefits seems clear.
    The Committee also recommends repeal of the current $1,200 
pay reduction under the MGIB-Active Duty program. The Committee 
estimates the cost of the repeal would be $227 million in the 
first year and $1.18 billion over five years. This repeal was a 
recommendation of the Congressional Commission on 
Servicemembers and Veterans Transition Assistance. The 
Committee notes the MGIB is the only form of federal student 
financial aid in which the student is required to furnish 
$1,200 in cash ``up-front'' to establish eligibility for the 
program.
    Congress has not updated the on-the-job training and 
apprenticeship programs under the MGIB and other VA educational 
assistance programs essentially since World War II. The 
Committee may report legislation to update this program to 
reflect on-job training and apprenticeship in business and 
industry today. Such legislation may incur limited costs 
against the baseline of $3 million or less per year.

    Option of $50 monthly MGIB pay reduction.--A 
servicemember's pay is reduced $100 per month for the first 12 
months of active-duty service to establish eligibility for the 
MGIB. The Committee views the $1,200 as a burdensome fee that 
discourages veteran participation in the program. No other 
federal education program charges such a fee. The Committee 
recommends legislation to give servicemembers the option of a 
pay reduction of $100 per month for 12 months or $50 per month 
for 24 months. The Committee estimates the cost to be $101 
million in 2004 and $101 million over five years.

    Access to Entrepreneurship.--The Committee recommends 
legislation to help veterans start small businesses. The 
legislation would: (1) allow veterans to use VA education 
benefits to enroll in non-credit small business courses 
sponsored by Small Business Development Centers and others, (2) 
liberalize current law language to make it easier for graduates 
of a VA vocational rehabilitation program to go directly into 
business for themselves, and (3) make revisions to current law 
to allow disabled veterans a greater opportunity to compete for 
contracts with the Federal government. The Committee estimates 
costs of $2 million or less per year.

    Dependency and Indemnity Compensation for Surviving Spouses 
Who Remarry after Age 55.--Dependency and Indemnity 
Compensation (DIC) provides a partial substitute for the 
economic loss suffered by the survivors upon the service-
connected death of a veteran. For a survivor to be eligible, 
the veteran must have died during military service, from a 
service-connected disability, or have had a service-connected 
disability that was rated 100 percent for 10 years prior to 
death from a non-service-connected condition. DIC terminates 
upon the remarriage of a surviving spouse, although benefits 
may be restored in the event that the subsequent remarriage 
ends in death or divorce. DIC is the only federal annuity 
program that does not allow a surviving spouse who is receiving 
compensation to remarry at an older age and retain the annuity. 
Public Law 107-330 provided that a surviving spouse, upon 
remarriage after attaining age 55, would retain health 
insurance under the Civilian Health and Medical Program of the 
Department of Veterans Affairs (CHAMPVA). The Committee 
recommends legislation to allow a surviving spouse who 
remarries after age 55 to retain DIC, education, and home loan 
benefits. In 2002, the Congressional Budget Office estimated 
the cost of this eligibility change to be $38 million in 2003, 
$368 million over five years, and $779 million over ten years.

    Vocational Training for Non-Service-Connected Pension 
Recipients under Age 50.--The non-service-connected disability 
pension program provides financial help to more than 348,000 
low-income veterans. To be eligible, veterans must have served 
on active duty for at least 90 days including at least one day 
of wartime service, and be totally and permanently disabled for 
employment purposes as a result of disability not related to 
their military service, or over age 65. To ensure the 
availability of vocational training to newly eligible VA non-
service-connected pension recipients age 45 or younger, the 
Committee recommends legislation to reinstate a pilot program 
that expired in December 1995. The program would afford pension 
recipients the opportunity to receive training, along with a 
stipend, in order to return to the job market rather than 
requiring these veterans to rely solely on the VA pension 
program for their financial well being. The Committee estimates 
the cost to be $1 million in the first year and $9 million over 
5 years.

    Accrued Benefits for Veterans' Survivors.--Current law 
restricts a surviving spouse to receiving no more than two 
years of accrued benefits if a veteran dies while a claim for 
VA periodic monetary benefits (other than insurance and 
servicemen's indemnity) is being processed. VA is making 
efforts to lower claims processing times, but it can sometimes 
take more than two years to correctly determine and adjudicate 
a claim for disability compensation or non-service-connected 
pension benefits. The Committee recommends legislation to 
repeal the two-year limitation so that the veteran's survivor 
may receive the full amount of the award and not be penalized 
if VA does not process claims in a timely manner. The Committee 
estimates the cost to be $1 million per year.

    Special Compensation for Former Prisoners of War.--The 
Committee recommends legislation to establish a three-tiered 
special monthly pension to former prisoners of war, to be based 
upon the length of captivity. Those who were detained 30-120 
days would receive $150 per month, those detained 121-540 days 
would receive $300 per month, and those detained 540 or more 
days would receive $450 per month. In 2002, the Congressional 
Budget Office estimated a direct spending increase of $24 
million in 2003, $345 million over five years, and $634 million 
over ten years for special compensation to former prisoners of 
war. The Committee also recommends legislation to extend VA 
dental benefits to all former prisoners of war, regardless of 
their length of captivity. The Congressional Budget Office 
estimates this program expansion would cost less than $500,000.

    National Cemetery Administration.--As discussed above, the 
Committee may direct the Secretary to begin the planning phase 
for the construction of seven new veterans' cemeteries in those 
areas, with a veteran population threshold of 150,000, that are 
deemed most in need between 2005 and 2020. In addition, the 
Committee recommends a five-year, $300 million restoration and 
improvements project at existing cemeteries to ensure that 
national cemeteries are dignified and respectful settings.

    Increase Auto Allowance and Specially Adapted Housing 
Allowance for Severely Disabled Veterans.--VA is authorized to 
provide a one-time reimbursement to severely disabled veterans 
of $9,000 for the cost of an automobile. According to the 
American Association of Motor Vehicle Administrators, the 
average cost of a new automobile was estimated to be $21,605 in 
2001. The Committee recommends legislation to increase the auto 
allowance to $11,000. VA also provides a grant to offset the 
cost of modifying a home to accommodate a veteran's 
disabilities. The Committee also recommends legislation to 
increase the grant for specially adapted housing for severely 
disabled veterans to $50,000 and for less severely disabled 
veterans to $10,000. The Committee estimates combining these 
two proposals to cost $6 million in 2004, $34 million over 5 
years, and $74 million over 10 years.

    Vendee Loans.--The Committee opposes VA's January 23, 2003, 
decision to administratively terminate the vendee loan program. 
When a purchaser agrees to buy a foreclosed VA home, VA often 
offers to finance the sale by establishing a vendee loan to 
encourage the prompt sale of the home. Vendee loans are made at 
market interest rates and often require a down payment. 
Borrowers are assessed a 2.25 percent funding fee that is paid 
in cash.
    The Committee views vendee loans as an important tool to 
obtain a higher return on property sales, which reduces the 
overall cost of program operations. VA makes, and subsequently 
sells, $800 million to $1.2 billion in such loans each fiscal 
year. There is an ample body of empirical data indicating that 
offering vendee financing is cost effective. In March 2002, 
Booz, Allen, and Hamilton, Inc., independently analyzed the 
cost effectiveness of vendee loan financing. Their report 
indicated a savings to the government of $16 million in fiscal 
year 1999 due to vendee financing. The Committee believes the 
vendee loan program is based on sound business principles and 
recommends legislation to reinstate the program.

    Guaranteed Health Funding.--Because VA health care 
discretionary appropriations have not kept pace with the needs 
of veterans enrolled in the VA health care system, H.R. 5250 
was introduced in the 107th Congress to establish a funding 
formula to guarantee sufficient annual funding to meet the 
medical care needs of these veterans. The bill was intended to 
stabilize VA's health care financing and promote more efficient 
use of funds.
    The Committee recommends to the Committee on the Budget 
that it convert the veterans health care account from 
discretionary to mandatory funding. The Committee believes the 
conversion would be essentially budget neutral because the 
increase in mandatory funding would be offset by a decrease in 
current discretionary appropriations for veterans health care. 
The continuing health care of veterans would be funded through 
a new financing system similar to the financing systems used 
for the military TRICARE for Life program, the Medicare program 
and the Federal Employees Health Benefits Program. In none of 
these programs has the funding formula itself been the source 
of increased costs. Veterans deserve a health care program with 
an equally reliable funding mechanism.

  Comparison of President's Proposed Budget, Independent Budget and VA Committee Recommendations for the Department of Veterans Affairs FY 2004 Budget
                                                             (Budget Authority in millions)
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                             FY 2003     FY 2004      Admin.                   IB Compared  VA Committee   VA Committee
                                                            Approved     Admin.    Compared to   Independent    to Admin.     Recommend     Compared to
                                                           (Estimate)    Request     FY 2003     Budget (IB)  FY04 Request                Admin. FY 2004
--------------------------------------------------------------------------------------------------------------------------------------------------------
Medical Care.............................................    $23,889     $25,218       $1,329       $27,201        $1,983       $27,488          $2,270
MCCF and HSIF Receipts...................................     $1,617      $2,141         $524   No estimate   ............       $1,778          ^\$363
                                                                                                   provided
Medical and Prosthetic Research..........................       $400        $408           $8          $460           $52          $460             $52
Medical Administration & Misc. Operating Expenses........        $70         $79           $9           $84            $5           $79              $0
Construction, Major......................................       $137        $273         $136          $436          $163          $773            $500
Construction, Minor......................................       $164        $252          $88          $440          $188          $252              $0
State Home Grants........................................       $100        $102           $2          $150           $48          $132             $30
State Cemetery Grants....................................        $32         $32           $0           $37            $5           $32              $0
General Operating Expenses (VBA and General                   $1,256      $1,283          $27        $1,545          $262        $1,312             $29
 Administration).........................................
National Cemetery Administration.........................       $132        $144          $12          $162           $18          $209             $65
Inspector General........................................        $55         $62           $7           $61          ^\$1           $62              $0
Total VA Discretionary (Excluding MCCF and HSIF Receipts)    $26,235     $27,853       $1,618       $30,455        $2,602       $30,688          $2,946
                                                          ----------------------------------------------------------------------------------------------
VA Mandatory Spending....................................    $31,678     $32,710       $1,032   No estimate   ............      $33,411            $701
                                                                                                   provided
                                                          ==============================================================================================
--------------------------------------------------------------------------------------------------------------------------------------------------------

 REPORT TO THE COMMITTEE ON THE BUDGET FROM THE COMMITTEE ON VETERANS' 
 AFFAIRS SUBMITTED PURSUANT TO SECTION 301 OF THE CONGRESSIONAL BUDGET 
ACT OF 1974, ON THE BUDGET PROPOSED FOR FISCAL YEAR 2005, MARCH 4, 2004


                         LETTER OF TRANSMITTAL

                              ----------                              

                          House of Representatives,
                            Committee on Veterans' Affairs,
                                  Washington, DC, February 26, 2004
Hon. Jim Nussle,
Chairman, Committee on the Budget
House of Representatives, Washington, DC

    Dear Mr. Chairman: We are pleased to convey with this letter the 
views and estimates of the Committee on Veterans' Affairs regarding the 
fiscal year 2005 budget for veterans' health care and benefits.
    On February 4, 2004, the Committee held a hearing to receive the 
testimony of the Secretary of Veterans Affairs and veterans service 
organizations on the proposed budget for veterans programs. The 
Committee also heard testimony from the authors of the Independent 
Budget proposed by the Veterans of Foreign Wars, Disabled American 
Veterans, AMVETS, and Paralyzed Veterans of America. The Secretary 
presented the Administration's fiscal year 2005 budget request for a 
total of $67.324 billion, an increase of $5.27 billion in budget 
authority. Entitlement programs would receive $35.3 billion and 
discretionary programs would receive $32.1 billion. The overall 
increase in discretionary funds would be $517 million.
    Congress should provide VA with sufficient funding to maintain 
current levels of service for veterans health and benefits programs. 
After carefully considering the VA's budget submission, the Independent 
Budget submission, and the testimony presented at the budget hearing, 
we have concluded that an additional $2.524 billion in budget authority 
for VA's discretionary programs would be needed to ensure a current 
services budget. In the Committee's view, this increase would allow the 
Department to continue during fiscal year 2005 to provide the level of 
benefits and services veterans are now receiving.
    The budget requested by the Administration for veterans medical 
care is $29.1 billion in total resources. Of this amount, $26.646 
billion would come from appropriated funds, an increase of $708 million 
over the adjusted appropriated level for the current fiscal year. The 
balance of the request for medical care consists of an estimated $2.4 
billion in collections, an increase of $667 million over the fiscal 
year 2004 projection.
    The Administration also proposes a $250 annual enrollment fee for 
priority 7 and 8 veterans seeking VA medical care, and an increase in 
drug and primary care copayments. Similar user fees were rejected by 
Congress last year, and the Committee again recommends against their 
adoption. VA's ability to provide long-term care would be severely 
impaired by another Administration proposal, also made last year, to 
close about 5,000 of its estimated 12,000 nursing home beds. Given the 
expected number of elderly veterans from World War II and the Korean 
War who are expected to seek nursing home care over the next ten years, 
these proposals are illogical and indefensible.
    Last year, the Committee favorably considered an Administration 
legislative proposal to provide VA with additional health care 
resources. Acting on the proposal, the Committee reported H.R. 1562, a 
measure that would increase VA medical care collections by holding 
insurers responsible for the cost of covered care provided by VA. The 
Congressional Budget Office estimated that this authority would boost 
collections by almost $800 million over five years. However, our 
efforts to have the House consider this measure have been rebuffed.
    For entitlement benefits, the Administration proposes $35.3 billion 
in funding to support programs for veterans compensation and survivors 
benefits, pensions, education, vocational rehabilitation and 
employment, housing, insurance and burial programs. However, the budget 
request would decrease total Veterans Benefits Administration (VBA) 
staffing by 540 FTEE. The Committee recommends an additional $32 
million in budget authority to maintain current levels of such staffing 
in order to continue needed performance improvements in disability 
claims processing and other entitlement programs. The Committee also 
recommends an additional $17.5 million to support initiatives to 
improve claims processing.
    The Administration also requests $161 million for fiscal year 2005 
to operate 125 National Cemeteries, and $180.9 million in mandatory 
spending for veterans burial benefits. The Administration requests $113 
million to develop new national cemeteries, expand existing cemeteries 
and provide grants for state cemeteries. The Committee believes these 
requests are adequate. However, the Administration did not request 
funding for 928 previously identified cemetery restoration and repair 
projects that are badly needed to restore older cemeteries as national 
shrines. Most of these cemeteries are closed to new interments and are 
in a decrepit state. Therefore, we are recommending $50 million for 
fiscal year 2005, for the first year of a five-year, $300 million 
national cemetery restoration and improvement project.
    The Committee's top legislative priority is a measure to create 
jobs and economic opportunity for those who have performed military 
service. Congress has not comprehensively updated the on-the-job 
training and apprenticeship programs under the Montgomery GI Bill and 
other VA educational assistance programs since World War II. ``Earning 
and learning'' on the job in these programs is also an excellent 
transition tool for returning servicemembers. A modernized statute 
reflecting the nature of structured training in today's workplace would 
improve access to these programs for recently-separated veterans by 
giving employers greater incentives to participate. The Committee 
recommends funding of $1.78 billion over 10 years to create new jobs 
and economic opportunities for veterans.
    The Committee believes that the increases it recommends in the 
accompanying views and estimates for fiscal year 2005 are necessary to 
maintain current services for veterans programs. Members of the 
Committee may submit additional views under separate cover. We thank 
the Committee on the Budget for its consideration of our 
recommendations and look forward to continued discussion on these 
important issues.

                                        Sincerely,

Christopher H. Smith,            Lane Evans,
Chairman                         Ranking Democratic Member

                                 ______
                                 

                BACKGROUND AND COMMITTEE RECOMMENDATIONS


                     DEPARTMENT OF VETERANS AFFAIRS


                     Veterans Health Administration

    The Status of VA Health Care.--Veterans have sought health 
care from the Department of Veterans Affairs (VA) in 
increasingly greater numbers over the past ten years as the VA 
evolved from a system that primarily focused on inpatient care 
to a primary care model. The increased capacity and 
availability of VA health care resulted from the opening of 
hundreds of new VA community-based outpatient clinics. VA's 
accessible and affordable pharmacy benefit also encouraged 
veterans to seek care.
    The Department cared for 4.7 million unique veteran 
patients in fiscal year 2002, 5 million in fiscal year 2003, 
and expects to treat 5.2 million veterans in fiscal year 2004. 
Approximately 2.4 million additional veterans will be enrolled 
in VA health care in fiscal year 2005 but will not actually use 
the health benefit. To respond to this growth, Congress has 
increased VA medical care funding by 22 percent over the past 
two years and 50 percent over the past five years, an average 
of 10 percent per year. In the current fiscal year, the 
Consolidated Appropriations Act of 2004, Public Law 108-199, 
provides $25.9 billion in appropriations for veterans' medical 
care (the funding level available for medical care assumes a 
transfer of $400 million to medical construction). This 
constitutes an increase of $2 billion or 9 percent over the 
previous fiscal year. In fiscal year 2003, Congress provided an 
increase of $2.6 billion or 12 percent for veterans' care.
    For fiscal year 2005, the Administration requests $26.6 
billion in appropriations for VA health care programs (not 
including construction, national management, or grant programs) 
an increase of $708 million or 2.7 percent over the fiscal 2004 
appropriated level.
    The Administration's budget proposes that Congress require 
veterans with no service-connected disabilities (priority 7 and 
priority 8 veterans) to pay a new annual enrollment fee of 
$250, as well as higher pharmaceutical co-payments ($15 for 
each 30-day prescription) and higher primary care appointment 
co-payments (from $15 to $20 for each appointment). The 
enrollment fee increase and the higher pharmaceutical co-
payments were proposed in previous budgets but were not 
approved by Congress.
    The Committee remains concerned about the growth in 
enrollment and VA's inability to respond to the needs of some 
patients once enrolled. Eighteen months ago, 310,000 enrolled 
veterans had to wait six months or more to see a VA physician, 
including some veterans who received no appointment at all. 
Today, VA is reporting that number has been reduced to about 
36,000. Following recommendations from the Members of this 
Committee, VA implemented a temporary program in late 2003 
designed to allow veterans who requested an initial appointment 
with a physician and who were still waiting longer than 30 days 
for that appointment to receive VA pharmacy services for 
prescriptions written by private physicians. More recently, the 
Secretary altered waiting policy by requiring facilities to 
schedule service-connected veterans for appointments within 30 
days. The Committee will continue to monitor the effect of this 
change on waiting times and VA expenditures.
    On January 17, 2003, the Secretary of Veterans Affairs 
suspended further enrollment of Priority 8 veterans 
(nonservice-connected veterans with incomes above a regionally 
adjusted means test). The announced purpose for this action was 
to ensure that VA was capable of caring for veterans with 
military-related disabilities, lower incomes and those in need 
of specialized care. The Secretary also announced a program in 
partnership with the federal Centers for Medicare and Medicaid 
Services (CMS) for VA to subcontract with Medicare+Choice 
Organizations (M+CO) under the Medicare Part C program. 
Projected to begin in late 2004, a small number of Medicare-
eligible Priority 8 veterans now excluded from direct 
enrollment in VA health care would be offered the option of 
receiving their Medicare benefits from VA facilities designated 
as Medicare provider organizations.

    Overall US Health Care Spending Growth.--Health care 
spending slowed in 2003, but is still expected to rise at an 
annual rate of 7.8 percent in 2004, about 3.5 percentage points 
higher than general inflation, according to a report issued 
February 11, 2004 by CMS. Prescription drugs continue to be the 
fastest-growing segment of health spending. For the VA's health 
care system, spending on prescription drugs was 13.4 percent of 
VA health expenditures in 2003. In fiscal year 2004, VA expects 
to spend about $3.7 billion on pharmaceutical products and 
anticipates spending $3.9 billion in fiscal year 2005, a 5 
percent increase. The projected increase stems from both higher 
utilization of VA health care by veterans and increased use of 
new drugs to deal with the chronic health problems of enrolled 
veterans.

    Health Care Inflation.--The Bureau of Labor Statistics 
(BLS) has released inflation data for 2003 that shows that the 
overall medical care inflation rate for calendar year 2003 was 
4 percent, almost double the domestic ``All Items'' inflation 
rate. Hospital care and related services grew faster than other 
components of health inflation, at 7.3 percent.

    Capacity and Demand for Long-Term Care Services.--The 
veteran population most in need of nursing home care, veterans 
85 years or older, grew from about 387,000 in fiscal year 1998 
to about 640,000 in fiscal year 2002 and to about 870,000 
during fiscal year 2003, amounting to more than a 100 percent 
increase over the past seven years. Over the next decade, this 
veteran population segment is expected to continue to rise to 
about 1.3 million. In 1997, VA established a Long-Term Care 
Federal Advisory Committee to recommend how VA should respond 
to this growing demand. The Committee was chaired by Dr. John 
Rowe, then President of Mount Sinai University and School of 
Medicine and a former VA geriatrician. Dr. Rowe and the panel 
of experts on the Advisory Committee issued a report in 1998 
entitled VA Long-Term Care at the Crossroads. The Committee 
offered 20 recommendations to guide the provision of VA long-
term care services through 2010.
    In the Crossroads report, the Advisory Committee concluded 
that ``[d]espite high quality and continued need, long-term 
care is perceived to be an adjunct entity, unevenly funded and 
undervalued. Continued neglect of the long-term care system 
will lead to further marginalization and disintegration, and 
have costly, unintended consequences throughout the VA health 
care system.'' The Advisory Committee stressed the need for 
nursing home capacity to remain at the 1998 bed level and for 
VA to significantly expand home and community-based service 
capacity to meet the anticipated growth in demand by a large 
oncoming wave of aging veterans.
    On November 30, 1999, Congress ratified many of the 
recommendations of this Advisory Committee with enactment of 
the Veterans' Millennium Health Care and Benefits Act (the 
Millennium Act), Public Law 106-117. Under this Act, VA is 
required to provide a comprehensive menu of extended care 
programs, including geriatric evaluation, community nursing 
home, domiciliary, adult day health, respite and other 
alternatives to institutional care, including palliative and 
hospice programs. VA is mandated to provide needed nursing home 
care to veterans who are either 70 percent service-connected or 
in need of such care for a service-connected condition, and is 
required to provide such care to other veterans to the extent 
VA has resources to do so. The Millennium Act also requires VA 
to give priority to veterans with unique needs (such as 
Alzheimer's) and for those without other placement options. It 
also requires VA to maintain the level of ``in-house'' extended 
care services and expand community-based long-term care 
programs, supported in part by increased copayments for long-
term care services for nonservice-connected veterans.
    In November 2002, the Committee Chairman requested the 
General Accounting Office (GAO) to analyze current trends and 
forecasts in veterans' nursing home utilization and VA's long-
term care expenditures. GAO testified before the Committee on 
January 29, 2004, questioning whether any real growth had 
occurred in VA's non-institutional care programs since 
enactment of the Millennium Act. Also, the VA Inspector General 
reported on December 13, 2003, on VA's homemaker and home 
health aide program (Report No. 02-00124-48, Healthcare 
Inspection: Evaluation of Veterans Health Administration 
Homemaker and Home Health Aide Program). Both reviews showed 
that VA's official policies had expired or that program 
managers were not complying with Veterans Health Administration 
(VHA) policies, and that there were no extant guidelines for 
contracting for services or for rates to be paid for services. 
Both reports observed significant differences between networks 
in long-term care services provided and the types of patients 
being served.
    Although VHA's overall long-term care services have 
expanded to some extent in recent years, VA's commitment to 
long-term care has not kept pace with veterans' needs. 
According to GAO, access to VA care remains markedly variable 
from network to network. VA's average daily nursing home census 
was 33,214 in fiscal year 2003, one percent below its fiscal 
year 1998 workload. All of the program growth reported by GAO 
was in the state home program and most of the shrinkage was in 
VA's in-house capacity. Also, according to a November 11, 2003, 
VA report, entitled VA Extended Care: Final Report to Congress 
of VA's Experience Under the Millennium Act, VA itself reported 
that it has not maintained the required level of in-house 
nursing home care.
    The Committee firmly rejects the Department's proposal to 
close 5,000 additional VA nursing home beds. Congress rejected 
a similar proposal last year. Outpatient programs cannot 
replace the nursing home beds that chronically ill veterans 
need. In order to maintain the required bed level, the 
Committee recommends that VA's budget request be augmented by 
$370 million. VA should also reopen the nursing home beds that 
have been closed since passage of the Millennium Act.

    Medical Care Collections Fund.--VA is authorized to bill 
some veterans and most health care insurers for nonservice-
connected care provided to veterans enrolled in VA health care. 
It retains this collection in the Medical Care Collections Fund 
(MCCF) to defray costs of delivering VA medical services. The 
Department projects that if its proposed fee increases are 
adopted, medical care collections for fiscal year 2005 will be 
$2.4 billion.
    The Committee supports the Department's efforts to improve 
performance in first and third party collections, but the 
Committee remains skeptical that VA can achieve all of its 
collections goals in fiscal year 2005. Much of the 38 percent 
increase ($403 million) projected for fiscal year 2005 is 
expected to come from new enrollment fees and increases in 
copayments for pharmaceuticals and primary care for certain 
veterans. Congress rejected these same proposals last year. 
Another $300 million is projected to come from improving 
collection methodologies. While VA might be successful in 
increasing collections, past projections have proven to be 
overly optimistic. The Committee believes a 10 percent increase 
in collections, based on the fiscal year 2004 estimate of $1.75 
billion in total collections, is a realistic goal. The 
Committee estimates that this would reduce VA's need for new 
appropriations in fiscal year 2005 by $175 million.

    Management Improvements and Efficiencies.--The Department's 
2005 budget proposes to achieve an additional $340 million from 
``management savings.'' VA testified that it plans to achieve 
these savings through improved standardization in the 
procurement of supplies, pharmaceuticals and other capital 
purchases, and by implementing a competitive out-sourcing plan, 
increasing health resources sharing with the Department of 
Defense (DOD), and continuing the trend of shifting patients 
from inpatient to outpatient levels of care. The budget also 
assumes that VA will continue to achieve the $950 million 
``management efficiencies and improvements'' programmed into 
the fiscal year 2004 budget. Management efficiencies, 
improvements and savings are laudable goals and some have 
indeed been achieved. However, based on prior experience, the 
Committee is not confident that optimistic plans and goals 
would produce the high-dollar reductions in costs the 
Administration projects in its budget request.
    On September 2, 2003, the Committee reported to the 
Committee on the Budget (House Committee Print No. 4, 108th 
Congress, 1st Session) on its review of efforts to eliminate 
waste, fraud and abuse in veterans' programs. The Committee 
invites close attention to this report as an indication of 
efforts within VA, its Inspector General's Office (OIG) and at 
GAO, to ferret out such conditions and improve VA programs, 
within the health care system. As evidenced by hearings before 
this Committee and other committees in the first session of the 
108th Congress, Congress and the Administration together should 
work aggressively to eliminate waste, fraud, abuse, and 
mismanagement in VA programs. As this Committee continues to 
examine VA funding needs, it will continue its efforts to 
reduce waste and inefficiencies in these programs.

    Enhanced Mental Health Services.--1. Peer Support Program 
and Education: On April 29, 2002, President Bush established 
the New Freedom Commission on Mental Health ``to conduct a 
comprehensive study of the United States mental health service 
delivery system, including public and private sector providers, 
and to advise the President on methods of improving the 
system.'' This Commission recently reported to the President. 
VA, which participated in the Commission as an ex-officio 
member, has established an action agenda to implement its 
recommendations.
    One recommendation of the Commission proposed ``peer 
support networks'' to align relevant Federal programs and to 
improve access and accountability for mental health services. 
Peer support programs have proven to be cost-effective and 
successful models for assisting veterans and others with mental 
illnesses. The Committee believes that VA should hire peer 
counselors to develop a training protocol and certification 
program. The Committee recommends $5 million to initiate this 
program.
    2. Mental Health Intensive Case Management: Mental Health 
Intensive Case Management (MHICM) programs are characterized as 
an intensive, multidisciplinary team approach to managing 
highly dysfunctional mentally ill veterans in the community. VA 
has estimated as much as 20 percent of its seriously mentally 
ill veteran population may be in need of such services. VA 
issued an internal directive more than three years ago to 
ensure that each of its networks establishes strategies to 
provide severely mentally ill veterans with appropriate access 
to mental health services. Recent reports from VA indicate that 
some MHICM's were initiated in the last year, more than two 
years after the directive was issued. Others have reduced or 
held steady the number of veterans they treat. Medical 
literature has shown the MHICM program to be a cost-effective 
means of managing mentally ill people. The Committee recommends 
VA continue to implement MHICM teams to treat veterans in the 
target population. VA's Committee on Care of Veterans with 
Serious Mental Illness has estimated that the cost to fully 
implement this program would be an additional $32 million.

    Enhancing VA Services along the VA Continuum of Care.--The 
same VA advisory committee on mental illnesses has identified a 
number of shortfalls in programs that aid veterans with mental 
health disorders. The cost to meet the full demand by veterans 
for mental health services in fiscal year 2004 would require 
double the amount obligated in fiscal year 2002 for these 
programs. However, in order to achieve realistic and feasible 
program growth, the Committee recommends an increase in the 
program funding by $55 million.

    Readjustment Counseling Services to Address the Needs of 
Veterans Returning from Iraq and Afghanistan.--Almost 287,000 
American servicemen and women serve or have served in Operation 
Enduring Freedom and Operation Iraqi Freedom. DOD reports that 
it has cared for more than 9,000 casualties since these 
deployments were authorized. Many of them have physical wounds; 
others have mental health problems stemming from the stressful 
conditions of combat. Patients with diagnoses of chronic Post 
Traumatic Stress Disorder (PTSD) may require long-term courses 
of treatment and often consume other types of health care 
services at higher rates than average.
    VA recently developed clinical guidelines in collaboration 
with DOD to diagnose PTSD in its earliest stages to prevent 
chronic and severe cases from developing. VA is now developing 
plans to screen servicemembers who have returned from a recent 
deployment. This outreach is intended to ensure that veterans 
who are likely to have problems are identified and are offered 
early intervention to address their problems.
    Strong family support is integral to the recovery of 
individuals with mental health disorders. Congress has 
authorized VA to offer care to family members when it is 
incidental to the treatment of the veteran or when a veteran 
has died of service-connected conditions. The Committee 
believes VA should take immediate steps to enhance the 
resources available to its current readjustment counseling 
centers (``Vet Centers'') to ensure that the program is 
adequately prepared to address the needs of returning troops 
and their immediate family members. To augment the existing 
care sites and add family therapists at 50 of its sites that 
may experience the greatest increase in demand due to 
demobilization, would require an $8 million investment for 
approximately 100 new full-time employees.
    In sum, the Committee recommends augmentation of the 
medical care budget by $100 million to account for these 
heightened requirements from wartime deployments and for 
programs that have not been adequately recognized as priorities 
for veterans in need of mental health services.

    Homelessness Among Veterans.--With the passage of the 
Homeless Veterans Comprehensive Assistance Act of 2001, Public 
Law 107-95, Congress established the goal of ending chronic 
homelessness in the veteran population within a decade. VA is 
not making sufficient progress in achieving this objective, as 
evidenced by the slow pace of developing regulations and 
policies to carry out several of these initiatives. In the case 
of the authorization to expand VA domiciliaries, VA has 
effectively prevented implementation of this authority, despite 
its proven effectiveness. Other programs, including VA's grant 
and per diem program for community providers, and the so-called 
``Health Care for Homeless Vets'' initiative, should be funded 
at higher levels if the goal is to be met. The Committee 
recommends that, consistent with the recommendations of the 
Administration, $15 million be added to the VA's budget to 
address the still unmet needs of an estimated one-quarter 
million homeless veterans. This will allow VA to increase 
funding available to the homeless grant and per diem providers, 
who, in turn, can assist thousands of veterans in returning to 
productive activity.

    Medical and Prosthetic Research.--The Department carries 
out an extensive array of research and development as a 
complement to its affiliations with medical and allied health 
professional schools and colleges nationwide. While these 
programs are specifically targeted to the needs of veterans, VA 
research has defined new standards of care that benefit all 
Americans. Among the major emphases of the program are aging, 
chronic diseases, mental illnesses, substance-use disorders, 
sensory losses, and trauma-related illnesses. VA's research 
programs are internationally recognized and have made important 
contributions in virtually every arena of medicine, health, and 
health systems.
    The Administration has requested a 2005 budget for VA 
Medical and Prosthetic Research of $385 million, a decrease of 
$21 million below the fiscal year 2004 appropriations level. 
The Committee strongly supports an increase in the research 
account to $415 million. The Committee believes this additional 
funding is needed to keep pace with funding trends in the 
Federal biomedical research community. The Committee places a 
high premium on VA's research focus in chronic diseases 
afflicting aging populations. The National Institutes of Health 
received an increase of 3.7 percent in the 2004 omnibus 
appropriations act. An equivalent increase in VA research for 
2005 would be $427 million. Additional funding of $30 million 
in VA biomedical research in fiscal year 2005, coupled with a 
$30 million increase in medical care funds to support these 
activities, would provide for inflation and permit a small 
expansion in VA research programs.

    Bio-Terrorism Research Centers.--The Department of Veterans 
Affairs Emergency Preparedness Act of 2002, Public Law 107-287, 
requires the Department to establish four national emergency 
preparedness centers, and authorizes $20 million per year for 
the support of those centers. A dispute over the funding for 
these centers has prevented their establishment. These centers 
are vital to VA's ability to care for veterans who may be 
exposed to weapons of mass destruction on the battlefield, as 
well as to provide assistance to the Departments of Homeland 
Security, Defense and others in the federal and state 
communities in contending with the health care challenges of 
the war on terrorism. The Committee believes that the 
Department should set aside $10 million from the amount the 
Committee recommends for medical care to support the 
establishment of four national medical preparedness research 
centers within existing VA medical centers in fiscal year 2005.
    The Act also authorizes the establishment of an education 
program to be carried out through VA. The education and 
training curriculum would include a program to teach current 
and future health care professionals how to diagnose and treat 
casualties who have been exposed to chemical, biological, or 
radiological agents. The Committee believes that the Department 
should set aside $5 million from the amount the Committee 
recommends for medical care to support the requirement in 
fiscal year 2005.

    Major Medical Construction Projects and CARES.--The 
physical infrastructure of the VA health care system is one of 
the largest in the federal government, with over 4,700 
buildings and thousands of acres valued at over $35 billion. 
Much of this infrastructure was built over 50 years ago. These 
aging facilities are in need of repair and restoration to 
ensure that veterans are provided care in safe, reliable and 
functional settings. In recent years, VA's investment in its 
health care infrastructure has been minimal compared to 
expected levels of investments in such capital facilities. At 
the same time, GAO has reported to Congress that VA is 
``wasting'' $1 million per day on unnecessary buildings and 
empty spaces. As described above, VA has moved from a hospital-
based health care system to a primary care delivery model. 
Accordingly, VA is completing its Capital Asset Realignment for 
Enhanced Services (CARES) initiative. The independent CARES 
Commission, chaired by Honorable Everett Alvarez, Jr., issued 
its report to the Secretary of Veterans Affairs and Congress on 
February 13, 2004. A major issue of concern to the Committee is 
that the draft plan omits veterans' long-term care, domiciliary 
care and outpatient mental health care, claiming that workload 
forecasts in these programs were inaccurate or unrealistic. 
This critical omission may call into question the validity of 
many CARES recommendations.
    The CARES Commission report confirms the need for at least 
$4 billion in capital improvements over the next decade. The 
CARES Commission agreed with VA's plan to build two new medical 
centers, in Denver, CO, and Orlando, FL. It also recommended a 
priority feasibility study for a new consolidated Medical 
Center in Boston, MA, to replace four existing VA centers. The 
Commission encouraged VA to continue its collaboration with the 
Mike O'Callaghan Federal Hospital in Las Vegas, NV, and also 
endorsed VA's proposals to further study the need for new 
facilities in the Las Vegas area, as well as in Louisville, KY, 
and in Charleston, SC. In testimony before the Committee on 
February 4, 2004, Secretary Principi stated his intention to 
proceed with CARES as a high priority. He identified $1.3 
billion in funds available to begin major capital projects in 
the next two fiscal years. Assuming that the Secretary does not 
completely reject the recommendations of the Commission, the 
Committee will carefully review the CARES report and VA's 
prioritized list of capital improvement projects over the next 
several months.

    State Home Grants Program.--In 47 states and Puerto Rico, 
there are 117 facilities for veterans that provide nursing 
(21,000 beds), domiciliary (6,066 beds), and adult day care 
(one small program) whose care is coordinated with VA. The 
current VA reimbursements for each day of care a veteran 
receives in a state home are: $57.78 for nursing home care, 
$27.19 for domiciliary care, and $42.57 for adult day health 
care.
    States pay 35 percent of the construction costs of projects 
for state home facilities, and bear most of the cost of the 
facilities' operations and health care that exceed amounts 
contributed by VA. Applications totaling $359.7 million for new 
construction and renovation grants to state veterans' homes are 
pending in the Department. A new round of requests will be 
solicited in April 2004 for fiscal year 2005 awards.
    In 1999, the Millennium Act reformed the state home 
construction grant program. It provided a higher priority for 
critically needed renovations in existing state homes, 
especially those projects involving fire and life safety 
improvements. Prior to enactment, these long-delayed projects 
were given a lower priority for funding than grants for 
constructing new state home beds. In fiscal year 2004, for the 
first time since the implementation of these provisions 
affecting the ranking criteria for funding, the backlogged 
renovation projects with state matching grants are eligible for 
funding.
    The Administration budget proposal for fiscal year 2005 
requests $105,163,000 to support the grant program, a 3.6 
percent increase over the fiscal year 2004 appropriated level. 
The Committee supports VA funding as many projects as possible 
for which states have certified their matching funds to be 
available. These projects will respond to the growing demand 
for new long-term care facilities, and will aid states in 
modernizing facilities in existing inventories.

    Current Services for Veterans Health Care.--VA's estimate 
of cost savings in this proposed budget does not consider the 
increased costs that Medicare, TRICARE, and other federally-
subsidized health care programs would incur for veterans who 
would be disenrolled from VA care as a result of proposals such 
as a $250 health care copayment and an increased prescription 
drug copayment. When the Congressional Budget Office and the 
Office of Management and Budget estimated the cost of the 
recently-enacted Medicare prescription drug benefit, they 
reduced the projected costs of that benefit by the $3 billion 
that VA spends annually to provide prescription drugs to 
veterans using VA care. Similarly, the Administration and 
Congress reduced the estimated cost of VA health care by $250 
million annually following the enactment of TRICARE for Life in 
2000. Veterans' use of VA care also reduces the cost of care in 
the Indian Health Service and in Medicaid.
    Rather than supporting Administration proposals that could 
reduce demand for VA health care and shift costs to other parts 
of the federal medical system, the Committee recommends 
treating spending on veterans programs the same as spending on 
Social Security and Medicare. To do so, a ``current services'' 
budget for VA medical care would require an increase of 
approximately nine percent over the appropriated fiscal year 
2004 level. A current services approach allows continued 
enrollment for those veterans enrolled today in VA health care.

                    Veterans Benefits Administration

    Veterans Benefits Administration.--The Administration 
requests $35.2 billion to support the entitlement benefits 
program, an increase of $2.5 billion over the appropriated 
level for fiscal year 2004, as well as another $1.464 billion 
for managing the programs for disability compensation, pension, 
education, vocational rehabilitation and employment, housing, 
life insurance, and burial. Over 3.3 million veterans, 
survivors and dependents were receiving compensation or pension 
benefits at the beginning of fiscal year 2003. An additional 
681,000 beneficiaries received education or vocational 
rehabilitation benefits.
    The ability of VA to provide accurate, timely and quality 
benefits delivery is dependent on a number of factors. These 
include an adequate number of properly trained staff, effective 
business process and information technology modernization 
initiatives, accountability measures, inter-departmental 
cooperation between the various VA administrations and military 
service departments, including the National Personnel Records 
Center and DOD's Center for Unit Records Research, and 
assistance from the veterans service organizations. The 
Administration requests $29.4 million to support new and on-
going initiatives designed to provide better customer service 
through improved accuracy and access for benefits. The 
Committee recommends an additional $17.5 million to support 
added initiatives to include Virtual VA (paperless claims 
processing), Data Quality Assurance, the One VA telephone 
system, computer training programs, and contract medical 
examinations.

    Disability Compensation.--The Administration requests $29.3 
billion to support compensation benefits to disabled veterans, 
certain survivors, and eligible dependent children, and $657.6 
million to fund the discretionary portion of the Disability 
Compensation program, which will provide funding for the 
administrative expenses of 7,057 FTEE, a decrease of 35 FTEE 
from fiscal year 2004.
    VBA is making every effort to increase quality and 
productivity in the current adjudicative and appellate 
processes for veterans. The Department has continued to make 
reducing the pending workload of veterans' claims and attendant 
quality in such claims top priorities. VBA decreased its 
average days to process a rating claim from 223 days in 2002 to 
182 days in 2003. By the end of 2004, VBA expects to be 
processing these claims in 145 days, and by the end of 2005 
expects them to be processed in 100 days. While significant 
progress has been made, VBA did not meet the Secretary's goal 
of processing claims within 100 days by the end of 2003. 
``Reopened'' claims, those in which a request for 
reconsideration of a previous denial is made, continue to 
outnumber original claims by about three to one. The accuracy 
rate for core rating work in claims decisions continued to 
improve, increasing from 81 percent in 2002 to 86 percent in 
2003.
    The Committee notes VBA's efforts to meet its timeliness 
goals through restructuring at its regional offices and 
redesigning workflow, strengthening its partnership with DOD 
and the U.S. Armed Services Center for Unit Records Research, 
and developing a joint VBA/VHA/DOD examination protocol for 
servicemembers leaving active duty. At the end of fiscal year 
2003, VBA's pending claims inventory was 253,000, a 41.4 
percent reduction in pending claims from a peak of more than 
432,000 in January 2002. However, as of early February 2004, 
336,721 claims were pending. This significant change in VBA's 
inventory was the result of a September 22, 2003, decision by 
the U.S. Court of Appeals for the Federal Circuit, Paralyzed 
Veterans of Am. v. Sec'y of Veterans Affairs, 345 F.3d 1334 
(Fed. Cir. 2003), which held that denial of a claim is 
premature before the expiration of the one-year period 
established by the Veterans Claims Assistance Act of 2000 
(VCAA), Public Law 106-475, even if VA has reviewed all 
available evidence. The VCAA requires VA to allow a claimant 
one year to submit requested information or evidence to 
substantiate a claim.
    The Veterans Benefits Act of 2003, Public Law 108-183, 
signed on December 16, 2003, changed the result of the Court's 
decision. Veterans no longer have to wait until the expiration 
of the one-year period to receive a decision on their claim. 
VBA has begun the process of issuing decisions on the 
approximately 60,000 cases deferred over the last three months 
due to the Court's ruling.
    Due to these workload considerations, the Committee rejects 
the proposed decrease of 35 FTEE and recommends $2 million to 
maintain current staffing levels.

    Pension Program.--The Administration requests $3.2 billion 
to support the pension program, and $139.4 million to fund the 
discretionary portion of the pension program, which will 
provide funding for the administrative expenses of 1,444 FTEE, 
a decrease of 255 FTEE from fiscal year 2004, despite a 
caseload increase of 8,024.
    The average number of days to process pension claims has 
decreased only slightly from 112 in 2000 to 98 in 2004, and the 
overall customer satisfaction rate with the pension program has 
remained static at 65 percent. The Committee rejects the 
proposed decrease of 255 FTEE and recommends $15 million to 
maintain current staffing levels.

    Education Service.--The Administration requests 888 FTEE 
for the Education Service, a decrease of 38 FTEE over fiscal 
year 2004, although participation in VA's education programs is 
projected to increase by about 29,000.
    The Committee observes no significant improvement in the 
quality of education claims processing from 2002 to 2003; some 
indicators are better and some are worse than the previous 
year. Moreover, from 2001 to 2003, overall payment accuracy 
improved only slightly from 92.0 percent to 93.5 percent.
    An additional priority for the Committee is the further 
development of apprenticeship and other on-job training 
programs for veterans. Sufficient resources and personnel must 
be allotted to the processing, review and evaluation of federal 
job training programs so that decisions are made accurately and 
expeditiously. The Committee rejects the proposed decrease of 
38 FTEE and recommends $2 million to maintain current staffing 
levels.

    Vocational Rehabilitation and Employment Service.--
Disability compensation can help offset a veteran's average 
loss of earning power, but long-term sustained employment and 
economic independence represent the aspirations of most 
disabled veterans, according to VA's comprehensive 2001 
National Survey of Veterans.
    VA's Annual Accountability Report for FY 2000 showed the 
rehabilitation rate of disabled veterans for the year was 65 
percent, which appeared to exceed the goal of 60 percent. 
However, VA's Inspector General concluded in its February 6, 
2003, report titled Accuracy of VA Data Used to Compute the 
Rehabilitation Rate for Fiscal Year 2000 (Report No. 01-01613-
52), the data VA used to compute the rehabilitation rate was 
not accurate. In numerous cases, VA classified disabled 
veterans as rehabilitated when they were not rehabilitated. The 
Committee expects improvements in the integrity of these data.
    The Administration requests 1,015 FTEE for the Vocational 
Rehabilitation and Employment program in fiscal year 2005, a 
decrease of 103 over the fiscal year 2004. The Committee 
rejects the proposed decrease of 103 FTEE and recommends $7 
million to maintain current staffing levels in order to allow 
the program an opportunity to improve its performance.

    Loan Guaranty Service.--In fiscal year 2003, this program 
guaranteed 489,418 loans, the second highest amount since 1970. 
The loans were valued at $63,254,794, with an average of 
$129,245. In general, VA's home loan program is one of its most 
popular with veterans and servicemembers. VA's 2001 National 
Survey of Veterans notes that about 60 percent of the 20,000 
veterans surveyed reported they had used VA's home loan program 
to purchase, improve or refinance their home. On average, 93.2 
percent of veterans have indicated satisfaction with VA's home 
loan assistance over the past five fiscal years. The Committee 
commends these results.
    Average FTEE in this program has already been reduced 
through careful administrative consolidation from 2,108 in 
fiscal year 1999 to 1,390 in fiscal year 2004 without any 
degradation in quality or cost-effectiveness. However, the 
Administration requests a further reduction of 109 FTEE. The 
Committee rejects the proposed decrease of 109 FTEE and 
recommends $6 million to maintain current staffing levels in 
order to maintain program performance.
    The Committee is also concerned about a proposal contained 
in the budget request to change the eligibility of the home 
loan program to one-time use for veterans (active duty 
servicemembers would continue to be able to use the benefits as 
many times as needed). Such a change in program entitlement for 
veterans is estimated by the Administration to cost $91 
million. The Committee rejects this proposal and recommends no 
change to current law in this regard.

    VBA Staffing for all Business Lines.--VBA has an 
administration-wide hiring freeze, effective May 8, 2003. 
Additional hiring in early fiscal year 2003 of 150 new Rating 
Veterans Service Representatives and 150 new Veterans Service 
Representatives, along with Congressionally-mandated pay 
increases, significantly increased the payroll base prior to 
the hiring freeze. An exception to the hiring freeze was 
granted to VBA's ``Tiger Team,'' located at the Cleveland 
Regional Office. The Tiger Team concentrates on processing 
older claims throughout the system, and top priority is given 
to those claims from veterans over age 70 that have been 
pending for a year or more.
    The Administration requests a decrease of 540 FTEE in total 
VBA staffing. The Committee is concerned that with decreased 
staffing, VBA would not be able to continue its improvements in 
disability claims processing, as well as improve its 
performance in other entitlement programs.
    The Committee rejects the total proposed decrease of 540 
FTEE across all business lines and recommends a total of $32 
million to maintain current full staffing for the disability 
compensation, pension, education, vocational rehabilitation and 
employment and housing business lines of VBA.

                    NATIONAL CEMETERY ADMINISTRATION

    The Administration requests $274.4 million in discretionary 
burial administration funding and $180.9 million in mandatory 
spending to provide burial benefits. The burial account 
includes operating and capital funding for the National 
Cemetery Administration (NCA), the burial benefits program 
administered by VBA, and the State Cemetery Grants Program. 
Specifically, the budget requests $161.3 million for NCA 
operation and maintenance of 125 national cemeteries and 33 
soldiers' and sailors' lots, plots and monument sites in 2005 
and $113 million for major construction, minor construction, 
and funding for the State Cemetery Grants Program. The budget 
requests $180.9 million in mandatory spending to provide burial 
benefits on behalf of eligible deceased veterans and eligible 
deceased dependents.
    The budget request supports 1,611 FTEE in NCA, an increase 
of 23 over the fiscal year 2004 request, and 168 FTEE in VBA, a 
decrease of 6 FTEE over last year's request. The Committee 
supports these requests.
    The Administration requests $113 million to develop new 
national cemeteries, expand and create additional gravesites at 
existing national cemeteries, and provide grants for state 
cemeteries. The funds would be used to develop and/or expand 
cemeteries in the following locations:

    *  Sacramento, California, phase one development 
of a new national cemetery;
    *  Florida National Cemetery at Bushnell, 
gravesite expansion and cemetery improvements;
    *  Rock Island, Illinois, gravesite expansion 
and cemetery improvements; and
    *  Ft. Snelling, Minnesota, gravesite expansion 
and cemetery improvements

    NCA maintains almost 2.6 million gravesites in 39 states, 
the District of Columbia and Puerto Rico. Of the 125 national 
cemeteries, 60 have available, unassigned gravesites for burial 
of both casketed and cremated remains; 23 will only accept 
cremated remains and the remains of family members for 
interment in the same gravesite as a previously deceased family 
member; and 37 are closed to new interments, but may 
accommodate family members in the same gravesite as a 
previously deceased family member.
    Occupied graves maintained by NCA are projected to increase 
from 2,574,489 in fiscal year 2003 to over 3,041,000 in 2009. 
NCA continues to develop new cemeteries in areas not presently 
served by NCA: Atlanta, Georgia; Detroit, Michigan; Miami, 
Florida; Pittsburgh, Pennsylvania; and Sacramento, California.
    Pursuant to section 613 of Public Law 106-117, the Veterans 
Millennium Health Care and Benefits Act, VA awarded a contract 
to Logistics Management Institute (LMI) to conduct an 
assessment of the current and future burial needs of veterans. 
Volume 1 of the study, entitled ``Future Burial Needs,'' 
identified areas of the country where new national cemeteries 
might be constructed. The LMI study projected burial needs in 
5-year increments to the year 2020 based on data derived from 
the 1990 census. In June 2003, VA updated the burial needs 
report to reflect the veterans' population from the 2000 
census.
    Based on the LMI rankings of the areas of the country most 
in need of a national cemetery burial option, Congress passed 
the National Cemetery Expansion Act of 2003, Public Law 108-
109, signed on November 11, 2003. It requires the Secretary to 
establish six additional national cemeteries by 2008 in the 
following areas: Southeastern Pennsylvania; Birmingham, 
Alabama; Jacksonville, Florida; Bakersfield, California; 
Greenville/Columbia, South Carolina; and Sarasota, Florida. The 
budget requests $1 million in Advance Planning Funds and 
includes funds for the site selection process for the six new 
national cemeteries authorized by this law. The Committee 
supports this request.
    Volume 2 of the LMI study, entitled ``National Shrine 
Commitment,'' was a report on capital improvements needed at 
existing veterans' cemeteries. The budget request does not 
provide funding for 928 full-scale cemetery restoration and 
repair projects, estimated to cost $279 million, as determined 
by the LMI study. Instead, the budget reflects a shift in 
funding for projects to improve the appearance of cemetery 
assets, and requests $15 million for funding gravesite 
renovations and cemetery repair and infrastructure projects, to 
be accomplished through the Minor Construction program.
    The Committee recommends a five-year, $300 million 
restoration and improvements project at existing cemeteries. 
The Committee recommends an additional first-year appropriation 
of $50 million for fiscal year 2005 to address this problem.

                          DEPARTMENT OF LABOR


               Veterans' Employment and Training Service

    The Veterans' Employment and Training Service (VETS) of the 
U.S. Department of Labor furnishes employment and training 
opportunities to veterans. The Assistant Secretary for VETS 
serves as the principal advisor to the Secretary of Labor on 
all policies and procedures affecting veterans. VETS also 
administers grants to States, public entities and non-profits, 
including faith-based organizations, to help veterans find 
jobs.
    The Administration requests $220.6 million for all VETS 
programs, a $1.9 million increase over the appropriated level 
for fiscal year 2004; $162.4 million for State grants (Disabled 
Veterans' Outreach Program and the Local Veterans' Employment 
Representative program); $29.7 million for program 
administration activities; $2 million for the National 
Veterans' Employment and Training Services Institute; $19 
million for the Homeless Veterans' Reintegration Program; and 
$7.5 million for the Veterans' Workforce Investment Program.
    The Committee supports this request and expects states to 
continue to use the flexibility furnished in the Jobs for 
Veterans Act to determine the number and role of DVOPs and 
LVERs in their state service plans. The Committee desires 
states to use such flexibility to tailor services to meet 
veterans' needs.

 LEGISLATION THE COMMITTEE MAY REPORT WITH DIRECT SPENDING IMPLICATIONS

    The Committee intends to continue its emphasis on economic 
opportunity for those who have worn the military uniform. 
Committee legislative accomplishments to date include: The 
Veterans Entrepreneurship and Small Business Development Act of 
1999 (Public Law 106-50), the Jobs for Veterans Act (Public Law 
107-288), aspects of the Veterans Benefits Act of 2003 (Public 
Law 108-183), and the Veterans Education and Benefits Expansion 
Act of 2001 (Public Law 107-103), which provided a 46 percent 
increase in the Montgomery GI Bill over three years.

    On-Job Training and Apprenticeship.--Congress has not 
comprehensively updated the on-job training (OJT) and 
apprenticeship programs under the Montgomery GI Bill (MGIB) and 
other VA educational assistance programs since World War II. 
Some apprenticeships in today's workplace can last as long as 
five years and most are competency-based. Title 38, United 
States Code, limits itself to time-based learning on the job. 
In addition, many technical and technology-based employers 
require that workers meet occupational licensing, 
certification, or other credentialing requirements that are an 
``outgrowth'' of such training. Although different from 
apprenticeships, on-job training is still time-based and lasts 
up to two years.
    About 65 percent of servicemembers are married and many 
have children at the time they separate from active duty. 
``Earning and learning'' on the job under a structured, VA-
approved OJT or apprenticeship program could serve as an 
excellent transition tool. The Department of Labor reported in 
2003 that the average unemployment rate for recently separated 
male veterans ages 20 to 24 years was 11.5 percent, and 8.7 
percent for similar female veterans. For 20-24 year old black 
male and female veterans, the 2003 unemployment rate was 21.9 
and 13.9 percent, respectively. For 20-24 year old male and 
female Hispanic veterans, the 2003 unemployment rate was 8.7 
percent and 21.4 percent, respectively.
    The Subcommittee on Benefits held a public hearing on OJT 
and apprenticeship programs on April 30, 2003. Business, 
industry, and organized labor representatives testified that a 
modernized statute reflecting the nature of structured training 
in today's workplace would help improve participation of 
recently-separated veterans in VA's OJT and apprenticeship 
programs because employers likely would be more willing to 
participate.
    The Committee may report legislation to modernize this 
program for business and industry. The Committee estimates the 
cost to be $187 million for fiscal year 2005, with a five-year 
cost of $769 million, and a 10-year cost of $1.782 billion.
                     ADDITIONAL VIEWS AND ESTIMATES


                          HONORABLE BOB FILNER


    I am submitting the following additional views on the 
budget for FY2005 to the Committee on Veterans' Affairs.
    For years, I have relied on The Independent Budget, a 
comprehensive budget and policy document created by veterans 
for veterans. Developed by four veterans service organizations, 
AMVETS, the Disabled American Veterans, the Paralyzed Veterans 
of America, and the Veterans of Foreign Wars of the United 
States, and endorsed by over thirty additional organizations, 
this budget is a collaborative effort to present 
recommendations on policy and the budget regarding veterans' 
programs administered by the Department of Veterans Affairs 
(VA).
    For FY2005, the Independent Budget recommends $29.8 
billion, an increase of $3.1 billion over the President's 
Budget Request for medical care and $33.5 billion, an increase 
of $3.9 billion over the President's Budget Request for VA 
discretionary funding.
    The recommendations of the Independent Budget meet the 
needs of our veterans seeking health care and other services 
from the VA. We must realize that the costs of war include 
taking care of veterans returning with physical and mental 
wounds. We must respond to the growing number of older veterans 
who need long-term care. We must re-open enrollment for VA 
health care to all veterans.
    To address these and other veterans' needs, I recommend 
that we follow the lead of the Independent Budget. I urge the 
Committee on the Budget to consider an additional $3.9 billion 
in budget authority for VA's discretionary programs.

                        HONORABLE CORRINE BROWN


    Time and time again our veterans get the shaft. President 
Bush came out with a budget that short changes the middle 
class, children, seniors, and our veterans.
    It is mind blowing to me that the Bush Administration is 
going to make the trillion dollar deficit they created even 
worse by keeping the tax cuts it gave to the wealthy. Americans 
deserve to have a President who looks out for the interests of 
the nation as a whole, not just for an elite few.
    Adding to this deficit is the proposal to increase NASA's 
budget by $1 billion dollars. Although I support NASA, this 
funding will come at the expense of our Nation's veterans who 
are waiting for a simple appointment with the doctor. HUD has 
already been stripped to the bone and I am worried that VA is 
next. America made a commitment to care for those who answered 
our Nation's call to service, and we are not honoring that 
commitment. If we can come up with an additional $1 billion for 
NASA, then surely we can give VA the money that it needs to 
provide for our veterans.
    We have given approximately $150 billion to the ongoing war 
in Iraq. We should be able to give VA enough money to take care 
of our soldiers when they return. The Bush Administration 
should be ashamed.
    President Bush is cutting funding for veterans' medical 
care in 2005. CBO has stated that the amount the President is 
providing is $257 million below what is needed to MAINTAIN 
purchasing power at 2004 levels. The Secretary of Veterans 
Affairs has testified that he sought $1.2 billion more than 
what the President provided. The fiscal year 2005 budget is a 
perfect example of how the Bush Administration is failing to 
treat our veterans with the respect that they have earned.
    I am very concerned that enrollment in the VA healthcare 
system continues to grow and of VA's inability to respond to 
veterans' needs once enrolled. Although VA is reporting that 
only 36,000 patients are waiting six months or more to see a VA 
physician, 2.4 million additional veterans are expected to 
enroll in VA healthcare for fiscal year 2005. Many of these 
veterans are not expected to use healthcare services, but the 
number is alarming.
    VA is facing a decrease of $21 million below the fiscal 
year 2004 appropriation for medical and prosthetic research. I 
have been to Walter Reed and have seen the physical scars that 
have been left on our soldiers returning home from Afghanistan 
and Iraq. Many of the soldiers that I visited with are 
amputees. How can the Bush Administration decrease prosthetic 
research at a time when a new round of soldiers is returning 
home and could benefit from new technology? I would like to see 
VA receive additional funding for medical research coupled with 
an increase in medical care funds to support these activities.
    We show potential and current members of the Armed Forces 
how America honors their sacrifice by how well we treat our 
veterans. This budget is not adequate to meet the needs of 25 
million of our Nation's finest individuals. President Bush 
needs to start walking the walk if he is going to talk the 
talk. Wearing a flightsuit and landing on a carrier does not 
take care of the needs of former members of our Nation's 
military.

                                Comparison of FY 2005 Budget Proposals: VA Department - VA Committee - Independent Budget
                                                                  (Dollars in Millions)
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                     Committee
                                                             Department                VA FY 2005        on      HCVA FY 2005                 IB FY 2005
                                                            of Veterans    VA's FY       Request     Veterans'    Compared to   Independent  Compared to
                                                              Affairs    2005 Budget   Compared to    Affairs      Admin. FY    Budget (IB)   Admin. FY
                                                              (VA) FY      Request       FY 2004     (HCVA) FY   2005 Request     FY 2005        2005
                                                             2004 Final                   Final         2005                     Recommend     Request
                                                              Approp.                                Recommend
--------------------------------------------------------------------------------------------------------------------------------------------------------
Medical Care1                                                   $25,938      $26,646         $708       $28,994       $2,348        $29,791       $3,145
MCCF and HSIF Receipts                                            1,752        2,419          667         1,927        ^\492    No estimate  ...........
Medical and Prosthetic Research                                     406          385         ^\21           415           30            460           75
MAMOE                                                                79           87            8            87            0             87            0
VA Medical Construction, Major                                      614          401        ^\213           401            0            571          170
VA Medical Construction, Minor                                      206          182         ^\24           182            0            545          363
VA State Home Grants                                                101          105            4           105            0            150           45
VA State Cemetery Grants                                             32           32            0            32            0             37            5
General Operating Expenses                                        1,276        1,325           49         1,375           50          1,618          293
National Cemetery Administration                                    143          149            6           199           50            175           26
Inspector General                                                    62           65            3            65            0             62          ^\3
Other Discretionary                                                 280          277          ^\3           323           46            100        ^\177
                                                           ---------------------------------------------------------------------------------------------
VA Discretionary (Excluding MCCF and HSIF Receipts)              29,137       29,654          517        32,178        2,524        $33,596       $3,942
                                                           ---------------------------------------------------------------------------------------------
Total VA Discretionary (INCLUDING Receipts)                      30,889       32,073        1,184        34,105        2,032   ............  ...........
                                                           ---------------------------------------------------------------------------------------------
VA Baseline Mandatory                                            31,166       35,252        4,086        35,252            0    No estimate  ...........
                                                           ---------------------------------------------------------------------------------------------
Committee Legislative Proposal                                                                              187          187    No estimate  ...........
                                                           ---------------------------------------------------------------------------------------------
Total VA Mandatory Spending                                      31,166       35,252        4,086        35,439          187    No estimate  ...........
                                                           ---------------------------------------------------------------------------------------------
TOTAL VA BUDGET (Mandatory and Discretionary)                   $62,055      $67,325       $5,270       $69,544       $2,219   ............  ...........
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 FY 2004 Medical Care number assumes transfer of $400 million from Medical Care to Major Medical Construction per P.L. 108-199.

        MESSAGES FROM THE PRESIDENT AND EXECUTIVE COMMUNICATIONS

                                ------                                


                         Presidential Messages

Feb. 13, 2003:
    Communication from the President of the United States, 
transmitting the Administration's 2003 National Drug Control 
Strategy, pursuant to 21 U.S.C. 1505.

June 16, 2003:
    Communication from the President of the United States, 
transmitting a report entitled, ``Demand Reduction Agenda: 
Critical Programs''.

Mar. 2, 2004:
    Communication from the President of the United States, 
transmitting the Administration's 2004 National Drug Control 
Strategy, pursuant to 21 U.S.C. 1705.
                                ------                                


                        Executive Communications

Jan. 7, 2003:
    Letter from the the Executive Secretary, the Disabled 
American Veterans, transmitting the 2002 National Convention 
Proceedings of the Disabled American Veterans, pursuant to 36 
U.S.C. 90i and 44 U.S.C. 1332.

Jan. 27, 2003:
    Letter from the Deputy General Counsel, Department of 
Veterans Affairs, transmitting the Department's final rule--
Health Care for Certain Children of Vietnam Veterans--Covered 
Birth Defects and Spina Bifida (RIN: 2900-AK88) Received 
January 8, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Jan. 27, 2003:
    Letter from the Acting Director, Office of Regulatory Law, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Extension of the Presumptive Period for 
Compensation for Gulf War Veteran's Undiagnosed Illnesses (RIN: 
2900-AK98) Received January 8, 2002, pursuant to 5 U.S.C. 
801(a)(1)(A).

Jan. 27, 2003:
    Letter from the Acting Director, Office of Regulatory Law, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Vocational Training for Certain Children of Vietnam 
Veterans--Covered Birth Defects and Spina Bifida (RIN: 2900-
AK90) Received December 4, 2002, pursuant to 5 U.S.C. 
801(a)(1)(A).

Jan. 27, 2003:
    Letter from the The American Legion, transmitting the 
financial statement and independent audit of The American 
Legion proceedings of the 84th annual National Convention of 
The American Legion, held in Charlotte, North Carolina from 
August 27, 28, and 29, 2002 and a report on the Organization's 
activities for the year preceding the Convention, pursuant to 
36 U.S.C. 49.

Jan. 31, 2003:
    Letter from the Deputy General Counsel, Department of 
Veterans Affairs, transmitting the Department's final rule--
Enrollment--Provision of Hospital and Outpatient Care to 
Veterans Subpriorities of Priority Categories 7 and 8 and 
Annual Enrollment Level Decision (RIN: 2900-AL51) Received 
January 22, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Feb. 5, 2003:
    Letter from the Deputy General Counsel, Department of 
Veterans Affairs, transmitting the Department's final rule--VA 
Acquisition Regulation: Simplified Acquisition Procedures for 
Health-Care Resources (RIN: 2900- AI71) Received January 22, 
2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Mar. 18, 2003:
    Letter from the Deputy General Counsel, Department of 
Veteran Affairs, transmitting the Department's final rule--Loan 
Guaranty: Implementation of Public Law 107-103 (RIN: 2900-AL23) 
Received February 6, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

March 20, 2003:
    Letter from the Deputy General Counsel, Board of Veterans' 
Appeals, Department of Veterans Affairs, transmitting the 
Department's final rule--Appeals Regulations: Title for Members 
of the Board of Veterans' Appeals (RIN: 2900-AK62) Received 
February 10, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

March 20, 2003:
    Letter from the Deputy General Counsel, Department of 
Veterans Affairs, transmitting the Department's final rule--
Provision of Drugs and Medicines to Certain Veterans in State 
Homes (RIN: 2900-AJ34) Received March 12, 2003, pursuant to 5 
U.S.C. 801(a)(1)(A).
Mar. 20, 2003:
    Letter from the General Counsel, Department of Defense, 
transmitting the Department's legislative proposal entitled, 
``To authorize appropriations for fiscal year 2004 for military 
activities of the Department of Defense, to prescribe military 
personnel strengths for fiscal year 2004, and for other 
purposes''.

Mar. 24, 2003:
    Letter from the Deputy General Counsel, VHA, Department of 
Veterans Affairs, transmitting the Department's final rule--VA 
Homeless Providers Grant and Per Deim Program (RIN: 2900-AL30) 
Received March 18, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Apr. 7, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Board of Veterans' Appeals: Rules of Practice-
Appeal Withdrawal (RIN: 2900-AK71) Received March 31, 2003, 
pursuant to 5 U.S.C. 801(a)(1)(A).

Apr. 10, 2003:
    Letter from the Under Secretary, Department of Defense, 
transmitting the Department's plan to implement legislation 
concerning the transfer of Montgomery GI Bill entitlements to 
family members, pursuant to 38 U.S.C. 3020 Public Law 107-107, 
Section 654.
Apr. 10, 2003:
    Letter from the Assistant Secretary, Department of Defense, 
transmitting a report on Outreach to Gulf War Veterans Calendar 
Year 2002.

Apr. 10, 2003:
    Letter from the Secretary, Department of Veterans Affairs, 
transmitting the Department's seventh report describing the 
administration of the Montgomery GI Bill educational assistance 
program.

Apr. 10, 2003:
    Letter from the Secretaries, 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).

Apr. 12, 2003:
    Letter from the Secretary, Department of Veterans Affairs 
transmitting a report covering those cases in which equitable 
relief was granted in calendar year 2002, pursuant to 38 U.S.C. 
210(c)(3)(B).

Apr. 29, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Referrals of Information Regarding Criminal 
Violations (RIN: 2900-AL31) Received April 12, 2003, pursuant 
to 5 U.S.C., 801(a)(1)(A).

Apr. 29, 2003:
    Letter from the Under Secretary, Department of Defense, 
transmitting the biennial report on the Montgomery GI Bill 
Education Benefits Program.

May 7, 2003:
    Letter from the Chairman, Department of Veterans Affairs, 
transmitting the Department's report of the chairman.

May 8, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Reasonable Charges for Medical Care or Services; 
2003 Update (RIN: 2900-AL57) Received April 22, 2003, pursuant 
to 5 U.S.C. 801(a)(1)(A).

May 8, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Eligibility for Burial of Adult Children; 
Eligibility for Burial of Minor Children; Eligibility for 
Burial of Certain Filipino Veterans (RIN: 2900-AI95) Received 
March 31, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

June 2, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Schedule for Rating Disabilities: Evaluation of 
Emeritus (RIN: 2900-AK86) Received May 14, 2003, pursuant to 5 
U.S.C. 801(a)(1)(A).

June 11, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Compensation and Pension Provisions of the Veterans 
Education and Benefits Expansion Act of 2001 (RIN: 2900-AL29) 
June 6, 2002, pursuant to 5 U.S.C. 801(a)(1)(A).

June 16, 2003:
    Letter from the Deputy General Counsel, Veterans Health 
Administration, Department of Veterans Affairs, transmitting 
the Department's final rule--Fisher Houses and Other Temporary 
Lodging (RIN: 2900-AL13) Received February 21, 2003, pursuant 
to 5 U.S.C. 801(a)(1)(A).

June 19, 2003:
    Letter from the Under Secretary for Health and Assistant 
Secretary of Defense, Health Affairs, Departments of Veterans 
Affairs and Defense, transmitting a letter concerning a joint 
review of the adequacy of processes and existing authorities 
for the coordination and sharing of health care resources, 
pursuant to Pubic Law 107-314, Section 723.

June 26, 2003:
    Letter from the Associate Administrator, Office of Veterans 
Business Development, Small Business Administration, 
transmitting a letter regarding a report describing the 
activities of the Committee and any recommendations developed 
by the Committee for the promotion of small business concerns 
owned and controlled by veterans.

July 7, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Increase in Rates Payable Under the Montgomery GI 
Bill--Active Duty and Survivors' and Dependents' Educational 
Assistance Program (RIN: 2900-AL17) Received June 9, 2003, 
pursuant to 5 U.S.C. 801(a)(1)(A).

July 7, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Veterans Education: Additional Opportunity to 
Participate in the Montgomery GI Bill and Other Miscellaneous 
Issues (RIN: 2900-AK81) Received June 9, 2003, pursuant to 5 
U.S.C. 801(a)(1)(A).

July 8, 2003:
    Letter from the Secretary of Veterans Affairs, Department 
of Veterans Affairs, transmitting a draft of proposed 
legislation to amend title 38, United States Code, to improve 
benefits for Filipino veterans of World War II and survivors of 
such veterans and extend health care benefits to certain 
Filipino veterans residing legally in the United States.

July 8, 2003:
    Letter from the Under Secretary, Department of Defense, 
transmitting the biennial report on the Montgomery GI Bill for 
Members of the Selected Reserve.

July 15, 2003:
    Letter from the Deputy General Counsel, Department of 
Veterans Affairs, transmitting the Department's final rule--
Recognition of Organizations and Accreditation of 
Representatives, Attorneys, and Agents (RIN: 2900-AI93) 
Received July 7, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

July 24, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Presumption of Service Connection for Cirrhosis of 
the Liver in Former Prisoners of War (RIN: 2900-AL36) Received 
July 21, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

July 24, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Increase in Rates Payable Under the Montgomery GI 
Bill--Selected Reserve (RIN:2900-AL41) Received July 21, 2003, 
pursuant to 5 U.S.C. 801(a)(1)(A).

July 24, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Medication Prescribed by Non-VA Physicians (RIN: 
2900-AL68) Received July 23, 2003, pursuant to 5 U.S.C. 
801(a)(1)(A).

July 25, 2003:
    Letter from the Secretary, Department of Veterans Affairs, 
transmitting a draft of proposed legislation relating to 
amending title 38 of the United States Code to modify and 
improve authorities relating to former prisoners of war.

July 25, 2003:
    Letter from the Secretary, Department of Veterans Affairs, 
transmitting a draft bill ``To amend title 38, United States 
Code, to simplify and improve pay provisions for physicians and 
dentists, to authorize alternate work schedules and executive 
pay for nurses''.

Sept. 9, 2003:
    Letter from the Director, Regulations Management, 
Department of Veteran's Affairs, transmitting the Department's 
final rule--Effective Dates of Benefits for Disability or Death 
Caused By Herbicide Exposure; Disposition of Unpaid Benefits 
After Death of Beneficiary (RIN: 2900-AL37) Received August 26, 
2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 9, 2003:
    Letter from the Secretary, Department of Veterans Affairs, 
transmitting a draft bill, ``To amend title 38, United States 
Code, to enhance the ability of the Department of Veterans 
Affairs to care for veterans, and for other purposes''.

Sept. 10, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Schedule for Rating Disabilities; The Spine (RIN: 
2900-AJ60) Received September 2, 2003, pursuant to 5 U.S.C. 
801(a)(1)(A).

Sept. 15, 2003:
    Letter from the Secretaries, Departments of Health and 
Human Services, Defense and Veterans Affairs, transmitting a 
report entitled ``Report to Congress on Accounting for VA and 
DoD Expenditures for Medicare Beneficiaries''.

Sept. 25, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Board of Veterans' Appeals: Rules of Practice--
Motions for Revision of Decisions on Grounds of Dear and 
Unmistakable Error: Advancement on the Docket (RIN: 2900-AJ85) 
Received September 23, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 25, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Board of Veterans' Appeals: Speeding Appellate 
Review for Aging Veterans (RIN: 2900-AL08) Received September 
23, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 25, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--VA Homeless Providers Grant and Per Diem Program 
(RIN: 2900-AL30) Received September 24, 2003, pursuant to 5 
U.S.C. 801(a)(1)(A).

Sept. 25, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Eligibility for an Appropriate Government Marker 
for a Grave Already Marked at Private Expense (RIN: 2900-AL40) 
Received September 24, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 25, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Compensation and Pension Provisions of the Veterans 
Benefits Act of 2002 (RIN: 2900-AL62) Received September 24, 
2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Oct. 24, 2003:
    Letter from the Secretary, Department of Veterans Affairs, 
transmitting a draft bill, ``To amend title 38, United States 
Code, to strengthen the ability of the Secretary of Veterans 
Affairs to manage Veterans Health Administration medical 
personnel effectively, and for other purposes''.

Oct. 29, 2003:
    Letter from the Director, Regulations Management, Office of 
Regulation Policy and Management, Department of Veterans 
Affairs, transmitting the Department's final rule--Exclusions 
from Income and Net Worth Computations (RIN: 2900-AJ52) 
Received October 27, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Oct. 29, 2003:
    Letter from the Director, Regulations Management, Office of 
Regulation Policy and Management, Department of Veterans 
Affairs, transmitting the Department's final rule--Co-payments 
for Inpatient Hospital Care Provided to Veterans Enrolled in 
Priority Category 7 (RIN: 2900-AL35) Received October 27, 2003, 
pursuant to 5 U.S.C. 801(a)(1)(A).

Oct. 29, 2003:
    Letter from the Director, Regulations Management, Office of 
Regulation Policy and Management, Department of Veterans 
Affairs, transmitting the Department's final rule--Veterans 
Education: Independent Study Approved for Certificate Programs 
and Other Miscellaneous Issues (RIN: 2900-AL34) Received 
October 16, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Oct. 29, 2003:
    Letter from the Director, Regulations Management, Office of 
Regulation Policy and Management, Department of Veterans 
Affairs, transmitting the Department's final rule--Disease 
Associated with Exposure to Certain Herbicide Agents: Chronic 
Lymphocytic Leukemia (RIN: 2900-AL55) Received October 16, 
2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Nov. 21, 2003:
    Letter from the Secretary, Department of Veterans Affairs, 
transmitting a draft bill, ``To amend title 38, United States 
Code, to improve veterans' benefits programs, and for other 
purposes''.

Nov. 25, 2003:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Accelerated Payments Under the Montgomery GI Bill--
Active Duty Program (RIN: 2900-AL22) Received June 12, 2003, 
pursuant to 5 U.S.C. 801(a)(1)(A).

Nov. 25, 2003:
    Letter from the Director, Office of Regulation Policy and 
Management, Veterans Benefits Administration, Department of 
Veterans Affairs, transmitting the Department's final rule--
Veterans Education: Increases Allowances for the Educational 
Assistance Test Program (RIN: 2900-AL52) Received November 19, 
2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Dec. 8, 2003:
    Letter from the the National Adjutant, the Disabled 
American Veterans, transmitting 2003 National Convention 
Proceedings of The Disabled American Veterans, pursuant to 36 
U.S.C. 90i and 44 U.S.C. 1332.

Dec. 8, 2003:
    Letter from the Director, Regulations Management, Office of 
Regulation Policy and Management, Department of Veterans 
Affairs, transmitting the Department's final rule--Board of 
Veterans' Appeals: Rules of Practice; Use of Supplemental 
Statement of the Case (RIN: 2900-AL42) Received November 13, 
2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Jan. 23, 2004:
    Letter from the Director, Office of Personnel Management, 
transmitting the Office's Fiscal Year 2002 annual report on 
Veteran's Employment in the Federal Government, pursuant to 38 
U.S.C. 4214(e)(1).

Jan. 27, 2004:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Reasonable Charges for Medical Care or Services; 
2003 Methodology Changes (RIN: 2900-AL06) Received December 15, 
2003, pursuant to 5 U.S.C. 801(a)(1)(A).

Jan. 30, 2004:
    Letter from the Secretary, Department of Veterans Affairs, 
transmitting the Special Medical Advisory Group's Annual Report 
to Congress for FY 2003, pursuant to 38 U.S.C. 4112(a).

Feb. 4, 2004:
    Letter from the The American Legion, transmitting the 
financial statement and independent audit of The American 
Legion proceedings of the 85th annual National Convention of 
The American Legion, held in St. Louis, Missouri from August 
26, 27, and 28, 2003 and a report on the Organization's 
activities for the year preceding the Convention, pursuant to 
36 U.S.C. 49.

Feb. 10, 2004:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Charges Used for Recovery from Tortuously Liable 
Third Parties for Medical Care or Services Provided by the 
Department of Veterans Affairs (RIN: 2900-AL48) Received 
January 8, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).

Mar. 12, 2004:
    Letter from the Director, Regulations Management, Office of 
Regulation, Policy, and Management, Department of Veterans 
Affairs, transmitting the Department's final rule--Delegation 
of Authority--Property Management Contractor (RIN: 2900-AL85) 
Received March 4, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).

Mar. 16, 2004:
    Letter from the Director, Regulations Management, National 
Cemetery Administration, Department of Veterans Affairs, 
transmitting the Department's final rule--Eligibility for an 
Appropriate Government Marker for a Grave Already Marked at 
Private Expense (RIN: 2900-AL40) Received March 8, 2004, 
pursuant to 5 U.S.C. 801(a)(1)(A).

Mar. 25, 2004:
    Letter from the Assistant Secretary for Health Affairs, 
Department of Defense, transmitting notice of a delayed 
delivery date for the final VA/DoD Joint Assessment Study, as 
required by Section 8147 of the Department of Defense 
Appropriations Act for FY 2002.

Mar. 30, 2004:
    Letter from the General Counsel, Department of Defense, 
transmitting the Department's legislative initiatives for 
inclusion in the National Defense Authorization Act for FY 
2005.

Apr. 21, 2004:
    Letter from the Secretary, Department of Veterans Affairs, 
transmitting a report covering those cases in which equitable 
relief was granted in calendar year 2003, pursuant to 38 U.S.C. 
503(c).

Apr. 22, 2004:
    Letter from the Secretary, Department of Labor, 
transmitting the first report of the President's National Hire 
Veterans Committee, pursuant to 38 U.S.C. 4100 Note.

Apr. 26, 2004:
    Letter from the Director, Regulations Management, Office of 
Regulation, Policy and Management, Department of Veterans 
Affairs, transmitting the Department's final rule--Board of 
Veterans' Appeals: Rules of Practice--Notice Procedures 
Relating to Withdrawal of Services by a Representative (RIN: 
2900-AL45) Received April 19, 2004, pursuant to 5 U.S.C. 
801(a)(1)(A).

May 5, 2004:
    Letter from the Director, Regulations Management, National 
Cemetery Administration, Department of Veterans Affairs, 
transmitting the Department's final rule--State Cemetery Grants 
(RIN: 2900-AH46) Received April 9, 2004, pursuant to 5 U.S.C. 
801(a)(1)(A).
May 5, 2004:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Board of Veterans' Appeals: Rules of Practice--
Medical Opinions From the Veterans Health Administration (RIN: 
2900-A K52) Received April 15, 2004, pursuant to 5 U.S.C. 
801(a)(1)(A).

May 20, 2004:
    Letter from the Secretary, Department of Veterans Affairs, 
transmitting the Department's Capital Asset Realignment for 
Enhanced Services (CARES) Decision, pursuant to Public Law 108-
170, Section 222.

June 9, 2004:
    Letter from the Chairman, Board of Veterans' Appeals, 
Department of Veterans Affairs, transmitting a copy of the 
Report of the Chairman for FY 2003.

June 17, 2004;
    Letter from the Secretaries, Departments of Defense and 
Veterans Affairs, transmitting a report for FY 2003 regarding 
the implementation of the health coordination and sharing 
activities portion of the National Defense Authorization Act of 
2003 (Pub. L. 107-314) and an estimate of the cost to prepare 
this report, as required by Title 38, Chapter 1, Section 116, 
pursuant to 38 U.S.C. 8111(f).

July 7, 2004:
    Letter from the Director, Regulations Management, Veterans 
Health Administration, Department of Veterans Affairs, 
transmitting the Department's final rule--VA Homeless Providers 
Grant and Per Diem Program; Religious Organizations (RIN: 2900-
AL63) Received June 7, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).

July 7, 2004:
    Letter from the Director, Regulations Management, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Board of Veterans' Appeals: Rules of Practice--
Motions for Revision of Decision on Grounds of Clear and 
Unmistakable Error: Advancement on the Docket (RIN: 2900-AJ85) 
Received May 27, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).

July 7, 2004:
    Letter from the Director, Regulations Management, Veterans 
Health Administration, Department of Veterans Affairs, 
transmitting the Department's final rule--Sensori-Neural Aids 
(RIN: 2900-AL60) Received June 16, 2004, pursuant to 5 U.S.C. 
801(a)(1)(A).

July 7, 2004:
    Letter from the Director, Regulations Management, Veterans 
Health Administration, Department of Veterans Affairs, 
transmitting the Department's final rule--Priorities for 
Outpatient Medical Services and Inpatient Hospital Care (RIN: 
2900-AL39). Received June 17, 2004, pursuant to 5 U.S.C. 
801(a)(1)(A).

July 7, 2004:
    Letter from the Director, Regulations Management, Veterans 
Health Administration, Department of Veterans Affairs, 
transmitting the Department's final rule--Change of Effective 
Date of Rule Adding a Disease Associated With Exposure to 
Certain Herbicide Agents: Type 2 Diabetes (RIN: 2900-AL93) 
Received June 7, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).

July 9, 2004:
    Letter from the Secretary, Department of Veterans Affairs, 
transmitting a draft bill "To amend title 38, United States 
Code, to improve the authorities of the Department of Veterans 
Affairs relating to compensation, dependency and indemnity 
compensation, life insurance benefits, memorial benefits, and 
education benefits, and for other purposes''.

Sept. 13, 2004:
    Letter from the Director, Regulations Management, Office of 
Regulation Policy and Management, Veterans Benefits 
Administration, Department of Veterans Affairs, transmitting 
the Department's final rule--Additional Disability or Death Due 
to Hospital Care, Medical or Surgical Treatment, Examination, 
Training and Rehabilitation Services, or Compensated Work 
Therapy Program (RIN: 2900-AK77) Received July 30, 2004, 
pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 13, 2004:
    Letter from the Director, Regulations Management, Office of 
Regulation Policy and Management. Veterans Health 
Administration, Department of Veterans Affairs, transmitting 
the Department's final rule--Copayments for Extended Care 
Services (RIN: 2900-AL49) Received June 28, 2004, pursuant to 5 
U.S.C. 801(a)(1)(A).

Sept. 13, 2004
    Letter from the Director, Regulations Management, Office of 
Regulation Policy and Management, National Cemetery 
Administration, Department of Veterans Affairs, transmitting 
the Department's final rule--Eligibility for Burial in a 
National Cemetery for Surviving Spouses Who Remarry and New 
Philippine Scouts (RIN: 2900-AM00) Received June 28, 2004, 
pursuant to 5 U.S.C. 801(a)(1)(A).

Sept. 29, 2004:
    Letter from the Director, Regulations Management, Office of 
Regulation Policy and Management, Department of Veterans 
Affairs, transmitting the Department's final rule--Compensation 
for Certain Cases of Bilateral Deafness (RIN: 2900-AL59) 
Received August 6, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).

Oct. 5, 2004:
    Letter from the Assistant Secretary of Defense for Health 
Affairs and the Acting Under Secretary for Health, Departments 
of Defense and Veterans Affairs, transmitting as required by 
Section 8147 of the Department of Defense Appropriations Act 
for FY 2002, the Findings and Recommendations from the 
Department of Defense (DoD)/Department of Veterans Affairs (VA) 
Joint Assessment Study.

Oct. 7, 2004:
    Letter from the Director, Regulations Management, Office of 
Regulation Policy and Management, Department of Veterans 
Affairs, transmitting the Department's final rule--Board of 
Veterans' Appeals: Obtaining Evidence and Curing Procedural 
Defects (RIN: 2900-AL77) Received August 30, 2004, pursuant to 
5 U.S.C. 801(a)(1)(A).

Oct. 8, 2004:
    Letter from the Chief, Reg. Development Ofc. of Regulations 
Policy & Mgt. VA, Department of Veterans Affairs, transmitting 
the Department's final rule--Presumptions of Service Connection 
for Diseases Associated with Service Involving Detention or 
Internment as a Prisoner of War (RIN: 2900-AM09) Received 
October 6, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).

Nov. 16, 2004:
    Letter from the the National Adjutant, the Disabled 
American Veterans, transmitting 2004 National Convention 
Proceedings of The Disabled American Veterans, pursuant to 36 
U.S.C. 90i and 44 U.S.C. 1332.

Nov. 19, 2004:
    Letter from the Office of Regulation Policy & Mgt., VA, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Increase in Rates Payable Under the Survivors' and 
Dependents' Education Assistance Program (RIN: 2900-AL64) 
Received October 22, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).

Nov. 19, 2004:
    Letter from the Office of Regulation Policy & Mgt., VA, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Veterans Education: Increased Allowances for the 
Educational Assistance Test Program (RIN: 2900-AL81) Received 
October 22, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).

Nov. 19, 2004:
    Letter from the Office of Regulation Policy & Mgt., VA, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Increase in Rates Payable Under the Montgomery GI 
Bill--Selected Reserve (RIN: 2900-AL80) Received October 22, 
2004, pursuant to 5 U.S.C. 801(a)(1)(A).

Nov. 19, 2004:
    Letter from the Office of Regulation Policy & Mgt., VA, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Standards for Collection, Compromise, Suspension, 
or Termination of Collection Effort, and Referral of Civil 
Claims for Money or Property; Regional Office Committees on 
Waivers and Compromises; Salary Offset Provisions; Delegations 
of Authority (RIN: 2900-AK10) Received October 22, 2004, 
pursuant to 5 U.S.C. 801(a)(A).

Nov. 19, 2004:
    Letter from the Office of Regulation Policy & Mgt., VA, 
Department of Veterans Affairs, transmitting the Department's 
final rule--Waivers (RIN: 2900-AK29) Received October 22, 2004, 
pursuant to 5 U.S.C. 801(a)(1)(A).
             STATISTICAL DATA--WAR VETERANS AND DEPENDENTS


                         (As of September 2004)


                     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,.............age 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
Last Union Widow, Gertrude Janeway, died January 17, 2003,........age 93

                    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.................................\1\ 
                                                       Approximately 100

                        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.........................................\1\ 
                                                               3,984,200

                       Korean Conflict (1950-1953)

Total Servicemembers (worldwide)...............................5,720,000
Battle Deaths.....................................................33,741
Other Deaths (In theater)..........................................2,835
Other Deaths in Service...........................................17,670
Non-mortal Woundings.............................................103,284
 Living veterans.........................................\1\ 
                                                               3,423,300

                         Vietnam Era (1964-1975)

Total Servicemembers (Worldwide)...............................9,200,000
Deployed to Southeast Asia.....................................3,403,000
Battle Deaths.....................................................47,415
Other Deaths (In Theater).........................................10,785
Other Deaths in Service......................................est. 32,000
Non-mortal Woundings.............................................153,303
 Living Veterans.........................................\1\ 
                                                               8,122,000

                 Desert Shield/Desert Storm (1990-1991)

Total Servicemembers (Worldwide)...............................2,322,332
Deployed to Gulf.................................................694,550
Battle Deaths........................................................147
Other Deaths (In Theater)............................................235
Other Deaths in Service..............................................914
Non-mortal Woundings.................................................467
Living Veterans................................................1,900,000

                     War on Terrorism (2001-Present)

Total U.S. Servicemembers (Worldwide)..........................1,428,383
Deployed to Iraq & Afghanistan...................................185,329
Battle Deaths........................................................848
Other Deaths (In Theater)............................................341
Non-mortal Woundings...............................................5,828
Living Veterans...........................................\3\ 
                                                                 194,700

                          America's Wars Total

Military Service During War...................................42,353,843
Battle Deaths....................................................651,254
Other Deaths (In Theater).........................................13,919
Other Deaths in Service (Non-Theater)............................524,545
Non-mortal Woundings...........................................1,434,076
  Living War Veterans....................................\4\ 
                                                              16,522,400
Living Veterans...............................................24,737,500
                                ------                                



                          Veterans and Dependents on the Compensation and Pension Rolls
                                             (As of September 2004)
----------------------------------------------------------------------------------------------------------------
                                                                                                      SURVIVING
                                                                VETERANS     CHILDREN     PARENTS      SPOUSES
----------------------------------------------------------------------------------------------------------------
Civil War...................................................  ...........            5  ...........  ...........

Indian Wars.................................................  ...........  ...........  ...........  ...........

Spanish-American War........................................  ...........          150  ...........          192

Mexican Border..............................................            5           23  ...........          101

World War I.................................................           26        4,486            1       11,773

World War II................................................      506,399       16,818          429      247,296

Korean Conflict.............................................      236,628        3,646          674       62,292

Vietnam Era.................................................    1,028,022       11,133        4,358      138,204

Gulf War....................................................      540,193       10,997          560       10,061

TOTAL WARTIME...............................................    2,898,599       51,757        7,681      503,760

Nonservice-connected........................................      342,903       22,852  ...........      199,614
Service-connected...........................................    2,555,696       28,905        7,681      304,146

----------------------------------------------------------------------------------------------------------------
Source: Department of Defense (DOD), except living veterans, which are VA estimates.

Periods of service used in Census data may differ slightly from those of DOD. For compensation and pension
  purposes, the Gulf War period has not yet been terminated and includes those discharged from 1991 to date. The
  living Gulf War veterans estimate is for the peak 1990-1991 period only.

``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 as of September 30, 2004.

\2\ Does not include 26,000 to 31,000 who died in Union prisons.

\3\ VA estimate may include veterans who both served in Iraq and Afghanistan.

\4\ Unless otherwise indicated, estimates for living U.S. veterans are based on the 2000 Census, except for WWI,
  which is based on the 1990 Census, the last census to include WWII figures. Dates for periods of service used
  in census data may differ slightly from those of VA and DOD. The total Living War Veterans estimate is not a
  cumulative of the individual war periods shown, as many veterans served in more than one war.

                                  
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