[Senate Report 113-1]
[From the U.S. Government Publishing Office]
113th Congress Report
SENATE
1st Session 113-1
======================================================================
LEGISLATIVE AND OVERSIGHT ACTIVITIES DURING THE 111TH CONGRESS BY THE
SENATE COMMITTEE ON VETERANS' AFFAIRS
_______
February 7, 2013.--Ordered to be printed
_______
Mr. Sanders, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
Pursuant to paragraph 8 of rule XXVI of the Standing Rules
of the Senate, the Committee on Veterans' Affairs (hereinafter
``Committee)'' submits its report on legislative and oversight
activities during the 111th Congress.
I. HEARINGS AND MEETINGS
A. First Session (2009)
During the First Session of the 111th Congress, the
Committee held 32 hearings, including four field hearings. At
those events, the Committee heard testimony from 219 witnesses.
Three hearings (April 22, April 29, and October 21) focused
exclusively on legislation pending before the Committee.
Testimony offered at those hearings covered 63 bills.
The Committee held six business meetings. The
organizational meeting was held on February 10. On May 21, six
measures were reported out of Committee. The Committee held six
meetings to discharge nominations.
The Session coincided with the election of a new President
of the nation, compelling the Committee to hold confirmation
hearings on his nominees to lead the Department of Veterans
Affairs (VA). The Committee's first hearing took place on
January 14, even before the inauguration of the then president-
elect, to consider the selection of General Eric K. Shinseki to
serve as VA Secretary. Several other VA nominees subsequently
came before the Committee this Session.
Notwithstanding the Committee's attention to the
confirmation process, a principal focus during this Session was
addressing the systemic problems besetting the VA's disability
compensation system. In a series of hearings on this topic,
Members examined proposed improvements to the appeals process
for claims decisions on February 11; state-of-the-art IT
solutions for benefits delivery on March 25; reforms to
increase the accuracy and timeliness of claims processing on
July 29; and, concerns over the rating system governing
disability payments on September 17.
In addition, the Committee looked at challenges on February
26 and August 26 in providing health care to veterans in rural
parts of the nation. The Chairman also convened a hearing on
July 14 to examine gaps in VA's system of care for women
veterans. Both hearings conveyed the high priority the
Committee placed on improving care for these important
components of the veteran population.
Following reports of several instances in which veterans
suffered or even died as a result of poor quality of care at VA
facilities, witnesses were called to testify before the
Committee on June 24 about concerns over VA enforcement of
standards governing the quality of health care.
Other oversight hearings included the topics of VA's
construction process, health care contracting, and cooperation
with the Indian Health Service, taking place on June 10,
September 30, and November 5, respectively.
To receive testimony on the complex issues stemming from
exposure of veterans to toxic substances during their military
service, on October 8 Members heard from witnesses on the
efforts of the Department of Defense (DOD) and VA to address
health care and compensation for such veterans. In a different
but equally pressing topic, in a November 18 hearing, Members
reviewed the programs and plans of the Department of Labor's
Veterans and Employment Service, along with certain non-profit
and private-sector initiatives, to promote the employment of
veterans.
The Committee held six joint hearings with the House
Committee on Veterans' Affairs in order to receive legislative
presentations from Veterans Service Organizations. These
hearings were held on January 28, February 24, March 5, March
12, March 18, and September 10.
The Committee held four field hearings during the First
Session. These hearings were held on June 29 in Philadelphia,
PA; August 20 in Omaha, NE; August 25 in Oahu, HI; and August
26 in Jesup, GA.
B. Second Session (2010)
During the Second Session of the 111th Congress, the
Committee held 21 hearings, including four field hearings. At
those events, the Committee heard testimony from 111 witnesses.
A hearing on May 19 focused exclusively on legislation
pending before the Committee. Testimony offered at those
hearings covered 20 bills.
On January 28, the Committee reported two pieces of
legislation, and on August 5, the Committee reported nine
measures and discharged one nomination.
Early in the Second Session, the Committee met to receive
testimony on the President's proposed fiscal year 2011 budget
for veterans programs. That hearing took place on February 26.
Reflecting its concern over systemic problems with VA's
disability compensation system, the Committee continued to hold
hearings in this Session on different parts of this problem. A
July 14 hearing examined VA efforts to reform the compensation
system, a September 23 hearing looked at the process for
determining when a disabling condition is presumed to be linked
to exposure to Agent Orange, and a November 18 hearing focused
on DOD and VA collaboration in a joint disability evaluation
system.
The Committee continued to examine in a March 3 hearing the
state of VA mental health care, especially for veterans
struggling with post traumatic stress disorder (PTSD) and
traumatic brain disorder (TBI), as well as on suicide
prevention programs. In a May 5 hearing, the Committee looked
exclusively at progress in treating TBI.
In several oversight hearings in this Session, the
Committee turned its attention on April 21 to the Post-9/11 GI
Bill, and, on July 21, proposed legislative enhancements to the
educational benefits under the new program. In a March 24
hearing, the focus was VA's 5-year plan to end homelessness
among veterans. In hearings on February 16 and 17, and June 16,
the Committee continued its examination of extending health
care to veterans living in rural and remote parts of the
nation. On October 6, Members convened to examine VA's plans
for modernizing its IT system.
The Committee held five joint hearings with the House
Committee on Veterans' Affairs in order to receive legislative
presentations from Veterans Service Organizations. These
hearings were held on March 2, March 4, March 9, March 18, and
September 22.
The Committee held four field hearings during the Second
Session. These hearings were held on January 7 in Maui, HI;
February 16 in Anchorage, AK; February 17 in Fairbanks, AK; and
April 5 in Cambridge, OH.
C. List of Hearings and Meetings Held in the 111th Congress
(1) Wednesday, January 14, 2009
Hearing: Nomination of General Eric K. Shinseki to be
Secretary of Veterans Affairs
(2) Tuesday, January 20, 2009
Meeting: The Committee met to vote on the nomination of
General Eric K. Shinseki to be Secretary of Veterans Affairs. A
hearing on Gen. Shinseki's nomination was held on January 14,
2009; his nomination was reported favorably by the Committee on
January 20, 2009, and he was confirmed by the Senate the same
day
(3) Wednesday, January 28, 2009
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentations of The American Legion,
Disabled American Veterans, Iraq and Afghanistan Veterans of
America, Paralyzed Veterans of America, Veterans of Foreign
Wars, and Vietnam Veterans of America
(4) Tuesday, February 10, 2009
Meeting: The Committee conducted a poll of its Members to
adopt the Committee's rules and budget for the 111th Congress
(5) Wednesday, February 11, 2009
Oversight Hearing: Review of Veterans' Disability
Compensation: What Changes are needed to improve the Appeals
Process?
(6) Tuesday, February 24, 2009
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentation of the Disabled American
Veterans
(7) Thursday, February 26, 2009
Oversight Hearing: Caring for Veterans in Rural Areas
(8) Thursday, March 5, 2009
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentations of American Ex-Prisoners
of War, Blinded Veterans Association, Gold Star Wives of
America, Iraq and Afghanistan Veterans of America, Jewish War
Veterans of the United States of America, Paralyzed Veterans of
America, and Wounded Warrior Project
(9) Tuesday, March 10, 2009
Hearing: FY 2010 Budget for Veterans' Programs
(10) Thursday, March 12, 2009
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentations of AMVETS; Air Force
Sergeants Association; Fleet Reserve Association; Non
Commissioned Officers Association; Military Order of the Purple
Heart; The Retired Enlisted Association; Military Officers
Association of America; National Association of State Directors
of Veterans Affairs; and Vietnam Veterans of America
(11) Wednesday, March 18, 2009
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentation of Veterans of Foreign
Wars
(12) Wednesday, March 25, 2009
Oversight Hearing: State-of-the-Art IT Solutions for VA
Benefits Delivery
(13) Wednesday, April 1, 2009
Hearing: Nomination of W. Scott Gould to be Deputy
Secretary of Veterans Affairs and nomination of L. Tammy
Duckworth to be Assistant Secretary of Veterans Affairs for
Public and Intergovernmental Affairs
(14) Thursday, April 2, 2009
Meeting: The Committee met to vote on the nomination of W.
Scott Gould to be Deputy Secretary of Veterans Affairs. A
hearing on Mr. Gould's nomination was held on April 1, 2009;
his nomination was reported favorably by the Committee on April
2, 2009, and he was confirmed by the Senate on April 3, 2009.
(15) Monday, April 20, 2009
Meeting: The Committee met to vote on the nomination of L.
Tammy Duckworth to be Assistant Secretary for Public and
Intergovernmental Affairs of Veterans Affairs. A hearing on Ms.
Duckworth's nomination was held on April 1, 2009; her
nomination was reported favorably by the Committee on April 20,
2009, and she was confirmed by the Senate on April 22, 2009.
(16) Wednesday, April 22, 2009
Legislative Hearing: Pending Health-Related Legislation
S. 226, a bill to designate the Department of
Veterans Affairs outpatient clinic in Havre, Montana,
as the Merrill Lundman Department of Veterans Affairs
Outpatient Clinic
S. 239, a bill to amend title 38, United States Code
(U.S.C.), to ensure that veterans in each of the 48
contiguous States are able to receive services in at
least one full-service hospital of the Veterans Health
Administration in the State or receive comparable
services provided by contract in the State
S. 246, a bill to amend title 38, U.S.C., to improve
the quality of care provided to veterans in Department
of Veterans Affairs medical facilities, to encourage
highly qualified doctors to serve in hard-to-fill
positions in such medical facilities, and for other
purposes
S. 252, a bill to amend title 38, U.S.C., to enhance
the capacity of the Department of Veterans Affairs to
recruit and retain nurses and other critical health-
care professionals, to improve the provision of health
care for veterans, and for other purposes
S. 362, a bill to amend title 38, U.S.C., to improve
the collective bargaining rights and procedures for
review of adverse actions of certain employees of the
Department of Veterans Affairs, and for other purposes
S. 404, a bill to amend title 38, U.S.C., to expand
veteran eligibility for reimbursement by the Secretary
of Veterans Affairs for emergency treatment furnished
in a non-Department facility, and for other purposes
S. 423, a bill to amend title 38, U.S.C., to
authorize advance appropriations for certain medical
care accounts of the Department of Veterans Affairs by
providing two-fiscal year budget authority, and for
other purposes
S. 498, a bill to amend title 38, U.S.C., to
authorize dental insurance for veterans and survivors
and dependents of veterans, and for other purposes
S. 509, a bill for the construction of a new multiple
specialty outpatient facility, campus renovation and
upgrades, and additional parking at the VA Medical
Center, Walla Walla, Washington, with the project not
to exceed $71,400,000
S. 543, a bill to require a pilot program on
training, certification, and support for family
caregivers of seriously disabled veterans and members
of the Armed Forces to provide caregiver services to
such veterans and members, and for other purposes
S. 597, a bill to amend title 38, U.S.C., to expand
and improve health care services available to women
veterans, especially those serving in operation Iraqi
Freedom and Operation Enduring Freedom, from the
Department of Veterans Affairs, and for other purposes
S. 658, a bill to amend title 38, U.S.C., to improve
health care for veterans who live in rural areas, and
for other purposes
S. 669, a bill to amend title 38, U.S.C., to require
a judicial body to determine whether VA beneficiaries
are a danger to themselves or others before they are
listed in the NCIS
S. 699, a bill to provide for the construction of a
full service hospital in Far South Texas by the
Secretary of Veterans Affairs
S. 734, a bill to amend title 38, U.S.C., to improve
the capacity of the Department of Veterans Affairs to
recruit and retain physicians in Health Professional
Shortage Areas and to improve the provision of health
care to veterans in rural areas, and for other purposes
S. 772, a bill to enhance benefits for survivors of
certain former members of the Armed Forces with a
history of Post Traumatic Stress Disorder or Traumatic
Brain Injury, to enhance availability and access to
mental health counseling for members of the Armed
Forces and veterans, and for other purposes
S. 793, a bill to direct the Secretary of Veterans
Affairs to establish a scholarship program for students
seeking a degree or certificate in the areas of visual
impairment and orientation and mobility
S. 801, a bill to amend title 38, U.S.C., to waive
charges for humanitarian care provided by the
Department of Veterans Affairs to family members
accompanying veterans severely injured after September
11, 2001, as they receive medical care from the
Department and to provide assistance to family
caregivers, and for other purposes
S. 821, a bill to amend title 38, U.S.C., to prohibit
the Secretary of Veterans Affairs from collecting
certain copayments from veterans who are
catastrophically disabled, and for other purposes
(17) Wednesday, April 29, 2009
Legislative Hearing: Pending Benefits-Related Legislation
S. 263, the Servicemembers Access to Justice Act of
2009
S. 315, the Veterans Outreach Improvement Act of 2009
S. 347, a bill to amend title 38, U.S.C., to allow
the Secretary of Veterans Affairs to distinguish
between the severity of a qualifying loss of a dominant
hand and a qualifying loss of a non-dominant hand for
purposes of traumatic injury protection under
Servicemembers' Group Life Insurance, and for other
purposes
S. 407, the Veterans' Compensation Cost-of-Living
Adjustment Act of 2009
S. 475, the Military Spouses Residency Relief Act
S. 514, the Veterans Rehabilitation and Training
Improvements Act of 2009
S. 691, a bill to direct the Secretary of Veterans
Affairs to establish a national cemetery for veterans
in southern Colorado region, and for other purposes
S. 663, Belated Thank You to the Merchant Mariners of
World War II Act of 2009
S. 728, the Veterans' Insurance and Benefits
Enhancement Act of 2009
S. 746, a bill to direct the Secretary of Veterans
Affairs to establish a national cemetery in the Sarpy
County region to serve veterans in eastern Nebraska,
western Iowa, and northwest Missouri
S. 820, a bill to amend title 38, U.S.C., to enhance
the automobile assistance allowance for veterans, and
for other purposes
S. 842, a bill to repeal the sunset of certain
enhancements of protections of servicemembers relating
to mortgages and mortgage foreclosures, to amend title
38, U.S.C., to authorize the Secretary of Veterans
Affairs to pay mortgage holders unpaid balances on
housing loans guaranteed by Department of Veterans
Affairs, and for other purposes
S. 847, a bill to provide that utilization of
survivors' and dependents' educational assistance shall
not be subject to the 48-month limitation on the
aggregate amount of assistance utilizable under
multiple veterans and related educational assistance
programs
S. 919, the Clarification of Characteristics of
Combat Service Act of 2009
S. 1015, a bill to amend title 38, U.S.C., to enhance
disability compensation for certain disabled veterans
with difficulties using prostheses and veterans in need
of regular aid and attendance, and for other purposes
S. 1016, a bill to amend title 38, U.S.C., to modify
the commencement of the period of payment of original
awards of compensation for veterans who are retired or
separated from the Armed Forces for disability
(18) Wednesday, May 6, 2009
Hearing: Nominations of John U. Sepulveda to be Assistant
Secretary for Human Resources and Administration at Veterans
Affairs; Will A. Gunn to be General Counsel; Jose D. Riojas to
be Assistant Secretary for Operations, Security, and
Preparedness; and Roger W. Baker to be Assistant Secretary for
Information and Technology
(19) Tuesday, May 12, 2009
Meeting: The Committee met to vote on the nominations of
John U. Sepulveda to be Assistant Secretary for Human Resources
and Administration at Veterans Affairs; Will A. Gunn to be
General Counsel; Jose D. Riojas to be Assistant Secretary for
Operations, Security, and Preparedness; and Roger W. Baker to
be Assistant Secretary for Information and Technology. A
hearing on all four nominations was held on May 6, 2009; their
nominations were reported favorably by the Committee on May 12,
2009, and they were confirmed by the Senate on May 18, 2009.
(20) Thursday, May 21, 2009
Meeting: Committee markup of a Committee Print of S. 252,
Veterans Health Care Authorization Act of 2009; the Committee
Print of S. 407, Veterans' Compensation Cost-of-Living
Adjustment Act of 2009; S. 423, Veterans Health Care Budget
Reform and Transparency Act of 2009; S. 475, Military Spouses
Residency Relief Act; S. 669, Veterans 2nd Amendment Protection
Act; the Committee Print of S. 728, Veterans' Benefits
Enhancement Act of 2009; and the Committee Print of S. 801,
Caregiver and Veterans Health Services Act of 2009
(21) Wednesday, June 10, 2009
Oversight Hearing: Oversight on VA's Construction Process
(22) Wednesday, June 24, 2009
Oversight Hearing: Oversight of VA Quality Management
Activities
(23) Monday, June 29, 2009
Field Hearing held in Philadelphia, Pennsylvania:
Philadelphia VA Medical Center Terminated Cancer Treatment
Program
(24) Tuesday, July 14, 2009
Oversight Hearing: Women Veterans: Bridging the Gaps in
Care
(25) Wednesday, July 22, 2009
Hearing: Nomination of Raymond M. Jefferson to be the
Assistant Secretary for Veterans' Employment and Training,
Department of Labor, and Joan M. Evans to be the Assistant
Secretary for Congressional and Legislative Affairs of Veterans
Affairs
(26) Wednesday, July 29, 2009
Oversight Hearing: Veteran's Disability Compensation:
Forging a Path Forward
(27) Monday, August 3, 2009
Meeting: The Committee met to vote on the nomination of
Raymond M. Jefferson to be Assistant Secretary for Veterans'
Employment and Training of the Labor Department. A hearing on
Mr. Jefferson's nomination was held on July 2, 2009; his
nomination was reported favorably by the Committee on August 3,
2009, and he was confirmed by the Senate on August 7, 2009.
(28) Thursday, August 20, 2009
Field Hearing held in Omaha, Nebraska: The Challenges of an
Aging VA Medical Center
(29) Tuesday, August 25, 2009
Field Hearing held in Oahu, Hawaii: VA Outreach to
Returning Guard Units
(30) Wednesday, August 26, 2009
Field Hearing held in Jesup, Georgia: Providing Care for
Rural Veterans: Community-Based Outpatient Clinics
(31) Thursday, September 10, 2009
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentation of The American Legion
(32) Thursday, September 17, 2009
Oversight Hearing: Review of Veteran's Disability
Compensation: Benefits in the 21st Century
(33) Wednesday, September 30, 2009
Oversight Hearing: VA's Contracts for Health Services
(34) Thursday, October 8, 2009
Oversight Hearing: VA/DOD Response to Certain Military
Exposures
(35) Wednesday, October 21, 2009
Hearing: Pending Health and Benefits Legislation
S. 977, the Prisoner of War Benefits Act of 2009
S. 1109, the Providing Real Outreach for Veterans Act
of 2009 or PRO-VETS Act of 2009
S. 1118, a bill to amend title 38, U.S.C., to provide
for an increase in the amount of monthly dependency and
indemnity compensation payable to surviving spouses by
the Secretary of Veterans Affairs, and for other
purposes
S. 1155, a bill to amend title 38, U.S.C., to
establish the position of Director of Physician
Assistant Services within the office of the Under
Secretary of Veterans Affairs for health
S. 1204, the Chiropractic Care Available to All
Veterans Act of 2009
S. 1237, the Homeless Women Veterans and Homeless
Veterans with Children Act of 2009
S. 1302, the Veterans Health Care Improvement Act of
2009
S. 1394, the Veterans Entitlement to Service Act of
2009
S. 1427, the Department of Veterans Affairs Hospital
Quality Report Card Act of 2009
S. 1429, the Servicemembers Mental Health Care
Commission Act
S. 1444, the COMBAT PTSD Act
S. 1467, the Lance Corporal Josef Lopez Fairness for
Servicemembers Harmed by Vaccines Act of 2009
S. 1483, a bill to designate the Department of
Veterans Affairs outpatient clinic in Alexandria,
Minnesota, as the ``Max J. Beilke Department of
Veterans Affairs Outpatient Clinic''
S. 1518, the Caring for Camp Lejeune Veterans Act of
2009
S. 1531, a bill to amend title 38, U.S.C., to
establish with the Department of Veterans Affairs the
position of Assistant Secretary for Acquisition,
Logistics, and Construction, and for other purposes
S. 1547, the Zero Tolerance for Veterans Homelessness
Act of 2009
S. 1556, the Veteran Voting Support Act of 2009
S. 1607, the Wounded Veteran Job Security Act of 2009
S. 1668, the National Guard Education Equality Act
S. 1752, a bill to amend title 38, U.S.C., to direct
the Secretary of Veterans Affairs to provide wartime
disability compensation for certain veterans with
Parkinson's disease
S. 1753, a bill to amend title 38, U.S.C., to
increase assistance for disabled veterans who are
temporarily residing in housing owned by a family
member, and for other purposes
S. 1779, based on S. 642, the Health Care for Members
of the Armed Forces Exposed to Chemical Hazards Act of
2009
(36) Thursday, November 5, 2009
Oversight Hearing: VA and Indian Health Services
Cooperation
(37) Wednesday, November 18, 2009
Oversight Hearing: Easing the Burdens through Employment
(38) Wednesday, December 9, 2009
Hearing: The Nomination of Robert A. Petzel, MD, to be
Under Secretary for Health and Raul Perea-Henze, MD, MPH, to be
Assistant Secretary for Policy and Planning of the Department
of Veterans Affairs
(39) Wednesday, December 16, 2009
Meeting: The Committee met to vote on the nomination of
Robert A. Petzel, MD, to be Under Secretary for Health of
Veterans Affairs
(40) Thursday, January 7, 2010
Field Hearing held in Maui, Hawaii: State of VA Services in
Maui
(41) Thursday, January 28, 2010
Meeting: To consider the Nomination of Raul Perea-Henze,
MD, MPH, to be Assistant Secretary for Policy and Planning of
Veterans Affairs; Committee markup of the Committee Print of S.
1237, Homeless Veterans and Other Health Care Authorities Act
of 2010; and the Committee Print of an original bill (became S.
3378 upon introduction), Examination of Exposures to
Environmental Hazards During Military Service and Health Care
for Camp Lejeune and Atsugi Naval Air Facility Veterans and
Their Families Act of 2010
(42) Tuesday, February 16, 2010
Field Hearing held in Anchorage, Alaska: Services for
Veterans in Alaska
(43) Wednesday, February 17, 2010
Field Hearing held in Fairbanks, Alaska: Services for
Veterans in Alaska
(44) Friday, February 26, 2010
Hearing: FY 2011 Budget for Veterans' Programs
(45) Tuesday, March 2, 2010
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentation of Disabled American
Veterans
(46) Wednesday, March 3, 2010
Oversight Hearing: Mental Health Care and Suicide
Prevention for Veterans
(47) Thursday, March 4, 2010
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentations of Jewish War Veterans of
the USA, Military Order of the Purple Heart, American Ex-
Prisoners of War, Blinded Veterans Association, Air Force
Sergeants Association, and Wounded Warrior Project
(48) Tuesday, March 9, 2010
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentation of Veterans of Foreign
Wars
(49) Thursday, March 18, 2010
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentations of AMVETS, Vietnam
Veterans of America, Iraq and Afghanistan Veterans of America,
Gold Star Wives of America, Inc., National Association of State
Directors of Veterans Affairs, Non Commissioned Officers
Association, The Retired Enlisted Association, and Fleet
Reserve Association
(50) Wednesday, March 24, 2010
Oversight Hearing: VA's Plan for Ending Homelessness among
Veterans
(51) Monday, April 5, 2010
Field Hearing (Cambridge, OH): Benefits and Services for
Veterans in Appalachia
(52) Wednesday, April 21, 2010
Oversight Hearing: Implementation of the New Post-9/11 GI
Bill--Looking Back and Moving Forward
(53) Wednesday, May 5, 2010
Oversight Hearing: TBI: Progress in Treating the Signature
Wound of the Current Conflicts
(54) Wednesday, May 19, 2010
Hearing: Pending Legislation
S. 1780, the Honor America's Guard-Reserve Retirees
Act
S. 1866, a bill to amend title 38, U.S.C., to provide
for the eligibility of parents of certain deceased
veterans for interment in national cemeteries
S. 1939, the Agent Orange Equity Act of 2009
S. 1940, a bill to require the Secretary of Veterans
Affairs to carry out a study on the effects on children
of exposure of their parents to herbicides used in
support of the United States and allied military
operations in the Republic of Vietnam during the
Vietnam era, and for other purposes
S. 2751, a bill to designate the Department of
Veterans Affairs medical center in Big Spring, Texas,
as the George H. O'Brien, Jr., Department of Veterans
Affairs Medical Center
S. 3035, the Veterans Traumatic Brain Injury Care
Improvement Act of 2010
S. 3107, the Veterans' Compensation Cost-of-Living
Adjustment Act of 2010
S. 3192, the Fair Access to Veterans Benefits Act of
2010
S. 3234, the Veteran Employment Assistance Act of
2010
S. 3286, a bill to require the Secretary of Veterans
Affairs to carry out a pilot program on the award of
grants to State and local government agencies and
nonprofit organizations to provide assistance to
veterans with their submittal of claims to the Veterans
Benefits Administration, and for other purposes
S. 3314, a bill to require the Secretary of Veterans
Affairs and the Appalachian Regional Commission to
carry out a program of outreach for veterans who reside
in Appalachia, and for other purposes
S. 3325, a bill to amend title 38, U.S.C., to
authorize the waiver of the collection of copayments
for telehealth and telemedicine visits of veterans, and
for other purposes
S. 3330, the Veterans' Health and Radiation Safety
Act of 2010
S. 3348, a bill to amend title 38, U.S.C., to provide
for the treatment as a motion for reconsideration of a
decision of the Board of Veterans' Appeals of a notice
of appeal of such decision misfiled with the Department
of Veterans Affairs, and for other purposes
S. 3352, the Veterans Pensions Protection Act of 2010
S. 3355, the Veterans OneSource Act of 2010
S. 3367, a bill to amend title 38, U.S.C., to
increase the rate of pension for disabled veterans who
are married to one another and both of whom require
regular aid and attendance, and for other purposes
S. 3368, a bill to amend title 38, U.S.C., to
authorize certain individuals to sign claims filed with
the Secretary of Veterans Affairs on behalf of
claimants and for other purposes
S. 3370, a bill to amend title 38, U.S.C., to improve
the process by which an individual files jointly for
social security and dependency and indemnity
compensation, and for other purposes
S. 3377, a bill to amend title 38, U.S.C., to improve
the multifamily transitional housing loan program of
the Department of Veterans Affairs by requiring the
Secretary of Veterans Affairs to issue loans for the
construction of, rehabilitation of, or acquisition of
land for multifamily transitional housing projects
instead of guaranteeing loans for such purposes, and
for other purposes
(55) Tuesday, June 16, 2010
Oversight Hearing: VA Health Care in Rural Areas
(56) Wednesday, July 14, 2010
Oversight Hearing: Review of Veterans' Claim Processing:
Are Current Efforts Working?
(57) Wednesday, July 21, 2010
Oversight Hearing: Improvements to the Post-9/11 GI Bill
(58) Thursday, August 5, 2010
Meeting: Committee Markup of S. 3107, Veterans'
Compensation Cost-of-Living Adjustment Act of 2010; the
Committee Print of S. 3234, Veterans Employment Assistance Act
of 2010; the Committee Print of S. 3325, Veterans Telehealth
and other Care Improvements Act of 2010; the Committee Print of
S. 3447, Post-9/11 Veterans Educational Assistance Improvements
Act of 2010; the Committee Print of S. 3517, Claims Processing
Improvement Act of 2010; S. 3609, a bill to extend the
temporary authority for the performance of medical disability
examinations by contract physicians for the Department of
Veterans Affairs; and the Committee Print of an original bill
(became S. 3765 upon introduction), to amend title 38, U.S.C.,
to improve Servicemember Group Life Insurance and Veterans'
Group Life Insurance and to modify the provision of
compensation and pension to surviving spouses of veterans in
the months of the deaths of the veterans, and for other
purposes
(59) Wednesday, September 22, 2010
Joint Hearing with the House Committee on Veterans' Affairs
to hear the legislative presentation of The American Legion
(60) Thursday, September 23, 2010
Oversight Hearing: VA Disability Compensation: Presumptive
Disability Decision-Making
(61) Wednesday, October 6, 2010
Oversight Hearing: VA's IT Program--Looking Ahead
(62) Thursday, November 18, 2010
Oversight Hearing: Review of the VA and DOD Integrated
Disability Evaluation System
II. LEGISLATION
A. First Session (2009)
In the First Session, the Committee met in open session on
May 21 and ordered reported seven pieces of legislation to the
full Senate.
1. S. 252, Veterans Health Care Authorization Act of 2009
To enhance the capacity of the Department of Veterans
Affairs to recruit and retain nurses and other critical health-
care professionals, to improve the provision of health care to
veterans, and for other purposes. This measure was introduced
in the Senate on January 15, 2009, and the Committee ordered it
to be favorably reported on May 21, 2009. Senate Report 111-60
was filed on July 24, 2009. These provisions were enacted on
May 5, 2010, as part of the Caregivers and Veterans Omnibus
Health Services Act of 2010, Public Law 111-163.
2. S. 407, Veterans' Compensation Cost-of-Living Adjustment
Act of 2009
To provide for an increase, effective December 1, 2009, in
the rates of compensation for veterans with service-connected
disabilities and the rates of dependency and indemnity
compensation for the survivors of certain disabled veterans, to
codify increases in the rates of such compensation that were
effective as of December 1, 2008, and for other purposes. This
measure was introduced in the Senate on February 10, 2009, and
the Committee ordered it to be favorably reported on May 21,
2009. S. Report 111-24 was filed on June 4, 2009. The Senate
unanimously passed the measure, as amended, on June 10, 2009,
and the House unanimously passed the measure on June 23, 2009.
The bill was signed on June 30, 2009, as Public Law 111-37.
3. S. 423, Veterans Health Care Budget Reform and
Transparency Act of 2009
To authorize advance appropriations for certain medical
care accounts of the Department of Veterans Affairs by
providing two-fiscal-year budget authority, and for other
purposes. This measure was introduced in the Senate on February
12, 2009, and the Committee ordered it to be favorably reported
on May 21, 2009. S. Report 111-41 was filed on July 8, 2009.
The House passed a companion measure on June 23, 2009, and the
Senate voted to pass the bill on August 6, 2009. The House
passed a compromise measure on October 8, 2009, which the
Senate passed on October 13, 2009. The bill was signed into law
on October 22, 2009, as Public Law 111-81.
4. S. 475, Military Spouses Residency Relief Act
To guarantee the equity of spouses of military personnel
with regard to matters of residency, and for other purposes.
This measure was introduced in the Senate on February 25, 2009,
and the Committee ordered it to be favorably reported on May
21, 2009. S. Report 111-46 was filed on July 15, 2009. The
Senate unanimously passed the bill on August 4, 2009, and the
House voted to pass it on November 11, 2009. The bill was
signed into law on November 11, 2009, as Public Law 111-97.
5. S. 669, Veterans 2nd Amendment Protection Act
To clarify the conditions under which certain persons may
be treated as adjudicated mentally incompetent for certain
purposes. This measure was introduced in the Senate on March
23, 2009, and the Committee ordered it to be favorably reported
on May 21, 2009. S. Report 111-27 was filed on June 16, 2009.
No further action was taken on the measure in the 111th
Congress.
6. S. 728, Veterans' Benefits Enhancement Act of 2009
To enhance veterans' insurance benefits, and for other
purposes. This measure was introduced in the Senate on March
26, 2009, and the Committee ordered it to be favorably
reported, as amended, on August 7, 2009. It was filed on
September 2, 2009. S. Report 111-71. No further action was
taken on the bill in the 111th Congress.
7. S. 801, Caregiver and Veterans Health Services Act of
2009
To authorize VA to provide financial, health services and
other support to the family caregivers of severely injured OIF/
OEF veterans, to improve access to care and quality of care for
rural veterans, and for other purposes. The bill was introduced
in the Senate on April 2, 2009, and the Committee ordered it to
be reported, as amended, on May 21, 2009. S. Report 111-80 was
filed on September 25, 2009. Provisions from S. 801 were
incorporated into S. 1963, the Caregivers and Veterans Omnibus
Health Services Act of 2010, which the Senate passed on
November 19, 2009, and the House passed on April 21, 2010. This
measure was signed into law on May 5, 2010, as Public Law 111-
163.
In addition, during the first session the Committee
discharged by unanimous consent several pieces of legislation,
as follows:
1. S. 509, a bill to authorize a major medical facility
project at the Department of Veterans Affairs Medical Center,
Walla Walla, Washington, and for other purposes, was introduced
in the Senate on March 2, 2009. The Committee discharged the
bill on July 15, 2009, and the Senate passed it by unanimous
consent later that day. The House of Representatives passed the
bill on November 2, 2009, and it was signed into law as Public
Law 111-98 on November 11, 2009.
2. S. Res. 340, a resolution expressing support for
designation of a National Veterans History Project Week to
encourage public participation in a nationwide project that
collects and preserves the stories of the men and women who
served our Nation in times of war and conflict. The bill was
introduced in the Senate on November 5, 2009. The Committee
discharged the resolution on November 10, 2009, and the Senate
agreed to the resolution that same day.
3. H.R. 1037, to enhance veterans' insurance benefits, and
for other purposes, was passed by the House of Representatives
on July 14, 2009, and discharged by the Committee on October 7,
2009. The Senate passed the bill on October 7, 2009, but no
further action was taken.
4. H.R. 1377, a bill to amend title 38, United States Code,
to expand veteran eligibility for reimbursement by the
Secretary of Veterans Affairs for emergency treatment furnished
in a non-Department facility, and for other purposes. The bill
was discharged by the Committee on December 12, 2009, and
signed into law as Public Law 111-137 on February 2, 2010.
B. Second Session (2010)
In the Second Session, the Committee met in open session on
January 28 and August 5, 2010, and ordered to be favorably
reported a combined total of nine pieces of legislation to the
full Senate.
1. S. 1237, the Homeless Veterans and Other Health Care
Authorities Act of 2010
To amend title 38, United States Code, to expand the grant
program for homeless veterans with special needs to include
male homeless veterans with minor dependents and to establish a
grant program for reintegration of homeless women veterans and
homeless veterans with children, and for other purposes. The
bill was introduced on June 11, 2009. The Committee ordered the
bill to be reported on January 28, 2010, and S. Report 111-175
was filed on April 29, 2010. No further action was taken on the
bill in this Congress.
2. S. 3107, Veterans' Compensation Cost-of-Living
Adjustment Act of 2010
To provide for an increase, effective December 1, 2010, in
the rates of compensation for veterans with service-connected
disabilities and the rates of dependency and indemnity
compensation for the survivors of certain disabled veterans,
and for other purposes. The bill was introduced on March 11,
2010. The Committee ordered it to be honorably reported on
August 5, 2010, and S. Report 111-281 was filed on the same
day. On September 22, 2010, the Senate passed the companion
measure to the bill, H.R. 4667, which was signed into law as
Public Law 111-247 on September 30, 2010.
3. S. 3234, Veteran Employment Assistance Act of 2010
To improve employment, training, and placement services
furnished to veterans, especially those serving in Operation
Iraqi Freedom and Operation Enduring Freedom, and for other
purposes. The bill was introduced on April 20, 2010, and the
Committee ordered it to be favorably reported, as amended, on
August 5, 2010. The report, S. Report 111-285, was filed on
September 2, 2011. No further action was taken on the bill.
4. S. 3325, Veterans Telehealth and other Care Improvements
Act of 2010
To waive copayments for telehealth and telemedicine visits
of veterans, and for other purposes. The bill was introduced on
May 6, 2010, and the Committee ordered it to be reported on
August 5, 2010. S. Report 111-286 was filed on September 2,
2010. No further action was taken on the bill.
5. S. 3378, Examination of Exposures to Environmental
Hazards During Military Service and Health Care for Camp
Lejeune and Atsugi Naval Air Facility Veterans and Their
Families Act of 2010
To authorize health care for individuals exposed to
environmental hazards at Camp Lejeune and the Atsugi Naval Air
Facility, to establish an advisory board to examine exposures
to environmental hazards during military service, and for other
purposes. The Committee ordered the legislation be favorably
reported on January 28, 2010, as an original measure. The bill
was introduced on May 17, 2010, and the report, S. Report 111-
189, was filed the same day. No further action was taken on the
bill.
6. S. 3447, Post-9/11 Veterans Educational Assistance
Improvements Act of 2010
To improve educational benefits under the Post-9/11
Veterans Education Assistance Act for veterans who served in
the Armed Forces after September 11, 2001, and for other
purposes. The bill was introduced on May 27, 2010. The
Committee ordered the bill to be favorably reported on
September 29, 2010, as amended, and the report, S. Report 111-
346, was filed on October 26, 2010. The bill was passed by the
Senate on December 13, 2010, and by the House three days later.
The measure was signed into law on January 4, 2011, as Public
Law 111-377.
7. S. 3517, the Claims Processing Improvement Act of 2010
To improve the processing of claims for disability
compensation filed with the Department of Veterans Affairs, and
for other purposes. The bill was introduced on June 22, 2010.
The Committee ordered that the bill be favorably reported on
August 5, 2010, and the report, S. Report 111-354, was filed on
November 29, 2010. No further action was taken on the bill.
8. S. 3609, an original bill to extend the temporary
authority for the performance of medical disability
examinations by contract physicians for the Department of
Veterans Affairs. The bill was introduced on July 19, 2010. The
Committee ordered the bill to be reported on August 5, 2010,
and S. Report 111-288 was filed on September 2, 2011. The bill
was introduced on the same day. The provisions of the bill were
incorporated into H.R. 3219, the Veterans Benefits Act of 2010,
which was signed into law on October 13, 2010, as Public Law
111-275.
9. S. 3765, an original bill to amend title 38, U.S.C., to
improve Servicemember Group Life Insurance and Veterans' Group
Life Insurance and to modify the provision of compensation and
pension to surviving spouses of veterans in the months of the
deaths of the veterans, and for other purposes. The Committee
ordered that this legislation be reported as an original bill
on August 5, 2010, which became S. 3765 when introduced on
September 2, 2010. S. Report 111-282, was also filed on
September 2, 2010. The provisions of the bill were incorporated
into H.R. 3219, the Veterans Benefits Act of 2010, which was
signed into law on October 13, 2010, as Public Law 111-275.
In addition, during the Second Session the Committee
discharged several bills by unanimous consent, as follows:
1. S. 3162, a bill to clarify the health care provided by
the Secretary of Veterans Affairs that constitutes minimum
essential coverage, was discharged by the Committee on March
26, 2010, and passed by the Senate by unanimous consent on the
same day. No further action was taken on the bill.
2. S. 3860, a bill to require reports on the management of
Arlington National Cemetery, was discharged by the Committee on
December 4, 2010, and passed by the Senate the same day. The
bill was passed by the House of Representatives on December 16,
2010, and signed into law as Public Law 111-339, on December
22, 2010.
3. S. Res. 451, a resolution expressing support for
designation of a ``Welcome Home Vietnam Veterans Day,'' was
discharged by the Committee on March 19, 2010, and agreed to in
the Senate on the same day.
4. H.R. 3219, the Veterans' Benefits Act of 2010, was
discharged by the Committee on September 28, 2010, and passed
in the Senate, as amended, by unanimous consent the same day.
The legislation was signed into law as Public Law 111-275 on
October 13, 2010.
5. H.R. 4360, a bill to designate the Department of
Veterans Affairs blind rehabilitation center in Long Beach,
California, as the ``Major Charles Robert Soltes, Jr., O.D.
Department of Veterans Affairs Blind Rehabilitation Center.''
The Committee discharged the bill on April 19, 2010, and the
Senate passed the bill the same day. The bill was signed into
law as Public Law 111-164, on May 7, 2010.
6. H.R. 4505, a bill to enable State homes to furnish
nursing home care to parents any of whose children died while
serving in the Armed Forces. The bill was discharged by the
Committee on September 20, 2010, and signed into law as Public
Law 111-246 on September 30, 2010.
7. H.R. 4667, the Veterans' Compensation Cost-of-Living
Adjustment Act of 2010, was discharged by the Committee on
September 22, 2010, and passed by the Senate by unanimous
consent on the same day. The bill was signed into law as Public
Law 111-247 on September 30, 2010.
C. Reports
S. 252, Veterans Health Care Authorization Act of 2009. S.
Report 111-60.
S. 407, Veterans' Compensation Cost-of-Living Adjustment
Act of 2009. S. Report 111-24.
S. 423, Veterans Health Care Budget Reform and Transparency
Act of 2009. S. Report 111-41.
S. 475, Military Spouses Residency Relief Act. S. Report
111-46.
S. 669, Veterans 2nd Amendment Protection Act. S. Report
111-27.
S. 728, Veterans' Benefits Enhancement Act of 2009. S.
Report 111-71.
S. 801, Caregiver and Veterans Health Services Act of 2009.
S. Report 111-80.
S. 3107, the Veterans' Compensation Cost-of-Living
Adjustment Act of 2010. S. Report 111-281.
S. 3234, Veteran Employment Assistance Act of 2010. S.
Report 111-285.
S. 3325, Veterans Telehealth and other Care Improvements
Act of 2010. S. Report 111-286.
S. 3447, Post-9/11 Veterans Educational Assistance
Improvements Act of 2010. S. Report 111-346.
S. 3609, a bill to extend the temporary authority for the
performance of medical disability examinations by contract
physicians for the Department of Veterans Affairs. S. Report
111-288.
S. 3765, an original bill to amend title 38, U.S.C., to
improve Servicemember Group Life Insurance and Veterans' Group
Life Insurance and to modify the provision of compensation and
pension to surviving spouses of veterans in the months of the
deaths of the veterans, and for other purposes. S. Report 111-
282.
D. Public Laws
S. 252, Veterans Health Care Authorization Act of 2009 is
Public Law 111-163.
S. 407, Veterans' Compensation Cost-of-Living Adjustment
Act of 2009. Public Laws 111-37 and 111-247.
S. 423, Veterans Health Care Budget Reform and Transparency
Act of 2009. Public Law 111-81.
S. 475, Military Spouses Residency Relief Act. Public Law
111-97.
S. 509, A bill to authorize a major medical facility
project at the Department of Veterans Affairs Medical Center,
Walla Walla, Washington, and for other purposes. Public Law
111-98.
S. 801, Caregiver and Veterans Health Services Act of 2009.
Public Law 111-163.
S. 1963, A bill to amend title 38, United States Code, to
provide assistance to caregivers of veterans, to improve the
provision of health care to veterans, and for other purposes.
Public Law 111-163.
S. 3107, the Veterans' Compensation Cost-of-Living
Adjustment Act of 2010. Public Laws 111-37 and 111-247.
S. 3447, Post-9/11 Veterans Educational Assistance
Improvements Act of 2010. Public Law 111-377.
S. 3860, A bill to require reports on the management of
Arlington National Cemetery. Public Law 111-339.
III. OVERSIGHT
A. First Session (2009)
In accordance with its mandate, the Committee engaged in
vigorous oversight of VA Regional Offices, hospitals, and other
health care facilities, as well as Department of Defense (DOD)
facilities.
A primary focus for the Committee is VA compliance with
policies and regulations in the processing of disability
compensation claims for veterans with service-connected
conditions. Toward this end, the Committee's Majority staff
visited 13 VA Regional Offices in 2009. Staff examined
individual claims in these offices, identifying patterns of
serious errors or omissions, relaying that information to VA
leadership so that it could improve the training, oversight,
and accuracy of VA claims decisions.
In a related effort, Majority Committee staff travelled to
the VA Regional Office in Manila, Philippines, to monitor the
administration and the adequacy of funding for the VA
entitlement providing a lump-sum payment to thousands of
surviving Filipino veterans who fought with U.S. Forces during
World War II when their country was under U.S. control, yet
were denied veterans benefits.
Other areas of specific concern for Majority Committee
staff included the denial of claims from Naval veterans for
conditions related to herbicide exposure without VA having
first ruled out the possibility that the ship on which the
veteran served had travelled on the inland waterways of
Vietnam. As a result of these efforts, VA improved the accuracy
of claims processing for such veterans. VA accomplished this by
establishing a central database with a list of ships for which
service on such inland waters is documented, thereby saving
claim adjudicators from the time-consuming process of
repeatedly substantiating service on such waters. The list
continues to increase, benefiting thousands of veterans.
The Committee's Majority staff also examined the quality of
decisions for claims related to Traumatic Brain Injury (TBI),
with the result that VA improved the adjudication of such
claims, specifically those in which a veteran's examination
includes neuropsychiatric testing for objective evidence of
impairments.
Also audited by the Committee Majority staff were decisions
for tinnitus, hearing loss, and Post Traumatic Stress Disorder
(PTSD); the quality of medical examinations conducted by VA
medical examiners; and, the adequacy of quality-control
measures employed by VA to ensure accurate and consistent
claims decisions.
Majority Committee staff traveled to several DOD facilities
to monitor efforts to help returning servicemembers, especially
those who were severely wounded, transition to civilian status.
Staff also visited Brooke Army Medical Center at Fort Sam
Houston in San Antonio, Texas, to tour the comprehensive
trauma, burn, surgical, and critical care units. They examined
the workings of the joint VA/DOD system for obtaining
disability compensation benefits for wounded warriors and other
returning servicemembers. To look at similar issues, staff
visited the Wounded Warrior Regiment at the Marine Corps Base
at Quantico, VA.
Among the areas Majority Committee staff examined at VA
health care facilities was VA's prosthetics and orthotics
program, covering the provision of artificial limbs, braces,
wheelchairs, and other devices that improve a veteran's
mobility.
In addition, Minority Committee staff carried out oversight
visits to Durham, North Carolina, to observe an oral argument
before the U.S. Court of Appeals for Veterans Claims and to
VA's Regional Office in St. Louis, MI, to monitor claims
processing.
B. Second Session (2010)
Building on the findings of field investigations from the
first session, the Majority Committee staff continued its
investigation into the administration of VA's disability
compensation system. Majority investigative staff traveled to
ten VA Regional Offices across the Nation, including Puerto
Rico, to closely examine individual claims and audited, through
remote technology, the adjudication of claims in several other
VA Regional Offices. Staff also examined the retrieval capacity
of the U.S. Army & Joint Services Records Research Center.
A key focus of the Majority Committee staff was claims
filed by veterans of Vietnam who served on Air Force bases in
Thailand. Staff provided documents to VA that show the use of
herbicides along the perimeters of Air Force bases in Thailand
during the Vietnam War and worked with VA to improve the
recognition of exposure in such cases to help ensure that
eligible veterans receive benefits for conditions linked to
Agent Orange exposure.
Majority Committee staff also examined VA processing of
claims for PTSD and for specially adapted housing grants. Staff
identified errors in both types of claims that caused delays or
even the denial of benefits to eligible veterans and worked
with VA to correct such errors and to take steps to avoid them
in the processing of future claims.
Majority Committee staff also identified cases in which
benefits were delayed in time-sensitive pension and death-
pension claims pending the determination of eligibility for
compensation or DIC benefits. VA subsequently instructed
adjudicators to first process pension or death pension claims
before moving on to the more time-consuming task of evaluating
disability compensation and DIC claims.
The Majority Committee staff also reviewed VA's management
of claims from veterans who live in Pacific Rim nations. In
reviewing claims from such veterans, staff identified a number
of cases in which veterans had waited more than two years to
receive a medical examination. At the Committee's request, VA
sent clinicians to Japan who completed 200 medical examinations
and reduced the backlog of pending examinations.
Majority and Minority Committee staff traveled to several
DOD and VA facilities to evaluate the effectiveness of
initiatives aimed at better coordination between the two
departments in the evaluation of service-connected disabilities
among returning servicemembers. Facilities were located in
Alaska, Pennsylvania, Georgia, Rhode Island, Arkansas,
Colorado, Louisiana, and Hawaii. Committee staff also examined
the responsiveness of VA health care programs to the needs of
women veterans and non-profit organizations that receive
funding from VA to those of veterans. Broader quality-of-care
issues were the focus at VA hospitals and VA community-based
outpatient clinics, and Vet Centers. Finally, Committee staff
traveled to VA facilities responsible for administering the
Post-9/11 GI Bill.
In addition, Minority Committee staff conducted oversight
visits to VA facilities including Pittsburgh, PA, and New
Orleans, LA, as well as to VA's Regional Office in Winston-
Salem, NC.
IV. NOMINATIONS
----------------------------------------------------------------------------------------------------------------
Date of Date of Date Date
Name and Position Nomination Hearing Reported Confirmed
----------------------------------------------------------------------------------------------------------------
First Session
General Eric K. Shinseki.................................. 12/7/08* 1/14/09 1/20/09 1/20/09
Secretary of Veterans Affairs
W. Scott Gould............................................ 3/11/09 4/1/09 4/2/09 4/3/09
Deputy Secretary of Veterans Affairs
L. Tammy Duckworth........................................ 3/16/09 4/1/09 4/20/09 4/22/09
Assistant Secretary of Veterans Affairs (Public and
Intergovernmental Affairs)
John U. Sepulveda......................................... 4/2/09 5/6/09 5/12/09 5/18/09
Assistant Secretary of Veterans Affairs (Human
Resources)
Jose D. Riojas............................................ 4/20/09 5/6/09 5/12/09 5/18/09
Assistant Secretary of Veterans Affairs (Operations,
Security, and Preparedness)
William A. Gunn........................................... 4/20/09 5/6/09 5/12/09 5/18/09
General Counsel, Department of Veterans Affairs
Roger W. Baker............................................ 4/20/09 5/6/09 5/12/09 5/18/09
Assistant Secretary of Veterans Affairs (Information and
Technology)
Raymond M. Jefferson...................................... 6/3/09 7/22/09 8/3/09 8/7/09
Assistant Secretary of Labor for Veterans' Employment
and Training
Joan M. Evans............................................. 6/23/09 7/22/09 8/7/09 8/7/09
Assistant Secretary of Veterans Affairs (Congressional
and Legislative Affairs)
Raul Perea-Henze.......................................... 11/9/09 12/9/09 1/28/10 3/19/10
Assistant Secretary of Veterans Affairs (Policy and
Planning)
Robert A. Petzel.......................................... 11/18/09 12/9/09 12/16/09 2/11/10
Under Secretary for Health of the Department of Veterans
Affairs
Second Session
[none]....................................................
----------------------------------------------------------------------------------------------------------------
*Designated as his future nominee on December 7, 2008, by then President-elect Barack Obama.
V. BUDGET FOR VETERANS PROGRAMS
A. First Session (2009)
Pursuant to the requirements of section 301(d) of the
Congressional Budget Act of 1974, the Democratic and Republican
Members of the Committee submitted letters to the Budget
Committee reflecting the Committee's Views and Estimates on the
Administration's proposed fiscal year 2009 budget for veterans'
programs. The letter submitted is printed below in its
entirety:
March 16, 2009.
Hon. Kent Conrad, Chairman,
Hon. Judd Gregg, Ranking Member,
Committee on the Budget,
U.S. Senate, Washington, DC.
Dear Chairman Conrad and Ranking Member Gregg: Pursuant to
Section 301(d) of the Congressional Budget Act of 1974, the
Undersigned Members of the Committee on Veterans' Affairs
(Undersigned Members) hereby report to the Committee on the
Budget their views and estimates on the Fiscal Year 2010 (FY
2010) Budget for Function 700 (Veterans' Benefits and Services)
and for Function 500 (Education, Training, Employment, and
Social Services) programs within the jurisdiction of the
Committee on Veterans' Affairs (Committee). This letter
responds to the Committee's obligation to provide
recommendations on veterans' programs within its jurisdiction
from the perspective of the Undersigned Members.
At the outset, we note that we have not received the full
budget, which is normally used by this Committee--and all
Committees--to inform our Views and Estimates. Given this
reality, we are severely limited in our ability to provide
detailed information on any account.
The outline of the President's proposed FY 2010 Budget
includes $55.9 billion in discretionary budget authority for
the Department of Veterans Affairs (VA), an increase of $5.6
billion from fiscal year 2009 (FY 2009). The Committee received
only this total number, which includes billions in medical
collections revenue, including funds potentially obtained by
enactment of a legislative proposal. By way of comparison, The
Independent Budget formulated by AMVETS, Disabled American
Veterans, Paralyzed Veterans of America, and Veterans of
Foreign Wars of the United States, and endorsed by 62 other
organizations, recommends $54.6 billion for FY 2010, which
includes projected revenues.
The President's budget request for VA mandatory budget
authority is $56.9 billion, which is $9.7 billion over the FY
2009 level.
The following are several areas we highlight:
Increased Veteran Enrollment. VA will likely face increased
enrollment in the wake of an anticipated drawdown of American
forces in Iraq. Through the fourth quarter of fiscal year 2008,
400,304 separated Operation Enduring Freedom/Operation Iraqi
Freedom veterans have utilized VA health care. Also, the
Administration proposes that VA open health care eligibility to
an additional 550,000 Priority 8 veterans by 2013, with nearly
half of these newly eligible veterans predicted to enroll
during the next fiscal year. This challenge is compounded by
the declining economy, which may cause a staggering and
unprecedented number of eligible veterans to enroll in, and
rely on, VA for health care. As such, we recommend continued
monitoring of any potential imbalance between the resources VA
has to operate with and the demand for medical care.
Advance Appropriations. We are concerned that the current
process of appropriating funds on an annual basis to fund the
upcoming fiscal year will--because of Congress's record of
passing funding bills late--continue to hamper VA's ability to
manage its health care operation in a rational manner. During
19 of the past 22 fiscal years, VA has not received its
appropriation by the start of the new fiscal year, with funding
sometimes coming as late as February. VA must be able to plan
for a coming fiscal year so that it may hire the personnel it
needs and meet necessary maintenance expenses in a responsible
way. Of course, VA managers should be held accountable when
they fail to do so, but the first step is to give them an
understanding of what they will have to work with well before a
fiscal year begins. Accordingly, we ask you to ensure that
there is no language in the Budget Resolution that would impose
a point of order on the consideration of an advance
appropriation for VA health care.
Outyear Budget. The outline of the President's proposed FY
2010 budget contains estimates for fiscal years 2011 through
2014 and suggests there will be less than 3 percent
discretionary spending increases in each of those years.
However, estimates of recent medical care inflation rates
applicable to VA range from 2.6 percent to about 5 percent.
Given the needs of the system, and inflation, we have concerns
about the accuracy of the proposed discretionary outyear
spending increases. We urge the Budget Committee to seek
information showing how these estimates are aligned with actual
program usage and stated policy objectives before carrying them
forward in the Budget Resolution.
Proposed Legislation. We understand that embedded within
the FY 2010 budget will be a proposal to bill insurers for care
provided to veterans for injuries and diseases incurred or
aggravated during their military service. We oppose any such
effort, as it is the responsibility of VA to cover the cost of
this care. Furthermore, we are concerned about potential
unintended consequences this policy might have on the ability
of veterans to remain insured.
Timely and Accurate Claims. The Undersigned Members remain
concerned that timely and accurate claims adjudication
continues to be a problem. Sufficient funds must continue to be
made available for staffing, training, and technology
enhancements, and VA managers must be held accountable for
performance with the resources provided.
Post-9/11 GI Bill. Full implementation of the Post-9/11 GI
Bill on August 1, 2009, must be achieved. The President's
Budget states that it ``facilitates timely implementation'' of
the new program. We will continue to monitor and evaluate the
situation as we move forward.
Mandatory Spending. Veterans' entitlement programs, such as
disability compensation and pension, are rarely adjusted by
Congress because of PAYGO rules that require offsets in
spending in other veterans' benefits programs. This rule makes
it difficult to adjust several benefit programs, which require
periodic adjustments in order to combat the erosion of the
value of those benefits over time due to inflation. We
recognize that the PAYGO rule's primary purpose is to prevent
the Federal budget deficit from growing. Therefore, the
Undersigned Members recommend that sufficient funds be included
to provide reasonable increases for burial benefits and
automobile grants. In addition, we recommend that the COLA
round-down be eliminated. Of course, we will make every effort
to identify offsets necessary to pay for these reasonable
increases if that can be done without harming the integrity of
other veterans' benefits programs and the beneficiaries who
rely on them.
The attached Appendix includes information on our various
priorities and demonstrates the need for additional resources
in certain areas.
Sincerely,
Daniel K. Akaka, Richard Burr,
Chairman. Ranking Member.
John D. Rockefeller IV. Arlen Specter.
Patty Murray. Johnny Isakson.
Bernard Sanders. Roger F. Wicker.
Sherrod Brown.
Jim Webb.
Jon Tester.
Mark Begich.
Roland W. Burris.
Enclosure.
Appendix
This Appendix includes information on various
recommendations on veterans' programs.
DISCRETIONARY ACCOUNT SPENDING
Medical Care
Advance Appropriations
VA has faced significant challenges over the years as a
result of politics hindering the regular appropriations
process. While this may be a reasonable setback for some
programs, it is not the case when the program in question is
health care for veterans, many of whom depend heavily or
exclusively on VA to fulfill their obligation to care for them,
and the quality or availability of that health care. During 19
of the past 22 fiscal years, VA has not received its
appropriation by the start of the new fiscal year, with funding
sometimes coming as late as February. VA must be able to plan
ahead so that it may hire the personnel it needs and meet
necessary maintenance expenses in a responsible way.
Additionally, having advance knowledge of future funding will
improve VA's ability to plan strategically and to ensure
programs are executed seamlessly, thereby increasing efficiency
and reducing waste of taxpayer dollars, as well as preventing
any gaps in services received by veterans.
In order to address this issue, many Members, including
several on the Committee on Veterans' Affairs, are supporting
S. 423 the Veterans Health Care Budget Reform and Transparency
Act of 2009. This bill would allow Congress to appropriate
money for certain Veterans Health Administration (VHA) accounts
one year in advance of the normal appropriation process in
order to provide timely, sufficient, predictable funding for
veterans' health care. As the funding will still be done
through the appropriations process, Congress will retain its
traditional oversight capabilities. The use of an advance
appropriation is not a unique arrangement. This approach is
used to fund other programs, such as Housing and Urban
Development (HUD) Section 8 Vouchers and Head Start.
Accordingly, we ask you to ensure that there is no language in
the Budget Resolution that would impose a point of order on the
consideration of an advance appropriation for VA health care.
Current Services
Using past experience as a guide, medical care inflation
(assuming an extremely conservative estimate of 2.6%),
increases in the costs of goods, and other uncontrollables may
dictate an increase in obligations in FY 2010 simply to
maintain the level of current services. Increased intensity
(which encompasses changes in medical care delivery to adjust
for more complex care) and utilization of medical services by
existing patients also continues to drive costs up as well.
Because we do not know whether the outline of the President's
proposed FY 2010 Budget accurately reflects inflation rates and
needs for services beyond FY 2010, we do not comment on the
adequacy of any budgetary projections beyond FY 2010. We urge
the Budget Committee to seek information showing how the
President's estimates are aligned with actual program usage and
stated policy objectives before carrying them forward in the
Budget Resolution.
Increased Workload
VA Secretary Shinseki testified before the Committee on
March 10, 2009, that the FY 2010 budget is sufficient to treat
5.5 million veteran patients, an expected 2.1% increase over
the FY 2009 projections. The outline of the President's
proposed FY 2010 Budget indicates an intention to expand
eligibility for VA health care to veterans without service-
connected disabilities earning modest incomes. VA expects that
this expansion will bring more than 266,000 eligible veterans
into VA in FY 2010.
The increased workload resulting from a net increase in
patients using the system--including the 266,000 middle-income
veterans--will certainly require additional resources. In the
absence of more specific data, however, we do not comment on
what that resource level may be.
Mental Health
VA estimates that, of the 5.2 million veteran users of the
health care system, 30% have a mental health disorder. Through
August 2008, it is estimated that 76,000 enrolled OEF/OIF
veterans have a probable diagnosis of post traumatic stress
disorder (PTSD), 60,000 have a diagnosis of depression, and
nearly 13,000 have been diagnosed with an alcohol dependence
syndrome. According to the Congressional Research Service, VA
estimates it will spend $319 million for PTSD treatment and
$15.5 million for suicide prevention treatment in FY 2009, with
aggregate expenditures for mental health services totaling $3.9
billion. Funding for mental health services in FY 2010 must
continue at least at this level to maintain current services
and allow VA to meet legislative requirements in the area of
mental health, such as offering health care during evening
hours at least one day a week.
The Readjustment Counseling Service (RCS) continues to help
veterans and their families with psychosocial readjustment
issues. The RCS provides services such as bereavement,
marriage, and family counseling services to family members.
These services are provided at 232 Vet Centers, expanding to
271 by the end of FY 2009. In addition, VA put its first mobile
Vet Center into service in October 2008. VA plans to deploy 50
of these centers, each with space for confidential counseling
and outreach workers. Without a full budget, we do not know
whether this program is sufficiently funded but we do support
adequate funding to continue providing needed mental health
services through this program.
Homeless Veterans
Outreach to homeless veterans continues to be a priority,
especially in light of estimates that at least 45% of homeless
veterans suffer from mental illness and more than 50% have
substance abuse problems. The Homeless Veterans Reintegration
Program (HVRP)--funded through the Department of Labor--
provides grants to agencies that help veterans find homes and
jobs. HVRP is currently authorized for $50 million but has not
had appropriations commensurate with its authorization. We
recommend increasing funding to its authorized level.
When homeless veterans seek employment, they have a need
for decent transitional housing and for programs to address the
special needs of specific subsets of the homeless population,
including women veterans, elderly veterans, veterans with
chronic mental illness, and those homeless veterans who are
terminally ill. We recommend full funding for VA's Homeless
Provider Grant and Per Diem program. In addition we are pleased
to see that the President's budget contains funding for a
program authorized in Public Law 110-387 enabling VA to make
grants to non-profit organizations that provide supportive
services for veterans at risk of homelessness. It is our hope
that taking a proactive, holistic approach to solving this
problem will prevent the cycle of homelessness from ever
beginning in the first place.
Caregivers
We believe that families often play a critical role in the
treatment and recovery of injured or disabled veterans. It has
been shown that involving family members of injured veterans in
medical care greatly enhances the probability and speed of
recovery. When a veteran cannot independently complete some of
the tasks of daily living, but does not require
institutionalized care, these family members can provide the
necessary care in the comfort of their own home.
In the course of providing the necessary care to a disabled
veteran, family members often find it difficult to maintain
full-time employment, due to the time-intensive nature of
providing the care. As a result, they lose the income necessary
to sustain their household, private health insurance, and other
critical benefits.
VA is currently unable to provide the appropriate training
and support services for family members caring for disabled
veterans, although it is essential to ensuring that the veteran
is receiving adequate home care. Considering that the average
cost of caring for a veteran in a long-term care institution is
over five times that of caring for a veteran through VA's home
based primary care program, this approach is short-sighted.
We expect to pursue authorizing legislation to establish a
caregiver program within VA. This program would authorize VA to
provide training and supportive services to family members and
loved ones who wish to care for the disabled veteran in the
home. These supportive services would include training and
certification, a living stipend, and health care--including
mental health counseling, transportation benefits, and respite.
The Committee is currently waiting on a Congressional Budget
Office score on this proposal, but the potential exists for
additional costs associated with a new caregiver program.
Rural Veterans
For FY 2009, VA will spend $250 million outside of its
medical services account for dedicated rural health and
outreach. This same amount, adjusted for inflation, is the
minimum required for existing services, assuming no new
veterans enter the system. We believe additional resources are
required, but cannot determine, without access to greater
details than provided in the outline of the President's
proposed FY 2010 Budget, whether the budget currently includes
adequate resources to expand VA's rural health effort. We
recommend funding to build more mobile clinics, offer
telehealth services at more of VA's remote clinics, and
research the best way to provide health care through this
technology.
Female Veterans
As of October 2008, the population of women veterans
numbered over 1.8 million--7.6% of the total veteran
population. By 2010, women are expected to represent over 14%
of the total veteran population. As the number of women who
access VA increases, we are concerned that there may be
insufficient attention to ensure uniform access to gender-
specific services across the VA health care system. The complex
needs of today's women veterans, particularly those who served
during Operations Enduring and Iraqi Freedom (OEF/OIF), require
that VA assess the effectiveness of its existing gender-
specific programs and initiate new ones that strategically
address the many needs of this cohort in a way that is
inviting, compassionate, and demonstrates a driven yield toward
the best outcomes.
Women veterans of childbearing age make up approximately
41% of the women veteran population. While VA may, under
current law, provide care related to a pregnancy, there is no
authority to cover medical expenses for newborn care. This can
create an unnecessary barrier for women veterans receiving
obstetric services from VA through fee basis because VA is
unable to address the expenses for the newborn post delivery
when contracting with the delivering hospital on all other
aspects of the care. We intend to advance legislation to
provide 7 days of newborn medical care for women veterans
giving birth. The cost of this new authority is estimated to be
$2.5 million for the coming fiscal year.
Veterans with Special Needs: Prosthetics and Sensory Aids
Many veterans suffer amputations, whether from combat
injuries, as is now happening for OEF/OIF servicemembers, or
because of medical conditions such as diabetes. Within the last
18 months, veterans with amputations accounted for nearly 1.5
million outpatient visits. Prosthetics, in VA, includes many
services and devices in addition to artificial limbs. In fact,
wheelchairs and access services cost VA more than artificial
legs.
The demand for prosthetic-related services has increased
dramatically. Since 2000, the total number of veterans
requiring prosthetics, sensory aids, and associated types of
health care services has increased by more than 70%. VA's FY
2008 expenditures exceeded the projected budget of $1.42
billion by $42.6 million. VA has historically underestimated
the cost associated with providing prosthetic and sensory aids
to veterans. Therefore, we anticipate that the President's
Budget may include only the minimum necessary to support this
program and therefore, recommend that additional funding be
included in the Budget Resolution.
Dental Services
Dental care represents a growing need among returning
veterans. Poor dentition can interfere with the proper
treatment for cancer and cause severe infections in diabetics
and other immunocompromised veterans. Dental care is available
to service-connected members, to newly discharged veterans, and
to veterans with other health care conditions negatively
impacted by dental problems. While VA has 755 community based
outpatient clinics, there are only 207 dental treatment sites.
VA has underfunded dental care in the past, obligating $485
million for FY 2009 when more was spent on that during the
previous year ($580 million). We recommend funding VA dental
services at a level which will allow VA to provide eligible
veterans with timely and quality dental care during FY 2010.
Quality and Performance Initiatives
VA's National Surgical Quality Improvement Program ensures
that VA can identify facilities with increased rates of death
or complications following surgery and respond appropriately.
This is regarded as a very effective program, and has been
adopted by other professional organizations and health care
systems. According to VA officials, VA was expected to allocate
$1.34 million to this program. However, it has already
obligated more than that. Improvements are needed to ensure
that this system continues to report problems accurately and
fairly, by hiring additional statistical support and other
services. As it has already obligated more funds than
previously expected, we recommend an appropriate level of
funding to keep this important quality assurance program fully
effective.
MEDICAL SUPPORT AND COMPLIANCE
Protecting Human Subjects
VA's Office of Research Oversight (ORO) is responsible for
overseeing VA research. Recently, ORO has been given the
responsibility of educating research compliance officers.
Research compliance officers are employees in VA medical
centers who monitor ongoing research projects to ensure that
the rights of veterans are protected when they participate in
research. We anticipate this educational effort will cost an
additional $750,000. As of December 31, 2008, VA has authorized
a research compliance officer for every VA medical center
conducting research.
Without the full detail included in the budget, we do not
know whether projected funding will be adequate for the needs
of ORO. We recommend ensuring that the Budget Resolution
include robust funding for this office so that those veterans
participating in research will be protected to the greatest
extent possible.
MEDICAL AND PROSTHETIC RESEARCH
VA reports that VA researchers co-authored 65,779 articles
in peer-reviewed scientific journals from January 1, 2001,
through November 7, 2008, a body of work representing
significant advances in the diagnosis and treatment of many
debilitating conditions. VA research must continue to focus on
conditions like Post Traumatic Stress Disorder, Traumatic Brain
Injury, and Persian Gulf War Illness that disproportionately
affect veterans. So that VA researchers may continue this work,
we recommend an additional increase for VA research in FY 2010.
In addition to improving care for veterans, funding
research also directly benefits recruitment and retention of VA
health care providers. Over three quarters of VA's researchers
provide direct patient care in VA. Supporting their research
efforts helps VA retain good quality providers to care for
veterans.
While VA does considerable research in prosthetics, the
amount of research dollars specifically devoted to this arena
is presently unclear. Prosthetics is an important area and we
recommend increasing funding so as to expand research
initiatives to ensure veterans with amputations enjoy the best
quality of life possible. As such, we suggest that the Office
of Research and Development include in its budget submission a
designated research area or other category indicating how much
of VA's research budget is devoted to prosthetic research.
MEDICAL FACILITIES
Non-Recurring Maintenance
The Medical Facilities account includes funding for
maintenance and operation of all VA facilities including
funding needed for non-recurring maintenance. VA received $1
billion in the American Recovery and Reinvestment Act for non-
recurring maintenance, which helps meet the existing backlog in
this area. As these funds are expected to address outstanding
projects, we recommend that this program continue to be funded
in an amount at least equivalent to the President's Budget.
CONSTRUCTION
Major, Minor, Grants for State Extended Care Facilities, and State
Veterans Cemeteries
VA currently has an extensive backlog in construction,
including $1.787 billion needed for major construction projects
that have already begun and have been partially funded. In
addition, VA has approximately $6.5 billion of major medical
facility construction projects in its 5-year capital plan. We
believe that sufficient funding should be provided on a set
schedule over the next several years to address both the
partially funded projects and the projects in VA's 5-year
capital plan. The scheduled funding should be done in a manner
that will result in all of these projects being completed on
time. The funding should be provided commensurate with the
stage of construction the project is in. It is likely that in
order to meet such a schedule that VA's major construction
account will need funding in FY 2010 that, at the very least,
equals the $1.069 billion provided for FY 2009.
In addition to the needed funding for construction, we
support a substantial investment in facilities for VA research.
VA will need $142 million in designated funding for necessary
renovation of existing research space and build-out costs for
leased researched facilities.
As VA continues to provide more institutional long-term
care in State Veterans Homes, we will evaluate the impact of
decreasing state revenues (or substantial state budget
deficits) on the future ability of states to provide matching
funds for the construction, rehabilitation, and repair of
facilities.
We recommend that the State Cemetery Grants Program be
funded at a level that funds all pending applications for state
cemetery construction, expansion, and improvement that are
ready for funding in FY 2010.
Without access to greater details than provided in the
outline of the President's proposed FY 2010 Budget, we cannot
accurately assess whether the President's budget will meet the
needs of State Veterans Cemeteries and State Extended Care
facilities.
VETERANS BENEFITS
Disability Claims Processing
VA must take aggressive action to improve the claims
adjudication process. During recent years, Congress has
provided increased staffing to the Veterans Benefits
Administration (VBA) to process disability claims. We will
continue to monitor current staffing levels at VBA to ensure
that it has adequate staffing resources to adjudicate claims in
a timely and accurate manner. In addition, we will look to the
President's budget for details on ongoing training initiatives.
We will also look to the Administration to show how it is
holding managers and employees accountable for performance with
the substantial resources already provided.
Any effort to reduce the backlog of disability claims must
use information technology to alleviate the burden on veterans
seeking benefits through the use of web-based technologies. VA
has developed a Paperless Delivery of Veterans Benefits
Initiative, which would allow veterans to apply quickly for
benefits online, reduce the adjudication time within VA, and
eliminate a major potential for personal information security
violations. Without access to more details than provided in the
outline of the President's proposed FY 2010 Budget, we cannot
accurately assess whether sufficient funding to accelerate the
development of this initiative has been provided. We recommend
that the Budget Resolution expressly include support to expand
the use of information technology to improve the timeliness and
accuracy of claims adjudication.
Vocational Rehabilitation and Employment
Without specific details on the staffing request for
Vocational Rehabilitation and Employment (VR&E) it is difficult
to evaluate the adequacy of the outline of the President's
proposed FY 2010 Budget request. However, we do believe that
staffing levels must be closely monitored for the program.
The effect of the enactment of the Post-9/11 GI Bill on the
enrollment of veterans in the chapter 31 program is not yet
known. However, we believe that the staffing levels for this
important function have been eroded over the years and that
increases in staffing levels are justified despite the
uncertainty that exists at this time. This is especially true
since the impact of service in Iraq and Afghanistan continues
to result in an increase in the number of more seriously
injured veterans who will likely qualify for the VR&E program.
In addition, we anticipate enactment of legislation to make
improvements in the current VR&E program and specifically to
increase the amount of the subsistence allowance. With the
enactment of the Post-9/11 GI Bill, veterans who are eligible
to participate in both programs may select to enroll in the new
GI Bill in order to receive a greater subsistence or living
allowance--even though they could benefit more by receiving the
additional counseling, training and job placement assistance
available through the VR&E program.
We recommend that the Budget Resolution include sufficient
funding for adequate staffing to ensure that the program
remains an attractive and effective one for severely disabled
veterans.
Education
The enactment of the Post-9/11 GI Bill, last Congress,
presents a challenge to VA to implement in a timely and
seamless manner.
The outline of the President's proposed FY 2010 Budget
request provides no detail on VA's plan to implement the
program successfully on August 1, 2009, and its short- and
long-term strategies for benefits delivery. However, VA's
progress in this important area is being closely monitored and,
should the need for additional resources become apparent,
appropriate recommendations will be made.
We recommend that additional resources, which were
referenced, but not detailed, in the outline of the President's
proposed FY 2010 Budget be included in the Budget Resolution,
together with a commitment to provide any needed additional
funding to support the workload associated with anticipated
increases in the number of education claims, as well as the
need to maintain the timeliness and accuracy of very complex
education claims processing.
DEPARTMENT OF LABOR, VETERANS' EMPLOYMENT AND
TRAINING SERVICE
The outline of the President's proposed FY 2010 Budget
includes the statement that the budget will honor ``the
commitment to returning servicemembers by supporting training
and placement services to ease their transition to
employment.'' We believe that this is a valid and worthwhile
goal. To this end, we believe that the Department of Labor's
Veterans' Employment and Training Service (VETS) should receive
appropriate funding for its Recovery & Employment Assistance
Lifelines (REALifelines) initiative which provides injured
servicemembers and veterans with one-on-one employment
assistance to help them transition into the civilian labor
force. We recommend that this program should be positioned to
meet the very pressing needs of those returning from combat
with serious injuries.
We further believe that adequate amounts in Grants to
States funding should be available to provide additional
services and assistance to targeted groups of veterans,
including the spouses of deployed servicemembers. The groups
targeted should include recently separated veterans, veterans
with service-connected disabilities, and homeless veterans. We
further recommend that the Budget Resolution include funding
that would support an appropriate number of Disabled Veterans'
Outreach Program Specialists and Local Veterans' Employment
Representatives.
Finally, we recommend that the Budget Resolution include
Federal Administration funds in an amount sufficient to permit
VETS to conduct a professional training conference for VETS
employees. VETS has not been able to convene such a meeting
since 2004. We believe that this meeting would be an
opportunity to improve operational performance within the
agency.
COURT OF APPEALS FOR VETERANS CLAIMS
The budget estimate for the U.S. Court of Appeals for
Veterans Claims (Court) shows a need of $27.1 million for FY
2010. This budget estimate includes increased staffing for 12
positions. This represents the personnel for the two additional
judicial chambers authorized by Congress effective December 31,
2009. We support the Court's request.
The Veterans Consortium Pro Bono Program estimates a need
of $1.82 million, an increase of $120,000 over the FY 2009
request. The estimate for the program is included in the
Court's $27.1 million dollar estimate. The need for the
consortium, which provides free legal representation to
veterans, has increased in the past few years, as more veterans
seek judicial review.
MANDATORY ACCOUNT SPENDING
We support the budget request of $56.9 million, an increase
of $9.7 billion, for entitlement programs over the FY 2009
level. However, there are several areas within this account
that require funding beyond what the President has requested.
We will make every effort to identify offsets necessary to pay
for these reasonable increases if that can be done without
harming the integrity of other veterans' benefits programs and
the beneficiaries who rely on them.
Cost-of-Living Adjustment
Under current law, the COLA applied to veterans' disability
compensation and survivors' dependency and indemnity
compensation (DIC) is rounded down to the next lowest whole
dollar. VA compensation is sometimes the sole source of income
for a veteran and his or her family. Over time, the effect of a
COLA round-down can be substantial. We owe it to our Nation's
veterans to provide them with appropriate compensation, the
value of which does not decrease with inflation. Although the
legal authority for an automatic COLA round-down is set to
expire in 2013, we recommend that funding be provided to end
the COLA round-down ahead of schedule.
Burial Benefits
The Federal Government has provided varying forms of burial
benefits since the Civil War. We are concerned that the
continued erosion of the value of benefits has resulted in a
burial benefit which covers just a small fraction of what was
covered in 1973 when VA first provided monetary burial benefits
for our veterans.
We recommend that funding be provided to bring the value of
this benefit to a reasonable level. Specifically, we recommend
that the Budget Resolution include funding that would support
reasonable increases in the plot allowance, service-connected
burial benefit, and non-service-connected burial benefit.
Automobile Grants
VA provides certain severely disabled veterans and
servicemembers grants for the purchase of automobiles. This
grant also provides for adaptive equipment necessary for safe
operation of those vehicles. When this grant was first
established in 1946, it covered approximately 85% of the
average cost of a new automobile. Over time, Congress adjusted
the amount provided to a level equal to 80% of the cost of a
new automobile. However, lack of further adjustments to this
grant have gradually eroded the benefit so that today, the
current allowance of $11,000 represents less than 40% of the
average cost of an automobile. We recommend that the Budget
Resolution include sufficient funding so as to support adequate
funding in FY 2010 to provide a reasonable increase to the
automobile grant.
Mandatory and Receipt Proposals
The outline of the President's proposed FY 2010 Budget
proposes two changes to the mandatory account: implementation
of the Administration's concurrent receipt policy and use of
discretionary funds for contract examinations for disability
compensation eligibility. We cannot comment on these two
proposals without a complete budget and additional details
regarding the implementation and possible effects of these
initiatives.
B. Second Session (2010)
Pursuant to the requirements of section 301(d) of the
Congressional Budget Act of 1974, the Democratic and Republican
Members of the Committee submitted a letter to the Budget
Committee reflecting the Committee's Views and Estimates on the
Administration's proposed fiscal year 2010 budget for veterans'
programs. The letter submitted is printed below in its
entirety:
March 5, 2010.
Hon. Kent Conrad, Chairman
Hon. Judd Gregg, Ranking Member
Committee on the Budget,
U.S. Senate, Washington, DC.
Dear Chairman Conrad and Ranking Member Gregg: Pursuant to
Section 301(d) of the Congressional Budget Act of 1974, the
Democratic and Independent Members of the Committee on
Veterans' Affairs (Undersigned Members) hereby report to the
Committee on the Budget their views and estimates on the Fiscal
Year 2011 (hereinafter, ``FY 2011'') budget for Function 700
(Veterans' Benefits and Services) and for Function 500
(Education, Training, Employment, and Social Services) programs
within the Committee's jurisdiction, including the Court of
Appeals for Veterans Claims. This letter responds to the
Committee's obligation to provide recommendations on veterans'
programs within its jurisdiction, albeit from the perspective
of the Undersigned Members.
I. Summary
The Undersigned Members support the President's request for
the FY 2011 budget for the Department of Veterans Affairs, but
recommend an increase, above the Department's requested
discretionary amounts, of $30 million for Information
Technology, $12 million for the Office of Inspector General,
$25.5 million for Medical and Prosthetic Research, $235 million
for Minor Construction, $20.5 million for Vocational
Rehabilitation and Employment, and $57 million in funding for a
new program to support family caregivers. The result of these
recommendations is an overall funding amount of $380 million
above the Department's requested discretionary amount for FY
2011.
The FY 2010 Appropriations Act (Public Law 111-117)
provided $48.183 billion in resources for FY 2011 for three
medical care accounts through advance appropriations. In
addition to the appropriated resource level, we anticipate
collections in the amount of $3.355 billion, for a total FY
2011 resource level of $51.538 billion. We support the
Department's request for an increase over the FY 2010 funding
level of $3.702 billion for medical care services.
While the requested appropriations level for FY 2011
appears sufficient to meet the estimated demands of FY 2011, we
are concerned that the President's requested advance
appropriations level for FY 2012 may not satisfy the health
care needs of veterans, based on anticipated increases in
veterans' health care service demands. At this time, however,
we support the President's request of $50.611 billion in FY
2012 advance appropriations for the three medical care
appropriations. When combined with the anticipated collections
amount of $3.679 billion, the total requested resource level of
$54.290 billion for FY 2012 would represent an increase of 5.3
percent over the FY 2011 estimate to support approximately 6.2
million patients. We anticipate adjusting this FY 2012 estimate
over the coming year, as more current actual obligation data
become available. In addition, we plan to review the Government
Accountability Office's report on its analysis of the
Administration's advance appropriations projections as compared
to VA's Enrollee Health Care Projection Model.
With respect to mandatory benefits, sufficient funding
should be provided to support a reasonable increase in the
Specially Adapted Housing Grant program for FY 2011 and to not
impose a Cost-of-Living Adjustment round-down for the upcoming
fiscal year.
II. Discretionary Account Spending
A. Medical Services
The President requests an overall funding amount of $40.742
billion for Medical Services for FY 2011, an increase of $2.159
billion over the amount in FY 2010. We support the President's
request for an additional $2.159 billion in funding for Medical
Services, as described in greater detail below:
Components of Recommended Increases
1. Health Care Services
Acute Care (+$173 million): VA provides veterans with acute
care services that include inpatient hospital care, ambulatory
care, and pharmacy services. Inpatient acute care services
include neurology and surgery. Ambulatory care includes care
provided at VA hospital-based and community-based clinics, as
well as contracted non-VA facilities. Pharmacy services include
prescriptions, over-the-counter medications, and pharmacy
supplies. VA estimates the demand for such services will cost
$27.137 billion in FY 2011, necessitating an additional $173
million in needed funding over the FY 2010 amount.
The Undersigned Members support the President's request for
an additional $173 million for acute care funding for FY 2011.
Rehabilitation (+$36 million): VA's rehabilitative care
programs include the Blind Rehabilitation and Spinal Cord
Injury programs, among others. Pursuant to Public Law 104-262,
which established the requirement that VA maintain its capacity
to provide for the specialized treatment and rehabilitative
needs of patients, the Administration is expanding the Blind
Rehabilitation program to accommodate the increased workload
due to additional numbers of eye injuries among Operational
Enduring Freedom and Operation Iraqi Freedom (OEF/OIF)
veterans.
The Undersigned Members support the President's request for
an additional $36 million in funding for FY 2011 for VA's
rehabilitation programs.
Mental Health (+$410 million): Funding for mental health
supports inpatient, residential, and outpatient mental health
programs. The number of veterans diagnosed with substance abuse
problems is increasing, necessitating more resources for mental
health services. The proposed additional funds will support the
following: integration of VA's specialized mental health
services with primary care; expansion of VA's specialized
substance abuse programs per Public Law 110-387; expansion of
VA's capacity to provide inpatient psychiatric and residential
care; addressing family-related needs of returning veterans
experiencing distress following reentry into civilian life;
more effective treatment for post traumatic stress disorder
(PTSD); treatment for veterans with traumatic brain injury; and
efforts to prevent suicide among veterans.
VA is integrating mental health and primary care in more
than 100 sites to facilitate treatment and has enhanced the
capacity of general mental health, substance abuse treatment,
and specialized PTSD programs.
The Undersigned Members support the President's request for
an additional $410 million in funding over FY 2010 levels for
mental health services, for a total funding amount of $3.717
billion for FY 2011.
Prosthetics (+$148 million): VA provides funds to veterans
for the purchase and repair of prosthetics and sensory aids,
such as artificial limbs, hearing aids, pacemakers, artificial
hip and knee joints, ocular lenses, and wheelchairs. VA
estimates the demand for such prosthetics and repairs to cost
$1.699 billion in FY 2011 and requests an additional $148
million in needed funding over the FY 2010 amount. Funding
allocations for 2010 were based primarily on FY 2009
expenditure data from the National Prosthetics Patient
Database. As of July 2009, VA reported that 557 OEF/OIF
veterans with amputations were using the VA health care system.
The Undersigned Members support the President's request for
an additional $148 million in funding for FY 2011, for a total
amount of $1.847 billion to meet the demand for prosthetics in
FY 2011.
Dental Care (+$47 million): VA provides veterans with
dental care services that include onetime Class II benefits to
all newly discharged combat OEF/OIF veterans within 180 days of
discharge. Class II benefits are provided to veterans with
service-connected, non-compensable dental conditions or
disabilities shown to have been in existence at the time of
discharge or release from active duty. VA also provides dental
services to veterans placed into dental Classifications III and
IV, those with a condition negatively impacted by poor
dentition. VA estimates the demand of such services will cost
$494.936 million in FY 2011, necessitating an additional $47
million in funding over the FY 2010 funding amount.
The Undersigned Members support the President's request for
an additional $47 million in funding for FY 2011, for a total
funding amount of $494.936 million for dental care for FY 2011.
Long-Term Care (+$819 million): VA projects the
institutional care average daily census (ADC) will increase
from 39,937 to 41,123 (3 percent) from 2010 to 2011, and the
non-institutional care ADC will increase from 93,935 to 111,484
(19 percent) from 2010 to 2011. Of this increase in the non-
institutional care ADC, VA's use of home telehealth accounts
for 28.6 percent of the increase. To support this increased
demand for telehealth, VA will be dedicating $163 million of
the $819 million increase requested for long term care in FY
2011 to telehealth services, which is an increase of $41.8
million, or 34.5 percent, above the FY 2010 level. Telehealth
and telemedicine have been shown to improve health care by
increasing access, eliminating travel, reducing costs, and
producing better patient outcomes, and we applaud these
efforts.
The Undersigned Members support the President's request for
an additional $819 million in funding for FY 2011, for a total
funding amount of $5.388 billion for long-term care services.
Civilian Health and Medical Program of the Department of
Veterans Affairs (CHAMPVA) (+$109 million): CHAMPVA provides
health care benefits for dependents and survivors of veterans
who are, or were at time of death, 100 percent permanently and
totally disabled from a service-connected disability, or who
died from a service-connected condition. CHAMPVA costs continue
to grow as a result of several factors. The Veterans' Survivor
Benefits Improvements Act of 2001 expanded eligibility to those
65 years of age and older who would have lost their CHAMPVA
eligibility when they became eligible for Medicare. The
Veterans Benefits Act of 2002 also allowed retention of CHAMPVA
for surviving spouses remarrying after age 55. In addition, VA
projects on increasing volume of claims, along with increasing
transaction fee costs for processing electronic claims. The
factors combined are projected to result in a 10.1 percent
increase in costs from 2010 to 2011.
The Undersigned Members support the President's request for
an additional $109 million in funding for FY 2011, and
recommend a total funding amount of $1.114 billion for CHAMPVA
services.
Readjustment Counseling (+$7.4 million): VA furnishes
readjustment counseling at VA's Vet Centers to veterans who
served in combat zones, including those involved in OEF/OIF. VA
had 271 Vet Centers operating across the country in 2009,
expanded to 299 in the current fiscal year, and intends to
operate 300 in 2011. Vet Centers provide essential counseling
related to combat service, bereavement counseling for families
of servicemembers who die while on active duty, as well as
outreach and referral services. VA expects an increase in PTSD
and other mental health conditions as veterans return from OEF/
OIF after multiple tours of duty. The President requests $179
million in total funding for FY 2011 to meet the increasing
demand for readjustment counseling.
Therefore, the Undersigned Members support an additional
$7.4 million in funding for FY 2011, and recommend a total of
$179 million in funding for readjustment counseling.
Other VA Health Care Programs (+$3 million): VA operates a
number of other VA health care programs, such as the Community-
Based Domiciliary Aftercare/Outreach Program; the Residential
Care Home Program; and the State Home Hospital Program. The VA/
DOD Health Care Sharing Incentive Fund will also require
continued funding. VA projects a slight increase in demand for
these services, necessitating an additional $3 million in
funding for FY 2011 above the FY 2010 funding amount.
The Undersigned Members support the President's request for
an additional $3 million in funding for FY 2011, and recommend
a total funding amount of $44.895 million for other health care
programs.
Combat Homelessness Pilot Program (+$26 million): VA is
requesting $26 million in funding for FY 2011 for continued
support of the Combat Homelessness Pilot Program, through which
VA partners with non-profit organizations, consumer co-
operatives, and other agencies to assist families of veterans
that might otherwise become homeless.
The Undersigned Members support the President's request for
$26 million to support VA's Combat Homelessness Pilot Program
for FY 2011, an amount that equals the support provided to the
program in FY 2010.
2. New Initiatives
While the Undersigned Members of the Committee support the
expansion of many existing initiatives in the areas of mental
health, readjustment counseling, and rehabilitative care as
discussed above, we believe that more can and should be done--
especially in the areas of homelessness, long-term care, and
family caregiving. The Undersigned Members support the
Administration's proposed ``New Initiatives'' discussed below.
Zero Homelessness (+$286.85 million): In an effort to end
homelessness among veterans, VA proposes to enhance its current
efforts to house homeless veterans by expanding the capacity of
the Housing and Urban Development-Veterans Affairs Supported
Housing (HUD-VASH), Health Care for Homeless Veterans (HCHV)
Contract Housing, Homeless Providers Grant and Per Diem, and
Domiciliary Care for Homeless Veterans (DCHV) programs.
We support the President's request for $286.850 million for
2011 to expand its efforts to end homelessness through the Zero
Homelessness Initiative.
Telehealth, Non-Institutional Long-Term Care (+$40
million): Telehealth technology expands access to care for
veterans in rural and highly-rural areas. A recent study found
patients enrolled in home telehealth programs experienced a 25
percent reduction in the average number of days hospitalized
and a 19 percent reduction in hospitalizations. In addition to
providing better outcomes, these methods also decrease costs of
health care.
The Undersigned Members support the President's request for
an additional $40 million to expand its Telehealth Initiative
in 2011 for its non-institutional long-term care patients, with
the goal of reducing overall costs by providing more accessible
high quality health care to veterans residing in rural areas.
Family Caregivers (+$57 million): The Committee is in the
final stages of bringing forward compromise legislation (S.
1963) to establish a caregiver program within VA. This program
would authorize VA to provide training and supportive services
to family members and other loved ones who wish to care for a
disabled veteran in the home and to allow veterans to receive
the most appropriate level of care. The newly authorized
supportive services would include training and certification, a
living stipend, and health care--including mental health
counseling, transportation benefits, and respite. The Committee
believes the score assigned to this legislation by the
Congressional Budget Office (CBO) is incorrect due to several
errors in interpretation, including:
Grossly overestimating the population of veterans
who will be eligible for caregiver services. A more correct
estimate\1\ provided by Center for Naval Analyses (CNA) is 720
veterans per year as opposed to 48,850 as estimated by CBO. CBO
and VA assume that the proposed new program will apply to all
injured veterans regardless of how seriously they are injured
or when they were injured. The legislation clearly states it
applies only to ``seriously injured or very seriously injured''
(SI/VSI) veterans who were injured or aggravated an injury in
the line of duty on or after September 11, 2001.
---------------------------------------------------------------------------
\1\Christensen, Eric, Candace Hill, Pat Netzer, DeAnn Farr,
Elizabeth Schaefer, Joyce McMahon. (April 2009). Economic Impact on
Caregivers of the Seriously Wounded, Ill, and Injured. CNA Publication
(CRM D0019966.A2).
---------------------------------------------------------------------------
Overestimating the length of time a veteran will
require caregiver services. CBO and VA assume it will be
indefinite. CNA's study finds the average requirement is for 18
months. Only 43 percent of veterans require caregiver services
in the long-term.
CBO also assumes that all enrolled veterans will
need a full-time caregiver, whereas CNA has found that, on
average, veterans need only 21 hours of services per week.
Assuming that 100 percent of injured veterans will
utilize the program. According to written testimony from Gerald
Cross, M.D., VA's former Acting Under Secretary for Health, to
date, only 233 family members have been referred for caregiver
training and certification.
Based on these points, the Undersigned Members strongly
recommend funding the new caregiver program using the
Committee's estimate of $57 million in FY 2011.
3. Major and Minor Construction (+$192 million):
The Administration requested $1.151 billion for Major
Construction in FY 2011, which is a decrease of almost $43
million from the FY 2010 funding level. Although this request
supports 3 medical facility projects already underway and
begins 2 new medical facility projects, there remains a huge
backlog of partially-funded construction projects. The Major
Construction request also fully funds the 2011 resources
required to support gravestone expansion at three National
Cemeteries. This expansion will provide a burial option to an
additional 500,000 deceased veterans and eligible family
members, address concerns in urban areas, and encourage new
burial practices such as ``green'' or eco-friendly burial
methods. The new policies will increase the current strategic
target for the percent of the veteran population served by a
national or state veterans cemetery within 75 miles of their
home to 94 percent.
VA has included a new initiative in the Major Construction
appropriation. Funding in the amount of $23.964 million is
requested to support resident engineers on major construction
projects of the Veterans Health Administration and National
Cemetery Administration. This funding will support
approximately 140 engineers at nearly 50 sites across the
country. Funding will cover all costs for these employees,
including salary and benefits, training, travel, permanent
change of station funds, etc. This proposal would allow for
additional critical staff in the areas of planning,
acquisition, as well as architectural and engineering support
to help VA better manage its physical infrastructure.
For Minor Construction, the Administration's budget request
of $467.700 million would reduce the account from its FY 2010
level by over $235 million. However, the costs of repairing all
of the facilities in need of repair--via minor construction and
nonrecurring maintenance funds--would total over $9 billion.
Funding for minor construction must, at the very least, stay at
a consistent level from the previous fiscal year.
Therefore, the Undersigned Members support the President's
request for $1.151 billion for Major Construction for FY 2011,
a decrease of nearly $43 million from FY 2010 levels. We also
recommend a total of $467.7 million for Minor Construction in
FY 2011, which is an additional $235 million over the level
requested by the Administration, and virtually the same amount
as appropriated in FY 2010.
4. Legislative Proposals (+$22.777 million):
The President requests an additional $58.201 million in
funding for FY 2011 to support a variety of legislative
proposals. Such proposals, which the Undersigned Members
support, include $18.9 million for the Homeless Providers Grant
and Per Diem Program to encourage eligible entities to
establish community-based programs that furnish outreach,
supportive services, and transitional housing for female
homeless veterans, homeless veterans with chronic mental
illness, and veterans who are frail and/or terminally ill.
In addition, reinstatement of the Health Professional
Scholarship Program and providing medical care for newborns are
included in the total requested amount of $58.201 million. As
the Committee is on the verge of passing these or related
provisions, it is critical to allocate sufficient funding for
these initiatives.
The President also proposes to provide caregiver support in
the form of CHAMPVA coverage, travel expenses, education, and
training. These caregiver provisions are included in the
pending S. 1963 and are accounted for in the Family Caregivers
section above. The total amount of the VA requested provisions
is $35.424 million, which has been deducted here as those
provisions are funded in the Family Caregivers total above.
Therefore, the Undersigned Members recommend an additional
$22.777 million in funding for FY 2011 to support these
legislative proposals.
5. Policy Highlights (The proposed increases for the
following veteran groups are incorporated within
the above requested amounts.)
Women Veterans: Women veterans are the fastest growing
segment of veterans. The percentage of women veterans is
nearing eight percent and expected to rise substantially over
the next two decades. While VA is an institution originally
designed and focused toward serving male veterans, there is a
crucial need to adapt to this change in the veteran population.
We support the President's request for an additional $19
million in funding for women veterans. An increase in the FY
2011 budget toward women veteran specific programs is a
positive sign that VA is making an effort to ramp up services
for the rapidly growing number of women veterans.
OEF/OIF Veterans: VA anticipates treating 439,000 OEF/OIF
veterans in the next fiscal year, an increase of over 56,000
(or 14.8 percent) above the 2010 level. In 2011, OEF/OIF
patients represent 7.2 percent of the overall VA patients
served. Through October 2009, VA reported that, of the 480,324
separated OEF/OIF veterans who have sought VA health care since
FY 2002, a total of 227,205 unique patients had a diagnosis of
a possible mental health disorder; of this total, 120,480 had a
probable diagnosis of PTSD; 83,671 were diagnosed with
depression; and 22,261 received a diagnosis of alcohol
dependence syndrome. These statistics highlight VA's efforts to
proactively identify mental health conditions among returning
OEF/OIF veterans, for the purpose of intervening early to
prevent chronic disorders and their debilitating impact on the
quality of life of veterans. Additionally, due to improved
battlefield medicine, OEF/OIF veterans are surviving more
serious injuries, but are often left with amputations and
traumatic brain disorder. These conditions result in profound
health care needs.
We support the President's request for an additional $597
million in funding towards OEF/OIF care for veterans. As more
OEF/OIF veterans return from multiple tours of duty, the FY
2011 budget increase will be critical to meeting the increased
demand for rehabilitative care, mental health care, and
readjustment counseling.
Priority Group 8 Veterans: VA's goal is to increase the
enrollment of Priority 8 veterans--namely, those with incomes
above a threshold based on family size who either have no
service-connected disability or a zero percent disability
rating--by 500,000 by FY 2013. In 2009, VA opened enrollment to
Priority 8 veterans whose incomes exceeded last year's
geographic and VA means-test thresholds by no more than 10
percent. VA estimates that 193,000 more veterans will enroll
for medical care by the end of 2010 as a result of this policy
change. In 2011, VA plans to further expand health care
eligibility for Priority 8 veterans to those whose incomes
exceed the geographic and VA means-test thresholds by no more
than 15 percent compared to levels in effect prior to expanding
enrollment in 2009. VA anticipates that this additional
expansion of eligibility for medical care will result in 99,000
new enrollees in 2011, bringing the total number of new
enrollees from 2009 to the end of 2011 to 292,000.
The Undersigned Members support the President's budget
request to be funded in full to ensure adequate funding for the
enrollment of Priority 8 veterans.
B. Medical Support and Compliance (+$377 million) and Medical
Facilities (+$881 million)
The Medical Support and Compliance appropriation provides
funds for the expenses of management, security, and
administration of the VA health care system. Such costs include
operation of VA medical centers, VHA headquarters, Veterans
Integrated Services Network (VISN) offices, Facility Director
offices, Chief of Staff operations, quality of care oversight,
security and legal services, billing and coding activities,
procurement, financial management, and human resource
management.
The President's FY 2011 and FY 2012 estimates for the
Medical Support and Compliance appropriation are based on an
actuarial analysis founded on current and projected veteran
population statistics, enrollment projections of demand, and
case mix changes associated with current veteran patients.
We support the President's recommendation of $377 million
in funding over FY 2010 levels for Medical Support and
Compliance and $881 million in funding over FY 2010 levels for
Medical Facilities. We expect these funding levels to be
adequate to maintain current levels of service.
C. Medical and Prosthetic Research (+$34.5 million)
VA medical and prosthetic research is key to advancing
health care in the nation, not only for veterans but for the
population at large. As the nation's largest health care
network, VA has unparalleled resources with which to conduct
research, including its cadre of dedicated physician
researchers. It is for this reason that the Undersigned Members
are concerned by the Administration's request for only an
additional $9 million over the FY 2010 funding level, with no
planned increase in FTE. This limited request is insufficient
when compared to the $70 million increase requested in FY 2010
over the FY 2009 amount. Additionally, The Independent Budget
projects a biomedical research and development inflation rate
of 3.3 percent in FY 2011 however VA's request is only 1.5
percent greater. This amount would cover less than half of the
increase in expenses due to inflation, which would have an
adverse impact on quality.
The Undersigned Members recommend $34.5 million over the FY
2010 level, for a total of $624.5 million for FY 2011.
D. Information Technology (+$30 million)
The FY 2011 President's Budget does not provide for any
increase in the area of Information Technology (IT). However,
there are several new and current initiatives VA intends to
accomplish that will require IT support. While it is
commendable that VA is carefully reviewing and prioritizing all
IT projects, we are concerned that flat-lining this area would
be problematic in accomplishing new initiatives or other
important but lower-profile projects, were it not for the large
increase in the FY 2010 budget and carry over from FY 2009. VA
believes flat-lining the budget will not have a negative impact
on both VBA and VHA IT initiatives and claims that it can carry
out operational support, security requirements, and develop new
projects within the FY 2010 budget level requested.
The Undersigned Members, therefore, support the President's
IT budget (as proposed) and are hopeful that the days of
investing significant funds into mismanaged programs are in the
past.
Health-Related Funding by Medical Care Account
------------------------------------------------------------------------
Increase above
Needed Discretionary Revenue for FY 2011 Total FY 2011 President's
(dollars in thousands) FY 2010
------------------------------------------------------------------------
Medical Services:.......................
Health Care Services:...................
Acute Care.......................... $27,136,581 $173,000
Rehabilitative Care................. $535,846 $36,000
Mental Health....................... $3,717,136 $410,000
Prosthetics......................... $1,698,613 $148,000
Dental Care......................... $494,936 $47,000
Long term Care...................... $5,387,995 $819,000
CHAMPVA............................. $1,113,947 $109,000
Readjustment Counseling............... $179,000 $7,400
Other VA Health Care Programs......... $44,895 $3,000
Combat Homelessness Pilot Program..... $26,000 $0
Initiatives:............................
Zero Homelessness..................... $286,850 $286,850
Telehealth............................ $40,000 $40,000
Family Caregivers..................... $57,000 \1\$57,000
Legislative Proposals................. $22,777 $22,777
-------------------------------
Total Medical Services.................. \2\$40,741,576 $2,159,027
Medical Care Appropriations:............
(1) Medical Services.................. $37,136,000 $2,443,500
(2) Medical Support and Compliance.... $5,307,000 $377,000
(3) Medical Facilities................ $5,740,000 $881,000
-------------------------------
Total Recommended for Medical Care $48,183,000 $3,701,500
Appropriations (without Collections &
Reimbursements)........................
Collections............................. $3,355,000 $329,000
-------------------------------
Total for Medical Care Appropriations $51,538,000 $4,030,500
with Collections (without
Reimbursements)........................
Reimbursements.......................... $327,000 $14,800
-------------------------------
Total Obligations for Medical Care $51,865,000 $4,045,300
Appropriations with Collections and
Reimbursements.........................
-------------------------------
Total for Medical and Prosthetics $624,500 \3\$34,500
Research...............................
-------------------------------
Total for Information Technology........ $30,000 \4\$30,000
------------------------------------------------------------------------
\1\Funding is $57 million above President's requested level
\2\Includes appropriations, collections, and reimbursements for Medical
Services
\3\Funding is $25.5 million above President's requested level
\4\Funding is $30 million above President's requested level
E. Compensation, Pension, and Burial Staffing and Training
VA must take aggressive action to improve the claims
adjudication process, with a focus on training and quality. The
Undersigned Members believe the Administration's request for
compensation, pension, and burial staffing in FY 2011 is
necessary to mitigate the impact of the recent decision to
extend presumptive service-connection for certain conditions
associated with exposure to Agent Orange, an increase in claims
receipts, and a growing complexity in claims adjudication.
Staffing: For FY 2011, the President requests 16,968 FTE
for compensation, pension, and burial staffing. This is a 30
percent increase over the FY 2010 level. Of this amount, 14,138
FTE would be dedicated to direct compensation--an increase of
1,820 FTE over the FY 2010 level.
The American Recovery and Reinvestment Act of 2009 provided
$150 million for the hiring and training of temporary claims
processors through 2010. With this funding, VA hired 2,300
compensation, pension, and education claims processors--1,870
of whom were dedicated solely to compensation and pension
claims processing. In FY 2011, VA anticipates retaining these
temporary hires and adding 2,050 new positions.
Workload: The disability claims workload from OEF/OIF
veterans, as well as from veterans of earlier periods, has
continuously increased since 2000. Annual claims grew from
674,219 in 2001 to 1,013,712 in 2009. Claims received by VA are
increasingly complex, and require more time to develop and
rate. In 2009, original claims for compensation with eight or
more claimed issues increased from 22,776 in 2001 to 67,175 in
2009--a 300 percent increase.
Veterans from the Vietnam conflict and the first Gulf War
are aging and filing reopened claims in greater numbers. In
2009, reopened claims comprised slightly more than 56 percent
of disability claims. Many veterans receiving compensation have
chronic, progressive diseases such as diabetes, mental illness,
and musculoskeletal or cardiovascular illnesses. It is
reasonable to project that as these veterans continue to age,
their disabilities will worsen and more claims will be reopened
as a result.
Timeliness: VA estimates that even with its expanded C&P
direct labor FTE that it will take an average of 190 days to
complete a claim--29 days longer than the current average. VA's
strategic target is to complete a claim is 125 days. The
Undersigned Members believe that VA must be able to absorb new
court decisions, changes in legislation and regulation, the
impact of other unforeseen events, and, above all, avoid
becoming paralyzed to the detriment of the veterans who rely on
it. The Undersigned Members additionally believe that this
cannot be accomplished through staffing alone and will monitor
VA's other initiatives, including the Veterans Benefits
Management System, which seeks a favorable impact on the
system.
The Undersigned Members will continue to monitor VBA's
staffing requirements and output in FY 2011. We also will look
to the Administration to show how it is holding managers and
employees accountable for performance with the substantial
additional resources provided.
Training: The President's FY 2011 budget submission
proposes a dramatic increase in staffing for VBA. This will
require an intensive training effort.
VBA has established a broad spectrum of training programs
and educational resources, both at VA's Regional Offices and at
the Veterans Benefits Academy in Baltimore, Maryland. Veterans
Service Representatives (VSRs) and Rating Veterans Service
Representatives (RVSRs) are provided three weeks of centralized
basic training at the Veterans Benefits Academy. The Veterans
Benefits Academy also offers a range of advanced training
courses in leadership and management development, as well as
computer-based learning tools and satellite broadcasts that
bring the Academy's expertise directly to staff desktops.
The Undersigned Members are disappointed that the
President's Budget request did not provide many particulars on
the training of new FTE to enable the Committee to better
understand the effect of the drastic hiring initiatives. The
Undersigned Members therefore recommend that the Budget
Committee require that the VA Office of Inspector General
conduct an audit of VBA's hiring and training initiatives. In
particular, the Undersigned Members recommend that the IG
examine VBA's process for hiring, training and supervising new
employees, and the Administration's progress in integrating new
employees into its workforce. The Undersigned Members believe
that training is an essential component of any strategy to
improve the timeliness and accuracy of claims processing, and
hopes that the quality of claims that are adjudicated does not
suffer as VA undertakes this effort.
F. Board of Veterans' Appeals
The Board of Veterans' Appeals (BVA) is responsible for
making final Departmental decisions on behalf of the Secretary
for the thousands of benefits claims presented for appellate
review annually.
The President's FY 2011 request for BVA is $75.2 million,
which would support 557 FTE, an increase of 5 FTE and $1.925
million over the estimate for the current fiscal year. The
Undersigned Members note that BVA was able to increase staffing
during FY 2010 through use of carryover funds.
The Undersigned Members agree with the President's
assessment and support the proposed increase to reduce the
backlog of claims at BVA, decrease the average days pending,
and further improve quality.
G. Education
The VBA's Education Service provides veterans,
servicemembers, Reservists, and certain family members with
educational resources. The implementation of the Post-9/11 GI
Bill has presented a challenge to VA in terms of making timely
and accurate payments.
The President's FY 2011 budget request calls for a
reduction in FTE from the FY 2010 level--from 1,889 to 1,521.
At the same time, an increase of 4.9 percent is projected in
workload. The Undersigned Members are aware of the improvements
in processing timeliness and the planned implementation of an
automated system for claims. At this time, we have no
justification for recommending any increase over the
President's recommendation. However, the Undersigned Members
intend to monitor the situation closely and will recommend
additional resources if necessary.
H. Vocational Rehabilitation and Employment (+$20.5 million)
The Vocational Rehabilitation and Employment (VR&E) Program
provides training, education, and other services to enable
veterans to obtain and maintain employment after sustaining
service-connected disabilities.
The President's FY 2011 budget request calls for a decrease
of nine in the number of direct FTE for VR&E. The VR&E workload
in 2009 continued to grow and the program experienced a 13.3
percent increase in the number of applications received. This
increase is expected to continue as VR&E increases outreach and
partnership activities with such programs as the Coming Home to
Work program, the Yellow Ribbon program, the Post Deployment
Health Re-Assessment program and the VetSuccess on Campus.
The Undersigned Members believe that in light of the growth
in the program and the anticipated demands generated by the new
and expanded initiatives--including an expansion in the number
of veterans enrolled in the program of Independent Living
Services--that an increase of 200 FTE is supported. This would
mean an increase of $20.5 million above the President's
recommendation.
I. Department of Labor, Veterans' Employment and Training Service
The Veterans' Employment and Training Service (VETS) of the
Department of Labor provides veterans and transitioning
servicemembers with resources and services designed to maximize
employment opportunities, protect employment and re-employment
rights, and achieve positive employment outcomes.
The President's FY 2011 Budget proposes an increase of $1
million in the amount designated for the Transition Assistance
Program (TAP). The resources available for TAP should permit
VETS to deliver more than 6,100 Employment Workshops throughout
the world. In addition, the President's Budget includes an
additional $5 million for the Homeless Veterans' Reintegration
Program (HVRP), which is focused on placing homeless veterans
into jobs. This increase for HVRP will allow VETS to provide
services to more than 25,000 homeless veterans--including
homeless women veterans and veterans with dependent children
who are homeless. This supports the President's initiative to
end homelessness among veterans.
The Undersigned Members are concerned that without
increased resources for additional staffing for both the State
Grants program and federal administration higher costs could
adversely impact the ability of VETS to deliver services
effectively. However, the Committee believes the program should
be able to realize efficiencies to absorb these higher costs.
J. Court of Appeals for Veterans Claims
The United States Court of Appeals for Veterans Claims
(CAVC), a legal body independent of VA, is vested with the
authority to review decisions of the Board of Veterans' Appeals
(BVA) regarding a veteran's entitlements to benefits offered by
VA. The Court is empowered to affirm, vacate, reverse, or
remand decisions made by BVA, as well as compel actions of the
Secretary, where such action is necessary to bring VA into
accordance with the law.
The Court's budget request of roughly $90 million for FY
2011 is approximately $63 million more than the FY 2010 level--
$62 million of this proposed increase is attributable to the
construction of a new courthouse. The construction estimate is
consistent with the General Services Administration's estimate
of the costs of land acquisition and construction. The
remaining increase would provide an additional $695,000 for the
Pro Bono program and $1.17 million for personnel costs. Part of
this personnel increase would provide for the hiring of 3
additional FTE: an Appellate Commissioner, staff attorney, and
secretarial support for judges who have been recalled. The
budget request also takes into consideration the possibility of
new judges joining the Court in FY 2011.
During FY 2009, the Court received more case filings than
at any other time in the Court's 20-year-plus history. This
amounts to a near doubling of the Court's filings in the past
decade. The FY 2009 case load of 4,725 is the largest in the
Court's history. There is no statistical indication that this
trend will abate.
To address this increased workload, the Court proposes to
hire three new staff: an Appellate Commissioner, a staff
attorney, and a secretary to support the recalled judges. The
Appellate Commissioner would review and decide procedural
motions received by the Court, which average over 1,500 per
month. By using an Appellate Commissioner, as other federal
courts have, the Court can free up judges to focus on the
merits of the cases before them. The staff attorney and recall
judge secretary positions reflect the increased workload within
the Court's mediation program and increased use of recall
judges.
The Undersigned Members support the Court's pursuit of
appropriate space and new FTE and therefore recommend that the
Court's requested funding be provided.
The Veterans Consortium Pro Bono Program requests
approximately $2.5 million for FY 2011, an increase of $695,000
over the level authorized for FY 2010. The bulk of this
increase, $477,000, would be dedicated to supporting the Pro
Bono Program as a stand-alone entity no longer relying upon
veterans service organizations for administrative and other
assistance. The Pro Bono Program anticipates that this will
require additional staff, including an executive director and
additional space to house personnel.
The need for the Pro Bono Program has increased in the past
few years, as more veterans seek judicial review. Demand for
free legal assistance through the program has increased
steadily; the Pro Bono Program received 793 requests for
assistance in 2009, compared to 313 requests in 2003. Of the
849 cases evaluated by the Pro Bono Program in 2009 (an
increase over the 737 cases in 2007) 265 cases were accepted
into the Pro Bono Program, compared with 209 cases in 2008, the
remainder being rejected for a variety of reasons.
The Undersigned Members agree with the Pro Bono Program's
assessment that the demand for free legal assistance will
increase in 2011 and beyond, and that veterans would benefit
from the program being able to operate as a self-sufficient
entity.
III. Mandatory Account Spending
The Undersigned Members support the President's FY 2011
budget request that would provide $64.7 for mandatory benefits,
including compensation for new Agent Orange presumptive
conditions (Ischemic Heart Disease, Parkinson's, Hairy Cell and
other chronic B-cell Leukemia). Of that amount, $13.4 billion
is in the form of a supplemental request to the FY 2010 budget
to pay for the retroactive portion of the presumptive benefit
as required under the Nehmer v. VA decision. As a result of
Nehmer, VA is required to go through its records and identify
all Vietnam veterans and survivors of Vietnam veterans who
filed a compensation claim back to 1985 for one of the three
new presumptive diseases. VA will then re-decide each of these
prior claims under its new rules. If the claim is granted, in
most cases, VA will pay benefits retroactive to the date VA
first received the claim for disability compensation or DIC for
the condition.
A. Specially Adapted Housing Grants
The Committee has identified inadequacies in VA's home
adaptation grant programs--namely, Specially Adapted Housing
(SAH), Special Home Adaptation (SHA), and Temporary Residence
Adaptation (TRA). The SAH/SHA grants allow severely disabled
service-connected veterans and servicemembers to adapt their
home or build a new home to accommodate their particular
disability. Similarly, VA may provide a TRA grant to eligible
veterans and servicemembers who temporarily reside in a home
owned by a family member and need modifications to accommodate
their disability. These grants maximize the ability of disabled
veterans and servicemembers to live independently.
The Committee intends to conduct oversight of these
programs. The Committee also anticipates legislation to adjust
the amounts of each of these grants under these programs, and
if called for, to make the TRA grant a stand-alone program.
However, we do not currently have specific estimates for the
increased cost of these programs and do not anticipate
providing any offset to cover them. The Government
Accountability Office is currently conducting a study of VA's
implementation of TRA grants that may provide a better
understanding of the funding needed for this program. An
interim report issued in June 2009 showed that since TRA was
established in 2006, only nine veterans have taken advantage of
this benefit. The fact that the TRA grant amount counts against
the SAH/SHA grants was one of the reasons for the low usage.
The Undersigned Members recommend that the Budget
Resolution include adequate funding for a reasonable increase
to the Specially Adapted Housing Grants in FY 2011.
B. Cost-of-Living Adjustment
Under current law, the COLA applied to veterans' disability
compensation and survivors' DIC is rounded down to the next
lowest whole dollar. VA compensation is sometimes the sole
source of income for a veteran and his or her family. Over
time, the effect of a COLA round-down can be substantial. We
owe it to our nation's veterans to provide them with
appropriate compensation, the value of which should not be
reduced by inflation. Although the legal authority for an
automatic COLA round-down is set to expire in 2013, we
recommend that funding be provided to end the COLA round-down
ahead of schedule.
The Undersigned Members recommend that the Budget
Resolution include sufficient funding to not impose a COLA
round-down.
IV. Closing
We thank the Budget Committee for its attention to the
Undersigned Members' views and estimates of the
Administration's Fiscal Year 2011 budget. We look forward to
working with the Budget Committee in crafting a budget for
veterans' programs that truly meets the needs of those who have
served our country.
Sincerely,
Daniel K. Akaka,
Chairman.
John D. Rockefeller IV.
Patty Murray.
Bernard Sanders.
Sherrod Brown.
Jon Tester.
Mark Begich.
Roland W. Burris.
Arlen Specter.
COMMITTEE ON VETERANS' AFFAIRS
DANIEL K. AKAKA, Hawaii, Chairman
RICHARD BURR, North Carolina, Ranking Member ROCKEFELLER IV, West
JOHNNY ISAKSON, Georgia Virginia
ROGER F. WICKER, Mississippi PATTY MURRAY, Washington
MIKE JOHANNS, Nebraska BERNARD SANDERS, (I) Vermont
SCOTT P. BROWN, Massachusetts SHERROD BROWN, Ohio
LINDSEY O. GRAHAM, South Carolina JIM WEBB, Virginia
JON TESTER, Montana
MARK BEGICH, Alaska
ROLAND W. BURRIS, Illinois
ARLEN SPECTER, Pennsylvania
William E. Brew, Staff Director
Lupe Wissel, Republican Staff
Director