[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

                                  
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