[Senate Report 114-156]
[From the U.S. Government Publishing Office]


114th Congress   }                                      {       Report
                                 SENATE
 1st Session     }                                      {      114-156

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



 
 LEGISLATIVE AND OVERSIGHT ACTIVITIES DURING THE 113TH CONGRESS BY THE 
                 SENATE COMMITTEE ON VETERANS' AFFAIRS

                                _______
                                

                October 21, 2015.--Ordered to be printed

                                _______
                                

         Mr. Isakson, 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 113th Congress.

                        I. HEARINGS AND MEETINGS


A. First Session (2013)

    During the First Session of the 113th Congress, the 
Committee held 17 hearings, including two field hearings. At 
those events the Committee heard testimony from 75 witnesses.
    Three hearings (May 9, June 12, and October 30) focused 
exclusively on legislation pending before the Committee. 
Testimony offered at these hearings covered 94 bills.
    The Committee held two business meetings.
    On July 24, eight measures were ordered reported out of the 
Committee and, on November 19, six measures were ordered 
reported out of the Committee. The Committee held one meeting 
to discharge nominations.
    Of primary focus for the Committee this session was mental 
health care for the newest generation of veterans and those of 
previous eras. To that end, the Committee held two hearings, 
including one field hearing, in order to better understand the 
mental health needs of veterans. These hearings were held on 
March 20 and August 7 (field hearing).
    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 February 26, February 28, March 5, March 
6, and September 10.
    The Committee held 2 field hearings during the First 
Session. These hearings were held on August 7 in Atlanta, 
Georgia, and August 26 in Anchorage, Alaska. The field hearing 
in Atlanta focused exclusively on mental health program 
management at the Department of Veterans Affairs (hereinafter, 
``VA''). The hearing in Anchorage focused on benefits and 
services available to veterans in Alaska.

B. Second Session (2014)

    During the Second Session of the 113th Congress, the 
Committee held 15 hearings, including one field hearing, as 
well as one Conference Committee Meeting to resolve differences 
in bills passed by the House and Senate. At the hearings, the 
Committee heard testimony from 61 witnesses.
    The Committee held three meetings to discharge nominations.
    The Committee continued its focus on veterans' mental 
health care needs and held two hearings on topics related to 
mental health on April 30 and November 19. However, during the 
Second Session the primary focus of the Committee was veterans' 
access to health care. To that end, the Committee held four 
hearings, May 15, July 16, August 19 (field hearing), and 
September 9 on the state of VA health care with an intense 
focus on access to timely health care services.
    The Committee held one field hearing during the Second 
Session. That hearing was held on August 19 in Honolulu, 
Hawaii, and focused on the state of VA health care in Hawaii.
    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 February 25, March 5, March 6, March 12, 
and March 26.

C. List of Hearings and Meetings Held in the 113th Congress

    (1) Tuesday, February 26, 2013
    Joint Hearing with the House of Representatives to receive 
the legislative presentation of the Disabled American Veterans
    (2) Thursday, February 28, 2013
    Joint Hearing with the House of Representatives to receive 
the legislative presentation of Iraq and Afghanistan Veterans 
of America, Military Order of the Purple Heart, Blinded 
Veterans Association, Military Officers Association of America, 
Non Commissioned Officers Association, The Retired Enlisted 
Association, American Ex-Prisoners of War, and the Wounded 
Warrior Project
    (3) Tuesday, March 5, 2013
    Joint Hearing with the House of Representatives to receive 
the legislative presentation of the Veterans of Foreign Wars
    (4) Wednesday, March 6, 2013
    Joint Hearing with the House of Representatives to receive 
the legislative presentation of AMVETS, Air Force Sergeants 
Association, Paralyzed Veterans of America, Jewish War 
Veterans, Gold Star Wives, Fleet Reserve Association, Vietnam 
Veterans of America, National Guard Association of the United 
States, and the National Association of the State Directors of 
Veterans Affairs
    (5) Wednesday, March 13, 2013
    Hearing: VA Claims Process: Review of VA's Transformation 
Efforts
    (6) Wednesday, March 20, 2013
    Hearing: VA Mental Health Care: Ensuring Timely Access to 
High-Quality Care
    (7) Monday, April 15, 2013
    Hearing: The Fiscal Year 2014 Budget for Veterans' Programs
    (8) Wednesday, April 24, 2013
    Hearing: Call to Action: VA Outreach and Community 
Partnerships
    (9) Thursday, May 9, 2013
    Legislative Hearing: Pending Health Care Legislation:

          S. 49, Veterans Health Equity Act of 2013
          S. 62, Check the Box for Homeless Veterans Act of 
        2013
          S. 131, Woman Veterans and Other Health Care 
        Improvements Act of 2013
          S. 229, Corporal Michael J. Crescenz Act of 2013
          S. 287, a bill to amend title 38, United States Code, 
        to expand the definition of homeless veteran for 
        purposes of benefits under the laws administered by the 
        Secretary of Veterans Affairs, and for other purposes
          S. 325, a bill to amend title 38, United States Code, 
        to increase the maximum age for children eligible for 
        medical care under the CHAMPVA program, and for other 
        purposes
          S. 412, Keep Our Commitment to Veterans Act
          S. 422, Chiropractic Care Available to All Veterans 
        Act of 2013
          S. 455, a bill to amend title 38, United States Code, 
        to authorize the Secretary of Veterans Affairs to 
        transport individuals to and from facilities of the 
        Department of Veterans Affairs in connection with 
        rehabilitation, counseling, examination, treatment, and 
        care, and for other purposes
          S. 522, Wounded Warrior Workforce Enhancement Act
          S. 529, a bill to amend title 38, United States Code, 
        to modify the commencement date of the period of 
        service at Camp Lejeune, North Carolina, for 
        eligibility for hospital care and medical services in 
        connection with exposure to contaminated water, and for 
        other purposes
          S. 543, VISN Reorganization Act of 2013
          S. 633, a bill to amend title 38, United States Code, 
        to provide for coverage under the beneficiary travel 
        program of the Department of Veterans Affairs of 
        certain disabled veterans for travel in connection with 
        certain special disabilities rehabilitation, and for 
        other purposes
          S. 800, Tetro Garza Far South Texas Veterans 
        Inpatient Act of 2013
          S. 825, Homeless Veterans Prevention Act of 2013
          S. 832, Improving the Lives of Children with Spina 
        Bifida Act of 2013
          S. 845, a bill to amend title 38, United States Code, 
        to improve the Department of Veterans Affairs Health 
        Professionals Educational Assistance Program and for 
        other purposes
          S. 851, Caregiver Expansion and Improvement Act of 
        2013
          S. 852, Veterans Health Promotion Act of 2013
          S. 877, Veterans Affairs Research Transparency Act of 
        2013
    (10) Wednesday, June 12, 2013
    Legislative Hearing: Pending Benefits Legislation:

          S. 6, Putting Our Veterans Back to Work Act of 2013
          S. 200, a bill to amend title 38, United States Code, 
        to authorize the interment in national cemeteries under 
        the control of the National Cemetery Administration of 
        individuals who served in combat support of the Armed 
        Forces in the Kingdom of Laos between February 28, 
        1961, and May 15, 1975, and for other purposes
          S. 257, GI Bill Tuition Fairness Act of 2013
          S. 262, Veterans Education Equity Act of 2013
          S. 294, Ruth Moore Act of 2013
          S. 373, Charlie Morgan Military Spouses Equal 
        Treatment Act of 2013
          S. 430, Veterans Small Business Opportunity and 
        Protection Act of 2013
          S. 492, a bill to amend title 38, United States Code, 
        to require States to recognize the military experience 
        of veterans when issuing licenses and credentials to 
        veterans, and for other purposes
          S. 495, Careers for Veterans Act of 2013
          S. 514, a bill to amend title 38, United States Code, 
        to provide additional educational assistance under 
        Post-9/11 Educational Assistance to veterans pursuing a 
        degree in science, technology, engineering, math, or an 
        area that leads to employment in a high-demand 
        occupation, and for other purposes
          S. 515, a bill to amend title 38, United States Code, 
        to extend the Yellow Ribbon G.I. Education Enhancement 
        Program to cover recipients of Marine Gunnery Sergeant 
        John David Fry scholarship, and for other purposes
          S. 572, Veterans Second Amendment Protection Act
          S. 629, Honor America's Guard-Reserve Retirees Act of 
        2013
          S. 674, Accountability for Veterans Act of 2013
          S. 690, Filipino Veterans Fairness Act of 2013
          S. 695, Veterans Paralympic Act of 2013
          S. 705, War Memorial Protection Act of 2013
          S. 735, Survivor Benefits Improvement Act of 2013
          S. 748, Veterans Pension Protection Act
          S. 778, a bill to authorize the Secretary of Veterans 
        Affairs to issue cards to veterans that identify them 
        as veterans, and for other purposes.
          S. 819, Veterans Mental Health Treatment First Act of 
        2013
          S. 863, Veterans Back to School Act of 2013
          S. 868, Filipino Veterans Promise Act
          S. 889, Servicemembers' Choice in Transition Act of 
        2013
          S. 893, Veterans' Compensation Cost-of-Living 
        Adjustment Act of 2013
          S. 894, a bill to amend title 38, United States Code, 
        to extend expiring authority for work-study allowances 
        for individuals who are pursuing programs of 
        rehabilitation, education, or training under laws 
        administered by the Secretary of Veterans Affairs, to 
        expand such authority to certain outreach services 
        provided through congressional offices, and for other 
        purposes
          S. 922, Veterans Equipped for Success Act of 2013
          S. 927, Veterans' Outreach Act of 2013
          S. 928, Claims Processing Improvement Act of 2013
          S. 930, a bill to amend title 38, United States Code, 
        to require the Secretary of Veterans Affairs, in cases 
        of overpayments of educational assistance under Post-9/
        11 Educational Assistance, to deduct amounts for 
        repayment from the last months of educational 
        assistance entitlement, and for other purposes
          S. 932, Putting Veterans Funding First Act of 2013
          S. 935, Quicker Veterans Benefits Delivery Act of 
        2013
          S. 938, Franchise Education for Veterans Act of 2013
          S. 939, a bill to amend title 38, United States Code, 
        to treat certain misfiled documents as motions for 
        reconsideration of decisions by the Board of Veterans' 
        Appeals, and for other purposes
          S. 944, Veterans' Educational Transition Act of 2013
          S. 1039, Spouses of Heroes Education Act
          S. 1042, Veterans Legal Support Act of 2013
          S. 1058, Creating a Reliable Environment for 
        Veterans' Dependents Act
    (11) Wednesday, July 24, 2013
    Business Meeting: Mark-up of Pending Legislation
     S. 944 (Committee Print), Veterans Health and 
Benefits Improvement Act of 2013, to improve the provision of 
medical services and benefits to veterans, and for other 
purposes
     S. 893, Veterans' Compensation Cost-of-Living 
Adjustment Act of 2013, to provide for an increase, effective 
December 1, 2013, 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
     S. 572, Veterans Second Amendment Protection Act, 
to amend title 38, United States Code, to clarify the 
conditions under which certain persons may be treated as 
adjudicated mentally incompetent for certain purposes
     S. 373 (Committee Print), Charlie Morgan Military 
Spouses Equal Treatment Act of 2013, to amend title 38, United 
States Code, to add a definition of spouse for purposes of 
veteran benefits that recognizes new State definitions of 
spouse
     S. 287 (Committee Print), Helping Homeless 
Veterans Act of 2013, to amend title 38, United States Code, to 
improve assistance to homeless veterans, and for other purposes
     S. 131 (Committee Print), Women Veterans and Other 
Health Care Improvements Act of 2013, to amend title 38, United 
States Code, to improve the reproductive assistance provided by 
the Department of Veterans Affairs to severely wounded, ill, or 
injured veterans and their spouses, and for other purposes
     S. 6 (Committee Print), Putting Our Veterans Back 
to Work Act of 2013, to reauthorize the VOW to Hire Heroes Act 
of 2011, to improve enforcement of employment and reemployment 
rights of members of the uniformed services, and for other 
purposes
     S. 851, Caregivers Expansion and Improvement Act 
of 2013, to amend title 38, United States Code, to extend to 
all veterans with a serious service-connected injury 
eligibility to participate in the family caregiver services 
program
    (12) Wednesday, July 31, 2013
    Hearing: Preserving the Rights of Servicemembers, Veterans 
and Their Families in the Financial Marketplace
    (13) Wednesday, August 7, 2013
    Field Hearing, Atlanta, Georgia: Ensuring Veterans Receive 
the Care They Deserve: Addressing VA Mental Health Program 
Management
    (14) Monday, August 26, 2013
    Field Hearing, Anchorage, Alaska: The State of Veterans 
Services in Alaska
    (15) Tuesday, September 10, 2013
    Joint Hearing with the House of Representatives to receive 
the legislative presentation of The American Legion
    (16) Wednesday, October 30, 2013
    Legislative Hearing: Pending Health and Benefits 
Legislation
          S. 875, Department of Veterans Affairs Disease 
        Reporting and Oversight Act of 2013
          S. 1148, Veterans Benefits Claims Faster Filing Act
          S. 1155, Rural Veterans Mental Health Care 
        Improvement Act
          S. 1165, Access to Appropriate Immunizations for 
        Veterans Act of 2013
          S. 1211, a bill to amend title 38, United States 
        Code, to prohibit the use of the phrases GI Bill and 
        Post-9/11 GI Bill to give a false impression of 
        approval or endorsement by the Department of Veterans 
        Affairs
          S. 1216, Improving Job Opportunities for Veterans Act 
        of 2013
          S. 1262, Veterans Conservation Corps Act of 2013
          S. 1281, Veterans and Servicemembers Employment 
        Rights and Housing Act of 2013
          S. 1295, a bill to amend title 38, United States 
        Code, to require the Secretary of Veterans Affairs to 
        provide veterans with notice, when veterans 
        electronically file claims for benefits under laws 
        administered by the Secretary, that relevant services 
        may be available from veterans service organizations, 
        and for other purposes
          S. 1296, Servicemembers Electronic Health Records Act 
        of 2013
          S. 1361, World War II Merchant Mariner Service Act
          S. 1399, a bill to amend the Servicemembers Civil 
        Relief Act to extend the interest rate limitation on 
        debt entered into during military service to debt 
        incurred during military service to consolidate or 
        refinance student loans incurred before military 
        service
          S. 1411, Rural Veterans Health Care Improvement Act 
        of 2013
          S. 1434, a bill to designate the Junction City 
        Community-Based Outpatient Clinic located at 715 
        Southwind Drive, Junction City, Kansas, as the 
        Lieutenant General Richard J. Seitz Community-Based 
        Outpatient Clinic
          S. 1471, Alicia Dawn Koehl Respect for National 
        Cemeteries Act
          S. 1540, a bill to amend title 38, United States 
        Code, to include contracts and grants for residential 
        care for veterans in the exception to the requirement 
        that the Federal Government recover a portion of the 
        value of certain projects
          S. 1547, a bill to require the Secretary of Veterans 
        Affairs to review the dialysis pilot program 
        implemented by the Department of Veterans Affairs and 
        submit a report to Congress before expanding that 
        program, and for other purposes
          S. 1556, a bill to amend title 38, United States 
        Code, to modify authorities relating to the collective 
        bargaining of employees in the Veterans Health 
        Administration
          S. 1558, a bill to require the Secretary of Veterans 
        Affairs to carry out a program of outreach for 
        veterans, and for other purposes
          S. 1559, Benefits Fairness for Filipino Veterans Act 
        of 2013
          S. 1573, Military Family Relief Act
          S. 1576, a bill to redesignate the Department of 
        Veterans Affairs Healthcare System located at 10000 Bay 
        Pines Boulevard in Bay Pines, Florida, as the ``C.W. 
        Bill Young Department of Veterans Affairs Medical 
        Center.''
          S. 1578, Medical Foster Home Act of 2013
          S. 1579, SCRA Enhancement and Improvement Act of 2013
          S. 1580, Ensuring Safe Shelter for Homeless Veterans 
        Act of 2013
          S. 1581, Survivors of Military Sexual Assault and 
        Domestic Abuse Act of 2013
          S. 1582, Improved Compensation for Hearing Loss Act 
        of 2013
          S. 1583, Mental Health Support for Veteran Families 
        and Caregivers Act of 2013
          S. 1584, a bill to amend title 38, United States 
        Code, to provide replacement automobiles for certain 
        disabled veterans and members of the Armed Forces, and 
        for other purposes
          S. 1585, a bill to amend title 38, United States 
        Code, to update the Service-Disabled Insurance program 
        to base premium rates on the Commissioners 2001 
        Standard Ordinary Mortality table instead of the 
        Commissioners 1941 Standard Ordinary Table of Mortality
          S. 1586, Enhanced Dental Care for Veterans Act of 
        2013
          S. 1588, a bill to amend title 38, United States 
        Code, to expand eligibility for reimbursement for 
        emergency medical treatment to certain veterans that 
        were unable to receive care from the Department of 
        Veterans Affairs in the 24-month period preceding the 
        furnishing of such emergency treatment
          S. 1589, Improving Quality of Care Within the 
        Department of Veterans Affairs Act of 2013
          S. 1602, Toxic Exposure Research and Military Family 
        Support Act of 2013
          S. 1604, Veterans Health Care Eligibility Expansion 
        and Enhancement Act of 2013
    (17) Wednesday, November 6, 2013
    Hearing: Nominations of Sloan D. Gibson, Nominee for Deputy 
Secretary of Veterans Affairs, Linda A. Schwartz, Nominee for 
Assistant Secretary of Veterans Affairs for Policy and 
Planning, and Constance B. Tobias, Nominee for Chairman, Board 
of Veterans' Appeals
    (18) Tuesday, November 19, 2013
    Business Meeting: Pending Nominations and Mark-up of 
Pending Legislation
    Nominations: Nomination of Sloan D. Gibson, Nominee for 
Deputy Secretary of Veterans Affairs, Linda A. Schwartz, 
Nominee for Assistant Secretary of Veterans Affairs for Policy 
and Planning, and Constance B. Tobias, Nominee for Chairman, 
Board of Veterans' Appeals. A hearing for these nominations was 
held on November 6, 2013. The Gibson and Schwartz nominations 
were ordered reported favorably by the Committee on November 
19, 2013.
    Mark-up of Pending Legislation:

     S. 932 (Committee Print), Putting Veterans Funding 
First Act of 2013
     S. 1262 (Committee Print), Veterans Conservation 
Corps Act of 2013
     S. 1556, a bill to amend title 38, United States 
Code, to modify authorities relating to the collective 
bargaining of employees in the Veterans Health Administration
     S. 1581 (Committee Print), Veterans Programs 
Improvements Act of 2013
     S. 1593 (Committee Print), SCRA Enhancement and 
Improvement Act of 2013
     S. 1604 (Committee Print), Veterans Health Care 
Expansion Act of 2013
    (19) Wednesday, December 11, 2013
    Hearing: VA Claims System: Review of VA's Transformation 
Progress
    (20) Tuesday, February 25, 2014
    Joint Hearing with the House of Representatives to receive 
the legislative presentation of Disabled American Veterans
    (21) Wednesday, March 5, 2014
    Joint Hearing with the House of Representatives to receive 
the legislative presentation of the Veterans of Foreign Wars
    (22) Thursday, March 6, 2014
    Joint Hearing with the House of Representatives to receive 
the legislative presentation of the National Guard Association 
of the United States, National Association of State Directors 
of Veterans Affairs, Vietnam Veterans of America, Jewish War 
Veterans of the USA, AMVETS, Military Order of the Purple 
Heart, The Retired Enlisted Association, Military Officers 
Association of America, and the Blinded Veterans Association
    (23) Wednesday, March 12, 2014
    Joint Hearing with the House of Representatives to receive 
the legislative presentation of Air Force Sergeants 
Association, American Ex-Prisoners of War, Fleet Reserve 
Association, Gold Star Wives, Iraq and Afghanistan Veterans of 
America, Non Commissioned Officers Association, Paralyzed 
Veterans of America, Wounded Warrior Project
    (24) Wednesday, March 12, 2014
    Hearing: The Fiscal Year 2015 Budget for Veterans' Programs
    (25) Wednesday, March 26, 2014
    Joint Hearing with the House of Representatives to receive 
the legislative presentation of The American Legion
    (26) Wednesday, April 30, 2014
    Hearing: Overmedication: Problems and Solutions
    (27) Thursday, May 15, 2014
    Hearing: The State of VA Health Care
    (28) Tuesday, June 24, 2014
    Conference Committee Meeting with the House Conference 
Committee
    (29) Wednesday, July 16, 2014
    Hearing: The State of VA Health Care
    (30) Tuesday, July 22, 2014
    Nomination Hearing on Robert A. McDonald to be Secretary of 
Veterans Affairs
    (31) Wednesday, July 23, 2014
    Business Meeting: Pending Nomination of Robert McDonald to 
be Secretary of Veterans Affairs. The nomination was ordered 
reported favorably by the Committee on July 23, 2014.
    (32) Tuesday August 19, 2014
    Field Hearing: The State of VA Health Care in Hawaii
    (33) Tuesday, September 9, 2014
    Hearing: The State of VA Health Care
    (34) Wednesday, November 19, 2014
    Hearing: Mental Health and Suicide Among Veterans
    (35) Wednesday, December 3, 2014
    Hearing: Hepatitis C in Veterans
    (36) Thursday, December 4, 2014
    Nomination Hearing on Leigh A. Bradley to be General 
Counsel, Department of Veterans Affairs
    (37) Monday, December 8, 2014
    Business Meeting: Nomination of Leigh A. Bradley to be 
General Counsel, Department of Veterans Affairs. The nomination 
was reported favorably by the Committee on December 8, 2014.

                            II. LEGISLATION


A. First Session (2013)

    In the First Session, the Committee met in open session on 
July 24, 2013, and ordered reported eight pieces of legislation 
to the full Senate.

    1. S. 944, the Veterans Health and Benefits Improvement Act 
of 2013, to improve the provision of medical services and 
benefits to veterans, and for other purposes. This measure was 
introduced in the Senate on May 14, 2013, and the Committee 
ordered it to be reported with an amendment in the nature of a 
substitute on July 24, 2013. Senate Report 113--123 was filed 
on December 9, 2013.
    2. S. 893, the Veterans' Compensation Cost-of-Living 
Adjustment Act of 2013, to provide for an increase, effective 
December 1, 2013, 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. This measure was 
introduced in the Senate on May 8, 2013, and the Committee 
ordered it to be favorably reported on July 24, 2013. Senate 
Report 113-87 was filed on September 4, 2013. The measure was 
passed by the Senate on October 28, 2013, and referred to the 
House Committee on Veterans' Affairs on October 29, 2013. The 
measure was passed by the House on November 12, 2013, and 
signed into law as Public Law 113-52 on November 21, 2013.
    3. S. 572, the Veterans Second Amendment Protection Act, to 
amend title 38, United States Code, 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 14, 2013, and the Committee 
ordered it favorably reported on July 24, 2013. Senate Report 
113-86 was filed on August 1, 2013. No further action was taken 
on this bill in the 113th Congress.
    4. S. 373, the Charlie Morgan Military Spouses Equal 
Treatment Act of 2013, to amend titles 10, 32, 37, and 38, of 
the United States Code, to add a definition of spouse for 
purposes of veteran benefits that recognizes new State 
definitions of spouse. This measure was introduced in the 
Senate on February 14, 2013, and the Committee ordered it to be 
reported with an amendment in the nature of a substitute on 
July 24, 2013. No further action was taken on this bill in the 
113th Congress.
    5. S. 287, the Helping Homeless Veterans Act of 2013, to 
amend title 38, United States Code, to improve assistance to 
homeless veterans, and for other purposes. This measure was 
introduced in the Senate on February 12, 2013, and the 
Committee ordered it favorably reported on July 24, 2013. 
Senate Report 113-110 was filed on September 23, 2013. The 
measure passed the Senate on November 6, 2013, and referred to 
the House Committee on Veterans' Affairs on November 12, 2013. 
No further action was taken on this bill in the 113th Congress.
    6. S. 131, the Women Veterans and Other Health Care 
Improvements Act of 2013, to amend title 38, United States 
Code, to improve the reproductive assistance provided by the 
Department of Veterans Affairs to severely wounded, ill, or 
injured veterans and their spouses, and for other purposes. 
This measure was introduced in the Senate on January 24, 2013, 
and the Committee ordered it reported July 24, 2013. Senate 
Report 113-106 was filed on September 17, 2013. No further 
action was taken on this bill in the 113th Congress.
    7. S. 6, the Putting Our Veterans Back to Work Act of 2013, 
to reauthorize the VOW to Hire Heroes Act of 2011, to improve 
enforcement of employment and reemployment rights of members of 
the uniformed services, and for other purposes. This measure 
was introduced in the Senate on January 22, 2014, and the 
Committee ordered it to be reported with an amendment in the 
nature of a substitute on July 24, 2013. No further action was 
taken on this bill in the 113th Congress.
    8. S. 851, the Caregivers Expansion and Improvement Act of 
2013, to amend title 38, United States Code, to extend to all 
veterans with a serious service-connected injury eligibility to 
participate in the family caregiver services program. This 
measure was introduced in the Senate on April 25, 2013, and the 
Committee ordered it favorably reported on July 24, 2013. 
Senate Report 113-107 was filed on September 17, 2013. No 
further action was taken on this bill in the 113th Congress.

    Also, the Committee met in open session on November 19, 
2013, and ordered reported six pieces of legislation to the 
full Senate.

    1. S. 932, the Putting Veterans Funding First Act of 2013, 
to amend title 38, United States Code, to provide for advance 
appropriations for certain discretionary accounts of the 
Department of Veterans Affairs. This measure was introduced in 
the Senate on May 13, 2013, and the Committee ordered it to be 
reported with an amendment in the nature of a substitute on 
November 19, 2013. No further action was taken on this bill in 
the 113th Congress.
    2. S. 1262, the Veterans Conservation Corps Act of 2013, to 
require the Secretary of Veterans Affairs to establish a 
veterans conservation corps, and for other purposes. The 
measure was introduced in the Senate on June 27, 2013, and the 
Committee ordered it to be reported with an amendment in the 
nature of a substitute on November 19, 2013. No further action 
was taken on this bill in the 113th Congress.
    3. S. 1556, a bill to amend title 38, United States Code, 
to modify authorities relating to the collective bargaining of 
employees in the Veterans Health Administration. The measure 
was introduced in the Senate on September 27, 2013, and the 
Committee ordered it to be reported without amendment favorably 
on November 19, 2013. No further action was taken on this bill 
in the 113th Congress.
    4. S. 1581, the Survivors of Military Sexual Assault and 
Domestic Abuse Act of 2013, to authorize the Secretary of 
Veterans Affairs to provide counseling and treatment for sexual 
trauma to members of the Armed Forces, to require the Secretary 
to screen veterans for domestic abuse, to require the Secretary 
to submit reports on military sexual trauma and domestic abuse, 
and for other purposes. This measure was introduced in the 
Senate on October 28, 2013, and the Committee ordered it to be 
reported with an amendment in the nature of a substitute 
favorably on November 19, 2013. No further action was taken on 
this bill in the 113th Congress.
    5. S. 1593, the Servicemember Housing Protection Act of 
2013, to amend the Servicemembers Civil Relief Act to enhance 
the protections accorded to servicemembers and their spouses 
with respect to mortgages, and for other purposes. This measure 
was introduced in the Senate on October 28, 2013, and the 
Committee ordered it to be reported with an amendment in the 
nature of a substitute favorably on November 19, 2013. No 
further action was taken on this bill in the 113th Congress.
    6. S. 1604, the Veterans Health Care Expansion and 
Enhancement Act of 2013, to amend title 38, United States Code, 
to expand and enhance eligibility for health care and services 
through the Department of Veterans Affairs, and for other 
purposes. This measure was introduced in the Senate on October 
29, 2013, and the Committee ordered it to be reported with an 
amendment in the nature of a substitute favorably on November 
19, 2013. No further action was taken on this bill in the 113th 
Congress.

    In addition, during the first session the Committee 
discharged by unanimous consent several pieces of legislation, 
as follows:

    1. H.R. 1412, Department of Veterans Affairs Expiring 
Authorities Act of 2013, was reported with amendment by the 
House Committee on Veterans' Affairs on May 17, 2013. It passed 
the House on May 21, 2013. The measure was discharged by the 
Senate Committee on Veterans' Affairs by unanimous consent on 
September 23, 2013, and passed the Senate that same day with an 
amendment and an amendment to the title by unanimous consent. 
The House agreed to the Senate amendment on September 27, 2013. 
It was signed into law as Public Law 113-37 on September 30, 
2013.
    2. H.R. 3302, to name the Department of Veterans Affairs 
medical center in Bay Pines, Florida, as the ``C.W. Bill Young 
Department of Veterans Affairs Medical Center,'' passed the 
House on October 22, 2013. It was discharged by the Senate 
Committee on Veterans' Affairs by unanimous consent on October 
31, 2013, and passed the Senate that same day. It was signed 
into law as Public Law 113-49 on November 13, 2013.

B. Second Session (2014)

    In the Second Session, the Committee did not meet to report 
legislation to the full Senate.
    However, during the Second Session the Committee discharged 
several bills and resolutions by unanimous consent, as follows:

    1. S. 1434, a bill to designate the Junction City 
Community-Based Outpatient Clinic located at 715 Southwind 
Drive, Junction City, Kansas, as the Lieutenant General Richard 
J. Seitz Community-Based Outpatient Clinic, was discharged on 
January 14, 2014, and passed the Senate without amendment by 
unanimous consent on that same day. The measure passed the 
House on December 8, 2014, and was signed into law as Public 
Law 113-231 on December 16, 2014.
    2. S. 2921, a bill to designate the community based 
outpatient clinic of the Department of Veterans Affairs located 
at 310 Home Boulevard in Galesburg, Illinois, as the ``Lane A. 
Evans VA Community Based Outpatient Clinic,'' was discharged on 
December 3, 2014, and passed the Senate without amendment by 
unanimous consent on December 3, 2014. The House passed the 
bill on December 8, 2014, and the measure was signed into law 
as Public Law 113-234 on December 16, 2014.
    3. S. 2258, Veterans' Compensation Cost-of-Living 
Adjustment Act of 2014, was discharged on September 11, 2014, 
and passed the Senate that same day by unanimous consent. The 
measure passed the House on September 16, 2014, and was signed 
into law as Public Law 113-181 on September 26, 2014.
    4. S. 2822, the Dignified Internment of Our Veterans Act of 
2014, was discharged on December 10, 2014, and passed the 
Senate without amendment by unanimous consent that same day. No 
further action was taken in the 113th Congress.
    5. S.Res. 479, a resolution recognizing Veterans Day 2014 
as a special ``Welcome Home Commemoration'' for all who have 
served in the military since September 14, 2001, was discharged 
from the Committee and passed the Senate on September 18, 2014.
    6. H.R. 1216, to designate the Department of Veterans 
Affairs Vet Center in Prescott, Arizona, as the ``Dr. Cameron 
McKinley Department of Veterans Affairs Vet Center,'' passed 
the House on June 17, 2014. It was discharged by the Senate 
Committee on Veterans' Affairs by unanimous consent on July 9, 
2014. It passed the Senate that same day. It was signed into 
law as Public Law 113-168 on July 25, 2014.
    7. H.R. 3375, to designate the community-based outpatient 
clinic of the Department of Veterans Affairs to be constructed 
at 3141 Centennial Boulevard, Colorado Springs, Colorado, as 
the ``PFC Floyd K. Lindstrom Department of Veterans Affairs 
Clinic,'' passed the House on June 17, 2014. It was discharged 
by the Senate Committee on Veterans' Affairs on December 3, 
2014, and passed the Senate that same day. It was signed into 
law as Public Law 113-215 on December 16, 2014.
    8. H.R. 3682, to designate the community based outpatient 
clinic of the Department of Veterans Affairs located at 1961 
Premier Drive in Mankato, Minnesota, as the ``Lyle C. Pearson 
Community Based Outpatient Clinic,'' passed the House on June 
17, 2014. It was discharged by the Senate Committee on 
Veterans' Affairs by unanimous consent on December 3, 2014, and 
it passed the Senate that same day. It was signed into law as 
Public Law 113-217 on December 16, 2014.
    9. H.R. 4276, the Veterans Traumatic Brain Injury Care 
Improvement Act of 2014, was reported with amendment by the 
House Committee on Veterans' Affairs on September 15, 2014, and 
passed the House on September 16, 2014. It was discharged by 
the Senate Committee on Veterans' Affairs on December 15, 2014, 
and passed the Senate that same day. It was signed into law as 
Public Law 113-257 on December 18, 2014.
    10. H.R. 4199, to name the Department of Veterans Affairs 
medical center in Waco, Texas, as the ``Doris Miller Department 
of Veterans Affairs Medical Center,'' passed the House on June 
17, 2014. It was discharged by unanimous consent by the Senate 
Committee on Veterans' Affairs on December 9, 2014, and passed 
the Senate that same day. It was signed into law as Public Law 
113-256 on December 18, 2014.
    11. S. Res. 506, a resolution recognizing the patriotism 
and contributions of auxiliaries of veterans service 
organizations was introduced on July 17, 2014. This measure was 
discharged from the Committee and agreed to in the Senate on 
September 16, 2014.

C. Reports

    S. 131, the Women Veterans and Other Health Care 
Improvements Act of 2013. Senate Report 113-106.
    S. 287, the Helping Homeless Veterans Act of 2013. Senate 
Report 113-110.
    S. 572, the Veterans Second Amendment Protection Act. 
Senate Report 113-86.
    S. 851, the Caregivers Expansion and Improvement Act of 
2013. Senate Report 113-107.
    S. 893, the Veterans' Compensation Cost-of-Living 
Adjustment Act of 2013. Senate Report 113-87.
    S. 944, the Veterans Health and Benefits Improvement Act of 
2013. Senate Report 113-123.

D. Public Laws

            Senate Vehicle
    S. 229, the Corporal Michael J. Crescenz Act of 2013, is 
Public Law 113-230.
    S. 893, the Veterans' Compensation Cost-of-Living 
Adjustment Act of 2013, is Public Law 113-52.
    S. 1434, a bill to designate the Junction City Community-
Based Outpatient Clinic located at 715 Southwind Drive, 
Junction City, Kansas, as the Lieutenant General Richard J. 
Seitz Community-Based Outpatient Clinic, is Public Law 113-231.
    S. 1471, the Alicia Dawn Koehl Respect for National 
Cemeteries Act, is Public Law 113-65.
    S. 2258, the Veterans' Cost-of-Living Adjustment Act of 
2014, is Public Law 113-181.
    S. 2921, a bill to designate the community based outpatient 
clinic of the Department of Veterans Affairs located at 310 
Home Boulevard in Galesburg, Illinois, as the ``Lane A. Evans 
VA Community Based Outpatient Clinic,'' is Public Law 113-234.
            House Vehicle
    H.R. 1216, to designate the Department of Veterans Affairs 
Vet Center in Prescott, Arizona, as the ``Dr. Cameron McKinley 
Department of Veterans Affairs Vet Center,'' is Public Law 113-
138.
    H.R. 1412, the Department of Veterans Affairs Expiring 
Authorities Act of 2013, is Public Law 113-37.
    H.R. 3230, the Veterans Access, Choice, and Accountability 
Act of 2014, is Public Law 113-146.
    H.R. 3302, to name the Department of Veterans Affairs 
medical center in Bay Pines, Florida, as the ``C.W. Bill Young 
Department of Veterans Affairs Medical Center,'' is Public Law 
113-49.
    H.R. 3375, to designate the community-based outpatient 
clinic of the Department of Veterans Affairs to be constructed 
at 3141 Centennial Boulevard, Colorado Springs, Colorado, as 
the ``PFC Floyd K. Lindstrom Department of Veterans Affairs 
Clinic,'' is Public Law 113-215.
    H.R. 3682, to designate the community based outpatient 
clinic of the Department of Veterans Affairs located at 1961 
Premier Drive in Mankato, Minnesota, as the ``Lyle C. Pearson 
Community Based Outpatient Clinic,'' is Public Law 113-217.
    H.R. 4199, to name the Department of Veterans Affairs 
medical center in Waco, Texas, as the ``Doris Miller Department 
of Veterans Affairs Medical Center,'' is Public Law 113-256.
    H.R. 4276, the Veterans Traumatic Brain Injury Care 
Improvement Act of 2014, is Public Law 113-257.

                             III. OVERSIGHT


A. First Session (2013)

    In accordance with its mandate, the Committee engaged in 
vigorous oversight of VA regional offices (hereinafter, 
``RO''), hospitals, and other health care facilities, as well 
as Department of Defense (hereinafter, ``DOD'') facilities.
    A primary focus for the Committee was oversight of VA's 
health care system. To that end, Committee Majority staff 
visited VA Medical Centers, Clinics, Vet Centers and State 
Homes located in Alaska, California, Florida, Georgia, 
Maryland, Michigan, Minnesota, New York, South Carolina, Texas, 
Vermont, Virginia, and West Virginia. These visits focused on 
quality-of-care, patient safety, Veterans Integrated Service 
Network (hereinafter, ``VISN'') operations, the availability of 
mental health care and dental services, and sustainability. 
Additionally, Majority and Minority Committee staff visited VA 
Medical Centers, Clinics, and Vet Centers located in Florida, 
Illinois, and Washington.
    Another focus of Committee oversight was to ensure that 
VA's programs for homeless veterans were being managed and 
operated appropriately. Toward this end, Majority and Minority 
Committee staff visited Florida to examine the training that VA 
provides for its Supportive Services for Veterans and Families 
grantees, visited one site of the National Center on 
Homelessness Among Veterans, and met with the Grant and Per 
Diem Program Office to discuss operations. Additionally, 
Committee Majority staff visited California to examine case 
management contractor operations for the HUD-VASH program and 
best practices for low-income veteran housing development.
    Committee oversight also focused on programs and efforts 
designed to help servicemembers transition to civilian status 
and improve VA/DOD collaborative efforts. Majority Committee 
staff placed significant attention on the transition of 
servicemembers through the Integrated Disability Evaluation 
System (hereinafter, ``IDES'') by visiting DOD facilities in 
Alaska and Texas. Majority Committee staff and Minority 
Committee staff jointly visited the Captain James A. Lovell 
Federal Health Care Center, North Chicago, Illinois, to examine 
collaborative efforts at the facility, which integrated care 
into a single facility with a combined VA and Navy mission.
    Majority and Minority Committee staff also conducted 
oversight of VA's efforts to transform the compensation claims 
system with visits to ROs in Washington and Wisconsin. In 
Washington, staff conducted oversight at the Disability Rating 
Activity Site, which has responsibility for processing claims 
of servicemembers involved with IDES. While in Wisconsin, the 
Majority and Minority staff visited the document conversion 
vendor to review VA's efforts to transition to paperless 
processing and spent time reviewing RO operations to include 
pension and fiduciary programs.
    Another focus of the Committee was ensuring that VA was 
appropriately implementing the terms of a Memorandum of 
Understanding with the Indian Health Service (hereinafter, 
``IHS'') in order to reimburse IHS for health care provided to 
eligible veterans and increase access to VA care and benefits 
for Native American veterans. Staff visited a Vet Center in 
Tulsa, Oklahoma, and the Pawnee Indian Health Clinic in Pawnee, 
Oklahoma, to review joint efforts to identify eligible patients 
at the IHS clinic and to transmit billing and care encounter 
summary information to VA.
    Understanding that medical facilities and data centers use 
substantially more energy than the average building, the 
Committee conducted oversight at several VA facilities in West 
Virginia and California in order to identify best practices for 
addressing energy use and reducing the Department's 
environmental impact.
    Committee Majority staff also visited National Cemeteries 
in California and Ohio.

B. Second Session (2014)

    During the Second Session, the Committee focused its 
oversight efforts on access to timely, high-quality health care 
at VA. In early 2014, media reports surfaced based on 
whistleblower allegations about poor patient care at the 
Phoenix VA Health Care System (hereinafter, ``PVAHCS''). 
Shortly after those initial reports, another whistleblower 
raised concerns about staffing issues in the Emergency 
Department and concerns over a shortage of mental health 
professionals at the PVAHCS during a May 1 interview with The 
Arizona Republic. A third former Phoenix employee came forward 
adding further credence to the allegations made by the first 
whistleblower. This individual, who worked as a medical support 
assistant while at VA, added that the use of a ``secret list'' 
was widely known at the PVAHCS and viewed as ``standard 
protocol.'' VA's Office of Inspector General (hereinafter, 
``VAOIG'') began investigating similar allegations at a number 
of other VA facilities around the country.
    In the wake of the allegations in Phoenix, Arizona, the 
Committee held a series of oversight hearings focused on the 
state of VA health care. The first oversight hearing titled, 
the State of VA Health Care, took place on May 15, 2014. The 
Committee received testimony from VA, witnesses from several 
veterans service organizations who discussed their members' 
experiences with VA health care services, VAOIG, the Government 
Accountability Office, the National Association of the State 
Directors of Veterans Affairs and Philip Longman, Senior 
Research Fellow at the New America Foundation. Based on the 
scope of the problem, the Committee committed to hold 
additional hearings on the topic as more information became 
available.
    On May 16, 2014, Under Secretary for Health Robert Petzel 
resigned. Further leadership changes occurred when Secretary 
Shinseki resigned his post. In his place, President Obama 
tasked VA's Deputy Secretary, Sloan Gibson, to act as the 
Department's temporary leader.
    On May 28, 2014, the VAOIG released its report on the 
interim findings of its investigation into events at PVAHCS. 
Initial findings identified ``gross mismanagement of VA 
resources and criminal misconduct by VA senior hospital 
leadership, creating systemic patient safety issues and 
possible wrongful deaths.'' Two days later, VA released the 
results of phase one of its face-to-face audit that occurred 
during May 12, 2014, to May 16, 2014. This phase covered VA 
medical centers and large Community-Based Outpatient Clinics 
serving at least 10,000 veterans--138 VA Medical Centers, 258 
separate points of access, and over 2,100 scheduling staff. The 
report noted: ``Meeting a 14-day wait-time performance target 
for new appointments was simply not attainable given the 
ongoing challenge of finding sufficient provider slots to 
accommodate a growing demand for services. Imposing this 
expectation on the field before ascertaining required resources 
and its ensuing broad promulgation represent an organizational 
leadership failure.'' During phase two of the audit, VA found 
nearly identical results. The second phase report detailed a 
number of obstacles that prevented front-line staff from being 
able to provide timely access to care. The lack of provider 
slots was found to be the most significant single barrier in 
the delays in access. The 14-day standard and the limited 
number of schedulers were identified as two other substantial 
barriers.
    In late June, Acting Secretary Gibson made further 
leadership changes at the Department when he named Dr. Carolyn 
Clancy interim Under Secretary for Health. Dr. Robert Jesse had 
been serving as acting Under Secretary for Health following Dr. 
Petzel's resignation.
    The Committee held its second oversight hearing on the 
State of VA Health Care on July 16, 2014, where it received an 
update from VA officials regarding improving veterans' access 
to care. VA officials also outlined a need for additional 
funding in order to bolster staffing and infrastructure in 
order to meet demand for VA health care.
    On June 29, 2014, the White House announced it was 
nominating Robert McDonald to be the Secretary of VA. He was 
confirmed by the Senate on July 29, 2014.
    A month later, the VAOIG released its final report about 
Phoenix. The Committee held a third oversight hearing on the 
State of VA Health Care on September 9, 2014, where it heard 
from the VAOIG that, while clinically significant delays in 
care were identified, the VAOIG was unable to conclusively 
assert that the absence of timely, quality care caused the 
death of any veterans at the PVAHCS.
    The Secretary of Veterans Affairs ordered medical 
facilities and ROs to hold town hall meetings to hear directly 
from veterans about their experiences with VA health care--and 
more specifically, access to timely health care. Committee 
Majority staff observed Access Town Halls in Massachusetts, 
South Carolina, and Tennessee. Additionally, Majority Committee 
staff observed a town hall hosted by The American Legion in 
Phoenix, Arizona.
    Committee Majority staff visited VA Medical Centers, 
Clinics, Vet Centers and State Homes located in Hawaii, 
Illinois, Minnesota, Mississippi, Nebraska, New Mexico, South 
Carolina, South Dakota, Texas, and Vermont. These visits 
focused on broader access to care, quality-of-care, patient 
safety, VISN operations, and the availability of mental health 
care and dental services. In New Mexico, staff sat in on a 
group therapy session and met with members of community groups 
that collaborate with the Albuquerque Vet Center to help 
veterans. In Illinois, staff reviewed the operations of a 
centralized mail outpatient pharmacy and a blind rehabilitation 
center. Committee Majority Staff and Minority Staff visited VA 
Medical Centers, Clinics, and Vet Centers located in Florida, 
Illinois, and Washington.
    Majority and Minority Committee staff continued oversight 
of VA's efforts to transform the compensation claims system 
with visits to ROs in New Jersey, Minnesota, and Pennsylvania. 
Staff conducted oversight of VA's disability and pension 
compensation claims systems at the Philadelphia RO. In addition 
to a general overview of the compensation and pension programs 
at the office, staff focused on the appellate and non-rating 
workloads pending at the RO. Staff also received a briefing on 
the various life insurance programs administered by VA from the 
Philadelphia RO. In Minnesota, Majority and Minority Committee 
staff again focused on the appellate workload and also 
administration of VA's pension program. Additionally, Majority 
Committee staff visited the Boston RO. At the Boston RO in 
Massachusetts, Majority Committee staff focused on the 
appellate workload pending at the RO and received a 
demonstration on a component of the centralized mail system.
    Building upon efforts from the first session of the 113th 
Congress, Majority Committee staff continued to closely monitor 
efforts to assist servicemember transition to civilian status. 
Oversight efforts focused on the status of VA/DOD 
collaboration, including the status of the integrated 
Electronic Health Record (hereinafter, ``iEHR'') program, the 
Virtual Lifetime Electronic Record (hereinafter, ``VLER''), and 
IDES. Majority and Minority Committee staff visited the DOD-VA 
Interagency Program Office to examine efforts to improve the 
interoperability of health data between the two departments, 
and the DiLorenzo TRICARE Health Clinic to examine the DOD-VA 
Bi-directional Health Exchange and Joint Legacy Viewer. 
Majority and Minority Committee staff also met with local 
program executives for the Virtual Lifetime Electronic Record 
Program at a VA facility in Illinois to discuss preparations in 
place to begin sharing veteran health data with community 
health providers through the VLER program. As part of this 
oversight on VA/DOD collaboration, Majority Committee staff 
also conducted an oversight visit to the Fort Belvoir Army 
Wounded Warrior program, commonly referred to as the AW2 
program. Majority Committee staff met with leadership from the 
Warrior Transition Battalion (hereinafter, ``WTB''), the 
Northern Regional Medical Command, the Soldiers and Family 
Assistance Center, and the Army Career and Alumni Program. 
Majority Committee staff also met with soldiers assigned to WTB 
without leadership presence.
    A critical component of seamless transition is 
participation in the Transition Assistance Program 
(hereinafter, ``TAP''). TAP has continued to be an area of 
focus for Committee staff due to its importance in educating 
transitioning servicemembers about the programs and benefits 
that are available to them as they enter civilian life. 
Majority Committee staff visited Marine Corps Base Quantico to 
observe a TAP briefing, including the education and employment 
tracks.
    Along that same vein, Committee Majority staff visited 
multiple Department of Labor (hereinafter, ``DOL'') One-Stops 
to observe the customer service provided to veterans looking 
for employment assistance. The staff also evaluated the quality 
of services available to those veterans. Staff visited five DOL 
One Stops in Maryland, Tennessee, and Virginia. Committee 
Majority staff also visited Austin Peay University in Tennessee 
and George Mason University in Virginia to discuss the 
specialized programs and services offered to their student 
veterans and to receive feedback regarding the implementation 
of a new law that provides recently separated servicemembers 
with the in-state tuition rate.
    Continuing efforts from the first session of the 113th 
Congress, Committee Majority and Minority staff focused on 
oversight related to the operations of VA's programs for 
homeless veterans. Toward this end, Majority and Minority 
Committee staff visited Illinois to visit a VA Community 
Resource and Referral Center for homeless and low income 
veterans. In Illinois, Committee staff examined how grantees 
were implementing the Grant and Per Diem Transition-in-place 
initiative, and met with homeless veterans participating in the 
program to understand its impact on veterans. Further, Majority 
and Minority Committee staff visited the Financial Services 
Center in Austin, Texas, to learn about its work in ongoing 
proactive audits and risk assessments of Supportive Services 
for Veteran Families grantees.
    Committee Majority and Minority staff also visited the 
Austin Information Technology Center in Austin, Texas, to 
examine information technology enterprise operations. More 
specifically, staff evaluated policy changes and remediation 
issues taken in response to a central server failure that 
resulted in the loss of nearly 500,000 digital documents and 
files for VA's home loan guaranty program. Committee staff also 
examined VA's data center consolidation and server 
virtualization programs, along with efforts to ``green'' the 
data center.
    Committee Majority staff also visited National and State 
Cemeteries in Hawaii and Minnesota.

                            IV. NOMINATIONS


 
----------------------------------------------------------------------------------------------------------------
                                                             Date of       Date of        Date          Date
                    Name and Position                      Nomination      Hearing      Reported      Confirmed
----------------------------------------------------------------------------------------------------------------
First Session
 
  Sloan D. Gibson.......................................    9/11/2013     11/6/2013     12/9/2013
    Deputy Secretary of Veterans Affairs
  Linda A. Schwartz.....................................     8/1/2013     11/6/2013     12/9/2013
    Assistant Secretary for Policy and Planning
  Constance B. Tobias...................................    3/21/2013     11/6/2013     12/9/2013
    Chairman, Board of Veterans' Appeals
  Helen Tierney.........................................    10/7/2013           N/A           N/A
    Chief Financial Officer (Privileged Nomination)
Second Session
 
  Robert Alan McDonald..................................     7/7/2014     7/22/2014     7/23/2014     7/29/2014
    Secretary of Veterans Affairs
  Sloan D. Gibson.......................................     1/6/2014     11/6/2013     1/16/2014     2/11/2014
    Deputy Secretary of Veterans Affairs
  Linda A. Schwartz.....................................     1/6/2014     11/6/2013     1/16/2014     9/16/2014
    Assistant Secretary for Policy and Planning
  Constance B. Tobias...................................     1/6/2014     11/6/2013
    Chairman, Board of Veterans' Appeals
  Jeffrey A. Murawsky...................................     5/5/2014
    Under Secretary for Health                            (Withdrawn 6/
                                                              9/2014)
  Helen Tierney.........................................     1/6/2014           N/A           N/A    12/16/2014
    Chief Financial Officer (Privileged Nomination)
  Leigh A. Bradley......................................   11/12/2014     12/4/2014     12/8/2014    12/16/2014
    General Counsel
----------------------------------------------------------------------------------------------------------------

                    V. BUDGET FOR VETERANS PROGRAMS


A. First Session (2013)

    Pursuant to the requirements of section 301(d) of the 
Congressional Budget Act of 1974, Chairman Sanders of the 
Committee submitted a letter to the Budget Committee reflecting 
the Committee's Views and Estimates on the Administration's 
proposed fiscal year 2014 budget for veterans' programs. The 
letter submitted is printed below in its entirety:

                                                     March 1, 2013.
Hon. Patty Murray, Chairman,
Hon. Jeff Sessions, Ranking Member,
Committee on the Budget,
United Senate, Washington, DC.

    Dear Chairman Murray and Ranking Member Sessions: Pursuant 
to Section 301(d) of the Congressional Budget Act of 1974, I 
write to provide my views and estimates to the Committee on the 
Budget on matters within the jurisdiction of the Committee on 
Veterans' Affairs.
    Although the President has yet to submit his budget request 
for this fiscal year, I applaud his continued support for 
veterans' programs throughout the difficult budgetary climate 
that has prevailed in recent years. I firmly believe that 
caring for our nation's veterans after they have returned home 
from the battlefield is a cost of war. To that end I am 
pleased, based on the Office of Management and Budget's 
assurance, that all veterans programs administered by the 
Department of Veterans Affairs (VA), including health care, 
will be exempt in the event of sequestration.
    Given the service and the sacrifice of America's veterans 
and their families, we, as a nation, have a special 
responsibility to pay this cost in full. The guarantees of 
adequate health care and appropriate benefits must be backed by 
a concrete capacity to fulfill these obligations. That is why 
we will continue to advocate for sufficient funding for VA and 
other agencies that provide veterans' programs and services.
    Noted below are areas within the jurisdiction of the 
Committee on Veterans' Affairs for which I have particular 
concern:

    Mental Health. The number of veterans battling mental 
health disorders--including post-traumatic stress and substance 
use disorder--continues to rise and the number of veterans that 
commit suicide remains unacceptably high. As a result, meeting 
demand for timely and effective mental health care is a 
persistent challenge for VA. VA has a number of efforts 
underway that aim to enhance the accessibility and quality of 
VA mental health care services, including hiring additional 
mental health staff and initiating periodic reviews of mental 
health services at each medical center. Further, VA has a 
longstanding commitment to supporting research on mental health 
disorders and treatments and I am optimistic that this research 
will expand treatment options available to veterans, including 
through complementary and alternative medicine. It is 
critically important that adequate funding mental health 
services and research, as well as complementary and alternative 
medicine, is available. Sufficient funding will ensure VA is 
able to meet rising demand, mitigate long wait times, and 
promote wellness among veterans receiving their health care at 
VA medical centers across the country.
    Readjustment Counseling. Vet Centers furnish readjustment 
counseling to veterans who served in combat zones, including 
those involved in Operations Enduring Freedom/Operation Iraqi 
Freedom/and Operation New Dawn (OEF/OIF/OND), and their 
families. In 2012, VA had over 300 Vet Centers and 70 Mobile 
Vet Centers operating across the country. These Vet Centers and 
Mobile Vet Centers supported more than 1.5 million visitors. 
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 anticipates an increase in demand for Vet Center 
services, given the high number of returning veterans with PTSD 
and other mental health issues, as well as the number of 
veterans from other eras reaching out for these services for 
the first time.
    Therefore, I recommend that the Budget Resolution support 
readjustment counseling in an amount that reflects the 
importance and significance of meeting this mission.
    Office of Inspector General. The work of the VA Office of 
the Inspector General (IG) has made invaluable contributions to 
management effectiveness throughout VA. The Committee relies 
heavily on the IG for unbiased investigations and audits. The 
IG conducts this vital oversight throughout the numerous areas 
of the Department's operations and budget. Unfortunately the 
President's request has repeatedly undervalued the importance 
of strengthening the IG's office. Historically, the level of 
resources requested would force the IG to triage reactive 
oversight work requested by the Secretary and Congress. Also, 
stagnant funding for the IG's office may unnecessarily increase 
risk for veterans in the critical areas of health care and 
compensation claims processing. I am particularly concerned 
that the IG's office might have an inadequate number of health 
inspectors to meet current demand.
    I recognize the importance of the work that the IG does and 
recommend that adequate funding be provided in the Budget 
Resolution to allow the IG's office to continue to address 
problem areas as they arise, and allow for new oversight 
initiatives.
    Purchased Care. Section 8153 of title 38, United States 
Code, authorizes the Department to purchase care from non-VA 
providers for reasons of geographic inaccessibility or 
inability by VA to provide the services needed. In an attempt 
to standardize purchased care contracts across the health care 
system, VA developed the Patient-Centered Community Care 
program, or PC3. The program will contract with five regional 
non-VA providers to provide veterans services when VA is unable 
to provide the services needed. PC3 will be centrally-managed, 
although regional VA staff will provide some level of program 
support. Each PC3 contract will reflect a 6-month start-up 
period, which will allow for contracted providers to implement 
their region under the awarded contract. This will be followed 
by a twelve month term and then any unexercised option--to not 
exceed four additional years. Each of the five PC3 contracts 
have a maximum contract dollar value of $5.3 billion, which is 
inclusive of all exercised option years.
    In FY 2011, VA purchased services from non-VA providers for 
approximately one million unique episodes of care. In the same 
fiscal year, the IG estimated VA spent about $4.6 billion to 
purchase health care services from non-VA providers, which 
included other government agencies, affiliated universities, 
community hospitals, nursing homes, and individual providers. 
Over the past 3 years, the IG has also issued seven reports on 
the deficiencies faced by VA's purchased care program office. 
More specifically, the IG audits and reviews pointed to 
significant weaknesses and inefficiencies in management of 
purchased care policies and procedures at VA that led to 
insufficient oversight. The IG also noted the lack of purchased 
care program processes in place to maximize VA's ability to 
determine whether fee basis authorizations are indeed 
necessary, timely, high quality, and properly contracted and 
billed.
    I recognize that VA's continued efforts to strengthen the 
management of its purchased care program. However, overpayments 
and unauthorized fee basis care limit the overall availability 
of resources available for VA medical services. Therefore, I am 
concerned about VA's ability to appropriately manage the 
purchased care program before, during, and after PC3 contracts 
are awarded, and its potential impact on the budget moving 
forward.
    Savings and Collections. The President's FY 2013 budget 
request forecasted operational cost savings to account for 
nearly $1.28 billion in cost avoidances. In August 2011, GAO 
found VA's operational improvements could not be specifically 
identified. Based upon operational efficiencies identified as 
cost savings in previous VA budgets, I am concerned there will 
be a similar shortfall in the next fiscal year. A contingency 
plan from VA will be necessary to ensure health care services 
will not suffer if the Department fails to meet its cost 
savings estimate in FY 2014 and I request they provide such a 
plan to the Committee. I am concerned by the potential impact 
that failing to achieve the identified cost savings may have on 
VA's provision of health care. Such failure may require VA to 
find ways to make up for lower than expected resources.
    I am also concerned with VA's recurring challenges in 
billing and collections. In May 2011, the IG found the 
Department's efforts to implement Consolidated Patient 
Accounting Centers have not improved its effectiveness and 
these centers were in fact no more effective than facilities 
that conducted no reviews of billings processes at all. 
Additionally, the IG found that VA lacked a system of controls 
to identify billable opportunities and process subsequent 
collections for those amounts. While VA continues to address 
those ineffective and unreliable processes identified by the IG 
report, failure to fully implement the IG's recommendations 
will result in approximately $553 million in unrecovered third-
party revenue. In FY 2011, VA collected $582.5 million less 
than it projected in the FY 2013 budget for its Medical Care 
Collections Fund (MCCF). Additionally, VA is anticipating a 
MCCF shortfall for FY 2013 of nearly $328.6 million from its FY 
2012 budget estimate. Therefore, I am concerned that the 
President's FY 2014 request will reflect this 2-year trend of 
declining MCCF revenue.
    The Department must do a better job of both accurately 
projecting collections and recouping revenue. Failure to meet 
these projections places an unfair burden upon VA to make 
budget reductions when a shortfall is recognized. I expect that 
VA will notify the Committee should these initiatives fail to 
meet budget projections and identify methods to improve the 
current process. I will continue to exercise oversight over 
these initiatives, and have asked GAO to examine the accuracy 
of VA's projections for health care demand.
    State Veterans Homes. The continued weak economy, lower 
than anticipated tax revenues, and budget shortfalls have 
hindered several states' abilities to make the required 
matching funds necessary to qualify for Federal Grants for 
State Extended Care Facilities, commonly referred to as State 
Home construction grants. Under this program, VA provides 65 
percent of project cost while states are required to fund the 
remaining 35 percent. Because limited state budgets have forced 
states to defer needed investments in State Homes, many 
previously proposed construction projects were removed from 
VA's construction grants priority list. As a result, the 
backlog of pending State Home construction projects has risen. 
Importantly, the total Federal share for priority group one 
projects--those affecting life, safety and other urgent needs, 
and for which states have certified the availability of 
matching funding, has fallen from $322 million in FY 2012 to 
just over $257 million in FY 2013. This trend is expected to 
continue in the coming years. Therefore, I recommend sufficient 
resources be allocated to fully fund VA for Grants for State 
Extended Care Facilities. Sufficient funding is necessary for 
the long list of projects to move forward with design and begin 
construction.
    Construction, Leasing and Non-Recurring Maintenance. In the 
last several years, the President's Budget Requests have shown 
continued a trend of reducing funding for major construction 
and non-recurring maintenance over the last several years. VA's 
facilities are aging and facility utilization continues to 
grow, even as facility conditions continue to deteriorate. 
During the FY 2013 budget cycle, VA's Strategic Capital 
Investment Plan identified $61 to $75 billion in facility 
improvements that should be made over the next 10 years. 
However, VA has requested between $1 and $1.5 billion annually 
for construction and maintenance during each of the last three 
fiscal years. This funding level is clearly insufficient to 
meet the needs identified during this time. Further, inadequate 
funding forces VA to defer maintenance, requiring more costly 
repairs in future years.
    VA uses a variety of tools, including construction, 
leasing, sharing agreements and others to acquire space to 
provide medical care to veterans. In order to avoid 
interruptions to patient care and VA operations, VA requests 
Congressional authorization to lease space to use. These leases 
increase access to care closer to home for veterans across the 
country. Congress has not yet authorized or appropriated the 
$1.26 billion necessary for 15 major medical facility leases 
that VA requested in FY 2013. I request that the Budget 
Resolution contain sufficient funding to authorize VA's FY 2013 
lease request.
    Physical infrastructure plays a significant role in VA's 
ability to provide high quality care to veterans. I recommend 
that sufficient funding be provided in the Budget Resolution to 
allow VA to construct, repair, or lease safe, high quality 
facilities.
    Information Technology. VA has undertaken a significant 
transformational effort, working toward becoming an innovative, 
outcomes-driven, veteran-centric Department. Work remains to 
achieve this goal, and information technology is an 
underpinning of each component of this initiative. From the 
Veterans Benefits Management System (VBMS) to the Homeless 
Operations and Management Evaluation System, VA's many 
information technology systems serve as the cornerstone of VA's 
efforts to move its operations into the 21st Century.
    Particularly significant among these systems is the VA-DOD 
integrated electronic health record (iEHR), which was expected 
to combine health information from VA and DOD into a single, 
unified system. I am deeply disappointed by the Departments' 
inability to successfully collaborate with each other, as 
evidenced by the recent announcement to pursue two separate, 
but interoperable, electronic health records instead of the 
planned-upon jointly developed single record. Joint development 
of a single iEHR would improve the claims process, reduce 
duplication in medical testing, and allow VA to provide more 
efficient, cost-effective treatment for both physical and 
mental health needs. Both Departments have invested a great 
deal in program development; however they must ensure that 
their decisions for future investments consider not only the 
short-term but also the long-term implications of their 
choices. Moving forward, it is of paramount importance that 
sufficient resources be available to ensure that VA and DOD are 
able to achieve maximum integration and interoperability of 
their electronic health record systems.
    The importance of information technology cannot be 
understated as VA seeks to transform its delivery of care and 
benefits. Therefore, I will work to ensure that VA and its 
Agency partners are investing in appropriate information 
technology solutions, as demonstrated by sound business cases 
that fully consider the life-cycle costs of these investments. 
I will continue to look to the Administration to provide 
additional information on their information technology 
programs, including the basis for decisionmaking on the iEHR, 
and have requested that GAO examine the program. I recommend 
that adequate funding be provided to invest in the future 
through well-placed investments in VA's information technology 
programs today.
    Compensation Claims System Transformation. The compensation 
claims workload remains one of the most significant challenges 
confronting VA. The Department must continue to take aggressive 
action to improve the claims adjudication process, with a focus 
on quality of decisions. To this end, VA has set ambitious 
goals of eliminating the disability claims backlog by 2015 and 
of providing a quality decision (98 percent accuracy) within 
125 days of application for benefits. VA has a long way to go 
in order to meet this goal. As of February 16, 2013, the most 
recent claims workload numbers remain troubling, with 69.9 
percent of the compensation and pension entitlement inventory 
of 897,714 claims pending over 125 days.
    Staffing. Over the past several years, Congress has 
provided the resources necessary in terms of personnel to 
support VA's increasing claims workload. The Veterans Benefits 
Administration's (VBA) direct FTE have grown by over 7,000 FTE 
from 10,676 in FY 2006 to 18,033 in FY 2011.
    VA must continue to ensure appropriate staffing levels in 
order to provide timely and accurate claims decisions. As 
transformation efforts continue, the Administration must 
provide more detail on the impact of transformation on 
personnel and resource requirements. This includes information 
on the model used to allocate personnel and resources to 
Regional Offices.
    I recommend that adequate funding be provided in the Budget 
Resolution to provide for the staffing levels necessary to 
support timely and accurate claims decisions. The Committee 
will continue to monitor VBA's staffing requirements, claims 
production, and quality of decisions throughout FY 2013.
    Transformation. VA's transformation efforts revolve around 
improvements in the areas of people, processes, and technology. 
VA is relying heavily on VBMS, a paperless claims processing IT 
solution, to transform VA's paper-based system into a more 
efficient paperless, and ultimately an electronic, claims 
processing system. As transformation continues throughout FY 
2013, the Committee will look to the Administration to provide 
greater detail on the results of its transformation efforts and 
more comprehensive data on the resource requirements necessary 
for continued support of these efforts to ensure VA's 
compensation claims system moves into the 21st Century.
    I would request that the Budget Resolution support VA's 
dedicated workforce by providing funding levels that allow VA 
to continue transformation by providing its employees with the 
appropriate training, technology, and business process reforms 
necessary to produce more timely and accurate claims decisions.
    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.
    BVA's production saw a slight decrease in the number of 
decisions issued in FY 2011, which the Report of the Chairman 
for FY 2011 attributed to a decrease in FTE. Historically, BVA 
receives on appeal approximately 5 percent of all claims 
decided by VA. Given the increased production of claims 
decisions by VA over the past several years, it is anticipated 
that the number of appeals received by BVA will continue to 
rise. This anticipated increase is further supported by the 
expectation that the completion of re-adjudication of the 
Nehmer workload will allow VA to focus on the certification of 
appeals that have been pending action at Regional Offices. 
Finally, BVA's projections for FY 2013 in the Report of the 
Chairman for FY 2011 estimated 73,932 appeals would be docketed 
at BVA in FY 2013.
    BVA staffing levels must support this anticipated increase 
in appeals. Failure to do so would result in the growth of the 
backlog in pending appeals while doing little to ease the 
strain on veterans and other beneficiaries who continue to find 
themselves waiting far too long for final compensation claims 
decisions.
    As the Committee continues to closely monitor BVA's 
caseload and whether ongoing processes and operational changes 
result in increased decisions, I recommend that the Budget 
Resolution provide sufficient funding to reduce the backlog of 
claims at BVA, decrease the average days pending, and further 
improve the quality of decisions.
    Education Service. The Post-9/11 GI Bill continues to be a 
significant program. Since the beginning of the program in May 
2009, VA has paid 920,306 total beneficiaries a total of $26.2 
billion. Additionally, a significant new program that was 
included as part of Public Law 112-56, which contained the VOW 
to Hire Heroes Act of 2011, will continue to increase 
Montgomery GI Bill usage with focus on retraining 99,000 
veterans. Processing times for new benefits can take up to 40 
days, depending on whether the claim is handled through VA's 
Long-Term Solution. This is well beyond VA's strategic goal of 
processing education claims in 14 days. I will continue to 
evaluate VA's performance in this area and will assess the 
President's budget when submitted if it appears that the 
request is inadequate to process education claims in a timely 
and accurate manner.
    Employment and Training. Despite the emphasis on employment 
and training programs last Congress, unemployment among our 
veterans is still a great concern.
    The VOW to Hire Heroes Act of 2011 established a 
significant new program, Veterans Retraining Assistance Program 
(VRAP), requiring VA and the Department of Labor (DOL) to 
partner to provide eligible veterans with up to 1 year of 
retraining assistance for jobs in high-demand sectors. 
Legislation has been introduced in the Senate and House to 
extend funding for specific provisions in that law that are set 
to expire. I recommend the Budget Resolution include funding 
for the extension of these important provisions.
    DOL also provides resources and services to help veterans 
succeed in the civilian workforce, including providing grants 
to states to support two principal positions in the American 
Job Centers. The Disabled Veterans' Outreach Program (DVOP) 
specialists and Local Veterans' Employment Representatives 
(LVERs) provide intensive services and outreach to meet the 
needs of veterans. It is important that states continue to 
receive these grants and provide veterans these critical 
services at the local level.
    The Transition Assistance Program (TAP) has been the 
primary method of disseminating critical information to 
transitioning servicemembers. I am pleased that TAP has been 
revamped within the last year and been made mandatory. It is 
now critical that VA, DOD, and DOL continue to work together to 
update and revise the program to ensure that our newest 
generation of veterans and servicemembers are aware of 
available benefits and services. I will continue to evaluate 
the performance of these programs and the collaboration among 
the Federal agencies to ensure veterans across the nation are 
provided the opportunities they deserve.
    Finally, demand for employment programs is high--as 
evidenced by the number of veterans who have come forward to 
take advantage of the VOW to Hire Heroes Act of 2011. It is my 
hope that the Budget Resolution reflects this demand and 
provides ample funding for opportunities for veterans in this 
area.
    Vocational Rehabilitation and Employment. VA's Vocational 
Rehabilitation and Employment (VR&E) Program provides 
counseling and rehabilitative services to disabled veterans. 
The veteran to counselor ratio is significantly higher than 
that of State programs. Further, VR&E operates the Vet Success 
on Campus program that provides critical outreach and 
counseling to student veterans. I recommend that funding be 
allotted to provide for additional counselors to reduce the 
veteran to counselor ratio to 125 to 1.
    Cost of Living Adjustment. Under current law, the COLA 
applied to veterans' disability compensation and survivors' DIC 
is rounded down to the next lowest dollar. VA compensation can 
be the sole source of income for a veteran and his or her 
family. Over the course of a veteran's lifetime, the effect of 
a COLA round-down can be substantial. Our nation's veterans 
deserve appropriate compensation, the value of which should not 
be reduced by inflation.
    The legal authority for the COLA round-down is scheduled to 
expire in 2013, and I recommend that the Budget Resolution 
include sufficient funding to support a COLA that finally ends 
the practice of rounding-down.
    On a related matter, I am committed to protecting veterans' 
and survivors' benefits from any reductions based on the manner 
by which the COLA is calculated. To that end, I recommend that 
the Budget Committee reject the adoption of the Chained 
Consumer Price Index.
    Other Mandatory Programs. Of specific concern to me is that 
the values of certain mandatory benefits have eroded over time. 
In particular, the service-connected and non-service connected 
burial allowances, as well as the plot allowance have seen 
their purchasing power go down. Further, I am concerned about 
the level of benefits paid to survivors, which remain at levels 
lower than other Federal survivor benefit programs.
    I recommend that the Budget Resolution contain adequate 
funding to improve the value of these important benefits.
    I thank the Budget Committee for its attention to my views 
and estimates on matters within the jurisdiction of the 
Committee on Veterans' Affairs.
            Sincerely,
                                           Bernard Sanders,
                                                          Chairman.

B. Second Session (2014)

    Pursuant to the requirements of section 301(d) of the 
Congressional Budget Act of 1974, Chairman Sanders submitted a 
letter to the Budget Committee reflecting the Committee's Views 
and Estimates on the Administration's proposed fiscal year 2015 
budget for veterans' programs. The letter submitted is printed 
below in its entirety:

                                                    April 10, 2014.
Hon. Patty Murray, Chairman
Hon. Jeff Sessions, Ranking Member
Committee on the Budget
U.S. Senate, Washington, DC.

    Dear Chairman Murray and Ranking Member Sessions: Pursuant 
to Section 301(d) of the Congressional Budget Act of 1974, I 
write to provide my views and estimates to the Committee on the 
Budget on matters within the jurisdiction of the Committee on 
Veterans' Affairs. In preparing these views and estimates, I 
have carefully reviewed the Administration's proposed Fiscal 
Year (FY) 2015 budget and 2016 advance appropriations request 
for veterans' programs. I have also carefully reviewed the 
testimony of Secretary Shinseki and other witnesses at the 
Committee's March 12, 2014, hearing on the proposed budget. 
Finally, I have given careful consideration to the 
``Independent Budget for the Department of Veterans Affairs for 
Fiscal Year 2015'' prepared by four veteran service 
organizations--AMVETS, The Disabled American Veterans, the 
Paralyzed Veterans of America, and the Veterans of Foreign 
Wars. This comprehensive budget and policy document created by 
veterans and for veterans is also supported by 53 other 
organizations that represent millions of veterans from across 
this nation.

                               I. Summary

    If I have learned anything during my short time as Chairman 
of the Veterans' Affairs Committee, it is that war comes with a 
very heavy price. That sacrifice in recent years was not just 
the loss of over 6,700 Americans who have lost their lives in 
Iraq and Afghanistan but the impact of these recent conflicts 
on hundreds of thousands of veterans who came home either 
wounded in body--loss of arms, loss of legs, loss of hearing, 
or loss of sight--or with the more invisible wounds of war.
    Today, all across this country, veterans and their families 
continue to face challenges. Family members across this 
nation--husbands and wives, fathers and mothers--often under 
great stress are taking care of disabled veterans and have been 
for years. These men and women have devoted their lives to the 
ones they loved and could use some assistance. Thousands of men 
and women, not only from the most recent wars in Iraq and 
Afghanistan but from other conflicts as well, continue to do 
their best to cope with post traumatic stress, which can take a 
tremendous toll on their lives and on their families' lives. 
These are but a few examples of the lasting costs of war that 
continue to have a significant impact on America's veterans and 
their families. These are lasting costs of war future budgets 
must continue to address.
    Overall, I believe the President's budget request reflects 
a continued commitment on the part of the Administration to 
ensuring veterans have access to the care and benefits they 
deserve. Specifically, I am pleased to see continued investment 
towards ending veteran homelessness and addressing the 
disability claims backlog. I do however have some specific 
areas of concern within the jurisdiction of the Committee on 
Veterans' Affairs, which are addressed in greater detail below.

                   II. Discretionary Account Spending


A. Medical Services

    Health Care Utilization and Expansion. Utilization of VA 
health care is on the rise. In the coming year alone, VA 
anticipates an increase of nearly 125,000 new patients. Despite 
this increase, the overall health care inflation rate and 
demand for a greater variety of health care services, the 
President's FY 2015 budget request reflects just a 3 percent 
increase in medical care spending over the previous year.
    VA has a history of underestimating increases in unique 
patients. In 2012, the Department underestimated the increase 
in unique patients by 78,354 and in 2013 it miscalculated by 
57,955. Moreover, during the March 15, 2014, budget hearing 
before the Veterans' Affairs Committee, Secretary Shinseki 
indicated, at present, VA does not have the ability to 
accurately predict the number of new patients that will come 
into VA in a given year. Rather, VA relies on predictions made 
from behavior of veterans in past years. Therefore, the 
predicted number of new unique patients does not take into 
account changing factors, such as the looming reduction of 
forces by the Department of Defense.
    In addition to ensuring VA is able to meet the increased 
health care demands of new patients, several potential 
initiatives could further increase veterans' access to timely 
and high-quality VA health care. Such initiatives include: 
expanding VA health care to certain veterans who are currently 
ineligible for enrollment in the VA health care system, but are 
required to have health care coverage; extending the period of 
eligibility for enrollment in the VA health care system post-
deployment for certain veterans, including members of the 
National Guard and Reserve; and simplifying VA's geographic 
income thresholds by establishing one income threshold per 
state to make clearer which veterans are eligible to enroll and 
help VA facilities conduct outreach to their local veterans. 
The Congressional Budget Office (CBO) has estimated these 
initiatives would cost $472 million in FY 2015.
    To better address the current and imminent demands on VA's 
health care system, I request an additional $1.6 billion in 
funding over the President's FY 2015 medical services request. 
This funding would provide the necessary resources to care for 
the additional 124,970 patients VA anticipates serving in 2015, 
allows for the expansion of services explained above, and 
preserves the President's increase to account for the cost of 
medical inflation. These funds would ensure there are no gaps 
in care or services for those veterans currently enrolled and 
would support increased access to VA health care.
    Mental Health. The President has requested $7.2 billion for 
mental health care for FY 2015, which represents a 4.5 percent 
increase over FY 2014 spending. Given the increased demand for 
mental health care, I am concerned the proposed 4.5 percent 
increase in funding may not be enough to keep pace with demand 
for timely and effective services.
    The number of veterans battling mental health disorders 
continues to rise and the number of veterans who commit suicide 
remains unacceptably high. While VA has made a number of 
improvements to enhance the accessibility and quality of VA 
mental health care services, including the hiring of additional 
mental health staff and initiating periodic reviews of mental 
health services at each medical center, more needs to be done. 
This past year a number of stories emerged regarding the 
overmedication of veterans. Additional funding to support 
research on mental health disorders could lead to expanded 
treatment options for veterans, including the growth of 
complementary and alternative medicine choices. Sufficient 
funding will ensure VA is able to meet rising demand, mitigate 
long wait times, and promote wellness among veterans receiving 
their health care at VA medical centers across the country.
    Dental. Under sections 1712 and 2062 of title 38, United 
States Code, VA dental care services are provided to a limited 
cohort of veterans: generally, those who are 100 percent 
service-connected, those who are service-connected due to a 
dental condition, and certain homeless veterans. In the 
President's FY 2015 budget request, VA noted an increase of 
more than 40 percent in dental patients over the last 5 years. 
With an expected increase in the overall number of veterans 
enrolled in the VA health care system and newly separated 
veterans accessing VA health care at higher rates, dental care 
utilization will likely increase in the coming years. 
Consequently, VA's request for $922 million in FY 2015 may not 
be adequate.
    According to data included in the President's FY 2015 
budget request, VA expects a 4-percent increase in the number 
of dental care procedures it conducts from 2014 to 2015. As a 
result, VA dentists are expected to carry out at total of 
4,529,000 procedures in FY 2015. I have heard from a number of 
veterans about the already long wait times at dental clinics. 
For example, a veteran was told he would have to wait 5 months 
in order to get an appointment with a VA dentist to adjust a 
lower partial. Without appropriate adjustments to funding, VA 
dentists will be required to conduct a greater number of 
procedures each day or VA will be required to provide a greater 
percentage of dental care through fee-basis care in order to 
reduce wait times for veterans.
    Furthermore, several potential initiatives could further 
improve veterans' access to high-quality dental care at VA. In 
particular, greater overall access to dental care could be 
achieved if VA carried out a 3-year pilot program to determine 
the feasibility of providing comprehensive dental care services 
to the 30,000 veterans currently not eligible to receive VA 
dental care services. Currently, if veterans are required to 
have all of their teeth pulled, due to a service-connected 
condition, VA is not authorized to provide them dentures. By 
authorizing VA to provide restorative dental services to 
veterans to reinstate dental functions lost as a result of VA 
dental care, the overall health of these individuals could be 
improved. In addition, by directing VA to offer a program of 
education to promote dental health for veterans enrolled in 
VA's health care system, veterans will be better informed of 
the techniques for, and benefits of, maintaining proper dental 
hygiene. Finally, a veteran's electronic health record would be 
made more comprehensive by requiring VA to include dental 
services provided by private sector providers enrolled in VA's 
Dental Insurance Program. The Congressional Budget Office (CBO) 
has estimated these initiatives would cost $305 million in FY 
2015.
    VA has stated proper dental care contributes to improved 
medical outcomes and well-being for veterans. I concur with 
this assessment and believe veterans deserve timely access to 
high quality dental care. Therefore, I ask that an additional 
$312 million over the President's FY 2015 budget request be 
provided to hire additional dentists and further expand VA 
dental care services to meet increased demand and improve 
overall veteran health.
    Caregivers. Public Law 111-163, the Caregivers and Veterans 
Omnibus Health Services Act of 2010 (Caregivers Act), was 
enacted to reduce the burden faced by family caregivers of 
post-9/11 veterans by providing them with a tax-free monthly 
stipend, reimbursement for travel expenses, health insurance, 
mental health services and counseling, training and respite 
care. Since its inception, the Caregivers Program has trained 
over 13,500 family caregivers according to data provided in the 
President's FY 2015 budget request.
    The passage of the Caregivers Act served as an important 
step in ensuring the caregivers of our newest generation of 
veterans received the resources necessary to provide the best 
possible care for their loved one. However, by limiting 
eligibility to caregivers of post-9/11 veterans, the law 
created an inequity. The tens of thousands of hardworking, 
dedicated caregivers who provide care to veterans of all other 
eras were left without access to the program. VA's 
congressionally mandated report titled Expansion of Family 
Caregiver Assistance Report, submitted to the Veterans' Affairs 
Committee in September 2013, recognized that inequality. The 
report went on to state, ``VA believes, apart from resource 
issues that are discussed below, such an expansion is 
operationally feasible.''
    In order to meet the needs of post-9/11 caregivers, the 
President's FY 2015 budget requests $306 million for the 
Caregivers Program. If the program was expanded to include 
veterans of all eras, this amount would be woefully 
insufficient. CBO estimates that approximately 70,000 
caregivers of pre-9/11 veterans would be eligible for the 
expanded program. VA estimates in the first year alone, an 
additional 38,000 caregivers may become eligible for these 
services and benefits if expansion occurs. In January of this 
year, CBO estimated expansion of the program would cost $5.8 
billion over 5 years.
    However, CBO's cost estimate does not take into account 
other factors that may actually lead to savings for the 
Department over time. For example, in FY 2013 the Department 
spent approximately $18,203 providing each caregiver their 
annual stipend, the most expensive aspect of the program. Even 
when looking at the total cost of the program for the most 
severely injured veterans who qualify, it is estimated the 
highest overall cost per veteran in the caregiver program is 
still under $30,000. Conversely, based on VA's FY 2015 budget 
request for long term care, the average cost of caring for a 
veteran in a VA Community Living Center is $1,022.31 per 
veteran per day. Therefore, the annual cost of VA's caregiver 
program is essentially equivalent to a 1-month stay in a 
Community Living Center. Aside from reducing the amount of 
money VA spends on institutional care, veterans' preferences 
for living at home, which often can lead to a higher quality of 
life and greater independence, could be met.
    To this end, I request an additional $661 million over the 
President's FY 2015 request be provided to expand the 
Caregivers Program to allow the caregivers of pre-9/11 veterans 
to participate, creating equality between pre- and post-9/11 
caregivers.
    Rural Health. More than 40 percent of military recruits are 
from rural parts of the country. After leaving the military, 
many servicemembers choose to return to these rural locations. 
According to the most recent census data, more than 3.1 million 
veterans reside in rural or highly rural areas. The geographic 
distribution of veterans in these areas poses a challenge for 
VA. For example, in my home state of Vermont, many veterans 
live in rural areas. These veterans are often required to 
travel significant distances for care at VA facilities. The 
work of the Office of Rural Health (ORH)--increasing the number 
of Community-Based Outpatient Clinics and utilization and 
funding for telehealth--is critical to serving this population.
    The ORH focuses on improving access and quality of care for 
veterans residing in these areas by developing evidence-based 
policies and ground-breaking practices. However, based on 
information provided in the President's FY 2015 budget request, 
funding will remain static for this program through FY 2016. 
Research indicates veterans who live in rural and highly rural 
areas suffer higher rates of depression, chronic disease and 
physical health problems. To this end, I request sufficient 
funding to allow expansion of ORH's efforts in rural and highly 
rural areas in order to ensure the unique needs of this 
population are being met.

B. Grants for State Extended Care Facilities

    In the last several years, the weak economy, lower than 
anticipated tax revenues, and budget shortfalls had kept 
several states from providing funding necessary to qualify for 
Federal Grants for State Extended Care Facilities, commonly 
referred to as State Home construction grants. Under this 
program, VA provides 65 percent of project costs while states 
are required to fund the remaining 35 percent. These 
limitations forced states to defer needed investments in State 
Homes, causing many previously proposed construction projects 
to be removed from VA's construction grants priority list.
    The backlog of pending State Home construction projects 
grew exponentially, but increasingly, states are making this 
funding available. Importantly, the total Federal share for 
priority group one projects--those affecting life, safety and 
other urgent needs, and for which states have certified the 
availability of matching funding, has grown from $257 million 
in FY 2013 to just over $489 million in FY 2014. With only $80 
million requested for this program in the FY 2015 budget 
request, this backlog of priority group one projects is 
expected to increase in the coming years. Therefore, I 
recommend sufficient resources be provided to fully fund 
important projects through VA Grants for State Extended Care 
Facilities. Sufficient funding is necessary in order to move 
forward with design and to begin construction on the extensive 
list of State Home construction projects.

C. Major and Minor Construction, Leasing and Non-Recurring Maintenance

    In the last several years, the President's Budget Requests 
have continued a trend of reducing funding for VA's capital 
asset construction and maintenance programs. VA's facilities 
are aging and facility utilization continues to grow, even as 
facility conditions continue to deteriorate. During the FY 2015 
budget cycle, VA's Strategic Capital Investment Plan identified 
$56 to $69 billion in facility improvements that should be made 
over the next 10 years. However, VA has requested between $1 
and $1.5 billion annually for construction and maintenance 
during each of the last four fiscal years. This funding level 
is clearly insufficient to meet the identified needs. Further, 
inadequate funding forces VA to defer maintenance, requiring 
more costly repairs in future years. Congress has not yet 
authorized 27 major medical facility leases that VA requested 
in FY 2013 and 2014.
    Physical infrastructure plays a significant role in VA's 
ability to provide high quality care to veterans. I recommend 
that sufficient funding should be allocated to allow VA to 
construct, repair, or lease safe, high quality facilities.

D. Information Technology

    Information technology plays an integral role in VA's 
transition into an innovative, outcomes-driven, veteran-centric 
organization. Work remains to achieve this goal, and 
information technology is an underpinning of each component of 
this initiative. VA's many information technology systems serve 
as the cornerstone of VA's efforts to move its operations into 
the 21st century.
    Particularly significant among these efforts is the VA-
Department of Defense (DOD) integrated electronic health record 
(iEHR), which will integrate health information from VA and 
DOD's separate electronic health record systems that will be 
designed to be interoperable based on open and joint standards 
and architecture. VA has chosen to modernize the Veterans 
Health Information Systems and Technology Architecture (VistA) 
as its core system for the iEHR while DOD has chosen to acquire 
a core system through the procurement process.
    Both Departments must ensure that their decisions for 
future investments consider not only the short-term but also 
the long-term implications and costs of their choices. Moving 
forward, it is of paramount importance that sufficient 
resources be available to ensure that VA can pursue agile 
development of VistA in order to modernize the system in line 
with meaningful use and interoperability requirements. It is 
also of paramount importance that sufficient funding be 
available to ensure VA and DOD can achieve maximum 
interoperability of their electronic health record systems in 
order to achieve the best possible integration of their health 
data.
    The importance of information technology cannot be 
understated as VA seeks to transform its delivery of care and 
benefits. Therefore, I will work to ensure that VA and its 
Agency partners are investing in appropriate information 
technology solutions, as demonstrated by sound business cases 
that fully consider the life-cycle costs of these investments. 
I recommend that adequate funding be provided to invest in the 
future through well-placed investments in VA's information 
technology programs today.

E. Employment and Training

    Although unemployment rates for veterans and nonveterans 
have been improving, unemployment among our veterans, 
particularly younger veterans, is still of great concern. The 
VOW to Hire Heroes Act of 2011 established a significant new 
program, the Veterans Retraining Assistance Program (VRAP), 
requiring VA and the Department of Labor (DOL) to partner to 
provide eligible veterans age 35-60 with up to 1 year of 
retraining assistance for jobs in high-demand sectors. To date, 
more than 74,000 veterans have enrolled in a training program 
under VRAP. There is clearly an impact being made by this 
program. Legislation has been introduced in the Senate and 
House that would extend funding for specific provisions in that 
law which expired on March 31, 2014. I recommend future budgets 
include funding for the extension of these important 
provisions.
    DOL also provides resources and services to help veterans 
succeed in the civilian workforce, including providing grants 
to states to support two principal positions in the American 
Job Centers. The Disabled Veterans' Outreach Program (DVOP) 
specialists and Local Veterans' Employment Representatives 
(LVERs) provide intensive services and outreach to meet the 
needs of veterans. It is important that states continue to 
receive these grants and provide veterans these critical 
services at the local level.
    The Transition Assistance Program (TAP) has been the 
primary method of disseminating critical information to 
transitioning servicemembers. I am pleased that VA, DOD, and 
DOL have worked together over this past year to update and 
revise the program to ensure that our newest generation of 
servicemembers and veterans are aware of available benefits and 
services. I will continue to evaluate the performance of these 
programs and the collaboration among the Federal agencies to 
ensure veterans across the nation are provided the 
opportunities they deserve.
    Finally, demand for employment programs is high--as 
evidenced by the number of veterans who have come forward to 
take advantage of the VOW to Hire Heroes Act of 2011. It is my 
hope that future budgets reflect this demand and provide ample 
funding for opportunities for veterans, particularly our 
younger Post-9/11 veterans, in this area.
    Employment Transition Program for Young Veterans. Private-
sector businesses have shown an interest in hiring veterans, 
but often find that veterans who apply lack the experience or 
skills they require to compete with non-veteran candidates. 
Businesses have also expressed, as reasons for not hiring 
veterans, a perception that veterans need time to acclimate to 
the civilian world and should not be hired immediately after 
discharge from the military; a lack of understanding concerning 
how a veteran's military experience benefits a company and how 
an individual's military skills and experience translate to the 
job; and a perception that veterans have difficulty 
transitioning from a military structure to the culture of the 
civilian workplace.
    According to the Defense Business Board, the transition 
process for servicemembers and exposure to the civilian job 
market is compressed and abrupt. A study conducted by Monster 
titled, Veterans Talent Index, released in 2012, found that the 
majority of veterans reported that they did not feel prepared 
to transition from military service to civilian life and 
finding employment as the greatest challenge during their 
transition. Other barriers reported by veterans regarding 
gaining employment included employers understanding their 
military skills and experience and their relation to a civilian 
job; finding a job that meets their needs and desires; finding 
a work environment where they feel comfortable; getting 
employers to contact them; and, applying their military skills 
in the civilian workplace. Furthermore, veterans reported 
tangible skills, such as writing, conducting research, and 
working with computers, as skills they would like to attain 
outside of the military.
    According to the BLS report entitled, Employment Situation 
of Veterans--2013, the unemployment rate for our youngest 
veterans, ages 18-24, transitioning from the military, averaged 
21 percent in 2013, compared to 14 percent for non-veterans 
between the ages 18-24. Additionally, veterans between the ages 
18-34 represented 22.5 percent of the total of all unemployed 
veterans, yet comprised only 13.8 percent of veterans in the 
labor force. Furthermore, in 2013, the unemployment rate among 
post-9/11 veterans was 9.0 percent, while the unemployment rate 
for all veterans was 6.6 percent and non-veterans was 7.2 
percent. More than half of all veterans that served post-9/11 
were between the ages of 25 and 34. This trend continues into 
this year, with our youngest veterans encountering the most 
difficulty finding employment.
    While it is important to ensure we provide programs to help 
veterans translate their military skills into the civilian 
sector, there remains a need to: equip veterans with civilian 
skills and experience necessary to meet the challenges of 
competing with those who have years of experience in the 
civilian workforce; find employers who understand military 
skills; and assist in helping them to readjust back to their 
local communities.
    Additionally, DOD expects between 250,000 and 300,000 
servicemembers to transition out of the military annually 
during the next 4 years. According to DOD, nearly one in five 
enlisted servicemembers separating from active duty have a 
military-learned skill that is not easily transferable to a 
civilian occupation. These servicemembers must be prepared to 
transition into a civilian career field that is different than 
their military occupation.
    This program would require VA to establish a 3-year program 
to assess the feasibility and advisability of establishing a 
program to provide career transition services to eligible 
individuals. The program would be designed to provide 
transitioning veterans ages 18-30 with work experience in the 
civilian sector, increased marketable skills, and assist them 
in obtaining long-term employment. Under the program, VA would 
be required to place veterans in an internship on a full time 
basis with an employer from the private sector, including 
nonprofit organizations and small businesses. VA would be 
authorized to furnish pay and benefits to each eligible 
participant for the duration of the eligible individual's 
participation in the program.
    Additionally, the program would require participants to 
perform qualified volunteer activities to help them readjust to 
their local community. Furthermore, to ensure veterans acquire 
basic workforce skills, VA would also be required to provide 
eligible individuals with workshops for the development of 
professional skills and conduct an assessment of a participant 
upon completion of such workshop to assess the participant's 
knowledge as a result of participating in the workshop. I 
recommend future budget resolutions provide the funding 
necessary for VA to establish and implement this employment 
program, which would provide important and necessary 
opportunities to assist our younger veterans transition to the 
civilian workforce.

F. Compensation Claims System Transformation

    VA continues to pursue its goal of eliminating the 
disability claims backlog by 2015 and of providing a quality 
decision (98 percent accuracy) within 125 days of application 
for benefits. Over the past year, VA has made significant 
progress in addressing the claims backlog. For example, VA's 
budget submission highlights an 18 percent reduction in the 
pending inventory from 884,000 to 722,000 from July 2012 to 
September 2013. The backlog has been reduced by 32 percent 
(611,000 to 418,000) from March 2013 to September 2013. 
Further, both claim and issue based accuracy measures continue 
to rise. More recent Monday Morning Workload Report figures 
demonstrate continuing progress. As of April 7, 2014, the 
pending inventory of claims stood at 614,641 and the backlog 
has been reduced to 337,357 or 54.9 percent of the pending 
inventory. The Department must continue to take aggressive 
action to improve the timeliness of the claims adjudication 
process, without sacrificing the quality of decisions.
    While VA has been making progress in addressing the rating 
claims workload, VA has seen a growth in other work pending at 
the regional offices. For example, the appellate workload 
pending at the regional offices has grown from 249,031 appeals 
on March 23, 2013 to 273,733 on April 7, 2014. Similarly, award 
adjustments, such as adding a dependent to an award, have 
increased significantly. As of April 7, 2014 there were 245,073 
compensation dependency award adjustments pending, which is a 
growth of nearly 60,000 adjustments since March 23, 2013. VA 
must have the resources necessary to address the entire 
compensation claims workload.
    Staffing. The President's budget requests $2.49 billion for 
general operating expenses (GOE) of the Veterans Benefits 
Administration (VBA), which supports nearly 21,000 full time 
equivalents (FTE). This request is an increase of $29 million 
over last FY's enacted amount. The President's budget request 
relies heavily on technology to continue addressing the claims 
backlog. For example, of the requested GOE amount, $138.7 
million is for the Veteran Claims Intake Program, VA's 
continuing effort to scan and digitize claims files and 
evidence. The President's budget requests $36.3 million to 
support the people behind the Veterans Benefits Management 
System (VBMS) technology. Despite these investments, VA still 
has a long way to go before it will operate in a truly 
electronic environment--an environment that does not rely upon 
the scanning of huge volumes of paper or the electronic 
transfer of scanned images. As a result, VA's employees will 
continue to be the backbone of the claims system for the 
foreseeable future.
    The President's FY 2015 budget request does not ask for 
additional employees to process claims. There is no doubt that 
mandatory overtime has had a significant impact on VBA's 
increased production. Further, VBA recently announced it will 
temporarily re-assign regional office employees with claims 
processing experience, such as supervisors and quality 
management specialists, to work on claims in order to account 
for early dismissals and closures due to weather. This 
temporary re-assignment, along with the impact of mandatory 
overtime, demonstrates VBA's reliance on staffing to address 
the backlog and calls into question whether VA's claims 
processing goals can be reached or maintained without 
additional personnel.
    This is not the only evidence demonstrating the need for 
additional personnel to address the challenges of the 
compensation claims system. The Independent Budget for FY 2015, 
which is an annual budget and policy document developed by a 
number of veteran service organizations, recommends that 
``Congress authorize and approve funding to allow VBA to hire 
at least 1,000 new temporary claims processors in order to 
provide additional capacity to reduce the backlog and to 
develop highly qualified candidates to replace employees 
leaving through attrition.'' Joseph Thompson, a previous 
Undersecretary for Benefits at VA, echoed a similar theme in 
testimony before the Senate Veterans' Affairs Committee in 
March 2013. His opinion was also that VA needed more people to 
address the work pending at the regional offices.
    Over the past several years, Congress has provided 
resources to increase the workforce responsible for claims 
processing to correspond with the growing workload. However, 
there has been little to no growth in the number of direct FTE 
supporting VA's claims processing efforts in the FY 2014 and FY 
2015 requests. VA must continue to ensure appropriate staffing 
levels in order to provide timely and accurate claims 
decisions. As transformation efforts continue, the 
Administration must provide more detail on the impact of 
transformation on personnel and resource requirements. This 
includes information on the model used to allocate personnel 
and resources to regional offices. Further, VA must also 
measure not only the number of claims completed per FTE, but 
also the number of issues completed per FTE. As claims continue 
to grow in complexity, VA must understand the amount of time it 
takes to address issues of differing levels of complexity and 
issue based measurement would allow greater insight into the 
personnel resources required to timely and accurately process 
compensation claims.
    I recommend that adequate funding be provided to support 
the staffing levels necessary to produce more timely and 
accurate claims decisions. The committee will continue to 
monitor VBA's staffing requirements, claims production, and 
quality of decisions throughout FY 2014.
    Transformation. VA's transformation efforts revolve around 
improvements in the areas of people, processes and technology. 
In addition to a number of temporary initiatives designed to 
target specific problem areas, VA is relying heavily on 
technology and specifically VBMS to transform the claims 
process into a more efficient paperless, and ultimately an 
electronic, system. As transformation continues throughout FY 
2014, the Committee will look to the Administration to provide 
greater detail on the result of its transformation efforts and 
more comprehensive data on the resource requirements necessary 
for its continued support of these efforts to ensure VA's 
compensation claims system moves into the 21st Century.
    I would request that appropriate funding be provided to 
support VA's dedicated workforce by providing funding levels 
that allow VA to continue transformation by providing its 
employees with the appropriate training, technology, and 
business process reforms necessary to produce more timely and 
accurate claims decisions.

G. Board of Veterans' Appeals

    The Board of Veterans' Appeals (BVA) is responsible for 
making final decisions on behalf of the Secretary for the 
thousands of benefits claims presented for appellate review 
annually. Historically, BVA receives on appeal approximately 5 
percent of all claims decided by VA. Given the increased 
production of claims decisions by VA over the past several 
years, it is anticipated that the number of appeals received by 
BVA will also continue to rise. VA's own projections support 
this assertion. The President's FY 2015 budget request projects 
that appeals received by the Board will increase 52 percent 
from 47,763 in 2011 to 72,786 cases by the end of 2015. 
Further, VA's Strategic Plan to Transform the Appeal Process 
provided to the Veterans' Affairs Committee at my request 
reports a pending inventory of approximately 350,000 appeals 
across VA.
    BVA staffing levels must support not only the reduction of 
the large pending inventory but also address the continued 
growth in appeals. Failure to do so would result in the 
continued growth of the appeals backlog while doing little to 
ease the strain on veterans and other beneficiaries who 
continue to find themselves waiting far too long for final 
claims decisions.
    As the Veterans' Affairs Committee continues to work with 
stakeholders, such as veteran service organizations, to build 
upon VA's plan, the Department must also continue to refine and 
build upon the efforts outlined in its self-described 
``preliminary plan.'' As the Committee continues to closely 
monitor BVA's caseload and whether ongoing processes and 
operational changes result in increased and more accurate 
decisions, I recommend that future budget resolutions continue 
to provide sufficient funding to reduce the backlog of claims 
at BVA, decrease the average days to resolve an appeal, and 
further improve the quality of decisions.

H. Medical Follow-Up Agency

    Section 603 of Public Law 108-183 required the Secretaries 
of Veterans Affairs and Defense to each provide the Medical 
Follow-Up Agency (MFUA) of the Institute of Medicine $250,000 a 
year from 2004 through 2014 for epidemiological research on 
members of the Armed Forces and veterans. Funding has been used 
to facilitate research on military and veterans' health, 
including the long-term health effects of participation in 
project SHAD (shipboard hazard and defense).
    Military personnel and veterans regularly contact MFUA for 
documentation gathered during research and studies that can be 
useful for medical care or disability claims. Without these 
funds, MFUA would be limited to quickly respond to the health 
information needs of active duty military and veteran 
populations. Therefore, I recommend $250,000 over the 
President's FY 2015 budget request be provided to fulfill this 
shortfall.

I. Vocational Rehabilitation and Employment

    VA's Vocational Rehabilitation and Employment (VR&E) 
Program provides counseling and rehabilitative services to 
disabled veterans. Further, VR&E operates the Vet Success on 
Campus program that provides critical outreach and counseling 
to student veterans. Over the past 5 years, VR&E's total 
caseload has generally increased each year. Although the number 
of vocational rehabilitation counselors (VRCs) has also 
increased during this period, the average caseload per 
counselor remains high at approximately 139 cases as of March 
31, 2013. Further, a recent report by GAO, ``VA Vocational 
Rehabilitation and Employment: Further Performance and Workload 
Management Improvements Are Needed,'' released in January 2014, 
found that veterans who work with a number of different VRCs 
over time are less likely to be successful in the program.
    VA's current caseload target of one counselor for every 125 
veterans is based on a study of the state vocational 
rehabilitation programs and not on VR&E's actual workloads. The 
January 2014 GAO report noted that the average ratio of cases 
to counselors vary considerably throughout the regional 
offices. Currently, VA's administration of VR&E is 
decentralized and regional offices implement various approaches 
to managing their caseloads. Further, the GAO report also noted 
that significant revisions have not been made by VA to the 
resource allocation model since fiscal year 2003. It is 
important that VA obtain data on how resources are being 
allocated and utilized across regional offices to ensure the 
VR&E program is being run efficiently and effectively. I 
recommend that VA assess its resource allocation models and 
gather information to determine an appropriate counselor ratio. 
I further recommend this information be used to determine the 
VR&E administrative budget and that funding be allotted to 
provide for additional counselors, as determined to be needed, 
to appropriately reduce the veteran to counselor ratio.

                    III. Mandatory Account Spending


A. Cost-of-Living Adjustment

    Congress provides cost-of-living adjustments or COLAs for 
veterans' disability compensation and survivors' dependency and 
indemnity compensation to ensure these benefits keep pace with 
inflation. For a number of years, the cost-of-living adjustment 
applied to veterans' disability compensation and survivors' 
dependency and indemnity compensation was rounded down to the 
next lowest dollar.
    For many veterans and their families, VA compensation may 
be the sole source of income and over the course of a veteran's 
lifetime, the effect of a COLA round-down can be substantial. 
Our nation's veterans deserve appropriate compensation, the 
value of which should not be reduced by inflation. The legal 
authority for the COLA round-down expired in 2013, and I 
recommend that future budget resolutions include sufficient 
funding to support cost-of-living adjustments that continue to 
reject the practice of rounding-down.
    On a related matter, I remain committed to protecting 
veterans' and survivors' benefits from any reductions based on 
the manner by which cost-of-living adjustments are calculated. 
To that end, I recommend that the Budget Committee reject the 
adoption of the Chained Consumer Price Index as a measure for 
use in COLA determinations.

B. Service-Disabled Veterans Insurance

    I recommend sufficient funding be provided to update the 
Service-Disabled Veterans Insurance program to base premiums 
rates on the Commissioners 2001 Standard Ordinary Mortality 
Table instead of the 1941 Standard Ordinary Table of Mortality 
so that veterans would benefit from lower life insurance 
premiums.

C. Other Mandatory Programs

    I remain concerned about the level of benefits paid to 
survivors, which remain at levels lower than other Federal 
survivor benefit programs.

                              IV. Closing

    I thank the Budget Committee for its attention to my views 
and estimates on the Fiscal Year 2015 budget and 2016 advance 
appropriations requests for the Department of Veterans Affairs 
and matters within the jurisdiction of the Committee on 
Veterans' Affairs. I look forward to working with you to 
continue to meet the needs of those who have served our 
country.
            Sincerely,
                                           Bernard Sanders,
                                                          Chairman.

                     COMMITTEE ON VETERANS' AFFAIRS

  BERNARD SANDERS, (I) Vermont, 
             Chairman
RICHARD BURR, North Carolina, Ranking Member ROCKEFELLER IV, West 
JOHNNY ISAKSON, Georgia              Virginia
MIKE JOHANNS, Nebraska               PATTY MURRAY, Washington
JERRY MORAN, Kansas                  SHERROD BROWN, Ohio
JOHN BOOZMAN, Arkansas               JON TESTER, Montana
DEAN HELLER, Nevada                  MARK BEGICH, Alaska
                                     RICHARD BLUMENTHAL, Connecticut
                                     MAZIE K. HIRONO, Hawaii
  Steve Robertson, Staff Director
  Lupe Wissel, Republican Staff 
             Director

                                  [all]