[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING ON `DRAFT LEGISLATION, THE LONG-TERM CARE VETERANS
CHOICE ACT'; H.R. 1443; H.R. 1612; H.R. 1702; H.R. 2065
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HEALTH
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
TUESDAY, JULY 9, 2013
__________
Serial No. 113-28
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado MICHAEL H. MICHAUD, Maine, Ranking
GUS M. BILIRAKIS, Florida Minority Member
DAVID P. ROE, Tennessee CORRINE BROWN, Florida
BILL FLORES, Texas MARK TAKANO, California
JEFF DENHAM, California JULIA BROWNLEY, California
JON RUNYAN, New Jersey DINA TITUS, Nevada
DAN BENISHEK, Michigan ANN KIRKPATRICK, Arizona
TIM HUELSKAMP, Kansas RAUL RUIZ, California
MARK E. AMODEI, Nevada GLORIA NEGRETE MCLEOD, California
MIKE COFFMAN, Colorado ANN M. KUSTER, New Hampshire
BRAD R. WENSTRUP, Ohio BETO O'ROURKE, Texas
PAUL COOK, California TIMOTHY J. WALZ, Minnesota
JACKIE WALORSKI, Indiana
Helen W. Tolar, Staff Director and Chief Counsel
______
SUBCOMMITTEE ON HEALTH
DAN BENISHEK, Michigan, Chairman
DAVE P. ROE, Tennessee JULIA BROWNLEY, California,
JEFF DENHAM, California Ranking Minority Member
TIM HUELSKAMP, Kansas CORRINE BROWN, Florida
JACKIE WALORSKI, Indiana RAUL RUIZ, California
BRAD R. WENSTRUP, Ohio GLORIA NEGRETE MCLEOD, California
VACANCY ANN M. KUSTER, New Hampshire
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
July 9, 2013
Page
Legislative Hearing On `Draft Legislation, The Long-Term Care
Veterans Choice Act'; H.R. 1443; H.R. 1612; H.R. 1702; H.R.
2065........................................................... 1
OPENING STATEMENTS
Hon. Dan Benishek, Chairman, Subcommittee on Health.............. 1
Prepared Statement of Hon. Benishek.......................... 32
Hon. Julia Brownley, Ranking Minority Member, Subcommittee on
Health......................................................... 2
Prepared Statement of Hon. Brownley.......................... 32
Hon. Jeff Miller, Chairman, Full Committee on Veterans' Affairs,
U.S. House of Representatives.................................. 18
Prepared Statement of Chairman Miller........................ 33
Hon. Jackie Walorski, Member, Committee on Veterans' Affairs,
U.S. House of Representatives, Prepared Statement only......... 34
WITNESSES
Hon. Mike Rogers, U.S. House of Representatives, 3rd District,
Alabama........................................................ 3
Prepared Statement of Hon. Rogers............................ 34
Hon. David McKinley, U.S. House of Representatives, 1st District,
West Virginia.................................................. 4
Prepared Statement of Hon. McKinley.......................... 34
Jacob Gadd, Deputy Director for Health Care, Veterans Affairs and
Rehabilitation Commission, The American Legion................. 9
Prepared Statement of Mr. Gadd............................... 35
Susan E. Shore, Ph.D., Chair, Scientific Advisory Committee,
American Tinnitus Association.................................. 11
Prepared Statement of Ms. Shore.............................. 38
Adrian Atizado, Assistant National Legislative Director, Disabled
American Veterans.............................................. 12
Prepared Statement of Mr. Adrian Atizado..................... 42
Robert Drexler, Member, Board of Directors, International Code
Council........................................................ 14
Prepared Statement of Mr. Drexler............................ 45
Raymond C. Kelley, Director, National Legislative Service,
Veterans of Foreign Wars....................................... 16
Prepared Statement of Mr. Kelley............................. 46
Robert L. Jesse, M.D., Ph.D., Principal Deputy Under Secretary
for Health, Veterans Health Administration, U.S. Department of
Veterans Affairs............................................... 26
Prepared Statement of Dr. Jesse.............................. 48
Accompanied by:
Susan Blauert, Deputy Assistant General Counsel, U.S.
Department of Veterans Affairs
STATEMENTS FOR THE RECORD
Hon. Ron Barber, 2nd District, Arizona, U.S. House of
Representatives................................................ 51
National Association of State Fire Marshals...................... 52
National Coalition for Homeless Veterans......................... 53
Paralyzed Veterans of America.................................... 55
Vietnam Veterans of America...................................... 57
Wounded Warrior Project.......................................... 58
LEGISLATIVE HEARING ON `DRAFT LEGISLATION, THE LONG-TERM CARE VETERANS
CHOICE ACT'; H.R. 1443; H.R. 1612; H.R. 1702; H.R. 2065
Tuesday, July 9, 2013
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Health,
Washington, D.C.
The Subcommittee met, pursuant to notice, at 10:08 a.m., in
Room 334, Cannon House Office Building, Hon. Dan Benishek
[Chairman of the Subcommittee] presiding.
Present: Representatives Benishek, Huelskamp, Brownley,
Ruiz, Kuster.
Also Present: Representative Miller.
OPENING STATEMENT OF CHAIRMAN DAN BENISHEK
Mr. Benishek. Good morning. The Subcommittee will come to
order.
Thank you all for joining us this morning to discuss pieces
of legislation concerning health care and services available to
the Department of Veterans Affairs' VA health care system.
The five bills that we will discuss today are draft
legislation, the Long-Term Care Veterans Choice Act; H.R. 1443,
the Tinnitus Research and Treatment Act of 2013; H.R. 1612, to
direct the secretary of Veterans Affairs to convey a parcel of
land in Tuskegee, Alabama, to Tuskegee University; H.R. 1702,
the Veterans Transportation Service Act; and H.R. 2065, the
Safe Housing for Homeless Veterans Act.
From ensuring the safety of homeless veterans residing in
VA homeless grant and per diem facilities to ensuring that
veterans eligible for VA-paid nursing home care are able to
receive care in certified medical foster homes should they
choose, these five bills address a number of critical issues
facing today's veterans and all of us charged with caring for
them.
I am eager to discuss each of these proposals in depth to
ensure a thorough understanding of their purpose, intended
benefits, and unintended consequences.
I am grateful to my colleagues who sponsored these bills
and to our witnesses for being here to discuss them with us. I
look forward to our conversation.
With that, I now yield to Ranking Member Brownley for any
opening statement she may have.
[The prepared statement of Hon. Benishek appears in the
Appendix]
OPENING STATEMENT OF HON. JULIA BROWNLEY
Ms. Brownley. Thank you, Mr. Chairman.
And we do have five important bills here today and look
forward to the discussion. And to allow maximum time for that
discussion, I will limit my opening remarks primarily to H.R.
1443 and H.R. 1702.
H.R. 1443, the Tinnitus Research and Treatment Act of 2013,
as offered by Ranking Member Michaud, according to the VA,
tinnitus is the number one service-connected disability for
veterans from all periods of service affecting over 840,000
veterans.
Since 2005, the number of veterans receiving service-
connected disability for tinnitus has increased by at least 15
percent each year and the VA has been paying out over $1.2
billion annually to veterans for tinnitus disability
compensation.
At the current rate of increase, service-connected
disability payments to veterans for tinnitus will cost $2.26
billion annually by 2014. Nevertheless only about $10 million
is dedicated to researching tinnitus in the public and private
sectors.
H.R. 1443 will allow for appropriate research time and
resources by directing the VA to recognize tinnitus as a
mandatory condition for research and treatment by the VA
auditory centers for excellence.
This will make certain that research is conducted at the VA
facilities on the prevention and treatment of this condition
and that the VA cooperates with the Department of Defense's
hearing center of excellence to further research on tinnitus.
H.R. 1443 would ensure that we remain on the cutting edge
for research and treatment of this issue facing veterans of all
ages.
Next, H.R. 1702, introduced by Mr. Barber of Arizona, would
permanently authorize the VA to operate the Veterans
Transportation Service which provides transportation for
individuals to and from the VA medical facilities in connection
with vocational rehabilitation, counseling, examination,
treatment, or care.
VTS was launched in 2010 and the VA's current authority to
operate the program is set to expire in January of next year. I
did want to emphasize the critical need for this legislation in
helping to increase access to care for those who would
otherwise face challenges in getting to and from their
appointments at the VA.
I also wanted to highlight that VA has estimated VTS to
save up to $19.2 million in fiscal year 2014 and $102.7 million
over five years because it is less expensive for the VA to hire
drivers through VTS than to contract with ambulance services or
to provide mileage reimbursement. So this is simply a common-
sense initiative.
Thank you, Mr. Chairman, for including these bills in the
agenda and I look forward to hearing the views of our witnesses
on the legislation before us today. And I yield back my time.
[The prepared statement of Hon. Brownley appears in the
Appendix]
Mr. Benishek. Thank you.
The Chairman of the Full Committee, Jeff Miller from
Florida's 1st Congressional District, will be joining us later
this morning to discuss his draft legislation, the Long-Term
Care Veterans Choice Act. I will yield to him when he arrives.
In the meantime, it is an honor to be joined by my friends
and colleagues, Mike Rogers, Representative from Alabama's 3rd
Congressional District, and David McKinley, Representative from
West Virginia's 1st Congressional District.
Thank you for your leadership on behalf of our veterans and
for being with us this morning to discuss your proposals. It is
an honor and pleasure to have you here this morning.
I would like to mention for the record that Mr. Barber will
not be with us today due to the tragic circumstances that have
taken place in Arizona and our thoughts and prayers are with
the families of the first responders there who have perished.
Their loved ones are true heroes and their sacrifice will never
be forgotten.
Mike, we will begin with you. Please proceed with your
testimony. You have five minutes.
STATEMENTS OF HON. MIKE ROGERS, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF ALABAMA; HON. DAVID MCKINLEY, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF WEST VIRGINIA
STATEMENT OF HON. MIKE ROGERS
Mr. Rogers. Thank you, Mr. Chairman and Ranking Member
Brownley.
First I want to thank the Chairman and the staff for
holding this hearing. I also want to thank the Full Committee
Chairman, Jeff Miller, for his leadership on behalf of our
Nation's veterans.
Mr. Chairman, H.R. 1612 will benefit the Department of
Veterans Affairs and the people of Tuskegee, Alabama.
In 1922, the Board of Tuskegee University voted to donate
300 acres of land to the Federal Government for a veterans'
hospital. Since that time, Tuskegee VA Hospital and Tuskegee
University have grown into integral parts of the community and
serve important roles for our Nation.
Now as the VA refocuses its mission to better serve our
veterans, some of the donated land near the university's campus
no longer fits the VA's needs.
My bill would transfer back 64.5 acres of land at 2400
Hospital Road back to Tuskegee University so that the land can
better serve the community.
This transfer also creates new opportunities for the VA by
reducing substantial overhead and maintenance costs and
providing cooperative authority to leverage the strengths of
both institutions.
This bill is supported by the VFW, the Vietnam Veterans of
America. Both organizations know well Tuskegee's place in our
history and I appreciate their continued support for the
community.
I thank you again, Mr. Chairman and Ranking Member
Brownley. And with that, I will yield back.
[The prepared statement of Hon. Rogers appears in the
Appendix]
Mr. Benishek. Thank you very much.
David.
STATEMENT OF HON. DAVID MCKINLEY
Mr. McKinley. Thank you, Mr. Chairman.
Ranking Member Brownley and the rest of you on the
Subcommittee, thank you for holding this hearing. I appreciate
the opportunity to give these remarks about H.R. 2065 called
the Safe Housing for Homeless Veterans Act.
This is the same bill that we passed last year, slightly
modified, but it is essentially the same bill for the homeless
veterans.
Currently, there are over 2,100 community-based homeless
veteran service providers across the country and many other
homeless assistance programs that have all demonstrated an
effort to try to take care of our homeless veterans.
I visited some of these shelters throughout West Virginia,
not only in my district, but elsewhere.
You have to understand my background. I come from the
construction industry. I am one of two licensed engineers in
Washington, in Congress. So it does not take me long to walk
into a building and I can tell you whether or not that building
meets code.
And when I walked into some of these shelters, I was
appalled with what we have done to our veterans. They have been
in harm's way and they come back and their lives are challenged
in some of these facilities.
There is no current law. There is a policy within the VA to
comply with building codes. Think about that. It is a policy,
not a requirement. It is a policy. I think this is an omission
governing our veterans' homeless program funds.
H.R. 2065 would require that any organization that seeks
funding from VA for services to homeless veterans have
documentation that their building meets or exceeds building
code. Not a policy. It shall. These men and women sacrificed
for our country, they must have a safe home.
This bill makes it easier for facilities to be certified as
we open up these requirements beyond just the life safety code,
which is 101, NFPA-101, to international building code and the
fire codes and other versions of these codes.
Essentially what the local jurisdiction has adopted, work
with them, but make it a requirement, not a policy.
Furthermore, the legislation would require adding a section
to VA annual report to Congress that would report the number of
grant recipients or eligible entities who have submitted a
certification, that their facility will meet all building
codes.
I understand there is some concern over the undue burden
for these facilities, but as you will see in the questions, I
will be able to expound a little bit further about that, that
is not quite accurate. When you travel, do your research in
other facilities around the country, annual inspections are
expected and demanded. And it is not an undue burden.
In West Virginia, it is at no cost to the facility provider
to have an inspection done to see that you are in compliance.
I am pleased. I want you to know that we have already begun
our discussions with those individuals that may have some
concerns with this, particularly the VA and others, that may
have a concern that we are undue burden.
Quite frankly, Mr. Chairman, I am more interested in the
veterans than I am about bureaucracy. If we are going to put
these men and women in harm's way, I want to take care of the
problem. And if it costs us $100 a year to have an inspection,
then that is the least of my concerns.
These men and women deserve to have a focus for them so
that when they come home and they have, for whatever the
circumstances are that they have to live in a homeless shelter,
they should feel comfortable that they are going to wake up in
the morning and there is not going to be a catastrophe wrapping
around them.
So with that, I will yield back my time and hope that we
have an opportunity to have further discussion and I hope you
will be able to support this effort to take care of our
homeless veterans. Thanks you.
[The prepared statement of Hon. McKinley appears in the
Appendix]
Mr. Benishek. Thank you, Mr. McKinley.
I will now yield to Ms. Brownley who will provide testimony
on H.R. 1443. No?
Ms. Brownley. No.
Mr. Benishek. Well, I think that I will proceed with the
questions. And I will start out.
Mr. Rogers, what is the key benefit for this piece of
legislation?
Mr. Rogers. Well, it is twofold. The university needs the
land back for its expansion, but more importantly the VA does
not need it and it has just been a maintenance burden for them
financially.
There is a large part of their campus that has not been
used for years. It is deteriorating. They are going to have to
spend money to either bring those buildings back or at least
make them safe or tear them down. And they do not really want
to do either.
Mr. Benishek. So there are some unused buildings there?
Mr. Rogers. That is exactly what it is, as well as land.
Mr. Benishek. Does the university have plans to do
something right away with the land?
Mr. Rogers. Not right away, but they would like to use it
for long-term plans.
Mr. Benishek. All right. Thank you.
Mr. McKinley, I appreciate your continued advocacy on this
issue and I completely agree with the need for safe shelters.
Can you comment on the scope of the problem and tell me
what you see as the lack of VA oversight?
Mr. McKinley. Thank you.
I do not want to speak necessarily for the VA. I think they
can speak for themselves. But it is my understanding that there
is an effort. They think they are handling these issues
internally. They may believe that.
But, again, my training, and I started in construction in
1965. Think about that, the age. That gives me away a little
bit, doesn't it, Ms. Brownley?
But it does not take me long to understand there is a
violation. And if they, Chairman, have that knowledge, then why
didn't they correct it?
Example could be down in Atlanta. We have from the Joint
Commission this report in Atlanta that says the Atlanta Medical
Center was supposed to take care of their facility, that they
have violations that are listed on page nine, insufficient
compliance on meeting the requirements under the NFPA-101. 101
is life safety.
Under the door category, insufficient compliance, space
around pipes, conduit where fire and smoke and gases,
insufficient compliance. I could go on. But here it is a
facility that should have the knowledge and they are not
fulfilling that.
We have examples around the country of fires.
Mr. Benishek. May I ask a question?
Mr. McKinley. Five people were killed in a Texas shelter.
Mr. Benishek. Mr. McKinley, let me ask you this question.
Mr. McKinley. I could go on. There are just examples like
that, Mr. Chairman--of examples where people have not followed
the code. They do a wink and a nod. But there are people that
are dying every day and there is needless deaths that are
occurring or harm coming to individuals because they are not
following the building code.
Mr. Benishek. Can you give me a couple examples of the
things that you saw yourself when you were there? You mentioned
that you are an engineer and you noticed some things right
away. What were some of the things that you noticed?
Mr. McKinley. I have seen lack of sprinkler systems and I
know that if you are going to have a combined-use where you
have counseling and housing, there is a requirement to have a
fire separation, a two-hour separation, as well as sprinkler
systems required by 101. Not what is happening time and time
again.
You are fortunate if you get an alarm system. I saw doors
that are not rated. When I mean rated doors, you can have
ratings that maybe have to be as long as two hours before the
door will burn. I can tell you these doors are not rated
because on the inside panel on the door, there is a chip that
is affixed. They have a label and it will tell you whether it
is rated. I went through, I do not know how many facilities and
I have looked for those labels and they are not there.
We see fire exit ways. They are supposed to be lit. There
are strobe lights that were not there at these facilities.
These people, Mr. Chairman, are trying to help out the
veterans, but in so doing they are cutting corners. And I just
want them to comply with the standards. This is not going to
cost the VA one additional dollar. But the owners of these
facilities are going to have to have proper compliance with the
code, not a wink and a nod, so our men and women are safe when
they go to bed at night.
Mr. Benishek. Thank you.
Ranking Member Brownley, do you have any questions?
Ms. Brownley. No.
Mr. Benishek. Dr. Ruiz.
Mr. Ruiz. Thank you both for your work and your support for
veterans.
I have a question for you, Honorable McKinley. The
veterans, do we now have a sense of how many go to veteran-
specific shelters versus general homeless shelters?
Mr. McKinley. That is a fair question. No, I do not know.
It is just a troubling statistic that anyone winds up in a
homeless shelter.
But when I have talked to some of them that are there,
keeping it certainly anonymous to keep their identify, just for
whatever has happened, whether it can be they are having post-
traumatic, they cannot keep a job, they have lost their family
life because of their issues, series of issues. Unfortunately,
they are there.
The VAs do not have the bed capacity to be able to keep
them there, so they are providing space for them here at, I
guess, a per diem basis for them to be able to stay at these
facilities.
So I do not know how many would be there in a VA sponsored
versus one that might be just a non-veterans' homeless shelter.
But I can tell you, Congressman, I am seeing the problems in
both. It is not just the VAs. The VAs, I think, want to do what
is right, but they want to use a policy.
I think we ought to make it statutory so that it does not
vary from state to state to state and municipality where there
is a wink and a nod that they will let them stay there. Let's
give people ability to have safe housing whether they are in a
public one or in a VA sponsored facility.
Mr. Ruiz. And that is the point of my question was to
figure out if--you know, our primary concern with this bill is
to make sure that veterans themselves have a safe place to rest
given the special covenant that we have with our veterans. And
in general, we should strive to make sure that any homeless
could have a safe place to stay at night as well.
But in this special case, if the majority go to private or
non-profit shelters, which is usually the case, the non-profit
organizations, then my concern is are we still reaching out to
those homeless shelters for them so they can have their place
to sleep?
Mr. McKinley. In my jurisdiction, in the 1st district of
West Virginia, whenever I see one of these in a non-VA related
facility, I talk to the municipality about whether or not to
make them in compliance.
Mr. Ruiz. Okay.
Mr. McKinley. But we do not have jurisdiction over those
facilities. We have the jurisdiction where there is Federal
money being used to help these individuals. That is why I am
dealing with it here, but I am dealing with the other in
another matter. And it has to be done on a case by case,
municipality by municipality.
Mr. Ruiz. Thank you very much.
Mr. McKinley. Thank you.
Mr. Benishek. Ms. Kuster, you have any questions?
Ms. Kuster. Just briefly. Thank you very much.
Thank you very much for your testimony and for bringing
these bills forward. And I just want to address a question to
Mr. McKinley.
And you seem well-versed in this, so I just want to
understand. I have worked in the past in my State of New
Hampshire with colleges and universities in dormitories and
housing and trying to comply with local codes. And I know that
there is a distinction between the international building and
fire codes and the life safety codes.
Mr. McKinley. Yes.
Ms. Kuster. And I am just wondering what the impact--I
agree with your intent and I want homeless veterans to be in
safe conditions.
In New Hampshire, the facilities that I have seen have been
very safe. But my concern is not to add to the burden and have
an unintended consequence of inadvertently making housing less
available to homeless veterans.
So if you could comment on how this will work with the
international code, the life safety code, and that there is
local approvals that might be required.
Mr. McKinley. Let me see. I will try to answer that.
Ms. Kuster. For the layperson.
Mr. McKinley. We took some time yesterday and I think it
also began on Friday trying to contact some other states to
find out how they deal with these shelters because if the
concern is over the $100 or whatever the cost, $200, if that is
going to be a burden.
Ms. Kuster. We can deal with it.
Mr. McKinley. Think about it. Think about that.
Ms. Kuster. Yes.
Mr. McKinley. An annual cost of $100 spread out over your
facility or $200. We found out again in West Virginia, those
inspections to see that they are in compliance are done at no
cost. In Virginia, they have an annual state requirement that
no one is complaining about in Virginia.
In New York, there is an annual local level for all
publicly accessed buildings and Utah performs the same thing,
fire safety. In fact, in Utah, they have to fill out this 60-
page document every year to give everyone a comfort level that
the buildings are safe and that we can put human occupants in
that building and they can walk out the next day.
So I think the little bit of burden of having to do
paperwork once a year, I think, is certainly appropriate given
that we are putting people that are hurting emotionally to give
them the comfort that their living conditions and their
environment, that they will be safe.
And I think we will find if we continue doing the research,
we will find that all across America there are those
requirements either to comply with life safety, the 101 and the
National Fire Protection Agency or some of these other codes,
the ICC which is generally observed for most of the states
around the country, but I think every state has to comply with
the NFPA-101.
Ms. Kuster. Good. Thank you.
Mr. McKinley. That is what we are asking for here. Do not
make it a policy.
Ms. Kuster. Uh-huh.
Mr. McKinley. Make it a requirement when they get their
license every year and it may not cost anything depending upon
your state.
Ms. Kuster. Okay. Thank you very much.
I yield back.
Mr. Benishek. Mr. Huelskamp, do you have any questions?
Mr. Huelskamp. No thanks.
Mr. Benishek. Well, thank you. Thank you again for coming.
Since there are no further questions, the first panel is now
excused.
I welcome our second panel to the witness table. Joining us
on the second panel is Mr. Jacob Gadd, the Deputy Director for
Health Care for the Veterans Affairs and Rehabilitation
Division in The American Legion; Dr. Susan Shore, Chair of the
Scientific Advisory Committee for the American Tinnitus
Association; Mr. Adrian Atizado, the Assistant National
Legislative Director for the Disabled American Veterans; Robert
Drexler, member of the Board of Directors for the International
Code Council; and Mr. Raymond Kelley, the Director of the
National Legislative Service for the Veterans of Foreign Wars.
Thank you all for being here this morning and for your hard
work and advocacy for our veterans. I appreciate you coming
here to present your views of your members and I anticipate
your testimony with eagerness.
We will begin with Mr. Gadd. Please begin your testimony.
You have five minutes.
STATEMENTS OF JACOB B. GADD, DEPUTY DIRECTOR FOR HEALTH CARE,
NATIONAL VETERANS AFFAIRS AND REHABILITATION DIVISION, THE
AMERICAN LEGION; SUSAN E. SHORE, CHAIR, SCIENTIFIC ADVISORY
COMMITTEE, AMERICAN TINNITUS ASSOCIATION; ADRIAN ATIZADO,
ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN
VETERANS; ROBERT DREXLER, MEMBER, BOARD OF DIRECTORS,
INTERNATIONAL CODE COUNCIL; RAYMOND C. KELLEY, DIRECTOR,
NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS
STATEMENT OF JACOB B. GADD
Mr. Gadd. On behalf of the 2.4 million members of The
American Legion, I would like to thank you, Chairman Benishek,
Ranking Member Brownley, and Members of the Committee, for the
opportunity to provide comments on these health care bills.
H.R. 1702 is needed to ensure that Veterans Transportation
Service program is authorized as a permanent authority. For
years, VA transportation programs and initiatives have been
viewed as an ancillary or secondary service area, but The
American Legion recognizes that veterans' transportation
programs are vital and often the difference between whether a
veteran is seen for care or not.
VTS originated as a VA transformation initiative to ensure
veterans with serious injury, illness, and those who live in
remote areas receive travel.
In May 2012, VA general counsel rendered an opinion which
found that VA only has the authority to use volunteer drivers
to provide veterans transportation to and from VA health
facilities, not paid employees.
The American Legion became involved after the general
counsel ruling as we had just finished up our system worth
saving report on rural health care.
In this report, we visited VA medical centers and hosted
town hall meetings with veterans to understand firsthand what
challenges veterans face in highly remote areas such as in
Maine, Kansas, Missouri, New Mexico, and Wyoming.
We found that for many veterans driving long distances were
a disincentive and barrier to them receiving care. We found
that VTS was a viable solution as it offered veterans a
secondary option to supplement current VA transportation
programs.
We found concerns with VA's current organizational
structure of transportation programs in VA medical facilities
which is fragmented and disjointed with different
transportation programs located throughout the hospital instead
of in one central place.
Based on the findings of the report and in response to VA's
general counsel ruling, The American Legion adopted Resolution
293, the veterans transportation system and benefits travel.
This resolution urged VA to establish a transportation
department within each VA medical center to coordinate and
oversee all transportation programs in the hospitals such as
conducting transportation catchment analysis, Veterans
Transportation Service program initiatives, volunteer
transportation drivers, beneficiary travel programs, and valet
programs.
As one veteran recently told us in Nevada, veterans travel
as far as 200 miles to the VA medical center for required
appointments as the service is not available in their CBOCs.
These van pools require them to leave their residence very
early in the morning and not return home until later in the
day. Due to medical conditions, not all veterans can withstand
this type of travel and instead take their personal vehicles. A
number of these veterans are subjected to a fixed budget and
often find the cost of travel for medical care a rather large
burden.
Veterans have a choice where they want to receive their
health care. If their transportation needs are not met or
fulfilled by VA, they may not receive care at VA or worse not
receive care at all.
The American Legion supports this legislation but urges
this Committee to include provisions requiring the VA to
establish veterans' transportation departments within VA
medical centers to maximize coordination, efficiency, and
availability of transportation options for veterans.
Regarding draft legislation on the Long-Term Care of
Veterans Choice Act, while The American Legion does not have an
official position on medical foster programs, we have noted
VA's trend in several years of reducing institutional care beds
in lieu of other community options.
American Legion Resolution 121 has three actions that we
stated VA be required by the 1998 Millennium Health Care Act to
maintain and restore its in-house nursing home capacity to
13,391 beds; second that VA create incentives and receive
appropriate funding to maintain its nursing home beds rather
than abandon them to alternative sources; third that Congress
appropriate sufficient funds to support the provisions of the
Millennium Health Care Act so VA is not forced to reduce its
nursing home care unit capacity.
Understanding that not every veteran requires long-term
care or skilled nursing in an institutionalized setting, it is
important to The American Legion and America's veterans that
the availability is there if the need in the VA exists,
particularly as the number of World War II veterans and Vietnam
veterans needing skilled care is poised to increase over the
coming years.
Now is not the time to be reducing capacity or availability
of long-term care. The consequence of not having availability
of long-term beds is that state veterans' homes and other non-
VA long-term care options will be overtaxed and unable to admit
veteran patients.
Once again, American Legion thanks you for this opportunity
to testify on these important bills today.
[The prepared statement of Jacob B. Gadd appears in the
Appendix]
Mr. Benishek. Thank you very much. I appreciate your
testimony.
Dr. Shore, why don't you please start.
STATEMENT OF SUSAN E. SHORE
Ms. Shore. Good morning. Thank you for this opportunity to
give testimony on H.R. 1443, the Tinnitus Research and
Treatment Act of 2013.
Good morning, Chairman Benishek and Ranking Member Brownley
and the rest of the distinguished Members of the Health
Subcommittee.
My name is Dr. Susan Shore and I am the chair of the
Scientific Advisory Board for the American Tinnitus Association
often called ATA.
This is a very important issue, the issue of tinnitus
sometimes pronounced tinnitus, and it is especially important
because it is often ignored as it is viewed as an invisible
disorder, an invisible disorder because nobody but the people
who are suffering from it know that it is there. It is a
subjective phenomenon.
And because of this, I think this is one of the reasons
that it is underfunded. So on behalf of the ATA and the 50
million Americans afflicted with tinnitus, I am going to give
you some background on why I think it is so important to get
more money for research.
So the ATA funds research grants and it is the only member-
based and non-profit organization dedicated to finding a cure
for tinnitus in the United States. Since 1980, we funded grants
towards better understanding of the mechanisms that are
responsible and underlying the genesis of tinnitus.
The advances in tinnitus research over the past decade have
been extraordinary. One of the most important advances has been
the ability to visualize tinnitus through the use of advanced
functional imaging technologies and also through the
development of animal models that can behaviorally assess the
presence of tinnitus in animals. These methods allow us to
pinpoint tinnitus to certain regions of the brain.
Another important advancement that has occurred mostly
through the use of animal models is the discovery that tinnitus
is a result of brain plasticity or disorganization of the
brain. And these developments have led the scientific community
to understand that tinnitus is a disorder of brain function and
not a disorder of the ear that has been the common
misconception for decades.
So while noise overexposure is still the number one cause
of tinnitus, it can also develop in the absence of hearing loss
and absence of hearing damage and because of the result of head
and neck injury.
Tinnitus is the number one service-connected disability for
returning veterans from Iraq and Afghanistan and elsewhere and
as mentioned in the introduction, tinnitus in these veterans is
most often the result of extreme noise exposure from either a
single impulse or the accumulation of noise exposures.
However, head and neck injuries are also a leading
complaint of these veterans. In fact, lumbosacral and cervical
strain account for 23 percent of service-connected disabilities
for Iraq and Afghanistan veterans.
And so in addition to these factors that cause hearing
loss, there are other factors that result from somatic insults
including lumbosacral and cervical strain.
Research into how these systems interact in the brain has
the potential to lead to treatment such as tailored devices
that aim to ameliorate the aberrant brain circuitries resulting
from both a combination of hearing loss and head and neck
injuries.
When you consider the costs that have already been
mentioned for disabilities and in comparison to what is being
spent on tinnitus research in the U.S., there is a severe
disconnect.
Up until very recently, the amount of money being spent on
tinnitus research has been negligible and amounts to about $10
million most recently which is up from $5 million in 2005, but
still it is not nearly enough to address a disorder that
affects so many millions of people.
I would like to just quickly address the current treatments
that are offered in the VA. And while we applaud the efforts of
the VA, current treatments that are offered as part of the
progressive tinnitus management program, while applaudable are
not addressing issues that have been highlighted through
research.
For example, they use sound therapy as their only treatment
which is not effective for many patients. And so because of
this, this is why expanded research is necessary to move
forward and use the discoveries that are being made throughout
the United States in laboratories as we speak.
So I would like to urge you to passage this legislation and
this important one, H.R. 1443. This will go a long way to
helping us achieve our goals of improving tinnitus treatment
and ultimately finding a cure for this disorder.
Thank you.
[The prepared statement of Susan E. Shore appears in the
Appendix]
Mr. Benishek. Thank you very much for your testimony. I
really appreciate it.
Mr. Atizado, I think you are up next.
STATEMENT OF ADRIAN ATIZADO
Mr. Atizado. Thank you, Chairman.
Ranking Member Brownley, Members of the Subcommittee, on
behalf of DAV and our 1.2 million members who are wounded and
injured veterans, I am pleased to provide our views on the
legislation that is on today's agenda.
I would like to highlight two bills to the Subcommittee,
the first of which is H.R. 1702. This bill would provide VA a
renewed and permanent authority to transport individuals in
connection with receiving VA benefits and services.
As mentioned earlier, previously enacted law prompted VA to
initiate the Veterans Transportation Service or VTS which were
it not for the expiration of its one-year statutory authority
would have extended to all VA locations by 2015.
Now, DAV believes VTS can be an ideal partner with our
transportation network, the DAV transportation network or
DAVTN. While the DAVTN continues to show tremendous growth as
an indispensable resource for veterans, VTS serves a special
subset of the veteran patient population, one which our
transportation network is unable to serve. And that deals
specifically with veterans in need of special mode of
transportation because of certain aspects of their conditions.
We believe that with a truly collaborative relationship
that DAVTN and VTS will meet the growing transportation needs
of ill and injured veterans in a cost-effective manner.
Now, as this Subcommittee may be aware, VTS operates on
funds that would otherwise go directly to medical care for
veterans. Thus, our current support for this bill is based on
the progress gained through our working relationship with VA to
resolve weaknesses that we have observed with VTS.
Like VA, we want to ensure VTS will indeed work in concert
with all existing and emerging transportation resources for
veterans who need VA care and to guard against fraud, waste,
and abuse of these limited resources.
The second bill is the Long-Term Care Veterans Choice Act
which we support based on our national resolution calling for
legislation to expand VA's long-term services and supports for
service-connected disabled veterans.
Established in 2000 and operating under the same authority
as VA's community residential care program, VA's medical foster
home approves a private home and the caregiver to care for no
more than three veteran residents in any one location.
Caregiver support is provided by the medical foster home
attendant. They are provided training and it is required that
these attendants have a secondary respite option.
Medical care under the medical foster home is supervised
through VA's home-based primary care program or VA's spinal
cord injury home care program. Patient participation in this
program is voluntary and veteran residents report very high
satisfaction ratings.
A lot of veterans that we hear from who would like to go in
a medical foster home are not able to do so simply because
veterans must pay out of pocket for both room, board, as well
as caregiver services. And that amount ranges anywhere from
$1,500 to $4,000 a month.
Even veterans who are otherwise entitled to the more costly
long-term nursing home care paid fully for by VA either by law
or policy cannot get in because they have no means to pay.
DAV is pleased with VA's innovation by offering the medical
foster home program as one part of its long-term services and
support portfolio and we applaud the intent of this draft
legislation to give VA the authority to enter into agreement or
contract with a VA approved medical foster home as well as pay
for the room, board, and caregiver services.
Mr. Chairman, DAV believes favorable consideration of this
draft bill is a good first step for this Subcommittee to ensure
veterans have access to a full array of home and community-
based long-term services and supports.
Oversight by this Subcommittee is sorely needed as VA
endeavors to shift more of its resources away from nursing home
care in order to serve more veterans in a cost-effective manner
while honoring their preferences in how they live the rest of
their lives in light of their impairments.
We urge this Subcommittee to ensure VA innovations and home
and community-based services are not stifled and that VA's
long-term services and supports provide the broadest array of
assistance as possible regardless of age to those veterans who
have lost the ability to function or maintain independence in
their community.
Mr. Chairman, we look forward to working with the
Subcommittee on these two bills and for its passage. I would be
happy to answer any questions that you or other Members of the
Subcommittee may have.
Thank you.
[The prepared statement of Adrian Atizado appears in the
Appendix]
Mr. Benishek. Thank you, Mr. Atizado.
Mr. Drexler, your testimony, please.
STATEMENT OF ROBERT DREXLER
Mr. Drexler. Good morning, Mr. Chair and Members of the
Subcommittee. My name is Rob Drexler, member of the Board of
Directors for the International Code Council. I also serve as
Fire Marshal for the town of Greece in New York.
With 26 years in the building and fire code profession and
have participated in both the NFPA and ICC code development
process, I am pleased to be here today to discuss the
importance of compliance with building and fire codes, speaking
on behalf of over 50,000 building and fire code officials and
other professionals across the United States who are the
members of the code council.
The code council was formed in 1994 as a non-profit
organization dedicated to developing a single set of
comprehensive and coordinated national model construction
codes.
The founders of the ICC were BOCA, ICBO, and SBCCI. We
joined these three groups together and published a single code
for the United States called the international codes.
In 2003, the International Code Council became the
successor organization to the three legacy code groups. We now
celebrate our tenth anniversary.
Today our international model codes have been adopted at
the state or local level in all 50 states and the District of
Columbia. Numerous Federal agencies including General Service
Administration, the Department of Defense, and the Architect of
Capitol have implemented the I codes as have Puerto Rico and
the U.S. Virgin Islands.
The code council's 50,000 members and over 300 chapters
include state, county, municipal code enforcement, fire
officials, architects, engineers, builders, contractors,
elected officials, manufacturers, and other construction
industry professionals.
I come before you today to encourage support of H.R. 2065,
the Safe Housing for Homeless Veterans Act, sponsored by
Representative David McKinley of West Virginia and
Representative Grace Napolitano of California.
Those of us who work to achieve building safety at both the
state and local level appreciate the concern that this bill has
for the welfare of our veterans who are living in housing
subsidized by the Department of Veterans Affairs.
In the building sector, the IRC, the IBC, and the IFC
established basic requirements for building safety at the time
of construction and in the case of the fire code at the time of
annual inspections.
The codes assure that when faced with hazards including
fire, windstorm, flooding, and normal or daily use, the
building will allow for residents and users to survive and the
first responders to safely rescue building occupants and
minimize property damage.
Around the country either at the state or at the local
level, both the IBC and the IFC assure that buildings used for
residential care and housing are safe. Local code officials
around the country inspect veterans' homes and assure that they
meet current code requirements just as they do with any other
building within their community.
Michigan as well as 42 other states have adopted both the
IBC and the IFC. In fact, all 50 states have adopted the IBC
while a significant number also adopt the life safety code
which is the LSC.
H.R. 2065 wisely does not attempt to mandate one code or
the other for compliance in facilities approved by the
Department of Veterans Affairs for reimbursement but requires a
certification for all homes that they meet either the IBC, the
IFC, or the LSC which are functionally and for a safety
standpoint equivalent code requirements.
In addition, the bill does not impose any onerous
administrative burden on the Department of Veterans Affairs,
only to assure that each facility receiving reimbursement has
obtained a certificate of compliance from the local code
official or from a competent third party. This requirement
mirrors similar requirements for other medical facilities that
must provide assurance to the centers for Medicaid and
Medicare.
I only had a few moments this morning to review the
statements that will be presented by the VA today, but I would
respectfully disagree with many of the talking points in that
statement.
It is true that veterans' homes covered by this requirement
that are located in jurisdictions that does not adopt and
enforce either the IFC or the LSC, there will be a small
additional burden of obtaining an annual inspection.
However, it is the clear intent of the bill's sponsors and
a worthy goal in our opinion that our veterans who sacrificed
so much for our freedoms should be provided with safe housing,
especially when the taxpayer is subsidizing that housing.
It is hard to argue that our veterans should not be assured
of minimal safety in their home when the cost of assuring
safety is only a couple of hundred dollars.
In closing, the International Code Council is proud of our
work in developing the model codes to assure basic level of
safety in the built environment and we applaud your efforts to
use those codes to protect the safety of our veterans.
I respect the work of your Subcommittee and encourage
continued collaboration between the public and private sectors
to achieve the important goal of increased safety in our
Nation's buildings.
Thank you very much for the opportunity today and I would
be happy to answer any questions.
[The prepared statement of Robert Drexler appears in the
Appendix]
Mr. Benishek. Thank you, Mr. Drexler.
Mr. Kelley.
STATEMENT OF RAYMOND KELLEY
Mr. Kelley. Mr. Chairman, Members of the Committee, on
behalf of the men and women of the Veterans of Foreign Wars,
thank you for the opportunity to testify today.
The VFW supports H.R. 1443 which would require the
Department of Veterans Affairs to recognize tinnitus as a
mandatory condition for research and treatment by the VA
auditory center of excellence in coordination with the
Department of Defense hearing center of excellence.
Although there is no known cure for tinnitus, it should not
be assumed that the condition is untreatable. VA's progressive
tinnitus management approach which assists tinnitus sufferers
through individual counseling and support is helping veterans
better manage their symptoms. Still more research is needed in
order to identify truly effective treatments in alleviating
these symptoms. This bill represents a positive first step
towards achieving that goal.
The VFW supports H.R. 1612, a bill that directs the
secretary of VA to convey a parcel of land to Tuskegee
University. More than 90 years ago, Tuskegee University donated
the land, nearly 300 acres, to the United States Government to
build a veterans' hospital. Today 21 of those buildings
accounting for nearly 280,000 square foot of space sit vacant
on that property.
Annually, VA spends approximately $2.00 a square foot to
maintain vacant space. For the buildings that fall within this
land transfer, VA spends more than $500,000 a year in
maintenance. Reducing the financial burden for upkeep of these
buildings and grounds will allow VA to better use those funds
to ensure the highest level of maintenance for the facilities
to provide care and services to our veterans and not to
buildings that are sitting vacant.
The VFW supports H.R. 1702 which permanently authorizes the
Veterans Transportation Service or VTS. This program
commissioned by the Office of Rural Health in 2010 has greatly
improved access to care for rural and seriously-disabled
veterans by allowing VA facilities to establish and coordinate
a network of local transportation providers.
In 2012, the program was temporarily suspended following a
determination by VA Office of General Counsel that VA lacked
the statutory authority to hire paid drivers to transport
veterans.
Congress wisely passed a one-year authorization of the VTS
program in January of 2013, but a long-term fix is still
needed. This legislation would guarantee the continuation of
and further expansion of VTS which plays a critical role in
minimizing the challenges many veterans face in traveling to
their appointments due to physical disabilities or great
distances.
The VFW supports H.R. 2065 which would require facilities
that house homeless veterans to meet the relevant local
building codes in order to receive per diem payments under VA
homeless providers grant and per diem program.
Currently the VA is required to check housing certificates
before awarding grants for housing services provided to
homeless veterans. However, thorough checks of fire and safety
requirements as well as structural conditions of buildings are
often overlooked.
This bill requires that current recipients of the per diem
payment submit a certification of compliance with local codes
within two years of the enactment of this act, giving them
ample time to make the necessary improvements.
The VFW believes that VA-funded transitional housing must
be safe, secure, and sanitary. This bill will ensure that those
standards are met, providing homeless veterans with the best
chance of successful community reintegration.
The VFW supports the Long-Term Care Veterans Choice Act
which would add language to Section 1720 of Title 38 to allow
veterans to receive VA care and require a protracted period of
nursing care to provide transfer into adult foster home at
their request.
To grant VA the authority to reimburse adult foster homes
would provide veterans with the additional residency choice,
potentially improving the quality of life for those who would
prefer this option.
The VFW strongly believes that all non-VA services should
be provided in conjunction with proper care coordination.
Currently VA handbook 1141.02, the medical foster home
procedures, establishes the policies and standards for VA care
coordination for veterans who choose to live in medical foster
homes.
The VFW feels that these procedures would ensure adequate
care coordination for veterans who choose to participate in
fully-funded adult foster care programs. However, these
procedures are now set to expire in 2014 and the VFW recommends
the care coordination policies outlined in that document should
be made permanent by adding them to the language of this
legislation.
Mr. Chairman, this concludes my testimony. I look forward
to any questions from you or the Committee.
[The prepared statement of Raymond C. Kelley appears in the
Appendix]
Mr. Benishek. Thank you very much for your testimony.
Well, we have the Chairman of the Full Committee. Would you
like to discuss your piece of legislation before we get to the
questions?
STATEMENT OF CHAIRMAN JEFF MILLER
Mr. Miller. If I could. I appreciate it. I did not walk in
here to automatically start talking about my piece of
legislation, but----
Mr. Benishek. If it is all right with the Committee, we
will let the Chairman go for five minutes.
Mr. Miller. Thank you very much. I appreciate it, Mr.
Chairman.
Thank you to the witnesses.
I apologize for stepping in front of the questioning, but I
want to talk to you about the Long-Term Veteran Care Choice Act
and I think it is something that this Committee can certainly
get behind and support because this act would authorize the
Department of Veterans Affairs to enter into a contract or
agreement with a certified medical foster home to pay for the
residential long-term care of service-connected veterans who
are eligible for VA-paid nursing home care.
As a component of such care, eligible veterans would also
be required to receive VA home health services.
VA medical foster homes for those of you who do not know
are private homes in which a trained caregiver provides 24-hour
around-the-clock care to a few individuals. They are designed
to provide a non-institutional long-term care alternative to
those who prefer a smaller, more like home setting, one that
they are more accustomed to in their own homes than traditional
nursing homes are able to provide.
VA has been helping to place veterans in medical foster
homes now for well over a decade. MFH are limited to no more
than three veterans at a time and veterans living in such homes
are provided with VA, with home-based primary care services.
They also provide safeguards to ensure that veterans
themselves are safe, that they receive high-quality care by
requiring the MFH caregivers to pass a Federal background check
and VA screening and agree to undergo annual training. And they
also allow VA adult foster home coordinators and members of a
VA home care team to make both announced and unannounced
visits.
Today, according to VA, over 400 approved caregivers
provide this type of care in their homes to over 500 veterans
daily in over 35 states.
The problem is, however, that VA does not have the
authority to pay for the cost of this care. So the veteran who
chooses to live in an MFH must pay out-of-pocket with their own
personal funds regardless of whether or not such veteran is
eligible for VA-paid nursing home care.
What this does is create a situation where many service-
connected veterans with limited financial resources who would
prefer to live in a medical foster home go to a nursing home
institution instead because VA will cover the cost of the
nursing home but not the foster home.
And while traditional nursing homes will always be a vital
component of long-term care, medical foster homes provide a
worthy alternative for many of our veterans.
According to the department itself, many more veterans
would elect to receive care in a medical foster home should VA
be granted the authority to pay for such care.
And I am sure we all agree that one thing we owe our
veterans, particularly those who are service-connected and in
need of long-term care, is the luxury of choice, the choice to
decide where, whether, and how they receive care.
As the veteran population continues to age, the need for
long-term care services will, in fact, continue to grow. The
Long-Term Care Veterans Choice Act would expand the long-term
care choices that are currently offered to veterans beyond
traditional services.
In addition to being beneficial for the health and the
well-being of veterans, the average cost of a medical foster
home is less than half the monthly cost of a nursing home,
making this legislation a very cost-effective health care
option.
This is a common-sense veteran-centric bill that will free
many veterans from financial turmoil and allow them to make
their own decisions about what kind of long-term care they
themselves want to receive.
I looked forward to working with all the interested parties
to resolve any issues they may have during today's discussion.
And, Mr. Chairman, thank you so much for allowing me the
opportunity to talk about this particular piece of legislation
at today's hearing.
And I also want to personally thank you for your hard work
as Chairman of this Subcommittee. It is very critical work for
the veterans of this country and your leadership is greatly
appreciated, and I yield back.
[The prepared statement of Chairman Jeff Miller appears in
the Appendix]
Mr. Benishek. Thank you, Mr. Chairman.
I am going to yield myself five minutes for a few questions
for the panel.
Dr. Shore, I have a great interest in tinnitus as well
because I realize it is a very prominent and probably the most
frequent disability that we see from our veterans returning
home now.
Several veteran service organizations with the Independent
Budget raised concerns about protecting and preserving the VA
research funding decisions by the scientific merit-based peer
review process without interference from outside stakeholders.
Please comment on that concern. Do you feel that this would
compromise in any way the current peer review system already in
place?
Ms. Shore. I am not sure what you are referring to by
outside----
Mr. Benishek. Well, I think the VA contends that they have
a peer review process for determining how to fund research and
they feel that, outside influences like Congress directing the
way that we conduct research would take away from, the peer
reviewed medical decision-making process of determining where
the funds should go.
Ms. Shore. Right. No, I do not agree, but I would----Yeah,
I see where you are coming from. I do not think that it would
interfere with that. I think it would enhance that process as
long as you have people that you are deferring to or consulting
with who know something about the way tinnitus works.
Mr. Benishek. Right.
Ms. Shore. So----
Mr. Benishek. What is the current funding level for
tinnitus research?
Ms. Shore. It is about $10 million everywhere.
Mr. Benishek. That is the total----
Ms. Shore. Yeah.
Mr. Benishek. --for this country, $10 million a year for
the research in tinnitus or is that just the VA?
Ms. Shore. Yes, it is--no, no. That is the total. So that
is much, much, much lower than it should be. So we have
increased the funding from what it used to be five years ago.
NIH is now recognizing tinnitus as a separate disorder that
needs to be considered for funding. The DoD is also putting
forth opportunities for people to submit grants to study
tinnitus. But it still is not nearly enough to bring the
research into reality because it takes a long time for our
research finding to then be taken into a clinical trial.
And we do not want to take research findings into clinical
trials unless they have been proven in the laboratory. So it
takes a lot of money for research to end up helping patients.
Mr. Benishek. No, I realize that amount seems very small
considering the number of veterans that are coming home with
the problem.
Ms. Shore. Oh, it is extraordinarily small, yeah.
Mr. Benishek. Especially due to the fact that we do not
really have much in the way of treatment or understanding of
the disease.
Ms. Shore. Right.
Mr. Benishek. So----
Ms. Shore. Well, I think it is progressing, but we are not
there yet. I mean, there has been a lot of progress in the last
decade. And as I said, one of the big jumps was in recognizing
tinnitus as a brain disorder and not just a disorder of the
ear.
Mr. Benishek. Right. Right. I did not realize that myself.
Ms. Shore. Yeah. So it is often triggered by damage to the
ear, but the reason that it is a brain disorder is because the
brain reacts to the lack of input from the ear and it starts
doing its own thing which is what produces the tinnitus.
Mr. Benishek. Right.
Ms. Shore. And many systems within the brain are acting
together and so treatments have to involve things other than
just sound therapy which is the most available treatment, but
not really very effective and in some people, not even
effective at all.
Mr. Benishek. Right.
Ms. Shore. So now there is the development of devices that
take into account other etiologies than just the ear. For
example, the somatosensory side of things which is going to be
even more prevalent in the veterans' population than it is even
in the normal population because they get head and neck
injuries as well.
Mr. Benishek. Right.
Ms. Shore. And so the hearing loss combined with the head
and neck injuries which themselves can cause tinnitus makes,
you know, that the reason----
Mr. Benishek. I think you explained that we need a little
more research in this department----
Ms. Shore. Yeah.
Mr. Benishek. --pretty well. I want to get to one other
topic before my time runs out. I thank you for your answer.
Mr. Gadd or Mr. Kelley, I have an issue with VA
transportation in rural areas. I am representative of rural
northern Michigan. And the DAV vans are being manned by more
and more elderly veterans and we have difficulty in providing
adequate transportation for veterans.
I guess my concern about VA--I want to be sure that we use
that money very efficiently. Like some of you mentioned, that
money is being diverted for transportation away from patient
care.
So how do you think that we should do oversight? I am
concerned about the fact that we hire a driver, we buy a van,
and then they sit there for 80 percent of the time, How do we
conduct of oversight that to ensure it is an efficient system
within the VA?
Mr. Gadd, do you have an idea or Mr. Kelley?
Mr. Gadd. Sure, I can respond to that. And thank you for
the question.
So I believe it was mentioned earlier and the VA will have
their particular figures on the cost savings, but when these
mobility managers came in with the VTS program, they really
aligned, they worked together with beneficiary travel. And so
there are some reduced cost savings from beneficiary travel.
And, you know, in addition to that, they were developing a tool
to be able to manage the cost and looking at cost and trying to
reduce the cost.
The other point that was mentioned earlier was about
special mode transportation. And the VA would have to contract
with third-party providers to, you know, provide that
transportation. But if they are able to have the ability
through the VTS program to do that in-house, there would be
some reductions in cost there.
And then, too, it just makes sense because it is one
additional option that, you know, if veteran service
organization drivers cannot take that, you know, van to that
veteran, you know, and they are outside of an area where
transportation is not offered, it could reach those particular
veterans.
So we see it as a win-win for veterans.
Mr. Benishek. Right. Mr. Kelley, you have any input there?
Mr. Kelley. I will just echo a sentiment. Beneficiary
travel is hard to have oversight of. Veterans come in and make
a claim that they traveled to their appointment. VA receives
the claim and then provides a check in return.
With this, I think it would be easier to do accountability
if you have a contractor who says we went to pick up these ten.
There is evidence of that, that they brought them to their
appointment and then took them home.
So I think in the long run, the oversight would be much
easier doing this VTS than beneficiary travel. And I think Mr.
Gadd said there is evidence that it will be a cost savings.
Mr. Benishek. Thank you, gentlemen.
I have overstepped my time a bit, but, Ms. Brownley, do you
have questions?
Ms. Brownley. Yes. Thank you, Mr. Chair.
I wanted to go back, Dr. Shore, and ask you a few more
questions about tinnitus.
So I am happy to hear that actually NIH and DoD are getting
involved in recognizing this as a serious problem. I am
interested to know. You talked a little bit about the research
or the lack thereof, but I am interested to know where the
promising research is. You talked about, you know, damage to
the ear, the brain being two possible causes for this disease.
Is the research going more towards, being more directed to
brain research or----
Ms. Shore. Yeah. I think the strong research that has begun
over the past decade or so has been targeting brain mechanisms.
And so there are many laboratories now around the country. Some
of them do imaging studies with humans. Many of them use animal
models because with the animal models, you can go into the
brain and record from single cells and see what happens to
those single cells after a noise exposure or after a head and
neck injury.
And so a lot of our understanding has come from those
animal models that show that after, especially after noise
exposure which is a lot of where the studies focus on, the
neurons in certain specific parts of the brain become
hyperactive.
So they are firing along as if there were a sound there and
higher neurons up there are interpreting that as a sound
whereas, in fact, there is no sound.
And then another thing that is being discovered is that it
is not only auditory centers in the brain that are involved in
tinnitus but non-auditory centers as well. Some of those I have
already mentioned such as the somatosensory system.
So many people who have tinnitus, if they clench their jaw
or push on their face, they can make their tinnitus louder or
softer or change the frequency or even make it go away. And
that highlights this interaction between the touch sensitive
neurons and the auditory neurons.
Another area of strong research over the past few years has
been the connection between tinnitus and depression. And it is
often comorbid and it is often comorbid again in disorders such
as PTSD. And it could be that the reason for that is because
the brain mechanisms are targeting both of these centers.
So it is, you know, not necessarily, you know, the chicken
and the egg stories. It may be that these conditions developed
together and you do not just get depressed because you have
tinnitus, but that depression and tinnitus sort of exhibit
themselves together.
And so some of the research is targeting those areas. I
could go on for a long time.
Ms. Brownley. But the damage to the ear then, it seems to
me as someone who does not have a medical background or a
science background really at all, it seems if there was damage
to the ear that that is something that could be fixed, that
perhaps would be a cure. So it seems to me that it is much more
on the brain sensory side.
Ms. Shore. Yeah. So one of the big questions with tinnitus
is that even some people who have noise damage and hearing loss
do not get tinnitus and why is that? We need to understand that
because if we understand that, maybe we could prevent the
people who do get tinnitus from getting it.
But even if somebody does not have a hearing loss, they can
get tinnitus. And that has been a big area of research recently
because audiology clinics, you know, can measure and they can
show that people do not have hearing loss. But if you do more
sophisticated hearing tests, you can show that hearing actually
is affected at a much milder level, enough to trigger a
tinnitus in the brain.
Ms. Brownley. Thank you.
And any research, we have talked about the research in the
United States, is there any research outside of the United
States internationally that is any different than what you have
just discussed?
Ms. Shore. Well, there are some research organizations
outside of the U.S. that have actually been very instrumental
in pushing tinnitus researchers forward even within the U.S.
And some of them are based in Germany and England. And they are
trying their best as well separately and together to try to
push tinnitus research forward so that we can find a cure.
Ms. Brownley. And is there some coordination that we are
doing between investments in the research now that other
agencies, NIH and you said DoD is providing some grants and
what the VA is doing?
Ms. Shore. Coordination in what sense?
Ms. Brownley. Well, coordination in terms of, you know,
progress or the research that needs to be done before, you
know, to pursue a clinical trial.
Ms. Shore. Right. Well, there are scientific meetings that
are very important that, you know, most people who do research
in tinnitus will go to those meetings and present their
findings and have discussions, set up collaborations.
And that is the major source of information transfer as
well as publication of papers. And that is going to be
available to everybody, not just within a certain organization.
Ms. Brownley. And of our veteran population that is
suffering from this, do you have some percentage of our
veterans who we just have not provided any kind of successful
treatment for it?
Ms. Shore. Well, I think the majority is not getting really
successful treatment because there is no cure. And like, you
know, I mentioned that there is a treatment program that is
available that does help, I think, to some extent because even
a person who comes in who has tinnitus, if they are told that
this is not due to some life-threatening condition, that makes
them feel better. But that does not make their tinnitus go
away.
Sound therapy is like masking. It sort of masks out the
tinnitus for some people some of the time, but it is not
actually getting rid of the tinnitus. And so currently there
are not any standard treatments that we could say everybody
should use this and their tinnitus will go away.
But there are a number of tinnitus treatments that are
being developed in research labs that are being tried out in
animal models and that are being moved for clinical trials. And
some of those are extremely promising because they are
targeting the root of the disorder and trying to change brain
circuitry.
Ms. Brownley. Thank you.
And thank you for the additional time. I yield back.
Mr. Benishek. Mr. Huelskamp.
Mr. Huelskamp. Thank you, Mr. Chairman.
A quick question first for Mr. Drexler. You do mention a
few of the rural areas might not have a code that you referred
to.
And then how are those situations handled and in your mind,
how should they be handled in terms of these inspections? Who
would inspect and what would be the basis for those
inspections?
Mr. Drexler. Essentially, the firm would hire a third-party
inspection agency and that is becoming very common across the
country.
A simple example would be the State of California. We have
all gone through, you know, the economic downturn. And
California really took a big hit and they were forced to reduce
numbers within their building and fire prevention staffs,
inspection staffs, and went and began hiring third-party
inspection agencies.
Third-party inspection agencies would provide those
inspections. They meet the certain qualifications that are
established by and within the municipality and would ensure
that----
Mr. Huelskamp. Mr. Drexler, a quick question. If there is
no code specified by the municipality or the county or the
state as a mandate, what should be the code, the basis of the
inspection then?
Mr. Drexler. What should be the code if there is no code
within that municipality? I think the legislation here would
draw the need to require either the I codes or the life safety
codes and recommend and require those codes to be in place
within the municipalities that do not have building and fire
prevention codes.
Mr. Huelskamp. So the municipality would be forced to adopt
those?
Mr. Drexler. Yes.
Mr. Huelskamp. Under this legislation. Okay. Well, thank
you. One other question though. I appreciate that.
Follow-up, a little bit more on the transportation issue. I
did a town hall in Syracuse, Kansas one week ago or eight days
ago. Same gentleman that was there a year ago brought up the
same story again. I am sure you hear that from rural areas.
In this case, he was asked to drive 524 miles to have blood
drawn. And it is just crazy. Cannot get the VA to figure out
that there are a dozen hospitals along the way including one in
his hometown. And here we are talking about encouraging
transportation, although we are encouraging to allow him to go
a few blocks to the local hospital.
What should I tell this veteran? What do I need to be
doing?
I cannot seem to get the VA to figure this out. He has
mentioned that to them again, 524 miles to get his blood drawn.
And it does not matter whether you have a contract issue of who
drives him. It is himself. And as long as he drives what, three
times a month, he can be reimbursed but not if he drives less.
Any thoughts on that from the veteran service
organizations? What are we supposed to be doing here? This is
just unacceptable and I cannot get an answer for him that
works.
Mr. Gadd.
Mr. Gadd. I can answer that question. We testified, The
American Legion did in the fall last year about fee-basis and
non-VA care coordination. And, you know, we said that the VA
should exercise discretion based on patient-centered approach.
And that approach is that, you know, we can understand if
they go for a major procedure within a VISN or near an area,
but to have multiple trips a couple days a week, you know, for
dialysis, you know, look at other options closer to that
veteran's community.
And I think that that is a perfect way to--in this case,
what was the local options? What was the closest community-
based outpatient clinic? Is there a demand for laboratory
services there in that area? Maybe that is something that the
gentleman from the VA could address this morning.
But we would argue that if it is multiple trips, and it is
inconvenient, that the VA does have that authority to allow
that veteran to be treated there locally near his home.
Mr. Huelskamp. Do you think that in your mind they do not
want to allow that or it gets lost in the shuffle or they just
generally do not want to allow that? What is your thought on
the VA's----
Mr. Gadd. They implemented the non-VA care coordination is
the new rollout of that program. And they are trying to
standardize procedures and how they formulate those decision-
making abilities.
You know, but we have argued that the veteran should have a
say in that process and that there should be some recourse that
the veteran has to appeal that decision, you know, and not have
to drive 500 miles to get a blood draw. You know, that is
ridiculous.
Mr. Huelskamp. Mr. Kelley or Mr. Atizado, any thoughts?
Mr. Atizado. I am just going to echo what Mr. Gadd
mentioned. That local VA facility, the parent facility that
that veteran is driving to, has the authority to pay for that
service or that lab service at the closest location to the
veteran's residence.
There are various reasons why a facility would choose not
to exercise that authority. And I do not think we can discuss
that at this point without all the information in front of us.
But, nonetheless, that veteran should be able to speak to
their primary care physician or social worker and hopefully
that health care team will say, you know, 500 miles is a little
too much.
But, again, I cannot answer one way or the other why that
is, just to say that VA does have the authority.
Mr. Huelskamp. Is this a situation you hear about with
regularity? How often does it happen? Is it just one guy in
Syracuse, Kansas or is it something that you continue to hear
from your constituents about as well?
Mr. Atizado. Well, as far as getting care in the community,
we hear it more often simply because it is an issue that is
brought up as opposed to a veteran who does get care in the
community and does not say, hey, I got care in the community,
it is great. They have nothing to contact and complain to us
about.
So, yeah. So there are issues like that where a veteran is
not being allowed by VA to go to a local or community service
and have VA pay, which is not to say that the issue of
transportation is without issues as well, but this is an issue.
That is why VA, as Jacob mentioned, has a non-VA care
coordination office set up to establish some semblance of
compassion in the fee-care program to make it more patient
centered.
Mr. Huelskamp. Okay. Thank you, Mr. Chairman, unless Mr.
Kelley had some thoughts. Thank you. I yield back.
Mr. Benishek. Well, I would like to thank the Members of
the panel for their testimony today. It was very enlightening
and I do appreciate your comments and look forward to any
further input you want to give to me in the future on this
bill.
So thank you very much for your participation and you are
excused.
We will now call Dr. Jesse as he is the sole member of the
third panel.
You can begin when you are ready, Dr. Jesse.
STATEMENT OF ROBERT L. JESSE, PRINCIPAL DEPUTY UNDER SECRETARY
FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF
VETERANS AFFAIRS, ACCOMPANIED BY SUSAN BLAUERT, DEPUTY
ASSISTANT GENERAL COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS
Dr. Jesse. Good morning, Mr. Chairman and Ranking Member
Brownley and Members of the Subcommittee.
We do appreciate your continuing efforts to support and
improve veterans' health care and we thank you for the
opportunity to address the bills on today's agenda along with
their impact on VHA's health care operations.
Joining me today is Deputy Assistant General Counsel Susan
Blauert.
And I would also like to thank Chairman Miller for coming
by earlier.
VA recognizes the importance of each one of these bills and
we are committed to work with you and the Members of the
Subcommittee and Congress on legislation that can enhance our
ability to provide health care to our Nation's veterans.
I am going to address a few key points on each of the bills
today, but the more detailed explanations are available in my
written statement.
Regarding the draft, Long-Term Care Veterans Choice Act, VA
supports the concept of medical foster homes as an alternative
to long-term institutional care as requested in VHA's fiscal
year 2014 budget submission.
We appreciate your interest in the concept, but we do need
additional time to continue technical assistance to the
Committee and particularly on details pertaining to the term
adult foster home versus medical foster home, the payment
methods, and cost analysis.
VA strongly supports H.R. 1702 which would make permanent
the authority to hire qualified drivers to expand access to VA
health care for individuals traveling to and from VA health
care appointments.
In 2012, though, Veterans Transportation Service or VTS
provided more than 199,000 one-way trips totaling more than 9.7
million miles. The average length of a one-way trip is over 48
miles and it is a considerable distance and often would be
prohibitive for those with poor health were transportation not
available.
Veteran service organizations are invaluable in providing
volunteers to drive veterans to their appointments. However,
there are often not enough volunteers to meet the level of
need. More importantly, they are often precluded from
transporting veterans with various clinical issues such as
portable oxygen, as you heard. We do not see VTS as
competitive, but rather supplemental to the important role
played by the VSOs.
VA is in agreement with the goal of H.R. 1443, the Tinnitus
Research and Treatment Act of 2013, which would recognize
tinnitus as a mandatory condition for research and treatment
and require cooperation with DoD to perform further research.
However, the bill describes programs and operations that
already exist within VA. Our audiology clinics already provide
tinnitus treatment through a progressive tinnitus management
program which includes group educational counseling treatment
and individualized management.
VA has active projects underway in researching the efficacy
of this multidisciplinary tinnitus treatment, the underlying
etiology of tinnitus, and the co-occurrence of hearing loss
along with tinnitus.
VA is also collaborating with DoD on the development of a
registry of the critical information to track the diagnosis,
surgical interventions, or medical treatments for tinnitus and
to follow-up for each case of hearing loss and auditory system
injury incurred by servicemembers while on active duty.
Currently, VA has the responsibility to ensure the safety
of veterans cared for in its grant and per diem or GPD
facilities through on-site inspections of each facility by
staff from the local VA medical center. Inspections are focused
on compliance with the requirements of the life safety code of
the National Fire Protection Association.
The inspection team is responsible for ensuring that
general operating requirements as noted in GPD regulations are
met.
VA believes these measures ensure the safety of those
properties and recognizing that as the intent of H.R. 2065, we
do have some concerns with the bill as written. Specifically,
we are concerned that H.R. 2065 will shift the cost of
certifying compliance with life safety code or other applicable
codes to the GPD grantees.
Currently, VA covers the cost by inspecting the GPD
facilities for compliance with life safety code at no charge to
the grantee. Over 96 percent of current GPD projects are
operated by non-profit community-based providers. Any increased
operating costs for these grantees could have a negative impact
on the type and quality of services provided to veterans.
We are also concerned that H.R. 2065 could have an
inequitable impact on GPD providers in rural areas because of
the difficulties of assessing qualified inspectors to certify
compliance in those areas.
We do not yet have testimony on H.R. 1612 which would
authorize VA to transfer a 64.5 acre tract to Tuskegee
University or as noted previously from the draft, Long-Term
Care Veterans Choice Act.
However, we look forward to working with the Committee in
providing technical assistance on these and any other bills
before the Committee today.
This concludes my remarks. On behalf of the department,
thank you again for the opportunity to provide our views and be
pleased to answer questions.
[The prepared statement of Robert L. Jesse appears in the
Appendix]
Mr. Benishek. Thank you, Dr. Jesse. It is a pleasure to see
you once again before the----
Dr. Jesse. Thank you, sir.
Mr. Benishek. --Committee. I have a couple of questions. I
will yield myself five minutes.
Is there a difference in what you are saying about the
amount of research in tinnitus?
You said you are already doing research because I think
this $10 million number is what keeps sticking in my mind, that
there are so many episodes of tinnitus and you have $10 million
for a multibillion dollar problem. It does not seem like much.
So you seem to say something that you are already doing
something about it.
Is that $10 million number wrong then?
Dr. Jesse. Well, that $10 million number, I think, was
nationally, not just VA, nationally. VA's investment is about
$1.2 million, so about a tenth of that is in VA, mostly in four
projects, three of which are really focused on the clinical
assessments, one specifically which was called for in the bill
to look at the efficacy of this multi-step treatment program.
Mr. Benishek. You do not dispute that number then? That
number seems reasonable to you?
Dr. Jesse. Oh, no. Actually, I think that is a pretty small
number compared to what we spend on a lot of other things.
And I think what is interesting is, as Dr. Shore noted,
that there has really been, I think, a dramatic change in the
past, I will just say a couple of years, through new imaging
modalities that are really beginning to describe the functional
changes within the brain in patients with tinnitus historically
which has really focused on it being an ear problem.
But those technologies are relatively new and it takes time
to get that kind of work into the, you know, the life cycle of
research.
But, yeah, I think it is--I guess I do not know that I can
say it is underfunded because there is not enough money for the
research or it is underfunded because there has not been the
kind of high-quality grants proposals coming through the system
in order to get them funded.
Mr. Benishek. So it is not like you are in favor of the
legislation.
Dr. Jesse. Well, we have no problems with the legislation.
I think basically what is described in the legislation is stuff
that we are already doing.
I guess the one issue, and just to be very clear because of
the dynamics of research, is remember that VA is only
authorized to do intramural research. We cannot fund extramural
research. That is one of the reasons why we value the research
partnerships with DoD who can.
Mr. Benishek. Okay.
Dr. Jesse. And I do not have the numbers for DoD.
Mr. Benishek. Well, that is an interesting point there.
I have another question for you, too, and that is this
transportation issue.
Dr. Jesse. Uh-huh.
Mr. Benishek. And that is something I think we may have
talked about before, and that is the fact that it came out here
in the earlier panel with Mr. Huelskamp pointing out the fact
that--are we going to transport more patients, make it easier
to transport the patient 500 miles or are we going to use, the
local community access mode and how are we going to balance
that.
I have been to town hall meetings myself where veterans
have said to me, I cannot get to the place I want to go to get
my x-ray and the other guy said, well, I can get the x-ray
right here. So one veteran wants to go the 100 miles to get the
chest x-ray. The next veteran does not want to go the 100 miles
to get the x-ray.
So I know there is a lot of individual variability in the
patient preference. And I do not really know the best answer to
that myself. I think now it all happens at the VA.
My concern is the fact that, does the patient have an
opportunity to call back once he gets an order to come in for
an x-ray or a blood test, he can just call the VA back and say
can I get the test done at my local hospital without having to
go back to the initial doctor because sometimes that can be the
problem?
And the person who is answering the phone cannot get a hold
of the regular doctor, or does not have the authority to make
that decision.
I think in the practical terms of how that gets done, there
may be some problem, when the patient says I would rather get
it done in my hometown and then the person they talk to on the
phone does not have the authority to do that and cannot get a
hold of the person that does.
How does that actually occur and how do we make it better
for the patient?
Dr. Jesse. So I think this is one of the reasons why we
are, as Jacob Gadd mentioned, the notion of having the
coordinator for non-VA care, so there actually is a person who
could make these kinds of decisions without somebody getting
into the swirl of administrative phone tag.
I know my patients, some that live still in Richmond where
I still have my clinic, we draw from northern, you know, down
into Roanoke Rapids areas of North Carolina and the far south
West Virginia, some people have to travel fair distances. I
mean, I think that common-sense is the thing that will prevail
here.
And I have patients who, for instance, are on Warfarin who
have to have their INRs checked. Most of them will get it
checked locally and they will also get it managed locally.
Occasionally people will get it done at the VA because they are
coming up for a lot of other things and we can coordinate the
visits around that.
I think traveling 500 miles to get a blood drawn is kind of
beyond common sense. I mean, if you are looking at a cost-
basis, what we pay for benny travel, far exceeds the cost of
that test.
And the other piece that comes in here and one of our real
fears many times is that the lack of coherence of the
information, meaning if it is done in the VA, we can track it
through our electronic medical record. It is there for
everybody to see. There really is the continuity of care-based
on the information. When it is done outside and gets reported,
it often gets lost.
And, you know, obviously a lot of what is going on
nationally around health IT is meant to take some of those
things into place. But I think we really try to do what is best
for the patient and, you know, I am sorry to hear that some
people have problems like this. I think that we need to be
doing better in those cases.
Mr. Benishek. Do you think that this coordinator, this
person is going to make the difference then? That is what you
are telling me.
Dr. Jesse. Well, I think the primary care, you know, as we
move to team-based care, as we move to the idea that you now
have actually a direct connection in and you should not be
having these, I cannot get my provider type of things, and
those decisions can get made and taken care of that way.
Mr. Benishek. My time is up here. I will leave it to Ms.
Brownley.
Ms. Brownley. Thank you, Mr. Chair.
I just also wanted to follow-up again on this tinnitus and
the role of the VA in it. I mean, it seems to me that, you
know, $1.2 million is not enough for the VA's participation.
And it seems to me if this is something, and clearly it is,
that our veterans are suffering from, that the VA should be
taking a significant leadership role in trying to lead the
research to find cures for this.
It is clearly costing the VA a lot of money for treatment
that does not seem to necessarily have great outcomes. And I
think always with research, if there is a will, there is a way.
And it seems to me that the VA should be the leader in this
area.
Dr. Jesse. So I think from a clinical perspective in the
treatment of tinnitus, we are. In terms of the basic research,
I do not know that we are not because obviously there is not a
lot going on in the country as it is.
But as I mentioned, I think one of the issues is it has
been a problem because we cannot quantitate it. We do not have
a biomarker for it. And so we do not have a cure for it because
we do not really understand in many cases what causes it. And
so we have had to focus on the treatment and amelioration of
the symptoms.
Now with newer imaging modalities and better science, I
think we are going to get a much better handle on the basis of
the disease. And then when one can understand that, you can
begin to define treatments that get to the root source rather
than treating the symptom.
Ms. Brownley. Well, I mean, in Dr. Shore's testimony
anyway, it seemed as though the treatments generally are not as
successful, I guess, as we would like them to be. And if that
is our leadership, it does not seem to me to be adequate
because we are not necessarily treating the condition
successfully and, yet, we also do not have a cure.
So it just feels to me very much like we should be in a
better leadership role around this because it is our customers,
it is our constituents who are suffering from it and we should
not be dependent on sort of outside research in hopes of, in
hopes of coming up with a cure.
I also just wanted to ask why at this moment you do not
have a position on H.R. 1612? Is that what I heard you say,
that you did not have a position?
Dr. Jesse. Oh, it is for Tuskegee.
Ms. Brownley. Yes.
Dr. Jesse. So just to be clear, we have no issue with
transferring the land. It is a technical issue about what is
required before we can do that. And so my understanding without
stepping over my knowledge-base or bounds on this is that in
order for us to transfer land back, certain assurances have to
be made. And those are already existent in other Federal
statutes. And so those have to be completely vetted and
understood and then we will work through the process.
Our objection is not in the transferring of the property.
It is making it happen in a way that meets all the requirements
and we just have not fully understood all of them yet. And also
what that is going to mean is, there is going to be some cost
associated with it that will have to be borne by somebody. We
just do not know what that is yet and that is why we do not
have the views.
Ms. Brownley. Thank you. I yield back.
Mr. Benishek. Thank you, Ms. Brownley.
Well, I think I have so many questions I could go on for a
couple more hours. To tell you the truth, there was a lot of
interesting things that came up in all the panels today. I may
put some written questions----
Dr. Jesse. Sure.
Mr. Benishek. --for the record to even some of the previous
panels because these are such an interesting subjects and I
think deserve a little more thought.
So I want to thank you for your testimony today, Dr. Jesse,
and thanks to all the other people that testified today. You
are excused, Dr. Jesse.
I ask unanimous consent that all the Members have five
legislative days to revise and extend their remarks and include
extraneous material. Without objection, so ordered.
I would like once again to thank all the witnesses and the
audience members for joining us in today's conversation.
The hearing is now adjourned.
[Whereupon, at 11:46 a.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Dan Benishek, Chairman
Good morning. The Subcommittee will come to order.
Thank you all for joining us this morning to discuss five pieces of
legislation concerning the health care and services available to our
honored veterans through the Department of Veterans Affairs' (VA's)
health care system.
The five bills we will discuss today are:
- Draft legislation, the Long-Term Care Veterans Choice Act;
- H.R. 1443, the Tinnitus Research and Treatment Act of 2013;
- H.R. 1612, to direct the Secretary of Veterans Affairs to convey
a parcel of land in Tuskegee, Alabama, to Tuskegee University;
- H.R. 1702, the Veterans Transportation Service Act; and,
- H.R. 2065, the Safe Housing for Homeless Veterans Act.
From ensuring the safety of homeless veterans residing in VA
Homeless Grant and Per Diem facilities to ensuring that veterans
eligible for VA-paid nursing home care are able to receive care in
certified medical foster homes should they choose, these five bills
address a number of critical issues facing today's veterans and all of
us charged with caring for them.
I am eager to discuss each of these proposals in-depth to ensure a
thorough understanding of their purpose, intended benefits, and
unintended consequences.
I am grateful to my colleagues who sponsored these bills and to our
witnesses for being here to discuss them with us.
I look forward our conversation.
With that, I now yield to Ranking Member Brownley for any opening
statement she may have.
Prepared Statement of Hon. Julia Brownley
Thank you, Mr. Chairman.
The purpose of today's hearing will be to explore the policy
implications of five bills before us today which cover a wide range of
topics that would expand and enhance VA's health care programs and
services. To allow maximum time for discussion, I will limit my opening
remarks primarily to H.R. 1443 and H.R. 1702.
H.R. 1443, Tinnitus Research and Treatment Act of 2013, is offered
by Ranking Member Michaud.
According to the VA, tinnitus is the number one service-connected
disability for veterans from all periods of service, affecting over
840,000 veterans. Since 2005, the number of veterans receiving service-
connected disability for tinnitus has increased by at least 15 percent
each year, and VA has been paying out over $1.2 billion annually to
veterans for tinnitus disability compensation. At the current rate of
increase, service-connected disability payments to veterans for
tinnitus will cost $2.26 billion annually by 2014. Nevertheless, only
about $10 million is dedicated to researching tinnitus in the public
and private sectors.
H.R. 1443 will allow for appropriate research time and resources by
directing VA to recognize tinnitus as a mandatory condition for
research and treatment by the VA Auditory Centers of Excellence. This
will make certain that research is conducted at VA facilities on the
prevention and treatment of this condition, and that VA cooperates with
the Department of Defense's Hearing Center of Excellence to further
research on tinnitus. H.R. 1443 would ensure that we remain on the
cutting edge for research and treatment of this issue facing veterans
of all ages.
Next, H.R. 1702, introduced by Mr. Barber of Arizona, would
permanently authorize VA to operate the Veterans Transportation Service
(or VTS), which provides transportation for individuals to and from VA
medical facilities in connection with vocational rehabilitation,
counseling, examination, treatment, or care. VTS was launched in 2010,
and VA's current authority to operate the program is set to expire in
January of next year.
I did want to emphasize the critical need for this legislation in
helping to increase access to care for those who would otherwise face
challenges in getting to and from their appointments at VA. I also
wanted to highlight that VA has estimated VTS to save up to $19.2
million in FY14 and $102.7 million over five years, because it is less
expensive for the VA to hire drivers through VTS than to contract with
ambulance services or to provide mileage reimbursements. So this is
simply a commonsense initiative.
Thank you, Mr. Chairman, for including these bills on the agenda. I
look forward to hearing the views of our witnesses on the legislation
before us today.
Thank you, and I yield back.
Prepared Statement of Hon. Jeff Miller
Thank you, Dan.
It is a pleasure to be here again with you, the Subcommittee on
Health, and all of our witnesses, stakeholders, and audience members to
discuss my draft bill, the Long-Term Care Veterans Choice Act.
The Long-Term Care Veterans Choice Act would authorize the
Department of Veterans Affairs (VA) to enter into a contract or
agreement with a certified Medical Foster Home (MFH) to pay for the
residential long-term care of service-connected veterans who are
eligible for VA-paid nursing home care. As a component of such care,
eligible veterans would also be required to receive VA home health
services.
Medical foster homes (M-F-Hs) are private homes in which a trained
caregiver provides twenty four hour, around-the-clock, care to a few
individuals. They are designed to provide a non-institutional long-term
care alternative to those who prefer a smaller, more home-like and
familial care setting than many traditional nursing homes are able to
provide.
VA has been helping to place veterans in medical foster homes for
over a decade. VA, as part of the placement process, inspects and
approves all MFH's, limits care to no more than three veterans at a
time, and provides veterans living in such homes with home based
primary care services. VA also provides safeguards to ensure veterans
receive safe, high-quality care by requiring MFH caregivers to pass a
Federal background check and VA screening, agree to undergo annual
training, and allow VA adult foster home coordinators and members of a
VA home care team to make both announced and unannounced home visits.
Today, according to VA, over four hundred approved caregivers
provide MFH care in their homes to over five hundred veterans daily in
over thirty five states.
The problem, however, is that VA does not have the authority to pay
for the cost of the MFH. So, the veteran who chooses to live in a MFH
must pay out of pocket with personal funds - regardless of whether or
not such veteran is eligible for VA-paid nursing home care.
This creates a situation where many service-connected veterans with
limited financial resources, who would prefer to live in a medical
foster home, go to a nursing home institution instead because VA will
cover the cost of the nursing home, but not the MFH.
And, while traditional nursing homes will always be a vital
component of long-term care, medical foster homes provide a worthy
alternative for many veterans.
According to the Department, many more veterans would elect to
receive care in a medical foster home should VA be granted the
authority to pay for such care.
I am sure we all agree that one thing we owe our veterans,
particularly those who are service-connected and in need of long-term
care, is the luxury of choice - the choice to decide where and how to
receive the care they need.
As the veteran population continues to age, the need for long-term
care services will continue to grow. The Long-Term Care Veterans Choice
Act would expand the long term care choices offered to veterans beyond
traditional services. Additionally, in addition to being beneficial for
the health and well-being of veterans, the average cost of a MFH is
more than half the monthly cost of a nursing home, making this
legislation a very cost effective health care option.
This is a common-sense, veteran-centric bill that will free many
veterans from financial turmoil, and allow them to make their own
decisions about what kind of long-term care they want to receive.
I look forward to working closely with all interested parties to
resolve any issues that may arise during today's discussion.
Thank you once again, Dan, for holding this hearing today and for
the hard work and leadership shown by you and all of the Members of
this Subcommittee. And, with that, I yield back the remainder of my
time.
Prepared Statement of Hon. Jackie Walorski
Mr. Chairman and Ranking Member, it's an honor to serve on this
Committee.
I thank you for holding this legislative hearing to enable relevant
stakeholders the opportunity to improve legislation directly impacting
them.
I also want to thank the veteran service organizations testifying
today and those in attendance. The selfless work your organizations
perform continues to inspire Members, such as me, to remain steadfast
in our commitment to improving veteran health care.
The Veteran Health Administration oversees an extensive integrated
health care system. In fiscal year 2012, approximately 8.76 million
veterans were enrolled in the VA health care system--with approximately
6.33 million unique patients treated. \1\ While these are impressive
numbers, we must not get buried in statistics and lose sight of what is
most important--the veterans who have earned their right to quality and
accessible health care.
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\1\ U.S. Department of Veterans Affairs, National Center for
Veterans Analysis and Statistics, ``Department of Veterans Affairs
Statistics at a Glance Pocket Card.'' Updated 17 April 2013. http://
www.va.gov/vetdata/docs/Quickfacts/Spring--13--sharepoint.pdf.
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I look forward to working with my colleagues and our panelists on
this legislation before us.
Thank you.
Prepared Statement of U.S. Rep. Mike D. Rogers
H.R. 1612
Thank you Chairman Benishek and Ranking Member Brownley.
First, I would like to thank you Mr. Chairman and your staff for
holding this hearing today. I also want to thank the Full Committee
Chairman, Jeff Miller, for his leadership on behalf of our Nation's
veterans.
Mr. Chairman, H.R. 1612 will benefit the Department of Veterans
Affairs (VA), the people of Tuskegee, Alabama and the taxpayer.
In 1922, the board of Tuskegee University voted to donate 300 acres
of land to the federal government for a veterans' hospital. Since that
time, the Tuskegee VA hospital and Tuskegee University have grown into
integral parts of the community and serve important roles for our
nation. Now, as the VA refocuses its mission to better serve our
veterans, some of the donated land near the University's campus no
longer fits the VA's needs.
My bill would transfer 64.5 acres of land at 2400 Hospital Road
back to Tuskegee University so that the land can better serve the
community. This transfer also creates new opportunities for the VA by
reducing substantial overhead and maintenance costs and providing
cooperative authority to leverage the strengths of both institutions.
This bill has been scored at no cost to the federal government and
is a prudent use of our federal resources. Thank you again for the
opportunity to testify Mr. Chairman and appreciate your leadership and
strong support for this legislation.
Prepared Statement of Honorable David B. McKinley, P.E.
Chairman Benishek, Ranking Member Brownley and Members of the
Subcommittee, thank you for holding this legislative hearing today on
important issues that affect our nation's veterans. I appreciate the
opportunity to give remarks on my bill, H.R. 2065, the Safe Housing for
Homeless Veterans Act. This is the same bill, with some modifications,
that I testified for before the Subcommittee in the last Congress and
that passed the House.
Currently, there are over 2,100 community-based homeless veteran
service providers across the country and many other homeless assistance
programs that have demonstrated impressive success reaching homeless
veterans. I have visited some of the shelters in my home district in
West Virginia and was struck by how many seemed to not be in compliance
with state, local or federal safety codes.
Consequently, we began to investigate how widespread this problem
was. It was unsettling to learn about shelter fires where lives have
been lost. We read stories of a homeless shelter fire where occupants
were killed because there was no sprinkler system at the facility and
another where homeless veterans were injured because a sprinkler system
was not working properly and the fire exits were blocked. These types
of tragedies could have been avoided.
This common sense legislation would ensure the wellbeing of
veterans who have fallen on hard times and are in the most need of
assistance. There is no current law mandating VA homeless shelters meet
code. There is only a loosely defined policy that is not universally
being followed. As a licensed professional engineer, I found this to be
an egregious omission in the law governing VA homeless program funds.
H.R. 2065 would require any organization that seeks funding from VA
for services to homeless veterans to have documentation that their
building meets or exceeds all building Codes. Since last Congress we
made some modifications to the bill after meeting with stake-holder
groups including the International Code Council. The current draft
actually makes it easier for facilities to be certified as we open up
the requirements beyond only Life Safety Codes to International
Building and Fire Codes or any version of these codes that a local
jurisdiction has adopted. Furthermore, the legislation would require
adding a section in the VA annual report to Congress that would report
the number of grant recipients or eligible entities who have submitted
a certification that their facility met all building Codes.
I understand that there is some concern over an undue burden for
facilities to be certified that they meet or exceed the building codes.
We welcome a continued dialogue on possible amendments to the
legislation to make sure that this bill is simply requiring the
facilities to follow what is already state and local law in most
jurisdictions. I am pleased to let you know that we have already begun
these discussions with the concerned parties and we are well on our way
to a solution.
After passing the House last year, this language was dropped from
the final package that became law at the end of the year. As a nation,
it should be unacceptable for us to allow homeless veterans be housed
in potentially unsafe conditions. In defense of our country, these men
and women were put in harm's way; they should not be in doubt about
their own safety now that they are home again. These homeless veterans
are experiencing a difficult phase of their lives and should be able to
trust that they will be safe each night as they continue their return
to being productive members of society.
I appreciate the testimony in support of H.R. 2065 from other
witnesses testifying here today and I thank you for your concern for
the safety and living environment of our veterans.
Prepared Statement of Jacob Gadd
Chairman Benishek, Ranking Member Brownley and distinguished
Members of the Subcommittee, on behalf of Commander Koutz and the 2.4
million members of The American Legion, I thank you and your colleagues
for the work you do in support of our service members and veterans as
well as their families. The hard work of this Subcommittee in
addressing the health care needs of the veterans' community makes a
substantial impact on the ability for veterans to receive, as they
deserve, the best care anywhere.
H.R. 1443: Tinnitus Research and Treatment Act of 2013
To direct the Secretary of Veterans Affairs to recognize tinnitus
as a mandatory condition for research and treatment by the Department
of Veterans Affairs, and for other purposes.
It is no secret that the men and women who serve in the armed
forces are potentially subjected to some of the most devastating noise
trauma in the occupational world. From noisy jet engines to gunfire and
artillery, to say nothing of the potentially damaging shock waves from
Improvised Explosive Devices (IEDs), the ubiquitous threat of the
recent and ongoing wars in Iraq and Afghanistan, veterans again and
again place their ears and hearing at risk in service to this country.
Tinnitus, which can stem from multiple causes, is often characterized
as a persistent ringing in the ears, ranging from the distracting to
severely disruptive to the ability to concentrate and focus on tasks.
The American Legion provides accreditation for over 2,600 service
officers nationwide who work with veterans to assist with claims for
disability benefits. As such, this dedicated network is intimately
familiar with the types of disorders affecting the nation's veterans.
Tinnitus represents the most prevalent service connected disability,
with over 840,000 veterans receiving compensation for the disorder as
of 2011 \1\. With so many veterans affected, research into the disorder
is critical.
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\1\ US Department of Veterans Affairs Annual Benefits Report, FY
2011.
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This bill would ensure a full spectrum of research would be
conducted through the Department of Veterans Affairs (VA) into such
varied topics as multidisciplinary treatment modalities, underlying
etiological studies of the disorder, contrasting types of tinnitus with
and without accompanying hearing loss, and other factors. The bill also
prompts close cooperation between VA and the Department of Defense,
perhaps a key component in preventing future incidences of the
disorder. The American Legion ``encourages acceleration in the
development and initiation of needed research on conditions that
significantly affect veterans. \2\'' All hearing trauma, be it tinnitus
or hearing loss, is a scourge veterans are quite familiar with.
Increased research into mitigating the effects of such traumas is a
boon not solely to today's veterans, but to generations to come.
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\2\ Resolution 108: Request Congress Provide the Department of
Veterans Affairs Adequate Funding for Research and Prosthetic Research,
- AUG 2012.
The American Legion supports the passage of H.R. 1443.
H.R. 1612:
To direct the Secretary of Veterans Affairs to convey a parcel of
land in Tuskegee, Alabama, to Tuskegee University, and for other
purposes.
This bill addresses land conveyance between the VA and Tuskegee
University.
The American Legion has no position on H.R. 1612.
H.R. 1702: Veterans Transportation Service Act
To amend title 38, United States Code, to make permanent the
authority of 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.
This bill provides a technical amendment to the existing law in 38
United States Code Sec. 111A, eliminating the provision in the current
law which causes the authority of VA to expire and making the authority
permanent. The authority in question allows VA to provide
transportation services, increasing access to their facilities and
health services.
The American Legion believes there is a vital need for the Veterans
Transportation System \3\ to ensure all veterans receive access to the
care they have earned through their service and sacrifice. Through the
conduct of our many System Worth Saving (SWS) visits to VA health care
facilities nationwide each year, our field staff and task force members
have seen firsthand the importance of this program in getting veterans
to the facilities. Whether through volunteer efforts or the VTS
program, many veterans need help to reach treatment and disruption in
the ability to provide that help results in a loss of care. Making this
authority permanent would help provide stability for planning purposes.
The American Legion would further urge Congress to continue to monitor
this program and to consider raises as appropriate for beneficiary
travel rates \4\ as that is also a key component of getting veterans to
the hospitals for treatment.
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\3\ Resolution 293: Veterans Transportation System (VTS) & Benefits
Travel - AUG 2012.
\4\ Ibid.
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The American Legion supports the passage of H.R. 1702.
H.R. 2065: Safe Housing for Homeless Veterans Act
To amend title 38, United States Code, to require recipients of per
diem payments from the Secretary of Veterans Affairs for the provision
of services for homeless veterans to comply with codes relevant to
operations and level of care provided, and for other purposes.
This legislation requires veterans' homeless shelters to meet all
appropriate building and fire codes. Veterans' homelessness is a
critical problem. That veterans should have to contend with
homelessness is a national shame. Secretary Eric Shinseki has been
steadfast in his efforts to bring to bear the resources of VA to combat
this issue, and great strides have been made in the last several years
in reducing the numbers of homeless veterans on the streets every
night.
The American Legion supports the efforts of public and private
sector agencies and organizations that aid homeless veterans and their
families \5\. Additionally, the Legion supports legislative proposals
to provide medical, rehabilitative, and employment assistance to
homeless veterans and their families. The American Legion places
special priority on the issue of veteran homelessness. To help our
struggling brothers and sisters-in-arms, the Legion works on a global
level, lobbying for legislation affecting veteran homelessness, and
acts on a local level, directly assisting veterans who have fallen on
tough times and are without a place to live or facing the prospect of
it.
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\5\ Resolution 306: Funding for Homeless Veterans - AUG 2012
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This direct assistance is coordinated by the Legion's Homeless
Veterans Task Force, which works to ensure local services and resources
are available to homeless veterans and their families. The Task Force,
which has chairpersons in each department, collaborates with government
agencies, homeless service providers and veterans service organizations
to develop and implement initiatives that will help homeless veterans.
The Legion recognizes that aiding homeless veterans requires a
sustained coordinated effort, which should provide secure housing and
nutritious meals; essential physical health care, substance abuse
aftercare and mental-health counseling, as well as personal development
and empowerment. Homeless veterans also need job assessment, training,
and placement assistance. The ultimate goal is total self management
for the homeless veteran.
Homeless veterans cannot be considered to have ``secure housing''
if they must contend with facilities that don't even meet basic
building codes and place these uniquely vulnerable veterans at risk of
serious injury or death from fires and substandard building materials.
If these veterans have lost their homes and livelihoods, we cannot in
good conscience place them at risk to life and limb in unsafe
facilities.
This legislation would ensure the facilities designated to serve
the needs of homeless veterans comply with appropriate codes and
regulations, and give them a stable and safe environment to help piece
their lives together as they move forward.
The American Legion supports the passage of H.R. 2065.
DRAFT LEGISLATION: Long Term Care Veterans Choice Act
To amend title 38, United States Code, to authorize the Secretary
of Veterans Affairs to enter into contracts for the transfer of
veterans to non-Department adult foster homes for certain veterans who
are unable to live independently.
Adult Foster Care homes provide an alternative in some situations
to traditional nursing home elder care. In general, these are single
family homes which provide room, board and supervision as well as
personal care services. These types of facilities provide for the needs
of the elderly who, though they may require periodic or regular
assistance with the activities of daily living, do not require full
time nursing services.
Individual states have a variety of rules and regulations related
to the governance and approval of such facilities. This draft
legislation would modify the United States Code to allow for veterans
``for whom the Secretary is required to provide nursing care under
section 1710A of [Title 38], the Secretary may transfer the veteran to
an adult foster home that meets Department standards, at the expense of
the United States, pursuant to a contract or agreement entered into
between the Secretary and the adult foster home for such purpose.'' In
essence, this legislation would allow VA to place veterans in these
adult foster homes and pay for the services provided. Veterans can
currently utilize such homes if they so choose, but they must pay out
of their own pocket for the services, even if VA is authorized to pay
for nursing care for the veteran.
VA is authorized \6\ to provide a comprehensive array of medically
necessary in-home services to enrolled veterans. This bill seeks to add
a provision in title 38, United States Code (U.S.C.), Section 1720 that
VA would be authorized to transfer veterans needing long-term care
services to ``Foster Homes,'' upon the request of the veteran or
Secretary of Veterans Affairs.
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\6\ Title 38, Code of Federal Regulations (CFR) Section 17.38
(a)(1)(ix)).
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VA issued VHA Handbook 1141.02, Medical Foster Home Procedures, in
November 2009, which outlined the Department's policy on definition,
responsibilities, selection, training, quality monitoring and financial
arrangements for this program.
VA defines a Medical Foster Home (MFH) in VHA Handbook 1141.02 as:
1) MFH is an adult foster home combined with a VA interdisciplinary
home care team, such as VA Home Based Primary Care (HBPC) or Spinal
Cord Injury - Home Care (SCI-HC), to provide non-institutional long-
term care for veterans who are unable to live independently and prefer
a family setting.
2) MFH is a form of Community Residential Care (CRC) for the more
medically complex and disabled veterans, and is generally distinguished
from other CRC homes by the following:
(a) the home is owned or rented by the MFH caregiver;
(b) the MFH caregiver lives in the MFH and provides personal care
and supervision,
(c) There are not more than three residents receiving care in the
MFH, including both veterans and non-veterans,
(d) veteran MFH residents are enrolled in a VA HBPC or SCI-HC
Program.
Each VA Medical Center facility appoints a MFH Coordinator which
oversees the recruitment of staff, new applications for MFH in the
community, training, quality assurance and inspections, and maintaining
files of patients and MFH caregivers.
While this program has been highlighted and encouraged because of
the additional cost savings and access to care options for the veteran
and VA, The American Legion seeks additional feedback from users of
this MFH program about the level of patient safety and feedback on
their quality of care that would be provided in a non-traditional care
setting. We are continuing to study and monitor this situation to
determine the best solution for veterans.
The American Legion has no position on this legislation.
For further questions or comments about this or other legislation
affecting America's veterans please contact The American Legion through
Ian de Planque, Deputy Legislative Director at [email protected]
Prepared Statement of Susan Shore
Good morning Chairman Benishek, Ranking Member Brownley, and
distinguished members of the Health Subcommittee. My name is Dr. Susan
Shore, and I am the Chair of the Scientific Advisory Committee of the
American Tinnitus Association. Thank you for holding this important
hearing on an issue of concern to our nation's armed forces and those
members returning from combat - Tin-night-us or tinn-it-us, most
commonly referred to as ``ringing in the ears.'' Tinnitus has long been
called the ``invisible injury,'' so because of this, and many other
reasons which I will be addressing, it is extremely relevant and timely
that tinnitus is recognized as a mandatory condition for research and
treatment by the Department of Veterans Affairs. On behalf of the
American Tinnitus Association and the 50 million Americans afflicted
with tinnitus I appreciate the opportunity to speak to you today and
respectfully urge your support for H.R. 1443, the Tinnitus Research and
Treatment Act of 2013.
The American Tinnitus Association focuses on curing tinnitus
through the development of resources that advance tinnitus research.
Founded in 1971, ATA is the only member- based and supported, national
non-profit organization, dedicated to finding a cure for tinnitus.
Since 1980 we have funded grants toward better understanding the
mechanisms responsible for and underlying the genesis of tinnitus. Our
Scientific Advisory Committee, comprised of 17 tinnitus investigators
from multiple disciplines across the U.S., conduct peer reviews of all
the grant proposals received at ATA. The most meritorious proposals
with promise to help us get to that cure, are then forwarded to members
of our Board of Directors who make the final funding decisions on these
grants.
The advances in tinnitus research over the past decade have been
extraordinary. Many researchers across the country are breaking down
barriers as I speak, in their own laboratories. One of the most
important advances through research in recent years is the ability to
``visualize'' tinnitus, through the use of advanced functional imaging
technologies and through the development of animal models that can
behaviorally assess the presence of tinnitus. These methods allow us to
pinpoint tinnitus to certain regions of the brain. Another important
advancement that has occurred mainly through the use of animal models
is the discovery that tinnitus is a result of brain plasticity that
occurs in response to outside insults such as noise damage or head and
neck injury. In layman's terms, brain plasticity refers to the ability
of neurons in the brain to change their responsiveness and connectivity
in the face of environmental influences. These developments have led
the scientific community to understand that tinnitus is a disorder of
brain function.
For decades, tinnitus was thought of as a disease of the ear, or
simply a symptom of hearing loss. Because of research we now know that
in most instances, tinnitus does not originate in the ear but rather in
the brain. And we also know that you do not need to have a measurable
hearing loss in order to have tinnitus. While noise overexposure is
still the number one cause of tinnitus, it can also develop in the
absence of hearing damage as the result of a head or neck injury. So,
while the relationship between hearing loss and tinnitus is high, we
still do not understand well why some people with hearing loss develop
tinnitus and others do not. This is an important area of research for
both human and animal models because if we understand why certain
vulnerabilities exist, we can come up with more appropriate treatments.
Tinnitus also does not discriminate. It can happen to anyone at any
time. 50 million Americans experience tinnitus and of those, 16 million
seek medical attention for recurrent or chronic tinnitus. Two to three
million are completely debilitated from their tinnitus rendering them
unable to work, interact with family and friends, or sometimes even
leave their home, degrading their quality of life. In addition to
tinnitus, these people often have feelings of anxiety, depression and
loneliness which can be directly attributed to their condition.
Research has uncovered that depression and anxiety are comorbid
conditions with tinnitus and may be part of the brain circuitry that is
misdirected in bothersome tinnitus.
Specific groups of people are disproportionately impacted by
tinnitus. These groups include, factory workers, police officers and
firefighters, emergency medical technicians, musicians, and, the reason
we are here today - our military personnel and veterans.
Tinnitus is the number one service-connected disability for
returning veterans from Iraq and Afghanistan. As I mentioned before, in
addition to hearing loss, head and neck injury can also contribute to
tinnitus. So while tinnitus in these veterans is most often the result
of extreme noise exposure from either a single impulse noise or the
accumulation of noise exposure, head and neck injury is also a leading
complaint of these veterans. In fact, lumbosacral or cervical strain
account for 23% of service-connected disabilities for Iraq and
Afghanistan veterans as of July 2009. In addition to factors that cause
hearing loss, such as noise over-exposure, the generation and
maintenance of tinnitus can occur as a result of temporal-mandibular
joint disorder, or somatic insults, including lumbosacral or cervical
strain. Research into how these systems interact in the brain has the
potential to lead to treatments such as tailored devices that aim to
ameliorate aberrant brain circuitries resulting from a combination of
hearing loss and head and neck injuries.
Since 2006, service-connected disability payments to veterans from
all periods of service for tinnitus, has been increasing at a rate of
15% per year. In 2012, the VA paid out $1.5 billion in disability
compensation to over 971,000 veterans for tinnitus alone. At the
current rate of increase the cost will exceed $3 billion annually by
2017. This dollar amount does not take into account the extreme
suffering and necessary clinical care for veterans with tinnitus or the
economic loss to society for those who are unable to work as a result
of their tinnitus.
When you consider that cost, in comparison to what is being spent
on tinnitus research in the U.S., there is a severe disconnect. Up
until very recently the amount of money being spent on tinnitus
research has been negligible. At the end of 2012, between all public
and private funding in the U.S., approximately $10 million was spent on
funding research toward a tinnitus cure. Though still a small number,
this is up from a mere $1.5 million in 2005, and that increase has been
all due to Congressional interest in this matter.
What have we learned as a result of recent increased research on
tinnitus? And where do we need to go from here?
It is now well-established that alterations in neural
plasticity in distinct parts of the brain are changed in patient and
animal models of tinnitus. This opens the way for stimulation
treatments that alter the aberrant neural circuitry. Some examples of
this are special devices that provide tailored auditory-somatosensory
or vagal nerve stimulation with the aim of returning the circuits to a
normal state.
Other treatments aim to target changes in the molecular
environment with targeted drug therapies but at present there is no
drug treatment that is specific to tinnitus.
The involvement of non-auditory systems in tinnitus is
increasingly becoming apparent through animal and human tinnitus
experimental models. Understanding these interactions in the brain is
crucial for the development of treatments for alleviating this often
debilitating condition.
Several studies have been conducted by both the Department of
Defense and the Department of Veterans Affairs as a result of the
growing need to address tinnitus in the military. Those studies
directly connect tinnitus as co-morbidity to both Traumatic Brain
injury and Post Traumatic Stress Disorder as well as indicate that
tinnitus is a larger problem than hearing loss in the blast exposed
population. This is why our organization has advocated for the
inclusion of tinnitus as a research condition in tandem with both TBI
and PTSD.
In particular, mild Traumatic Brain Injury or mTBI often includes
tinnitus as a manifestation of injury. mTBI as defined by the
Department of Defense Policy for Mild Traumatic Brain Injury is the
presence of a documented head trauma or blast exposure event, followed
by a change in mental status which could include nausea, dizziness/
balance problems, temporary headache, sensitivity to noise or lights,
vomiting, fatigue, insomnia and sleep disturbances, drowsiness, blurred
vision, memory problems, poor concentration and tinnitus. A recent DoD
study on Iraq veterans exposed to blast indicated that 70% of those
exposed to blast reported tinnitus within the first 72 hours after the
incident. 43% of those seen one-month after exposure to blast continued
to report tinnitus. While the rate decreases over time, tinnitus rates
exceeded hearing loss rates at all the time points. These findings also
demonstrate the need for more comprehensive diagnostics and broader
range of therapeutic approaches for tinnitus which can only be achieved
by continued and additional research on the condition.
There have been some important bipartisan legislative steps taken
by Congress in recent years to address the growing problem of tinnitus
in veterans and active duty military personnel, including the addition
of tinnitus as a researchable condition in the DoD Congressionally
Directed Medical Research Program. The American Tinnitus Association
applauds these efforts, and we very much appreciate the efforts of the
Department of Veterans Affairs through the Portland VA Medical Center's
National Center for Rehabilitative Auditory Research (NCRAR) to support
tinnitus treatment. At the same time, we respectfully believe that
tinnitus, which is so often associated with both TBI and PTSD deserves
additional scrutiny. Improving tinnitus treatment with the goal of
curing this disorder will almost assuredly impact treatment modalities
for these other invisible wounds of war.
Through passage of legislation such as H.R. 1443, the lives of
veterans will be improved. And every research dollar spent, each
discovery, and every step toward a cure for tinnitus benefits all
Americans who suffer with this disorder.''
I would like to close by sharing with you an email (one of hundreds
I receive) that exemplifies the impact of research in the life of a
veteran:
``Dear Dr. Shore
Like many vets I have suffered from tinnitus ever since I was
exposed through my line of work during the four years I served in the
USAF servicing F-4 Phantom Jets from 1966 to 1970. They had massive
engines running nearby and ear protection was often lacking or in need
of repair. My ears would often ring after work but after a few years
began to ring more often until, as now, they ring 24-7. It is now to
the point of changing much of my life through constant use of masking
devices, insomnia and general aggravation. The VA will sometimes allow
a very small 10% disability for tinnitus but has made it very difficult
and time consuming to all but those who can afford an attorney to
represent them. That level of disability amounts to a small pittance of
about 100 bucks a month but can be helpful with hearing aids later in
life.
However, I did file a claim with the VA which after many, many
months was denied, the reason being according to their reviewing
officer is that although I have some reduction in hearing (and had a
reduction from my initial entrance to my discharge exam) it's not
enough under VA standards PLUS they stand by statement quoted from and
publication called the NOISE MANUAL (Fifth Edition, Berger, AIHA Press
2000, P125) ``only seldom does noise cause a permanent tinnitus without
also causing hearing loss''. Aside from the fact that ``hearing loss''
is an arbitrary term and by the VA standard I have none, I am living
proof that this statement is not always true and is not a valid
criteria for denial of claims. Thank you greatly for your time and for
your research into what has become for me a lifelong constant
aggravation.
Yours sincerely, DCS''
This patient is correct in that tinnitus does not always have to
occur in the presence of hearing loss detectable by conventional
clinical methods. However recent research has indicated that more
extensive hearing tests than are performed in the clinic may unveil
hidden abnormality in the auditory system that may contribute to the
brain plasticity underlying tinnitus. Even conventional hearing tests
indicate that up to 19% of adolescents in the United States show
evidence of mild hearing impairment caused by exposure to loud
environmental and recreational sounds. Because peripheral hearing
damage tends to worsen over the years, tinnitus is a looming public
health challenge for citizens of all ages as well as a major disability
affecting thousands of veterans in our armed forces.
Thank you again for the opportunity to be here and bring attention
to tinnitus, a condition that has been far too long neglected. Passage
of legislation such as H.R. 1443 will go a long way to helping us
achieve our goals of improving tinnitus treatment and ultimately,
finding a cure for this disorder. ATA is happy to provide any
additional technical information on existing tinnitus research efforts
as well as our suggestions for future activities, as embodied in the
ATA ``Roadmap'' which is included as an addendum to my testimony.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Adrian M. Atizado
Chairman Benishek, Ranking Member Brownley, and Members of the
Subcommittee:
On behalf of the DAV (Disabled American Veterans) and our 1.2
million members, all of whom are wartime wounded and injured veterans,
I am pleased to present our views on legislative measures that are the
focus of the Subcommittee today.
Draft Bill, the Long Term Care Veterans Choice Act
Many veterans who are disabled due to complex, chronic disease or
traumatic injury may be unable to live safely and independently, or may
have health care needs that exceed the capabilities of their families.
While many of these veterans are placed in nursing homes, others can
remain in their community of choice with proper support, delaying or
avoiding nursing home care. Since 1951, the VA's Community Residential
Care (CRC) Program has provided health care and sheltered supervision
to many of these veterans. This program has evolved through the years
to encompass Psychiatric CRC Home, Assisted Living, Personal Care Home,
Family Care Home, and Medical Foster Home (MFH).
Established in 2000, VA's Medical Foster Home (MFH) program
currently operates under the same authority \1\ as the CRC program. A
type of community residential care facility limited to no more than
three eligible \2\ veteran residents in a private home, caregiver
support is provided by the MFH attendant, and health care supervision
is provided through VA's Home-Based Primary Care program or VA spinal
cord injury home care program.
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\1\ 38, United States Code Sec. 1730.
\2\ (1) The veteran is unable to live independently safely or is in
need of nursing home level care; (2) The veteran must be enrolled in,
or agree to be enrolled in, either a VA Home Based Primary Care or VA
Spinal Cord Injury Homecare program, or a similar VA interdisciplinary
program designed to assist medically complex veterans living in the
home; and (3) The medical foster home has been approved in accordance
with 38 C.F.R. Sec. 17.73(d).
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Patient participation in the MFH program is voluntary and veteran
residents report very high satisfaction ratings. Furthermore, the
administrative costs for VHA are less than $10 per day, and the cost of
Home Based Primary Care, medications and supplies averages less than
$50 per day. VA perceives this program as a cost-effective alternative
to nursing home placement, and it is gaining popularity as evidenced by
the program's expansion at the initiative of local VA providers with
support from local VA facility leadership and VA Central Office.
However, because MHF operates under the CRC authority,
participating veterans must pay the MFH caregiver approximately $1,500
to $4,000 per month for room and board, 24-hour supervision, assistance
with medications, and whatever personal care may be needed. \3\ Even
veterans, who are otherwise entitled to nursing home care fully
reimbursed by VA under the Veterans Millennium Health Care and Benefits
Act (Millennium Act) \4\ or under VA's policy on nursing home
eligibility, \5\ must pay to live independently in a CRC or MFH.
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\3\ 38 U.S.C. Sec. 1730(a)(3).
\4\ P.L. 106-117, 113 Stat. 1545 (1999) required that through
December 31, 2003, VA provide nursing home care to those veterans with
a service-connected disability rated at 70 percent or greater, those
requiring nursing home care because of a condition related to their
military service who do not have a service-connected disability rating
of 70 percent or greater, and those who were admitted to VA nursing
homes on or before the effective date of the act. Subsequent law
extended these provisions.
\5\ VA's policy on nursing home eligibility required that VISNs
provide nursing home care to veterans with 60 percent service-connected
disability ratings who are also classified as unemployable or permanent
and total disabled.
---------------------------------------------------------------------------
Were it not for the MFH program, veterans who meet the nursing home
level of care standards would qualify for VA paid care to receive it at
a significant cost to the Department. In addition, veterans who do not
have the resources to personally pay for room, board, and caregiver
services are not able to avail themselves of this benefit.
DAV is pleased with VA's innovation by offering the MFH program as
part of its long-term services and supports (LTSS) portfolio, and we
applaud the intent of this draft legislation to give VA authority to
enter into an agreement or contract with or a VA approved MFH and pay
for room, board, and caregiver services of veterans already eligible
for VA paid nursing home care.
Accordingly, we support this draft measure based on DAV National
Resolution No. 214, calling for legislation to expand the comprehensive
program of LTSS for service-connected disabled veterans regardless of
their disability ratings.
Mr. Chairman, DAV believes favorable consideration of this draft
bill is a good first step for this subcommittee to assist VA in its
effort to ``rebalance'' its LTSS portfolio. VA is and will continue to
be challenged in providing appropriate LTSS due to the diversity,
increasing number, and medical complexity of the veteran population who
will need these services.
Research on consumer preferences and well-being--together with the
1999 Olmstead decision in which the Supreme Court upheld an
individual's right to receive services ``in the most integrated setting
appropriate''--has motivated states to pursue rebalancing initiatives
to shift LTSS systems away from institutional care and toward a system
that embraces consumer choice and care in the home or community, and to
reduce cost. The federal government's most recent commitment to
rebalancing is found in numerous provisions in the Patient Protection
and Affordable Care Act, where new authorities offer financial
incentives to states to shift rebalancing efforts to the next level in
order to continue to transform the LTSS system.
Though concern about the financing and delivery of LTSS is a
recurring issue among policymakers, states have utilized a variety of
innovative programs and services to rebalance their LTSS services, and
spending for Medicaid Home and Community-Based Services (HCBS) has
increased, accounting for 45 percent of total Medicaid long-term care
services in 2010, up from just 13 percent in 1995. \6\
---------------------------------------------------------------------------
\6\ Kaiser Commission on Medicaid and the Uninsured. ``Medicaid and
Long-Term Care Services and Supports.'' 2012. Available at http://
www.kff.org/medicaid/upload/2186-09.pdf.
---------------------------------------------------------------------------
Today, VA lags behind States in offering and providing HCBS. The
proportion of VA LTSS expenditures devoted to HCBS is little more than
20 percent for FY 2012. Oversight by this Subcommittee is sorely needed
as VA endeavors to shift resources from nursing home care to more cost
effective HCBS in order to serve more veterans while honoring their
preferences. We urge is subcommittee to ensure VA HCBS innovations are
not stifled and VA LTSS encompass a broad range of assistance to
veterans regardless of age who have lost the ability to function
independently thus preventing them to be active participants in their
community.
H.R. 1443, the Tinnitus Research and Treatment Act of 2013
If enacted this bill would require VA to recognize tinnitus as a
``mandatory condition'' for purposes of research and treatment, led by
VA's Auditory Centers of Excellence. The bill also would specify and
define such research to include various assessments and studies of the
condition of tinnitus. Finally, the bill would require cooperation
between VA and the Department of Defense Hearing Center of Excellence
with respect to tinnitus.
Despite tinnitus being the top service-connected condition in the
veteran population today, our members have not approved a DAV national
resolution specific to research about, or treatment of, the condition.
However, as a partner organization of the Independent Budget for Fiscal
Year 2014, DAV believes that nothing should be permitted to interfere
with the scientific merit review process within the VA's research
program, whether for tinnitus or for any other particular condition,
disease, illness or injury.
While we are sensitive to the sponsor's expression of need for more
research into tinnitus, as we would be for any condition endemic in the
veteran population, as we indicated in the Independent Budget,
``Ultimately, scientific merit based on careful peer review must be the
determining factor in whether a [VA research] project is funded, not
pressure from interest groups or interference in the selection of peer
reviewers. The IBVSOs [Independent Budget veterans service
organizations] and FOVA [Friends of VA Medical Care and Health
Research, a 60-organization coalition] contend that between VA's
current peer-review system and the public status of this federally
funded activity, sufficient accountability is present and that no
further outside interference or influence is warranted. The Independent
Budget veterans service organizations urge Congress and VA to take
assertive steps to preserve and protect the quality and transparency of
VA's research funding decisions.''
On the basis of these concerns, expressed collectively by DAV,
AMVETS, Paralyzed Veterans of America and Veterans of Foreign Wars of
the United States, we believe the purpose and requirements imposed by
this bill should be reconsidered by its sponsor.
H.R. 1612, to direct the Secretary of Veterans Affairs to convey a
parcel of land in Tuskegee, Alabama, to Tuskegee University, and for
other purposes
This bill would require the VA to convey 64.5 acres of the present
VA Medical Center in Tuskegee, Alabama, comprising 20 structures, to
the Tuskegee University, for the university's purposes.
We have received no resolution on this specific matter from our
members, and thus, DAV takes no position on this legislation.
H.R. 1702, Veterans Transportation Service Act
This bill would provide VA a renewed authority to transport
individuals in connection with their vocational rehabilitation,
counseling, examination, treatment, or care, and make permanent an
important transportation program after only one year of life.
Notably, VA has implemented the provisions of Section 202 of Public
Law 112-260, the Dignified Burial and Other Veterans' Benefits
Improvement Act of 2012, except for eliminating the authority granted
under Section 111A of title 38, United States Code, to create a VA-
operated transportation program one year after enactment. That act had
prompted VA to initiate the Veterans Transportation Service (VTS),
supported by the Veterans Health Administration (VHA) Chief Business
Office (CBO). The VTS was established to provide veterans with
convenient and timely access to transportation services and to overcome
access barriers certain veterans may have experienced, and in
particular to increase transportation options for veterans who need
specialized forms of transportation to VA facilities. The VTS
transportation services to VA medical centers include the use of
technology and mobility management training for medical center staff
that in turn enable VTS services to better interface with other
community transportation resources.
VA medical centers and sites where VTS is operating can be ideal
partners with the DAV National Transportation Network and for the
Veterans Transportation and Community Living Initiative grant projects
establishing One-Call/One-Click Transportation Resource Centers. Based
on our review of this situation, were it not for the expiration of
statutory authority from Public Law 112-260, VTS would have grown from
its current 45 sites to all remaining VA locations by 2015.
The DAV National Transportation Network continues to show
tremendous growth as an indispensable resource for veterans. Across the
nation, DAV Hospital Service Coordinators operate 200 active programs.
They have recruited 9,249 volunteer drivers who logged over 27 million
miles last year, providing almost 721,000 rides for veterans to and
from VA health care facilities. These veterans rode in vans DAV
purchased and donated to VA health care facilities for use in the DAV
National Transportation Network. DAV Departments and Chapters, together
with our national organization, have now donated 2,586 vans to VA
health care centers nationwide at a cost to DAV of $56.7 million.
DAV believes VTS serves the transportation needs of a special
subset of the veteran patient population that the DAV National
Transportation Network is unable to serve--veterans in need of special
modes of transportation due to certain severe disabilities. We believe
that with a truly collaborative relationship, the DAV National
Transportation Network and VTS will meet the growing transportation
needs of ill and injured veterans in a cost-effective manner.
Currently, DAV supports enactment of this bill; however, our
support is based on the progress gained through our collaborative
working relationship with VHA and CBO to resolve weaknesses we have
observed in the VTS program. As you may be aware, VTS operates with
resources that would otherwise go to direct medical care and services
for veterans. These resources should be used carefully for all
extraneous programs to ensure veterans are not denied care when they
most need it.
We thank VHA and CBO for their commitment and continuing efforts in
working with DAV to ensure VTS will indeed work in concert with all
existing and emerging transportation resources for veterans who need VA
care, and to guard against fraud, waste and abuse of these limited
resources.
We look forward to continuing our work with the Committee on this
measure, and to work for its passage.
H.R. 2065, Safe Housing for Homeless Veterans Act
The Safe Housing for Homeless Veterans Act would amend Title 38,
United States Code, to require entities that receive per diem payments
through the Department of Veterans Affairs (VA), for the provision of
services to homeless veterans, to submit an annual certification to the
Secretary of Veterans Affairs proving that the building where the
entity provides housing or services is in compliance with codes
relevant to the operations and level of care provided.
The certification would include compliance with requirements
outlined in the recently published version of the Life Safety Code,
International Building Code and International Fire Code, or similar
codes that have been adopted as State or local codes in the
jurisdiction of the project. In addition, all licensing requirements
regarding the condition of the structure and the operation of
supportive housing or service center, including fire and safety
requirements, must be provided.
For entities that receive per diem payments during the year in
which the legislation is enacted, the recipient must submit all
certifications required no later than two years after the date of
enactment to the Secretary, or additional per diem payments will be
halted until certification is received.
DAV previously testified on a similar bill, H.R. 4079 introduced in
the 112th Congress, that while we did not have a National Resolution
from our membership specifically covering the state of the housing
provided to veterans or the safety of the facilities where homeless
services are provided, we did not oppose favorable consideration of the
legislation. Since that hearing, it has been brought to our attention
that the requirements outlined in H.R. 2065 may adversely impact Grant
and Per Diem providers, which could leave many homeless veterans and
their family without the services they need.
While DAV agrees with the intent of the measure to provide safe
shelters for our homeless veterans, we urge the Subcommittee work with
VA and Homeless Grant and Per Diem providers, to mitigate any
detrimental effects this bill may have while meeting the needs of
homeless veterans in a safe environment.
DAV appreciates the opportunity to submit our views on the
legislative measures under consideration at this hearing. This
concludes my testimony, Mr. Chairman. I would be pleased to answer any
questions related to my statement and the views I have expressed on
behalf of DAV.
Prepared Statement of Robert Drexler
Good morning, Mr. Chairman, and distinguished Members of the
Subcommittee. My name is Robert Drexler, Member of the Board of
Directors of the International Code Council. I also serve as Fire
Marshal for the town of Greece, New York . I am pleased to be here to
discuss the importance of compliance with building and fire codes,
speaking on behalf of the over fifty thousand building, fire code
officials and other professionals across the United States who are the
members of the Code Council.
The Code Council was formed in 1994 as a nonprofit organization
dedicated to developing a single set of comprehensive and coordinated
national model construction codes. The founders of the ICC were the
Building Officials and Code Administrators International, Inc. (BOCA),
International Conference of Building Officials (ICBO), and Southern
Building Code Congress International, Inc. (SBCCI). Since the early
1900s, these nonprofit organizations developed three separate sets of
regional model codes used throughout the United States. We joined these
three groups together, and published a single code for the United
States- the International Codes- beginning in 2000. In 2003, the
International Code Council became the successor organization to the
three legacy code groups, and so we are celebrating our tenth
anniversary as an organization in 2013.
Today our International Model Codes have been adopted at the state
or local level in all 50 states and the District of Columbia. Numerous
federal agencies, including the General Services Administration, the
Department of Defense and the Architect of the Capitol have implemented
the I-Codes, as have Puerto Rico and the U.S. Virgin Islands. The Code
Council's 50,000 members and over 300 chapters include state, county
and municipal code enforcement and fire officials, architects,
engineers, builders, contractors, elected officials, manufacturers and
other construction industry professionals.
I come before you today to encourage support for HR 2065, the Safe
Housing for Homeless Veterans Act, sponsored by Rep. David McKinley of
West Virginia and Rep. Grace Napolitano of California. Those of us who
work in the realm of building safety at both the state and local level
appreciate the concern that this bill has for the welfare of our
veterans, who are living in housing subsidized by the Department of
Veterans Affairs.
In the building sector, the International Residential Code, the
International Building Code, and the International Fire Code establish
the basic requirements for building safety at the time of construction,
and in the case of the Fire Code, at the time of the annual inspection.
These codes do not guarantee that a building will be safe from any and
all hazards, as destructive forces can bring down any building if
enough force is applied. But the codes do assure that when faced with
the typical hazards that buildings are expected to encounter, including
fire, windstorm, flooding, and even normal or even somewhat careless
daily use, the building will allow for building residents and users to
survive, and for first responders to safely rescue building occupants,
and minimize property damage.
In most jurisdictions around the country, either at the state
level, or at the local jurisdictional level, both the International
Building Code (IBC) and the International Fire Code (IFC) assure that
buildings used for residential care and housing are safe. Our local
code officials around the country inspect veterans' homes and assure
that they meet currently adopted codes, just as they do other
commercial buildings. This is true in California, as well as 42 other
states that have adopted both the IBC and the IFC. In fact all 50
states have adopted the IBC at either the state or local level, and 43
states adopt the IFC, while a significant number also adopt the Life
Safety Code(LSC), at either the state or local level.
HR 2065 wisely does not attempt to mandate one code or the other
for compliance by facilities approved by the Department of Veterans
Affairs for reimbursement, but requires a certification from all homes
that they meet either the IBC and IFC, or the LSC, which are
functionally, and from a safety standpoint, equivalent code
requirements.
In addition, the bill does not impose any onerous administrative
burden on the Department of Veterans Affairs, other than to assure that
each facility receiving reimbursement has filed a certification, either
from the local code official, or from a competent third party, that
code requirements are met. This is a reasonable and very workable
requirement that mirrors similar requirements in place for other
medical facilities that must provide very similar assurances to the
Centers for Medicaid and Medicare (CMS), in the Department of Health
and Human Services.
It is true that for veterans' homes covered by this requirement
that are located in a jurisdiction that does not adopt and enforce
either the IFC or LSC, there will be a small additional burden of
obtaining an annual inspection to show compliance with the relevant
code provisions. However, it is the clear intent of the bill sponsors,
and a worthy goal in our opinion, that the safety of our veterans, who
sacrificed so much for our freedoms, should be provided with safe
housing, especially when the taxpayer is subsidizing that housing. It's
hard to argue that our veterans should not be assured of minimal safety
in their housing, when the cost of assuring safety is a few hundred
dollars or less.
In closing, the International Code Council is proud of our work in
developing the model codes used by most jurisdictions to assure a basic
level of safety in the built environment, and we applaud your efforts
to use those codes to protect the safety of our veterans. We continue
to work to update and improve the codes, issuing revised codes every
three years, through our governmental consensus process for the
regulation of building construction. I applaud the work of your
Subcommittee and encourage continued collaboration between the public
and private sectors to achieve the important goal of increased safety
in our nation's buildings. Thank you again for the opportunity to
appear before you today. I will gladly answer any questions.
Prepared Statement of Raymond C. Kelley
MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE:
On behalf of the men and women of the Veterans of Foreign Wars of
the United States (VFW) and our Auxiliaries, I would like to thank you
for the opportunity to offer testimony on today's pending legislation.
H.R. 1443, the Tinnitus Research and Treatment Act of 2013
The VFW supports this legislation which would require the
Department of Veterans Affairs (VA) to recognize tinnitus as a
mandatory condition for research and treatment by the VA Auditory
Centers of Excellence in cooperation with the Department of Defense
Hearing Center of Excellence. Characterized by a steady or intermittent
ringing of the ears, tinnitus can cause sleep disruption, cognitive
impairment and employment difficulties, and can worsen the symptoms of
depression and anxiety disorders. Tinnitus is the most frequent
service-connected disability awarded by VA among veterans of all eras.
The common causes of tinnitus are acoustic trauma and traumatic brain
injury, placing Iraq and Afghanistan veterans at particularly high risk
due to IED blast exposure. Since 2000, the number of veterans who are
service-connected for tinnitus has increased by at least 16.5 percent
each year.
Although there is no known cure for tinnitus, it should not be
assumed that the condition is untreatable. VA's Progressive Tinnitus
Management approach, which assists tinnitus suffers through individual
counseling and support, is helping veterans better manage their
symptoms. Still, more research is needed in order to identify truly
effective treatments to alleviate those symptoms. This bill represents
a positive first step towards achieving that goal.
H.R. 1612, to direct the Secretary of Veterans Affairs to convey a
parcel of land in Tuskegee, Alabama, to Tuskegee University.
The VFW supports H.R. 1612, a bill that directs the Secretary of VA
to convey a parcel of land in Tuskegee, Alabama, to Tuskegee
University. More than 90 years ago, Tuskegee University, a land grant
university, voted to donate 300 acres of land so the United States
government could build a veterans hospital. Today, 21 of the buildings,
accounting for nearly 280,000 square feet of space, sit vacant on that
property. Nearly half of the buildings that would accompany the
transfer are former quarters for employees who worked in housekeeping
within the hospital, while several others are small 500 square feet or
less storage buildings.
Annually, VA spends approximately $2 per square foot to maintain
vacant space. For the buildings that fall within this land transfer, VA
spends more than $500,000 per year in maintenance. Reducing the
financial burden for upkeep of these buildings and grounds will allow
VA to better use those non-recurring maintenance funds to ensure the
highest level of maintenance for the facilities that provide care and
service to our veterans and not on buildings that are sitting vacant.
With nearly 1000 vacant or underutilized buildings within their
system, the VA must work to right-size its property inventory,
decreasing its footprint in some areas and increasing it in others. In
doing so, VA must ensure they can provide a full continuum of care for
veterans. At the Tuskegee VA Campus, programs and services have been
expanded to include homeless shelters, community living facilities and
women veterans services. Knowing VA has utilized as much of the
property as possible, it is a financially responsible decision to
return 64.5 acres of the original 300 acres land and improvements back
to Tuskegee University.
H.R. 1702, the Veterans Transportation Service Act
The VFW supports this legislation to permanently authorize the
Veterans Transportation Service (VTS). This program, commissioned by
the VHA Office of Rural Health in 2010, has greatly improved access to
care for rural and seriously disabled veterans by allowing VA
facilities to establish and coordinate networks of local transportation
providers, including community and commercial transportation providers,
and government transportation services. The VTS augments veterans
service organizations' volunteer-based transportation services, which
are limited to transporting ambulatory veterans, and supplements the
existing beneficiary travel programs of mileage reimbursement, which
does not provide assistance with the coordination of transportation for
those who need it, and special mode travel, for which few veterans
medically qualify.
The VTS suffered a major setback in 2012 when it was temporarily
suspended following a determination by the VA Office of General Counsel
that VA lacked the statutory authority to hire paid drivers to
transport veterans. Congress wisely passed a one-year authorization of
the VTS program in January 2013, but a long-term fix is still needed.
The VFW believes that unnecessary hardships associated with
accessing VA health care should be eliminated at every opportunity.
This legislation would guarantee the continuation and future expansion
of VTS, which plays a critical role in minimizing the challenges many
veterans face in traveling to their appointments due to physical
disabilities or great distances.
H.R. 2065, the Safe Housing for Homeless Veterans Act
The VFW supports this legislation which would require facilities
that house homeless veterans to meet all relevant local building codes
in order to receive per diem payments under the VA Homeless Providers
Grant Per Diem Program. Currently, VA is required to check housing
certificates before awarding grants for housing services provided to
homeless veterans. However, thorough checks of fire and safety
requirements, as well as structural conditions of the building, are
often overlooked. The bill requires that current recipients of per diem
payments submit certification of compliance with local codes within two
years of the enactment of this act, giving them ample time to make any
necessary improvements.
The VFW believes that VA funded transitional housing must be safe,
secure, and sanitary. This bill would ensure that those standards are
met, providing homeless veterans with the best chances of successful
community reintegration.
Draft Bill, the Long-Term Care Veterans Choice Act
The VFW supports this legislation, which would add language to
Section 1720 of Title 38 to allow veterans who receive VA care and
require a protracted period of nursing home care to transfer into an
adult foster home at their request. Under the bill, such homes must be
``designed to provide non-institutional, long-term, supportive care for
veterans who are unable to live independently and prefer a family
setting.'' VA currently has the authority to reimburse institutional
care facilities such as nursing homes for long-term domiciliary care,
but veterans who choose to live in adult foster homes must do so at
their own expense. To grant VA the authority to reimburse adult foster
homes would provide veterans with an additional residency choice,
potentially improving the quality of life for those who would prefer
this option.
The VFW strongly believes that all non-VA services should be
provided in conjunction with proper care coordination. VA Handbook
1141.02, Medical Foster Home Procedures, establishes the policies and
standards of VA care coordination for veterans who choose to live in
medical foster home settings. It requires an interdisciplinary VA Home
Care Team to provide the veteran with primary care, regularly
communicate with the foster home caregiver, and monitor the care
provided by the foster home with frequent unannounced visits. The VFW
feels that these would ensure adequate care coordination for veterans
who chose to participate in a fully-funded adult foster care program.
VA Handbook 1411.02 is scheduled for recertification in 2014, and the
VFW recommends that the care coordination policies outlined in that
document should be made permanent by adding them to the language of
this legislation.
Mr. Chairman, this concludes my statement. I am happy to answer any
questions you or other Members of the Committee may have.
Information Required by Rule XI2(g)(4) of the House of Representatives
Pursuant to Rule XI2(g)(4) of the House of Representatives, VFW has
not received any federal grants in Fiscal Year 2013, nor has it
received any federal grants in the two previous Fiscal Years.
Prepared Statement of Robert L. Jesse
Good Morning Chairman Benishek, Ranking Member Brownley, and
Members of the Subcommittee. Thank you for inviting me here today to
present our views on several bills that would affect Department of
Veterans Affairs (VA) health programs and services. Joining me today is
Susan Blauert, Deputy Assistant General Counsel.
We do not yet have cleared views on H.R. 1612, a bill that would
direct VA to convey a parcel of land to Tuskegee University. We will
forward views and any estimated costs to you as soon as they are
available.
H.R. 1443 Tinnitus Research and Treatment Act of 2013
Section 2 of H.R. 1443 would require VA to recognize tinnitus as a
mandatory condition for research and treatment by VA Auditory Centers
of Excellence. Section 3 of the bill would require the Secretary to
ensure that research on the prevention and treatment of tinnitus is
conducted at VA facilities. Required research would include an
assessment of the efficacy of multidisciplinary tinnitus treatment
modalities on different subsets of patients; studies on the underlying
etiology of tinnitus in Veteran populations that occur as a result of
different causal factors, including blast-related tinnitus, where there
is no measurable hearing loss, versus other forms of noise-induced
tinnitus, where there is hearing loss; and a study of the underlying
mechanisms between hearing loss and tinnitus, including cases in which
one or the other condition is present, but not both. VA would be
required to ensure VA cooperation with the Hearing Center of Excellence
established by the Department of Defense (DoD) to perform further
research on tinnitus.
This bill appears to be consistent with existing programs and
operations within the Veterans Health Administration. Therefore, we do
not believe this legislation is necessary.
VA Audiology Clinics currently provide tinnitus treatment through
VA's Progressive Tinnitus Management Program, a five-level program that
provides education and treatment services to Veterans tailored to the
degree of the disabling effects of tinnitus. Basic tinnitus
intervention involves group educational counseling focused on providing
Veterans with the knowledge and skills to self-manage their tinnitus.
This group counseling involves interdisciplinary collaboration between
audiology and psychology. For those Veterans who do not obtain relief
from hearing aids or group educational counseling, VA offers treatment,
including a comprehensive assessment and individualized counseling. If
none of the above services are beneficial, VA begins treatment
involving individualized management including relaxation techniques,
cognitive behavioral therapy, drug therapy, sound-based therapy, and
combined techniques. VA has also developed patient education materials
and clinical training materials to advise clinicians on how best to
identify, diagnose, and treat tinnitus and other auditory conditions.
VA's National Center for Rehabilitative Auditory Research (NCRAR),
a VA Rehabilitation Research and Development Center of Excellence, has
active research projects underway on the efficacy of multidisciplinary
tinnitus treatment (e.g., Progressive Tinnitus Management) as
referenced in Subsection (1) of Section 3 of the bill. NCRAR is also
collaborating with the VA Audiology Program to develop and evaluate
Progressive Tinnitus Management at VA medical centers.
VA has active research projects underway addressing the underlying
etiology of tinnitus, as well as the mechanisms underlying the co-
occurrence of hearing loss and tinnitus, as referenced in Subsections
(2) and (3) of Section 3.
VA is also collaborating with DoD on the development of the Defense
Center of Excellence for Hearing Loss and Auditory System Injuries, as
mandated by Congress in section 721 of Public Law 110-417. The Center
will develop a registry of information to track the diagnosis, surgical
intervention, or other operative procedure, or treatment, and follow up
for each case of hearing loss and auditory system injury incurred by
Servicemembers while on active duty. This registry will also facilitate
an electronic data exchange with VA. The law further requires the
Center to collaborate with NCRAR and VA to ensure coordination of
ongoing auditory system rehabilitation benefits and services by VA.
VA believes that implementation of H.R. 1443 would be cost-neutral,
if enacted, because VA already complies with the provisions of the
bill.
H.R. 1702 Veterans Transportation Service Act
VA supports this legislation which would permanently extend the
Secretary's authority to hire qualified drivers to transport any person
to or from a Department facility or other place in connection with
vocational rehabilitation or counseling required by the Secretary
pursuant to chapter 34 or 35 of title 38, or for the purpose of
examination, treatment, or care. The Veterans Transportation Service
(VTS) depends on paid drivers to provide transportation services.
Section 111A of title 38 of the United States Code (U.S.C.) currently
provides authority for use of paid drivers until January 9, 2014.
Through the VTS program, VA provides funding to local VA facilities
for mobility managers, transportation coordinators, and vehicles to
complement the existing services that volunteers already provide. The
service provides Veterans with transportation to and from their VA
health care appointments, improving both access to care and continuity
of care for many who would otherwise be limited in mobility. In 2012,
VTS provided Veterans with more than 199,000 one-way trips totaling
more than 9.7 million miles. The average length of a one-way trip is
over 48 miles--a considerable distance and a prohibitive one for those
with poor health if transportation were not available. Veterans with
prostheses or those who use wheelchairs have particularly benefited
from the VTS program.
Veterans Service Organizations such as Disabled American Veterans
are invaluable in providing volunteers for VA's Volunteer
Transportation Network. However, with increasing numbers of
transportation-disadvantaged Veterans, there simply are not enough
volunteers in all regions of the country to serve the level of need.
Furthermore, volunteer drivers are generally precluded from
transporting Veterans who are not ambulatory, require portable oxygen,
have undergone a procedure involving sedation, or have other clinical
issues. Some volunteers, for valid reasons, are reluctant to transport
non-ambulatory or very ill Veterans. Without paid drivers, many
Veterans would not have transportation to get to their medical
appointments to receive the care they need.
VA was grateful for enactment of the temporary authority to ensure
we could continue to use paid drivers in the VTS program. The temporary
nature of the authority, however, has impacted expansion of VTS, as VA
facilities have been cautious in adding staff in light of the
expiration that would occur early next year without legislative action.
This has understandably dampened our ability to expand the program.
Permanent authority will provide this beneficial program with the
stable foundation it merits.
VA is unable to provide an accurate estimate of the cost savings
associated with this bill at this time. However, since VTS became
operational, savings have resulted from the use of paid VA drivers over
Beneficiary Travel Special Mode transportation. VA paid drivers are a
less expensive option than Special Mode transport. VA is closely
examining the cost data across locations where VTS is implemented and
will provide this information for the record as soon as we are able.
H.R. 2065 Safe Housing for Homeless Veterans Act
H.R. 2065 would amend 38 U.S.C. 2012(c)(1), which requires that
Grant and Per Diem (GPD) grantees or eligible entities comply with
specified fire and safety rules. In place of the current section
2012(c)(1), H.R. 2065 would impose a new requirement that would limit
per diem payments to grant recipients or eligible entities who submit
an annual certification (that has been approved or verified by the
``authority having jurisdiction or a qualified third party'') that the
building where the entity provides housing or services is in compliance
with codes ``relevant to the operations and level of care provided.''
VA does not support H.R. 2065. We are concerned it would
fundamentally shift VA's role in inspecting and overseeing GPD
facilities and would shift some of the costs of facility inspections
from VA to the GPD grantee. Currently, VA ensures that GPD facilities
meet the requirements of the Life Safety Code (LSC) of the National
Fire Protection Association through on-site inspections of each
facility by staff from the local VA medical center. The inspection team
includes representatives from the local VA medical center, who are
responsible for ensuring that general operating requirements as noted
in GPD regulations are met. The inspection team members are responsible
for the review of the project in the following areas: clinical,
facilities management, security/law enforcement, and nutrition and food
services. The facilities management portion of the inspection includes
a requirement for VA staff to evaluate compliance with the LSC. These
projects must pass an initial inspection prior to per diem being
awarded. Any deficiencies (e.g., nutrition, security, clinical, safety)
noted by the inspection team must be corrected by the GPD-funded
organization before the project can become operational. A completed
initial inspection is signed by the VA medical center Director,
approving the placement of Veterans within the project. The inspection
packet is then reviewed by the Veterans Integrated Service Network
(VISN) Homeless Coordinator for completeness and sent to the GPD
National Program Office. GPD providers are also subject to annual re-
inspection. The annual inspections are conducted in the same manner as
the initial inspection. VA is concerned that merely requiring a
certification of compliance with the LSC would remove an essential
component of VA's GPD facility inspection process making homeless
Veteran transitional housing less safe and secure.
Presently, the cost of inspecting a GPD facility for compliance of
the LSC currently falls on VA. Ostensibly, section 2(a)(1) of H.R. 2065
would shift the cost of LSC compliance to the GPD provider. Because
section 2(a)(1) merely specifies that the annual certification must be
``approved or verified by the authority having jurisdiction or a
qualified third party,'' the concern is that a GPD provider would
receive certifications of compliance from individuals or entities who
are not truly qualified to certify compliance. Under the current
statute and regulations, VA officials inspect and determine whether GPD
facilities comply with the LSC. VA inspectors are directly accountable
to the Department, and there are no concerns about the suitability or
qualifications of third parties providing ``certifications.'' However,
VA notes that many of the concerns addressed by section 2(a)(1) could
be resolved through regulation.
Furthermore, VA does not agree with the suggestion in section
2(a)(1) that the ``International Building Code and International Fire
Code'' are a suitable alternative to the LSC. VA is not aware of any
single standard that is comparable to the LSC. The LSC is unique in
that it is organized with chapters that address each occupancy type,
has specific infrastructure requirements for existing as well as new
facilities, and also provides operational requirements. The LSC
accomplishes by itself what it would require multiple other codes to
accomplish. For example, if the International Code Council (ICC) Family
of codes was utilized, it would require use of the International
Building Code, International Residential Code, International Fire Code,
and International Existing Building Code in order to encompass the same
scope as the LSC.
While a different set of standards (other than the LSC) could be
utilized to provide a comparable set of fire and safety requirements,
VA believes that introducing another set of codes and standards would
not benefit Veterans or VA in any material way. It would also not
likely result in increasing the number of facilities that could be
approved for the GPD program, and it could create an added burden for
VA by potentially requiring VA staff to be trained on two sets of codes
and standards instead of one.
It should also be noted that VA facilities receive accreditation
from The Joint Commission, which requires compliance with the LSC. VA
uses the LSC for all VA facilities (including accredited facilities) to
establish consistency across the country for minimum life safety
requirements, code interpretation, and fire safety training for VA
staff. Finally, section 2(b)(2) could be an extremely burdensome and
costly reporting requirement. Although section 2(b)(2) gives little
guidance on the extent and scope of these reporting requirements, it
requires an evaluation of all facilities receiving per diem payments.
Since VA has an active and robust cadre of GPD Liaisons, individuals at
the local VA medical center who liaise with GPD grantees and ensure
compliance with inspection findings, VA does not believe these
potentially burdensome reporting requirements are necessary.
If enacted, this bill would be cost neutral to VA; however the cost
to VA's community-based providers could be substantial.
Draft bill entitled the ``Long-Term Care Veterans Choice Act''
The draft bill would allow Veterans, for whom VA is required to
provide nursing home care by law, to request a transfer to homes
designed to provide non-institutional long-term supportive care for
Veterans, who are unable to live independently and prefer to live in a
family setting. VA would pay the expenses by a contract or agreement
with the home. One condition upon the transfer would be the Veteran's
agreement to accept home health care services furnished by VA.
VA supports the Medical Foster Home (MFH) concept, where eligible
Veterans who would otherwise need nursing home care could get, when
clinically appropriate, long-term care in a more personal home setting.
VA endorsed this idea in its fiscal year 2014 budget submission. Our
experience has shown that VA-approved MFHs can offer safe, highly
Veteran-centric care that is preferred by many Veterans at a lower cost
than traditional nursing home care. While endorsing the MFH concept, VA
cannot today offer a complete evaluation of the text of the draft bill.
We have been working with the Subcommittee on technical assistance and
look forward to further discussion.
Mr. Chairman, thank you for the opportunity to present VA views on
these bills, and we will be glad to answer any questions you or the
other Members may have.
Statements For The Record
U.S. REP. RON BARBER
H.R. 1702 the Veterans Transportation Service Act
Mr. Chairman and Ranking Member Brownley, thank you for your
leadership on this subcommittee, which is so vital to meeting the
health care needs of America's veterans.
Thank you for the opportunity to attend this hearing and to offer
testimony on H.R. 1702, the Veterans Transportation Service Act. I
apologize that I cannot be here in person, as I am with the Arizona
Congressional Delegation attending the funerals of nineteen
firefighters who perished fighting the Yarnell Hill Fire.
Mr. Chairman, according to data provided by the Department of
Veterans Affairs and Veterans Service Organizations, about six million
veterans reside in rural areas of the United States.
Of these six million veterans, more than half are enrolled in the
Department of Veterans Affairs healthcare system.
In my district alone, there are nearly ninety thousand veterans,
many of whom live outside of the major cities in communities very far
away from VA clinics or service centers. My office receives a
significant number of calls every week from veterans who live in rural
areas and who need medical services from the VA and for whom
transportation is a major problem.
The stories that I hear from rural veterans are no different, I
imagine, from those that you are hearing from veterans in your
districts as well.
Those who live in rural areas are not the only veterans who need
assistance. Thousands of veterans who live in the cities and towns
across this nation need help with transportation as well.
In 2010, the Department of Veterans Affairs launched a Veterans
Transportation Service (VTS) initiative to enhance transportation
options for veterans who were seeking health care at VA facilities.
Through the Veterans Transportation Service, funding is provided to
local VA facilities to hire transportation coordinators and purchase
vehicles driven by VA-trained staff.
Over the course of the last two years, VTS has provided veterans
with more than 199,000 trips to medical facilities, totaling more than
9.7 million miles in 37 states.
As you can tell from these numbers, this is a service that plays an
important role in supporting our veterans. I believe we need to expand
it so that we may assist transportation-disadvantaged veterans in other
un-served or underserved areas of the country.
I have introduced H.R. 1702, along with my colleague and Vice
Chairman of the House Armed Services Committee, Mac Thornberry, to
enact a permanent reauthorization for the VTS service.
I would be remiss if I did not also mention the leadership provided
by Senator Jon Tester on this issue as well; he is a champion in the
Senate where this legislation also has strong bipartisan support.
Last year, the VA's Office of General Counsel raised questions as
to whether the VA could hire drivers to operate the VTS without
specific Congressional authorization. The program was discontinued as a
direct function of the VA.
Luckily, with Senator Tester's leadership, the Congress moved
quickly at the end of last year to provide the authorization needed to
get the program back in operation.
That authorization will only run until the end of 2013.
Questions have been raised about the possibility of volunteers
providing transportation.
We all appreciate the invaluable volunteer transportation
assistance the Disabled American Veterans provide to veterans, but
there are many veterans who need a service different from the one
provided by the DAV. The VTS is therefore complementary, not
competitive, to the DAV program.
VA Mobility Managers are trained to help make transportation
decisions that are in the best interest of the veteran, often directing
veterans to DAV services when appropriate and available.
VTS drivers operate Americans with Disabilities Act compliant
wheelchair and stretcher vehicles.
For those veterans who are not ambulatory, who require portable
oxygen, who have undergone a procedure involving sedation, or who have
other clinical issues, these transportation services are critical to
ensure their safe transportation to medical appointments and
facilities.
One of the most important aspects of the Veterans Transportation
Service Act is that it saves the taxpayers money.
The Department of Veterans Affairs has projected that they will
save 19.2 million dollars in fiscal year 2014 alone by using the VTS
for appropriate patients.
This legislation is estimated to save the VA over 100 million
dollars in five years. This is money that could be well spent on other
aspects of veteran care.
I believe HR 1702 is critical to the care of veterans in my
Southern Arizona district and across this nation.
I urge the Committee to take up this needed legislation so that the
VA can continue and expand the VTS program. Thank you again for the
opportunity to present this testimony, and I look forward to answering
your questions. Thank you.
NATIONAL ASSOCIATION OF STATE FIRE MARSHALS
Mr. Chairman and Honorable Members of the House Committee on
Veterans' Affairs Subcommittee on Health, the National Association of
State Fire Marshals (NASFM) is pleased to submit this statement for the
record in support of HR 2065, the Safe Housing for Homeless Veterans
Act. NASFM applauds Congressman McKinley's leadership on this issue.
NASFM's mission is to protect life, property and the environment
from fire and related hazards. NASFM's members are the senior fire
safety officials in the United States and the District of Columbia.
State Fire Marshals' responsibilities vary from state to state, but
most State Fire Marshals are responsible for fire safety code adoption
and enforcement, fire and arson investigation, fire incident data
reporting and analysis, public education and advising Governors and
State Legislatures on fire protection matters. Some State Fire Marshals
are responsible for fire fighter training, hazardous materials incident
responses, wildland fires and the regulation of natural gas and other
pipelines.
In connection with their code adoption and enforcement
responsibilities, State Fire Marshals care deeply that occupancies of
all kinds meet minimum safety code requirements--particularly those in
which groups of individuals, at least some of whom may be challenged
physically, gather and spend the night. We have learned from HR 2065's
sponsor, Congressman McKinley, that more than 67,000 veterans are
homeless on any given night, and, over the course of a year,
approximately twice that many experience homelessness. Just as our
veterans helped to ensure the safety of Americans during their active
service, the United States should do no less for them now, especially
if they are experiencing the hardship of homelessness.
Without HR 2065, homeless veteran shelters are subject to whatever
fire and building codes apply in their particular jurisdiction. In some
places, the existing codes establish minimum requirements that are
enforced. However, in some states, no minimum building or fire code
requirements exist, except in the larger cities. And within states,
code requirements can vary from jurisdiction to jurisdiction, as do the
capabilities of code enforcement entities.
This is why it is crucial to include a provision in HR 2065 that
would require any state or local code to provide an equivalent or
higher level of safety than is provided by the Life Safety Code.
According to the National Fire Protection Association, the scope of the
Life Safety Code (also known as NFPA 101) is as follows: ``The Code
addresses those construction, protection, and occupancy features
necessary to minimize danger to life from the effects of fire,
including smoke, heat, and toxic gases created during a fire. The Code
establishes minimum criteria for the design of egress facilities so as
to allow prompt escape of occupants from buildings or, where desirable,
into safe areas within buildings. The Code addresses other
considerations that are essential to life safety in recognition of the
fact that life safety is more than a matter of egress. The Code also
addresses protective features and systems, building services, operating
features, maintenance activities, and other provisions in recognition
of the fact that achieving an acceptable degree of life safety depends
on additional safeguards to provide adequate egress time or protection
for people exposed to fire. The Code also addresses other
considerations that, while important in fire conditions, provide an
ongoing benefit in other conditions of use, including non-fire
emergencies. The Code does not address . . . general fire prevention or
building construction features that are normally a function of fire
prevention codes and building codes.''
NASFM believes that the Life Safety Code is an appropriate code to
cite in HR 2065 for minimum safety criteria, because it not only
contains both fire and building safety provisions, but it also
addresses both new and existing buildings in the same code. Another
Federal agency, the Centers for Medicare & Medicaid Services, requires
compliance with the Life Safety Code by health care organizations in
order to begin and continue participating in the Medicare and Medicaid
programs, so there is precedence for its use in this situation. By
referencing the most current edition of the Life Safety Code (the 2012
edition being the most recent), HR 2065 would help ensure that homeless
veterans are protected with a consistent fire protection code if they
are sheltered in occupancies that receive grants from the Secretary of
Veterans Affairs, no matter where in the United States they may be.
Applicable provisions of the International Building Code and the
International Fire Code - or the versions of those codes that have been
adopted at the state or local levels by the jurisdiction in which the
project is located - may be appropriately applied instead of the Life
Safety Code, as long as they are demonstrated to provide equivalent or
higher levels of safety than is provided by the Life Safety Code. We
know from our discussions with Congressman McKinley's staff that this
bill does not intend to preempt any state or local codes that may
provide an equivalent or higher level of life safety than HR 2065 would
provide. Fire and building safety codes are an intricate subject, to
say the least. As the debate on HR 2065 continues, NASFM stands ready
to work with the U.S. Congress and the U.S. Department of Veterans
Affairs if questions arise regarding the implementation of the code-
related provisions of this bill.
NATIONAL COALITION FOR HOMELESS VETERANS
Chairman Dan Benishek, Ranking Member Julia Brownley, and
distinguished members of the House Committee on Veterans' Affairs,
Subcommittee on Health:
The National Coalition for Homeless Veterans (NCHV) is honored to
present this Statement for the Record for the legislative hearing on
July 9, 2013. On behalf of the 2,100 community- and faith-based
organizations NCHV represents, we thank you for your steadfast
commitment to serving our nation's most vulnerable heroes.
This statement will focus on Rep. David McKinley's H.R. 2065, the
``Safe Housing for Homeless Veterans Act.'' While we are appreciative
of any effort to protect homeless veterans from unnecessary harm as
they work to reintegrate into society, NCHV believes that this bill as
currently written could adversely impact organizations that seek to
serve those veterans. Therefore, NCHV does not support H.R. 2065 at
this time.
Evolution of ``Safe Housing'' Legislation
The original ``Safe Housing for Homeless Veterans Act,'' introduced
in the second session of the 112th Congress by Rep. McKinley, would
have required entities to perform the following in order to receive
funding under Title 38 U.S. Code Chapter 20 to house or serve homeless
veterans:
``(Submit) to the Secretary a certification that the building where
the entity proposes to provide such housing or services is in
compliance with codes relevant to operations and level of care
provided, including the most current Life Safety Code and all
applicable State and local housing codes, licensing requirements, fire
and safety requirements, and any other requirements in the jurisdiction
in which the project is located regarding the condition of the
structure and the operation of the supportive housing or service
center.'' \1\
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\1\ http://thomas.loc.gov/cgi-bin/bdquery/z?d112:h.r.004079:
In its testimony before this Subcommittee on April 16, 2012, the
Department of Veterans Affairs correctly noted that this legislation
would have a very broad application, affecting such programs as the
Supportive Services for Veteran Families (SSVF) Program, ``even when
veterans are not cared for in these structures.'' \2\
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\2\ http://veterans.house.gov/witness-testimony/robert-l-jesse-md-
phd-0
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NCHV appreciates that the present version of the ``Safe Housing for
Homeless Veterans Act,'' introduced by Rep. McKinley in May 2013, would
no longer affect programs that do not necessarily involve housing for
homeless veterans. However, we are concerned about this bill's
potential impact on community- and faith-based organizations.
Need to Clarify Who Bears the Burden of Certification
The Department of Veterans Affairs is barred by law from making per
diem payments under Title 38 U.S. Code Sec. 2012 unless an
organization has shown that its facilities ``meet applicable fire and
safety requirements under the Life Safety Code of the National Fire
Protection Association or such other comparable fire and safety
requirements as the Secretary may specify.'' \3\ VA abides by this
statute by conducting thorough inspections before making an initial per
diem award to a service provider.
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\3\ http://www.law.cornell.edu/uscode/text/38/2012
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If this initial inspection is successful and per diem funding is
awarded, VA will continue to monitor the facility in question as well
as provide regular re-inspections to ensure that, among other things,
it continues to meet the applicable fire and safety requirements.
H.R. 2065 introduces the concept of an ``annual certification''
that would require all per diem recipients to demonstrate the
following:
``That the building where the entity provides such housing or
services is in compliance with codes relevant to the operations and
level of care provided, including applicable provisions of the most
recently published version of the Life Safety Code or International
Building Code and International Fire Code (or such versions of such
codes that have been adopted as State or local codes by the
jurisdiction in which the project is located), licensing requirements,
fire and safety requirements, and any other requirements in the
jurisdiction in which the project is located regarding the condition of
the structure and the operation of the supportive housing or service
center.'' \4\
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\4\ http://www.gpo.gov/fdsys/pkg/BILLS-113hr2065ih/pdf/BILLS-
113hr2065ih.pdf
NCHV is concerned that H.R. 2065 - as currently written - could
discontinue VA's current practices, in which the department determines
whether facilities are in Life Safety Code compliance during its
regular re-inspections.
Do these current practices constitute ``annual certification,'' as
described in this bill? If so, H.R. 2065 should be amended to clarify
that VA maintains responsibility for conducting all such inspections
and providing certification. If not, this bill could place a
significant burden on service providers to orchestrate and pay for
these rigorous inspections out-of-pocket. This issue must be addressed
before NCHV could consider making an endorsement.
On the topic of whether or not International Building and Fire
Codes should be used interchangeably with the Life Safety Code, as this
bill would allow, NCHV defers to VA for its expertise in this area.
In Summation
While NCHV does not support H.R. 2065 at this time, we are hopeful
that the appropriate changes can be made to ensure that veteran service
providers are not adversely impacted by this legislation.
Thank you for the opportunity to submit this Statement for the
Record. It is a privilege to work with the House Committee on Veterans'
Affairs, Subcommittee on Health, to ensure that every veteran in crisis
has reasonable access to the support services they have earned through
their service to our country.
Matt Gornick
NCHV Policy Director
202-546-1969
[email protected]
NCHV Disclosure of Federal Grants
Grantor: U.S. Department of Labor
Subagency: Veterans' Employment and Training Service
Grant/contract amount: $350,000
Performance period: 8/13/2012 - 8/12/2013
Indirect costs limitations or CAP limitations: 20% total award
Grant/contract award notice provided as part of proposal: Yes
Grantor: U.S. Department of Labor
Subagency: Veterans' Employment and Training Service
Grant/contract amount: $350,000
Performance period: 8/13/2011 - 8/12/2012
Indirect costs limitations or CAP limitations: 20% total award
Grant/contract award notice provided as part of proposal: Yes
PARALYZED VETERANS OF AMERICA
Chairman Benishek, Ranking Member Brownley, and members of the
Subcommittee, Paralyzed Veterans of America (PVA) thanks you for the
opportunity to submit a statement for the record regarding the five
pieces of proposed legislation being considered today. PVA appreciates
that you are addressing these important issues involving the health of
our nation's veterans.
The ``Long-Term Care Veterans Choice Act''
PVA generally supports the ``Long-Term Care Veterans Choice Act.''
This bill proposes to amend title 38, United States Code to authorize
the Department of Veterans Affairs (VA) to enter into contracts or
agreements for the transfer of veterans to non-VA adult foster homes
for certain veterans who are unable to live independently. PVA believes
that VA's primary obligation involving long-term support services is to
provide veterans with quality medical care in a healthy and safe
environment.
As it relates to veterans with a catastrophic injury or disability,
it is PVA's position that adult foster homes are only appropriate for
disabled veterans who do not require regular monitoring by licensed
providers, but rather have a catastrophic injury or disability and are
able to sustain a high level of independence. When these veterans are
transferred to adult foster homes, care coordination with VA
specialized systems of care is vital to the veterans' overall health
and well-being. The drafted text of this bill requires the veteran to
receive VA home health services as a condition to be transferred. As
such, PVA believes that if a veteran with a spinal cord injury or
disorder is eligible and willing to be transferred to an adult foster
home, the VA must have an established system in place that requires the
VA home based primary care team to coordinate care with the VA SCI/D
Center and the SCI/D primary care team that is within the closest
proximity to the adult foster home. When caring for a veteran with a
catastrophic injury or disability this specialized expertise is
extremely important to prevent and treat associated illnesses that can
quickly manifest and jeopardize the health of the veteran.
When catastrophically injured or disabled veterans who receive
services from one of the VA's specialized systems of care are placed in
a non-VA adult foster home they must be regularly evaluated by
specialized providers who are trained to meet the needs of their
specific conditions. PVA also believes that as this draft legislation
is aptly titled the, ``Long Term Care Veterans Choice Act,'' veterans
should only be transferred from a VA facility to a non-VA adult foster
home with the full consent of the veteran, pursuant to title 38 U.S.C.,
Section 1710A(b)(1).
H.R. 1443, the ``Tinnitus Research and Treatment Act''
PVA does not have a position on H.R. 1443, the ``Tinnitus Research
and Treatment Act of 2013,'' a bill that proposes to direct the VA to
recognize tinnitus as a mandatory condition for research and treatment.
PVA supports VA research efforts involving hearing loss and conditions
such as tinnitus, however, we believe that the selection of research
subject areas and projects should be done through the VA scientific
peer review process.
H.R. 1612
PVA does not have a position on H.R. 1612, a bill to direct the VA
to convey a parcel of land in Tuskegee, Alabama, to Tuskegee
University.
H.R. 1702, the ``Veterans Transportation Service Act''
PVA supports H.R. 1702, the ``Veterans Transportation Service
Act,'' a bill to amend title 38 United States Code to make permanent
the authority of the VA to transport individuals to and from VA
facilities when it is in connection with rehabilitation, counseling,
examination treatment, and care. Too often lack of transportation is a
barrier to veterans' access to medical care. This is frequently the
case for disabled veterans who do not have a personal means of
transportation. Arranging for accessible transportation can be very
arduous and time consuming, and as a result it is common for disabled
veterans who are not able to drive themselves to medical appointments
to delay health care until transportation can be arranged, or forgo
medical attention completely. It is for this reason that PVA strongly
supports H.R. 1702 and encourages Congress and VA to further improve
veterans' access to care by providing accessible transportation for
disabled veterans, specifically veterans who have incurred a spinal
cord injury or disorder, or veterans who use a wheelchair.
H.R. 2065, the ``Safe Housing for Homeless Veterans Act''
PVA does not have a position on H.R. 2065, the ``Safe Housing for
Homeless Veterans Act.'' If enacted this legislation would amend title
38, United States Code, to require entities that provide services to
homeless veterans and receive per diem payments from the VA to comply
with codes relevant to operations and level of care provided to
veterans. PVA supports Secretary Shinseki's goal of eradicating
homelessness among America's veterans, and believes that the safety of
facilities that offer services to homeless veterans is of extreme
importance.
Paralyzed Veterans of America appreciates this opportunity to
express our views on the proposed bills being reviewed. We look forward
to working with the Subcommittee on these and other issues in the
future, and are happy to answer any questions.
Information Required by Rule XI 2(g)(4) of the House of Representatives
Pursuant to Rule XI 2(g)(4) of the House of Representatives, the
following information is provided regarding federal grants and
contracts.
Fiscal Year 2013
No federal grants or contracts received.
Fiscal Year 2012
No federal grants or contracts received.
Fiscal Year 2011
Court of Appeals for Veterans Claims, administered by the Legal
Services Corporation--National Veterans Legal Services Program--
$262,787.
VIETNAM VETERANS of AMERICA
Chairman Benishek, Ranking Member Brownley, and distinguished
members of the House Veterans' Affairs Subcommittee on Health, Vietnam
Veterans of America (VVA) appreciates the opportunity to offer this
Statement for the Record on pending legislation before this
subcommittee.
Draft legislation: Long-Term Care Veterans Choice Act: Would
authorize the Secretary of Veterans Affairs to enter into contracts for
the transfer of certain veterans who are unable to live independently
into non-Department adult foster homes.
This seems like a good idea on the face of it, but there just isn't
enough detail for VVA to support this bill at this juncture. For
example, what is the meaning of the phrase ``. . . for certain veterans
who are unable to live independently''?
Furthermore, the proposed legislation states that ``At the request
of a veteran for whom the Secretary is required to provide nursing home
care under 1710A of this title, the Secretary may transfer the veteran
to an adult foster home that meets Department standards at the expense
of the United States . . . '' Who will decide which type of facility
(and where) the veteran can choose to be transferred to? Currently
there is a variety of facility options currently recognized by the VA,
such as an adult family home, an assisted living facility, a community
nursing home, a medical foster home, a state veterans home, or a
community living center, and each of these options has separate
eligibility criteria, including the veteran's income level.
This proposed draft legislation needs far more detail before VVA
can give further consideration of support. The issue, though, is of
high import to us, inasmuch as Vietnam-era veterans now constitute the
largest living cohort of elderly American veterans.
H.R.1443: Tinnitus Research and Treatment Act of 2013; introduced
by Congressman Michael Michaud (ME-2): would direct the Secretary of
Veterans Affairs to: 1) recognize tinnitus as a mandatory condition for
research and treatment by Department of Veterans Affairs Auditory
Centers of Excellence; 2) ensure that research is conducted at VA
facilities on the prevention and treatment of tinnitus; and 3) ensure
VA cooperation with the Hearing Center of Excellence established by the
Department of Defense (DoD) to further research on tinnitus. VVA
supports H.R. 1443.
H.R.1612: To direct the Secretary of Veterans Affairs to convey a
specified parcel real property at 2400 Hospital Road in Tuskegee,
Alabama, to Tuskegee University, for the purpose of permitting the
university to use the property to further the educational and general
welfare of its students; introduced by Congressman Mike Rogers, (AL-3).
The Tuskegee Airmen were the most highly respected African American
troops of World War II, the University of Alabama donated 300 acres of
land to build a hospital solely to care for black veterans in the South
and today that hospital is the Tuskegee Veterans Affairs Medical
Center. In February 2013 the Tuskegee VAMC celebrated 90 years of
service to veterans and their families. In honor of the Tuskegee
Airmen's service and sacrifice to our nation, VVA supports H.R. 1612.
H.R.1702: Veterans Transportation Service Act; introduced by
Congressman Ron Barber (AZ-2); makes permanent (under current law,
expires on January 10, 2014) the authority of the Secretary of Veterans
Affairs to transport individuals to and from facilities of the
Department of Veterans Affairs in connection with vocational
rehabilitation, counseling, examination, treatment, or care. VVA
supports making this provision of the law permanent.
H.R.2065: Safe Housing for Homeless Veterans Act; introduced by
Congressman David McKinley (WV-1); would require recipients of per diem
payments for the provision of services for homeless veterans to comply
with codes relevant to operations and level of care provided.
The VA Homeless Providers Grant and Per Diem Program provides
grants and per diem payment assisting public and nonprofit
organizations in establishing and operating supportive housing and
service centers for homeless veterans. When enacted into law, H.R 2065
would mandate that these public and nonprofits organizations are in
compliance with Life Safety Code of the National Fire Protection
Association and other requirements as stated in Section 61.20 Life
Safety Code Capital Grants in the VA Homeless Providers Grant and Per
Diem Program regulations. VVA applauds Congressman McKinley for
introducing this legislation and supports H.R. 2065 as written.
Mr. Chairman and members of the House Veterans Affairs Subcommittee
on Health VVA would like to thank you for the opportunity to submit our
Statement for the Record on legislation that would improve the quality
of life for veterans and their families before this subcommittee today.
VIETNAM VETERANS OF AMERICA
Funding Statement
July 9, 2013
The national organization Vietnam Veterans of America (VVA) is a
non-profit veterans' membership organization registered as a 501(c)
(19) with the Internal Revenue Service. VVA is also appropriately
registered with the Secretary of the Senate and the Clerk of the House
of Representatives in compliance with the Lobbying Disclosure Act of
1995.
VVA is not currently in receipt of any federal grant or contract,
other than the routine allocation of office space and associated
resources in VA Regional Offices for outreach and direct services
through its Veterans Benefits Program (Service Representatives).
This is also true of the previous two fiscal years.
For Further Information, Contact:
Executive Director of Policy and Government Affairs
Vietnam Veterans of America.
(301) 585-4000, extension 127
WOUNDED WARRIOR PROJECT
Chairman Benishek, Ranking Member Brownley, and Members of the
Subcommittee:
Thank you for inviting Wounded Warrior Project (WWP) to provide
views on pending health-related legislation. We welcome this
opportunity to address two of the measures before you.
Long Term Care Veterans Choice Act
A draft bill under consideration is apparently intended to
authorize VA to contract for room, board, and caregiver services in
adult foster homes for veterans for whom VA would have an obligation to
provide needed nursing home care. The measure would also provide for a
participating veteran to receive VA home health services.
Wounded Warrior Project welcomes the proposal to add medical foster
home care to the continuum of long-term care options for wounded
warriors. Almost without exception, our work with wounded warriors and
their families has underscored how important it is to enable the
individual to live in the community and avoid institutionalization. The
comprehensive caregiver assistance program established in Public Law
111-163 has proven enormously helpful in realizing that goal for those
who were seriously injured on or after 9/11 and need personal care
services. But we do encounter parents and other family members who
worry about a time when they might no longer be able to sustain
caregiving, as well as seriously injured warriors who have no family to
provide care. Given wide-ranging needs and preferences among those who
cannot live independently, \1\ there is merit to fostering new
approaches. In sum, we applaud the effort to develop a statutory
framework to enable VA to provide a community-based, home-like
alternative to institutional care that includes needed home-health
services.
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\1\ A 2012 report on deinstitutionalized disabled individuals by
the National Council on Disability cited studies based on the National
Core Indicators 2009-10 Survey to assess their preferences for housing,
dividing responses into independent living, living with family members,
living in a community-based setting (such as a small group home or
foster care with a host family) or living in an institution (nursing
home or large group home). Overall, ninety percent responded that they
liked where they lived, but those surveyed expressed the most
satisfaction with living with family members (96%) and the least with
institutional settings (83%). Those in individual homes (90%) and in
community based settings (87%) were in the middle. When asked if they
would like to live somewhere else findings were somewhat consistent.
Only 20% of those living with parents expressed a desire to live
elsewhere compared with 39% of institutionalized respondents. Twenty-
six percent of those in individual homes and 30% of those in community
settings responded positively. Human Services Research Institute/
National Association of State Directors of Developmental Disabilities
Services, National Core Indicators, 2011 as cited in
Deinstitutionalization Toolkit: Community in Detail, National Council
on Disability, 2012, Figures 2-6.
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The legislation would vest the Department with broad authority to
set standards for these homes. It is our understanding that adult
medical foster homes are generally subject to state licensing
requirements. But the draft bill sets no express expectations of VA
with regard to those standards, which in our view should not simply
default to a state licensure requirement, given the very vulnerable
individuals covered under the draft bill. We do understand that VA has
worked for some time with foster-home care providers under arrangements
where the veteran has borne the costs of that care. It seems likely
that the number of veterans who might choose a foster home option would
grow were such legislation enacted. That scenario does raise questions
as to how the program would operate, and what kind of oversight would
be provided. What kind of training would caregivers receive? What
precautions would be taken to ensure placements were clinically and age
appropriate for the veteran? How would VA ensure that medical foster
homes have appropriate oversight and that veterans and their families
are satisfied with the services they receive there? We would encourage
the Subcommittee to press VA to address those questions early on and
clearly define expectations regarding standards of care, as well as
outline how they would evaluate a potential residence's ability to
provide for younger generations of veterans who have unique
rehabilitative needs.
Finally, while we welcome this initiative, we would be remiss if we
failed to note that VA still has important work to do as it relates to
the long term rehabilitative care for those with moderate to severe
traumatic brain injury, and particularly with implementation of section
107 of Public Law 112-154. Those provisions of law require that
rehabilitative care for traumatic brain injury focus not only on
achieving functional gains but on sustaining them, and that veterans be
afforded community-based rehabilitative services or supports that
contribute to maximizing an individual's independence. While Wounded
Warrior Project, through our Independence Program, is working every day
to help warriors with severe traumatic brain injury reach their fullest
potential in their communities, we have not seen VA take comparable
steps to implement a now year-old law requiring such action.
Without ongoing rehabilitative care and community supports that
Congress directed VA to provide, many post 9/11 Warriors with severe
brain trauma will be relegated to lives of greater dependency, and
without the social networks or employment options their non-disabled
peers take for granted. VA must make significant improvements to ensure
an adequate rehabilitative services continuum is available before
placement of younger gravely injured veterans in residential settings
other than their own or family homes will be acceptable.
Tinnitus Research and Treatment Act of 2013
H.R. 1443 would direct VA to recognize tinnitus as a mandatory
condition for research and treatment by VA Auditory Centers of
Excellence and for that research to include the study of treatments,
etiology, and underlying mechanisms of the disorder. The bill also
directs VA to work with the Department of Defense's Hearing Center of
Excellence to advance research on tinnitus.
With 52% of Wounded Warrior Project Alumni reporting tinnitus and
17% experiencing severe hearing loss, we welcome the focus on exploring
improved prevention and treatment of hearing disorders. \2\ As a very
common health problem with limited treatment options, advancing
research in this area could have a significant impact in improving care
for wounded veterans. We see particular value in fostering the study
and evaluation of prevention, assessment, and treatment of tinnitus
through collaboration between the VA and the Department of Defense
since it is strongly associated with service and exposure to a combat
zone. \3\ Advancements in preventing hearing loss and tinnitus will
have to happen within the military, so it is important to ensure gains
in knowledge and understanding are translated into improvements on the
battlefield and in training.
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\2\ 2013 Wounded Warrior Project Survey Results
\3\ Tzounopoulos, T. 2013. Mechanisms underlying Noise- Induced
Tinnitus. Retrieved from http://cdmrp.army.mil/prmrp/research--
highlights/2013.shtml
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We are supportive of continuing research and improvements in the
treatment of tinnitus, as well as other forms of hearing loss. Tinnitus
is an often very disabling problem that affects many warriors
frustrated by the fact that there are as yet no effective treatments.
We urge that continuing research also explore the varying impact
tinnitus can have on different people. As a chronic condition, the
level of disability can differ significantly and improved understanding
could better describe the spectrum of the condition and contribute to
scientific and medical knowledge, as well as better prevention and care
in the future and increased accuracy in disability ratings. Tinnitus
merits robust research efforts and WWP would support legislation to
advance understanding in this area.
Thank you for your consideration of WWP's views on these issues.