[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING ON H.R. 5413 AND H.R. 6418
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
SECOND SESSION
__________
THURSDAY, SEPTEMBER 13, 2018
__________
Serial No. 115-77
__________
Printed for the use of the Committee on Veterans' Affairs
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Available via the World Wide Web: http://www.govinfo.gov
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COMMITTEE ON VETERANS' AFFAIRS
DAVID P. ROE, Tennessee, Chairman
GUS M. BILIRAKIS, Florida, Vice- TIM WALZ, Minnesota, Ranking
Chairman Member
MIKE COFFMAN, Colorado MARK TAKANO, California
BILL FLORES, Texas JULIA BROWNLEY, California
AMATA COLEMAN RADEWAGEN, American ANN M. KUSTER, New Hampshire
Samoa BETO O'ROURKE, Texas
MIKE BOST, Illinois KATHLEEN RICE, New York
BRUCE POLIQUIN, Maine J. LUIS CORREA, California
NEAL DUNN, Florida CONOR LAMB, Pennsylvania
JODEY ARRINGTON, Texas ELIZABETH ESTY, Connecticut
CLAY HIGGINS, Louisiana SCOTT PETERS, California
JACK BERGMAN, Michigan
JIM BANKS, Indiana
JENNIFFER GONZALEZ-COLON, Puerto
Rico
BRIAN MAST, Florida
Jon Towers, Staff Director
Ray Kelley, Democratic Staff Director
SUBCOMMITTEE ON HEALTH
NEAL DUNN, Florida, Chairman
GUS BILIRAKIS, Florida JULIA BROWNLEY, California,
BILL FLORES, Texas Ranking Member
AMATA RADEWAGEN, American Samoa MARK TAKANO, California
CLAY HIGGINS, Louisiana ANN MCLANE KUSTER, New Hampshire
JENNIFER GONZALEZ-COLON, Puerto BETO O'ROURKE, Texas
Rico LUIS CORREA, California
BRIAN MAST, Florida
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
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Thursday, September 13, 2018
Page
LEGISLATIVE HEARING ON H.R. 5413 AND H.R. 6418................... 1
OPENING STATEMENTS
Honorable Neal Dunn, Chairman.................................... 1
Honorable Julia Brownley, Ranking Member......................... 2
WITNESSES
The Honorable Brian Mast, U.S. House of Representatives, 18th
District; Florida.............................................. 3
Prepared Statement........................................... 17
The Honorable Elizabeth Esty, U.S. House of Representatives, 5th
District; Connecticut.......................................... 4
Prepared Statement........................................... 17
Melanie Brunson, Director of Government Relations, Blinded
Veterans Association........................................... 6
Prepared Statement........................................... 18
Matthew Shuman, Director, National Legislative Division, The
American Legion................................................ 7
Prepared Statement........................................... 21
Jose Ramos, Legislative Director, Wounded Warrior Project........ 8
Prepared Statement........................................... 22
LEGISLATIVE HEARING ON H.R. 5413 AND H.R. 6418
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Thursday, September 13, 2018
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Health
Washington, D.C.
The Subcommittee met, pursuant to notice, at 9:59 a.m., in
Room 334, Cannon House Office Building, Hon. Neal P. Dunn
[Chairman of the Subcommittee] presiding.
Present: Representatives Dunn, Mast, Brownley, Takano,
Kuster, and Esty.
OPENING STATEMENT OF NEAL DUNN, CHAIRMAN
Mr. Dunn. So it is the habit of this Committee to run on a
punctual time. I am glad to see everybody here that we need,
and the Subcommittee will now come to order. Thank you all for
joining us today, and this morning, we will be discussing two
bills that have been referred to the Subcommittee on Health in
response to my Committee Members from both sides of the aisle.
I am grateful to Representative Brian Mast and Representative
Elizabeth Esty for working to ensure the Department of Veterans
Affairs is best able to provide the high-quality care and
services that our Nation's veterans have earned and certainly
deserve.
The bills that we will be discussing this morning seek to
improve a veteran's ability to identify and utilize services
available to them from the VA and from Congress. Representative
Mast's bill, H.R. 5413, the Improving Veterans Access to
Congressional Services Act of 2018, would make it easier for
veterans to interact with their Representatives by requiring VA
to prescribe regulations allowing Members of Congress to use
space within a VA facility to meet with veteran constituents.
This bill will build on a successful agreement in place
since last year with a number of Members, including
Representative Mast, and the West Palm Beach VA Medical Center.
It would make it easier for the Members in other districts to
enter into similar agreements with their local VA facilities
and, most importantly, benefit veterans by allowing for
increased communication and on-the-ground resolution with
constituent casework issues involving the VA arise.
Representative Esty's bill, H.R. 6418, the VA Website
Accessibility Act of 2018, would require VA to examine all Web
sites, apps, attachments, and electronic forms to determine
which are inaccessible to veterans with disabilities and
develop a plan to make each of them accessible.
The Blinded Veterans Association is going to testify today
that visually impaired veterans, in particular, often face
barriers to accessing information from the VA because they are
directed to forms or pages that are incompatible--excuse me--
with screen readers, in violation of Federal law, which
requires agencies to make electronic information accessible to
those with disabilities unless doing so would impose an undue
burden.
This bill would require VA to take systematic action to
address areas of inaccessibility and eliminate barriers to
needed VA information for veterans with visual impairments and
other disabilities.
Once again, I thank our two bill sponsors for introducing
these proposals and for their attendance here today. I also
thank the veteran service organizations who will be testifying
and submitting statements for the record for their willingness
to lend their opinions and expertise to this discussion this
morning.
I now yield to Ranking Member Brownley for any opening
statement that she may have.
OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER
Ms. Brownley. Well, thank you, Dr. Dunn, and thank you for
holding this legislative hearing. And I too want to thank our
colleagues on the Committee, Congressman Mast and Congresswoman
Esty, for introducing these bills. It is always important to
hear the concerns of various stakeholders as we draft and pass
legislation on ways, we can improve these bills. For that
reason, I also appreciate each of the witnesses' ability to
organize and submit remarks in such a short timeframe.
On Mr. Mast's bill specifically, which focuses on
congressional offices operating in VA facilities, I am open to
the idea if there is space available and we are not taking away
from patient care. In my district, for example, our local
veterans service officer in our county, Ventura County, is
interested in opening a field office in the Oxnard VA, which
will be leasing a larger clinic in the coming years. I think
these types of partnerships can help veterans, again, as long
as we are not taking space away that could be caring for
veterans.
I would have liked to ask the VA about this issue today,
but unfortunately the VA wasn't given adequate time to prepare
their views on today's legislation. I believe that today's
hearing would have benefited had we been able to learn the
agency's position on these bills.
With that said, I look forward to discussing the positions
of our VSOs on these pieces of legislation and am hopeful we
are able to incorporate those concerns into amendments to be
offered in tomorrow's proceeding if we have one, which sounds
like that might get postponed. So thank you, and I yield back.
Mr. Dunn. Thank you very much, Representative Brownley.
I will now welcome our first panel, who will be our authors
testifying from the dais. Speaking on their bills today are
Congressman Brian Mast from the great State of Florida and
Congresswoman Elizabeth Esty from Connecticut.
Mr. Mast, you are now recognized for 5 minutes.
STATEMENT OF THE HONORABLE BRIAN MAST
Mr. Mast. Thank you, Chairman Dunn, Ranking Member
Brownley, I appreciate it, the opportunity to testify here
before the House Veterans Subcommittee on Health on this
legislation. I introduced it back in March of 2018, H.R. 5413,
the Improving Veterans Access to Congressional Services Act.
Now my commitment, as I believe every commitment--every Member
of this Committee has the same commitment--is to help the end
user of the VA be served every single day with dignity and
honor that they have earned, the best possible experience every
day going through the VA.
Now I firmly believe that in order to understand an issue
best, you have to be present to see that issue day in and day
out. I also believe that our veterans have to know that we care
about things before they really care what it is that we know
about the issues that we have to deal with, and it is why I
still do, and I always will, get every bit of my health care
from the Department of Veterans Affairs personally.
It is why, as an incredible pilot program, we opened the
first ever congressional office inside of a VA hospital, the
West Palm Beach VA Medical Center, last year. This office, it
is probably smaller than the table that our panelists sit at,
but its efforts have been far-reaching and tremendous. Having
this office, I have experienced the good and the bad firsthand,
but I also get the opportunity to see what is working well and
what is not working, hear it from our veterans firsthand on a
weekly basis.
By opening up this office, my staff and I get to see week
in, week out, the daily operations of our VA facility. Walking
in the door every single week, walking past the same locations
every single week, past the same offices every single week, we
interact with our veterans daily, receive positive and negative
feedback on the operations of the facility in real-time.
When common threads or issues surface, I address it
immediately with the hospital administration, which they have
appreciated the fact that many veterans share their experiences
with me, knowing that I am a veteran, knowing that I am a
Member of Congress, knowing that they are heard at the highest
possible level, and they appreciate having that information
shared with them as the hospital administrators.
Additionally, when veterans have negative personal
experiences at our VA facility, they know that they get to be
heard by their Member of Congress immediately. They can see
their Representative on their turf, where they are comfortable,
where they believe that they are in a safe location for them.
And they know that their Representatives and their Members of
Congress and their government cares. They cry in that office.
They get a hug from their Representative in that office. They
know that they are heard.
To provide a bit of background and context on this office,
we opened it for the first time on December 18, 2017. I share
this office with three other Members of the Florida delegation:
Representatives Alcee Hastings, Lois Frankel, and Ted Deutch.
We all hold office hours there now. I try to personally be in
that office on Mondays before I fly up here to Washington so
that I can be there personally with those veterans and get that
one-on-one time with them, to hear about whatever it is they
want to speak about.
In 9 short months, this office has held over 400 meetings
with our veterans and their families and their caregivers, and
opened up nearly 200 additional pieces of casework. The office
has allowed me to expedite the assistance that I provide to our
veterans and improve their overall quality of service that we
deliver to each and every one of them. I truly believe that
every Member of Congress should at least have the opportunity
to open an office in their local VA. The more present that
Members of Congress are, the better quality of service that our
veterans can receive.
Now, since our office opened in the VA, I have been
approached by countless other Members of Congress looking to
replicate these efforts. It took me 8 months of administrative
processing from the date that previous Secretary Shulkin gave
me the commitment that we could open this office until it
actually opened. I was happy to be the first through this door,
and the lesson that we learned about the process of opening
this congressional office in the VA should be simplified and
institutionalized. That is why I introduced the Improving
Veterans Access to Congressional Services Act, to pave the way
for our colleagues to open up their own VA office, their own
congressional offices inside VA medical centers, and together,
we do what we do. We work to improve our veterans' access to
us, to health care, to every service that it is that they need
across the country.
This legislation that requires the Secretary of the
Veterans Affairs to permit the use of VA facilities by Members
of Congress for the purpose of meeting with their veteran
constituents. Additionally, it requires the Secretary to
establish a standard operating procedure to facilitate and
expedite these requests with inside the VA's facility.
Chairman Dunn, Ranking Member Brownley, and Members of the
Committee, I appreciate the opportunity to testify on this
legislation. Thank you.
[The prepared statement of Brian Mast appears in the
Appendix]
Mr. Dunn. Thank you, Mr. Mast, for that passionate
presentation.
Ms. Esty, you are now recognized for 5 minutes.
STATEMENT OF THE HONORABLE ELIZABETH ESTY
Ms. Esty. Chairman Dunn, Ranking Member Brownley, and my
fellow Members of the House Veterans' Affairs Committee. I want
to thank you for giving me the opportunity to testify today
about my bill, H.R. 6418, the VA Website Accessibility Act of
2018.
As the Ranking Member of the House Committee on Veterans'
Affairs Disability Assistance and Memorial Affairs
Subcommittee, I know all too well how many veterans live with
the wounds of war. And according to the Blinded Veterans
Association--again, I want to thank Ms. Brunson for being with
us here today--there are an estimated over 130,000 legally
blind veterans in the United States and another 1.5 million
veterans with low vision. These veterans require and deserve
the same services and support as other veterans with
disabilities. The needs and deservingness of the disabled
veteran is reflected in law. Section 508 requires the VA Web
site to be accessible to persons with disabilities.
However, blind veterans currently face challenges accessing
the VA Web sites and mobile applications which are often the
gateway to VA services and benefits. Navigating the VA's often
complicated bureaucracy for the detailed information necessary
to apply for VA benefits should not be doubly difficult for our
visually impaired veterans. While assistance from a friend or a
loved one can be invaluable, not every blind veteran has
somebody available at all times to help them with the services
and access they need for this critical information, and,
frankly, they shouldn't have to rely on someone else to get the
services they need.
Reader apps and other devices provide helpful support, but
I have heard from blind veterans that--they say these apps are
not always supported and don't always work. Perhaps one of the
most alarming instances of inadequate access to VA mobile apps
was identified earlier this year when the VA updated the
veteran's crisis line mobile app but failed to verify that the
update was section 508 compliant. Visually impaired veterans
were unable to access this vitally important mobile app: the
crisis line. And when we have a crisis of military suicide and
veteran suicide in this country, it is completely unacceptable
that that wasn't checked. Thankfully, quick action by the
Blinded Veterans Association, the staff of this Committee, and
calls to VA corrected that unacceptable error.
And I know that everyone on this Committee and in this room
shares the same goal of providing the best for all of our
veterans, but we must not let this happen. That is why I
introduced this bill, the VA Website Accessibility Act, which
will require a study to determine the accessibility of the VA
Web site, and the mobile apps, to ensure that they really truly
function for all veterans with disabilities. It is very
important that this Congress and the VA continue to ensure that
all of our veterans, including those with visual impairments,
have full access.
Now, we are all aware, Federal law already requires this,
but in fact, we know it is not working. Our commitment is not
to have good intentions, is not to have laws in place but
actually make sure they are implemented in a way that functions
for the people we are honored to serve. So, again, I know
everyone on this Committee shares that commitment, and we owe
it to all our veterans, including the blind and visually
impaired, to ensure this access is real and available when they
need it. I want to thank the VSOs here today for their
suggestions. We have already talked some, and I know they are
going to have some suggestions for us how to improve this
legislation.
I want to thank all of you for joining us here today. I
want to thank the Committee. Again, I apologize, I have another
Committee going, as many of us do, but again, thank you for
joining us. Thank you to the Chairman and Ranking Member and my
fellow colleagues on the Committee, and I appreciate your
assistance in making sure that the VA works for all veterans.
Again, my thanks and I yield back.
[The prepared statement of Elizabeth Esty appears in the
Appendix]
Mr. Dunn. Thank you, Ms. Esty, and thank you for your
diligent work on this bill.
Once again, I am grateful for both of you being here, and
for sponsoring bills on our agenda this morning.
I will now welcome our second panel to the witness table.
And we have joining us:
Ms. Melanie Brunson, Director of the Government Relations
for the Blinded Veterans Association. Thank you, ma'am.
Mr. Matthew Shuman, Director of the National Legislative
Division of The American Legion. Sir.
And Jose Ramos, Legislative Director for the Wounded
Warrior Project.
We will begin with Ms. Brunson. You are now recognized for
5 minutes.
STATEMENT OF MELANIE BRUNSON
Ms. Brunson. Thank you, Chairman Dunn. On behalf of the
national officers and Members of the Blinded Veterans
Association, I want to thank you, Ranking Member Brownley, and
all the Members of the Health Subcommittee for the opportunity
to participate in this hearing. Both bills under consideration
today offer thoughtful means of addressing significant needs of
our Nation's veterans.
Because of the time constraints this morning, I would like
to focus my comments on H.R. 6418. We thank Representative Esty
for introducing this bill because it provides some practical
steps that address some of the Blinded Veterans Association's
most persistent concerns about the VA's compliance with section
508 accessibility standards. Section 508 compliance is an issue
that people throughout the VA generally agree is important, but
at the same time, the issue never seems to rise to the level
where it gets the attention of VA's leadership for any length
of time.
Having the VA secretary compile a report on the current
state of this compliance could help change that scenario. And
with the recent rollout of the electronic medical record
collaboration with Cerner Corporation, along with the focus on
the IT modernization across the VA, the Blinded Veterans
Association believes the time for a new scenario is now. For
this reason, we support H.R. 6418.
Having said that, though, we would like to see some
additional measures included that we think would strengthen the
bill's effectiveness. We offer these for your consideration.
First, in addition to directing the Secretary to develop a
plan that addresses current accessibility shortfalls, we
believe the plan should also include steps that will be taken
to ensure that these shortfalls are not repeated in the future.
Because all too often the VA does not learn from its
accessibility-related mistakes.
Second, we suggest that the scope of the evaluation and the
report called for in this bill should be broadened to include
other items besides Web sites that are covered by section 508,
such as the inaccessible kiosks that have been deployed at VA
facilities around the country, telehealth tools that are meant
to be used in the homes of veterans, but cannot be used by
veterans who have visual impairments, and a variety of software
and hardware for VA employees to use but is incompatible with
the assistive technology used by VA employees who have
disabilities.
Including these items in the Secretary's evaluation and
report would give both him and Members of Congress a more
accurate snapshot of the current state of VA's compliance with
section 508 accessibility standards. It would also give the
Secretary more compelling reasons to develop a plan that is
comprehensive in nature and provides long-term solutions,
rather than simply short-term fixes for present concerns.
Finally, once this report is completed, we would like to
see the Members of Congress commit to holding the VA Secretary
and his department accountable for taking the actions set forth
in the Report. The Secretary's perspective on how to bring his
Department into compliance is certainly important, but it is
just as important that this bill provide for congressional
oversight of the Department's response to the legislation,
especially the content and implementation of the Secretary's
plan of action.
Knowing there will be such follow-through by Congress, we
believe, could impact the quality of the response from the VA
and the subsequent report of the Secretary. Thank you for your
consideration of these suggestions. I am now happy to answer
any questions you may have.
[The prepared statement of Melanie Brunson appears in the
Appendix]
Mr. Dunn. We will take the questions at the end, if we may,
and pass on to Mr. Shuman. You are now recognized for 5
minutes.
STATEMENT OF MATTHEW SHUMAN
Mr. Shuman. Thank you, sir.
The American Legion is adamant in assuring both VA and our
representative government is accessible to all veterans. The
Secretary of the Department of Veterans Affairs has the
authority to provide office space to Members of Congress. This
is the same authority that was used to open the office in West
Palm Beach, but obtaining this authorization was an
overwhelmingly complicated process. It took Congressman Mast
more than 1 year to open the office space to be utilized for
assisting local veteran constituents with obtaining their well-
deserved health care benefits.
These are incremental steps in the right direction, but
there is still much work to be done. Chairman Dunn, Ranking
Member Brownley, Vice Ranking Member Takano, Congressman Mast,
distinguished Members of the Subcommittee, on behalf of
National Commander Brett P. Reistad and the nearly 2 million
members of The American Legion, I thank you for the opportunity
to testify on H.R. 5413 and H.R. 6418. If signed into law, H.R.
5413, the Improving Veterans Access to Congressional Services
Act of 2018, will direct the Secretary of the Department of
Veterans Affairs to permit Members of Congress to use VA
facilities to meet with constituents in an attempt to increase
and improve the access veterans have to their elected
officials. Following an invitation to testify before this
Committee, The American Legion engaged the Florida delegation's
offices who share the space at the West Palm Beach VA Medical
Center to learn more about the creation and day-to-day
operations.
The use of this potentially valuable resource appears to
vary greatly among the Members of Congress. The American
Legion, with nearly 100 years of dedicated experience, can
certainly see the potential value added to a Member of Congress
having visible office space within a VA facility, but we can
also see the possible negative consequences.
As an example, Congressman Mast himself often maintains a
presence in the VA office, leading to a great success in
engaging the veteran community, whereas other Members sharing
the space do not seem to have the same dedication to fulfill
such a presence. The American Legion is not only concerned that
VA will be required to provide space to congressional Members
but that it may limit space available for other necessary
services.
Chairman Dunn, in order to support this bill, The American
Legion calls on this Committee to augment H.R. 5413 to create a
pilot program with--sorry--with quantifiable criteria that will
yield empirical data and show the potential efficacy of the
legislation. This evidence-based approach will help to
conclusively determine the value to all veterans. The American
Legion applauds and appreciates the intentions, efforts, and
leadership of Congressman Mast, particularly as a fellow
veteran. His efforts, which we can all learn from, highlight
the desire of a Member of Congress who understands the value of
first-hand engagement with veteran stakeholders in the VA
health care system.
The American Legion, the largest representative of those
stakeholders, will continue researching and working with this
Committee, Congressman Mast, and our membership of war-time
veterans to best serve those who have selflessly raised their
right hands and taken the oath to protect this great Nation.
Separately, H.R. 6418 will direct the Secretary of
Veterans' Affairs to conduct a study regarding accessibility of
Web sites at the Department of Veterans Affairs for individuals
with disabilities. An accessible information technology system
is one that is operated in a variety of ways and does not rely
only on a single sense or user ability.
Further, the VA Website Accessibility Act of 2018 requires
VA to compile a list of noncompliant Web sites and submit a
plan to this Congress to make sure those Web sites are finally
compliant. The American Legion is faithful and applauds the
leadership of Representative Esty for creating legislation
which, in time, Mr. Chairman, will assist VA in becoming more
user-friendly to those veterans in need.
In closing, The American Legion, just as this Committee,
believes in commonsense, evidence-based solutions. Chairman
Dunn, Ranking Member Brownley, Vice Ranking Member Takano,
Representative Kuster, and Congressman Mast, I appreciate the
opportunity to share with you today the position of The
American Legion. I look forward to answering any questions you
may have. Thank you, sir.
[The prepared statement of Matthew Shuman appears in the
Appendix]
Mr. Dunn. Thank you very much, Mr. Shuman.
Mr. Ramos, you are now recognized for 5 minutes.
STATEMENT OF JOSE RAMOS
Mr. Ramos. Chairman Dunn, distinguished Members of the
Subcommittee, thank you for inviting Wounded Warrior Project to
testify today. My name is Jose Ramos, and I am a legislative
director for the Wounded Warrior Project. In 2004, while
serving in Iraq as a member of a marine sniper team, I was hit
by a rocket and critically injured. When I returned to the
United States, Wounded Warrior Project was there to assist me
and my family as they did with all other ill and injured
servicemembers.
Over the last 14 years, I worked closely with the injured
veteran community, I served on the Dole-Shalala committee,
stood up the Congressional Inquiries Division for the Office of
the Secretary of Defense, and served as an ambassador for the
military program. I am honored to say that I am living proof of
the positive outcomes Wounded Warrior Project has had on this
community, and it is a privilege to speak to you today
regarding the proposed legislation.
In regard to H.R. 5413, Improving Access to Congressional
Service Act, Wounded Warrior Project fully supports this
legislation. Thousands of veterans turn to you and your staff
with a broad spectrum of complex requests. You act as the
ombudsman between your veteran constituents and the VA.
Wounded Warrior Project is engaged with the veteran
community in a different way. Our organization continues to be
at the bedside of some of the Nation's most critically injured
as well as through the delivery of a dozen free direct-service
programs to warriors and families in need. Wounded Warrior
Project often finds itself advocating for critically injured
and their caregivers while communicating with the VA and
congressional staff.
We believe creating a one-stop shop for advocacy and
medical treatment makes sense. It alleviates the need for
multiple trips to different locations and provides a holistic
approach to address the needs of the most critically injured.
Additionally, it would also provide congressional offices and
their Members the opportunity to interact more often with local
veterans and caregivers within their communities to better
understand the difficulties veterans face, as well as observe
the challenges and successes at their local VMCs.
It is our hope that these congressional offices are used to
conduct constituent outreach, to provide pertinent information
to veteran populations, and above all, to allow Congress to
learn from the veteran community they physically interact with
in a common, veteran focal point. Although we support this
legislation, Wounded Warrior Project would like to caution
Congress on a few aspects: first, the potential for misusing
these offices as an inappropriate oversight tool; second, the
potential for new congressional staff to bypass already
available resources because they are unaware of the VA process.
Therefore, Wounded Warrior Project recommends that, one, the VA
and Congress work together to create clear guidance determining
what actions are acceptable at the locations; and, two, for the
VA to develop an introduction to veterans affairs class which
outlines a clear VA advocacy chain of procedures, which
requires any individual working at a VAMC-based office to not
only attend these classes but also agree to properly direct
veterans who ask for assistance to the appropriate VA entity.
Lastly, Congress should be extremely sensitive to the
perception of using veterans for political purpose, and
therefore, we strongly support the closing of VAMC's
congressional office during campaign season as outlined in the
current shared state agreement being utilized at West Palm
Beach VAMC.
In regard to H.R. 6418, VA Websites Accessibility Act,
Wounded Warrior Project supports the intent of this legislation
but offers additional recommendations. Through the delivery of
our programs and services, our goal is to increase access to
community services and empower to achieve goals of living a
more independent life.
To empower warriors with physical or cognitive disabilities
to live a more independent life, they will rely on web-based
platforms to schedule VA appointments, seek information on
programs, and communicate with their VA health care provider.
Prior to passing H.R. 6418, Wounded Warrior Project recommends
Congress receive a brief from the VA CIO, the Department of
Justice Civil Rights Division responsible for obtaining
information on section 508 compliance, and the Federal CIO
Council Accessibility Committee on the status of ongoing
efforts being conducted for VA IT systems to ensure they are in
compliance with section 508.
Any report produced should also include a strategic plan
with stated timelines for fixing inaccessible Web sites to make
them accessible for individuals with disabilities.
Lastly, Congress should institute annual briefs to continue
to monitor progress, including the ongoing, electronic health
record modernization efforts.
I, on behalf of Wounded Warrior Project, thank the
Subcommittee and its distinguished Members for the invitation
to testify on the bills under consideration. I want to thank
Representative Mast and Representative Esty for their
leadership, and I stand ready to answer any questions you may
have. Thank you.
[The prepared statement of Jose Ramos appears in the
Appendix]
Mr. Dunn. Thank you very much, Mr. Ramos.
I now yield myself 5 minutes for questions.
Mr. Shuman, you made reference to specific quantifiable
criteria that will yield empirical data. Can you tell us what
quantifiable criteria those are?
Mr. Shuman. Well, thank you for the question, Mr. Chairman.
That is something that we are more than willing to work with
this Committee and certainly somebody at the dais who has
experience on this. We didn't want to create the arbitrary
information ourselves. I think it would be critical to work
with subject-matter experts to know exactly what that would
look like.
As we have heard Congressman Mast testify, the number of
cases that he has opened through this office, along with the
number of engagements, we just want to be able to quantify that
and see if it truly impacts. But additionally, there are three
other Members of Congress that utilize the space as well. We
would like to be able to receive the same data from them as
well just to truly understand the full scope and use of this
beyond the physical Member himself being there and learning
what the staff is doing as well.
Mr. Dunn. All right, thank you. I certainly understand the
concerns about space constraints within the VA facility's
campuses. If space was not a concern at all in any of these
facilities, would you have any reservations about 5413? And I
will just go right down the line. Ms. Brunson, first?
Ms. Brunson. No.
Mr. Dunn. Thank you.
Mr. Shuman?
Mr. Shuman. I think we have other concerns with the bill
beyond just space, Mr. Chairman, but we would be happy to look
at that at that time.
Mr. Dunn. Thank you.
Mr. Ramos?
Mr. Ramos. No.
Mr. Dunn. Okay. Mr. Ramos, you made a comment about misused
oversight bypassing internal VA advocacy. Have you actually
witnessed any of that at the West Palm Beach Veterans Center?
Mr. Ramos. Great question, Mr. Chairman, and the answer is
we have not witnessed, but what our concern would be is, if you
have a new congressional staff member working at one of the
AMCs, that they would be unaware of maybe the services
available, whether it is a patient advocacy or the local
service advocacy through the VA. So that is why we recommend
that some sort of tutorial or class be implemented and that new
staff or staff working there go through them so that they
direct the veteran to the appropriate entity first so that they
are not bypassing them.
Mr. Dunn. No blowback on this yet, no problems--
Mr. Ramos. No, sir.
Mr. Dunn. Ms. Brunson, do you think the office of IT there
at the VA has the needed authorities and abilities to address
these noncompliance issues?
Ms. Brunson. Yes.
Mr. Dunn. Good.
Ms. Brunson. The difficulty, of course, is that they
haven't done so in a comprehensive manner. So what we see
happening is the same mistakes being repeated over and over
again. Oftentimes things are rolled out in a hurry, and it
appears to us that sometimes the request for a determination as
to whether something is 508-compliant is sort of a process that
we know we are supposed to go through, but if they say it
isn't, we implement it anyway because we are in a hurry to get
it out, and we figure we will fix it later.
And in the meantime, a certain percentage of the population
that the Web site is supposed to serve, or the app is supposed
to be useable by, or the equipment is supposed to be for,
cannot access it.
Mr. Dunn. Do you know if there are any representatives from
the section 508 compliance office embedded in the IT office at
VA?
Ms. Brunson. The section 508 office is under the IT office,
and--
Mr. Dunn. So, yeah, then the entire 508 section is embedded
in IT.
Ms. Brunson. Yes.
Mr. Dunn. How about that. Well, that concludes my
questioning.
Ranking Member Brownley, do you have any questions?
Ms. Brownley. Just very, very quickly. I first would like
to thank Ms. Brunson for her advocacy. I shudder to think if
you weren't on top of this compliant issue, it would be worse
than it is. So I thank you for that. And I just wanted to ask,
outside of simply the VA not making this a priority, what other
barriers do you see with regards to compliance?
Ms. Brunson. I am not exactly sure what you are looking
for--
Ms. Brownley. Well, I think the main reason is that the VA
just does not make this a priority, and so they are not focused
on it. So what I am asking is, is there anything else, other
than that, that is a barrier to the compliance?
Ms. Brunson. Well, I think that the lack of focus manifests
itself in a lot of different ways. I have had, in the time that
I have been meeting with the section 508--well, the IT office
in particular--the same question, conversation, over and over
again, about some of the issues that folks have. And every time
we have the conversation, the response is the same, which is:
Wow, this is the first time I have heard that.
And I know that is not true because I have had the same
conversation with the same individual at a previous meeting.
For instance, I had a conversation in a meeting with other
VSOs where we were getting an update on some of the IT
modernization dealing with the ability to collect information
for databases about veterans that would help make the
electronic medical record more comprehensive. And they
demonstrated a field that had been added to a particular
database that would enable medical providers to collect
information about someone's hearing impairment and whether or
not they needed an interpreter. And they said: This is really a
great step.
And so I raised my hand, and I said: Well, that is great,
but have you also included whether someone is visually impaired
and might need to have medical information in an alternate
format?
And they hadn't thought about that one.
Ms. Brownley. Thank you.
And just, Mr. Shuman, I think you said in your comments, in
your beginning comments, that the fact that Mr. Mast, it took
him a year to make this partnership and this agreement happen
in West Palm Beach, and I agree with that. I think that, you
know, partnerships, really across the board within the VA, is
always time-consuming and difficult, and somehow, we should be
able to streamline those. Because I think those, in many cases,
those partnerships are going to help to better serve veterans.
So, having said that, I am not sure that there is, you
know, in the language, in the body of this bill, where there is
a lot of language here that kind of streamline that process.
And I think we kind of need--we need to attack that. But, you
know, having said that, and you said you have got a few more
concerns other than space, and I think you have articulated
that. I mean, do you think the way the bill is written at this
moment, understanding that I think we all agree with the spirit
and the intent here, do you think the bill, as written, is
ready to go to the floor to vote by the House?
Mr. Shuman. Thank you for the question, Congressman. The
short answer is no. We think there is more information that is
still needed. I think that the bill in the first place calls
for an SOP, a standard operating procedure, to be created. And
it is quite a while, particularly when the Secretary authorized
it, and it took 8 more months for that to happen is
interesting. And it should have happened faster in the opinion.
But at the current form, there need to be some concerns that
need to be addressed, I believe, before it would move to the
floor, ma'am, in The American Legion's opinion.
Ms. Brownley. Thank you.
And, lastly, Mr. Ramos, you had said space was the only
issue, but I thought that the Wounded Warrior Project had also
raised the Hatch Act as a concern around the bill. Is that
still a concern or?
Mr. Ramos. Correct, ma'am, it is a concern. I believe it is
addressed in the shared agreement that exists now, but it is a
concern that we would have, not only with the Hatch Act, but
all the other concerns that we have addressed during the oral
testimony and our written.
Ms. Brownley. Thank you very much, and I yield back.
Mr. Dunn. Thank you very much, Representative Brownley.
Representative Mast, you are recognized for 5 minutes.
Mr. Mast. I thank you all for speaking on this bill and for
the concerns that you brought up. This is how we get to good
legislation, is by having everybody be a part of the
discussion. And so I appreciate your comments.
I would like to ask a couple questions, beginning with you,
Mr. Shuman. Do the VA hospitals have locations for shopping in
them right now? You have seen one VA, you have seen one VA. But
do VA hospitals have locations in them for shopping?
Mr. Shuman. I am not sure, sir.
Mr. Mast. Do you know if the West Palm Beach VA has a
location in it for shopping?
Mr. Shuman. I have never physically been to the West Palm
Beach VA.
Mr. Mast. I can tell you that it does. It has quite an
amount of space in there for shopping for various things from
blankets to pins to, you name it. Would you rank shopping above
advocacy?
Mr. Shuman. No, sir.
Mr. Mast. Okay. Do VA locations--again, you have seen one
VA, you have seen one VA--do VA locations of hospitals have
locations for employee unions?
Mr. Shuman. I am not sure, sir.
Mr. Mast. Do you know if the West Palm Beach VA has a
location inside of it for an employee union?
Mr. Shuman. I do not, sir.
Mr. Mast. It does. I mentioned that my office is about the
size of that table there, maybe even smaller than that. The
space for the employee union is probably close to half the size
of this room, so quite a bit larger, to employ--for VA employee
union duties.
I would ask this--and this is just in response to some of
the things that you said--does impacting the life of one
veteran make it worth it?
Mr. Shuman. Indeed.
Mr. Mast. Absolutely. I would agree with you.
You did also bring up--saying that some Members of Congress
that I share this office space with have not taken the same
amount of time. Would you like to share those numbers, with the
differences in time?
Mr. Shuman. Certainly, sir. So we reached out to the other
three Members of Congress and received some feedback from the
others. What we found is that your staff and yourself manage
that office every day--your 1 day a week that you have
available. And, quite frankly, I think you would do it more if
you had the ability to.
The other offices sometimes maintain that office once a
month compared to the once a week. So that is some of the data
that we got back from them, which is why we referenced that
there are some that would not use it to the fullest capacity
that you have, and I believe you would even use it more.
To the other point that you raise is that space is
critical. And I understand what you are saying, advocacy is,
you know, some would say is more important than a shopping
space. I think our concern is that we want to make sure this is
implemented correctly. We don't want to force the VA Secretary
to have to do it if they don't have the space. You say that if
you have seen one VA, you have seen them all. I would disagree.
I would think that many VA facilities are different. Look at
the Denver VA brand-new today compared to the one in Phoenix,
Arizona, where I am from. So they are slightly different. I am
not saying all of them have shopping centers, but I understand
your argument there.
Mr. Mast. My statement was actually, ``If you have seen one
VA, you have seen one VA.''
Mr. Shuman. Oh, sorry, sir.
Mr. Mast. Yeah, they are not the same; they are all
different. I would be perfectly happy to meet with our veterans
in a boiler room if that is what it took to have appropriate
advocacy for them. I would meet them wherever it is that they
want to meet.
I would like to go to you, Mr. Ramos, for a question as
well. You spoke about needing some classes for staff, for us as
Members of Congress, for our staff to understand how to
appropriately advocate, and the levels at which people are
supposed to be seen: You know, do you speak to the VA
Administrator? Do you go and speak to one of the VSOs? What are
those channels and the order in which you are supposed to do
them?
Would you suggest that such a class exist for the staff of
Members of Congress now? Because we are dealing with all of the
same issues. The difference is the convenience and the location
where we are dealing with those issues and how quickly a
veteran can access us. But we are still dealing with all of the
exact same conversations that a constituent would want to come
see us in some other facility. So that being said, would you
advocate that we have a class just right now, just for our
staff to address those same things?
Mr. Ramos. That is a good question. And I believe OCLA has
a guidebook for it but not a class. So the answer would be yes,
but more importantly for those working within an installation
because the concern would be that a veteran goes to a
representative office and bypasses those. So it is just to
reinforce that those entities within the VA exist and that they
should go through that process first.
Mr. Mast. And that is an appropriate concern, and that is
something that I would like you to know that my staff is
educated in that and directs those constituents: These are the
appropriate channels in which you are supposed to go through in
order to address this issue.
And I would just make one other comment as it was brought
about, about Hatch Act violations. I think the same concern can
be brought about when you are talking about any congressional
office anywhere. There is always a risk that some member of
staff could dive into something political in a location that is
meant very strictly for official work. That is a problem that
can exist anywhere. No office anywhere in the country for any
Member of Congress is barred from that risk, regardless of its
location. I thank you for the time for answering my questions.
Mr. Dunn. Thank you, Mr. Mast.
Mr. Takano, do you wish to be recognized?
Mr. Takano. Yes.
Mr. Dunn. You are recognized for 5 minutes.
Mr. Takano. Yes, Mr. Chairman.
You know, for Members of the panel, outside of embedding
congressional offices outside of VA facilities, how can Members
of Congress improve access to have congressional services they
offer?
Mr. Shuman. Well, thank you for the question, Congressman.
Quite frankly, I think, thinking such as Mr. Mast has
deployed is a step in the right direction. Trying to find sort
of target-rich environments for constituents in general, not
just veteran constituents, is great. You will find a lot of
Members of Congress host mobile office hours. That is the--that
is the direction that they should be going, not just having one
stationary office or two stationary offices; moving around and
really trying to find the environment where the constituents
are gathering, or like I said earlier, a target-rich
environment where, in this particular situation, veterans
gather at VA, it makes sense.
Mr. Takano. One of the things that my office engaged in was
to--I know that congressional offices can obtain information
about the veterans that they represent in the district. I am
pretty sure that that is a pretty standard sort of piece of
information that congressional offices can obtain. And they can
do mailings--not mailings--but they can do questionnaires via
email about the services they have, the quality of the services
that they have at the local VA. Kind of a questionnaire or
survey. I know that my office did that, and we got an idea of
what our veteran constituents felt about the local VA service,
but it also garnered quite a bit of inquiries about
representation and advocacy that they--it was a way for our
office to engage with those veterans.
And if there was anybody who scored the VA health care
system in a very low manner, we called them up and said: You
know, what can we do to help you in this sort of situation?
So I think that is another way in which we can try to
engage veterans who may not be aware of the services or who are
engaged with services and aren't quite happy with them. What do
you think about that?
Mr. Shuman. Well, sir, again, I think any medium that
allows a Member of Congress to reach out to their constituents
is important. One thing from my time working in a district
office for a Member of Congress is that many constituents are
not aware that a Member of Congress can even help with these
services. For the ability to be able to inquire, to sort of
assist the VA in moving along in rendering a decision on a
claim, many general citizens are not aware of those services
that your office can assist with. So I think any way sharing
that information with your constituents, particularly the
veteran constituents, is a massive step in the right direction,
sir.
Mr. Ramos. I would add that personal interaction, though,
goes a long way. So, in addition to reaching out
electronically, I think attending or participating locally
within events, particularly where veteran population is.
Mr. Takano. Oh, I would agree with you. I think a
combination of an all-hands-on-deck approach to try and reach
out. Veteran advocacy is one of the--unfortunately, one of the
things that congressional offices have to do. And I say
``unfortunate'' because, you know, if we had a more well-
functioning VA, it would imply that congressional offices
wouldn't have to do so much advocacy.
I just want to point out, it is true that at least one-
third--at least one-third of people employed at the VA are
veterans themselves. Is that a number that you are familiar
with?
Mr. Shuman. I don't know what the exact number is, but I
know there is quite a few employees that--
Mr. Takano. My recollection is at least one-third. And at
least, you know, one-third of the workforce, frontline,
nonmanagerial employees are members of an employee union. And I
want to differ somewhat. I mean, I do think that what my
colleague from Florida, in casting aspersions on union
employees, a lot of what the union does is defend veteran
employees who need due process.
And we certainly--I certainly believe that veterans, of all
people, who fought for our country, also fought for important
workplace employment rights, and they deserve it just as many
as any other employee. And to the extent that there is office
space available for them, I think that it is appropriate.
Mr. Dunn. Thank you very much, Mr. Takano.
Any further questions from up here?
All right. Thank you all. Thank you all for participating
in this hearing. If there are no further questions, the second
panel is now excused.
I ask unanimous consent that all Members have 5 legislative
days to revise and extend their remarks and include extraneous
material.
And, without objection, that is so ordered.
This hearing is now adjourned.
[Whereupon, at 10:47 a.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Honorable Brian Mast
Chairman Roe and Ranking Member Walz, I appreciate the opportunity
to testify before the House Veterans' Affairs Subcommittee on Health on
legislation I introduced in March 2018- HR 5413, the Improving Veterans
Access to Congressional Services Act.
My commitment every day is to prioritize fixing the issues our
veterans face, no matter my station. However, I firmly believe that in
order to fix an issue, we must be present to understand the problem.
That is why I still do, and always will, get my healthcare from the
Department of Veterans Affairs. I experience the issues and problems
first hand, but I also get the opportunity to see what is working well.
That is also why, as many of you may know, we opened the first-ever
congressional office inside the West Palm Beach VA Medical Center last
year. By opening up this office, my staff and I get to see, week in and
week out, the daily operations of our local VA. We interact with our
veterans daily and receive positive and negative feedback on the
operations of the facility in real-time. When common threads or issues
surface, I address it with the hospital administration and we work
collaboratively to resolve them. Additionally, when veterans have a
negative personal experience at our VA facility, they know they can be
heard at the highest possible level - immediately.
To provide a bit of background and context, our office in the VA
opened for the first time on December 18, 2017. I share this office
with three other members of the Florida Congressional Delegation:
Representatives Alcee Hastings, Lois Frankel, and Ted Deutch. I try to
personally be in the office on Mondays before I fly back here to
Washington. In just 9 short months, my office has held over 400
meetings there with our veterans and their families and caregivers and
opened nearly 200 additional cases. This office has allowed me to
expedite the assistance I provide our veterans and improve the overall
quality of service my office delivers.
I truly believe that every Member of Congress should have the
opportunity to open an office at their local VA. The more present
Members of Congress are, the better quality of service our veterans
will receive. Since I opened our office in the VA, I've been approached
by several other members looking to replicate our efforts. It took me
eight months of administrative processing from the date Secretary
Shulkin gave me is commitment until the office actually opened. I was
happy to be the first through this door and lessons learned about the
process of opening a Congressional VA office should be simplified and
institutionalized.
That is why I introduced the Improving Veterans Access to
Congressional Services Act, to pave the way for our colleagues to open
VA offices of their own. Together, we can improve our veterans' access
to us and make a high level of service a reality across the country.
This legislation requires the Secretary of Veterans Affairs to permit
the use of VA facilities by Members of Congress for the purposes of
meeting with their veteran constituents. Additionally, H.R.5413
requires the Secretary to establish standard operating procedures to
facilitate and expedite requests for space within a VA facility by
Members of Congress.
By building off the process established by the Veterans
Administration when I opened my office, we can improve our veterans'
access to Congressional services, as well as their overall care.
Chairman Roe, Ranking Member Walz and members of the Committee, I
appreciate the opportunity to testify on my legislation.
Prepared Statement of Honorable Elizabeth H. Esty
Chairman Dunn, Ranking Member Brownley, and my fellow members of
the House Committee on Veterans' Affairs, thank you for the opportunity
to testify today about my bill, H.R. 6418, the VA Website Accessibility
Act of 2018.
As the Ranking Member of the House Committee on Veterans' Affairs
Disability Assistance and Memorial Affairs Subcommittee, I know all too
well how many veterans must live with the wounds of war.
According to the Blinded Veterans Association, there are an
estimated over 130,000 legally blinded veterans in the United States,
and another 1.5 million with low-vision. These veterans require and
deserve the same services and support as other veterans with
disabilities. The needs and deservingness of disabled veterans is
reflected in law - Section 508 requires the VA Website to be accessible
to people with disabilities. However, blind veterans currently face
undue challenges accessing VA websites and mobile applications which
are often the gateway to VA services and benefits. Navigating the VA's
often complicated bureaucracy for the detailed information necessary to
apply for VA benefits should not be doubly difficult for our visually
impaired veterans. While assistance from a friend or a loved one can be
invaluable, not every blind veteran has somebody available at all times
to help them access the critical information they need, nor should they
have to rely on someone else to help them gain access. Reader apps or
other devices provide helpful support but I have heard from blind
veterans who say that these apps do not always work on VA websites as
required by law.
Perhaps one of the most alarming instances of inadequate access to
VA mobile applications was identified earlier this year when the VA
updated the Veterans' Crisis Line mobile application, but failed to
verify that the update was Section 508 compliant. Visually impaired
veterans were unable to access this critical mobile resource.
Thankfully, quick action by the Blinded Veterans Association, our staff
and calls to the VA corrected this unacceptable error. I know that
everyone on the dais shares my opinion that we cannot let things like
this happen again.
That is why I introduced the VA Website Accessibility Act which
would require a study to determine the accessibility of VA websites to
individuals with disabilities. It is incredibly important that this
Congress and the VA continue to provide all our veterans, including
those with visual impairments, with full access to all the resources
and information they need to be successful.
I understand that federal law already requires VA's websites to be
accessible to veterans with disabilities. But reports from visually
impaired veterans and the VSO community demonstrate that in practice,
this is not always the case. I am sure that this is often not
intentional, but we must take steps to ensure that total compliance to
508 regulations is the standard 100 percent of the time. Good
intentions are not enough. We owe it to all veterans - including the
blind and visually-impaired--to ensure that they are able to access the
benefits that they have earned through service to our nation.
I thank the Committee for inviting me to testify today. I hope to
see this bill move quickly through this committee and on to the House
floor.
Thank you.
Prepared Statement of Melanie Brunson
INTRODUCTION
Chairman Dunn, Ranking Member Brownley, and Members of the Health
Subcommittee, THANK YOU, on behalf of the Blinded Veterans Association
(BVA), its national officers and members nationwide, for this
opportunity to offer our views on HR6418 and HR5413. BVA is the only
congressionally chartered Veterans Service Organization (VSO)
exclusively dedicated to serving the needs of our Nation's blinded
veterans and their families.
As such, we thank Rep. Esty, and Reps. Mast and Higgins for their
interest in meeting the needs of our nation's veterans, as evidenced by
the provisions in these bills. We will offer some comments on each of
these pieces of legislation, beginning with HR6418 below.
I. HR6418, The VA Website Accessibility Act of 2018
By directing the Secretary of the Department of Veterans Affairs to
examine and compile a report on the accessibility of VA's websites,
HR6418 provides a welcome opportunity to finally raise the profile of
some of the VA's longest standing barriers to its effective
communication with people who have visual disabilities, whether they
are employees of the VA, or veterans seeking to utilize the benefits
and services administered by the Department. We believe this
legislation gives the Secretary a concrete means of launching an
initiative that could result in addressing IT and website accessibility
issues in a meaningful and long-term manner.
Section 508 of the Rehabilitation Act requires federal agencies to
ensure that all electronic and information technologies developed,
procured, maintained, or used in the federal environment provide equal
access for people with disabilities, whether they are federal employees
or members of the public. Section 508 implementing regulations,
together with web accessibility guidelines (WCAG) compiled periodically
over the years by the Worldwide Web Accessibility Consortium, have
sought to put agencies of the United States government, including the
VA, in a position to lead the way and make websites accessible to all
users, regardless of disability. Unfortunately, our experience
indicates that while the VA has made significant progress toward
consistent compliance with these accessibility guidelines, the
department has a long way to go to be a leader in this area. BVA's
national officers and staff meet regularly with staff of the Section
508 Compliance Office and they are generally responsive to the concerns
we raise. They address the accessibility barriers we bring to their
attention promptly. However, all too often, those same barriers, are
erected again a few months later when websites are updated, or a new
website is rolled out. The scenario that is most disturbing is when
accessibility features are put in place, only to be broken the next
time the site is updated.
One example of this was cited in BVA's testimony during the joint
House and Senate Veterans' Affairs Committee hearing last March. It
involved use of the chat feature on the VA Crisis Line's website. When
the website launched, that feature could not be accessed by anyone
using screen reading software commonly used by people who are blind to
read websites. The VA was notified of this issue and eventually a
software patch was developed to allow screen readers to access the chat
feature. However, several months later, a different problem arose,
which once again, made it difficult to access this feature. In order to
invoke it, one had to get to it from vets.gov, rather than through the
Crisis Line's website. We once again contacted VA, and once again, I am
happy to report, the problem did get resolved. However, the sad
situation is that twice, during a period of less than a year, if any
visually impaired veteran was in crisis and could have benefited from
that tool, it was off limits to them. This seems to defeat the purpose
for which the feature was launched in the first place.
Another example has created significant hardships for BVA's own
veteran service officers who have visual impairments. It concerns the
Veterans Benefits Administration's (BVA's)VSO training course, TRIP.
After repeated requests by BVA, beginning two years ago, asking VA
staff to insure this course would be accessible upon its release, the
course was released early this year by BVA posted on a website that is
incompatible with screen reading software utilized by blind persons.
Furthermore, barriers to access via screen readers that were
inadvertently built into the website's design cannot be readily removed
without requiring a major, expensive, overhaul of the entire design.
Additionally, VA frequently circulates, both through its websites
and in e-mail communications, files that are created in inaccessible
formats. We receive pdf documents on a regular basis from various
offices within the VA that are not readable by screen readers.
The question that arises then, is whether the Congressional
directive to the VA Secretary that is proposed in HR6418 will help to
improve the situation, as described above. Our belief is that it has
the potential to do so. The trouble with a report on website
accessibility is that websites are not static. A report can only
describe their status at a particular point in time, and that status
can change even before the ink dries on the report, as website
administrators add tools, redesign features, or update content. Any one
of these alterations can render aspects of that site inaccessible,
unless the industry standards for website accessibility are followed.
In each of the examples we noted earlier, the accessibility barriers
were avoidable. Industry standards for making each of the features we
discussed accessible were clear and widely available to website
developers. Therefore, while we support this legislation as a positive
step toward more consistent accessible compliance with accessibility
requirements on the part of the VA, we think some additional direction
would increase its effectiveness as a means of addressing VA's
compliance issues. First, identifying VA's ``inaccessible websites'' in
the report is not enough. The report should also specify what makes
each item inaccessible and what is required to fix it. This would
inform the plan the legislation directs the secretary to develop.
Second, this plan should not only address current accessibility
shortfalls, but should also set forth practices and policies the OIT
will implement to insure that VA follows Section 508 compliance
guidelines more consistently in the future.
To be effective as a means of addressing crucial accessibility
issues within the VA, the scope of this report should also be broadened
beyond VA's websites, as there are additional concerns of Section 508
compliance that the VA needs to deal with sooner rather than later, as
part of its IT modernization effort. Some areas of ongoing concern
include:
Continued reliance on inaccessible kiosks at VA Medical
Centers, the use of which is required to check in for scheduled
appointments.
Inaccessible Telehealth tools, namely the Health Buddy
home monitoring station.
VBA web pages containing eBenefits information that are
inaccessible to blind people who use screen readers.
The continuing accessibility barriers faced by VA
employees with visual disabilities who are forced to use legacy systems
that are largely incompatible with adaptive software in order to do
their jobs.
Inadequate staffing by the VA to ensure its capacity to
address internal and external accessibility issues.
Lack of an enforcement mechanism or other means of
addressing compliance issues, so that if equipment, hardware, software,
or a website is found to be noncompliant with accessibility standards,
someone follows through and addresses the issues that are identified,
and thereby fixes the accessibility problem.
In summary, greater priority must be given to insuring that VA's IT
infrastructure, including websites, apps, and IT equipment procured by
the department for use by employees or members of the public who may
have visual impairments, is accessible at the time of implementation or
rollout. The current practice of relying on later ``fixes'' is neither
cost-effective nor acceptable. If approved by Congress, this
legislation could give Secretary Wilkie the impetus to lead the VA's
effort to insure compliance with accessibility guidelines is central to
all of the department's IT policies and practices, and not just an add-
on once the important things are completed. This is especially
important as VA rolls out its new initiative in collaboration with
Cerner. The veteran-facing aspects of the electronic medical record
this collaboration produces must be accessible to those veterans who
have visual impairments or other print reading disabilities, just as it
is for nondisabled veterans. If this does not occur, the system will
once again fail to serve a significant portion of our nation's
veterans.
Before concluding our discussion of this bill, there is one final
question we want to raise. What will Congress do with the report called
for in this legislation? It is our hope that the members of this
subcommittee, and the House and Senate Veterans' Affairs Committees,
will exercise greater oversight of VA's compliance with accessibility
guidelines. While the report called for here can highlight what needs
to be done, it doesn't make its accomplishment a foregone conclusion.
We urge members of this committee to hold VA accountable for addressing
the barriers and implementing the plan set forth in any report Congress
receives on the accessibility of VA's websites to people with
disabilities.
II. HR5413, Improving Veterans Access to Congressional Services Act of
2018
Like other VSOs, BVA has several staff members, as well as a number
of members across the country, who volunteer time each week to assist
veterans with claims for VA benefits. We know this is an important
service, and we are pleased that members of Congress have constituent
services staff who are dedicated to helping veterans with such claims.
Reaching those veterans who need help can be a challenge for all of us.
While one reasonable way to address that challenge could be to open
more claims offices within VA medical centers, where veterans
congregate, the proposal described in HR5413 raises some questions for
us. Chief among these is the space limitations at many VA facilities.
BVA's claims staff have experienced these limitations numerous times
over the years. It is not uncommon for VA directors to run out of space
for the offices of the medical personnel they hire to try to meet the
needs of their increasing patient population. Given the shortage of
space for their medical staff, it may not even be possible to find
space for a claims representative at some facilities, regardless of how
much value there might be in doing so. A related question arises with
regard to VA medical centers whose patients live in several
Congressional districts. We understand that the authors of this bill
work well with other members to share VA office space. But we can't
help but question whether the all-too-common absence of bipartisan
working relationships these days could make this difficult in some
districts. How many office spaces would, or should, be obligated for
use by Congressional staffers in such cases? While we support any
effort to reach veterans who are in need of assistance with their
claims, we have not taken a position on the particular proposal set
forth in HR5413, because of the logistical questions listed here. Even
so, we appreciate the intent of the bill's authors and we would welcome
further clarification on how these issues might be addressed in order
to minimize the burden on local VAs and maximize the benefits veterans
could gain from having access to additional resources.
Our thanks, once again, to the members of the Health Subcommittee,
for the opportunity to speak with you about the above legislation. If
you would like any further information, please feel free to contact
Melanie Brunson, Director of Public Affairs, at [email protected]. We
look forward to answering any questions you may have.
Prepared Statement of Matthew J. Shuman
Chairman Dunn, Ranking Member Brownley, and distinguished members
of this critical subcommittee, on behalf of National Commander Brett P.
Reistad and the 2 million members of The American Legion, the country's
largest patriotic wartime veterans service organization, we thank you
for the opportunity to testify on the H.R. 5413, the Improving Veterans
Access to Congressional Services Act of 2018 & H.R. 6418, the VA
Website Accessibility Act of 2018.
H.R. 5413
To direct the Secretary of Veterans Affairs to permit Members of
Congress to use facilities of the Department of Veterans Affairs for
the purposes of meeting with constituents, and for other purposes.
In 2017, Representative Brian Mast, a special-forces combat veteran
and Veterans Health Administration patient, opened the first-ever
congressional office at the West Palm Beach Veterans Affairs Medical
Center (VAMC). The purpose of this office is to meet with constituents,
primarily veteran constituents receiving healthcare at the Department
of Veterans Affairs (VA). Working with then VA Secretary, Dr. David
Shulkin, an office was dedicated for congressional use in late 2017.
\1\ The West Palm Beach VAMC services four different congressional
districts, and VA supplied the office space, but required the space be
shared between the four Members of Congress who represent the area.
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\1\ https://cbs12.com/news/local/rep-brian-mast-to-open-new-office-
inside-va-medical-center-in-west-palm-beach
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The Secretary of the Department of Veterans Affairs has the
authority to provide office space for Members of Congress. This is the
same authority used to open the office in West Palm Beach. Congressman
Mast has shared the process for obtaining this authorization is arduous
and time-consuming. It took him more than a year to open the West Palm
Beach location.
H.R. 5413, the Improving Veterans Access to Congressional Services
Act of 2018, will direct the Secretary of VA to permit Members of
Congress to use VA facilities to meet with constituents. This bill will
afford Members of Congress the ability to have physical offices at VA
Medical Centers, allowing them to meet with and assist their veteran
constituents with VA claims, earned benefits, and to receive comments
about care received at their local VAMC. The bill also requires VA to
develop regulations regarding the use of agency office space by Members
of Congress, mandating that space is made available during normal
business hours and in a location that is easily accessible to the
Member's constituents.
The American Legion, when invited to testify before this committee,
engaged Representative Mast's congressional office, as well as the
other Members sharing the space in the West Palm Beach VAMC, to learn
more about the creation and day-to-day operations. Congressman Mast's
District Director, who manages their weekly office hours, explained the
agreement to provide office space in the facility shared among the four
Members of Congress who represent the area, is on a rotating basis.
Each of the four members offices is assigned a day of the week to staff
the office from 10:00 am to 2:00 pm. The American Legion agrees
expanding access to services, especially congressional services is a
good thing, however, our experience also makes us wary of possible
negative unintended consequences.
The use of this potentially valuable resource appears to vary
greatly among Members. Whereas Congressman Mast often personally
maintains a presence in the location and his office has had great
success in engaging the veteran community, other members sharing the
space do not seem to have the same level of commitment or resources to
fulfill such a presence. For example, in Congressman Mast's May 16th,
2018, testimony before the full House Veterans' Affairs Committee, he
expressed that his VA office, in only five months of existence, had
conducted more than 250 meetings with veterans, their families and
caregivers, and has opened more than 110 individual constituent cases
to assist veterans. \2\ In contrast, other offices indicate the office
space is used as little as once a month and provides minimal value. The
American Legion is not only concerned that VA will be required to
provide space to congressional members who may further limit space
currently available for necessary healthcare services, but that this
valuable space may be underutilized.
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\2\ https://mast.house.gov/2018/5/mast-testifies-before-va-
committee-on-his-legislation-encouraging-congressional-offices-at-va-
facilities
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The American Legion is adamant in ensuring both VA and our
representative government are accessible to all veterans. We are also
concerned an office of this type will be little more than a ``Complaint
Department,'' where veterans will express only issues and concerns
about VA care, services, and VA employees.
The American Legion, in order to support this bill, calls on this
committee to augment the Improving Veterans Access to Congressional
Services Act of 2018, to create a pilot program with quantifiable
criteria that will yield empirical data to show the potential efficacy
of this legislation to conclusively determine the value to veterans.
The American Legion applauds and appreciates the intentions,
efforts, and leadership of Congressman Mast, particularly as a fellow
veteran. His effort, which we can all learn from, highlights the desire
of a Member of Congress who understands the value of firsthand
engagement with veteran stakeholders in the VA healthcare system. The
American Legion, the largest representative of those stakeholders, will
continue researching and working with this committee, Representative
Mast's congressional office, and our membership of wartime veterans to
determine our position and course of action, to best serve those who
have selflessly raised their right hands and taken the oath to protect
this great nation.
The American Legion supports H.R. 5413 with recommended amendments.
H.R. 6418
To direct the Secretary of Veterans Affairs to conduct a study
regarding the accessibility of websites of the Department of Veterans
Affairs to individuals with disabilities.
20 USC 794d Sec. 508 (Section 508), of the Rehabilitation Act
establishes requirements for electronic and information technology
developed, maintained, procured, or used by the federal government.
Section 508 requires federal electronic and information technology to
be accessible to people with disabilities, including employees, and
members of the public. An accessible information technology system is
one that is operated in a variety of ways and does not rely on a single
sense or user ability.
The VA Website Accessibility Act of 2018, is not proposing any
changes to Section 508. H.R. 6418 requires VA to examine all websites
(including attached files and web-based applications) of VA to
determine whether such websites are accessible to individuals with
disabilities in accordance with Section 508. Further, H.R. 6418
requires VA to compile a complete list of non-compliant websites and
submit a plan to Congress to make these websites compliant with the
requirements of Section 508.
The American Legion is thankful and applauds the leadership of
Representative Esty for creating this legislation, which, in time, will
assist VA in becoming more user friendly to veterans in need.
The American Legion supports H.R. 6418.
Conclusion
The American Legion thanks this committee for the opportunity to
elucidate the position of the nearly 2 million veteran members of this
organization. For additional information regarding this testimony,
please contact the Senior Legislative Associate, Mr. Larry Lohmann, at
The American Legion's Legislative Division at (202) 861-2700 or
[email protected].
Prepared Statement of WOUNDED WARRIOR PROJECT - Jose Ramos
Chairman Dunn, Ranking Member Brownley, and distinguished Members
of the Subcommittee on Health, on behalf of Wounded Warrior Project, we
thank you for the opportunity to testify on legislation before the
House Committee on Veterans' Affairs.
Wounded Warrior Project is transforming the way America's injured
veterans are empowered, employed, and engaged in our communities. Since
our inception in 2003, Wounded Warrior Project has grown from a small
group of friends and volunteers delivering backpacks filled with
comfort items to the bedside of wounded warriors here in our nation's
capital, to an organization of nearly 700 employees in 29 locations
across the country and overseas delivering over a dozen direct-service
programs to warriors and families in need. Through our direct-service
programs, we connect these individuals to their communities and with
one another through our peer-to-peer programming. We serve them by
providing mental health support and clinical treatment, physical health
and wellness programs, job placement services, and benefits claims
help; and we empower them to succeed and live life on their own terms.
We are constantly striving to be as effective and efficient as possible
and are in daily communication with the warriors and caregivers we
serve to ensure we are constantly adapting to their unique challenges
and needs.
H.R. 5413: Improving Access to Congressional Services Act of 2018
To direct the Secretary of Veterans Affairs to permit Members of
Congress to use facilities of the Department of Veterans Affairs for
the purposes of meeting with constituents, and for other purposes.
Each year, thousands of veterans turn to Members of Congress with a
range of requests that span the spectrum of complexity. The Members and
their staff act as the ombudsmen between their constituent, in this
case veterans, and the Department of Veterans Affairs (VA).
Congressional casework not only helps individual congressional offices
assist veterans with critical needs, but it also provides Members and
their staff with a better understanding of government programming, how
policies affect the veteran population, and whether there is a
necessity for congressional oversight or legislative action.
Throughout our 15-year history, WWP has been at the bedside of some
of the nation's most critically injured warriors. Through two programs
in particular - our Independence Program and the work of our Veterans
Disability Benefits Services Team - WWP assists service members and
veterans living with moderate to severe traumatic brain injuries,
spinal cord injuries, and other neurological conditions that impact
independence. We also have partnerships with specialized neurological
case management teams at Neuro Community Care and Neuro Rehab
Management that provide individualized services to meet the needs of
veterans and their families. Warriors that use these programs present
with complex needs and the challenges they face are reflective of those
seen in the greater veteran's community. This year, the Independence
Program will deliver more than 200,000 hours of care to the nearly 700
warriors enrolled.
When serving these warriors, WWP has often found itself advocating
for the critically injured and their caregivers, while communicating
with the VA and congressional staff. WWP believes this process can be
improved by co-locating a congressional representative's district staff
member within a VA Medical Center (VAMC). Doing so would alleviate the
need for multiple trips to different locations and provide a more
holistic approach to address the needs of the most critically injured.
Simply put, this could create a one-stop-shop for advocacy and medical
treatment for the most seriously wounded among our veteran population.
A prototype already exists and appears to be working. The first-
ever VAMC-based congressional office was opened in January 2018 at the
West Palm Beach VAMC. This office is shared by four Members of Congress
and occupied by congressional staff on a rotational basis. Through
discussions with some of the participating warriors we serve, it is
apparent that there is significant value provided to constituents - in
this case, both veterans and their families. Additionally, relations
between the congressional offices and VA has allowed for the resolution
of some issues, instead of submitting a congressional inquiry which
often takes time to respond. The shared space agreement between the
congressional offices and VA was written to mitigate issues around
prohibited political activities, the use of VA facilities for public
fora, and usurping the existing pathways for veterans to seek concern
resolution through Service Level Advocates and Medical Center Patient
Advocates.
Although it has been demonstrated that a legislative solution is
not required to establish a congressional office within a VAMC, the
absence of such legislative authority allows the VA to deny space to
those who seek it. We suggest a climate survey be conducted to assess
the needs and see how each stakeholder feels about the prototype
agreement.
The VA's Office of Congressional and Legislative Affairs (OCLA) is
the focal point for VA management and coordination of all matters
involving Congress. Assistance to Members of Congress and their staff
is available through offices located at VA's Central Office and on
Capitol Hill. Within VA OCLA, congressional interaction is further
separated between Outreach and Oversight Divisions. The Outreach
Division is responsible for receiving and coordinating constituent
related casework and is broken down into seven geographical regions. On
average, the Outreach Division receives approximately 40,000 cases per
year. Of note, approximately 25 percent are cases received directly
from veterans, including some who walk into Capitol Hill offices
located in the Rayburn House Office Building and Russell Senate Office
Building.
We believe that co-locating a congressional office within a VAMC
will lessen the burden on an already overtasked VA Outreach team and
facilitate the resolution of some issues locally with greater
transparency and efficiency. It would also provide congressional
offices and Members of Congress the opportunity to interact more often
with the veteran population in their communities and to better
understand the challenges veterans may face and observe the challenges
and successes at their local VAMC.
Although we support H.R. 5413, WWP would like to caution Congress
on a few aspects regarding this legislation. It is our hope that these
congressional offices are used to conduct constituent outreach,
dissemination of information pertinent to the veteran population, and
above all, allow Congress to learn from the veteran community through
physical interaction at a common veteran focal point. There is some
concern with the potential for misusing theses offices as an
``oversight'' to local VA facilities instead of allowing the VA's
Service Level Advocates and Medical Center Patient Advocates from
executing their mission. Clear guidance should be considered when
determining what actions are acceptable at these locations. Therefore,
we suggest VA develop an ``Introduction to Veteran Affairs'' class,
outline a clear ``VA advocacy chain of procedures,'' and require any
individual working at the VA based offices to not only attend these
classes but also agree to properly direct veterans who ask for
assistance to the appropriate Service Level Advocates or Medical Center
Patient Advocates VA. The intent is to ensure that congressional staff
working at the local VAMC do not bypass already available resources
because they are unaware of how the VA operates. Lastly, Congress
should be extremely sensitive to the perception of using veterans for
political purposes, and therefore strongly support the closing of the
VAMC congressional offices during campaign season as outlined in the
current shared space agreement being utilized at the West Palm Beach
VAMC.
For these reasons, Wounded Warrior Project fully supports H.R.
5413, the Improving Access to Congressional Services Act of 2018.
H.R. 6418: VA Website Accessibility Act of 2018
To direct the Secretary of Veterans Affairs to conduct a study
regarding the accessibility of websites of the Department of Veteran
Affairs to individuals with disabilities.
Wounded Warrior Project's mission to honor and empower wounded
warriors drives us to foster the most successful, well-adjusted
generation of injured veterans in our nation's history. The warriors,
caregivers, and family members we serve are at the center of every
decision we make.
While the past several years have seen an increased focus on the
mental health needs of post-9/11 veterans, WWP remains vigilant in
addressing the needs of those with severe physical and cognitive
injuries. According to the Department of Defense (DoD)-VA Extremity and
Amputation Center of Excellence, as of June 2018, there have been a
total of 1,719 OEF/OIF/OND/OIR/OFS amputee patients treated in all
Military Treatment Facilities. A large portion of those patients was
treated following high-impact or blast-related injuries. Additionally,
the 2017 Wounded Warrior Survey - distributed annually by WWP to
warriors registered with our organization - illustrates that 40.9
percent of the 34,822 warriors who completed the survey self-reported
to have a traumatic brain injury (TBI). This population includes those
with severe TBI who experience significant cognitive issues.
According to the DoD's Vision Center of Excellence, eye/head trauma
or exposure to a blast can result in immediate and/or longer-term
vision loss and visual dysfunction that can be difficult to initially
detect, making those affected with TBIs more prone to vision problems
in the future \1\. Research also notes that among the 41,469 OEF/OIF/
OND veterans diagnosed with eye conditions, more than 75 percent of all
TBI patients experienced short- or long-term visual dysfunction,
including double vision, sensitivity to light, and inability to read
print, among other cognitive problems \2\. Furthermore, according to
DoD military eye trauma statistics, from 2000 through 2010, there were
186,555 eye injuries worldwide in military medical facilities \3\. The
most significant factors leading to hospitalization were ordnance
handling (16.9 percent), enemy action (13.1 percent), and assaults and
fighting (11.9 percent) \4\.
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\1\ DoD Vision Center of Excellence. Vision Problems Associated
with TBI.
\2\ DoD Armed Forces Health Surveillance Center, Medical
Surveillance Monthly Report (MSMR), vol. 18, no. 5, Eye Injuries,
Active Component, U.S. Armed Forces 2000-2010, May 2011, 2-7.
\3\ Ibid at 2-7.
\4\ Hilber D, Mitchener TA, Stout J, Hatch B, Canham-Chervak M. Eye
injury surveillance in the U.S. Department of Defense, 1996-2005. Am J
Prev Med. 2010;38(1S): S78-S85.
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Section 508 of the Rehabilitation Act (29 U.S.C. Sec. 794d)
requires federal agencies to ensure that all electronic and information
technologies developed, procured, maintained, or used by the Federal
Government provide equal access for people with disabilities, whether
they are federal employees or members of the public. According to a
2012 Department of Justice report, there are still major challenges
throughout the government, including at VA, with the implementation and
management of Section 508 compliance. Even though the Attorney General
is required to submit reports to the President and Congress on the
state of federal agencies' compliance with Section 508, WWP was unable
to find a more recent report. This highlights the necessity for
additional congressional oversight.
According to VA's 2016 American Community Survey, Profile of
Veterans: Internet Use Deep Dive, most households in which a veteran
resides have internet access and use/own a computer or smartphone
regardless of gender, age, economic status or educational level \5\.
This means that the likelihood of a veteran or a Service member with a
physical or cognitive disability relying on or utilizing an electronic
or information technology web-based system to seek their care or
communicate with VA is extremely likely. As VA introduces new
technologies or modifies old systems, it must recognize the potential
of inadvertently removing accessibility features that were once in
place. The VA must ensure that website developers follow industry-
standard accessibility guidelines to ensure compatibility with screen
reading software utilized by individuals who are visually impaired.
Additionally, as VA executes the implementation of the electronic
health record management system, which will have a robust external
facing platform, it must do so with thoughtful consideration of end
users who may have visual or cognitive deficiencies.
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\5\ U.S. Census Bureau, American Community Survey PUMS, 2016
Prepared by the National Center for Veterans Analysis and Statistics.
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Wounded Warrior Project was pleased to learn that the Cerner
patient portal currently being developed is being rewritten and will be
Section 508 compliant. This will be the portal a veteran uses to access
their medical records and the portal used for the initial operating
capacity (IOC) site when they go live. One thing to be mindful of
regarding the Cerner application programming interface (API) framework;
mobile apps could be developed by several third parties, including VA,
so additional oversight may be needed to ensure Section 508 compliance
by non-Cerner developers.
For all other administrative or clinical-facing workflows and
solutions, Cerner is not fully compliant because much of the code was
developed prior to the availability of requirements. It is our
understanding that Cerner is working closely with VA on completing a
compliance roadmap.
For these reasons, WWP supports the intent of H.R. 6418, the VA
Website Accessibility Act of 2018 with additional recommendations:
Prior to passing H.R 6418, WWP recommends Congress receive a brief
from the VA CIO, the Department of Justice Civil Rights Division
responsible for obtaining information on Section 508 compliance, and
the Federal CIO Council Accessibility Committee on the status of
ongoing efforts to bring VA IT systems in compliance with Section 508.
Any report produced should also include a strategic plan with stated
timelines for fixing its inaccessible websites to make them accessible
and usable by people with disabilities. Lastly, Congress should
institute annual briefs to continue monitoring progress made to include
electronic health record modernization efforts.
Conclusion
Wounded Warrior Project thanks the Subcommittee on Health, its
distinguished Members, and all who have contributed to the policy
discussions surrounding the bills under consideration at today's
hearing. We share a sacred obligation to serve our nation's veterans,
and WWP appreciates the Subcommittee's effort to identify and address
the issues that challenge our ability to carry out that obligation as
effectively as possible.
[all]