[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
US DEPARTMENT OF VETERANS AFFAIRS BUDGET REQUEST FOR FISCAL YEAR 2020
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
WEDNESDAY, APRIL 3, 2019
__________
Serial No. 116-4
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
38-954 WASHINGTON : 2021
--------------------------------------------------------------------------------------
COMMITTEE ON VETERANS' AFFAIRS
MARK TAKANO, California, Chairman
JULIA BROWNLEY, California DAVID P. ROE, Tenessee, Ranking
KATHLEEN M. RICE, New York Member
CONOR LAMB, Pennsylvania, Vice- GUS M. BILIRAKIS, Florida
Chairman AUMUA AMATA COLEMAN RADEWAGEN,
MIKE LEVIN, California American Samoa
MAX ROSE, New York MIKE BOST, Illinois
CHRIS PAPPAS, New Hampshire NEAL P. DUNN, Florida
ELAINE G. LURIA, Virginia JACK BERGMAN, Michigan
SUSIE LEE, Nevada JIM BANKS, Indiana
JOE CUNNINGHAM, South Carolina ANDY BARR, Kentucky
GILBERT RAY CISNEROS, JR., DANIEL MEUSER, Pennsylvania
California STEVE WATKINS, Kansas
COLLIN C. PETERSON, Minnesota CHIP ROY, Texas
GREGORIO KILILI CAMACHO SABLAN, W. GREGORY STEUBE, Florida
Northern Mariana Islands
COLIN Z. ALLRED, Texas
LAUREN UNDERWOOD, Illinois
ANTHONY BRINDISI, New York
Ray Kelley, Democratic Staff Director
Jon Towers, Republican Staff Director
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
----------
Wednesday, April 3, 2019
Page
US Department Of Veterans Affairs Budget Request For Fiscal Year
2020........................................................... 1
OPENING STATEMENTS
Honorable Mark Takano, Chairman.................................. 1
Honorable David P. Roe, Ranking Member, prepared statement only.. 47
WITNESSES
The Honorable Robert L. Wilkie, Secretary, U.S. Department of
Veterans Affairs............................................... 3
Prepared Statement........................................... 47
Accompanied by:
Dr. Paul Lawrence, Under Secretary for Benefits, U.S.
Department of Veterans Affairs
Dr. Richard Stone, Executive in Charge, VHA, U.S. Department
of Veterans Affairs
Mr. Jon Rychalski, Assistant Secretary of Management/CFO,
U.S. Department of Veterans Affairs
Ms. Joy Ilem, National Legislative Director, Disabled American
Veterans....................................................... 37
Prepared Statement........................................... 58
Accompanied by:
Ms. Heather Ansley, Associate Executive Director of
Government Relations, Paralyzed Veterans of America
Mr. Patrick Murray, Associate Director, National Legislative
Service, Veterans of Foreign Wars
Larry L. Lohmann, Esq., Senior Legislative Associate, Legislative
Division, The American Legion.................................. 38
Prepared Statement........................................... 64
QUESTIONS FOR THE RECORD
House Committee Members To: Department of Veterans Affairs (VA).. 78
MATERIALS SUBMITTED FOR THE RECORD
Letter From Elaine Luria To: Department Of Veterans Affairs...... 80
Letter From Chairman Mark Takano and David P. Roe, Ranking Member
To: Department Of Veterans Affairs............................. 80
Letter From Robert L. Wilkie To: Mark Takano, Chairman........... 81
US DEPARTMENT OF VETERANS AFFAIRS BUDGET REQUEST FOR FISCAL YEAR 2020
----------
Wednesday, April 3, 2019
Committee on Veterans' Affairs,
U. S. House of Representatives,
Washington, D.C.
The Committee met, pursuant to notice, at 2:20 p.m., in
Room 1334, Longworth House Office Building, Hon. Mark Takano,
[Chairman of the Committee] presiding.
Present: Representatives Brownley, Rice, Lamb, Levin,
Brindisi, Rose, Pappas, Luria, Lee, Cunningham, Cisneros,
Peterson, Sablan, Allred, Underwood, Roe, Bilirakis, Radewagen,
Bost, Dunn, Bergman, Banks, Barr, Meuser, Watkins, Roy, Steube,
and Mast.
OPENING STATEMENT OF MARK TAKANO, CHAIRMAN
The Chairman. Good afternoon. I call this hearing to order.
First, I'd like to welcome Secretary Wilkie and our
Veterans service organizations, the American Legion, Disabled
American Veterans, Paralyzed Veterans of America, and the
Veterans of Foreign Wars to this hearing on the President's
Fiscal Year 2020 Budget Request.
This budget reflects the Administration's priorities, many
of which we can all agree upon. The fact that we can agree on
so much is a bright spot in the function of this chamber and
our government.
However, in some cases we continue to see the same
proposals from this Administration that we will never support.
Proposals like taking disability benefits from veterans by
rounding down the cost of living adjustment to pay for other
veterans' programs.
The VA budget does not contain the proposed cuts to its
programs and benefits that we see in other parts of the
President's fiscal year 2020 budget request.
Yet we cannot forget that cuts to important safety net
programs like SNAP benefits, Medicare, and Medicaid, and the
agencies responsible for providing them will have serious
impacts on the lives of veterans and their families who depend
on those benefits, and will likely place a greater strain on VA
resources as veterans look to fill the void these programs have
left.
Although VA's budget reflects an overall increase of 9.5
percent over Fiscal Year 2019 appropriate levels, I remain
concerned about whether this budget provides appropriate levels
of funding to implement the VA MISSION Act, address VA's
information technology needs and provide Blue Water Navy
veterans exposed to Agent Orange disability and health care
benefits, and address veteran suicide, including an alarming
trend of veterans committing suicide on VA campuses.
Now, we are all aware of the significant challenges at VA
and our task today is to ascertain whether this budget request
goes far enough to address these challenges, and whether
funding has been prioritized to best support the needs of
veterans.
For example, with the passage of the MISSION Act,
implementation of the law and providing coordinated community
care has been a focus of the Department. However, funding for
this program and the prioritization of this program must not be
done at the expense of addressing VA's significant workforce
and infrastructure needs.
Based on the Congressional Budget Office's cost
projections, we do not know if this budget request goes far
enough to cover the projected cost of this program, an
estimated $47 billion over five years without pulling resources
from other VA programs.
The hasty rollout of IT systems and programs like Medical
Surgical Prime Vendor without involving the clinicians and
users of these systems, or having the leadership and governance
in place has led to disruptions in services, and we are afraid
problems with the delivery of care and benefits to veterans may
continue without the appropriate leadership commitment,
expertise, and resources.
Most recently we witnessed this with a disruption to
student veterans GI Bill Housing Stipend benefits.
The VA includes a hefty increase of $426 million to prevent
veteran suicide. Yet, last year VA spent only $57,000 on
suicide prevention outreach to veterans. It took oversight from
the Inspector General and this Committee to get the VA back on
track. The budget request includes an additional $15 million
for suicide prevention outreach and if VA receives this
funding, I intend to closely monitor spending of these funds to
ensure that every last cent is spent to get the word out to
veterans in crisis.
If we are to be successful in preventing 20 veterans from
taking their lives each day, veterans must have easy access to
VA mental health care, and they must know that VA is ready and
immediately available to help when veterans need it most.
The VA must be prepared to provide disability benefits and
health care to the Blue Water Navy veterans who have been
waiting over 40 years for their benefits. It must invest in its
workforce, including recruitment of providers to fill the
48,985 vacancies in the department, and address severe morale
issues at some facilities.
VA contracting has now been added to the Government
Accountability Offices' high-risk list, and the Veteran's
Health Administration has remained on that list since 2015.
These challenges play out each day at the D.C. VA Medical
Center, practically footsteps from the White House.
The D.C. VA was in the news again last night because of low
morale, severe understaffing, and a dysfunctional medical
supply chain. Meanwhile, the clinicians and front-line staff at
that hospital make do with limited resources and support to
provide high quality and timely care to veterans. We wanted to
know which funds in the budget are requested to address these
challenges.
Then we talk about student veterans, who have been robbed
of their time and GI Bill benefits by predatory for-profit
schools and must be made whole. The recent closings at Argosy
campuses have left thousands of veterans in limbo. Congress was
forced to step in two years ago to restore benefits to veterans
affected by for-profit schools closing, such as ITT Tech and
Corinthian, and we may have to do it again.
But the Department has a role in preventing these schools
from taking advantage of veterans in the first place. We need
to know how VA's budget addresses this problem. And finally we
need to understand the Administration's rationale for the
proposed $17 million cut to VA research, and 45 percent cut to
VA's construction budget, which is contrary to what our veteran
service organizations recommend.
I have invited them here today so that they can weigh in on
what they believe to be the appropriate funding levels and
priorities for VA.
Now these challenges are not insurmountable and as I said
in our last hearing we are to work with VA as a partner to
ensure VA can meet these challenges now and in the future. To
do that, we need transparency from VA so that we can have an
open and honest dialogue about the resource needs of the
Department, and today we are here to conduct oversight so that
Congress, veterans, and the American people all understand our
investment in the VA and ensure the funds that we provide are
used to support the needs of veterans.
I see that I started the hearing without Dr. Roe here, and
I'm sorry I did that. I'm sorry. So what I will do is I want to
recognize the Secretary for his opening comments and then I'll
recognize Dr. Roe when he arrives.
STATEMENT OF ROBERT WILKIE
Secretary Wilkie. Mr. Chairman, I'll stop when Dr. Roe
comes. Thank you again for your courtesy to me. This is my
second appearance in the last, I think, month in front of the
Committee and I am pleased to present to you the largest budget
recommendation in the history of our department. I am very
happy to be here with veterans. Jon Rychalski, who is our Chief
Management Officer; Dr. Richard Stone, who is our Executive in
Charge of health and the recent award winner for outstanding
senior executive in the Federal government; Dr. Paul Lawrence
who works for our VBA.
I have said before, Mr. Chairman, that we are in the middle
of the greatest transformative period in the history of our VA.
We are no longer on the cusp; we are in the middle. And that
is, in part, because of the leadership of this Committee and
your companion in the United States Senate.
We are also very happy to report in response to some of the
things that you pointed out that morale at VA is at an all-time
high. For the first time in my professional career the
Department of Veterans Affairs is no longer 16 out of 17, or 17
out of 17 when it comes to the best places in government to
work. We are at sixth place and we are rising.
In addition, our veterans are voting with their feet. The
satisfaction rate for America's veterans for the services that
they get at the Department of Veterans Affairs has now reached
90 percent.
That is also my response to those who say that we are in
the middle of privatizing this wonderful institution. Our
veterans are telling the world that they are getting the best
service in the country from their VA, and I am very proud to be
part of that team.
I will be short then and allow Dr. Roe to take his usual
place, but I did want to finish. I'm not giving you an
extensive statement since I did that a few weeks ago, but to
respond to something that you raised during your hearing
yesterday with Dr. Stone, and that was questions about
community care and our ability to carry forth with the payment
of our doctors and community medical facilities if contracts
are under challenge.
I am happy to say that because of the military training
that all of us at this table have that we believe in
redundancy, and TriWest is responsible for handling those
accounts until a new contract is in place and people are
working those new contracts. So there is not going to be an
interruption in service.
Our new community care contracts are coming into place and
there will be no gap between what TriWest has been doing and
what our new partners will be doing when it comes to fulfilling
our community care obligation.
So I will stop and not give a lengthy opening statement and
yield to Dr. Roe.
[The prepared statement of Robert L. Wilkie appears in the
Appendix]
Mr. Chairman. Thank you, Mr. Secretary. Before I recognize
Dr. Roe, without objection Mr. Mast will be permitted to sit at
the dais and ask questions when recognized. I now recognize Dr.
Roe for his opening statement.
Mr. Roe. Mr. Chairman, I think what we can do, and we have
a long hearing this afternoon. I'll just submit it for the
record, and we can move on.
[The prepared statement of David P. Roe appears in the
Appendix]
The Chairman. Thank you, Dr. Roe. We've already heard from
the Secretary. I would like now to recognize myself for five
minutes, and I want to begin with a question to Secretary
Wilkie.
Mr. Secretary, I understand from an interview you did with
the Colorado Public Radio station that you said, and I quote,
``I refute everything in that report,'' and I'm referring to
the report by the U.S. Digital Service. You go on to say,
``that's an interesting report that was done without discussing
any of the issues with any senior leader at the Department of
Veterans Affairs, including the people who actually handle our
information technology systems.''
In a hearing this Committee held yesterday, Dr. Glynn, the
Assistant Secretary for the Office of Enterprise Integration
confirmed that she herself requested the report from the United
States Digital Service and said it was standard practice for VA
to request such a report from subject matter experts, and
requested a briefing that was attended by VA senior staff to
discuss the report's findings.
So do you still stand by your assertion that no senior
leaders or individuals handling the information technology
systems were briefed or took part in discussions with USDS?
Secretary Wilkie. I do, and I'm talking about process, Mr.
Chairman. That report was in pro publica before any of us saw
it. It was a draft report. It was not a complete report. What
was interesting to me is that for an organization that
specializes in high tech, 80 percent of the draft report was
about policy.
Having grown up in this institution I know what would have
happened in the Majority Leader's office in the Senate where I
worked, if we had a report that was incomplete and was in the
press before the Majority Leader saw it.
That was the thrust of my remarks that it is bad process
for me and for the leaders at this table to read about a report
in pro publica before any of us have ever seen it.
So I was talking about process and I was saying that I
refute the process that was involved in releasing that before
any of us at the table saw it.
The Chairman. So you were not refuting the content in that
report?
Secretary Wilkie. I don't refute all of it, no. I was
talking about the process in which I found out about it.
The Chairman. I see. Well, you know, Dr. Roe the Ranking
Member and I both sent you a letter on March 21, and I'm
holding the letter in my hand, requesting that the VA provide
all U.S. Digital Service reports on VA systems for the last
five years, and without objection I'm going to enter this
letter and the response that we received from you on March 29,
and I'm holding your response right here--the March 29 response
from you into the record. So without objection I enter both
documents in the record.
After the deadline of March 28, we received your response,
and this is that response I'm speaking of, that VA could not
provide these reports to us because they belong to OMB.
However, we discussed these reports with OMB, and this is not
true.
These reports are VA documents. Will you provide Ranking
Member Roe and me with these reports by the close of business
this Friday, April 5?
Secretary Wilkie. First of all, Mr. Chairman, I understand
that the White House counsel itself wrote that letter and
anything that's in VA's purview to hand to this Committee, I
will hand to this Committee.
The Chairman. So we can expect these reports by Friday?
Secretary Wilkie. Anything that is in our purview to hand
to you, I will do that.
The Chairman. I appreciate that, but specifically the U.S.
Digital Service Reports that we've asked for the past five
years. That's what I'm asking. I understand those to be in VA's
possession.
Secretary Wilkie. And I don't know all of the details, but
you've got my promise that if we have the authority to release
things that are in our custody, I will release them.
The Chairman. Well, my understanding is that they are in
your custody and that it is the purview of the oversight of
this Committee to request and be able to receive those reports
and I will expect those reports by Friday.
I see that I'm running out of time. I had wanted to ask you
about the Loma Linda Medical Center, but I hope we can dialogue
more about that, but I will now recognize Ranking Member Roe
for his five minutes.
Mr. Roe. Thank you, Mr. Chairman. I'm going to yield at
this time to Mr. Banks.
Mr. Banks. Thank you, Mr. Chairman and Ranking Member Roe.
First of all, Mr. Secretary and Dr. Stone, I would just like to
add that I, too, think that the U.S. Digital Service makes a
valuable contribution.
Technology is one of our government's biggest struggles and
the members of USDS are some of the best and brightest from the
private sector coming to work with Federal agencies each and
every day. Just because USDS may have gotten outside of their
lane in this particular report, and some of their
recommendations were taken out of context, I don't believe that
they should be discredited.
So, Mr. Secretary, do you intend to continue working with
USDS in the future?
Secretary Wilkie. Yes, sir, and I wasn't discrediting their
work. I was simply saying that I was asked to respond to
something that I had never seen, and I think you know from your
political life that is a very interesting place for a leader to
be in.
Mr. Banks. Fair enough. Let me move on to something else,
Mr. Secretary. The VA is now adopting DoD's logistics software
demos at the James Lovell Medical Center to harmonize the two
supply chains.
I agree with this concept, though I'm worried about adding
demos onto the EHR modernization too early. How exactly is this
software different from what you have now and what else will it
enable you to do?
Secretary Wilkie. Well, it is also a process question. What
is different now is that we have systems that are spread out
throughout the Department of Veterans Affairs. We don't have a
single comprehensive supply chain management system.
We have different parts of the country--different medical
centers asking for things in an inchoate way. I testified in
front the Senate a few weeks ago that we actually--I came
across warehouses of material that had been ordered willy-nilly
without any centralized accounting system to make provision for
them.
What this will do is create a nationwide system that will
allow our people to punch into it and put in requests that they
need, and we will be able to distribute supplies and material
across the country to meet the greatest need.
I would be lying to you if I told you I was an expert in
IT. But having been on the other side as the Undersecretary of
Defense, I know how well that system works.
I want it to work for us because we're not going to be able
to do--if everything in the MISSION Act worked perfectly, if we
don't have a modern supply chain system, a modern HR system and
the electronic health record, it's going to be difficult to
continue the progress VA has been making.
Mr. Banks. Let me follow up on that. The OIT budget
proposal allocates $36.8 million for this supply chain
initiative. Is that just the cost for the pilot site or to
purchase demos in VA across--
Secretary Wilkie. That's the cost of the pilot site.
Dr. Stone. Yes, sir, that is the cost of the pilot site.
There are nine different subsystems within supply in
maintenance that are held within the supply chain. So how we
maintain the services on our major end items like CT scanners
and MRIs, right down to how we buy Band-Aids. So there's nine
different subsystems.
Right now what we discovered when we arrived is that about
36 of our medical centers that are on a system called Sword
Maximo, that was not propagated across the rest of the system.
What see in demos is an opportunity to combine closely with
Department of Defense and really leverage the power of both
departments against potential savings for the American
taxpayer.
Mr. Banks. Okay. So $36.8 million is the cost of the pilot.
How much will demos and the rest of the supply chain initiative
cost when it's rolled out nationally? And when will that
national rollout occur?
Dr. Stone. So we will break the code on how we've done it
north Chicago about mid-May and begin to look at the financial
implications of it. Should it make sense we'll then go forward
in the initial operating sites in Spokane and Seattle and at
that point we'll step back and see if we can--
Mr. Banks. If we're making an investment of $36.8 million
for a pilot site, what can we expect the cost totally when it's
rolled out nationally?
Dr. Stone. It would be our hope that this can be self-
funded. That is the plan, is to try and self-fund this
initiative from savings in the supply chain.
Mr. Banks. My time is almost expired. I'll yield back.
Mr. Rychalski. One comment about that is we are doing the
cost analysis now. One point here is demos is a fully mature
system, so we have pretty good cost information. We also don't
have to develop anything so it's a matter of installing the
system. We can provide you cost estimates frankly for the
continuation once we have them later this year.
Secretary Wilkie. And I would add, sir, if the Chair would
indulge me because Chairman Takano mentioned this in his
opening remarks. My impetus for moving was precisely the
situation that the Chairman laid out.
I was familiar with what was going on at the D.C. VA. The
stories in the Washington Post about how operating room
technicians running across the parking lot to MedStar to get
equipment that they should have had. You cannot run a modern
organization without a modern supply chain, especially for an
organization that has 170 hospitals.
The Chairman. I now recognize Ms. Brownley for five
minutes.
Ms. Brownley. Thank you, Mr. Chairman, and thank you, Mr.
Secretary for being here today and thank you for your visit to
my office last week. I enjoyed it very, very much.
I have two questions that I want to ask and both questions
are under the umbrella of IT, one for the MISSION Act and the
other for the electronic health care records.
So, the first on the MISSION Act and its implementation. I,
too, as some members have already expressed was very concerned
at yesterday's hearing, having read the USDS report and I
understand what you're saying. It's never fun to have the press
out in front of you. I get that.
And as you said it's a draft and somewhat incomplete, but
there were still some very alarming issues that were raised
within that report and I think it actually put our oversight
responsibilities on sort of high alert.
I also recognize that you have written a letter to the
Appropriations Committee about an increase in funding for
MISSION Act implementation.
And so given the concerns from yesterday's meeting I
actually have a letter that I wrote to you that I'd like to
deliver to you today just asking some follow-up questions with
regard to the IT systems and the implementation of the MISSION
Act, and if you would be so kind to respond to me, I'd
appreciate it.
Secretary Wilkie. I will, and I also thank you for the
visit. Let me answer quickly about what will happen on June 6.
I mentioned a few minutes ago the issue of redundancy in
military systems. That's how I was trained. I expect a decision
support tool which was mentioned in that report to be online on
June 6. It is a tool for our doctors and health care
professionals at VA. It is not a tool for our veterans'
community to use. It is for the doctors to determine in
consultation with the veteran what the best health care outcome
is, where to go. So, that is that.
The other side is we're going to be implementing MISSION
Act even if the decision support tool is at 70 percent or 50
percent. Our people have been trained on how to work with our
veterans in getting the accessibility and availability
standards to them and to get them out into the community if we
do not have that particular service.
Ms. Brownley. And Dr. Stone said the same thing yesterday,
as well. But still some concerns obviously and we don't have--I
think it's fair to say that we don't have the greatest
reputation when it comes to IT implementation.
But second question around the MISSION Act is I know that
your people are meeting with our Committee staff I think on a
monthly basis and now that we're in essence three months away
from the MISSION Act rollout, I was hoping that we, and I think
staff is, and I think the Chairman supports me in this request
in terms of having more frequent briefings with the Committee
staff just so that we can have some greater oversight.
And would you agree to in these next few months to provide
the Committee staff with biweekly updates rather than monthly
updates?
Secretary Wilkie. Yes.
Ms. Brownley. Thank you, sir.
Secretary Wilkie. And anything you need on that.
Ms. Brownley. Thank you very, very much. And then my last
question is with regard to the electronic health record.
Yesterday we had a hearing with the IG and GAO and I
believe it was the GAO who said--I'm paraphrasing, but the gist
of what she said was that if DoD and the VA don't square off on
the issues and issues that have to be adjudicated, if that
can't be done, implementing the electronic health record is
going to fail. Period.
And so that also raised my hackles and I think it did for
everyone on the Committee and, you know, obviously again our
oversight on that is on red alert, as well. Your comments?
Secretary Wilkie. Actually I would agree with the statement
that says if we can't agree with DoD then the process is in
trouble. I would not have embarked on this if I thought that
was a potential.
I mentioned that the precursor to this was me sitting with
Secretary Mattis and we were finally able to say to both the
DoD and the VA community that we will deliver a continuum of
care from the time that a young American walk into the entrance
processing station, and the time that that American is handed
over to VA.
I am looking at making the Integrated Program Office much
more robust. It's worked in more complex defense programs than
the electronic health record. I think it will be the coming
together for the first time of two major departments of the
Federal government for a common system. I'm absolutely
confident that we're going to get this onboard and I will again
use the personal impetus for me proving this. Days of people
like my father with an 800-page paper record walking around
have to be over.
Ms. Brownley. You will be the first to break through these
silos, so we are all counting on you. Thank you very much and I
yield back.
The Chairman. I'm going to recognize Dr. Roe for five
minutes.
Mr. Roe. Thank you all. Thanks for being here. Dr. Warren,
she's very quickly--we're about six weeks into appeals
modernization. How is that going?
Dr. Lawrence. Very well. The experience you had when you
were down in Nashville has been validated. One month in I think
we received about 1,100 of new appeals and those-- some of them
have been processed within 30 days. So far so good. Some
tweaks, we're doing some after action but we're going forward
as planned.
Mr. Roe. I think that is a real ongoing success story for
VA and one that folks should know about.
I had an opportunity, Mr. Secretary, to go through the
budget and as we go into the MISSION Act, what's the total
budget for non-VA care?
Secretary Wilkie. The total budget, and I'll give you the
percentage, Dr. Roe, is about 19.1 percent with 81 percent
being within VA, and that meets the trends that you and I have
discussed, and I mentioned earlier that we foresee veterans
continuing to vote with their feet and come to VA. I think that
81-19 split is perfectly in line with that.
Mr. Roe. In real dollars how much is that?
Mr. Rychalski. So for the consolidated community care it's
about--in purchasing power it will be about $16.8 billion.
Mr. Roe. Okay. I just wanted to--and that pretty well, if
you looked at the six other ways that VA had to provide care
and add that to what we provided with choice, I think that's
about where that number--am I correct on that?
Mr. Rychalski. That's correct.
Mr. Roe. Okay. The second question I have is I was looking
at the budget and we know VA's record on major construction
projects has been less than stellar. I noticed there was a $2
billion in a new--what's that $2 billion for?
Mr. Rychalski. Two billion dollars in new construction?
Mr. Roe. Yes, sir.
Mr. Rychalski. I think some of it was--it was in major and
minor construction. I think there was 1, maybe 1.2, some of
that for Louisville. I think New York, Manhattan. I'll have to
look at the other projects.
Mr. Roe. Are these new hospitals that we're building?
Secretary Wilkie. The Louisville hospital is new and
Manhattan is a complete overhaul.
Mr. Roe. Okay. Well, I know my good friends in Kentucky
will probably not like me saying this, but should we be
thinking about looking at the Air Act and has that been taken
into consideration? Maybe they're both needed and it's great if
they do. We got it. We need to go ahead.
But the question is does that fall into the market
assessments that we've done and let's don't lay out $2 billion
worth of new construction and find out five years from now we
goofed up?
Secretary Wilkie. Well, yes, sir. I am almost as vocal a
proponent of the market assessments and the Air Commission as
you are. This is the wave of the future. We are conducting the
market assessments as we speak.
My understanding is that the requests for Louisville and
Manhattan long predated my tenure here. But it is my intention
to come to this Committee in the near future as the market
assessments are completed and actually ask for the Air
Commission to begin its work in a time sooner than what is in
the legislation.
The legislation calls for 2022. I think we'll be finished
with most of this next year and we owe it to our veterans to
get this commission rolling because of the issues that you've
just raised.
Mr. Roe. Yeah. I mean, they may be absolutely needed. They
might fit right in the niche exactly. But I don't want us to be
sitting there having spent this money and then realize that we
don't have any veterans to take care of.
So anyway I just wanted to know about that. So your
suggestion would be to step up, as the market assessments are
done in 2020 to go ahead and begin to assimilate the
commission?
Secretary Wilkie. And, yes, sir. And as I said we have
started the market assessments. Thirty one of the 96 that the
legislation calls for are already underway. They're running
concurrently across the country and I am very happy with their
progress.
Mr. Roe. When will we have access to those so we can begin
to get our arms around it on the Committee?
Secretary Wilkie. I don't know the answer to that. As soon
as the information that I have I will share.
Mr. Roe. Okay. Thank you very much. I yield back.
The Chairman. Thank you, Dr. Roe. I now recognize Mr. Lamb
for five minutes.
Mr. Lamb. Thank you, Mr. Chairman. Mr. Secretary, welcome
back. Thank you for the budget proposal. I'm encouraged by a
lot of the things that we saw in there.
When you were here for the VA 2030 hearing we talked a
little bit about vacancies in the VA and you mentioned your
priorities were primary care, women's health, and mental health
and I saw the increases in the budget for hiring full-time
employees, student loan incentives, that kind of thing.
Is there a plan within VA to target those three
specialities, or Dr. Stone if this is better for you, please go
ahead? I was just kind of curious on the details of how we're
going to go out and get those folks once we have the additional
funding.
Dr. Stone. Congressman, yes. There is a plan to increase
all of these. We have very active mini-residencies in women's
services that we'll train another 600 providers, especially in
our rural areas trying to get the right expertise into the
remote areas of our delivery system.
For mental health we had committed over the last 15 months
to hire 1,000 additional behavioral health providers. We've
exceeded that and we'll continue to grow.
Within this budget there is the plan to grow our employment
by another 13,000 individuals to ensure access. I'm quite
pleased at the continued reduction in wait times across much of
the delivery system. But we will progress on all of these
fronts.
Mr. Lamb. Thank you. And I guess what I am asking you is
how are you going to go and get them and get them to the places
where we really need them? Is there a recruiting challenge or
do you feel like with the additional money you can kind of just
post the jobs, or what's the strategy there?
Dr. Stone. Hiring medical professionals and getting them
into remote areas is a difficulty across all of American
medicine but you've given us within the MISSION Act some great
tools.
You've given us location specific pay. You've given us the
ability to pay in enhanced amounts relocations. You've given us
the ability to pay back student loans, and those are all proper
areas and we appreciate those portions of the Act.
Mr. Lamb. Thank you.
Secretary Wilkie. And my view on that is in the next budget
I believe I will be coming back to you and asking to make that
program more robust. I've talked about a veteran's equivalent
of the Peace Corps.
Mr. Lamb. I noticed that in your testimony.
Secretary Wilkie. And I think that's where Chairman Takano
has been in the last few years, to get our young people back
into rural areas in exchange for debt relief which this
Committee championed in exchange for a specific period of
service.
Mr. Lamb. Thank you. And I agree, we want to help
legislatively. Please let us know besides the budget what we
can do to help carry the ball on that.
Dr. Lawrence, sorry. Mr. Cisneros, could you lean back or
something? Thank you.
Mr. Lamb. I have to say I know Dr. Roe characterized the
appeals modernization process as a success so far and I think
in a lot of ways on paper it might be. But I had a very
troubling meeting with a lot of folks who are kind of on the
front lines of this for us in Pittsburgh under VBA.
And they were called in. These are ordinary raters. They
were called in on the Friday before this thing went live and
told they needed all kind of new training and they needed to do
things differently, and they did not feel anywhere close to
adequately prepared for the changes that came, again at the
ground level.
So I don't know what the strategy was there, but can you
explain why a significant number of your employees would have
only been told that really the business day before this thing
went live that they had to do things differently than they were
doing before?
Dr. Lawrence. No, I really can't. I'll have to get behind
that and maybe talk to you as to how that came about. The major
processing of the appeals is done in Seattle and Tampa, so
those are where we hired the 605 people you allocated for us.
Some of the runoff is done in a couple of other places like
that. I don't understand why that happened.
We had schedules that laid out several months in advance
what was to take place, who was identified in the training they
were provided. That's the anomaly but I'm happy to go and look
and we can back to you on that.
Mr. Lamb. We'll follow up with you on that. I appreciate
it. It definitely caused a distressed workforce. So I don't
know if it was just a local decision to start doing things
differently in advance of this or not. But I would appreciate
it if you could look into that and maybe we could follow up on
it.
Mr. Chairman, I yield back. Thank you.
The Chairman. I now recognize Dr. Dunn for five minutes.
Mr. Dunn. Thank you, Chairman Takano.
Secretary Wilkie, Dr. Stone, it is nice to see you again.
Thank you for your time here today. I think we all know that
there is a crushing shortage of GME residency slots in the
country. The Choice Act authorized an additional 1,500. Can you
tell me how many of those to date have been filled and what the
uptake rate is on those?
Dr. Stone. I can't tell you exactly where we are. I know
that we are at 123,000 residents that are training in our
facilities. How many of ours, how many are part of our academic
affiliates, I can break out for you and I will take that one
for the record. I know that our goal was to grow over 1,000,
but we will get that for you.
Mr. Dunn. I would appreciate the follow-up on that because
I have to tell you, every single medical group that I speak to
or comes in the office, that is among their first two or three
questions, so I appreciate--
Dr. Stone. If I may, sir, let me add one other thing. We
had 24 facilities that did not have teaching positions,
especially in rural areas. In order to enhance rural attraction
of physicians when they finish, 23 of those 24 are now online--
Mr. Dunn. Excellent news.
Dr. Stone [continued].--with residencies. And so, we just
added that this year.
Mr. Dunn. Excellent, thank you very much.
Also, the President's budget acknowledges the
administrative costs of implementing the MISSION Act's
transplant authority for increased access. So, does that
budget, does it include the estimated costs for a veteran
seeking a transplant outside the VA transplant system? And
also, does it include the costs for the new authority to pay
for those who are having a donor, a living-donor transplant,
and the donor is not a veteran?
Dr. Stone. It does, sir.
Mr. Dunn. Excellent, thank you.
And so, with this revised requested $2.862 billion,
roughly, for implementing new access standards and the 2021 VA
advanced appropriations of $4.583 billion, the money, in
theory, will actually be appropriated well before the final
roles on transplant authority will be finalized, which we
expect in July of 2020. So, if we authorize the money for this
purpose, is there still a delay in implementing the transplant
policy or would you agree that we don't need to have a delay in
implementing that policy?
Dr. Stone. Sir, we are still propagating the regulations.
We are very hopeful that in the very near future, you will see
those regulations and they will go out for comment. Following
the comment, we will work our way through the rest of the
process, including the comment from this body, that we will
take. But we are very close with these, and I promised you that
in a previous hearing. We are very close to having those out.
Mr. Dunn. You know how near and dear to my heart the
transplant programs are. I look forward to working on that with
you in the future.
Mr. Chairman, I yield back.
Dr. Stone. Thank you, sir.
The Chairman. Thank you, Dr. Dunn.
I now recognize Mr. Pappas for 5 minutes.
Mr. Pappas. Thank you, Chair Takano.
Thank you, Mr. Secretary, Dr. Stone, and the panel for
joining us here today. I understand, Mr. Secretary, we may be
seeing you later this month up in New Hampshire at the
Manchester VA?
Secretary Wilkie. I will be up there in a few weeks, as a
matter of fact.
Mr. Pappas. Excellent.
Secretary Wilkie. I am looking forward to it.
Mr. Pappas. Well, great. They are in a period of
transition, but they are on the upswing and I think the
volunteers, the veterans, the leadership, the staff, is
certainly really eager to talk with you.
Secretary Wilkie. And I will add one thing about the
wonderful reception that people in uniform get in New
Hampshire. When I was the Under Secretary of Defense and prior
to that, assistant secretary, the greeting that the people of
New Hampshire provide to returning soldiers, sailors, airmen,
Marines, at your airport in Manchester is probably the best in
the country.
Mr. Pappas. Thank you. I will relay that message, and I
don't doubt it.
I want to talk today about whistleblowers and the
importance of them. It is a courageous act when someone at the
VA brings forward information, complaints, or allegations
regarding serious problems, wasteful and unsafe practices, even
malfeasance. There is understandable fear that blowing the
whistle could result in retaliation, including risk to the
employee's job and livelihood. Whistleblowers represent a
critical source of information about the VA and we must
encourage people come forward.
I recognize that your budget proposal includes a four- and-
a-half-million-dollar increase in the Office of Accountability
and Whistleblower Protection. It is a good step forward, but I
have some serious concerns about the office and how well it is
performing. I have heard of shortcomings in meeting the needs
of whistleblowers and whether they are protected from
retaliation.
And, Mr. Secretary, I was curious if we have your
commitment to an open and robust dialogue about the VA's
support of whistleblowers and the strength and effectiveness of
the Office of Accountability and Whistleblower Protection?
Secretary Wilkie. Absolutely. I had the pleasure of serving
as the acting VA secretary for 8 weeks. One of the first visits
I made was to the now-Chairman's office. Whistleblower
protection was the first IT that he raised in that meeting.
I can say for the first time, we are requesting a direct
appropriation for the Office of Accountability and
Whistleblower Protection. We have, finally, a confirmed leader
in place, someone known to the leadership of this Committee;
she came off of the staff of this Committee.
In the last year, we have assessed about 2,400
whistleblower submission. We have 1,000 referred investigations
in place. It is absolutely vital, particularly in an area as
sensitive as veterans' care, that that office is as robust as
possible.
Mr. Pappas. Well, thank you. And, Mr. Secretary, the budget
that is appropriated, will that also result in more resources
for responding to FOIA requests by whistleblowers?
Secretary Wilkie. Oh, yes.
Mr. Pappas. Thank you. And I will have my team follow up
with your office at a later time to continue that discussion. I
appreciate it.
Secretary Wilkie, your budget includes $107 million for the
Department's Office of Inspector General, representing about a
fifteen-million-dollar increase. The inspector general, the
agency's independent watchdog, obviously plays a critical role
in overseeing the operations of the VA, investigating instances
of waste, fraud, and abuse. I applaud the increase.
I understand that the VA still has a lot of work to do in
implementing many of the IG's recommendations; in fact, there
are 557 recommendations that have yet to be addressed,
including more than 140 that have remained unimplemented for
more than a year, some for many years. Concerning the financial
implications of not implementing recommendations, I am
wondering if you can respond to this, and in addition to that,
talk about your willingness to respond to the GAO high- risk
list, which just recently added contracting to that list. Talk
about your ability to implement and address these concerns.
Secretary Wilkie. Well, let me talk about the latter,
first. And that is part of our response is modernizing the
institution through business transformation. We are spending
about $189 million or requesting $189 million on business
transformation. Some of that is for IT funding. We have a
1960s- and 70s-business process system. That is why we are
engaging in that reform, as well as supply chain.
As for the Office of Inspector General, that is why we
requested additional monies, because we are doing so many
things at one time. I would also say that we have an advantage
that other departments don't have. We have really three law
enforcement mechanisms. We have the Office of Accountability
and Whistleblower, we have the IG, and we have the general
counsel. There is a reason for that: Because no one else has
the kind of mission that we have, and the results of us not
doing our job can, at times, be catastrophic. So, that is why I
put more emphasis on those arms.
Mr. Pappas. Thank you. We have got work to do.
I yield back, Mr. Chair.
The Chairman. I recognize Mr. Bost for 5 minutes.
Mr. Bost. Thank you, Mr. Chairman.
Dr. Lawrence, I am going to go down probably the path that
Mr. Lamb did, because I don't think that it is a localized
issue. You know, we have been working really hard to ensure the
new disability appeals system is implemented correctly. And I
have recently been in contact with some of my constituents who
are working to implement it and the concern that they have is
they don't feel that the proper training is being done at the
level and at the speed in which they need it to be able to
implement the program.
Can you kind of explain to us what collaboration is taking
place between the Appeals Management Office and Comp Services
for training all of our employees.
Mr. Lawrence. Sure. So, first, I will follow up and try to
understand that. This is important. Training on appeals
modernization began more than 3 years ago with the
understanding of what was new about the law and the different
lanes it set in motion. About a year out, after working through
the IT issues, began to identify the need for staffing and how
we would actually process.
As I indicated, specialized centers were set up in St. Pete
and Seattle for this reason; for this dedicated sorted of
stuff. One lane would--it is a little complex--requires some
work be distributed to around the regional offices. Some of
those folks were to handle that other, what I call ``runoff
work'' earlier. They were to get the training you are talking
about. I don't understand how both, you and Mr. Lamb, described
that, because the training schedules and the feedback that I
received throughout was very, very positive about how it was
done.
There is an element of learning going on. We appreciate
that. There is an element of understanding by our team that we
measure performance and they are naturally uncomfortable when
that happens, but it wasn't designed--it was designed to
provide training for this very purpose. So, I would be happy to
follow up and better understand.
Mr. Bost. I hope you do. Believe me, I am one that
understands old dog, new trick, okay, but these are pretty
young people and they actually know their systems pretty well
and it concerns me. And we want to make sure it works. Dr. Roe
is right, I think it is a great process.
But that is going to lead me to my next question, and I
don't know whether to ask the secretary or possibly you,
Doctor. In 2020, the VA is projecting to complete 1.3 million
disability-rating claims and the number of claims pending
longer than 125 days will remain between 90 to 100,000 claims.
My concern has been the legacy appeals, really.
So, can you please kind of explain how you intend to handle
the legacy appeals and bring them online and get them to faster
resolutions.
Mr. Lawrence. Sure. In terms of legacy appeals--I have had
this conversation with Dr. Roe and his office about 6 or 8
months ago--we understand that it is important. So, as we shift
to the new appeals modernization, we want to work off the
legacy appeals we have; those before appeals modernization by
the end of 2020. In our math, we have the dedicated staff to do
that and it is our desire to get that down to, essentially,
zero--a little bit north of zero because of some puts and takes
on that next year.
The claims you talked about are traditional disability
claims are the 1.3 to 4 million we process every year for what
they are: disability claims. A couple of things are going in on
that and that backlog is slowly creeping up and we have plans
to deal with that. But it is sort of some simple math if I can
share with you, right. The number of claims continues to go up
every other year 3 to 4 percent. The number of folks we have
working claims is essentially flat. We try to find some people
and free them up and go do that. And the claims are getting
more complex, more issues per claim. So, you see the math begin
to work that way.
We are very concerned about rework and quality and we think
that those are areas we could improve, which would enable the
claims to process faster and bring those numbers down.
Mr. Bost. Like I said, I think it is a good program. I
think we have to work the bugs out of it and speed up the
process.
So, Mr. Secretary, I want to--also in my short period of
time that I have left here-- I recently introduced legislation
that would require VA medical centers to do cost- benefit
analysis of treating medical waste on-site. Now, I am asking
for your support of it to bring the VA in line with the
practices of CDC and world health organizations, because I
think it would save us a lot of money. I think we are kind of
behind the overall curve on implementing the waste disposal.
Are you familiar with what we are trying to get done?
Secretary Wilkie. I know the subject in general, and I will
take a close look. I don't know if Dr. Stone has a medical
response.
Dr. Stone. I agree with you, sir. I think it is time that
we take a good, strong look at that, and we would support that.
Mr. Bost. Thank you. Mr. Chairman, I yield back.
The Chairman. I now recognize Mr. Brindisi for 5 minutes.
Mr. Brindisi. Thank you, Mr. Chair.
Thank you, Secretary, for being here. Just an issue that is
important in the district that I represent in New York state.
The Albany VA Medical Center has proposed to move the
Bainbridge CBOC, which is in the congressional district I
represent, to a neighboring county.
Bainbridge and the surrounding Chenango County are
extremely rural. Transportation and health care options are
very limited, and the population is aging. Over 3,600 veterans
reside in Chenango County and any potential move of the CBOC
out of the Bainbridge area would have a tremendous impact on
the veterans and their families in having access to VA care.
The Bainbridge clinic does not have a shortage of veterans
utilizing its services; in fact, they are operating above
capacity. So, if the VA does go through with moving the CBOC
out of Bainbridge, as it is proposing, how will you make sure
that veterans relying on the Bainbridge CBOC are able to access
reasonable care and health after moving the clinic?
Secretary Wilkie. Congressman, I am familiar with this
issue, and this clinic really draws from 3 counties. One of the
difficulties we have in the current location is a lack of
public transportation, and many of our veterans need help
getting there. So, we considered moving about 20 miles away to
an area that does have public transportation.
The lease on this facility that they are in, they have
outgrown the footprint. We got some issues for women veterans
in privacy in the current structure there. We have also got
some issues in the surrounding buildings on this, as far as the
safety of the area.
So, our lease is up in 2021. We are just in the early
process of looking. This came to my attention been the last
month. We are taking another look at it and would be happy to
engage your office in that discussion. Especially because of
the rural nature of this, we do have the need to be able to
accommodate another PAC team at that site and we don't feel
that specific facility will accommodate it. But whether we
could accommodate a closer location than going all the way to
the hub of the area where public transportation is, I think, is
an open discussion and I will more than willing to have it with
you.
Mr. Brindisi. I would like to have that discussion, because
I think the county that you would be moving from, that is where
the public transportation options are very limited. So, getting
the veterans from that rural area into a more populated area is
going to be very difficult for them to get there.
The other issue that I was pleased to hear the secretary
say that he is a vocal proponent of market-area assessments,
which I think is a great thing and certainly a requirement
under the VA MISSION Act. As I understand it, there is not a
market-area assessment that is going to take place until at
least 2020 in this region. So, why move forward with moving the
CBOC until you do that market-area assessment to determine the
needs of that community?
Dr. Stone. I understand, and I am in full agreement with
the secretary on the market-area assessments. Please remember,
though, that the lease on this facility is not up until 2021,
so we would be through a market-area assessment before we
decided on that move.
Mr. Brindisi. Okay. So, I can get a commitment from you
today that you are not moving the CBOC until at least 2021?
Dr. Stone. Unless I am substantially misunderstanding this
issue, and I would be more than happy to engage after the
hearing in this one to make sure that I have got the dates
right.
Mr. Brindisi. Okay. I would love to follow up with you
after.
And just second, I was pleased to read in the secretary's
testimony that the VA remains committed to investing in the
National Cemetery Administration's infrastructure, including
constructing new cemeteries. As you know, one of the NCA goals
is to provide access to a national or VA-funded state cemetery
within 75 miles of a veteran's residence. And I read in your
testimony that following completion of planned expansion
projects, nearly 95 percent of veterans will have access to
these burial options. I think this is great progress, but
unfortunately, the veterans from the district that I represent
would still be part of that 5 percent that is still lacking
access to a national cemetery. The closest cemetery to our
district is over 90 miles away in Albany, New York.
So, I just would encourage you to look at that and ensure
that we can close the gap certainly in those areas that are a
little more rural and a little further away from some of the
national cemeteries.
Secretary Wilkie. Yes, sir, absolutely. And I understand
that the Under Secretary for memorial affairs, Randy Reeves is
either visiting with you or your staff to discuss the way
forward. I also encourage Secretary Reeves across the country,
to make sure that we also interact with states in terms of us
getting grants to the state so that state-veteran cemeteries
are made whole. But he will have a way forward for you when he
meets with you.
Mr. Brindisi. Thank you so much, Secretary.
I yield back, Mr. Chairman.
The Chairman. I now recognize Ms. Radewagen for 5 minutes.
Ms. Radewagen. Thank you, Chairman Takano, and Ranking
Member Dr. Roe for today's hearing.
Thank you to Secretary Wilkie and the rest of VA for
coming. It is always a pleasure to see you, and I also want to
welcome the VSOs and thank them for their input today.
Mr. Secretary, one of the provisions of the MISSION Act
included an assessment of health care furnished by the
Department to veterans who live in the territories of the
United States. The report determined that VA furnished health
care in the territories overall and it is considered both,
sufficient and efficient, but also projected an increase in
demand for services and noted that veterans in the U.S.
territories have to travel to Hawaii or the mainland for much
of their care.
The report seemed optimistic about the VA's ability to
handle health care needs of the territories through the use of
Community Care to provide services closer to home. The report
cites projections of our territory veterans' demands for care
across 10 to 20 years. Does this same sort of foresight apply
to this budget proposal? And could you please go over, briefly,
the VA's short-term and long-term plans to meet the needs of
the territories and remote areas.
Secretary Wilkie. I have been very, very open about my
desire to serve those communities in the country, in our rural
areas, and in our territories, particularly in the Native
American communities and the native communities of the Pacific.
One of the reasons I have stated is that no group of
Americans serves in higher number than those Americans, and no
group of Americans has more medals of honor per capita than the
Americans that you represent. I will be headed to the
territories at the end of May.
In the short term, our budget for telehealth is the
quickest way that we can respond to the needs of diverse
populations, not only in your area of the Pacific, but also in
places like Alaska. By getting our VA doctors to service those
veterans in your area, across jurisdictional lines, state
lines, in addition to doing as much as we can to make more
robust the clinics that we have in the territories.
We are not going to be able to give you a 100 percent
answer that 100 percent of the health delivery--health services
that we provide will be available to all the territories, but
it is something that we are working diligently on. And I do
think that telehealth is the most important investment that we
can make right now to make a difference.
Ms. Radewagen. Thank you, Mr. Chairman. I yield back.
The Chairman. Thank you. And now I will recognize Ms. Rice
for 5 minutes.
Ms. Rice. Thank you, Mr. Chairman. Secretary Wilkie, in
response to the IG report that found millions of dollars in GI
bill benefits going to for profit colleges that violated VA
standards, what steps have you at the VA taken to address this
issue and where are you in the process of implementing the IG's
recommendations?
Secretary Wilkie. I would say before Dr. Lawrence answers,
I do want to respond to something that the Chairman said. It is
our policy when these institutions that you described fail to
make our veterans whole, they will not be penalized when an
organization goes out of business.
Dr. Lawrence can talk about some of the hurdles that we
have under the law, dealing with state accrediting agencies. I
think that is a topic for another hearing. But I did, before he
answers, want to make sure that veterans who find themselves in
those situations, we will make whole again.
Mr. Lawrence. Sure. We agreed with the report. And we began
expeditiously to implement the recommendations almost
immediately. Perhaps the most thing that had the direct effect
was in the fall when we renegotiated our contracts with the
state approving agencies, we put in more of the teeth they
suggested we do to get them to make some of the things we
requested of them not so optional, that they would go and do
it. But we are implementing those recommendations. Most of them
were to take place over a year and we are on track to have them
all done.
Ms. Rice. Secretary Wilkie, do you support closing the 9010
loophole?
Secretary Wilkie. I support institutions--let me, I will
confess I am not an expert on that matter. I support
institutions that serve students. And yes, I will say something
that is probably against interest, I agree with the Chairman's
view that institutions that are primarily dependent on Federal
students and students who bring to those institutions' Federal
money, they need to be looked at carefully.
Ms. Rice. So have you spoken personally with Betsy DeVos
about ways to address this issue?
Secretary Wilkie. I actually have spoken with her. We have
had one meeting on it.
Ms. Rice. And can you expound on that?
Secretary Wilkie. And I shared my concerns.
Ms. Rice. So I want to talk about women veterans, in order
to ensure that they are included in VA health care and
benefits. We often concentrate solely on health care, but there
are other non-health care related issues that affect women
veterans, which includes access to benefits. Now, you have
testified to this Committee now on more than one occasion that
the VA is working to increase the trust of women veterans in
the VA, so they choose the VA for benefits and services.
However, there still remain cultural barriers women veterans
face at many, not all, but many, VA facilities. And it
continues to be a significant deterrent for women in terms of
accessing VA benefits.
You have got the issue of sexual harassment, which remains
a major problem at VA facilities, and for the roughly 30
percent of women veterans who have reported being harassed or
assaulted while serving in the military, and for those
specifically seeking treatment from the VA for military sexual
trauma, this type of environment isn't only an impediment to
accessing VA benefits, it can be traumatic. Beyond that, women
veterans continue to say they are made to feel like they don't
belong at the VA, often citing situations where VA employees
assume, they are a veteran's spouse, rather than a veteran or
combat veteran themselves.
Now, you and I disagree on the VA motto. And I am going to
ask you to please reconsider your position. Because it is not
just what you do internally once a woman begins to wear the
uniform of this great country of ours, which over 2 million
women have, but it is what you say and what you hold out as the
motto of this great agency that speaks to women about how they
are going to be respected within the VA. So do you--
Secretary Wilkie. Well, let--
Ms. Rice. So do you consider changing the culture at VA to
be one of the department's goals under your leadership, and how
are you working to address the cultural barriers that have
inhibited women veterans from accessing services at the VA?
Secretary Wilkie. Let me take a step back and talk about my
record and then the change in culture. But I will first say
that those same VA satisfaction reports that I mentioned at the
beginning of my testimony, 84 percent of all women veterans who
use VA trust the VA and they are very satisfied with the VA.
As the Under Secretary of Defense and some of the members
have been on the Armed Services Committee, my first directive
was to give the Department of Defense its first comprehensive
sexual harassment and equal opportunity policy. I am the son of
a combat soldier. My father spent most of his career in the
82nd Airborne Division. It was unthinkable as a child that I
would see an American woman wearing the red beret of the All-
American division. It is not unthinkable anymore because of the
changes in the military culture.
VA has moved to change with that culture. The young
Americans who serve today are not the veterans who served with
my father in Vietnam. We have a diverse and integrated
military, and those changes are bleeding over into VA. It is my
goal to make sure that our VA is as welcoming as possible, and
I talked a little bit about that in the last hearing. But I am
very happy that for the first time, I can tell you that the
satisfaction rates for American women using the VA are at an
all-time high and they are getting better. 500,000 women had VA
appointments last year.
In terms of the budget, about 10 percent of the budget that
we spend on medical care go to American women. That represents
10 percent of the veterans' population. So we are moving. Our
people are being trained. Certainly if we find any problems, we
address them right away.
Ms. Rice. I just ask you, when we talk about all these
issues and modernization, you cannot leave women out of that
modernization.
Secretary Wilkie. Absolutely not.
Ms. Rice. Thank you, Mr. Chairman.
Secretary Wilkie. Absolutely not.
The Chairman. I now recognize Mr. Bilirakis for five
minutes. Mr. Bergman, General Bergman.
Mr. Bergman. Thank you, Mr. Chairman. Every budget cycle,
we have been giving the VA more money because we are not only
hopeful, but we are optimistic that you are going to provide
better outcomes, you know, with that money. One of the
challenges that we have all--we have had hearings on is the
appeals process. And I have got an appeal here dated March
22nd, 2019, in which basically the word remanded is used in six
different instances. Okay, so one more time back through the
loop.
And this--my constituent caseworkers have been working on
this for a while, working with an 85-year-old veteran, 9-year-
old Legacy, one more time just recently remanded by the Board
of Veterans Appeals. Unfortunately, and it has been remanded
multiple times. Unfortunately, the VA regional office erred by
not complying with the Board's previous remand order, which
further prolonged--you know, you see the scenario I am building
here.
As the VA updates and modernizes the appeals process, what
improvements--I mean, really, what improvements are we going to
make so that we can--I mean, maybe--hopefully this is just an
outlier, but we talk about the numbers of, I was going to say
back orders, but backlog, if you will, on the timeliness issue.
How are we going to improve the accountability, the timeliness,
especially when errors occur of our own doing? If we kick the
ball in the stands, do we have a way to bump it up in priority
saying because this 85-year-old is not getting any younger. And
we owe it to them.
Secretary Wilkie. So I will let Dr. Lawrence get into the
particulars, but let me tell you where we are. We have the
largest budget request in the history of the appeals process.
That is to sustain about 1,500 full time people handling
appeals. We will achieve the largest number of appeals ever
processed by VA this year, over 90,000. But this is not immune
to the modernization efforts that we have under way. There are
too many appeals that start with the hand processing of those
appeals.
So my directive is to modernize and have an IT system in
place so that the triaging is rapid, that we don't have
somebody who sits at a desk and processes 10 appeals a day, a
request manually. That that process is modernized, and it is
made efficient and relevant to the 21st century.
Mr. Lawrence. Let me comment without going too much into
the weeds, sir. But part of what you are seeing is an outlier,
but it is not unusual. Part of what happens, which led to
appeal modernization, is a case made its way to appeal. And
while it was waiting, the reasons why the veteran was asking
for help changed. And so when it came time to deal with the
claim, the reasons that changed, and they would send it back
and say, ``We now need more information.'' The condition has
gotten worse and this doesn't reflect that. That led to appeals
modernization in part because it was designed to sort of have
these lanes, which could deal with things.
Thing one would be a higher level of review. A math mistake
was made, can you correct it? A more senior person could look
at that and deal with that right away. Additional evidence is
needed, but it can be done quickly. Each of those two lanes
will hopefully enable the appeal to be resolved quickly so it
doesn't linger and require the looping back and forth that you
described. I am happy to learn more about that and look in on
and see if we can't figure out why it is going back.
Mr. Bergman. Thank you. And we are dealing with exceptions
here and not the rule, but the question is how do you--we have
to have a way. And just one quick last question because I see
my time is getting short. And this is a yes or no answer. The
current budget funds an increase of over 13,000 positions, you
know, within the Veterans Health Administration. Is there a TO,
table of organization, that we could look at that shows those
13,000 openings so you know exactly when we hire them, we have
got a place to put them?
Dr. Stone. The answer is we are getting closer and it is
not as simple as yes or no.
Mr. Bergman. As you got one, I would certainly like to see
it.
Dr. Stone. It is not like you were used to in the
Department of Defense.
Mr. Bergman. Okay. Well, we like those tables of
organization to give an idea.
Secretary Wilkie. Mr. Chairman, may I give a more complete
answer to that?
The Chairman. Proceed.
Secretary Wilkie. Thank you for your indulgence. You just
hit it. We are used to more complete table of organization in
the Department of Defense. I have used this description before
in testimony. I don't know that I have used it in the House. My
first week as secretary, I asked two different senior leaders
for the number of employees that we had. I got two different
answers.
And then I asked for a manning document, which you know is
the table of requirements and the people needed to meet them.
We never had one. We now have a modern sophisticated HR team in
place, some of whom coming on were senior leaders in the A-1 of
the Air Force. One is already on board. Another is coming. They
are going to get that manning document and we are going to--we
will put in place the type of HR system that you are used to in
your military career, I am used to, the people at this table
are used to.
Again, that is part of the overhaul of a department that I
think if General Bradley walked into it a year ago, he would
probably recognize a lot of the processes.
The Chairman. Now, I will recognize Mr. Cisneros for 5
minutes.
Mr. Cisneros. Thank you, Mr. Chairman. Thank you,
gentlemen, for being here this afternoon. Mr. Secretary, I just
want to follow up really quickly on Ms. Rice's question about
the GI bill and your statement about making the veterans whole.
My hope would be that when they would--that these veterans
that were at these schools that have been closed, they would be
able to transfer their credits to an accreditable university.
But in cases where the existing credits cannot transfer or the
school closed mid-semester, that the veteran would hopefully
receive their tuition back, receive their VA stipend back. That
is my definition of whole. What would be your definition of
whole?
Mr. Lawrence. We are very similar. So when schools are
closed, we then reach out to the students and figure out
exactly how we restore eligibility. As part of the Forever GI
bill, that is the new benefit exactly as you said. You don't
lose the months. You continue on a new process. So we restore
months of eligibility when this happens.
Mr. Cisneros. That would be a student who is maybe going to
school, been there three years already, used maybe about 24--
we'll say 24 months of his eligibility, school closes. Would he
be able to get all 24 months back?
Mr. Lawrence. Perhaps. But also, he would hopefully
transfer credits and only needs a limited number of those. So
everything is case specific. But that is the intention to not
penalize them the way you are describing for the school's
behavior.
Mr. Cisneros. Secondly, I want to talk about vocational
rehabilitation employment program. I had a veteran's roundtable
recently in my district and a lot of the veterans that we sat
down and spoke with were saying that they were constantly
shifted counselors. They would tell them their story. They
would get a counselor and explain their situation. And then
next time, it was a whole different counselor and they would
have to start the process all over again.
To that end, I understand that in 2016, Congress passed
into law a requirement that the VA must ensure a ratio of 125
veterans to every 1 voc. rehab counselor. And I also understand
that the VA is moving 127 of those counselors out of those
positions and into full time positions for support and
management. How are we going to hire more people and how are we
going to fill those positions to ensure that the veterans, that
we are keeping the proper ratio?
Mr. Lawrence. I was confirmed about a year ago. And in
preparation for that confirmation, I learned about the law, the
1 to 125 and realized we were out of balance. One of the first
things that happened when I came onto the job, when I was
confirmed, is to begin executing a plan of hiring counselors to
deal with exactly that. We are in the process of hiring to meet
that number and hope to have it done shortly. We had to hire a
couple hundred through the process.
In addition, we had to reallocate. I don't know about the
moving amount of management positions because that would work
against the intent to meet the ratio. I will tell you that we
had some misallocation of those that I inherited in the wrong
place. Also we had some of the wrong people in the jobs, and we
had some of the churn you are describing. So we are in the
process of not only hiring, but reallocating to make sure that
doesn't happen the way you are describing. But it is our intent
to fund and support the voc. rehab program directly and
consistent with the law.
Mr. Cisneros. So when do we think we will have a timeline
of when that will be fully?
Mr. Lawrence. I am tempted to tell you a date off the top
of my head, but it will be wrong. There are little puts and
takes as some people were recruited away from us. So shortly
and I will be happy to get back to you with the exact date.
Mr. Cisneros. So currently, you are going to spend about
$60 million in overtime for these counselors. You are only
asking for about $35 million from the 2020 budget. So can we
expect maybe that is because you are going to have the number
hired by 2020? You think you will be fully manned by 2020 or is
it going to go beyond that?
Mr. Lawrence. Let's separate two issues. I think the
overtime request we are making is for more broadly all of VBA,
not just the counselors, sir. But the answer is yes. We are
going to have them hired in fiscal year 2019. I don't want to
give you a date to be off by a couple of weeks, but I am going
to give you a date that precisely shows you when we are going
to meet the ratio.
Mr. Cisneros. So you are saying--I will take 2019. By the
end of fiscal year 2019, you are saying we will be fully
manned? We will have enough counselors to me the 1--
Mr. Lawrence. Not only that, I will come to your office on
the day it is, and we will count the days between the end of
the fiscal year to see how many there are.
Mr. Cisneros. All right. I will hold you to that.
Mr. Lawrence. I will be happy to come and talk to you about
voc. rehab then, sir.
Mr. Cisneros. I yield back my time.
The Chairman. I recognize Mr. Barr for 5 minutes.
Mr. Barr. Thank you, Mr. Chairman. And gentlemen, then you
for your service in uniform, and thank you for your service
today to our veterans.
Mr. Secretary, this budget request provides $15.3 billion
for medical community care. You are asking for a $2.9 billion
appropriation to roll out the access standards for the program.
Obviously, you see that there is a need for veterans to be able
to access care in our own community, yet this funding is not
going to be effective if there is a lack of quality providers
in the community who choose not to participate in the community
care program.
Are we funding the MISSION community care program in a way
that supports provider reimbursement and in a way that attracts
quality providers and makes the program work? And Dr. Stone,
you can answer that question as well.
Dr. Stone. Congressman, I think the only way you retain
providers to any delivery network is to pay him in a timely
manner and treat him respectfully. So therefore, the community
care contracts, the first of which in Region 1 where we are
beginning to implement is in full partnership with the provider
networks. We continue to stress timely payment. I am quite
pleased that in the month of March, we paid over 1.7 million
claims in less than 30 days. That in comparison to a year ago
was at 140,000 in a month.
We anticipate going over 2.3 million claims paid in the
month of April as we continue to progress through this. But
retaining good community providers at high quality institutions
will only be effective if we can treat them respectfully and
pay them in a timely manner.
Mr. Barr. I fully agree with that. And the community care
program is certainly something that the veterans that I
represent are clamoring for, but they obviously--it won't be
effective if we don't not only timely reimburse, but adequately
reimburse to attract quality specialists to the program. And on
that point, Mr. Secretary, if the requested budget were to be
enacted as requested, it looks like 19.2 percent of the VA's
medical care dollars would be allocated to community care while
80.8 percent would be allocated to care provided in VA medical
facilities.
Given the plan's streamlining of community care options for
veterans alongside the funding to strengthen VA medical care,
do you feel that this 80/20 split is accurate or about right in
terms of meeting the needs of how veterans will seek care?
Secretary Wilkie. I think it is about right, based on what
I have seen in terms of patterns of our veterans in terms of
the care that they seek. The other thing that I would add to
that is it is adequate because the MISSION Act is not full
choice. The MISSION Act applies only when we cannot provide the
veteran a particular medical service within a specific amount
of time. Based on the numbers that I have seen, that is not
going to be a regular occurrence for most of our veterans.
Mr. Barr. No, I understand that. And so your assessment is
that that 80/20 split is in line with the share of veterans
actually seeking care within the VA versus within the
community?
Dr. Stone. Congressman, let me give a little more detail.
In 2017, we purchased 32.5 million visits in the community. In
2018, that dropped by about 2 million to 30,500,000. In
addition, this year, in the first six months of this fiscal
year, the direct care system, the VA itself, has grown by over
a million visits and over 100,000 additional veterans have come
to us and enrolled in care.
So we think the split is about right.
Mr. Barr. Okay. Thank you. Final question, Mr. Secretary. I
want to ask you about how the VA disburses compensation
payments for disabilities, specifically sleep apnea. A 2018 VA
annual benefits report listed sleep apnea as one of the most
prevalent service-connected disabilities triggering VA
compensation benefits. It is my understanding, however, that
the VA does not track to make sure veterans are actually
complying with treatments as a condition of receiving benefits.
Meaning that the VA could be expending resources that may not
actually be helping veterans.
How much does the VA spend on treating sleep apnea, and how
does the VA monitor benefit awards to make sure that those
receiving compensation benefits are actually getting helped
with treatment?
Dr. Stone. So CPAP machines are our greatest prosthetic,
our largest prosthetic that we purchase, and I can get you the
exact number on that. We are actually progressing very nicely
with a national contract for that in order to control cost. But
the second thing is how do we monitor compliance with therapy.
And it is my understanding, and I am going to correct this. We
were talking about this in the last 24 hours. It is my
understanding that the current devices actually have a
monitoring device that then can be monitored during a physician
visit to monitor compliance with the use of the device. But let
me confirm that and bring it back to you, sir, and make sure
that we have got it. But that is my understanding.
Mr. Barr. That would be great. My time has expired, but
obviously we want the veterans to get the help that they need
as we help them with that. I yield back.
The Chairman. Ms. Lee is recognized for 5 minutes.
Ms. Lee. Thank you, Mr. Chairman. Thank all of you for
being here and for your service to our country's veterans. I
want to reiterate and touch on what Congresswoman Brownley
briefly discussed regarding our Subcommittee meeting yesterday,
where the GAO continues to see governance issues as a problem
for the implementation of the EHRM.
We are coming up on almost a year from when the GAO first
testified and proposed a governance structure that would be
expected to leverage the existing joint governance and
suggested the IPO, the inter-agency program office. And then in
September, the VA, you all then concurred with that
recommendation and stated that the Joint Executive Committee, a
joint governance body between the DoD and VA had approved the
role for the IPO.
But we do not yet have this inter-agency program office
plan, this Committee, and the Subcommittee doesn't have this
either. So Mr. Secretary, when you were before the Senate a
couple weeks ago, you were not able to provide a timeline then
for this office. Are you able today to tell us what plan you
have?
Dr. Stone. Congresswoman, the inter-agency program office,
we continue to discuss with DoD. As you know, because of
substantial oversight, we are working our way through, trying
to make sure we are complying with what everybody wants and we
are sharing with you openly how we are proceeding, and that we
are giving you appropriate chance to give oversight.
So that said, we have a couple of big problems as we
approach this implementation. Number one, the common technology
platform, and secondly, the cybersecurity of this as we move
into the DoD enclave. We need more rapid decisions. And if we
are going to deliver potential advantage to the American
taxpayer based on efficiencies, we need to make these decisions
quickly together.
We are in active consultation. I had a discussion Friday
with the acting Secretary of Defense for health about this as
we try to decide leadership and move our way through. But there
are lots of emerging interests as we work our way through this
very difficult process. But we owe you a common platform of
leadership that delivers the efficiencies that you expect.
Ms. Lee. Thank you and thank you, Secretary. I know you
understand the importance of having this leadership role well
defined. We have heard that the DoD might leave this office and
I just wanted to--which causes concern, given that this is
supposed to be a joint effort and it is true that the VA has a
bigger investment in terms of dollars and in people. What is
your view on leadership of the IPO and how will you ensure that
the VA's equities are just as represented as DoD's?
Dr. Stone. What we would really like is the best person in
the place, regardless of their background. We want somebody
that fully understands both departments, fully understands the
complexity of these departments. So I would say that first, we
want the best person. And we want that person to understand
both departments.
I think in addition to that, finding the interim leadership
that can lead us through some decisions in the next 6 months is
essential. We do believe that this should move beyond the
acquisition community, which leads both areas today and move to
the end technical user. And so you should look for a leader
that understands the end technical and clinical components of
what we are trying to implement.
Secretary Wilkie. And I would say that has been my
emphasis. I have the advantage of having led both
organizations. Led defense health, now leading VA. I would be
lying if I said that the Department of Defense was a less than
complex organization with a less than complex bureaucracy
because they deal in the most massive expenditures of
government money in our experience. They tend to look at things
as acquisition.
I am not going to be satisfied unless we have what we now
call a purple person, a joint person, who understands Dr.
Stone's world and understands the world of the patient. That
really is my bottom line.
Ms. Lee. Great. Thank you. Appreciate that. I yield.
The Chairman. I recognize Mr. Meuser for 5 minutes.
Mr. Meuser. Thank you, Mr. Chairman. Thank you, Dr. Roe.
And thank you, all of you, and Secretary Wilkie, very nice
seeing you again. Appreciate you making the time to join us
this afternoon.
I would like to begin by thanking the president and the
Department of Veterans Affairs for their budget proposal. I
truly can't think of many tasks more important than ensuring
our veterans and the VAs have the resources they need to serve
those who have served our Nation. I recently toured the Wilkes-
Barre VA, met with the director, Russell Lloyd, had the great
opportunity to meet with many of the veterans that utilize the
Wilkes-Barre VA. And I also had the chance last week to meet
again with Director Bob Callahan with the Lebanon VA, who do a
terrific job for the veterans in the 9th District.
I have heard from many, I attended a Vietnam veterans
celebration last week, and I heard many challenges from them,
of course, and successes, and problems that they may be having,
but I am very encouraged by the proposal set forth by the
department to do the best job for the veterans as possible.
This budget proposal does invest in our Nation's VAs,
especially with regard to the implementation of the MISSION
Act, to help ensure that the men and women who fought for our
country, again, and defended our freedoms received the timely,
high quality care they deserve.
So my first question is to Mr. Secretary, the 2020 budget
request is $220 billion; does it, in fact, fulfill the promises
made in the MISSION Act? Will it allow you to carry out the
goals of the MISSION Act?
Secretary Wilkie. Yes. And it does so by recognizing the
fundamental change that is made evident actually in the title
of the legislation, integrated service, where veterans now will
be part of a nationwide, integrated health care system, with VA
at the apex, and we will be able to access for them, when
needed, care in the community when it is called for.
I think this budget is the first important step, but it is
a step that goes beyond MISSION, that includes the fundamental
reform of the entire way we do business; everything from as
Congresswoman Lee said, the electronic health record, to
business transformation, to HR transformation, and to supply
chain transformation, which is all included in the budget.
Mr. Meuser. Sure. All right, excellent. Very happy to hear
that. I do represent a part of Pennsylvania that is relatively
rural. Can you speak about the investments made to help
veterans in such rural communities?
Secretary Wilkie. Absolutely. And I have said, I think the
most important part of this is to create that balance that
takes cognizant of the fact that almost half of our veterans
live in rural areas of this Nation and in the territories. One
of the things this budget calls for is the expansion of
telehealth. Tele-health allows us to reach into communities
that in many instances we have not been able to reach. It is on
the cutting edge of mental health services.
The other part of this is, as Dr. Stone said earlier,
making it easier for us to get medical professionals into rural
areas by using the tools in the MISSION Act: loan forgiveness,
relocation pay. We are able, thanks to the legislation, to
provide compensation that is outside of the usual OPM buckets.
Mr. Meuser. Well, thank you. There are certainly many
veterans counting on your work. Thank you very much for your
service, and please continue to notify us as to how we can
help.
Secretary Wilkie. Thank you, sir.
Mr. Meuser. Chairman, thank you. I yield back.
The Chairman. I am going to recognize Ms. Rice for one
minute to ask a question, since she was kind enough to yield
her time to the secretary to answer a question.
Ms. Rice. Thank you, Mr. Chairman. First, Mr. Secretary, I
want to thank you for supporting closing the 9010 loophole,
number one. And number two, I have a question about a concern
that is based on the VA's challenges with the development of a
medical surgical supply formula that looking to DoD to solve
these supply chain challenges may be a mistake, given the fact
that the DoD has a well-documented history of medical supply
chain challenges, which is why we have asked GAO to review this
pilot program. If you could just answer the question, why did
the VA choose DoD's model?
Dr. Stone. This is a deeply fractured supply chain within
the VA, one in which it is very difficult to assess where we
are at and where we are not. And the secretary has spoken
extensively in previous testimony about the use of credit cards
in our system.
There are two pieces of this decision. One is the use of
DMLSS as a software system. The second is the potential use of
DLA as a potential supplier of medical supplies. We have not
made a final decision on the use of the defense logistics
agency, and won't until we break the code in mid- May in North
Chicago. That final decision will not be made until we go
through the IOC sites in Spokane and Seattle and can
demonstrate and share with you the actual financial
implications of this. And this comes back to the previous
questions on how will you fund this.
I think there is a lot more data that has to be tackled,
but I think it is worth a good try. Secondly, you have to
recognize that all of us grew up with the defense supply chain
in combat, experienced the defense supply chain's ability to
get material--medical materials to us anywhere in the world.
And so we are deeply respectful of it and look forward to its
ability to potentially meet all of the additional requirements
that we live with under, including--in our preferred small
businesses.
Secretary Wilkie. And I would add, what we have is not
working. And Dr. Stone mentioned something that I said when I
appeared in front of the Committee in December. Last year,
there were almost 4 million individual credit card
transactions, buying everything from boxes of tongue depressors
to radiological equipment. That is a system not only ripe with
inefficiencies, but I believe is ripe for potential corruption.
And getting to the heart of this is the only way I believe that
we can provide veterans with the stability that they deserve
when it comes to their VA facilities having equipment ready and
able to meet their needs.
Ms. Rice. Thank you.
The Chairman. I know recognize Mr. Levin for 5 minutes.
Mr. Levin. Thank you Chair Takano for holding this hearing.
I would also like to thank Secretary Wilkie and his team, as
well as the representatives from our key VSOs, who are joining
us today. I have the great opportunity to be the Chairman of
the Economic Opportunities Subcommittee, so I would like to
focus today on the issues of veteran homelessness, education,
and employment.
Mr. Secretary, I appreciate your comprehensive overview you
provided to us. I did notice that your budget request only
provides level funding for homelessness programs. And while I
understand that the number of homeless veterans nationwide has
dropped over the last decade, as we discussed last time you
were here, it is obviously a very big issue in Southern
California where I represent. During the VA 2030 hearing, you
said, and I quote, ``If we got a handle on homelessness in
Southern California, the number of homeless veterans in this
country would reduce exponentially. That is the epicenter.''
And unfortunately, that is, as you know, that is an accurate
statement.
We had the 2018 point in time count recently and it found
that nearly 29 percent of our Nation's homeless veterans are
located in California. So it stands to reason that the
resources should be directed accordingly, but that is not
always the case. For example, in fiscal year 2019, our state
only received 18 percent of funding under Supportive Services
for Veteran Families.
So my question for you, Mr. Secretary, can you tell me how
the department plans to ensure that the requested $1.8 billion
targets the geographic areas that need it the most?
Secretary Wilkie. Well, it is my intention and my directive
that we go to the heart of the matter. There is a good news
story. A few years ago, there were 700,000--let's say almost
700,000 veterans experiencing homelessness at any time of the
year. That is down to about 40,000 now. As you mentioned,
primarily on the west coast and in Hawaii.
What we have been able to do is use HUD and some of our
partners to address the immediate needs of those who are
homeless. It is a good news story in that we have over 60
communities in this country who have effectively ended
veterans' homelessness. I will speak to Southern California.
Before he left office, I had conversations with Governor
Brown. I have had conversations with Mayor Garcetti. The only
way we are going to get a handle on this is to increase the
amount of money flowing to the states and localities to help us
find those homeless veterans.
I will say emotionally, one of the saddest sights that I
have seen in my professional life and in my time being around
the military is West Los Angeles at night when veterans come in
in their cars, and they have jobs, but they have no place to
live.
I talked to the Mayor about establishing more transitional
homeless housing for them. I have asked HUD to increase the
number of vouchers. But I am also looking at ways, big cities
like New Orleans, and smaller cities like Abilene, Texas, have
been able to eliminate homelessness by engaging what properly
called NGOs. As I said, 64 communities, 3 states have
eliminated homelessness.
So it is not a VA specific issue. It is one that requires
more close cooperation with the states and localities, as well
as HUD, and some of the other agencies.
Mr. Levin. Sir, obviously our Subcommittee would love to
follow up and work with you on that.
Another question for you, during the 2030 hearing again, we
discussed your commitment to implement Sections 107 and 501 of
the Forever GI Bill by Spring 2020, while simultaneously
correcting claims retroactive to August of 2018. And you said
then that you didn't envision any new staff needing to be hired
due to improvements under the new IT system.
I noticed this budget actually cuts education by $30
million and 45 full time employees. So how do you plan to
transition to this new system and implement the Forever GI bill
with fewer resources? And have you planned for the possibility
that technological glitches may occur, which would actually
increase staff workloads?
Mr. Lawrence. Sure. A couple things. Our plan is to
implement in Spring 2020 as we have indicated. We have been
working this very closely. We are on track to do that. Our
intention is to do so. One of the things the new plan will have
is increased automation, making those few people unnecessary
and the savings accordingly. We are on track to do that. Worst
case scenario is we will continue to process it as we have
been, and we executed the spring of this year on schedule. So
positive news there for that. Everything is positive going
forward. We think we are going to meet that, and we talk
regularly to your staff once a month about the status of where
we are, what we are doing, and how it is going.
Mr. Levin. I am over time, Mr. Chair, but I appreciate your
answers. Thank you.
The Chairman. I now recognize Ms. Luria for 5 minutes.
Ms. Luria. Thank you, again, Secretary, for appearing
before our Committee, and I wanted to thank you for your
recommendations against an appeal of Procopio. As you know,
Blue Water Navy veterans have waited decades to receive
benefits for diseases related to herbicide exposure during
their service in the Republic of Vietnam.
Dr. Stone. Particularly on Hampton Roads.
Ms. Luria. Yes.
Secretary Wilkie. And in light of that, I wanted to follow
up on my question from our hearing in February regarding VA
health care benefits for Blue Water veterans. At that time, I
asked you if you plan to treat Blue Water veterans as eligible
for Priority Group 6 health care benefits based on service in
Vietnam.
I was wondering if you have an update on that now.
Dr. Stone. I believe that is our intention, but let me
confirm that for sure.
Ms. Luria. Okay. And I will submit for the record, as well,
a follow-up letter that I sent on April 1st also requesting the
information from the previous hearing.
Ms. Luria. On the note of that with the Blue Water
veterans, have you estimated the additional full-time
equivalents or additional costs or additional personnel that
you will need in order to process these claims for Blue Water
veterans?
Secretary Wilkie. Before Dr. Lawrence talks, I will say
what I have said to departments of our Federal Government and
to some VSOs: We are just beginning to get our hands around the
issue in the sense that part of our process will involve being
historical detectives. The Navy in the Vietnam era had no
standard policy when it came to report service in the waters
off of Southeast Asia.
I will give you an example. You might have a destroyer
captain who gives all of the members of his crew a service
ribbon for time in those waters.
Ms. Luria. Are the deck logs of all of our ships not
available through the Navy?
Secretary Wilkie. Many have deteriorated.
Ms. Luria. Okay.
Secretary Wilkie. And then the carrier that it is serving
with 6,000 sailors doesn't have that ribbon. I have looked at
some of these records and they fall apart.
Ms. Luria. So, I understand the complexity. And do you
acknowledge that it will take additional resources to do this
analysis?
Secretary Wilkie. Yes, and we will look to that.
Ms. Luria. Okay. Thank you.
Secretary Wilkie. I think Dr. Lawrence had a comment.
Ms. Luria. No, I would like to just move on in the limited
time I have left. So, looking at the budget, and I will just
reference the page, VBA 57, it gave a table of veteran
compensation by degree of disability. And so, I went through
this table between 2012 and 2018 and I noticed that during that
six-year timeframe, there was an increase in 1.2 million
veterans, about 200,000 a year, or a 35 percent increase during
that timeframe.
And then I broke it down a different way to look at both,
the number of veterans over 50 percent as well as the number of
veterans at 100 percent disability. So, in the over-50 percent
category, that went up by 11.8 percent in the six-year period,
or a 27 percent increase, and in the 100 percent, it went up by
4.26 percent, or a 42 percent increase over that timeframe,
between 2012 and 2018.
And this seems like both, a large number, an increase of
200,000 additional veterans being qualified as having a
disability requiring compensation over that period of time, and
then also a shift, as well, in those receiving higher levels of
compensation.
So, do you have a reason or a cause to attribute this rise
to?
Mr. Lawrence. I would be happy to talk to you in more
detail about this. The numbers reflect what we are seeing as
veterans apply for benefits broadly--and I know your analysis
is not broad--broadly, as our population of veterans ages, and
we understand more about the medicine and the problems that
they are dealing with. They are applying for claims and we are
adjudicating them. That is what you are seeing taking place in
those numbers; they are accessing the benefits that they have
earned.
Secretary Wilkie. I didn't finish answering your first
question about 39,000, 40,000 veterans who have--Blue Water
veterans who have at least one Agent Orange condition have been
treated by VA for that condition. So, this is not a zero-sum
game. We are actually in the process of--
Ms. Luria. But when you refer to that approximately 39 or
40,000 people, because this ruling is recent, they would
already be treated for other reasons that qualify them for a
disability; is that correct?
Secretary Wilkie. For Agent Orange, right. For Agent Orange
conditions; the conditions that are listed as conditions that
we have to treat as a result of the Agent Orange Act.
It is not as if under Blue Water, we are going to be
starting afresh. We have thousands of veterans who are being
treated who fall into that category.
Ms. Luria. They fall into that category because they served
in that time and place, but they are currently being treated
and they are rated for a disability because of other causes,
because this was not previously recognized as a standalone
cause; is that correct?
Mr. Lawrence. So, again, let me take you into the weeds. If
you were on a ship in the Blue Water and you came onto the
land, you then now had access to the presumptive, because you
are on land, and that is where the presumptive covers you. Some
of what the secretary is referring to is that sort of taking
place.
Ms. Luria. Thank you.
Dr. Stone. Congresswoman, I think you are substantially
correct in your assumption that part of that tens of thousands
that we are currently treated are not related to their Blue
Water service; it has to do with other forms of disability.
Ms. Luria. Thank you.
The Chairman. I now recognize Ms. Underwood for 5 minutes.
Ms. Underwood. Thank you, Mr. Chairman.
And thank you, Mr. Secretary, for appearing before the
panel today.
Based on the most recent data available, the suicide rate
was one and a half times greater for veterans than non- veteran
adults and based on that same data, the suicide rate for women
veterans was 1.8 times higher than the suicide rate for non-
veteran women. While the population of women veterans continues
to grow, the actual number of female veterans makes research
into the population difficult and more expensive.
And so, Secretary Wilkie, how is the VA incentivizing
research into risk factors for suicides specific to women
veterans, and does your suicide-prevention requests or research
requests include funds for this more expensive, yet important
research?
Secretary Wilkie. Well, our budget for suicide prevention
is about $222 million.
Ms. Underwood. Uh-huh.
Secretary Wilkie. That is about $16 million over last year.
Ms. Underwood. Uh-huh.
Secretary Wilkie. What has changed is that I am now in
charge of a national suicide-prevention effort and as a result
of the President's executive order, on the task force. The goal
of this task force is to treat suicide prevention in a way that
we have not, and that is a whole-health, Whole-of- Government
Approach.
My view is that we bring together NIH, HHS, DoD, and we
strike at the heart of those causes of suicide with our
veterans, but more importantly--and this applies to both men
and women--14 out of the 20 veterans who take their lives every
day are not in the VA system.
Ms. Underwood. Right.
Secretary Wilkie. My goal is to open the aperture of
funding to the states and localities to allow them outreach
into the community to help us find them. I will give you an
example. I was in Alaska in October. Half of the veterans in
Alaska are outside of VA and I asked the Alaska Federation of
Natives to double the number of veterans' tribal
representatives that they have in order to reach those
veterans.
That is absolutely essential. Not only in rural--
Ms. Underwood. Sir, I am going to ask you to focus on the
research part.
Secretary Wilkie [contined].--but also in the urban areas.
You want to hit research?
Ms. Underwood. Please.
Dr. Stone. I think there is a number of very troubling
things about the population of female veterans. High rates of
pain, as much as 70 percent complaining of chronic pain--
Ms. Underwood. Sure.
Dr. Stone [continued].--high rates of military sexual
trauma; as mentioned previously by one of your colleagues, 30
percent--29.1 percent with history of military sexual trauma;
about 40 percent with mental health-related issues. But that is
in the 25 percent of women veterans that we have attracted to
the system. For the other 70--
Ms. Underwood. Sir, I would like to ask you to specifically
focus your comments on the research dollars and any incentives
to study the female veteran.
Dr. Stone. Yeah. So, my specific answer to that is, what we
have to do is find the reasons that the other 75 percent of
American women veterans are not choosing us.
Ms. Underwood. I understand the research question. I am
talking about the funding.
Secretary Wilkie. I will answer that. That is the reason
for the Suicide Task Force.
Ms. Underwood. I understand--
Secretary Wilkie. That is to go outside of VA to pull in
the research capabilities of NIH, DoD, and HHS--
Ms. Underwood. Okay.
Secretary Wilkie [continued].--because they have more
expansive research capabilities than we have. In my discussions
with the White House about that, that is what I insisted upon.
Ms. Underwood. So, are you saying that there is no
incentive in your current structure or in this current budget
request for the VA suicide-prevention research funding to focus
on women veterans who have a higher risk of suicide: yes or no?
Dr. Stone. I think there is incentive.
Ms. Underwood. What is that incentive?
Dr. Stone. I think that incentive is the programs that we
have set up specifically for women veterans and to attract,
train, and retain those medical specialists that will support
the reduction in harm to women.
Secretary Wilkie. It is to take care of all veterans who
are on this terrible spectrum. And I would go beyond your
question, because the research that we actually have that
started before the President announced his task force includes
what your colleague just said, homelessness and opioid abuse,
which is on that spectrum that creates many of these problems.
So, a one-off VA program, in my opinion, was not sufficient
to tackle the problems that you have addressed. That is why the
President has created the national task force that will bring
together all of the things that you just said you wanted, to
focus on this one terrible issue.
Ms. Underwood. Okay. Well, any veteran suicide is tragedy
and it is our goal with the dollars that the Federal
Government, that the Congress appropriates for the Federal
Government to spend in this area to be properly used. We know
that there is a problem specifically of the subset of female
veterans and we need to make sure that as we do the research in
the Whole-of-Government Approach, that there is a specific
targeting of this female veteran's population, okay.
And so, I think that we do need to outline some kinds of
incentives to get there and we are happy, as a Committee, to
help work with you to do that.
Mr. Chairman, thank you.
The Chairman. I now recognize Mr. Mast for 5 minutes.
Mr. Mast. Thank you, Mr. Secretary for waiving me onto the
Committee or thank you, Mr. Chairman, for waiving me onto the
Committee.
Thank you, Mr. Secretary, for being here.
Secretary Wilkie. Thank you, sir.
Mr. Mast. I was glad to see you take this post. We have
known each other for a number of years. I need to ask you about
some things going on back in my own--
Secretary Wilkie. Yes.
Mr. Mast. Are you aware of what happened at the West Palm
Beach VA on March 14th, 2019?
Secretary Wilkie. I am aware of several instances of
tragedy that happened at West Palm Beach--suicide, an attempt
at police-induced suicide, at West Palm Beach, yes.
Mr. Mast. Yes. March 11th, Bruce Dash came in under a Baker
Act for suicidal thoughts. March 14th, he was found at 6:00
p.m. dead on the mental health ward, unfortunately tragic, as
you said.
February 27, Larry Bond, admitted, again, under a Baker
Act, drew a gun from his motorized scooter and shot Dr. Bruce
Goldfeder, another bystander; again, very, very tragic.
Not that you would be expected to know this, but going back
to January 10th of 2018, I visited the Department of Veterans
Affairs, here in Washington, specifically to discuss Veterans
Affairs security issues nationwide, but very specifically, back
home.
May 30th of 2018, my legislative director met with the
administration at our local VA hospital, came down and met with
the administration there about security issues local to the
hospital.
On June 29th, 2018, I met with the West Palm Beach VA
director about security concerns that we had in the facility.
Weekly, my staff and I, we hold office hours at the West Palm
Beach VA, where we have spoken to the security personnel about
the issues and concerns that we have here.
I would like to know, Mr. Secretary, have you or Dr. Stone
before to the West Palm Beach VA since the recent suicide and
recent shooting?
Dr. Stone. I have not. My director of mental health
services will be down there later this week.
Mr. Mast. Mr. Secretary, have you been?
Secretary Wilkie. No, I have not; although, as you know,
that was the very first place that I visited when I became the
secretary. We are, as a result of what happened at Palm Beach,
we have a new security protocol in place that will apply to the
entire country.
But you have hit on an issue that is wider than your
district. Last year, I believe 19 veterans across the country
took their lives in various VA facilities and as a result of
that, we have undergone a complete review of our security
protocols. We found that on the medical front that these are
not connected; that there is not one pattern.
But what happened at Palm Beach with the wounding of the 3
medical professionals, has led us to revamp the entire way we
do security. Because I will tell you that the method that was
used there was entirely unexpected.
Mr. Mast. I am glad to hear that. I believe that these
tragic events, they warrant your direct attention, as well as
you, Dr. Stone. So, I am asking for the most valuable thing
that you both have to offer; that is your time.
Will you give us your time in West Palm Beach, come down,
let us show you our concerns in the facility. Meet behind
closed doors with our veterans that would love to have the
chance to speak to you both about what they are experiencing,
what they are seeing, what they are concerned about. Will you
give us your time, come down to the West Palm Beach VA? I am
asking this to both of you.
Secretary Wilkie. Well, I am in Florida quite a bit, and,
of course, I will come.
But let me refer back to an answer that I gave earlier.
Mr. Mast. So, I have your commitment?
Secretary Wilkie. I will be happy to come with you.
Mr. Mast. Will you meet--
Secretary Wilkie. I will meet with everybody. I would meet
with everybody; in fact, in the first 3 months that I was
secretary before this current condition got me and I couldn't
travel, I was in almost 20 states--I think 20 states.
Mr. Mast. Before my time runs out, can you give me a
timeframe when yourself, when Dr. Stone will find time to meet,
most importantly, with my local veterans. I know that we have
access to one another--
Secretary Wilkie. I will say as soon as possible, but let
me also finish by saying--
Mr. Mast. I was a bomb technician. We used to always use
vague terms like that so people would never know exactly when
we would get on the ground. I would like a more specific
answer.
Secretary Wilkie. Well, the problem is that as a secretary,
I don't control my own time, so I have to respond to the entire
country. And that is what I was going to answer in this sense
of what I just said about suicide. Palm Beach had tragedies.
The thrust that we have undertaken--and Palm Beach, if you go
back and listen to my remarks in the Roosevelt Room in the
White House, I said that Palm Beach was the final impetus that
got us across the finish line in creating a national suicide
task force. It was Palm Beach that allowed the President to put
his signature on the Suicide Task Force. I said that at the
signing ceremony.
Because Palm Beach is indicative of what we are seeing
across the country, and my thrust is national. Obviously, I
will go as many places as I can, but as the leader of this
institution, I am taking, as a result of what happened in your
district, a national approach that is now buttressed by the
President of the United States and his emphasis on suicide.
Mr. Mast. Thank you, Mr. Secretary. I will look forward to
seeing you back home.
Thank you, Mr. Chairman.
The Chairman. Mr. Secretary, I thank you for your
testimony, and the first panel, you are now excused.
Mr. Roe. Let me ask him one question, and not to get
answered on the way out the door, but give me an answer to
this.
The Chairman. Mr. Roe?
Mr. Roe. Yeah, just a very simple thing for you all. I saw
your opioid initiative and I just wonder how many inpatient
treatment facilities that the VA has for opioid addiction
across the country. And you can answer--the secretary--the
Chairman has been very kind to let me ask the question.
Secretary Wilkie. Can I take that one for the record,
Doctor?
Mr. Roe. Yes.
Secretary Wilkie. I don't know off the top of my head.
Mr. Roe. I think I would like to know that because I think
it would probably be inadequate.
The Chairman. All right. The panel is excused.
Thank you, Mr. Secretary, again, for your testimony.
I am going to, out of mercy for, I would presume myself,
but also maybe Dr. Roe, a 5-minute recess before we call the
next panel.
[Recess.]
The Chairman. I now invite our second panel to the witness
table: Ms. Joy Ilem, the National Legislative Director for
Disabled American Veterans; Mr. Patrick Murray, representing
the Veterans of Foreign Wars; Ms. Heather Ansley, representing
Paralyzed Veterans of America; and Mr. Larry Lohmann, Senior
Legislative Associate of the Legislative Division from The
American Legion.
Ms. Ilem, I now recognize you for 5 minutes.
STATEMENT OF JOY ILEM
Ms. Ilem. Thank you, Chairman Takano, Ranking Member Roe,
and Members of the Committee.
On behalf of the co-authors of the Independent Budget, DAV,
PVA, and VFW, representing our more than 2 million members, I
am pleased to present our views regarding the President's
funding request for the Department of Veterans Affairs for
fiscal year 2020.
For more than 30 years, our organizations have worked
together to develop Independent Budget and policy
recommendations that reflect the true needs of America's
veterans. We believe the implementation of the VA MISSION Act
reforms, along with the projected increased demand for veterans
of benefits and medical care both, inside VA and in the
community, validates our funding increases we are recommending
for 2020.
The IB recommends total discretionary funding of $103
billion to ensure the VA is able to fully and faithfully
implement the MISSION Act and deliver timely benefits to
veterans, their families, and survivors, and provide medical
care service to all enrolled veterans using VA care.
We appreciate that Congress remains committed to improving
services for our Nation's veterans; however, the serious access
problems in the health care system identified in 2014 and the
ultimate passage of the MISSION Act have created high
expectations which, absent sufficient resources to fully enact
the law, could erode promised reforms and modernization.
To ensure these promises are kept, the IB recommends
approximately $88 billion in total medical care funding for
fiscal year 2020; $4 billion more than the Administration's
request. Of the $88 billion, we recommend $70 billion to fund
VA-provided medical care and the remaining $18 billion for
Community Care funding; nearly double current funding levels.
The amount includes $8.5 billion to meet all related VA
MISSION Act requirements, including replacing the Veterans
Choice Program and the new Veterans Community Care Program by
the start of fiscal year 2020, and expanding transplant-care
services and implementing the new urgent care benefit.
The Administration's request for VA medical services is
approximately $4.7 billion below the IB recommendation of $56
billion. Although the Administration's request reflects an
apparent increase of 3 percent, the IB believes that when taken
into account the increased costs to maintain current services,
anticipated increases in workload, as well as increased costs
for projects inside VA mandated by the MISSION Act, that the
apparent increase falls short of what may be needed.
The $56 billion includes an additional $1.2 billion for
several other important health care programs to include
increased funding for VA's long-term care services, its
comprehensive caregiver program, the women veteran's health
program, reproductive services, and prosthetics and sensory
aids program. The IB recommends $6.1 billion for information
technology to sustain VA's electronic health record
modernization efforts and to reverse the trend of underfunding
development and innovation of IT. We strongly believe IT
improvements are critical to the overall success of reform
efforts underway. The IB recommends $840 million for medical
and prosthetic research. VA's research program ensures ill and
injured veterans have access to the most advanced evidence-
based and cost-effective treatments available; one of VA's core
missions.
The Administration's request of $762 million for this
critical program represents a 2 percent cut below current
funding, compounded by medical research inflation estimated to
be 2.8 percent.
The IB recommends $3.5 billion for VA's major- and minor-
construction programs to repair, renovate, expand, and replace
VA's aging infrastructure. The Administration's request of $1.8
billion represents a 44 percent reduction from VA 2019 levels
and a significant retreat in funding when VA estimates at least
$60 billion necessary over the next 10 years to address VA's
infrastructure issues.
Finally, while the Administration's recommended funding
level of $3 billion for the Veterans Benefit Administration is
sufficient, we oppose several proposals that would negatively
impact veterans; specifically, we oppose the rounding down of
cost-of-living adjustments and making it harder for veterans to
receive examinations necessary to establish their disability
claims.
In closing, we thank you for the opportunity to testify
today and present our budget views and recommendations for
fiscal year 2020 and we would be happy to answer and respond to
any questions that you or Members of the Committee may have.
Thank you.
[The prepared statement of Joy Ilem appears in the
Appendix]
The Chairman. Mr. Lohmann, you are recognized for 5
minutes.
STATEMENT OF LARRY LOHMANN
Mr. Lohmann. Chairman Takano, Ranking Member Roe,
distinguished Members of the Committee, on behalf of Brett P.
Reistad, national commander of The American Legion, and our
nearly 2 million members, we thank you for the opportunity to
present our position on President Trump's proposed fiscal year
2020 budget for the Department of Veterans Affairs.
Last month, The American Legion celebrated our 100th
anniversary. When National Commander Reistad testified earlier
this year before a Joint Committee on Veterans Affairs, he
spoke about The American Legion's mission: a mission to care
for veterans, a mission to provide patriotic youth programs, a
mission to advocate for strong national defense, and a mission
to instill pride about what it means to be American. As he
said, our mission continues.
Inherently, an adequately funded VA budget provides care to
veterans and that makes it a paramount objective in the The
American Legion's mission. The American Legion generally
supports the President's proposed budget for fiscal year 2020
as it applies to VA programs, though we believe additional
funding is needed in several areas.
We appreciate the continued commitment of the President,
Congress, and the Committee following through with promises
made to care for those who have served our great country in
uniform. The fact that the Department of Veterans Affairs is
only one of two civilian agencies that will experience an
increase in funding in 2020 is not lost on The American Legion.
At a time when most federal agencies are experiencing a
decrease in their respective budgets, the VA, will hopefully,
with assistance from this critical committee, receive a much-
needed increase in line with, or greater than the President's
proposal.
As VA continues to serve the veterans of this Nation, it is
vital the secretary has the necessary tools and resources to
ensure that those who have served receive timely, professional,
and courteous service. They have earned it.
Today, I will focus on a few key issues highlighted in the
budget: implementation of the VA MISSION Act, appeals
modernization, and COLA round downs. The 115th Congress was
very productive in enacting veteran legislation.
One critical piece of legislation championed by The
American Legion was the VA MISSION Act. If faithfully
implemented, the VA MISSION Act will expand the availability of
high-quality medical care to veterans in a timely manner. Two
of the most notable functions of the VA MISSION Act include
reforms for the Department of Veterans Affairs health care
system and expanding the VA's caregiver service support
program.
MISSION consolidated 7 existing Community Care programs,
including the Veterans Choice Program, and further expanded VA
Caregiver Support Program to eligible veterans severely injured
prior to September 11th, 2001. The underlying principles behind
the creation of these programs is fundamentally sound; however,
success of these programs depend upon the existence of
sufficient resources.
Under the President's proposed budget, we are concerned
with the ability of VA to expand its comprehensive Caregiver
Support Program to severely injured World War II, Korean, and
Vietnam War veterans and their family caregivers under the
statutorily mandated timetable.
VA MISSION Act will require more resources that have been
provided through regular appropriations in fiscal year 2019 and
will cause care-appropriation needs for the VA for future
fiscal years. These appropriation needs must be addressed by
Congress.
Also passed by the 115th Congress, the Appeals
Modernization Act. The Appeals Modernization Act, or MA, became
fully effective earlier this year. The MA sets forth specific
elements that VA must address in its implementation.
The American Legion currently holds power of attorney on
more than 1.3 million claimants. We spend millions of dollars
each year defending veterans through the claims and appeals
process. As such, we feel we have a vested interest in the
success of this new system.
The American Legion believes working together with VA and
Congress is vital to ensuring the success of the new appeals
system. The American Legion supports the funding of the
President's budget as it applies to VA programs and urges
Congress to appropriate this money as it uses its oversight
authority to make sure stakeholder voices continue to be heard.
In addition to funding newly implemented laws, care for
veterans means making sure long-existing programs continue to
operate as they were intended to. The President's proposed
budget seeks multiple cost-of-living adjustment round downs.
These round downs would impact both, dependency indemnity
compensation, as well as education programs.
The American Legion, through resolution, opposes these
round downs. The effect of these proposed round downs would
serve as a tax on disabled veterans and their survivors,
decreasing the amount of money they receive each year. Veterans
and their survivors rely on their compensation for cost-of-
living to make sure essential purchases, such as
transportation, rent, utilities, and food.
The American Legion is opposed to any COLA round down. The
Administration and Congress should not seek to balance the
budget on the backs of veterans who have served their country.
In closing, Chairman Takano, Ranking Member Roe, and
distinguished Members of this Committee, The American Legion
stands ready to work with Congress and the VA. We understand
with creative solutions that have been made possible with
innovative legislation enacted by the last Congress, come new
questions to be answered. Together with cooperation and by
remaining flexible, we will make these programs work and answer
those questions for America's veterans.
The American Legion thanks you for the opportunity to share
with you this afternoon, and I am happy to answer any questions
that you may have.
[The prepared statement of Larry Lohmann appears in the
Appendix]
The Chairman. Ms. Ilem and Mr. Lohmann's full written
testimony will be included in the hearing record.
I now recognize myself for 5 minutes, and I want to begin
by asking our VSO representatives this question. The
Administration has stated this budget proposal would provide
the highest funding levels in the Department's history. In many
of your testimonies, you expressed concern that the
Administration's request was not wholly sufficient to provide
for both, VA's internal capacity and the full and faithful
implementation of the MISSION Act.
What do you believe will be the consequences for veterans
if this budget is adopted as is, beginning with Ms. Ilem?
Ms. Ilem. If it was adopted, as is, without the additional
funding, we believe, you know, there could be severe
consequences, again, for veterans. We might be back in the same
situation with access issues that occurred.
With this big--with the implementation of the MISSION Act,
it is such a critical period right now, we are not sure how the
access standards are going to work, how this is all going to
roll out, obviously; there are a lot of unknowns. So, we want
to make sure that veterans--this, you know, goes as seamless as
possible for them.
And we want to make sure that a sufficient budget is there
to support VA. So, whether they need to continue to make the
reforms inside that they have promised, in terms of the IT
reforms and all the other hiring of clinical staff and the
other necessary improvements in VA, as well as be able to build
their network and be able to make sure that veterans have
access to that Community Care if VA is not able to provide it.
The Chairman. Mr. Lohmann?
Mr. Lohmann. Thank you, Mr. Chairman, for the question. We
share your concerns with the funding of the VA. We have a
system we are saving that goes out and visits VAs through the
year and we have 2 million members that are regularly
participating in the VA system.
We believe that once those problems become recognizable, we
would be able to react to it. And I think that it is something
that we will keep monitoring and we want to address
proactively, but we want to see how the funding is currently
working that has been appropriated.
The Chairman. Mr. Murray?
Mr. Murray. Sir, I believe that it is--I agree with our
partners in the IB. It is absolutely critical that this funding
is done properly and make sure that the attention for the right
programs is being put on different parts within the budget
appropriately. I think that just saying that it is a higher
dollar amount isn't enough if the right attention isn't being
given to the right areas.
The Chairman. Ms. Ansley.
Ms. Ansley. Thank you, Chairman, for the question. PVA, as
part of the Independent Budget, believes that if the budget
were implemented as requested, that it would leave shortfalls
in key areas, including the implementation of the VA MISSION
Act to Community Care, medical research, and through VA's
provision of care through its direct-care system. And we
believe, ultimately, as was stated by our partners, it would
lead to problems that we have seen in the past and also to
veterans not receiving the care that they have deserved and
earned.
The Chairman. Thank you. The VA's shift toward a public
health approach to suicide prevention has led the agency to
begin developing veteran-focused community-based support
systems. Do any of you believe that the VA does enough to
prepare a veteran's personal support system, his or her family
or friends, to understand and respond to the red flags that
often indicate suicidality? Anyone who would care to start--Ms.
Ilem, go ahead.
Ms. Ilem. Certainly VA's public health approach is a big
challenge for them. I mean, they are reaching way beyond their
capacity internally and trying to reach those veterans who
haven't engaged with VA.
VA has tried to provide a number of--they have a number of
programs on suicide prevention and that are on their website
available--the Be There campaign--and a number of ones that are
specifically about outreaching to family members, looking at
red flags, trying to coach veterans into care that--are a
family member might be reaching out to the VA saying, I think
my loved one, my veteran needs help, but they are very
resistant in doing it, what can I do?
So, I know that they are trying, but it is very insular
within VA. So, hopefully, this program, the public approach,
they will share some of that information wider, to this wider
network in the community, because I think they do have some
excellent programs that they have tried to set up to make that
information available to family members about the red flags.
And they are also doing a lot of outreach to veteran service
organizations on their suicide hotline, you know, the crisis
line, and how to spot when people are in trouble, and
especially when they call in and you just might be talking to a
veteran on the phone, how to pick up on signals that there
might be something serious and that how you can help get that
veteran the help that they need.
The Chairman. Thank you. My time is expired.
I now recognize Dr. Roe for 5 minutes.
Mr. Roe. Thank you, Chairman.
And thank you all for being here, and thank you for your
partnership over the last several Congresses in trying to
advance the status of our veteran population in the country.
One of the things that I was asking Jon here during the
first panel was, how much money does the VA carryover? How much
money that they had, that they did from fiscal year 2014, 2015,
2016, whatever, how much they have carried over, and it is my
understanding--and we sort of looked it up. It is about $3
billion in health care.
Does that give you all some peace of mind to know that
there will be plenty of enough resources to take care of the
needs that you just discussed? And anyone can take that.
Mr. Murray. Sir, yes. We have found that same number, but
one of the questions we actually have for VA is: What is that
money targeted for? If they are just simply putting it in, you
know, a general fund is one thing, but making sure that it is--
in the past, those monies have gone to Community Care to fund
extension for that. There have been some excess monies that
have gone to the Filipino Veterans Fund that they have had
extra, almost slush money to put there.
What we would like to see is that this money is being kind
of allocated for specific programs, and then we would like to
be a little bit more reassured about where that is going, sir.
Mr. Roe. Yeah, we can help. Believe me, they will have to
answer to this Committee, so I think we have a lot of leverage
there on that issue.
We were talking a lot about--and the Chairman and I have
agreed that one of our focuses will be on suicide prevention--
and we spend a tremendous amount of money on suicide
prevention, to the tune of billions of dollars and we haven't
moved the needle at all. So, we are looking at alternative ways
or whatever, and if you all would assist us in that, if you
find out there when you are traveling, you are all out there in
the country and your members are, NGOs or others that are doing
this that are having some success, please share those with us,
because we would like to see if those are scalable.
And we are looking at things that are, already, and
changing some of the things that we are currently doing. I know
that the effort is there. I know the will of the Congress and
the President; the Administration is there. We just have not
seen the results and I am not sure why. I wish I had the answer
to it.
One little something we looked up, which is really
astonishing to me, in fiscal year 2020, the budget request for
homeless veterans, as treatment costs and initiative spending,
is $9.3 billion, and the fiscal year 2020 budget request for
Post-9/11 veteran medical needs are 8.3. We are actually
spending more money on medical needs and initiatives and
homeless veterans than we are our Post-9/11-injured veterans. I
found that an amazing number.
And with today's economy being what it is, as good as it
is, I think we also need to do--and the Chairman and I have
also talked about this--to do a deep dive on homeless veterans
and find out--and I think it was mentioned by one of our
colleagues here--in California, a huge number of homeless
veterans are in Southern California, mainly.
So, if you could help us with that, we would be--I would
much appreciate that. And any of you can make a comment if you
would like.
Ms. Ansley. Thank you, Ranking Member Roe.
Certainly, the Independent Budget spoke to the needs of
homeless veterans, as it has. We continue to work together to
ensure that every veteran is able to be housed and receive the
care and services they need to be able to live full lives.
And we commit to working with you and the Committee,
continuing on that issue. We know it has been an initiative for
a number of years and Congresses, but as you said, there is
still more to be done and we want to make sure that we are a
part of that solution.
Mr. Roe. And it is one of the VA's successes. I mean, I
have met veterans out there who have been homeless. I met one
in Nashville not long ago that was out of the street and had a
HUD voucher, had a job, and is doing great. And I have run
across that many, many times. So, I don't think that we hear
those stories enough.
We talk about the things that's not happening, but we
should talk about the things that have happened, positively,
and that is one of the things.
And very quickly, because my time is about gone, please
elaborate on the Independent Budget's contention that the
current budget request will not allow VA to fully and
faithfully implement the MISSION Act.
Ms. Ansley. Thank you, Ranking Member.
The Independent Budget's recommendation for the Community
Care effort was $18.1 billion versus the Administration's
request of $15.3 billion. We have concerns that that funding is
not going to be sufficient to meet the requirements. Also, our
estimates did not include the access standards as it relates to
the drive time and wait lists that recently came out from the
Administration in looking at access standards.
So, we have concerns moving forward that will be sufficient
funding to address all of those needs. There is a lot of
unknowns still. Even, you know, 60 days out or so as the
program is beginning into effect is how many veterans are going
to be using that. The marketing assessments are not complete to
know what resources are available in the community. And all of
those come together to just give us pause that there may not be
sufficient funding available.
Mr. Roe. Thank you. I yield back.
The Chairman. I now recognize General Bergman for 5
minutes.
Mr. Bergman. Thank you, Mr. Chairman.
I guess the only thing between us ending is me; is that
right? Okay. Well, then, let's get right to the meat of the
point, and this is your chance.
What is the one heartburn that each of you have with the
budget?
Mr. Lohmann. I think, principally, the one thing that
really hits--resolutions is the COLA round downs. I think every
time that these come up, every single budget is something that
we continually have to keep sticking to is that these round
downs affect veterans and it turns into a tax every single time
to nickel-and-dime our veterans that have served and continue
to rely on this money for rent and tight budgets, and to
incrementally chip away at it.
Mr. Bergman. So, round downs, okay.
This is like one of these one-minute speed rounds.
Mr. Murray. So, sir, for my portion, I would say aging
infrastructure. The VA is not properly funding its capital
infrastructure program. There are billions of dollars of
seismic correction that need to be done that are not being
funded at anywhere an appropriate rate to get rid of those.
Mr. Bergman. Okay. So, infrastructure?
Mr. Murray. Infrastructure.
Ms. Ilem. I would say women veterans. As part of the
Independent Budget, we requested an additional $76 million. VA
has made a lot of progress, but we really want to see more
being done. A number of the members today talked about there
was concern over women veterans' issues within VA and how they
are going to resolve them.
Mr. Bergman. Okay. So, process? Bureaucratic? I am trying
to get a word down--get it down to a word.
Ms. Ilem. Culture issues, and just having enough focus on
making sure that VA has the providers it needs that have
expertise in women's health to serve the small--it is a small
population: 500,000--but it is growing. It grew 175 percent
over a short period. So, VA has been playing catchup.
Mr. Bergman. Okay.
Ms. Ilem. So, between just making sure culture, that all
women veterans feel welcome, and feel that they are being, you
know, treated with dignity and respect, just like any veteran--
Mr. Bergman. Okay.
Ms. Ilem [continued].--and we want to make sure that all
veterans can go to VA and take advantage of their great
services.
Mr. Bergman. Culture?
Ms. Ilem. Yes.
Mr. Bergman. Okay.
Ms. Ansley. I would say the decrease that we have seen in
medical research. IB recommended $840 million. The
Administration came in at $762 million. This will not even keep
up with the rate of medical inflation that occurs.
And, certainly, research is important to all types of
issues, and, particularly, to PVA members.
Mr. Bergman. Okay. I appreciate your candor and I
appreciate your directness. One of the challenges that we have
as a Committee, whether it be round downs, infrastructure,
culture, medical research, is that how do we get the most bang
for our buck? And what we count on for everybody, whether it is
the VA or the VSOs, is that we look, honestly, at how much
value we are getting for our dollar and being able to say--I am
just going to pick on infrastructure for a second here, because
it is--we don't need more buildings, necessarily, but we need
places for veterans to get health care.
So, anyway, my point is we got that review. I am not asking
for a response, okay, but the idea is how do we get our
veterans the health care in a timely manner? And it is quality
health care, whether it is through telehealth, whether it is
through CBOCs, whether it is through the VA hospital, whether
it is through whatever it happens to be. So, the goal is the
same. The question is: How do we get there?
Mr. Chairman, I yield back.
The Chairman. Thank you. I have a few words that I would
like to say before I close the hearing.
While I appreciated the secretary and the members of the
senior staff of the VA appearing before us today, I had hoped
that they would remain to hear the concerns of our VSOs and I
am disappointed that they did not do so.
But I want you to know that we have heard your concerns. I
have heard your concerns, and we will be working closely with
all of you.
I did want the VA to hear--and this will go into the
record--that when this Committee invites a VA witness to
participate in the hearing, the VA is required to make that
witness available to provide testimony until that witness has
been excused, and I am willing to work with the Department if
it believes another witness would be more appropriate, and work
to schedule hearings when the witnesses are available.
The VA's refusal to provide a witness at the Technology
Modernization Subcommittee hearing yesterday was unacceptable.
If the VA refuses to make witnesses available, I will take
steps to compel the appearance of witnesses, if necessary.
With that, I will say that all Members will have 5
legislative days to revise and extend their remarks and include
extraneous material.
Again, thank you for appearing before us today, and this
hearing is now adjourned.
[Whereupon, at 4:59 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of David P. Roe, Ranking Member
When I came to Congress in 2009, the Department of Veterans
Affairs' (VA's) budget totaled $97.7 billion.
Today - a decade later, despite years of fiscal austerity that has
impacted virtually every other Federal agency - that budget has more
than doubled.
Coming in at just over $220 billion - an increase of 9.6 percent
above 2019 - the Trump Administration's fiscal year (FY) 2020 budget
submission once again requests a record amount of funding for VA.
I commend the President for his unflagging commitment to investing
in our Nation's veterans and ensuring that they receive the support
they need from the government they fought for.
This budget reflects our mutual goal of strengthening VA by
increasing easy access and timely receipt of care, benefits, and
services to veterans across the country.
It continues to advance the important modernization efforts that
this Committee has prioritized and Secretary Wilkie has since
championed, including electronic health record modernization.
It also funds the implementation of the MISSION Act, which will
transform the VA health care system and benefit veteran patients for
years to come.
I am grateful to Secretary Wilkie and his team as well as to the
representatives from the veteran service organizations for being here
this afternoon and I look forward to hearing from them shortly.
But - before I yield, Mr. Chairman - I want to address Secretary
Wilkie's comments before the Senate Veterans' Affairs Committee last
week regarding VA's physical infrastructure requirements.
Mr. Secretary, you testified that the Department has a $60 billion
capital investment need over the next decade.
You and I both know that that need is far from new and that it
exists in large part because of how costly and complicated it is to
operate a health care system whose medical facilities are five times
older than they are in the private sector.
I wholeheartedly agree with you that the Asset and Infrastructure
Review (AIR) Commission that was included in the MISSION Act is key to
addressing that need and should be ready to go as soon as the
Department has completed the market assessment process that will inform
the Commission's work.
I understand that the market assessments are on track to be
complete by next summer and I want to work hand-in-hand with VA to
remove any barrier that stands in the way to getting the Commission
underway not long after that.
I thank all of our witnesses once again for being here.
Prepared Statement of Robert L. Wilkie
Good afternoon, Mr. Chairman, Congressman Roe, and distinguished
Members of the Committee. Thank you for the opportunity to testify
today in support of the President's Fiscal Year (FY) 2020 Budget for
the Department of Veterans Affairs (VA), including the FY 2021 Advance
Appropriation (AA) request. I am accompanied today by Dr. Richard
Stone, Executive in Charge, Veterans Health Administration (VHA), Dr.
Paul Lawrence, Under Secretary for Benefits, and Jon Rychalski,
Assistant Secretary for Management and Chief Financial Officer.
I begin by thanking Congress and this Committee for your continued
strong support and shared commitment to our Nation's Veterans VA. In my
estimation, two Federal Government departments must rise above partisan
politics-the Department of Defense (DoD) and VA. The bipartisan support
this Committee provides sustains that proposition. To continue VA's
momentum, the FY 2020 budget request fulfills the President's strong
commitment to Veterans by providing the resources necessary to improve
the care and support our Veterans have earned through sacrifice and
service to our country.
Fiscal Year (FY) 2020 Budget Request
The President's FY 2020 Budget requests $220.2 billion for VA -
$97.0 billion in discretionary funding (including medical care
collections). The discretionary request is an increase of $6.8 billion,
or 7.5 percent, over the enacted FY 2019 budget. It will sustain the
progress we have made and provide additional resources to improve
patient access and timeliness of medical care services for the
approximately 9 million enrolled Veterans eligible for VA health care,
while improving benefits delivery for our Veterans and their
beneficiaries. The President's FY 2020 budget also requests $123.2
billion in mandatory funding, $12.3 billion or 11.1 percent above 2019.
For the FY 2021 AA, the budget requests $91.8 billion in
discretionary funding including medical care collections for Medical
Care and $129.5 billion in mandatory advance appropriations for
Compensation and Pensions, Readjustment Benefits, and Veterans
Insurance and Indemnities benefits programs in the Veterans Benefits
Administration (VBA).
For VA Medical Care, VA is requesting $84.1 billion (including
collections) in FY 2020, a 9.6 percent increase over the 2019 level,
and a $4.6 billion increase over the 2020 AA, primarily for community
care and to transition the Choice Program workload to VA's
discretionary Medical Community Care account. This Budget will provide
funding for treating 7.1 million patients in 2020.
This is a strong budget request that fulfills the President's
commitment to Veterans by ensuring that they receive high-quality
health care and timely access to benefits and services while
concurrently improving productivity and fiscal responsibility. I urge
Congress to support and fully fund our FY 2020 and FY 2021 AA budget
requests - these resources are critical to enabling the Department to
meet the evolving needs of our Veterans and successfully execute my top
priorities.
Customer Service
It is the responsibility of all VA employees to provide an
excellent customer service experience (CX) to Veterans, Servicemembers,
their families, caregivers, and survivors when we deliver care,
benefits, and memorial services. I am privileged to champion this
effort.
Our National Cemetery Administration has long been recognized as
the organization with the highest customer satisfaction score in the
Nation. That's according to the American Customer Satisfaction Index
ACSI). And that's across all sectors of industry and government. We
need to work to scope that kind of success across all benefits and
services.
That's why I incorporated CX into the FY 2018-2024 VA Strategic
Plan. Last year, I issued VA's first customer service policy. That
policy outlines how VA will achieve excellent customer service along
three key pillars: CX Capabilities, CX Governance, and CX
Accountability. I am holding all VA executives, managers, supervisors,
and employees accountable to foster a climate of customer service
excellence. We will be guided by our core VA Values of Integrity,
Commitment, Advocacy, Respect, and Excellence (I-CARE). These values
define our culture of customer service and help shape our standards of
behavior.
Because of VA's leadership in customer experience, our Veterans
Experience Office has been designated Lead Agency Partner for the
President's Management Agenda (PMA) Cross-Agency Priority (CAP) Goal on
Improving Customer Experience across government.
Our goal is to lead the President's work of improving customer
experience across Federal agencies and deliver customer service to
Veterans we serve that is on par with top private sector companies.
This is not business as usual at VA. We are changing our culture
and putting our Veteran customers at the center of our process. To
accomplish this goal, we are making investments in Customer Service,
and we are making bold moves in training and implementing customer
experience best practices.
Veterans Experience Office. The Veterans Experience Office (VEO) is
my lead organization for achieving our customer service priority and
providing the Department a core customer experience capability. VEO
offers four core customer experience capabilities, including real-time
customer experience data, tangible customer experience tools, modern
technology, and targeted engagement. For FY 2020, VEO is shifting from
a full reimbursable authority (RA) funding model to a hybrid of a RA
and budget authority (BA) model. The FY 2020 request of $69.4 million
for the VEO ($8.6 million in BA and $60.6 million in RA) is $8.1
million above the FY 2019 enacted budget. The budget increase and the
transition to a BA highlights VA's commitment to customer service and
the institutionalization of CX capabilities within the Department to
improve care, benefits and service to Veterans, their families,
caregivers and survivors.
MISSION Act Implementation
The VA MISSION Act of 2018 (the MISSION Act) will fundamentally
transform elements of VA's health care system, fulfilling the
President's commitment to help Veterans live a healthy and fulfilling
life. It is critical that we deliver a transformed 21st century VA
health care system that puts Veterans at the center of everything we
do. The FY 2020 budget requests $8.9 billion in the VA Medical Care
program for implementation of key provisions of the MISSION Act: $5.5
billion for continued care of the Choice Program population; $2.9
billion for expanded access for care based on average drive time and
wait time standards and expanded transplant care; $272 million for the
Urgent Care benefit, and $150 million to expand the Program of
Comprehensive Assistance for Family Caregivers.
Access to Care. Over the past few years, VA has invested heavily in
our direct delivery system, leading to reduced wait times for care in
VA facilities that currently meet or exceed the quality and timeliness
of care provided by the private sector. And VA is improving access
across its more than 1,200 facilities even as Veteran participation in
VA health care continues to increase.
From FY 2014 through FY 2018, VA saw an increase of 226,000 unique
patients for outpatient appointments (a four percent increase). Since
FY 2014, the number of annual appointments for VA care is up by 3.4
million. There were over 58 million appointments in VA facilities in FY
2018-620,000 more than the prior fiscal year. We have significantly
reduced the time to complete an urgent referral to a specialist. In FY
2014, it took an average of 19.3 days to complete an urgent referral
and in FY 2018 it took 2.1 days, an 89 percent decrease. As of December
2018, that time was down to about 1.6 days.
Still, our patchwork of multiple separate community care programs
is a bureaucratic maze that is difficult for Veterans, their families,
and VA employees to navigate.
The MISSION Act empowers VA to deliver the quality care and timely
service Veterans deserve so we will remain at the center of Veterans'
care. Further, the MISSION Act strengthens VA's internal network and
infrastructure so VA can provide Veterans more health care access more
efficiently.
Transition to the New Community Care Program. We are building an
integrated, holistic system of care that combines the best of VA, our
Federal partners, academic affiliates, and the private sector.
The Veterans Community Care Program consolidates VA's separate
community care programs and will put care in the hands of Veterans and
get them the right care at the right time from the right provider. On
January 30, 2019, we announced proposed access standards that would
determine if Veterans are eligible for community care under the access
standard eligibility criterion in the MISSION Act to supplement care
they are provided in the VA health care system. The proposed regulation
for the program (RIN 2900-AQ46) was published in the Federal Register
on February 22, 2019, and was open for comments through March 25, 2019.
New Veterans Community Care Program Eligibility Criteria
1. VA does not offer the care or services the Veteran requires;
2. VA does not operate a full-service medical facility in the State
in which the Veteran resides;
3. The Veteran was eligible to receive care under the Veterans
Choice Program and is eligible to receive care under certain
grandfathering provisions;
4. VA is not able to furnish care or services to a Veteran in a
manner that complies with VA's designated access standards;
5. The Veteran and the Veteran's referring clinician determine it
is in the best medical interest of the Veteran to receive care or
services from an eligible entity or provider based on consideration of
certain criteria that VA would establish; or
6. The Veteran is seeking care or services from a VA medical
service line that VA has determined is not providing care that complies
with VA's standards for quality.
Proposed Access Standards. VA's proposed access standards-proposed
for implementation in June 2019-best meet the medical needs of Veterans
and will complement existing VA facilities with community providers to
give Veterans access to health care.
1. For primary care, mental health, and non-institutional extended
care services VA is proposing a 30-minute average drive time from the
Veteran's residence.
2. For specialty care, VA is proposing a 60-minute average drive
time from the Veteran's residence.
3. VA is proposing appointment wait-time standards of 20 days for
primary care, mental health care, and non-institutional extended care
services and 28 days for specialty care from the date of request,
unless a later date has been agreed to by the Veteran in consultation
with the VA health care provider.
----------------------------------------------------------------------------------------------------------------
Primary/Mental Health/Non-
institutional Extended Care Specialty Care
----------------------------------------------------------------------------------------------------------------
Appointment Wait Time Within 20 Days Within 28 Days
----------------------------------------------------------------------------------------------------------------
Average Drive Time Within 30 Min Within 60 Min
----------------------------------------------------------------------------------------------------------------
VA remains committed to providing care through VA facilities as the
primary means for Veterans to receive health care, and it will remain
the focus of VA's efforts. As a complement to VA's facilities eligible
Veterans who cannot receive care within the requirements of these
proposed access standards would be offered community care. When
Veterans are eligible for community care, they may choose to receive
care with an eligible community provider, or they may continue to
choose to get the care at their VA medical facility.
The proposed access standards are based on analysis of practices
and our consultations with Federal agencies-including the DoD, the
Department of Health and Human Services, and the Centers for Medicare &
Medicaid Services-private sector organizations, and other non-
governmental commercial entities. Practices in both the private and
public sector formulated our proposed access standards to include
appointment wait-time standards and average drive time standards.
VA also published a Notice in the Federal Register seeking public
comments, and in July 2018, VA held a public meeting to provide an
additional opportunity for public comment.
With VA's proposed access standards, the future of VA's health care
system will lie in the hands of Veterans-exactly where it should be.
Urgent Care. This budget will also invest $272 million in
implementing the new urgent (walk-in care) benefit included in the VA
MISSION Act. On January 31, 2019, VA published a proposed rule that
would guide the provision of this benefit using the provider network
available through national contracts. Under the new urgent care
authority, we will be able to offer eligible Veterans convenient care
for certain, limited, non-emergent health care needs.
Caregivers. The MISSION Act expands eligibility for VA's Program of
Comprehensive Assistance for Family Caregivers (PCAFC) under the
Caregiver Support Program, establishes new benefits for designated
primary family caregivers of eligible Veterans, and makes other changes
affecting program eligibility and VA's evaluation of PCAFC
applications. Currently, the Program of Comprehensive Assistance for
Family Caregivers is only available to eligible family caregivers of
eligible Veterans who incurred or aggravated a serious injury in the
line of duty on or after September 11, 2001. Implementation of the
MISSION Act will expand eligibility to eligible family caregivers of
eligible Veterans from all eras.
Under the law, expansion will begin when VA certifies to Congress
that VA has fully implemented a required information technology system.
The expansion will occur in two phases beginning with eligible family
caregivers of eligible Veterans who incurred or aggravated a serious
injury in the line of duty on or before May 7, 1975, with further
expansion beginning two years after that.
Over the course of the next year, VA will be establishing systems
and regulations necessary to expand this program. Caregivers and
Veterans can learn about the full range of available support and
programs through the Caregivers website, www.caregiver.va.gov, or by
contacting the Caregiver Support Line toll-free at 1-855-260-3274.
The FY 2020 Budget for the Caregivers Support Program is $720
million, $150 million of which is specifically requested to implement
the program's expansion because of the MISSION Act.
Telehealth. VA is a leader in providing telehealth services. VA
leverages telehealth technologies to enhance the accessibility,
capacity, and quality of VA health care for Veterans, their families,
and their caregivers anywhere in the country. VA achieved more than one
million video telehealth visits in FY 2018, a 19 percent increase in
video telehealth visits over the prior year. Telehealth is a critical
tool to ensure Veterans, especially rural Veterans, can access health
care when and where they need it. With the support of Congress, VA has
an opportunity to continue shaping the future of health care with
cutting-edge technology providing convenient, accessible, high-quality
care to Veterans. The FY 2020 Budget includes $1.1 billion for
telehealth services, a $105 million or 10.5 percent increase over the
2019 current estimate.
Section 151 of the MISSION Act strengthens VA's ability to provide
even more telehealth services because it statutorily authorizes VA
providers to practice telehealth at any location in any State,
regardless of where the provider is licensed. VA's telehealth program
enhances customer service by increasing Veterans' access to VA care,
while lessening travel burdens.
In FY 2018, more than 782,000 Veterans (or 13 percent of Veterans
obtaining care at VA) had one or more telehealth episodes of care,
totaling 2.29 million telehealth episodes of care. Of these 782,000
Veterans using telehealth, 45 percent live in rural areas. VA's major
expansion for telehealth and telemental health over the next five
years, for both urban and rural Veterans, will focus on care in or near
the Veteran's home. VA's target is to increase Veterans receiving some
care through telehealth from 13 percent to 20 percent using telehealth
innovations like the VA Video Connect (VVC) application, which enables
private encrypted video telehealth services from almost any mobile
device or computer. VVC will be integrated into VA clinicians' routine
operations to provide Veterans another option for connecting with their
care teams.
Strengthening VA's Workforce. Recruitment and retention are
critical to ensuring that VA has the right doctors, nurses, clinicians,
specialists and technicians to provide the care that Veterans need. The
FY 2020 Budget strengthens VHA's workforce by providing funding for
342,647 FTE, an increase of 13,066 over 2019. VA is also actively
implementing MISSION Act authorities that increased VA's ability to
recruit and retain the best medical providers by expanding existing
loan repayment and clinical scholarship programs; it also established
the authority to create several new programs focused on medical school
students and recent graduates. VA is also implementing additional
initiatives to enhance VA's workforce, such as the expanded utilization
of peer specialists and medical scribes.
Business Transformation
Business transformation is essential if we are to move beyond
compartmentalization of the past and empower our employees serving
Veterans in the field to provide world-class customer service. This
means reforming the systems responsible for claims and appeals, GI Bill
benefits, human resources, financial and acquisition management, supply
chain management, and construction. The Office of Enterprise
Integration (OEI) is charged with coordination for these efforts.
Office of Enterprise Integration. The scale and criticality of the
initiatives underway at VA require management discipline and strong
governance. As part of OEI's coordination role in VA's business
transformation efforts, we have implemented a consistent governance
process to review progress against anticipated milestones, timelines,
and budget. This process supports continuous alignment with objectives
and identifies risks and impediments prior to their realization.
For example, our VA Modernization Board recently initiated a
leadership integration forum to synchronize deployment schedules across
three major enterprise initiatives: adoption of Defense Medical
Logistics Standard Support (DMLSS), financial management business
transformation, and our new electronic health record. This forum
allowed us to assess the feasibility of a concurrent deployment and
identify an alternate course of action. By implementing strong
governance and oversight, we are increasing accountability and
transparency of our most critical initiatives.
Appeals Modernization. The Veterans Appeals Improvement and
Modernization Act of 2017 (AMA) was signed into law on August 23, 2017
and took effect on February 19, 2019. The Appeals Modernization Act
transforms VA's complex and lengthy appeals process into one that is
simple, timely, and fair to Veterans and ultimately gives Veterans
choice and control over how to handle their claims and appeals.
The FY 2020 request of $182 million for the Board of Veterans'
Appeals (the Board) is $7.3 million above the FY 2019 enacted budget
and will sustain the 1,125 FTE who will adjudicate and process legacy
appeals while implementing the Appeals Improvement and Modernization
Act. The Board continues to demonstrate its commitment to reducing
legacy appeals and decided a historic number of appeals - 85,288--in FY
2018, the highest number for any fiscal year. The Board is on pace to
decide over 90,000 appeals in 2019.
To ensure smooth implementation, the Board launched an aggressive
workforce plan to recruit, hire, and train new employees in FY 2018.
The Board on-boarded approximately 242 new hires, including 217
attorneys/law clerks and approximately 20 administrative personnel.
The new appeals process features three decision-review lanes:
1. Higher-Level Review Lane: A senior-level claims processor at a
VA regional office will conduct a new look at a previous decision based
on the evidence of record. Reviewers can overturn previous decisions
based on a difference of opinion or return a decision for correction.
VBA has a 125-day average processing goal for decisions issued in this
lane.
2. Supplemental Claim Lane: Veterans can submit new and relevant
evidence to support their claim, and a claims processor at a VA
regional office will assist in developing evidence. VBA has a 125-day
average processing goal for decisions issued in this lane.
3. Appeal Lane: Veterans who choose to appeal a decision directly
to the Board of Veterans' Appeals (Board) may request direct review of
the evidence the regional office reviewed, submit additional evidence,
or have a hearing. The Board has a 365-day average processing time goal
for appeals in which the Veteran does not submit evidence or request a
hearing.
In addition to focusing on implementation of the Appeals
Modernization Act, addressing pending legacy appeals will continue to
be a priority for VBA and the Board in FY 2019. VBA's efforts have
resulted in appeals actions that have exceeded projections for fiscal
year to date 2019. VBA plans to eliminate completely its legacy, non-
remand appeals inventory in FY 2020 and significantly reduce its legacy
remand inventory in FY 2020.
Finally, VBA is also undertaking a similar, multi-pronged approach
to modernize its appeals process through increased resources,
technology, process improvements, and increased efficiencies. VBA's
compensation and pension appeals program is supported by 2,100 FTEs.
VBA added 605 FTEs in FY 2019 to process legacy appeals and decision
reviews in the modernized process. As of October 1, 2018, to best
maximize its resources an enable efficiencies, VBA centralized these
assets to conduct higher-level reviews at two Decision Review Operation
Centers (DROC). VBA will convert the current Appeals Resource Center in
Washington, DC, into a third DROC using existing assets.
Forever GI Bill. Since the passage of the Harry W. Colmery Veterans
Educational Assistance Act of August 16, 2017, VA has implemented 28 of
the law's 34 provisions. Twenty-two of the law's 34 provisions require
significant changes to VA information technology systems, and VA has
202 temporary employees in the field to support this additional
workload.
Sections 107 and 501 of the law change the way VA pays monthly
housing stipends for GI Bill recipients, and VA is committed to
providing a solution that is reliable, efficient and effective. Pending
the deployment of a technology-based solution, Veterans and schools
will continue to receive GI Bill benefit payments as normal. By asking
schools to hold fall enrollments through the summer and not meeting the
implementation date for the IT solutions of Sections 107 and 501, some
beneficiaries experienced delayed and incorrect payments.
In accordance with the Forever GI Bill Housing Payment Fulfillment
Act of 2018, VA established a Tiger Team tasked to resolve issues with
implementing sections 107 and 501 of the Forever GI Bill. This month we
awarded a new contract that we believe will provide the right solution
for implementing Sections 107 and 501. By December 2019, we will have
Sections 107 and 501 fully implemented. By spring 2020, all enrollments
will be processed according to the Colmery Act. We will recalculate
benefits based on where Veterans take classes, and we will work with
schools to make Sections 107 and 501 payments retroactive to the first
day of August 2018, the effective date.
The Department is committed to making sure every Post-9/11 GI Bill
beneficiary is made whole based on the rates established under the
Forever GI Bill, and we are actively working to make that happen. We
got the word out to Veterans, beneficiaries, schools, VSOs, and other
stakeholders that any Veteran who is in a financial hardship due to a
late or delayed GI Bill payment should contact us immediately.
In December 2018, we updated the housing rates like we normally
would have in August. Those rates were effective for all payments after
January 1, 2019. Additionally, we processed over 450,000 rate
corrections, ensuring that any beneficiary who was underpaid from
August through December received a check for the difference. We have
completed the spring peak enrollment season without any significant
challenges. We worked with schools to get enrollments submitted as
quickly as possible.
As VA moves forward with implementation, we will continue to
regularly update our Veteran students and their institutions of
learning on our progress and what to expect. Already, VA has modified
its definition of ``campus'' to better align itself with statutory
requirements, and in doing so has lessened the administrative burden on
schools to report to VA housing data.
Information Technology Modernization. The FY 2020 budget request of
$4.343 billion continues VA's investment in the Office of Information
Technology (OIT) modernization effort, enabling VA to streamline
efforts to operate more effectively and decrease our spending while
increasing the services we provide. The budget allows OIT to deliver
available, adaptable, secure, and cost-effective technology services to
VA-transforming the Department into an innovative, twenty first century
organization-and to act as a steward for all VA's IT assets and
resources. OIT delivers the necessary technology and expertise that
supports Veterans and their families through effective communication
and management of people, technology, business requirements, and
financial processes.
The requested $401 million funds for development will be dedicated
to mission critical areas, continued divestiture of legacy systems such
as the Benefits Delivery Network and the Burial Operations Support
System, and initiatives that are directly Veteran-facing. Funds will
continue to support Veteran focused initiatives such as Mental Health,
MISSION Act and Community Care, and the continued transition from the
legacy Financial Management System (FMS) to the new Integrated
Financial and Acquisition Management System (iFAMS). The Budget also
invests $379 million for information security to protect Veterans'
information.
Financial Management Business Transformation (FMBT). As mentioned
above, a critical system that will touch the delivery of all health and
benefits is our new financial and acquisition management system, iFAMS.
In support of the Financial Management Business Transformation (FMBT)
program, the FY 2020 budget requests $66 million in IT funds, $107
million in Franchise Fund Service Level Agreement (SLA) funding from
the Administrations and other Staff Offices to be paid to the Financial
Services Center (FSC), and General Administration funding of $11.9
million.
Through the FMBT program, VA is working to implement an enterprise-
wide financial and acquisition management system in partnership with
our service provider, CGI Federal Inc. VA will utilize a cloud hosted
solution, configured for VA, leveraging CGI's Software as a Service
(SaaS) model. VA will gain increased operational efficiency,
productivity, reporting capability, and flexibility from a modern
Enterprise Resource Planning (ERP) cloud solution. The new cloud
solution will also provide additional security, storage, and
scalability.
Infrastructure Improvements and Streamlining. I want to thank
Congress for providing $2 billion in additional funding for VA
infrastructure in 2019. This additional funding for minor construction,
seismic corrections, and non-recurring maintenance will enhance our
ability to address infrastructure needs. In FY 2020, VA will continue
improving its infrastructure while transforming our health care system
to an integrated network to serve Veterans. This budget allows for the
expansion of health care, burial and benefits services where needed
most. The request includes $1.235 billion in Major Construction
funding, as well as $399 million in Minor Construction to fund VA's
highest priority infrastructure projects. These funding levels are
consistent with our requests in recent years.
Major and Minor Construction
This funding supports major medical facility projects including
providing the final funding required to complete these projects: New
York, NY - Manhattan VAMC Flood Recovery, Bay Pines, FL - Inpatient/
Outpatient Improvements, San Juan, PR - Seismic Corrections, Building
1; and Louisville, KY - New Medical Facility. The request also includes
continued funding for ongoing major medical projects at San Diego, CA -
Spinal Cord Injury and Seismic Corrections, Reno, NV - Correct Seismic
Deficiencies and Expand Clinical Services Building, West Los Angeles,
CA - Site utilities for Build New Critical Care Center, and Alameda, CA
- Outpatient Clinic & National Cemetery.
The 2020 request includes additional funding for the completion of
the new cemetery at Western New York Cemetery (Elmira, NY) and the
replacement of the cemetery at Bayamon, PR (Morovis), and expansion
project at Riverside, CA. The national cemetery expansion and
improvement projects at Houston and Dallas, TX and Massachusetts
(Bourne, MA) are also provided for. The FY 2020 Budget provides funds
for the continued support of major construction program including the
seismic initiative that was implemented in 2019 to address VA's highest
priority facilities in need of seismic repairs and upgrades.
The request also includes $399 million in minor construction funds
that will used to expand health care, burial and benefits services for
Veterans. The minor construction request includes funding for 131 newly
identified projects as well as existing partially funded projects.
Leasing
VA is also requesting authorization of seven major medical leases
in 2020 to ensure access to health care is available in those areas.
These leases include new leases totaling $33 million in Colombia, MO
and Salt Lake City, UT as well as replacement leases totaling $104
million in Baltimore, MD; Atlanta, GA; Harlingen, TX; Jacksonville, NC;
and Prince George's County, MD. VA is requesting funding of $919
million to support ongoing leases and delivery of additional leased
facilities during the year.
Repurposing or Disposing Vacant Facilities
To maximize resources for Veterans, VA repurposed or disposed of
175 of the 430 vacant or mostly vacant buildings since June 2017. Due
diligence efforts (environmental/historic) for the remaining buildings
are substantially complete, allowing them to proceed through the final
disposal or reuse process.
Suicide Prevention
Suicide is a national public health issue that affects all
Americans, and the health and well-being of our nation's Veterans is
VA's top priority. Twenty (20) Veterans, active-duty Servicemembers,
and non-activated Guard or Reserve members die by suicide on average
each day, and of those 20, 14 had not been in our care. That is why we
are implementing broad, community-based prevention strategies, driven
by data, to connect Veterans outside our system with care and support.
The FY 2020 Budget requests $9.4 billion for mental health services, a
$426 million increase over 2019. The Budget specifically invests $222
million for suicide prevention programming, a $15.6 million increase
over the 2019 enacted level. The request funds over 15.8 million mental
health outpatient visits, an increase of nearly 78,000 visits over the
2019 estimate. This builds on VA's current efforts. VA has hired more
than 3,900 new mental health providers yielding a net increase in VA
mental health staff of over 1,000 providers since July 2017.
Nationally, in the first quarter of 2019, 90 percent of new patients
completed an appointment in a mental health clinic within 30 days of
scheduling an appointment, and 96.8 percent of established patients
completed a mental health appointment within 30 days of the day they
requested.
Preventing Veteran suicide requires closer collaboration between
VA, DoD, and the Department of Homeland Security (DHS). On January 9,
2018, President Trump signed an Executive Order (13822) titled,
``Supporting Our Veterans During Their Transition from Uniformed
Service to Civilian Life.'' This Executive Order directs DoD, VA, and
DHS to develop a Joint Action Plan that describes concrete actions to
provide access to mental health treatment and suicide prevention
resources for transitioning uniformed Servicemembers in the year
following their discharge, separation, or retirement. On March 5, 2019,
President Trump signed the National Roadmap to Empower Veterans and End
Suicide Executive Order (13861), which creates a Veteran Wellness,
Empowerment, and Suicide Prevention Task Force that is tasked with
developing, within 1 year, a road map to empower Veterans to pursue an
improved quality of life, prevent suicide, prioritize related research
activities, and strengthen collaboration across the public and private
sectors. This is an all-hands-on-deck approach to empower Veteran well-
being with the goal of ending Veteran suicide.
For Servicemembers and Veterans alike, our collaboration with DoD
and DHS is already increasing access to mental health and suicide
prevention resources, due in large part to improved integration within
VA, especially between the VBA and VHA. VBA and VHA have worked in
collaboration with DoD and DHS to engage Servicemembers earlier and
more consistently than we have ever done in the past. This engagement
includes support to members of the National Guard, Reserves, and Coast
Guard.
VA's suicide prevention efforts are guided by our National Strategy
for Preventing Veteran Suicide, a long-term plan published in the
summer of 2018 that provides a framework for identifying priorities,
organizing efforts, and focusing national attention and community
resources to prevent suicide among Veterans. It also focuses on
adopting a broad public health approach to prevention, with an emphasis
on comprehensive, community-based engagement.
However, VA cannot do this alone, and suicide is not solely a
mental health issue. As a national problem, Veteran suicide can only be
reduced and mitigated through a nationwide community-level approach
that begins to solve the problems Veterans face, such as loss of
belonging, meaningful employment, and engagement with family, friends,
and community.
The National Strategy for Preventing Veteran Suicide provides a
blueprint for how the nation can help to tackle the critical issue of
Veteran suicide and outlines strategic directions and goals that
involve implementation of programming across the public health
spectrum, including, but not limited to:
Integrating and coordinating Veteran Suicide Prevention
across multiple sectors and settings;
Developing public-private partnerships and enhancing
collaborations across Federal agencies;
Implementing research informed communication efforts to
prevent Veteran suicide by changing attitudes knowledge and behaviors;
Promoting efforts to reduce access to lethal means;
Implementation of clinical and professional practices for
assessing and treating Veterans identified as being at risk for
suicidal behaviors; and
Improvement of the timeliness and usefulness of national
surveillance systems relevant to preventing Veteran suicide.
Every day, more than 400 Suicide Prevention Coordinators (SPC) and
their teams-located at every VA medical center-connect Veterans with
care and educate the community about suicide prevention programs and
resources. Through innovative screening and assessment programs such as
REACH VET (Recovery Engagement and Coordination for Health-Veterans
Enhanced Treatment), VA identifies Veterans who may be at risk for
suicide and who may benefit from enhanced care, which can include
follow-ups for missed appointments, safety planning, and care plans.
VHA has also expanded its Veterans Crisis Line to three call
centers and increased the number of Veterans served by the Readjustment
Counseling Service (RCS), which provides services through the 300 Vet
Centers, 80 Mobile Vet Centers (MVC), 20 Vet Center Outstations, over
960 Community Access Points and the Vet Center Call Center (877-WAR-
VETS). In the last two fiscal years, clients benefiting from RCS
services increased by 14 percent, and Vet Center visits for Veterans,
Servicemembers, and families increased by 7 percent.
We are committed to advancing our outreach, prevention, and
treatment efforts to further restore the trust of our Veterans and
continue to improve access to care and support inside and outside VA.
Electronic Health Record Modernization (EHRM)
We made a historic decision to modernize our electronic health
record (EHR) system to provide our nation's Veterans with seamless care
as they transition from military service to Veteran status. On May 17,
2018, we awarded a ten-year contract to Cerner Government Services,
Inc., to acquire the same EHR solution being deployed by DoD that
allows patient data to reside in a single hosting site using a single
common system to enable sharing of health information, improve care
delivery and coordination, and provide clinicians with data and tools
that support patient safety. The FY 2020 Budget includes $1.6 billion
to continue to support VA's EHRM effort to create and implement a
single longitudinal clinical health record from active duty to Veteran
status, and to ensure interoperability with DoD.
The request provides necessary resources for post Go-Live
activities completion of Office of Electronic Health Record
Modernization's (OEHRM) three Initial Operating Capability (IOC) sites
and full deployment of the remaining sites in Veterans Integrated
Service Network (VISN) 20, the Pacific Northwest region. Additionally,
it funds the concurrent deployment of waves comprised of sites in VISN
21 and VISN 22, the Southwest region. The solution will be deployed at
VA medical centers, as well as associated clinics, Veteran centers,
mobile units, and other ancillary facilities.
We are working closely with DoD to synchronize efforts as we deploy
and test the new health record. We are engaging front-line staff and
clinicians to identify efficiencies, hone governance, refine
configurations, and standardize processes for future locations. We are
committed to a timeline that balances risks, patient safety, and user
adoption while also working with DoD in providing a more comprehensive,
agile, and coordinated management authority to execute requirements and
mitigate potential challenges and obstacles.
Throughout this effort, VA will continue to engage front-line staff
and clinicians, as it is a fundamental aspect in ensuring we meet the
program's goals. We have begun work with the leadership teams in place
in the Pacific Northwest. OEHRM has established clinical councils from
the field that will develop National workflows and serve as change
agents at the local level.
Supply Chain Transformation
VA has embarked on a supply chain transformation program designed
to build a lean, efficient supply chain that provides timely access to
meaningful data focused on patient and financial outcomes. We are
pursuing a holistic modernization effort which will address people,
training, processes, data and automated systems. To achieve greater
efficiencies by partnering with other Government agencies, VA will
strengthen its long-standing relationships with DoD by leveraging
expertise to modernize VA's supply chain operations, while allowing the
VA to remain fully committed to providing quality health care and
applying resources where they are most needed. The FY 2020 budget
includes $36.8 million in IT funding to support this effort.
As we deploy an integrated health record, we are also collaborating
with DoD on an enterprise-wide adoption of the Defense Medical
Logistics Standard Support (DMLSS) to replace VA's existing logistics
and supply chain solution. VA's current system faces numerous
challenges and is not equipped to address the complexity of decision-
making and integration required across functions, such as acquisition,
logistics and construction. The DMLSS solution will ensure that the
right products are delivered to the right places at the right time,
while providing the best value to the government and taxpayers.
We are piloting our Supply Chain Modernization program initially at
the Captain James A. Lovell Federal Health Care Center (FHCC) and VA
initial EHR sites in Spokane and Seattle to analyze VA enterprise-wide
application. On March 7th, 2019, we initiated the pilot kickoff at the
FHCC for VA's business transformation and supply chain efforts. This
decision leverages a proven system that DoD has developed, tested, and
implemented. In the future, DMLSS and its technical upgrade LogiCole
will better enable whole-of-government sourcing and better facilitate
VA's use of DoD Medical Surgical Prime Vendor and other DoD sources, as
appropriate, as the source for VA medical materiel.
Veterans Homelessness
The FY 2020 Presidents Budget (PB) continues the Administration's
support of VA's Homelessness Programs, with $1.8 billion in funding,
which maintains the 2019 level of funding, including $380 million for
Supportive Services for Veterans Families (SSVF).
Over the past five years, VA and its federal partners have made a
concerted effort to collaborate at the federal level to ensure
strategic use of resources to end Veteran homelessness. Coordinated
entry systems are the actualization of this coordinated effort at the
local level. Coordinated entry is seen, and will continue to be seen,
as the systematic approach that is needed at the community level to
ensure that resources are being utilized in the most effective way
possible and that every Veteran in that community is offered the
resources he or she needs to end their homelessness. All homeless
Veterans in a given community are impacted by the coordinated entry
system given that its framework is designed to promote community-wide
commitment to the goal of ending homelessness and utilizing community-
wide resources (including VA resources) in the most efficient way
possible for those Veterans who are in most need. This includes the
prioritization of resources for those Veterans experiencing chronic,
literal street homelessness. The number of Veterans experiencing
homelessness in the United States has declined by nearly half since
2010. On a single night in January 2018, fewer than 40,000 Veterans
were experiencing homelessness-5.4 percent fewer than in 2017.
Since 2010, over 700,000 Veterans and their family members have
been permanently housed or prevented from becoming homeless. As of
December 19, 2018, 69 areas-66 communities and three states-have met
the benchmarks and criteria established by the United States
Interagency Council on Homelessness, VA, and the Department of Housing
and Urban Development to publicly announced an effective end to Veteran
homelessness.
Efforts to end Veteran homelessness have greatly expanded the
services available to permanently house homeless Veterans and VA offers
a wide array of interventions designed to find homeless Veterans,
engage them in services, find pathways to permanent housing, and
prevent homelessness from occurring.
Opioid Safety & Reduction Efforts
In October 2017, the President declared the opioid crisis in our
country a public health emergency. Opioid safety and reduction efforts
are a Department priority, and we have responded with new strategies to
rapidly combat this national issue as it affects Veterans. Success
requires collaboration among VA leadership and all levels of VA staff-
from medical centers to headquarters-Congress, and community partners
to ensure we are working with Veterans to achieve positive, life-
changing results. The fact that opioid safety, pain care
transformation, and treatment of opioid use disorder all contribute to
reduction of suicide risk makes these efforts particularly important.
The FY 2020 Budget includes $397 million, a $15 million increase over
2019, to reduce over-reliance on opioid analgesics for pain management
and to provide safe and effective use of opioid therapy when clinically
indicated.
VA's Opioid Safety Initiative has greatly reduced reliance on
opioid medication for pain management, in part by reducing opioid
prescribing by more than 50 percent over the past four years. Most of
this progress is attributable to reductions in prescribing long-term
opioid therapy by not starting Veterans with chronic, non-cancer pain
on opioid therapy and, instead utilizing multimodal strategies that
manage Veteran pain more effectively long-term such as acupuncture,
behavioral therapy, chiropractic care, yoga, and non-opioid
medications.
We are committed to providing Veteran-centric, holistic care for
the management of pain and for promoting well-being. We are seeing
excellent results as sites across the country deploy this ``Whole
Health'' approach. Non-medication treatments work as well and are often
better than opioids at controlling non-cancer pain. We want to assure
Congress-and Veterans on opioid therapy-that Veterans' medication will
not be -decreased or stopped without their knowledge, engagement, and a
thoughtful discussion of accessible alternatives. Our goal is to make
sure every Veteran has the best function, quality of life, and pain
control.
Women's Health
VA has made significant progress serving women Veterans in recent
years. We now provide full services to women Veterans, including
comprehensive primary care, gynecology care, maternity care, specialty
care, and mental health services. The FY 2020 Budget requests $547
million for gender specific women Veterans' health care, a $42 million
increase over 2019.
The number of women Veterans using VHA services has tripled since
2000, growing from nearly 160,000 to over 500,000 today. To accommodate
the rapid growth, VHA has expanded services and sites of care across
the country. VA now has at least two Women's Heath Primary Care
Provider (WH-PCP) at all of VA's health care systems. In addition, 91
percent of community-based outpatient clinics (CBOCs) have a WH-PCP in
place. VHA now has gynecologists on site at 133 sites and mammography
on site at 65 locations. For severely injured Veterans, we also now
offer in vitro fertilization services through care in the community and
reimbursement of adoption costs.
VHA is in the process of training additional providers so every
woman Veteran has an opportunity to receive primary care from a WH-PCP.
Since 2008, 5,800 providers have been trained in women's health. In
fiscal year 2018, 968 Primary Care and Emergency Care Providers were
trained in local and national trainings. VA has also developed a mobile
women's health training for rural VA sites to better serve rural women
Veterans, who make up 26 percent of women Veterans. This budget will
also continue to support a fulltime Women Veterans Program Manager at
every VHA health care system who is tasked with advocating for the
health care needs of women Veterans.
VA is at the forefront of information technology for women's health
and is redesigning its electronic medical record to track breast and
reproductive health care. Quality measures show that women Veterans who
receive care from VA are more likely to receive breast cancer and
cervical cancer screening than women in private sector health care. VA
also tracks quality by gender and, unlike some other health care
systems, has been able to reduce and eliminate gender disparities in
important aspects of health screening, prevention, and chronic disease
management. We are also factoring care for women Veterans into the
design of new VA facilities and using new technologies, including
social media, to reach women Veterans and their families. We are proud
of our care for women Veterans and are working to increase the trust
and knowledge of VA services of women Veterans, so they choose VA for
benefits and services.
National Cemetery Administration (NCA)
The President's FY 2020 budget positions NCA to meet Veterans'
emerging burial and memorial needs through the continued implementation
of its key priorities: Preserving the Legacy: Ensuring ``No Veteran
Ever Dies''; Providing Access and Choosing VA; and Partnering to Serve
Veterans. The FY 2020 Budget includes $329 million for NCA's operations
and maintenance account, an increase of $13.2 million (4.2 percent)
over the FY 2019 level. This request will fund the 2,008 Full-Time
Equivalent (FTE) employees needed to meet NCA's increasing workload and
expansion of services, while maintaining our reputation as a world-
class service provider. In FY 2020, NCA will inter an estimated 137,000
Veterans and eligible family members and care for over 3.9 million
gravesites. NCA will continue to memorialize Veterans by providing
383,570 headstones and markers, distributing 634,000 Presidential
Memorial Certificates, and expanding the Veterans Legacy Program to
communities across the country to increase awareness of Veteran service
and sacrifice.
VA is committed to investing in NCA's infrastructure, particularly
to keep existing national cemeteries open and to construct new
cemeteries consistent with burial policies approved by Congress. NCA is
amid the largest expansion of the cemetery system since the Civil War.
By 2022, NCA will establish 18 new national cemeteries across the
country, including rural and urban locations. The FY 2020 request also
includes $172 million in major construction funds for three gravesite
expansion projects (Houston and Dallas, TX and Bourne, MA) and
additional funding for the replacement cemetery in Bayamon, PR, the
gravesite expansion project in Riverside, CA, and the new national
cemetery in Western NY. The Budget also includes $45 million for the
Veteran Cemetery Grant Program to continue important partnerships with
States and tribal organizations. Upon completion of these expansion
projects, and the opening of new national, State and tribal cemeteries,
nearly 95 percent of the total Veteran population-about 20 million
Veterans-will have access to a burial option in a national or grant-
funded Veterans cemetery within 75 miles of their homes.
Accountability
The FY 2020 Budget requests direct appropriations for the Office of
Accountability and Whistleblower Protection (OAWP) for the first time
since it was established. The total request for OAWP in FY 2020 is
$22.2 million, which is $4.5 million, or 25 percent higher than the
2019 funding level. This funding level demonstrates VA's commitment to
improving the performance and accountability of our senior executives
through thorough, timely, and unbiased investigations of all
allegations and concerns. This funding level will also enable OAWP to
continue to provide protection of valued whistleblowers against
retaliation for their disclosures under the whistleblower protections
provisions of 38 U.S.C. Sec. 714. In FY 2018, OAWP assessed 2,241
submissions, conducted 133 OAWP investigations, and monitored over
1,000 referred investigations. These efforts are part of VA's effort to
build public trust and confidence in the entire VA system and are
critical to our transformation.
The FY 2020 budget also requests $207 million, a $15 million
increase over 2019, and 1,000 FTE for the Office of Inspector General
(OIG) to fulfill statutory oversight requirements and sustain the
investments made in people, facilities, and technology during the last
three years. The 2020 budget supports FTE targets envisioned under a
multi-year effort to grow the OIG to a size that is more appropriate
for overseeing the Department's steadily rising spending on new complex
systems and initiatives. The 2020 budget request will also provide
sufficient resources for the OIG to continue to timely and effectively
address the increased number of reviews and reports mandated through
statute.
Conclusion
Thank you for the opportunity to appear before you today to address
our FY 2020 budget and FY 2021 AA budget request. VA has shown
demonstrable improvement over the last several months. The resources
requested in this budget will ensure VA remains on track to meet
Congressional intent to implement the MISSION Act and continue to
optimize care within VHA.
Mr. Chairman, I look forward to working with you and this
Committee. I am eager to continue building on the successes we have had
so far and to continue to fulfill the President's promise to provide
care to Veterans when and where they need it. There is significant work
ahead of us and we look forward to building on our reform agenda and
delivering an integrated VA that is agile and adaptive and delivers on
our promises to America's Veterans.
Thank you.
Prepared Statement of Joy Ilem
JOINT STATEMENT OF THE CO-AUTHORS OF THE INDEPENDENT BUDGET: DISABLED
AMERICAN VETERANS, PARALYZED VETERANS OF AMERICA, VETERANS OF FOREIGN
WARS
``The President's Fiscal Year 2020 Budget Request for the Department of
Veterans Affairs''
Chairman Takano, Ranking Member Roe, and members of the committee,
the co-authors of The Independent Budget (IB)-DAV (Disabled American
Veterans), Paralyzed Veterans of America (PVA), and Veterans of Foreign
Wars (VFW)-are pleased to present our views regarding the President's
funding request for the Department of Veterans Affairs (VA) for Fiscal
Year (FY) 2020, including advance appropriations for FY 2021.
In February, prior to the Administration's budget request, the IB
released our comprehensive VA budget recommendations for all
discretionary programs for FY 2020, as well as advance appropriations
for FY 2021. \1\ The recommendations include funding to implement the
VA MISSION Act of 2018 (P.L. 115-182) and other reform efforts. After
reviewing the Administration's budget request for VA and comparing it
to the IB recommendations, particularly in light of the requirements of
the VA MISSON Act, we believe that the request falls short of meeting
the needs of veterans seeking care through VA. Although the budget
request provides a seven percent increase in the level of discretionary
funding, when factoring in VA's own estimates of the cost of
implementing the VA MISSION Act, the shift of $5.5 billion from
mandatory to discretionary funding from the Choice program, and the
increased cost for providing medical care due to inflation and other
factors, VA will not have sufficient resources to meet the health care
needs of America's veterans.
---------------------------------------------------------------------------
\1\ The full IB budget report addressing all aspects of
discretionary funding for VA can be downloaded at
www.independentbudget.org.
---------------------------------------------------------------------------
The Administration's request of $84 billion for Medical Care is $4
billion less than the IB estimates is necessary to fully meet the
demand by veterans for health care during the fiscal year. For FY 2020,
the IB recommends approximately $88.1 billion in total medical care
funding and approximately $90.8 billion for FY 2021. This
recommendation reflects the necessary adjustments to the baseline for
all Medical Care program funding in the preceding fiscal year, and
assumes the Choice program is fully replaced at the beginning of FY
2020 by the Veterans Community Care Program (VCCP).
For FY 2020, the IB recommends $56.1 billion for VA Medical
Services. This recommendation is a reflection of multiple components,
including the current services estimate, the increase in patient
workload, and additional medical care program costs. The current
services estimate reflects the impact of projected uncontrollable
inflation on the cost to provide services to veterans currently using
the system. This estimate also assumes a 2.1 percent increase for pay
and benefits across the board for all VA employees in FY 2020.
Our estimate of growth in patient workload is based on a projected
increase of approximately 90,000 new unique patients. These patients
include priority group 1- 8 veterans and covered non-veterans. We
estimate the cost of these new unique patients to be approximately $1.3
billion.
The IB believes there are additional projected medical program
funding needs for VA totaling over $1.2 billion. Specifically, we
believe there is a real need for funding to address an array of issues
in VA's Long-Term Services and Supports (LTSS) program, including the
shortfall in non-institutional services due to the unremitting waitlist
for home and community-based services; to provide additional
centralized prosthetics funding (based on actual expenditures and
projections from the VA's Prosthetics and Sensory Aids Service);
funding to expand and improve services for women veterans; funding to
support the recently approved authority for reproductive services, to
include in vitro fertilization (IVF); and initial funding to implement
extending comprehensive caregiver support services to severely injured
veterans of all eras.
The Administration's request for VA Medical Services of $51.4
billion is approximately $4.7 billion below the IB recommendation. To
better understand the shortfall, it should be noted that the IB does
not include anticipated receipts from VA's Medical Care Collections
Fund in its recommendation. Although the Administration's request
reflects an apparent increase of three percent, the IB believes that
when taking into account the increased cost to maintain current
services and anticipated increases in workload, as well as increased
costs inside VA due to the VA MISSION Act that apparent increase will
ultimately result in a shortfall.
Of great concern to our members, the Administration's budget
request estimates that VA will fail to meet the VA MISSION Act's very
clear timetable for expanding its comprehensive caregiver support
program to severely injured World War II, Korean War, and Vietnam War
veterans and their family caregivers. Although we were pleased to hear
at the Senate Committee on Veterans' Affairs hearing this past week
that VA is still aiming to certify expansion by the October 1, 2019,
deadline, we still have concerns as to whether VA will truly be able to
meet the deadline, particularly in light of conflicting messages from
VA and recent history in delayed implementation of IT solutions for
this program. These men and women have waited nearly a decade for equal
treatment and it is simply unacceptable to ask them to wait longer.
As this Committee is aware, the VA Caregiver Support Program
currently uses the IT system known as the Caregiver Application Tracker
(CAT), which was rapidly developed due to time constraints on
implementing the program and was not designed to manage a high volume
of information as is required today. We are aware VA has requested a
reprogramming of nearly $96 million in Medical Care funding to the IT
Systems account, which includes just over $4 million to continue
development and stabilization of CAT, while in its FY 2020 budget
submission, VA is requesting $2.6 million to update the Caregivers Tool
(CareT) to support the first phase of expansion. As this Committee is
aware, VA notified Congress in April 2017 that CareT, which at that
time was expected to fully automate the application and stipend
delivery process for the program, experienced significant delays
associated with external dependencies and lost prioritization among
competing projects. As a result, a new contract had to be drafted to
continue work pushing the delivery of CareT out one year to June 2018.
Today, while the estimated certification date of CareT remains
uncertain, there are important budgetary implications based on when
certification occurs and phase one of the expansion begins, with full
expectation that VA will issue interim final rules to expedite the
process.
In terms of funding, the Administration included $150 million to
expand VA's comprehensive caregiver program, which is over $100 million
less than the IB recommendation of $253 million to fully implement
phase one of the caregiver expansion in FY 2020. The IB's
recommendation is based on the Congressional Budget Office estimate for
preparing the program, including increased staffing and IT needs, and
the beginning of the first phase of expansion.
For Medical Community Care, the IB recommends $18.1 billion for FY
2020, which includes the growth in current services, estimated spending
under the Choice program, and additional obligations under the VA
MISSION Act of $3.7 billion. The Administration's FY 2020 request for
$15.3 billion in discretionary funding appears to be a $5.9 billion
increase in funding for Community Care. However, VA has indicated that
$5.5 billion of that increase merely represents shifting $5.5 billion
that would otherwise be necessary to pay for the Choice program, from
mandatory funding. Considering that VA estimated the VA MISSION Act
will require $2.6 billion in new funding for expanded access based on
new access standards, expanded transplant care, and $271 million for
urgent care, there appears to be a significant shortfall for VA
community care programs.
Furthermore, during VA's budget briefing on March 11, VHA officials
stated that there would be no Medical Community Care funding required
to implement the new wait time access standards, that VA would be able
to fully meet those standards within VA facilities; therefore, not one
veteran would get VCCP eligibility due solely to the wait time
standard. However, VA has also stated that the current median wait time
for primary care is 21 days, which would mean that approximately half
of all veterans seeking primary care appointments today have a greater
than 20-day wait time. Yet, VA's budget request assumes that they would
achieve 100 percent compliance with the wait time standard through
greater efficiency and an approximate 30 percent increase in VA primary
care providers. We have serious doubts about whether this is realistic
given the national shortage of primary care providers and the time
needed to recruit, hire, and onboard new employees; and certainly,
whether it is achievable by the first day of the next fiscal year, just
over six months from today.
The Administration's FY 2020 request for VA's construction programs
of $1.8 billion dollars is a 44 percent reduction from FY 2019 funding
levels, and a deeply disappointing retreat in funding to maintain VA's
aging infrastructure. At the Senate Veterans' Affairs Committee hearing
on March 26, 2019, in response to Senator Manchin's question about VA's
``.44 percent decrease in funding levels for construction programs.,''
Secretary Wilkie stated that he estimates VA will need, ``.$60 billion
over the next five years to come up to speed.'' This backlog is
confirmed by VA's FY 2020 budget submission, which states that VA's,
``.Long-Range SCIP plan includes 4,059 capital projects that would be
necessary to close all currently-identified gaps with an estimated
magnitude cost of between $62-$76 billion including activation costs.''
[Volume IV, FY 2020 Congressional Submission, Page 8.2- 47]. However,
VA's FY 2020 budget request for Major & Minor Construction combined is
just over $1.6 billion, significantly below the true need stated by the
Secretary and identified by SCIP. At a time when VA is seeking to
expand its capacity by hiring additional doctors, nurses, clinicians
and supporting staff, it is absolutely critical that VA continue to
invest in the infrastructure necessary for them to care for veterans.
For major construction in FY 2019, VA requested and Congress
appropriated a significant increase in funding for major construction
projects- an approximate $700 million increase. While these funds will
allow VA to begin construction on key projects, many other previously
funded sites still lack the funding for completion. Some of these
projects have been on hold or in the design and development phase for
years. Additionally, there are outstanding seismic corrections that
must be addressed. Thus, the IB recommended $2.78 billion in major
construction, nearly $1 billion more than VA's total construction
request.
To ensure VA funding keeps pace with all current and future minor
construction needs, the IB recommends Congress appropriate an
additional $761 million for minor construction projects. It is
important to invest heavily in minor construction because these are the
types of projects that can be completed faster and have a more
immediate impact on services for veterans. Previously, these changes
fell under facilities similar to Non-Recurring Maintenance (NRM), but
the IB recommends these specific modifications be under a different
authority to ensure their priority.
In addition, the Administration's FY 2020 Medical Facilities
request of $6.1 billion, which includes critical NRM to ensure VA
facilities have the space to provide care, is a $660 million cut
compared to FY 2019 levels. The IB recommends $6.6 billion for FY 2020.
The Administration's request of $762 million for Medical and
Prosthetic Research is nearly $80 million below the IB recommendation
of $840 million. The request represents a 2 percent cut, at a time when
medical research inflation is estimated to be 2.8 percent. The VA
Medical and Prosthetic Research program is widely acknowledged as a
success, with direct and significant contributions to improved care for
veterans and an elevated standard of care for all Americans. This
research program is also an important tool in VA's recruitment and
retention of health care professionals and clinician-scientists to
serve our nation's veterans. This reduction would diminish VA's ability
to provide the most advanced treatments available to injured and ill
veterans in the future, one of VA's core missions.
Overall, the IB believes that the Administration's FY 2020 budget
request for VA will neither allow the Department to fully and
faithfully implement the VA MISSION Act, nor will it fully meet the
requirements to provide the health care, benefits, and services that
veterans have earned. Below are some of the questions about VA's budget
request that have not been answered.
At its March 11 budget briefing, VA officials stated that
the FY 2020 budget request was predicated on a carryover of
approximately $3 billion from FY 2019 appropriations, but did not
specify how much of it was unobligated. Specifically, how much
``carryover'' is assumed in the FY 2020 budget request that could have
been used to meet veterans' health care needs? What are the specific
dollar amounts being carried over and from what specific accounts, and
into what accounts and for what purposes will this carryover funding be
used in FY 2020?
As discussed above, VA officials indicated that there
would be zero new dollars necessary for the Medical Community Care
account as a result of the new wait time access standards proposed
because VA assumes it will be able to meet those standards 100 percent
of the time within VA facilities. VA indicated it will do this through
workload recapture, greater efficiency, and a 30 percent increase in
the total number of VA primary care providers. What new initiatives
will VA undertake and what are the specific increases in productivity
that each will achieve? What are VA's detailed plans and projections
for increasing primary care providers by 30 percent, and how will these
new providers be in place at the beginning of FY 2020?
What factors did VA consider in reaching its decision to
cut research spending for the emerging field of genomics research in FY
2020 by two percent at a time when medical research inflation is
estimated to be 2.8 percent?
In the full budget documents made available on March 18,
the Veterans Benefits Administration budget request seeks
appropriations to support the exact same level of FTE for FY 2020 as it
does in FY 2019. However, the Direct Labor estimate for the Disability
Compensation program shows a decrease of 51 FTE in FY 2020. This small
decrease in claims processors occurs at a time that the VA budget is
projecting that number of pending claims for disability compensation
will rise to over 450,000 by the end of FY 2020, almost a 50 percent
increase in just the past three years. Why is VA requesting fewer
claims processing staff in FY 2020 when its own data shows that the
number of pending claims is rising dramatically?
VA budget documents state that the Vocational
Rehabilitation and Employment (VRE) program will meet and sustain the
congressionally mandated goal of 1:125 counselor-to-client ratio.
However, the latest data in the VA budget document also shows that from
2016 to 2018, the number of VRE participants fell from 173,606 to
164,355, more than a five percent decrease. During that same period,
VRE's caseload also dropped from 137,097 to 125,513, an 8.4 percent
decline. It would appear that VRE is able to meet the 1:125 goal by
serving fewer veterans. Given how important and beneficial the VRE
program is to disabled veterans-providing many of them with the ability
to increase their economic independence-why are fewer veterans taking
advantage of this program? Is the lack of counselors impacting veteran
utilization? Has VRE instituted any new policies or practices that have
deterred disabled veterans from seeking VRE services and what actions
is VRE taking to increase awareness about the availability and benefits
of VRE services?
Lastly, the IBVSOs strongly oppose four legislative proposals
included in the budget that would reduce benefits to disabled veterans
that were earned through their service:
1. Round-Down of the Computation of the Cost of Living Adjustment
(COLA) for Service-Connected Compensation and Dependency and Indemnity
Compensation (DIC) for Five Years:
In 1990, Congress, in an omnibus reconciliation act, mandated
veterans' and survivors' benefit payments be rounded down to the next
lower whole dollar. While this policy was initially limited to a few
years, Congress continued it until 2014. While not significant at the
onset, the overwhelming effect of twenty-four years of round-down
resulted in veterans and their beneficiaries losing billions of
dollars.
In last year's budget request, the Administration sought
legislation to round-down the computation of COLA for ten years. This
would have cost beneficiaries $34.1 million in 2019, $749.2 million
over five years, and $3.1 billion over ten years.
The Administration's new proposed budget for FY 2020 is seeking to
round-down COLA increases from 2020 to 2024. The cumulative effect of
this proposal levies a tax on disabled veterans and their survivors,
costing them money each year. When multiplied by the number of disabled
veterans and DIC recipients, millions of dollars are siphoned from
these deserving individuals annually. All totaled, VA estimates it
would cost veterans $34 million in 2020, $637 million over five years
and $2 billion over ten years.
Veterans and their survivors rely on their compensation for
essential purchases such as food, transportation, rent, and utilities.
Any COLA round-down will negatively impact the quality of life for our
nation's disabled veterans and their families, and we oppose this and
any similar effort. The federal budget should not seek financial
savings at the expense of benefits earned by disabled veterans and
their families.
2. Clarify Evidentiary Threshold for Ordering VA Examinations:
This proposal would increase the evidentiary threshold at which VA,
under its duty to assist obligation in 38 U.S.C. Sec. 5103A, is
required to request a medical examination for compensation claims.
Section 5103A(d)(2) requires VA to ``treat an examination or opinion as
being necessary to make a decision on a claim'' if the evidence of
record, ``taking into consideration all information and lay or medical
evidence . . . (A) contains competent evidence that the claimant has a
current disability, or persistent or recurrent symptoms of disability;
and (B) indicates that the disability or symptoms may be associated
with the claimant's active military, naval, or air service; but (C)
does not contain sufficient medical evidence for the Secretary to make
a decision on the claim.''
The Court of Appeals for Veterans Claims (CAVC), in McLendon v.
Nicholson, 20 Vet.App. 79 (2006), determined that in disability
compensation claims, VA must provide a VA medical examination when
there is:
Competent evidence of a current disability or persistent
or recurrent symptoms of a disability, and
Evidence establishing that an event, injury, or disease
occurred in service or establishing certain diseases manifesting during
an applicable presumptive period for which the claimant qualifies, and
An indication that the disability or persistent or
recurrent symptoms of a disability may be associated with the veteran's
service or with another service-connected disability, but,
Insufficient competent medical evidence on file for the
secretary to make a decision on the claim. It notes that the
requirement of (3) is a low threshold.
We oppose this proposal as it would be inherently detrimental to
the VA claims process for all veterans. The Administration asserts the
holdings by the CAVC, specifically in McLendon v. Nicholson, are
inconsistent and too low a bar when compared to 38 U.S.C. Sec.
5103A(d)(2). However, that is not correct. As noted above, the
statutory requirements for a VA examination are consistent with the
CAVC's holding. The Administration's proposed legislation would
intentionally raise the bar of the VA's Duty to Assist and allow the VA
to hold veterans to a much higher threshold and result in fewer
examinations with more claim denials. This would lead to more Higher
Level Review requests, supplemental claims, and appeals directly to the
Board of Veterans' Appeals. Ultimately, this will result in an
increased number of veterans never receiving the benefits they earned.
The Administration's proposal would reduce anticipated disability
compensation to veterans by $233 million in 2020, $1.3 billion over
five years, and $2.8 billion over ten years. We strongly oppose this
attempt to limit the due process rights of veterans, particularly when
the result will be billions of dollars in lost disability compensation
for those who were injured or made ill in service.
3. VA Schedule for Rating Disability (VASRD) Effective Dates:
VA seeks to amend 38 U.S.C. Sec. 1155 so that when VASRD is
readjusted, such changes would apply to any new or pending claims and
may include action to decrease an existing evaluation. Under section
1155, ``The Secretary shall from time to time readjust this schedule of
ratings in accordance with experience. However, in no event shall such
a readjustment in the rating schedule cause a veteran's disability
rating in effect on the effective date of the readjustment to be
reduced unless an improvement in the veteran's disability is shown to
have occurred.''
Currently, if a diagnostic code rating criteria changes, the
veteran can only be granted an increased evaluation under the old
rating criteria up to the date of the change to the new rating
criteria. The new rating criteria must be applied from the date of the
change. The Administration's proposal would eliminate a veteran's
ability to receive an increased evaluation up to the date of the change
and only apply the new criteria. This proposal would have a negative
impact on veterans and would clearly be in contrast to 38 C.F.R. Sec.
3.103, which states, ``Proceedings before VA are ex parte in nature,
and it is the obligation of VA to assist a claimant in developing the
facts pertinent to the claim and to render a decision which grants
every benefit that can be supported in law while protecting the
interests of the Government.''
The Administration's proposed budget does not show any estimate of
budgetary savings based on this legislative proposal and mentions only
that it would make it easier for VA rating personnel to make decisions
on veterans' claims. However, this proposal will eliminate any
potential increased evaluations prior to the change of the rating
criteria; thereby, lowering the earned benefit for affected disabled
veterans. We oppose this proposal as it will have negative consequences
on veterans.
4. Elimination of Payment of Benefits to the Estates of Deceased
Nehmer Class Members and to the Survivors of Certain Class Members:
VA seeks to amend 38 U.S.C. Sec. 1116 to eliminate payment of
benefits to survivors and estates of deceased Nehmer class members. If
a Nehmer class member, per 38 C.F.R. Sec. 3.816, entitled to
retroactive benefits dies prior to receiving such payment, VA is
required to pay any unpaid retroactive benefits to the surviving spouse
or subsequent family members. This proposed legislation would deny
veterans' survivors and families' benefits that would have otherwise
been due to their deceased veteran family member as a result of
exposure to these toxic chemicals while in service. It is outrageous
that the Administration would deny compensation payments due to a
surviving spouse. We adamantly oppose this or any similar proposal that
may be offered.
The IBVSOs support VA's legislative proposal regarding Medical
Foster Homes (MFH). This proposal would require the VA to pay for
service-connected veterans to reside in VA approved MFHs.
MFHs provide an alternative to long-stay nursing home (NH) care at
a much lower cost. The program has already proven to be safe,
preferable to veterans, highly veteran-centric, and half the cost to VA
compared to NH care. Aligning patient choice with optimal locus of care
results in more veterans receiving long-term care in a preferred
setting, with substantial reductions in costs to VA. This proposal
would require VA to include MFH in the program of extended care
services for the provision of care in MFHs for veterans who would
otherwise encumber VA with the higher cost of care in NHs.
Many more service-connected veterans referred to or residing in NHs
would choose MFH if VA paid the costs for MFH. Instead, they presently
defer to NH care due to VA having payment authority to cover NH, while
not having payment authority for MFH. As a result of this gap in
authority, VA pays more than twice as much for the long-term NH care
for many veterans than it would if VA was granted the proposed
authority to pay for MFH. This proposal would give veterans in need of
NH level care greater choice and ability to reside in a more home-like,
safe environment, continue to have VA oversight and monitoring of their
care, and preferably age in place in a VA-approved MFH rather than a
NH. The proposal does not create authority to cover veterans who reside
in assisted living facilities. MFH promotes veteran-centered care for
those service-connected veterans who would otherwise be in a nursing
home at VA expense, by honoring their choice of setting without
financial penalty for choosing MFH.
Thank you for the opportunity to submit our views on the
Administration's budget request for VA. We firmly believe that unless
Congress acts to substantially increase VA's funding for FY 2020,
veterans will be forced to wait longer for care, whether they seek care
at VA or in the community, leaving unfulfilled the promises made to
veterans in the VA MISSION Act.
Prepared Statement of Larry L. Lohmann
Chairman Takano, Ranking Member Roe, and Members of the Committee;
on behalf of Brett P. Reistad, National Commander of the largest
veteran service organization in the United States representing nearly 2
million members; we welcome the opportunity to comment on specific
funding programs of the Department of Veterans Affairs (VA) in the
federal budget.
The American Legion is a resolution-based organization directed and
driven by active Legionnaires who dedicate their money, time, and
resources to the continued service of veterans and their families. Our
positions are guided by 100 years of advocacy and resolutions that
originate at the grassroots level of the organization - local American
Legion posts and veterans in every congressional district across the
United States. The headquarters staff of The American Legion works
daily on behalf of veterans, military personnel, and our communities
through our roughly 20 national programs and thousands of outreach
programs led by our posts across the country.
As VA continues to serve the veterans of this nation, it is vital
the Secretary has the necessary tools and resources to ensure they
receive timely, professional, and courteous service - they have earned
it. The American Legion calls on this Congress to ensure that funding
for VA is maintained by implementing the president's budget request. At
a time when most federal agencies are experiencing a decrease in their
respective budgets, the hope of The American Legion is that VA, with
assistance from these critical committees, receives a much-needed
increase.
Sustainability, accountability, information technology (IT)
integration and updates, Electronic Health Records (EHR), facilities
repair, construction, staff recruiting, and healthcare are paramount
programs requiring adequate funding. In the 115th Congress, The
American Legion testified on the need for increased funding for each of
the aforementioned programs.
Implementing the VA MISSION Act
``The Budget fully supports implementation of the VA MISSION Act of
2018 and provides veterans greater choice on where they receive their
healthcare-whether at VA or through a private healthcare provider. The
Budget consolidates all veterans' community care programs into a single
program, reducing bureaucracy and making it easier for veterans to
navigate their healthcare needs.''
-A Budget for a Better America, Trump Administration's Proposed FY
20 Budget
The 2014 VHA Wait Time Scandal in Phoenix demonstrated to the
veteran community the increased need for care in the community.
Veterans desiring community care after the enactment of the Choice Act
increased. The American Legion supported the Choice Program when it was
added as a temporary emergency measure as part of the Veterans Access,
Choice Accountability Act (VACAA) of 2014 because of our firsthand
experience witnessing the need across the country. \1\
---------------------------------------------------------------------------
\1\ Veterans Access, Choice, and Accountability Act of 2014, Pub.
L. No. 113-146, 38 U.S.C. 101
---------------------------------------------------------------------------
In 2014, The American Legion established a dozen Veterans Crisis
Command Centers (VCCCs) in affected areas (Fulton et al., 2018). VCCCs
were established from Phoenix to Fayetteville and The American Legion
spoke to hundreds of veterans personally affected by the scheduling
problems within VA. The Choice program provided an immediate short-term
option, and provided an opportunity to learn how veterans utilized the
program. At that time, The American Legion recommended gathering as
much data as possible from veterans using the program to improve the
ability of VA's other existing authorities for care in the community.
\2\ Additionally, The American Legion supported the Veterans Choice
Continuation Act, which continued the Veterans Choice Program (VCP)
that was due to expire on August 7, 2017. Continuation of VCP ensured
veterans within the VA healthcare system would continue to have the
ability to access quality healthcare within their communities without
interruption of services.
---------------------------------------------------------------------------
\2\ Department of Veterans Affairs. ``Veterans Choice Program
(VCP).'' Veterans Choice Program (VCP), 30 Jan. 2018, www.va.gov/
COMMUNITYCARE/programs/veterans/VCP/index.asp.
---------------------------------------------------------------------------
In 2018, a large percentage of veterans, many of which are proud
members of The American Legion, voiced a preference to receive medical
services closer to their homes. In response, Congress enacted the VA
MISSION Act, a historic law that contains a number of policy priorities
of The American Legion and other veteran stakeholders. \3\ VA MISSION
Act, principally, reforms the Department of Veterans' Affairs care
programs, including Choice, into a single Veterans Community Care
Program (VCCP). MISSION Act requires VA to promulgate new access
standards, released earlier this year, and to develop strategic plans
with completed market assessments to provide care to veterans under the
new VCCP.
---------------------------------------------------------------------------
\3\ VA Mission Act Pub. L. No: 115-182
---------------------------------------------------------------------------
The budget includes $8.9 billion in 2020 and $11.3 billion in 2021
for the VA Medical Care program to implement the MISSION Act, including
access standards that expand Veterans' care options and reduce wait
times for primary and specialty care. \4\ The American Legion supports
the President in adequately funding the MISSION Act to support VA's
implementation of a new consolidated community care program. We offer
this support recognizing the president will continue to request,
Congress must continue to appropriate, and VA must continue to properly
allocate sufficient funding to maintain VA's existing healthcare
infrastructure. Further, our support relies on the understanding VA
must expand capacity in locations where demand for care justifies
additional VA infrastructure.
---------------------------------------------------------------------------
\4\ Department of Veterans Affairs ``Budget In Brief 2019.''
Department of Veterans Affairs (BiBs-8) www.va.gov/budget/docs/summary/
fy2020VAbudgetInBrief.pdf
---------------------------------------------------------------------------
Ensuring Proper VA Staffing
``Each day, more than 380,000 VA employees come to work for
America's Veterans. These employees have a close connection with
Veterans - over 33 percent are Veterans themselves. The 2020 Budget
supports an increase of 13,805 Full-Time Equivalent Employees (FTE)
above the 2019 estimated level to expand access to healthcare and
improve benefits delivery.''
-Department of Veterans Affairs - Budget in Brief 2020
The American Legion has long expressed concern about staffing
shortages at VA and Veterans Health Administration (VHA) medical
facilities including physicians and medical specialist staffing.
Unfortunately, no easy solutions exist for VHA to effectively and
efficiently recruit and retain staff at VA healthcare facilities. It is
important to understand that simply providing additional funding will
not resolve the issue of staff shortages. The American Legion believes
access to basic healthcare services offered by qualified primary care
providers should be available locally, and by a VA healthcare
professional, as often as possible at all times.
While VA's Academic Residency Program made significant
contributions in training VA healthcare professionals, upon graduation
many of these healthcare professionals choose a career outside the VA
healthcare system. The VA will remain unable to compete with the
private sector without changes to current hiring practices. To this
end, The American Legion supports legislation such as The VA Hiring
Enhancement Act and initiatives such as establishing its own VA Health
Professional University. Such initiatives address the shortcomings in
recruitment and retention of highly qualified physicians \5\ and allow
VA to train their medical healthcare professionals to serve as a
supplement to VA's current medical residency program. \6\
---------------------------------------------------------------------------
\5\ The American Legion Resolution No. 115 (2016): Department of
Veterans Affairs Recruitment and Retention
\6\ American Legion Resolution No. 377: Support for Veteran Quality
of Life: (Sept. 2016)
---------------------------------------------------------------------------
The American Legion understands filling highly skilled vacancies at
premiere VA hospitals around the country is challenging. VA has a
variety of creative solutions available to them beyond additional
legislative action. One such idea involves aggressively seeking public-
private partnerships with local area hospitals. VA could expand both
footprint and market penetration by renting space in existing hospitals
enabling VA to leverage existing resources and foster comprehensive
partnerships with the community. Further, VA could research the
feasibility of incentivizing recruitment at level 3 hospitals by
orchestrating a skills sharing program that might entice physicians to
work at level 3 facilities if they were eligible to engage in a program
where they could train at a level 1 facility for a year every 5 years
while requiring level 1 facility physicians to spend some time at level
3 facilities to share best practices. Currently, medical staff is
primarily detailed to temporarily fill vacancies. This practice fails
to incentivize the detailed professional to share best practices and
teach, but rather to hold down the position until it can be filled by a
permanent hire.
Prioritizes Funding for Suicide Prevention
Reducing deaths by suicide among the Nation's veterans continues to
be VA's top clinical priority. The Budget provides essential resources
for VA's suicide prevention programs and supports the expansion of key
initiatives aimed at advancing VA's National Strategy for Preventing
Veteran Suicide.
-A Budget for a Better America, Trump Administration's Proposed FY
20 Budget
Suicide prevention is a top priority of The American Legion, The
Department of Veterans Affairs (VA), and the Department of Defense
(DoD). Last summer, the nation's largest organization of wartime
veterans published a white paper report titled, Veteran Suicide. \7\
The American Legion is deeply concerned by the high suicide rate among
servicemembers and veterans, which has increased substantially since
2001. \8\ The suicide rate among 18-24-year-old male Iraq and
Afghanistan veterans is particularly troubling, having risen nearly
fivefold to an all-time high of 124 per 100,000, 10 times the national
average. A spike also occurred in the suicide rate of 18-29-year-old
female veterans, doubling from 5.7 per 100,000 to 11 per 100,000. \9\
These increases are startling when compared to rates of other
demographics of veterans, whose suicide rates have remained constant
during the same time period.
---------------------------------------------------------------------------
\7\ The American Legion . Veteran Suicide: A White Paper Report.
Indianapolis: The American Legion , 2018. ``Veterans Affairs &
Rehabilitation Commission.'' (2018, July 12). www.legion.org/
commissions/veterans-affairs-rehabilitation-commission
\8\ U.S. Department of Veteran Affairs. Suicide Among Veterans and
Other Americans 2001-2014. 2017. ``Health Services Research &
Development.'' www.hsrd.research.va.gov/publications/forum/spring18/
default.cfm?ForumMenu=Spring18-5
\9\ Id.
---------------------------------------------------------------------------
VA has taken great strides to reduce veteran suicide. Of particular
note, VA expanded the Veterans Crisis Line (VCL), responding to 500,000
phone calls every year, as well as thousands of electronic chats and
text messages. Since its launch in 2007, through September 2018, VCL
staff dispatched emergency services to callers in crisis over 93,000
times. \10\
---------------------------------------------------------------------------
\10\ Department of Veteran Affairs OIG. Healthcare Inspection:
Evaluation of the VHA Veterans Crisis Line. 2018. Department of
Veterans Affairs Office of Inspector General. ``Office Of Healthcare
Inspections''. www.va.gov/oig/pubs/VAOIG-16-03985-181.pdf
---------------------------------------------------------------------------
VA also hired hundreds of Suicide Prevention Coordinators (SPCs),
mental health professionals that specialize in suicide prevention. SPCs
are based in VA medical centers and local community-based outpatient
clinics all over the country. Over 80 percent of the SPCs are
conducting five outreach activities per month for at-risk veterans.
\11\ These events provide opportunities for VA to connect to veterans
who may have fallen through the cracks and are not currently seeking VA
healthcare.
---------------------------------------------------------------------------
\11\ Department of Veteran Affairs OIG. Evaluation of Suicide
Prevention Programs in VHA Facilities. 2017. Veterans Health
Administration. (2009, June 10). Veterans Health Administration.
www.va.gov/health/aboutvha.asp
---------------------------------------------------------------------------
The American Legion remains committed to working with Congress to
reduce the high suicide rate among service members and veterans and is
committed to finding solutions to help end this crisis. To ensure that
all veterans are properly cared for at Departments of Defense and
Veterans Affairs medical facilities, The American Legion, through
Resolution No. 2 Suicide Prevention Program, has established a Suicide
Prevention Program and aligned it under the TBI/PTSD Committee. \12\
This committee reviews methods, programs, and strategies that can be
used to reduce veteran suicide. The work of this body will help guide
American Legion policy and recommendations.
---------------------------------------------------------------------------
\12\ National Executive Committee Of The American Legion Resolution
No. 20 , ``Suicide Prevention Program.'' archive.legion.org/bitstream/
handle/20.500.12203/9286/2018S020.pdf?sequence=1&isAllowed=y
---------------------------------------------------------------------------
President Donald Trump signed an executive order last month
establishing a new task force aimed at empowering military veterans and
ending the suicide epidemic among them. \13\ The order, titled the
``President's Roadmap to Empower Veterans and End a National Tragedy of
Suicide,'' or (PREVENTS), will require top officials from multiple
government agencies to coordinate a strategy to tackle the issue of
veterans suicide and release recommendations to the president within
the next 365 days. The American Legion believes this group led by
Secretary Wilkie is a step forward, but we still have questions about
how it will be executed and where the resources to support it will come
from.
---------------------------------------------------------------------------
\13\ Exec. Order 13,861, 84 FR 8585 (2019)
---------------------------------------------------------------------------
Congress must ensure sufficient resources are available for
effective VA suicide prevention efforts. One death by suicide is one
death too many. Funding for the aforementioned programs must be
provided as well as money for new programs, including those to
effectively treat individuals with previous suicide attempts, to deploy
new interventions, and to identify those at higher risk of suicide.
President Trump has called for a 9.5 percent increase in VA spending in
2020, up to a total of $216 billion. The American Legion appreciates
the serious attention paid to this issue by the White House and urges
Congress to appropriate these funds.
Provides Critical Funding for IT
``In 2020, OIT is requesting $4.343 billion, an increase of $240.0
million (5.8 percent) over the 2019 enacted budget. This requested
increase will support critical investments to Veteran-focused
development, IT modernization and transformational efforts.''
-Department of Veterans Affairs - Budget in Brief 2020
Department of Veterans Affairs (VA) Information Technology (IT)
infrastructure has been an evolving technological necessity over the
past 40 plus years, sometimes leading the industry, and sometimes
trailing. Leading the field in 1978, VA doctors developed an electronic
solution to coordinate and catalog patients healthcare long before
their private sector colleagues, who were slow to follow, while some
private physicians still refuse to automate today. The American Legion
has been intrinsically involved with VA's IT transformation from the
inception of Veterans Health Information and Technology Architecture
(VistA) to being a pioneer partner in the concept and integration of
the fully electronic disability claims process, as well as through the
new telehealth project, Atlas. Atlas will enable remote examinations in
selected American Legion posts.
IT automation is expensive to implement and expensive to maintain,
especially while working on legacy equipment. As in all digital space,
IT infrastructure advances so quickly that most IT infrastructure is
outdated by the time it is fully implemented, and VA's IT
infrastructure is no different. This is the cost of doing business in a
technologically advancing society. With this in mind, companies are
turning to rented cloud-based resources and Software as a Service (SAS)
to mitigate costs. These services have a lower up-front investment and
negate the need for hardware maintenance and software upgrades in many
cases.
IT is inextricably intertwined into many of the services we take
for granted, such as; telephone systems, appointment scheduling,
procurement, building access, safety controls, and much more.
Maintaining an up-to-date system is not a luxury, it is a necessity.
The American Legion supports the continued effort by VA to update their
systems. The president's Budget provides $4.3 billion for essential
investments in IT to improve the online interface between the veterans
and the Department. This includes an increase of more than $200 million
to recapitalize aging network infrastructure, to expedite VA's
transition to the cloud, and to support emerging VA MISSION Act of 2018
IT requirements. \14\
---------------------------------------------------------------------------
\14\ A Budget for a better America, Promises Kept. Taxpayers first.
``Fiscal Year 2020 Budget of the U.S Government.'', www.whitehouse.gov/
wp-content/uploads/2019/03/budget-fy2020.pdf
---------------------------------------------------------------------------
The American Legion continues to call on Congress to consider
funding that enables VA to tie all of their IT programs together. This
should be a seamless program capable of processing claims, managing
veterans' healthcare needs, integrating procurement needs so that VA
leaders and Congress can analyze annual expenditures versus healthcare
consumption. Additionally, patient information must be integrated into
their profiles ensuring seamless transition between the Department of
Defense and VA.
Electronic Health Record Modernization (EHRM)
``The EHR is a high-priority initiative that would ensure a
seamlessly integrated healthcare record between the Department of
Defense and VA, by bringing all patient data into one common system.''
-A Budget for a Better America, Trump Administration's Proposed FY
20 Budget
The American Legion, through resolution, has long endorsed and
supported the Department of Veterans Affairs (VA) in creating a
Lifetime Electronic Health Records (EHR) system. Additionally, The
American Legion has encouraged both DoD and the VA to either use the
same EHR system, or, at the very least, systems that were
interoperable.
The American Legion recognizes the advantages of a bi-directional
interoperable exchange of information between agencies. Collaborating
with DoD offers potential cost savings and opportunities for VA.
Opportunities include capitalizing on challenges DoD encounters
deploying its own Cerner solution, applying lessons learned to
anticipate and mitigate issues, and identifying potential efficiencies
for faster and successful deployment. The American Legion supports the
president's Budget including $1.6 billion as part of a multiyear effort
to continue implementation of a new EHR system. The EHR is a high-
priority initiative that ensures a seamlessly integrated healthcare
record between the Department of Defense and VA, by bringing all
patient data into one common system, as such we call on Congress to
fund it accordingly.
Medical Facilities
During FY 2012, VA unveiled the Strategic Capital Investment
Planning (SCIP) program. This ten-year capital construction plan was
designed to address VA's most critical infrastructure needs. Through
the plan, VA estimated the ten-year costs for major and minor
construction projects and non-recurring maintenance would total
approximately 60 billion over ten years.
The American Legion is supportive of the SCIP program which
empowers facility managers and users to evaluate needs based on patient
safety, utilization, and other factors. While it places the onus on
these individuals to justify the need, these needs are more reflective
of the actuality as observed by our members and during our visits. VA
has taken this process and effectively neutered it through budget
limitations thereby underfunding the accounts and delaying delivery of
critical infrastructure.
While failing to meet these needs, facility managers will be forced
to make do with existing aging facilities. While seemingly saving money
in construction costs, VA will be expending money maintaining
deteriorating facilities, paying increased utility and operational
costs, and performing piecemeal renovation of properties to remain
below the threshold of major or minor projects.
This is an inefficient byproduct of budgeting priorities. The
reality remains that the SCIP program is unlikely to be funded at
levels necessary to accomplish the ten-year plan. Therefore, this
account must be increased to meet the short-term needs within the
existing facilities.
Addresses Infrastructure Deficiencies
VA requests $1.2 billion for Major Construction operations, a
decrease of $942 million (43 percent) over 2019 and similar substantial
decreases in Minor Construction from $800 million to $399 million (50
percent).
-Department of Veterans Affairs - Budget in Brief 2020
Since 2003, The American Legion's Veterans Affairs and
Rehabilitation Commission members conduct a series of site visits to VA
medical facilities and regional offices. While on site, Legionnaires
visit with veterans, their families, and VA administrators and
employees to discuss successes, challenges, and limitations at each
site. Included in these System Worth Saving (SWS) reports are
observations and challenges concerning infrastructure. In the 2018
System Worth Saving report, The American Legion noted multiple
infrastructure issues with a number of facilities around the country,
including Fort Harrison, Montana; Manchester, New Hampshire; Denver,
Colorado; and Durham, North Carolina. \15\
---------------------------------------------------------------------------
\15\ The American Legion, 2018 System Worth Saving, www.legion.org/
sites/legion.org/files/legion/publications/
50VAR0718%20SWS%20Executive%20Summary.pdf
---------------------------------------------------------------------------
Unfortunately, the types of issues found in these facilities are
not isolated incidents and are too often found in VA facilities all
around the country. For more than 100 years, our nation's solution to
care for those who have defended us has been to build a network of care
facilities across the country. The VA system currently boasts more than
1,750 facilities with more than 5,600 buildings.
The current process to manage this network of facilities is the
Strategic Capital Investment Planning program (SCIP). SCIP identifies
VA's current and projected gaps in access, utilization, condition, and
safety. The SCIP planning process develops data for VA's annual budget
requests. These infrastructure budget requests are divided into several
VA accounts: Major Construction, Minor Construction, Non-Recurring
Maintenance (NRM), Enhanced-Use Leasing, Sharing, and Other Investments
and Disposal. The VA estimates costs at approximately $60 billion. \16\
---------------------------------------------------------------------------
\16\ Fiscal Year 2020 Budget for Veterans' Programs and Fiscal Year
2021 advance Appropriations Request, 116th Cong. (2019) Secretary,
Robert Wilkie
---------------------------------------------------------------------------
The American Legion is very concerned about the lack of funding in
the Major and Minor Construction accounts. Based on VA's SCIP plan,
Congress underfunded these accounts and the president's budget does not
propose enough. Clearly, if this underfunding continues VA will never
fix its identified deficiencies within its ten-year plan. At current
rates, it will take VA almost sixty years to address current
deficiencies. VA currently has 24 partially funded major construction
projects that need to be put on a clear path to completion and numerous
additional projects that are in the design phase and have already
received large expenditures in planning time, resources, and fees.
The American Legion also understands there is a discussion to refer
to SCIP in the future as a ``planning document'' rather than an actual
capital investment plan. Under this proposal, VA will still address the
deficiencies identified by the SCIP process for future funding requests
but rather than having an annual appropriation, SCIP will be extended
to a five-year appropriation, similar to the appropriation process used
by the Department of Defense as its construction model. Such a plan
will have huge implications on VA's ability to prioritize or make
changes as to design or project specifications of its construction
projects. The American Legion is against this five-year appropriation
model and recommends Congress continue funding VA's construction needs
on an annual appropriations basis.
The American Legion recommends Congress adopt the 10-year action
plan created by the SCIP process. Congress must appropriate sufficient
funds to pay for needed VA construction projects and stop underfunding
these accounts.
Modernizes the Veteran Appeals Process.
``The Budget provides sufficient resources for the Board of
Veterans Appeals and the Veterans Benefits Administration to implement
the Veterans Appeals Improvement and Modernization Act of 2017, a new
streamlined framework that will provide quicker decisions on new
veteran compensation appeals and resolve the remaining legacy appeals
inventory. The new framework will provide veterans with increased
options to resolve their appeals and improve the timeliness of appeals
decisions.''
-A Budget for a Better America, Trump Administration's Proposed FY
20 Budget
The American Legion currently holds power of attorney on more than
1.3 million claimants. We spend millions of dollars each year defending
veterans through the claims and appeals process, and our success rate
at the Board of Veterans Appeals (BVA) continues to hover around 75
percent. Until President Trump signed the Veterans Appeals Improvement
and Modernization Act of 2017 (Appeals Modernization Act or AMA) at The
American Legion's National Convention in Reno, Nevada, VA had a complex
claims and appeals system. \17\
---------------------------------------------------------------------------
\17\ Veterans appeals Improvement and Modernization Act of 2017,
Pub. L. No: 115-55.
---------------------------------------------------------------------------
This ``legacy'' system divided jurisdiction amongst VA's three
administrations and the Board of Veterans' Appeals (BVA). This
confusing and complex process eventually led to extensive wait times
and created a backlog. At the time, it was estimated it would take over
nine years to resolve the over 200,000 case backlog. \18\
---------------------------------------------------------------------------
\18\ VA Debt Management Brief, Office Of Management, ``Department
of Veterans Affairs Debt Management and Collections'' drive.google.com/
file/d/0B70--mGYT1tJETzZGWUZKYzdGXzg/view
---------------------------------------------------------------------------
Recognizing this indefensible state of affairs, The American Legion
worked with other stakeholders, VA, and Congress to develop the Appeals
Modernization Act. The law created a new system with three review
options:
A ``higher-level review'' by a more senior claims
adjudicator
A ``supplemental claim'' option for new and relevant
evidence
An ``appeal'' option for review by the Board of Veterans'
Appeals
Now, claimants may choose the option that best suits their needs.
This new framework reduces the time it takes to review, process, and
make a final claim determination, all while ensuring veterans receive a
fair decision. Additionally, the Appeals Modernization Act framework
includes safeguards to make sure claimants receive the earliest
effective dates possible for their claims.
The Appeals Modernization Act became fully effective earlier this
year. The AMA sets forth specific elements that VA must address in its
implementation. The American Legion believes working together with VA
and Congress is vital to ensuring the success of the new appeals
system. VA must provide stakeholders and Congress clear metrics to
measure the progress and success of appeals and claims reform and
strengthen Congress's ability to hold VA accountable for meeting these
metrics. The American Legion supports the funding in the president's
budget and urges Congress to appropriate this money and use its
oversight authority to make sure stakeholder voices continue to be
heard.
Vocational Rehabilitation & Employment
The Vocational Rehabilitation and Employment (VR&E) Program
provides comprehensive services and assistance enabling veterans with
service-connected disabilities and employment handicaps to achieve
maximum independence in daily living, become employable, and maintain
suitable employment. After a veteran is found to be entitled to VR&E, a
vocational rehabilitation counselor helps the veteran identify a
suitable employment goal and determines the appropriate services
necessary to achieve their goal.
Once a veteran's claim has been adjudicated through the appeals
process, the next step is approval and access to utilize the VR&E
program. However, if the processing rate of adjudicating claims is
increased and no investment into the VR&E program is made, The American
Legion fears the unintended consequence of increasing the applicant
pool for VR&E without increasing support staff will cause concern.
Between FY11 and FY16, VR&E applicants rose from 65,239 to 112,115,
creating increasing workloads for VR&E counselors tasked with
developing employment goals and services for beneficiaries. The
American Legion recognized the escalating problems associated with
VR&E, and at our 2016 National Convention enacted Resolution No. 345:
Support for Vocational Rehabilitation and Employment Program Hiring
More Counselors and Employment Coordinators \19\.
---------------------------------------------------------------------------
\19\ American Legion Resolution No. 345: archive.legion.org/
bitstream/handle/123456789/5663/2016N345.pdf?sequence=1&isAllowed=y
---------------------------------------------------------------------------
The combination of the increased output of claims and appeals
without increasing the number of program counselors in the Vocational
Rehabilitation and Employment program has the potential to accelerate
the challenge into a crisis for veterans enrolled in the program.
The American Legion is thankful and proud to have worked closely
with this committee and others in Congress to modernize the appeals
process and is appreciative that the president's budget requests the
funding necessary to keep up with a streamlined appeals process. We
also encourage this committee to consider and take into account the
impending need to increase funding for the VR&E program, so we can
assist veterans in finding quality employment.
Increases Access to Burial and Memorial Benefits
``The Budget includes $329 million, a 4.2-percent increase from the
2019 enacted level, to expand veteran access to memorial benefits,
deliver premier services to veterans' families, and provide perpetual
care for more than 3.9 million gravesites.''
-A Budget for a Better America, Trump Administration's Proposed FY
20 Budget
National Cemetery Administration (NCA)
No aspect of the VA is as critically acclaimed as the National
Cemetery Administration (NCA). In the 2016 American Customer
Satisfaction Index, the NCA achieved the highest ranking of any public
or private organization, again. \20\ In addition to meeting this
customer service level, the NCA remains the highest employer of
veterans within the federal government and remains the model for
contracting with veteran-owned businesses.
---------------------------------------------------------------------------
\20\ ACSI Benchmarks for U.S Federal Government 2016, ACSI
Benchmark for U.S Federal Government www.theacsi.org/acsi-benchmarks-
for-u-s-federal-government-2016
---------------------------------------------------------------------------
One of the NCA's strategic goals is to provide reasonable access
(within 75 miles of a veteran's residence) to a burial option in a
national or Department of Veterans Affairs (VA)-funded state or tribal
veterans' cemetery for 95 percent of eligible veterans. Currently, the
NCA reports that they have reached 92 percent of this access standard.
\21\ Congress must provide sufficient major construction appropriations
to permit NCA to accomplish this goal and open five new cemeteries in
the coming five years. Moreover, funding must remain to continue to
expand existing cemetery facilities as the need arises.
---------------------------------------------------------------------------
\21\ National Cemetery Administration. (2008, April 29). ``National
Cemetery Administration.'' www.ea.oit.va.gov/EAOIT/docs/NCA--LRP.pdf
---------------------------------------------------------------------------
While the costs of fuel, water, and contracts have risen, the NCA
operations budget has not received a significant increase in the past
three budgets. Unfortunately, recent audits have shown cracks beginning
to appear. Due predominantly to poor contract oversight, several
cemeteries inadvertently misidentified burial locations. Although only
one or two were willful violations of NCA protocols, the findings
demonstrate a system nearly ready to burst.
To meet the increased costs of fuel, equipment, and other resources
as well as ever-increasing contract costs, The American Legion believes
a small increase is necessary. In addition, we urge Congress to
adequately fund the construction program to meet the burial needs of
our nation's veterans.
State Cemetery Grant Program
The NCA administers a program of grants to states to assist them in
establishing or improving state-operated veterans' cemeteries through
VA's State Cemetery Grants Program (SCGP). Established in 1978, this
program funds nearly 100% of the costs to establish a new cemetery, or
expand existing facilities. For the past two budgets, this program has
been budgeted $45 million to accomplish this mission.
New authority granted to VA funds Operation and Maintenance
Projects at state veterans cemeteries to assist states in achieving the
national shrine standards VA achieves within national cemeteries.
Specifically, the new operation and maintenance grants have been
targeted to help states meet VA's national shrine standards with
respect to cleanliness, height, and alignment of headstones and
markers, leveling of gravesites, and turf conditions. In addition, this
law allowed VA to provide funding for the delivery of grants to tribal
governments for Native American veterans. Yet we have not seen the
allocation of funding increased to not only meet the existing needs
under the construction and expansion level but also the needs from
operation and maintenance and tribal nation grants. Moreover, as these
cemeteries age, the $5 million limitations must be revoked to allow for
better management of resources within the projects.
Better Care for Female Veterans
VA is anticipating and preparing for the increase in the number of
women Veterans as well as for the accompanying complexity and longevity
of their treatment needs.
-Department of Veterans Affairs - Budget in Brief 2020
In 2018, women Veterans comprised over 15 percent of active duty
military forces and 19 percent of National Guard and Reserves. The
number of women serving is growing, composing an increasingly large
share of the military and veterans' populations. \22\ Women veterans
now comprise about 10 percent of the total veteran population, and more
than 7 percent of the veterans using VA healthcare services. \23\ The
2015 Department of Veterans Affairs Women Veterans Report not*ed that
the total population of women veterans is expected to increase at an
average rate of about 18,000 per year for the next 10 years. \24\
---------------------------------------------------------------------------
\22\ Women Veterans 2015, The Past, Present and Future of Women
Veterans, ``Women Veterans' Report.'' www.va.gov/vetdata/docs/
specialreports/women--veterans--2015--final.pdf
\23\ Id.
\24\ Women Veterans 2015, The Past, Present and Future of Women
Veterans. ``Women Veterans' Report.'' www.va.gov/vetdata/docs/
specialreports/women--veterans--2015--final.pdf
---------------------------------------------------------------------------
VA needs to be prepared for a significant increase of younger
female veterans, as those who served in the War on Terror separate from
active service. Never before have so many women servicemembers been
routinely assigned to combat zones. They sustain the same types of
injuries as their male counterparts. The number of women enrolled in
the VA system is expected to grow by 33 percent over the next three
years.VA must ensure women veterans receive gender-specific healthcare
to meet their needs across the entire network. The diverse population
of women veterans using VA care require knowledgeable providers in
women's health to deliver comprehensive primary care services,
including mental health, gender-specific care, and referrals for
reproductive healthcare needs. Finding ways to ensure that these
veterans are welcome and receive the services they deserve is vital to
The American Legion.
VA needs to develop a comprehensive health-care program for female
veterans that extend beyond reproductive issues. Bills like the Deborah
Sampson Act and the Women Veterans Access to Quality Care Act are a
step in the right direction. Provider education needs improvement.
Furthermore, as female veterans are the sole caregivers in some
families, services, and benefits designed to promote independent living
for combat-injured veterans must be evaluated, and needs such as child-
care must be factored into the equation. Additionally, many female
veterans cannot make appointments due to the lack of child-care options
at VA medical centers. Since the 2011 survey, The American Legion has
continued to advocate for improved delivery of timely, quality
healthcare for women using VA. The American Legion is encouraged that
the president's budget recognizes the need for additional funding in
this critical area, and has proposed an increase of $42 million almost
8 percent over last year's authorization levels.
Medical Services
Over the past two decades, VA has dramatically transformed its
medical care delivery system. Through The American Legion visits a
variety of medical facilities throughout the nation during our System
Worth Saving Task Force, we see firsthand this transformation and its
impact on veterans in every corner of the nation.
While the quality of care remains exemplary, veteran healthcare
will be inadequate if access is hampered. Today there are over 20
million veterans in the United States. \25\ While 8.3 million of these
veterans are enrolled in the VA healthcare system, a population that
has been relatively steady in the past decade, the costs associated
with caring for these veterans has escalated dramatically.
---------------------------------------------------------------------------
\25\ United States Department of Veterans Affairs, ``Profile of
Veterans': 2017" www.va.gov/vetdata/docs/SpecialReports/Profile--of--
Veterans--2017.pdf
---------------------------------------------------------------------------
Since 2010, VA enrolment has increased from 8.3 million to over 9
million \26\. During the same period, inpatient admissions increased
from 662 thousand to 764 thousand. Outpatient visits also increased
from 80.2 to 109 million. Correspondingly, cost to care for these
veterans increased respectively. The increase during these years is a
trend that dramatically impacts the ability to care for these veterans.
---------------------------------------------------------------------------
\26\ Department of Veterans Affairs, Veterans Health
Administration, Office of the Assistant Deputy Under Secretary for
Health for Policy and Planning. Prepared by the National Center for
Veterans Analysis and Statistics
---------------------------------------------------------------------------
While FY 2010 numbers seemingly leveled off - to only 3 percent
annual growth - will adequate funding exist to meet veteran care needs?
If adequate funding to meet these needs isn't appropriated, VA will be
forced to either not meet patient needs or shift money from other
accounts to meet the need.
Even with the opportunity for veterans from OIF/OEF to have up to 5
years of care following their active duty period, we have not seen a
dramatic change in overall enrollee population. Yet The American Legion
remains concerned that the population estimates are dated and not
reflective of the costs. If current mandatory healthcare mandates for
veterans remain and with the Vietnam Era Veterans continuing to retire
and needing healthcare that may no longer be provided by their
employers, VA medical care will become enticing for a veteran
population that might not have utilized those services in the past.
In order to meet the increased levels of demand, even assuming that
not all eligible veterans will elect to enroll for coverage, and keep
pace with the cost trend identified above, there must be an increase to
account for both the influx of new patients and increased costs of
care.
Military and Veteran Caregiver Services
The Budget also supports the VA MISSION Act of 2018's expansion of
the Caregivers program to include eligible veterans who incurred or
aggravated a serious injury in the line of duty before September 11,
2001. Expansion of the Caregivers program would coincide with new
information technology (IT) updates necessary to effectively manage the
program.
-Department of Veterans Affairs - Budget in Brief 2020
The struggle to care for veterans wounded in defense of this nation
takes a terrible toll on families. In recognition of this, Congress
enacted, and President Barack Obama signed into law, the Caregivers and
Veterans Omnibus Health Services Act of 2010. The unprecedented package
of caregiver benefits authorized by this landmark legislation included
training to ensure patient safety, cash stipends to partially
compensate for caregiver's time and effort, caregiver health coverage,
and guaranteed periods of respite to protect against burnout.
The comprehensive package, however, was still not available to most
family members who are primary caregivers to severely ill and injured
veterans. Congress opened the program only to caregivers of veterans
severely injured, either physically or mentally, in the line of duty on
or after Sept. 11, 2001.
Finally, VA will begin to extend eligibility for the Program of
Comprehensive Assistance for Family Caregivers to severely injured
veterans of all eras, through a phased approach. First, VA must submit
to Congress certification that the IT system relied upon by the program
is prepared to accommodate a higher workload. Once the system is
prepared, VA will begin processing applicants injured on or before May
7, 1975, in addition to those injured after September 11, 2001. Two
years after this expansion, the program will accept all veterans
severely injured in all eras.
The American Legion has long advocated for expanding eligibility
and ending the obvious inequity that Caregivers and Veterans Omnibus
Health Services Act of 2010 created. Simply put, a veteran is a
veteran! All veterans should receive the same level of benefits for
equal service. As affirmed in American Legion Resolution No. 259:
Extend Caregiver Benefits to Include Veterans Before September 11,
2001, The American Legion supports the expansion to include all
veterans who otherwise meet the eligibility requirements. \27\
---------------------------------------------------------------------------
\27\ American Legion Resolution No. 259 (2016): Extend Caregiver
Benefits to Include Veterans Before September 11, 2001
---------------------------------------------------------------------------
The American Legion believes that providing expanded support
services and stipends to caregivers of veterans to all eras is not only
possible but also budgetary feasible and the right thing to do. We urge
this committee and the U.S. Congress to allocate the required funding
to continue and expedite the expansion of the caregiver program to all
eras of conflict and veterans who should be in this program. The
president's FY20 Budget requests $720 million for the Caregiver Support
Program, a $213.5 million (42 percent) increase over the 2019 level, to
support over 27,000 caregivers through the Caregiver Support Program.
The American Legion supports this proposal.
Ensuring Quality Care to Rural Veterans
``The budget maintains the strong level of funding for rural health
projects at $270 million. As a complement to telehealth, VA is
committed to improving the care and access for Veterans in
geographically rural areas.''
-Department of Veterans Affairs - Budget in Brief 2020
The American Legion's System Worth Saving task force travels the
country to evaluate VA medical facilities and ensure they are meeting
the needs of veterans. From June 2017 to April 2018, the task force has
been conducting site visits to VA medical facilities and town hall
meetings to receive feedback from local veterans who utilize VA to
receive their healthcare.
The Task Force, in its 18th program year, is focusing on VA's
accomplishments and progress over the past decade and a half, current
issues and concerns, and VA's five-year strategic plan for several
program areas. These areas of focus are VA's budget, staffing,
enrollment/outreach, hospital programs (e.g. mental health, intensive
care unit (ICU), long-term services and support, homelessness programs)
information technology and construction programs.
During each site visit, a town hall meeting is hosted by an
American Legion Post. The town hall meetings have consistently
illustrated that veterans are worried VA has turned a deaf ear to their
concerns and is intentionally ignoring their complaints. We have seen
firsthand where VA has closed intensive care departments, downgrading
emergency departments to urgent care clinics, or has proposed to closed
or reconfiguring hospital services under the guise of ``realigning
services closer to where veterans live.''
The American Legion urges Congress to evaluate VA's plan in rural
areas and to stop VA from closing hospitals and community-based
outpatient clinics unless existing requisite community services are
meet or exceed that VA currently provides to veterans.
In addition to ensuring improvements to infrastructure in rural
areas, Congress must support increased funding to support telehealth.
As the largest integrated healthcare system in the United States, the
VA provides telehealth at more than 900 sites across the country in
over 50 areas of specialty care. In 2017, 45 percent of Veteran who
received care via telehealth lived in rural areas, yet many Veterans
are limited from this option due to lack of availability of reliable
connectivity or technology.
The American Legion, Veterans of Foreign Wars, the U.S. Department
of Veterans Affairs (VA) and Philips have partnered to bring VA
healthcare to veterans through VA's ``Anywhere to Anywhere'' program.
This program will allow veterans to be examined by a doctor in a
familiar setting, their American Legion posts.
Through Project Atlas, Philips will install video communication
technologies and medical devices in selected American Legion posts to
enable remote examinations through a secure, high-speed internet line.
Veterans will be examined and advised in real time through face-to-face
video sessions with VA medical professionals, who may be located
hundreds or thousands of miles away. The program enables the ``Anywhere
to Anywhere'' VA initiative to benefit veterans who would otherwise
need to travel to receive care.
The president's proposed budget requests $1.1 billion for the total
Telehealth program, an increase of $105 million above the 2019 level.
In 2021, VA is requesting $1.7 billion, an increase of $623 million
above the 2020 level. The American ardently supports this initiative
and urges Congress to appropriate funds to bring affordable VA
Healthcare to veterans in rural areas through this program.
Assisting Homeless Veterans
``VA requests $1.8 billion for homeless programs, maintaining the
significant funding provided in 2019 and increasing funds by $179
million above the 2018 level, to provide the type of resources most
needed where they are most needed across the country.''
The American Legion strongly believes that homeless veteran
programs should be granted sufficient funding to provide supportive
services such as, but not limited to: outreach, healthcare,
rehabilitation, case management, personal finance planning,
transportation, vocational counseling, employment, and education. In
that vein, we support the proposed funding in the president's budget
and urge Congress to appropriate the funds.
Furthermore, The American Legion continues to place special
priority on the issue of veteran homelessness. With veterans making up
approximately 9% of our nation's total adult homeless population, there
is plenty of reason to give this issue special attention. Along with
various community partners, The American Legion remains committed to
seeing VA's goal of ending veteran homelessness come to fruition. Our
goal is to ensure that every community across America has programs and
services in place to get homeless veterans into housing (along with
necessary healthcare/treatment) while connecting those at-risk veterans
with the local services and resources they need. We hope to see that
with the expansion of assistance afforded to homeless veterans and
their dependents, there will also be an increase in funding to support.
We estimate that an additional $10 million annually will be sufficient
to accomplish this goal.
Mental Health
Post-traumatic stress disorder and traumatic brain injury are the
signature wounds of today's wars. Both conditions are increasing in
number, particularly among those who have served in Operation Iraqi
Freedom and Operation Enduring Freedom. The President's request for a
4.7 percent increase in funding will provide find much-needed funding
dedicated to this area. While Veterans who served in Iraq and
Afghanistan make up only a small percentage of VA's patient population
they require a disproportionate amount of VA specialized mental health
services. There are nearly 3.5 million veterans who served after
September 11, 2001. The need for specialized mental health services
will only grow.
In July 2010, VA took significant strides towards assisting
veterans suffering from PTSD. The liberalization of regulations relaxed
the need for veterans to provide proof of a PTSD stressor; instead,
veterans only needed to prove a ``fear of hostility.'' Further, since
2012, VA has increased staffing of new mental health providers, made
efforts to improve wait times for mental health services, and removed
numerous barriers to care.
While The American Legion acknowledges advancements in this area,
we also know there is significant room for improvement. From
development of PTSD claims, through compensation and pension (C&P)
examinations, to ultimate adjudication, The American Legion accredited
representatives routinely see errors throughout the process.
Furthermore, if a veteran seeks service connection for a physical
condition that manifested secondary or was aggravated by PTSD, veterans
routinely are faced with a difficult journey.
VA has hired more than 3,900 new mental health providers yielding a
net increase in VA mental health staff of over 1,000 providers, since
July 2017. However, during that time there has been a massive influx of
veterans into the system, with a growing need for psychiatric services.
With over 1.5 million veterans separating from service in the past
decade, nearly half have not utilized VA for treatment or evaluation.
The American Legion is deeply concerned about nearly 750,000 veterans
who are slipping through the cracks unable to access the healthcare
system they have earned through their service.
The American Legion believes VA must focus on head injuries and
mental health without sacrificing awareness and concern for other
conditions afflicting servicemembers and veterans. As an immediate
priority, the VA must ensure staffing levels are adequate to meet the
need. The American Legion also urges Congress to invest in research,
screening, diagnosis, and treatment of PTSD and TBI.
The American Legion recently published in, The Road Home, we
believe VA must continue to search for the most effective treatment
programs for veterans with comorbidities of PTSD, and TBI with
substance use disorder (SUD) and chronic pain. \28\ We should also seek
to develop treatment options including Complementary and Alternative
Medicine (CAM) for veterans who are newly diagnosed. Providers in VA
must take care to prevent at-risk veterans from becoming dependent on
alcohol or drugs used to ``self-medicate.''
---------------------------------------------------------------------------
\28\ The Road Home American Legion, TBI/PTSD Committee
www.legion.org/sites/legion.org/files/legion/publications/
60VAR0818%20The%20Road%20Home%20-%20TBI-PTSD.pdf
---------------------------------------------------------------------------
Through Resolution No. 160 Complementary and Alternative Medicine,
Congress is urged to provide oversight and funding VA for innovative,
evidence-based, CAM in treating various illnesses and disabilities. The
president's proposed budget requests $9.4 billion for Veterans' mental
health services, an increase of $426 million (4.7 percent) above 2019.
The American Legion supports this action. Additionally, The American
Legion remains committed to working with the VA in any way possible to
move the VA toward their goal of becoming a fully integrated paperless
system. \29\
---------------------------------------------------------------------------
\29\ The American Legion Resolution No. 160 (2016): Complementary
and Alternative Medicine
---------------------------------------------------------------------------
Medical Support and Compliance
The Medical Support and Compliance account consist of expenses
associated with administration, oversight, and support for the
operation of hospitals, clinics, nursing homes, and domiciliaries.
Although few of these activities are directly related to the personal
care of veterans, they are essential for quality, budget management,
and safety. Without adequate funding in these accounts, facilities will
be unable to meet collection goals, patient safety, and quality of care
guidelines. The American Legion has been critical of programs funded by
this account. We remain concerned patient safety is addressed at every
level.
State Veteran Home Construction Grants
Perhaps no program facilitated by the VA has been as impacted by
the decrease in government spending than the State Veteran Home
Construction Grant program. This program is essential in providing
services to a significant number of veterans throughout the country at
a fraction of the daily costs of similar care in private or VA
facilities. As the economy rebounds and states are pivoting towards
resuming essential services, taking advantage of depressed construction
costs, and meeting the needs of an aging veteran population, greater
use of this grant program will continue. As our baby boomer population
continues to transition into retirement, many more of these veterans
are retiring to state veteran homes due to their excellent reputation
for care and cost. The popularity of these retirement options will
cause any surplus of space to become consumed. The American Legion
encourages Congress to increase the funding level of this program.
Medical and Prosthetic Research
The American Legion believes VA research must focus on improving
treatment for medical conditions unique to veterans. Because of the
unique structure of VA's electronic medical records (VISTA), VA
Research has access to a great amount of longitudinal data incomparable
to research outside the VA system. Because of the ongoing wars of the
past decade, several areas have emerged as ``signature wounds'' of the
Global War on Terror, specifically Traumatic Brain Injury (TBI),
Posttraumatic Stress Disorder (PTSD), and dealing with the effects of
amputated limbs.
Much media attention has focused on TBI from blast injuries common
to Improvised Explosive Devices (IEDs) and PTSD. As a result, VA
devoted extensive research efforts to improve the understanding and
treatment of these disorders. Amputee medicine has received less
scrutiny but is no less a critical area of concern. Because of
improvements in body armor and battlefield medicine, catastrophic
injuries that in previous wars would have resulted in loss of life have
led to substantial increases in the numbers of veterans who are coping
with loss of limbs.
As far back as 2004, statistics were emerged indicating amputation
rates for US troops were as much as twice that from previous wars. By
January of 2007, news reports circulated noting the 500th amputee of
the Iraq War. The Department of Defense's response involved the
creation of Traumatic Extremity Injury and Amputation Centers of
Excellence, and sites such as Walter Reed have made landmark strides in
providing the most cutting-edge treatment and technology to help
injured service members deal with these catastrophic injuries.
America's disabled veterans depend on VA maintaining its reputation
as the leader in prosthetics care and service. VA has a reputation in
the United States and around the world of providing the best possible
prosthetic care to its disabled veterans. However, The American Legion
remains concerned that once these veterans transition away from active
duty status to become veteran members of the communities, there is a
drop-off in the level of access to these cutting edge advancements.
Ongoing care for the balance of their lives is delivered through the VA
Healthcare system, and not through concentrated active duty centers.
Reports indicate the state of the art technology available at DoD
sites is sometimes not available through a VA Medical Center. With so
much focus on ``seamless transition'' from active duty to civilian life
for veterans, this is one critical area where VA cannot afford to lag
beyond the advancements reaching service members at DoD sites. If a
veteran can receive a state of the artificial art limb at the new
Walter Reed National Military Medical Center (WRNMC) they should be
able to receive the exact same treatment when they return home to the
VA Medical Center in their home community, be it in Gainesville, Battle
Creek, or Fort Harrison.
American Legion contact with senior VA healthcare officials has
concluded that while DoD concentrates their treatment in a small number
of facilities, the VA is tasked with providing care at 152 major
medical centers and over 1,700 total facilities throughout the 50
states as well as in Puerto Rico, Guam, American Samoa and the
Philippines. Yet, VA officials are adamant their budget figures are
sufficient to ensure a veteran can and will receive the most cutting
edge care wherever they choose to seek treatment in the system.
The American Legion remains concerned about the ability to deliver
this cutting edge care to our amputee veterans, as well as the ability
of VA to fund and drive top research in areas of medicine related to
veteran-centric disorders. There is no reason VA should not be seen at
the world's leading source for medical research into veteran injuries
such as amputee medicine, PTSD, and TBI.
The American Legion urges Congress to ensure appropriations are
sufficient to meet the prosthetic needs of all enrolled veterans. We
believe the VA must continue to protect all funding for prosthetics and
sensory aids. The VA must maintain a dedicated, centralized funding
prosthetic budget to ensure the continuation of timely delivery of
quality prosthetic services to the millions of veterans who rely on
prosthetic and sensory aids' devices and services to recover and
maintain a reasonable quality of life. The American Legion is skeptical
of the reduction of funding for FY 20 from FY 19 in the president's
proposed budget and urge Congress to, at a minimum, maintain funding.
Medical Care Collections Fund (MCCF)
In addition to the aforementioned accounts which are directly
appropriated, medical care cost recovery collections are included when
formulating the funding for VHA. Over the years, this funding has been
contentious because they often include proposals for enrollment fees,
increased prescription rates, and other costs billed directly to
veterans. The American Legion has always ardently fought against these
fees and unsubstantiated increases.
Beyond these first party fees, VHA is authorized to bill healthcare
insurers for nonservice-connected care provided to veterans within the
system. Other income collected into this account includes parking fees
and enhanced use lease revenue. The American Legion remains concerned
that the expiration of authority to continue enhanced use leases will
greatly impact not only potential revenue but also delivery of care in
these unique circumstances. We urge Congress to reauthorize the
enhanced use lease authority with the greatest amount of flexibility
allowable.
It would be unconscionable to increase this account beyond the
previous levels that were not met. To do so without increasing co-
payments or collection methods would be counterproductive and mere
budget gimmickry. While we recognize the need to include this in the
budget, The American Legion cannot condone a budget that penalizes the
veteran for administrative failures.
Advance Appropriations for FY 2020
The Veterans Health Administration (VHA) manages the largest
integrated health-care system in the United States, with 152 medical
centers, nearly 1,400 community-based outpatient clinics, community
living centers, Vet Centers and domiciliary serving more than 9 million
veterans every year. The American Legion believes those veterans should
receive the best care possible.
The needs of veterans continue to evolve, and VHA must ensure it is
evolving to meet them. The rural veteran population is growing, and
options such as telehealth medicine and clinical care must expand to
better serve that population. Growing numbers of female veterans mean
that a system that primarily provided for male enrollees must now
evolve and adapt to meet the needs of male and female veterans,
regardless whether they live in urban or rural areas.
An integrated response to mental healthcare is necessary, as the
rising rates of suicide and severe post-traumatic stress disorder are
greatly impacting veterans and active-duty servicemembers alike.
If veterans are going to receive the best possible care from VA,
the system needs to continue to adapt to the changing demands of the
population it serves. The concerns of rural veterans can be addressed
through multiple measures, including expansion of the existing
infrastructure through CBOCs, MISSION Act initiatives, improvements in
telehealth and telemedicine, improved staffing and enhancements to the
travel system, and other innovative solutions.
Patient concerns and quality of care can be improved by better
attention to VA strategic planning, concise and clear directives from
VHA, improved hiring practices and retention, and better tracking of
quality by VA on a national level.
And finally, mandatory funds must be included in Advanced
Appropriations along with full discretionary funding of all VA
accounts. Veterans and dependents having their compensation and
disability checks delayed because Congress refuses to pass an annual
budget before being forced to close the federal government is
reprehensible. Pass full advanced appropriations now.
Round-Downs
In the president's proposed budget the VA seeks multiple Cost of
Living Adjustment (COLA) round-downs. VA seeks to amend 38 U.S.C.
Sec. Sec. 1104(a) and 1303(a) to round-down COLA computations for
Dependency and Indemnity Compensation (DIC) from 2020 to 2024 and amend
38 U.S.C. Sec. Sec. 3015(h) and 3564 to round-down COLA computations
for Education Programs from 2020 to 2029.
The American Legion, through Resolution No. 164, Oppose Lowering
Cost-of-Living Adjustments, opposes these round-downs. The effect of
the proposed round-down would serve as a tax on disabled veterans and
their survivors, costing them money each year. Veterans and their
survivors rely on their compensation for cost-of-living for essential
purchases such as transportation, rent, utilities, and food. The
American Legion is opposed to any COLA round-down as it will negatively
impact the quality of life for our nation's veterans and their
families. The Administration should not seek to balance the budget on
the backs of veterans.
Conclusion
Implementing the VA MISSION Act will require more resources than
have been provided through regular appropriations in FY19 and it will
cause care appropriation needs by the VA for future fiscal years.
MISSION Act changes how VA purchases health services for veterans from
community providers, is projected to increase veterans' enrollment in
the VA healthcare system, and increase veterans' utilization and
reliance on VA as a direct provider of care. Any and all future funding
levels must reflect this as part of the plan, not wait until VHA is in
crisis.
Greater emphasis needs to be placed on VA's hiring and incentives,
and if additional resources are needed to secure key providers like
psychologists and physician's assistants, then VHA must be provided
with the funding needed to make those critical hires. That is the long-
term key to ensuring that veterans get the care they need in a timely
fashion in the system that is designed to treat their unique wounds of
war.
For Caregivers, older veterans' participation is unlikely to
fluctuate, caregivers of older veterans likely will. Younger veterans
tend to rely consistently on a spouse or a parent for care. Older
veterans are less likely to have a spouse still capable of the physical
demands of providing daily care. VA must be able to accommodate
rotating caregivers, providing adequate and relevant training needed to
sustain their veteran and maintain the caregivers own health as well.
VA must continue to research the most effective treatment programs
for veterans with post-traumatic stress disorder (PTSD), military
sexual trauma (MST), and Traumatic Brain Injury (TBI), as well as
researching biomarkers and complementary and alternative medicine to
include cannabis.
Individuals affected by homelessness should not have to choose
between staying with their dependents or obtaining needed resources
from a homeless shelter. Funds must be allocated to supporting veterans
affected by homelessness who are also caring for others.
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 Mr. Larry Lohmann, Senior Associate of The American
Legion Legislative Division at (202) 861-2700 or [email protected].
References
Fulton, L. V., & Brooks, M. S. (2018). An Evaluation of
Alternatives for Providing Care to Veterans. Healthcare (Basel,
Switzerland), 6(3), 92. doi:10.3390/healthcare6030092
Questions For The Record
House Committee Members To: Department of Veterans Affairs (VA)
Questions for the Record from Rep. Lee
Question 1: According to the Fiscal Year 2020 President's Budget
request, the Department of Veterans' Affairs is requesting $1.1 billion
for telehealth services - a $105 million or 10.5 percent increase over
the 2019 current estimate. How does the Department intend to use the
$105 million budget increase to ensure open and competitive telehealth
acquisitions and fair consideration of commercial-off-the-shelf
telehealth solutions?
VA Response: Telehealth funding supports several aspects of VA's
Telehealth program including providers' salaries, telehealth support
staff salaries, training, implementation, evaluation, and technology
acquisitions. When additional telehealth technology is needed, VA will
leverage, where applicable, existing VA telehealth contract vehicles
that VA established through the open and competitive Federal
Acquisition Regulation process.
Questions for the Record from Rep. Cunningham
Question 1a: ``Hospitals and medical clinics, like the Ralph H.
Johnson VA Medical Center in my district, are facing increased
instances of flooding. These events can be extremely disruptive to
healthcare operations, even isolating the hospital from the community
it serves and delaying emergency responders. Will the VA make funding
accessible to address flooded access roads that service these medical
facilities?
VA Response: Funding is available through the Non-Recurring
Maintenance program to address infrastructure issues such as flooded
access roads as long as the road is VA owned and operated.
Question 1b: Does the VA have a strategic plan to address increased
flooding from tidal influences, precipitation, and hurricane storm
surge at its medical centers across the country?''
VA Response: The Veterans Health Administration (VHA) complies with
the VA Physical Security Design Manual, which was most recently revised
in January 2015, for all new and existing facilities. The manual
addresses both manmade and natural disasters, including hurricane surge
and other natural events. The manual states that no new facilities
shall be constructed in the 100-year flood plain and addresses the
housing of equipment and construction materials in existing facilities
that may be in the 100-year flood plain.
Questions for the Record from Rep. Cisneros
Question 1: I understand from a VSO that they are concerned about
the proposed $234 million offset to standardize and enhance VA
Compensation and Pension benefit programs, listed under ``mandatory and
Receipt Proposals'' on page 130 (PDF controls) of the proposed budget.
Will this proposed initiative result in the reduction of Individual
Unemployability (IU) benefits or other benefits veterans depend on to
make ends meet?
VA Response: The heading ``Standardize and Enhance VA Compensation
and Pension Benefit Programs'' includes the following legislative
proposals from the 2020 Budget:
------------------------------------------------------------------------
Cost/(Savings) to VA in
Proposal Title FY 2020 ($ in Millions)
------------------------------------------------------------------------
1) Clarify Evidentiary Threshold for Ordering ($233)
VA Examinations
2) Prohibition of Entitlement to VA's IU ($7)
Benefit for Individuals Serving in the
Reserve Component
3) Reissue VA Benefit Payments to all Victims $6
of Fiduciary Misuse
------------------------------------------------------------------------
Total Cost/(Savings) ($234)
------------------------------------------------------------------------
Summaries of these legislative proposals can be found on pages 15-
17 of Volume 1 of VA's 2020 Budget. The proposal to clarify the
evidentiary threshold for ordering VA examinations would result in a
savings associated with a reduction in the number of medical exams
completed and would not represent a reduction in benefits to Veterans.
The proposal to prohibit entitlement of IU for individuals serving in
the reserve component would prohibit an individual from receiving IU
while concurrently performing duties in the reserve components and
receiving active service pay from such duty.
Questions for the Record from Rep. Peterson
Question 1: Mr. Secretary, I have two new, skilled-nursing veterans
home project proposals in my district that will greatly benefit
underserved rural veterans. One is in Bemidji and the other is in
Montevideo. Each home has raised enough state and local funds to be
listed under Priority Group 1.
For Fiscal Year 2019, the VA received $150 million and there were
not enough funds to provide grant offers to all proposals under
Priority Group One.
In your proposal for FY 2020, the VA's budget only requests $90
million for the extended care grant program.
How will you make sure that the need for these two veteran home
projects in my district will be accounted for in your FY 2020 budget
request?
VA Response: VA acknowledges that increase in requests for State
Home construction funding; however, State Home construction grant
funding must compete with other VA programs and needs for funding
priorities. The process for awarding State Home construction grants is
established in title 38 United States code, part 59. The statute
outlines the process for prioritizing state projects and gives the
highest priority to life or safety projects. These are projects to
remedy a condition, or conditions, at an existing facility that have
been cited as threatening to the lives or safety of one or more
residents or program participants in the facility. The statute also
requires that VA fund projects in the order of the list and that VA
funding not exceed 65 percent of the total project cost. In this
process, by law there is no flexibility or alternative financing
mechanisms for awarding grant funds to states.
Question 2: Mr. Secretary, when will you let me know how these two
veteran home projects rank compared to other grant requests?
VA Response: To be included on the VA priority list, initial grants
applications are due to VA by April 15th of the prior fiscal year.
Additionally, project budgets and certifications of state matching
funds are due to VA by August 1st of the prior fiscal year. VA approves
the project application and creates preliminary ranking of all state
projects based on project type, application date, type of renovation,
and the need for Veterans beds within the state. Life and safety
projects are ranked above all others. The Fiscal Year 2020 State
Veterans Home Construction Grant priority list is expected to be
released by the second quarter of FY 2020.
Question 3: Mr. Secretary, will you and your department be willing
to provide me with updates on your review progress for the two veteran
home project proposals in Bemidji and Montevideo?
VA Response: All States are provided with updates on the status of
their requests as part of the annual State Home Construction Grant
priority list notification process.
Materials Submitted For The Record
Letter From Elaine Luria To: Department Of Veterans Affairs
April 1, 2019
The Honorable Robert Wilkie
Secretary
Department of Veterans Affairs
810 Vermont Avenue, N. W.
Washington, D.C. 20420
Dear Secretary Wilkie:
Thank you for your commitment while testifying before the Senate
Veterans' Affairs Committee on March 26, 2019, to not recommend an
appeal of the U.S. Court of Appeals for the Federal Circuit's decision
in Procopio v. Wilkie. As you know, Blue Water Navy Veterans have
waited decades to receive benefits for diseases related to herbicide
exposure during their service in the Republic of Vietnam. The Blue
Water Navy Vietnam Veterans Act, H.R. 299, enjoys broad bipartisan
support as we collectively work to compensate these veterans. I applaud
this step by VA toward recognizing Blue Water Navy Veterans as eligible
for the same benefits as their fellow Vietnam veterans.
On February 27, 2019, you testified before the House Veterans'
Affairs Committee. At that hearing, I asked whether you intended to
extend Priority Group 6 VA healthcare benefits to Blue Water Navy
Veterans. You replied that you assumed so. but would consult your
attorneys and provide me with a complete answer. In light of your
recommendation against appeal of Procopio, I am following up on a
response to my question.
To reiterate, Procopio v. Wilkie detennined that a servicemember
present within the 12 nautical mile territorial sea of the Republic of
Vietnam between January 9, 1962, and May 7, 1975, is entitled to a
presumption of herbicide exposure for purposes of VA disability
benefits. Do you intend to treat this class of veterans as equally
eligible for Priority Group 6 VA healthcare benefits based on service
within the Repubic of Vietnam?
Please provide a response to this request by April 12, 2019. If you
have questions or require additional infonnation, please contact Julie
Turner, Counsel for the Subcommittee on Disability Assistance and
Memorial Affairs, at 202-225-6603 or [email protected].
Sincerely.
Elaine Luria
Chair
Subcommittee on Disability Assistance and Memorial Affairs
Committee on Veterans' Affairs
Letter From Chairman Takano and David P. Roe, Ranking Member To:
Department Of Veterans Affairs
March 21, 2019
The Honorable Robert Wilkie
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Mr. Secretary:
We are aware that the U.S. Digital Service (USDS) recently
prepared an analysis regarding development of information
technology (IT) systems to support implementation of the
Community Care requirements of the Mission Act. \1\ It is our
understanding that USDS has prepared similar reports about
other Department of Veterans Affairs (VA) systems over the last
five years, including an ongoing report about implementation of
systems to support the Caregiver Program.
---------------------------------------------------------------------------
\1\ U.S. Digital Service, USDS Discovery Sprint Report Mission Act:
Community Care (Mar. 1, 2019).
---------------------------------------------------------------------------
In order to assist with the Committee's oversight of
implementation of information technology at VA, we request that
you provide complete and unredacted copies, including any
attachments or appendices, of any USDS report, memorandum, or
analysis pertaining to any VA IT systems prepared in the last
five years. We also request that you disclose any ongoing
analysis by USOS and the expected date of completion. We
request that these reports be provided to the Committee no
later than close of business on March 28, 2019.
Please provide the documents in electronic, soft-copy
format. Do not alter the documents in any way, including but
not limited to applications of redactions or a water mark. Only
relevant documents and tangible things should be provided as
part of the submission. Also provide the contact information
for the individual(s) responsible for assembling the
submission. This/These individual(s) shall certify and attest
to the accuracy of the submission.
Thank you for your assistance. Should you have any
questions about this request, please contact Sarah Garcia,
Majority Staff Director, Subcommittee on Technology
Modernization at [email protected] or Bill Mallison,
Minority Staff Director, Subcommittee on Technology
Modernization at [email protected].
Sincerely,
Mark Takano, Chairman
David P. Roe, Ranking Member
Letter From Robert L. Wilkie To: Mark Takano, Chairman
March 29, 2019
The Honorable Mark Takano Chairman
Committee on Veterans' Affairs
U.S. House of Representatives Washington, DC 20515
Dear Mr. Chairman:
This is a response to your March 21, 2019, letter to the
Department of Veterans Affairs (VA) requesting copies of any
U.S. Digital Service (USDS) reports pertaining to VA
information technology (IT) systems prepared in the last 5
years, in addition to information related to any ongoing
analysis by USDS of VA IT systems and the expected date of
completion. It is my understanding that USDS is a component of
the Office of Management and Budget (0MB) within the Executive
Office of the President. As such, your request for USDS
reports, in addition to information related to ongoing USDS
assessments, should be directed to 0 MB.
It also has come to my attention that on March 19, 2019,
the Committee sent a letter to Ms. Marcy Jacobs, Executive
Director of Digital Services at VA, requesting that she appear
on Tuesday, April 2, 2019, before a full 'Committee oversight
hearing, to testify on behalf of VA on the implementation of IT
systems to support the Maintaining Internal Systems and
Strengthening Integrated Outside Networks (MISSION) Act of
2018. As I have expressed to you before, VA is committed to
being as transparent as possible with Congress, Veterans, and
the American people. However, respectfully, Ms. Jacobs is not
the most appropriate witness to address theVA's IT
systems.Instead, as an accommodation to the Committee's
exercise of legitimate oversight responsibility on this
important subject, I will make available Mr. James Gfrerer,
Assistant Secretary for Information and Technology and Chief
Information Officer, to answer any questions the Committee has
in connection with the implementation of IT systems to support
the MISSION Act when he appears on April 2, 2019, before the
Full Committee.
Sincerely,
Robert L. Wilkie
[all]