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                                                       Calendar No. 290
109th Congress                                                   Report
                                 SENATE
 1st Session                                                    109-180

======================================================================
 
                   VET CENTER ENHANCEMENT ACT OF 2005

                                _______
                                

               November 16, 2005.--Ordered to be printed

                                _______
                                

   Mr. Craig, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 716]

    The Committee on Veterans' Affairs (hereinafter, ``the 
Committee''), to which was referred the bill (S. 716), to amend 
title 38, United States Code, to enhance services provided by 
vet centers, to clarify and improve the provision of 
bereavement counseling by the Department of Veterans Affairs 
and for other purposes, (hereinafter ``VA''), having considered 
the same, reports favorably thereon, and recommends that the 
bill, do pass.

                              Introduction

    On April 6, 2005, Committee Ranking Member Daniel K. Akaka 
introduced S. 716, the Vet Center Enhancement Act of 2005 on 
behalf of himself, Committee member John D. Rockefeller, IV, 
and Senator Kent Conrad. The bill as introduced and ordered 
reported: authorizes the employment of as many as 50 veterans 
of Operation Enduring Freedom (hereinafter ``OEF'') and 
Operation Iraqi Freedom (hereinafter ``OIF'') as additional 
outreach workers for readjustment counseling and related mental 
health services for veterans; clarifies the immediate family 
members eligible for bereavement counseling to include parents 
of an Armed Forces member who dies in active service duty; 
provides that bereavement counseling may be provided through 
the facilities and personnel of Vet Centers; and authorizes 
expenditures in Fiscal Year 2006 for the provision of 
readjustment counseling and related mental health services at 
veterans' facilities. The bill was referred to the Committee on 
Veterans' Affairs.

                           Committee Hearings

    On June 9, 2005 the Committee held hearings on, among other 
bills, S. 716, S. 1177, S. 1180, S. 1189, and S. 1190. 
Testimony was heard from: The Honorable R. James Nicholson, 
Secretary of Veterans Affairs, The Honorable Jonathan B. 
Perlin, VA's Under Secretary for Health, and The Honorable Tim 
McClain, VA's General Counsel; Mr. Donald Mooney, Assistant 
Director, The American Legion; Mr. Dennis Cullinan, Director of 
National Legislative Service, Disabled American Veterans; Mr. 
Adrian Atizado, Assistant National Legislative Director, 
Disabled American Veterans; Mr. Carl Blake, Associate National 
Legislative Director, Paralyzed Veterans of America; and Mr. 
Richard Jones, AMVETS.

                           Committee Meeting

    After carefully reviewing the testimony from the foregoing 
hearing, the Committee met in open session on September 15, 
2005, and voted by unanimous voice vote to report S. 716, 
without amendment, favorably to the Senate.

               Summary of the Committee Bill as Reported

    S. 716, as reported (hereinafter the ``Committee bill''), 
consists of changes to current law as summarized below:
          1. Authorize the employment of up to 50 veterans of 
        Operation Enduring Freedom and Operation Iraqi Freedom 
        to provide outreach to veterans regarding availability 
        of readjustment counseling and related mental health 
        services, and to terminate the employment duration 
        limitation that currently applies to these employees 
        under section 1712A of title 38, United States Code 
        (section 2);
          2. Clarify the immediate family members eligible for 
        bereavement counseling to include parents of an Armed 
        Forces member who dies in active service duty (section 
        3);
          3. Authorize the appropriation of $180,000,000 for 
        Fiscal Year 2006 for readjustment counseling and 
        related mental health services in Vet Centers (section 
        4).

                       Background and Discussion


Section 2.--Expansion of Outreach Activities of Vet Centers

    The Department of Veterans Affairs administers many 
programs and services aimed at addressing the transitional and 
readjustment needs of veterans returning from combat or 
theaters of war. Congress authorized VA to provide readjustment 
counseling services to veterans in 1979. VA then developed Vet 
Centers to meet the recognized needs of Vietnam era veterans 
experiencing readjustment problems. These community-based Vet 
Centers have continued since that time to provide various 
counseling, outreach, and referral services to eligible 
veterans. Most recently, in April 2003, eligibility for care 
was extended to veterans of OEF, OIF, and subsequent operations 
within the Global War on Terrorism (hereinafter ``GWOT'').
    The 207 Vet Centers across the country are staffed by small 
interdisciplinary service teams, with more than 65 percent of 
staff being veterans themselves. To increase outreach forces to 
the growing number of OEF/OIF veterans needing services, VA 
authorized the Vet Center program to hire 50 veterans in 
February of 2004 to provide outreach to fellow GWOT veterans. 
These coordinators are fully trained and briefed on the mission 
of the Vet Centers and on the readjustment services available 
to veterans. These coordinator positions were authorized by VA 
for a three year period to reach out to veterans and veteran 
family members in the community. In FY 2005, the cost to fully 
staff the 50 positions was $2.5 million.
            Committee bill
    The Committee bill would authorize 50 additional veterans 
of OEF and OIF to perform outreach efforts for Vet Centers. 
Under the Committee bill, these veteran-employees may be 
assigned to any Vet Center deemed appropriate by the Secretary. 
Also under the Committee bill, outreach coordinators would not 
be subject to VA's stipulation that these positions be subject 
to only three years of hiring authority.
    The need for additional outreach coordinators was also 
addressed by the Department of Veterans Affairs. Shortly after 
introduction of S. 716, VA announced that it would hire 50 
additional outreach workers for Vet Centers. The intentions 
were echoed by VA at the Committee's legislative hearing on 
June 9, 2005, when Secretary Nicholson in his testimony stated, 
``. . . .last year VA employed and trained an additional 50 
veterans from the ranks of those recently separated from OEF/
OIF to work in Vet Centers providing outreach, and we have 
committed to hiring an additional 50 veterans this year.'' 
Despite this, the Committee still finds a need to legislate in 
this area, to ensure that these positions will remain for some 
time.
    The Committee bill received support from various veteran 
service organizations. In testimony given by the Veterans of 
Foreign Wars, Dennis Cullinan referred to these outreach 
workers and said, ``Who better to explain service and help ease 
their transition than someone who served alongside them, can 
relate to their experiences, and has already navigated VA's 
many benefits programs?''
    The number of returning OEF/OIF servicemembers continues to 
grow, therefore the number of outreach workers needed must be 
increased to provide veterans with the services they need.

Section 3.--Clarification and Enhancement of Bereavement Counseling

    In August of 2003, the Secretary of Veterans Affairs 
enabled Vet Centers to provide bereavement counseling services 
to immediate family members of servicemembers who died while 
defending their country. Family members of servicemembers who 
die while on active duty, as well as federally activated 
Reserve and National Guard personnel, can seek comfort and help 
through Vet Centers. However, it is currently unclear whether 
or not a bereaved parent can receive such services, which is a 
significant problem as many of those who die on active service 
have surviving parents. Furthermore, while the Secretary 
allowed the Vet Centers to provide bereavement counseling to 
parents of servicemembers who die in combat, it is unclear if 
the law allows such counseling.
    Through the Vet Centers' bereavement counseling services, 
family members dealing with the emotional and psychological 
stress of losing a loved one in combat are able to receive the 
assistance and support they need right in their community. 
Outreach efforts, referral services, and other transitional 
services are provided through the bereavement counseling 
program to these family members.
    The first bereavement counseling case was initiated in 
December 2003 and the roster of cases has unfortunately grown 
since then. From briefing information on Vet Centers provided 
to the Committee, it was reported that Vet Centers served 342 
family members. Recorded casualty cases seen through Vet 
Centers include a total of 233 cases, with 169 in-theater 
casualties. These cases are referred to Vet Centers through 
various sources, mainly self referrals, referral from 
Transition Assistance Programs, and also from Casualty 
Assistance Officers. The casualty type ranges from those killed 
in action to suicide and extends through various branches of 
service, with more than half from the Army.
    In February 2005, the Washington Post printed an article 
that detailed a mother's experience after her son was killed in 
Iraq and how she finally felt relief at an unexpected place, a 
Vet Center. The author painted a clear picture of the distress 
that surviving family members endure as a result of the death 
of a beloved soldier and how some are able to find solace 
through the Vet Center bereavement counseling program. However, 
despite her loss and the difficulty of recovering from her 
son's death, the mother in this story is not currently 
guaranteed access to bereavement counseling services.
            Committee bill
    The Committee bill would provide express authority to Vet 
Centers to provide bereavement counseling to all immediate 
family members. The bill would also ensure the furnishing of 
bereavement counseling services to parents by defining them as 
members of the immediate family when a servicemember dies in 
active service.

Section 4.--Funding for Vet Center Program

    For more than two decades, Vet Centers have provided 
counseling and referral services to an expanded veteran 
population. All care isconducted in a safe and confidential 
environment and in a manner respective of the culture of veterans.
    Vet Centers are staffed by a total of 943 full time 
employees, of which over 65 percent are veterans. Having these 
community-based centers staffed by veterans, who understand and 
have themselves had similar experiences with the difficulties 
of post-war transition, supports the statement of purpose for 
the Vet Centers.
    Staff workload through January 2005 included a total of 
14,692 OEF/OIF veterans and families served by Vet Center 
staff. Of these, 2,590 veterans were seeking treatment for 
post-traumatic stress disorder (hereinafter ``PTSD''), with 
projections of OEF/OIF PTSD clients estimated to increase to 
4,752 in FY 2005 from 1,569 in FY 2004. The number of visits 
from OEF/OIF returning servicemembers increased from 2,450 in 
FY 2003 to 18,819 in FY 2004 and is projected to further 
increase to 31,068 this year. Vet Center staff has also 
provided vital services to over 7,000 servicemembers 
exclusively at demobilization sites and transitional assistance 
program (hereinafter ``TAP'') briefings.
    The workload demonstrates that Vet Centers have provided 
added services to a growing number of servicemembers and 
families but have not seen a corresponding increase in funding. 
Indeed, funding levels have remained relatively stagnate with 
increases reflecting solely cost of living adjustments (with 
the exception of a small funding increase in FY 2005). Vet 
Centers received $83.1 million in FY 2003; $87.4 million in FY 
2004; and $94 million in FY 2005. Funding levels for FY 2005 
were increased specifically to fund particular initiatives and 
not to compensate for the growing number of services delivered 
subsequently over the years.
            Committee Bill
    Considering that Vet Centers have provided services to an 
increasing population of returning servicemembers during the 
past three years, the Committee bill would address the need for 
additional resources.
    These additional funds would also augment Vet Centers in 
underserved rural communities and would expand the capacity for 
these centers to provide readjustment services to those 
veterans who may struggle to obtain access because they live in 
a remote area. Surviving immediate family members of those 
servicemen who paid the ultimate price will be able to find 
solace through the Vet Centers' bereavement counseling program. 
Vet Centers would be able to hire more bereavement counselors 
to provide services for those who must endure the pain of 
losing a family member in combat.
    In addition, Vet Centers could more readily participate in 
the transition efforts of the Department of Defense 
(hereinafter DoD''). The Vet Centers' twenty five year history 
of working with combat veterans to overcome the stigma 
associated with seeking professional assistance, plus the Vet 
Centers' understanding of military culture and experience, 
means that the Centers are a perfect fit to assist DoD with its 
counseling programs.
    The Committee Bill would authorize $180 million for the 
Department of Veterans Affairs in fiscal year 2006 for the sole 
purpose of increased funding for Vet Centers.

               Congressional Budget Office Cost Estimate

    In compliance with paragraph 11(a) of rule XXVI of the 
Standing Rules of the Senate, the Committee, based on 
information supplied by the CBO, estimates that enactment of 
the Committee bill would, relative to current law, increase 
spending by $102 million in 2006 and by about $185 million over 
the 2006-2010 period. Enactment of the Committee bill would not 
affect direct spending or receipts, and would not affect the 
budget of state, local or tribal governments.
    The cost estimate provided by CBO, setting forth a detailed 
breakdown of costs, follows:
                                                September 28, 2005.
Hon. Larry E. Craig,
Chairman, Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman. The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 716 the Vet Center 
Enhancement Act of 2005.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Michelle S. 
Patterson.
            Sincerely,
                                       Douglas Holtz-Eakin,
                                                          Director.
    Enclosure.

S. 716--Vet Center Enhancement Act of 2005

    S. 716 would authorize the appropriation of $180 million in 
2006 for veterans' readjustment counseling and related mental 
health services and to carry out the specific requirements of 
this bill. The bill also would require the Secretary of the 
Department of Veterans Affairs (VA) to hire up to 50 additional 
veterans of Operation Enduring Freedom or Operation Iraqi 
Freedom to provide outreach on the availability of counseling 
services. Finally, the bill would clarify that parents of a 
member of the Armed Forces are eligible for bereavement 
counseling.
    CBO estimates that implementing this bill would cost $102 
million in 2006 and about $185 million over the 2006-2010 
period, assuming appropriation of the authorized and estimated 
amounts. Enacting the bill would not affect direct spending or 
receipts.
    S. 716 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would not affect the budgets of state, local, or tribal 
governments.
    The estimated budgetary impact of S. 716 is shown in the 
following table. For this estimate, CBO assumes the bill will 
be enacted early in fiscal year 2006. The costs of this 
legislation fall within budget function 700 (veterans benefits 
and services).

                                 TABLE 1.--ESTIMATED BUDGETARY IMPACT OF S. 716
----------------------------------------------------------------------------------------------------------------
                                                               By fiscal year, in millions of dollars--
                                                     -----------------------------------------------------------
                                                        2005      2006      2007      2008      2009      2010
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law for Veterans'
 Readjustment Counseling Services:
    Budget Authority 1..............................        94         0         0         0         0         0
    Estimated Outlays...............................        85         8         0         0         0         0
Proposed Changes:
    Estimated Authorization Level...................         0       180         3         3         3         3
    Estimated Outlays...............................         0       102        30        47         3         3
Spending Under S. 716 for Veterans' Readjustment
 Counseling Services:
    Estimated Authorization Level 1.................        94       180         3         3         3         3
    Estimated Outlays...............................        85       110        30        47         3        3
----------------------------------------------------------------------------------------------------------------
1 The 2005 level is the amount appropriated for that year.

    Section 4 would authorize the appropriation of $180 million 
for fiscal year 2006 for veterans' readjustment counseling and 
related mental health services provided through VA's Vet 
Centers and to carry out the specific requirements in this 
bill. Because the authorized amount is almost twice the current 
budget amount for these programs, CBO expects that it would 
take VA about three years to increase the size and scope of 
these counseling programs to the level authorized for 2006. 
Thus, CBO estimates that implementing this provision would cost 
$102 million in 2006 and about $180 million over the 2006-2008 
period, assuming appropriation of the authorized amount.
    Section 2 would require VA to hire up to 50 additional 
veterans of Operation Enduring Freedom or Operation Iraqi 
Freedom to provide outreach on the availability of counseling 
services. The provision would remove any current limits on the 
duration of the employment for such hires, and would direct VA 
to employ these veterans in a career conditional status. 
According to VA, most of the veterans currently employed in 
this program are hired as general schedule (GS) grade 7 
employees. Assuming that these veterans would all be hired by 
the end of 2006, CBO estimates that employing these additional 
veterans would cost about $1 million in 2006 and $3 million 
annually thereafter.
    Section 3 would clarify that parents of members of the 
Armed Forces who die while on active duty are eligible for 
bereavement counseling from VA. According to VA, it already 
provides such counseling through existing resources. In fact, 
VA has counseled about 600 family members, including parents, 
since the program to provide bereavement counseling to family 
members of active-duty servicemembers began about two years 
ago. Thus, CBO estimates that implementing this provision would 
have no additional cost.
    S. 716 contains no intergovernmental or private-sector 
mandates as defined in UMRA and would not affect the budgets of 
state, local, or tribal governments.
    The CBO staff contact for federal costs is Michelle 
Patterson. For impact on state, local, and tribal government, 
the CBO staff contact is Melissa Merrell. The CBO staff contact 
for private sector impact is Joshua Lee. This estimate was 
approved by Peter H. Fontaine, Deputy Assistant Director for 
Budget Analysis.

                      Regulatory Impact Statement

    In compliance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the Committee on Veterans' 
Affairs has made an evaluation of the regulatory impact that 
would be incurred in carrying out the Committee bill. The 
Committee finds that the Committee bill would not entail any 
regulation of individuals or businesses or result in any impact 
on the personal privacy of anyindividuals and that the 
paperwork resulting from enactment would be minimal.

                 Tabulation of Votes Cast in Committee

    In compliance with paragraph 7 of rule XXVI of the Standing 
Rules of the Senate, the following is a tabulation of votes 
cast in person or by proxy by members of the Committee on 
Veterans' Affairs at its September 15, 2005 meeting. On that 
date, the Committee, by unanimous voice vote, ordered S. 716 
reported favorably to the Senate.

                             Agency Report

    On June 9, 2005, Secretary of Veterans' Affairs, the 
Honorable James Nicholson, appeared before the Committee on 
Veterans' Affairs and submitted, testimony on, among other 
things, S. 716. Excerpts from this statement are reprinted 
below:

              STATEMENT OF THE VIEWS OF THE ADMINISTRATION

   Statement of the Honorable James Nicholson Secretary of Veterans' 
                                Affairs

    Good Afternoon Mr. Chairman and Members of the Committee:
    I am pleased to be here this morning to present the 
Department's views on several different bills being considered 
by the Committee. They cover a wide range of subjects related 
to VA's provision of health care services to veterans.


                                 s. 716


    I next turn to S. 716, which deals with VA's outreach to 
veterans returning from OEF and OIF regarding services they can 
receive from VA's Readjustment Counseling Program and other VA 
mental health programs. The bill would specify that VA may 
provide bereavement counseling to the families of those who die 
in the active military service. We fully support the intent of 
S. 716, and in fact are currently carrying out most of its 
requirements. That being the case, enactment of the bill is 
unnecessary.
    Specifically, S. 716 would require that VA employ 50 new 
individuals, all of whom must be veterans of either OEF or OIF, 
to provide outreach to other veterans when they return from 
service in those operations. As we have previously advised the 
Committee, last year VA employed and trained an additional 50 
veterans from the ranks of those recently separated from OEF/
OIF to work in Vet Centers providing outreach, and we have 
committed to hiring an additional 50 veterans this year. The 50 
persons hired last year were all given career-conditional 
appointments. That means that these veterans can expect to 
retain their employment. This bill further provides that any 
limitation on the duration of employment for these employees is 
terminated, and it would require that the additional 50 
appointments that we make this year also receive career-
conditional appointments. The latter provision is imprudent.
    We do not intend to terminate any of the positions in 
question, but at the same time we do not expect that the 
conflicts in Central Asia will continue indefinitely. We hope 
the day will come when we will no longer have to undertake the 
outreach contemplated by this bill. If the need for these 
positions ends at some point in the future, the employees would 
likely move into other positions in VA, or be eliminated by 
attrition. However, to permit wise and efficient stewardship of 
the Department, we urge amendment of this legislation so as not 
to restrict the nature and duration of the appointments we 
make.
    S. 716 would also more explicitly provide that VA has 
authority to provide bereavement counseling for the families of 
deceased active duty servicepersons, including parents, and 
that VA can provide the counseling in Vet Centers. In August 
2003, former Secretary Principi directed that Vet Centers 
develop a program to provide such bereavement counseling, and 
we are now actively providing that service. In the operation of 
that program, we have permitted counseling various members of 
the family, including the parents of the deceased. Since the 
inception of the program, the families of over 365 
servicepersons who have died on active duty have been referred 
to the Vet Centers for counseling assistance, and the Centers 
have provided services to over 555 family members. The average 
number of counseling sessions provided to each family member 
has been six. Program clinical experience has been that most 
families need a supportive therapeutic environment to assist 
them in processing the immediate stages of grief and to 
stabilize their situation sufficient to mobilize their own 
coping resources.
    Finally, S. 716 would authorize $180 million to be 
appropriated for the provision of readjustment counseling and 
related mental health services through Vet Centers. In the 
current fiscal year VHA allocated a total of $94 million for 
all Readjustment Counseling Service activities. We estimate 
that the additional services that this bill would direct, and 
that we are in fact already implementing, will require only 
about $8 million. There is no necessity or justification for 
nearly doubling the amount we spend on Readjustment Counseling 
Service.

           *       *       *       *       *       *       *


    Changes in Existing Law Made by the Committee Bill, as Reported

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, changes in existing law made by the 
Committee bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *


CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

           *       *       *       *       *       *       *



Subchapter VIII--Health Care of Persons Other Than Veterans

           *       *       *       *       *       *       *



Sec. 1783. BEREAVEMENT COUNSELING

           *       *       *       *       *       *       *


    (b) Deaths in active service. (1) The Secretary may provide 
bereavement counseling to an individual who is a member of the 
immediate family of a member of the Armed Forces who dies in 
the active military, naval, or air service in the line of duty 
and under circumstances not due to the person's own misconduct.
    (2) For purposes of this subsection, the members of the 
immediate family of a member of the Armed Forces described in 
paragraph (1) include the parents of such member.
    (c) Provision of Counseling Through Vet Centers. 
Bereavement counseling may be provided under this section 
through the facilities and personnel of centers for the 
provision of readjustment counseling and related mental health 
services under section 1712A of this title.
    [(c)] (d) Bereavement counseling defined. For purposes of 
this section, the term ``bereavement counseling'' means such 
counseling services, for a limited period, as the Secretary 
determines to be reasonable and necessary to assist an 
individual with the emotional and psychological stress 
accompanying the death of another individual.