Filner, Ranking Member Buyer and distinguished Members of the Committee,
on behalf of all of our officers, Board of Directors, and members, I
thank you for giving Vietnam Veterans of America (VVA) the opportunity
to testify regarding the President’s fiscal year 2008 budget request
for the Department of Veterans Affairs today. I am pleased to welcome
so many new and returning Members onto the Committee this year. VVA looks
forward to working with all of you to address the needs of the unique
system created to serve our Nation’s veterans.
I particularly wish to thank you, Mr. Chairman, for your impassioned
and erudite speech to the majority caucus that resulted in $3.6 billion
being added to the continuing resolution for health care at the Veterans
Health Administration. Your willingness to take a strong stand when it
was not yet the “conventional wisdom” once again helped America,
and particularly America’s veterans and our families. VVA thanks
you for your strong leadership, and salutes your life-long willingness
to “speak truth to power.”
Mr. Chairman, several years ago, Vietnam Veterans of America developed
a White Paper in support of the need for assured funding for the veterans
health care system, which I know you have read and shared with others.
I also know you have been a long time supporter of legislation to achieve
assured funding. You have always understood the need for such a mechanism
to correct the problems in the current system of funding. As we have
this discussion in regard to the FY’08 budget for VA, the readily
apparent need for this legislation has never been more pressing. We look
forward to working with you to ensure its enactment.
VVA does wish to recognize that this year’s request from the President
for the VA Budget, while lacking in many other respects, is relatively
free of “budget gimmicks” that have so plagued discussions
in the past. VVA believes that this is due to the strong efforts of Secretary
Nicholson in doing battle to strip out the favorite ‘gimcrackery” of
that permanent staff over at the Office of Management & Budget (OMB).
VVA commends the Secretary of Veterans’ Affairs in this regard
for seeking to have an honestly presented budget proposal.
Veterans Health Administration
VVA is recommending an increase of $6.9 billion to the expected fiscal
year 2007 appropriation for the medical care business line. We recognize
that the budget recommendation VVA is making this year is extraordinary,
but with troops in the field, years of under funding of health care organizational
capacity, renovation of an archaic and dilapidated infrastructure, and
updating capital equipment and several cohorts of war veterans reaching
ages of peak health care utilization, these are extraordinary times.
It’s past time to meet these needs.
In contrast to what is clearly needed, we believe the Administration’s
fiscal year 2008 request for $2 billion more than the expected 2007 appropriation
in the continuing resolution is inadequate. Unfortunately, we still are
unsure of the bottom line for fiscal year 2007. While we certainly appreciate
that the Congress is planning to restore funding for veterans health
care in the continuing resolution (and it is essential that it does so
to ensure the Department’s ability to meet ongoing obligations),
the fact that VA is still uncertain about the amount of funding it will
receive a third of the way through the fiscal year does, virtually in
and of itself, make the case for assured funding.
The $2 billion increase the Administration has requested for medical
care may almost keep pace with inflation, but it will not allow VA to
enhance its health care or mental health care services for returning
veterans, restore diminished staff in key disciplines like clinicians
needed to care for Hepatitis C, restore needed long-term care programs
for aging veterans, or allow working-class veterans to return to their
health care system. VVA’s recommendation does accommodate these
goals, in addition to restoring eligibility to veterans exposed to Agent
Orange for the care of their related conditions.
I need not tell you about the many successes of the Department of Veterans
Affairs in recent years. The veterans’ service organizations are
often seen as critics of the Department, but while it’s true that
we sometimes take exception to its policy decisions we are, in fact,
also its most stalwart champions. Over the last decade the Veterans Health
Administration (VHA) at VA has taken steps to become a higher quality,
more accessible health care system. It has demonstrated great efficiency
by almost doubling the number of veterans it treats while holding per
capita costs relatively constant. It has developed hundreds of Community
Based Outreach Clinics (CBOC). VHA has received many prestigious awards
for excellence and innovation. While VVA remains extremely concerned
about recent breaches that compromised veterans’ personal data,
VVA appreciates the fact that VA has put together a computerized system
of medical records that sets the standard for modern health care delivery.
These achievements are to be celebrated.
Yet, these advances have not come without a cost. For years, the veterans’ health
care system has been falling behind in meeting the health care needs
of some veterans. At the beginning of 2003, the former Secretary of Veterans
Affairs made the decision to bar so-called priority 8 veterans from enrolling.
In most cases, these veterans are not the well-to-do—they are working
class veterans or veterans living on fixed incomes whose incomes are
as little as $28,000 a year. It’s not uncommon to hear about such
veterans choosing between getting their prescription drug orders filled
and paying their utility bills. The decision to bar these veterans is
still standing, and it is still troubling to thoughtful Americans.
In addition to the current bar on health care enrollment, in recent
years VA has sent Congress a budget that requires more cost sharing from
veterans, and eliminates options for their care—particularly long
term care. We appreciate that VA’s proposal this year has not presumed
enactment of some of the cost-sharing legislative proposals Congress
has opposed in the past. This may allow Congress more leeway to augment
it’s request in concrete ways rather than merely filling deficits
left by the Administration presuming that revenues and savings from these
unpopular initiatives will be realized.
Congress is to be commended for turning back many legislative requests
for enrollment fees and outpatient cost increases, which would have jeopardized
hundreds of thousands of veterans’ access to health care. Hard-fought
Congressional add-ons, such as the $3.6 billion for fiscal year 2007
currently being debated as part of the continuing resolution, have kept
the system afloat. The budget recommended by VVA in addition to the enactment
of some assured funding mechanism will enable a robust health care system
to meet the needs of all eligible veterans—now and in the future.
For medical services for fiscal year 2008, VVA recommends $34.5 billion
including collections. This is approximately $5 billion more than the
Administration’s request for fiscal year 2008. VVA is making its
budget recommendations based on re-opening access to the millions of
veterans disenfranchised by the Department’s policy decision of
early 2003, that was supposed to be “temporary.” The former
ranking member of this Committee, Lane Evans, discovered that a quarter
million priority 8 veterans had applied for care in fiscal year 2005.
Similar numbers of veterans have likely applied in each of the years
since their enrollment was barred. Our budget allows 1.5 million new
priority 7 and 8 veterans to enroll for care in their health care system.
While this may sound like too great a lift for the system, use rates
for priority 7 and 8 veterans are much lower than for other priority
groups. Based on our estimates it may yield only an 8% increase in demand
at a cost of about $1.5 billion to the system for additional personnel,
supplies and facilities.
The budget axe has fallen hard on long-term care programs in the VA.
About a decade ago, there was a major policy shift throughout the health
care industry including with VA, which encouraged programs to deliver
as much care as possible outside of beds. In many cases this has been
a productive policy. Veterans value the convenience of using nearby community
clinics for primary care needs, for example.
However, the change took a great toll on the neuro-psychiatric and long-term
care programs that housed and cared for thousands of veterans, often
keeping them institutionalized for years. Instead of developing the significant
community and outpatient infrastructures that would have been necessary
to adequately replace the care for these most vulnerable veterans, the
resources were largely diverted to other purposes.
Where have these vets gone? The fiscally challenged Medicaid program
supports many of those who need long-term care, adding an additional
burden to the states. State homes play an important role in remaining
the only VA-sponsored setting that provides ongoing, rather than rehabilitative
or restorative, long-term care. VA’s mental health programs—some
of the finest in the nation—as well as significant advances in
pharmaceuticals continue to serve and allow many veterans to recover.
However, what are in fact increasing waiting times for mental health
programs and the lack of treatment options often contribute to incarceration
and homelessness for the most vulnerable of these veterans. Sadly, we
hear increasing numbers of stories of veterans of Iraq and Afghanistan
whose inability to deal with readjustment post-deployment have lead them
to the streets or even suicide.
Mr. Chairman, Vietnam Veterans of America’s founding principle
is: “Never again will one generation of veterans abandon another.” This
is why we are imploring this committee to ensure that VA has the imperative
and the resources to bolster the mental health programs that should be
readily available to serve our young veterans from Iraq and Afghanistan.
Experts from within the Department of Defense estimate that as many as
17% of those who serve in Iraq will have issues requiring them to seek
post-deployment mental health services and recent studies have shown
that four out of five of the veterans who may need post-deployment care
are not properly referred to such care. There is good reason to believe
that even the rates forecast by DoD may be too low.
VA has not made enough progress in preparing for the needs of troops
returning from Iraq and Afghanistan—particularly in the area of
mental health care. Its own internal champions—the Committee on
Care of the Seriously Mentally Ill and the Advisory Committee on Post
Traumatic Stress Disorder, for example, have expressed doubts about VA’s
mental health care capacity to serve these newest vets. As recently as
last March, VHA’s Undersecretary for Health Policy Coordination
told one Commission that mental health services were not available everywhere,
and that waiting times often rendered some services “virtually
inaccessible.” The doubts about capacity to serve new veterans
have reverberated in reports done by the Government Accountability Office
(GAO). In addition, one recent working paper by Linda Bilmes of the John
F. Kennedy School of Government at Harvard University estimates that
in a “moderate” scenario in 2008 VA will require $1.8 billion
to treat the veterans returning from Iraq and Afghanistan—much
of this funding would be used to augment mental health care to properly
serve these veterans. VA has projected that approximately 260,000 Global
War on Terrorism (GWOT) veterans will use the VA health care system in
FY 2008. VVA and others believe that well more than 300,000 “new” veterans
will use the VHA system in FY 2008.
A further reason that VA has underestimated the need for medical services
is that they continue to use the same formula that they use for CARES,
which is a civilian based model. Mr. Chairman, VVA has testified many
times that the VHA must be a “veterans’ health care system” and
not a general health care system that happens to see veterans if the
VHA is to properly and adequately address the needs of veterans, particularly
veterans who are sick or injured in military service. The model VA uses
was designed for middle class people who can afford HMOs or other such
programs. It projects only one to three “presentations” (things
wrong with) patients as opposed to the five to seven that is the average
at VHA for veterans. Obviously one using the VA model will continually
underestimate overall resources needed to care for the veterans who come
to the system by using this civilian formula. Further, VHA has been consistent
in underestimating the number of GWOT returnees who will seek services
from the system in each of the last four years. VVA has corrected these
errors in our projections.
In addition to the funds VVA is recommending elsewhere, we specifically
recommend an increase of an additional billion dollars to assist VA in
meeting the long term care and mental health care needs of all veterans.
These funds should be used to develop or augment with permanent staff
at VA Vet Centers (Readjustment Counseling Service or RCS), as well as
PTSD teams and substance use disorder programs at VA Medical Centers
and CBOC, which will be sought after as more troops (Including demobilized
National Guard and Reserve members) return from ongoing deployments.
In addition, VA should be augmenting its nursing home beds and community
resources for long term care, particularly at the State veterans’ homes.
To assist in developing these programs and augmenting all areas of veterans’ care,
VVA recommends funding to accommodate the staff to patient ratio VA had
in place before VA had dismantled so much of its neuro-psychiatric and
long-term care infrastructure. This would allow VA to better ensure timely
access to care and services. Studies have shown that inadequate staffing—particularly
of nurses involved in direct care--is correlated with poorer health care
outcomes in all medical disciplines. To allow the staffing ratios that
prevailed in 1998 for its current user population, VA would have to add
more than 20,000 direct care employees--MDs and nurses--at a cost of
about $2.2 billion.
The $2.2 billion funding for the staff shortfalls identified by VVA
closely corresponds to the funding from unspecified so-called “management
efficiencies” VA has had to shoulder throughout this Administration.
It is important to realize that the effect of leaving these funding deficiencies
unfulfilled is cumulative. That is, each year VA is forced to live with
a greater hole in its budget. GAO has joined VSOs and Congress in questioning
the extent to which VA has been able to identify and realize the so-called “savings” created
by such proposed efficiencies. VA officials have advised GAO that the
efficiencies identified in at least two recent budget proposals—FY
2003 and 2004—were developed to allow VA to meet its budget guidance
rather than by detailed plans for achieving such savings (GAO-06-359R).
In other words, the savings were justified only by the need to meet the
Administration’s “bottom line.” I hope Congress agrees
that this is no way to fund our veterans’ health care system.
Finally, VVA believes Congress did a grave injustice to Vietnam-era
veterans. For decades, veterans exposed to Agent Orange and other herbicides
containing dioxin had been granted health care for conditions that were
presumed to be due to this exposure. This special eligibility expired
at the end of 2005 and, despite our request, Congress did not reauthorize
it. Had Congress simply reauthorized existing authority, VA would have
realized no new costs. Now we have heard that the Congressional Budget
Office estimates that it will cost more than $300 million to restore
this eligibility. Why this eligibility was allowed to expire seems more
a matter of dollars than sense to VVA, given the ever mounting body of
research that clearly points to conditions such as diabetes being linked
to dioxin exposure. However, the pressing issue now is to reinstate veterans
with these conditions for the higher priority access to services that
For medical facilities for fiscal year 2008, VVA recommends $5.1 billion.
This is approximately $1.5 billion more than the Administration’s
request for fiscal year 2008. Maintenance of the health care system’s
infrastructure and equipment purchases are often overlooked as Congress
and the Administration attempt to correct more glaring problems with
patient care. In FY 2006, in just one example, within its medical facilities
account VA anticipated spending $145 million on equipment, yet only spent
about $81 million. (The rest of the funds went just to meet operating
costs to keep the facilities open and operating.) However, these projects
can only be neglected for so long before they compromise patient care,
and employee safety in addition to risking the loss of outside accreditation.
The remainder of the funding was apparently shifted to other more immediate
priority areas (i.e., keeping facilities operating in the short run).
VA undertook an intensive process known as CARES (Capital Asset Realignment
to Enhance Services) to “right size” its infrastructure,
culminating in a May 2004 policy decision that identified approximately
$6 billion in construction projects. While for the reasons noted above
the VA has consistently underestimated future needs by using a fatally
flawed formula, thus far Congress and the Administration have only committed
$3.7 billion of this all too conservative needed funding.
We believe the CARES estimate to be extremely conservative given that
the models projecting health care utilization for most services were
based on use patterns in generally healthy managed care populations rather
than veterans and that the patient population base did not include readmitting
Priority 8 veterans, or significant casualties from the current deployments.
Notwithstanding our concerns about the methods used in CARES, very few
of the projects VA agrees are needed have been funded since this time.
Non-recurring maintenance and capital equipment budgets have also been
grievously neglected as administrators have sought to shore up their
In a system in which so much of the infrastructure would be deemed obsolete
by the private sector (in a 1999 report GAO found that more than 60%
of its buildings were more than 25 years old), this has and may again
lead to serious trouble. We are recommending that Congress provide an
additional $1.5 billion to the medical facilities account to allow them
to begin to address the system’s current needs. We also believe
that Congress should fully fund the major and minor construction accounts
to allow for the remaining CARES proposals to be properly addressed by
funding these accounts with a minimum of remaining $2.3 billion.
Medical and Prosthetic Research
For medical and prosthetic research for fiscal year 2008, VVA recommends
$460 million. This is approximately $50 million more than the Administration’s
request for fiscal year 2008. VA research has a long and distinguished
portfolio as an integral part of the veterans’ health care system.
It’s funding serves as a means to attract top medical schools into
valued affiliations and allows VA to attract distinguished academics
to its direct care and teaching missions.
VA’s research program is distinct from that of the National Institutes
of Health because it was created to respond to the unique medical needs
of veterans. In this regard, it should seek to fund veterans’ pressing
needs for breakthroughs in addressing environmental hazard exposures,
post-deployment mental health, traumatic brain injury, long-term care
service delivery, and prosthetics to meet the multiple needs of the latest
generation of combat-wounded veterans.
Further, VVA brings to your attention that VA Medical & Prosthetic
Research is not currently funding a single study on Agent Orange or other
herbicides used in Vietnam, despite the fact that more than 300,000 veterans
are now service connected disabled as a direct result of such exposure
in that war. VVA submits that this is unacceptable.
Mr. Chairman, finally I urge this Committee to at long last urge your
colleagues on the Appropriations Committee to use the power of the purse
to compel VA to obey the law (Public Law 106-419) and conduct the long-delayed
National Vietnam Veterans Longitudinal Study. VVA ask that you specifically
request report language in the Appropriations bill for Military Construction,
Veterans Affairs, and Related Areas that compels VA to advise the Appropriators
and the Authorizers as to how VA plans to complete this study properly
within two years, as a comprehensive mortality and morbidity study.
Assured Funding for Veterans Health Care
Once this Congress provides a budget that shores up VA medical services
and facilities, it will need to assure that VA continues to be funded
at a level that allows it to provide high-quality health care services
to the veterans that need them. That is where enactment of assured funding
will come in. Once enacted, an assured funding mechanism will ensure
that, at a minimum, annual appropriations cover the cost of inflation
and growth in the number of veterans using VA health care. It will allow
VA administrators some predictability in both how much funding it will
receive and when it will be received resulting in higher quality and
ultimately more cost-effective care for our veterans.
Veterans Benefits Administration
The Veterans Benefits Administration (VBA) is in even more acute need
of additional resources and enhanced accountability measures now than
they were a year ago. VVA recommends an additional 400 over and above
the roughly 470 new staff members that are requested in the President’s
proposed budget for all of VBA.
Compensation & Pension
VVA recommends adding one hundred staff members above the level requested
by the President for the Compensation & Pension Service (C&P)
specifically to be trained as adjudicators. Further, VVA strongly recommends
adding an additional $60 Million dollars specifically earmarked for additional
training for all of those who touch a veterans’ claim, institution
of a competency based examination that is reviewed by an outside body
that shall be used in a verification process for all of the VA personnel,
veteran service organization personnel, attorneys, county and state employees,
and any others who might presume to at any point touch a veterans’ claim.
VVA recommends that you seek to add an additional three hundred specially
trained vocational rehabilitation specialists to work with returning
servicemembers who are disabled to ensure their placement into jobs or
training that will directly lead to meaningful employment at a living
wage. It is clear that the system funded through the Department of Labor
simply is failing these fine young men and women when they need assistance
most in rebuilding their lives.
VVA has always held that the ability to obtain and sustain meaningful
employment at a living wage is the absolute central event of the readjustment
process. Adding additional resources and much, much greater accountability
to the VA Vocational Rehabilitation process is absolutely essential if
we as a nation are to meet our obligation to these Americans who have
served their country so well, and have already sacrificed so much.
Accountability at VA
So much of what VVA, and the Congress on both sides of the aisle find
wrong or disturbing at the VA revolves around the general and all pervasive
issue of little or no accountability, or imprecise fixing of authority
commensurate with accountability mechanisms that are meaningful (and
vice versa) in all parts of the VA.
Within the past year VA has finally made significant progress in meeting
the minimum goal of at least 3% of all contracts and 3% of all subcontracts
being let to service disabled veteran business owners. Secretary Nicholson,
and Deputy Secretary Mansfield, is to be commended on setting the pace
for the Federal government. It is instructive in this discussion, however,
that the action directed by the Secretary to put achievement or substantial
real progress toward meeting or exceeding the 3% minimum into the performance
evaluation of each Director of the twenty one Veterans Integrated Service
Networks (VISNs) was a key element in VA to be the first large agency
to reach the goal mandated by law. (85% of all VA procurement is through
VHA, primarily through the VISNs) was the key element in this achievement.
All people (particularly people with a great deal of responsibility
who work long hours) care about what they feel they have to care about.
Putting it in the performance evaluations means that those managers who
ignore a requirement do not get an outstanding or superior rating, and
hence no bonus. VVA, and now the VA in at least this one instance, has
always found that it is amazing how reasonable almost all people can
be when you have their full attention.
There is no excuse for the dissembling and lack of accountability in
so much of what happens at the VA. It can be cleaned up and done right
the first time, it there is the political will to hold people accountable
for doing their job properly.
Lastly, there is no excuse for the continuation of the practice of VHA
to “lose” tens of millions (sometimes hundreds of millions)
of taxpayer dollars that are appropriated to VHA for specific purposes,
whether that purpose be to restore organizational capacity to deliver
mental health services, particularly for PTSD and other combat trauma
wounds, or to conduct outreach to GWOT veterans as well as de-mobilized
National Guard and Reserves returnees from war zone deployments. There
is a consistent pattern of VA, particularly VHA, to either really not
know what happened to large sums of money given to them for specific
reasons, or they7 are not telling the truth to the Congress and the public.
In either case, it is unacceptable, and cannot be tolerated any longer.
In the proposed budget submittal, VVA struggled with accounting for
the dollars footnoted in the President’s submittal as “Adjusted
for IT.” We could not find an accurate accounting. When we asked
in the twenty seven hours we had to prepare this submittal, it turns
out that no one else that we have spoken to, including the VA officials,
can fully explain at least $200 (+) Million plus of this “adjustment” either.
And this is BEFORE they get their hands on the dollars. VVA urges this
Committee and your colleagues on Appropriations to make this the year
that this sloppy nonsense and dissembling is stopped once and for all.
Accountability will only come about when the Congress absolutely demands
that these folks be fully accountable for performance, and for accounting
for each and every taxpayer dollar.
Thank you again, Mr. Chairman. We look forward to working with you and
this distinguished Committee to obtain an excellent budget for VA in
this fiscal year, and to ensure the next generation of veterans’ well
being by enacting assured funding. I will be happy to answer any questions
you and your colleagues may have.
VIETNAM VETERANS OF AMERICAPRIVATE
February 8, 2007
The national organization Vietnam Veterans of America (VVA) is a non-profit
veterans membership organization registered as a 501(c)(19) with the
Internal Revenue Service. VVA is also appropriately registered with the
Secretary of the Senate and the Clerk of the House of Representatives
in compliance with the Lobbying Disclosure Act of 1995.
VVA is not currently in receipt of any federal grant or contract, other
than the routine allocation of office space and associated resources
in VA Regional Offices for outreach and direct services through its Veterans
Benefits Program (Service Representatives). This is also true of the
previous two fiscal years.
For Further Information, Contact:
Executive Director of Policy and Government Affairs
Vietnam Veterans of America
(301) 585-4000, extension 127
John Rowan was elected National President of Vietnam Veterans of America
at VVA’s Twelfth National Convention in Reno, Nevada, in August
John enlisted in the U.S. Air Force in 1965, two years after graduating
from high school in Queens, New York. He went to language school, where
he learned Indonesian and Vietnamese. He served with the Air Force’s
6990 Security Squadron in Vietnam and at Kadena Air Base in Okinawa helping
to direct bombing missions.
After his honorable discharge, John began college in 1969. He received
a BA in political science from Queens College and a Masters in urban
affairs at Hunter College. Following his graduation from Queens College,
John worked in the district office of Rep. Ben Rosenthal for two years.
He then worked as an investigator for the New York City Council and recently
retired from his job as an investigator with the New York City Comptroller’s
Prior to his election as VVA’s National President, John served
as a VVA veterans’ service representative in New York City. John
has been one of the most active and influential members of VVA since
the organization was founded in 1978. He was a founding member and the
first president of VVA Chapter 32 in Queens. He served as the chairman
of VVA’s Conference of State Council Presidents for three terms
on the national Board of Directors, and as president of VVA’s New
York State Council.
He lives in Middle Village, New York, with his wife, Mariann.