Good morning, Mr. Chairman, Ranking Member Burr, other Distinguished
Senators of this Committee, and guests. On behalf of VVA National
President John Rowan and all of our officers and members, I thank
you for the opportunity to share our views on pending health care
legislation for our nation’s veterans and for your leadership
in holding this hearing today.
My name is Tom Berger, Chair of the National PTSD & Substance
Abuse Committee for Vietnam Veterans of America (VVA). I am a Vietnam
combat veteran, having served as a Fleet Marine Force Navy corpsman
with the 3rd Marine Division, 1966 – 68, in I Corps, Vietnam.
S.2573, the “Veterans Mental Health Treatment First” Act
Obviously there is a range of issues to be considered here today,
but VVA wishes to start by focusing on the proposed legislation S.2573,
the “Veterans Mental Health Treatment First” bill that
is to some degree, derived from the Dole-Shalala Commission’s
recommendations. Although this bill focuses on service-connected
disability compensation and does not directly address evidence-based
mental health diagnoses, treatment modalities, or recovery programs,
the potential impact of this bill if enacted on veterans suffering
from PTSD, TBI and related mental health disorders cannot be overstated.
This in practice has the potential to change virtually everything – but
not in a positive direction.
I am certain that we’re all aware of the independent Rand
Corporation study released last month showing that 18.5 percent of
returning OEF/OIF troops meet the criteria for either PTSD or depression
(i.e., 14 percent for PTSD and 14 percent for depression) some 19.5
percent have experienced a probable TBI. Even more distressing is
the testimony by Colonel Charles Hoge, M.D., before the House Veterans’ Affairs
Health Subcommittee last month in which he indicated a 20 percent
PTSD rate for troops serving two combat tours and a 29.9 percent
PTSD rate for those serving three tours -- a number that is very
close to that obtained for Vietnam veterans in the original National
Vietnam Veterans Readjustment Study conducted in the 1980’s,
some years after the end of the war that put PTSD on the reality
map. Our troops now are seeing both more and longer deployments,
with at least four Army Brigade Combat Teams (CBCTs) now in their
fourth deployment cycle. What is beyond argument is that the more
combat exposure a soldier sees, the greater the odds that soldiers
will suffer mental and emotional stress that can become debilitating.
And in wars without fronts, “combat support troops” are
just as likely to be affected by the same traumas as infantry personnel.
While we are appreciative of Senator Burr’s sincere motivation
to do what is best for all concerned, including potentially affected
veterans, VVA does not believe that the program outlined in this
legislative initiative is either the best way to address this problem
nor is it a prudent course in regard to assisting veterans to continue
to serve our nation in civilian life as they did in the military.
In truth, with no end to the Iraq and Afghanistan wars in sight,
the true incidence of PTSD among active duty troops may still be
underreported because of stigma and discrimination. Without proper
diagnosis and treatment, the psychological stresses of war never
really end, increasing the odds that our soldiers will suffer mental
and emotional stress that can become debilitating if left untreated.
This places them at higher risk for self-medication and abuse with
alcohol and drugs, domestic violence, unemployment & underemployment,
homelessness, incarceration, medical co-morbidities such as cardiovascular
diseases, and suicide.
VVA remains opposed to S.2573 principally because it would create
a two-tiered disability benefits system that would treat veterans
differently based on their periods of service – that is, a
system that gives different disability rating awards to classes of
veterans from different combat eras under the guise of saving the
VA money. VVA is especially concerned with the impact of the so-called “buy
out” program of this bill, not only on those veterans currently
suffering from mental health disorders, but also on those who will
encounter mental health problems later in life as a result of their
military service. As you know one of the well-known characteristics
of PTSD is that the onset of symptoms is often delayed, sometimes
for decades, despite unfunded assertions to the contrary.
We are not disputing the fact that claims for mental health service-connected
disability compensation are rising and the accompanying costs for
such are growing as well. But under S. 2573, this problem cannot
be resolved unless fewer vets are rated disabled and/or fewer disabilities
are rated, and/or smaller amounts of compensation are awarded. The
responsibility of providing service-connected disability compensation
for a veteran’s mental health injuries must not be trivialized
by providing a one-time payment for wounds that may take years to
heal, if ever.
This is especially applicable to our nation’s largest living
veteran cohort, Vietnam veterans, who are now aging, retiring, and
suffering the aftermath of physical and emotional injuries incurred
as a result of their military service 40 years ago.
The legitimacy of veterans’ claims that they suffer from PTSD
is apparently again under the gun by a small number of media savvy
professional skeptics (some would call them “hired guns”),
who have waged a campaign to discredit PTSD as a valid diagnosis,
and whose views, I might add, are not generally shared by mainline
PTSD experts nor by the vast majority of mental health professionals
nor by the Institute of Medicine of the National Academies of Science.
(The IOM convened several panels at the request of the Department
of Veterans Affairs relating to this issue of whether PTSD was a
legitimate medical condition, whether PTSD could be accurately diagnosed,
and whether PTSD could be effectively treated. (All three of these
reports, released on June 16, 2006, May 8, 2007, and October 17,
2007, respectively, are available at http://www.iom.edu www.iom.edu
in the Military & Veterans section.)
Without a shred of evidence veterans who suffer from PTSD are portrayed
by these skeptics as looking for easy disability payments that provide
an incentive for staying sick rather than getting well, with the
implication that sick veterans are welfare cheats. In addition to
claims of veteran fraud, these skeptics also claim that cases of
delayed onset of PTSD “are rare to non-existent,” and
that “PTSD is an acute, not chronic, disease and only rarely
should there be a need to give long-term disability.” In fact,
there are no data to support these opinions. Studies done at the
National Center for PTSD confirm the delayed onset of PTSD, as well
as the fact that mental health utilization is actually higher for
veterans granted disability claims than for those who apply and are
turned down. VVA would also argue that use of the standardized and
validated PTSD diagnostic assessment tools in the “Best Practices
Manual for PTSD” would pick up any factitious PTSD disability
claims, and provide for better guidance in developing individualized
VVA’s concern is also focused on those veterans suffering
from TBI, the so-called “signature wound” of the war
in Iraq, because it presents a most puzzling challenge, especially
in mild to moderate cases. Symptoms can be hidden or delayed, diagnosis
is difficult, and evidence-based treatments are as of yet largely
undetermined. And if left untreated over time, even mild TBI can
cause epilepsy/seizure disorder. Very few medical facilities in the
U.S. are capable of providing even the most minimal level of specialized
care for brain-injured patients, forcing most survivors to find treatment
hundreds of miles from home, if they can find it at all -- and more
than 40 percent of our military deployed in Afghanistan and Iraq
come hail from rural America.
In addition, the most commonly utilized current treatment modality
for epilepsy/seizure disorder is medication. However, we must remember
that epilepsy/seizure disorder caused by either a concussive or contusive
brain injury, is never just an isolated incident. Over time without
proper treatment and care, TBI can affect nearly everything associated
with the survivor, including one’s cognitive, motor, auditory,
olfactory, and visual skills, perhaps resulting in behavioral modifications,
not mental illness. Epilepsy/seizure disorder treatment, recovery
services and programs can also collapse a family and its finances.
Of all the medically challenging injuries, brain injuries require
the most involvement and cost over time.
And so the question then becomes: How can we really expect a veteran
currently suffering from chronic PTSD or TBI – perhaps even
on medication for such wounds -- to be able to make an informed decision
now about his/her future mental health care needs and service-connected
Lastly, VVA acknowledges that the culture of the VA mental health
system itself may play a yet undefined role in this current debate
over PTSD and VA compensation. For example, the studies of Sayer
and Thuras (1), as well as Kimbrell and Freeman (2) suggest that
VA clinicians had a more negative view of the treatment engagement
of veterans who were seeking compensation and of clinical work with
these patients in comparison with those veterans not seeking compensation
and those certified as permanently disabled and thus not needing
to reapply for benefits. The longer VA clinicians had been working
with veterans who had PTSD, the more extreme were these negative
What is clear to us is that these so-called clinical “researchers” are
not even aware that their patients seek service connection so that
they will not have to pay for medical treatment for a condition that
they believe resulted from their military service. This, and the
sense of validation of the reality of the suffering they endure is
in fact a result of neuro-psychiatric wounds suffered in service
are often more important to the individual veteran that any compensation
payment he or she may derive (and deserve!) as a result of this psychiatric
wound(s) that are every bit as real as a gunshot wound, if properly
diagnosed according to the VA’s own “Best Practices Manual.”
VVA would point out that the VA refuses to issue these manuals to
relevant staff in the Veterans Benefits Administration and in the
Veterans Health Administration because “it takes too much time” and
to follow the best practices is “too expensive.” VVA’s
rejoinder is that if you do not have the time and resources to do
it right the first time, when are you going to have the time and
money to do it over, and then do it over yet again? Our veterans
deserve better than slapdash, simplistic “fixes” that
in fact do not address their legitimate needs, and would actually
serve to exacerbate their very real wounds incurred in military service.
S.2273: The Enhanced Opportunities for Formerly Homeless Veterans
Residing in Permanent Housing Act of 2007
VVA strongly supports this legislation. The crux of the problem
with transitional housing for homeless veterans (aside from the fact
that there is not enough of it) is that often there is no available
permanent housing to which a transition can take place. In other
words, persons make it off the street into a transitional housing
unit, but then have no permanent affordable housing to go to when
their time in the transitional supportive housing is done. What is
needed are both affordable permanent housing, and supportive services
that are available and focused on the needs of these persons to help
them maintain a stable life situation. It is very important that
the VA provide grants to fund such services, as HUD is increasingly
cutting back on program dollars and focusing on “bricks and
mortar.” (Whether that is a smart public policy move on the
part of HUD is certainly debatable, but the fact remains that this
is the direction in which they seem to be heading.)
The pilot program as outlined in this proposal is solid, but we
would suggest that you consider both enlarging the size of the pilot,
provide for regular reporting to Congress at regular intervals (at
least once per year), and after evaluation of the experience of what
works and what does not work, provide for moving beyond the pilot
in short order should the model(s) prove to be as successful as we
think they will be if the VA implements them correctly. VVA has no
doubt that Pete Dougherty (who coordinates homeless programs at VA
nationally) will do a sterling job of the implementation and running
this additional needed aspect of the VA homeless program(s), if he
is given the resources and the backing.
S. 2377: A bill to amend title 38, United States Code, to improve
the quality of care provided to veterans in Department of Veterans
Affairs' medical facilities, to encourage highly qualified doctors
to serve in hard-to-fill positions in such medical facilities, and
for other purposes.
VVA endorses passage of this bill. We do however, have some suggestions
that we hope you will consider. First, the Chief of Staff and the
top medical officer of each VA Medical Center need s to be written
into the chain of reporting in this bill. Similarly, so does the
clinical director of each Veterans Integrated Services Network (VISN
and the Under Secretary for Health of the Department of Veterans
Affairs. While the principal ones to carry out the activities mandated
by this bill may in fact be as described, it is the chief medical
officer at each level who does have, and should have, ultimate responsibility
for the overall quality of medical care delivered to veterans by
that unit. While the mechanism prescribed in this legislation will
be another tool toward that end, it is only part of the puzzle of
how to maintain the highest quality of care for our nation’s
VVA also strongly favors additional financial and other incentives
to attract and keep high-quality physicians and other vitally needed
clinicians and medical specialists in the VA.
Lastly, although it is not at the high professional credential level
of the mechanism described in this legislative proposal, the fact
is that many veterans cannot properly communicate with their clinician,
nor is their clinician able to effectively communicate with them
and others in the VA. Language barriers have become an impediment
to quality care in too many instances. The lack of full command of
the English language by clinicians and others at the VA is probably
the most common complaint we hear from our members, their families,
and other veterans.
This is a complaint that is founded on frustration voiced by many
veterans that they cannot understand what their physician is trying
to say to them, and their physician simply does not understand or
misunderstands what they are trying to communicate. This can result
in erroneous medical notes in the veterans’ record, or even
misdiagnoses. In more than a few cases, it would appear that these
communication barriers impede the delivery of quality medical care.
At minimum, it detracts from it.
The reality is that the VA will likely need to continue to hire
foreign born physicians. So the question is: what can be done to
help those physicians to be more effective in communicating with
their patients, and therefore more effective clinically? VVA urges
that Congress consider mandating the VA to regularly offer basic
communication skills courses to clinicians and others within the
VA, and to make it a requirement for a physician or other clinician
(no matter where they were born or what their native tongue) to pass
both an oral and written test in English before being made permanent
in their employment. (The same would hold true for Spanish at the
Puerto Rico VAMC.)
S. 2383 - A bill to require a pilot program on the mobile provision
of care and services for veterans in rural areas by the Department
of Veterans Affairs, and for other purposes.
VVA endorses this proposal.
As VVA noted in our last appearance before this distinguished Committee,
the current paradigm for delivery of health care is predicated on
placing resources where there is a large concentration of veterans
eligible for service. In other words, the mechanism for service delivery
of veterans’ health care is in or near urban centers. However,
those fighting our current wars in Iraq and Afghanistan (and elsewhere)
comprise the most rural army we have fielded since before World War
The Department of Defense reports that about 40 percent of the current
military force comes from towns of 25,000 or less. What this means
is that we collectively must re-think the paradigm of how we deliver
medical services to veterans in need.
The pilot program outlined in this bill is a good start toward testing
what is going to work in regard to delivering quality health care
to veterans (including demobilized National Guard and Reserves) who
live in less populous areas of our country, and deserves to be immediately
enacted, and implemented as quickly as possible.
S. 2639 – The Assured Funding for Veterans
Health Care Act
Americans have long held that health care for veterans is a national
obligation, part of the covenant between the American people, through
our democratically elected representatives and agencies of government,
and the men and women who have pledged to defend the Constitution
and the cherished principles of our nation. Because those who render
military service pledge not only their loyalty but their life, knowing
that they may be called to combat, understanding that they may give
up their life, this covenant is more profound than a legal contract.
Now, at a time when a new generation of our sons and daughters is
on the front lines defending America’s interests, it is our
obligation as citizens of a generous and compassionate society to
ensure that the funding to care for the injuries, illnesses, and
disabilities they may suffer is assured and not relegated to a “discretionary” appropriation
of inadequate proportions.
Those who serve during times of war or conflict, particularly those
who are deployed to a war zone, return home changed. Many are seared
psychologically. Some are wounded or maimed by the weapons of modern
warfare. Yet just as they have fulfilled their obligation to their
country – to all of us – it is our collective obligation
to do all that we can, through the appropriate agencies of government,
to restore as much as possible to each veteran who has been lessened
physically, psychologically, or economically; and all that we can
individually and through our communal and religious institutions
to heal each veteran who has been lessened spiritually.
All Americans committed to justice for veterans understand that
the annual budget battles in Congress do little to inspire confidence
that we will do right by our veterans. Budgets and appropriations
are, of course, a reflection of the values and priorities of the
administrators who design them and the legislators who approve them.
What does “discretionary” funding for the care of men
and women who defend our country say about America? What does the “temporary” triage
of veterans classified as “Priority 8” say about our
government’s priority for veterans who want to use the VA health-care
In the last five sessions of Congress, legislation has been introduced
in both the House and Senate that would drastically re-engineer the
process by which the Administration and Congress fund veterans’ health
The highest legislative priority of Vietnam Veterans of America
is the institution of assured funding for veterans’ health
care, or another mechanism that will enable predictable schedules
of appropriations increases that account for medical inflation and
is calculated on a truthful per capita basis of projected use of
VHA services. The Disabled American Veterans have been working on
such a model that while still not what VVA’s ultimate goal
is – assured funding – is still better that the mess
we have now.
Of all such mechanisms, however, VVA is still committed ultimately
to the assured funding mechanism as described in Senator Johnson’s
VVA also strongly supports immediate reinstatement of eligibility
for enrollment for Priority 8 veterans. VVA asks that this Committee
take the first steps toward directing that the VA use numbers for
its future planning and projection purposes that include provision
of services for Priority 8 veterans who are not currently enrolled.
A funding mechanism that annually makes allowances for the growth
in the beneficiary population and inflation would ensure adequate
additional funding as needed. Many of these plans offer similar funding
mechanisms that already exist for the TRICARE for Life program serving
the nation’s military retirees and their dependents who are
also eligible for Medicare. The funding mechanism created for this
program requires annual increments based on health care inflation
and growth in the number of beneficiaries. Rather than allowing politics
to affect funding decisions, the Government Accountability Office
(GAO) considers whether the annual increment determined will be adequate
to meet costs. This methodology brought stability and predictability
to a program that, in its infancy, suffered significant problems
attributable to funding.
Unfortunately, despite a recommendation from its own Task Force
to Improve Health Care For Our Nation’s Veterans (Final Report,
2003) to consider mandatory funding for VA health care, the Administration
has rejected any meaningful consideration of funding reform. Bills
have been introduced in both the House and Senate to no avail.
VVA is grateful to and salutes Senator Tim Johnson of South Dakota
for his fortitude in not only overcoming his own health crisis, but
for his extraordinary efforts in continuing to push for real reform
in the way in which our nation funds health care for our nation’s
Unfortunately the debates regarding funding of veterans’ health
care continue to focus on the year-to-year “band-aids” and
quick fixes needed to keep the health care system afloat. Last year,
$3.7 billion had to be appropriated as emergency supplemental funding
in order to make progress on restoring both the infrastructure and
the organizational capacity of the VHA to deal with the needs America’s
It is time to act to ensure a consistent, predictable, and responsible
level of funding that will give more than lip service to the mandates
for health care set forth in law, and by the will of the American
people, for those who have borne the battle in the fertile fields
of Europe, the islands of the South Pacific, the rice paddies and
jungles of Southeast Asia, the sands of Kuwait and Afghanistan and
Iraq, and the peacetime confrontations of the Cold War.
Establishing a method that will ensure the fair, adequate and predictable
funding of the VA health care system which would better ensure timely
access to quality care remains the highest legislative priority of
Vietnam Veterans of America.
In the five years that have followed publication of our original
White Paper asserting the need for assured funding, the Administration
and Congress have continued to provide compelling demonstrations
of the weaknesses of the current funding method.
VVA is grateful to you, Senator Akaka, and to all Senators on both
sides of the aisle who have accorded the veterans health care system
with more increase in the past eighteen months than they have ever
had, and to your counterparts on the other side of the Hill for all
of their hard work as well to achieve these record increases.
However, despite these efforts and progress, the appropriations
for the VA health care system continue to be inadequate to the degree
that the VA is still barring eligibility to health care for many
working-class veterans without compensable service-connected disabilities,
limiting long-term care options, and compromising access to quality
The uncertainty of when and how much funding it will receive wreaks
havoc upon the VA’s ability to make effective planning, policy
and purchasing decisions. While that has appeared to improve, it
will take increases of the magnitude of the last calendar year for
another several years to restore what was lost from the funding base,
and the overall organizational capacity of the VHA during the “flat
line” years of 1996 to 1999, and several years thereafter when
the increase in funding did not keep pace with either the increase
in veterans entering the system, nor rapidly rising costs of medical
care, many of which are not controllable.
Recent budget cycles call into question the VA’s ability to
produce a budget that credibly funds its health care system. Even
after compensating for the savings and foregone revenues that have
proven to be distasteful to Congress (new enrollment fees and dismantlement
of the state home program, for example), the VA had to admit it would
be $1 billion deficient in funding for fiscal year (FY) 2005 and
also would require almost $2 billion more than originally projected
for FY 2006.
Critics of the VA continue to call for it to live within its budgets
by increasing efficiency. While VVA supports much greater accountability
for VA officials, VA has proven its efficiency by actually reducing
per user costs in a time of double-digit health care inflation. VA
users’ per capita costs actually decreased by about 6 percent
(without including the eroding effects of inflation), while Medicare
per capita costs and those of the average American consumer will
have almost doubled.
Other federally funded health programs do not annually suffer through
the funding cycle as the VA does. The nation’s largest health
care system that serves some of our most deserving citizens—veterans—should
be accorded the same funding assurances as Medicare and TRICARE for
Accordingly, VVA has joined every other major veterans’ service
organization as part of the Partnership for Veterans Health Care
Budget Reform in calling for assured funding that is indexed for
medical inflation and accounts for a credible expectation of utilization
of health care services of all eligible veterans who desire enrollment.
Without fundamental changes in the VA’s budget process, veterans
who rely upon the VA’s health care services will continue to
have a system plagued by deficiency and unpredictability.
For the coming fiscal year (FY 2009), VVA testified earlier this
year that we believe the VA medical care business line will require
at least $5.24 billion over FY 2008 VHA appropriations. Some contend
that even adding that amount will not allow VHA the latitude to restore
access to all veterans.
As we all are aware, on January 17, 2003, then-Secretary Anthony
J. Principi decided to “temporarily” suspend enrollment
to Priority 8 veterans. While this decision may be reconsidered on
an annual basis, every budget proposal sent to the Congress by the
Administration since continues to omit funding for this group, and
attempts to discourage use and enrollment of “higher income” groups—that
is, all Priority 7 and Priority 8 veterans who had enrolled prior
to the suspension. The Administration has proposed new enrollment
fees for these groups in addition to imposing higher co-payments
for the pharmaceutical drugs that are largely responsible for bringing
many into the system. These proposals are designed to do two things—eliminate
services provided to higher income veterans and generate additional
revenues to partially cover the cost of their care.
Priority 8 veterans—mostly working-class Americans without
compensable disabilities incurred during their military service—are
known as “higher-income” veterans. “Higher income” is
a misleading label considering the growing rates of uninsured Americans
directly subjected to spiraling health care costs and the relatively
low-asset levels of those affected (currently, as low as about $27,000
for a veteran with no dependents). Far from redressing what veterans’ advocates
were given to believe was a “short-term” panacea, budgets
for the five years since suspension of enrollment have omitted funding
to restore access to these veterans and have espoused policies—such
as new enrollment fees and higher co-payments—that are specifically
designed to discourage these veterans’ use of their health
In last year’s proposal, the VA estimated that more than one
million “higher-income” veterans who have not been suspended
from enrollment would be discouraged from using their health care
system under their plan. Additionally it has been reported that more
than a half a million veterans have been excluded from vitally needed
services of the VHA system since that time. VVA has reason to believe
that this is too conservative a figure, and the number of those excluded
is higher still.
In an era in which health care inflation has regularly outstripped
increases in wages, it is not surprising that veterans remain attracted
to the re-engineered VA system. The proliferation of new outpatient
clinics in addition to the benefits provided to all enrollees, including
some that are not typically covered by private-sector health plans,
such as prescription drugs, eyeglasses, and hearing aids, continue
to encourage veterans’ use of VA health care services. Even
more veterans who are not considered regular users will be enrolled.
VVA estimates 8.4 to 9 million would enroll if Priority 8 veterans
were reinstated for enrollment without an enrollment fee). Enrollment
is a prerequisite for eligibility for health care services for all
but the most highly rated service-connected disabled veterans.
Recent budgets sent to Congress have also attempted to ration services
for veterans—particularly long-term care. In recent years,
state homes have overtaken the VA in the long-term care workload
they provide veterans and these homes are the only VA-sponsored settings
that continue to support custodial care for veterans whom VA is not
mandated to treat. Yet in VA’s FY 2006 budget request, a policy
shift was proposed that would have effectively shuttered as many
as 80 percent of the state veterans homes (as estimated by the National
Association of State Veterans Homes) with whom the federal government
has been working for more than 100 years. The VA is currently planning
a study of the law that requires to provide nursing home care for
veterans with a high-level of disability because of military service
that may result in requests for further curtailments in their authority.
Over the last decade VA has attempted to shift care as quickly as
possible from its own settings to the community where veterans can
be made eligible for the similarly fiscally challenged Medicaid program.
The folks at OMB just want to shift the cost away from the federal
budget, whether the states have the resources to help here or not.
Frankly, it is easy to get the impression OMB does not care whether
these veterans get the services they need or not as long as the federal
government does not have to pay.
The uncertainty of when and how much funding it will receive wreaks
havoc upon VA’s ability to make effective policy (including
enrollment), personnel, contracting and other purchasing decisions.
The VA often misses critical windows to hire new physicians and nurses
because officials do not know when new funding will become available.
Health care workers are not willing to put off employment indefinitely
when other—and often more lucrative—opportunities are
readily available in their communities. In years of relative scarcity,
most of the VHA 21 regional Veterans Integrated Service Networks
(VISNs) routinely delay badly needed equipment purchases and repairs
to meet their operating expenses.
Since FY 2002, management “efficiencies” have accumulated,
creating a $1.8 billion hole in the VA’s medical services funds
by FY 2006 (or about 8 percent the medical services budget). In a
February 1, 2006 report to Senator Daniel Akaka, Ranking Member of
the Senate Veterans Affairs Committee and Congressman Lane Evans,
Ranking Member of the House Veterans Affairs Committee, the Government
Accountability Office found that VA lacked a methodology for producing
the management efficiencies projected in budget submissions for FY
2003 and FY 2004 and that:
the management efficiency savings assumed in these requests were
savings goals used to reduce requests for a higher level of annual
appropriations in order to fill the gap between the cost associated
with VA’s projected demand for health care services and the
amount the President was willing to request.
From FY 1996 through FY 2006, however, it is clear that the VA has
had to do “more with less.” Although the Administration
continues to tout increases in the funding for the veterans health
care system, the VA’s resources per veteran user have dropped
precipitously, particularly in comparison to the per capita costs
based on national health care expenditures and the costs per Medicare
enrollee. VA users’ per capita costs actually decreased by
about 6 percent (without including the eroding effects of inflation),
while Medicare per capita costs will have almost doubled.
VA’s per capita costs for users, once higher than national
per capita costs and costs per Medicare enrollee, have actually dropped
below both of these groups and this was not included third party
collections While national health care expenditures and Medicare
enrollees’ costs have almost doubled over the period of time
studied, VA’s per capita costs have actually decreased. FY
2006 dollars were adjusted for health care inflation they would not
have nearly as much buying power as the 1996 dollar. The average
annual medical care inflation for 2001-2004 has been double the growth
for the Consumer Price Index for all other items (2.2% v. 4.4%).
A comparison of per capita costs is particularly compelling since
national health care expenditures include the costs of all Americans—many
of whom are young and healthy and may not be expected to require
the same level services as the mostly older and disabled populations
Medicare and VA serve.
Without considering the effects of medical care inflation, in sharp
contrast to the average American’s health care expenditures
or the average Medicare enrollee’s costs (both of which almost
doubled), VA’s per capita costs actually drop slightly from
1996 to 2006. This is because VA health-care funding is not linked
to growth in the beneficiary population or medical inflation.
What led to this drop in funding per VA user during a time when
other health care consumers’ costs doubled? Simply put, the
growth in the number of veterans who now use their health system
has outpaced the growth in financial resources the federal government
has invested in it (or, at least the growth has outpaced to willingness
of the OMB to recommend increases that are needed just to maintain
Still, the effects of deficient budgeting are still being felt in
many areas, despite the tremendous strides made in the past two years.
The VA estimates that almost half of its obligations for medical
services in 2006 would be spent on personal services and benefits
for its 130,000 employees. Decreases in the VA’s per user costs
have clearly translated to fewer doctors and nurses per patient.
The most likely outcomes of understaffing are adverse effects on
the timeliness and quality of care. At this time there are still
many thousands of veterans projected to wait longer than six months
for an appointment with a clinician, even though the “official” estimates
are much smaller than VVA would estimate. The Inspector General report
that was released research points out that VHA is still often not
telling the truth about waiting times, and so many clinics are “gaming” the
system that it is hard to figure out what the actual figures might
be. In many areas of the country, such as Florida, VA has experienced
severe problems placing even service-connected veterans on waiting
With funding uncertainties removed, the VA leadership could focus
on implementing measures to create a true veterans health-care system—a
system in which every veteran who enrolls would be given a full physical
examination, including a comprehensive military health and medical
history and a psychosocial evaluation. This history would provide
an epidemiological baseline to help measure future health conditions
not only for a particular veteran but potentially for others with
whom (s)he served. When an extensive epidemiological database is
finally compiled, it can serve as an invaluable tool for physicians.
With more information about a patient’s military background,
a doctor would know to test for particular conditions, parasites,
and toxic exposures that may already be adversely affecting the health
of that veteran. Such a database could reveal whether others who
served in the same unit reported similar health effects. It could
also serve as a tool to identify common exposures that may be related
to the incidence of conditions that have long latency periods.
Such findings, combined with better sharing of military records,
including the location of troops, deployment health, and pre- and
post-deployment health information, could serve as the basis for
research into the health effects of a particular exposure, occupation
or even combat or theater experience.
VVA has long stressed the importance of collecting such information,
and the results are taking root in the Veterans Health Initiative
(VHI). This VA endeavor educates providers about certain exposures
and health effects that are prevalent among veterans or for which
veterans have been shown to be at unique risk The VA has made these
training modules available to its providers and should take further
steps to educate the general medical community from whom most veterans
VVA still maintains that managerial accountability goes hand-in-hand
with assured or “mandatory” funding. To its great credit,
the VA has implemented a clinical information system which allows
it to evaluate its success in meeting a variety of clinical and administrative
goals. However, some managers who have had problems overseeing high-investment
projects or publicized breaches in government protocols, spotty records
of adherence to departmental directives and law, and cited problems
in Government Accountability Office and Inspector General reports
on their area in negative ways continue to be rewarded. Rewards cannot
solely be based on achievement of certain goals, if there are well
documented (and often highly publicized) problems that are not rectified.
The deposition of the Associate Deputy Under Secretary for Health
for a recent civil action in Federal Court demonstrated (in his own
words) that in regard to quality assurance for delivery of PTSD and
other neuro-psychiatric are that “we do not have metrics in
place to measure that.”
When clearly understood performance standards have been met and
there are not clear violations in protocol, rewards should be made
from the top-down. Just as rewards must be provided, the system must
also sanction those whose performance is inadequate.
While there is a legitimate need to make significant adjustments
in the compensation for critical healthcare workers, the current
use of “merit bonuses” has been corrupted. Merit bonuses
must be just that: bonuses for merit and achievement above and beyond
that which is required. The current mode does a disservice to the
many fine VA physicians and administrators who deserve more competitive
pay and bonuses for truly outstanding performance. The system of
rewards and punishment must be adjusted to sanction those who do
a poor job or are not fully open and honest with appointed or elected
To ensure accountability, the VA must develop adequate training
and testing tools for personnel at all levels of the organization.
Neither managers nor their employees can be held responsible for
violating protocols of which they are not aware. In a constantly
evolving health care environment governed by a complex array of law,
regulations, internal guidance and voluntarily imposed guidelines
from accreditation agencies, compliance is difficult. Without ensuring
that management and employees receive updates and appropriate training
it is impossible.
We as a nation can and must do better for our veterans. Funding
for veterans’ health care has been woefully inadequate for
years. As Dr. Linda Spoonster Schwartz, currently Commissioner of
Veterans Affairs for the State of Connecticut and Chair of the Health
Care Committee of the National Association of State Directors of
Veterans Affairs put it: “The lack of a consistent, reliable
budget has, in essence, obstructed VA’s capacity to respond
to the changing needs of the health-care system, to efficiently grow,
to acquire competent personnel and maintain a viable service infrastructure.” And
as the President’s Task Force to Improve Health Care Delivery
for Our Nation’s Veterans concluded:
Funding provided through the current budget and appropriations process
for VA health care delivery has not kept pace with demand, despite
efforts to increase efficiencies and focus health care delivery in
the most cost-effective manner. . . . Full funding should occur through
modification to the current budget and appropriation process by using
a mandatory funding mechanism, or by some other change in the process
that achieves the desired goal.
It is imperative to enact legislation that would assure funding
for veterans’ health care. An assured, predictable and reliable
funding stream would enable the VA to concentrate on achieving accountability
for performance from senior managers and building a system that is
not only cost-effective and efficient, but contributes to the mission
of restoring veterans who have been lessened physically through injury
or illness or the psychic wounds of war, or economically by virtue
of military service.
VVA and other VSOs believe it is ultimately disingenuous for our
government to promise health care to veterans and then fail to provide
adequate funding. Rationed health care must only be a temporary expedient
as Congress moves toward an assured funding model. We endorse the
proposition that “by including all veterans currently eligible
and enrolled for care, we protect the system and the specialized
programs VA has developed to improve the health and well-being of
our nation’s sick and disabled veterans.”
A Word on the Office of Management & Budget (OMB)
It should be clear to all that the current method of funding health
care services to veterans has not been working very well for some
years now, despite some nigh on to heroic efforts by the Congress.
Some of this is due to the funding for this vital function being
classified as “discretionary” funding. But it needs to
be publicly noted that much of the difficulty in this being “discretionary” spending
is the difficulty of overcoming the churlish attitude toward veterans
of the OMB and their willful ignorance of the reality of veterans’ needs
or even of what actually happens in VA facilities.
The current Deputy Director of OMB and her staff have never visited
a VA medical center, not even once. The previous permanent ranking
civil servant permanent employee the veterans unit at OMB had held
her job for about two decades and never once even entered a VA medical
facility. We would also point out that the last time we checked,
OMB less than 10 veterans employed out of more than 970 employees,
and 0 disabled veterans. And yet OMB is theoretically subject to
the same Veterans’ Preference laws as the rest of the government.
The only way this could happen is in a corp. Just by accident they
should have had more than 10 veterans and at least SOME disabled
veterans in their orate culture that condones the conscious and deliberate
patterns and practices of overt discrimination against persons who
served our nation in military service, and particularly prejudice
against employing disabled veterans.
If OMB had hired no women, or no African-Americans, or no of Hispanic
decent, or no Asian Americans would anyone accept their contention
that could find no qualified candidates from those groups to work
there? VVA thinks not, and that similarly we should not accept this
continued illegal pattern and practice by OMB that discriminates
against veterans, particularly disabled veterans.
Given OMB’s clear attitude toward employing veterans, it should
come as no surprise to anyone that this lack of respect should be
reflected in their work and budgets produced in regard to the VA
and other programs vital to veterans. At least it is now more understandable
that they always try to give too few resources to properly assist
veterans, no matter how good the program. That does not make it proper
or legitimate, but at least we know what we are dealing with.
S. 2796 - Community-Based Organization Pilot Programs
VVA strongly endorses this bill. The experience of Vietnam veterans
in the 1970s showed that the most effective, and certainly the most
efficient, mechanism for serving otherwise “under-served” veterans
was by means of funding community based organizations (CBOs) for
specific purposes on a pay for performance basis. The experience
in the past decade has clearly shown that the most cost effective,
cost efficient means of reaching and properly serving homeless veterans
has been though funding community based organizations to do this.
For example, the Homeless Veterans Reintegration Project (HVRP)
which helps place homeless and formerly homeless veterans in full
time employment is far and away the most cost effective, cost efficient
program administered though any branch of the U. S. Department of
Labor. It is therefore a mystery to VVA as to why this program is
not funded at the full $50 million that is authorized, as it works
and works well to move veterans from the welfare dole to the tax
rolls, and helps them restore their sense of dignity and self worth,
in addition to helping them lift themselves off of the street and
back into society, through supporting them in their effort to work
their way back up.
A similar program funded by up to $50 million at VA to perform the
duties as outlined in this proposed legislation would be similarly
successful. We can cite at least two organizations that are CBOs
that have been doing this multi-service center work successfully
for three decades. One is Swords to Plowshares, in San Francisco,
California, and the other is the Veterans Outreach Center in Rochester,
New York. Both of these organizations have received funding from
various sources over the years, some from private donations, some
via grants from private donations, at times they have received state
funding, and sometimes local government funding. From time to time
their funding sources have changed, but their core commitment to
serving the whole person, and assisting the veteran in all aspects
of his or her life to re-construct a decent life and a way forward
toward a more complete human existence has not changed or wavered.
Furthermore, they do so and achieve a success rate of reaching and
substantially assisting veterans to meet their recovery goals at
a cost per participant that is far less than most programs delivered
by large agencies. This model already demonstrably works.
Chairman Akaka is to be commended for introducing this legislation,
but we suggest that you consider giving this pilot an authorized
amount of funding for at least three years, and direct VA to work
with already existing similar programs in developing the Request
For Proposal, as well as consulting with the National Coalition for
Homeless Veterans and the veterans’ service organizations who
may have knowledge of such programs. We also suggest that the VA
be directed to report back to you within 180 days of enactment their
plan for issuing a Request for Proposal, and that VA deliver a report
and analysis of the pilot to VA on a yearly basis thereafter.
S. 2797 -Construction Authorization
VVA has no objection to most of these requests, as most of the items
requested by the Administration are needed. VVA does believe, however
that the pace of reconstructing and replacing of the physical infrastructure
of the Veterans Health Administration needs to be quickened. For
quite a number of years virtually no construction was funded until
VA designed a plan that had some sense and rationale to it. Even
though VVA still has significant reservations in regard to the CARES
formula, at least there is a comprehensible model to formulate a
plan for facilities for the future. Therefore, we should get on with
it at a faster pace, before construction costs soar even higher.
However, in regard to the medical facility in San Juan, Puerto Rico
VVA has serious reservations about VA’s plan to try and jury
rig and shore up an outdated and outmoded early 1960s style building
that is in danger of collapsing in a hurricane currently, as opposed
to designing and building a new, strong, and modern medical facility.
If you fix up an outmoded structure that was poorly designed to begin
with, then you have a poorly designed facility that still is inadequate
to meet the needs of the future.
Frankly, one has to question whether some other factor was operating
here that Denver gets a $2 billion state-of-the-art beautiful facility
that will not even be fully owned by VA, but San Juan gets some left-overs
and an as cheap as possible retrofit of an outmoded and energy inefficient
structure that even when the projected work is finished will not
even approach being the “best,” nor will it be able to
withstand a direct hit of the likely stronger storms that we will
experience in the coming decades. VVA understands that if the money
is authorized and appropriated to do this retro-fit in San Juan,
then the possibilities of a proper new building will be slim to none.
Therefore, VVA strongly encourages the Committee to take a very
strong look at Puerto Rico as to every aspect of services provided
there, from medical services to claims adjudication to the state
of the cemetery which will be full in a relatively short time. The
construction plans for parking, the medical facility, and additional
space for proper burial of veterans there all seem to be less than
one would expect, or certainly less than accorded other areas in
the United States. The veterans in Puerto Rico performed no less
well, and fought no less valiantly, and in fact served in a higher
than average percentage in the combat arms than those from elsewhere,
and so should not be relegated to cut rate facilities or service.
The veterans of San Juan deserve no less consideration than the veterans
S. 2799 - Women Veterans Health Care Improvement Act of 2008
VVA salutes Senator Murray for introducing this much needed legislation,
which should be enacted as soon as possible.
Women comprise the fastest growing segment of the Armed Forces,
and therefore as they leave the military, the fastest growing sub-set
of the veterans’ population. Thousands have been deployed to
Iraq and Afghanistan. This has particularly serious implications
for the VA healthcare system because the VA itself projects that
by 2010 more than 14 % of all veterans utilizing its services will
Women’s health care is not evenly distributed or available
throughout the VA system. Although women veterans are the fastest
growing subset, there remains a need for increased focus on health
care and its delivery to women, particularly the young women coming
home today. What is needed are real women’s medical clinics
that are separate places within each hospital, and ensure that the
women get the privacy and the “comfort level” needed
for them to seek assistance for he full range of maladies from which
they may suffer, including Military Sexual Trauma (MST).
Although women veterans are the fastest growing population within
the VA, there remains a need for an increased focus on health care
and its delivery for women, particularly the new women veterans of
today. Although VA Central Office may interpret women's health services
as preventive, primary, and gender-specific care, this comprehensive
concept remains ambiguous and splintered in its delivery throughout
all the VA medical centers. Many at the VHA appear (unfortunately
and wrongly) to view women's health as only a GYN clinic. It certainly
involves more than gynecological care. In reality, women's health
is viewed as a specialty unto itself as demonstrated in every University
Medical School in the country.
Furthermore, some women continue to report a less than "accepting,” "friendly,” or "knowledgeable" attitude
or environment both within the VA and/or by third party vendors.
This may be the result, at least in part, of a system that has evolved
principally (or exclusively) to address the medical needs of male
veterans. But reports also indicate that in mixed gender residential
programs, women remain fearful and unsafe.
The nature of the combat in Iraq and Afghanistan is putting service
members at an increased risk for PTSD. In these wars without fronts, “combat
support troops” are just as likely to be affected by the same
traumas as infantry personnel. They are clearly in the midst of the “combat
setting”. No matter how you look at it, Iraq is a chaotic war
in which an unprecedented number of women have been exposed to high
levels of violence and stress as more than 160,000 female soldiers
have been deployed to Iraq and Afghanistan… This compared
to the 7,500 who served in Vietnam and the 41,000 who were dispatched
to the Gulf War in the early ‘90s. Today, nearly one of every
20 U.S. soldiers in Iraq/Afghanistan is female. The death and casualty
rates reflect this increased exposure.
With 15-18 percent of America's active-duty military being female
(20% of all new recruits) and nearly half of them have been deployed
to Iraq and/or Afghanistan, there are particularly serious implications
for the VA healthcare system because the VA itself projects that
by 2010, more than 14 percent of all its veterans will be women,
compared with just two percent in 1997. Although the VA has made
vast improvements in treating women since 1992, returning female
OIF and OEF veterans in particular face a variety of co-occurring
ailments and traumas heretofore unseen by the VA healthcare system.
There have been few large-scale studies done on the particular psychiatric
effects of combat on female soldiers in the United States, mostly
because the sample size has heretofore been small. More than one-quarter
of female veterans of Vietnam developed PTSD at some point in their
lives, according to the National Vietnam Veterans Readjustment Survey
conducted in the mid-‘80s, which included 432 women, most of
whom were nurses. (The PTSD rate for women was 4 percent below that
of the men.) Two years after deployment to the Gulf War, where combat
exposure was relatively low, Army data showed that 16 percent of
a sample of female soldiers studied met diagnostic criteria for PTSD,
as opposed to 8 percent of their male counterparts. The data reflect
a larger finding, supported by other research that women are more
likely to be given diagnoses of PTSD, in some cases at twice the
rate of men. Matthew Friedman, Executive Director of the National
Center for PTSD, a research-and-education program financed by the
Department of Veterans Affairs, points out that some traumatic experiences
have been shown to be more psychologically “toxic” than
others. Rape, in particular, is thought to be the most likely to
lead to PTSD in women (and in men, where it occurs). Participation
in combat, though, he says, is not far behind.
Much of what we know about trauma comes primarily from research
on two distinct populations – civilian women who have been
raped and male combat veterans. But taking into account the large
number of women serving in dangerous conditions in Iraq and reports
suggesting that women in the military bear a higher risk than civilian
women of having been sexually assaulted either before or during their
service, it’s conceivable that this war may well generate an
unfortunate new group to study – women who have experienced
sexual assault and combat, many of them before they turn 25.
Returning female OIF and OEF troops also face other crises. For
example, studies conducted at the Durham, North Carolina Comprehensive
Women’s Health Center by VA researchers have demonstrated higher
rates of suicidal tendencies among women veterans suffering depression
with co-morbid PTSD. And according to a Pentagon study released in
March 2006, more female soldiers report mental health concerns than
their male comrades: 24 percent compared to 19 percent.
VA data showed that 25,960 of the 69,861 women separated from the
military during fiscal years 2002-06 sought VA services. Of this
number approximately 35.8 percent requested assistance for “mental
disorders” (i.e., based on VA ICD-9 categories) of which 21
percent was for post traumatic stress disorder or PTSD, with older
female vets showing higher PTSD rates. Also, as of early May 2007,
14.5 percent of female OEF/OIF veterans reported having endured military
sexual trauma (MST). Although all VA medical centers are required
to have MST clinicians, very few clinicians within the VA are prepared
to treat co-occurring combat-induced PTSD and MST. These issues singly
are ones that need address, but concomitantly create a unique set
of circumstances that demonstrates another of the challenges facing
the VA. The VA will need to directly identify its ability and capacity
to address these issues along with providing oversight and accountability
to the delivery of services in this regard. All of these issues,
traumas, stress, and crises have a direct effect on the women veterans
who find themselves homeless. Early enactment of Senator Murray’s
bill on women veterans currently pending in the Senate will do much
to rectify this situation, and VVA commends her for her leadership
in this and other matters of vital interest to veterans.
Although veterans make up about 11% of the adult population, they
make up 26% of the homeless population. Of the 154,000 homeless veterans
estimated by the VA, women make up 4 percent of that population. Striking,
however, is the fact that the VA also reports that of the new homeless
veterans more than 11% of these are women. It is believed that this
dramatic increase is directly related to the increased number of
women now in the military (15% - 18%). About half of all homeless
veterans have a mental illness and more than three out of four suffer
from alcohol or other substance abuse problems. Nearly forty percent
have both psychiatric and substance abuse disorders. Homeless veterans
in some respects make use of the entire VA as do any other eligible
group of veterans. Therefore all delivery systems and services offered
by the VA have an impact on homeless veterans. Further, the failure
of the Department of Labor system to provide needed employment assistance
in a nationwide accountable manner to many veterans means they lose
their slim purchase on the lower middle class, and therefore end
up homeless. Once homeless, it becomes very difficult for these veterans
to find employment for a multiplicity of reasons.
The VA must be prepared to provide services to these former servicemembers
in appropriate settings.
VVA thanks Senator Patty Murray for her leadership on the issue
of ensuring that women veterans get proper health care and services
that is different but equal to me. This bill warrants speedy passage
and prompt full implementation.
S. 2824 - A bill to amend title 38, United States Code, to improve
the collective bargaining rights and procedures for review of adverse
actions of certain employees of the Department of Veterans Affairs.
VVA supports collective bargaining rights, and commends Senator
Rockefeller for his leadership in introducing this bill.
S. 2889 (Akaka, by request) Veterans Health Care Act of 2008, Sections
2, 3, 4, 5, and 6
VVA generally supports Sections 3, 4, 5, and 6 of this proposed
legislation. In regard to Section 2, VVA suggests you consider revising
to say Global War on Terror, which is generic enough to cover anyone
who experiences such deficits due to traumatic brain injury wherever
they might be serving in the world in the United States Armed Services.
Further, VVA suggests that a clause be added to the effect “and
other such veterans who may be eligible for and in need of this type
As you know, VVA’s founding principle is “Never again
shall one generation of veterans abandon another generation.” VVA
continues to try and live up to that principle in regard to both
our fathers who served in World War II and toward the young people
serving today and who have already come home, all too often wounded.
However, the disturbing trend in much of what the Administration
proposes would divide the generations. We suggest that by adding “and
other such veterans as may be in need of this type of care” that
this distinguished committee can avoid the slippery slope of dividing
the generations, no matter whether that is intended or not.
S. 2899 - A bill to direct the Secretary of Veterans Affairs to
conduct a study on suicides among veterans
VVA generally favors anything that will produce reliable data regarding
the thorny question of suicide among veterans of every generation.
Any suicide is a terrible thing that leads almost all who know the
person to question themselves: what could I have done better to have
saved him or her? Good data on suicides is a very scarce commodity.
Suicide has been a topic of much (often quite animated and passionate)
debate and discussion about and among Vietnam veterans for 30 years,
However, since VA refuses to obey the law and complete the National
Vietnam Veterans Readjustment Study replication, thus producing a
longitudinal study of Vietnam veterans utilizing a statistically
valid random sample, we do not have any idea of why Vietnam veterans
and, we suspect young veterans are dying by their own hand in disproportionate
Given their poor track record in regard to telling the whole truth
on this and other sensitive subjects (particularly regarding suicides),
VVA does not feel that VA can be trusted to do such a study on its
own, as most people would have doubts as to the credibility of almost
any statistics on suicide they advance at this time.
Therefore we urge that this bill be modified so as to prescribe
the protocol to be used and direct VA to contract it out to a nationally
respected research institution after first consulting with the VSOs,
entities such as the American Psychiatric Association, the American
Psychological Association, and others as appropriate to produce a
Request for Proposal (RFP) that is supplied to the Committees on
Veterans Affairs for review prior to publishing said RFP.
S. 2921- Caring for Wounded Warriors Act of 2008
VVA generally favors this proposal. As VVA has pointed out in numerous
forums, soldiers are surviving initial wounds that would have killed
them in previous wars, and therefore are suffering really grievous
wounds in larger percentages than previous conflicts. When we came
home from Vietnam, when you were in the hospital, you were literally
in the hospital for many months or even years while undergoing treatment.
That is just not the case today, as the overwhelming majority of
health care delivery is on an outpatient basis, even for those with
really severe multiple wounds, or wounds that would preclude them
being able to drive a car or function on public transport (where
there is such public transportation).
The treatment model currently being used for these veterans with
severe conditions is all predicated on having an intact nuclear family
akin to Ozzie & Harriet, where a parent or the spouse can be
full time chauffer and caregiver for many months or even years. This
has placed terrible strains on many young marriages that were already
stressed by the absence of one member of the couple in a war zone,
and then the swift change of reality for the soldier or marine (and
by extension his or her family) in one terrible instant.
For starters, many spouses or other family members have to work
to help provide additional income to keep the family together and
the bills paid. This proposal would allow spouses, mothers, or other
family members to receive remuneration and training to provide these
essential services that are necessary for the best possible recovery
and rehabilitation of these fine service members. Further, this proposal
would allow graduate students to be trained to provide respite care,
which is necessary so that the primary care giver does not suffer
from utter exhaustion and compassion fatigue. VVA suggest that you
consider opening this up further to nursing students, students in
other medical and helping professions (particularly veterans who
are attending institutions of higher education after return from
military service), and possibly undergraduates, if they are more
than 21 years old and/or they are returning veterans themselves that
have completed at least one year or more of study in their field.
This proposal is a practical one, and meets a real need.
S. 2926 - Veterans Nonprofit Research and Education Corporations
Enhancement Act of 2008.
VVA does not have objection to this legislation. However, we do
urge that there be much more disclosure of the activities of each
of these corporations as may be established, both to the Secretary
of Veterans Affairs and to the Congress. We also urge that public
posting on the internet of who are on the Boards of Directors of
these corporations, what their profession and or business interests
are, and regular summaries of any and all funds accepted and the
source(s), all funds spent on research for each purpose, and other
information regarding governance or what research is being funded
by what source of funds, producing what results toward what end?
There is already a disturbing trend in the Veterans Health Administration
toward excessive secrecy, e.g. conducting the Secretary of Veterans’ Affairs
Advisory Committee on PTSD in total secrecy, with not even a minimal
publication of the work of this committee. Similarly, the decision
of the previous Undersecretary and which the current Undersecretary
continues to intransigently insist on keeping the sunshine of daylight
and public or consumer advocates off of much of the proceedings of
the Advisory Committee on Serious Mental Illness.
It will certainly take action by the Congress and probably a new
President who is committed to open and honest government of the people
by the people to change this “We know best, and if you only
knew what we know” current mentality of some in VHA that is
unworthy of a constitutional democracy.
Until then, the attitude at VHA apparently will continue to one
This attitude does a great disservice to veterans who depend on
this system for quality medical care, and a great disservice to the
many thousands of fine clinicians across the country in VA who just
want to do a good job of helping veterans heal, and who do in fact
manage to do outstanding work, no matter how much some of them are
punished for doing right by the veterans we all serve.
S. 2937 - A bill to provide permanent treatment authority for participants
in Department of Defense chemical and biological testing conducted
by Deseret Test Center and an expanded study of the health impact
of Project Shipboard Hazard and Defense, and for other purposes.
VVA favors making permanent the right of all participants in chemical,
biological, and pharmacological testing by the military services
or any other federal government entity to be able to receive medical
care without charge from the VA.
VVA is very supportive of the right that those who participated
in the Shipboard Hazards and Decontamination (Project SHAD).
However, Project SHAD was just one part of Project 112, which includes
many more individuals than served in Project SHAD tests per se. VVA
urges this Committee to broaden the group covered by this part of
VVA also urges the Committee to consider the proposed legislation
being advanced in the House of Representatives by Congressman Mike
Thompson of California, which would go further in that it would create
a commission to study all of Project 112, and possibly other tests
that took place of a chemical, biological, or pharmacological nature
during that same time period of 1963 to 1973.
Lastly, there is a real need for further study of the adverse health
effects due to exposure of service members in Project SHAD that focuses
on the crews of the light tugs, and others who were not properly
covered by the previous IOM study. VVA will be pleased to work with
Senator Tester and with staff to make the changes briefly outlined
here to produce a bill that we can enthusiastically support.
S. 2963 - A bill to improve and enhance the mental health care benefits
available to members of the Armed Forces and veterans, to enhance
counseling and other benefits available to survivors of members of
the Armed Forces and veterans, and for other purposes.
Vietnam Veterans of America is grateful to Senator Bond for his
leadership on this and other issues of medical care and treatment
of returning war fighters, both while they are still in the Armed
Forces, and once they become veterans. The work and thinking that
went into this proposal is both laudable and solid.
In regard to Section 1 of S.2963, VVA has favored and advocated
such scholarships for the education and training of behavioral health
specialists for Vet Centers operated by the Readjustment Counseling
Service of the VHA for 26 years, ever since VVA made the motion that
led to the very first recommendation of the then brand new Administrator’s
Advisory Committee on the Readjustment of Vietnam Veterans (now the
Secretary’s Advisory committee on the Readjustment of Combat
Veterans) that called for such scholarships to be created. VVA does
urge that preference be accorded to veterans for receipt of these
scholarships, especially those who have served in a combat theater
In Section 2 of S.2963, VVA recommends that the wording be changed
to veterans of the Global War on Terror (GWOT) who have served in
a theater of combat, or have experienced combat situations. Those
who have and are serving in the southern Philippines or the horn
of Africa, and elsewhere should be covered by this provision as well.
Further, VVA strongly believes that the Vet Centers are the ones
who have the mind set, training, and the treatment models to best
help the still on active duty troops and their families. However,
the VA must be mandated to add to the credentialed professional counseling
staff in significant numbers before we can fully support this title.
The Congress gave VA an additional $20 million specifically to add
at least another 250 counseling staff members to the Vet Centers
as part of the Emergency Supplemental War Appropriation bill signed
by the President on March 7, 2007. The VA did not release the money
to the Readjustment Counseling Service until past the mid- August,
which was far too late to spend any of these funds on personnel before
the Fiscal Year ended. Therefore the VA bought much needed computers
and computer software upgrades in addition to purchasing vehicles
for outreach into rural and other hard to reach areas where veterans
currently were not being served.
Since that time the RCS has only hired another 62 professional counselors
in the pre-existing centers (to wit, separate and apart from the
staff being hired to staff the more than two dozen new Vet Center
sites that have already or will be opening by the end of this year.).
The problem is that the existing Vet Centers (or at least the majority
of them) are virtually over-run with more veteran clients than they
can effectively serve. The reason they have so many clients is that
they are generally very good at what they do. So, what already is
happening in regard to basically pushing aside earlier generations
of veterans will be accelerated if the centers are opened to active
duty personnel and their families.
The solution is to add the resources beginning immediately so that
the Vet Centers are not forced into a situation of forced “Triage” that
leaves some older veterans who depend on their local Vet Center to
keep them alive, help them keep it together to successfully continue
in their job, and veterans of previous conflicts who need the Vet
Center to help them deal with relationship and family problems, to
keep families together, are not pushed out into the cold (both figuratively
and in some instances literally).
The simple solution is for them to start adding more staff immediately.
For the VHA to say they do not have enough money to do so is simply
disingenuous, as the Congress gave them more than $3 Billion for
the current fiscal year more than they said they needed to provide
all services to all legally entitled to service.
VVA very much wants to support this section, but the VA must be
compelled to add another 250 to 350 staff members to serve the needs
of those whom they are already seeing, as well as to be ready to
effectively serve those active duty service members who will seek
their services once they know of the Vet Centers, and understand
they can go there with no potentially bad effect on their military
career. That way these fine young war fighters will be able to enhance
their career as they learn to better cope with their symptoms, and
overcome their neuro-psychiatric wounds.
In regard to Section 3 of S. 2963, VVA favors this provision, and
recommends in addition that all former members of the Armed Services
who were separated from the military for reason of “personality
disorder” after having served in a combat theater of operations
be accorded full rights under the law to utilize any and all services
of the VA Vet Centers.
In regard to Section 4 of S. 2963, VVA strongly supports this provision.
Further VVA asks that the Committee considers adding the phrase “died
by their own hand” so as to include those who take their lives
via single car accidents and one person “hunting accidents” and
the like to this category. Coroners are often loath to list these
formally as suicides in many cases, even though we have good reason
and experience to suspect that many of these so-called “accidents” within
the first two years after return from a combat situation are really
In regard to Section 5 of S. 2963, VVA strongly favors utilizing
the services of not for profit organizations to provide services
to veterans in hard to reach communities and to hard to reach constituencies
whether they are located in rural or in urban areas. As one example,
perhaps the most effective way to reach veterans who live in the
Bedford-Stuyvesant or Fort Green sections of Brooklyn is through
contracting with the “Black Veterans for Social Justice” organization
that has been amassing credibility with veterans and their families,
and delivering quality services to veterans in a way in which they
will accept that help for thirty years.
S. 2969 Veterans’ Medical Personnel Recruitment
and Retention Act of 2008
VVA has no objection to this proposed legislation.
We do have some concerns, however. In regard to “nursing assistants” VVA
hopes that there will continue to be an emphasis on a career track
for nursing assistants to acquire needed education to become vocational
nurses or registered nurses if they so desire. VVA also urges the
Committee to consider including a special scholarship program for
returning Army medics and Navy Medical Corpsmen/women to become Physician
Assistants, and to require VA to have a range of practice for PAs
in the VA that is comparable to the range of practice for PAs in
the military services.
VVA has long favored competitive salaries for top VA personnel and
managers. Thus we support the proposed increases to enhance recruitment
and retention of top professionals to run the VA health care system.
However, with increased pay must come much greater accountability.
For someone in the VA to make just a bit less than the Nation pays
the Commander in Chief does seem to be pushing the limits. Therefore,
VVA will ask on behalf of all veterans (and all other tax payers
as well), what are the mechanisms/means in place for evaluation to
ensure that we are getting our money’s worth?
VVA suggests that the VA will pay attention to this crying need
for holding these same highly paid employees more accountable for
performance or non-performance by VA officials if the Congress takes
steps to require them to pay attention to measuring and evaluating
the value that the nation gets for expenditures made.
S.2984 – “Veterans Benefits Enhancement
Act of 2008”
At first blush VVA has no objection to this bill, although we do
recommend that Committee study the provisions pertaining to the elimination
of certain reporting requirements very carefully to assess what if
any impact this will have on the already most inadequate transparency
of the workings of the VA.
This concludes our testimony. I shall be glad to answer any questions
you might have. Again, all of us at VVA thank you for the opportunity
to provide our thoughts and hopefully useful suggestions regarding
these proposed legislative initiatives. VVA thanks you and your distinguished
colleagues for your fine efforts on behalf of America’s veterans.
1. Sayer, N. A. and Thuras, P. 2002. The influence of patients’ compensation-seeking
status on the perception of veteran’s affairs clinicians. Psychiatry.
Serv. 53: 210-212.
2. Kimbrell, T.A. and Freeman, T. W. 2003. Clinical care of veterans
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VIETNAM VETERANS OF AMERICA
May 21, 2008
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
Thomas J. Berger, Ph.D.
Dr. Tom Berger is a Life Member of Vietnam Veterans of America (VVA)
and founding member of VVA Chapter 317 in Kansas City, Missouri.
He currently serves as National Chair of VVA’s PTSD and Substance
Abuse Committee. As such, he is a member and Chair of the Veterans’ Healthcare
Administration’s (VHA) Consumer Liaison Council for the Committee
on Care of Veterans with Serious Mental Illness (SMI Committee),
the Executive Committee of the Mental Health Quality Enhancement
Research Initiative Depression Work Group (MHQUERI), and the South
Central Mental Illness Research and Education Clinical Center (SC
MIRECC). In addition, Dr. Berger holds the distinction of being the
first representative of a national veterans’ service organization
to hold membership on the VHA’s Executive Committee of the
Substance Use Disorder Quality Enhancement Research Initiative (SUD
QUERI). He also serves as a member of the National Leadership Forum
for Behavioral Health and Criminal Justice Services with the CMHS
National GAINS Center, the National Steering Committee of the CMHS
National Center for Trauma-Informed Care and as a reviewer of research
proposals for DoD’s “Congressionally Directed Medical
Research Programs”. He is a member of VVA’s national
Health Care, Government Affairs, Agent Orange and Toxic Substances,
Women Veterans, and Homeless committees. At the local level he serves
as a Board member and Secretary of the Missouri Vietnam Veterans
Foundation and as both President and Secretary of Welcome Home, Inc.,
a non-profit domiciliary for veterans suffering from PTSD and substance
abuse, located in Columbia, Missouri.
Dr. Berger served as a Navy Corpsman with the 3rd Marine Corps Division
in Vietnam, 1967-68. Following his military service and upon the
subsequent completion of his postdoctoral studies, he held faculty
and administrative appointments at the University of Kansas in Lawrence,
the State University System of Florida in Tallahassee, and the University
of Missouri-Columbia, as well as program administrator positions
with the Illinois Easter Seal Society and United Cerebral Palsy of
Northwest Missouri. His professional publications include books and
research articles in the biological sciences, wildlife regulatory
law, adolescent risk behaviors, and post-traumatic stress disorder.
Dr. Berger now devotes his efforts full-time to veterans’ advocacy
at the local, state and national levels on behalf of Vietnam Veterans
of America. He presently resides in Columbia, Missouri and his hobbies
are cycling, music, cooking, and reading.
Richard F. “Rick” Weidman serves as Director of Government
Relations on the National Staff of Vietnam Veterans of America. As
such, he is the primary spokesperson for VVA in Washington. He served
as a 1-A-O Army Medical Corpsman during the Vietnam War, including
service with Company C, 23rd Med, AMERICAL Division, located in I
Corps of Vietnam in 1969.
Mr. Weidman was part of the staff of VVA from 1979 to 1987, serving
variously as Membership Service Director, Agency Liaison, and Director
of Government Relations. He left VVA to serve in the Administration
of Governor Mario M. Cuomo as statewide director of veterans’ employment & training
(State Veterans Programs Administrator) for the New York State Department
He has served as Consultant on Legislative Affairs to the National
Coalition for Homeless Veterans (NCHV), and served at various times
on the VA Readjustment Advisory Committee, the Secretary of Labor’s
Advisory Committee on Veterans Employment & Training, the President’s
Committee on Employment of Persons with Disabilities - Subcommittee
on Disabled Veterans, Advisory Committee on Veterans’ Entrepreneurship
at the Small Business Administration, and numerous other advocacy
posts. He currently serves as Chairman of the Task Force for Veterans’ Entrepreneurship,
which has become the principal collective voice for veteran and disabled
veteran small-business owners.
Mr. Weidman was an instructor and administrator at Johnson State
College (Vermont) in the 1970s, where he was also active in community
and veterans affairs. He attended Colgate University (B.A., 1967),
and did graduate study at the University of Vermont.
He is married and has four children.
VVA estimated this number by applying the growth in numbers of
enrollees from 2002-2003 to estimates of enrollees (without the proposed
enrollment fee) in the Administration’s budget submission for
2006. VVA estimated 70% of these enrollees would use VA services.