Chairman Akaka, Ranking Member Burr, and other members of this distinguished and important committee, Vietnam Veterans of America (VVA) appreciates the opportunity to offer our statement for the record concerning several bills affecting veterans that are up for your consideration. Please know that VVA appreciates the efforts of this committee for the work you are doing on behalf of our nation’s veterans and their families.
Mr. Chairman, as you have indicated that you are most interested in VVA’s views on S. 1237 and S. 1547, we’ll commence with these, and then follow with the other bills in the order in which they were introduced.
S. 1237, the Homeless Women Veterans and Homeless Veterans with Children Act of 2009. Enactment of this legislation would expand the grant program for homeless veterans with special needs to include male veterans who are homeless with minor dependents, and to establish a grant program for reintegration of homeless veterans, both male and female, with children.
Vietnam Veterans of America (VVA) has a long history of promoting equal access to care, treatment, and benefits for all veterans. With the increasing number of new, and younger, veterans who find themselves without a home and with dependent children, it is essential that the agencies of government and the non-governmental entities funded to assist these men and women be given the mandate and the funding necessary to assist these veterans – before their homelessness becomes chronic. Job training and job skills enhancement and placement services can lead to employment possibilities that will otherwise likely escape these veterans. Providing funding for the care of their children, too, is a vital facet of this effort.
While VVA supports enactment of this legislation, we caution, though, that for many of these veterans, job counseling, training, and assistance need to be coupled with appropriate mental health and substance abuse services and housing. The VA needs to be held accountable for the tens millions of dollars that were supposed to go toward hiring new mental health clinicians. Were the clinicians actually hired? Have they been they properly trained and supervised? Are they following the recognized best practices protocols? We urge that the Congress do much more stringent oversight of the VA for how they actually use the funds they get. With this in mind, VVA urges that Congress take a holistic approach to the persistent issue of homelessness among veterans.
S. 1547, the Zero Tolerance for Veterans Homelessness Act of 2009. This bill, with its almost utopian title, would enhance and expand the assistance provided by the Departments of Veterans Affairs and Housing and Urban Development to veterans who are homeless and veterans at risk of homelessness. President Obama recently stated that ending homelessness among veterans in five years will take a serious infusion of resources, coordination of services, and overhaul of the way we treat our vets after their service. While VVA supports enactment of this legislation, we would like to offer our comments on how this legislation can be strengthened to achieve the goal established by the President.
We might quibble with the numbers of homeless veterans estimated by the VA: It seems that the census of homeless veterans dipped from more than 200,000 to 153,000, and then in short order to 131,000, while at the same time there appears to be an increase in the number of homeless women veterans and homeless veterans, male and female, who served in Afghanistan and Iraq. The “numbers game” seems to have more to do with how one defines homeless than with any change in the number of veterans affected by this situation. (Incidentally, VVA argues that a veteran who has no permanent domicile is homeless. That is not the litmus test used by the VA.) However, the persistent problem of homelessness among veterans is all too real, and VVA applauds Congress for recognizing this fact and seeking solutions.
Certainly, the VA ought to be able to identify veterans receiving healthcare through VA medical facilities or disability compensation who are homeless or who are in danger of becoming homeless. We question, however, if this represents “all” of the target population. We would posit that the VA needs to formulate a strategic program of outreaching to veterans who otherwise do not utilize VA services, or receive monthly compensation from the Veterans Benefits Administration, the VBA.
The VA has legal authority as mandated by P.L. 110-389, the Veterans’ Benefits Improvement Act of 2008, Section 532 to advertise in national media, and an ethical obligation to reach out to all veterans and their families to inform them of the benefits to which they are entitled. While populating kiosks in VA medical centers and regional offices with booklets and pamphlets is fine, these do little good if they do not get into the hands of the very poor who do not use the system, the “middle class” who use private physicians and who may be living from paycheck to paycheck, and some who, so many reasons, either choose to or are forced to dissociate from society. To reach these folks, the VA has had no real strategic outreach plan. In fact, VA outreach to those who do not use VA facilities is negligible at best, and has been for a long, long time. A strategic plan, aided perhaps by the Ad Council with input from veterans service organizations and military unit associations, needs first to be well thought out, and then implemented. How much such an outreach effort will cost will be dependant in part on the media (TV and radio, billboards, electronic media) that are used. Part of such an outreach effort ought to include a “help line” modeled after the VA’s suicide hotline.
We would offer, too, that a plan that targets the homeless, or those at risk of incipient homelessness, ought to be part of this larger, more inclusive outreach strategy that informs veterans of the benefits and services they have earned by virtue of their military service, and that informs veterans of any health conditions or health care risks that might derive from their time, and place, in service.
Sec. 3: That said, we caution that there will need to be a very close and collaborative interaction between those tasked by the Secretary of Veterans Affairs with identifying and assisting veterans who are homeless or at imminent risk of becoming homeless and their counterparts at HUD.
Sec. 4: In testimony provided by VVA in April 2008, we recommended that Congress go above the authorizing level for the Homeless Grant and Per Diem program and fund the program at $200 million and not the $150 million authorized. We are gratified that this funding increase is stipulated herein.
We would hope, however, that no consideration be given to provide per diem payments to entities that house veterans but offer no services. “Three hots and a cot” is little more than a very temporary palliative. Should this occur, it would open the door to funding “empty-shell shelters” in every city, municipality, or county in the country, and would defeat the purpose of this bill.
We would offer that a consolidation of the VA’s Homeless Grant and Per Diem (HGPD) projects be included in this bill. This is a per diem issue for all existing programs that received a second grant for expansion of an existing original program. In the past, some successful VA HGPD residential programs identified a need for increased bed space because of the number of veterans requesting admission. These programs asked for additional beds under a “Per Diem Only” (PDO) grant process and were awarded the ability to increase their overall program beds. But because the original grant and the PDO grant were awarded at different times, they have separate project numbers, which leads to an accounting nightmare as everything related to the program has to be divided by percentages and every veteran who changes beds has to be tracked by not one but two project numbers. This does not make much sense to us. There should be a provision by which a modification of the original grant can accomplish the same purpose without adding “busy work” that actually does not increase accountability.
Sec. 5: Perhaps the key area in this section is the promise of case management services, without which far too many veterans who are homeless will inevitably drift back into homelessness even after they are afforded rental housing. Caring, informed case management is particularly critical in assisting those homeless veterans who have mental health and/or substance abuse issues. Yet herein is a conundrum: Many veterans do not meet the criteria for HUD-VASH because they require case management. They also do not meet the criteria for Mental Health Intensive Case Management (MHICM) included in this legislation. These compromised veterans are left without recourse to fend for themselves. Therefore, we would urge inclusion in this bill for case management services for those individuals who would otherwise be ineligible for HUD-VASH.
Sec. 6: The appointment of a Special Assistant for Veterans Affairs in the Office of the Secretary of Housing and Urban Development simply makes sense. HUD needs an individual who has the ear of the Secretary and who can coordinate all programs and activities at HUD relating to veterans. This position needs to be high enough within the HUD hierarchy to be taken seriously.
Sec. 7: Establishing a method for the collection and aggregation of data on homeless veterans participating in VA and HUD programs also makes sense.
Sec. 8: Researching and writing and devising a “comprehensive plan to end homelessness among veterans” sounds fine. It is likely, however, to result in yet another tome that does little more than gather dust. What may make more sense, of course, is to focus on preventing homelessness in the first place. But program managers within HUD and the VA, along with key leaders working in non-governmental organizations that provide assistance to homeless veterans, perhaps need to form working groups on different facets of the homeless veteran issue, conclude what programs work and need enhancement and what programs ought to be consigned to the dust bin of history, and make recommendations to their respective Secretaries. The watch word of any such plan should be KISS (Keep It Simple, Soldier). Just because it is simple does not mean it is easy.
Whether we want to acknowledge this or not, our nation is likely always to have some veterans who drift through life, without roots, many of them battling the demons of their wartime experiences. However, we can and must do a far better job than we are currently doing.
S. 977, The Prisoner of War Benefits Act of 2009. This bill would provide certain improved benefits for veterans who are former prisoners of war. It would repeal the minimum period of internment for presumption of service connection for certain diseases. It would make ex-POWs afflicted with diseases determined by the Secretary of Veterans Affairs to have “positive association with the experience of being a prisoner of war” eligible to receive disability compensation.
As long as any determination by the Secretary, as stipulated in the bill’s language, is made based on sound medical and scientific information and analyses, VVA supports enactment of this bill, as there are so few former POWs left that the cost of the bill should be minimal, and therefore any “pay-go” implications not particularly onerous.
S. 1109, Providing Real Outreach for Veterans Act or PRO-VETS Act of 2009. Should this bill be enacted, it would direct the Secretary of Veterans Affairs to enter into an agreement with the Secretary of Defense for the transfer of data to the VA to provide members of the Armed Forces as well as veterans with individualized information concerning veterans' benefits for which each member and veteran may be eligible. It would require the VA Secretary, after receiving such data, to: 1) compile a list of all benefits for which each member or veteran may be eligible; 2) notify the member or veteran (or their legal representative) of such benefits; and 3) provide a second notification if the member or veteran does not apply for a listed benefit within 60 days. It would provide for annual notifications thereafter. And it would require additional notifications based on changed circumstances, although it would allow each member or veteran the option to decline further notifications.
There are many difficulties in this proposed legislation, not the least of which is cost. The sheer effort to comply with the provisions of S. 1109 would bloat an already bloated central bureaucracy.
Yes, the VA as well as DoD needs to do a far better job of informing troops and veterans of their rights and benefits. But there are far better ways of accomplishing this. The VA could start with a much better search engine on their web site, as well as other enhancements to make their web site more user friendly. Many veterans, particularly the newest generation of veterans, get their info on the Internet. Why not provide veterans with a card listing key VA telephone numbers and web addresses? Why not incorporate information about benefits in an overall outreach strategy to be developed by the VA, one that would use billboards as well as public service announcements?
While this bill is very well meaning, taken alone it is not the answer.
S. 1118 would provide for an increase in the amount of monthly dependency and indemnity compensation (DIC) payable to surviving spouses by the Department of Veterans Affairs. One provision of this bill would reduce eligibility to receive DIC from age 57 to age 55, after which remarriage shall not terminate such compensation.
VVA endorses enactment of this legislation. Even as the fighting in Afghanistan and Iraq are adding surviving spouses almost daily, the majority of surviving spouses are women who are nearing retirement age, or have been retired for some time if they ever worked outside the home. Many of these women devoted themselves to caring for their spouse who may have been profoundly disabled as a result of his service in the military; many of these spouses did not have the opportunity to build a career of their own. Enactment of S. 1118 would in effect recognize their service, and sacrifice, even though DIC payments alone are inadequate to support an adult in most parts of the country.
S. 1155 would establish within the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) the position of Director of Physician Assistant Services in the Office of the Under Secretary for Health.
VVA endorses S. 1155 as we have endorsed its companion bill in the House, H.R. 1302. As we noted in testimony in the House, this bill seems to us a logical if somewhat belated effort to establish the position of Director of Physician Assistant Services under the Under Secretary of Veterans Affairs for Health. As stipulated in this bill, the director, who would be a qualified physician assistant, “shall be responsible to and report directly to the Under Secretary for Health on all matters relating to the education and training, employment, appropriate utilization, and optimal participation of physician assistants within the programs and initiatives of the Administration.”
The last three individuals to occupy the position of Under Secretary for Health have refused to accord Physician Assistants, most of whom are veterans, equal prestige and respect with Nurse Practitioners (most of whom are not veterans). The reasons are puzzling, and to say the aforementioned individuals and their functionaries have been less than honest in discussing this issue with Congress, veterans service organizations, and organized labor would be an understatement. It is shameful that this bill needs to be enacted to get the VHA to act decently, honestly, and as common sense would dictate, but this is the case.
S. 1204, the Chiropractic Care Available to All Veterans Act of 2009. This bill would amend the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001 to require the provision of chiropractic care and services to veterans at all VA Medical Centers.
While VVA supports the enactment of this bill, we would suggest that this body consider looking into other alternative healthcare options that have shown varying degrees of effectiveness. These might include acupuncture. These might include as well such modern relaxation techniques as biofeedback, which has proven successful in treating fibromyalgia, hypertension and certain heart conditions, and even traumatic brain injuries (TBI).
S.1302, the Veterans Health Care Improvement Act of 2009. This bill would provide for the introduction of pay-for-performance compensation mechanisms into contracts between the VA and community-based outpatient clinics (CBOCs) operated by private contractors for the provision of healthcare services.
VVA endorses S. 1302. It recognizes that, while the “top priorities for CBOCs should be to provide quality health care and patient satisfaction for America’s veterans,” in some instances “current contracts for CBOCs may create an incentive for contractors to sign up as many veterans as possible, without ensuring timely access to high quality health care for such veterans.” It also would set in place mechanisms to “eliminate abuses in the provision of health care services by CBOCs under contracts that continue to utilize capitated-basis compensation mechanisms for compensating contractors.” It would also set in place mechanisms to “ensure that veterans are not denied care or face undue delays in receiving care.”
S. 1394, the Veterans Entitlement to Service Act or the VETS Act of 2009. This legislation would direct the Secretary of Veterans Affairs to acknowledge the receipt of medical, disability, and pension claims and other communications submitted by claimants within 30 days of the receipt of the claim or other communication.
If enactment of this legislation can increase the efficiency and accountability of VA personnel, we would endorse it. We fear, however, that it has the potential to create more flurries of action and/or mounds of additional paperwork without increasing efficiencies in the adjudication of claims.
S.1427, the Department of Veterans Affairs Hospital Quality Report Card Act of 2009. This bill would establish and implement a Hospital Quality Report Card Initiative to report on health care quality in VA medical centers.
VVA is in favor of much more disclosure of information by VA, especially as to resource allocation and quality measures. This report card has the potential to make every veteran and ombudsman.
Further, if this initiative can inspire a competition among VA medical centers to be the best, to get the highest rating, this could be a good thing, but only if the VA is measuring the right things in the right way as to actually improve the quality of care.
S. 1429, the Servicemembers Mental Health Care Commission Act. This bill would establish a commission on veterans and members of the Armed Forces with Post-traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), or other mental health disorders, to enhance the capacity of mental health care providers to assist such veterans and members of the military, and to ensure that such veterans are not discriminated against.
Another commission! Although there are myriad efforts by both public and private entities to deal with the epidemic of mental health woes that afflict men and women who have served in a combat zone, there is no single entity extant to “oversee” this. Our skepticism about this bill, however, is based on the yet-another-commission attempt to deal with a problem or an issue. After the scandal at Walter Reed Army Medical Center was exposed by the Washington Post two and a half years ago, of a sudden there were task forces and commissions appointed by the President and hearings by Congress to ask how such a thing could happen and how we could prevent it from happening again.
Well, after all the heat, there was very little light. The heralded case management initiative for the severely wounded has had some successes but is, from all that we can see, a washout. Many of the same problems remain. The case management system at Walter Reed Army Medical Center still does not work very well, and the so-called pilot project for the Medical Evaluation Boards / Physical Evaluation Boards (MEB/PEB) is not working very well at all.
Will a commission enhance the treatment of servicemembers and veterans afflicted with PTSD or TBI or a host of other mental health issues? Not unless it is a permanent body, and answers directly to the White House, and has some actual power to help force positive change on this process.
S. 1444, the Compensation Owed for Mental Health Based on Activities in Theater Post-traumatic Stress Disorder Act, or the COMBAT PTSD Act. This bill attempts to “clarify the meaning of ‘combat with the enemy’ for purposes of service-connection of disabilities.”
VVA can support this bill if its intent is that it be applied to veterans with a valid diagnosis of PTSD (i.e., in the manner called for as noted in the 2006 Institute of Medicine report at HYPERLINK "http://iom.CMS/3793/32410.aspx" http://iom.CMS/3793/32410.aspx), and if the intent is that any veteran who served “in a theater of combat operations (as determined by the Secretary in consultation with the Secretary of Defense) during a period of war,” or “in combat against a hostile force during a period of hostilities” be taken at their word that the event or incident which occurred in service gave rise to their disability.
As VVA has stated repeatedly in prior Congressional testimony, an appropriate process already exists for VA PTSD claims processing as mandated by Congress back in 2000 under the Veterans Claims Assistance Act. However, it doesn’t work because the VA fails time and time again to provide for the uniformity, consistency, and efficiency that are necessary to ensure that the claims process works in a timely fashion for all veteran claimants.
TheVA does not use the guidelines established by the IOM on the medical side, and does not use their own “Best Practices Manual for Adjudication of PTSD Claims.” The problem is not with the law; rather, it’s with the implementation of the law by the VA that’s the issue.
S. 1467, the Lance Corporal Josef Lopez Fairness for Servicemembers Harmed by Vaccines Act of 2009. If passed, this bill would provide coverage under Traumatic Servicemembers' Group Life Insurance for adverse reactions to vaccinations administered by the Department of Defense.
There can be no doubt that some members of the military who are given inoculations against certain diseases suffer adverse reactions. Some of these reactions are life-altering, even life-threatening. All such adverse reactions are covered under existing Traumatic Servicemembers’ Group Life Insurance guidelines under DoD, but the Department of Veterans Affairs Insurance Center does not follow suit in all instances, as in the case of former Marine Lance Corporal Lopez.
Enactment of this bill would in effect close a loophole that would benefit Mr. Lopez and his family and perhaps countless others. It has the unqualified support of VVA.
S. 1518, the Caring for Camp Lejeune Veterans Act of 2009. The intent of this bill is to furnish hospital care, medical services, and nursing home care to veterans who were stationed at Camp Lejeune, North Carolina, while the water there was contaminated by volatile organic compounds, including known and probable human carcinogens. It would provide the same services to a family member of a veteran who resided at Camp Lejeune during a given period, as well as to a child who was in utero at the time.
Passage of this legislation would provide a measure of justice to veterans and their families who, through no fault of their own, were harmed simply by being assigned to Camp Lejeune. It would be up to the Secretary of Veterans Affairs to prescribe the regulations that would specify which conditions are associated with exposure to the contaminants, and which disabilities are associated with such conditions. We hope that this bill receives swift passage.
S. 1531, the Department of Veterans Affairs Reorganization Act of 2009. The purpose of this legislation is to establish within the VA the position of Assistant Secretary for Acquisition, Logistics, and Construction to provide policy direction and manage oversight with respect to acquisition and construction programs of VA facilities.
Although we think the title of this bill is far too broad, we strongly support its purpose. It is key that the individual named to this position have a strong and unwavering commitment to small business, particularly veteran-owned and service-disabled veteran-owned small business. We all want accountability and the best “bang for the buck” in federal procurement. The fallacy is that we can achieve this by giving the majority of business to big firms. Competition is what creates innovation and ultimately drives down the prices, thereby increasing value for dollar invested.
S. 1556, the Veteran Voting Support Act of 2009. This bill would require the Secretary of Veterans Affairs to permit facilities of the Department to be designated as voter registration agencies.
Enactment of S. 1556 would avoid what had been a brewing controversy prior to the 2008 presidential election when the previous administration at first refused to let VA facilities act as voter registration agencies. While we support the intent of this bill, we do not endorse the provision in the bill that would require the Secretary to provide a mail voter registration application form to each veteran who seeks to enroll or is enrolled in the VA healthcare system. We do agree that the VA can and should provide voter registration information and assistance, as well as absentee ballots to veterans residing in a community living center or domiciliary to “the same degree of information and assistance with voter registration as is provided . . . with regard to the completion of its own forms, unless the applicant refuses such assistance.”
We agree as well with the provision that would instruct the Secretary to permit nonpartisan organizations along with state and local election officials to provide voter registration information and assistance at facilities of the VA healthcare system, subject to reasonable time, place, and manner restrictions, including limiting activities to regular business hours and requiring advance notice.
S. 1607, the Wounded Veteran Job Security Act of 2009. The goal of this bill is to provide for certain rights and benefits for persons who are absent from positions of employment to receive medical treatment for service-connected disabilities.
To fight the war on terror, officials at the Department of Defense have bled the Reserves and National Guard, which comprise almost 50 percent of our military strength. Far too many Reservists and Guardsmen and –women have returned to find that they have lost their job, or have lost their seniority and other rights and benefits. This is wrong. This is un-American. It will make individuals think twice about enlisting or re-enlisting in the Guard or Reserves, to the detriment of the citizens in the states in which they are based.
The intent of this bill is noble; passage of this bill is needed. It has the endorsement of VVA.
In this same regard, VVA would note that a small minority of employers are helping to bear the cost of this war because it is their employees are being activated. There needs to be a system of tax breaks and re-training funds for these employers to make at least some effort of holding them harmless.
S. 1668, the National Guard Education Equality Act. This bill provides for the inclusion of certain active duty service in the reserve components as qualifying service for the Post-9/11 Educational Assistance Program.
This bill attempts to cover members of the Army National Guard or Air Force National Guard who had “full-time duty” in response to a domestic emergency; as part of the Active Guard Reserve; as part of the Air Sovereignty Alert; as part of Operation Jumpstart; in response to Hurricane Katrina; as part of an airport security mission; or as part of a counterdrug activity. It is a bill VVA would support so long as those who served in these capacities meet the minimum amount of active-duty service as any Guardsman or Reservist who was activated and sent to Iraq or Afghanistan.
S. 1753, the Disabled Veteran Caregiver Housing Assistance Act of 2009. This bill would increase assistance for disabled veterans who are temporarily residing in housing owned by a family member.
Catastrophically disabled veterans need a significant amount of care. In many instances, their families will provide such care as best as they can. However, providing this care may entail not insubstantial reconstruction of a home. S. 1753 recognizes this, increasing the amount of financial assistance allowable and providing for future increases based on the residential cost-of-construction index for the preceding year.
VVA supports passage of this bill.
Last but not least, is S. 1779, the Health Care for Veterans Exposed to Chemical Hazards Act of 2009. This bill would provide health care to veterans exposed in the line of duty to occupational and environmental chemical health hazards “notwithstanding that there is insufficient medical evidence to conclude that [a veteran’s health condition or disability] may be associated with such exposure.”
This bill derives from National Guardsmen taken ill after being exposed to a chemical burn pit in Iraq. We fear that their exposure may be only the tip of the iceberg, to borrow a cliché. VVA believes that enactment of this bill is critical if a new generation of veterans is to be taken care of for respiratory and other health conditions that have an excellent possibility of having been caused by exposure to the toxic soup of burn pits in Iraq.
Mr. Chairman, Vietnam Veterans of America sincerely appreciate the opportunity to provide our views on these bills, and we look forward to working with you and your distinguished colleagues to address the concerns of our nation’s veterans.
VIETNAM VETERANS OF AMERICA
October 21, 2009
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 for Policy and Government Affairs
Vietnam Veterans of America
(301) 585-4000, extension 127