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march/april 2008

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VA Budget Request: $5.24 Billion Short

“The annual exercise of debating the merits of the President’s proposed budget is flawed,” said John Rowan, National President of Vietnam Veterans of America, in prepared testimony before the Senate Committee on Veterans’ Affairs. “Medical center directors should not have to be held in limbo as Congress reworks and adjusts this budget and perhaps misses, yet again, the start of the next federal fiscal year.

“These public servants can be more effective, more efficient, and better managers of the public trust if they can properly plan for the funding they need to carry out their mission of caring for their patients. We hope that this can be avoided this year, and ask that you seriously consider an immediate alternative to the broken system we currently have.”

Rowan characterized as “inadequate” the FY’09 request for $2.34 billion more than the FY’08 appropriation. This “does not quite keep pace with medical inflation” and “will not allow VA to continue the needed pace of enhancing its health care and mental health care services for returning veterans, restore needed long-term care programs for aging veterans, or allow working-class veterans to return to their health care system.” To accommodate these goals, Rowan said, VVA recommends an increase of $5.24 billion.

Of this amount, $1.3 billion should be dedicated to restoring the access of so-called Priority 8 veterans who were “temporarily” barred from entering the system five years ago.

The House Veterans’ Affairs Committee is committed to an increase of $4.6 billion.

Rowan condemned the proposed budget for again attempting to tax “higher income” veterans with an annual fee for signing into the VA health care system and for almost doubling the co-payment for prescription pharmaceuticals. “This is further evidence,” Rowan said, “of the attempt to rid the system of as many ‘higher income’ veterans as possible. We trust that you will see the folly in this and will reject outright any attempt to enact these measures into the law of the land.”

If you are the head of a household that earns more than $28,000 a year, you are considered by the VA to be “higher income.” Really.

Rowan voiced skepticism that the President’s budget will provide resources “to virtually eliminate the patient waiting list by the end of 2009.” He voiced concern that the budget will provide adequate resources “to deal with the flood of troops and veterans returning to our shores with a range of mental health issues.” And he dismissed the claim that “one of VA’s highest priorities will be to continue an aggressive research program to improve the lives of veterans returning from Iraq and Afghanistan.

“It is our understanding,” Rowan said, “that data collecting on the maladies and diseases of returning troops is not happening. It’s almost as if our government does not want to know about these ailments so that it won’t be burdened with Dependency Indemnity Compensation payments.”

Last November, VVA sponsored a parade in Washington, D.C., to commemorate the 25th anniversary of The Wall. One component of the parade consisted of informational tents on issues, most of them health-related, of concern to veterans. Shortly after the parade ended, two young women and their father, a Vietnam veteran, visited VVA’s Agent Orange Awareness exhibit. There they spoke with a VVA employee from our Veterans Benefits Department.

The father suffered from both diabetes type II and prostate cancer. Both girls were born with spina bifida. Neither father nor daughters were aware that they were eligible for VA benefits because of presumptive service connection for exposure to Agent Orange. We ask: How many other families like this are out there?

Part of the problem exists because VA honchos are not committed to effective outreach. After all, the more veterans and their families know about what is available to them—what the veteran has earned by virtue of his or her service in uniform—the more claims the VA will have to rate, and the more money it will have to pay out.

To help remedy this, we recommend S. 1314, introduced by Sens. Russ Feingold (D-Wisc.) and Richard Burr (R-N.C.). The Veterans Outreach Improvement Act would help the VA achieve real outreach: “reaching out in a systematic manner to provide proactively information, services, and benefits counseling to veterans, and to the spouses, children, and parents of veterans who may be eligible to receive benefits under the laws administered by the Secretary of Veterans Affairs, to ensure that such individuals are fully informed about, and assisted in applying for, any benefits and programs under such laws.”

If enacted, S. 1314 would mandate that the VA Secretary establish a separate account for the funding of the outreach activities of his department, and to establish a separate sub-account for funding the outreach activities for the Veterans Health Administration, the Veterans Benefits Administration, and the National Cemetery Administration. Such a provision would establish and maintain procedures for ensuring the effective coordination of outreach activities of the various facets within the VA—and with state veterans agencies.

Passage of such a measure surely is needed. Left to their own devices, VA managers will continue to do very little.

The new Secretary of Veterans Affairs, General James Peake, M.D., has one year to make his mark on the VA. VVA National President John Rowan and Rick Weidman, executive director for policy and government affairs, have met with Dr. Peake and have been favorably impressed.

The big questions are: Can he light a fire under a torpid bureaucracy? Will he be the true veterans’ advocate that his predecessor was not? Will he think out of the box and try alternate ways of funding both the VA’s health care system and benefits administration?

All this remains to be seen. We wish him well and will work with him to achieve mutually acceptable goals.

Shortly after Dr. Peake took occupancy of his office on the tenth floor at 810 Vermont Avenue, one of his top aides left. Adm. Dan Cooper, who had headed the Veterans Benefits Administration for the past six years, left under a cloudburst. It seems that the admiral’s public statements hyping religion were not embraced outside the administration. He was also criticized for the continuing backlog in processing benefits claims.

Of the new secretary, President Bush has said, “Dr. Peake takes office at a critical moment in the history of this department. Our nation is at war—and many new veterans are leaving the battlefield and entering the VA system. This system provides our veterans with the finest care—but sometimes the bureaucracy can be difficult. To address these problems, our administration, along with the Secretary’s leadership, is implementing recommendations of the Dole-Shalala Commission on Wounded Warriors.

“In other words, we’re not going to tolerate bureaucratic delays. We want the very best for our veterans…. Our nation has no higher calling than to provide for those who have borne the cost of battle—and we will honor our responsibilities.”

Deputy Secretary of Veterans Affairs Gordon H. Mansfield, a life member of VVA, was named the first recipient of the Robert Dole National Award for Service on Jan. 28 during the annual conference of the Military Health System, which provides health care for the Department of Defense.

“Gordon Mansfield has devoted much of his adult life to serving this nation and its veterans,” said Secretary Peake. “Making him the first recipient of this honor sets the bar high for those who follow.”

Mansfield, a combat-wounded Vietnam veteran and a long-time official with the Paralyzed Veterans of America, has been the second ranking officer in the VA since January 2004. The award was established in Sen. Dole’s name to recognize veterans who continue to serve the nation through public service.

“I cannot think of anyone who has done more [than Sen. Dole] for the military and veterans health care systems,” Mansfield said. “As a patient and as a proponent in Congress, he did everything he could to improve the care we provide for our active-duty personnel, our veterans, and their families.”

Finally moving quickly, the Department of Defense announced a further step in its ability to share electronic health information with the Department of Veterans Affairs.

The latest development allows each agency to view the other’s clinical encounters, medical procedures, and lists of medical problems on shared patients, according to a DoD news release.

This is the third enhancement announced this year to the ability of DoD and VA to exchange information. In October, the VA was provided access to DoD in-theater clinical data. In July, pharmacy, allergy, microbiology, chemistry/hematology data, and radiology reports were made available.
Data standardization remains a significant hurdle to the ultimate goal of VA-DoD electronic medical record interoperability. To achieve interoperability, both agencies must standardize how data are defined, structured, and communicated and agree on interagency code sets for such domains as pharmacy, allergy, chemistry, and radiology.

Most of these elements have not yet been standardized.

But the two departments, under the watchful eyes of Congress, insist that they are committed to making incremental improvements, allowing more records to follow patients as they move from the military to the veterans health care system.

More than a million eligible veterans should be seeing their mileage reimbursement more than double for travel to VA medical facilities.

The 2008 appropriations act provided funding for the VA to increase the beneficiary travel mileage reimbursement rate from 11 cents per mile to 28.5 cents per mile. The increase went into effect Feb. 1.

After little more than a month on the job, Secretary Peake used his authority to establish the first increase in the mileage reimbursement in 30 years, fulfilling a pledge he made during his Senate confirmation hearing.

While increasing the payment, the VA, as mandated by law, also equally increased the deductible amounts applied to certain mileage reimbursements. The new deductibles are $7.77 for a one-way trip, $15.54 for a round trip, with a maximum of $46.62 per calendar month. However, these deductibles can be waived if they cause a financial hardship to the veteran.


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