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September/october 2009

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On June 23, the House of Representatives overwhelmingly approved, by a vote of 409-1, H.R. 1016, landmark legislation to secure timely funding for veterans’ health care delivered through the Veterans Health Administration (VHA).  Rep. Bob Filner (D-Calif.), chair of the House Veterans’ Affairs Committee, announced passage of the bill he had introduced that authorizes the “advance appropriations” process. 
The bill provides Congress greater ability to develop appropriation bills that provide a sufficient, timely, and predictable funding stream to meet the best estimate of anticipated demand for VA health care services in future years. It allows funding for the Department of Veterans Affairs’ medical accounts one year in advance.  An advance appropriation would provide the VA with up to one year in which to plan how to deliver the most efficient and effective care to an increasing number of veterans with increasingly complex medical conditions. 
Unlike proposals to convert VA health care to a mandatory funding program, an advance appropriation does not create so-called PAYGO concerns since VA health care funding would remain discretionary.  Congress employs a PAYGO rule which mandates that new proposals must be budget-neutral or offset with savings derived from existing funds. 
The measure would require the Office of Management and Budget to request the advance funding a year ahead of time and make the VA submit to Congress detailed explanations of those advance-funding figures. The VA then would have to update Congress each July if it had the resources for the upcoming fiscal year in order for Congress to address any funding imbalances. 
The Senate unanimously approved Senate Veterans’ Affairs Committee Chair Daniel K. Akaka’s (D-Hawaii) legislation, the Veterans Health Care Budget Reform and Transparency Act of 2009 (S. 423), to secure timely and predictable funding for the veterans’ health care system. This set the stage for the House and Senate Veterans’ Affairs Committees to negotiate a final version of the legislation, which could then be approved by the full House and Senate. Only then would it go to the President for his signature. 


The $133.7 billion spending bill that was passed in the House by a vote of 415-3 boosts funding for veterans benefits in fiscal 2010. It was described as “an unprecedented increase in Congress’ commitment to veterans” by Rep. Chet Edwards (D-Tex.), chair of the Military Construction-Veterans’ Affairs Appropriations Subcommittee.
The spending measure also would set aside $48.2 billion for three veterans’ medical accounts in fiscal 2011, about 8 percent more than it would appropriate for fiscal 2010. The idea is to give decision makers foreknowledge about future funding levels so plans could be made with greater confidence.
Rep. Zach Wamp (R-Tenn.), the ranking Republican on the panel, added strong support for the legislation, but said that he continues “to be concerned about the ability of the [department] to absorb large funding increases provided in this bill.”
VVA’s concerns mirror Rep. Wamp’s. A 58 percent increase in less than three years is, to put it mildly, a lot. Yet the bottom line has got to be: Is this influx of funding improving the health care for veterans? Are more clinicians and support staff in critical areas being properly hired and trained? Are nurses being retained? Is state-of-the-art high-tech equipment being purchased? Are waiting times to see primary-care doctors as well as specialists being cut to fewer than 30 days? Are health care services for women veterans and those living in rural—and remote—areas being improved? Are rational, sensible steps being taken to reduce the backlog in claims for disability compensation? 
And, finally, is the VA reaching out to the seven out of ten veterans who do not use the VA health care system and who are not aware of the benefits available to them and the potential health conditions that may be associated with their time in service?
According to Rep. Edwards, the historic increases in funding
l -have resulted in a total increase of 7,100 claims processors (the total increase will be 8,300 when this bill has passed)
l -have provided an additional 115 community-based outpatient clinics (this bill adds 30 more)
l -have provided an additional 42 Vet Centers (this bill adds 28 more)
l -have allowed the Veterans Health Administration to hire an additional 2,657 doctors, 11,509 nurses, and 40,604 total new staff (this bill provides for 6,992 more)
l -have increased the travel reimbursement rate (which had not been increased since 1979) to 41.5 cents per mile.
“These resources mean that our veterans have better access to the health care that they need, to include improved access in rural areas and increased access for our middle- and lower-income Priority 8 veterans,” Edwards said.  “Additionally, these resources insure that our veterans wait less time to get the services and benefits that they have earned.” 
It is up to Congress to exercise its oversight responsibilities to insure that the dollars are doing all this, and not going to prettify grounds or redo the offices of hospital administrators in the latest designer colors.
It is up to VVA and the other veterans service organizations, which for so long have advocated for more funding for VA programs, also to look with a critical eye at how VA leadership spends the bucks.


During the Vietnam War, some 2.75 million men, and 10,000 women, served in country.  In today’s wars in Afghanistan and Iraq, women comprise some 14 percent of those deployed. Many see combat. Scores have been killed. Hundreds have received wounds, many of them grievous.
As these women move from active-duty to veteran status, will the VA be ready to provide the necessary gender-specific services they will need? To insure that the VA will be ready, Congress passed a bill to authorize $4 million to study the barriers women face in gaining access to medical care at the VA and $5 million to assess VA health services and programs for female veterans.
The legislation, H.R. 1211, was introduced in the House by Rep. Stephanie Herseth Sandlin (D-S.D.).  It passed by a vote of 408-0.
“With an increasing number of women seeking access to care for a diverse range of medical conditions, the challenge of providing adequate health care services for women veterans is one the VA must meet,” Herseth Sandlin said. “Unfortunately, services in VA facilities often fall short of properly providing for the health care needs of women. There is too much fragmentation of care and not enough clinicians with the current training and experience.”
The bill would create a new program to offer graduate medical education, training, and certification to health professionals who give counseling, care, and services to veterans suffering from sexual trauma and post-traumatic stress disorder.
In addition, the legislation would authorize $1.5 million in each of fiscal years 2010 and 2011 for a pilot program to provide child-care assistance to veterans receiving mental health services at VA hospitals, as well as seven days of medical care to newborns of female veterans who give birth at the hospitals.


In the wake of the release, just before the National Convention, of the 2008 Biennial Review of the Institute of Medicine of the National Academies of Science, which determined there is “limited or suggestive evidence” of an association between Parkinson’s disease and ischemic heart disease with exposure to herbicidal agents, collectively referred to as Agent Orange, VVA immediately sent a letter petitioning VA Secretary Shinseki to make these diseases, as well as hypertension, presumptive for service-connection.
The association between a disease and exposure is considered to be positive if “credible evidence for the association is equal to or outweighs the credible evidence against the association.”  Because the 2006 Biennial Review found elevated evidence of an association between exposure and hypertension, VVA National President John Rowan added this malady in the letter of petition.
“There can be no doubt today that all of us who are veterans who served in Vietnam faced exceedingly more than the dangers associated with hostile action during our tours there, even though we were unaware of it at the time,” Rowan said. “The environment in which we lived, fought, and died teemed with toxic chemicals and endemic diseases. Much has been accomplished in recognizing this basic truth, but there is still a long way to go.
“Vietnam veterans incur common diseases of old age many years sooner than those of similar age who did not serve in Vietnam. Parkinson’s disease, ischemic heart disease, and hypertension are but three prime examples of this phenomenon. Many Vietnam veterans are dying of these diseases much too early, far before our time. Where affected veterans do continue to survive, it is all too often with a dramatically reduced quality of life and loss of earning power due to the disability or infirmity caused by these diseases.” 
The letter concluded:  “With the body of scientific evidence that currently exists, as well as the Secretary’s congressional authority to take immediate action through administrative rule-making, VVA believes that there is now no factual or legal impediment to presumptive service connection for ischemic heart disease, hypertension, and Parkinson’s disease.”
 In response to the IOM report and VVA’s letter, Secretary Shinseki has appointed a panel of VA health experts to review the IOM report and make recommendations to the Undersecretary for Health, who will make the decision whether or not to pass it up the bureaucratic ladder. VVA intends to follow this process very, very closely, and to continue to press the Secretary to do the right thing.



Robert S. McNamara Dead At 93


Robert Strange McNamara has died. The former Secretary of Defense was 93. He “has finally shuffled off,” the journalist Joe Galloway wrote, “to join LBJ and Dick Nixon in the 7th level of Hell.” 
McNamara, the main architect of the Vietnam War, lived more than 70 years longer than most of the 58,000 servicemembers who died in a war that he had misgivings about at its height, yet continued to prosecute and express confidence in publicly.
It wasn’t until 1995, with the release of his memoir, In Retrospect: The Tragedy and Lessons of Vietnam, that he acknowledged his early disillusionment with what Sen. Wayne Morse of Oregon, one of two U.S. Senators to vote against the Gulf of Tonkin Resolution, dubbed “McNamara’s War.”
In an interview with the Associated Press prior to the release of his book, McNamara said, “We of the Kennedy and Johnson administrations acted according to what we thought were the principles and traditions of our country. But we were wrong. We were terribly wrong.”
For his admission and belated apology, he was denounced by many—including many at VVA—who were enraged by his high-handed hypocrisy. McNamara was one of the prime overseers of the escalation of the American presence in Vietnam. On his many visits to South Vietnam, he extolled the progress of American and South Vietnamese troops, declaring that “the light at the end of the tunnel” was growing ever brighter, yet knowing, finally, that, as Tim Weiner wrote in McNamara’s obituary in The New York Times, “none of the tools at his command—the power of American weapons, the forces of technology, and the logic or the strength of American soldiers—could stop the armies of North Vietnam.”
An editorial written by Howell Raines, the op-ed page editor of The Times when In Retrospect was published, perhaps best summed up McNamara’s legacy. “Mr. McNamara must not escape the lasting moral condemnation of his countrymen…. Surely he must in every quiet and prosperous moment hear the ceaseless whispers of those poor boys in the infantry, dying in the tall grass, platoon by platoon, for no purpose. What he took from them cannot be repaid by prime-time apology and stale tears, three decades late.”
McNamara’s sullied reputation survives him. The spraying of million of gallons of herbicides throughout Vietnam has killed more veterans after the war than the number who perished in the war. What’s more, the effects of dioxins in these herbicides and defoliants on the reproductive glands of Vietnam veterans are responsible for birth defects and learning disabilities in our children and grandchildren.
McNamara kept his doubts about the war to himself for far too long. That is why for veterans of the Vietnam War, his legacy is one of shame. Robert S. McNamara was, to quote Joe Galloway, “the original bean-counter—a man who knew the cost of everything but the worth of nothing.”




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