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An organization chartered by the U.S. Congress

June 2001/July 2001

Government Relations

President Appoints New Deputy Administrator of VA

By Phillip A. Litteer, Chairman, National VVA Government Affairs Committee, with Rick Weidman, Director of Government Relations, and Pat Eddington, Associate Director

Dr. Leo S. Mackay, Jr., was officially sworn in on May 24, 2001 as Deputy Secretary of Veterans Affairs. On June 8, Dr. Mackay visited the VVA National Office for a wide-ranging discussion of the many issues of concern to Vietnam Veterans of America (VVA). In a frank but cordial exchange, VVA staff outlined to Dr. Mackay our deep concerns about accountability within the VA system.

These concerns include accountability for funds allocated by Congress for key health programs, particularly hepatitis C screening and testing. Other major concerns include more real accountability of VISN directors for their actions, greater accountability of VA regional directors, as well as claims adjudicators and benefits supervisors, so that they "get it right the first time" and are sanctioned when appropriate. Mackay ended the visit by expressing a desire to maintain an open dialogue with VVA leaders and staff members. VVA staff expressed a similar desire.

Rockefeller Becomes Chair of Senate Veterans Committee

Due to the recent change in control of the Senate, Sen. John D. Rockefeller IV (D- W.Va.) has assumed the role of chairman of the Senate Committee on Veterans’ Affairs, which he last held in 1994. Chairman Rockefeller wasted no time, holding a hearing on more than ten bills on June 28. VVA favors a number of these pieces of proposed legislation, including S. 71, Sen. Olympia Snowe’s proposal to accord presumption of service connection to Vietnam veterans for hepatitis C.

However, VVA strongly objects to parts of S. 1093 that would to limit benefits for incarcerated veterans. VVA opposes the provision designed to completely eliminate benefits for these veterans who are incarcerated. VVA noted in its written testimony that such a provision would penalize the families of such veterans and undermine the very concepts behind rehabilitation and reduction of recidivism.

Representing the Bush administration at the hearing was newly appointed Deputy Secretary of Veterans Affairs Mackay. VVA was disappointed to learn during his testimony that the administration opposed two bills of vital importance to VVA and tens of thousands of affected veterans. These two bills are S 457 (the hepatitis C presumption bill) and S 409 (the Gulf War illness compensation bill).

The administration claims that S 457 would make it too easy for intravenous drug users to claim hepatitis C presumption. As a matter of policy, VVA has and will continue to dispute such sweeping and fundamentally inaccurate characterizations for which the VA can produce no substantive scientific evidence.

The Gulf War claims bill, S 409, and the companion bill in the House, HR 612, are designed to close the language loophole that the VA has used to deny 75 percent of Gulf War veterans’ undiagnosed illness claims. VVA staff and leaders will meet with Sen. Rockefeller’s staff over the summer to craft a strategy that will hopefully secure passage of S 457 and S 409.

VVA was also very disappointed in the President’s Supplemental Budget Request for VA health care in that none of the additional funds (more than $1.4 to $1.7 Billion) needed just to handle inflation was included in the request. The administration and VA have yet to answer what they will do to comply with the capacity legislation enacted in 1996.

There must be a plan to reestablish proper funds and staff in order to restore proper and legal treatment capacity in specialized services such as spinal cord injury treatment and Post-traumatic Stress Disorder treatment. Currently the VA is acting illegally by not meeting the required levels of services and treatment.

Additionally, the President and the VA has thus far ignored VVA’s repeated requests for additional desperately needed funding and staff for the VA Vet Centers, which is the most cost effective health care program operated by the Department of Veterans Affairs.

Montgomery GI Benefits Increase

On June 19, the House Committee on Veterans’ Affairs Chairman Christopher Smith (R-N.J.) moved to have HR 1291 discharged from the committee for a vote of the full House under suspension of rules, meaning that no amendments could be offered and debate was strictly limited. The measure was passed 416 to 0 and referred to the Senate for consideration. Thanks to the vigorous efforts of Rep. Smith, HR 1291 will be fully funded upon enactment.

Ranking Democrat Lane Evans and the House Democrats favored a more generous measure for which the Republicans on the House Budget and Appropriations Committees had not agreed to fund.

Shays and GAO Criticize Uneven VA Hepatitis C Effort

On June 14, the National Security, Veterans' Affairs, and International Relations Subcommittee of the House Government Reform committee held an oversight hearing into the VA's efforts to screen and test veterans for Hepatitis C (HCV) infection. At this hearing, GAO released its findings on a months-long investigation into the VA’s Hepatitis C screening and testing program. Testifying for GAO, Ms. Cynthia Bascetta noted that " VA missed opportunities to screen as many as 3 million veterans when they visited medical facilities during fiscal years 1999 and 2000, leaving as many as 200,000 veterans unaware that they have Hepatitis C infections. Most remain undiagnosed primarily because local managers adopted restrictive hepatitis C screening practices" These local restrictions ignore national standards of care established by VHA.

GAO also noted that while the pace of screening and testing appears to have improved somewhat in 2001, GAO warned that "any currently undiagnosed veterans may not be identified expeditiously unless VA (1) establishes early detection of hepatitis C as a (REQUIRED) standard for care and (2) holds managers accountable for timely screening, testing, and proper treatment of veterans who visit VA medical facilities."

VA’s Deputy Undersecretary for Health, Dr. Frances M. Murphy finally conceded to Chairman Christopher Shays (R-NJ) that hepatitis C screening had been hampered by the oft-stated view of VAMC clinicians and administrators that "the increased activities in hepatitis C screening and treatment were an "unfunded mandate." Shays laid the blame for that perception squarely at the feet of the VA Central Office, and made it clear that the committee would hold another hearing next year to evaluate the VA's progress in improving hepatitis C screening, testing, and treatment programs.

Mental Health, Substance Abuse, and Homeless Veterans Issues

On June 20, Dr. Linda Schwartz, Chairperson of VVA's National Task Force for Health Care Policy and Planning, accompanied by Government Relations Director Rick Weidman, testified before the Subcommittee on Health of the House Veterans Affairs Committee regarding mental health, substance-use disorders, and homeless programs.

Schwartz noted that there has been a significant reduction in specialized services capacity to treat substance abuse that has occurred between FY 1996 and FY 2000. Dr. Schwartz testified that "Our organizational representatives around the country share information with us at the national level that would suggest that the decimation of alcohol and substance abuse services continues unabated. To maintain, as some have at VA, that the dramatic reductions in available services is not the cause of the reduced number of veterans in treatment for substance abuse is sophistry Newspeak thinking worthy of the now defunct Soviet system."

Criticizing the managerial and budgetary effects of the VISN model, Schwartz noted that "What the VA has done is to give the VISN Directors unprecedented power and authority, with virtually no accountability except in the area of fiscal restraint (read: denial of vitally needed services to those with the least public voice, such as veterans with severe neuropsychiatric wounds of war, who may also be homeless). The inability and/or unwillingness of the VA to hold these employees (the 22 VISN Directors) accountable is simply intolerable to veterans and to the taxpayers."

Schwartz and Weidman pointed out that VA had an increase (8 percent) in the number of individual veterans that met the definition of SMI (severely mentally ill) which was accompanied by a decrease (9 percent) in funding, excluding the impact of medical inflation, estimated to run 8-9 percent per year. The bottom line is that funding (and therefore staff and other resource needs) for mental health care has been slashed by more than one third since FY 1996.

VVA argued forcefully that the reductions in funding for treatment of SMI veterans who are homeless is directly linked to the reduction in funding for seriously mentally ill veterans, particularly inpatient or residential treatment services for these veterans, particularly in substance abuse treatment programs.

"In other words," VVA told the committee, "the VA has been creating homeless veterans faster than the Congress can devise, pass, and fund new programs to help reduce homelessness among veterans. It is time that all concerned recognize this fact."

Regarding substance abuse treatment, the VVA team noted that since the capacity legislation became law, funding for Substance Abuse Treatment Programs overall were reduced by 37%plus inflationary deficits, meaning that funding for alcohol and substance abuse programs have been reduced by almost 60% since 1996. (To read the full written statement, please see www.vva.org, Legislative Issues Section.)

Re-centralizing Central Office control of funds solved a major problem with provision of artificial legs, wheelchairs, and other devices from Fiscal Year 96 until the time when control over distribution of funds for prosthetics was taken away from the VISN Directors.

VVA strongly urges the Congress to mandate that the VA prepare a plan for rebuilding organizational capacity (i.e., qualified & trained staff as well as well as money to secure other goods and services) in the specialized services that has been lost since FY96. VVA has estimated that it will take a bare minimum of $3 Billion over and above inflation in a three-year period to begin to restore a significant part of the lost organizational capacity in the specialized services.

VVA also called on the Committee to move quickly to pass the Heather French Homeless Act of 2001.


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