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S. HRG. 114–735 

VA’S TRANSFORMATION STRATEGY: EXAMINING 

THE PLAN TO MODERNIZE VA 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED FOURTEENTH CONGRESS 

SECOND SESSION 

JANUARY 21, 2016 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

JOHNNY ISAKSON, Georgia, Chairman 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

DEAN HELLER, Nevada 

BILL CASSIDY, Louisiana 

MIKE ROUNDS, South Dakota 

THOM TILLIS, North Carolina 

DAN SULLIVAN, Alaska 

RICHARD BLUMENTHAL, Connecticut, Ranking 

Member 

PATTY MURRAY, Washington 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JON TESTER, Montana 

MAZIE K. HIRONO, Hawaii 

JOE MANCHIN III, West Virginia 

TOM BOWMAN, Staff Director 

JOHN KRUSE, Democratic Staff Director 

(III) 

C O N T E N T S 

JANUARY 21, 2016 

SENATORS 

Page 

Isakson, Hon. Johnny, Chairman, U.S. Senator from Georgia ............................ 1 

Blumenthal, Hon. Richard, Ranking Member, U.S. Senator from Connecticut ... 3 

Tillis, Hon. Thom, U.S. Senator from North Carolina .......................................... 27 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 29 

Moran, Hon. Jerry, U.S. Senator from Kansas ..................................................... 32 

Heller, Hon. Dean, U.S. Senator from Nevada ..................................................... 34 

Boozman, Hon. John, U.S. Senator from Arkansas .............................................. 37 

Sullivan, Hon. Dan, U.S. Senator from Alaska ..................................................... 38 

Murray, Hon. Patty, U.S. Senator from Washington ........................................... 41 

Rounds, Hon. Mike, U.S. Senator from South Dakota ......................................... 44 

Manchin, Hon. Joe, U.S. Senator from West Virginia .......................................... 47 

WITNESSES 

McDonald, Hon. Robert A., Secretary, U.S. Department of Veterans Affairs; 

accompanied by David J. Shulkin, M.D., Under Secretary for Health; and 

Danny Pummill, Interim Under Secretary for Benefits .................................... 4 

Prepared statement .......................................................................................... 10 

Appendix A–article from The Baltimore Sun .......................................... 21 

Response to posthearing questions submitted by: 

Hon. Johnny Isakson .................................................................................... 53 

Hon. Richard Blumenthal ............................................................................ 65 

Hon. Sherrod Brown ..................................................................................... 69 

APPENDIX 

American Federation of Government Employees, AFL–CIO (AFGE); prepared 

statement .............................................................................................................. 73 

Zumatto, Diane M., National Legislative Director, AMVETS; prepared statement ...................................................................................................................... 74 

Concerned Veterans for America (CVA); prepared statement ............................. 78 

Joy J. Ilem, National Legislative Director, DAV; prepared statement ............... 80 

Paralyzed Veterans of America (PVA); prepared statement ................................ 84 

The American Legion; prepared statement ........................................................... 85 

Fuentes, Carlos, Senior Legislative Associate, National Legislative Service, 

Veterans of Foreign Wars of the United States (VFW); letter ......................... 86 

(1) 

VA’S TRANSFORMATION STRATEGY: 

EXAMINING THE PLAN TO MODERNIZE VA 

THURSDAY, JANUARY 21, 2016 

U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 10:01 a.m., in room 

418, Russell Senate Office Building, Hon. Johnny Isakson, Chairman of the Committee, presiding. 

Present: Senators Isakson, Moran, Boozman, Heller, Rounds, 

Tillis, Sullivan, Blumenthal, Murray, Brown, Tester, Hirono, and 

Manchin. 

OPENING STATEMENT OF HON. JOHNNY ISAKSON, CHAIRMAN, 

U.S. SENATOR FROM GEORGIA 

Chairman ISAKSON. I want to call the meeting of the Senate Veterans’ Affairs Committee together to get started, and I want to expedite our meeting. I would like for everybody to pay close attention so they do not think I am rushing the thing through. We have 

a storm coming. We have a vote at 10:30. We have a lot of people 

moving and a lot of pieces in place, including some of our witnesses 

that are here today. We are going to start promptly at 10, which 

we are doing. I will make a brief opening statement. If the Ranking 

Member is here in time, I will recognize him. If not, he can make 

his statement later on in the hearing. 

We will then go to Secretary McDonald, who has asked—and I 

have granted—for no limitation on time, so we do not have a 5- 

minute red light. We are going to let him take the time he needs 

to make his testimony, which I think is only appropriate given the 

serious intent of this particular hearing. I would like to thank Senator Tillis and Senator Tester, the two who originated the idea of 

having the Secretary come to lay out the entire vision for the VA 

and the I-CARE program. I am glad the Secretary has come and 

agreed to do that. I am delighted to be able to—and the Ranking 

Member has made it, so you are lucky. You are not going to get 

cut out after all. [Laughter.] 

Any Member of the Committee, other than the Ranking Member 

and myself, who wants to make a statement can submit it for the 

record after the hearing is over. I will make a brief statement and 

then go to Senator Blumenthal, and then we will go directly to the 

Secretary. Hopefully, we can accomplish all of that before the 10:30 

vote. We will then go to vote at 10:30 and rush back here for unlimited questioning until noon today. I thank everybody for being 

here. 

2 

I want to, first of all, especially thank Dale Barnett. Dale, would 

you stand up for a second and remain standing? I just love to tell 

officers that. [Laughter.] 

Dale is The American Legion National Commander. He is from 

Douglasville, GA, which is the county next to my county of Cobb 

in the State of Georgia. He is from the Fayetteville Legion Post. Is 

that not correct? 

Mr. BARNETT. That is correct. 

Chairman ISAKSON. We want to thank you for your service, and 

that of all of your members, to our country and for your continuing 

service to help support us on this VA Committee. You are the eyes 

and the ears in the clinics, in the CBOCs, and in the hospitals that 

give us the feedback for us to try and see to it that we hold the 

Veterans Administration accountable. 

Nobody has a better, more conscientious, more constructive view 

than The American Legion. I want to thank you for what you all 

have done. I appreciate you being here to hear this today and I will 

appreciate your comments. I have read some of them already, but 

after the hearing, any additional comments you have for the record, 

we will be happy to submit. Welcome, we are glad to have you 

here. 

Mr. BARNETT. Thank you, Mr. Chairman. 

Chairman ISAKSON. I want to talk about three things in my 

opening remarks and three things only. I am interested in making 

Choice ultimately work for the veteran, the Veterans Administration, and for the taxpayer. We had some issues come up recently 

in anticipation of this hearing taking place, and I am going to 

make them public in my testimony so the Secretary can at a point 

in time in his testimony address those. 

We had a situation in New Hampshire in the past couple of 

weeks where we have lost providers, which I think Dr. Shulkin is 

already aware of. The issue basically gets down to prompt pay. We 

have got to get a situation in the Veterans Administration where 

a physician can reasonably anticipate a prompt payment for services rendered under the Choice Program, or Choice will not work. 

In my hearing that the Secretary was kind enough to come to in 

Hall County in Gainesville, GA—I guess back in December or November of last year—we learned that some of the cumbersome nature of the paperwork that is required by the third-party administrators to get an appointment set up has to be worked on between 

the VA and the third-party administrator. Once the appointment is 

set up and the bill is actually sent, the VA has to expedite or reasonably speed up the prompt payment so a doctor or a physician 

in a hospital will really want to provide that benefit. That is the 

goal I would like to see us continue to work on and do everything 

we can to do. 

We also had the CACI situation in my State of Georgia, which 

I think the Secretary is already familiar with, as well as the other 

Members. We continue to find cases where the Inspector General 

finds backlogs in terms of records. In the case of CACI, we had 

boxes of records that were supposed to have been scanned and put 

in the VA system that were stacked up in a corner, which was bad 

for veterans, bad for accountability, and something we need to 

work on to make sure we do. 

3 

The point I am trying to make is that it is the little things that 

get you, not the big things. The big vision in terms of the VA for 

the Secretary is one I admire, and I am looking forward to hear 

from him. It is the little things that fall through the cracks that 

cause you the biggest problems, and I think for all of us on the 

Committee who are in our districts on a daily basis, it is prompt 

pay, it is accessibility to the Choice Program, and it is accountability within the VA. It is kind of a no excuses, ‘‘the dog ate my 

homework’’ type of environment, but instead a can-do type of 

environment. 

The Secretary has been a great leader for the Department since 

he was sworn in July, I think, of 2015. Is that not correct? 

Secretary MCDONALD. Yes, sir. 

Chairman ISAKSON. We have about 11 months to go under the 

current administration. We want to make every single month count 

for our veterans and for the taxpayer. I look forward to chairing 

the Committee as we work hand in hand to do that, overcome our 

obstacles, bring about accountability, and provide better service at 

a better cost to the veterans of the United States of America. 

With that, I will recognize Ranking Member Blumenthal. 

STATEMENT OF HON. RICHARD BLUMENTHAL, RANKING 

MEMBER, U.S. SENATOR FROM CONNECTICUT 

Senator BLUMENTHAL. I am not sure that I would take that as 

a compliment because, frankly, Mr. Secretary, your job is a lot 

more difficult than ours. We thank you for your very diligent and 

dedicated work, and that as well of your colleagues who are with 

you today. 

Today is an important hearing because the VA is at a real milestone turning point. With the last stretch of the administration 

ahead, the opportunity to make fundamental cultural and institutional changes is fast disappearing. So, today’s hearing is about 

your vision and the plan to achieve it. It is a tremendous opportunity because there is a lot of work to be done, but it is also a 

tremendous challenge. I know that you have been working at it 

very hard and very long. 

I am focusing on a number of changes that I think are very important. Obviously, consolidating care in the community, the VA 

has estimated the annual cost of care through the current Veterans 

Choice Program would be about $6.5 billion with an additional $7 

billion in general community care. That is about $13.5 billion, 

which seems largely unsustainable at the present rate. So, something needs to be done. 

The inventory of appeals at the VA has skyrocketed to 440,000. 

That is 440,000 claims that are under appeal and need to be in 

some way expedited. I am a supporter and a cosponsor of the Veterans Appeals Assistance and Improvement Act of 2015, which 

would change current law to expedite the most egregiously delayed 

claims, namely, those over 8 years old. It is hard to believe that 

some claims are over 8 years old, but if they are, there is simply 

no reason that they should not be expedited. 

And, finally, Rob Nabors in his report of June 2014 talked about 

the corrosive culture at the VA which has led to personnel problems across the board. Changing the culture is a big job, and partly 

4 

it will impact the ability to fill VHA open positions, which I know 

has been one of your priorities. One of the goals of the Department 

in 2016 is to increase access to health care and reduce the amount 

of time it takes to fill open positions by 30 percent. That is a critically important goal because 900 vacancies, which I think is the 

last number that I saw, means there are 900 fewer people than 

there should be to be caring for our veterans. 

So, those are among my concerns, and we are looking forward to 

hearing from you, and, again, thank you for your work at the Department. 

Chairman ISAKSON. Secretary McDonald, you are recognized. The 

floor is yours. 

STATEMENT OF HON. ROBERT A. McDONALD, SECRETARY, U.S. 

DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY 

DAVID J. SHULKIN, M.D., UNDER SECRETARY FOR HEALTH; 

AND DANNY PUMMILL, INTERIM UNDER SECRETARY FOR 

BENEFITS 

Secretary MCDONALD. Thank you. Chairman Isakson, Ranking 

Member Blumenthal, Members of the Committee, thank you for 

this opportunity to discuss the important transformation of VA, 

what we call ‘‘MyVA.’’ 

My personal thanks also to Senators Tom Tillis and Jon Tester 

for meeting with us repeatedly to hone our transformation plans. 

I believe they know MyVA is about fulfilling the Nation’s obligation 

to those who have served and that they share our vision for VA to 

become the number 1 customer service agency in the Government. 

We have a lot of work to do to reach that goal, but we are making 

progress. 

This chart reflects the tremendous work done by our Veterans 

Benefits Administration in reducing the backlog of disability 

claims, an almost-90-percent reduction in the backlog since March 

2013. 

Our National Cemeteries Administration (NCA) is already rated 

number 1 in the Nation by the American Customer Satisfaction 

Index (ACSI). ACSI rates all customer service companies in the NaVerDate Mar 15 2010 16:02 Jan 30, 2018 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 Z:\ACTIVE\012116.TXT PAULIN

121psVA8.eps
5 

tion, and NCA came out on top. We aim to make it so for all of 

VA. 

Last year, J.D. Power rated our consolidated mail outpatient 

pharmacy with the highest customer satisfaction score among the 

Nation’s public and private mail-order pharmacies for the sixth 

year—higher than Kaiser, higher than Humana, higher than 

Walmart. 

That said, let me tell you about our framework to transform all 

of VA by combining functions, simplifying operations, and providing veterans care and services so that they see VA as their VA, 

MyVA, a world-class, customer-focused, veteran-centered service 

organization. 

This chart shows our five critical MyVA objectives. First, we 

want to improve the veteran experience. Every contact between 

veterans and VA should be predictable, consistent, and easy. It begins with respectfully receiving our veteran clients, but it is also 

a science. We are focusing on Human-Centered Design, process 

mapping, and working with exceptional design firms and companies to make every interaction with our clients better. 

Second, we need to improve the employee experience. We cannot 

make things better for veterans without improving the work environment of employees. It is no coincidence that the best private 

sector service organizations are also the best places to work. 

Third, we need to improve internal support services. We must 

enable employees and leaders by bringing our IT infrastructure 

into the 21st century. Our scheduling system dates to 1985. Our financial management system is written in COBOL, a language I 

used in 1973. This is unacceptable, and it impedes our efforts to 

serve veterans. 

Fourth, we need to establish a culture of continuous improvement. We will apply Lean Six Sigma strategies and other performance improvement capabilities to help employees improve processes 

and build a culture of continuous improvement. 

Last, enhancing strategic partnerships. Expanding our partnerships will allow us to extend the reach of services available for veterans and their families. 


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6 

The MyVA is a framework for modernizing VA’s culture, processes, and capabilities to put the needs and interests of veterans 

and their families first. Changes to leadership were also necessary. 

Ten of our top 16 executives are new since I became Secretary. All 

of them have substantial business experience. Our new leadership 

team feels comfortable having honest and sometimes tough discussions to transform VA. This team includes a former banking industry CFO and the president of the USO; a former CEO of Beth 

Israel Medical Center and Morristown Medical Center; a former 

chief executive of Jollibee Foods and president of McDonald’s Europe; a former CIO of Johnson & Johnson and Dell; a former chief 

customer officer for the city of Philadelphia who spent 10 years at 

USAA; a retired Disney executive who spent 2010–11 at Walter 

Reed enhancing the patient experience; and I am the former chairman, president, and chief executive officer of the Procter & Gamble 

company. 

Our MyVA Advisory Committee, led by Chairman Joe Robles, a 

retired U.S. Army major general and former chairman and CEO of 

USAA, is also comprised of a diverse group of business leaders, 

medical professionals, and experienced Government executives. I 

knew that we needed outside expert advice on business and government transformation, so I recruited these leaders well before the 

independent commission was established to help advise our team 

on VA transformation. 

We are working collaboratively with many world-class institutions to capture ideas and best practices as we transform. As well, 

we are listening to key stakeholders, even those who are critical of 

VA. 

We are forming strategic partnerships with external organizations to leverage their good will, their resources, and their expertise to better serve veterans. VA cannot do everything itself. Over 

the last year, we have cultivated meaningful partnerships in employment, ending homelessness, wellness, and mental health, with 

dozens of productive partners. We are streamlining business processes with community care providers, reimagining how we obtain 

services such as billing, reimbursement, and information sharing. 

We must operate as part of a community of care. 

We know that VA has significant issues that need to be addressed, so we are listening to others’ perspectives, and we are investing in our people. We are running the Government’s second 

largest Department like a $181 billion Fortune 6 organization 

should be run, balancing the near-term performance improvements 

while rebuilding the long-term organizational health of VA. 

7 

We have narrowed down our near-term focus to 12 breakthrough 

priorities, as shown on this slide. On the left are eight veteran-facing priorities. On the right are four VA-facing priorities. Make no 

mistake: All 12 are designed to improve the delivery of timely care 

and benefits to veterans. We had many accomplishments in these 

areas in 2015, but I will spend most of my time focusing on what 

we will accomplish in 2016. These are the stretch objectives that 

we are committed to. We understand this will be a challenge, but 

we are committed to producing results for veterans. 

First, improve the veteran experience. In 2015, we named VA’s 

first Chief Veteran Experience Officer and began staffing that office that will set customer service standards, spread best practices, 

and train employees. We are creating a national network of community veteran engagement boards to leverage non-VA assets to 

meet veterans’ needs. We have established 36 communities with 15 

more in development. In fact, the Ranking Member attended the 

event that we had in Connecticut where we established one of our 

very first Community Veteran Engagement Boards. 

In 2016, we will establish department-wide customer experience 

measurements to enable service improvements and increase veterans’ trust in the VA from 47 percent—that is the baseline data 

that we have gotten—to 70 percent. 

We will also ensure our Veterans Experience Office is fully operational and expand our network of Community Veteran Engagement Boards to over 100. Our medical centers will be fully staffed 

at the front line with well-prepared, customer-oriented employees. 

Second, increased access to health care. Last year, VA increased 

the number of veteran appointments by more than 1.2 million and 

completed over 96 percent of appointments in October within 30 

days of clinically indicated or veteran’s preferred dates. By the end 

of this year, when veterans call or visit primary care at a VHA 

medical center, their clinical needs will be addressed that day. Enrolled veterans will conveniently get medically necessary care, referrals, and information from any VA medical center. 


121psVA6.eps
8 

Number 3, improve community care. In 2015, VA issued authorizations resulting in 12 million community care appointments, 

thanks to the flexibility of the Choice Act. In 2016, pending legislation that we need, VA will begin consolidation and streamlining of 

access to our care in the community network. Veterans will see a 

community provider within 30 days of referral. Community care 

claims will be processed and paid within 30 days 85 percent of the 

time, and the claims backlog will be reduced to less than 10 percent of inventory. 

Number 4, deliver a unified veterans experience. Last November, 

VA launched the initial Vets.gov capability. This is a mobile-first, 

cloud-based Web site that will replace numerous other Web sites 

with a single log-in. In 2016, Vets.gov will provide veterans, their 

families, and caregivers with the top 100 search terms found within one click. Additionally, 100 percent of content, features, and 

forms from the current public-facing VA Web sites will be redesigned, rewritten in plain language, and migrated to Vets.gov, 

prioritized by veteran demand. 

Five, modernize contact centers, including the Veterans Crisis 

Line. Last year, the heroic staff of our Veterans Crisis Line in 

Canandaigua, New York, was featured in the Oscar-winning documentary ‘‘Crisis Hotline: Veterans Press 1.’’ They answered over 

490,000 calls, initiated the dispatch of emergency services to callers 

in imminent crisis over 11,000 times, and provided over 81,000 referrals to VA suicide prevention coordinators. By the end of this 

year, veterans in crisis will have their call promptly answered by 

an experienced responder at the Veterans Crisis Line. All veterans 

will be able to access the VA contact centers 24 hours a day, know 

where to call to get their questions answered, receive prompt service and accurate answers, and be treated with kindness. 

Number 6, improve the Compensation and Pension Exam Process. Many veterans find the C&P Exam, often their first impression 

of VA, to be confusing. Last year, VBA, VHA, and our Veterans Experience team worked to redesign the process using Human-Centered Design and Lean techniques. By February, we will have a 

baseline metric in place to measure veteran satisfaction with the 

C&P Exam process, and by the end of 2016, we will complete a national rollout of initiatives demonstrating improvement in Veterans 

Experience with the C&P Exam. 

Number 7, develop a simplified appeals process. We have driven 

down the disability claims backlog to fewer than 82,000 from a 

peak of 611,000 in March 2013, fully transitioning processing from 

paper to electronic, eliminating 5,000 tons of paper a year. We decided 1.4 million disability compensation and pension claims for 

veterans and survivors. That is the highest for VA in a single year. 

In 2016, subject to successful legislation, we will put in place a 

simplified appeals process enabling the Department to resolve 90 

percent of appeals within 1 year of filing by 2021. 

Number 8, continue progress in reducing veteran homelessness. 

Last year, we provided services to more than 365,000 homeless or 

at-risk veterans and placed almost 108,000 in permanent housing 

or prevented them from being homeless. In 2016, we will continue 

reducing veteran homelessness and demonstrate progress toward 

9 

an effective end by assisting an additional 100,000 veterans and 

family members. 

Number 9—these are the internal-facing initiatives—improve 

employee experience. In 2015, we launched a program called Leaders Developing Leaders, which trained over 5,000 leaders. We also 

trained critical parts of our workforce in Lean and Human-Centered Design to improve and encourage problem solving. In 2016, 

we will continue improving the employee experience by developing 

engaged leaders who inspire and empower employees to deliver 

seamless, integrated, and responsive customer service and have 

over 12,000 leaders trained in these Leader Developing Leader 

principles. All VA employees will have a customer service standard 

in their performance plans. 

Number 10, staff critical positions. In 2015, we hired over 41,00 

employees, a net increase of almost 14,000 health care staff, or a 

4.7-percent increase that included over 1,300 physicians and 3,600 

nurses. Additionally, we filled several critical leadership positions 

to include the Under Secretary for Health, the Chief Information 

Officer, and the Chief Veterans Experience Officer. 

In 2016, our targets include 95 percent of medical center director 

positions filled with permanent appointments and 90 percent of 

other critical shortages addressed, while reducing ‘‘time to fill’’ vacant positions standards by 30 percent. 

Number 11, transform our Office of Information and Technology. 

In July 2015, LaVerne Council was confirmed as our new Chief Information Officer. She has developed a multi-year plan for a worldclass IT organization. 

In 2016, our key IT goals include ensuring 15 percent of our IT 

projects are on time and on budget. We will stand up an account 

management office and develop portfolios for all administrations. 

One hundred percent of IT’s executive performance goals will be 

tied to strategy goals, and we will close 100 percent of current 

cybersecurity weaknesses. We will develop a holistic veteran data 

management strategy, implement an IT quality and compliance office, and finalize congressionally mandated interoperability requirements. 

Number 12, transform the supply chain. In 2016, we will build 

an enterprise-wide integrated medical surgical supply chain that 

leverages VA’s scale to drive an increase in responsiveness and a 

reduction in operating costs, with $150 million plus of cost avoidance, which we will redirect to priority veterans programs. 

Those are our 12 action steps for 2016, including the commitments that we have made to get them done. We are rigorously 

managing each of these breakthrough priorities by instituting a department-level scorecard, metrics, and tracking system. Each priority has a responsible individual and a cross-department team 

that meets every other week with either the Secretary or the Deputy Secretary. 

Mr. Chairman, VA is grateful for your continuing support and 

appreciates your efforts to pass legislation enabling high-quality 

veterans’ care. We have identified a number of necessary legislative 

items that we need your help with in 2016. Details are in my written statement, but we need assistance with consolidation of care in 

the community, flexible budget authority, support for the PurVerDate Mar 15 2010 16:02 Jan 30, 2018 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 Z:\ACTIVE\012116.TXT PAULIN
10 

chased Health Care Streamlining and Modernization Act, special 

legislation for VA’s West Los Angeles campus, and overhauling the 

claims appeals process. I also encourage the Committee to support 

other key legislative proposals in the President’s 2017 budget that 

will be delivered on February 9. 

Last, we need your assistance in supporting the cultural change 

of MyVA to transform the Department. We need you to have the 

courage to help make the changes you are asking VA to make and 

that we must make. Your legislative support in these areas is critical to achieve irreversible momentum for our MyVA transformation. 

On behalf of the vast majority of VA employees who work hard 

and do the right thing for veterans every day, thank you again for 

this opportunity. We look forward to working together to solve 

what I believe is one of the most important national issues: caring 

for those who protect our freedom. We have the capability and determination to make a difference in veterans’ lives, to make the Department the best it can be so that every veteran’s experience with 

VA is world-class. We know we can do this. 

Thank you. 

[The prepared statement of Secretary McDonald follows:] 

PREPARED STATEMENT OF ROBERT A. MCDONALD, SECRETARY, 

U.S. DEPARTMENT OF VETERANS AFFAIRS

Chairman Isakson, Ranking Member Blumenthal, and Members of the Committee. Thank you for the opportunity to discuss the radical transformation that the 

Department of Veterans Affairs (VA) is undergoing. 

I am accompanied today by Dr. David Shulkin, Under Secretary for Health, and 

Mr. Danny Pummill, Acting Under Secretary for Benefits. 

Mr. Chairman, our vision for the future is to be the No. 1 customer-service agency 

in Government. Our cemeteries administration is already rated No. 1 in that respect 

by the American Customer Satisfaction Index. We aim to make it so for all of VA. 

In order to successfully transform VA, we are looking at the entire Department— 

not at incremental changes to parts of it. We began by immediately reinforcing the 

importance of our inspiring mission, caring for those ‘‘who have borne the battle,’’ 

their families, and our survivors. Then, we re-emphasized our exceptional I-CARE 

Values: Integrity, Commitment, Advocacy, Respect, and Excellence. Everything we 

do must be built on this rock solid foundation of mission and values to provide timely quality care and benefits for Veterans. 

I conducted an assessment of the status quo at VA in my first couple of months 

as Secretary. I shared the results of that assessment with President Obama and 

gained his input. During this time, I had discussions with you and other Members 

of Congress privately and during hearings. I spoke to thousands of Veterans, VA 

clinicians, and VA employees. I held dozens of meetings with VSOs and other stakeholders. I recognized from this assessment that we would need to change fundamental aspects of every part of VA to rise to excellence. 

We have a distinguished mission and the right, inspiring values—but we were not 

demonstrating the attributes of a High Performance Organization (HPO): 

11 

Chart 1: High Performance Organizations 

This chart shows a model I developed over my many years in the private sector, 

where these attributes, or the lack of them, could make or break an organization. 

My assessment revealed VA had many issues blocking our path to becoming a High 

Performance Organization. 

• Purpose, Values & Principles: We have a noble mission and outstanding values, 

but inconsistent behavior—a few in our workforce were not keeping our mission in 

mind and not adhering to our values. They are being held accountable. Due to a 

culture of risk aversion, fear, and reprisals, we were not always executing our mission as well as we could or living our values consistently. 

• Technical Competence: VA was often plagued by misplaced priorities, staffing 

shortfalls, and severe hiring challenges. We have to give the workforce what they 

need to succeed. 

• Passionate Leadership: We often suffered from a leader-employee disconnect, an 

overly strict hierarchy, middle management complexity, and communications gaps. 

• Sound Strategies: We had many of them, but all too often they were not effectively deployed. 

• Robust Systems: Many of our existing systems acted as impediments rather 

than catalysts for effective service to Veterans. 

• High Performing Culture: We found the culture within the Department formal 

and hierarchical, rules-based, with ineffective problem-solving systems. 

Despite these shortcomings, I found dedicated, purposeful people serving an inspiring mission everywhere I visited during my travels, which now include more 

than 264 trips to VA facilities and events in more than 100 cities. The face of VA 

looks very much like the face of each Veteran, family member, employee, student, 

researcher, and Member of Congress that it touches every day. 

In terms of VA healthcare, I’ve come to recognize the unique combination of what 

VA care provides: Research leading to major advances in medicine, such as pioneering and developing modern electronic medical records, developing the 

implantable cardiac pacemaker, conducting the first successful liver transplant, creating the nicotine patch to help smokers quit, artificial limbs that move naturally 

when stimulated by electrical brain impulse, and creating applied bar-code software 

for administering medications to patients—the initiative of a VA nurse; training 

that is essential to building and maintaining proficiency of health care—70 percent 

of American doctors receive training from VA; and delivery of clinical care that is 

often Veteran-specific, including polytrauma care for some of our most seriously 

wounded Veterans and the treatment of Traumatic Brain Injuries and post-traumatic stress. 

We have an obligation to be transparent with the American people about both our 

strengths and weaknesses and to inform them about the exceptional work VA accomplishes each day for our Veterans. My views on the importance of VA health are 

best captured in my Baltimore Sun Op Ed, dated October 23, 2014 (see Appendix 

A). 

Since my initial assessment of the Department, subsequent studies and assessments, to include the $68 million Independent Assessment that Congress mandated 

as part of the Choice Act, have reinforced my findings. These assessments provided 


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far greater detail into the challenges and opportunities which we are incorporating 

into our transformation. 

Informed by my initial assessment, we began what we called the ‘‘Road to Veterans Day 2014’’ to: 

• Rebuild Trust with Veterans and stakeholders. 

• Improve service delivery, by focusing on Veteran outcomes. 

• Set a course for long-term excellence and reform. 

We also designed and released VHA’s ‘‘Blueprint for Excellence’’—four broad 

themes and 10 essential strategies to improve the performance of VHA healthcare 

by: 

• Developing a positive culture. 

• Transitioning from ‘‘sick care’’ to ‘‘healthcare’’ in the broadest sense. 

• Developing efficient, transparent, accountable, and agile business and management processes. 

I believe all these assessments and initiatives helped set the stage and build the 

momentum to begin delivering the changes that VA needs. They allowed us to develop the detailed framework to transform the entire Department by combining 

functions, simplifying operations, and providing Veterans care and services so that 

they see VA as MyVA—a world-class, customer-focused, Veteran-centered service organization. 

Chart 2: The 5 MyVA Objectives 

There are five critical MyVA objectives: 

1. Improving the Veteran experience: At a bare minimum, every contact between 

Veterans and VA should be at least predictable, consistent, and easy; however, we 

are aiming to make each touchpoint exceptional. It begins with receptionists who 

are pleasant to our Veteran clients, but there is also a science to this. We are focusing on human-centered design, process mapping, and working with leading design 

firms to learn and use the technology associated with improving every interaction 

with clients. 

2. Improving the employee experience—so we can better serve Veterans: VA employees are the face of VA. They provide care, information, and access to earned benefits. They serve with distinction daily. We cannot make things better for Veterans 

without improving the work experience of our dedicated employees. We must train 

them. We must move from a rules/fear-based culture to a principles/values based 

culture. I learned in the private sector that it is absolutely not a coincidence that 

the very best customer-service organizations are almost always among the best 

places to work. 

3. Improving internal support services: We will let employees and leaders focus on 

assisting Veterans, rather than worrying about ‘‘back office’’ issues. We must bring 

our information technology (IT) infrastructure into the 21st century. Our scheduling 

system, where many of our issues with access to care were manifest, dates to 1985. 

Our Financial Management System is written in COBOL, a language I used in 

1973. This is simply unacceptable. It impedes all our efforts to best serve Veterans. 


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4. Establishing a culture of continuous improvement: We will apply Lean strategies and other performance improvement capabilities to help employees examine 

their processes in new ways and build a culture of continuous improvement. 

5. Enhancing strategic partnerships: Expanding our partnerships will allow us to 

extend the reach of services available for Veterans and their families. We must work 

effectively with those who bring capabilities and resources to help Veterans. 

The MyVA Vision: 

MyVA puts Veterans in control of how, when, and where they wish to be served. 

It is a catalyst to make VA a world-class service provider—a framework for modernizing VA’s culture, processes, and capabilities to put the needs, expectations and interests of Veterans and their families first. 

This transformation is an enormous undertaking and will not happen overnight. 

By revamping our functions to fit Veteran needs, rather than asking Veterans to 

navigate our complicated internal structure, we are rededicating ourselves to the 

proposition General Omar Bradley expressed in 1947: ‘‘We are dealing with Veterans, not procedures; with their problems, not ours.’’ 

A Veteran walking into any VA facility should have a consistent, high-quality experience. MyVA will buildupon existing strengths to promote an environment where 

VA employees see themselves as members of one enterprise, fortified by our diverse 

backgrounds, skills, and abilities. Moreover, every VA employee—doctor, rater, 

claims processor, custodian, support staff, or Secretary—will understand how they 

fit into the bigger picture of providing Veteran benefits and services. VA, of course, 

must also be a good steward of public resources. Citizens and taxpayers should expect to see efficiency in how we run our internal operations. 

Changing the Culture: A New VA: 

We are already changing our culture and operating differently, starting with me. 

When I first arrived at VA, the way I was addressed by my colleagues and the very 

formal format of meetings made me feel like I came first, not Veterans. That is not 

the way the Department should operate. 

Chart 3: Organizational Hierarchy: Supporting Veterans 

We want to turn the pyramid structure of VA upside down, consistent with the 

culture of a High Performance Organization that serves Veterans and their Families. This graphic reflects the way I see VA working—Sloan Gibson and I are at the 

bottom, not the top—supporting our subordinate leaders and our workforce. Veterans and their Families are at the top. This method of thinking and operating is 

a reminder to employees and other stakeholders that we are here to support our 

Veterans, not our bosses. Our bosses are there to support us. We have made other 

changes to systems and behavior which served to insulate our challenges rather 

than expose them. I routinely provide people with my personal phone number and 

email address so that they can contact me. Since August 2014, I have received more 

than 4,800 phone calls and over 15,000 e-mails. Every query receives a response, 

and many of the calls and e-mails received today are to thank us for solving their 

issue. 


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I believe that we can only address the challenges and accept the good ideas we 

know about. I believe our new leadership team feels comfortable having honest, if 

sometimes uncomfortable, discussions in order to transform the Department. We are 

working to ensure that this new ethos permeates every part of our enterprise. 

Changes to leadership were necessary. Of our top 16 executives, 10 are new to 

their positions since I became Secretary. Included on our present team is extensive 

executive expertise from the private sector: A former banking industry Chief Financial Officer and President of the USO; the former Chief Executive Officer of Beth 

Israel Medical Center in New York City and Morristown Medical Center in New 

Jersey; a former Chief Executive of Jollibee Foods and President of McDonald’s Europe; a former Chief Information Officer of Johnson & Johnson and Dell Inc.; a 

former partner in McKinsey & Company’s Transformational Change and Operations 

Transformation Practices; a retired partner in Accenture’s Federal Services Practice; 

a former Chief Customer Officer for the city of Philadelphia who previously spent 

10 years at United Services Association of America (USAA), one of the best and foremost customer-service organizations in the country; a former entrepreneur and CEO 

of multiple technology companies; and a retired Disney executive who spent 2010– 

2011 at Walter Reed enhancing the patient experience, among many other capable 

individuals. 

I am the former Chairman, President, and Chief Executive Officer of Procter & 

Gamble. In addition, VA’s new interim Chief of Staff, who assumed his new duties 

on January 15, has for over the past year co-led VA’s MyVA Taskforce and been responsible for many of the accomplishments I will describe later. 

Combining these fresh perspectives with our more experienced government and 

health care executives has been and will continue to be powerful catalyst for change. 

Most members of the executive leadership team are Veterans themselves who have 

served in every era from Vietnam to Iraq and Afghanistan. Each member of our 

team is here because they demonstrate a personal commitment to our mission. 

To advise this new team on our transformation, we formed a MyVA Advisory 

Committee (MVAC) made up of a diverse group of business leaders, medical professionals, experienced government executives, and Veteran advocates. The Chairman 

is retired Major General Joe Robles, former Chairman and CEO of USAA and the 

Vice Chairman is Dr. J. Michael Haynie, Air Force Veteran, Vice Chancellor of Syracuse University and founder of the Institute for Veteran and Military Families 

(IVMF). The MVAC includes executives with deep customer service and transformation expertise from organizations such as Amazon, The Cleveland Clinic, 

McKinsey & Company, Johns Hopkins, Mayo Clinic, as well as a former Surgeon 

General, a former White House doctor for three U.S. Presidents, a university president who was a Rhodes Scholar from the Air Force Academy who currently serves 

as a reserve Air Force Lieutenant Colonel, and advocates for both the traditional 

VSOs and post-9/11 Veterans’ organizations. 

Chart 4: Learning from the Best Organizations 

We are working collaboratively with many world-class institutions to benchmark 

and capture ideas and best practices along our transformation journey. Institutions 

we have benchmarked include Procter & Gamble, USAA, Cleveland Clinic, 


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Wegmans, Starbucks, Marriott/Ritz Carlton, NASA, Kaiser Permanente, Hospital 

Corporation of America, Virginia Mason, DOD, and GSA among others. 

We are bringing in leadership experts to develop our leaders in new ways. We 

have already trained over 5,000 senior leaders while working with the University 

of Michigan on our ‘‘Leaders Developing Leaders’’ program. We are training critical 

pockets of our workforce on techniques, such as Lean and Human-Centered Design, 

leveraging various private sector experts to bring these cutting edge capabilities and 

skills to government. We are reinforcing our values and moving from a rule-based 

culture to a principles-based culture based on values, sound judgment and the courage to do ‘‘harder right rather than the easier wrong.’’ 

We are encouraging different perspectives and listening to all of our key stakeholders, even those who are critical of VA. We continue to listen, learn, and grow. 

We have renewed and redefined the working relationships with our union partners. The union leaders are part of the team and have had significant input into 

MyVA. We continue to work with them to address issues and make sure our employees are involved as often and early in every major decision. In fact, at our MVAC 

meeting last October, leaders from our five major national unions presented to the 

Committee their intentions for helping to achieve the MyVA vision. 

Chart 5: Increasing Collaborations to Best Serve Veterans 

We are forming strategic partnerships with external organizations to leverage the 

goodwill, resources, and expertise of valuable partners to better serve our Nation’s 

Veterans. We understand that VA cannot do everything itself. Over the last year, 

we have cultivated meaningful partnerships to help address a wide variety of Veteran needs, including, but not limited to, employment, homelessness, wellness, and 

mental health. Our partners include the YMCA, the Elks, the PenFed Foundation, 

LinkedIn, Coursera, Google, Walgreens, other Federal agencies, academic institutions, and many more. These partnerships reflect our commitment to re-thinking 

how VA does business in order to leverage the strengths of others who also care for 

Veterans. 

As we continue to develop a robust provider network, we are also streamlining 

business processes. We are re-imagining how we obtain services, such as billing, reimbursement credentialing, and information sharing. We no longer operate in a vacuum, but as part of a community of care. In West Los Angeles, VA is teaming with 

the city and former plaintiffs to put Veterans first. After settling a long-standing 

lawsuit with those who disagreed with VA’s vision for the 387-acre campus, VA 

reached out to them, and other community stakeholders, to reimagine usage of the 

land. Looking ahead, these new partners are working together to build new facilities 

and networks that will better assist homeless Veterans and other Veterans in southern California. 

We know that VA has significant issues that need to be addressed. As you can 

see, we are listening to various perspectives, bringing the very best America has to 

offer and we are investing in the long term capabilities of our people to ensure these 

skills and ideas continue long after individuals on the current leadership team are 

gone. We are running the government’s second largest Department like a $170 billion, Fortune 6 organization should be run—balancing near term performance imVerDate Mar 15 2010 16:02 Jan 30, 2018 Jkt 000000 PO 00000 Frm 00019 Fmt 6633 Sfmt 6621 Z:\ACTIVE\012116.TXT PAULIN

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provements, while rebuilding the long-term foundational organizational health of 

the Department. 

Focus for 2016: 12 Priorities: 

While we have made progress, we are still on the first leg of a multi-year journey. 

We have narrowed down our near-term focus to 12 ‘‘breakthrough priorities.’’ 

Chart 6: Breakthrough Priorities 

Many of these reflect issues which are not new—they have been known problems, 

in some cases, for years. We have already seen some progress in solving many of 

them. However, we still have much work to do. 

The following are our 12 priorities, major 2015 accomplishments for each, and the 

2016 outcomes to which we aspire. We understand that it will be a challenge to accomplish all of these goals this year, but we have committed ourselves to producing 

results for Veterans: 

Veteran Facing Goals 

1. Improve the Veteran Experience. 

• 2015 Accomplishments: 

– VA named the Department’s first Chief Veteran Experience Officer and began 

staffing the office, which will work with the field to set customer service standards, spread best practices, and train our employees on advanced capabilities, 

such as Lean and Human Centered Design. 

– We are enabling a national network of Community Veterans Engagement 

Boards, designed to leverage all community assets, not just VA assets, to meet 

local Veteran needs. Thirty-six communities are fully formed and 15 communities are in development. 

• Breakthrough Outcome for 2016: 

– Strengthened trust in VA to fulfill our country’s commitment to Veterans; 

currently measured at 47 percent, we want it to be 70 percent by year end. 

– Establish a Department-wide customer experience measurement framework 

to enable data-driven service improvements. 

– Make the Veterans Experience office fully operational. 

– Expand the network of Community Veteran Engagement Boards to 100+. 

– Additionally, in order to deliver experiences to Veterans that are effective, 

easy, and where they feel valued, medical centers will ensure they are fully 

staffed at the frontline with well-prepared employees who have been selected 

for their customer service orientation. Functionally, this means new frontline 

staff will be assessed through a common set of customer service criteria, hired 

within 30 days of selection, and provided a nationally standardized on boarding 

and training program. 

2. Increase Access to Health Care. 


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• 2015 Accomplishments: 

– Increased the number of Veteran appointments by more than 1.2 million. 

– Completed over 96 percent of appointments in October 2015 within 30 days 

of clinically indicated or Veteran’s preferred date. • Breakthrough Outcome for 2016: 

– When a Veteran calls or visits primary care at a VA Medical Center, their 

clinical needs will be addressed that day. 

– Veterans will be able to conveniently get medically necessary care, referrals, 

and information from any VA medical center, in addition to the facility where 

they typically receive their care utilizing existing VISTA technology. 

3. Improve Community Care. • 2015 Accomplishments: 

– Issued authorizations resulting in 12 million appointments for non-Department care, thanks to the expanded flexibility of the Choice Act. • Breakthrough Outcome for 2016: Improve the Veterans’ experience with non-Department Care. Pending legislation, by the end of the year: 

– VA will begin to consolidate and streamline its non-Department Provider Network and improve relationships with community providers and core partners. 

– Veterans will be able to see a community provider within 30 days of their 

referral. 

– Non-Department claims will be processed and paid within 30 days 85 percent 

of the time. 

– Claims backlog will be reduced to less than 10 percent of total inventory. 

– Referral and authorization time will be reduced. 

4. Deliver a Unified Veteran Experience. • 2015 Accomplishments: 

– On November 11, VA launched the initial capability of Vets.gov, a modern, 

mobile-first, cloud-based website that will replace numerous other websites and 

will replace multiple website logins to a single easy to navigate location. Developed with support from the U.S. Digital Services Team and with extensive feedback from Veterans, the website puts Veteran needs and wishes first. • Breakthrough Outcome for 2016: 

– Vets.gov will be able to provide Veterans, their families, and caregivers with 

a single, easy-to use, and high-performing digital platform to access the VA benefits and services they have earned. 

– The top 100 search terms will all be addressed within one click. 

– All current content, features and forms from the current public facing VA 

websites will be redesigned, rewritten in plain language, and migrated to 

Vets.gov prioritized based on Veteran demand. 

– Additionally, we will have one authoritative source of customer data; eliminating the disparate streams of Administration-specific data that require Veterans to replicate inputs. 

5. Modernize our Contact Centers (Including Veterans Crisis Line). 

• 2015 Accomplishments: 

– The amazing heroes who staff our Veterans Crisis Line (VCL) in 

Canandaigua, NY were featured in the Oscar winning documentary ‘‘Crisis Hotline: Veterans Press 1.’’ 

– The VCL answered over 490,000 calls and initiated the dispatch of emergency 

services to callers in imminent crisis over 11,000 times. VCL answered over 

58,000 and 16,000 requests for chat and text services respectively. VCL provided over 81,000 referrals to local VA medical facility Suicide Prevention Coordinators ensuring Veterans are connected to care in their community. 

• Breakthrough Outcome for 2016: 

– By the end of this year, every Veteran in crisis will have their call promptly 

answered by an experienced responder at the Veterans Crisis Line. 

– Veterans will be able to access the VA system 24 hours a day, know where 

to call to get their questions answered, receive prompt service and accurate answers, and be treated with kindness and respect. VA will do this by establishing 

the initial conditions necessary for an integrated system of customer contact 

centers. 

6. Improve the Compensation & Pension Exam Process. 

• 2015 Accomplishments: 

– The Compensation and Pension Examination (C&P Exam) exam is often a 

Veteran’s first impression of the VA when separating from service. We have received consistent feedback this is a confusing and uncomfortable experience. 

Last year, VBA, VHA and our Veterans experience team worked together to redesign this process using Human Centered Design and Lean techniques. 

• Breakthrough Outcome for 2016: 

18 

– Improved Veteran satisfaction with the C&P Exam process. We will have a 

baseline satisfaction metric in place by February and will set a goal for significant improvement once we know our baseline. 

– VA will have a national rollout of initiatives to ensure the experience is 

standardized across the Nation. 

7. Develop a Simplified Appeals Process. 

• 2015 Accomplishments: 

– Drove down the disability claims backlog to under 81,717, from a peak of 

611,000 in March 2013. 

– Guaranteed a record 631,000 home loans totaling $153 billion and assisted 

90,000 Veterans in avoiding foreclosure, saving taxpayers over $2.8 billion. 

– Reduced the time for Home Loan Certificate of Eligibility processing from 26 

business days to 2 business days and automated the processing of dependency 

claims filed online, as well as burial and death benefits for certain surviving 

spouses. 

– Automated burial benefits were paid to surviving spouses within 6 days 

(down from 190 days). 

– VA transitioned disability compensation claims processing from a paper-intensive process to a fully electronic processing system; 5,000 tons of paper per 

year were eliminated. 

– Decided 1.4 million disability compensation and pension (rating) claims for 

Veterans and survivors—the highest in VA history for a single year. 

• Breakthrough Outcome for 2016: 

– Subject to successful legislative action, put in place a simplified appeals process, enabling the Department to resolve 90 percent of appeals within one year 

of filing by 2021. 

– Increase current appeals production to more rapidly reduce the existing appeals inventory. 

8. Continue Progress in Reducing Veteran Homelessness. 

• 2015 Accomplishments: 

– Provided services to more than 365,000 homeless or at-risk Veterans in 

VHA’s homeless programs. 

– Placed almost 107,500 Veterans in permanent housing or prevented them 

from becoming homeless. 

• Breakthrough Outcome for 2016: 

– Continue progress toward an effective end to Veteran homelessness by permanently housing or preventing homelessness for an additional 100,000 Veterans and their family members, 

VA Internal Facing Goals 

9. Improve Employee Experience (Including Leadership Development). 

• 2015 Accomplishments: 

– Launched Leaders Developing Leaders (LDL) which has already trained over 

5,000 leaders in applying LDL principles. 

– Additionally, to improve and encourage problem solving, we are already training critical pockets of our workforce on techniques, such as Lean and HumanCentered Design. 

• Breakthrough Outcome for 2016: 

– Continue to improve employee experience by developing engaged leaders at 

all levels, who inspire and empower all employees to deliver a seamless, integrated, and responsive VA customer service experience. 

– Over 12,000 engaged leaders skilled in applying LDL principles, concepts, 

and tools will work projects and/or initiatives to make VA a more effective and 

efficient organization. 

– Improve VA employee experience by incorporating LDL principles into VA’s 

leadership and supervisor development programs and courses of instruction. 

– VA Senior Executive performance plans will include an element that targets 

how to improve employee engagement and customer service, and all VA employees will have a customer service standard in their performance plans. 

– All VA supervisors will have a customer service standard in their performance plans. 

– VA will begin moving from paper-based individual development plans to a 

new electronic version, making it easier for both supervisors and employees. 

10. Staff Critical Positions. 

• 2015 Accomplishments: 

– VHA hired 41,113 employees, for a net increase of 13,940 healthcare staff, a 

4.7 percent increase overall , including 1,337 physicians and 3,612 nurses. 

19 

– Additionally, we filled several critical leadership positions to include the 

Under Secretary of Health, Chief Information Officer, and Veterans Experience 

Officer. 

• Breakthrough Outcome for 2016: 

– Achieve significantly improved critical staffing levels that balance access and 

clinical productivity, with targets of 95 percent Medical Center Director positions filled with permanent appointments (not acting) and 90 percent of other 

critical shortages addressed—management as well as clinical. 

– Work to reduce ‘‘time to fill’’ standards by 30 percent. 

11. Transformation the Office of Information & Technology (OIT). 

• 2015 Accomplishments: 

– In July, LaVerne Council was confirmed as our new Chief Information Officer 

(CIO). 

– LaVerne has developed a multi-year plan for creating a world class Information Technology organization. 

• Breakthrough Outcome for 2016: Achieve key milestones on the path to creating 

a world-class Information Technology (IT) organization that improves the support to 

business partners and Veterans. 

– 50 percent of projects on time and on budget. 

– Stand up an account management office. 

– Develop portfolios for all Administrations. 

– All supervisors and executives performance goals tied to strategy goals. 

– Close all current cybersecurity weaknesses. 

– Develop a holistic Veteran data management strategy. 

– Implement a quality and compliance office. 

– Deploy a transformational vendor management strategy. 

– Ensure implementation of key initiatives to improve access to care. 

– Strengthen EHR Strategy. 

– Establish one authoritative source for Veteran contact information, military 

service history, and Veteran status. 

– Finalize the Congressionally mandated DOD/VA Interoperability requirements. 

12. Transform Supply Chain. 

• 2015 Accomplishments: 

– VA’s Consolidated Mail Outpatient Pharmacy received the highest customer 

satisfaction score among the Nation’s public and private mail-order pharmacies 

for the sixth year in a row according to J.D. Power; while having an average 

unit price far below national average in both branded and generic drugs. This 

is a powerful example of what the VA is capable with when our supply chain 

leverages our scale. 

• Breakthrough Outcome for 2016: 

– VA will build an enterprise-wide integrated Medical-Surgical supply chain 

that leverages VA’s scale to drive an increase in responsiveness and a reduction 

in operating costs. Over $150 million in cost avoidance will be redirected to priority Veteran programs. 

We are rigorously managing each of these ‘‘breakthrough priorities’’ by instituting 

a Department level scorecard, metrics, and tracking system. Each priority has an 

accountable and responsible official and a cross-functional, cross-Department team 

in support. Each team meets every other week in person with either the Secretary 

or Deputy Secretary to discuss progress, identify roadblocks, and problem solve solutions. This is a new VA—more transparent, collaborative, and respectful; less formal 

and bureaucratic; more execution and outcome-focused; principles based, not rulesbased. 

Thanks to the continuing support of Congress, VSOs, union leaders, our dedicated 

employees, states, and private industry partners, we have made tremendous headway over the past 18 months. Congress has passed key legislation, such as the Veterans Access, Choice, and Accountability Act and the Clay Hunt Suicide Prevention 

for American Veterans Act, which gives VA more flexibility to improve our culture 

and ability to execute effectively. 

The Department is grateful for your continuing support of Veterans and appreciates your efforts to pass legislation enabling VA to provide Veterans with the highquality care they have earned and deserve. We have identified a number of necessary legislative items that require action by Congress in order to best serve Veterans going forward in 2016: 

1. Consolidate Care in the Community: We need your help, as discussed on many 

occasions, to help overhaul our Care in the Community programs, specifically, to 

consolidate the seven existing programs, each with its own rules and requirements. 

20 

VA staff and subject matter experts have communicated regularly with congressional staff to discuss concepts and concerns as we shape the required plan and recommendations. We believe that together we can accomplish legislative changes to 

streamline Care in the Community programs before the end of this session of 

Congress. 

2. Flexible Budget Authority: We need flexible budget authority to avoid artificial 

restrictions that impede our delivery of care and benefits to Veterans. Currently, 

there are over 70 line items in VA’s budget that dedicate funds to a specific purpose 

without adequate flexibility to provide the best service to Veterans. These include 

limitations within the same general areas, such as health care funds that cannot 

be spent on health care needs and funding that can be used for only one type of 

Care in the Community program, but not others. These restrictions limit the ability 

of VA to deliver Veterans with care and benefits based on demand, rather than specific funding lines. 

3. Support for the Purchased Health Care Streamlining and Modernization Act: 

This legislation would allow VA to contract with providers on an individual basis 

in the community outside of Federal Acquisition Regulations, without forcing providers to meet excessive compliance burdens and while maintaining essential worker protections. Already, we have seen certain nursing homes not renew their agreements with VA because of these burdens, requiring Veterans to find new facilities 

for residence. VA further requests your support for our efforts to recruit and retain 

the very best clinical professionals. These include, for example, flexibility for the 

Federal work period requirement, which is not consistent with private sector medicine, and special pay authority to help VA recruit and retain the best talent possible 

to lead our hospitals and health care networks. 

4. Special Legislation for VA’s West Los Angeles Campus: VA has provided technical assistance on special legislation connected to the use of VA’s West Los Angeles 

Campus in a way that will most benefit area Veterans, especially homeless Veterans. VA urges your support for this bill, which will allow us to move forward and 

get positive results for the area’s Veterans after years of debate in the community 

and court action. This bill would reflect the settlement of that litigation, and truly 

be a win-win for Veterans and the community. I believe this is a game changing 

piece of legislation as it highlights the opportunities that are possible when VA 

works in partnership with the community. 

5. Overhaul the Claims Appeals Process: We need legislation that permits the Veterans Benefits Administration (VBA) and the Board of Veterans Appeals to provide 

Veterans with the timely, fair, and quality appeals decisions they deserve thereby 

addressing the growing inventory of appeals, which currently stands at over 

444,000. The antiquated appeals process set in law is failing Veterans,—and American taxpayers. It is too complex and causes Veterans to wait far too long for final 

resolution on an appeal. Fundamental legislative reform to modernize the appeals 

process is critical to ensure that Veterans are provided with a fair, streamlined, and 

understandable appeals process in which most Veterans can be assured of receiving 

a final appeals decision within one year of filing that appeal. 

6. President’s FY 2017 Budget Legislative Proposals: I encourage the Committee 

to support other key legislative proposals that will be included in the President’s 

FY 2017 Budget that will be delivered to Congress on February 9th. 

7. Cultural Change: Last, let me again remind everyone that the vast majority 

of VA employees are hard workers who do the right thing for Veterans every day. 

However, we need your assistance in supporting the cultural change we are trying 

to drive. We are working to change the culture of VA from one of rules, fear, and 

reprisals to one of principles, hope, and gratitude. We need all stakeholders in this 

transformation to embrace this cultural transformation, including Congress. In fact, 

I think Congress, above all, recognizes the policy window we have at hand and must 

have the courage to make the type of changes it is asking VA and our employees 

to make. Congress can only put Veterans first by caring for those that serve 

Veterans. 

Our dedicated VA employees, if given the right tools, training, and support, can 

and do go out of their way to provide the best care possible to our Veterans and 

their families. 

21 

Chart 7: VA Exceptional Employees 

Three of them are pictured above. Last month, Registered Nurse Sharon 

Levenson, who works in a clinic in Battleboro, Vermont, noticed that one of her regular patients did not come in as scheduled. She could have been thankful for a lighter workload that day, but instead, she called her patient. He did not answer so she 

grew concerned. She contacted the VA Police. When VA Police Chief John A. Richardson received Ms. Levenson’s request for a home welfare check, he cited the rules 

and informed Nurse Levenson that unless there was a threat of harm, they were 

not supposed to conduct home welfare checks. 

Chief Richardson could have been satisfied that he followed the rules. Instead, he 

directed Officer Guy Gardner to investigate. Officer Gardner also failed to reach the 

Veteran. He could have stopped there. Instead, he decided to call the Veteran’s 

emergency point of contact. The point of contact visited the Veteran’s home, but no 

one answered. A lack of tracks in the snow indicated no one had recently come or 

gone from the home. Concerned, Officer Gardner called local police and requested 

a welfare check. Local police entered the home and found the Veteran, unconscious 

but alive. He was rushed to the hospital where he was revived and is regaining his 

health. 

These three VA employees demonstrated every bit of the Veteran-focused cultural 

change VA is undergoing. I hear stories like this every day. These are the stories 

that don’t make the newspapers and blogs, but make a difference in the lives of Veterans. We are celebrating the kind of initiative displayed by these employees and 

herald their stories to inspire our other employees to be led by principles and values 

rather than rules and fear. 

Thank you again for this opportunity and thank you for all you do for Veterans. 

We are extremely grateful for having this two-way dialog and we look forward to 

working together to solve what we believe is one, if not the, most important issue 

our country faces... caring for those who protect our freedom. 

APPENDIX A 

THE BALTIMORE SUN 

VA IS CRITICAL TO MEDICINE AND VETS

BY ROBERT A. MCDONALD

OCTOBER 23, 2014

During preparation for my confirmation as secretary of Veterans Affairs (VA), I 

was repeatedly asked, ‘‘Why doesn’t VA just hand out vouchers allowing veterans 

to get care wherever they want?’’ For a department recovering from serious issues 

involving health care access and scheduling of appointments, that was a legitimate 

question. 

After nine weeks at VA, travel to 31 VA facilities in 15 cities, discussions with 

hundreds of veterans and VA clinicians, meetings with 75 Members of Congress, two 

hearings before the Senate and House Veterans’ Affairs committees and dozens of 


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meetings with Veterans Service Organizations and other stakeholders, I can answer 

that question. 

VETERANS NEED VA, AND MANY MORE AMERICANS BENEFIT FROM VA. 

Almost 9 million veterans are enrolled to receive health care from VA—a unique, 

fully-integrated health care system, the largest in the Nation. The VA stands atop 

a critical triad of support—three pillars that enable holistic health care for our patients: research, leading to advances in medical care; training that’s essential to 

build and maintain proficiency of care; and delivery of clinical care to help those 

in need. 

VA’s accomplishments on all three pillars and contributions to the practice of 

medicine are as broad, historically significant and profound as they are generally 

unrecognized. 

VA is affiliated with over 1,800 educational institutions providing powerful teaching and research opportunities. And our research initiatives, outcomes and honors 

are tremendous. Few understand that VA medical professionals: 

• Pioneered and developed modern electronic medical records; • Developed the implantable cardiac pacemaker; • Conducted the first successful liver transplants; • Created the nicotine patch to help smokers quit; • Crafted artificial limbs that move naturally when stimulated by electrical brain 

impulses; • Demonstrated that patients with total paralysis could control robotic arms 

using only their thoughts—a revolutionary system called ‘‘Braingate;’’ • Identified genetic risk factors for schizophrenia, Alzheimer’s and Werner’s syndrome, among others; • Applied bar-code software for administering medications to patients—the initiative of a VA nurse; • Proved that one aspirin a day reduced by half the rate of death and nonfatal 

heart attacks in patients with unstable angina; • Received three Nobel Prizes in medicine or physiology; seven prestigious Lasker 

Awards, presented to people who make major contributions to medical science or 

public service on behalf of medicine; and two of the eight 2014 Samuel J. Heyman 

Service to America medals. 

No single institution trains more doctors or nurses than VA. More than 70 percent 

of all U.S. doctors have received training at VA. Each year, VA trains, educates and 

provides practical experience for 62,000 medical students and residents, 23,000 

nurses and 33,000 trainees in other health fields—people who go on to provide 

health care not just to veterans but to most Americans. 

The 278,000 employees of the Veterans Health Administration work in a system 

spanning all 50 states and beyond, providing—from Maine to Manila—a high volume of quality, clinical care. Our 150 flagship VA medical centers are connected to 

819 Community-Based Outpatient Clinics, 300 Vet Centers providing readjustment 

counseling, 135 Community Living Centers, 104 Residential Rehabilitation Treatment Centers, and to mobile medical clinics, mobile Vet Centers and telehealth programs providing care to the most remote veterans. 

That network of facilities allows VA to deliver care to veterans from the greatest 

generation of World War II to the latest generation from Afghanistan and Iraq. In 

2013, VA provided over 90 million episodes of care; that’s an average of over 240,000 

each day. And since 2004, the American Customer Satisfaction Index survey has 

consistently shown that veterans receiving inpatient and outpatient care from VA 

hospitals and clinics give a higher customer satisfaction score, on average, than patients at private sector hospitals. 

Finally, VA is uniquely positioned to contribute to the care of veterans with Traumatic Brain Injury (TBI), prosthetics, PTSD and other mental health conditions, 

and the treatment of chronic diseases such as diabetes and hepatitis. The work we 

do in these areas, as well as many others, produces results and life changing improvements in care for veterans—and for all Americans and people around the 

world who suffer from these conditions. 

Fixing access to VA care is important; we have a plan to do that and are dedicated to implementing it. That process will take time—but it must be done, and we 

will be successful. Those who fully understand the value of the department in research, training, and clinical care understand that veterans and all Americans need 

and deserve their VA to continue providing exceptional care to those we serve. 

Chairman ISAKSON. Well, thank you, Mr. Secretary. I appreciate 

your testimony. 

23 

We are going to open to as many rounds of questions as we can 

do between now and noon. When the vote is called, I am going to 

ask if Senator Tillis would, as soon as the vote is called, if he would 

go vote, then he would come back and take my place as Chairman 

to continue the hearing so we can keep going all the way through. 

I would appreciate it. When the bell rings, if you will show us your 

North Carolina sprint and get over there and get back in time for 

me to vote, I would appreciate it. [Laughter.] 

Senator TILLIS. I will do my best Jonathan Stewart run. 

[Laughter.] 

Chairman ISAKSON. Do your best Carolina Panther run. If you do 

as good as they did, you will be fast. I can tell you that. 

Secretary McDonald, thank you for your testimony. You referred 

to some of the specific suggestions that you had in your testimony 

to address your seven goals. I want to talk about two of those to 

start with. 

One, on the cultural change, I think the quote is you ‘‘need our 

help’’ for you to make the cultural change within the VA. We want 

to help you make that change, as much as you can coordinate with 

us on decisions that you make before the proverbial banana hits 

the fan, we would appreciate it, because we are in a reactive mode 

as a body. We can do nothing but be critical. If we are in partnership mode, we can do a lot to help, and there are things that you 

might want to do that we do not know about that might get a totally different response if you consulted with us first. I am not saying that you do not, but I know there are some big things in here 

that you are going to want to do to accomplish that are going to 

require consultation with us. 

For example, I am assuming that when you want to make a 

breakthrough, in terms of subject to legislative action being put in 

place, you want to resolve 90 percent of appeals within 1 year of 

being filed. Is that correct? 

Secretary MCDONALD. Yes, sir, that is correct, and that will require legislation. 

Chairman ISAKSON. Is that the legislation that would allow you 

to not allow additional information to be submitted at the time— 

after a claim has been originally filed? 

Secretary MCDONALD. Well, we would like to work with you on 

that legislation. 

Chairman ISAKSON. That is the fully-developed claim? 

Secretary MCDONALD. Fully-developed claim. We would like to 

work with you on that. We think there are steps that can be cut 

out of the process. I am sure Danny could go into greater detail if 

you would like, but we would like to work with you on that legislation. I pledge to you that we will work together as partners, and 

I think this hearing is great evidence that we are doing that today. 

I appreciate you scheduling this hearing. 

Chairman ISAKSON. It is also great evidence that Dale is here 

from The American Legion, the commander of The American Legion. You are going to need to be a part of that particular issue. 

We all want to be able to resolve claims within a year. Everybody 

wants to do that. But the fully developed claim process, which I am 

not necessarily opposed to at all, but that is going to be a major 

move forward that would need the VSOs support, or else we would 

24 

never be able to get it done, because it involves reasonable cutoff 

periods for data to be submitted for a claim to be finally resolved. 

Is that not correct? 

Secretary MCDONALD. Absolutely, and we have involved the 

VSOs in all of our work on fully-developed claims. As recently as 

yesterday morning, I think it was, I had breakfast with the 

Veterans Service Organizations leaders. Dale graduated from West 

Point a year ahead of me, so I am used to him hazing me. 

[Laughter.] 

So, we look forward to working with him on this. 

Chairman ISAKSON. Well, I want to get all of the frogs in the 

wheelbarrow to begin with rather than afterwards, so as quickly as 

we can get a representative of The Legion that Dale thinks is appropriate, including himself if possible, we can involve some Members of the Committee from both sides of the aisle, a change like 

that is going to take significant legislative willpower and cooperation to do, but it is achievable. It is achievable if we are working 

together. 

Secretary MCDONALD. It is achievable. Mr. Chairman, if I just 

may add that only about 11 or 12 percent of claims are appealed, 

so it is a relatively small percentage of the total. But, because veterans continue to add information to their files, many of these 

claims go on for years and years and years. And, generally, the 

people who are appealing are people who are already getting disability payments from the VA. 

So, you know, what we have got to do is get a process which is 

manageable where we can get them adjudicated quickly, but where 

the continuing process does not get in the way of getting these 

claims resolved quickly. 

Chairman ISAKSON. I concur, and I appreciate you making that 

one of your seven priorities. 

Mr. Pummill, you have got a new job. You are one of the 10 of 

16, I guess. Is that correct? You said you had 10 new critical people 

out of the 16? 

Secretary MCDONALD. Yes, sir, he is. Yes, sir. 

Chairman ISAKSON. Well, if you can do as good a job as Dr. 

Shulkin, we are going to be all right. He has done an excellent job 

taking over his position, as has Ms. Council in terms of IT. Which 

leads me to a suggestion, because I am going to run out of my first 

5 minutes in just a second. Tell her to get in touch with Georgia 

Tech. I told you before the hearing, they are developing an interoperable coordinator translator that will allow non-working, nonfunctional IT systems to talk to each other in terms of medical IT. 

If we can break through that, we can end the DOD/VA problem 

where a DOD veteran leaves active duty, goes to Veterans Affairs 

and the two systems do not talk to each other. It is very important 

for us to be able to do that. I would appreciate your having her give 

me a call, then I will tell her the right people to contact. 

Secretary MCDONALD. We will do that. 

Chairman ISAKSON. Last, we want to be a part of the cultural 

change. It is important to make that change happen, and it is important to see to it that we are partners in it. It means we address 

the tough questions. 

25 

My last comment is there was an exchange of letters from Senator Moran and the Chairman in the House, and I know you have 

got a response today in the Wall Street Journal, which is healthy 

in strengthening our relationship to air our differences and air our 

answers to those differences. I agree with your letter in that you 

say you cannot fire your way into success. I would also agree that 

if we do not have a recognized system of accountability that people 

can see actually working within the Veterans Administration. 

There will always be somebody to throw up a news story that slows 

down our cultural change within the organization; so, we need to 

work on that as much as we can. 

Secretary MCDONALD. We agree, Mr. Chairman. As you know 

and as we have talked, we have terminated over 2,600 employees 

since I have been Secretary. After 33 years in the private sector, 

I have done many restructurings, and I know the importance of 

making sure we get people who violate our values out of the organization. We are doing that. We are doing it consistent with what 

they have done, and we are doing it consistent with due process. 

We know that is necessary for cultural change. 

Chairman ISAKSON. Thank you for being with us. 

Senator Blumenthal? 

Senator BLUMENTHAL. Thank you, Chairman. Let me begin with 

your chart which shows a reduction in VA disability claims. In a 

sense, those claims now have caused an increase in the number of 

appeals, which demonstrates in a sense that you have reduced the 

numbers, but simply shifted the problem. That is an oversimplistic 

way of putting it, but as a lawyer, in the Federal courts, or State 

courts, for that matter, if a backlog were cleared simply by moving 

that great mound of work to the appellate process where appeals 

languish for years and years and years, it would not be regarded 

as a success story. So, the 440,000 appeals that currently are pending are, in my view, unacceptable. 

Secretary MCDONALD. That is exactly why it is one of our breakthrough objectives. As we have said, assuming we can work together on the legislation, we are planning to get 90 percent of appeals resolved within 1 year, and I think we can all sign up for 

that objective. 

Senator BLUMENTHAL. Just as a qualification to the point that 

you just made, many of those veterans are receiving benefits. 

Secretary MCDONALD. Yes. 

Senator BLUMENTHAL. But they may be nowhere near the 

amount of benefits that they deserve and need. So, simply to say, 

‘‘Well, they are already getting something,’’ does not mean they are 

getting everything that they need and deserve. 

Secretary MCDONALD. That was a statement of fact. There was 

not any intent to downgrade the importance of getting them what 

they deserve. 

Senator BLUMENTHAL. I understand. So, let me come to the question that you have just raised. Could you give us the details—I assume that you would support the measure that I mentioned earlier 

that Senator Shaheen, myself, and others have supported to expedite those appeals, other additional authorities that you need to get 

this job done? 

26 

Secretary MCDONALD. We will have to overhaul the appeal process. It is really that simple. The law was created at the turn of the 

century—the turn of the previous—well, in the early 1900s—— 

Senator BLUMENTHAL. The turn of the last century. 

Secretary MCDONALD. Yeah, the last century. I am sorry. You 

used to be able to say that. So, the basis of it is antiquated technology and many other things that are no longer applicable. We 

have used our process mapping techniques, the Lean Six Sigma I 

talked about. We have process mapped the process. We think there 

are steps we can take out, but it will require a change in legislation. 

Do you want to say anymore, Danny? 

Mr. PUMMILL. Yes, Senator, it will require a change in legislation, and we are going to have to put some more people against the 

problem, too, in order to tackle it. 

Senator BLUMENTHAL. My question is: specifically, what legislative changes are necessary? 

Mr. PUMMILL. I think the legislative changes that we are working with the Veterans Service Organizations right now to close the 

record. I think if we can get that in place, I think that will go a 

long way to solving the problem. I really believe, looking at the figures they have shown us, that we can do veterans appeals in 1 

year. We just have to continue to work with the VSOs to make sure 

we are doing that the right way. 

I have not had a chance to look at the legislation that has been 

proposed, the 8-year legislation. That sounds like a great idea to 

expedite the ones like—that is what we did with the backlog. We 

did the oldest ones first. Right now they are doing it by docket 

order. We have to make sure that that does not inadvertently harm 

a veteran. That is all. 

Senator BLUMENTHAL. Well, you know, let me make a suggestion 

to you. I am just a country lawyer from Connecticut. In Connecticut, in criminal matters, because of the backlog, a rule was 

adopted that the failure to prosecute within a set amount of time 

would result in a dismissal—the speedy trial rule—and I think that 

became law in various forms in the Federal system as well. In 

other words—and do not hold me to the details, but deadlines were 

set, timelines were established. The failure to proceed within that 

timeframe meant that the Government’s case in effect would be 

dismissed, and the burden was on the Government to prosecute the 

matter. 

At some point, an appeal that is pending for that amount of time 

within a Government structure or process perhaps should result in 

the Government losing the case. 

Secretary MCDONALD. Senator, I would rather work, like the 

Chairman said, on coming up with good legislation and also systemic changes to the way we do our work rather than just setting 

a somewhat arbitrary 8-year limit. I mean, I understand the legislation. I understand the 8 years. But the legislation does not say 

how you do it. 

As a business guy, the biggest challenge is always figuring out 

how you do it, and so I would rather work with you and the Chairman to figure out how we do it and then make sure we put the 

legislation in place that we need to get it done. 

27 

Senator BLUMENTHAL. I am not advocating arbitrary deadlines. 

I am not suggesting that I am supporting a system now. But at 

some point, if this problem is not alleviated, that kind of approach 

is going to be necessary. 

To go back to your days in the private sector, if you could not 

get products to the shelf, you were penalized. Nobody said, ‘‘We are 

going to keep the stores closed until P&G has its products ready 

to go on the shelves.’’ So, there is a burden of proof, so to speak, 

a burden of going forward, a burden of proceeding, a burden of fulfilling the Government’s obligation here. I do not want to go on at 

great length, but what I am suggesting is that the remedies for 

delay may well be that the veteran receives what his claim is because he is the one who is prejudiced. The Government is not. 

Delay works in the Government’s favor, just as it did in the criminal context, because very often the criminal defendant was kept 

without bail, or with bail but could not be made, or under the great 

burden of charges pending. These kinds of deadlines for proceeding, 

whether in the civil or criminal context, in the judicial world may 

have applicability here. That is what I am suggesting. We may not 

be at that point yet, but we may soon be there. 

Secretary MCDONALD. We have identified it as one of our 12 priorities for the year. Let us work together on it, and hopefully by 

the end of the year we will get to a point where 90 percent of appeals are resolved in a year. 

Senator BLUMENTHAL. Thank you. 

HON. THOM TILLIS, U.S. SENATOR FROM NORTH CAROLINA 

Senator TILLIS [presiding]. Thank you. Actually, I am next in the 

order, so I am not taking any sort of the Chairman’s prerogative 

here, Senator Hirono. 

First, I want to thank you for being here. I want to thank you 

for the time you spent in my office. We have had several meetings, 

along with Senator Tester, in the office. I think they have been 

very productive. I like what you have laid out. 

I do have a couple of questions for you. I know that because of, 

I guess, the limitations of the room, one thing that we ought to talk 

about as you go forward is how members will have the ability to 

track progress on these initiatives. These are not just pretty pictures in a PowerPoint presentation, but they are a map to initiatives. I think it was Mike who outlined some of the online access 

that we will have where we can see red, yellow, green, and see 

where you are making progress, particularly on the priority 

projects. I think it is very important to do that. 

Another thing going forward that I think is important is to make 

sure that when we make requests of you, in addition to what you 

have in this transformation—we are going to have day-to-day 

things we are going to complain about. We are going to mess your 

hair up in Committee meetings and do all that we have to do as 

a part of oversight. You all need to make sure that you are very 

direct when we make requests of you that all of a sudden puts 

something else in the critical path of these things that we should 

be able to watch on your project dashboard. That is a very important part of the back-and-forth as we go forward. 

28 

One question that I have is the discussion and some concern that 

we have had expressed to us—and I mentioned this briefly when 

we met last week, Mr. Secretary—about some of the consolidation 

of the providers who may have had a point of entry, been in a relationship with Choice. You are trying to do a better job of consolidating that, I guess, as non-VA providers, concerns we are hearing 

about in terms of reimbursement, those sorts of things. 

Can you give the veterans who may be concerned with the providers, some sense of why this is better for them over time and why 

it is an important part of what you are trying to accomplish? 

Secretary MCDONALD. Thank you, sir, I will, and thanks again 

to Senator Tillis and Senator Tester for meeting with us repeatedly 

and honing these plans. 

As you know, we do have a dashboard that you can drill down 

on. We shared that with you in your office. I would love to be able 

to provide that to this Committee. I just would ask that we work 

together so that I am not spending more time answering questions 

of you drilling down on the dashboard than I am solving problems 

for veterans. If we can come to that kind of arrangement, then I 

have no issue in sharing the dashboard, because that is, in essence, 

how you are going to evaluate us, and these are the commitments 

we have made for the year. 

Senator TILLIS. I think over time it should be rolled up to a level 

to where we are not sweating the details but really just looking at 

trending—— 

Secretary MCDONALD. Just the 12. 

Senator TILLIS [continuing]. And where you are off track so that 

we can dedicate—— 

Secretary MCDONALD. I agree. 

Senator TILLIS [continuing]. It to the stakeholders. 

Secretary MCDONALD. Just the 12 priorities, yeah. 

Relative to providers, I am going to ask David to comment, but 

I think one of the most important things that we can do in 2016 

is develop a network of providers, including Department of Defense, VA, Indian Health Service, private sector, so that by the end 

of the year we have a network that—and academic affiliates—that 

we have a network that we all feel good about, where billing is not 

an issue anymore, where paying bills is not an issue, and where 

we can move forward on behalf of veterans. 

We have had some providers move out of the network. I was recently in Massachusetts where we were having a discussion with 

one of our academic affiliates because the hospital did not want to 

accept Medicare rates for veterans. Well, you know, these are the 

rates that we have to pay. 

So, we have to find a way to get to this, and I know David is 

working hard on it. 

Senator TILLIS. Dr. Shulkin, as you respond to that, you are not 

going to be able to see this. This is my redneck PowerPoint. One 

thing that I want to make sure—I put this together while you were 

doing your opening statement. One thing that I think we need to 

do is always talk—I think that there is a place for Choice long 

term. The question is, to what extent in the pyramid—and this is 

the provider network, not all of VA. To what extent does this increase or decrease based on the State that you are operating in, 

29 

based on the nature of the veterans population that you are serving? We want to make absolutely certain that we are communicating, that at the end of the day this is about getting the veteran to a point of care that they are comfortable with as quickly 

as possible. 

Dr. SHULKIN. Senator, we would appreciate a copy of your 

PowerPoint. We would like to use that. Thank you. 

But I think we are on the same page here, which is that we need 

providers to want to work with VA, because, frankly, veterans need 

the private community. We have recognized that this is a partnership. 

I have spent my career in the private sector trying to get paid 

most of the time from payers. So, my sympathies actually go with 

the providers who are providing a service then having a delay in 

payment. We recognize we have a problem. Today we are at 72 percent payment within 30 days. That is not good enough. 

We are going to take some dramatic actions in the next couple 

weeks in order to improve that. The major issue here, frankly, is 

that we are only getting 40 percent of our claims electronically. We 

should be getting 100 percent. The reason for that is that we demand that not only do we get a bill, but we get all the medical 

record documentation in paper. We are going to have to change 

that policy, and we should so that we can pay providers in a faster 

timeframe. 

Senator TILLIS. Thank you. My time is up. Just a final comment. 

The other things that I hope that we see come through in this 

transformation are leveraging best practices from similar operations like Medicare, in terms of the relationship with the providers, the onboarding, and all of those sorts of things. I hope we 

are not reinventing the wheel, and I think that you all are focused 

on that. 

Secretary MCDONALD. We totally agree. 

Senator TILLIS. Senator Tester. 

HON. JON TESTER, U.S. SENATOR FROM MONTANA 

Senator TESTER. Thank you, Chairman Tillis. Since you are in 

that position—and thank you guys for being here. I think it is appropriate that I ask the Secretary of the VA, there are four teams 

that may win the Super Bowl. Who are you rooting for? 

Secretary MCDONALD. Which one are you for? [Laughter.] 

Senator TESTER. I think it is more important you take a look at 

who is in the chair. 

Secretary MCDONALD. Thank you. Carolina. Carolina for sure. 

Senator TILLIS. You are a great American. [Laughter.] 

Senator TESTER. Thank you all for your work. I appreciate being 

able to be in on some of the plans that you have been putting forward, and I do mean that. Thank you. I can tell you that I met 

with Dr. Shulkin yesterday, and there are still plenty of issues out 

there we need to deal with as far as care to the veterans on the 

ground, and we are going to continue to pester until we get to that 

point. 

But we passed a number of bills out of here, and I do not know 

that any of them have made it to the floor yet. We are not exactly 

the gold standard when it comes to efficiency here in Congress. Do 

30 

you have contingency plans if we do not pass some of the bills that 

you need? 

Secretary MCDONALD. We do. It will cause us to dial back on 

what our outcome goals will be. I wanted to take the MyVA transformation, which, arguably, is a big, multi-year process, and boil it 

down to what are we going to accomplish by December 31st. What 

I have given you is what I think we can accomplish by December 

31; and I think, arguably, there are good outcomes there for veterans. But we are going to need the legislation that we have identified. If we do not get that, we will have to dial back. 

Senator TESTER. OK. If you have covered this before I got here, 

I can go back and read the record on it. But what are maybe three 

of the most significant short-term deadlines? 

Secretary MCDONALD. The first is provider agreements. We have 

long-term-care facilities right now refusing to do business with us 

because they are too small to deal with the Federal acquisition 

rules. That is number 1. 

Second, I would have to add the consolidation of care in the community. You all have had a hearing on it. I thought it was a very 

good hearing. I think the plan we put forward is a good plan. We 

cannot get to that ideal, optimum network of providers, including 

private sector providers, until we get that rule, that law done, because right now, as you know, there are many different programs, 

seven different programs, all with different criteria, specifications, 

and, importantly, all with different payment schedules, which really confuses veterans, and it confuses employees. It is distorts incentives, because people want the program that is the most expensive. 

I think that is number 2. 

Number 3, I would say flexible budget authority. Last year, I had 

to come to the House Committee and the Senate Committee begging for money for care in the community, for hepatitis C, this new 

miracle drug, because we had money in a separate pot that was designed for that purpose, but I do not have the authority to move 

that money. I think as long as it is about caring for veterans, I 

should have the ability to use the money to care for veterans. 

Senator TESTER. OK. Of those three short-term deadlines, how 

many can be done without action from the Congress? 

Secretary MCDONALD. Well, the consolidation of care, as soon as 

we get that, we can—I mean, it is huge. 

Another, a fourth one—I am sorry. 

Senator TESTER. Go ahead. 

Secretary MCDONALD. The West Los Angeles campus extended 

use leasing (EUL), the minute we get that passed, we can put 

spades in the ground in West Los Angeles and start building buildings with private sector partners. 

Senator TESTER. I got you. Here is the point I am trying to make, 

Mr. Secretary. That is that you can have all the greatest ideas you 

want, your management team can have all the greatest ideas, and 

the folks at the different regions can have the best of ideas, but I 

think you need to be very, very direct with this Committee as to 

what needs to pass if you are going to meet the needs of the veterans out there. That is all I will tell you, because, quite frankly, 

if you cannot do what you are going to do, we are just talking to 

one another, and we are not getting to where we need to be. 

31 

Secretary MCDONALD. I agree. Senator, in my written testimony 

and in my oral testimony, I said pending legislation purposely for 

a number of the outcomes that we cited. 

Senator TESTER. Right. 

Secretary MCDONALD. So, anybody who wants that information 

can go back to the written testimony, and you can see how the legislation is tied to those outcomes for veterans. 

Senator TESTER. We can also connect up with you for that, too. 

I just think it is really, really important that we can talk about 

changing the VA. We can talk about providing better service, but 

part of that talk is actually getting something done, too. OK. 

Thank you. 

Look, I talked to Dr. Shulkin about this yesterday. Could you 

give me any sort of update? You have got a lot of leadership positions that were open, maybe still are open. Give me some kind of 

update on where we are at on that and what we are doing to help 

fill those vacancies. 

Secretary MCDONALD. I would like to ask David to do that. 

Dr. SHULKIN. Senator, thank you for the question. I know the 

Chairman had some comments about this as well. 

Our biggest challenge is getting the right leadership in place and 

then getting critical positions filled within the VA system. As of 

last evening, we had listed 43,000 recruits for the VA health system, and we are desperately trying to attract the top-quality professionals to come in. We have in our medical centers 34 medical 

center director positions that are open. Now, you know, running a 

health care system without having permanent leadership in place 

is a challenge. 

One of the legislative authorities that we have asked for is just 

one of the ones listed in the testimony is to give us the flexibility 

to use Title 8 funding to be able to recruit medical center directors 

and network directors. Frankly, I have had a significant challenge 

convincing any of my colleagues from the private sector to look at 

VA as a career, and I desperately need that talent. 

We are working very hard to hire physicians, nurses, pharmacists, psychologists, mental health workers, and leaders of our 

system. Those are our priorities. I know the Secretary in particular, every day talking about what a privilege it is to join the 

VA, and if anyone knows of people who want to join the VA, we 

try to talk to them on a daily basis to come and join us. 

Secretary MCDONALD. I would like to add three other things, if 

I may, very quickly. 

Number 1, I asked in my opening testimony about the Congress 

helping us with this cultural change. To the degree that we continue to see negative news articles and other things, the number 

of people applying for VA positions is about three-quarters lower 

than it was 2 years ago before the crisis occurred. 

Number 2, recruiting. I have asked Members of Congress to go 

recruit with me. You have done that. You and I went to the University of Montana together. This is very important, and Senator 

Isakson has come to VA to talk to town hall meetings. It is very 

important to show our employees that we are all together and our 

prospective employees that we are all together. I have been to over 

32 

two dozen medical schools, and I have recruited many people right 

on the spot. 

The third point is we are leaving positions vacant because we do 

not want to add more people than we need, and we are in the process of trying to figure out how to reduce the levels and how to become more productive. For example, we recently realigned our 

VISNs, which are our regional medical networks. We eliminated 

three of them. So, what we want to do is make sure we are only 

recruiting for positions we want to fill rather than all positions that 

may be vacant. 

Senator TESTER. I got you and I appreciate that. I can tell you 

I do not know what is going on in North Carolina or Georgia or 

Connecticut, but I have a pretty good idea what is going on in Montana. For the record, the vets who go to Fort Harrison love those 

people, but they are also quick to point out we are burning them 

out because we do not have enough staff. I think it is really critically important. We can talk about it, but we have got to do it. It 

is really important. 

I will walk hand in hand with you if it comes to recruitment because these folks have done a lot for us. We owe it to them. Thank 

you. 

Chairman ISAKSON [presiding]. Senator Moran? 

STATEMENT OF HON. JERRY MORAN, 

U.S. SENATOR FROM KANSAS 

Senator MORAN. Mr. Chairman, thank you very much. Mr. Secretary, welcome. 

Secretary MCDONALD. Good morning. 

Senator MORAN. Good morning. Please consider me an ally when 

it comes to trying to accomplish the things that you outlined in 

MyVA in your testimony this morning. I am anxious to see a transformation at the Department of Veterans Affairs, and that transformation is that those who served our country receive the care, 

treatment, and benefits that they are entitled to. And do so in a 

timely, cost-effective way for the taxpayers and that they receive 

quality service. That is what your statements were all about this 

morning, and I certainly support that outcome. 

What I want to again focus on is the current circumstance in 

which I find myself trying to help veterans. We did have a hearing 

with Under Secretary Gibson on December 2 on consolidation of 

those community-based programs. Clearly, I understand the value 

of consolidating. We have over time created too many programs 

that cannot be administered efficiently. 

Secretary Gibson committed to me during that hearing to do several things which have not yet happened, and I am asking you for 

your help to see that they do. On his own volition, he volunteered— 

we had a conversation about veterans who were not qualifying for 

the Choice Act, and his offer of his own volition was that he would 

provide me with a list of those veterans who qualify for Choice in 

Kansas. That seems a very generous offer, but it has not happened. 

Perhaps it was too generous. But if you could help me in that regard—because we have, again, those who are caught in the process 

of calling the third-party vendor and being told they do not qualify, 

or being told they do not qualify because they live within 40 miles. 

33 

Then, you start digging down, and neither one of those things are 

true. I guess the goal here is to try to figure out who does qualify 

so that there is an understanding by the person on the end of the 

phone who is telling a veteran whether he or she can access the 

Choice Act. So, that was one request we had—or an offer that Secretary Gibson indicated. 

Also, the conversation occurred about the number of people who 

have been abandoned, and what I asked for was something I think 

the VA calls their ‘‘abandonment rate.’’ I was originally concerned 

about what was said by the Under Secretary several months ago, 

a long time ago when Choice was new. One of the comments in a 

hearing was that Choice is not popular with veterans, they do not 

want Choice. 

What worried me about that is that I did not want to see the VA 

create a circumstance in which the Choice Act became so unappealing that veterans decided they did not want it. Give it a chance to 

work. We will let our veterans decide. I have a clear sense that it 

will be very valuable. Part of that is the geography and demographics of a State like mine. 

One of the things that I have asked for is what that abandonment rate is. Just as an analogy, a long time ago I was in the State 

legislature, and the railroad started reducing the services available 

to my community, my home town. Over time, customers decided 

they did not use the rail service because it was not any good. Then, 

the railroad goes to the regulators and says, ‘‘Well, nobody uses the 

rail line. Let us get rid of it.’’ I want to make certain that that is 

not the intention of VA, and I do not have the sense or the fear 

that I had some time ago. It seems to me the VA is more and more 

embracing community care, and I appreciate that. But when we see 

these numbers about people served, what I want to make certain 

is that we are taking care of those who have just given up. That 

is one of the most common conversations I have with Kansans. 

They tried the Choice Act, and either they were told they did not 

qualify, and they try again and still—or they are told they live 

within 40 miles, and more recently it has been, ‘‘Well, I used the 

Choice Act. They provided me with my hometown provider, but 

then when the hometown provider insisted that I see a specialist, 

then I had to go through it all over again, and I was denied the 

chance to go have the radiologist look at my X-rays.’’ 

It may work initially and then, again, fall apart in the process. 

I want to make certain we do not discourage veterans from using 

the program because it is not working up front. That abandonment 

rate, which I was told I would be provided, I would like to have 

to see how many people are walking away, not really because they 

want to but because it is not meeting their needs. 

Also, Secretary Gibson and I had a conversation about ten specific cases in Kansas. It was his willingness to take those cases on 

and solve the problems, and I appreciate what he said. He said, 

‘‘We are committing to fix it, and if we are not executing, shame 

on us, bad on us.’’ He offered to take care of the ten cases that had 

come into our office that week dealing with Choice. The ultimate 

outcome was that somebody from the VA called our caseworkers 

and said, ‘‘What do we need to do?’’ So, it ended up back in our 

office as compared to the VA stepping in and solving the specific 

34 

problem. I would highlight that opportunity for the VA to see— 

maybe this is just a pilot program in which you can see what kind 

of conversations I have with veterans and how the Choice Act is 

failing them. Maybe these ten examples would be useful to you as 

you try to solve the problems systemwide. So, I would appreciate 

that help. 

Again, we want good things to happen at the VA. The challenge 

that you will have as you are trying to reinvigorate the VA, alter 

its course, and change quality, day-to-day veterans are being left 

behind. Those are problems we have to solve while we transform 

into the future. 

Secretary MCDONALD. Absolutely, and we will get on those three 

things you mentioned, Senator Moran. There is no question by any 

of us that care in the community is absolutely essential for us to 

have a network of providers in this country to care for veterans. 

Absolutely no question. In fact, earlier, when Senator Tillis was sitting as Chairman, I meant to say we have a map of the United 

States, a dynamic map that lays out where we think the veterans 

live and where we think they are going to live, where the providers 

are, whether they are DOD, VA, private sector. It would be good 

to have that discussion with each Member of the Committee, eventually each Member of Congress, so you see the kinds of capability 

we are trying to put in place. We do not want anybody to be abandoned, and so we are very much—— 

Senator MORAN. Mr. Secretary, thank you for saying that, and I 

would tell you that I think every Republican Member of this Committee, at least on the staff level, we asked for a meeting with 

somebody from the VA to describe to us, to explain, and to have 

a consultation on the definition of a full-time position or a full-time 

facility, and that was to take place. It as not taken place yet. We 

asked for it, and I think every Republican member would like to 

be—has asked to join us in that request, to have a meeting with 

somebody from the VA, not you, not necessarily Secretary Gibson, 

just someone who can tell us how the new definition—and I would 

respond to what you just said, and—— 

Secretary MCDONALD. Sir, I was not familiar with that. I would 

be happy to meet with every member. I have met with caucuses. 

I have met with doctors’ caucuses. I would be happy to do that. 

Senator MORAN. Great. What I would conclude by saying is that 

the Choice Act is a way for the VA to solve some of its professional 

inabilities. One of the theories was we will take care of veterans 

where they live, but the other component of why we approved the 

Choice Act was to help the VA meet the needs because of the shortage of professionals. So, if we can utilize those professionals in the 

community, it reduces the challenges you face in recruiting. 

Thank you. 

Chairman ISAKSON. Senator Heller. 

HON. DEAN HELLER, U.S. SENATOR FROM NEVADA 

Senator HELLER. Mr. Chairman, thank you. To the Secretary, 

thank you for being here today. You know, we have seen some improvements out in the State of Nevada, and I want to thank you 

for that. We have a pretty good team out there. Not this weekend 

but next weekend, we have the Pahrump Health Clinic finally—I 

35 

have been working on this since I was in the House, so you can 

imagine how many years it has taken. I am glad to see that. We 

have a new director in the regional office there in Nevada, very 

helpful, and we are looking forward to good things. Also a new director in the hospital down in southern Nevada. Seeing those 

changes, moving in the right direction, I certainly do appreciate it. 

But I do have a couple questions for you. If you are a California 

veteran and you are in the Chairman’s State of Georgia and you 

need immediate health care, is there a problem with them going to 

a VA hospital in Georgia to get that health care? 

Secretary MCDONALD. This is a very relevant and insightful 

question. No, it is not a problem, but today we do not yet have 

the—we have not yet built the capability to allow that to occur. 

One of our breakthrough objectives here is by the end of the year 

a veteran can go anywhere they want and we will serve them. So, 

that is one of the things we have identified that we want. 

David, do you want to talk about that a little more? 

Dr. SHULKIN. Senator, we call this ‘‘seamless care.’’ It is exactly 

what we want, which is that if you are a veteran, you should be 

able to be cared for at every facility. We do have some challenges 

to doing that, but all but three of our facilities have what is called 

a ‘‘traveling veteran coordinator.’’ So, a veteran can ask to speak 

to them, and their job is to help facilitate it. Our goal is to make 

sure that you do not need to contact a person, that our systems recognize you as a veteran, and you should be able to get care wherever you walk into a facility. 

Senator HELLER. What is the timeline for putting that system in 

place? 

Dr. SHULKIN. December 31, 2016. 

Senator HELLER. 2016, by the end of the year. 

Dr. SHULKIN. By the end of the year. 

Senator HELLER. Would you care if a veteran say in Ely or Elko, 

NV, went to Salt Lake? I mean, I guess when the system is in 

place, would it matter if they went to Reno or went to—— 

Secretary MCDONALD. It will not matter where they go. It will 

just be like you get your prescription at CVS or Walgreen’s, and 

you go to a different State and get the same thing. 

Senator HELLER. We are getting some feedback, just so you know 

the purpose of this question, out of Mesquite, which is right on the 

Nevada-Utah border. Some of them want to go to St. George, and 

some of them want to go to Las Vegas. It is a lot further to Las 

Vegas than it is to St. George. So, you are saying—— 

Secretary MCDONALD. We want to be agnostic. We want the veteran to be able to decide where they go. 

One of the things we have talked about here which is also critical 

to this issue is that today if you are veteran and you move and 

have to change your address with VA, you have to change it in 

about nine different places. We want to move to one data backbone 

for all of VA, what is called a ‘‘consumer response system,’’ where 

if you go online to populate a form, we automatically populate it 

from the data backbone we have so you do not have to write the 

information in. We do not have that single data backbone today, 

but it is one of our objectives that we are taking on for this year. 

36 

Senator HELLER. OK. So, I can go to Mesquite and talk to them 

and say, you know, sometime around the end of the year you would 

be comfortable going to either hospital of your choice? Is that fair? 

Dr. SHULKIN. Yes. You should today be able to—you should 

today. It is just going to be more painful than we want it. 

Senator HELLER. OK. 

Dr. SHULKIN. We are trying to make the system actually support 

what you are asking. 

Senator HELLER. Right now some of our veterans in that particular area are being restricted, telling them that they have to 

travel the extra mileage—45 minutes—as opposed to going to St. 

George. I would certainly like to see that change. 

I have one other question based on your IG’s report and the 

question that they have relative to your backlog. They say they do 

not trust the data. You know, in the State of Nevada, we were 

ground zero for the problems with these backlogs, and we are seeing some improvement. Can you assure me that the Inspector General is not accurate on some of this data that they claim that they 

do not trust? 

Secretary MCDONALD. I am not sure of the date of that report, 

but I imagine it was probably in 2014. I believe the data is accurate. 

Senator HELLER. Today you are painting a rosy picture, if I understand correctly. Is that—— 

Secretary MCDONALD. We go through it every day. Danny? 

Mr. PUMMILL. Senator, I would disagree with the IG on their assessment that they do not trust the data for the backlog. The one 

thing that we have tons of in VBA is data, and I can tell you that 

the data on the backlog is accurate. It is still not where we want 

it to be, and we are going to continue to drive it down, the same 

thing with appeals. But I believe that the data is accurate data. 

Senator HELLER. The Nevada VFW had their midwinter conference last Saturday, and I had a chance to address them, and 

this was one of the concerns that they brought up. They are concerned that we are painting too good of a picture. They are obviously on top of this IG report saying that perhaps the data is not 

as accurate as being reported back to them and to the State. 

Secretary MCDONALD. Every time I get one of those questions or 

commission—and as you know, I have given out my cell phone 

number publicly. I encourage people to call me. I always ask, you 

know, give me the instance, give me the date, who did you deal 

with, because a lot of this is just simply that—we have got to continue to work to rebuild trust, but a lot of this is the trust that was 

lost in 2014. 

A lot of the IG reports coming out right now date to some time 

ago and have already been remediated. But, anyway, I would be 

happy to get together on that one and get into great detail. 

Senator HELLER. Mr. Secretary, thank you for being here. 

Secretary MCDONALD. Thank you. 

Senator HELLER. Mr. Chairman, thanks for the time. 

Chairman ISAKSON. Senator Boozman. 

37 

HON. JOHN BOOZMAN, U.S. SENATOR FROM ARKANSAS 

Senator BOOZMAN. Thank you, Mr. Chairman. Thank you so 

much for being here. We do appreciate your hard work. 

In Arkansas, we have got two VA hospitals where they work 

really hard at serving veterans and do a good job. One of the huge 

problems that we have got is that right now, because of the turnover in leadership throughout the system, either people retiring 

that are my age and, you know, not wanting to fight the battle anymore, or good people being taken to other jobs that perhaps are a 

little bit more important, more authority within the bigger system. 

But it is a huge problem, and right now, you know, most of the people in key positions are acting people, and they simply do not have 

the authority. They do and they do not. You know, it is just very 

difficult when you are the acting head versus the other. When 

tough decisions come up, you know, the tendency is to put those 

aside to let somebody else deal with them. How can we resolve 

that? I know it is true in Arkansas; I am sure it is true throughout 

the system. 

Secretary MCDONALD. We talked a little bit about this previously, and I will ask David to comment. But I think there are a 

number of things that we can do together. 

Number 1, I would encourage that when you are in the district— 

and I will go there with you—let us recruit together. Let us go to 

the medical schools. Let us go to the hospitals. Let us recruit people for the VA together. I think it really is a very positive sign 

when Members of Congress and the VA leadership are together. I 

have been to over two dozen medical schools. I would like to get 

to more. 

Second, we have put in, as part of our proposed legislation, legislation that would allow us to treat medical center directors as Title 

38. Many of our medical center directors are not doctors; they are 

not Title 38. As a result, they are paid significantly less than the 

private sector. That is a very important job. It should be Title 38, 

and we would like your help to make it that so we can pay them 

competitively. 

David? 

Dr. SCHULKIN. I think the Secretary has identified key issues. 

We are trying to attract new professionals into the VA to see this 

as a career because many of our people, Senator, are retiring, and, 

unfortunately, some people are leaving the system. We have put 

out a call to the private sector to answer, which is to come and 

serve your country. You can serve your country in many ways, one 

of those would be to join the VA system. We have actually had a 

pretty good response, so we are looking at trying to decrease our 

hiring time to bring in new people into the system. It is one of our 

initiatives. We would appreciate your support on the pay authority 

that the Secretary just mentioned and creating an environment 

that people feel that they can be successful in. That is where I 

think much of the dialog today about us being on the same page 

and you helping us recruit would make a difference. 

Senator BOOZMAN. Switching gears a little bit, you do have a lot 

of people who want to come forward, some people that have come 

forward in the past, and the whistleblowers really in the VA system have a reputation of not getting a very good rap. That comes 

38 

from, I think, just circumstances, you know, cases that have come 

up. 

Also, when you look at the agency where you appeal, in visiting 

with them, they say that probably the majority of their caseload 

throughout Government comes from the VA. It is not a good 

situation. 

Can you talk a little bit about what you are trying to do to address the problems with the retaliation and then, again, encouraging others in a non-hostile environment to come forward so that 

we can make things better? 

Secretary MCDONALD. Surely. We have trained over 450 people 

in something we call ‘‘Leaders Developing Leaders.’’ It is a program 

we put together in conjunction with a professor at the University 

of Michigan, and it is a program where we actually train the leaders in 3 days. We train them in leadership, we train them in whistleblowing, we train them in everything we can. The cultural 

change we want from that is that we want every employee at VA 

feeling enabled to come forward with their criticisms. We want our 

employees to redesign the systems they work on. That is one of the 

reasons we are training our employees in Lean Six Sigma. 

You know, a good customer service organization cannot survive 

unless it is a great place to work, and the people have to be trained 

and enabled to do that. 

I would also say we were the first agency to get certification from 

the Office of Special Counsel on whistleblowers. We also have rewarded and called out whistleblowers who have helped us. It is 

something we are working very, very hard on to make sure that 

there is no retaliation, or if there is, that those who retaliate receive the appropriate discipline. 

Senator BOOZMAN. Very good. Thank you, Mr. Chairman. 

Secretary MCDONALD. Thank you. 

Chairman ISAKSON. Senator Sullivan. 

HON. DAN SULLIVAN, U.S. SENATOR FROM ALASKA 

Senator SULLIVAN. Thank you, Mr. Chairman, and thank you, 

gentlemen, for your testimony today. 

I want to compliment Dr. Shulkin. Mr. Secretary, I have spent 

a lot of time with him in the last year, really, in Alaska and Phoenix, in my office, and we have a lot of work to do, but I think he 

is somebody who is doing a good job. 

Secretary MCDONALD. I apologize for my trip to Alaska coinciding with your service in the military. 

Senator SULLIVAN. Well, you know, sometimes you cannot always 

pull it off, but we will get you up there next time when I am there. 

I do appreciate the fact that both of you have been up there recently. Dr. Shulkin, you and I got all over the State. Mr. Chairman, 

thanks again for allowing me to hold a VA hearing up there. And, 

you know, you saw the level of frustration, both of you. You saw 

that the Choice Act, which in many ways got ideas in the Choice 

Act from what was working in Alaska, came in and then when it 

was implemented in Alaska, it just kind of was a fiasco. I think everybody recognizes that. So, then you committed to this pilot program in Alaska that was going to be up and running initially you 

committed to me in November. We missed that deadline. I mean, 

39 

not we. You. But it is starting to take hold. I would just like an 

update on where we are on that pilot program. You know, Mr. Secretary, from a broader strategic perspective, if we are able to fix 

the big issues in Alaska, I think it is going to give you a good sense 

of how to fix things nationally. But if we are not in Alaska, I think 

it is going to spell trouble for what every Member of this Committee cares about and that you care about, which is fixing the 

Choice Program so it is serving our veterans. Right now it is still 

not in my State, and I would like an update just on the timeline 

and how you see that pilot program going forward. 

Dr. SHULKIN. Well, Senator, first of all, I do want to thank you 

and acknowledge you have been a great partner in this. You have 

been very clear with the problems, and that you expect solutions, 

but you have been working with us all along, so I thank you for 

that. 

You are correct that we agreed upon a solution that we would 

try this pilot program in Alaska, which can serve as a model for 

the rest of the country. It was delayed. The reason for its delay was 

actually Federal contracting rules. It was very tough for us, once 

you are in a contract, to actually get agreement to change the 

rules. We finally got that done, and as you may be aware, January 

11th, the pilot went live in Alaska. We now have actually embedded staff where actually the third-party administration (TPA) staff 

are in our medical centers—— 

Senator SULLIVAN. Are those temporary hires, or are you going 

to move to permanent hires? I know there is a bit of confusion on 

that. 

Dr. SHULKIN. Right. Well, the staff in the VA are permanent 

staff, and the TPA is committing to getting permanent hires in 

there. TriWest moved very, very quickly to make sure we did not 

miss the January 11 date that we had our second commitment to 

you, and we are now taking this up to a new level. We have to 

have, again, an additional contracting approval. There is one more 

approval to get the full pilot in place, and that is to have VA staff 

do the care coordination. 

Senator SULLIVAN. When do you anticipate being able to make 

that commitment? What date? 

Dr. SHULKIN. Well, we are pushing—I hesitate to give you a specific date because it has to do with contracting—— 

Senator SULLIVAN. Well, I like dates. 

Dr. SHULKIN. Yeah, yeah. I will get back to you with the specific 

date. 

Senator SULLIVAN. OK. 

Dr. SHULKIN. Everybody knows that is the final piece to get done, 

and we do believe—we were talking to Senator Tester yesterday 

about potentially in Montana doing a similar pilot. 

Senator SULLIVAN. OK. It would be good to get back to us. I 

would like the specific dates on that. 

I wanted to turn to the issue of—and I know we have been talking about it here today—shortage of professionals, particularly 

medical professionals. As you know, Mr. Secretary and Dr. Shulkin, 

we have talked about this. It is particularly acute in States that 

actually do not have medical schools. What we have been doing is 

working on legislation that can help States—particularly rural 

40 

States without medical schools like Alaska, but I know there are 

other members on the Committee that would benefit from this— 

that would encourage the partnership that, Mr. Secretary, you 

talked about when you were in Alaska, with the different health 

organizations, particularly the tribal organizations in Alaska. I 

would like your commitment to work with us. We have some legislation already drafted up looking to maybe get it marked up here 

soon, but I would like to get your commitment to work with my 

team on making sure the VA is good to go with it. I think you 

would be. But we would like to do that with you soon. 

Secretary MCDONALD. We agree. We actually worked on that together when I was in Alaska with the—— 

Senator SULLIVAN. South Central. 

Secretary MCDONALD. South Central Foundation. 

Senator SULLIVAN. They have been back, and they have been 

working with us. 

Secretary MCDONALD. I think it is a great plan. I could not agree 

with you more. I am sorry Senator Heller is not here, because we 

are working together to set up a medical school in Las Vegas, NV. 

We have got to have more medical schools in these States if we are 

going to expect doctors to locate in these States. I thought this was 

a great program. 

Dr. SHULKIN. If I could just add, I actually think that the critical 

factor to getting somebody to take a job in the VA is having your 

residency program. 

Senator SULLIVAN. Right. 

Dr. SHULKIN. It is your post-graduate training that is important 

in addition to medical schools. That is what we are trying to do 

with South Central. 

Senator SULLIVAN. Yes, and that is what our legislation is looking at. 

Dr. SHULKIN. We could use some help with legislation. What we 

found is there were 1,500 new graduate medical education spots 

given to VA through the VACAA legislation. We have only filled 

372 of those spots, and the reason is that what we learned is that 

VA needs the ability to actually help the private hospitals in paying for these spots. They are over their caps, so they do not get reimbursement, and that has been the limitation. 

The hospitals and foundations want to increase training. We 

want to increase training, however, we could use some legislative 

fixes. 

Senator SULLIVAN. Thank you. Mr. Chairman, just if I may one 

other quick—and it is just a commitment from the leadership here. 

I was back home recently and once again heard about the issue of 

providers not getting paid and, therefore, dropping out, which I 

think has been a problem in Alaska. Dr. Shulkin, you remember— 

and I heard about it again, which is veterans who get commitments 

from the VA to go to providers, and then have their medical procedures completed, the providers do not get paid, and these guys are 

being dogged by credit agencies to pay $25,000, $30,000 bills. I 

have heard about it again where our veterans who got permission 

to move forward on a procedure are the guys getting the credit 

agencies coming after them. As you know, that is incredibly stressVerDate Mar 15 2010 16:02 Jan 30, 2018 Jkt 000000 PO 00000 Frm 00044 Fmt 6633 Sfmt 6601 Z:\ACTIVE\012116.TXT PAULIN
41 

ful. You and I heard about it in Alaska, and I heard about it the 

last time I went home. 

So, I really want to work with the two of you—I am sorry, Mr. 

Chairman, this is a big deal—just to get your commitment to being 

able to work on some ways to just stop this. I mean, it is—you 

heard it. It is outrageous. 

Dr. SHULKIN. Well, thank you. You are calmer than the last time 

that you expressed this to me, and, look, there is no excuse. We 

should never be putting the veteran in the middle of this. So, we 

are setting up a special team to deal with veterans who find themselves in this situation so they can reach us. We cannot put them 

in the middle of this. We recognized before you came in we have 

to fix the provider payment issue as well. 

Senator SULLIVAN. OK. 

Secretary MCDONALD. We committed in one of our breakthrough 

goals to pay our providers within 30 days, 85 percent by the end 

of the year. 

Senator SULLIVAN. Great. 

Secretary MCDONALD. That would be a breakthrough. 

Senator SULLIVAN. OK. Thank you, Mr. Chairman. 

Chairman ISAKSON. Well, I appreciate your raising the question 

because the first question I raised in my time was exactly the same 

thing. What has happened in Alaska has happened in New Hampshire and other places around the country. Prompt pay is a huge 

issue that we have got to address if we are going to deliver choice 

to our veterans. Thank you. 

Senator Murray? 

HON. PATTY MURRAY, U.S. SENATOR FROM WASHINGTON 

Senator MURRAY. Thank you very much, Mr. Chairman. I ask 

unanimous consent to put my full statement in the record. 

Chairman ISAKSON. Without objection. 

Senator MURRAY. Thank you. 

[The prepared statement of Senator Murray follows:] 

PREPARED STATEMENT OF HON. PATTY MURRAY

Thank you, Mr. Chairman, for holding this hearing and thank you to the witnesses appearing here today. 

I think everyone in this room agrees that our country has a duty to do everything 

it can to care for its veterans. Unfortunately, when it comes to VA care, we know 

our Nation continues to fall far short of its goal of honoring our veterans. 

It’s particularly frustrating, because many of the concerns I hear about from veterans in my home state are the same year after year. 

So, we know that the current system is not working. The question I pose today: 

is VA ready to step up and change course? 

Now, I was encouraged in 2014, when the VA announced the MyVA program to 

take a serious look at the systemic problems and cultural shortfalls of VA. 

I look forward to hearing more today about how that plan is progressing, especially the challenges you’ve overcome and the successes you’ve had in the last 15 

months. We must continue the forward momentum. 

I know a number of critical goals have been set for 2016, and as this plan moves 

forward I remain hopeful that it will produce the VA our veterans deserve. 

Here’s what I am hearing in my home state of Washington, and what I am particularly interested in seeing happen: 

• VA must continue to make significant efforts to address staffing shortages, 

• ensure retention of critical personnel, and; 

• guarantee high quality mental health care for all veterans—including oversight 

and coordination of care. 

42 

It is also essential, as VA looks to implement these proposals, it is transparent 

with Congress and outside stakeholders about what it needs for these changes to 

be effective. 

I want to emphasize that point—this Committee, and this Congress, wants to help 

VA in this effort. Because I think we all agree that this country needs to fulfill its 

promise to take care of veterans. 

As I’ve said before, this is a pivotal time for the VA, and the demands on the system will only go up as wars continue to wind down and the Vietnam-era veterans 

continue to seek more care for the injuries and illnesses they suffer from. 

This is why I have long urged the VA to commit to improve the veteran experience, and create a culture that is focused on serving the veteran while strengthening performance and partnerships. Veterans deserve a system that works. 

We know veterans want to receive care within the VA and that the answer isn’t 

just to dismantle the VA and leave veterans to fend for themselves, as some proposals would do. 

I know that together we can work to truly meet the needs of our veterans and 

restore the trust and confidence that they have in the Nation that they served. 

Thank you, Mr. Chairman. 

Senator MURRAY. Secretary McDonald, thank you. In your time 

as Secretary, you have talked about moving VA’s focus to the individual veteran’s experience trying to get care and benefits. That is 

the right move, getting the VA away from focusing on its bureaucracy and procedures. But, I am really concerned that those changes 

are not really taking hold. Over the last year, in my homestate of 

Washington, I have gotten complaints of the Seattle VA refusing to 

help a veteran who was in serious pain with a broken foot get from 

the sidewalk to the ER and instead making him wait for an ambulance to show up. I have heard of elderly and sick veterans who 

are being forced to wait outside in the rain and freezing temperatures while they were waiting for a shuttle; veterans seeking care 

at a clinic, including one with a dangerously high heart rate, rudely turned away from the clinic with only, ‘‘We are not taking new 

patients’’; and a veteran with shooting pains in his arm who had 

to wait for 2 months to get an MRI and then a year and a half for 

someone to read the results. Those are just a few of the problems 

I am hearing, and they are deeply disconcerting. 

Secretary MCDONALD. They are disconcerting to us as well. Get 

me the names, the dates, the individuals involved. That is the only 

way we can do anything with it. The situation you talked about, 

about the individual in the car that was told to call 911, we actually have used that in all of our training. We talked earlier before 

you got here about our Leader Developing Leader training. We 

have now trained thousands of people in the organization. We use 

that episode as exactly what we do not want to do. 

We have an organization that is rules-based, and we need an organization that is principle-based. The best customer service organizations run on principles, not rules. this individual thought they 

were following a rule. That is the wrong thing to do. We are training our leaders in this, and we are going to make a difference. That 

is one of the commitments we have made. 

Senator MURRAY. OK. I love the words that you say. I do. But 

how do you have accountability for that? 

Secretary MCDONALD. Well, like I said, you need to give me the 

dates, the names, and then I have a discussion. In the case of the 

person that told the person to call 911, we actually conducted an 

investigation to find out what disciplinary action we should take 

against the person who did that, because that is unacceptable. 

43 

Senator MURRAY. OK. I appreciate that. It is just really hard to 

say to all of our vets, ‘‘If you have a problem, call your Senator. 

They will get hold of the VA.’’ 

Secretary MCDONALD. Have them call me. 

Senator MURRAY. I will. 

Secretary MCDONALD. My telephone number is on the Internet. 

Senator MURRAY. I appreciate that. 

Secretary MCDONALD. People call me every day. 

Senator MURRAY. You have been accessible. I appreciate that 

when we pass them along. What I am saying is that we cannot 

have the message be, ‘‘If you have a problem, call your Senator. 

They will pass it on.’’ We need to make sure that those people are 

held accountable at the very basic level so these do not occur. 

Secretary MCDONALD. I agree. As I told you, we ran an investigation on that one lady. 

Senator MURRAY. Right. 

Secretary MCDONALD. The other thing we have got to do is we 

have got to train people. 

Senator MURRAY. OK. 

Secretary MCDONALD. VA has not been doing enough training. In 

fact, in 2014—— 

Senator MURRAY. How does that happen and when? 

Secretary MCDONALD [continuing]. We spent $100 a person 

training. If I did that running the Procter & Gamble, I would be 

fired. We are taking people offsite, we are training them, and that 

is the way you change a culture. Holding people accountable, I 

agree, but training. 

Senator MURRAY. OK. That is happening, so we are going to see 

less of this? 

Secretary MCDONALD. It is happening. If you go to your facilities 

and ask the people what they thought about their Leader Developing Leader training, I think you would get positive feedback. 

Senator MURRAY. OK. We will do that, and we will pass on the 

results to you, too, because it has to get down on the ground. 

Dr. SHULKIN. Senator, let me just add this one example, which 

is exactly what you had talked about in Seattle with somebody not 

being helped in the parking lot. The Deputy Secretary sent a 

memo, an email to every single employee in the VA talking about 

how that did not honor our principles. So, we are getting that message out. 

Senator MURRAY. OK. I very much appreciate that. 

Mr. Secretary, one of your 2016 breakthrough goals is to continue to decrease the number of homeless veterans and families, 

which I applaud. Last year, the Senate passed unanimously my 

Homeless Veterans Services Protection Act, which you know will 

allow VA to continue funding homeless services to thousands of 

veterans. It is sitting over in the House waiting for action. How important to your goal is it to get that passed out of the House? 

Secretary MCDONALD. It is important, I mean, anything we can 

do to house homeless veterans. We talk about the fact that we have 

decreased the number of homeless veterans by 36 percent since 

2010, but there are still 47,000 homeless veterans. Those that are 

homeless now generally have issues, medical issues, that we have 

to care for—drug addiction, mental illness. So, as we committed 

44 

here, we are going to continue to cause the number of homeless 

veterans to decline, but we need your help to do that. One of 

the—— 

Senator MURRAY. We need that legislation passed. 

Secretary MCDONALD. Yes, and one of the big helps we need is 

the EUL legislation for Los Angeles, because we are paralyzed from 

our ability to build the buildings we need without that legislation. 

Senator MURRAY. OK. Mr. Chairman, if you would not mind, I 

just want to ask about filling the vacancies in the health care system, because, again, in my State the Spokane Medical Center has 

been without a permanent director since May of last year. They do 

not have a permanent associate director for patient care or a chief 

of surgery. The slow hiring, I am told, is leaving a lot of these positions unfilled and has now forced the hospital to cut hours back. 

So, it is a critical goal you have set. What are we doing to make 

sure those positions are filled? 

Dr. SHULKIN. Senator, the Chairman and several of your colleagues have also mentioned this. This is not only important to 

you—— 

Senator MURRAY. Sorry I was late to the hearing. 

Dr. SHULKIN. This is absolutely one of our key priorities. We 

have put out a call for help. We have asked for any of your help 

in recruitment. We are trying to identify individuals. We have 

asked for several things to be able to help do that, including giving 

Title 38 authority to us to use funding to compensate medical center directors and network directors. 

Unfortunately, we are so below market that has become a barrier 

to us. The culture in VA and all of the negative attention that we 

received has hurt our recruiting. We are working very, very hard 

to give an accurate picture of what it is to serve in VA, which is 

a tremendous privilege. It is a fantastic institution, and leaders, I 

think, would be very attracted if they took a look at us. So, we are 

working very hard. We have 34 medical center spots open, the director spots. That is far too many. I cannot tell you—there is not 

a day where I am not calling people to ask them to come and help 

us. 

Senator MURRAY. OK. All right. We have got to keep it up. 

Thank you very much. I really appreciate it. 

Chairman ISAKSON. Senator Rounds. 

HON. MIKE ROUNDS, U.S. SENATOR FROM SOUTH DAKOTA 

Senator ROUNDS. Thank you, Mr. Chairman. 

I just want to go back a little bit. I think back about the goals 

that you have got here and the layout that you have put together 

with regard to the MyVA. As an integrated plan, you have laid this 

out. As I am looking at it, it looks to me like you are trying to 

change the culture in the VA. First I would like to know initially 

what your thought is. What is it going to take to actually change 

that culture, the specifics of how do you actually get that message 

across? You have got over 300,000 employees right now. 

The second part I guess I would have is, is it time to actually 

look at integrating the areas of excellence, the Centers of Excellence that you do have within the VA and integrate those within 

the community health care services that the rest of our citizens in 

45 

the United States actually utilize today? Can we do that? What is 

the challenge for you right now, number 1, in changing the culture? 

Second of all, can you integrate that into the existing health care 

we have out there for the rest of our citizens in the U.S. today? 

Secretary MCDONALD. Well, Senator, I think we are changing the 

culture. I obviously do not think the work is done yet, but the plan 

I laid out will have a huge culture change by the end of 2016. 

What we have talked about is creating the irreversible momentum by the end of 2016 so that no matter what happens when the 

administration changes and the Government changes, the VA employees can carry this on, because as I covered in my opening statement and written statement, this is the first time, I think, that the 

business acumen and the leaders with business experience have 

been brought to bear on the sixth largest company in the country. 

VA, if it were a company, is the sixth largest company in the country. We are not going to have another CIO of the VA who has been 

the CIO at Johnson & Johnson and Dell. If we are going to get it 

done, we need to get it done now, and we need to get it done this 

year. We laid out the steps to do that. 

How do you accomplish culture change? Well, there are lots of 

things. Number 1, you have to raise standards. Our standards have 

been too low. Many of our leaders, when I first looked at their performance evaluations, everybody rated everybody 5, Outstanding. 

How can you be rated Outstanding when your employees rate your 

organization as one of the worst in Government? That does not 

make sense. 

That is why we have created this Leaders Developing Leaders 

training, to take our leaders offsite and say, ‘‘Here is the way you 

run a performance management system.’’ It is not about everybody 

getting rated wonderfully. It is about identifying what we can do 

to help train people. It is about holding people accountable. It is 

about providing the customer service. That training, we gave it to 

450 individuals, and that is now cascading through the organization. 

What we did was we enabled the leaders of the organization to 

go train their leaders and their subordinates. That is why I say it 

is cascading through the organization right now. You can check on 

your own facility. 

You wanted to say something? 

Senator ROUNDS. Yes, I am just thinking, in looking at the 

timeline that you have laid out for the MyVA plan, full implementation goes well beyond 2016. I like the idea that you are looking 

long term on it. If you are going to get past not only this administration but into the next administration as well, it would seem that 

some of the tools that you may need might be statutory changes, 

or additional tools. Have you laid out—or is there a layout specifically that you need, that you have got to have, to get the MyVA 

in? 

Secretary MCDONALD. Yes, sir. In my written testimony, it lists 

about nine different statutory changes that we need. In my oral 

testimony I talked about consolidation of care in the community, 

flexible budget authority, and the Purchased Health Care Streamlining and Modernization Act. David talked about Title 38 authority for medical center directors. I talked about the EUL, the exVerDate Mar 15 2010 16:02 Jan 30, 2018 Jkt 000000 PO 00000 Frm 00049 Fmt 6633 Sfmt 6601 Z:\ACTIVE\012116.TXT PAULIN
46 

tended use leasing, on the West Los Angeles campus, and overhauling the claims appeal process, which we guaranteed by the end 

of the year. If we can get that done, 90 percent of appeals will be 

solved in 1 year. 

We laid it all out, and as the Chairman has rightly pointed out, 

we will work together and partner with you to get that done. We 

know you cannot do it by yourself. We know we cannot do it by 

ourselves. We need to work together. 

Senator ROUNDS. I hope that one area that we are successful in 

is actually integrating and getting a system in place so that the 

veterans, regardless of whether they are in rural areas or urban 

areas, they can use the health care facilities that are closest to 

them, not just VA facilities but the other facilities as well. I know 

that is the goal, but I am wondering sometimes if we are working 

against ourselves when we are talking about trying to establish 

and build new facilities, modernize existing facilities, while at the 

same time suggesting that we still want these veterans to be able 

to go to their local facilities as well. Are we working at—do we 

have two different goals that may be inconsistent with one 

another? 

Secretary MCDONALD. I do not think so. I think we are after 

building the very best network with the veteran at the center of 

it. I mean, forget all the politics, and look at it simply from the veteran’s standpoint. We want the veteran to be able to go where they 

want to go to get the service that they demand. We are in the process of building the optimum network across the country. 

Earlier, I talked about the fact that we have a map of the country where we have the various affiliates identified, whether it is 

the medical schools we do business with, whether it is the Indian 

Health Service, the Department of Defense. We partner with all of 

these folks in addition to the private sector, the TriWest or Health 

Net. We look at that every day to see what specialties are necessary in what areas in order to try to recruit the professionals we 

need to get that job done. 

Senator ROUNDS. So, still committed to the idea of Centers of Excellence? 

Dr. SHULKIN. Yes, Senator. I think the goal, as the Secretary 

said, is to give the veteran the very best care that can be given in 

the VA and the very best are that, frankly, can be given in the 

community. Whatever the answer is, that is where the veteran 

should go. 

I have a unique perspective on this, having spent my time in the 

private sector, now coming to the VA, now starting to practice as 

a physician in the VA. Since I worked on this chart, I really want 

to use it just for a second. 

47 

This is really quite a surprise to me, how much a veteran gets 

in the VA system that is not available in the private sector. That 

is why we believe strongly in building the things that are great in 

the VA and investing in those. We are not trying to dismantle the 

VA in this plan; we are trying to do the right thing for the veteran, 

and that is going to mean supporting our Centers of Excellence 

programs that you cannot find in the private sector. 

Senator ROUNDS. Thank you, Mr. Chairman. 

Senator MURRAY. Tell us what is on that chart. 

Dr. SHULKIN. I am sorry. When you are in the private sector 

versus the VA, you can see we provide peer support. You cannot 

find that in the private sector. Our crisis lines that are not available in most hospitals. Transportation services, if you cannot get to 

your doctor or your hospital, you cannot get good care. Caregivers, 

not available readily, and we provide that support. Homelessness, 

obviously, as the Secretary talked about. Medication support. Behavioral health integration into primary care, rare in the private 

sector. Clothing allowances. These lifelong relationships. The single 

EMR, as you know about. The fact that we work with almost every 

leading academic medical center, there is no health system in the 

country who can say that. We are getting intellectual property and 

input from every leading academic medical center to help veterans 

in these Centers of Excellence. So, these are just some of the reasons why the VA is unique and, frankly, why we need the VA to 

be strong. 

Senator MURRAY. Thank you. 

Chairman ISAKSON. Senator Manchin. 

HON. JOE MANCHIN III, U.S. SENATOR FROM WEST VIRGINIA 

Senator MANCHIN. Thank you, Mr. Chairman. I thank all of you. 

Let me say, Mr. Secretary, I know your commitment; I have seen 

it up close and personal. I know the desire you have, and can tell 

you it resonated with all of the veterans in West Virginia when you 

came there. Basically, you have done some things that have 

changed, and it lets them know that you care. By doing that, you 

were able to put a portable medical center that we needed around 

rural West Virginia. We did not have one in the south because we 

lost one of our CBOCs, if you will. A temporary one has been 


121psVA9.eps
48 

opened, so we are moving in the right direction. I support what you 

are doing, and I want to make sure that we facilitate what is needed to make these changes. It is like turning the Titanic. I understand what you are dealing with in the bureaucracy, but we have 

to cut through that. 

I do not think there is one of us who believes that there should 

be one veteran that is homeless. There should not be a veteran 

without a job. 

Now, with that, sometimes there are problems that accentuate 

what we have to address, and I think you are trying to do all of 

that. 

There are two things I wanted to ask. I had someone bring something to my attention, and he was complaining about income-based 

service. He was led to believe that if his income, if he had done better in life, he is not afforded the same service. He said, ‘‘Now, wait 

a minute, Joe. I put on the uniform. I would have taken the same 

bullet that a person that when they got out of the service did not 

do quite as well as me. I was very lucky, but, still, it made me feel 

like now I am not expected to get the service because I did too well 

in the private sector.’’ 

I cannot answer that. It does not make sense to me. It is like we 

have scholarships, and if you do well and you exceed in school, you 

should get a scholarship. Well, if your mom and dad make this 

much, maybe you should get it, but you really do not need it, so 

we cannot give it to you. We are not rewarding for excellence. 

Is that a problem? 

Secretary MCDONALD. That is a true statement, Senator. 

Senator MANCHIN. OK. Well, he hit me hard then. 

Secretary MCDONALD. I am a veteran. I went to West Point. I 

served 5 years in the 82nd Airborne Division. I cannot be served 

at the VA because I am in a category called 8-Plus. I have too 

much net worth. 

Senator MANCHIN. Is that—— 

Secretary MCDONALD. It is basically—— 

Senator MANCHIN. It is a fact of life, what we are dealing with, 

need-based? 

Secretary MCDONALD. Well, I think what we deal with is we deal 

with requirements versus budget. You know, we would not have 

enough budget to serve all the Category 8’s. 

Senator MANCHIN. Right. I know that. 

Secretary MCDONALD. So, the question is, you know, where is the 

balance? 

Senator MANCHIN. We have accepted that as a policy, and I 

would say that the majority of vets who have done extremely well 

in life and God has blessed them would probably forsake that, anyway, or even pay. 

Secretary MCDONALD. Well, it is, frankly, even worse than that, 

in a sense. We have policies that are written in the law that, obviously, if an individual gets cured, they would not get the disability 

payment for the ailment that was cured. It seems like the incentive 

there is to not be cured. These are the kinds of things that, if we 

work together, I think we can, you know, make the laws better so 

we do not have these—— 

49 

Senator MANCHIN. The big thing I want to talk about in my 

State is the prescription drug addiction that we have. 

Secretary MCDONALD. Yes, I know it is a huge issue. 

Senator MANCHIN. It is huge throughout the services. I understand that, too. You know, if you go back in history, I think that 

chronic pain was something that the VA acknowledged early, and 

it was one of the factors as far as wellness that basically we said 

there are other ways to treat. I think that is when this onslaught 

of opiates came onto the market, in the 1980s and 1990s. If that 

is the case, we know the detriment it has had to society. I truly 

believe that the VA could change the culture of America, of how we 

treat chronic pain. I am imploring any way, shape, or form that we 

can support you, that these service people do not go to prescriptions first but prescriptions last. 

Secretary MCDONALD. As you and I have talked when we were 

together in West Virginia, we could not agree more. When you look 

at what the VA is doing on an evidence-based basis, equine therapy 

works with some veterans. Acupuncture works with some veterans. 

Some stimulation technology works with some veterans. Yoga 

works with some veterans. There are so many things we are learning that we can use to substitute for the opioids, and we track this 

every day. We track how many opioids we are using, and David 

tracks it to make sure we are going down. There is a lot that American medicine can learn from what we are doing. 

Senator MANCHIN. Well, we need to change code here as far as 

in the general public, but basically the policy that you all can adopt 

can lead to the cultural change that needs to be done. And, also, 

as far as the education that these doctors are not getting in how 

they are prescribing—— 

Secretary MCDONALD. Right. 

Senator MANCHIN. You go for a toothache, you get 30 days of 

OxyContin. If you go—— 

Secretary MCDONALD. Well, as you know—— 

Senator MANCHIN [continuing]. For a headache, you get 30 days 

of OxyContin. 

Secretary MCDONALD [continuing]. We train 70 percent of the 

doctors in the country, so why can’t we take the knowledge we 

have and train them? That is what we want to do. 

Dr. SHULKIN. We see our role as a leadership role in the country 

on this issue, and we are doing several things. Evidence-based 

therapy, we have protocols that the VA has put out. We have to 

be open to new innovations because, quite frankly, there are new 

technologies coming out that could help. Third, we are doing what 

is called academic detailing. We have mandated that VA doctors 

get academic detailing. That means teaching them on the right way 

to use opioids. 

Senator MANCHIN. And continuing education. They get no continuing education on dispensing of opiates. None. If you ask any of 

the doctors, they maybe get less than 1 week in medical school out 

of probably a 5-year rotation. It is just awful. 

So, I would encourage you—we are not going to change unless 

you all take the lead on this and do it, because going through our 

process is quite cumbersome at times to get something passed that 

makes sense. But you all have experience, and basically you have 

50 

had success, have you not, as far as an alternate care of chronic 

pain? 

Secretary MCDONALD. Yes. 

Senator MANCHIN. It has helped with PTSD, also? 

Secretary MCDONALD. Yes. 

Senator MANCHIN. So, those who might have some mental challenges, you know you can cure them, work on that. 

Secretary MCDONALD. Yes. We have a leadership role in American medicine, as David said, and this is a big innovation for us 

that we can help American medicine. 

Senator MANCHIN. Mr. Chairman, if I may say one more thing. 

How difficult—you have come from the private sector at the highest level, running a large corporation, and a very good corporation, 

Procter & Gamble. They just chose West Virginia as their new site, 

so it is a very smart, very good corporation. 

With that being said, the difference in management of what you 

are able to do and the public sector versus the private sector—we 

know that they do not operate the same—we have got to allow you 

to have your top management changes and flexibility. How much 

is protected by the civil service that you cannot even touch? How 

far down in the pecking order can you get to make the systemic 

changes you need to make? 

Secretary MCDONALD. I think the difficulty of this challenge of 

changing the VA is a difficulty of scale. This is the sixth largest 

business in the country. It is a challenge of time, because I was 

with the same company for 33 years, during that time the stock 

price went from $2.32 to $81 when I retired. So, you know, it takes 

time. 

But I think that having somebody with experience in business is 

critically important. What I joke with—— 

Senator MANCHIN. If you cannot make the changes that you 

made—if someone—I think we gave legislation that you could fire 

some of the people who are—— 

Secretary MCDONALD. We have enough authority to fire people. 

Senator MANCHIN. You do? 

Secretary MCDONALD. I do not think—— 

Senator MANCHIN. At the top level, you can move people around 

and—— 

Secretary MCDONALD. Listen, that is not the most—as I said in 

my opening statement, 10 of my 16 top leaders are new since I was 

Secretary. That is, what, 18 months ago. We have been able to 

change the leadership. We have been able to do the things we need 

to do. 

I think the question this raises is: should we treat this like a 

business, and should we make sure that somebody—whoever is 

Secretary—has business experience? Because this is a very, very 

large business. What is at stake here is veterans’ lives. 

Senator MANCHIN. Thank you. 

Secretary MCDONALD. Thank you, Senator. 

Chairman ISAKSON. Well, thank you, Senator Manchin, for your 

focus on opioids and addiction. You have been a real leader in that 

and helped us in the changes we made vis-a-vis Tomah. 

It is also important to point out that 72 percent of the physicians 

practicing in America today go through the Veterans AdministraVerDate Mar 15 2010 16:02 Jan 30, 2018 Jkt 000000 PO 00000 Frm 00054 Fmt 6633 Sfmt 6601 Z:\ACTIVE\012116.TXT PAULIN
51 

tion in their training. If there was one place we could make a cultural change, that is the place, and I think his emphasis on that 

is a good lesson to all of us to do that, to make that change. 

Mr. Secretary, thank you for being with us today. I want to 

thank the members who—Senator Tillis? 

Senator TILLIS. I appreciate you all being here. I do have a few 

more homework assignments that I need to elaborate. 

One, I think it is very important—Senator Rounds asked a question, I think a couple of the other Senators, too. I think it would 

be very helpful to map actions that we need to take, legislative actions, to these 12 breakthrough priorities. 

Secretary MCDONALD. You got it. 

Senator TILLIS. Please make it very clear, either draft legislation 

or legislation that needs to be drafted that puts these—that are on 

the critical path, but for them you will not accomplish the goals, 

so that you put—— 

Secretary MCDONALD. That is a great idea. We can have that 

this afternoon. 

Senator TILLIS. Thank you. I think it is also very important in 

terms of stakeholder management—we talked a little bit about 

this—that we get to the VSOs. I think they are—some are interested in what you have to say, some are concerned with what you 

have to say. We have to find what that stakeholder plan looks like 

so that I can look to my VSOs and—— 

Secretary MCDONALD. Sir, we have been doing that. I have a 

breakfast with the VSO leaders every month, and we have been 

sending out our MyVA team—— 

Senator TILLIS. I would like to get—— 

Secretary MCDONALD [continuing]. To meet with the VSOs. 

Senator TILLIS. I hear it. You know, I am just hearing some feedback. I do not know what level it rises to in terms of a general concern, but I would like to know a lot of the major stakeholders that 

are an integral part of what we are doing here. 

Secretary MCDONALD. Yes, absolutely. 

Senator TILLIS. In fact, I wanted to include that in my redneck 

PowerPoint, the VSOs’ role and the care that we are providing out 

in the field. 

Secretary MCDONALD. But if you hear of someone who thinks 

they are being excluded, let us know. 

Senator TILLIS. We will. 

Secretary MCDONALD. Because we will make sure they are 

included. 

Senator TILLIS. I also wanted to underscore your point about 

training, because people talk about the top-line number for training. It looks like a big number. But when it is $100 on a per person 

basis, we are talking about better treatment for pain medicine and 

other things, I think you need to really emphasize that it may look 

like a big number, but when you are talking about the sixth largest 

organization in the U.S. business operation. 

The last thing—two other things. With the CIO Council? 

Secretary MCDONALD. Yes. 

Senator TILLIS. I would like to see a matrix going forward of any 

of the infrastructure or technical decisions that you are making. I 

would like to see a running list of the buy versus build decision. 

52 

You all know that if you have got a build decision, boy, you better 

have a really good reason for why you are building versus buying. 

Secretary MCDONALD. Well, you know our prejudice because we 

have talked—— 

Senator TILLIS. I know that LaVerne Council—but I want to see 

it in writing, because you hear things about, well, you know, people 

are saying it is not going to—look, scheduling systems, those sorts 

of things, the private sector has got it down. I would like to see a 

running list of that. 

The last thing would be to extend into the other areas such as 

Womack, other capacity. When you are looking at your capital expenditure going forward, optimizing that and making sure you are 

getting creative about maybe even collaborations with the DOD 

where they have capacity. I am thinking about Fayetteville, and I 

am thinking about Womack. But, making sure that that is all 

articulated. 

A final thing—I said that was final, but this is the final one. Organizational comparison. This speaks to something that Senator 

Manchin discussed. I would like to see what that organizational 

model looks like as you get to a full transformation. Does it have 

the kind of elements of a pyramid that you would see in business? 

Is the bureaucracy that we find in the middle that I think sometimes is problematic being thinned out, pushing more of those resources down to providing care? The organizational transformation 

model is something we have not really talked about to the extent 

that it involves reorganizing the VISNs. All of those things I think 

would be very helpful for us to see, and I would like to be able to 

measure it on some basis that makes sense. 

The final thing—this is truly the final thing—has to do with the 

toxins at Camp Lejeune. I am going to—Senator Burr and I are 

going to communicate out to your office. There is a potential issue 

with timing. We like the work that you have done. Now the timing 

of really getting that stuff online. I have heard things that I am 

not going to react to, but I just want to let you know we are going 

to be in touch with your office. 

Secretary MCDONALD. OK. Do not write me a letter. Let us get 

together and talk. I get too many letters. 

Senator TILLIS. Yes. Well, we need to get—we will get our office 

together fairly quickly. I think it was Senator Burr’s inclination to 

write a letter. I am happy to have a phone call if it is not on that 

track. 

Secretary MCDONALD. Let us get it done quickly. 

Senator TILLIS. Thank you. 

Secretary MCDONALD. We will reduce the middle management. 

Organizations today do not need the middle management that they 

have had historically because of information technology, so we will 

do that. 

Senator TILLIS. I find it hard to believe that one VISN needs to 

be fundamentally different from another. 

Secretary MCDONALD. They should not be. 

Senator TILLIS. Today I do not think that that is the case. 

Secretary MCDONALD. They should not be. 

Senator TILLIS. Thank you. 

53 

Secretary MCDONALD. My principle is you standardize and get 

scale as much as you can, but you customize when you need to, to 

meet a certain customer need. 

Senator TILLIS. Thank you, Mr. Chair, for holding this important 

meeting. 

Chairman ISAKSON. Well, thank you for raising the question of 

the VSOs, and for your edification. The first remarks I made in my 

opening statement were that the VSOs are the representatives of 

our customers, and in the changes legislatively that are being 

talked about, the seven items the Secretary outlined in his remarks. It is going to be critical to have the input of the VSOs and 

have them be partners in making this change. Some of the changes 

are going to take hard decisions that affect our customers. We need 

to make sure our customers have some input before the fact and 

be a team player in the culture change rather than after the fact 

being reactionary. I am going to see to it that it is all hands on 

deck when we make those decisions. 

Mr. Secretary, thank you very much for your testimony. To all 

of you, thank you for being here. 

Secretary MCDONALD. Thank you, Mr. Chairman. 

Chairman ISAKSON. Commander, thank you very much, and we 

will get back to Georgia before the snowstorm hits. 

We stand adjourned. 

[Whereupon, at 11:53 a.m., the Committee was adjourned.] 

RESPONSES TO POSTHEARING QUESTIONS SUBMITTED BY HON. JOHNNY ISAKSON TO

HON. ROBERT A. MCDONALD, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. Earlier this month, the VA Inspector General released a report finding 

that there was a significant backlog of unprocessed veteran material at a scanning 

contractor’s facility in Georgia, which in part resulted from VA regional offices sending the contractor unorganized boxes of documents that were not ready for scanning. 

The Inspector General also found that the contractor was improperly storing papers 

containing veterans’ sensitive information, making it subject to loss, theft, or misuse. a. Would you please give us an update on what has been done to protect veterans’ 

personally identifiable information at that facility and to ensure that mail can be 

scanned in a timely manner? 

Response. Veteran privacy is an extremely important component of the scanning 

process and at no time was any Veteran information compromised or in danger of 

being compromised. All boxes were sealed and tracked during transit and were 

opened only inside the scanning facility, and only handled by cleared vendor personnel. Each vendor employee receives VA-mandated privacy awareness training 

and a background investigation consistent with Federal employment. Additionally, 

the security protocols in place at each of the scanning vendors’ facilities are more 

robust than most regional offices. Some of these protocols include: 

1. Vendor staff members are prohibited from taking backpacks, bags, lunchboxes 

or other containers into the production area. 

2. Vendor staff members are prohibited from taking paper in or out of the production area. 

3. Vendor systems track exactly which employee reviews each document, ensuring 

accountability in the event of an issue. 

4. Each facility is protected by a third party alarm vendor. The alarms are enabled at the end of each shift when the facility will be vacant and de-activated by 

authorized personnel prior to the next scheduled shift arrival. 

5. Each facility is equipped with Close Circuit Television systems. Cameras are 

positioned inside the exterior entrances of each facility and throughout the interior 

of the production facility. 

6. All external doors use a proximity card system with employee-specific badges 

to limit physical access based on clearance level, tour-of-duty, and business need. 

The improperly stored materials pictured in the OIG report were characterized as 

original claims materials; however, those materials actually consisted of document 

54 

separator sheets, internal operational documents, and training materials specific to 

the vendor. There was one box of contractor-generated photocopies of Veterans’ documents which were created by the vendor in an effort to meet VA’s required image 

quality requirements. As the contract did not instruct CACI on specific storage requirements of internal business practices, VA was limited in its response to the improper storage of materials, including the one box of copies of claims materials. 

However, VA took several immediate actions: 

1. Audited the stored material to ensure it did not contain VA source materials. 

2. Directed the vendor to reorganize their storage space and properly dispose of 

contractor materials no longer used. For reference, the referenced area was cleaned 

and reorganized by 6am on January 22, 2015 (while the OIG was still onsite at 

CACI). 

3. Followed-up to ensure CACI completed handling of those documents. As those 

documents were CACI materials, CACI entered into a contract with a local company 

to dispose of the documents identified by the IG, as well as any photocopies of documents created as part of ongoing operations. CACI has since provided certificates 

of disposition to demonstrate the documents were disposed of properly. (Certificates 

are dated 7/13/2015 and 7/20/2015). 

4. Increased the frequency of VA’s scheduled and unscheduled site audits. 

5. Logged the contractor’s performance in the monthly Performance Based Service 

Assessment (PBSA). 

VA’s contract with the scanning vendor required a five day turn around for a specific volume of material. During the timeframe identified by the OIG report, VA sent 

the Newnan, Georgia facility a much greater volume of material than covered under 

the contract. Much of the volume consisted of inactive records 

(i.e. files without active claims) which were shipped and subsequently scanned to 

reduce overcrowding at various facilities, and to allow VA to respond more rapidly 

when a Veteran files a claim. The vendor’s actual scan time during the period was 

2.97 days for mail and 13.66 days for active claims, while some boxes were there 

for much longer, those boxes were of inactive records. Since VA had shipped a greater quantity than covered in the contract, VA and the contractor worked together to 

ensure active claims were scanned first without sacrificing accuracy. 

VA welcomes an ongoing dialog concerning this mission-essential program, to include onsite reviews of any scanning or storage site affiliated with this program. 

Question 2. VA call centers have made news in the past for an extremely high 

call ‘‘block rate’’ (the number of calls that are not connected) with over 50 percent 

of veterans unable to get through to a representative. 

a. With regard to call centers, how are you measuring customer satisfaction? 

Response. VA operates Call Centers that provide a variety of services (e.g., pharmacy, claims, memorials) to Veterans. Call center performance metric goals are established and measured for each of the enterprise call centers. J.D. Power, an industry leader in customer market research, is one of the providers VA uses to provide 

an independent and comprehensive understanding of customer satisfaction at these 

centers. 

Additionally, an enterprise initiative, being run by the Veteran Experience Office, 

is underway to standardize the customer satisfaction method of collection, measurement, and goals based on industry best practices in order to provide an aggregate 

view of the Veteran experience. The VA is currently focusing this standardization 

on understanding how Veterans feel about the following: 

• How effective was the service provided? Did you get the correct, complete answer? • How easy was to reach VA? • How much effort did you personally need to expend to resolve your inquiry? • Do you trust VA to address your problems? 

b. How are you improving your call centers to ensure all veterans are able to have 

their calls answered in a timely manner? 

Response. VA is currently undertaking an initiative, titled ‘‘Breakthrough Initiative for Call Centers,’’ that is reviewing all aspects of all call centers’ performance 

to ensure calls are answered in a timely manner. Where improvements are needed, 

the team is onboarding additional staff, improving self-service options for Veterans 

(e.g., website, mobile applications, automated telephone service), enabling Veterans 

to utilize non-phone communication channels (e.g., chat, text, etc.), providing additional training, and enhancing existing tools (e.g., Knowledgebase, Customer Relationship Management). Additional targeted initiatives are being undertaken at the 

tactical level to ensure calls are answered, including utilizing continuous feedback 

loops whereby call center representatives and Veterans provide direct feedback to 

the call center management that can be acted upon immediately. The call centers 

55 

recognize that Veterans contact VA for a variety of reasons (e.g., health, benefits, 

memorials), and, where possible, are tailoring the services provided to best meet the 

Veterans’ needs. 

c. What security and fraud protection measures do you have in place for Veterans 

personal information? 

Response. VA requires all Government and Contractor personnel to undergo annual training on the proper use, and protection of personally identifiable information (PII). VA requires that PII be protected at all times by all personnel, and only 

accessed when personnel have a need to know information about a specific Veteran. 

Moreover, call centers have specialized procedures for validating, and verifying a 

caller’s identity prior to providing information regarding a Veteran. Typically, these 

procedures restrict disclosure of PII to the record holder (e.g., the Veteran, Beneficiary) or those specifically authorized by the record holder in accordance with the 

Privacy Act of 1974 and other legal statues. Moreover, VA has a Privacy Office in 

place that develops privacy protection policies, and follows up on any suspected Privacy incidents to determine if PII was released, address spillage (if the release was 

verified), and implement lessons learned. VA Office of Information Security (OIS) 

under the Office of Information and Technology (OIT) oversees the security posture 

of all VA systems. 

d. To what extent are you using commercial best practices to ensure better 

response? 

Response. Call Center teams are leveraging best practices for all aspects of the 

call center operations and improvement initiatives. For example, VA is working to 

incorporate International Customer Management Institute (ICMI), and Utilization 

Review Accreditation Commission best practices which govern speed, timeliness, 

and accuracy of response. We leverage best practices to improve our knowledge 

management solution that provides employees the ability to respond to Veterans 

with the right answer, or route them to the right location the first time. Recently, 

on April 28, 2015, the Health Resource Center was awarded a 2-year ICMI site certification. They continuously invest in their most important resource—their employees, which is evidenced by the incorporation of Lean Six Sigma White Belt training 

into their New Employee Orientation program, in addition to their existing comprehensive recruitment and training program. 

e. How do you benchmark commercial best practices? 

Response. VA collects and reviews best practices by meeting with representatives 

from the New York City and Philadelphia 311 systems to understand how they 

transformed their contact center systems. We have also hired personnel, such as our 

Enterprise Contact Center lead, who have experience with best practice call center 

organizations such as United Services Automobile Association. We also have 

partnered with organizations that have either collected from, or worked with, best 

practice commercial organizations such as Zappos, and Lands’ End, as well as government agencies such as Centers for Medicare and Medicaid Services, Consumer 

Financial Protection Bureau, and Centers for Disease Control and Prevention. Both 

our government and contractor personnel have also attended conferences on call 

centers such as the ICMI to gather best practices as well. 

Question 3. In your testimony, one of the ‘‘breakthrough outcomes for 2016’’ for 

the Office of Information and Technology (OI&T) is that 50 percent of projects be 

on time and on budget. VA has a less than stellar track record when it comes to 

the implementation of IT projects. 

a. What is the percentage of IT projects are completed on time and on budget 

now? 

Response. The Veteran-Focused Integration Process (VIP) replaces the Project 

Management Accountability System (PMAS) for enterprise IT management of products and services, which VA has used since 2009, to oversee its information technology (IT) project delivery. The move from PMAS to VIP takes a generational leap 

forward in VA’s commitment to serve our Nation’s Veterans. Using PMAS criteria 

(which measures work product delivery), VA currently has a 78 percent on-time rate 

for delivering increments of work within IT projects. 

However, the evolution to VIP greatly expands the scope and span of what VA 

will be measuring, while reducing the paperwork requirements by 88 percent. Under 

VIP, VA is reorganizing a portfolio management construct focused on measuring end 

product delivery rather than increments of work. The near-term (6–18 months) goal 

for VIP is targeting 50 percent on-time and on-budget delivery, higher than the industry standard of 45 percent. 

b. You state in your testimony that 95% of the current content and features will 

be redesigned and migrated to vets.gov. How long and at what cost will this migration take before vets.gov is fully functional? 

56 

Response. The current plan is to have 100 percent of the current Veteran-focused 

content and access to services redesigned and migrated to www.vets.gov by December 2016. We expect www.vets.gov to continue to evolve and develop beyond December 2016, as we respond to Veteran feedback, develop new online capabilities, and 

continue work on backend system migrations and technical platform enhancements. 

This effort is fully funded. 

Question 4. As we discuss modernization of the Department of Veterans Affairs, 

I’d like to specifically discuss a recent GAO report regarding Total Disability Individual Unemployability (TDIU) benefits. According to GAO, this disability supplement program increased 30 percent over a 5-year period with annual outlays of over 

$11 billion. GAO concluded that VA procedures do not ensure that Individual 

Unemployability benefit decisions are well-supported, and given the amount of 

growth and size of this program, that is concerning. To quote GAO: 

‘‘VA does not use available third-party earning data to verify veterans’ selfattested employment history and income information. Without such 

verification, VA cannot adequately ensure that the eligibility standards are 

being met, which places these benefits at risk of being awarded to ineligible 

veterans... Having a strong framework for program integrity is important 

for any Federal program, and in light of the multi-billion dollar—and growing—TDIU benefit, taking steps to ensure payments are properly awarded 

to veterans is essential.’’ 

a. What progress has the VA made specifically regarding GAO’s recommendation 

that VA verify veterans’ self-reported income through the use of available thirdparty data sources to independently verify income and improve integrity in this program? 

Response. To verify Total Disability Based on Individual Unemployability (TDIU) 

claimants’ reported employment history and income information, VA has expanded 

its data sharing agreement with the Social Security Administration (SSA). The expanded agreement allows VA to obtain Federal tax information from SSA in order 

to compare claimants’ reported income with their tax information, including employment wages. 

To leverage this expanded data agreement, VA is developing an upfront income 

verification process. Under its new process, VA will verify with SSA claimants’ reported income at the time they file a TDIU claim. The new verification process is 

expected to take approximately 10 to 16 days. User Accepted Testing (UAT) of the 

new process is scheduled to be completed by April 30, 2016. VA anticipates conducting national training of Veterans Benefits Administration (VBA) personnel on 

the new process by June 2016, with a targeted implementation date of June 30, 

2016. 

In addition, VA is developing technical requirements to verify income for Veterans 

who are currently receiving TDIU benefits. Scheduled UAT of the data match, processes, and validations is scheduled to be completed by April 1, 2016, with national 

training of VBA personnel expected by September 2016. Wage income verification 

for TDIU recipients will resume on an annual basis in fiscal year (FY) 2017, and 

continue thereafter. 

b. Has VA done any analysis regarding the estimated level of improper payments 

associated with this program? 

Response. VA has not identified TDIU payments as a root cause of improper payments in its testing and program reviews under the Improper Payment Information 

Act of 2002, as amended by Improper Payments Elimination and Recovery Act and 

Improper Payments Elimination and Recovery Improvement Act. As a result, there 

are no calculations available relating to TDIU payments constituting improper payments. With resumption of wage income verification for TDIU recipients in FY 2017, 

VA will collect and analyze data on improper payments associated with TDIU. 

Question 5. In 2015, the VA’s Office of Inspector General completed two reports 

about VA’s Fiduciary program, raising concerns with the potential misuse of beneficiary funds and the waiting lists and the caseloads of field examiners. In addition, 

the Committee has heard anecdotal evidence that VA’s current policies have led to 

a trimming-back of the caseloads of larger, private fiduciaries who serve veterans. 

Although VA did not identify the Fiduciary program as a top 12 priority, it is an 

area that deserves scrutiny. 

a. Could you please explain VA’s current position on whether it intends to reduce 

the cases that it allows private fiduciaries (such as those that might serve more 

than 200 veterans) to manage? 

Response. Under current VA regulations, the number of beneficiaries for whom 

an individual may serve as a fiduciary is limited to the number that the fiduciary 

57 

may reasonably be expected to properly serve. 38 Code of Federal Regulations, Section 13.69. It is the fiduciary hub manager who exercises his or her discretion when 

appointing fiduciaries to serve in the best interest of beneficiaries. If the fiduciary 

hub manager determines the number of beneficiaries served by a fiduciary could 

negatively impact the welfare of beneficiaries in the fiduciary program, no additional information is considered. 

In VA’s proposed rewrite of its fiduciary regulations, this issue is addressed in 

Section 13.100(d). VA did not propose to prescribe a specific limit on the number 

of beneficiaries a single fiduciary may serve. Rather, each hub manager would have 

discretion to determine whether it is in a beneficiary’s interest to appoint a particular fiduciary after carefully considering any potential degradation of service to 

any other beneficiary in the fiduciary program. 

b. Has VA considered allowing certain highly-rated, private providers to serve 

greater numbers of veterans—for example, being a ‘‘consolidated’’ provider for an entire Hub? 

Response. While VA does not prescribe a specific limit on the number of beneficiaries a single fiduciary may serve, the hub manager must consider whether the 

fiduciary has the capacity to manage additional appointments without degrading the 

service that the fiduciary provides to any other beneficiary. In addition to services 

potentially degraded due to exceeding a fiduciary’s capacity, service to other beneficiaries could be disrupted if a fiduciary with a large number of beneficiaries suddenly decides that it wants to get out of the business of providing fiduciary services. 

Such a decision could interrupt VA’s delivery of benefits to affected beneficiaries if 

VA is unable to timely appoint a large number of successor fiduciaries. 

c. Could you briefly identify the top five changes or initiatives that VA is pursuing 

to modernize its Fiduciary program? 

Response. VA continues to work hard to develop and implement fiduciary program 

improvements to enhance service delivery and protect our beneficiaries. Please find 

enclosed the Fiduciary Program Modernization Plan for FY 2016 (Attachment One), 

which details our focus on improving and enhancing oversight of beneficiaries to ensure their well-being, and overseeing the activities of the fiduciaries who manage 

their benefits. Our modernization efforts include the following five priority initiatives: 

• Clarifying and strengthening policies and procedures: 

– Publishing the final fiduciary regulations. 

– Rewriting the Fiduciary Program Manual. 

• Modernizing information technology systems: 

– Deploying Beneficiary Fiduciary Field System (BFFS) 3.0 with an enhanced 

business intelligence platform and comprehensive real-time data analytics. 

– Replacing the current telephone system to improve call routing and reporting 

capabilities and allow for the recording of telephone calls for quality monitoring. 

• Strengthening oversight of operations: 

– Expanding the fiduciary quality assurance program to include the tasks associated with investigating fiduciary misuse of beneficiary funds. 

– Conducting Targeted Program Reviews to identify best practices and the need 

for national areas of improvement, to include IT enhancements, training, operations, and policy and procedures. 

• Training fiduciary program personnel: 

– Providing training on implementing policy and procedure changes in the new 

fiduciary regulations and revised Fiduciary Program Manual. 

– Developing a BFFS user-guide and providing training on the BFFS 3.0 enhancements. 

• Improving VA communication with beneficiaries and fiduciaries: 

– Publishing beneficiary training videos to prepare for the personal visit with 

a field examiner. 

– Improving the language and increasing the frequency of accounting letters to 

notify fiduciaries of the importance of submitting timely and correct accountings. 

– Developing training videos targeted to fiduciaries required to provide an accounting. 

58 

ATTACHMENT ONE


121q3-Att1VA1.eps

Fiduciary Program 

Modernization Plan 

Pension and Fiduciary Service 

Fiscal Year 2016 
59 


121q3-Att1VA2.eps

Fiduciary Program Modernization Plan e 

The fiduciary program protects the Department of Veterans Affairs' (VA) most 

vulnerable beneficiaries, who because of disease, injury, or advanced age, are unable 

to manage their VA benefits. 

Fiduciary Program Modernization 

In 2014, VA protected more than 172,800 Veterans and survivors, who were in receipt 

of VA benefits, which is a 41 percent increase in the number of beneficiaries in the 

program from 2011 . Approximately 138,900 VA-appointed fiduciaries provided services 

to these beneficiaries who received annual VA benefit payments of almost $2.9 billion. 

The number of beneficiaries in the program will continue to grow as VA decides more 

benefit claims and the beneficiary population ages. 

The Veterans Benefits Administration (VBA) has been working hard to implement 

fiduciary program improvements to enhance service delivery and protection of 

beneficiaries. These efforts include implementing operational efficiencies, clarifying and 

strengthening policies and procedures, modernizing information technology systems, 

and providing training to fiduciary program staff and fiduciaries. The following initiatives 

reflect VBA's priorities and its focus on improving and enhancing oversight of 

beneficiaries to ensure their well-being, and overseeing the activities of the fiduciaries 

who manage their benefits. 

Organizational Changes 

Completed 

FY 2011 Reorganized to create its Pension and Fiduciary (P&F) Service. P&F 

Service focuses on the unique needs of these beneficiaries and on 

strengthening oversight of VA-appointed fiduciaries. This 

reorganization has allowed VA to increase the staff responsible for 

fiduciary program policies and procedures, quality, training, and site 

visits. 

March 2012 Consolidated the management of its fiduciary activities at six 

fiduciary hubs nationwide. VA moved all fiduciary workload from 

individual VA Regional Offices (ROs) to fiduciary hubs to improve 

controls and consistency in processing the work. Under this hub 

concept, fiduciary hub managers deploy their field examination 

resources according to the location of beneficiaries within the hub 

and without regard to state borders or VA regional office jurisdiction, 

while centralizing all other fiduciary functions at the hub site. 

FY 2012 Established phone units in the hubs to respond to direct inquiries 

from beneficiaries and fiduciaries and ensure consistent service 

delivery. The fiduciary hubs have a toll-free number dedicated to 

answering fiduciary program inquiries. 

Pension and Fiduciary Service 

I 
60 


121q3-Att1VA3.eps

Fiduciary Program Modernization Plan e 

August 2014 I Established claims processing teams in the fiduciary hubs to produce 

beneficiaries' final ratings of incompetency, initiate monthly benefit 

payments to fiduciaries, and release retroactive awards to fiduciaries. 

Strengthening Oversight through Policy and Procedures 

Completed 

FY 2012 Awarded a National contract to perform criminal background checks 

of proposed fiduciaries. This practice will be expanded to include 

periodic checks of existing fiduciaries upon finalization of the j proposed regulations. 

December 2011 Implemented policy and procedural guidance which allowed I 

beneficiaries and persons designated as having legal authority of 

beneficiaries to appeal VA's selection of a fiduciary. The guidance 

also required VA to furnish beneficiaries with the name and contact 

information of the fiduciary appointed and information regarding fund 

usage. 

March 2012 Issued policy which required VA to notify a fiduciary who prepares 

an annual accounting to provide a copy of the VA-approved 

accounting to the beneficiary. 

March 2012 Issued policy which limits fiduciaries' fees to only allow a percentage 

of monthly VA benefits. 

April2013 Affirmed the role and responsibilities of VA-appointed fiduciaries 

with guidance that specifically addresses the authority of a fiduciary 

to act in the beneficiary's best interest. 

August 2013 Issued standard operating procedures for P&F Service negligence 

determinations. If VA is negligent in the appointment or oversight of 

a fiduciary, and the negligence results in misuse of benefits, VA has 

authority to reissue benefits to the beneficiary. 

November 2013 Implemented formal procedures for creating a debt against a 

fiduciary who misused VA benefits, initiating debt collection 

activities, and referring debts to the U.S. Department of the Treasury 

for offset against other Federal payments, including Federal tax 

returns. Through formal guidance and field staff training, VBA is 

aggressively pursuing recoupment of VA benefits in all cases of 

misuse and has significantly increased the number and amount of 

debts established as the result of fiduciary misuse. 

January 2014 Published proposed fiduciary regulations to prescribe new rules for 

all aspects of the program's administration. 

October 2014 Issued policies and procedures to expand the use of streamlined 

oversight for certain less vulnerable beneficiaries. These policies 

and procedures provide for more frequent oversight through 

telephone calls or correspondence for beneficiaries whose wellbeing is monitored by a spouse, another agency, or a licensed 

facility. 

Pension and Fiduciary Service 
61 


121q3-Att1VA4.eps

Fiduciary Program Modernization Plan e 

FY 2016 Budget Submitted a legislative proposal during the 2016 budget process 

Request that would authorize VA to automatically reissue misused benefits in 

all cases of fiduciary misuse. Under 38 U.S.C. § 6107, VA must 

reissue benefits to victims of fiduciary misuse when the fiduciary is 

not an individual, or when the fiduciary is an individual who 

manages benefits for 10 or more beneficiaries. In all other cases of 

fiduciary misuse, VA's authority to reissue benefits is limited to 

cases in which VA was negligent in its appointment or oversight of 

the fiduciary. Absent negligence in these cases, the Government's 

ability to make the beneficiary w-hole is limited to recoupment from 

the fiduciary, court-ordered restitution in a criminal or civil action, or 

recovery under a surety bond that the fiduciary purchased. 

FY 2016 Budget Submitted a legislative proposal during the 2016 budget process 

Request that would authorize an exemption to the Right to Financial Privacy 

Act (12 U.S.C. § 3401), so that VA will have enhanced access to 

financial accounts held by all fiduciaries of VA beneficiaries. It 

I provides fiduciary staff with an efficient tool to verify account 

balances, as well as detect common misuses including pooled 

accounts, ATM withdrawals, payments for unauthorized 

expenditures, and checks written to inappropriate payees. This 

proposal will allow VA to monitor fiduciary activities more effectively, 

provide VA with the ability to investigate quickly when there are 

sions of possible misuse, and serve as a deterrent to misuse. 

On going Revised the form that fiduciaries execute at the time of appointment 

to clarify their responsibilities. Revisions of all other fiduciary 

program forms are either under review or in the concurrence 

process. I 

Future 

FY 2016 Q1 Develop procedures and systems functionality to initiate a review for 

potential misuse when an accounting becomes seriously delinquent. 

FY 2016 Q1 Improve the language and increase the frequency of accounting 

letters to notify fiduciaries of the importance of submitting timely and 

correct accountings. 

FY 2016 Q1 Propose guidance to require the reissuance of benefits, when 

I possible, to beneficiaries who are the victims of misuse without 

regard to any ongoing investigation by the Office of the Inspector 

General. 

FY 2016 Q2 Publish final fiduciary regulations to prescribe new rules for all 

aspects of the program's administration. Draft final regulations are 

under review. 

FY 2016 Q2 Issue a complete rewrite of the Fiduciary Program Manual, which I will contain the procedures necessary to implement VA's new 

fiduciary reoulations. 

Pension and Fiduciary Service 
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121q3-Att1VA5.eps

Fiduciary Program Modernization Plan e 

FY 2016 02 Develop and provide training to all fiduciary field personnel I concerning final fiduciary regulations, Fiduciary Program Manual, 

BFFS user-guide and BFFS 2.0 enhancements. 

Strengthening Oversight through Technology I 

Completed I 

October 2012 Implemented mandatory use of a standardized template to 

accurately and consistently collect information obtained during field 

examinations. 

May 2014 Deployed a new information technology system, the Beneficiary 

Fiduciary Field System (BFFS), to enhance service to beneficiaries 

and improve workload management. BFFS provides: 

• Real time reporting capabilities; robust and meaningful data 

capture to identify trends and conduct analysis; custom 

workflows designed to automatically and effectively assign 

fiduciary work; and audit tracking to improve user monitoring 

and data integrity. 

• Improved oversight of fiduciaries and more effective I safeguards against misuse of benefits through improved 

fiduciary misuse reporting and monitoring. 

July 2014 Added a Daily Fiduciary Workload Report to BFFS to include the 

number of misuse actions outside the timeliness standard to assist 

field personnel in prioritizinQ their misuse cases. 

November 2014 Deployed knowledge management (KM), an electronic system, as a 

single repository for all fiduciary program reference material in an 

easily searchable format. KM supports agile revision of policies and 

procedures. 

July 2014 Deployed a tool for use by field personnel which assists with the 

audit of fiduciary accountings and accurately identifies VA funds I 

under management. 

May 2015 Updated BFFS to incorporate an agile quality review process at the 

National and local level. BFFS allows VA Central Office to provide 

real-time results to fiduciary hubs, which also allows hubs to provide 

targeted training to improve the quality of services VBA provides to 

beneficiaries in the fiduciary program. 

June 2015 Released BFFS enhancements to ensure the integrity of debt 

collection and benefit reissuance data and to improve user interface, 

data collection, and automation functions of the misuse protocol. 

Future I 

FY 2016 01 Develop an on-line accounting assistant to aid fiduciaries in I 

completing their accounting forms. 

FY 2016 Develop BFFS 2.0 with an enhanced business intelligence platform 

and comprehensive real-time data analytics metrics, which allows 

end-users to drill down to the case management level. 

Pension and Fiduciary Service 
63 


121q3-Att1VA6.eps

Fiduciary Program Modernization Plan e 

FY 2016 Develop and publish BFFS 2.0 user guide that integrates and I 

compliments the Fiduciary Program Manual in KM. 

FY 2016 Modernize the current telephone system to improve call routing and 

reporting capabilities and allow for the recording of telephone calls 

for quality monitoring. 

Strengthening Oversight through People I 

Completed I 

April 2013 Implemented a standardized, national training curriculum for 

fiduciary personnel, which, among other things, addresses 

applicable fiduciary program policies and procedures, file 

documentation, account audits and appropriate follow-ups, surety 

bonds, fiduciary appointments, and workload management. 

April2013 Trained 290 field examiners, with less than one year of experience, 

(Training on through deployment of new Centralized Field Examiner Training. 

going) This training provides consistent and standardized instruction, 

including field examination techniques and customer service, as well 

as the responsibilities of the fiduciarv. 

August 2013 Published A Guide for VA Fiduciaries, which is a reference booklet 

for fiduciaries that helps them understand their responsibilities and 

perform their duties. 

FY 2014 Developed a standardized computer-based training module for 

fiduciaries that is hosted on VA's Internet site. This training 

educates fiduciaries on beneficiary rights, fiduciary responsibilities, 

management of funds, and accounting and audit procedures. 

March 2014 Trained 429 field examiners through deployment of a new self-study 

(Training on course for journey-level field examiners. The training includes field 

going) examination and customer service techniques, as well as instruction 

on fiduciary responsibilities. 

March 2015 Provided instructor-led training to 279 legal instruments examiners 

(LIE), which included training on all LIE workflow functions in BFFS 

and additional training for advanced BFFS users. 

May 2015 Provided Centralized Fiduciary Service Representative Training at 

the Indianapolis Fiduciary Hub to provide instruction on finalizing 

incompetency ratings and releasing funds to VA fiduciaries. I 

FY 2015 Deployed a web-based misuse training course designed for the 

specific roles of fiduciary field personnel. The misuse training is 

mandatory for all fiduciary staff and provides the knowledge and 

tools necessary to properly address misuse allegations, conduct 

investigations, and finalize misuse determinations. 

On going Provided on site training to field fiduciary program personnel on hubspecific topics, such as misuse procedures, BFFS tools and reports, 

and error trends discovered durinq quality reviews or site visits. 

sl Pension and Fiduciary Service 
64 


121q3-Att1VA7.eps

Fiduciary Program Modernization Plan e 

Future 

FY 2016 Q1 Develop training videos targeted to fiduciaries required to provide an 

accounting. This video will provide step-by-step instructions to 

complete an accounting form and information on necessary 

documentation. I 

Strengthening Oversight of Operations I 

Completed I 

October 2014 Added a misuse timeliness performance measure to the FY 2015 I Director's Performance Dashboard Measures to ensure 

accountability of misuse action processing timeliness. 

December 2014 Revised the site survey protocol to ensure that P&F Service's site 

visit teams conduct comprehensive inspections of fiduciary hub I 

compliance with program policies and procedures, to include a 

comprehensive review of the workflow, procedures, and processes 

for all misuse actions. 

June 2014 Emphasized the identification and reporting of misuse allegations to 

fiduciary field personnel, resulting in an increase in documented 

allegations. VBA centralized third-party reports of alleged misuse 

within its National Call Centers. 

June 2015 Conducted a work measurement study of all fiduciary work tasks to 

more accurately define and quantify the time involved in completing 

fiduciary program work, and to refine assessments of the program's 

resource requirements. 

On going Completed site visits at three fiduciary hubs and has three site visits 

scheduled for FY 2016. During a site visit, the team reviews the 

hub's organizational structure and workload management plans. 

Prior to the visit and while on-site, the site visit team reviews 

processing operations and station controls for data integrity, quality 

and training. 

Future 

FY 2016 Develop procedures for expanding the fiduciary quality assurance 

program to include the tasks associated with investigating fiduciary 

misuse of beneficiary funds. 

2016 Q1 Expand P&F Service's program oversight function, which is currently 

limited to site visits and the quality assurance program, to include 

Targeted Program Reviews (TPR). These program reviews will 

consist of a remote, centralized, and detailed analysis of fiduciaryrelated topics for the purpose of better informing and assisting the 

Under Secretary for Benefits, Deputy Under Secretary for Field 

Operations, and Deputy Under Secretary for Disability Assistance. 

TPRs will identify best practices and the need for national areas of 

improvement, to include IT enhancements, training, operations, and 

policy and procedures. 

sl Pension and Fiduciary Service 
65 

RESPONSES TO POSTHEARING QUESTIONS SUBMITTED BY HON. RICHARD BLUMENTHAL

TO HON. ROBERT A. MCDONALD, SECRETARY, U.S. DEPARTMENT OF VETERANS

AFFAIRS

Question 6. Over the last fiscal year, VHA has been able to increase its health 

care staff by 4.7 percent. This means the Department has increased its capacity to 

see veterans within its wait time standard. One of the Department’s 2016 goals is 

to increase access to health care by reducing the amount of time it takes to fill open 

positions by 30 percent. While this goal is commendable, I fear it is unrealistic considering the fact in mid-September last year VHA had more than 900 vacancies 

across Human Resource positions—these are the staff who actually post notices for 

employment opportunities, set up interviews, and process general paperwork related 

to hiring. How does the Department intend to reduce fill times for open VHA positions when it lacks so many critical human resources (HR) staff? 

Response. VHA continually employs an aggressive, multi-faceted approach to attract top quality candidates for human resource positions. As of March 10, 2016, 

VHA has an estimated 452 vacancies in human resources positions. While filling 

these HR positions will be critical to the success of reducing hiring timeframes, VHA 

has also implemented other strategies such has providing the HR community best 

practices on reducing hiring timeframes such as appropriately utilizing recruitment 

authorities such as non-competitive hiring under Title 38 and Veteran hiring authorities, improving tracking of recruitment actions, and providing reporting tools 

which assists HR in identifying barriers within the recruitment process. In addition, 

VA’s HR Academy supports the development of a qualified and effective community 

of HR professionals through the delivery of training designed to improve HR professional’s proficiency and reduce competency gaps. 

Question 7. VA’s written testimony identifies improving community care as a 

breakthrough priority for improving VA and highlights the need for legislation in 

order to implement such a change to care that VA provides through community providers. Improving veterans’ access to care is going to require long-term sustainability across the different care options. In FY 2015, VA estimated that care in the 

community would cost just shy of $10 billion for FY 2016, which included $3.3 billion in Veterans Choice Funding. As a part of the rollout of VA’s plan for consolidating care in the community, VA estimated that the annual cost of care through 

the amended Veterans Choice Program in FY 2017 would be about $6.5 billion with 

an additional $7 billion in general community care. That is about $13.5 billion—not 

including the changes to urgent/emergency care that have been desperately needed. 

This figure seems difficult to sustain. In your vision of turning VA into a high-performing organization, how will the business processes you plan to put into place 

help to better monitor the appropriate care levels to make sure that VA is providing 

high-quality, appropriate care to veterans without engaging in wasteful spending 

practices? 

Response. The consolidation of community care programs will enable VA to better 

implement standardized business processes for monitoring and regulating spending 

on Veterans’ health care. This new program will use a single set of eligibility criteria, with standardized and negotiated provider reimbursement rates, allowing VA 

to conduct necessary oversight to ensure Veterans are receiving timely and highquality care within the community. VA will be able to integrate a single set of business rules into critical systems, improving VA’s ability to identify potential areas 

of risk and reduce wasteful spending. By establishing a single program, VA will be 

able to manage oversight through the entire community care process. The future 

state will leverage robust analytics to improve VA’s ability to identify waste, fraud, 

and abuse. For example, VA will be able to more easily identify duplicative claims 

and authorizations. By streamlining these programs into one single program, VA 

will be able to better monitor the care that is being provided, and the funds that 

are being spent on this care, allowing them to properly plan for the future of care 

delivery. 

Question 8. At present, VA’s website is challenging to navigate. Often users have 

a better chance of locating VA information by using a search engine like Google. In 

addition, when users find the relevant information, it can be out-of-date, frustrating 

the veteran and potentially leaving them with a bad first impression or inaccurate 

information. Given VA’s intent to create a single authoritative website to improve 

user experiences, please provide information on how the interface will be user 

friendly and what efforts VA will make to ensure the information it provides is 

accurate. 

Response. Veteran research and feedback drives all of our design and development 

work. The reason we launched such a small portion of www.vets.gov back in November 11, 2015, is so we can make sure we are getting Veteran feedback throughout 

66 

our deployment. So our ‘‘agile’’ and ‘‘developing in the open’’ approach is to build 

a small portion of www.vets.gov, then go talk to Veterans and see what they think. 

Then our team modifies vets.gov based on that data. That’s the approach we plan 

to use for everything we do on www.vets.gov. It is the only way to make sure that 

Veteran needs are the primary driver of our design and features. 

We talk to Veterans every week. We use a combination of methods: in-person 

meetings, remote sessions, group and individual activities. In January, we visited 

a homeless shelter in Seattle, Washington and talked to a group of Veterans, and 

we conducted multiple interviews and usability sessions here in the District of Columbia (at city libraries) and remotely. We do these types of activities every week. 

We have to work with Veterans at every step of deployment, or we won’t be successful. Our email is vavetsgov-feedback@va.gov for any Veteran who would like to give 

us feedback. Sessions are scheduled at the convenience of the Veteran and take only 

30–60 minutes. 

Our goals and methods for creating the most user-friendly website in the Federal 

Government are posted publicly on the www.vets.gov Playbook website 

(www.vets.gov/playbook). Vets.gov combines human centered design with agile development to deliver products grounded in customer need and supported through cycles of continuous improvement. This methodology is intended for teams designing 

new products for vets.gov and for those migrating existing tools and content from 

VA websites. The framework, while not prescriptive, is a best practice model that 

aligns human-centered design with the vets.gov development and migration process. 

The activities of cross-functional teams are detailed out by phase as well as specific 

VA stakeholder engagement points with the Vets.gov team. The result will be information and experiences that are understandable and easy to find and complete. 

Question 9. VA’s written testimony mentions that a key goal of Secretary McDonald’s plan to transform VA is to change the culture of VA from one of ‘‘rules, fear, 

and reprisals’’ to a ‘‘principles-based culture.’’ What metrics is the Department using 

to determine whether VA is meeting this goal? 

Response. Crucial to changing the VA culture from one of ‘‘rules, fear, and reprisals’’ to a ‘‘principles-based culture,’’ requires improving the Employee Experience. 

Considered so important to the VA transformation efforts, it has been identified as 

one of the VA’s Agency Priority Goals (APG). 

Improve VA’s Employee Experience by developing engaged leaders at all levels that inspire and empower all VA employees to deliver a seamless, integrated, and responsive VA customer service experience. 

Leader and managerial actions can help boost job satisfaction and ultimately improve business outcomes. Strong leaders are important to creating a positive organizational culture and climate. Employees who are regularly engaged with their leaders are more innovative than others, more likely to want to remain with their employer, absent less often, enjoy greater levels of personal well-being, and perceive 

their workload to be more sustainable than others. Ultimately, our customer, the 

Veteran, will enjoy a higher level of satisfaction with VA services as a result of an 

improved Employee Experience. 

VA is committed to creating a work environment which provides all employees 

with a more consistent, positive Employee Experience, which ultimately improves 

the Veteran’s experience with our organization. Studies indicate that employees who 

are satisfied with leadership behaviors provide a higher level of positive responses 

on employee surveys. 

To measure and evaluate progress toward this goal, and to operationalize this 

APG, VA will use six questions from the Federal Employment Viewpoint Survey 

(FEVS) to pulse VA employees on a quarterly basis about their experience with VA 

leaders. The six questions were selected after a thorough review and assessment of 

what leadership behaviors can drive the biggest improvements in employee engagement and job satisfaction. The responses to the survey questions will help determine 

to what extent VA programs are impacting leadership excellence and overall Employee Experience. 

Success by September 30, 2017, will be measured by an increase of four percentage points or more of positive responses by VA employees (over VA’s FY 2015 baseline) to these six statements: 

1) My supervisor provides me with constructive suggestions to improve my job 

performance. 

2) In my work unit, steps are taken to deal with a poor performer who cannot 

or will not improve. 

3) Employees have a feeling of personal empowerment with respect to work processes. 

67 

4) I feel encouraged to come up with new and better ways of doing things 

5) How satisfied are you with the information you receive from management on 

what’s going on in your organization? 

6) My organization’s leaders maintain high standards of honesty and integrity 

Annual targets for the six pulse survey questions are: 

Survey Question FY16 Target FY17 Target 

#1 ................................. 60.12 percent 62.12 percent 

#2 ................................. 29.47 percent 31.47 percent 

#3 ................................. 41.51 percent 43.51 percent 

#4 ................................. 55.40 percent 57.40 percent 

#5 ................................. 45.05 percent 47.05 percent 

#6 ................................. 45.50 percent 47.50 percent 

Transformational leaders engage in relationship-building and relationship maintaining behaviors with their employees. Strong leaders tend to have the ability to 

motivate employees, establish trust, communicate goals, and generate commitment. 

Changing an organization’s culture may take a decade or longer, especially with a 

large organization such as VA. This APG, which covers only the 2-year time period 

2016–2017, focuses on a strategy that primarily addresses improving leadership 

practices, and that can bring about measurable changes in a relatively short period 

of time. 

To create an improved Employee Experience, VA shall implement a strategy that 

will enhance leadership skills in collaboration and communication with employees. 

One new key initiative, Leaders Developing Leaders (LDL), is VA’s vanguard effort 

to not only train senior leaders, but also to cascade the training to lower-level leaders. LDL, combined with myriad other leadership development programs, should 

help raise the level of positive responses to the six employee survey questions. VA 

will conduct quarterly employee surveys to monitor the positive responses to those 

six APG questions on leadership. 

The following are project milestones as of February 25, 2016 and measures for 

LDL program; the key initiative supporting this APG: 

• Milestone: LDL follow-up session conducted for select leaders (approx. 450 

attendees). 

– Completed: February 29, 2016. 

• Milestone: Cascade session and a leaders ‘‘100-day’’ project are completed by 

LDL participants. 

– Target: April 30, 2016. 

• Milestone: Strategies developed for broad roll-out of LDL concepts and tools beyond leadership levels to front-line supervisors/employees and for embedding in 

daily operations. 

– Target: April 15, 2016. 

• Milestone: Strategy established for an enterprise approach to leadership development. 

– Target: September 15, 2016. 

• Measure: Number of VA leaders who receive LDL training by 

30 September 2016. 

– Target: 10,000–12,000 leaders. 

• Milestone: LDL concepts and tools provided to supervisors, and embedded in 

daily operations. 

– Target: November 30, 2016. 

• Milestone: All VA employees exposed to LDL and understand how to leverage 

the concepts and tools in their work to serve Veterans. 

– Target: December 31, 2016. 

The desired outcomes of this program by December 2016 are: 

• Improved leadership capabilities of VA leaders. 

• Engaged Employees make principle-based decisions that positively impact the 

Veteran’s experience. 

• LDL concepts and tools provided to supervisors and embedded in day-to-day operations. 

• Employee behavior demonstrates the MyVA priorities (Veterans Experience and 

Employee Experience) in day-to-day activities. 

• LDL’s impact is sustained by, and embedded in, an enterprise approach to leadership development. 

68 

The strategic objective beyond 2016 is to transform VA from a rules-based to a 

principles-based organization by developing authentic servant leaders who inspire 

and empower engaged employees, foster an environment based on trust and accountability, and work collaboratively to provide a superior Veteran experience. 

In addition to the metrics above, another way the VA measures the transformation of VA culture from one of ‘‘rules, fear, and reprisals’’ to a ‘‘principlesbased culture,’’ is to review metrics related to psychological safety, which looks at 

an employee’s ability to speak up and address mistakes or errors without fear of 

harsh treatment by supervisors or peers. 

The VA monitors psychological safety using question 17 on FEVS to measure success in this area. The results of the FEVS are publically accessible (http:// 

www.fedview.opm.gov/) and offer data comparisons of VA to other Federal agencies. 

Q17: Psychological Safety (Fear of Reprisal): I can disclose a suspected violation of any law, rule or regulation without fear of reprisal. 

The VA also uses the VA All Employee Survey (AES) to measure the transformation of VA culture from one of ‘‘rules, fear, and reprisals.’’ The AES measures 

psychological safety within workgroups and between an employee and supervisor 

through employee responses to the following questions: 

WORKGROUP PSYCHOLOGICAL SAFETY

• Psychological Safety (Bring Up Problem): Members in my work group are able 

to bring up problems and tough issues. 

• Psychological Safety (Try New Thing): It is safe to try something new in this 

work group. 

• Workgroup Communication: Members of my work group communicate well with 

each other. 

SUPERVISORY PSYCHOLOGICAL SAFETY

• Psychological Safety (Disagreement): My supervisor encourages people to speak 

up when they disagree with a decision. 

• Psychological Safety (Comfort Talking): I feel comfortable talking to my supervisor about work-related problems even if I’m partially responsible. 

Additionally, moving the VA to a ‘‘principles-based culture,’’ is also assessed 

through the VA’s ICARE qualities (Integrity, Commitment, Advocacy, Respect, and 

Excellence), culture of engagement, and servant leadership principles. Enclosure 2, 

reflecting analysis by the VA’s National Center for Organizational Development, 

shows a mix of AES and FEVS items that show employee responses related to the 

ICARE concepts. Enclosure 3 reflects data on the Servant Leadership Index which 

is a mix of 11 AES items. Analysis of these data groupings reflects the VA’s efforts 

to transform the VA into a principles-based culture. 

Finally, VA has implemented and continues to implement numerous strategies to 

enhance the VA culture through MyVA Transformation, and specifically its focus on 

People and Culture. Notably in 2015, VA achieved Office of Special Counsel certification for notifying all VA employees of Whistleblower Protection rights and implementing mandatory Whistleblower Protection training to all VA supervisors, managers, and executives. VA’s Office of Diversity & Inclusion (ODI) is enhancing the 

Whistleblower content in its mandatory Workplace Harassment Prevention and No 

FEAR training for all employees, and biennial EEO, Diversity & Inclusion, and Conflict Management training for Managers and Supervisors. ODI continues to expand 

its training portfolio in areas such as cultural competency, workforce diversity, organizational inclusion, unconscious bias awareness, and psychological safety. It has 

launched its new World Cafe ́ initiative which is a series of employee dialogs on race 

relations and other timely workplace culture issues. 

To gauge our progress in these areas, ODI implemented its groundbreaking Diversity and Inclusion Indices, holds quarterly Diversity & Inclusion Council meetings, 

and collaborates with the VA Office of Human Resources Management to promulgate its new Employee Engagement Playbooks for managers and employees. The Diversity index is a measure of VA’s aggregate workforce diversity in terms of race, 

ethnicity, and gender, as compared with the corresponding demographic groups in 

the U.S. Civilian Labor Force (CLF). The Inclusion Index is a measure of organizational inclusion as indicated by favorable employee responses to 20 validated items 

relating to workplace inclusion on the FEVS. The target benchmark for the Diversity Index is 90 percent and the target goal for the Inclusion Index is 56percent VA’s 

2015 Diversity index is currently 87.84 percent (U.S. Civilian Labor Force -based) 

and its 2015 Inclusion Index is 53 percent. 

69 

ODI is partnering with the Veterans Health Administration to roll out its Just 

Culture and Stop the Line initiatives VA-wide to move the VA culture to one of 

shared accountability committed to Veteran and employee safety. Additionally, VA 

stood up its new Office of Accountability Review and Anti-Harassment Office in 

2015 to ensure accountability for leadership misconduct and negligence, and for 

promptly responding to employee allegations of harassment, respectively. 

Question 10. VA’s written testimony discusses how VA needs additional statutory 

authority to modernize the disability claims appeals process. Following the hearing, 

Secretary McDonald issued a statement on VA needing legislation ‘‘to put in place 

a simplified appeals process that enables the Department to resolve the majority’’ 

of appeals in a reasonable timeframe for veterans. The Secretary’s statement, however, did not specify which statutory changes are necessary to reform the appeals 

process. What specific authority does VA need to reform the disability claims appeals process? 

Response. VA’s current appeals process is too complex, lengthy, and contains too 

many unnecessary and duplicative steps. It is confusing and frustrating for Veterans. The legislative proposals in the President’s 2017 Budget supports the development of a simplified appeals process, which would provide most Veterans a final 

decision on their appeal within one year of filing by FY 2021. We intend that these 

proposals will be the starting point for the broader conversation about how the Department, Congress, Veterans Service Organizations, and other stakeholders can 

work together to provide Veterans with the timely appeals process they deserve. 

RESPONSES TO POSTHEARING QUESTIONS SUBMITTED BY HON. SHERROD BROWN TO

HON. ROBERT A. MCDONALD, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 11. Secretary McDonald, at a critical time for the VA, post-Phoenix, Congress provided the Department with additional flexibility though the Choice Act. 

Veterans are now able to receive care from non-VHA facilities, but there are still 

some concerns regarding the process and authorizations for these appointments. 

What steps has the VA taken to ensure that all employees are properly trained regarding the policies associated with the CHOICE Act, and how can the Department 

encourage third party providers to approve authorizations more quickly? 

Response. The Veterans Health Administration (VHA) is working with the third 

party administrators in several key areas to expedite the approval of authorizations 

that leads to improved access to care for our Veterans. A Referral and Authorization 

Tiger Team performed a review of the current process and has identified enhancement opportunities. VHA continues to utilize the contractual agreement as a means 

to evaluate compliance and expedite care for Veterans. When third party administrator issues arise, contractual remedies help address these and provide resolution 

and direction to our business processes. 

In addition VHA has created training sessions for the field to include guidance, 

standard operating procedures and fact sheets related to sending accurate clinical 

documentation to the third party administrators. VHA communicates changes in 

processes and regulations through a bimonthly Choice Champion call, this allows for 

relay of information related to new processes, regulations, and updates to be discussed in an open forum. VHA has assigned subject matter experts to each Veterans 

Integrated Service Network (VISN) to address, their individual concerns and training ne each subject matter expert meets biweekly with the their VISN points of contacts to discuss and develop forward thinking plans for training needs, based on the 

current known barriers. 

Question 12. Finally, you mention that Department needs additional legislation to 

move forward on several of your ‘‘Breakthrough goals for 2016’’ including, the ability 

to see a community provider within 30 days, non-department claims processing, and 

reducing claims backlog, referral and authorization time. What legislative help do 

you need from the Committee to make this happen? 

Response. VA submitted to Congress on October 30, 2015 its ‘‘Plan to Consolidate 

Programs of Department of Veterans Affairs to Improve Access to Care,’’ as required 

by Title IV of the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (P.L. 114–41) (the Plan). The Plan included a detailed thorough treatment of policies for Congress to consider to transform VA Community 

Care, with a relatively detailed description of legislation necessary to carry out 

those ideas. VA would also refer the Committee to the discussion on Community 

Care in Volume II of its FY 2017 Budget Submission, beginning at page VHA–165. 

VA is eager to continue its active engagement with the Committee through informal discussions on the Plan and associated legislation. A formal VA legislative proposal is under review and forthcoming. 

70 

Question 13. I have heard from one veteran who says that he’s had a pending 

claim appeal for over three years. Last year, the VA told him the appeal would be 

settled no later than May 2015, two years from the original application. After working with a VSO representative to track his case, he discovered that his settlement 

day was again delayed. 

The VA told him that his case may not be settled until May of this year. The reason he was given was a backlog in cases. In your testimony you say that additional 

legislation is needed to simplify the appeals process to resolve appeals within one 

year of filing. 

a. What would this legislation entail and what other steps are you taking to address the backlog crisis? 

Response. VA’s present legal appeals framework is complicated and ineffective, 

and is confusing for Veterans who wait much too long for a final resolution of their 

appeal. The average processing time for all appeals resolved in FY 2015 was three 

years. For those appeals reaching the Board of Veterans’ Appeals, Veterans wait on 

average at least five years for a decision, with thousands of Veterans waiting much 

longer. The current statutory appeal process is failing Veterans. Over the years, 

laws have changed to add layers of process, perceived as being necessary to protect 

the interests of Veterans; however, those perceived protections have crippled the 

system and are no longer serving Veterans well. Many find it confusing and are 

frustrated by the endless process and the length of time it can take to get an 

answer. 

We are applying lessons learned from the transformative changes that allowed us 

to reduce the disability claims backlog. Like our work with the claims processing, 

the appeals process will need changes in people, process and technology. Upgraded 

technology will make changes to our mail system and paper records, and incorporate 

some efficiency in the way appeals are managed and processed. Retraining and increased staff will be necessary. But these measures will not be enough. Fundamental legislative reform is essential to ensure that Veterans have a timely, fair, 

and quality appeals process. To this end, the President’s 2017 Budget proposes a 

simplified appeals initiative—legislation and resources—to provide most Veterans a 

final decision on their appeal within one year of filing by FY 2021. We intend that 

the legislative proposals in the Budget will be the starting point for the broader conversation about how the Department, Congress, Veterans Service Organizations 

(VSO), and other stakeholders can work together to provide Veterans with the timely appeals process they deserve. 

b. Would H.R. 800, the Express Appeals Act, accomplish these goals? 

Response. For more than 2 years, VA has worked with VSOs in their efforts to 

develop the pilot that has become known as the Fully Developed Appeals pilot program. VA has supported the FDA pilot in the past, but at this point, we believe the 

growing appeals challenge requires much more widespread reform that will address 

all future appeals, not just the voluntary participants that may elect the FDA pilot. 

This proposal will not reduce the pending appeals inventory and will not significantly address the future appeals inventory. As a pilot for voluntary participants, 

we believe it does too little to streamline the VA appeals process for all veterans, 

or to provide an improved experience for all Veterans. The current VA appeals process is lengthy, complex, confusing, and frustrating for Veterans. All Veterans, not 

just those who elect to participate in an optional FDA pilot program, deserve an efficient, transparent, and streamlined appeals experience. The FDA pilot program in 

its current form is not enough to change the current broken VA appeals system. 

True comprehensive legislative reform that is as ambitious as that presented in the 

President’s 2017 Budget is required. 

Question 14. Too many veterans don’t believe that they have had a voice to 

present concerns back to the VA. And that is why I applaud your Community Veterans Engagement Boards initiative. Hearing from Veterans should be a mandatory 

part of any VA Secretary’s job (and it should be part of our job, too). Do you receive 

feedback from these meetings, and if so is it used to inform any changes made to 

the MyVA initiative? 

Response. Receiving input and feedback from Veterans, Servicemembers and their 

families is one of the key functions of a MyVA Community. What’s different about 

the MyVA Communities initiative is that our leaders on the ground are taking immediate, local actions to improve Veterans’ experiences based on the feedback they 

receive. We do not wait for the information to funnel up to headquarters before 

something can be done about it. The MyVA Communities model is about improving 

Veterans’ experiences and outcomes. It is about getting the people who can make 

a difference at the same table and empowering them to make a difference. VA has 

heard anecdotes about Veterans who benefited from the local collaboration in these 

71 

communities to overcome complex issues which could not be resolved by one organization alone. VA expects as the initiative matures to hear more and more about the 

positive impact of these boards. 

While the Veteran feedback obtained through community Veterans engagement 

boards is acted on swiftly by local leaders, we also are in the process of developing 

a mechanism for these boards to elevate important systemic or national issues to 

the Veterans Experience Office for enterprise level action. We also recognize the 

need for a mechanism to share best practices between communities so that they can 

learn from one another, so we are looking into the best way to support this type 

of information sharing. 

Question 15. I wanted to specifically ask you about the ways that the Department 

will measure its commitment to veterans. On page nine of your testimony, you say 

you’d like to strengthen trust in VA’s ability to ‘‘fulfill our country’s commitment to 

veterans,’’ from 47 percent to 70 percent. Can you breakdown the metrics that the 

department is using to measure whether veterans believe that goal will be met? 

Response. Trust in VA is built one interaction at a time based on experiences that 

are effective, easy and engaging, reflective of a valued, personal relationship with 

our Veterans. To measure VA’s progress in strengthening Veterans trust, the Veterans Experience Office developed and tested four new survey questions to ask 

every Veteran, for every line of business, and across every channel of interaction. 

Veterans will be asked their level of agreement (Likert scale) with four statements, 

one assessing overall trust in VA, and three capturing specific aspects of their experience with VA. The four statements are ‘‘I trust VA to fulfill our country’s commitment with Veterans,’’ ‘‘I got the service I needed,’’ ‘‘It was easy to get the service 

I needed,’’ and ‘‘I felt like a valued customer.’’ VA began adding these four questions 

to new and existing customer experience surveys; Veterans responses to these questions will be used to establish a baseline by quarter 3 of FY 2016 and measure VA’s 

progress toward achieving its goal of strengthening trust in VA. 

Question 16. Historically the VA has not received the funding or support that it 

needs to properly prepare for the growing and aging veteran population. You have 

laid out a detailed and comprehensive plan to reestablish confidence in the VA. 

There is only one more year in this Administration. Can you walk us through the 

timeline that you are using to ensure that these goals are met by the end of the 

year? 

Response. The Secretary selected the twelve breakthrough initiatives from an initial set of 28 candidate initiatives. These breakthrough initiatives represent the 12 

most impactful of the 28; combining benefits to Veterans, Employees, and Tax payers while rating highest for feasibility achieving results in calendar year (CY) 2016 

that contribute to sustained transformational momentum in CY 2018. 

The twelve initiative outcomes are achieved through separate, but coordinated, 

timelines of events each managed via individual bi-weekly executive forums (i.e., for 

each initiative a bi-weekly oversight meeting is chaired by either the Secretary or 

Deputy Secretary). 

The twelve timelines generally follow the sequence below: 

1. Establishment of a weekly senior leader coordination forum comprised of the 

Secretary, Deputy Secretary, Under Secretaries and Assistant Secretaries (established FY 2015). 

2. Establishment of bi-weekly executive forums for each breakthrough initiative 

(Quarter 1, FY 2016). 

3. Assignment of the accountable executive leader (Quarter 1, FY 2016). Assigned 

by the Secretary and answerable for the accomplishment of the assigned initiative. 

Required tasks include: 

– Verifies/approves the final wording of the initiative(s). 

– Confirms identify of the Responsible, Accountable, Consulted and Informed 

leader ( RACI) information with particular attention to the consulted (dependency) assignments. 

– Completes the definitions for the department-level metric (description, baseline, current, 2016 goal, strategic goal) for the assigned initiative. 

– Provides status, assessments and recommendations for resources, dependencies, execution, overall and projection. 

– Provides information on milestones, resources, dependencies, and status by 

completing the management dashboard. 

4. Definition of effective metric(s) to assess attainment of objective (Quarter 1, FY 

2016). 

5. Establishment of performance indicators (Quarter 2, FY 2016). 

6. Reallocation of required FY 2016 resources (Quarter 2, FY 2016). 

72 

7. Coordination for support from internal and external organizations (e.g., administrations, staff offices within the Department, Office of Personnel Management) 

(Quarter 2, FY 2016)). 

(73) 

A P P E N D I X 

PREPARED STATEMENT OF AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES, 

AFL–CIO 

Chairman Isakson, Ranking Member Blumenthal, Members of the Committee, 

Thank you for the opportunity to present the views of the American Federation of 

Government Employees, AFL–CIO and its National Veterans Affairs Council 

(AFGE) regarding VA Transformation. AFGE represents over 670,000 non-management Federal employees. Over forty percent of AFGE members are veterans working in the VA, Department of Defense, Department of Homeland Security and other 

agencies. AFGE represents more than 220,000 VA employees working in the Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and 

National Cemetery Administration (NCA). 

AFGE and its National VA Council (AFGE) believe that the MyVA Transformation initiative has a great deal of potential to make needed improvements to 

the VA. AFGE was a true partner with VA leadership during the highly successful 

transformation carried out by Undersecretaries Kizer, Garthwaite and Murphy. In 

contrast, our role in the current transformation process is more superficial and uneven for a number of reasons. As a result of less meaningful employee engagement, 

the current Transformation effort’s likelihood of success is more limited. 

For example, AFGE represents more than 220,000 VA employees working in every 

VA occupation but has only assigned one seat on MyVA. The other unions participating in MyVA each have one seat even though they represent only a small percentage of the workforce in far fewer occupations. At the same time, twenty or more 

management representatives typically participate in these work groups. The number 

of consultants who are completely outside the VA workforce also far exceeds the 

number of employee representatives. AFGE has requested that the VA allot employee representative slots on MyVA that are proportionate to the number of employees represented by each union; that request is still outstanding. 

AFGE is also frustrated by the VA’s recent decision to eliminate the Robert W. 

Carey Performance Excellence Awards Program that recognized high performing organizations within the Department. In the past, AFGE served as a full partner in 

this valuable program that based its awards on Baldridge Criteria for Performance 

Excellence. AFGE helped evaluate nominees, made site visits and trained examiners 

through the National Quality Council. 

To ensure more meaningful labor-management collaboration on VA quality improvement initiatives, we urge the Department to build in more incentives and recognition for labor participants in its current performance improvement projects associated with leadership development programs. 

One would think that of all the VA transformation activities, the unions would 

have the most active roles in initiatives around employee engagement and improving the employee experience. Unfortunately, that is often not the case. For example, 

we recently learned inadvertently about a management-only workgroup on physician engagement and its focus on two issues that AFGE has raised with the Administration and Congress on numerous occasions: excessive computer view alerts and 

an inflexible leave policy. It appears that this workgroup never contacted AFGE to 

get the input of non-management front-line physicians even though our union represents physicians at most medical centers around the country. 

A recent survey of local union presidents by the National Partnership Council confirms that true employee engagement is still lacking. The vast majority of respondents indicated that they are not involved in MyVA, ICare or other purported employee engagement initiatives at any level. As one AFGE local president noted, even 

when management at the facility level does hold town hall meetings or other efforts 

to solicit employee input, they often do so in a ‘‘robotic’’ manner as if they are merely going through the motions. For example, employees can rarely attend town hall 

74 

meetings because facilities are so short staffed. Management should work with the 

unions to identify ways to make these town hall meetings more accessible to employees who want to attend. 

Our members also feel that their suggestions for reducing bureaucracy are not 

adequately considered. For example, a local AFGE president was recently told by 

her director that the new ‘‘consult clinics’’ that seemed to add an unnecessary administrative layer to the appointment process were going to be dissolved. Once that 

director left, the AFGE local president received no other updates. 

Our local leaders expressed similar concerns about unnecessary management layers created by the ‘‘New Matrix Redesign’’ and Primary Care Clinical Practice Management Groups. At the same time, the primary care ‘‘PACT’’ teams continue to be 

chronically understaffed with long term vacancies for front-line, non-management 

provider and nurse slots. There is also widespread frustration with VHA’s longstanding practice of mandating new positions without additional funding. 

On the VBA appeals front, AFGE recently conducted a membership survey and 

received responses from Decision Review Officers (DRO) on the progress of the Veterans Benefits Management System (VBMS) and the need for additional improvements. We ask that Congress and VBA in its MyVA plan create an effective feedback protocol for employees and the union to provide regular recommendations on 

improving VBMS. Several DROs claimed that VBMS has helped productivity with 

initial disability claims but the system still presents glaring issues for more complex 

appeals cases. AFGE members’ suggestions for VBMS included: 

• Alerts: Many members requested meaningful alerts in VBMS to notify the user 

of pending appeals or that another user working the claims. 

• System Delays and Capability: Members requested additional emphasis and assistance in VBMS for appeals which are often far more complex. System delay and 

equipment issues particular hurt DROs. 

• Document Viewing: Increase the ability to view multiple documents at once for 

appeals. 

Thank you for the opportunity to share AFGE’s views on VA Transformation 

Strategies. 

PREPARED STATEMENT OF DIANE M. ZUMATTO, NATIONAL LEGISLATIVE DIRECTOR, 

AMVETS 

Distinguished members of the Senate Veterans’ Affairs Committee, On behalf of 

the 23 million American Veterans in this country, AMVETS, a leader since 1944 in 

preserving the freedoms secured by America’s Armed Forces and providing support 

for Veterans, Active Duty military, the National Guard/Reserves, their families and 

survivors, it is my pleasure, to offer this ‘Statement for the Record’ concerning VA’s 

Transformation Strategy. 

According to a June 2015 VA Patient Access Progress Update, the VA increased 

the number of appointment by 2.7 million over the previous year’s same time-frame, 

for a total of more than 51 million completed appointment between 1 June 2014 and 

30 April 2015. During this same time-frame, the VA’s Electronic Wait List saw an 

encouraging 45% reduction, going from a high of over 56,000 appointments down to 

30,520. 

The VA also saw a nearly 12% increase in the usage of its Telehealth services, 

serving more than 717,000 veterans and 2 million telehealth visits. Not surprisingly, roughly 45% of those utilizing telehealth services were rural veterans. 

VA also authorized over 2.8 million Veterans, a 45% increase from the previous 

year, to receive care in the private sector between June 1, 2014 and May 15, 2015. 

With this kind of encouraging data coming out of the VA, no one can doubt their 

good intentions in continuing to transform the current VA into a new and improved 

VA. AMVETS is encouraged and optimistic, that given time, the VA will achieve its 

goals. 

Let me briefly touch on the 5 areas of focus of the MyVA plan: 

1. Improving the Veteran experience 

2. Improving the employee experience, and achieving ‘‘people excellence’’ so they 

can better serve Veterans 

3. Improving our internal support services 

4. Establishing a culture of continuous improvement 

5. Enhancing strategic partnerships 

The list above clearly shows that the VA is not only fully aware of its shortcomings, but is equally invested in improving the current system. AMVETS appreVerDate Mar 15 2010 16:02 Jan 30, 2018 Jkt 000000 PO 00000 Frm 00078 Fmt 6601 Sfmt 6621 Z:\ACTIVE\012116.TXT PAULIN
75 

ciates the time, effort and the of multiple data sources that went into the development of this fresh and aggressive plan to improve the VA. 

I’d like to break the VA’s focus areas into two groups: a. Improving the Veteran 

Experience; and b. Improving the Employee Experience, because we believe the 

other three areas can be fairly treated under these two broader headings. 

a. Improving the Veteran Experience: 

AMVETS feels that this is the most critical facet of the VA’s improvement plan, 

since the whole VA system was created specifically to care for and meet the needs 

of veterans. If veterans are not having positive and beneficial interactions with the 

VA, whether in healthcare, education, benefits, etc., then the system is a failure and 

needs to be fixed. This is where the VA’s improvement plan comes into play. 

The VA’s previously quoted data (see above) should go a long way toward providing veterans with the world class healthcare they have earned, deserve and were 

promised. By increasing both internal and external access to healthcare, working toward more timely appointments and accommodating the specific needs of rural veterans should all increase overall veteran satisfaction. 

Another critical area that AMVETS is pleased to see the VA address in their improvement plan is the lack of continuity across the VA system. Though the VA has 

a number of strengths, they seem to be found only in isolated pockets. We’ve all 

heard widely varying reports of exceptional VA service, as well as, sub-optimal service from various VA medical centers around the country. 

Since every veteran is entitled to a positive experience when using the VA, it is 

absolutely critical that VA’s operations be standardized across all of their business 

lines and that anyone ‘doing it right’ should be recognized and required to share 

their best practices nationally. 

Perhaps the most important part of the VA’s efforts to improve itself, is the creation of the MyVA Task Force. This body is meant to be nimble and quick, creative, 

thoughtful and ultimately will be responsible for turning ideas into reality, while 

simultaneously preserving those things which VA does best and ensuring interoperability of all processes. In a nutshell, their job is to ‘make things happen’. Never 

an easy task to accomplish, the Task Force, which is comprised of both leadership 

and staff members, will have two years to bring the VA, and all its business lines, 

into the 21st century. 

AMVETS applauds the VA for establishing a new system-wide customer service 

organization whose mission is to design and implement a superior Veteran Experience, to include integrating the mechanisms to deliver it. A Chief Veteran Experience Officer, who reports to the Secretary, will lead this organization. We believe 

this is a critically needed improvement, which should pay huge dividends for veterans. 

Additionally, the creation of the national network of Community Veteran Advisory 

Councils (CVACs) to coordinate better service delivery with local, state and community partners will play an important role in helping to rebuild trust between the 

VA and the veterans it serves. 

Change and employees who are willing and able to effect that change are vital 

for the success of any business, but the best laid plans can die a slow death without 

the ‘buy-in’ of every employee at every level. Every organization has its own specialized culture and historically the VA’s culture has been part of its problem. A negative or close-minded culture stifles innovation and hinders progress and merely 

changing the top dog alone is not enough to break through this kind of inertia. Until 

every VA leader and every employee is held responsible and accountable for their 

contributions to the organization as a whole, as well as their actions (or lack thereof), nothing will change for the better. It is for this reason that AMVETS is glad 

to see that this issue has been recognized by the Secretary and that the VA’s improvement plan contains a framework to address this concern. 

Though to some, the following features of the VA’s plan to improve the veteran 

experience may seem somewhat trivial, in the grand scheme of things, the positive 

benefits are cumulative and include: 

• the development of user-friendly, consistent and accurate signage at all VA facilities; 

• Wi-Fi access at VHA facilities; 

• Integrated (VHA, VBA & NCA), Local Town Halls; 

• Improved organizational phonebook search capability; 

• development of a single customer-facing website; 

• implementation of ‘‘VA311’’ so veterans can more easily get information via 

phone; and 

• installing a VBA presence at VHA facilities 

76 

b. Improving the Employee Experience: 

While AMVETS acknowledges that without employees, there would be no VA, it 

is somewhat frustrating that every conversation about veterans and VA accountability generally seems to focus more on VA employees and their needs than on the 

needs of veterans. AMVETS is also aware that a large number of VA employees are 

also veterans, but VA’s employees are represented by a union which advocates for 

them, so we believe their interests are already being addressed. In general, 

AMVETS believes VA employees are more than adequately compensated for the 

work they do. To the best of our understanding, VA employees are not required to 

risk their lives on a daily basis, face deployments, work in the extremes of heat or 

cold, leave their families, etc., yet they enjoy employment protections that non-Federal workers don’t. 

This does not mean that AMVETS condones unfair treatment of any kind for any 

Federal, military or civilian employees, we support equity and justice for all workers; it merely means that our specific job, as a Veteran Service Organization, is to 

focus only on our veterans and their needs. 

AMVETS acknowledges that a fairly compensated, knowledgeable and well 

trained staffs that have the proper tools to accomplish their mission make the best 

employees. Therefore we are encouraged to see the VA reviewing their employee 

evaluation and hiring processes so that only the best and the brightest will be hired, 

which ultimately will greatly improve the veteran experience. 

All this being said, AMVETS is encouraged by the VA’s plan to harness the expertise of its own employees by creating ‘performance improvement teams’, which will 

help to eliminate or improve any processes that impede excellent customer service 

or service delivery. 

Not sure where the consolidating of VA’s various maps falls within these focus 

areas, but AMVETS is happy to see VA’s many organizational maps restructured 

into one map with five regions. This single regional framework should make it easier for both veterans and VA employees to navigate the VA’s convoluted system 

while simultaneously improving communications, optimizing productivity and more 

efficiently coordinating VA services. AMVETS also supports the downsizing of the 

VISNs from 21 to 18 for the same reasons. 

Some of the additional employee related features that VA hopes to have in place 

by the end of 2016 which AMVETS fully endorses include: 

• VA 101 training to improve employee knowledge and understanding of VA’s history and its various services; 

• improved customer service training for front line employees; 

• expanded leadership development opportunities; 

• improved line of communications between management and employees; 

• streamlined hiring process; and 

• improved evaluation and performance measures 

Inevitably, these efforts will not only improve the morale and competence of VA 

employees, but the end result should help to improve the veteran experience. 

The last thing AMVETS wants to do is to gratuitously criticize the VA, so I’d like 

to take this opportunity to briefly focus on some of the positives of the VA 

healthcare system. Those positives include the fact that: 

• VA is the largest direct provider of health-care services in the Nation; 

• VA provides the most extensive training environment for healthcare professionals; 

• VA is the Nation’s most clinically focused setting for specialized medical and 

prosthetics research; 

• VA provides specialized health-care services in a number of areas that cannot 

be adequately duplicated in the private sector, including: spinal cord injury/dysfunction; blind rehabilitation; Traumatic Brain Injury; prosthetic services; mental 

health; and war-related poly-traumatic injuries; 

• VA is among the most efficient and cost-effective healthcare system in the Nation; 

• VA sets the standards for quality and efficiency and does so at or below the 

Medicare rates, while simultaneously serving a population that is older and has a 

higher percentage of individual health problems. 

What is needed now more than ever to effect beneficial changes within the VA 

are cool heads and creative thinkers, to include the VA and all it stakeholders. This 

is where the MyVA plan comes into play. 

AMVETS too has some suggestions, that some of you may have previously seen, 

which we would like to reiterate before closing out these remarks. I believe there 

are some commonalities with the MyVA plan. 

77 

AMVETS Specific Recommendations: 

1. Ensure that both advanced appropriations and discretionary funding for VA 

keeps pace with medical care inflation and healthcare demand as recommended in 

the IB so that all veterans healthcare needs can be adequately met; 

2. Maximize the use of non-physician medical personnel as a way to mitigate physician shortages, while always maintaining the highest level of patient safety and 

reduce patient wait times especially while utilization of the VA system continues to 

rise; 

3. Ensure that VA makes more realistic third-party medical care collection estimates so that Congress doesn’t end up under-appropriating funds based on false expectations which in turn negatively impact veteran care. Additionally, VA needs to 

redouble its efforts to increase its medical care collections efforts, because taken together, the cumulative effects of overestimating and under-collecting only degrade 

the care available to our veterans. Furthermore, VA needs to establish both firstand third-party copayment accuracy performance measures which would help minimize wasted collection efforts and veteran dissatisfaction; 

4. VA needs to incorporate civilian healthcare management best practices and include a pathway to VA hospital/clinic management for civilians as part of their succession plan requirements, so that VA will be able to attract the best and the brightest healthcare managers in the industry; 

5. VA could immediately increase its doctor/patient (d/p) ratio to a more realistic 

and productive levels in order to cut wait times for veterans needing treatment and/ 

or referrals. While the current VA (d/p) ratio is only 1:1200, the (d/p) ratio for nonVA physicians is close to 1:4200. Instituting this one change would drastically improve our veterans access to needed healthcare; 

6. VA needs to improve its patient management system so that veterans have 

more appointment setting options available to them, which could reduce staffing errors and requirements. VA should also consider utilizing a hybrid system whereby 

half the day might consist of scheduled appointment and the other half would be 

for walk in or same-day appointment. The elimination of the need for non-specialty 

appointments would allow veterans quicker access to their primary care providers; 

7. The current VA healthcare system appears to be top-heavy with administrative 

staff and short-handed when it comes to patient-focused clinical staff. This imbalance can only exacerbate veteran wait times; 

8. The VA needs to thoroughly review its entire organizational structure in order 

to take advantage of system efficiencies and to maximize both human and financial 

resources, while also minimizing waste and redundancies; 

9. VA needs to collaborate with HHS (Health & Human Services) so that it can 

utilize/share the benefits of the UDS (Uniform Data System). The UDS is a core set 

of information appropriate for reviewing and evaluating the operation and performance of individual health centers. The ability to track, through the UDS system, a 

wide variety of information, including patient demographics, services provided, staffing, clinical indicators, utilization rates, costs, and revenues would be invaluable in 

improving the overall VA healthcare system; 

10. Rather than have veterans go unseen or untreated due to limited appointment 

or physician availability, veterans should be allowed to utilized the currently existing system of FQHCs (federally Qualified Health Centers). FQHCs include all organizations receiving grants under section 330 of the Public Health Service Act, certain tribal organizations, and they qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs are required to: serve an underserved area or population; offer a sliding fee scale; provide comprehensive services; have an ongoing quality assurance program; and to have a governing board of 

directors. Allowing veterans to seek care, even on a temporary basis, until the VA 

appointment backlog is eliminated, would provide our veterans with immediate care 

and would relieve some of the pressure on the VA system; 

11. VA should review, and consider adopting, civilian medical management best 

practices as a tool for improving its own healthcare operations; 

12. VA must immediately improve its recruitment, hiring and retention policies 

to ensure the timely delivery of high quality healthcare to our veterans. VA currently utilizes a cumbersome and overly-lengthy hiring process which reduces its 

ability to deliver critical services. VA need to consider adopting a more expedient 

hiring/approval process which could include some form of provisional employment; 

13. VA needs to have, and utilize, the option to terminate non-performing employees at all levels of the organization so that only dedicated, accurate, motivated employees will remain in service to our veterans; and 

14. Finally, VA needs to reform their incentive programs so that only high-performing employees receive appropriate bonuses for their excellence in serving our 

veterans. 

78 

1Department of Veterans Affairs. ‘‘MyVA Integrated Plan.’’ http://www.va.gov/opa/MyVA/docs/ 

MyVA_integrated_plan.pdf (accessed January 19, 2016) 3. 2Daly, Matthew ‘‘VA announces ‘MyVA’ plan, largest reorganization in department’s history.’’ 

PBS http://www.pbs.org/newshour/rundown/va-announces-MyVA-plan-largest-reorganization-departments-history/ (accessed January 14, 2016). 3The Risk Assessment included in the plan recognizes a ‘‘moderate-high’’ risk that ‘‘stakeholders will not accept the MyVA initiative as a viable solution for correcting VA’s perceived 

shortfalls;’’ a ‘‘moderate-high’’ risk that ‘‘stakeholders will question whether or not we should 

be spending the money on this transformative effort;’’ a ‘‘high’’ risk that MyVA initiatives will 

not be completed on time due to personnel resource constraints resulting from challenges in the 

hiring process;’’ a ‘‘moderate’’ risk that ‘‘MyVA progress will be limited due to funding challenges;’’ and a ‘‘moderate-high’’ risk that ‘‘MyVA progress will be limited due to finite leadership 

capacity.’’ MyVA Integrated Plan, 32–33. 

In closing, it is interesting to note that in the last couple of years, numerous entities have developed a variety of proposals for addressing the shortcomings within 

the VA. While no individual plan has been ‘‘perfect’’, they are worth reviewing and 

perhaps incorporating specific recommendations on a case-by-case basis. Perhaps 

most importantly, the Commission of Care has not yet completed their mission and 

their recommendations will have to be incorporated into the VA’s overall redesign. 

This completes my statement at this time and I thank you again for the opportunity to offer our comments on pending legislation. Feel free to reach out to me 

if have any questions. 

PREPARED STATEMENT OF CONCERNED VETERANS FOR AMERICA

Chairman Isakson, Ranking Member Blumenthal, and Distinguished Members of 

the Committee, Thank you for this opportunity for CVA to provide a statement for 

the record regarding the Department of Veterans Affairs’ (VA) ‘‘MyVA’’ initiative. 

In November 2014, following significant scandals causing then-VA secretary Eric 

Shinseki to step down, VA announced—to much fanfare—an initiative ostensibly 

aimed at improving the veteran’s experience when dealing with VA. In a fifty-page 

document entitled the MyVA Integrated Plan, released last July, VA details the plan 

with the stated goal of ‘‘provid[ing] a seamless, unified Veteran Experience across 

the entire organization and throughout the country.’’1 Top-line priorities of the plan 

include: ensuring that veterans receive uniform and consistent care across VA; improving the overall veteran experience; and improving the VA employee experience. 

This is to be done in three ‘‘horizons’’: the first will ‘‘leverage existing programs 

and initiatives’’ that are performing well, in order to deliver better services to veterans. The second will be to concentrate ‘‘on a relatively small set of catalytic efforts’’ aimed at accelerating ‘‘transformation already underway,’’ among them, ensuring that support services are functioning optimally, cultivating a ‘‘culture of continuous improvement,’’ and ‘‘enhancing strategic partnerships.’’ The third will focus 

on ‘‘optimizing and scaling MyVA’’ which entails the utilization of a ‘‘MyVA Task 

Force’’ that will ‘‘coordinate initial operational planning’’ and will continue to work 

through 2016 and 2017 until implementation is complete. 

Looking deeper into the specifics, many are commendable. A single, easy-to-use 

website is long overdue, for example; improved customer service training for VA employees is needed; and every taxpayer will be grateful that VA is taking seriously 

its responsibility to be a good steward of public resources. 

However, these changes do little in terms of providing a real basis for systemic 

change. While it is touted as a comprehensive overhaul, it seems to be, in truth, 

little more than a customer service plan. In fact, Secretary McDonald described it 

as a customer service plan in his announcement, saying MyVA will be ‘‘a seamless, 

integrated and responsive customer service experience.’’2

Improved customer service is, of course, desperately needed at VA, and a plan to 

improve customer service is appreciated. But the question that needs to be asked 

whether MyVA—assuming that can be implemented comprehensively and relatively 

effectively, which, by the plan’s own admission is less than clear 3—will solve the 

difficulties faced by VA. Does the plan get to the root of the problem? Unfortunately, 

the answer is no. The challenges faced by VA are deep and systemic—problems that 

cannot be solved by a mere customer service plan, no matter how sweeping. 

Last fall, VA released the Independent Assessment, a report mandated by the 

Veterans Access, Choice, and Accountability Act of 2014 and conducted by analysts 

including Mitre Corp., Rand Corp. and McKinsey & Co. The over 4,000 page report 

shows structural misalignment, bloated bureaucracy plagued by cultural problems, 

leadership failings, and an unsustainable budget to be major factors in VA’s mismanagement and inefficiency. 

79 

4 CMS Alliance to Modernize Healthcare, (September 1, 2015) Independent Assessment of the 

Health Care Delivery Systems and Management Processes of the Department of Veterans Affairs, 

Volume 1: Integrated Report, xiii. 5 Independent Assessment Integrated Report, 61. 6For more on this, see e.g. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ 

ACO/index.html and http://www.npr.org/2011/04/01/132937232/accountable-care-organizationsexplained 7Kussman, M. et al. (2015, February). Fixing Veterans Healthcare Report. Fixing Veterans 

Health Care Task Force. http://cv4a.org/veterans-health-care-report/. 8 Independent Assessment Integrated Report, 61. 9Walters, H. et al. (2009, December). Commission on the Future for America’s Veterans: Preparing for the Next Generation. Commission on the Future for America’s Veterans. 10 Independent Assessment Integrated Report, 26. 11 Independent Assessment Integrated Report, 26. 

Specifically, the integrated report of the assessment enumerates four ‘‘systemic 

findings that impact mission execution’’: (i) ‘‘A disconnect in the alignment of demand, resources, and authorities;’’ (ii) ‘‘Uneven bureaucratic operations and processes;’’ (iii) ‘‘Non-integrated variations in clinical and business data and tools;’’ (iv) 

‘‘Leaders are not fully empowered due to a lack of clear authority, priorities, and 

goals.’’ 4

Clearly, these are not problems that can be righted through a customer service 

plan—deep structural changes are necessary. VA needs to transition from a government organization attempting to do healthcare to a healthcare organization chartered and funded by the government to care for veterans. In a word, VA needs to 

modernize. 

The staid state of VA health care is the result of inherent problems in the way 

VA has developed since its inception nearly a century ago. Moreover, entrenched interests often stand in the way of the kind of real reform that would transform VA 

into, as the Independent Assessment puts it, a ‘‘High-Performing Healthcare System.’’5 If the Independent Assessment is correct, VA’s problems are structural, not 

merely aesthetic; and structural problems require systemic solutions. Healthcare delivery has changed dramatically in recent years, but VA still remains tied to outdated structures and methods. VA would do well to examine the highest functioning 

healthcare organizations in the country, such as the so-called ‘‘Accountable Care Organizations (ACO),’’ 6 and remain open to implementing best practices gleaned from 

them. Congress would do well to examine the structures utilized in those organizations and consider legislatively restructuring VA along those lines. 

The Independent Assessment details a number problems with the current state 

of the system and offers a number of recommendations. On page 61 of the report, 

under the section ‘‘Transformation,’’ the Independent Assessment quotes the CVAsponsored Fixing Veterans Health Care Task Force Report 7 saying ‘‘Minor tweaks 

to the current system may incrementally improve health care in the near term, but 

the monopolistic VHA bureaucracy is likely to return to a standard operating model 

heavily influenced by the desires and concerns of the institution and its employees. 

Only fundamental reform will break the cycle and empower Veterans.’’ 8 The Fixing 

Veterans Healthcare Task Force Report provides a comprehensive plan to overhaul 

the VA healthcare system in a way that is consistent to the above-mentioned ACOs. 

This kind of transformation is what CVA firmly believes is required in order to fix 

veterans’ healthcare. Anything less, including the MyVA plan, will be insufficient 

over the long term. 

The recommendations included in the Independent Assessment contain a significant amount of overlap with the structural realignments recommended in the Fixing 

Veteran Health Care Task Force Report. For example, on page 26, the assessment 

quotes the 2009 Commission on the Future for America’s Veterans: Preparing for 

the Next Generation 9 report which recommends placing VHA under a new kind of 

governance: ‘‘Congress [should] ‘establish a new entity with characteristics not unlike a Federal Government ‘‘not for profit’’ corporation’ that would be empowered 

with ‘unencumbered’ authority to use all the assets of VHA to ‘maximize benefits 

to Veterans.’ ’’ 10 This is remarkably similar to the recommendation of the Fixing 

Veteran Health Care Report. Such a model would avoid disputes about, for example, 

the closing of certain obsolete or underused VA facilities, which as the Assessment 

notes, ‘‘can meet strong resistance from multiple groups.’’ 11 Such a governance system would allow VA to address many of the problems it faces in a rational way, 

doing what is best for the veteran, rather than focusing on how to sustain the system as it currently exists. 

VA is not beyond saving, but doing so will require bold thinking and a willingness 

to consider a broad range of reform possibilities, including—and especially—those 

that offer systemic changes to address systemic problems. 

80 

That is why CVA asks all stakeholders to join with us in striving for a VA system 

that serves veterans comprehensively, efficiently, and effectively. Only then will VA 

be able to fully and effectively meet the healthcare needs of veterans in a truly customer service-oriented manner. 

PREPARED STATEMENT OF JOY J. ILEM, NATIONAL LEGISLATIVE DIRECTOR, DAV 

Thank you for inviting DAV (Disabled American Veterans) to submit this statement for the record of today’s hearing. As you know, DAV is a congressionally chartered national veteran’s service organization of 1.3 million wartime veterans, all of 

whom were injured or made ill while serving on behalf of this Nation. 

Your invitation letter indicated the focus of today’s hearing is to assess the Department of Veterans Affairs (VA) and its efforts and plans to modernize its benefits 

and health care system. You asked that we identify any issues or barriers that we 

believe VA may face in advancing its planned and proposed reforms. We appreciate 

the opportunity to share our views and recommendations in this regard. 

Mr. Chairman, in recent years, VA has undertaken a number of modernization 

initiatives, including a claims processing transformation that has helped to reduce 

the backlog of claims by more than 80 percent, and is now shifting to focus on appeals. Another major system-wide effort is the MyVA initiative. Launched by the VA 

on September 2, 2014, the MyVA Integrated Plan was designed to reorient VA 

around veteran needs and empower employees to assist in providing them with a 

seamless, integrated and responsive customer service experience—whether they arrive at VA digitally, by phone or in person. MyVA it is the largest department-wide 

transformation in VA’s history and is intended to coalesce ideas and insights shared 

by veterans, employees, Members of Congress, veteran service organizations, and 

other stakeholders. VA’s goal is to modernize its culture, processes and capabilities 

in addition to consolidating its community care programs. 

The MyVA framework for restructuring includes four basic pillars: 

1. The establishment of a new VA-wide customer service organization, led by a 

chief customer service officer who will report to the Secretary; 

2. The incorporation of a single, regional framework to allow veterans to more 

easily navigate the VA through simplified internal coordination; 

3. The creation of Community Veteran Advisory Councils that will work to coordinate veteran-related service delivery with local, state and community partners; and 

4. The identification of opportunities to restructure internal business processes 

into a shared services model, thereby improving efficiency and productivity and reducing costs. 

According to VA the first phase of the MyVA plan includes creating a task force 

and building the team to support the mission and an organizational change of this 

breadth with a focus on five key areas of improvement: 

• Improving the veteran experience; 

• Improving the employee experience so they can better serve veterans; 

• Improving internal support services; 

• Establishing a culture of continuous improvement; and 

• Enhancing strategic partnerships. 

VA reports that veterans are already seeing the impacts of changes made through 

the MyVA initiative. At the suggestion of VA employees, the Department notes it 

has recently improved customer service at call centers; started up VA 101 training 

for employees; improved veteran access to audiology and optometry appointments; 

modernized Veterans Crisis Line (VCL) operations; implemented memorial affairs 

pre-need eligibility screening; and stopped printing and mailing certain unnecessary 

and costly paper reports. 

VA reports that by the end of 2016, MyVA should accomplish the following improvements for veterans: 

• A single customer facing website that veterans can use to do business with VA 

(initial capability in fall 2015, with additional incremental capability being built 

through June 2017); 

• A unified ‘‘VA311’’ enterprise-wide approach that veterans can use to easily find 

information via telephone; 

• A way for veterans to update or change their authoritative data in one place, 

one time, and have that information available and securely shared throughout VA; 

• Greater VBA presence in VHA facilities to increase benefits access and enhance 

service; 

• 100+ MyVA Communities established across the Nation; 

81 

• A more consistent level of customer service in every interaction—enabled by 

consistent front-line training across VA and measured by operational metrics; and 

• The establishment of a Veterans Experience (VE) office at both national and 

district levels to bring a new lens to how VA analyzes and designs the services provided to veterans. According to VA, the VE office is not intended to be another layer 

of management or bureaucracy, but will: 

– Work collaboratively with local facilities in analyzing and designing better 

customer interactions and the tools that support them; 

– Develop and deliver customer service training curricula and methodologies; 

– Keep a close eye on customer service performance to make sure the right 

issues are being addressed in the right ways; and 

– Implement better ways to help veterans navigating through the range of services within VA. 

Additionally, by the end of 2016, VA intends to accomplish the following for employees: 

• Deliver VA 101 training to approximately 50 percent of employees to improve 

their knowledge and understanding of VA’s history and services; 

• Conduct front line customer service training pilots in each of its five Districts; 

• Expand leadership development programs; 

• Vastly improve employee communications; 

• Complete standardized staffing models, with vacancies filled for mission critical 

occupations; 

• Improve and streamline recruitment and hiring practices for VA facilities; and, 

• Establish better linkage of organizational and performance measures to VA 

Goals and Objectives. 

VA also intends to fully transition to a five-district configuration to align unequal 

organizational boundaries of the Department into a single framework based upon 

state boundaries. The goal is to: 

• Ease internal coordination challenges; 

• Enhance collaboration amongst all of VA’s nine business lines, which will continue to remain responsible for their respective services and benefits; 

• Standardize performance measurement; 

• Enhance collaboration with external stakeholders; and finally 

• Prepare for the rollout of the VE office, which will support VA product and service lines in the delivery of excellent care and benefit experiences. 

VA notes if done properly, it will build a high-performing organization that will 

be nimble enough to continually change and improve. The Secretary came into VA 

during a crisis and a low point for the Department and we acknowledge his hard 

work and that of his team to properly assess and lay out a comprehensive plan to 

improve systemic business practices as well as his dedication to the VA’s core mission of serving veterans and efforts to improve the veterans experience. DAV believes the Secretary’s plan is thoughtful and heading in the right direction. Most importantly it focuses, at its core, on the veteran, as it should. We concur with VA 

that this transformation will take time. The question now before us is VA’s estimated timeline and progress toward accomplishing its goals, and what needs to be 

done by the Administration and by Congress to aid and support these proposals. In 

addition, we must be cognizant of the time required for such major changes to fully 

take effect. As the Independent Assessment of the VA health care system produced 

last year by MITRE, Rand and other cautioned, ‘‘Most transformations take at least 

12 to 18 months for initial impact, and transformations of the magnitude needed at 

VHA may take 5 to 10 years to fully take hold.’’ (Independent Assessment, Integrated Report, page 61) 

We believe that the current MyVA initiative taking place will go a long way toward improving the veteran’s experience and satisfaction with VA. Furthermore, we 

recommend that Patient Advisory Councils be established to act as a catalyst advocating integration of patient-centered care across the facility. Such councils are not 

new and have been proven to be an effective strategy for involving patients and 

their family to improve the quality in patient care. Veteran patients and their family caregivers are often the most knowledgeable members of the VA health care 

team, and can offer unique perspectives and valuable feedback regarding the standard of care they receive. 

Mr. Chairman, the other major transformation that must take place is to evolve 

the VA health care system to address longstanding access issues that erupted two 

years ago in Phoenix. As Congress, the media and ultimately VA discovered, thousands of veterans had been waiting too long to access the VA health care system 

to receive medical services they had earned. In response, Congress rushed to pass 

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the Veterans Access Choice and Accountability Act (VACAA) to create a new procedure to provide non-VA health care access to veterans on an emergency and temporary basis, appropriating $10 billion in emergency funding for a new ‘‘choice’’ program. The law also provided $5 billion for VA to rebuild its internal capacity to deliver care, primarily by expanding usable treatment space and hiring more doctors 

and nurses. As noted previously, it required an independent assessment of the VA 

health care system and established a Commission on Care to develop recommendations for providing quality, accessible health care to veterans over the next 20 years. 

Since the troubling events in Phoenix, DAV has presented our views and recommendations to the VA Secretary of Veterans Affairs (VA) and other senior VA officials, as well as to this Committee and others in Congress, on numerous occasions. 

Our focus has always remained the same: what is best for veterans. Based on our 

experience and the needs of millions of injured and ill veterans, we have repeatedly 

called for preserving, strengthening and reforming the veterans health care system 

so that DAV members and all eligible veterans may continue to enjoy the unique 

benefits and vital services provided by VA well into the future. 

At the same time, we recognize that VA has flaws and shortcomings that must 

continually be addressed through cultural and systemic reform. For decades DAV 

has worked in conjunction with our partner organizations in the Independent Budget (IB) to highlight necessary systemic changes and the need for modernization of 

VA’s H.R. policies, aging infrastructure and IT systems. 

Over the past year, DAV and our IB partners have developed a comprehensive 

framework for VA health care reform based on the principle that it is the responsibility of the Federal Government to ensure that disabled veterans have proper access to the full array of benefits, services and supports promised to them by a grateful Nation. This view was clearly echoed in DAV’s national Pulse Survey released 

last November, in which the vast majority of veterans (87%) responded that the 

Federal Government should provide a health care system dedicated to the needs of 

ill, injured and wounded veterans. Such a system must provide high-quality, accessible, comprehensive, and veteran-centric health care designed to meet the unique 

circumstances and needs of those who served. In order to achieve that goal, DAV 

and our partners in the IB have developed a comprehensive framework for such reform that has four pillars: 

I. Restructure our Nation’s system for delivering health care to veterans, relying 

not just on a Federal VA and a separate private sector, but instead creating a local 

community networks that optimize the strengths of all health care resources to best 

meet veterans’ needs; 

II. Redesign the systems and procedures by which veterans access their health 

care with the goal of expanding actual, high-quality, timely options; rather than just 

giving them hollow choices; 

III. Realign the provision and allocation of VA’s resources so that they fully meet 

our national and sacred obligation to make whole those who have served; and 

IV. Reform VA’s culture to ensure that there is sufficient transparency and accountability to the veterans this system is intended to serve. 

The framework we have proposed is consistent with VA’s New Veterans Choice 

Plan sent to Congress. In addition to consolidating most non-VA community care 

programs, the new VA plan also seeks to create a network of both VA and community providers to provide veterans a seamless system in the future. In our framework, we proposed creating local Veterans-Centered Integrated Health Care Networks to seamlessly integrate community care into the VA system to provide a full 

continuum of care for veterans. VA would be the coordinator and principal provider 

of care, particularly its primary care model with integrated mental health care, 

which is more likely to prevent and treat conditions unique to or more prevalent 

among veterans, particularly those with disabilities or chronic conditions. 

VA has also proposed that an urgent care benefit for veterans be established. In 

our framework, we had proposed that VA increase its capacity to deliver urgent care 

at existing VA medical facilities and develop additional capacity by establishing urgent care clinics around the country to create new options in the treatment space 

between emergency care and primary care. 

Another critical component of our framework recommends moving away from arbitrary Federal access standards, such VA’s current 40-mile and 30-day standards. 

For too many veterans, particularly those with severe disabilities and chronic conditions, 40 miles may be too far to travel and 30 days far too long to wait for urgent 

conditions. Rather than a system that empowers bureaucrats, any future veterans 

health care system must ensure that access to care is a question for veterans and 

their doctors. Decisions about when and where veterans can receive medical treatment are clinical decisions that should be made between the veteran and his or her 

83 

doctor, not legislators, regulators or bureaucrats. We note that VA is already moving 

in this direction based on the guidance provided with their newest choice regulations. 

Overall, we are pleased that many of our recommendations have been incorporated into VA’s new plan; however, unless VA has the resources to implement 

these or better plans, real reform will not be possible. 

There were several critical findings in Independent Assessment worth noting. Initially, ‘‘. . . increases in both resources and the productivity of resources will be necessary to meet increases in demand for health care over the next five years . . .’’ with 

a core recommendation of ‘‘increasing physician hiring . . .’’ (Page B–3) They also 

identified the key barriers that limited provider productivity, including ‘‘a shortage 

of examination rooms and poor configuration of space’’ and ‘‘insufficient clinical and 

administrative support staff,’’ all of which would require additional funding for the 

VA health care system. Furthermore, the Independent Assessment found that the, 

‘‘. . . capital requirement for VHA to maintain facilities and meet projected growth 

needs over the next decade is two to three times higher than anticipated funding levels, and the gap between capital need and resources could continue to widen.’’ (Page K–1) and they estimated this gap at between $26 and $36 billion over the next decade. The findings of this Independent Assessment are fully consistent with what 

DAV and our IB partners have said for more than a decade: the resources provided 

to VA health care have been inadequate to meet the mission to care for veterans, 

which fueled access problems. 

To be clear, we do not believe that simply increasing funding by itself—without 

making some significant reforms to the VA—will lead to better health outcomes for 

veterans over the next 20 years. However, no VA reform plan has any chance of 

success unless sufficient resources are consistently provided to meet the true need 

and demand for services by veterans, when and where they need them. VA recently 

testified that by improving access to care, their New Choice Plan will increase both 

enrollment and utilization of the VA health care system, and would cost up to an 

additional $10 billion per year to meet the increased demand of current and new 

veterans. We believe additional funding will be essential for success as will some 

additional flexibility. 

As you will recall, last year VA reported a funding shortfall due to a significant 

increase for new medical treatment for hepatitis C patients and of veterans seeking 

care both inside VA and through community care programs. By last summer, it became clear that numerous facilities had spent so much money on contract and feebasis services from their Medical Services appropriation (outside the fenced Choice 

Fund) that they were running out of funds to operate facilities. However, even 

though there was sufficient money in the Choice Fund, VA had no ability to utilize 

those funds to provide necessary care to veterans. Ultimately, legislation was enacted to make a one-time transfer to meet VA’s shortfall. That same law also required VA to produce a plan to consolidate non-VA care programs, which was discussed above. To avoid the possibility of such a crisis occurring again, Congress 

must work with VA to ensure there is sufficient flexibility in law or regulation to 

allow such contingencies to be quickly resolved, while ensuring proper oversight and 

accountability to the clear purposes of every Congressional appropriation. 

In order to ensure VA has the capacity to meet veterans’ demand for health care 

services VA must also modernize its personnel practices by removing unnecessary 

and often counterproductive restrictions to its hiring process. Some of these restrictions are embedded in appropriations law; others, in civil service law or in title 38 

of the Code. In order to help VA to attract and keep quality employees needed by 

VA to implement the new plan, these restrictions must be lifted. With morale so 

low after two years of scandal and negative media coverage, it is vitally important 

that VA be given new tools to hire the best and brightest to care for our nations 

heroes. 

Mr. Chairman, DAV and our members urge serious reform of the VA health care 

system to address access problems while preserving the strengths of the VA system 

and its unique model of care. An overlooked finding from the Independent Assessment is its analysis of VA’s quality, which confirmed what we, other veterans organizations and most studies have been saying for years: when veterans get access to 

VA care, the quality is high. Specifically, the Independent Assessment found that: 

‘‘In new analyses comparing VHA’s quality with non-VA providers, VHA 

performed the same or significantly better on average than the non-VA provider organizations on 12 of 14 effectiveness measures (providing recommended care) in the inpatient setting, and worse on two measures. On 

average, VHA performed significantly better on 16 outpatient Healthcare 

Effectiveness Data and Information Set® (HEDIS) measures of effectiveness compared with commercial health maintenance organizations (HMOs); 

84 

on the 15 outpatient HEDIS measures of effectiveness that were available 

for Medicaid HMOs; and on 14 of 16 outpatient effectiveness measures compared with Medicare HMOs.’’ 

While VA outperforms the private sector on average—the IA notes that across the 

system the quality of care is quite variable, reflecting there is much work to be 

done. 

In conclusion, overall, we are pleased that many of our recommendations have 

been incorporated into VA’s new plan, although our framework goes farther, addressing such matters as infrastructure, planning and budgeting, all explained in 

greater depth in the IB Framework for Veterans Health Care Reform, previously 

presented to this Committee. We feel confident that if the VA plan is enacted, with 

our recommendations and improvements, veterans will have more options to receive 

timely, high-quality care closer to home in the future. 

Thank you for inviting DAV to submit this testimony. We would be pleased to further discuss any of the issues raised by this statement, to provide the Committee 

additional views, or to respond to specific questions from you or other Members. 

PREPARED STATEMENT OF PARALYZED VETERANS OF AMERICA

Chairman Isakson, Ranking Member Blumenthal, and Members of the Committee, Paralyzed Veterans of America (PVA) would like to thank you for the opportunity to submit our views on the Department of Veterans Affairs’ (VA) plans and 

efforts to modernize under the MyVA initiative. We appreciate the Committee focusing on this critical issue that will affect veterans and their families for years to 

come. 

The MyVA Integrated Plan established on July 30, 2015 is focused on restructuring VA to better serve the veteran population. After careful review, the plan 

demonstrates a well thought out process that if properly implemented would ultimately ease access to quality health care, reduce VA claims backlog, and make 

interactions between veterans and the VA more fluid. Unfortunately, the roll out of 

this plan appears to have fallen flat. Despite Secretary McDonald’s constant reiteration and discussion of the plan with congress, countless veterans have never heard 

of this initiative. 

As we continue to see the MyVA initiatives unfold, we cannot forget the circumstances surrounding the reasons why this plan was formulated. At the time this 

initiative was created, VA was under fire for the horrendous lack of care and the 

extended wait times seen at VA medical facilities across the Nation. Despite moving 

in the right direction, this initiative has a long way to go before the underlying concerns are fully resolved. 

Within the MyVA Integrated Plan, Secretary McDonald established a Veterans 

Experience Office (VEO). The focus is on supporting VA employees in the delivery 

of excellent health care and benefit experience. Although it appears to be geared toward ensuring that veterans and their dependents have the most pleasant interactions with the department, at its roots it is another potential level of bureaucracy 

that must be navigated to resolve issues. One example of this would be a veteran 

who may experience an issue at a medical facility. If the veteran was to bring the 

issue to the VEO, the VEO would not have the power to resolve the issue but instead would have to refer the veteran to the patient advocate office. Similarly, we 

have consistently heard from veterans that their patient advocates are ineffective, 

or they seek to protect the medical facility leadership instead of addressing their 

concerns. It is clear that patient advocates cannot effectively meet their obligations 

to veterans if their chain of command includes VA medical facility staff that is responsible for the actions and policies they are required to address. Nor can the VEO 

provide better experiences for our veterans without being empowered to resolve 

issues rather than just fielding complaints. 

PVA along with the co-authors of The Independent Budget—Disabled American 

Veterans and Veterans of Foreign Wars—have previously laid out a framework 

which includes strengthening the Veterans Experience Office by combining its capabilities with the patient advocate program. Veterans experience officers would advocate for the needs of individual veterans who encounter problems obtaining VA benefits and services. They would also be responsible for ensuring that the following 

rights and laws are fully complied with by all providers who participate in VeteransCentered Integrated Health Care Networks, both in the public and private sector: 

1. Health care protections afforded under Title 38 

2. The right to seek redress through clinical appeals 

3. Claims under 38 U.S.C. § 1151 

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1http://www.va.gov/JOBS/VA_In_Depth/mission.asp 2http://www.va.gov/opa/MyVA/docs/MyVA_integrated_plan_overview.pdf 3http://www.agingstats.gov/main_site/data/2012_documents/population.aspx 

4. The Federal Tort Claims Act 

5. The right to free representation by accredited veteran service organizations. 

Finally, any plan to reform the culture of VA must also take into consideration 

the need to modernize VA’s workforce and ensure VA employees serve the interest 

of the veterans’ community. While Congress has focused on firing underperforming 

employees, PVA believes that the situation is more complicated and demands a holistic approach to workforce development that allows VA to recruit, train, and retain 

quality professionals capable of caring for our veterans, while simultaneously ensuring that VA has the authority to properly discipline employees when appropriate. 

PVA applauds the MyVA taskforce for acknowledging that employee experience is 

also vital to its transformation efforts. The taskforce has developed a number of programs and initiatives to engage and empower VA employees. However, Federal hiring still reflects a mismatch between the skills desired and the compensation provided for many of the professionals VA recruits. If Congress is focused on bolstering 

VA’s ability to fire poor-performing employees, Congress must also give VA the leverage to hire employees quickly and offer compensation commensurate with their 

skill level. 

By focusing solely on disciplinary proceedings and failing to properly cultivate a 

motivated and compassionate workforce, we make VA an unattractive employer to 

potential recruits. PVA believes that we must build a framework that makes VA an 

attractive employment option for the best and brightest who want to care for our 

veterans. 

Although it is understandable that all of the issues with the VA cannot be resolved over night, it is essential that this plan be implemented with more vigor and 

transparency. Currently the MyVA plan is not set to fully evolve until well into the 

2017 fiscal year. While it is great to see VA moving forward and becoming more efficient, this plan must move faster and with more tenacity. The Nation’s veterans 

cannot wait two or more years for access to the health care benefits they so desperately need and deserve. Once again, we appreciate the opportunity to discuss 

PVA’s views on the MyVA initiative. We would be happy to take any questions for 

the record you may have. 

PREPARED STATEMENT OF THE AMERICAN LEGION

The Department of Veterans Affairs (VA) states ‘‘Communication’’ is one of their 

Core Values, and to define it they state: 

‘‘We will listen to our veterans, to each other, and to people outside of our 

organization. We will be candid, accurate, and quick to heed their counsel 

and respond to their concerns. We will never stop trying to improve.’’ 1

The American Legion strongly believes listening to the voice of veterans is one 

of the most critical components of a successful VA. Unfortunately, ‘‘MyVA,’’ VA’s 

plan to transform their way of doing business to ‘‘one that puts Veterans in control 

of how, when, and where they wish to be served’’ 2 missed the mark right out of 

the gate, raising concerns about its ability to make VA the responsive entity it 

needs to be to meet the needs of veterans. 

Chairman Isakson, Ranking Member Blumenthal, and distinguished Members of 

the Committee, on behalf of National Commander Dale Barnett and the over 2 million members of The American Legion, the Nation’s largest wartime veterans’ service organization, thank you for taking the time to focus attention on VA’s modern 

transformation strategy, and for soliciting insight from the key stakeholders, the 

veterans, as to whether this plan can be successful. 

‘‘MyVA’’ is what VA calls their transformation plan to modernize and provide 

seamless service across the country. The plan is well intentioned, and recognizes 

and addresses real concerns. Veteran use of VA has been steadily increasing over 

not only the past decade of active war overseas, but over several decades as the 

Vietnam cohort of veterans ages and sees increasing health care needs. ‘‘[This] large 

increase in the oldest segment of the veteran population will continue to have significant ramifications on the demand for health care services, particularly in the 

area of long-term care.’’ 3

Before the onset of the MyVA plan, none of VA’s regional authorities lined up with 

each other. Regional Offices (VAROs) that deal with benefits were not aligned in 

any real way with Veterans Integrated Service Networks (VISNs) that deal with 

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4http://valegion.org/wp-content/uploads/2015/03/Cmdr-Helm-to-Sec-McDonald-RE-MyVA03302015120719.pdf 

healthcare delivery. This impacts communication and consistency. That VA recognized this obstacle and sought to change things deserves recognition. 

Unfortunately, one of the earliest acts in the MyVA plan was the creation of a 

MyVA Advisory Committee that minimized the input from Veterans Service Organizations (VSOs) by limiting their access to the creation process for long term strategies. While corporations and academic institutions were robustly represented on the 

Advisory Committee, VSOs were relegated to a single seat to be shared in rotation. 

As the National Commander of The American Legion Michael Helm pointed out 

in his March, 2015 letter to Secretary Bob McDonald: 

‘‘[The American Legion feels] that the lack of representation by those with 

the most expertise, the major Veterans Service Organizations, dooms any 

chance that the MyVA Advisory Committee (MVAC) has for success . . . While The American Legion welcomes the input and experience of 

leaders in the academic and business communities, it is the veterans that 

are the biggest stakeholders in VA . . . As accomplished and impressive as 

the current committee members are, nobody can match the collective wisdom and expertise of The American Legion and other VSOs when it comes 

to relating to veterans.’’ 4

It is still too early to tell what, if any success in meeting the needs of veterans 

the MyVA plan is delivering. Anecdotally, discussing VA with thousands of veterans 

in communities across the country, The American Legion has found little difference 

in delivery of service now from when MyVA was initiated. To be fair, this is still 

early in the implementation and change does not occur overnight. 

It is possible that MyVA may in fact change VA and provide a better experience 

for veterans. It is also possible that it will only add another layer to an already 

bloated bureaucracy. In this, only time will tell. What is clear is that the voice of 

those who matter, the veterans themselves, has been somewhat softened by diminished input in crafting their own VA for their own future, and that’s not what America needs to build the best system to serve veterans. 

The American Legion staunchly believes in a strong and robust VA to serve the 

needs of veterans nationwide, in delivery of healthcare, benefits and a wide range 

of services. The American Legion is deeply committed to working with all stakeholders to ensure that a robust VA is built, maintained and operated with the needs 

of veterans first and foremost in its goals. To build that system, the voice of veterans must be robust. The voice of the principal consumers of the system must be 

the most important voice in planning the road ahead. 

The American Legion thanks this Committee for their diligence and commitment 

to examining VA’s roadmap to the future. 

PREPARED STATEMENT OF CARLOS FUENTES, SENIOR LEGISLATIVE ASSOCIATE, NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED

STATES

Chairman Isakson, Ranking Member Blumenthal and Members of the Committee, 

On behalf of the men and women of the Veterans of Foreign Wars of the United 

States (VFW) and our Auxiliaries, I would like to thank you for the opportunity to 

testify on VA’s efforts and plan to modernize. 

Soon after being confirmed as Secretary of Veterans Affairs, Robert A. McDonald 

began his ambitious mission to transform the Department of Veterans Affairs (VA) 

into an exemplary Federal agency. The VFW is glad to see that Secretary McDonald 

has been inclusive of the major veterans service organizations (VSOs) from the very 

beginning. In an effort to shape his transformation plan, known as MyVA, Secretary 

McDonald turned to the VFW and our VSO colleagues to help him improve the veteran experience and identify barriers that adversely impact VA’s ability to serve 

veterans. 

As a direct result, many of the programs and incentives being championed by the 

MyVA Task Force reflect issues the VFW has highlighted for many years, including 

unsatisfactory customer service at VA facilities across the country and a disconnect 

between different administrations and programs, which leads to bureaucratic processes that place unnecessary burdens on veterans. The MyVA Task Force has established and begun to implement numerous programs geared toward veteran experience, employee experience, support service excellence, performance improvement, 

87 

and strategic partnerships. Due to our mission as veteran advocates, our testimony 

will mainly focus on the veteran experience pillar of the MyVA transformation plan. 

The VFW has consistently said that veterans do not see VA as three independent 

administrations. One of the many benefits of having the overwhelming majority of 

veterans’ benefits and services administered by one agency is the seamless experience it is able to provide veterans who access multiple benefits and services. For 

example, when a veteran applies for disability compensation through the Veterans 

Benefits Administration (VBA), VA has the ability to access the veteran’s Veterans 

Health Administration (VHA) health care records and, even though the compensation and pension examination process has significant issues that need to be addressed, VBA is able to schedule a veteran’s compensation and pension examination 

at a VHA health care facility without requiring the veteran to transfer the medical 

documentation from VHA to VBA or request a VBA appointment through VHA. 

However, there are a number of areas where the interaction between program offices can be improved. The VFW is glad that the MyVA Task Force has established 

the Veterans Experience Office to identify and address areas where veteran experiences and interaction with VA can be improved. 

The Veterans Experience Office is independent of the three VA administrations, 

with a presence at VA central office and throughout VA’s five districts. The Chief 

Veterans Experience Officer reports directly to the Secretary and coordinates an enterprise customer experience strategy, develops employee customer service training, 

and advises the three VA administrations. The field teams are tasked with building 

relationships, identifying systemic issues, and supporting national initiatives. While 

the VFW fully supports the Veterans Experience Office’s current mission, we believe 

that the office could be strengthened by integrating the Patient Advocacy Service 

into its mission. 

The Veterans Experience Office’s mission already includes navigation and advocacy. Through a planned cadre of 34 employees, the Veterans Experience Office intends to ensure veterans’ concerns regarding the benefits and services they receive 

are properly addressed. While the VFW believes this is a step in the right direction, 

we would ideally like to see the entire Patient Advocacy Service reorganized under 

the Veteran Experience Office of Navigation and Advocacy. Local patient advocates 

would remain embedded at VA medical centers (VAMC) on a day-to day basis, but 

fall under the Veterans Experience Office’s chain of command, rather than that of 

their detailed VA facility. 

In speaking to VFW members from around the country, we find that patient advocates often assume the role of apologizing for VA medical center shortcomings rather than aggressively working to fix them. We strongly suspect that this is a function 

of the fact that they are ultimately employees of medical center directors, and are, 

therefore, hesitant to expose shortcomings in the administration of their facilities. 

Making the Patient Advocacy Service completely independent of the VAMC chain 

of command would mitigate this problem. We envision the Veterans Experience Office using the Patient Advocacy Service as their eyes and ears to provide the Secretary with a better understanding of the veteran experience on the ground, and address acute and systemic problems as they arise. 

Ideally, the Veterans’ Experience Office would then be able to aggregate patient 

advocacy casework and generate periodic public reports on the challenges veterans 

face from their perspectives. These reports could also be used to generate legislative 

requests to alleviate the problems veterans experience in timeliness of appointments, securing referrals for community care, access to benefits, and overall satisfaction. Conveniently, all the employees needed to execute this model are already 

in place at VA medical facilities around the country. Reorganizing them under an 

office that reports directly to the Secretary would maximize their usefulness to veterans, Congress and VA. 

Another program geared toward improving the veteran experience is the Veteran 

Economic Communities Initiatives (VECI). Established to ‘‘increase the number of 

education and employment opportunities available to Veterans and their families in 

their communities,’’ VECI relies on economic liaisons around the country to 

incentivize employers to hire veterans and connect veterans to organizations and 

programs that help them overcome education and career challenges. Although the 

VFW strongly supports efforts to ease the transition from military service to the civilian workforce, we feel that many efforts by the VECI are duplicative of programs 

and services administered by the Department of Labor (DOL) Veterans’ Employment and Training Service (VETS). In recent years, VETS has made significant 

progress toward reducing veteran unemployment across key demographics. While 

there is still work to be done, VETS programs are embedded in with Department 

of Defense (DOD) through the transition assistance program and integrated in communities across the country through its presence at American Job Centers and its 

88 

Jobs for Veterans State Grants program. One of the key advantages to VETS is that 

they are able to provide services to vulnerable veteran populations who may not be 

eligible for VA services, such as homeless veterans with other than honorable discharges. The VFW feels that a parallel employment service administered by VA is 

unnecessary and runs the risk of creating confusion for transitioning servicemembers. Instead, we encourage VA and DOL to adopt better coordination and referral for the services each agency provides. 

Still, the VECI initiative contains certain programs that are beneficial to transitioning servicemembers and should be continued. The VECI Accelerated Learning 

Programs (ALP) and VA Learning Hubs allow veterans to receive free certifications 

in high demand fields through public-private partnerships, without tapping into 

their VA educational benefits. The VFW supports these programs and believes they 

should be expanded, perhaps under the VA Office of Economic Opportunity. With 

full coordination between VA and DOL VETS, ALPs and Learning Hubs could be 

integrated into DOL VETS programs and services to ensure veterans are maximizing the employment and education benefits they have earned and deserve. 

An important measure of success for the MyVA Task Force will be its ability to 

incorporate local stakeholders into the transformation plan. The MyVA Task Force 

seeks to accomplish this goal through the creation of MyVA communities around the 

country. Each MyVA community will include local representatives from the three 

VA administrations; VSOs; local, state and Federal Government; Department of Defense and National Guard; and other organizations that represent the local community’s interests and priorities. The VFW has been an active participant in many of 

the MyVA communities around the country. In San Diego, our service officers report 

that the One VA Community Advocacy Board, which was the inspiration for the 

MyVA Communities Initiative, has served as a platform for veteran-centric organizations to share ideas and concerns at a leadership level sufficient to make true 

progress. 

The VFW supports the MyVA Communities Initiative and recommends that they 

be expanded to every VA medical center and regional office. Doing so allows VA to 

leverage the expertise and experience of local stakeholders to improve the benefits 

and service it provides veterans. 

Another vital pillar of the MyVA transformation is improving employee experience. The VFW agrees with VA that veteran experience is largely dependent on employee experience. We have constantly heard from veterans that VA employees lack 

customer services training and often turn veterans away when they should look for 

opportunities to help. We agree with Secretary McDonald that VA’s rules-based culture must be transformed into a people-based culture that empowers VA employees 

to treat veterans as they would want to be treated. 

The MyVA Task Force has established a number of programs geared toward 

changing culture at VA. The first is a ‘‘training the trainer’’ program called Leaders 

Developing Leaders. This program aims to ensure VA leaders at all levels are incorporated into the transformation effort and have the proper training and tools to improve the esprit de corps among VA employees. This includes providing local leaders 

the tools they need to improve VA benefits and service for the veterans they serve 

and empowering them to use those tools when needed. The VFW supports the Leaders Developing Leaders program and believes it has the potential of breaking 

through the institutional resistance of middle management officials who are only 

concerned with their day-to-day duties and disseminate the MyVA culture change 

to all VA employees. However, we have urged VA to incorporate outside stakeholders into the program’s workshops to ensure VA leaders at all levels are aware 

of the benefits and services offered by veteran service organizations and other stakeholders whose main mission is to serve veterans. 

The VFW also supports requiring all VA employees to receive VA 101 training, 

which gives them an overview of the full array of benefits services VA provides veterans. While such training helps VA employees understand the important part they 

play in the VA system, it also enables VA employees to inform veterans of the benefits and services they may not have known they were eligible to receive. 

The MyVA Task Force has also established programs to improve VA’s supports 

services, establish a culture of continuous improvement, and enhance strategic partnerships. The VFW supports VA’s efforts to leverage economies of scale to reduce 

its supply chain costs by ensuring all VA facilities are able to quickly obtain highlevel goods and services at reasonable prices. We commend VA for its plan to leverage the district model to consolidate and integrate support services, such as information technology, human resources, and procurement to ensure seamless operation 

and coordination among the three administrations. We also support VA’s adoption 

of lean six sigma to improve problem solving at all levels throughout VA, and create 

89 

a culture where VA employees seek to constantly streamline programs and processes to maximize their performance. 

The VFW also supports VA’s efforts to integrate outside stakeholders into its programs and services. Through its strategic partnerships, VA is able to ensure veterans who are using services through private or non-profit organizations are made 

aware of the full suite of veterans’ benefits and services available to them. Through 

such partnerships VA is also able to ensure outside organizations who assist veterans receive the training they need to provide veteran-centric services. 

The VFW understands that VA will not be able to change its culture overnight 

and that the numerous MyVA transformation programs must be given time to mature. However, we are pleased to see that the MyVA Task Force has begun to implement many of its proposed programs and has set appropriate milestones and reasonable expectations to ensure these programs succeed. The VFW will continue to 

evaluate the MyVA programs and report on what is working and what needs to 

improve. 

The VFW is concerned, however, that the impending change at the White House 

may stall the MyVA Task Force’s hard work. While the Task Force has made a concerted effort to build momentum that cannot be stopped, a new president may 

refocus the Task Force’s mission and erode the successful programs it has established. That is why the VFW has urged the Presidential candidates to ensure they 

continue Secretary McDonald’s MyVA transformation plan if they are elected. 

We urge this Committee to use its legislative authority to ensure transformation 

programs and plans established by Secretary McDonald and the MyVA Task Force 

receive the resources and support needed to succeed. 

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