U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001

28-559 PDF 2007

S. HRG. 109–598

VA RESEARCH: INVESTING TODAY TO GUIDE

TOMORROW’S TREATMENT

HEARING

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE

ONE HUNDRED NINTH CONGRESS

SECOND SESSION

APRIL 27, 2006

Printed for the use of the Committee on Veterans’ Affairs

(

Available via the World Wide Web: http://www.access.gpo.gov/congress/senate 

(II)

COMMITTEE ON VETERANS’ AFFAIRS 

LARRY CRAIG, Idaho, Chairman 

ARLEN SPECTER, Pennsylvania 

KAY BAILEY HUTCHISON, Texas 

LINDSEY O. GRAHAM, South Carolina 

RICHARD BURR, North Carolina 

JOHN ENSIGN, Nevada 

JOHN THUNE, South Dakota 

JOHNNY ISAKSON, Georgia 

DANIEL K. AKAKA, Hawaii, Ranking Member, 

JOHN D. ROCKEFELLER IV, West Virginia 

JAMES M. JEFFORDS, (I) Vermont 

PATTY MURRAY, Washington 

BARACK OBAMA, Illinois 

KEN SALAZAR, Colorado 

LUPE WISSEL, Majority Staff Director 

D. NOELANI KALIPI, Minority Staff Director 

(III)

C O N T E N T S 

APRIL 27, 2006

SENATORS 

Page 

Craig, Hon. Larry E., Chairman, U.S. Senator from Idaho ................................. 1

Akaka, Hon. Daniel K., Ranking Member, U.S. Senator from Hawaii ............... 3

Thune, Hon. John, U.S. Senator from South Dakota ........................................... 4

Burr, Hon. Richard, U.S. Senator from North Carolina ....................................... 4

Salazar, Hon. Ken, U.S. Senator from Colorado ................................................... 5

Jeffords, Hon. James M., U.S. Senator from Vermont ......................................... 6

WITNESSES 

Perlin, Jonathan B., M.D., Ph.D., Under Secretary for Health, Department 

of Veterans Affairs; accompanied by Richard F. Weir, Ph.D., Research Scientist, Prosthetics Research Laboratory, Jesse Brown VA Medical Center, 

Chicago, Illinois, Department of Veterans Affairs, and Joel Kupersmith, 

M.D., Chief Research and Development Officer (CRADO), Department of 

Veterans Affairs ................................................................................................... 6

Prepared statement .......................................................................................... 8

Wright, Fred S., M.D., Associate Chief of Staff for Research, VA Connecticut 

Healthcare System, Department of Veterans Affairs ........................................ 24

Prepared statement .......................................................................................... 25

Stevens, Dennis L., M.D., Ph.D., Associate Chief of Staff for Research, Veterans Affairs Medical Center, Boise, Idaho, Department of Veterans Affairs 26

Prepared statement .......................................................................................... 28

Feussner, John R., M.D., M.P.H., Professor and Chairman, Department of 

Medicine, Birmingham, Alabama; Medical University of South Carolina, 

Charleston, South Carolina ................................................................................. 28

Prepared statement .......................................................................................... 30

Responses to written questions submitted by Hon. Larry E. Craig ............. 33

Kennedy, John I., Jr., M.D., Professor, Department of Medicine, University 

of Alabama at Birmingham, Birmingham VA Medical Center, Birmingham, 

Alabama; on behalf of The Alliance for Academic Internal Medicine .............. 34

Prepared statement .......................................................................................... 36

APPENDIX 

Letter to Hon. Kay Bailey Hutchison and Hon. Dianne Feinstein from the 

Department of Veterans Affairs Medical and Research Prosthetics Research 

Program ................................................................................................................ 45

Friends of VA Medical Care and Health Research, prepared statement ............ 46

(1)

VA RESEARCH: INVESTING TODAY TO GUIDE 

TOMORROW’S TREATMENT 

THURSDAY, APRIL 27, 2006

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

The Committee met, pursuant to notice, at 10 a.m., in room SR–

418, Russell Senate Office Building, Hon. Larry E. Craig, Chairman of the Committee, presiding. 

Present: Senators Craig, Burr, Thune, Isakson, Akaka, Jeffords, 

Obama, and Salazar. 

OPENING STATEMENT OF HON. LARRY E. CRAIG, CHAIRMAN, 

U.S. SENATOR FROM IDAHO 

Chairman CRAIG. Good morning, ladies and gentlemen. The Committee on Veterans’ Affairs will now be in order. 

We have entitled this hearing today ‘‘VA Research: Investing 

Today to Guide Tomorrow’s Treatment.’’ Today’s hearing will focus 

on an aspect of the VA Health Administration that often goes without the full measure of recognition that, I believe and I think most 

who know about it believe it, is due. The Medical and Prosthetic 

Research Program, VA’s research program, encompasses bench 

science, clinical research, health service research, and rehabilitation research. Today these research activities have vastly contributed to the scientific knowledge base, led to the development of 

new technologies and improved the delivery of health services at 

VA medical facilities across the country. 

VA research has played a major role in a number of historic 

breakthroughs: the first successful liver transplant, the development of the first cardiac pacemaker, and the technology that led to 

the development of the CT scan, just to name a few. Impressively, 

VA has accomplished all of this on a limited budget. Each year, direct appropriations for VA R&D are leveraged with the NIH grant 

funding and resources from VA-affiliated nonprofits. Due in part to 

this maximization of research funds, the roughly $400 million of 

annual appropriations for VA research brings about improvements 

from a $34 billion health system. 

As you know, this year’s budget proposed a $13 million reduction 

in VA research funding. With servicemembers returning from Iraq 

and Afghanistan with traumatic injuries and in need of innovative 

medical care, now is not a time to cut research funding. I would 

like to thank the Members of our Committee for joining both with 

me and Senator Akaka, I believe some additional Members joined, 

in writing a letter to the appropriators urging them to overturn 

2

this reduction. We proposed that VA research be funded at $432 

million, a modest increase over last year’s budget, to keep pace 

with inflation and ensure that critical initiatives involving traumatic brain injury, spinal cord injury and prostheses are able to 

move forward. 

Beyond addressing this year’s budget, we must look ahead to the 

future of VA research. Many of the research facilities are in great 

need of repair and modernization. Researchers carry out their dayto-day activities while under serious space constraints and in outdated buildings, many of which are approaching a 100-year-old 

mark. For example, in one site that is not fully equipped with modern air conditioning and ventilation systems, researchers opt to 

work at night so that extreme temperatures will not interfere with 

their results. There are limits to how long we can rely on early 

20th century research facilities to yield cutting-edge 21st century 

research discoveries. 

However, there are also limits to the amount of funds the Congress can provide. As part of our focus on the infrastructure needs, 

it is important that we look for innovative ways for VA to enhance 

its existing relationships with universities. I am especially interested in exploring VA-university collaboration in the form of jointly 

operating research space. Modern facilities are not just about attractive work space for academics. 

One of the myriad ways that research benefits the VA health 

care system is through recruitment of physician researchers. We 

will hear from our witnesses here today about how the shortage of 

modern research is hindering recruitment of new physicians. 

I want to be clear that this hearing is not about pointing out our 

shortcomings or our failures. It is about assessing our challenges 

for the future. In fact, I commend VA for its remarkable record of 

research accomplishments in spite of some serious obstacles. This 

exciting work will be highlighted during VA Research Week which 

will be held the second week of May. As one of the outcomes of this 

hearing, I hope that Members of this Committee will make a point 

of touring the research bases when making visits to their local VA 

facilities. 

We are joined today with VA Under Secretary of Health, Dr. Jonathan Perlin, who happens to be an academically trained researcher. He is accompanied by Dr. Joel Kupersmith, VA’s Chief 

Research and Development Officer, and Richard Weir, who is a researcher at VA’s Prosthetic Research Laboratory in Chicago. 

Following their testimony, we will hear from four distinguished 

witnesses who are involved in VA research throughout the country. 

Dr. Fred Wright comes to us from the West Haven, Connecticut 

VA, and Dr. Dennis Stevens is from the Boise, Idaho VA. We will 

also hear from Dr. Feussner, who is a former head of VA Research 

and currently chairs the Department of Medicine at the Medical 

University in South Carolina, and Dr. John Kennedy, from the 

University of Alabama, in Birmingham’s School of Medicine, who 

will testify on behalf of the Alliance for Academic Internal Medicine. So we have some very distinguished and talented people before us.

3

Before we go further, let me turn to my colleague and Ranking 

Member, Senator Akaka, for any opening comments he may have. 

Danny. 

STATEMENT OF HON. DANIEL K. AKAKA, RANKING MEMBER, 

U.S. SENATOR FROM HAWAII 

Senator AKAKA. Mr. Chairman, thank you so much. As always, 

Mr. Chairman, I appreciate the work of Chairman Craig in crystallizing the most pressing issues before the Committee, and as always, I enjoy working with him and with the Committee as well. 

Today we will assess the tremendous value of VA’s research program, and I want to associate myself with the comments that were 

made by the Chairman. I welcome our witnesses to the hearing, including Dr. Perlin, good to see you again, and to the other witnesses that were already introduced by the Chairman. 

I thank you all for being here today. We are all without question 

immensely proud of VA research. The traditional research model, 

which stems from the peer-review process, has yielded an impressive list of accomplishments for the VA. VA’s research strengths 

have spanned large clinical trials and more narrow looks into the 

fundamental parts of biology, what some call bench research. However, the value of VA’s research enterprises do not lie solely in its 

results. The VA Medical Research has been instrumental in allowing recruitment and retention of physicians in the VA Health Care 

System. Adequately funding VA research helps to ensure that VA 

remains an attractive option to our best and brightest in medicine. 

VA cannot compete with the nongovernmental health care sector 

to attract highly paid physicians. But if VA can continue to attract 

some of our Nation’s best doctors, veterans will receive the care 

they deserve, and I give some of this credit to Dr. Perlin and what 

you are doing here. Some of VA’s researchers’ greatest achievements have not been in the arena of new treatments for war 

wounds or for service-connected disabilities per se, but for illnesses 

affecting the populace. It is my view that young or old, combat veteran or peacekeeper, all of our Nation’s veterans can and should 

be the recipients of a vibrant VA research program. 

Funding for the research program is obviously quite critical as 

well. I am extremely grateful that we all came together and agreed 

on the importance of fully funding VA research. The $399 million 

proposed by the VA and the Administration is simply not sufficient. 

I am confident that we will more appropriately fund the research 

program and that we will protect peer review research. 

With that, Mr. Chairman, I look forward to this hearing. Thank 

you very much for having it. Thank you very much. 

Chairman CRAIG. Senator Akaka, thank you very much. Before 

I turn to the rest of our colleagues on the Committee for any opening statements, we do have a markup, that is when we get a 

quorum of eight here. 

We now have that magic number in front of us. 

[Whereupon, at 10:10 a.m., the Committee proceeded to a markup nominations hearing.] 

[Whereupon, at 10:12 a.m., the Committee reconvened.] 

4

Chairman CRAIG. Now let me move on to anyone who would wish 

to make a comment before we move to our panelists. Senator 

Isakson, you are here next in order. 

Senator ISAKSON. I will yield to Senator Thune. 

Chairman CRAIG. And that is the appropriate yield, because that 

is the order involved. 

John. 

STATEMENT OF HON. JOHN THUNE, U.S. SENATOR FROM 

SOUTH DAKOTA 

Senator THUNE. Thank you, Mr. Chairman. I want to thank you 

for holding this important hearing to examine the VA’s Medical 

and Prosthetic Research Program. I also would like to extend a 

warm welcome to our panelists today. I am pleased to see Dr. 

Perlin again testifying before the Committee. 

The VA’s researchers have the noble task of finding ways to more 

effectively address the unique medical problems that our veterans 

tend to suffer due to their service to our country. I applaud the efforts of the researchers testifying today who have dedicated their 

lives to improving the health conditions of our veterans. You and 

the 3,000 VA researchers across the country who work every day 

on behalf of our veterans are truly great Americans, and I would 

like to thank you all for your service to our country. 

Mr. Chairman, I was pleased to join with you and with Ranking 

Member Akaka, as well as with many other Members of the Senate, to send a letter to the Appropriations Committee this year expressing support for increased funding for the VA’s medical research programs. While the Administration’s fiscal year 2007 proposal for VA funding overall was quite generous, medical research 

funding required some improvement. I am glad to see that we are 

working in a bipartisan way to provide that improvement by increasing funding for medical research by $20 million over last 

year’s level. 

As we continue with the process of developing the VA’s budget 

for fiscal year 2007, I am confident that we will continue as well 

to find ways to improve funding for the VA while not spending beyond our means. So, Mr. Chairman, I applaud your efforts to increase funding for VA medical research. I appreciate the opportunity to join you in that effort, and again want to thank you for 

holding this hearing, and thank our panelists for sharing their testimony. Thank you, Mr. Chairman. 

Chairman CRAIG. Senator Thune, thank you very much. Senator 

Burr, do you have any opening comments you wish to add? 

STATEMENT OF HON. RICHARD BURR, U.S. SENATOR

FROM NORTH CAROLINA 

Senator BURR. I can ditto to what Senator Thune said, thank you 

to you and the Ranking Member. More importantly, I cannot think 

of a more important hearing for this Committee to have at this 

what I think is a very pivotal time where the signal that we send 

about the investment that we make and the tools that the VA has 

should be very clear. I think this is a statement, and I thank the 

Chair. 

Chairman CRAIG. Senator Burr, thank you. Senator Salazar. 

5

STATEMENT OF HON. KEN SALAZAR, U.S. SENATOR

FROM COLORADO 

Senator SALAZAR. Thank you very much, Chairman Craig and 

Senator Akaka, for your leadership on this Committee and on veterans’ issues, and thank you, Dr. Perlin, as well for your leadership 

of the VA. 

We all know how important the Veterans’ Health Administration 

is to all of our veterans in our country, but something that I think 

we often overlook is how important VHA is to our Nation’s health 

care system as a whole. Our veterans’ health care system is often 

on the cutting edge of critical advances in prevention, diagnosis 

and treatment, and VA’s medical research programs are a driving 

force behind its ability to serve this important capacity for our veterans and for our Nation. Because the core mission of the VHA is 

to address the prevention and treatment needs of our Nation’s veterans, the services it provides and the research it conducts are patient-oriented. Six out of every ten VA researchers treat veterans. 

As a result, VA researchers do not operate in a vacuum. They deal 

with the very real and very serious health problems resulting from 

combat and from the sacrifices of our men and women in uniform. 

For the 5 million veterans enrolled in the VA health care system, 

they also have unique access to a clinical setting in which to put 

the results of their research into practice every day. For these reasons, VA medial research has been responsible for significant 

breakthroughs in the fields of prosthetics, diabetes, spinal cord injury, substance abuse, mental illness, heart disease, and cancer, all 

of which are prevalent among America’s veteran population. 

I understand today’s hearing will focus on some of the infrastructure challenges that VA’s medical research programs currently 

face. Challenges ranging from extremely old facilities, to poor heating and ventilation, to outdated equipment. There is no question 

we need to work to address these needs if VA’s research programs 

are to continue to be a leader in health care innovations, and I look 

forward to the testimony of today’s panelists. However, we must be 

careful not to overlook the need to provide adequate resources to 

the many important research initiatives that are currently underway in VA facilities across the Nation. 

Despite the progress that research programs across the country 

have made, this year’s budget request proposed cutting funding for 

research by $13 million. If anything, we should be increasing funding for these important programs so that the VA can continue to 

be a leader in innovation. I am proud to have joined my colleagues 

including Senator Craig and Senator Akaka in urging $432 million 

in funding for VA medical research. 

Thank you again, Chairman Craig and Senator Akaka, for holding today’s hearing, and I look forward to hearing from the witnesses. 

Chairman CRAIG. Thank you very much, Senator Salazar. 

Senator Jeffords.

6

STATEMENT OF HON. JAMES M. JEFFORDS, U.S. SENATOR

FROM VERMONT 

Senator JEFFORDS. Mr. Chairman, thank you for holding this 

hearing on the VA research funding. I think we all agree that the 

cutting-edge research being conducted by the VA is one of the most 

important functions of the Veterans Administration. The VA is responsible for significant advances in medical treatment, specialty 

care, prosthetics, and development in outcomes research. The VA’s 

research activities are one of the big attractions for top-quality doctors who want to explore advancements in medicine as they treat 

patients. I am concerned by the proposal in the President’s budget 

to cut $13 million from the VA research budget. I joined many of 

my colleagues here in signing a letter to the Appropriations Committee urging the VA Subcommittee to increase the funding for VA 

research by $33 million. I look forward to hearing from you, Dr. 

Perlin, on this important topic. 

Chairman CRAIG. Jim, thank you very much. Now we turn to our 

panel. I have introduced them, but Dr. Perlin, once again let me 

introduce you, the Under Secretary for Health, United States Veterans Administration. So we welcome you and those who you have 

brought with you not only to tell us what you are doing, but to 

show us some of what you are doing. Welcome before the Committee. 

STATEMENT OF JONATHAN B. PERLIN, M.D., PH.D., UNDER 

SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS

AFFAIRS; ACCOMPANIED BY RICHARD F. WEIR, PH.D.,

RESEARCH SCIENTIST, PROSTHETICS RESEARCH LABORATORY, JESSE BROWN VA MEDICAL CENTER, CHICAGO,

ILLINOIS, DEPARTMENT OF VETERANS AFFAIRS, AND JOEL 

KUPERSMITH, M.D., CHIEF RESEARCH AND DEVELOPMENT 

OFFICER (CRADO), DEPARTMENT OF VETERANS AFFAIRS 

Dr. PERLIN. Thank you very much, Chairman Craig, Ranking 

Member Akaka, Members of the Committee, good morning. It is a 

delight to be here with you, and we thank you for your support of 

VA research and the recognition that VA research is indeed a 

crown jewel among the Veterans Health Administration’s resources 

to serve our Nation’s heroes. I am pleased to have the opportunity 

to discuss our Medical and Prosthetics Research Program with you 

today. 

As mentioned, Dr. Joel Kupersmith is the Chief Research and 

Development Officer, and I am also honored to be joined by Dr. 

Richard Weir, a research scientist from the VA Chicago Health 

Care System who, indeed, will demonstrate a cutting-edge prosthetic device. 

Mr. Chairman, our research program has a proud history of accomplishments that have resulted in marked improvements in the 

health not only of veterans, but of all Americans. VA researchers 

developed the first effective therapies for tuberculosis, the 

implantable cardiac pacemaker, the Seattle Foot, and other prosthetic devices. Researchers made incredible contributions to such 

things as the development of the CT scan and the MRI, and just 

last year we announced the results of a clinical trial finding that 

will make a new shingles prevention vaccine the standard of care. 

7

Today, VA researchers are developing artificial retinas, biohybrid 

limbs and other futuristic prosthetic devices, including those designed for high-performance athletes who ski, play basketball, and 

other competitive sports. 

We are also evaluating and improving the care that VA now provides to veterans suffering from multiple injuries, or polytrauma, 

and those who use prosthetic devices. This year we are beginning 

a series of research projects on traumatic brain injury and spinal 

cord injuries. These projects will directly benefit veterans from Operations Enduring Freedom and Iraqi Freedom, as well as all veterans of other eras. 

Last week, Mr. Chairman, we established new collaboration with 

the University of Texas Southwestern Medical Center to launch a 

Center of Excellence for the research of Gulf War illnesses. This 

collaboration will help expand our research programs to help Gulf 

War veterans who continue to suffer from unexplained illnesses. 

We are collaborating with the Department of Defense and the 

National Institute of Mental Health to look at the incidence of 

PTSD among veterans of the Global War on Terror, and we will 

also be looking at our ability to improve treatment of burn injuries, 

long-term care issues involved with recovery from traumatic brain 

injury as well. 

Improving our ability to treat veterans is at the very core of VA 

research. VA clinicians who treat veterans are also the researchers 

who investigate the questions that they form at the bedside. No 

other health system can match VA’s strong connection between 

clinical care and research, especially coupled with our exceptional 

electronic health record. 

Our unique position also enhances our ability to provide longterm care and to use genomic medicines as a means to move from 

preventive medicine to predictive medicine. In fact, we recently established a Genomic Medicine Advisory Committee composed of renowned scientists who will advise us on policy and process, and 

their first meeting will be later this year. 

For us to continue to build on the successes of both the past and 

the present, there are four things that we need to do. First, we 

need to continue our support to recruitment, retention, and training programs for clinical investigators; Career development awards 

bring tomorrow’s stars to the care of today’s veterans. In particular, 

we must continue to nurture our affiliations with medical schools 

which, as General Omar Bradley recognized 60 years ago, were 

vital to providing veterans with top-notch care. 

Second, we must maintain a modern, safe, and appropriate research infrastructure. This year we have already funded approximately $2 million to provide new or replacement research equipment and facility environment upgrades. We are currently surveying facilities, identifying deficiencies and ensuring our highly 

specialized needs are met. We will report the results of the survey 

to Congress early next year. 

Third, we must continue to lead the nationwide effort to improve 

protection for human research subjects. VA is a recognized leader 

in accrediting research facilities and training staff. We are working 

with other Federal agencies, medical school affiliates, and others to 

develop new institutional review board structures. These structures 

8

will allow us to maintain strict standards for subject protection, yet 

provide flexibility to expedite the review process, especially useful 

for smaller research facilities. 

We are in the process of developing a Central Institutional Review Board to facilitate consistent expertise and greater efficiency, 

and this will particularly enfranchise and help our smaller and 

rural research programs, allowing rural veterans greater access to 

research protocols that may offer new treatments for infections, 

heart disease, cancer, or other illnesses under investigation. 

Finally, we must support VA research. Appropriated funds are 

VA researchers’ core funding. We can leverage these funds with 

money from industry, nonprofits and other Federal agencies, as 

well as continue our partnerships and collaborations, use our research programs to recruit and retain investigators and clinicians 

who in fact treat patients and help to find new solutions, treatments, devices, and discoveries to benefit both veterans and our 

Nation. 

Mr. Chairman, I thank you and all of the Senators who have 

asked for additional funding for VA research. We are grateful for 

your confidence in our program and in the work of our researchers, 

in our basic science research to advance the understanding of life 

and disease, who in our clinical research and cooperative studies 

help to bring new medications, devices, and treatments to the care 

of veterans and all Americans, who in our rehabilitation research 

help make injured veterans whole, and who in our Health Services 

Research Program in the words of Dr. Jonathan Lomas in the British Medical Journal, ‘‘Focus the light of health services research on 

our health care delivery, helping make VA one of the leading 

health care systems in the world.’’ This concludes my statement, 

sir. Thank you. 

[The prepared statement of Dr. Perlin follows:]

PREPARED STATEMENT OF JONATHAN B. PERLIN, M.D., PH.D., UNDER SECRETARY FOR

HEALTH, DEPARTMENT OF VETERANS AFFAIRS

Mr. Chairman and Members of the Committee, 

Thank you for the opportunity to appear before you today to discuss the Department of Veterans Affairs (VA) medical and prosthetic research program. I am 

pleased to have Dr. Joel Kupersmith, Chief, Research and Development Officer 

(CRADO), accompany me today. 

Also, Dr. Richard Weir, a VA Research Scientist from the VA Chicago Healthcare 

System working in the Prosthetic Research Laboratory, is here to describe the work 

he is doing. Dr. Weir will explain the efforts to develop a new hand/wrist prosthetic. 

I am proud to say that over three thousand researchers have the same commitment 

to their work as Dr. Weir does. 

INTRODUCTION

The original design for the Veterans Health Administration (VHA) Office of Research and Development (ORD) was clear: VA shall carry out a program of medical 

research to provide health care more effectively and contribute to the Nation’s 

knowledge about disease and disability with emphasis on injuries and illnesses particularly related to service. We hold to that same purpose today. 

A year ago in my confirmation hearing before you, I highlighted several accomplishments of VA’s research program. Today, I would like to reiterate these and describe their importance to veterans and the Nation as a whole. 

• VA pioneered the first effective therapies for tuberculosis in the 1940s; veterans 

returning from the Pacific theater and POW camps in World War II were some of 

the first to receive these treatments. 

• From the 1940s to the present, VA researchers have led the development of better fitting, lighter, more functional artificial limbs. In the late 1970s and early 1980s 

9

the Veterans Administration, as it was called then, supported research that led to 

the Seattle Foot, a prosthetic device for lower limb amputees. This revolutionary device has allowed thousands of amputees from the Vietnam War to return to an active life and participate in activities like basketball, skiing, or running, all of which 

were impossible with traditional artificial limbs. By 1991, more than 70,000 Seattle 

feet were in use in the United States. Later, I will describe the exciting work VA 

research is doing today in the area of robotics and other cutting edge prosthetics. 

• VA was instrumental in the invention and use of the first implantable cardiac 

pacemaker. William C. Chardack, chief of surgery at Buffalo’s Veterans Administration Hospital, collaborated with Wilson Greatbatch in a partnership to develop the 

device and surgical techniques that have helped millions of Americans, including 

our aging veterans. 

• VA research contributed significantly to the development of the CT scanner and 

MRI machine. VA’s basic science research in 1960 and 1961 contributed to the development of the computerized axial tomography (CAT scan) in the early 1970s and 

modern radioimmunoassay diagnostic techniques in the mid-1980s. This illustrates 

that the progress of discovery is not an overnight task. Sometimes, scientists must 

work for decades to find solutions to complex problems. Today, veterans and all of 

us benefit from the basics discovered by VA investigators. 

• Smoking and military service have coincided for many years, so VA has a longstanding history of investigating treatments for nicotine dependence. VA’s investigator, Jed Rose at the Durham VA Medical Center (VAMC), worked with others to 

invent the nicotine patch. Today, VA continues to support a strong portfolio of research about the effects of nicotine and its relationship with substance abuse, a 

major concern for many veterans. 

But, the history of VA research extends well beyond what we discussed last year: 

• In the 1950s and 1960s, the VA cooperative studies program developed the essentials of the multi-site randomized controlled clinical trial that is the standard for 

testing the safety and efficacy of new treatments today. VA cooperative studies in 

the 1960s, 70s, and 80s proved the value of such widely used therapies as coronary 

artery bypass, the use of lithium in bipolar disorders, and aspirin’s ability to ward 

off heart attacks. More recent VA clinical trials have led to non-surgical treatments 

for gastro-esophageal reflux disease and prostate enlargement, demonstrated the 

value of advanced cochlear implants in veterans with profound hearing loss, and established effective treatments for post-traumatic stress disorder (PTSD). Such results have extended life and improved the quality of life for veterans and non-veterans alike. 

• In the 1960s, the VA invented the radioimmunoassay, a procedure that is now 

a mainstay of clinical laboratory testing through the world for detecting biological 

markers associated with health and disease such as prostate-specific antigen (PSA). 

• More recently in 2005, VA showed that an experimental vaccine for shingles 

cuts its incidence in half and dramatically reduces severity and complications in 

those that develop the disease. 

• Also, researchers from VHA, Stanford University, and Duke University reported 

in the October 2005 New England Journal of Medicine that the implantable 

cardioverter defibrillator, although a costly device, is a relatively cost effective way 

to help prevent sudden cardiac deaths for some high risk patients. This is a good 

example of collaboration involving our academic partners with funding from another 

Federal agency (the Agency for Healthcare Research and Quality) as well as industry (Blue Cross Blue Shield Technology Evaluation Center). 

But, past success is not enough. Research must be future oriented. We must look 

at how we practice health care today and ask: how can we do better? Our research 

program builds on its past by identifying and confronting the important questions 

and challenges of today and then doing the hard work to find solutions for the future. 

VA RESEARCH AS A UNIQUE LABORATORY

A special advantage of the VA research program is that it is nested within a 

health care system that serves more than 5 million veterans. This creates a unique 

national laboratory for the discovery and application of new medical knowledge. 

Translating research into clinical practice is talked about throughout the medical 

community, but VA is one place where we apply research every day. VA research 

has made direct contributions to current clinical practices for hypertension, PTSD, 

diabetes, and other chronic diseases. VA clinicians who have responsibility for providing care for patients and for training future health care providers are the same 

scientists who initiate our research projects; nurture the proposal through VA’s rigorous scientific merit review; identify and secure additional funding from other FedVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
10

eral agencies, non-Federal sources, and industry; conduct the research; publish the 

results in prestigious medical journals; and then complete the circle back to the bedside. VA research truly brings scientific discovery from bedside to bench and then 

back to the bedside. 

In fact, the chance to conduct research has been a strong tool for VA to recruit 

and retain high quality physicians and other clinicians. Other health care systems 

rarely provide physicians and other clinicians with the opportunity to research questions that are most relevant to patient care. VA’s healthcare system allows that we 

promote the idea of research within our unique research setting with tools such as 

the computerized patient record system and protected time for research. Allowing 

researchers to identify or ‘‘protect’’ time within their work week is part of VA’s 

strong Career Development Program that allows investigators to nurture a research 

career in the VA system. 

The opportunity to conduct research has been one of our most effective tools to 

improve the quality of our care, as well as to recruit and retain top-notch clinicians. 

It also creates a culture of continuous learning and innovation that helps us maintain our position of leadership among health systems. Studies by the Institute of 

Medicine, RAND, and others have highlighted the delays that occur from the time 

of scientific discovery to the time an evidence-based practice becomes routine—in 

US healthcare, on average, the likelihood of receiving a treatment based on credible 

scientific evidence is only about 50 percent. VA far exceeds that level of performance 

on virtually every evidence-based indicator. Furthermore, VA has established a 

unique program, the Quality Enhancement Research Initiative (QUERI), whose mission is to bring researchers into partnership with health system leaders and managers in order to ensure the care we provide to veterans is based on the most current scientific evidence. 

EMERGING PRIORITIES OF VA RESEARCH

Although in any given year the bulk of VA’s research budget is committed to ongoing investigation, each year we re-evaluate our priorities based on the changing 

needs of the veterans we serve, and attempt to fund high quality science that meets 

those priorities. I would like to highlight our current areas of focus for VA research. 

Operation Iraqi Freedom and Enduring Freedom (OIF/OEF). In order to better 

serve military personnel injured during OIF/OEF, VA has implemented a new research agenda which brings all parts of ORD together to develop new treatments 

and tools for clinicians to use to ease the physical and psychological pain of the men 

and women returning from conflicts, to improve access to VHA services, and to accelerate discoveries and applications, especially for PTSD diagnosis and treatment, 

state-of-the art amputation and prosthetics methods, and polytrauma. 

Neurotrauma (including traumatic brain injury and spinal cord injury). Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) account for almost 25 percent 

of combat casualties suffered in OIF/OEF by US Forces. In November 2005, VA 

issued a program announcement to stimulate research in the area of combat casualty neurotrauma. This research initiative seeks to advance treatment and rehabilitation for veterans who suffer multiple traumas from improvised explosive devices and other blasts. Eighty-five letters of intent to submit a research proposal 

were received, indicating a high level of interest among our investigators, and we 

hope to fund as many high quality projects from this initiative as our budget will 

allow. 

Polytrauma and Blast-Related Injuries. Improvements in body armor and battlefield medicine have resulted in higher survival among wounded soldiers but also 

new combinations of critical injuries, including head injuries, vision and hearing 

loss, nerve damage, infections, emotional problems, and in some cases amputation 

or severed spinal cords. This is a new challenge for VA, and we need to develop the 

knowledge base to manage these conditions over the remaining lifetime of the veteran. VA has devoted its newest QUERI center to polytrauma and blast-related injuries with a focus on using the results of research to promote the successful rehabilitation, psychological adjustment, and community reintegration of these veterans. 

Other VA scientific studies are currently underway to characterize these injuries 

and delineate their outcomes and costs, and to identify geographic areas where the 

need for rehabilitation is greatest. Such information is critically important in helping VA redesign its care delivery system to meet the needs of these veterans. 

Amputation and Prosthetic Research. VHA ORD currently supports a broad research portfolio pertaining to amputation and prosthetics, and more research in this 

area is planned. Areas of interest include: 

• Nanofabrication, microelectronics and robotics to create lighter, more functional 

prostheses. ORD is funding two new Prosthetics Rehabilitation Engineering and 

11

Platform Technology Centers that are national resources to develop computerized 

state-of-the art prosthetic limbs with the goal of using the latest advances in orthopedic surgery, tissue engineering, nanotechnology, and microelectronics to create 

prosthetics that look, feel, and act more like one’s own limb. • The Providence VA Medical Center, in collaboration with Brown University and 

the Massachusetts Institute of Technology, is working to develop a ‘‘biohybrid’’ limb 

that will use regenerated tissue, lengthened bone, internal and external implants 

and sensors to allow amputees to use brain signals and residual limb musculature 

to have better control of their limbs and reduce the discomfort and secondary complications associated with current prostheses. These researchers are already publishing and presenting about their work. • The Advanced Platform Technology (APT) Center at the Cleveland VA Medical 

Center focuses on sensory and implanted control of prosthetic limbs, accelerated 

wound healing, and biological sensors for the detection of health and function to accelerate the use of new materials and innovative micro-mechanical or 

nanotechnologies to provide more independence to veterans with disabilities. • ORD is starting a study to gather information about how prosthetic devices are 

used, costs, amputee satisfaction, comparisons selected prosthetic devices, and various prosthetic procurement alternatives to help VA match technology to the needs 

of an individual veteran. • ORD is partnering with the Department of Defense (DoD), Walter Reed Army 

Medical Center, the Defense Advanced Research Projects Agency and Brooks Army 

Medical Center to compare prosthetic designs; define standards of function; evaluate 

psychological issues faced by returning service personnel; determine psychosocial 

issues that challenge successful reintegration; and initiate longitudinal studies to 

study veterans care over time. • VA investigators are examining rehabilitation for the visually impaired including artificial retinas, especially for polytrauma victims; new treatments for burn victims; restoration of hearing and maximizing function for those with hearing loss, especially for polytrauma victims; and natural mechanisms of neural regeneration to 

return function to paralyzed veterans and those with brain injuries. VA investigators also plan to study advanced tissue engineering and the manufacturing of artificial skin to accelerate wound healing. 

Mental Health and PTSD Research. Studies about PTSD and other mental health 

issues are an important part of the VHA ORD research portfolio, and special attention is being paid to the circumstances of the returning OIF/OEF veteran. 

Interagency Collaboration regarding OIF/OEF Mental Health. VA, the National 

Institutes of Health (NIH) and DoD jointly issued a Request for Applications (RFA) 

in late 2005, to enhance and accelerate research on the identification, prevention 

and treatment of combat related post-traumatic psychopathology and similar adjustment problems. The goal is to encourage studies involving active-duty or recently 

separated National Guard and Reserve troops involved in current and recent military operations (e.g., Iraq and Afghanistan). This RFA specifically encouraged participation of clinicians and researchers who screen, assess or provide direct care to 

at-risk, combat exposed troops, and emphasized interventions focusing on building 

resilience for veterans suffering from mental health problems, including PTSD, and 

developing new modes of treatment that can be sustained in community-based settings. Among the approaches being considered are novel pharmacological, psychosocial and combination treatments as well as the use of new technologies (e.g., 

World Wide Web, DVD, Virtual Reality, Tele-health) to extend the reach of VA’s 

health care delivery system. Fifty-five proposals were received earlier this year in 

response to this RFA, and those proposals deemed to have scientific merit and relevance to veterans will start October 1, 2006. 

Women and PTSD. Because of women’s new roles in the military and subsequent 

combat experiences, VA and DoD are studying the use of psychotherapy for treatment of PTSD in female veterans and active duty personnel. A randomized clinical 

trial, part of VA’s Cooperative Studies Program, has recently been completed and 

results are currently being analyzed, with a report expected in 2007. Those results 

will inform additional research and implementation activities across VHA. 

Depression. Several approaches have been developed and tested by VA investigators to improve the assessment and treatment of mental health disorders. For example, implementation of an evidence-based collaborative care model for depression 

called ‘‘TIDES’’ (or Translating Initiatives in Depression into Effective Solutions) 

has demonstrated significant improvements in depression symptomatology among 

patients referred by their primary care providers. This study plus two companion 

evaluations of the processes, outcomes, and costs of implementation (called WAVES 

or Well-Being among Veterans Enhancement Study and COVES or Cost and Value 

of Evidence-based Solutions for Depression) are part of national VA strategic planVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
12

ning and rollout for improving the quality of depression care. Future research 

projects are planned to develop and test collaborative care models for PTSD and 

other anxiety disorders. 

Other projects. ORD is currently conducting and planning projects that address 

the long-term care needs of veterans with TBI, and assess (in collaboration with 

DoD) the long-term changes in health status resulting from combat deployment. We 

are studying the role of smoking and nicotine dependence among veterans with 

PTSD, and will begin this fall a multi-site clinical trial to study the effects of 

risiperidone on PTSD. ORD will continue to support other studies that test the effectiveness of virtual reality therapy and other new treatments for PTSD. It is important to note that this research will also have direct applications for all veterans 

and not simply those involved in OIF/OEF. 

Genomic Medicine Program. VHA, as a large healthcare system with an integrated research network and an unrivaled electronic medical record system, is 

uniquely positioned to develop a national Genomic Research Program. The goal of 

this program is to expand VA’s ongoing genomic medicine effort. Research efforts 

will be developed to: understand the role of genetics in the prevention and cause 

of disease; use genetic information to improve how clinicians prescribe medications 

and to prevent adverse reactions; develop computer systems to manage genetic data 

and identify genetic predispositions; develop laboratory capability to do genetic and 

pharmacogenomic profiling within VA; and learn how to use genetic information effectively in everyday practice. The ultimate goal of these efforts is to predict and 

prevent disease and to treat more effectively and at lower costs through the 

customization of clinical interventions. 

In the March 22, 2006 Federal Register, VA announced the establishment of the 

Genomic Medicine Program Advisory Board. The Committee is composed of nationally renowned medical experts in genomic research, bioethics, and disease management. The purpose of the Committee is to provide advice to the Secretary of Veterans Affairs on the scientific and ethical issues related to the establishment, development, and operation of a genomic medicine program. Specifically, the Committee 

will assess the potential impact of a VA genomic medicine program on existing VA 

patient care services; recommend policies and procedures for tissue collection, storage and analysis; and develop a research agenda and approaches to incorporate research results into routine medical care. 

Gulf War Veterans’ Illnesses. VA research places a high priority on scientific research aimed at improving the quality of life for veterans of the 1990–1991 Gulf 

War affected by chronic multisymptom illnesses commonly referred to as Gulf War 

Veterans’ Illnesses (GWVI). Some veterans who participated in Operations Desert 

Shield and Desert Storm have reported conditions and chronic symptoms such as 

fatigue, weakness, gastrointestinal difficulties, cognitive dysfunction, sleep disturbances, persistent headaches, skin rashes, respiratory problems, and mood changes 

at rates that significantly exceed those reported by comparison groups. VA research 

continues to expand its efforts to understand and treat GWVI. The core objective 

is to improve the health of ill Gulf War veterans. It is important to note that Gulf 

War veterans with chronic unexplained symptoms are eligible for disability benefits 

even when the cause of their illness cannot be determined. 

VA has committed $15 Million in fiscal year 2006 for collaboration with the University of Texas Southwestern Medical Center and has also funded VHA ORD investigators for on-going projects. These ongoing studies address areas of interest that 

include: chronic multisymptom illnesses (CMI) affecting GW veterans; conditions 

and/or symptoms frequently reported by GW veterans; long-term health effects of 

potentially hazardous substances, alone and in combination, to which GW veterans 

may have been exposed during deployment; and any of the 21 Research Topics forming the framework for the Annual Report to Congress of federally Sponsored Research on GWVI. 

Chronic Disease. According to a study of 1999 VA health care expenditures, VA 

health care users have more chronic diseases than the general population. This 

study also indicated that 72 percent of VA patients had at least 1 of 29 chronic diseases such as diabetes, Parkinson’s disease, HIV/AIDS, Alzheimer’s disease and substance abuse, and the care for these veterans accounted for 96 percent of health care 

expenditures provided at VA facilities. The following are examples of efforts by VA 

researchers to discover how to prevent and treat chronic disease. 

Diabetes. According to the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health, 20.8 million people—7 percent of 

the population—have diabetes. An estimated 4.6 million people are diagnosed and 

6.2 million people are undiagnosed. In 2005, 1.5 million new cases of diabetes were 

diagnosed in people aged 20 years or older. Diabetes affects nearly 20 percent of veterans receiving health care from VA: 1 million veteran users. An estimated 2 million 

13

veterans without diabetes have metabolic syndrome, which places them at high risk 

for diabetes. The cost is tremendous: 30 percent of VA health care costs (in- and 

out-patient and pharmacy) are attributable to patients with diabetes. This includes 

1.7 million days of hospital care. VA investigators have completed the first study 

to compare the quality of diabetes care among patients in VA and commercial managed care organizations. Quality of care measures were compared for seven diabetes 

processes of care, three diabetes intermediate outcomes, and four dimensions of satisfaction. Results from this study showed that VA patients had better scores than 

commercially managed care patients on all assessed quality of care measures. VA 

patients also had better low-density lipoprotein control and were slightly more satisfied with the overall quality of diabetes care at VA. 

Identifying the most effective treatment methods is crucial to reducing the incidence of diabetes among veterans. Although more patients are accessing medical information on the Internet, few studies have examined the effects of web-based interventions that incorporate an interactive component requiring feedback from patients. A VA study tested diabetes care management using a web-based system for 

veterans with poorly controlled diabetes. Results showed that web-based care management improves poorly controlled diabetes in veterans. Veterans participating in 

the web-based management program had significant improvements in HbA1c over 

1 year compared to usual care, and persistent website users had even greater improvements compared to intermittent users. 

ORD has also initiated the VA Diabetes Trial to determine whether intensive control of blood sugar, compared to standard methods, can reduce other blood vessel 

damage and other complications. Smaller trials to determine the value of the interventions will come first, with more research to follow. 

Obesity. Results from the 2003–2004 National Health and Nutrition Examination 

Survey (NHANES) indicate that an estimated 66 percent of U.S. adults are either 

overweight or obese. The problem is similar or worse among VA’s patient population, with 73 percent of veteran patients overweight or obese. Obesity contributes 

to increased heart disease, diabetes, and sleep apnea, and an estimated 300,000 

Americans die annually from illnesses related to overweight and obesity. 

Findings from VA studies to assess the efficacy and safety of weight loss medications, as well as the effectiveness and adverse events associated with the surgical 

treatment of obesity, demonstrated that surgical treatment is more effective than 

non-surgical treatment for weight loss in severely obese patients; weight loss was 

maintained for up to 10 years and longer and was accompanied by significant improvements in several comorbid conditions. 

Other examples of VA research include studies on traditional and new approaches 

to prevent and treat obesity, such as a comparison of lower extremity functional 

electrical stimulation on obesity and associated co-morbidities in comparison to 

upper extremity aerobic exercise for persons with paraplegia; an assessment of the 

impact of walking aides on quality of life and physical activity in overweight and 

obese veterans with osteoarthritis; and explorations of drug therapies. 

Alzheimer’s Disease. Alzheimer’s Disease (AD) and related dementias affect 7.3 

percent of veterans over age 65. VA research is helping to discover new facts about 

AD and other diseases and conditions that affect older veterans. For instance, researchers at the Bronx VA medical center have reported that diet-induced insulin 

resistance, a cause of type II diabetes, promoted beta-amyloid production concurrent 

with decreased insulin-degrading enzyme (IDE) activity in an animal model of AD. 

Beta-amyloid is the major component of amyloid plaques, the hallmark of AD pathology. IDE has been proposed to be responsible for the degradation and clearance 

of beta-amyloid in the brain. Such research is needed to form the basis of future 

interventions to prevent or reverse this devastating condition. 

Influenza. VA health services researchers have been instrumental in improving 

vaccination rates for veterans with chronic diseases that place them at high risk for 

complications from influenza, as well as enhancing vaccination among health care 

workers and veteran groups that historically have had low vaccination rates, such 

as minorities, smokers, and those with spinal cord injuries and disorders. 

Pandemic influenza infection has the potential for causing significant morbidity 

and mortality in the United States and elsewhere. ORD is responding, along with 

other Federal agencies, to this unprecedented public health threat by initiating 

studies that examine optimal dosing strategies for the antiviral agent oseltamivir 

(Tamiflu) in the event of an emerging pandemic of human infection with an avian 

or other influenza strain for which an effective vaccine is lacking. 

HIV/AIDS. AIDS (acquired immunodeficiency syndrome) is caused by HIV 

(human immunodeficiency virus). The virus kills or damages the body’s immune system, which lowers the body’s ability to fight infections and certain cancers. According to the Centers for Disease Control, at the end of 2003, an estimated one million 

14

persons in the United States were living with HIV/AIDS, with 24–27 percent 

undiagnosed and unaware of their HIV infection. VHA is the largest single provider 

of HIV care in the US, with nearly 20,000 patients seen annually with the disorder. 

Accordingly, ORD funds a full range of studies from bench research aimed at elucidating the underlying mechanisms of HIV to implementation projects that improve 

VHA’s effectiveness in caring for this population. 

Researchers at the VA South Texas Health Care System and the University of 

Texas Health Science Center recently showed that people who have a below-average 

number of copies of a particular immune-response gene have a greater likelihood of 

acquiring HIV and, once infected, of progressing to full-blown AIDS. These findings, 

cited as one of the top articles published in the eminent journal Science, have important implications for the treatment and prevention strategies for HIV/AIDS and 

possibly other infectious diseases as well. 

Women’s Health. According to information from the VA’s Center for Women Veterans, in 1973, women in the active duty military accounted for 2.5 percent of the 

armed forces. By fiscal year 2001, however, the number of women significantly increased making up 15 percent of the armed forces and those numbers are expected 

to increase. To respond to this demographic change and develop a more comprehensive VA women’s health research agenda, a VA Women’s Health Research Planning 

Group recently identified the needs of women veterans and a corresponding research 

agenda. VA researchers currently are investigating optimal strategies for conducting 

preventive health and disease screening activities among women veterans (e.g., cervical cancer screening) and developing and evaluating computerized, interactive 

educational programs to enhance VA staff awareness of women veterans and their 

health-care needs. 

INFRASTRUCTURE

It is crucial that VA investigators have the equipment and facilities necessary to 

conduct cutting-edge research in the twenty-first century. To identify where improvements may be needed, ORD has initiated a comprehensive review of VA’s research facilities to identify deficiencies and corrective actions. The objectives of the 

Research Infrastructure Evaluation and Improvement Project are to review the 

overall adequacy and utilization of research space and infrastructure (including animal research facilities); to develop a plan to update and maintain facilities; to ensure compliance with biosafety and research laboratory security requirements; to enhance collaborations between the local VA Medical Center and its academic affiliate; 

and to ensure that the needs for highly specialized research programs (e.g., Rehabilitation Research and Development (RR&D) and Health Services R&D (HSR&D) 

Centers of Excellence) are met. 

Survey teams including VA research administrators and scientists, as well as 

other VA employees and engineering contractors, will review documentation and 

visit facilities to evaluate the physical infrastructure (including the animal facility, 

research laboratories and common equipment rooms); operational infrastructure (capability to conduct research while meeting requirements for compliance with safety, 

animal welfare, and human subjects protection regulations); and equipment (major 

items of equipment used for the conduct of research) of VA facilities with active research programs. The data collected from the surveys will be used to develop financial needs and an asset management plan. We expect to have a report to Congress 

early in fiscal year 2007. 

In addition, ORD recently funded proposals as part of the Shared Equipment 

Evaluation Program that is managed by the Biomedical Laboratory and Clinical 

Science Research and Development Services. The purpose of this program is to fund 

new or replacement research and animal facility equipment. The program requires 

that facilities identify dollar-for-dollar matches in order to leverage the VA contributions. As a result of a December 2005 request for applications, a total of $2,086,173 

for facility projects and research equipment has been funded for the following sites: 

Decatur, GA; Chicago, IL; Cleveland, OH; Miami, FL; Loma Linda, CA; Memphis, 

TN; Nashville, TN; New Orleans, LA; Omaha, NE; Palo Alto, CA; Philadelphia, PA; 

Portland, OR; Richmond, VA; San Francisco, CA; Seattle, WA; San Diego, CA; San 

Antonio, TX; and Los Angeles, CA. 

Other proposals for research equipment are pending funding with decisions expected later this fiscal year. This program was suspended for a number of years, 

but plans are to begin funding proposals on an annual basis after a review to determine merit and priorities. 

15

CONCLUSION

As an academically trained researcher, I understand the complexities of the research process, and I am fascinated by the results. I fully support this program and 

advocate to you that its value, both to veterans as well as the Nation, far exceeds 

the costs. The history of VA research is impressive, and the future promises even 

more important advances. Can we prevent infections that hamper the use of biohybrid limbs? Can we develop artificial retinas so that wounded OIF/OEF soldiers 

and our aging veterans can regain their sight? Can we use our computerized medical record system and genetic samples to individualize drug and clinical treatments, 

or identify those veterans who may have a predisposition for a particular disease 

and prevent the onset of, rather than treat, the symptoms? Can we continue to examine ourselves to find out how to deliver patient care more effectively? The answers to these questions must be ‘‘yes’’, as no other health system is better positioned than VHA to make these discoveries, and no other group of patients is as 

deserving as America’s veterans to receive the benefit of such innovation.

Chairman CRAIG. Thank you very much, Dr. Perlin. You have 

been accompanied by Dr. Joel Kupersmith, Chief Research and Development Officer for the VA, and Dr. Richard Weir, VA Prosthetics Research Laboratory, in Chicago. Before we get into dialog 

and questions, obviously Dr. Weir has brought a unique device 

along, and I think it is time our Committee Members see it. I had 

the privilege of trying it on, fellow Senators, before you arrived and 

before we convened the Committee, and so I think it is important 

that we see some of this cutting-edge technology firsthand, may I 

say? Dr. Weir, if you would, please. 

Dr. PERLIN. Mr. Chairman, if I might introduce Dr. Weir as he 

gets assembled there. 

Chairman CRAIG. Please do. 

Dr. PERLIN. It is my privilege to introduce Dr. Richard F. Weir, 

in fact, a former Career Development Awardee, and now a research 

scientist, with the VA Prosthetics Research Laboratory, at the 

Jesse Brown VA Medical Center in Chicago. As with many, the Career Development Program nurtures the work of young investigators so that they can mature in their career and bring exciting new 

technology to the care of America’s veterans. Dr. Weir will demonstrate the work that the VA and their partners are doing on 

hand and wrist prostheses. Too many servicemembers who have 

served in the Global War on Terror or in military careers experience trauma resulting in loss of their hands, and Dr. Weir and his 

fellow scientists are doing vital work that will significantly help 

these heroes. It is my pleasure to introduce Dr. Weir, and one of 

the most futuristic devices for restoring function to injured veterans. 

Mr. WEIR. Good morning, and thank you, Mr. Chairman. It is an 

honor to be here today to have a chance to present on some of the 

work that I have been doing for the VA. 

We have been working on a new prosthetic for people who have 

lost all fingers and the thumb. 

Chairman CRAIG. Dr. Weir, we haven’t made you sweat yet, so 

as to your connection with your sensors, I’m sorry. Go ahead. You 

need that moisture connection there. 

Mr. WEIR. I need some more moisture. It dried out in the interval here. 

This is a new prosthetic device for a particular level of amputation that had not actually been addressed in the past, and it was 

for those individuals who had lost all fingers and thumb but still 

16

had a wrist. The wrist is a very important joint to maintain if you 

want to give somebody some function if you have lost all your fingers and thumb. So the challenge from our perspective in this 

project was actually to be able to develop a mechanism and a fitting technique that would allow any residual motion in the wrist 

to be maintained, and to allow an individual to regain as much 

function as possible. 

From an engineering design point of view, the challenge is where 

to put everything if you have only got the volume of the fingers, 

because someone who has a wrist still has this portion of their 

hand left, and then so the challenge is to get everything into just 

the fingers and the thumb. 

This was the little device that we came up with as an armature. 

Then we have little sensors that sit in the prosthetic socket it is 

called, or prosthetic interface, and this pushes onto the residual 

limb and these sensors sit over the residual muscles in the hand. 

The person will then think about closing their hand to close the 

hand like this, and then opening the hand to open the hand. 

The other thing is to develop a prosthetic socket, though, that 

keeps that motion going, and so this is the device we have come 

up with. We are in the process of fitting this to some patients at 

the moment, and we are in the process of developing this prosthetic 

interface so that it can be freely suspended without restricting 

wrist motion. Ironically enough or unfortunately, this project was 

started before Operation Iraqi Freedom just because the VA has a 

long-term view on prosthetics and the development of orphaned 

products, and the problem is that we are seeing injuries now coming from Operation Iraqi Freedom where soldiers are incurring 

burns and some of these burn injuries are resulting in amputation 

or loss of all digits and thumb. So now this little mechanism has 

particular relevance to fitting that level of amputation. That is 

pretty much all I have to say. 

Chairman CRAIG. Thank you very much, Dr. Weir, for that demonstration. I think it is a phenomenal example of the kind of work 

that is going on. Dr. Perlin, as you said, while the work is going 

on at VA and collaboratively with university settings, NIH and others, it is not exclusively for veterans. Once this is done, it goes to 

the market, and that is what becomes increasingly exciting, that 

the research going on for veterans really gets spread across the 

world scene ultimately, and that makes it all the more meaningful. 

In your testimony you stated that VA has begun a comprehensive 

review of its research infrastructure, and I am glad to hear that. 

We look forward to that report, as you are projecting its completion 

early next fiscal year? 

Dr. PERLIN. Yes, sir. 

Chairman CRAIG. Meanwhile, can you elaborate, or possibly Dr. 

Kupersmith could, on the kind of information you expect to find 

from this report? 

Dr. PERLIN. Thank you, first, Mr. Chairman, Ranking Member 

and Committee Members for your support of VA research. I think 

what you have seen today is truly extraordinary. 

Mr. Chairman, in particular you have really focused in on an 

area that helps not only veterans, but all Americans, and you have 

worked with us in grappling with serving veteran in an infrastrucVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00020 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
17

ture that is aging. Nationally, the CARES process reviews some of 

the infrastructure, and the mean age of our buildings is about 58 

years. The research facilities are equally aged. Let me ask Dr. Joel 

Kupersmith to describe some of the findings that suggest that we 

need to invest to improve and bring veterans and all Americans the 

sort of cutting-edge research that you saw this morning. 

Dr. Kupersmith. 

Dr. KUPERSMITH. Thank you very much. I want to also echo my 

thanks for your comments earlier. Much of the research space is inadequate for very simple reasons, there is not enough space, the 

ventilation in some places is not quite what it should be, and the 

basic structure of the space is also not necessarily easily adaptable 

to modern equipment. So I think those rather simple factors are 

why it becomes difficult to work in some of these areas. 

Chairman CRAIG. I presume that a substantial portion of the fiscal year 2007 research budget will be going toward projects VA has 

already committed to fund. If Congress were to provide additional 

funds for research above the President’s request, can you give 

Members of this Committee an idea of where the additional funds 

would be allocated? And without asking you to commit on any level 

of research funding for a particular area, can you please explain if 

it would include research directly related to OIF or OEF veterans 

at this time? 

Dr. PERLIN. Mr. Chairman, thank you for that question. Of 

course, we have an obligation to do the sort of research that helps 

assist our servicemembers in any injuries or illnesses that they 

might experience, especially in combat, as that is increasingly a 

focus, and the President’s budget itself increases the funding these 

areas of acute trauma, spinal cord injury, brain injury, mental illness. 

Of course, any additional funds that were to be provided would 

be greatly appreciated and would be focused not only on the issues 

of America’s combat veterans, but the issue of America’s veterans 

broadly which, as you described, include not only those things that 

occur as a result of service, but those things that are part of the 

challenges of life, of aging, ranging from heart disease to cancer, 

especially diabetes, a challenge in our environment, and mental-illness research. Let me ask Dr. Kupersmith to speak more, perhaps, 

on some of the areas of strategic investment such as the Career Development Awards that also bring new investigators, new clinician/

researchers, top-notch individuals, to the care of veterans. 

Dr. KUPERSMITH. Yes, certainly I think Dr. Weir exemplifies this 

because he is the product of a Research Career Development 

Award as are many of the people who work in rehabilitation medicine. 

I think some of the programs that we are specifically doing in regard to veterans of the Afghani and Iraqi Wars have to do with 

neurotrauma, cervical spine injury, traumatic brain injury which is 

very common, and looking at this at all levels, both at the laboratory level as well as the clinical level, and how to approach longterm care in a younger patient. So many of our efforts in the past 

have been long-term care in the older individual and there are different needs, obviously, as there are different needs in prosthetics 

in younger and older individuals. In addition, in the wide range of 

18

prosthetics research, we are developing artificial retinas and some 

others. 

But I think we do make an investment in people, and we have 

an extensive Research Career Development Award program. That 

is, I think, one of the best there is to create investigators for the 

future. We like to keep all of these investigators, but we do not. 

They go on to other things, and they go on to help the country as 

a whole. Most of them stay with us and work in these areas, and 

that is a very important investment we make. 

The other important investment we make, as was mentioned, is 

collaboration with the universities. Again, Dr. Weir’s work is an example of extensive collaboration on a number of prostheses between Northwestern and the Research Institute of Chicago and us. 

So these are the kinds of things we are doing. 

Chairman CRAIG. Gentlemen, thank you. Let me turn to Senator 

Akaka. 

Danny. 

Senator AKAKA. Thank you very much, Mr. Chairman. 

Dr. Perlin, in the fiscal year 2007 budget, I read funding cuts are 

slated for research projects focusing on cancer, on diabetes, and 

heart disease. We all understand the pressing need and desire for 

the state of prosthetics and new treatments for service-connected 

disabilities, but these projects should not come, I believe, at the expense of peer-reviewed projects which address all kinds of health 

care needs. Can you please explain the rationale behind reducing 

funding for disease-related research? Is there not enough room for 

all kinds of research? 

Dr. PERLIN. Thank you, Senator Akaka, and thank you for the 

support you have expressed for VA research in your introductory 

comments and with the recognition that all of the areas of research 

conducted are of significant value. 

In the current environment with our troops deployed, we felt the 

commitment to increase the focus on areas that are related to injury or illness to which troops may be exposed, so we did prioritize 

in that direction. We always do hope to leverage and have had tremendous success in leveraging the investment that you make in 

the direct appropriation through recruiting additional grants in 

areas such as cancer or other illnesses from other funding entities 

such as the National Institutes of Health. In fact, the current support from the National Institutes of Health and other Federal 

Agencies is about $662 million, and so your investment in VA research is significantly amplified. But you are correct that when we 

focus on one area, it does push on project capacity in other areas 

which is why we are particularly appreciative of the support that 

you have endorsed. 

Senator AKAKA. As I am pointing out here, somehow we need to 

continue the tradition of research that VA has in all of these areas. 

Dr. Perlin, the fiscal year 2008 construction list includes a $7 

million project for a research facility located at Tripler Army Medical Center in Honolulu. This facility would be, as I understand it, 

the first of its kind, a joint center of cooperation and collaboration 

between VA and DOD. Do you see this concept of joint research facilities as a future avenue for success and innovation? 

19

Dr. PERLIN. Senator Akaka, let me endorse the general concept 

of collaboration with our partners in the Department of Defense. In 

fact, throughout the country there are over 450 separate sharing 

arrangements ranging from clinical activities, to shared infrastructure, to shared capital equipment. So there is no reason that 

should not extend to shared support of the research environment. 

I would note that the sharing of a physical space may have some 

unique aspects, and that is certainly a part of the culture sharing 

in terms of research activity. 

In terms of mental-health care, mentioned in my opening comments, there is collaboration with the Department of Defense on 

mental health and PTSD which also includes a third partner, the 

National Institute of Mental Health. We have collaborated on physical illnesses research as well, and look forward to, where we have 

the capacity to, be synergistic in sharing physical infrastructure as 

well. 

Senator AKAKA. Dr. Perlin, I would like to ask you how much 

VHA spends on the indirect costs for conducting NIH grants. I ask 

that because NIH has refused to reimburse VA for the indirect 

costs of conducting research grants, and, therefore, those costs 

come out of health care dollars. Are you working with NIH on this? 

Dr. PERLIN. Thank you, Senator. This has been an area of ongoing discussion with the National Institutes of Health. When NIH 

funds come directly to a VA medical center, they do not pay an indirect research cost as would occur were those funds to be conferred to any other institution. When funds come through a university, the university actually receives the indirects, and if there are 

space costs, some of those supports come through. Certainly, when 

NIH funds through our not-for-profit research corporations, the dollars come through. I would ask Dr. Joel Kupersmith to elaborate 

on the actual dollar amounts or provide for the record the complete 

figure. 

Dr. KUPERSMITH. Our estimate in the budget submission for 2006 was $353 million coming from VERA dollars. The NIH issue has 

been a subject of ongoing discussion for several years and is pretty 

much in the same area. As Dr. Perlin mentioned, the essential way 

that the overhead dollars can be recovered is through the nonprofits. We have not been able to recover them in other ways. And 

may I add only in certain places have they been recovered. This is 

not uniform nationally by any means. 

Senator AKAKA. Thank you. Mr. Chairman, my time has expired. 

Chairman CRAIG. Danny, thank you very much. Senator Burr, 

any questions of the panel? 

Senator BURR. Thank you, Mr. Chairman. Again let me reiterate 

my thanks to you and Senator Akaka for your persistence on this. 

Dr. Perlin, let me ask you, Durham, North Carolina, does a sizable amount of research for the VA, and it is unique in its location 

to Duke University, and the relationship that Duke University has 

with the VA is an incredible one. Are you able to work with academic institutions and with the private sector often enough on the 

research directions to make sure that there is little to no duplication in what our efforts are? 

Dr. PERLIN. Senator, first, thank you very much for your question. Indeed, the relationship with Duke University and the DurVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00023 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
20

ham VA is a terrific one that has produced very important and cutting-edge research as, frankly, have many of the relationships with 

other universities in the State of North Carolina. 

That said, nationally I would say whether it be VA or elsewhere, 

there is not a program to effectively assure that research activities 

are not reduplicated. I do know that sometimes the advances are 

made in areas where there is competition, as in industry as well, 

but in VA at least we try to coordinate our portfolio to assure that 

we get the most product for the investment. I don’t know, Dr. 

Kupersmith, if you would like to elaborate. 

Dr. KUPERSMITH. There is no national strategic plan among universities or for our collaboration with universities. I would point 

out that there is a certain amount of duplication that is appropriate because it is scientifically checking what happens, and so a 

certain amount of that is appropriate. 

I think that our collaborations, generally when grants are applied for, one has to give the uniqueness of the grant whether it 

is for us or NIH, and that guards against duplication in many 

ways. 

Senator BURR. The VA is faced with an increasing population as 

is the rest of the country of type 2 diabetes. I think by any historical standard, one might call this an epidemic, and that I am not 

sure that we as a Nation yet have accepted like we should. In 

North Carolina we are working on building a public-private partnership that is a research institution specifically focused on health 

science nutrition. You are aware of this and we have talked. It is 

extremely close to the Salisbury VA facility. It would probably be 

an ideal partnership for ongoing research that the VA is currently 

conducting in the area of diabetes. 

Dr. Perlin, what do you see as the VA’s role not only in the North 

Carolina entity that we have talked about, but in replicating something like that elsewhere in the country? I just truly believe that 

public-private partnerships offer us an opportunity to leverage Federal dollars in a way that produce much more from the standpoint 

of the research bench and that means the Government and the private sector have to find these common points. 

Dr. PERLIN. Senator Burr, thank you for both parts of your question, first, the public-private partnerships, and, second, the epidemic of obesity, overweight, and diabetes. 

I join the Secretary in being a fan of public-private partnerships. 

In fact, this terrific demonstration that we saw today has spawned 

a patent, and as Chairman Craig indicated, will not only benefit 

the immediate and obvious needs for veterans, but will benefit our 

country. It also will go into the marketplace and help to provide an 

economic engine for America’s leadership in advanced biotechnology. 

The areas of diabetes is, sadly, not only an American epidemic, 

it is a worldwide epidemic. Our Secretary has championed a program called HealthierUS Veterans. The toll of overweight, obesity, 

and diabetes is affecting not only our military personnel, a large 

population, but especially our VA population, and this is one of the 

areas where if we can partner strategically with the private sector 

to improve exercise. In our HealthierUS Veterans program, you actually get a prescription for health, a ‘‘prescription for life,’’ arming 

21

veterans with pedometers now and new treatments. We offer care 

for something that is, in the words of Surgeon General Carmona, 

the number one threat to public health in the country, the complications of obesity and diabetes, and that in the VA population 

approaches nearly 1 in 4 veterans under our care. 

Senator BURR. Thank you. Thank you, Mr. Chairman. 

Chairman CRAIG. Senator Burr, thank you. Senator Jeffords, 

questions? 

Senator JEFFORDS. Dr. Perlin, the VA Medical Center at White 

River Junction, Vermont, together with Dartmouth Medical Center 

is doing a significant amount of cutting-edge research. It is one of 

the programs that draws talented medical professionals to our VA. 

A critical component of the medical research is infrastructure and 

facilities, laboratories, and access to patients. You mentioned that 

a study of the VA’s infrastructure needs is underway. Shouldn’t we 

be funding some of the needs that have already been identified? 

Dr. PERLIN. Thank you, Senator Jeffords, for your comments. Indeed, the relationship of White River Junction and Dartmouth is 

a terrific example of the academic affiliation. It produces not only 

the basic science research that you have indicated, but leading 

health services research, improving the quality of health service delivery in many areas including to rural Americans. 

It is absolutely a necessity that we invest in our research infrastructure. There has been a phased approach thus far. There have 

been some issues related to improving the hardening and security 

of research areas that was one of the first areas of concentration 

and funding, and I would ask Dr. Kupersmith to elaborate on some 

of the areas for infrastructural improvement now and in the future, 

particularly as guided by the report that will be forthcoming to 

Congress. 

Dr. KUPERSMITH. As I said, I think the space issue is very important, and in many areas there is a need for space. I think some of 

these scientific appurtenances that older space have do not come 

up to what the newer spaces have, so these are the kinds of things 

that we are going to be interested in. This survey is beginning, will 

be complete by the end of the fiscal year and will be reported at 

the beginning of next year. We will have very detailed information 

on each site and what it needs, and I think it will incorporate all 

of these things. 

Senator JEFFORDS. I am pleased to hear that. Your demonstration of the hand was fascinating. Thank you for bringing it, Dr. 

Weir. I note that you said that you began your research work on 

this hand before the Iraq War. Dr. Perlin, has the Iraq War demanded more from the VA? And how is the VA redirecting its future research as a result of the war injuries coming to the VA? 

Dr. PERLIN. Thank you, Senator Jeffords for the comment. About 

505,000 Americans have separated after having served in combat, 

and in sheer numbers, the number of individuals who have experienced amputation to date is about 424. But whatever the number, 

our goal, our mission, is to restore function, and this is in part the 

very central reason for VA. The promise of doing what we can to 

make veterans whole, particularly, if they have experienced a loss 

in service to our country is so core to our mission that this really 

reminds us to refocus on the rehabilitation. So both preceding the 

22

war, but certainly in the context of combat, we are increasing our 

commitment to not only prosthetic advances, but advances in brain 

injury, spinal cord trauma such as occurs with the Improvised Explosive Devices, in areas of amputation, of course, blindness, hearing loss, and of course, the mental-health concerns that are important not only in their own right, but also would accompany the 

physical loss of function. 

Dr. Kupersmith has put together a very exciting and important 

portfolio for improving the care of injured veterans ranging from 

combat casualty, neurotrauma, blast injury, a program research on 

quality enhancement in care delivery, to the long-term care management of complex injury, limb loss, performance and an advanced 

platform technology development program at Cleveland that produced such things as the Functional Electrical Stimulator which 

actually gave Christopher Reeve, Superman, the ability to breathe 

without a ventilator, and artificial retina research. I believe in your 

package you will find a picture of a device that can be implanted 

in the back of the eye and work with a camera on a pair of eyeglasses. In the same way that we now take for granted that we can 

restore hearing with the cochlear implant, we have the ability now 

and in the future to begin to restore vision to veterans with physical injury, of trauma perhaps, or macular degeneration, retinitis 

pigmentosa, or diabetes, through these cutting-edge advances. Program projects with the Department of Defense, NIH, and longitudinal studies just as some examples. 

Dr. Kupersmith. 

Dr. KUPERSMITH. I just want to add that last study is a deployment health study in which we are examining soldiers and other 

military before they go to these wars, and then we will be examining them after. It is the first study to look at the genesis of PTSD 

and other mental difficulties in this way. I think this will add a 

tremendous amount to our information in gaining data on who is 

more likely to get PTSD and how it happens. 

Chairman CRAIG. Interesting. 

Senator JEFFORDS. I have another question. 

Chairman CRAIG. Please proceed. 

Senator JEFFORDS. The aging of our veteran population presents 

special challenges to the VA in treatment of veterans. Can you discuss in more detail the specific research the VA is doing to assist 

the Nation in understanding how to provide better care to the elderly and better understand the unique challenges of the diseases 

that disproportionately affect the elderly? 

Dr. PERLIN. Again, Senator, a great question and a great area. 

In VA’s portfolio, there is work directed specifically at improving 

the quality of life for aging veterans. Of course, this will provide 

insight for the aging of all Americans. 

In a sense, much of the disease-focused research that we undertake has implications for aging. Cancer or heart disease, stroke, as 

examples, are all areas where there are components specifically directed at the disease of interest, but there is another element of 

that that is focused on the complexity of that disease in an aging 

population such as much of the veteran population. 

VA has been making particular focus on improving quality of life 

at end of life as in palliative care. I recently came across a statistic 

23

yesterday: Asking about pain at each visit actually exceeds recording of any other vital sign, which is really quite a testament. The 

usual four vital signs are pulse, respiration, temperature, and blood 

pressure, and VA has a program to record pain as the fifth vital 

sign, and it is now the number one vital sign in VA. Improving the 

quality of palliative care is particularly important not only in illness in general, but at end of living in improving end-of-life care, 

and hospice programs have been an area of focus and leadership 

as well. Understanding the basis of dementia and Alzheimer’s is 

one example, but also vascular dementias that are caused by the 

same sort of plaque buildup that lead to heart attacks is another. 

These are not only of interest in terms of treatment, but with our 

genomic medicine, it is very exciting, not only about getting to good 

prevention, controlling the cholesterol and the blood pressure, but 

getting to an era where we can actually predict who is at risk, and 

even before the cholesterol gets high, develop treatments and start 

treatments that prevent things from deteriorating even before they 

would be obvious to the clinician, and that is the promise of some 

of the genomic medicine, the genetics-based therapy, that we hope 

and the Secretary commits, to bring as the state-of-the-art care for 

veterans. Dr. Kupersmith? 

Dr. KUPERSMITH. I think the main point is that so much of our 

research is relevant to the aging individual, and kidney disease, 

lung disease, and particularly cancer, because as our population 

ages, the incidence of cancer will rise. But the other point is that 

many of our programs are related to implementation of research 

and actually translation of research to the beside have to do with 

aging individuals, and our so-called QUERI program has a number 

of topics that are very directly related to aging individuals so that 

we actually assure that the care that the research is informing is 

provided to the veteran. 

Senator JEFFORDS. Thank you very much. 

Chairman CRAIG. Jim, thank you. We could spend all day with 

you, but we do not have all day, and neither do you. Thank you, 

gentlemen, very much. Dr. Perlin, Dr. Kupersmith, Dr. Weir, the 

work you are doing is going to make some people a good deal more 

capable than they otherwise might be in the future because of their 

injuries, and thank you for that work. Gentlemen, thank you for 

your testimony. 

Chairman CRAIG. We have a second panel, and we would like you 

to come forward, please. If we could get our panelists seated, we 

will proceed. Thank you. I guess the expression of the next panel 

is where the rubber hits the road or where the funding dollars 

make it to the bench or to the laboratory facility. We are pleased 

to have with us Dr. Fred Wright, Associate Chief of Staff, Research 

and Development, West Haven, Connecticut, VA Medical Center; 

Dr. Dennis Stevens, Associate Chief of Staff for Research Development, Boise, Idaho Medical Center; Dr. John Feussner, Chairman, 

Department of Medicine, Medical University of South Carolina. and 

Dr. John Kennedy, Professor, Department of Medicine, University 

of Alabama, in Birmingham, Alabama, VA Medical Center, representing the Alliance for Academic Internal Medicine. Dr. Wright, 

we will start with you. 

24

STATEMENT OF FRED S. WRIGHT, M.D., ASSOCIATE CHIEF OF 

STAFF FOR RESEARCH, VA CONNECTICUT HEALTHCARE 

SYSTEM, DEPARTMENT OF VETERANS AFFAIRS 

Dr. WRIGHT. Mr. Chairman and Ranking Member, thank you for 

the opportunity to discuss the importance of the VA research program in general, and the research program and the facility infrastructure at the VA Connecticut Healthcare System. 

Our program has more than 350 active projects led by more than 

100 principal investigators. The majority of our investigators are 

clinicians who also provide patient care in internal medicine, surgery, mental health, or neurology. The topics of VA Connecticut research include basic science (including molecular biology, cell biology, and genetics) and clinical research (clinical trials, health services, epidemiology and rehabilitation). Approximately two-thirds of 

the projects are clinical research studies involving human subjects. 

Of the remainder, about half are investigations using animal subjects, and the other half involve data analysis or cell lines. Last 

year, the competitively awarded funding for these projects exceeded 

$40 million. Most of this research activity is concentrated at our 

West Haven campus. 

The program centers on research to improve the health of and 

the health care for veterans, including our newest returning veterans. For example, our investigators at the National Center for 

PTSD seek ways to improve treatment for combat-related posttraumatic stress disorder and the associated depression. A current 

project in that program, in collaboration with the Department of 

Defense, is studying PTSD in soldiers returning from Iraq to correlate specific genetic information with response to a newly developed treatment. 

Another group of investigators in our Neuroscience Research 

Center is combining efforts in basic molecular biology, clinical 

trials, and clinical rehabilitation to treat spinal cord injury. Current work in that program is using tissue transplant procedures to 

insert healthy myelin-producing cells into damaged spinal cords in 

order to restore function. 

Attracting, hiring, and retaining outstanding clinician investigators is crucial to our ability to deliver high-quality primary and 

specialty care to veterans. These clinicians are individuals who are 

committed to academic medicine and are attracted to work in VA 

by the combination of providing care to veterans, teaching trainees, 

and conducting research in an environment enhanced by the resources of the nearby medical school. Without a robust research 

program, we would not be able to recruit the nationally recognized 

clinician investigators who also serve as attending physicians, clinical leaders, and specialist consultants to whom our primary care 

physicians refer patients. 

Our affiliations with Connecticut’s two medical schools are also 

important to the success of VA Connecticut research. Nearly all 

members of our medical staff have dual appointments, as both VA 

physicians and medical school faculty members. Our ability to recruit physicians to VA Connecticut medical staff is greatly enhanced by the associated appointment to the Yale facility, the opportunity to serve as a teacher for Yale medical students and resiVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00028 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
25

dents, and the expectation to carry independent research in an environment enriched by the proximity of the medical school. 

Funding: Approximately one-third of the direct-cost funding for 

VA Connecticut research comes from the VA research appropriation, while nearly one-half of our funding is provided by grants 

from the National Institutes of Health. VA research funds provide 

the necessary core support for veteran-centric research. However, 

we are able to supplement this funding by competing successfully 

for funds from NIH and other non-VA sources. This allows us to 

leverage what we are doing to increase VA research. 

Facilities: In the non-VA research world of public and private 

universities and medical schools, facilities for research, whether 

laboratories, offices, or patient care settings, are maintained, replaced, or expanded by a combination of funds from State governments, private philanthropy, and Federal Agencies such as NIH. 

These sources of funds are not generally available to VA medical 

centers, and in my experience, have not been available at VA Connecticut to support our needs for major infrastructure improvements. To ensure that VA investigators are able to conduct cuttingedge research in the 21st century, we will need appropriate facilities and proper research infrastructure that will enable us to attract clinician investigators to our medical staff. Thank you again 

for this opportunity to describe our research program at VA Connecticut. 

[The prepared statement of Dr. Wright follows:]

PREPARED STATEMENT OF FRED WRIGHT, M.D., ASSOCIATE CHIEF OF STAFF FOR

RESEARCH, VA CONNECTICUT HEALTHCARE SYSTEM, DEPARTMENT OF VETERANS

AFFAIRS

Thank you for the opportunity to discuss the importance of the VA research program in general, the research program at VA Connecticut Healthcare System 

(VACHS), and the facility infrastructure. Our program has more than 350 active 

projects led by more than 100 principal investigators. The majority of our investigators are clinicians who also provide patient care in Internal Medicine, Surgery, Mental Health, or Neurology. The topics of VACHS research include basic science (including molecular biology, cell biology, and genetics) and clinical research (clinical 

trials, health services, epidemiology, and rehabilitation). Approximately two thirds 

of the projects are clinical research studies involving human subjects. Of the remainder, about half are investigations using animal subjects, and half involve data 

analysis or cell lines. Last year the competitively awarded funding for these projects 

exceeded $40 million. Most of this research activity is concentrated at the West 

Haven campus. 

The program centers on research to improve the health of and healthcare for veterans, including our newest returning veterans from Operation Iraqi Freedom and 

Operation Enduring Freedom (OIF/OEF). For example, our investigators in the National Center for PTSD seek ways to improve treatment for post-traumatic stress 

disorder and associated depression. A current project, in collaboration with Department of Defense, is studying PTSD in soldiers returning from Iraq to correlate specific genetic information with response to a newly developed treatment. Another 

group of investigators, in our Neuroscience Research Center, are combining efforts 

in basic molecular biology, clinical trials and clinical rehabilitation to treat spinal 

cord injury. Current work is using tissue transplant procedures to insert healthy 

myelin producing cells into damaged spinal cords in order to restore function. 

Attracting, hiring, and retaining high quality clinical researchers are crucial to 

advance the research agenda. These are individuals, who are committed to academic 

medicine, and are attracted to work in VA by the combination of providing care for 

veterans, teaching trainees, and conducting research in an environment enhanced 

by the resources of the nearby medical school. Without a robust research program, 

we would not be able to recruit the nationally recognized clinician investigators who 

also serve as attending physicians, clinical leaders, and specialist-consultants to 

whom our primary care physicians refer patients. 

26

Our affiliations with Connecticut’s two medical schools—the Newington campus 

with the University of Connecticut Health Center and the West Haven campus with 

the Yale University School of Medicine—are also important to the success of VACHS 

research. Nearly all members of the VACHS medical staff have dual appointments 

as both VA physicians and medical school faculty members. In addition to their VA 

patient care activities, VACHS physicians have responsibilities in teaching and research. For example, the VA’s West Haven campus is an important site for clinical 

rotations by Yale medical students, residents, and fellows in specialty training programs. They contribute to the care of VA patients and are taught by Yale faculty 

who are based at the VA medical center. VA’s ability to recruit physicians to the 

VACHS medical staff is greatly enhanced by the associated appointment to the Yale 

faculty, the opportunity to serve as a teacher for Yale medical students and residents, and the chance to carry out independent research in an environment enriched 

by the proximity of the medical school. 

Approximately one third of the direct cost funding for VACHS research comes 

from the VA Research appropriation while nearly one-half of our funding is provided 

by grants from the National Institutes of Health (NIH). VA research funds provide 

the necessary core support for veteran-centric research. However, we are able to 

supplement this funding by competing successfully for funds from NIH and other 

non-VA sources. This allows us to leverage what we are doing to increase VA research. 

In the non-VA research world of public and private universities and medical 

schools, facilities for research (whether in laboratories, offices, or patient care settings) are maintained, replaced or expanded by a combination of funds from state 

governments, private philanthropy, and Federal agencies such as the NIH. These 

sources of funds are not generally available to VA medical centers. 

To ensure that VA investigators have the equipment and facilities necessary to 

conduct cutting-edge research in the twenty-first century, the Office of Research and 

Development has initiated a review of VA’s research facilities. We believe that maintaining the proper research infrastructure is necessary in facilitating cutting edge 

research, and will enable us to attract outstanding clinician-investigators to our 

medical staff. 

Thank you again for the chance to describe our research program at VACHS. I 

am ready to respond to any questions that you may have.

Chairman CRAIG. Doctor, not only did you do well, but your timing was amazing. 

Dr. WRIGHT. Thank you. 

Chairman CRAIG. Now we turn to Dr. Dennis Stevens. 

Dr. Stevens. 

STATEMENT OF DENNIS L. STEVENS, M.D., PH.D., ASSOCIATE 

CHIEF OF STAFF FOR RESEARCH, VETERANS AFFAIRS MEDICAL CENTER, BOISE, IDAHO, DEPARTMENT OF VETERANS 

AFFAIRS 

Dr. STEVENS. Senator Craig, Members of the Senate Veterans’ 

Affairs Committee, and colleagues from the Department of Veterans Affairs, it is with great pride that I come before you as a veteran myself, and as Associate Chief of Staff for Research at a small 

VA medical center in Boise, Idaho. As a current member of the VA 

Career Development Review Board, and as a science investigator 

who has enjoyed 26 years of funding through the Department of 

Veterans Affairs Merit Review Program, I want to say that at all 

VA medical centers of all size, the important of research cannot be 

separated from the quality of care that we provide for veterans. 

Most VAs with research programs are affiliated with medical 

schools. Having none in Idaho, we have had to be very creative in 

establishing affiliations, both academic and research. Specifically, 

we have a strong academic affiliation with the University of Washington as part of the WAMI Program and have a residency training 

27

program in collaboration with the University of Washington in 

Boise. 

While those relationships are very strong and have been very 

productive in generating high-quality education, they really have 

not improved the research capabilities of the Boise VA. The topic 

that we have today is the infrastructure mechanisms and costs, 

and clearly, building is one of those. The space that we have I am 

not going to into in great detail, but it is essentially one large room 

with two or three small laboratories. We have a very excellent animal care facility, and we have a very small clinical research unit. 

At the local level of VA operations, most investigators in small 

places wear many hats. We have about 30 percent of our time, if 

we do have a merit review grant, to conduct research. The rest of 

the time we are seeing patients, we are taking care of Committees 

and various other things. So I think we have special problems at 

small VAs just because of a lack of depth. 

There are many things that we should talk about in terms of VA 

infrastructure, but I think, clearly, buildings is one, renovation 

projects is another. Equipment, and not only equipment, but service contracts. Probably the VA’s central office could play a major 

role in addressing ways that we could creatively reduce the cost of 

service contracts in dealing with large corporations that make such 

equipment. 

One of the major problems we have had at our small VA is recruitment of new physician investigators, and that is currently at 

an all-time low. I think the reasons for this are multiple, but, first, 

the population of Boise has grown and therefore the number of patients that we care for has increased. For example, in 1995, we had 

10,000 veterans that we took care of, in 10 years this increased to 

19,000. We have conscientiously hired clinically oriented physicians 

to take care of these patients to reduce the waiting list, but we 

really have not actively recruited physician investigators, and that 

is currently a high priority. 

Lacking a medical school, it is also necessary to develop a critical 

mass of researchers at the Boise VA, and that has required very 

innovative relationships with the other universities throughout the 

State. Specifically, I have been able to develop collaborations with 

Boise State University, Idaho State University, and the University 

of Idaho. I have met with the research and development heads of 

all those universities, and we have a plan together to develop a 

critical mass of researchers at the Boise VA, and they are committed to provide graduate student stipends, postdoctoral stipends, 

as well as salaries for several faculty members, and I think this is 

really going to help us. We have also coordinated these efforts with 

the State legislature and the Governor’s office and so on. 

The only thing that we really require is building space to accomplish these goals, and we plan this fall to submit a small research 

proposal for minor construction of a building for research and education on the grounds of the Boise VA. 

Thank you. 

[The prepared statement of Dr. Stevens follows:]

28

PREPARED STATEMENT OF DENNIS L. STEVENS, M.D., PH.D., ASSOCIATE CHIEF OF

STAFF FOR RESEARCH, VETERANS AFFAIRS MEDICAL CENTER, BOISE, IDAHO, DEPARTMENT OF VETERANS AFFAIRS

Senator Craig, Members of the Senate Veterans Affairs Committee, and Colleagues from the Department of Veterans Affairs. 

It is with great pride that I come before you as a veteran, as Associate Chief of 

Staff (ACOS) for Research at a VA Medical Center (VAMC), a current member of 

the VA Career Development Review Board, and as a basic science research investigator who has enjoyed 26 years of continuous funding through the Department of 

Veterans Affairs (VA) Merit Review Research Program. 

Clinical investigators have successfully conducted basic science research for more 

than 25 years at the VAMC in the areas of cardiology, oncology, pharmacology, immunology and infectious diseases. Patient related research has been conducted 

through outcomes research projects involving clinical pharmacology, pulmonary 

medicine and the modern mechanisms of clinical teaching. Investigators have also 

participated or served as Principal Investigators in clinical trials involving treatment of hepatitis C, HIV, pneumonia, bronchitis, skin and soft tissue infections, septic shock, exacerbations of asthma and urinary tract infections. These clinical studies have been in FDA phase II and III clinical studies using novel new antibiotics 

and anti-viral agents. All have been on the cutting edge of new clinical treatments. 

Boise VAMC is currently participating in a clinical trial to compare treatments for 

clinically localized prostate cancer. Prostate cancer therapy is a topic of considerable 

discussion in the medical community, and this study could provide significant value 

to that discussion. 

At all VAMCs, the importance of research cannot be separated from quality medical care for veterans. The VA’s model of patient care, teaching and research attracts the best, brightest and most hard working of physicians. While translational 

research defined as ‘‘from the bench to the bedside’’ has been newly discovered by 

other healthcare systems, this is exactly what the VA Merit Review Program at 

Boise VAMC and elsewhere has been doing for over 25 years. Historically, within 

the VA system, we have learned to make clinical observations, ask research questions, design experiments to answer these questions and then move our results to 

clinical trials to improve the care of veterans. As a consequence of the VA model 

for research, there is currently a remarkable cadre of ‘‘clinical investigators’’ who 

enjoy national and international acclaim. The title of this hearing, ‘‘VA Research: 

Investing Today to Guide Tomorrow’s Treatment’’ is in keeping with the historical 

theme of the VA Office of Research and Development. 

For example, a Boise researcher is currently studying how the heart reacts when 

anthracyclines are used to treat cancer or infections. Another researcher is working 

on what may be causing the increasing number of streptococcal infections. 

At small VA research operations, we must continuously identify opportunities to 

improve our program, while balancing the responsibilities and work loads of investigators and administrative staff. As we develop plans to improve our program, it 

is also crucial that we continue to identify funding sources to support our facility 

infrastructure needs. Our goal is to improve patient care by finding solutions 

through research projects that meet the needs of veterans in Idaho as well as the 

Nation as a whole. Your support and interest in our needs is appreciated.

Chairman CRAIG. Dr. Stevens, thank you very much. Now we 

turn to John Feussner. 

Dr. Feussner. 

STATEMENT OF JOHN R. FEUSSNER, M.D., M.P.H., PROFESSOR 

AND CHAIRMAN, DEPARTMENT OF MEDICINE, MEDICAL

UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH 

CAROLINA 

Dr. FEUSSNER. Mr. Chairman and Senator Akaka, good morning. 

After listening to your opening statements, it appears to me that 

the best my testimony can do is merely reinforce what you already 

seem to know. Nonetheless, I appreciate the opportunity to share 

my perspective on the importance and value of the Veterans Affairs 

research program as it relates to academic affiliations between VA 

and academic medical centers. In addition to my role as professor 

and chairman of the Department of Medicine at the Medical UniVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00032 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
29

versity in Charleston, South Carolina, I also serve as a volunteer 

staff physician at the Ralph H. Johnson VA Medical Center. 

You already know about the extensive collaboration that exists 

between the VA and the large majority of schools of medicine and 

their academic centers. The affiliated VA Medical Centers share 

key features in common with their academic affiliates. The shared 

academic missions include superior patient care, innovative and 

path-breaking medical research, and broad-based medical education efforts. As a physician researcher who has worked within 

university and VA medical centers throughout my career, I provide 

a personal testimonial to the importance and value of that affiliation, not just to our Department of Medicine in Charleston, but 

for similar affiliated Departments of Medicine throughout the country. 

Clearly, the VA research program is superb in its own right. You 

already know that. The presence of VA’s research activities coupled 

with excellent collaboration with academic medical centers creates 

a culture of inquiry and innovation that has the additional effect 

of attracting the best practicing physicians. To be sure, the presence of the VA Research Program raises the standard of medical 

care and improves the quality of care delivered to our veteran patients. 

Mr. Chairman, one of the key features of the growth and success 

enjoyed by our two affiliated medical centers in Charleston was the 

joint construction in 1996 of a new state-of-the-art laboratory research facility named the Strom Thurmond and Peter Gazes Biomedical Research Center. This excellent research facility, now operating in its tenth year, provides nearly 120,000 square feet of stateof-the-art research space. The initial cost of this research building 

in 1996 was $31 million. 

In addition, and historically, the VA has focused efforts on training future physician researchers, and in this regard it serves its 

clinical research and education missions simultaneously. The VA’s 

research career development program provides excellent and stable 

support for new physician researchers during the most vulnerable 

period of their careers, the initial startup phase. 

Given such a superb track record of achievement, the current Administration budget recommendation is especially disappointing in 

that it would result in an actual reduction of $13 million in the VA 

research appropriation. Clearly, this will have a deleterious effect 

for VA-supported physician researchers and a loss of many new initiatives. And this deleterious funding climate will also do harm to 

the VA/academic affiliations, as opportunities will be reduced for 

both. If the budget for research decreases, the competition for 

grants of necessity will escalate, so meritorious proposals will not 

be funded. And the newest physician researchers will be especially 

disadvantaged and could be lost from the research pool permanently. 

Mr. Chairman, with regard to this Committee’s activities, I was 

gratified to note in your major views and estimates report to the 

Budget Committee earlier this year that you recommended VA research be augmented for fiscal year 2007 by an additional $30 million. I believe Senator Akaka made a similar recommendation. This 

type of bipartisan support by the Senate Veterans’ Affairs ComVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00033 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
30

mittee for research is deeply appreciated, sir, by those of us who 

are engaged in these pursuits. I know I speak for the entire academic medical community in thanking you and urging you to persuade the Senate and the House appropriators to follow your lead. 

Finally, Mr. Chairman, at some point in time—maybe this point 

in time—somebody has to make the decision to make an investment in the VA’s future by repairing the VA’s deteriorating research infrastructure. VA, in conjunction with its academic partners, operates dozens of substantial research laboratories. It saddens me to say that most of them need major renovations and some 

need complete replacement, as was the case in Charleston nearly 

a decade ago. 

Please remember that an investment in VA’s research program, 

whether in direct funding or infrastructure improvement, preferably for both, counts twice in a way, as it strengthens VA research and simultaneously enhances the half-century of excellent 

affiliation and partnership between the VA and some of the country’s finest academic institutions. 

Mr. Chairman, thank you. I am pleased to answer your questions. 

[The prepared statement of Dr. Feussner follows:]

PREPARED STATEMENT OF JOHN R. FEUSSNER, M.D., M.P.H., PROFESSOR AND CHAIR- MAN, DEPARTMENT OF MEDICINE, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

Mr. Chairman and Members of the Committee, good morning. I appreciate the opportunity to share my perspective on the importance and value of the Veterans Affairs research program as it relates to academic affiliations between Department of 

Veterans Affairs Medical Centers and Academic Medical Centers. My name is Jack 

Feussner, and I am Professor and Chairman of the Department of Medicine at the 

Medical University of South Carolina in Charleston. I am also a WOC (without compensation, volunteer) staff physician at the Ralph H. Johnson VA Medical Center. 

I have spent my entire academic career in a University-based Academic Medical 

Center setting with a strong and effective University and VA affiliation. I first became a funded VA physician researcher in 1982, and I maintained that funding 

until I moved to VA Central Office nearly 10 years ago to serve as the VA’s Chief 

Research Officer. 

I am sure you already know about the extensive collaboration that exists between 

the VA and the large majority of Schools of Medicine and their Academic Medical 

Centers who are closely affiliated with the VA. These affiliated Department of Veterans Affairs Medical Centers share key features in common with their academic 

affiliates. The shared academic missions include superior patient care, innovative 

and path breaking medical research, and broad based medical education efforts. As 

a Professor of Medicine, and as a physician researcher who has worked within University and VA medical centers throughout my career, I provide a personal testimonial to the importance and value of that affiliation, not just to our Department 

of Medicine in Charleston, but for similar affiliated Departments of Medicine 

throughout the country. 

Clearly, the VA research program is superb in its own right. VA research focuses 

on health issues that are common to or unique among veteran patients. The VA research program is not just focused on medical discoveries, or the generation of new 

medical knowledge, treatment options, or diagnostic strategies. VA research focuses 

also on translating this knowledge into improved patient care. The VA Research 

Program is a potent enabler for VA and Academic Medical Centers in facilitating 

recruitment of superior physician clinical researchers. The VA Research Program, 

being completely intramural and available only to VA employed staff, provides a 

special and incremental source of funding that allows VA investigators additional 

options for successful funding, especially in the current budgetary milieux, where 

even non-VA research dollars are somewhat scarce. VA Research, in collaboration 

with its academic affiliates, generates a halo effect facilitating recruitment of outstanding physicians who themselves do not do research. The presence of VA’s superb 

research activities, and excellent collaboration with Academic Medical Centers, creVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00034 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
31

ates a culture of inquiry and innovation that has the additional effect of attracting 

the best practicing physicians. With this academic affiliation, VA is able to recruit 

scarce subspecialties to work in VA Medical Centers, such as physicians who are 

expert in cardiology, GI and liver disease, and medical oncology. Stability in VA research, and until recently, reasonable annual growth in the VA Research Program 

have also contributed to the retention of a cadre of superb VA physicians and physician researchers. To be clear, the presence of VA’s research program raises the 

standard of medical care and improves the quality of care delivered to our veteran 

patients. 

In our own community, the Department of Medicine at MUSC and the Charleston 

VA Medical Center collaboration has produced tremendous success in acquiring NIH 

research funding, in addition to VA research support, for illnesses important to veterans. Sustained funding in the area of cardiovascular disease, kidney disease, diabetes, and psychiatric illness has helped us address many medical problems that are 

common in veterans and non-veterans alike. For example, in the area of cardiovascular diseases, heart failure is one of the most frequent causes of hospitalization 

and premature death among veterans. A VA/MUSC based research program focused 

on understanding heart muscle dysfunction and heart muscle disease was initially 

awarded to VA and Medical University based investigators in 1993. This major NIH 

program project grant has been continuously funded since then and will continue 

through 2008. The grant is the second longest continuously funded major heart research project funded by the National Heart Lung and Blood Institute, and the principle researchers are faculty and staff at the Medical University and VA, respectively. The research is conducted in a shared VA MUSC state-of-the-art research facility. This research opportunity has permitted the tripling of cardiology physicians, 

over the grant period of time. While there is a national shortage of highly qualified 

heart specialists, the Medical University and Charleston VA Medical Center have 

not experienced such a shortage. The research funding available to these collaborating investigators exceeds $3 million per year, and nearly $18 million in total 

funding over all years of the current grant cycle. This collaborative research effort 

between the Medical University and VA has led to significant research success for 

a major clinical problem. The research has also facilitated the recruitment, retention 

and stabilization of a group of medical specialists that is currently in short supply 

nationally. As I said earlier, the collaboration between the VA and the University, 

and the availability of VA research funding, have permitted both institutions to 

achieve success out of proportion to what either could have achieved alone. In my 

opinion, the other key beneficiaries of such a successful affiliation are veteran patients who receive excellent medical care from superb doctors who care for their illnesses, and in addition, these investigators conduct research that promises new 

therapies in the future. 

One of the key features of this growth and success between our two affiliated 

medical centers was the joint construction in 1996 of new, state-of-the-art clinical 

and laboratory research facilities, named the Strom Thurmond and Peter Gazes Biomedical Research Center. This excellent research facility, now in its tenth year, provides nearly 120,000 square feet of state-of-the-art research space. The initial cost 

of this research building was $31 million with subsequent renovations costing $12 

million over the past decade. Because of the close and productive affiliation between 

our state supported medical school and the federally supported Department of Veterans Affairs Medical Center, we were able to create a state and Federal partnership which facilitated the building of modern research facilities, which improved the 

infrastructure for both partners and greatly facilitated additional high quality faculty recruitment. Unfortunately, few such examples of successful partnering and 

planning between state and Federal institutions exist, especially now when resources are scarce! 

There are other examples of tremendous success within the context of this one 

academic partnership between the Charleston VA and the Medical University of 

South Carolina. Kidney disease, infectious diseases, cancer, diabetes, and other medial illnesses benefit greatly from the affiliation between an Academic Medical Center and a VA Medical Center. The affiliation arrangement results in improved faculty recruitment, improved research opportunities and infrastructure, and as mentioned previously, improved retention of excellent physicians and scarce specialists. 

In addition, and historically, the VA has focused efforts on training future physician researchers, and in this regard serves its clinical, research and education missions simultaneously. The VA research program offers a strong attractant for recruitment of young physician researchers. The VA’s research career development 

program provides excellent and stable support for new physician researchers during 

the most vulnerable period of their careers, the initial startup phase. In the mean 

time, these VA Research Career Development awards winners provide superb medVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00035 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
32

ical care to veterans, and often bring the interest and expertise of their Academic/

University mentors to an engagement with other VA programs. 

Given such a superb track record of achievement, and with all the opportunities 

created by the affiliation between VA and the Academic Health Centers, the current 

Administration budget recommendation is especially disappointing in that it would 

result in an actual reduction of $13 million in the VA research appropriation, from 

the current level of $412 million to $399 million. This will have a deleterious effect 

for VA supported physician researchers and a loss of many new initiatives. And this 

deleterious funding climate will also do harm to the VA/Academic affiliations, as opportunities will be reduced for both! While the research infrastructure in Charleston, which culminates in an excellent partnership between a state supported institution and a Federal entity, is adequate now, such is not the case nationally. Much 

like the VA’s hospital facilities are aging and deteriorating, the same applies for its 

research infrastructure. Furthermore, the difficulties with the VA research infrastructure extend beyond buildings, laboratories, and the customary bricks and mortar. VA needs resources to update expensive research equipment. The VA also is 

suffering from a lack of non-facility infrastructure. VA is having increasing difficulty 

supporting its network of clinical trials centers, and may also have difficulty supporting its outstanding centers in Outcomes (or Health Services) and Rehabilitation 

Research. With a decrementing budget, the VA will have difficulty sustaining its excellence in translational research, which focuses on the transfer of research knowledge into clinical practice to improve patient care. The current research budget does 

not permit even secure support of ongoing studies. If the budget for research decreases, the competition for grants will escalate, so meritorious proposals will not 

be funded, and the newest physician researchers will be especially disadvantaged 

and could be lost from the research pool permanently. The research training that 

is so critical to the VA and the academic community would also be diminished as 

VA loses research resources—VA would lose the ability to fund research career development awards. 

The VA is an attractive partner with the academic community because the missions of patient care, medical research and medical education are shared and mutually supported. If VA must choose to retreat from its commitment to excellence in 

research, decrement its training opportunities, or continue to have its infrastructure 

deteriorate it will become more problematic to achieve future success together. If VA 

investment in these critical missions is diminished, another casualty of that diminution in research resources will be the highly successful Academic and VA affiliation. 

Other groups such as the Friends of VA Medical Care and Health Research 

(FOVA) have made recommendations for both research funding and for separate 

funding for the VA research infrastructure. In the context of the overall budget for 

the Department of Veterans Affairs, additional funding for research seems like a 

necessary and valid additional investment given the tremendous downstream returns, and given VA’s important role as a partner with Academic Medical Centers. 

Mr. Chairman, with regard to this Committee’s responsibilities, I was gratified to 

note in your Majority Views and Estimates report to the Budget Committee earlier 

this year that you recommended VA research be augmented for fiscal year 2007 by 

an additional $30 million, bringing its total to $429 million. Senator Akaka made 

a similar recommendation. This bipartisan support by the Veterans’ Affairs Committee for VA research is deeply appreciated by those of us who are engaged in 

these pursuits. I hope I can speak for the entire Academic/VA research community 

in thanking you and urging you to persuade Senate and House Appropriators to follow your lead. 

Mr. Chairman, at some point, someone has to decide to make an investment in 

the VA’s future by repairing VA’s deteriorating research infrastructure. VA, in conjunction with its Academic partners, operates dozens of substantial research laboratories. It saddens me to say that most of them need major renovations and some 

need complete replacement. But year in, year out these laboratories’ needs do not 

draw any significant funds from VA’s major or minor construction accounts. Those 

accounts are exclusively reserved for VA patient care and other projects. To complicate matters further, since 1989 NIH has refused to fund any facility-related costs 

in its VA-based grants. Some of the VA’s research and education foundations have 

supported the VA research laboratories, but frankly, with very few exceptions, they 

do not have the depth of funding resources to continue doing this in general. Please 

remember that an investment in VA’s research program, whether in direct funding 

or infrastructure improvement, counts twice, in a way, as it both strengthens VA 

research and also enhances the half-century of excellent affiliation and partnership 

between the VA and some of the country’s finest academic institutions. While the 

dollars are difficult, I am sure, and recognizing there are many competing needs, 

33

this one is an especially good investment that the Congress can make in support 

of veterans’ health for today, and into the future. 

Thank you, Mr. Chairman. I would be pleased to answer any questions you or 

other Committee Members wish to ask. 

RESPONSES TO WRITTEN QUESTIONS SUBMITTED BY HON. LARRY E. CRAIG

TO JOHN R. FEUSSNER, M.D. M.P.H. 

Question. ‘‘As past director of the national VA research program, what were the 

unmet needs in VA’s laboratories, how did you try to address them, and what is 

your assessment of those needs today? Do you have any recommendations for the 

Committee in dealing with those needs?’’

Answer. The intramural research program in the Department of Veterans Affairs 

is conducted in laboratories in VA Medical Centers nationwide. These laboratories 

must be equipped and maintained to meet standards for physical and operational 

infrastructure in order to ensure the efficient operation of laboratories and animal 

facilities, and to maximize the protection of personnel, experimental animals, the 

public and the environment. Many VA Medical Centers do not provide sufficient or 

appropriate space to investigators because of either a shortage of laboratory space 

or deficiencies in the quality of space. There is a serious risk that an aging and inadequately maintained research infrastructure will become an impediment to recruitment of the ‘‘best and brightest’’ clinician scientists to VA facilities. 

In 2001–2002 the VA research program compiled a list of thirty (30) priority sites 

requiring research infrastructure improvements. These needed improvements 

ranged from minor construction or renovation of ‘‘wet’’ laboratories, construction of 

new research structures and other capital improvements. The list of thirty sites is 

contained in an official VA report filed in the Office of Research and Development. 

An important observation of this process was that research space in the majority 

of the minority sites could be adequately renovated as ‘‘minor renovation,’’ or for approximately $4 million/site. The VA’s medical research appropriation cannot be expended for capital improvements, therefore available support from the research office alone has been limited. VA has no other designated funding stream for improving, renovating, or updating research facilities. 

In addition to these construction costs, the second unmet need that VA research 

has is a sustainable source of funding for equipment purchases or modernization. 

Again, any funding for research equipment, especially expensive, technologically sophisticated equipment must come from the same funds that support individual research grants. 

As there is no current mechanism for supporting research infrastructure needs, 

I was unable to address the issue of remodeling wet lab facilities or building new 

facilities. In the summer of 2001, we initiated discussions with the House Veterans 

Affairs Committee and had reached a mutual agreement that the only strategy for 

improving VA research infrastructure, and addressing this problem systematically 

through time, was to create a new line appropriation for research construction similar to the line for construction of medical care facilities in the medical care appropriation. The chairman of the House Committee at the time was Congressman 

Christopher Smith, but our plans and recommendations were hi-jacked by events occurring on September 11, 2001. 

Fundamentally, the VA study that was done and discussed with the House Veterans Affairs Committee was comprehensive and robust. This was done with the intention that Congress might to address these serious shortcomings on an incremental basis over a multi-year period. Our initial request in 2001 was for approximately $40–45 million/year as a new line item appropriation. As I reported in my 

congressional testimony, ‘‘at some point in time somebody has to make a decision 

to make an investment in the VA’s future by repairing the VA’s deteriorating research infrastructure.’’ Given that this matter has garnered little attention over the 

past 5 years, I am sure that the situation has deteriorated further. 

I do have several recommendations for the Committee in dealing with these 

needs. First, the Committee could charge the Office of Research and Development 

in VA to update the previous VA research report cataloging the unmet needs for 

research construction and facilities modernization. I would estimate that such an activity should take no more than 90 to 120 days. The Committee could compare the 

original report and the new report, where VA would again prioritize its facilities 

needs in terms of minor construction or new facility construction. I would estimate 

that if the Congress would create a new line item for VA research facilities construction of approximately $40–50 million per year, VA would be able to refurbish and 

upgrade its thirty (30) most pressing infrastructure problems in as little as 2 years. 

34

In addition, the Committee could direct that any construction funds not allocated 

for renovation and remodeling of existing facilities should be applied to modernization with replacement of state-of-the-art research equipment. 

Finally research facility construction is a separate and serious challenge. And as 

you recall, the joint facility built in Charleston in 1996 cost $31 million a decade 

ago. Individual research buildings constructed in multiple locations would probably 

cost upwards of $50 million per building with 2006 dollars. I would recommend that 

if the Congress wishes to fund selected new construction, that the VA could request 

matching monies in a joint venture effort with the affiliated research universities. 

Several areas in need of serious research construction in 2002 were the Pittsburgh 

VA (affiliated with the University of Pittsburgh); the Los Angeles VA (affiliated with 

UCLA); the VA Puget Sound (affiliated with the University of Washington); the 

Philadelphia VA (affiliated with the University of Pennsylvania); the Iowa City VA 

(affiliated with the University of Iowa) and the Nashville VA (affiliated with Vanderbilt University) as several examples. New construction is fundamentally more expensive and challenging than renovations, and I would recommend the renovations 

proceed first. 

As you already know Mr. Chairman, the VA research is superb in its own right. 

The affiliation between Department of Veterans Affairs and research universities 

benefits VA in ways that are numerous and recognizable to VA leadership. As the 

VA’s research infrastructure continues to deteriorate, the VA will become a less viable and less attractive site for new physician specialists who wish to develop a research career. Any progress that this Committee can make in this critically important area of medical care and biomedical research will greatly benefit current and 

future generations of veterans. Given the stellar performance of VA research in the 

past, this investment will inevitably return superior dividends to all Americans. Mr. 

Chairman, I can not thank you enough for your persistent interest in this important 

issue and your unflagging support for veterans’ needs.

Chairman CRAIG. Doctor, thank you very much. 

Now we turn to Dr. John Kennedy. Welcome. 

STATEMENT OF JOHN I. KENNEDY, JR., M.D., PROFESSOR,

DEPARTMENT OF MEDICINE, UNIVERSITY OF ALABAMA AT 

BIRMINGHAM, BIRMINGHAM VA MEDICAL CENTER,

BIRMINGHAM, ALABAMA; ON BEHALF OF THE ALLIANCE 

FOR ACADEMIC INTERNAL MEDICINE 

Dr. KENNEDY. Good morning, Mr. Chairman and Senator Akaka. 

I am honored to be here today. As you know, I am a professor of 

medicine at the University of Alabama at Birmingham. I am proud 

to tell you that I spend the majority of my professional time at the 

Birmingham VA where I hold the positions of Associate Chief of 

Staff for Acute and Subspecialty Care and Chief of the Medical 

Service there. I am also a funded investigator, and I take care of 

patients. I am testifying today, however, on behalf of the Alliance 

for Academic Internal Medicine, so I want to thank you again for 

providing me the opportunity to testify about VA research. 

I am here today to tell you that the VA research program works, 

but as you know, it also faces important challenges. My examples 

of its success will come from my local experience in Birmingham, 

but the Nation is replete with similar stories. 

We have many successful research programs in our center. I 

want to highlight two of the large multi-investigator programs. The 

first is VA’s Birmingham Atlanta Geriatrics Research unit, or 

GRECC. In their research, 22 GRECC investigators focus on genitourinary disorders, mobility in older patients, and palliative care. 

Work of these GRECC investigators has led to the development of 

a new palliative care program with an inpatient unit in Birmingham where veterans nearing the end of life receive compassionate care from specially trained, multidisciplinary teams. The 

35

VA’s research support of the GRECC has also leveraged funds from 

other sources. In fiscal year 2005, two-thirds of the GRECC’s total 

research funding came from sources outside of VA. However, without the VA’s initial investment in the GRECC, none of this would 

have materialized. 

The Deep South Center on Effectiveness at the Birmingham VA 

is another excellent example of VA’s research successes. This center’s mission is to improve health care for veterans and the Nation 

through partnerships in effectiveness research. Some highlights of 

this center’s success include a joint effort with UAB to develop programs to educate providers about bioterrorism; examining new approaches for the treatment of PTSD, as you know an important 

concern both for current and newly returning veterans; and innovative uses of the electronic health record combined with Internet to 

support providers in community-based outpatient clinics as they 

care for patients after heart attacks. 

Now, despite these successes of the VA research program, AAIM 

has concerns for its future. The lack of growth in program funding, 

as you have heard, is particularly troubling to us all. A flat budget 

sends messages to young clinician-scientists that hard times are 

ahead and that research may not be the career for them. Over the 

past 4 years, a time of level funding in our center, the number of 

funded investigators has decreased by 30 percent and the entry of 

new investigators has dropped dramatically. Senior researchers 

with a history of sustained funding have found it increasingly difficult to obtain continued funding in VA. Gaps in support lead to 

losses of technicians and other key personnel and seriously erode 

the momentum of the research effort. Faced with these ongoing 

problems, some physicians from our center have left VA. As a result, our ability to recruit and retain the highly skilled specialists 

needed to care for our complex patient population is seriously compromised. 

AAIM thanks the Committee and its leadership for its ongoing 

support of the research programs. As a member of FOVA, AAIM 

supports the $460 million appropriation for the VA research program in fiscal year 2007. I cannot overstate how important growth 

to the program will be given the likely difficulties in increasing the 

overall Federal support for research in the coming year, despite 

your best efforts. 

AAIM’s second specific concern is VA’s research infrastructure. 

As you have heard, modern scientists need modern facilities in 

which to conduct their research. I have heard countless stories 

from all across the country about difficulties in upgrading ventilation and electrical systems. These basic needs are absolutely critical. More investment in core facilities to house essential research 

tools will be required for VA to move into the future of research 

where it most deservedly belongs. AAIM encourages you to consider 

the development of a designated authority for funding VA research 

infrastructure. 

The Alliance’s final concern pertains to the distribution of VA’s 

scarce research resources. The successes I have reported to you inherently result from the intramural structure of the research program, which assures that these investigators are also available as 

clinicians and educators. The other inherent element of the proVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00039 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
36

gram is peer review, the process through which the very best research can be identified and priorities for funding can be determined. AAIM encourages this Committee to lead efforts to retain 

these valuable aspects of the program and to strengthen VA research as it serves today’s and tomorrow’s veterans. 

Again, thank you for the opportunity to appear today. I look forward to your questions. 

[The prepared statement of Dr. Kennedy follows:]

PREPARED STATEMENT OF JOHN I. KENNEDY, JR., M.D., PROFESSOR, DEPARTMENT OF

MEDICINE, UNIVERSITY OF ALABAMA AT BIRMINGHAM, BIRMINGHAM VA MEDICAL

CENTER, BIRMINGHAM, ALABAMA; ON BEHALF OF THE ALLIANCE FOR ACADEMIC

INTERNAL MEDICINE

Good morning Mr. Chairman and Members of the Committee. My name is John 

Kennedy, and I am a Professor of Internal Medicine and Residency Site Director at 

the University of Alabama at Birmingham. I spend the majority of my professional 

time at the Birmingham VA Medical Center where I hold the positions of Associate 

Chief of Staff for Acute and Subspecialty Care and Chief of the Medical Service. I 

am testifying today, however, in my role as a leader of the Association of Program 

Directors in Internal Medicine and on behalf of the Alliance for Academic Internal 

Medicine. 

Thank you for providing me the opportunity to testify about the successes of and 

challenges to the VA medical and prosthetics research program. Internists represent 

roughly 50 percent of all VA researchers and conduct bench research, clinical research, and health services research in all the specialties of internal medicine. 

These specialties range from the primary care field of general internal medicine to 

rheumatology, gastroenterology, and cardiac electrophysiology—as well as my own 

field of pulmonary and critical care medicine—to name a few. Internists have also 

been at the forefront of providing excellent leadership to the VA research program, 

and I must take this opportunity to thank my fellow internists here today, Drs. 

Feussner, Perlin, and Kupersmith, for their vision and management of the program. 

I am here today to tell you that the VA research program works but faces challenges. My examples of this success will come from my local experience, but the Nation is replete with similar stories. 

My first example of the success of the program is VA’s Birmingham/Atlanta Geriatrics Research, Education, and Clinical Center, or GRECC. The GRECC employees 

22 core VA personnel at the two VA medical centers. In their research, the GRECC 

investigators focus on genitourinary disorders, mobility, and palliative care, studying such topics ranging from sarcopenia, or loss of muscle, to driving issues among 

older veterans. Among the results reported by investigators from the GRECC in 

2005 were studies showing that daytime exercise and bladder control strategies 

were more effective than medication in controlling the need to urinate at night and 

studies documenting the important aspects of team functioning that yielded functional improvements for stroke patients. 

Of course, the GRECC investigators are also clinicians and educators in the two 

facilities. Notable among their clinical accomplishments has been the development 

of a palliative care program at the facility in Birmingham, well-recognized among 

the best in the Nation if not the world. Approximately 25 percent of all patients hospitalized at the Birmingham VA Medical Center are seen by palliative care consultants who address their needs for relief of suffering of all types and assist with development and implementation of directives for future care and at the end of life. This 

work has ultimately led to the opening of a new 10-bed inpatient palliative care unit 

in our medical center where veterans nearing the end of life can receive compassionate care from a multidisciplinary team trained to address their particular needs 

and those of their families. 

On the education front, GRECC educators have been successful in raising over $2 

million in the last year alone to improve the training medical practitioners receive 

in caring for elderly patients, a critical area for education given America’s aging 

population. The GRECC has also reached out to the community with its VA Teacher 

Ambassador Training Program, a VISN recognized effort to honor veterans. 

In addition to these programmatic accomplishments, VA research support has 

worked in this case by leveraging funds from other sources. In fiscal year 2005, the 

GRECC had a total of more than $35 million in research funding. Of this total, $9.9 

million came from VA while $25.8 million came from outside funding sources. This 

group of researchers has proven to be highly productive and able to successfully 

37

compete for funding in every sphere. However, without VA’s investment in the 

GRECC, it is hard to see how any of these results would have materialized. 

The Deep South Center on Effectiveness at the Birmingham VA Medical Center 

is another excellent example of VA’s research successes. The Center is funded as 

a VA Research Enhancement Award Program, or REAP. The Center’s mission is to 

improve healthcare for veterans and the Nation through partnerships in effectiveness research. The Center develops strategies to change provider practice patterns 

using evidence-based interventions to improve the quality of care for veterans, and 

it uses VA’s extensive data bases to promote improved care by establishing links between direct patient care and population-based analyses. The Center includes 35 investigators and 14 FTE support staff. 

One of the reasons this Center is a success for VA research is because it has 

forged strong liaisons with the University of Alabama at Birmingham. In one linkage, the Center has undertaken a research project to assess the effectiveness of bioterrorism preparedness education among health care practitioners. This project directly ties in with the work of the UAB Center for Biodefense and Emerging Infections. Through the affiliation with UAB, several VA researchers also participate in 

major national research initiatives such as Coronary Artery Risk Development in 

Young Adults, or CARDIA. Utilizing the CARDIA data base, these VA researchers 

recently published their important new findings identifying a link between secondhand smoke exposure and glucose intolerance, a precursor of diabetes. This function 

of the academic affiliation strengthens both the VA and UAB, improving their research efforts and the care provided to veterans and other patients. 

The Center is also a success in that it is a platform for research efforts with possible effects on both the Nation’s current veteran population as well as the veterans 

returning from Afghanistan and Iraq. For instance, the Center is planning a study 

of atypical antipsychotic medications in post-traumatic stress disorder, while at the 

same time studying best practices for hernia repair and improving intermediate outcomes in veterans with diabetes. 

Finally, the Center is a success in utilizing VA as an excellent laboratory for 

projects that aim to improve care for veterans. The Center’s recently funded VA MI+ 

study seeks to understand and increase provider adherence to clinical practice 

guidelines for post-heart attack patients. The study integrates the VA electronic 

health record system and its community based outpatient clinics, or CBOCs, to 

achieve this goal. No other health system in the United States could serve as well 

as VA as a setting for this study. 

Despite the successes of the VA research program, AAIM has concerns for its future. 

The lack of growth in program funding, particularly the Administration’s long 

standing reluctance to incorporate increases for the program in its budget proposal, 

is particularly troubling. A flat budget sends messages to young clinician-scientists, 

as well as established investigators, that hard times are ahead and that research 

may not be the career for them. Over the past 4 years, during which overall research funding to our VA medical center has remained relatively flat, the number 

of funded investigators has decreased by 30 percent and the entry of new investigators has dropped dramatically. Mid-level and senior researchers with a prior history 

of sustained funding, and active funding from NIH and other sources, have found 

it increasingly difficult to obtain research funding in VA. Several of our physicianinvestigators have had to resubmit grant proposals up to four times before obtaining 

funding. During such gaps in support, the momentum of the research effort is seriously eroded. One investigator working in HIV reported that 60 percent of the lab’s 

personnel departed during such a gap. Faced with these ongoing problems, physicians from our medical center in the specialties of nephrology, gastroenterology, and 

pulmonary diseases have abandoned efforts to obtain future research funding from 

VA. As a result, our ability to recruit and retain the highly skilled specialists needed to care for our complex patient population is compromised. 

AAIM thanks the Committee for its support of the program in your views and estimates letters. The Alliance also thanks Senator Craig and Senator Akaka for their 

sponsorship of the Dear Colleague letter to appropriators. As a member of the 

Friends of VA Medical Care and Health Research coalition, or FOVA, AAIM supports a $460 million appropriation for the VA research program in fiscal year 2007. 

I cannot overstate how important growth to the program will be given the likely difficulties in increasing overall Federal support for research in the coming year, despite your best efforts. 

AAIM’s second specific concern for the future of the program is VA’s research infrastructure. Modern scientists need modern facilities in which to conduct research. 

I have heard countless stories from AAIM members across the country about difficulties in upgrading ventilation and electrical systems. These basic needs are critVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00041 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
38

ical. The precision equipment required for modern research programs, such as 

genomics, will require precise control of the laboratory environment. The advanced 

computer systems and high-tech equipment that will support this work will absolutely demand consistent, uninterrupted supply of electrical power. More investment 

in core facilities to house essential research tools, such as mass and NMR spectrometers, advanced microscopy, robotics and computer equipment, will be required for 

VA to move into the future of research where it most deservedly belongs. AAIM encourages you to consider the development of a designated authority for funding VA 

research infrastructure. 

The alliance’s final concern pertains to the distribution of VA’s scarce research resources. The successes outlined in my statement inherently result from the intramural structure of the research program. In most cases, VA funded investigators 

must have at least a 5/8ths appointment. This structure assures these same investigators are available as clinicians and educators in the VA, vital roles for caring 

for the veteran population. The other inherent element of the program is peer review, the process through which the best research can be identified and prioritized 

for funding. AAIM encourages this Committee to lead efforts to retain these valuable aspects of the program and strengthen VA research as it serves today’s and 

tomorrow’s veterans. 

Again, thank you for the opportunity to appear today. I look forward to your questions.

Chairman CRAIG. Dr. Kennedy, thank you very much, and to all 

of our panelists, thank you. 

Let me ask a question specific of you, Dr. Stevens, because of the 

size of the facility in Boise compared with, I think, your peers who 

are here and are dealing with probably university settings and a 

larger type of research setting. And then I want to ask a series of 

questions that I think all of you might want to react to. 

Dr. Stevens, I understand that you specialize in the area of infectious diseases. Can you briefly describe the range of research activities that are underway at your facility? 

Dr. STEVENS. Yes, sir. We have done basic science research in 

gram-positive bacteria, such as Group A strep, Staph. aureus, Clostridium perfringens, gas gangrene, and we have investigated how 

these toxins really cause destruction of limbs, and how they cause 

shock, in an effort to try to explain why with battlefield injuries, 

for example, people lose arms and legs in a matter of hours. And 

so we have defined the important toxins for many of these organisms and have actually, in collaboration with Porton Down in 

great Britain, developed a vaccine to prevent gas gangrene, at least 

in animal models. 

We also have done clinical studies with hepatitis C, and I am 

happy to say that for genotype II and III, we have been able to cure 

95 percent of veterans that have hepatitis C that are non-genotype 

I. 

We have also done clinical studies with HIV, and we have investigated mechanisms of actions of antibiotics and defined some better ways to treat gram-positive infections that are associated with 

toxins, like toxic shock syndrome. 

Chairman CRAIG. What strategies have been effective in maximizing the research funds for your relatively small-scale type program? 

Dr. STEVENS. Well, I think collaborations. You know, we don’t 

have a critical mass of people there to collaborate with, but we 

have been able to collaborate with people from all over the world 

that have similar interests. So I think collaboration is one. Partnerships with pharmaceutical companies in terms of clinical trials as 

well as investigation-initiated research projects are also important. 

39

We have worked with the various universities that I mentioned to 

try to improve collaboration and to try to develop joint graduate 

school programs. And I think those are the things that are kind of 

in their infancy but we are very excited about and moving forward 

and I think trying to develop a critical mass there in Boise. 

Chairman CRAIG. Gentlemen, to all of you, you bring with you 

a wide range of perspectives from regionally diverse VAs, major 

medical schools, and from academic clinical experiences. If we are 

to move forward toward enhancing VA’s university collaboration in 

the area of research, your views would certainly be welcome in all 

of these discussions. 

Can any of you comment, or would you, on the degree of opportunity you see in the joint operation of a VA university research 

space? Do you foresee certain obstacles that the Committee should 

be aware of in these kinds of relationships? 

Dr. FEUSSNER. Well, Senator, I would be happy to take that 

question since we currently operate a joint research facility between the VA and the medical university. 

I think the obstacle, the operative obstacle is finding the original 

startup capital to create the facilities. In our case, it was a joint 

venture not between public and private partners but between Government partners. The Federal Government contributed dollars, 

the State of South Carolina contributed dollars, and the medical 

university financed the rest. 

We share 120,000 square feet of research space. The investigators experience no barriers. The VA administrative office is actually 

housed in the research building. If anything, the sharing, in my 

opinion, facilitates collaboration. It gets the researchers out of their 

silos and gets them to collaborate with one another. In our case, 

two major program project grants initially seeded by VA research 

dollars, funded to our investigators, one in cardiovascular disease, 

continuously funded now for almost 15 years, and another one in 

diabetes, a program project funded by the NIH. And both those 

major grants, the investigators for the most part are both VA and 

university faculty. 

So I think the real barrier, the operative barrier, is getting the 

initial startup capital to make the investment happen. 

Dr. WRIGHT. I could provide a slightly different perspective on 

that in southern Connecticut. We are very fortunate to be in a community with a large research-oriented medical school. The challenge that we face is that our facility is 4 miles away from Yale, 

and so it is difficult to co-occupy a single facility. In the efforts that 

we have made in working with the school we have found that the 

school, with its view on its own concerns, is most interested in facilities that are immediately on the campus. 

As Dr. Kennedy said, that the VA-appropriated funds provide the 

core support or the initiating support, is either in projects or in 

capital funding, that then enable the VA to make other funds materialize. In our experience, without adequate appropriated funding 

support directed at the VA, the VA has great difficulty in attracting the additional funds, which in our case is two-thirds of our 

funding. 

Chairman CRAIG. Dr. Kennedy. 

40

Dr. KENNEDY. Mr. Chairman, I would just agree with my colleague Dr. Feussner that I think the major obstacle is the capital 

to fund these buildings. But sort of going at a different perspective 

from Dr. Wright, I think there is a tremendous opportunity in 

those settings, as in Birmingham, where the VA and the university 

are in very close proximity, immediately adjacent to one another, 

and there are other such arrangements where the proximity is not 

an issue, and these are tremendous opportunities for joint efforts 

for space and other activities. 

So, again, on a positive note, seeking out opportunities, I think 

this is one. 

Chairman CRAIG. Thank you very much. 

Senator Akaka. 

Senator AKAKA. Thank you very much, Mr. Chairman. 

Dr. Stevens, you detailed the success researchers have in areas 

such as cardiology, oncology, and infectious diseases. However, 

these are programs that are facing the real funding cuts. Is it not 

possible for VA researchers to work on service-connected research 

and concurrently on diseases facing all Americans? 

Dr. STEVENS. Well, thank you for that question, Senator Akaka. 

I agree with you. I think that there are many priorities for research within the veteran population, and I think that there should 

be basic research and clinical research and outcomes research in 

the areas of cardiovascular disease, oncology, et cetera. Those 

things all affect veterans as well. I don’t think it should just be 

limited to war-type injuries, although in my own case we have 

spent a lot of time trying to solve some of the infectious disease 

problems from some of those cases. 

So I do not want to cutoff my nose to spite my face here, but, 

on the other hand, I think that it should be a broad base. 

Senator AKAKA. You also mentioned in your testimony about the 

growth of need for services in Idaho, and in 10 years you went from 

10,000 to almost double, which is 19,000, and also the problem of 

recruiting for new positions because of this kind of growth, which 

make it so important that we got some of these shifts in emphasis. 

Dr. Kennedy, your testimony discusses the fact that in some 

cases, VA research is funded more from outside sources than from 

Federal funding. For example, the GRECC, or Geriatrics Research, 

Education Clinical Center, received a total of $35 million last year; 

only $9.9 million was from VA funds. Outside funding then is vital 

in the program’s success. 

You have cited the lack of growth in program funding as a concern. Can you, Dr. Kennedy, describe how continued lack of funding will impact recruitment and retention of new clinician scientists? And would more VA funding for programs such as GRECC 

perhaps minimize attrition of researchers and continue to encourage outside funding? 

Dr. KENNEDY. Thank you, Senator Akaka. That is a wonderful 

question. 

As you point out, this investment that you make in VA research, 

as all the testimony has alluded to today, is a tremendous bargain 

and the yield is phenomenal. So I do not know any other investment where you get a two-for-one return on investment in the 

41

short term. And this is in the grand scheme of the Federal budget 

not a huge amount of money. 

That said, I can tell you specific examples in Birmingham where 

we have lost physicians. We were the only facility in our network 

to employ a full-time neurosurgeon, who was a basic science investigator, who lost funding and left VA. We have senior faculty, as 

I have mentioned already, who have become very discouraged. 

Some have gone through four cycles of repeat submissions in order 

to gain continued funding after long periods of successful funding. 

They have become very discouraged, and some have left the VA, 

gone back solely into the university. This is a major impact for me 

as the Chair of Medicine trying to staff the wards and the clinics 

to provide the specialists that we need there. 

This research avenue is the critical one to help us recruit such 

people. Even as the pay bill, we hope, brings the pay up to competitive levels, that alone will not be sufficient, in my opinion, to keep 

this steady supply of highly trained specialists in VA. 

Senator AKAKA. Well, thank you, Mr. Chairman. If I may proceed 

to another question? 

Chairman CRAIG. Please. 

Senator AKAKA. Because of the shift of emphasis, I would like to 

hear what your feelings about this. My question goes to each of 

you. As experienced researchers, I do not have to tell you about the 

value of maintaining a vital peer review process. From my vantage 

point, we have seen an increase in earmarks in the case of sending 

VA dollars outside of VA to other entities. Now, my question to you 

is: Is the peer review process as vital as we need it to be? 

Dr. STEVENS. Thank you, Senator Akaka. I would to take a shot 

at that, if I may. 

I think the peer review process is absolutely vital to a healthy 

competitive research program, and I think the VA’s central office 

has just done a marvelous job in the peer review program over the 

years. And I think it is impartial. I think it gives money to the best 

grants, the best people. And I think they do a wonderful job in that 

respect. 

I think as you have pointed out, as you have both pointed out, 

the research money that is allocated is, in my opinion, inadequate 

and it has been inadequate for a long time. The peer review process 

is excellent, but when the funding level gets down, it is devastating. And it takes an awfully good researcher to be able to compete with everyone else in the world when the funding level is 10 

percent or even 15 percent. That is a destructive level. The funding 

level of grants’ approval rate has got to be higher than that. 

You know, you would not want to just allow 20 percent to the 

VAs throughout the Nation to have research programs. That is 

what it boils down to. 

So I think that the peer review process is excellent. It is necessary. But, believe me, it weeds out very good people when the 

funding level gets too low. 

The other thing that is, I think, related to the question of funding in the VA system is the amount of the award. And 10 or 15 

years ago, I think the maximum was $150,000 per year for a merit 

review. It is now $125,000 a year maximum. And so, you know, 

within inflation and the cost of equipment and salaries, that is not 

42

a lot of money. I mean, we are very grateful. We are very grateful 

for it. But everything else in the world has grown. The awards for 

a merit review have actually decreased in total amount for those 

people that are successful. And I think at a small VA like I am, 

I think this is devastating. But I think it is equally devastating for 

large programs such as in our VISN, the University of Oregon, 

Portland VA, the Seattle VA. It is devastating for them as well. 

Senator AKAKA. Dr. Wright. 

Dr. WRIGHT. Senator, if I may, extend that briefly with our experience: I have heard people compare the peer review system to democracy. I think people have said about democracy that it is painful and it can be messy and it is difficult. The peer review system 

is like that also, but like democracy, we think it is the best way 

to do it. 

I can give an example from our recent experience this year. 

When the funding level of available funds to divide up by peer review is in this 10- to 15-percent range, that does not necessarily 

mean that 85 or 90 percent of the applications are not worthwhile. 

In fact, I was very disappointed this year when one of our new potential recruits, a woman who I taught as a medical student sometime ago, and who has now been through residency and fellowship 

training and graduate training and is ready to embark on her own 

research career did not receive VA funding. My understanding is 

she came in about fifth out of 25 applicants in the last round and 

will have to reapply for funding. So she will be treading water with 

us and trying to conduct her research. She wants very much to stay 

at the VA and be a clinician and an investigator. 

Senator AKAKA. Dr. Feussner. 

Dr. FEUSSNER. Yes, Senator. I do not think the power of your 

question can be understated, and if we start by saying what my 

colleagues have already said, that the start point is a situation 

where research resources are precious and scarce, the peer review 

process promotes very strong very rigorous science, very rigorous 

research methods, and it provides an opportunity for accountability 

of how the research dollars are spent. 

You might say that bypassing that process in a period of scarce 

resources cheats hard-working scientists who are participating in 

the research process, who go through this rigorous review with perhaps a front-end opportunity of being succeeded one in five, or 20 

percent. So I think activities that bypass this process are—I should 

not say reprehensible, but are unfortunate. And I would commend 

the VA. The VA has a rigorous peer review process. It has for decades. It emulates the peer review process of other major biomedical 

Federal funders like the National Institutes of Health, to a degree 

the NSF. 

Senator AKAKA. Dr. Kennedy. 

Dr. KENNEDY. I would just echo those comments from my colleagues and point out that in this time of scarcity, any constraint, 

any further constraint on funding does indeed discourage particularly young investigators, and that interrupts severely the pipeline 

as we send those people away from VA and perhaps away from research careers altogether, then we face a gap, a significant gap in 

time before replacements will be available, people trained and able 

to begin to initiate new research initiatives. 

43

So that is a key element. This is really a vital investment. This 

program cannot be sustained without steady and predictable funding. 

Senator AKAKA. Thank you, Dr. Kennedy. 

Thank you for the time, Mr. Chairman. 

Chairman CRAIG. Well, gentlemen, we will end on that note. I 

think that was an excellent wrap-up, Senator Akaka, that question, 

and all of your responses to it. I think it demonstrates obviously 

the value of the research dollar, and we have certainly known over 

the years, as we brought money into NIH and other areas and 

bumped those up, the level of research, the types of research programs underway and the findings that are now pouring out as it 

relates to human health and human health-related problems. And 

certainly VA has played and will continue to play a role in that, 

and I think that is why 62 of us joined together to express our concern as to a bump-up in these research dollars and at least sustaining a progressive level of increase instead of cuts. It remains 

critical, and we will continue to push to assure that happens. 

So, gentlemen, again, thank you for coming. Thank you for your 

time and your insight. As we continue to work on these issues, we 

will be back to you to question you and to ask for your advice as 

we move along. 

Thank you very much. The Committee will stand adjourned. 

[Whereupon, at 11:47 a.m., the Committee was adjourned.] 

(45)

A P P E N D I X 

DEPARTMENT OF VETERANS AFFAIRS’ MEDICAL AND

RESEARCH PROSTHETICS RESEARCH PROGRAM. 

Hon. KAY BAILEY HUTCHISON, Chairman, 

Hon. DIANNE FEINSTEIN, Ranking Member, 

Subcommittee on Military Construction and Veterans 

Affairs Committee on Appropriations, 

U.S. Senate, 

Washington, DC. 

DEAR CHAIRMAN HUTCHISON AND RANKING MEMBER FEINSTEIN: We strongly urge 

the Appropriations Subcommittee on Military Construction and Veterans Affairs to 

demonstrate this Nation’s commitment to its veterans for the Department of Veterans Affairs’ Medical and Prosthetics Research program. 

The Administration’s proposed fiscal year 2007 budget for the direct costs of VA 

research is $399 million, a $13 million cut from the current year’s level of $412 million. The proposed level of direct funds does not keep pace with inflation and will 

compel VA to cut numerous projects. Therefore, we support a fiscal year 2007 funding level of $432 million, in order to cover inflation, sustain current VA research 

and development commitments, and allow critical new research initiatives to move 

forward. 

If enacted, the proposed cuts to the VA research budget will result in the loss of 

96 research projects in valuable areas such as diabetes, cancer, aging, heart disease, 

and 286 full-time. employees (FTE) are projected to lose their jobs. Further, given 

that participation in VA’s top-notch research program is a major factor in recruiting 

physicians to VA, the research program must be provided the necessary funds to 

attract and retain quality clinical staff. 

Another point to take into account is that the nature of modem warfare and battlefield medicine has resulted in servicemembers coming home with wounds that 

would have been fatal in previous wars. Many wounded servicemen d women are 

in need of prosthetic limbs, extensive physical therapy, or have endured traumatic 

brain injuries. With thousands of military personnel engaged in service overseas, it 

is vital that Congress invest in research that could have a direct impact on their 

post-deployment quality of life. 

VA research programs have been instrumental in developing innovative and effective methods of treatment since World War II, making landmark contributions to 

the welfare of veterans and the entirety of the Nation. Past VA research projects 

have resulted in the first successful liver transplant performed in the U.S., development of the cardiac pacemaker, and pioneering the concepts that led to the CT scan. 

VA research also has played a vital role in treating tuberculosis, rehabilitating blind 

veterans, and more recently, in launching the largest-ever clinical trial of psychotherapy to at PTSD. For the last 60 years, VA research has been extremely competitive with its private sector counterparts. 

Today, VA’s research program continues to remain appropriately focused. In 2004, 

VA research took on leadership of a $60 million nationwide study- funded by the 

Nation& Institute on Aging and other partners—to identify brain changes linked 

with Alzheimer’s disease. VA research, in partnership with Brown University and 

MIT, established a major center of excellence to develop state-of-the-art prosthetics 

for veteran amputees. In June 2005, US. News & World Report called VA hospital 

care ‘‘the best around.’’ The important role VA research played in this transformation of the VA medical care system cannot go overlooked; its innovations improved the overall quality and delivery of VA health care for years to come. 

Keeping this distinguished record of success in mind, we ask you to further support VA research by ensuring that an appropriate level of funding continues for this 

program. These funds must be at a level that accounts for inflation, new and 

46

daunting challenges, and most importantly, enables VA to remain attractive option 

to our best and brightest in medicine. Adequately funding VA’s Medical and Prosthetics Research Program is vital to maintaining our commitment to veterans.

Signed by,

SENATORS CRAIG, AKAKA, SALAZAR, JOHNSON, ROCKEFELLER, KENNEDY, BURNS, 

JEFFORDS, SPECTER, LEAHY, MURRAY, LEVIN, LAUTENBURG, BAUCUS, BINGAMAN, 

OBAMA, ENSIGN, STABENOW, CLINTON, DEWINE, MIKULSKI, ALLEN, CONRAD, 

INOUYE, DORGAN, BOND, BOXER, SARBANES, PRYOR, DODD, SANTORUM, KOHL, 

DURBIN, SNOWE, KERRY, ISAKSON, ROBERTS, COLEMAN, NELSON, GRAHAM, 

MENENDEZ, LOTT, HAGEL, DAYTON, BIDEN JR., TALENT, CANTWELL, LANDRIEU, 

SCHUMER, CARPER, LIEBERMAN, LINCOLN, FEINGOLD, CRAPO, THUNE, WYDEN, 

DOLE, BURR, HARKIN, REED, MURKOWSKI, AND NELSON. 

PREPARED STATEMENT OF FRIENDS OF VA MEDICAL CARE AND HEALTH RESEARCH

The Friends of VA Medical Care and Health Research (FOVA) member organizations thank both the House and Senate Committees on Veterans Affairs for their 

views and estimates with regard to fiscal year 2007 funding for the VA Medical and 

Prosthetic Research program. Their recommended increases, ranging from least $28 

million up to $51.5 million over the Administration’s budget request for the VA research program, affirm their ongoing support for our Nation’s veterans. We also 

thank the many Senators that co-signed Chairman Larry Craig’s and Ranking Member Daniel Akaka’s Dear Colleague letter to Senators Kay Bailey Hutchison and 

Diane Feinstein, the Chair and Ranking Member of the Military Construction and 

Veterans Affairs Appropriations Subcommittee, urging an fiscal year 2007 appropriation of $432 million for the VA Medical and Prosthetic Research program. 

FOVA is a diverse coalition of 86 national academic, medical, and scientific societies; voluntary health and patient advocacy groups; and veterans service organizations, all committed to high quality health care for veterans. We appreciate the opportunity to submit a statement today regarding the role of the VA Medical Research and Prosthetics Research program in attracting and retaining physicians, 

and we urge your support for an fiscal year 2007 appropriation of $460 million so 

that this success may continue. 

THE ROLE OF VA RESEARCH IN THE RECRUITMENT AND RETENTION OF PHYSICIANS

VA Medical Care 

The mission of the Veterans Healthcare System is ‘‘to serve the needs of America’s 

veterans by providing primary care, specialized care, and related medical and social 

support services.’’ The Veterans Health Administration (VHA) operates one of the 

largest comprehensive, integrated health care delivery systems in the United States. 

Organized around 21 Veterans Integrated Service Networks (VISNs), VA’s health 

care system includes 154 medical centers and operates more than 1,300 sites of 

care, including 875 ambulatory care and community-based outpatient clinics, 136 

nursing homes, 43 residential rehabilitation treatment programs, 206 Veterans Centers, and 88 comprehensive home-care programs. 

More than 5.3 million unique patients received care in VA health care facilities 

in 2005. That same year, VA inpatient facilities treated 587,000 patients and VA’s 

outpatient clinics registered nearly 57.5 million visits. VHA has experienced unprecedented growth in the medical system workload over the past few years. The number of patients treated increased by 29 percent from 4.1 million in 2001. In fiscal 

year 2007, VHA estimates it will care for almost 5.5 million veterans. 

The VA health care system had 7.7 million veterans enrolled to receive VA health 

care benefits as of October 2005. To help VA manage health care services within 

budgetary constraints, enrolled veterans are placed in priority groups or categories. 

Unfortunately, with limited resources, VA has had to restrict the number of priority 

8 veterans—higher-income veterans suffering from conditions not related to their 

service—who can receive VA care. 

Despite limiting access of enrolled veterans, a significant backlog of delayed appointments has resulted from an inadequate supply of clinical physicians. While the 

VHA has made commendable improvements in quality and efficiency, the Independent Budget veterans service organizations cite excessive waiting times and 

delays as the primary problem in veterans’ health care. Without increases in clinical 

staff, veterans’ demand for health care will continue to outpace the V’s ability to 

supply timely health-care services and will erode the world-renowned quality of VA 

medical care. 

47

Physician Shortage 

The Council on Graduate Medical Education (COGME), a national advisory body 

that makes policy recommendations regarding the adequacy of the supply and distribution of physicians, predicts that if current trends continue, demand for physicians will significantly outweigh supply by 2020. With the VA already struggling to 

meet the needs of our Nation’s sick and disabled veterans, the looming physician 

shortage poses a serious threat to VA’s ability to competitively recruit and retain 

the physicians who wi11 be critical to its future success. 

VA Medical and Prosthetic Research Program 

To accomplish its aforementioned mission, VHA acknowledges that it needs to 

provide ‘‘excellence in research,’’ and must be an organization characterized as an 

‘‘employer of choice.’’ The VA Medical and Prosthetic Research program is one of the 

Nation’s premier research endeavors and attracts high-caliber clinicians to deliver 

care and conduct research in VA health care facilities. The VA research program 

is exclusively intramural; that is, only VA employees holding at least a five-eighths 

salaried appointment are eligible to receive VA awards. Unlike other Federal research agencies, VA does not make grants to colleges and universities, or to any 

other non-VA entity. As such, the program offers a dedicated funding source to attract and retain high-quality physicians and clinical investigators to the VA health 

care system. This in turn ensures that our Nation’s veterans receive state-of-theart health care. 

VA currently supports 5,143 researchers, of which nearly 83 percent are practicing physicians who provide direct patient care to veteran patients. As a result, 

the VHA has a unique ability to translate progress in medical science directly to 

improvements in clinical care. 

Academic Affiliations 

The affiliations between VA medical centers and the Nation’s medical schools 

have provided a critical link that brings expert clinicians and researchers to the VA 

health system. As stated in seminal VA Policy Memorandum No. 2 published in 

1946, the affiliations allow VA to provide veterans ‘‘a much higher standard of medical care than could be given [them] with a wholly full-time medical service.’’ At 

present, 130 VA medical centers have such agreements with 107 of the 126 

allopathic medical schools. This represents 84 percent of the 154 VA medical centers. These long standing affiliations with the academic health care community are 

a major factor in ensuring quality care for U.S. veterans and represent a model 

partnership between the Federal Government and non Federal institutions. 

Over six decades, these affiliations have proven to be mutually beneficial by affording each party access to resources that would otherwise be unavailable. It would 

be difficult for VA to deliver its high quality patient care without the physician faculty and residents that are available through these affiliations. In return, the medical schools gain access to invaluable undergraduate and graduate medical education opportunities through medical student rotations and residency positions at 

the VA hospitals. Faculty with joint VA appointments are afforded opportunities for 

research funding that are restricted to individuals designated as VA employees. 

These faculty physicians represent the full spectrum of generalists and specialists 

required to provide high quality medical care to veterans, and, importantly, they include accomplished sub-specialists who would be very difficult and expensive, if not 

impossible, for the VA to obtain regularly and dependably in the absence of the affiliations. According to a 1996 VA OIG report, about 70 percent of VA physicians 

hold joint medical school faculty positions. These jointly appointed clinician-investigators are typically attracted to the affiliated VA Medical Center both by the challenges of providing care to the veteran population and by the opportunity to conduct 

disease-related research under VA auspices. 

FISCAL YEAR 2007 APPROPRIATIONS FOR THE VA MEDICAL AND PROSTHETIC RESEARCH

FOVA recommends an fiscal year 2007 direct research appropriation of $460 million for VA medical and prosthetic research and development. Investments in investigator-initiated research projects at VA have led to an explosion of knowledge that 

is advancing the understanding of disease and unlocking strategies for prevention, 

treatment, and cures. The complexity of research, combined with biomedical research inflation, has increased the cost of research. Biomedical research inflation 

alone, estimated at 5.5 percent for fiscal year 2005 and projected at 4.1 percent for 

fiscal year 2006, has reduced the purchasing power of the VA Research appropriation by $22.7 million and $16.5 million respectively for a total impact of $39.2 million over just 2 years. In the absence of commensurate increases, VA is unable to 

sustain important research on diabetes, hepatitis C, heart diseases, stroke and subVerDate 0ct 09 2002 15:34 Jan 29, 2007 Jkt 000000 PO 00000 Frm 00051 Fmt 6601 Sfmt 6621 H:\RD41451\DOCS\28559.TXT SENVETS PsN: ROWENA
48

stance abuse while also addressing emerging needs for more research on post traumatic stress disorder and long-term treatment and rehabilitation of veterans with 

polytraumatic blast injures. Additional funding is needed to take advantage of burgeoning research opportunities within the VA to improve quality of life for our veterans and the Nation as a whole. 

Administration’s Budget Recommendation 

The Administration’s fiscal year 2007 budget request includes $399 million for the VA Medical and Prosthetic Research program, a $13 million (3.2 percent) reduction 

from the final fiscal year 2006 appropriation of $412 million. These VA research 

funds provide direct support for research projects as well as the salaries of non-clinician investigators. 

FOVA members are deeply disappointed with the Administration’s budget request 

and note that if enacted, it will have significant adverse consequences for the VA 

research program. In its budget summary, the VA anticipates that this $13 million 

reduction will result in the elimination of 82 investigator-initiated programs, 15 special research initiatives, and 7 multi-site research projects. Furthermore, the department would reduce the number of VA’s direct research employees by 286. 

In fiscal year 2007, VA expects to increase funding for studies of acute and traumatic injury as well as central nervous system injury and related disorders. However, to fund these new studies with a shrinking budget, VA projects cuts to research in aging, cancer, infectious diseases, kidney diseases, diabetes, lung disorders, and heart diseases, among others. In other words, VA is proposing to rob 

Peter to pay Paul. 

As in prior years, the Administration’s fiscal year 2007 budget includes projections for VA research spending from the VA medical services appropriation. This 

‘‘medical care support’’ is slated for a $13 million increase, from $353 million in fiscal year 2006 to $366 million in fiscal year 2007. While this increase might seem 

to offset the proposed cut to direct research funding, the medical care support allocation does not directly support research projects. As the budget submission indicates, this allocation funds ‘‘facility costs of heat, light, telephone, and other utilities 

associated with laboratory space; the administrative cost of human resource support, fiscal service, and supply service attributable to research; research’s portion of 

a medical center’s hazardous waste disposal and nuclear medicine licenses; and, 

most importantly, the time clinicians devote to their research activities.’’

The VA budget also includes non-VA funding sources among the lines of support 

for VA research. The budget optimistically projects a $13.24 million increase (from 

$662 million in FY 2006 to $675 million in fiscal year 2007) in other federally funded research conducted at VA, funds that have primarily come from the National Institutes of Health (NIH). 

However, the Administration’s fiscal year 2007 budget for the NIH is flat, making 

it highly unlikely that VA will enjoy significant growth in NIH-funded research 

grants. 

Though the Administration’s projections of private contributions for VA research 

have been inflated in previous years, the VA budget anticipates a reasonable $4 million increase for fiscal year 2007 (from $204 million in fiscal year 2006 to $208 million in fiscal year 2007). This funding comes from industry for support clinical trials 

as well as foundations and other non-profit entities to support a variety of research 

projects. 

Programmatically, the VA research budget includes plans for two special research 

projects to begin in fiscal year 2007. The first project focuses on the special needs 

of service personnel returning from Operation Iraqi Freedom and Operation Enduring Freedom. The project envisions wide ranging research efforts, including posttraumatic stress disorder and other mental health issues; amputation and prosthetics research; and returning personnel reentry and reintegration. A second special project would focus on genomic medicine. The thrust of this project is to link 

veterans’ genetic information with the VA electronic health record. According to the 

budget submission, ‘‘The goal is to develop genetic assessments that will potentially 

enable ‘mass customization’ of medical treatment.’’ These new projects necessitate 

additional funding over FY 2006 levels plus an accommodation for biomedical research inflation if VA is to continue pre-existing endeavors as well implementing 

these new initiatives. 

The coalition wholeheartedly supports the vision to expand the VA research program to encompass the needs of service personnel returning from current conflicts, 

whether they include polytrauma, massive burn injury, or mental conditions. Such 

expansion of the program requires new resources so VA’s other research areas, 

which are equally important to the care of large numbers of veterans, do not languish in the meantime. 

49

Earmarks and Designation of VA Research Funds 

The members of FOVA oppose earmarking the VA research appropriation because 

they jeopardize the strengths of the VA Research program. VA has well-established 

and highly refined policies and procedures for peer review and national management of the entire VA research portfolio. Peer review of proposals ensures that VA’s 

limited resources support the most meritorious research. Additionally, centralized 

VA administration provides coordination of VA’s national research priorities, aids in 

moving new discoveries into clinical practice, and instills confidence in overall oversight of VA research, including human subject protections, while preventing costly 

duplication of effort and infrastructure. 

VA research encompasses a wide range of types of research. Designated amounts 

for specific areas of research compromise VA’s ability to fund ongoing programs in 

other areas and force VA to delay or even cancel plans for new initiatives. While 

Congress certainly should provide direction to assist VA in setting its research priorities, earmarked funding exacerbates resource allocation problems. FOVA urges 

Congress to preserve the integrity of the VA research program as an intramural 

program firmly grounded in scientific peer review. These are principles under which 

it has functioned so successfully and with such positive benefits to veterans and the 

Nation since its inception. 

VA Research Infrastructure 

State-of-the-art research requires state-of-the-art technology, equipment, and facilities. Such an environment promotes excellence in teaching and patient care as 

well as research. It also helps VA recruit and retain the best and brightest clinician 

scientists. In recent years, funding for the VA medical and prosthetics research program has failed to provide the resources needed to maintain, upgrade, and replace 

aging research facilities. Many VA facilities have run out of adequate research 

space, and ventilation, electrical supply, and plumbing appear frequently on lists of 

needed upgrades along with space reconfiguration. Under the current system, research must compete with other facility needs for basic infrastructure and physical 

plant improvements which are funded through the minor construction appropriation. 

FOVA appreciates the attention the Appropriations Committee gave to this problem in the House Report accompanying the fiscal year 2006 appropriations bill (P.L. 

109–114), which expresses concern that equipment and facilities to support the research program may be lacking and that some mechanism is necessary to ensure 

the Department’s research facilities remain competitive. It noted that more resources may be required to ensure that research facilities are properly maintained 

to support the Department’s research mission. 

To ensure that funding is adequate to meet both immediate and long term needs, 

FOVA recommends an annual appropriation of $45 million in the minor construction budget dedicated to renovating existing research facilities and additional major 

construction funding sufficient to replace at least one outdated facility per year until 

the backlog is addressed. 

Again, FOVA appreciates the opportunity to present our views to the Committee. 

While research challenges facing our Nation’s veterans are significant, if given the 

resources, we are confident the expertise and commitment of the physician-scientists 

working in the VA system will meet the challenge. 

Administrators of Internal Medicine 

Alliance for Academic Internal Medicine Alliance for Aging Research 

American Academy of Child and Adolescent Psychiatry 

American Academy of Neurology 

American Academy of Orthopaedic Surgeons 

American Association for the Study of Liver Diseases 

American Association of Anatomists 

American Association of Colleges of Nursing 

American Association of Colleges of Osteopathic Medicine 

American Association of Colleges of Pharmacy American 

Association of Spinal Cord Injury Nurses 

American Association of Spinal Cord Injury Psychologists and Social Workers 

American College of Chest Physicians 

American College of Clinical Pharmacology 

American College of Physicians

50

American College of Rheumatology 

American Dental Education Association 

American Federation for Medical Research 

American Gastroenterological Association 

American Geriatrics Society 

American Heart Association 

American Hospital Association 

American Lung Association 

American Military Retirees Association 

American Occupational Therapy Association 

American Optometric Association 

American Osteopathic Association 

American Paraplegia Society 

American Physiological Society 

American Podiatric Medical Association 

American Psychiatric Association 

American Psychological Association 

American Society for Bone and Mineral Research 

American Society for Pharmacology and Experimental Therapeutics 

American Society of Hematology 

American Society of Nephrology 

American Thoracic Society 

Association for Assessment and Accreditation of Laboratory Animal Care 

International 

Association for Research in Vision and Ophthalmology 

Association of Academic Health Centers 

Association of American Medical Colleges 

Association of Professors of Medicine 

Association of Program Directors in Internal Medicine 

Association of Schools and Colleges of Optometry 

Association of Specialty Professors 

Association of VA Chiefs of Medicine 

Association of VA Nurse Anesthetists 

Blinded Veterans Association 

Blue Star Mothers of America 

Clerkship Directors in Internal Medicine 

Coalition for Heath Services Research 

Digestive Disease National Coalition 

Federation of American Societies for Experimental Biology 

Gerontological Society of America 

Gold Star Wives 

Hepatitis Foundation International 

International Foundation for Functional Gastroenterological Disorders 

Juvenile Diabetes Research Foundation International 

Legion of Valor of the USA, Inc. 

Medical Device Manufacturers Association 

Medicine-Pediatrics Program Directors Association 

Military Officers Association of America 

National Alliance on Mental Illness 

National Association for the Advancement of Orthotics and Prosthetics 

National Association for Uniformed Services 

National Association of VA Dermatologists 

National Association of VA Physicians and Dentists 

National Association of Veterans’ Research and Education Foundations 

National Mental Health Association 

Nurses Organization of Veterans Affairs 

Osteogenesis Imperfecta Foundation 

Paralyzed Veterans of America 

Paralyzed Veterans of America Spinal Cord Research Foundation 

Partnership Foundation for Optometric Education 

Society for Investigative Dermatology

51

Society for Neuroscience 

Society for Women’s Health Research 

Society of General Internal Medicine 

Spinal Cord Research Foundation 

The Endocrine Society 

United Spinal Association 

Veterans Affairs Physician Assistant Association 

Veterans of the Vietnam War and the Veterans Coalition 

Vietnam Veterans of America

Æ