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87–670 2015

U.S. DEPARTMENT OF VETERANS AFFAIRS BUDGET 

REQUEST FOR FISCAL YEAR 2015 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

THURSDAY, MARCH 13, 2014 

Serial No. 113–57 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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


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COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida, Vice-Chairman 

DAVID P. ROE, Tennessee 

BILL FLORES, Texas 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

PAUL COOK, California 

JACKIE WALORSKI, Indiana 

DAVID JOLLY, Florida 

MICHAEL H. MICHAUD, Maine, Ranking 

Minority Member 

CORRINE BROWN, Florida 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

ANN KIRKPATRICK, Arizona 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

JON TOWERS, Staff Director 

NANCY DOLAN, Democratic Staff Director 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 


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C O N T E N T S 

Page 

Thursday, March 13, 2014 

U.S. Department of Veterans Affairs Budget Request for Fiscal Year 2015 ......

OPENING STATEMENTS 

Hon. Jeff Miller, Chairman ..................................................................................... 1 

Prepared Statement ......................................................................................... 34 

Hon. Michael Michaud, Ranking Minority Member ............................................. 2 

Hon. Corrine Brown 

Prepared Statement ......................................................................................... 35 

WITNESSES 

Hon. Eric K. Shinseki .............................................................................................. 4 

Prepared Statement ......................................................................................... 35 

Accompanied by: 

Hon. Robert A. Petzel, MD, Under Secretary for Benefits, Department of Veterans Affairs 

Hon. Allison A. Hickey, Under Secretary for Benefits, Department 

of Veterans Affairs 

Hon. Steve L. Muro, Under Secretary for Memorial Affairs, Department of Veterans Affairs 

Ms. Helen Tierney, Executive in Charge for the Office of Management and Acting Chief Financial Officer Department of Veterans 

Affairs 

and 

Mr. Stephen Warren, Executive in Charge for Information and Technology, Office of Information, Department of Veterans Affairs 

MATERIALS SUBMITTED FOR THE RECORD 

Paralyzed Veterans of America .............................................................................. 45 

Veterans of Foreign Wars fo the United States .................................................... 49 

Disabled American Veterans .................................................................................. 51 

Statement of Diane M. Sumatto, Director of AMVETS ........................................ 58 

The American Legion .............................................................................................. 61 


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U.S. DEPARTMENT OF VETERANS AFFAIRS 

BUDGET REQUEST FOR FISCAL YEAR 2015 

Thursday, March 13, 2014 

U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS’ AFFAIRS, Washington, D.C. 

The committee met, pursuant to notice, at 10:00 a.m., in Room 

334, Cannon House Office Building, Hon. Jeff Miller [chairman of 

the committee] presiding. 

Present: Representatives Miller, Lamborn, Roe, Flores, Runyan, 

Benishek, Huelskamp, Coffman, Walorski, Michaud, Brown, 

Takano, Brownley, Titus, Kirkpatrick, Negrete-McLeod, Kuster, 

O’Rourke, and Walz. 

OPENING STATEMENT OF CHAIRMAN, JEFF MILLER 

The CHAIRMAN. Good morning, everybody. I want to welcome 

each and every one of you here this morning to our hearing on the 

President’s fiscal 2015 budget request for the Departments of Veterans Affairs. 

Mr. Secretary, we are glad to have you back with us here in the 

room. I appreciate your attendance and that of your entire leadership team. 

We have only had a short time to review the details of the budget request, so I am sure that we will likely have some follow-up 

questions after the hearing. And as usual, I would ask for you and 

your folks’ cooperation in trying to get the answers to those questions to us as quickly as possible. 

You know, in a fiscal climate that has seen budget cuts all the 

way to the bone, funding for our veterans has emerged as an obvious priority for both the Administration and the Congress. For 

that, I commend you for your leadership and fighting to ensure 

that veterans of this country remain a priority. 

I also want to commend VA on the operation of its veterans’ crisis line. I have heard some really positive feedback in the most recent days. Paul Rieckhoff was testifying in the joint hearing over 

in the Senate and your statement that roughly 35,000 men and 

women have been rescued from suicide because of VA’s intervention, it is the rough equivalent of two army divisions. And certainly 

that speaks for itself and is a great success. So with that, we say 

keep up the good work. 

I have listened carefully in the last few weeks to testimony from 

a whole myriad of veteran service organizations who testified before our committees regarding the need to improve timely delivery 

of mental healthcare, to not only ensure that healthcare is delivered in state-of-the-art facilities, and to sustain VA’s progress in reducing the backlog that exists out there, but also making sure that 


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we have timely decisions and accurate decisions on the backlog of 

claims that exist out there. 

When I look at this $163.9 billion budget request, I am left wondering why we cannot do better than we are in some areas. I think 

it is fair to say that Congress has supported nearly every request 

that the Administration has asked for when it comes to our veterans, yet I think we can all acknowledge that serious problems 

still exist within the system. 

Although it is nice to see a steady downward trend in the backlog 

over the last year, what I am hearing from veteran service organizations and veterans themselves is that VA is sacrificing accurate 

decisions for fast decisions and that it is falling behind on appeals. 

With the record funding provided in this area over the last decade both in manpower and in technology, it is frustrating, I think, 

to all of us to continue to hear some of those same complaints. 

And I am also concerned about continued inspector general and 

media reports regarding preventable deaths at a number of VA facilities across the country. I know that VA is not infallible, but serious, even deadly mistakes merit swift and clear accountability. 

I know you believe as I believe and we are ready to work with 

you and your agency to give you any of the tools that you need in 

order to get the job done. 

I am going to follow-up on this last issue in questioning, but I 

am troubled with what appears to be a common practice with VA’s 

budget submissions of late. And that is to identify based on updated information excess funds that are no longer necessary, then 

redirecting those funds toward initiatives that were budgeted and 

appropriated in advance at a lower level. For example, VA overestimated by about $700 million what it 

needs for long-term care resources in fiscal year 2015, but now the 

agency wants to redirect all of that money and more towards its 

homeless initiatives, facility activations, and other needs. In fact, notwithstanding the overestimation of $700 million, VA now seeks a supplemental budget for fiscal year 2015 of $368 million. Needless to say, I think this practice needs further discussion. 

Mr. Secretary, these are just a couple areas I would like to address with you this morning. In the interest of time, however, I am 

going to recognize the ranking member for his opening statement. 

[THE PREPARED STATEMENT OF CHAIRMAN JEFF MILLER APPEARS

IN THE APPENDIX] 

OPENING STATEMENT OF MICHAEL MICHAUD, RANKING 

MINORITY MEMBER 

Mr. MICHAUD. Thank you very much, Mr. Chairman, for holding 

this hearing. 

And thank you, Mr. Secretary, and the panel for being here this 

morning as well. 

Mr. Secretary, I would like to begin by noting that in your written statement, you applaud, and I quote, ‘‘Congress’s foresight,’’ 

end of quote, in providing for advanced appropriation for the Department of Veterans Affairs’ healthcare budget. 

This committee is again trying to show that foresight in looking 

down the road and providing advanced appropriation authority for 


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the remaining 14 percent of the Department of Veterans Affairs’ 

discretionary budget. 

As you know, H.R. 813, Putting Veterans’ Funding First Act of 

2013, would give the Department of Veterans Affairs a certain and 

stable budget. It would also implement some vital planning and 

programming provisions. 

You have seen firsthand how valuable these can be. Help us help 

you and the veterans you serve by coming out today in support of 

H.R. 813. 

This morning, we are discussing the budget for fiscal year 2015 

and 2016. Mr. Secretary, two of the VA’s top three goals have due 

dates in 2015, eliminating veterans’ homelessness and eliminating 

the disability claims backlog. 

My question to you and a perspective is, I believe that we should 

take in regard to this hearing is, does this proposed budget provide 

the Department of Veterans Affairs with all the resources needed 

to meet both of these goals in 2015? If not, now is the time to let 

us know what you need to meet both those goals. 

I have been a champion, as you know, of improving access, especially for rural veterans, since I first came to Congress in 2003. As 

such, your third goal of improving veterans’ access to benefits and 

services is of special interest to me. 

Today I hope to receive some assurance that the Department of 

Veterans Affairs is pursuing new technologies, infrastructure, and 

construction management process that will increase access to all 

veterans. 

And, finally, in December, the Department of Veterans Affairs 

issued a final rule granting a presumption for certain illnesses relating to traumatic brain injury. In the past, the Department of 

Veterans Affairs has pointed to past presumptions for leading up 

to the disability claims backlog. And today I look forward to hearing what advanced planning you are doing to ensure that this does 

not happen again when you look at presumption as it relates to 

TBI. 

And, Secretary Shinseki, this will be the sixth time that you 

have come before this committee to discuss the Department of Veterans Affairs’ budget, more times than any other previous secretary, so I applaud you for your willingness to serve as the secretary for that many years. And I want to thank you for your continued service to our veterans and to the Department of Veterans 

Affairs and to the Nation, and I look forward to your testimony 

today. 

And with that, Mr. Chairman, I yield back the balance of my 

time. 

The CHAIRMAN. Thank you very much. 

Members, at this time, I want to recognize our first and only 

panel that will be with us this morning. We are going to hear testimony from the Honorable Eric K. Shinseki, secretary of the Department of Veterans Affairs. 

Accompanying the secretary this morning is the Honorable Robert A. Petzel, under secretary for Health; the Honorable Allison A. 

Hickey, under secretary for Benefits; the Honorable Steve L. Muro, 

under secretary for Memorial Affairs; Ms. Helen Tierney, executive 

in charge for the Office of Management and acting chief financial 


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officer; and Mr. Stephen Warren, the executive in charge for Information and Technology within the Office of Information and Technology at the Department of Veterans Affairs. 

Secretary Shinseki, you are now recognized for your testimony, 

sir. 

STATEMENT OF ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY ROBERT A. 

PETZEL, UNDER SECRETARY FOR HEALTH, DEPARTMENT 

OF VETERANS AFFAIRS; ALLISON A. HICKEY, UNDER SECRETARY FOR BENEFITS, DEPARTMENT OF VETERANS AFFAIRS; STEVE L. MURO, UNDER SECRETARY FOR MEMORIAL 

AFFAIRS, DEPARTMENT OF VETERANS AFFAIRS; HELEN 

TIERNEY, EXECUTIVE IN CHARGE FOR THE OFFICE OF MANAGEMENT AND ACTING CHIEF FINANCIAL OFFICER, DEPARTMENT OF VETERANS AFFAIRS; STEPHEN WARREN, EXECUTIVE IN CHARGE FOR INFORMATION AND TECHNOLOGY, 

OFFICE OF INFORMATION AND TECHNOLOGY, DEPARTMENT 

OF VETERANS AFFAIRS 

Secretary SHINSEKI. Well, thank you, Mr. Chairman. 

Chairman Miller, Ranking Member Michaud, distinguished 

Members of the committee, thanks for this opportunity to present 

to you the President’s fiscal year 2015 budget and fiscal year 2016 

advance appropriations requests for the Department of Veterans 

Affairs. 

As the Ranking Member noted, I am working my sixth budget 

cycle with you and together we have made a lot of progress. I express our thanks from all of us at VA. We deeply appreciate your 

unwavering support for our veterans and our past five years of 

work, I think, reflects a good bit of that commitment. 

Let me also acknowledge the representatives of our Veteran 

Service Organizations who are here today. Their insights and support make us better at caring for veterans, their families, and our 

survivors. 

Mr. Chairman, thank you for introducing the members of my 

panel here, and I have a written statement which I ask to be submitted for the record. 

The CHAIRMAN. Without objection. 

Secretary SHINSEKI. Thank you, Mr. Chairman. 

The Fiscal Year 2015 budget and 2016 advance appropriations 

requests demonstrate once again President Obama’s steadfast commitment to our Nation’s veterans. His leadership and the support 

of the Congress and especially Members of this committee has allowed us for five years now to answer one of our abiding guides 

and that is President Lincoln’s charge from 149 years ago to the 

American people to care for those who shall have borne the battle, 

their families, and our survivors. 

I thank the Members for your commitment to veterans and seek 

once again your support for these budget requests. 

The President’s vision reflected in these budget requests is about 

empowering veterans to help lead the rebuilding of the middle class 

in this country much as they did following World War II through 

access to quality healthcare, benefits, training, education, and employment that enabled achieving the American dream. 


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VA’s 2015 budget request seeks $163.9 billion, $68.4 billion of 

that in discretionary funding, including medical care collections, 

and that is an increase of three percent above our 2014 enacted 

funding level. 

And the other piece of that budget request is $95.6 billion in 

mandatory funding. This budget also requests $58.7 billion for the 

fiscal year 2016 advance appropriations for medical care, an increase of $2.7 billion or 4.7 percent above the 2015 budget request 

that we are submitting today. 

This is another strong budget and your support of it is critical 

to providing veterans the care and benefits they have earned 

through their service and sacrifice. It enables VA to further the 

three significant top priorities that we have discussed budget after 

budget cycle here, and laid out for you our plans and our progress. 

The first is expanding veterans’ access to benefits and services; 

the second, eliminating the disability claims backlog in 2015; and, 

thirdly, ending Veterans’ homeless in 2015 as well. 

Since 2009, we focused the resources you have provided to address these three key priorities, among other requirements. These 

three have been the driving force behind our efforts to serve veterans better. 

And where it comes to access, I would report that more than two 

million additional veterans have enrolled in VA healthcare. We 

opened our 151st hospital, our first in 17 years, and we have increased our community-based outpatient clinics by a net of 55, 

bringing our total CBOCs today in this country to 820. 

More than a million veteran and family member students have 

received VA educational assistance and vocational training. Nearly 

90 percent of all veterans now have a burial option within 75 miles 

of their home, and our plans are to increase that to 96 percent by 

2017, so just a way ahead beyond these budget requests. 

In terms of disability claims, the backlog has declined 40 percent 

in the past 12 months. We are transitioning from paper to digital 

processing and we are on track to end the backlog in 2015. 

In terms of veterans’ homelessness, the estimated number of 

homeless veterans fell by 24 percent between 2010 and 2013 and 

we expect another reduction when this year’s point in time count, 

which was taken in January, is tallied. 

These are some of our key accomplishments. The momentum is 

up. I think we are making good progress across the board and we 

will continue to leverage every resource in these budget requests 

to do what is right for veterans. 

In closing, I would say as we have for five years now, I assure 

the committee that we will use these resources that the Congress 

provides effectively, efficiently, and with accountability to best care 

for veterans. 

So, again, Mr. Chairman, Members of the committee, thank you 

for the opportunity to appear here today and for your continued 

support of veterans. We look forward to your questions. 

[THE PREPARED STATEMENT OF ERIC K. SHINSEKI APPEARS IN THE

APPENDIX] 


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The CHAIRMAN. Thank you very much, Mr. Secretary, for your 

testimony. I am sure we all have a significant amount of questions 

that we would like to ask. 

If I can, I would like to talk about Senator Sanders’ legislation 

that he had proposed, Senate 1982, on the floor a couple of weeks 

ago, which incorporated a number of House bills that have passed 

this committee and the full House. And we have actually sent it 

over, and we await the Senate’s response. 

But like many committee Members here, I support a great number of the pieces of legislation that Senator Sanders had, but I 

would like to get your take, if you would, on some of those pieces 

that he included. 

I think it was in Section 301 of the bill that mandates the enrollment of certain Priority 8 veterans by December 31st of 2014. And 

I noted that the Administration embarked on a limited expansion 

of Priority 8 veterans being able to use VA about five years ago. 

So my question is, does the Administration support an expansion 

beyond what you have already allowed and, if so, what resources 

would be required before such an expansion could be accommodated without negatively impacting existing healthcare being provided to users within the system? 

Secretary SHINSEKI. Mr. Chairman, when we focused on Priority 

Group 8 veterans five years ago, we had a number in mind that 

established a goal, what we thought we would see join us. In many 

ways, the specific focus on Priority Group 8 veterans became somewhat less focused because many ended up in other higher categories and, therefore, were able to join us. 

And we exceeded the number of veterans we thought would be 

in this Priority Group 8 category. I think it was about 500,000 that 

was a rough target that we thought would respond incrementally 

over time. 

I would say that over the last five years, we have had over two 

million veterans join VA’s rolls for healthcare. And so while we 

have exceeded the number, a little bit of the priority group focus 

was addressed when veterans qualified for other categories. 

The CHAIRMAN. But going back to category—— 

Secretary SHINSEKI. We met the initial milestones we set. 

The CHAIRMAN. Correct. And I am just saying now if you expand 

it beyond what you had already opened up, what would the agency 

need in order to expand for all Category 8s? 

Secretary SHINSEKI. I do not know that we have made a financial 

assessment to respond to that question. 

The CHAIRMAN. Would the Administration support opening up 

for—— 

Secretary SHINSEKI. I would be happy to provide an estimate of 

what the cost might be, but I have not done that personally. 

The CHAIRMAN. And in Section 303 of the bill, it expands the 

caregiver program to all eras of veterans. And I note from a report 

from last July, I think it was, that VA says they cannot responsibly 

advise the Congress on expansion without realistic consideration of 

the resources necessary to carry out the expansion. 

In the same report, it stated that VA believes that expansion 

poses the risk of compromising resources needed for its core veteran healthcare mission. 


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So my question is, does the Administration now support this provision? 

Secretary SHINSEKI. Here again, Mr. Chairman, I think when we 

put the program together, we expected about a 3,000 population of 

caregivers that would meet the requirements of the law. Today we 

are over 13,000. And I just share that with you to understand how 

popular and how helpful this program has been. 

To the degree we can, we are interested in helping all of our 

caregivers who have responsibilities for veterans who have served 

this country, and I have an appreciation of what caregivers have 

to go through. This is a good program and I am happy to work with 

you in answering that question. 

The CHAIRMAN. And one other real quick question is, part of Senator Sanders’ bill provided dental care as well. And my question is, 

does the Administration support that provision? 

Secretary SHINSEKI. Mr. Chairman, dental healthcare is part of 

our healthcare program, so we provide dental care to veterans 

today. It is based on service connection for dental work, and so I 

would try to understand what the qualifying conditions would be. 

The CHAIRMAN. And the pilot in the legislation it is a comprehensive approach for all veterans to get all dental care provided, so it 

expands way beyond those that may have received some type of injury in their service. 

Secretary SHINSEKI. Sure. And I would say there is a way to 

work with you and also the other body to get language that makes 

sense for providing the best quality healthcare, which includes dental healthcare for our veterans. 

The CHAIRMAN. Mr. Michaud. 

Mr. MICHAUD. Thank you very much, Mr. Chairman. 

And thank you again, Mr. Secretary. 

The VA state home construction grant program priority one list 

for fiscal year 2014 lists a total of $489 million, you know, waiting 

for VA funding, projects that are waiting for funding. You have requested $80 million for this program for fiscal year 2015, $5 million 

below the 2014 levels. 

In light of the backlog of nearly $500 million in projects for fiscal 

year 2014, what do you anticipate to be the total of unfunded priority one projects for fiscal year 2015 if you indeed receive $80 million? 

Secretary SHINSEKI. Well, Mr. Michaud, we have a prioritization 

process here and this is a program that we work in collaboration 

with the states. And there may be a long list of projects that we 

see on the list. Some of them are on hold until states can generate 

their portion of the funding, which we then intend—you know, it 

is our responsibility to try to meet. 

If you have a specific state home in mind, I will try to address 

that. 

Mr. MICHAUD. Well, actually, the priority one list shows that in 

2014, a backlog of $489 million. Priority one applications are those 

that have, already have state matching funds in place. So the state 

matching funds are there. You have that huge backlog currently. 

And my only concern is you are only asking for $80 million, 

which is $5 million less than what—it is a $5 million cut from the 


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previous year. So there already is a huge backlog with state funds 

available. 

And the issue here is GAO just came out with a report that 

shows state homes provide cost-effective, long-term care for our veterans. So I have a concern with this huge backlog already out there 

with state funding available, that you are asking for less money 

than—— 

Secretary SHINSEKI. Yes. 

Mr. MICHAUD [continuing]. What you received in the previous 

year. 

Secretary SHINSEKI. Let me give you a better answer for the 

record. As I say, we work these off in priority. A good bit of work 

goes into this. I would say every now and then, we have projects 

that fall off the list because something happens and we move 

projects up. 

But no question there is a long list of things we would like to 

do. We pay for 65 percent of these projects which is a significant 

investment by the Federal Government. 

Mr. MICHAUD. Okay. Yeah, if you can get it for the record, I appreciate that. 

Secretary SHINSEKI. Right. 

Mr. MICHAUD. I also understand that non-VA care coordination 

is designed to ensure a more effective procedure to third-party billing and also oversight of the continuity of care for our veterans. 

VHA has been rolling this program out over the last year. 

Can you give a status update on non-VA care coordination initiatives? 

Secretary SHINSEKI. Let me call on Dr. Petzel to do this. 

Dr. PETZEL. Thank you, Congressman Michaud. 

VA spends approximately $6.8 billion a year on non-VA care in 

a variety of different programs. The thing that I think you are talking about directly is the approximately $5 billion that we spend on 

non-VA medical care across the country. 

And in order to provide better access for America’s veterans that 

live in rural parts of this country so that they can have care that 

is very similar to the care that you can receive in a less rural, more 

urban area, we have developed a program called patient-centered 

community care or PC3. 

PC3 provides for a standardized way of a physician asking for 

community care or a patient asking for community care, a structured referral with a very clear template for what needs to be in 

the request, and then we go to the network that has been developed by the two contractors that we have, Health Net and TriWest, 

to identify the providers within their network that can meet the 

need in whatever part of the country it might be. 

It is going to provide better access for veterans that live in rural 

America, better choices about where they go, and much more timely service. We have in the contract a number of requirements regarding timeliness, reporting, et cetera. 

To date, about 5,500 individuals have been involved with PC3, 

contracted PC3 care. It started in January with the beginning of 

the rollout. TriWest’s network and now Health Net’s network is out 

as well. 


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We expect that this is going to be an important part of reaching 

particularly specialty care into rural America for veterans that live 

in those communities. 

Mr. MICHAUD. Thank you very much. 

I yield. Thank you, Mr. Chairman. 

The CHAIRMAN. Mr. Lamborn, you are recognized for five minutes. 

Mr. LAMBORN. Thank you, Mr. Chairman. 

And thank you all for being here and for your service to our veterans. 

Last night, I had a telephone town hall meeting and one of the 

questions that came up is the impending construction of a new national veteran cemetery in southern Colorado, in El Paso County. 

I want to commend and thank Under Secretary Steve Muro for 

his hard work on this project, and veterans and active-duty folks 

are very excited that that is coming along. So I commend you for 

your contribution to southern Colorado and veterans living anywhere near there. 

That will help reach that 96 percent goal that you mentioned, 

Mr. Secretary, of people living within 75 miles of a national veteran cemetery. 

Changing subject, I was a little concerned to hear that there are 

continuing, not little, I am very concerned that there are some continuing issues with quality control over claims processing. 

And an example recently in my office back in Colorado Springs 

is a veteran who waited a year for the claim to be processed and 

then was told that he did not produce enough documentation about 

his service in Vietnam. And he had served in Korea and that was 

what his claim was based on. Now, maybe that was a typo or 

maybe it was actually a sign of inadequate claims processing. 

I know that you have a tremendous need and desire to work 

through this big backlog that we have, but I want to make sure 

that we are not sacrificing, and the chairman brought this up a 

minute ago, quantity over quality. 

How would you respond to that, Mr. Secretary? 

Secretary SHINSEKI. Let me begin and then I will turn to Under 

Secretary Hickey. 

Congressman, I will tell you that no veteran should have to wait 

for benefits and services we provide that they earned a long time 

ago. And so we are committed to making that available as quickly 

as possible. 

The other aspect of that is not going so fast that you lose control 

over the precision of getting it right. And for us, the goal is getting 

it right the first time through. Not only is that better for veterans, 

but it also improves our efficiency. Any time you have to handle 

the same claim more than once, it is an increase in workload. 

We in VA are, about one-third of us, about 100,000 of us, are veterans. And so looking after veterans’ claims issues is something we 

spend a good bit of time on. Fifty percent of VBA is veterans. And 

what you are describing is a lack of precision on a point. I would 

like to get some more details on that. 

Mr. LAMBORN. Okay. We can provide those to you. 

Secretary SHINSEKI. And I will ask Secretary Hickey to talk 

about the overall accuracy picture. 


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Ms. HICKEY. Thank you, Congressman. 

As the secretary said, our VBA employees are 52 percent veteran 

and many more are a direct family member of a veteran or a family 

member of a serving military member and all of them care deeply 

about delivering both a timely and an accurate claim decision for 

their brothers and sisters whom they have served alongside. 

Let me just tell you very quickly that our approach and method 

for determining our quality, it has both been audited and validated 

by an external agency outside of VA and has been found to be statistically sound, highly reliable not only for the defined governance 

process but also for the accuracy of the results. And it does cover 

the complete body of claims that we do across the board. 

Your budget help over the last couple of years has allowed us to 

take additional steps to improve that quality. The budgets associated with training have allowed us to stand up challenge training 

for all of our new employees. That lets us improve the skills and 

abilities of our folks. 

We have made an investment in quality review teams at the individual regional offices that have caught errors before they become 

final which is a great way to make sure that does not end up in 

a problem for our veterans. 

Also, we have begun a new process in this last year called consistency studies where we send out a scenario and we ask everybody to do the exact same scenario, and then we look at the consistency of the answers and apply direct training all the way down 

to the employee level, if necessary, to improve on the consistency 

of the responses. 

Mr. LAMBORN. Okay. I see we have run out of time and I was 

hoping I would be able to yield some additional time to my colleague from Colorado, but I cannot do that. 

So, Mr. Chairman, I yield back. 

The CHAIRMAN. Thank you very much. 

Mr. Takano. 

Mr. TAKANO. Thank you, Mr. Chairman. 

I am not sure who to direct my question to, but I presume it is 

Ms. Hickey. Is the VA working on fully completing the long-term 

solution for the Post-9/11 GI Bill claims so that automation will include original claims and supplemental claims? 

Ms. HICKEY. Thank you, Congressman, for the question. 

Long-term solution is VA’s paperless IT system that has been put 

in place to help our student veterans and their family members go 

to school in a timely way and with a high-quality accuracy decision. 

I can tell you that we have put new capability into the long-term 

solution that allows now more than 80 percent of our claims to go 

through with the benefit of automation that allows us to get those 

student veterans going to school with very quick answers and highly accurate answers. 

Right now we have actually exceeded for more than a year now 

the agency priority goals for both timeliness and accuracy for those 

student veterans. And so our long-term solution is proving its value 

for both original claims and for supplemental claims. 

Mr. TAKANO. Well, how far along are you towards completion of 

the solution and if you still have further to go, how much longer 

will it take and how much more money will it take to complete? 


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Secretary SHINSEKI. Let me ask our IT expert to address that. 

Mr. WARREN. Thank you, sir. 

Right now the system is, we have it in sustainment or in operations mode. As Secretary Hickey walked through, we build to 

what the performance goal needs are. So today it is exceeding what 

is needed. 

So as a result of our internal prioritization of resources, we move 

the IT dollars to hit what is not meeting our goals or targets we 

have set. So today we are sustaining the system. We are making 

updates to it as needed. 

But with respect to new capability, that is something that is 

probably projected for the out years because today it is doing the 

job. It is moving those claims through and, as Secretary Hickey 

talked about, tremendous amount of automation such that as soon 

as it comes in, it moves through and we are able to get the dollars 

out to those veterans so they can take advantage of that great benefit. 

Mr. TAKANO. So are you telling me that it is complete for the moment? 

Mr. WARREN. It is complete for the moment. It meets what our 

mission needs are. And if the mission needs change or if legislation 

comes in that requires more, then we would go back and re-look 

at where we placed our investments to meet those needs, sir. 

Mr. TAKANO. So you do not need additional funding at this time? 

Mr. WARREN. At this time for the goals that we set, it meets 

those goals, so we have funding needs, and appreciate your support 

for that, to continue running that system in terms of paying for the 

underlying. But with respect to new investments right now, there 

are none planned, sir. 

Mr. TAKANO. Well, I congratulate you if you have achieved your 

goals and I am pleased to hear that. 

Do you think that this budget and everything that the VA, the 

Department of Defense, and Department of Labor are doing to improve the transition process is enough, Mr. Secretary? 

Secretary SHINSEKI. Let me start and then I will call on Secretary Hickey to provide some detail. 

This program began, we have just started this program about a 

year ago. And the program is designed to take care of the transition of every servicemember leaving the military. 

The transition assistance program, which is a DoD program, has 

VA representatives as well as Department of Labor representatives 

inserted into the training that goes on for every servicemember. 

Every departing servicemember gets a departure physical, something that was not done before. And so we have a pretty good idea 

of what the needs are going to be and then the transfer of this information to VA is much better than it has ever been. 

Your question is it all that we need it to be: is what we designed, 

understanding what we thought the needs are. And we will learn 

as we execute the program, what needs to be adjusted. So we are 

still gathering data. 

DoD has just announced that they will be looking at a 

downsizing requirement which will then allow us to understand 

what our requirements are going to be for throughput and we are 

working with them right now to understand what that plan is. 


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Mr. TAKANO. If I may, and I am going to run out of time, my suggestion is that maybe servicemembers should be encouraged to 

start thinking and preparing for the transition much earlier than 

they are. 

Secretary SHINSEKI. I agree. I agree. And those are discussions 

that both VA and DoD have and understand those encouragements 

occur while they are still in uniform. And I know that is a priority 

at DoD. 

Mr. TAKANO. Thank you. 

Mr. Chairman, my time is—— 

The CHAIRMAN. Dr. Benishek. 

Dr. BENISHEK. Thank you, Mr. Chairman. 

I was looking at, you know, the overall numbers here and, you 

know, I am a little concerned about the care of our veterans and, 

you know, the medical aspect. 

What percentage of the new employees that you are planning on 

hiring will be actual medical care providers and what percentages 

are the, you know, administrative staff? 

Secretary SHINSEKI. Let me ask Dr. Petzel to discuss that. 

Dr. PETZEL. Thank you, Congressman Benishek. 

I would have to go back and look at what the plan is for these 

hires that we probably will make over the next year. I do not have 

in my mind the figure. 

But let me just relate the fact that when we underwent the mental health hiring initiative starting in March of 2012 in order to 

provide better access for veterans to mental healthcare, we hired 

what eventually turned out to be 2,400 clinical professionals in the 

six different clinical categories and about 600 administrative people 

to help support those. 

Now, whether that plays out in our entire hiring, I would have 

to go back and look. 

Dr. BENISHEK. I would appreciate to be able to see what those 

kind of numbers look like because, as you know, I am interested 

in making sure that, you know, the people—you are running an efficient program and there is more healthcare providers than there 

are, you know, clipboard carrying bureaucrats. 

Another question I have to tell you the truth is a little bit more 

about the PC3 program. You know, I have asked—I cannot remember who it was I asked about the implementation of the program 

and the amount of people that are actually going to participate. 

And I am a little concerned over the what is it going to cost the 

VA to have this intermediary. I mean, there are two contractors, 

right? Was it TriWest and Health Net are the two? They are the 

only two providers in the entire country then? 

I mean, can you tell me why that is and kind of what is the percentages that they are going to be taking of the VA’s money to just 

organize this network? 

Dr. PETZEL. Thank you, Congressman Benishek. 

There are two networks. There are literally thousands of providers around the country. We negotiated with those two organizations to basically have very close to Medicare rates for reimbursement. You cannot get anything better than that. 

They then go out and negotiate with individual providers to join 

their network. So we are expecting, quite frankly, that we are 


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going to save money over what we have spent in the past in nonVA medical care in those areas where we do use the contractors. 

Dr. BENISHEK. Well, that is my concern, you know, that they are 

going to be paying providers less than Medicare. Are you going to 

get providers to actually sign up? 

Dr. PETZEL. To date—— 

Dr. BENISHEK. Like my district, as you know, is very rural. 

Dr. PETZEL. Right. 

Dr. BENISHEK. And, you know, many of my veterans want to 

have access to, you know, multiple facilities like X-ray in Sault Ste. 

Marie rather than to drive to Iron Mountain. 

So are you going to be able to get, you know, the Sault Hospital 

to provide an X-ray when it is going to be paying them less than 

Medicare, maybe close to Medicaid rates? Are they going to want 

to join a network like that? 

Dr. PETZEL. We believe that this is going to do a better job of 

providing access across the country for veterans. So far, the networks have been very successfully set up according to the two network providers. And we have been able to—we have had about 

5,500 people actually use this and we have been able to—— 

Dr. BENISHEK. Five thousand five hundred providers or 

5,000—— 

Dr. PETZEL. No, 5,500 patients since we—we have just gotten 

started. And we have been able to meet the needs that were identified for those patients within the network. So I am expecting that 

again—— 

Dr. BENISHEK. That sounds like a very small number of patients, 

though, Dr. Petzel. 

Dr. PETZEL. Oh, it is just starting, sir, just starting. 

Dr. BENISHEK. Well, I am very concerned about this process and 

I am concerned that there is going to be a difficulty in getting 

enough outside providers. 

I understand the difficulty with the VA individually trying to 

contract providers on your own because I have been a part of that, 

you know, as a physician working for the VA and it is not easy to 

get the payment system arranged in a logical fashion. So I understand maybe the need for that intermediary, but I am just concerned about people participating in it, frankly, because of low reimbursement. 

Secretary SHINSEKI. Congressman, Dr. Petzel is our expert here 

on these things, but I would say if you look at our discussion of delivery of healthcare, this is one of the options where we try to get 

as much access to veterans in as many places as we can using the 

experience of these two networks. 

We also still have fee basis that we provide for those areas that 

do not quite fit. 

Dr. BENISHEK. Well, I guess what I would like is I would like to 

have an update to me as to how much you are actually paying. 

If you are paying these guys Medicare rates, are they taking 20 

percent of the money to provide the network to you? You understand me? And how much are we paying this intermediary to provide the care to our veterans? 

And, you know, those are tax dollars that these guys are making 

money on and they are not actually providing the care. They are 


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just signing everybody up. I just want to know how much of the 

take they are getting. 

Secretary SHINSEKI. As Dr. Petzel says, we are just getting started. We are happy to have that discussion with you. 

Dr. BENISHEK. Appreciate that. Sorry. My time is up. 

The CHAIRMAN. Ms. Brownley. 

Ms. BROWNLEY. Thank you, Mr. Chairman. 

And thank you, Mr. Secretary, for your testimony this morning. 

I remain concerned with the mental healthcare needs of our Nation’s heroes. And I know we have touched upon it this morning. 

Three weeks ago, thanks to Dr. Benishek, we had a hearing in 

Ventura County, which is the district that I represent, and discovered that the response time in Ventura County is 44 days for mental health needs as opposed to, I think the goal was a minimum 

of 14 days. 

So I am wondering, and we talked a little bit about the mental 

health initiative in terms of trying to hire more mental health professionals, so I am just wondering, you know, the VA’s plan is to 

use the budget to make sure that we are meeting the mental 

health needs of our veterans and sort of what metrics we are using 

to gauge that. 

Clearly we discovered an area within California where the response and I think the number of FTEs are below what is needed 

to meet the demand there and what is going to be done about that. 

Secretary SHINSEKI. Congresswoman, let me just say that, we all 

know that we have been at war for a decade, over a decade now, 

and the great young people we send off have done fantastic jobs 

carrying the mission load that we have given them. 

So after ten years, we ought to be very sensitive to this area that 

you talk about. And I would assure you that inside this leadership 

team and throughout VA, this is something that we work quite 

closely. It is trying to understand. First of all, it is a difficult area 

and, secondly, exactly what will work. 

And one of the metrics would be what you are talking about, the 

full-time equivalent employees. But we have done other things. We 

have in those areas where we have difficulty hiring providers, just 

because they are not available, we are challenged and we have set 

up a network where a virtual mental health connection can be 

made between an individual in that kind of a situation and the rest 

of the system where we have mental health providers, sort of a virtual mental health clinic. 

We in our work are a little bit reactive, and this is not an excuse, 

a little bit reactive because we look at who walked in for treatment 

this year and we try to adjust it for next year. We do not have a 

good metric for anticipating what next year’s load is going to be. 

We put an estimate in there, but it is less precise than we would 

like. And so we are constantly having to look at ourselves, looking 

at those access metrics you describe. 

I am going to ask Dr. Petzel to provide a little more detail here, 

but it is something we adjust over time and we are looking at how 

we sit today. 

Ms. BROWNLEY. Thank you, sir. 

Secretary SHINSEKI. Dr. Petzel. 

Dr. PETZEL. Thank you, sir. 


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It is very important to us that we are able to provide good access 

to high-quality mental health services for these people who are returning from conflict. As the secretary mentioned, multiple deployments and the stress involved in their particular circumstance 

there make them very vulnerable. 

Our fiscal year 2015 budget requests $7.1 billion to treat approximately 1.7 million patients with specialized mental health services. 

With the addition of the 2,400 people that I spoke about earlier, 

we have improved access across the country. We are not where we 

want to be yet. 

And there are places such as the Oxnard Clinic, which you and 

Dr. Benishek visited, where for new patients, we are not meeting 

our goals of providing timely access. And there are places where we 

are doing an excellent job of meeting the goals of timely access. 

We are in the process of assessing those places where we are 

having difficulty to look at what the recruitment problems are and 

what the issues might be associated with not providing timely care. 

I know specifically in Oxnard, as we have discussed, their plans 

to hire two additional psychotherapists which should be able to 

then manage the individual psychotherapy needs for both PTSD 

and depression in that clinic and provide for timely access. So we 

acknowledge the difficulties with Oxnard and also the fact that we 

are, I think, working hard to try and correct that situation. 

Ms. BROWNLEY. Thank you, sir. 

My time has run out. I yield back. 

The CHAIRMAN. Thank you. 

Mr. Coffman, you are recognized. 

Mr. COFFMAN. Thank you, Mr. Chairman. 

Secretary Shinseki, as you know, there is current litigation between the prime contractor and the VA with regards to the cost of 

construction of the Aurora VA Medical Center. The prime contractor is arguing the cost is $1.1 billion and the VA argues the 

cost is $600 million. 

Does the VA have a contingency plan if the prime contractor 

walks off the job or VA realizes a shortfall of between $400 and 

$500 million? 

Secretary SHINSEKI. Congressman, this is in litigation, so I cannot go into too much detail except to tell you that for the design 

of the Denver medical center, a contractor was brought in early to 

help with the design and it happened to be this contractor. And 

this contractor then was allowed to compete for the project and did 

and signed the contract at $604 million. And that is the contract 

we are pursuing. 

We understand that because of mutual agreement about requirements to improve on the contract that the figure has now been increased, I think, to $612 million. And this negotiation continues. 

We work with this contractor. It is our intent to do that. 

I have not heard from the contractor any indication that he is 

thinking about walking off the project. We certainly, you know, 

hope that is not the case. We are committed to funding this project. 

And I would point out, as I mentioned to you in the past, this 

project did not exist before 2009. And today there are pilings in the 

ground and it is going vertical in about five years. I think this conVerDate Aug 31 2005 11:40 Jun 12, 2015 Jkt 000000 PO 00000 Frm 00019 Fmt 6633 Sfmt 6633 Y:\87670.TXT PAT

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tract has done well. We just need to work out what is usually construction negotiation between a contractor and the government. 

Mr. COFFMAN. If the appeals court does determine that the cost 

is closer to the billion dollar figure than the $600 million that you 

have just referenced, would the VA have to ask Congress for additional appropriations to complete the project? 

Secretary SHINSEKI. I will have to see, wait and see what the figure that comes out of the appeals process nails. 

Mr. COFFMAN. That is not the question. The question is, if it is 

closer to a billion dollars, would you have to come before Congress 

for an appropriation? 

Secretary SHINSEKI. You are asking a hypothetical here, Congressman. I do not know. I will have to take a look. I have not 

heard the billion dollar figure before. 

Mr. COFFMAN. That is in the litigation. 

Secretary SHINSEKI. Well, we have not accepted all of what the 

contractor said is part of that, so—— 

Mr. COFFMAN. Thank you, Mr. Chairman. I yield back. 

The CHAIRMAN. Thank you. 

But I think the question is, if the court’s rule is that the agency 

owes an additional $400 million, would that require VA to come to 

Congress for additional funds? 

Secretary SHINSEKI. It may, but I am not going to speculate here 

today. 

The CHAIRMAN. That is not a hypothetical. That is if the court 

rules and says you owe it, I need to know, we need to know from 

an authorization—— 

Secretary SHINSEKI. We may re-prioritize other projects, Mr. 

Chairman—— 

The CHAIRMAN. I am sorry. I missed that. 

Secretary SHINSEKI [continuing]. Before I come back. Yes. 

The CHAIRMAN. Yeah. I missed—— 

Secretary SHINSEKI. We may look at re-prioritization and come to 

you for reprogramming. 

The CHAIRMAN. Reprogramming? 

Secretary SHINSEKI. Yes. 

The CHAIRMAN. But you would have to come to Congress for reprogramming or reauthorization—— 

Secretary SHINSEKI. We always do, Mr. Chairman. 

The CHAIRMAN [continuing]. Of funds? Mr. O’Rourke. 

Mr. O’ROURKE. Thank you, Mr. Chair. 

Secretary Shinseki, I would like to start out by thanking you and 

commending you for your responsiveness to me and to our office in 

the many requests that we have put before you, commend your 

team collectively and individually for their responsiveness to us. 

We do not always agree with the conclusions that members of 

your leadership team reach. For example, Mr. Muro and I have 

talked about re-grassing the Fort Bliss Cemetery which right now 

is xeriscaped and covered in essentially gravel and dirt. We would 

love that to be re-grassed. But we are working constructively with 

Mr. Muro to try to beautify what is there already and I think that 

holds true for everyone almost without exception. 


VACREP180 with DISTILLER
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I would like to go through a few of our priorities in El Paso and 

I think they pertain to national issues and to the fiscal year 2015 

budget. 

The first is expanding capacity and quality of care, primary care 

at the El Paso VHA Clinic and ultimately we need a full-service 

veterans’ hospital in El Paso. Currently when veterans need that 

kind of care, they are traveling on a 9 to 10-hour round trip to Albuquerque, New Mexico which is the closest full-service VA hospital. 

We looked at the 14-day access numbers in El Paso for the last 

year. In October, only 18 percent of the veterans who are trying to 

see a primary healthcare provider were able to get an appointment 

within 14 days. 

It has improved since then thanks to Mr. John Mendoza and his 

wonderful team of doctors, nurses, and front-line staff in El Paso, 

but it is in desperate need of improvement. 

Second is we need to improve claims’ turnaround times out of the 

Waco regional office. It did go from a peak of 470 days that the average El Paso veteran was waiting to hear back on their claim last 

year to the current number which is 288. So it is an improvement. 

It is not at 125, but we are moving in the right direction. And we 

thank Under Secretary Hickey and her team for helping us out 

with that. 

Third is the backlog on the IDES claims processing in Washington State that our wounded warriors who at the WTU at Fort 

Bliss are languishing for hundreds of days beyond when they 

should be so that they can transition out and get on with their 

lives. We would love your help with that and look forward to working with you there. 

And the fourth one, and this is where I want to ask my question 

finally, is on access to mental healthcare and to pick up on something that Congresswoman Brownley brought up. That is perhaps 

the most critical issue in El Paso and I would guess in other VHA 

centers around the country. 

When I was running for office, I was approached by a young man 

who just returned from Afghanistan, had PTSD, was using his 

Post-9/11 GI money to go to the El Paso Community College, at 

night was flipping burgers at Carl’s Jr., and said I cannot get in 

to see a mental healthcare specialist. I am supposed to be in every 

single week. I am lucky if I get in every 6 to 8 weeks. When I get 

in, it is a different counselor each time. I have no continuity of 

care. If I could pay for this myself, I would, but I cannot afford it. 

Will you help me out? 

That anecdote and others that I have heard have since been 

borne out by the statistics that we have seen. The recent SAO report puts El Paso at 118 of 128 VHAs around the country for access 

to mental healthcare. 

We surveyed our own veterans’ population and found that a 

quarter of them could not make a mental healthcare appointment 

within 1 calendar year. 

So we have been able to work with Dr. Petzel on this. He has 

made a commitment to me and to my team that by May of this 

year, we will get to that 14-day number for 90 to 95 percent of the 

population. 


VACREP180 with DISTILLER
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But my question for you, Secretary Shinseki, and for Dr. Petzel 

is, ours in El Paso, as I heard from Ms. Brownley, is not a unique 

story. What are you going to do in addition to the additional $309 

million that we are requesting in the fiscal year 2015 budget for 

mental healthcare to surge providers’ access, care, and resources to 

these desperately under-served areas where we are failing to care 

for those who have borne the battle? 

Secretary SHINSEKI. Dr. Petzel. 

Dr. PETZEL. Thank you, Mr. Secretary. 

Congressman O’Rourke, we, as you have heard me say previously, are committed to providing access to these veterans who 

have suffered these invisible wounds of war and are now living 

often for our purposes in terms of not meeting needs in relatively 

remote areas. 

And we have talked about what we are doing in El Paso. Specifically I would point out, and I think you know this, that the access 

has improved rather substantially since that survey that you did 

with your constituents. 

What we have done there is, number one, hired up to the ceiling 

that they have, 80 mental health professionals. And number two is 

that we provided for a network of tele-home health. Psychiatrist recruitment in El Paso has been difficult and they are needed for 

medication management. 

We have now two tele-health providers, one in Salt Lake City, 

the other in San Diego, who are doing medication management and 

individual psychotherapy via tele-mental health very successfully. 

The patients like it. The service has improved dramatically and the 

access now to those particular services. 

But I am empathetic with what your constituents have said. We 

need to be able to assure every veteran that they can get ready access to mental health services in El Paso as well as every other 

providing community in the country. 

Mr. O’ROURKE. Mr. Chairman, I yield back. 

The CHAIRMAN. Mr. Runyan, you are recognized. 

Mr. RUNYAN. Thank you, Mr. Chairman. 

I am going to have one question. It is probably more directed to 

Under Secretary Hickey dealing with VBA, and we talk about the 

processes and initiatives are outlined in the budget and they are 

centered around concepts and centralization, national work queue 

and centralized mail operations. 

The biggest question here is—get that—I think most people will 

ask what are we doing to fix the systematic at—I have had the conversation with Ms. Titus—at the Reno office? How are we addressing the underperforming things because from a big-picture view, it 

looks like we are shifting workload away from them to just get the 

job done. What are we doing to address the actual problem in these 

underperforming offices? 

The CHAIRMAN. Secretary Hickey? 

Ms. HICKEY. Thank you, Congressman Runyan, for your question. 

And I will tell you we are—the entire transformation effort—people, the most important piece of it, 52 percent of those people doing 

this job every day are veterans and a large portion of them are a 

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tary—serving veteran, so everybody wants to come to work and 

tries to come to work every single day to do the right thing by 

these men and women they served alongside. 

So what I will tell you we have done—and we have talked to you 

about this before and we are seeing great merit from it—challenge 

training, which this committee has supported in budget; not a 

cheap venture, but a critically important piece of training our entire workforce, no matter where they sit, to do a great job every 

single day from the moment they join us in the workforce. We continue those efforts. You see it represented in our budget today for 

fiscal year 2015 continuing to grow that way. 

We have taken and done, and thanks to this committee as well 

and its support, station enhancement training where we have gone 

into a complete office and we have stood down and now we are 

doing a non-stand down form of that for other offices that are challenged and retrained everybody, top to bottom, including leadership, in all of their responsibilities in order to get a way ahead and 

a better result and a better outcome every single day. 

The other things that this committee has supported, frankly— 

and I need your support continued—is our IT budget. We have 

built rules into the IT systems that now make it easier to deliver 

on the right and accurate answer every single time. That is critically important in this 2015 budget because everything now in 

VBMS forward is about automation and building those rules into 

the system so it eases the burden of remembering a book, bigger 

than the one sitting in front of me full of rules, that are the complexity of this kind of business. So our IT budget is critical to that 

aim. We have also—and, yes, we are helping across the Nation, all 

veterans. From no matter where we sit, we care about all veterans 

and every bit of those family members that are supported by that 

veteran, no matter the geography of where they sit. 

But first and foremost, the filter for national work, too, is, can 

the regional office where that veteran lives near do that work? And 

if they have a surge because they have had a recent redeployment 

from the theater—some of our states have been impacted by a large 

National Guard redeployment at that time and it puts a sudden 

surge in their system—yes, we are helping others from across the 

Nation. And we can now because we are electronic and because this 

committee has blessed us with the IT resources to build a virtual 

electronic system that allows anybody, anywhere to help on that 

claim for that veteran, so it goes better and faster all at the same 

time. 

Mr. RUNYAN. Thank you. 

I yield back, Chairman. 

The CHAIRMAN. Ms. Kuster. 

Ms. KUSTER. Thank you very much, Mr. Chairman. I just have 

a couple of questions. I, first, just want to thank you for your attention and I am delighted—I just yesterday spoke with the new director at the VA in Manchester, New Hampshire, who has now finally 

been installed and look forward to working with her as well. 

So, three quick questions: The first has to do with acquisition of 

medical devices. We have a company in Salem, New Hampshire 

called ‘‘Gamma Medica’’ and what they make is a medical device 

that produces bone density imaging to help with early detection of 


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breast cancer, and the challenge has been two, year-long delays at 

the National Acquisition Center and so that veterans are not getting the opportunity to get access to early detection of breast cancer. And I am just wondering if there is anything in the budget 

that is going to help to speed up the processes at the National Acquisition Center? 

Dr. PETZEL. Thank you, Congresswoman Kuster. 

The need for timely purchase of medical equipment in order to, 

again, be able to meet the needs of veterans who are coming to our 

clinics and our medical centers is very important. And I am familiar with—we have gotten some information about—some letters 

from you about Gamma Medica and looking at what we call the 

NAC, the National Acquisition Center, to try and reduce this time 

frame. Currently, two years is what it is taking us to acquire more 

costly medical equipment. We have two pilot projects with the 

NAC; they have a streamlined approval process. 

And the second thing we are doing is looking at unbundling. One 

of the things that takes time is that purchases are bundled in order 

to get a better price, and we are trying to find, perhaps, a compromise between getting those things done quickly and getting a 

good price. So I am very familiar with that circumstance and we 

are exploring ways to cut down on that acquisition time. 

Ms. KUSTER. Thank you. 

The second issue is a focus that I have had with Representative 

Walorski and others in the congress about military sexual trauma 

and sexual assault. This committee had a hearing with both men 

and women victims, and my question is: As more survivors and 

whistleblowers come forward, how does the VA plan to meet the 

growing need for mental health and other services for veterans that 

are victims of sexual trauma and does this budget provide you with 

the resources that you will need to address these needs? 

Secretary SHINSEKI. Congresswoman, thanks for that question. 

We have all learned a considerable amount in dealing with the 

issue of military sexual trauma: serious, sensitive, greatly underreported: and so those of us that are in the validation of a connection of something, we don’t have much data to go on. And what I 

would say is that we have been very open about understanding this 

is a circumstance that doesn’t lend to connecting, so we have committed to providing access for care, both to physical medicine, as 

well as the mental health aspects of this. And we have been—we 

provide this free of charge even if the eligibility to other, VA services are not being provided. Every medical center provides treatment and they have a military sexual trauma coordinator. The 

same is true at each VISN network location. 

I am going to call on Secretary Hickey to talk about the efforts 

she went through in reviewing benefits decisions to ensure that 

claims for PTSD resulting from MST and PTSD from other primarily combat reasons, there was some comparative discussion 

here, and I think terrific work done on her part. 

Ms. HICKEY. Congresswoman, when I arrived here in June of 

2011, one of the very first things I did was call for a full review 

of all of our PTSD due to military sexual trauma decisions and ask 

for a complete statistically valid review of them and what I found 

was a problem we had. We had granted these conditions lower than 


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PTSD claims for combat terrorism, results of terrorism, things of 

that nature. 

Working with my counterpart in VHA, we took very aggressive 

action to completely revamp that whole program. We designated 

only specific people that can make those decisions on both sides. 

We brought them all together at the same time with both of us 

there at the training event to completely retrain that workforce 

from top to bottom. I put those claims in our special operations 

lanes where we have our most senior, most highly qualified individuals to be able to work with those claims, and together, working 

with our VHA counterparts, in very quick timing, we closed the gap 

on that grant denial rate and we have sustained that closed gap 

on that grant denial rate since. And so we are very focused on that. 

I routinely ask about every six months to review, to make sure that 

we are holding that effort closed. 

Those folks we had made decisions on previously, we invited by 

letter and we asked the VSOs to help get the word out to come 

back to us if they felt they were denied in error. We had some come 

back and we have redone those and in those cases, there have been 

grants at a higher level commensurate with how we are now granting and denying those claims. 

Ms. KUSTER. Thank you very much. 

And my time has expired, Mr. Chairman. 

Secretary SHINSEKI. Mr. Chairman, may I just add one last 

point? 

The CHAIRMAN. Yes, sir. 

Secretary SHINSEKI. Fiscal year 2014, we had a number of veterans coming to us to report an MST prior history for most of 

whom we had no documentation. So more than 77,000 women and 

more than 57,000 men came to see us in fiscal year 2013. Our outpatient visit was significant, 16 percent increase over whatever had 

happened before. So that has been put in the calculation for the 

2015 budget and I expect that we will have most of our requirements covered here. 

The other issue is: We are going to watch this as we begin to see 

the downsizing of the military and we will expect to see more of 

these cases, but we are sensitive to it. 

Ms. KUSTER. Thank you very much, Mr. Secretary, and thank 

you, Under Secretary Hickey. Thank you, Mr. Chair. 

The CHAIRMAN. Yes, ma’am. 

Dr. Roe. 

Dr. ROE. Thank you, Mr. Chairman. 

I want to start by thanking you all for what you do for veterans 

each day in my district. We have a, as you know, a large VA Medical Center and numerous CBOCs and I know a lot of times you 

hear negative things, but when I go home I hear many more positive things than I do negative things and I think you don’t hear 

that enough. I mean you hear a lot of the complaints that go on, 

but I certainly hear a lot of very positive comments about the care 

that our veterans get in our area. Imperfect, yes—individuals with 

problems, but overall it has been a very positive experience. I 

wanted you to hear that publicly. 


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I think we mentioned a few things earlier about the Caregiver 

Program, a tremendous program, that the VA has initiated to help 

veterans. 

The homeless issue is one that I will continue to work on with 

you, Secretary, as long as I am here, and I know as long as you 

are here, that is a passion you have. One of the saddest things I 

think I can think of is a homeless veteran, a person who served 

this country honorably that now doesn’t have a place to live. That 

is a very good—VASH program is a tremendous program. 

And also, the Post-9/11 GI Bill that Mr. O’Rourke brought up, I 

can’t say more good things about that. That is an incredible educational opportunity. I know maybe others in this room have used 

the GI Bill. I remember I had $300 a month—I will never forgot 

the number—and it helped me tremendously when I got that, and 

it is a wonderful benefit. 

I think a couple things I do want to talk about, what percent of 

veterans do we serve in this nation—does the VA serve? There are 

22 million veterans—— 

Secretary SHINSEKI. Twenty-two million veterans, Enrolled for 

healthcare, probably 8.9 million. 

Dr. ROE. So about a third, okay. 

Secretary SHINSEKI. And then over in our benefits, we have 

about 11—12 million who are enrolled for benefits, and some of 

these numbers are—— 

Dr. ROE. Are overlapped? 

Secretary SHINSEKI. Yes. 

Dr. ROE. Okay. I appreciate that. 

Just a comment that Mr. Michaud made a minute ago, I wanted 

to emphasize of the size of the state VA homes. I have seen that— 

where I grew up in Clarksville, Tennessee, they are beginning to 

build one there and I want to encourage the VA to continue to invest in those. 

As our veterans age—that is a huge demographic of people out 

there—and it is just the population in general, as we get older and 

we live longer, as a society, we are going to have to figure out how 

to take care of these people in a dignified way, and I think the VA 

is a very good way to help with veterans. And I would encourage 

you to re-look that number and see if more couldn’t be invested, 

along with state homes. Since the states makes a—I know 65 percent is a lot of money, but the states make a huge investment. 

Just to comment there—I mean nothing to do now, but when we 

look at future budgets, I would strongly encourage you to increase 

that significantly. 

Secretary SHINSEKI. We will look at that. 

Dr. ROE. Thank you. 

I think one other—two other issues I want to talk about just 

briefly, and I guess this is probably Mr. Warren that will take this 

question, but is, again, the interoperability—and we talked about 

this in your office—between DoD and VA and would just briefly tell 

us where that is because we spent a billion dollars—we were here 

last year and we don’t know where the billion went and we still 

can’t interact. 


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I know when the bill—the budget was passed, we put—Chairman 

Rogers put 300 million more dollars, technical dollars, in to make 

this happen. Where is that, for the record? 

Secretary SHINSEKI. I am going to call on Mr. Warren to talk 

about the dollars that are being allocated. I would just say—a 

quick look back here—when Secretary Gates and I launched this, 

we envisioned a single, joint, common, integrated health record and 

pretty much we have worked on this project with that in mind. 

When Secretary Hagel arrived, he took a look at how he was 

structured to deliver his half of that commitment and he didn’t feel 

he was properly organized, so he asked for the opportunity to relook at his structure. And his decision coming out of that—I respect 

his decision—was to pursue an acquisition strategy. 

We have had VistA, our electronic healthcare record system since 

1997. Technology turns over every 18 months. Some say that the 

technology turn is moving closer to nine months, but it says something about our electronic health record, that since 1997, it has 

been the one that we have been able to evolve into more and more 

capability. And so we are comfortable with it and we are going to 

pursue raising VistA from a level two electronic healthcare record 

to a level four, which would put it at the top of the, competitors. 

Dr. ROE. We have talked about this and this is a critical decision 

because we have now been years trying to get this to happen to 

make veterans’ healthcare better and I think this is one of the biggest decisions, from the VA standpoint, technologically, that will be 

made in my tenure in congress. Because I don’t want to be here 

at ten years, if my voters will let me come back for a few terms, 

to be having the same conversation that we can’t talk that we have 

had for 15 years. 

Secretary SHINSEKI. Well, I would just say, Congressman, that 

these conversations don’t just occur here. They occur between Secretary Hagel and myself, and what I will tell you is that he is pursuing an acquisition strategy. I am evolving my VistA, which is— 

at what was at one time head and shoulders above everybody else. 

The gaps closed, we are still a great health record. 

As he pursues his requirements for his acquisition, we are monitoring and having discussions and if there is a capability there that 

he is looking for that we don’t have, we are going to go after that 

and make sure that we include that. When we get to the point 

where he is ready to make a decision on the DoD electronic health 

record, we want to be in the competition and I have talked to Secretary Hagel about that. He has assured me we are going to be in 

the competition, and so my work for the next two years is to get 

us as competitive as anybody else. 

We have taken our code, the MUMPS code that drives our VistA 

program. We put it in the commercial space, workspace. Other contractors have picked up on it and have begun to incorporate that 

into their solutions. I think that makes it healthy. 

When we get down to the end, even if we don’t get the nod, the 

differences between what we have and what is available in the 

commercial workspace I think is going to be pretty close just because of what is going on now. Our code is government-owned, government-operated and we are comfortable with it. We think we are 

going to be competitive, but however it comes out, we are going to 


VACREP180 with DISTILLER
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be very, very close at the end, even if it is not a single, joint, common electronic health record. Interoperability is going to be much 

greater than it is today. 

And I think you know, Congressman, we designed a joint viewer 

that takes our two databases now and it sits so that a care provider can pull data from both and see, on one screen, all the critical 

data and make decisions that are required and then that data goes 

back and resides in the proper database. We know that isn’t good 

enough and we are going to be much closer here down the road. 

Dr. ROE. The Chairman has been very generous with his time. 

I yield back. 

The CHAIRMAN. Ms. Titus. 

Ms. TITUS. Thank you, Mr. Chairman. 

Thank you, Mr. Secretary. I have always been especially appreciative of your accessibility, as well as your team, so thank you for 

being here. 

A lot of good points have been made today and I would like to 

go back and just focus on a couple of them, maybe from the perspective of Nevada and the West. First, I have to take a little exception to your cemetery policy that says a veteran will be within 

75 miles of a national cemetery. There is a big difference between 

a rural burial initiative and a national cemetery, and there will 

still be 11 states without a national cemetery, including six in the 

West, and if you look at the map, that covers an awful lot of territory. 

Second, I want to talk to the doctor, perhaps offline, because I 

want to get to national issues about our hospital in Las Vegas 

where there are some serious problems, especially with the emergency room coming on. So if we could meet about that, I would appreciate it. 

Third, I would like to thank Chairman Runyan for bringing up 

the point about the Reno office and the backlog. Our committee has 

been working very hard to assist you and do what we can to support your efforts to reduce that backlog, which you have done a 

good job of and that we appreciate that. 

And that is true Reno, too, which was one of the worst places in 

the country. I support the brokering initiative, but I don’t want this 

to just be a policy where we ship a lot of cases somewhere elsewhere they are doing a good job and we don’t fix the problem at 

Reno. So I was glad to hear the report of some of the initiatives 

that are taking place there. 

And when you look at state nursing homes, again, a problem we 

are having, and I think you will see it nationally, is that many of 

the veterans nursing homes are mostly contracted to the State and 

to Medicare, and they are the ones who do the accountability and 

there is not very much of it. So if you look at that budget or look 

at going into that business more, I hope that you will build in some 

accountability by the VA and not just leave that to somebody else 

to check. 

And then finally, I would ask you this: I have a bill that is called 

Pay As You Rate; it has been moving forward out of this House, 

but where you can pay a veteran some of his benefits as you assess 

different parts of the claim, instead of waiting until it is all finVerDate Aug 31 2005 11:40 Jun 12, 2015 Jkt 000000 PO 00000 Frm 00028 Fmt 6633 Sfmt 6633 Y:\87670.TXT PAT

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ished to then give him some compensation. That way, you get a little bit as you go along. 

And we talked to some veterans and found out that in Nevada 

only 8 percent receive any kind of payment as you go along, even 

though the VA can apparently already do this. I understand that 

it is something about the way that claims personnel are paid or 

their claims are counted towards pay. I can’t quite understand why 

that is, but would you address it and let us know if there is some 

way that we can fix it so that this could be a policy going forward? 

Secretary SHINSEKI. Let me try to hit all of the issues, and let 

me start with the claim-as-you-go payment that you brought up 

last, Congresswoman. 

Ms. HICKEY. Congresswoman Titus, when we get fully into an 

electronic process—we are still sort of standing a foot in paper and 

a foot in the electronic process—and we are able to start really seeing, as we can now when we work a claim in VBMS, medical issue 

level capability where it could keep that claim—that medical issue 

could move forward without human intervention, into and through 

a paid process, that is a long-term objective for us. Today, when we 

do it in paper, it means the person has to stop what they are doing 

to rate all the rest of the issues, take it to the next step manually. 

A person has to come off of doing a full authorization and award 

and manually paying the thing, and it becomes actually a process 

in a manual environment that could extend out the experience for 

the veteran and many more veterans. 

But in an electronic environment where you can move it faster 

into an electronic payment environment, that is exactly where we 

are trying to go, but we are not quite there yet. Next year, 2015, 

with a strong IT budget, we get closer. 

Secretary SHINSEKI. May I just address some of your other questions here. I would say your sensitivity about rural cemeteries is 

one that Mr. Muro has brought up in the last five years. We looked 

at the way we have our population-based national cemeteries. So 

in a population close to 80,000, we try to locate a cemetery within 

75 miles of everyone in that cluster. We discovered what you just 

described; there are whole states that don’t have 80,000 veterans 

residing within a contiguous border. 

Maybe as many as eight states? 

Mr. MURO. Yes, sir. 

Secretary SHINSEKI. So, as many as eight states, and so we 

began a commitment to put a VA cemetery in at least each state 

so that veterans can say they have a VA resting place that honors 

them. It is probably a poor choice in words to call it burial ground 

because it seems like it is something less than a cemetery. If it is 

less, it is only by size because of the population that will use that 

capability. We establish it in the same way we establish other national cemeteries and we set a standard that is expected to be 

maintained by all of our national cemeteries and whether that arrangement is out in a rural area on tribal land, we have the same 

standard. 

So we are sensitive to your point and we will continue to work 

that, and I am happy to work with you on that as well. Elko, Nevada is one of those sites in which we have programmed to a ‘‘burial ground.’’ 


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On the emergency room in Las Vegas, before I arrived, I believe 

that that facility, that entire hospital, was designed to be linked to 

the Air Force hospital medical program at Nellis Air Force Base. 

Someplace along the way there was a change in priorities, and so 

we were required to build a freestanding facility of our own. That 

facility would have linked in with the Air Force hospital, and therefore, the requirement for a large emergency room wasn’t necessary 

now that we were required to build a hospital in north Las Vegas. 

We put it up because the overall plan was good. We knew when 

we did that, that we were going to have to go back and make the 

emergency room a little larger. 

I don’t like doing that, but in this case, it was better to get the 

hospital up, take care of veterans, and then make the adjustment. 

Ms. TITUS. Thank you, Mr. Chairman. 

The CHAIRMAN. Mr. Flores. 

Mr. FLORES. Thank you, Mr. Chairman. 

Mr. Secretary, thank you for joining us today, and I thank all of 

your team for your commitment to our nation’s veterans. 

I do have one question that is a non-budget related question related to the VA nursing handbook. We will send that to you supplementally, and ask that you respond to that. 

Also, my next question is to—well, before I do this, let me echo 

what Mr. O’Rourke said. I want to thank you for your commitment 

to the Waco regional office and to commend them for the improvements they have made in disability claims processing and look forward to the day when we all meet our goal of having zero backlog 

and meeting our performance objective. 

The first question I have, and you probably need to answer this 

supplementally, is based on headlines that came out of my district 

last week, and that is because of the President’s Executive Order 

to force contractors to pay a wage rate higher than minimum wage, 

a veteran in my district was displaced from the nursing home in 

which he had resided for five years and forced to move to another 

one. And so I would ask you to go back and give us an analysis 

of the impact on the VA’s budget of the increase of the minimum 

wage, and also, more importantly, what the impact will be on the 

potential displacement of veterans from the nursing homes that 

they currenty reside in. I think that was one of the unintended adverse consequences that is coming out from this unilateral increase 

of the minimum wage, so that would be helpful to have that information. 

With respect to the IT budget, as Chairman of the Economic Opportunity Subcommittee, I am keenly interested in two IT systems 

that affect the economic opportunity for our veterans: the Long 

Term Solutions system which Mr. Takano asked about a few minutes ago, and then also the CWINRS system that deals with voc 

rehab cases. 

On the LTS system, and, Mr. Warren, this question may be for 

you, as I understand it, you are investing only in sustainability and 

not into additional capabilities; is that correct? 

Mr. WARREN. Yes, sir. Today it meets the mission needs and so 

we are making sure we keep it up and running, but there is nothing scheduled this year or next year to bring more capability online, sir. 


VACREP180 with DISTILLER
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Mr. FLORES. Okay. I would ask the VA to go back and reassess 

two things. One is the performance objectives. I still have veterans 

in my district that are having to go through the original claims 

process, which is lengthy, and that is just when they are getting 

into the door of starting their GI benefits and that is when the 

most frustration occurs, not only with the educational institutions, 

but with the veterans. So I would ask you to, you as the organization, to relook at that. I think for a modest amount of money, redirected from probably VBMS since that is where the biggest pot of 

money is, to look at just a little incremental improvement so that 

original claims processing follows the rules-based system that you 

are doing in the VA that General Hickey has done so well. 

The second area is on CWINRS. Can you tell me what the 

amount of investment versus sustainment spending is going to be 

in the budget? 

Mr. WARREN. Sir, I do not have that in hand, but I can get that 

for you on the record, sir. 

Mr. FLORES. Okay. That would be great if you would. I think 

those would be interesting for this committee to know, and, again, 

I would urge you to go back and re-look at the objectives for the 

LTS processing, particularly with respect to original claims. 

Secretary SHINSEKI. Congressman—— 

Mr. FLORES. Yes, sir. 

Secretary SHINSEKI [continuing]. We are happy to do that. Again, 

a little bit of history here, you know, we started out doing this by 

hand. 

Mr. FLORES. I know. 

Secretary SHINSEKI. And it was tough just getting 173,000 

youngsters in the fall term of 2009 and so we began building this 

without a clear understanding of what we needed and we have 

built as we went. And as Mr. Warren says, what we have today 

seems to be meeting our needs. 

What we wanted was a TurboTax arrangement where you could 

fill the bins and push a button, and the calculations would be made 

and payments would follow. I don’t think we are there yet, so we 

will continue to look at this. 

Mr. FLORES. Right. And first of all, don’t—this is not—I am not 

being critical. I think you have come a long way with LTS. I am 

just saying I think for a modest amount of money, we could go considerably farther than where we have gone today. 

So, I agree, I mean from where you started, you had an immense 

task and I think that you have made progress, but I would like to 

have an analysis of what we could get, particularly with respect to 

original claims, what improvement we could get and for a modest 

amount of investment, that probably wouldn’t hurt the continued 

investment, VBMS. 

The next area has to do with VistA. I think you are spending $269 million for fiscal year 2015, proposing to spend that. What 

does that compare to for this current fiscal year? 

Secretary SHINSEKI. Mr. Warren. 

Mr. WARREN. Thank you for that question, Congressman Flores. 

The request in 2015, as you stated, is approximately $270 million 

and that is tied to VistA Evolution so that we can continue to 

evolve that world class system. In the 2014 budget, there is $290 


VACREP180 with DISTILLER
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million, but the majority of those resources are presently withheld 

while we bring our plan up to yourselves to play out what is the 

future for VistA Evolution and what that Long Term Solution looks 

like in the plan. So when that plan clears, and I believe it goes to 

GAO, per the NDA requirements, then the dollars will be released 

into us. 

So, in the budget, but not released, so those resources are actually not being applied today, sir. And we appreciate the support 

when the plan comes up to get the resources out so we can continue to evolve this world class system. 

Mr. FLORES. Okay. So when we suspended Evolution, we basi- cally said $290 million is just going to be on hold while we figure 

out the direction that we are going to go? Again, I am not making 

a judgment, I am just asking the question. 

Mr. WARREN. It has 75 percent of that, sir, so we have some 

work underway to make sure we are continuing to meet critical 

healthcare needs. Under Secretary Petzel lays those out. We work 

on those. But the focus is continue that sharing of information in 

a clinical engagement. 

If you haven’t seen that demo, I would suggest we can do that 

for you. The Janus Viewer is doing great work. Continuing to 

evolve that, as well as maintain systems. 

Mr. FLORES. Thank you. My time has expired. Again, I appreciate your service to our veterans. 

And, Mr. Chairman, thank you for your forbearance. 

The CHAIRMAN. Thank you, Mr. Flores. 

Ms. Brown. 

Ms. BROWN. Thank you, Mr. Chairman. Thank you very much. 

Before I begin the VA, I want to take off my VA hat and put on 

my transportation hat. Let me just read this: As a Vietnam veteran 

and in support of our Nation’s efforts to ensure our veterans get 

good important jobs after their service, we have set a hiring goal 

of 25 percent for veterans. Please accept this photo. 

And this is from the CEO, Joseph Boardman, President of Amtrak, and I have the painting here and I would like the entire 

statement about Amtrak and their hiring policy pertaining to veterans, and I would like the members to see the painting. And this 

was done at Beachwood Station, and I was very instrumental in 

keeping that station open, so I want to pass this around and I 

would like to take a picture at the end with this painting that Mr. 

Boardman sent to you, Mr. Secretary. 

Secretary SHINSEKI. Thank you. 

Ms. BROWN. Let me just thank you again for the VA hospital 

in—well, clinic, in Jacksonville, the cemetery in Jacksonville. I 

mean I am very happy with everything that are going on in Jacksonville, and I am almost happy with some of the things that is 

going on in Orlando. I am just very impressed with the clinic that 

has opened up. We have about 123 patients there. It is one of the 

best facilities that I have seen, and I spent about four hours at the 

facility. 

I just want to know when can we get that hospital open? You 

know, we have been working on it for 25 years and I would like 

for us to get it complete. I spent a couple of hours with the VA, 

a couple hours with the contractors and it is just not there. 


VACREP180 with DISTILLER
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Secretary SHINSEKI. Fair enough. 

The construction in Orlando is about 87 percent complete. What 

you listed were the 120-bed community living center and a 60-bed 

domiciliary, all of that delivered and in good shape. 

Ms. BROWN. Beautiful. 

Secretary SHINSEKI. We just have the main building left to do 

and we are well along. 

Next to you, and maybe the Chairman, I am most disappointed 

that this project didn’t come in on schedule and we continue to 

work with the contractor to get the work done that needs to be 

done. Right now we are looking probably at summer 2015, which 

is what the contractor is asking for. We have not agreed to that; 

we are still working with him and will continue to do that. 

What has been completed is great. We just need to get this 

project across the line and we are working very hard at this. 

Ms. BROWN. Thank you, and let me just say, I am very supportive of the Chairman and the ranking member’s effort to get 

your budget completely forward budgeted. I know that we have 

done part of it, but I am very interested in getting the entire budget and it is waiting for the leadership to take it up at the House. 

I know once they take it up, we will probably have zero votes 

against it. 

You want to say anything about it, because in some areas, I 

mean, you know, you don’t need to go with the whims of the House 

when we can’t come together on a budget, but at least it is always 

comforting to know that the veterans budget is not included. 

Secretary SHINSEKI. Well, I would begin by thanking the members of this committee. We have advance appropriations for veterans healthcare. You have provided that to us since 2012. We 

have learned a lot in the advance appropriations arena, and we do 

that piece quite well, and it has been a good fit for the Veterans 

Health Administration. 

As I testified to in October in this very room, what I have 

learned since is that in the area, of—and by the way, veterans 

healthcare is about 80 percent of the budget, maybe even 85 percent. So for the remainder of the budget, and one specific area, 

processing of claims, I can’t do it internal to VA. We have done a 

lot of work in the last 5 years to create a relationship with DoD 

and it is has been a very good one. We now get service treatment 

records electronically. Prior to this it was a paper exchange, and 

so we have made a tremendous adjustment here. 

We still have to go to the Social Security Administration to validate other disability payments. We have to go to IRS to validate 

threshold income levels. We still work with Department of Education on 9/11 GI Bill and, as I said, DoD. And so I would, as I 

did with great deference during the October testimony, say that, 

what would be most helpful to VA is for the Federal Government 

to get a budget every year because my ties to these other departments, even if I have advance appropriations for this department, 

doesn’t quite get done the specific work that needs to be done in 

the benefits arena. 

And for example, our concerns—I mean this committee’s concerns 

and our concerns and testimony—were that Treasury, for example, 

wasn’t funded. The checks that we would have—the tapes that we 


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would have passed that would have resulted in checks being cut 

would not have happened so, this is a bigger discussion than just 

the VA budget, but I appreciate the question. 

Ms. BROWN. Thank you very much and thank you for your service. 

The CHAIRMAN. Thank you, Ms. Brown. 

Dr. Huelskamp. 

Dr. HUELSKAMP. Thank you, Mr. Chairman. 

And, Secretary, thank you for being here today and I appreciate 

your latest comments in reference to actually having a budget. It 

is important to note, as well, the President was a month late on 

his budget this year and—which is that much later, but I have 

been concerned—both houses, leadership and both chambers have 

not brought many parts of the budget to the floor for debate and 

a lot of it is left in the committee or in subcommittee, but I do have 

one particular budget question. 

Do you have a rough count, a general idea, of how many public 

affairs employees are funded in your budget? 

Secretary SHINSEKI. I don’t here today, but I am happy to provide that for the record. 

Dr. HUELSKAMP. All right. Does he have any guesstimates on 

that at all? We will have to wait for any range on that? 

Secretary SHINSEKI. Yes, I regret I don’t have that. 

Dr. HUELSKAMP. Okay. I appreciate it, Mr. Secretary, and the 

reason I ask is that I have a list here of nearly 70 different instances in the last year, year and a half in which your agency has 

failed to respond to requests for information and these, generally, 

are from media requests and some very specific questions and the 

answers are always, ‘‘No comment,’’ ‘‘No answer,’’ ‘‘No response.’’ 

What level of transparency do you expect and what are the roles 

of these public affairs officers, other than to say, ‘‘We can’t answer 

that question now.’’ 

Mr. Secretary, I am very concerned about transparency. We have 

had numerous hearings on things in which the agency was not very 

responsive even before the committee, so if you could share your 

thoughts on that. 

Secretary SHINSEKI. Well, as I stated in the beginning, and this 

was probably prior to your arrival, Mr. Huelskamp, transparency 

is an important aspect of our being able to establish and retain 

trust in this department. It is a high item on my list of things we 

commit to and I regret that you probably have some data here that 

I need to get into. I am happy to do that. 

Dr. HUELSKAMP. Excellent. And I appreciate that. Will you commit to directing you employees to do a better job responding to 

these inquiries, whether it has come from Congress or members of 

the media or of the public? 

Secretary SHINSEKI. I will do that. 

Dr. HUELSKAMP. Okay. Well, thank you. 

And I do also have a report specifically in which I have not seen 

comments from your agency, but a January CNN story that had 

identified at least 19 preventable veteran deaths due to delays in 

simple medical screenings, are you familiar with this report and 

what is your reaction? 


VACREP180 with DISTILLER
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Secretary SHINSEKI. I am familiar with what was reported in the 

press and I would begin by saying that any time we lose a veteran 

under circumstances that we can’t explain, even though our veterans are amongst the oldest and sickest patients, any time we 

have a death it is an issue of concern to me and I look for factors 

that may have contributed to that. 

I would say that every one of these incidents has been reviewed 

and investigated, what I think we need to recognize is that many 

of those reports originate from inside VA and we—I am pleased 

that we have employees who are honest and courageous enough to 

call themselves on something they either saw or might have committed, and it is because of that kind of transparency on the part 

of the workforce that we are able to pursue some of these issues. 

It doesn’t mean that we are without having made errors, but if 

the reporting continues we can do something about that and that 

is what I think is important to be retained here. That is part of 

our discussion as well. 

Dr. HUELSKAMP. And I appreciate that. That is a great comment 

on that, but, you know, the employees that reported that, but have 

any employees been held accountable for these preventable deaths? 

Secretary SHINSEKI. I can certainly turn to Dr. Petzel for the specific 19. We do hold employees accountable. I would say, Congressman, that in 2012, we involuntarily removed over 3,000 employees. 

In 2013, we involuntarily removed another 3,000 employees, and 

then over the past two years, six members of the senior executive 

service have been dismissed as well. 

Dr. HUELSKAMP. And I will look forward to the response of the— 

for the committee. I don’t want to take up any more time. 

But if I might ask Mr. Warren an IT question, Mr. Chairman, 

could I—— 

The CHAIRMAN. We are really running out of time. 

Dr. HUELSKAMP. Okay. Well, I will hold that until the next 

round, so thank you. 

The CHAIRMAN. We are not even going to have a second round. 

I mean the Secretary has been very gracious with his time. 

If you could, we will put a package of questions together for the 

record and we will do it that way. Thank you, sir. 

Mrs. Negrete McLeod. 

Mrs. NEGRETE MCLEOD. Thank you, Mr. Chairman. 

Mr. Chairman, homelessness among veterans is a serious problem in California and in my district. An issue not mentioned about 

the per diem program is that these funds cannot be used to help 

children who are under the care of a homeless veteran. It is for this 

reason that I introduced H.R. 4140, the Homeless Veterans with 

Children Act of 2014. This bill doesn’t cost any money, it just gives 

the VA more flexibility on how to use per diem funds to help homeless—victim homeless veterans. 

Mr. Chairman, I hope that H.R. 4140 will be included in our sub 

health committee legislation hearing this spring. Helping homeless 

veterans with dependents is an issue that has been identified by 

the VSOs and needs to be fixed now. 

My question is: How is the VA working with per diem recipients 

to ensure that they have the protection of privacy for homeless veterans? 


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Secretary SHINSEKI. I am going to ask Dr. Petzel to address the 

per diem question, but Congresswoman, this—in discussing the 

homeless program, this is one piece of that. I think you are familiar 

with the HUD–VASH program, the HUD–VASH voucher. 

This would be another example, Mr. Chairman, of where our 

working relationship with another federal department allows for us 

to get our work done. The HUD–VASH voucher is key to this and 

it is the most versatile of our options that we can provide to the 

homeless and, in fact, it does care for families and for children. 

And in the case of California, I think we have about 9500 HUD– 

VASH vouchers already in place, in addition to the per diem grants 

that we provide. 

Dr. Petzel. 

Dr. PETZEL. Thank you, Mr. Secretary, Congresswoman McLeod. 

Two programs, the Grant and Per Diem Program and the Supportive Services for Veterans and Families are really the important 

parts of our providing transitional housing for these veterans who 

are on the streets and for the families of those unfortunate people 

who have been unable to maintain themselves in their home. We 

contract across the country. We spent approximately $230 million 

in the Grant and Per Diem Program, and approximately $300 million last year in the Supportive Services. We are trying to increase 

that to $500 million in the fiscal year 2015. 

In those contracts, there are provisions for maintaining the privacy and the security of the people who use those services. Tangentially to your question, I would point out that there is a growing 

need in this country for Grant and Per Diem housing for women 

and for families. There are plenty of families for men, and the VA, 

I am proud to say, has been a leader in facilitating the development of Grant and Per Diem housing and Supportive Services for 

women in a number of places around the country. I think we would 

be viewed as one of the national leaders in recognizing the need for 

women and the need for special, secure, private arrangements in 

these circumstances for women. 

Mrs. NEGRETE MCLEOD. Thank you. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you very much. 

The last question for the day comes from Ms. Walorski. 

Ms. WALORSKI. Thank you, Mr. Chairman. 

Secretary Shinseki, good to see you. Just a quick question: IT se- curity is 6 percent of your budget and your 2015 budget seeks $33 

million over the 2014 budget for a total of approximately $189 million for IT security. Will that amount finally assist the VA in addressing the numerous IT deficiencies that we have brought to the 

attention of the VA? 

Secretary SHINSEKI. Let me ask Mr. Warren to address that. 

Mr. WARREN. Thank you, Congresswoman Walorski. 

Yes, we take information protection very seriously and the resources that we have asked for will allow us to keep up with the 

evolving threats that all of us face. 

Ms. WALORSKI. Thank you. 

And, Mr. Secretary, the NDAA, as somebody alluded to earlier, 

explains that neither the VA nor the DoD can spend more than 25 

percent until the Secretary has briefed the appropriate congresVerDate Aug 31 2005 11:40 Jun 12, 2015 Jkt 000000 PO 00000 Frm 00036 Fmt 6633 Sfmt 6633 Y:\87670.TXT PAT

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sional committees on their plan. And I know that the VA and the 

DoD did provide a brief to the committees on January 27th, but 

there were key elements that were missing that had to be included 

in that report. 

I understand the plan that includes the missing details is awaiting clearance at OMB. Do you know when we might receive that 

information? 

Secretary SHINSEKI. Let me call on Mr. Warren. 

Mr. WARREN. We believe that that plan will clear in the next 30 

days. We want to make sure that it is responsive to the questions 

in the NDAA, but not only responsive, but answers to questions in 

a way that are understandable. So we are making sure when it 

comes over that it meets the need so that we can get the dollars 

released and start working on VistA Evolution and appreciate your 

support for that, ma’am. 

Mrs. WALORSKI. And will the committee receive the Interagency 

Program Office Interoperability Report sometime in that same time 

frame? 

Mr. WARREN. I believe we have already done one quarterly report. The next quarterly report is going through review, and so 

that should be coming out, I believe, in the next three to four 

weeks and it has a joint report of the two departments, and again, 

we want to make sure that we are responsive to your requests. 

Mrs. WALORSKI. Thank you. 

And then finally, I would be remiss if I didn’t ask about the 

CBOC in Indiana’s Second District. That is a familiar conversation 

here. When I was in your office just a couple of weeks ago, we had 

received an update that they at least would be awarded winter of 

2013/2014, and is that still the latest update, because we just received report last week outside the VA that there is potentially a 

delay now until summer of 2014. 

Secretary SHINSEKI. Let me ask Dr. Petzel. 

Dr. PETZEL. Thank you, Congresswoman. 

The project is proceeding. There was a NEPA study that needed 

to be done, an environmental study. This study revealed some 

issues with potential artifacts. That has been taken care of and the 

evaluation is proceeding. 

Mrs. WALORSKI. And so is it still on track for winter/spring, if 

winter ever ends up there? 

Dr. PETZEL. Yes. 

Mrs. WALORSKI. Okay. So there has not been—we were made 

aware last week that there is a possibility that the VA has asked 

the bidders to refresh or update their proposals; is that true that 

they have 30 days to do that? 

Dr. PETZEL. I will have to go back and check for the record, Congresswoman. I am not familiar with that detail. 

Mrs. WALORSKI. Okay. 

Secretary SHINSEKI. I would not be surprised if there are any 

lengthy delays, we want to be sure the bidders have the best information in the competition before the decision is made. So this is 

something that occurs from time to time. 

Mrs. WALORSKI. Thank you. 

Thank you. I yield, Mr. Chairman. 

The CHAIRMAN. Thank you very much, Ms. Walorski. 


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Mr. Secretary, thank you for being so generous with your time. 

Thank you to the under secretaries for being here with us. 

Of course there will be some follow-up questions for the record. 

I would ask unanimous consent that all members would have five 

legislative days with which to revise and extend their remarks. 

Without objection and with that, this hearing is adjourned. 

[Whereupon, at 11:54 a.m., the committee was adjourned.] 

f 

APPENDIX 

PREPARED STATEMENT OF CHAIRMAN JEFF MILLER

Good morning everyone. Welcome to our hearing on the President’s Fiscal Year 

2015 budget request for the Department of Veterans Affairs. 

Mr. Secretary, welcome. I appreciate your attendance today and that of your leadership team. We’ve only had a short time to review the details of the budget request, 

so we will likely have numerous follow-up questions. I’d ask for your cooperation in 

getting those back to us in a timely manner. 

Once again, in a fiscal climate that has regrettably seen the military budget cut 

to the bone, funding for veterans has emerged as an obvious priority, both for the 

Administration and the Congress. For that, I commend you for your leadership in 

fighting to ensure veterans remain a priority. 

I also want to commend VA on the operation of its Veterans’ Crisis Line. I heard 

some really positive feedback yesterday from Paul Rieckhoff at yesterday’s hearing. 

Your statement that roughly 35,000 men and women have been rescued from a suicide because of VA’s intervention—the rough equivalent of two Army divisions— 

speaks for itself. Keep up the good work. 

Mr. Secretary, I listened carefully the last few weeks to the military and veterans’ 

organizations who testified before the Veterans’ Committees regarding the need to 

improve timely delivery of mental healthcare, ensure that healthcare is delivered in 

state-of-the-art facilities, and sustain VA’s progress in producing timely and accurate disability claims decisions. 

When I look at this $163.9 billion budget request, I’m left wondering why we can’t 

do better than we are in some of those areas. I think it’s fair to say that Congress 

has supported nearly every request the Administration has asked when it comes to 

veterans, yet significant problems remain. 

For example, although it’s nice to see a steady downward trend in the backlog 

over the last year, what I hear from service organizations and veterans themselves 

is that VA is sacrificing accurate decisions for fast ones, and that it is falling behind 

on appeals. With the record funding provided in this area over the last decade, both 

in manpower and technology, it’s frustrating to hear those complaints. 

I am also concerned about continued Inspector General and media reports regarding preventable deaths at a number of VA facilities across the country. I know that 

VA is not infallible, but serious, even deadly, mistakes merit swift and clear accountability. I know you believe that as well, and we’re ready to work with you to 

give you any tools you may need. 

I will follow up on this last issue in questioning, but I’m troubled with what appears to be a common practice with VA’s budget submissions of late. And that is 

to identify, based on updated information, excess funds that are no longer necessary, 

then redirecting those funds toward ‘‘initiatives’’ that were budgeted and appropriated in advance at a lower level. 

For example, VA overestimated by about $700 million its need for long-term care 

resources in FY 2015, but now wants to redirect all of that money and more toward 

its homeless initiatives, facility activations, and other needs. In fact, notwithstanding the overestimation of $700 million, VA now seeks a supplemental budget 

for FY 2015 of $368 million. Needless to say, I think this practice needs further discussion. 

These are just a couple of areas I’d like to address with you, Mr. Secretary. In 

the interest of time, however, I’ll recognize the Ranking Member for his opening 

statement. 


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PREPARED STATEMENT OF CORRINE BROWN, RANKING MEMBER

Mr. Secretary: 

I want to put on my Transportation hat at this time. Amtrak, our nation’s passenger rail carrier, is committed to American veterans and their families. 

Amtrak has a long history of providing career opportunities to veterans as well 

as active military members and values the leadership, reliability and high-tech 

skills they bring to the company. 

Amtrak currently employs more than 1,500 military veterans and is a member of 

the Employer Partnership of the Armed Forces program, recruiting at numerous 

military job fairs across the country. Since January 2012, more than 14 percent of 

new hires have been veterans. and across the rail industry, about 25% of the employees are veterans. 

The Obama Administration, along with the Joint Forces Initiative, the Department of Transportation and the Department of Veterans Affairs has started the Veterans Transportation Careers Center. 

Mr. Secretary, Joseph Boardman, President and CEO of Amtrak wanted me to 

present to you this print of the Veterans’ Locomotive. It features a red, white and 

blue paint scheme, 50 stars and specially designed logo with military service ribbons. 

f 

PREPARED STATEMENT OF HON. ERIC K. SHINSEKI

Chairman Miller, Ranking Member Michaud, and Distinguished Members of the 

House Committee on Veterans’ Affairs: 

Thank you for the opportunity to present the President’s 2015 Budget and 2016 

advance appropriations requests for the Department of Veterans Affairs (VA). This 

budget continues the President’s historic initiatives and strong budgetary support 

for Veterans, their families, and survivors. We value the sustained support that 

Congress has demonstrated in providing the resources and legislative authorities 

needed to honor our Nation’s promises to these unique and special citizens. Let me 

acknowledge our partners here today—the Veterans Service Organizations— whose 

insight and support make us better at fulfilling our mission. 

After more than a decade of war, many Servicemembers are returning home and 

making the transition to Veteran status. As the war in Afghanistan enters its final 

chapter, our work is more urgent than ever. The current generation of Veterans will 

help to grow our middle class and provide a significant return on the Nation’s investments in them. The President fully supports Veterans and their families, and 

by providing them the care and benefits they have earned, we pay tribute to the 

sacrifices that Veterans have made for this Nation. 

The 2015 Budget for VA requests $163.9 billion—$68.4 billion in discretionary 

funds, including medical care collections, and $95.6 billion in mandatory funds for 

Veterans benefits programs. The discretionary request reflects an increase of $2.0 

billion (3.0 percent) above the 2014 Budget level. The Budget also requests a 2016 

advance appropriation for Medical Care of $58.7 billion, an increase of $2.7 billion 

(4.7 percent) above the 2015 Budget. The President’s 2015 Budget will allow VA to 

operate the largest integrated healthcare system in the country, including nearly 

1,750 VA points of healthcare and approximately 9.3 million Veterans enrolled to 

receive healthcare; the ninth largest life insurance provider, covering both active 

duty Servicemembers and enrolled Veterans; an education assistance program serving nearly 1.1 million students; a home mortgage program with a portfolio of over 

2 million active loans, guaranteed by the agency; and the largest national cemetery 

system that leads the Nation as a high-performing organization, with projections to 

inter 128,100 Veterans and family members in 2015. 

Growing Demand for VA Services and Benefits 

Long after conflicts end, VA requirements continue to grow, due to the substantial 

needs of Veterans. VA’s budgetary requirements arise from our Nation’s national security engagements, which are not within our control. As the President said on Veterans Day last November, ‘‘when we talk about fulfilling our promises to our Veterans, we don’t just mean for a few years; we mean now, tomorrow, and forever.’’ 

Over the next decade, the Department of Defense (DoD) predicts that military separations will approach three million. This growing population is demanding more 

services from VA than ever before. Currently, 11 million of the approximately 22 

million Veterans in this country are registered, enrolled, or use at least one VA benefit or service, and this number will undoubtedly continue to grow. 


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Meeting VA’s Top Three Goals 

In 2015, our challenges are clear and significant. VA must deliver on the ambitious goals we established 5 years ago, which are to: 

• Increase Veterans’ access to VA benefits and services; • Eliminate the disability claims backlog in 2015; and • End Veterans’ homelessness in 2015. 

The 2015 Budget is critical to VA meeting these goals. Without the proper level 

of funding to meet the growing demand for benefits and services, investing in our 

physical and Information Technology (IT) infrastructure to assure reliable access, 

eliminating the disability claims backlog, and completing the rescue phase of ending 

Veterans’ homelessness become even more difficult. VA remains committed to meeting these challenges and appreciates the continued support of the Congress. 

Stewardship of Resources 

At VA, we are committed to responsible stewardship, using resources effectively 

and efficiently and aggressively identifying budget savings. Over the past three 

years, we have averaged $1.6 billion annually in efficiencies and budget savings, 

and in 2015, that commitment to budget efficiencies and savings is more than $2 

billion. We are attentive to areas in which we need to improve our operations, and 

are committed to taking swift corrective action to eliminate any practices that do 

not deliver value for Veterans. For 15 consecutive years, VA delivered clean financial audits, during which time material weaknesses were reduced from four to one, 

and in 2013, for the first time, we had no significant deficiencies, having eliminated 

16 prior significant financial deficiencies. This is an area of major accomplishment 

in our internal controls and fiscal integrity. 

Information Technology 

To serve Veterans as well as they have served us, we are working to deliver a 

21st century VA that provides medical care, benefits, and services through a secure 

digital infrastructure. IT affects every aspect of what we do at VA. It has a direct 

impact on the quality of healthcare we provide Veterans; our ability to process 

claims efficiently; and our ability to provide Veterans’ benefits and services. In 2013, 

VA IT systems supported nearly 1,750 VA points of healthcare: 151 medical centers, 

135 community living centers, 103 domiciliary rehabilitation treatment programs, 

820 community-based outpatient clinics, 300 Vet Centers, and 70 mobile Vet Centers. The corresponding increase we have seen in the medical care spending for 

these facilities directly translates to new and increased services provided to Veterans. To provide Veterans access and benefits, we must make the necessary investments in IT innovations and deployments. Our 2015 Budget requests $3.9 billion for IT, consisting of $531 million for devel- opment; $2.3 billion for sustainment; and $1 billion for more than 7,400 staff, most 

of whom serve in VA hospitals and regional offices. The request will sustain our infrastructure while making necessary investments in critical business processes, such 

as modernizing healthcare scheduling, streamlining benefits processing, enhancing 

and modernizing VA’s electronic health record, enhancing data security, and achieving health data interoperability with DoD. Information security is a top priority at VA. The 2015 Budget requests $156 mil- lion for information protection and cyber security, an increase of $33 million (27 percent) over 2014. VA is constantly strengthening information security and improving 

technology and processes to ensure Veteran data and VA’s network are secure. Like 

any organization, public or private, we must continue to adapt. Our security posture 

is based on a ‘‘defense–in-depth’’ approach, which includes our partners at the Department of Homeland Security who maintain an over watch on our exterior perimeter. Working inward from our firewalls, VA has additional layers and protections 

that are constantly monitoring potential threats. 

Technology is also a critical component for achieving our goal to eliminate the dis- ability claims backlog in 2015. The 2015 Budget requests $137 million in IT funding 

for the Veterans Benefits Management System (VBMS), including $44.5 million for 

development and $92.5 million for sustainment. The 2015 development funds will 

allow VA to electronically process disability compensation claims in VBMS, from establishment to award. Planned enhancements and increased automation will allow 

end-users to focus on more difficult disability compensation claims by reducing the 

time required to process less complex claims. Sustainment funds will support the 

infrastructure behind VBMS as well as the deployment of additional new 

functionality features. 

The 2015 Budget continues our progress toward evolving VA’s VistA electronic 

health record (EHR) and achieving seamless integration of health data with the 

DoD by 2017. The budget requests $269 million to help achieve our shared goal of 


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providing the best possible support for Servicemembers and Veterans. In the near 

term, we are working to create seamless integration of DoD, VA, and private provider health data. In the mid-term, we are working to modernize the software supporting DoD and VA clinicians. Together, these two goals will help to create an environment in which clinicians and patients from both Departments are able to share 

current and future healthcare information for continuity of care and improved treatment. As we strive to build on our successful history of health data sharing and collaboration, we understand our EHR modernization efforts are complicated, dynamic, 

and multi-faceted. 

Improving and Expanding Access to Benefits and Services 

The number of Veterans receiving VA benefits and services has grown steadily 

and will continue to rise as overseas conflicts end and more Servicemembers transition to Veteran status. In 2015, the number of patients treated within VA’s 

healthcare system is projected to reach 6.7 million, an increase of nearly one million 

patients (17.4 percent) since 2009. Within VBA, the number of Veterans and survivors receiving Compensation and Pension benefits will approach 5 million in 2015, 

while the number of Education and Vocational Rehabilitation beneficiaries will exceed 1.1 million. 

We continue to improve access to VA services by opening new, and improving current, facilities closer to where Veterans live. Since January 2009, we have added approximately 55 community-based outpatient clinics (CBOCs), for a total of 820 

CBOCs, and the number of mobile outpatient clinics and Mobile Vet Centers, serving rural Veterans, has increased by 21, to the current level of 78. In addition, while 

opening new and improved facilities is essential for VA to provide world-class 

healthcare to Veterans, so too is enhancing the use of ground breaking new technologies to reach countless other Veterans. We continue to invest in ‘‘taking the facility to the Veteran’’—through expanded access to telehealth, sending Mobile Vet 

Centers to reach Veterans in rural areas where certain services are limited or difficult to reach, and by deploying social media to connect with Veterans to share information on the VA benefits they have earned. 

The Affordable Care Act (ACA) expands access to coverage, provides new ways to 

bring down healthcare costs, improves the Nation’s healthcare delivery system, and 

has important implications for VA. VA is ensuring a coordinated and collaborative 

approach to ACA implementation. We estimate that there are approximately 1.3 

million uninsured Veterans, of which 1 million may be eligible for, but not enrolled 

in VA healthcare. We will continue our education and outreach efforts so Veterans 

know the healthcare law does not affect their VA health benefits or out-of-pocket 

costs, and that Veterans enrolled in VA healthcare do not need to take additional 

steps to meet ACA’s new coverage standards. We will also encourage Veterans’ family members not enrolled in a VA healthcare program to obtain coverage through 

the Health Insurance Marketplaces. 

A large part of our Veteran population hails from the small towns of rural America. Some 3.1 million Veterans enrolled in VA’s healthcare system live in rural or 

highly rural areas, about 36 percent of all enrolled Veterans. In total, more than 

$17.36 billion were obligated in 2013 for the healthcare needs of rural Veterans. As 

technology advances and broadband access expands across rural America, we have 

been able to extend the availability of VA healthcare through telemedicine, webbased networking tools, and the use of mobile devices—all of which help improve 

access to care and support economic development for people in rural areas. Telehealth is a transformative breakthrough in healthcare delivery in 21st century medicine, allowing care to reach Veterans who otherwise may not have access, especially 

those who live in rural and extremely remote areas. The 2015 Budget requests $72 

million for Rural Health telehealth. 

Changing demographics are driving transformation at VA. Women now comprise 

nearly 15 and 18 percent of today’s active duty military forces and Reserve component, respectively. Women are the fastest growing segment of our Veteran population. Since 2009, the number of women Veterans enrolled in VA healthcare increased by almost 29 percent, to 629,683. The 2015 Budget includes $403 million 

for gender-specific healthcare services for women Veterans. Today, nearly 49 percent 

of our facilities have comprehensive women’s clinics, and every VA healthcare system has designated women’s health primary care providers and a women Veterans’ 

program manager on staff. 

The Caregivers and Veterans Omnibus Health Services Act (Caregivers Act) 

marked a major step forward in America’s commitment to those who provide daily 

care for wounded warriors, who have borne the battle for us all. The sustainment 

phase of the Caregivers program began in 2013, and includes application processing; 

stipends; travel and healthcare coverage; education, training, and competency; and 


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IT support. The 2015 Budget includes $306 million for the Caregivers program, including $235 million for caregiver stipends. 

Since VA began implementation of the Honoring America’s Veterans and Caring 

for Camp Lejeune Families Act in August 2012, more than 10,100 Veterans have 

contacted VA concerning Camp Lejeune-related treatment, as of February 27, 2014. 

Of these, roughly 8,300 were already enrolled in VA healthcare. Veterans who are 

eligible for care under the Camp Lejeune authority, regardless of current enrollment 

status with VA, will not be charged a co-payment for healthcare related to the 15 

illnesses or conditions recognized, nor will a third-party insurance company be billed 

for these services. VA continues a robust outreach campaign to these Veterans and 

family members while we press forward with implementing this law. The 2015 

Budget includes $51 million to provide healthcare for Veterans and family members 

who were potentially exposed to contaminated drinking water at Camp Lejeune. The 2015 Budget requests $99.6 million in IT funding for the Veterans Relationship Management (VRM) initiative, which is transforming Veterans’ access to VA 

benefits and services by empowering Veterans with new self-service tools. In addition, VRM is essential to achieving our access goals. We are transforming VA’s national call centers into service centers by delivering enhanced, integrated, systemwide telephone capabilities. VBA is also implementing the Client Relationship Management Unified Desktop that provides Veterans or beneficiary contact history and 

a consolidated view of benefit programs for our employees to enhance the customer’s 

experience and provide responsive and complete information. 

As part of this experience, VBA aggressively promoted eBenefits and improved 

Veterans ability to enroll in and access VA benefits and services. The joint VA–DoD 

eBenefits Web portal is a personalized central location for Veterans, 

Servicemembers, and their families to research, access, and manage their benefits 

and personal information. More than 3.2 million Servicemembers and Veterans are 

enrolled in eBenefits, and our goal is to expand enrollment to 5 million users in 

2015. Over 50 self-service features, including online filing of claims, online 

uploading of evidence, and claim status tracking are now available in eBenefits; VA 

and DoD continue to expand functionality with each quarterly release. 

VA also continues to increase access to burial services for Veterans and their families through the largest expansion of its national cemetery system since the Civil 

War. At present, approximately 90 percent of the Veteran population—about 20 million Veterans—has access to a burial option in a national, state, or tribal Veterans 

cemetery within 75 miles of their homes. In 2004, only 75 percent of Veterans had 

such access. This dramatic increase is the result of a comprehensive strategic planning process that efficiently uses resources to serve the greatest number of Veterans. 

Improving Access to Mental Health Services 

We have been a Nation at war for more than a decade, and the state of 

Servicemembers’ and Veterans’ mental health is a National priority. At VA, meeting 

the individual mental health needs of Veterans is more than a system of comprehensive treatments and services; it is a philosophy of ensuring that Veterans receive 

the best mental healthcare possible, while focusing on the overall mental well-being 

of each Veteran. VA remains committed to doing all we can to meet this challenge. 

Through the strong leadership of the President and the support of Congress, Veterans’ access to mental healthcare has significantly improved. Some of the stigma 

associated with seeking help has diminished. We proactively screen all Veterans for 

PTSD, depression, TBI, problem drinking, substance abuse, and military sexual 

trauma (MST) to identify issues early and provide treatments and intervention opportunities. We know that when we diagnose and treat people, they get better. 

Rates of suicide among those who use VHA services have not shown increases similar to those observed in all Veterans and the general U.S. population. Since 2006, 

the number of Veterans receiving specialized mental health treatment has risen 

each year from 927,000 to more than 1.3 million in 2013. In addition, Outpatient 

visits and encounters will increase to 12.8 million in 2015, from 12.1 million in 

2013. Vet Centers are another avenue for mental healthcare access, providing services to 195,913 Veterans and their families in 2013. 

While we made significant progress in serving the growing number of Veterans 

seeking mental healthcare, our work is not done. The 2015 Budget includes $7.2 billion for mental healthcare, an increase of $309 million (4.5 percent). VA efforts are 

crucial to dispel the lingering stigma surrounding treatment, and help Veterans regain their dignity and the ability to hold meaningful employment and maintain a 

home, which helps, in turn, strengthen our Nation’s economy. 

In response to the growing demand for mental health services, VA enhanced capacity and improved the system of care so that services are more readily accessible. 


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In 2012, VA completed a comprehensive assessment of the mental health program 

at every VA medical center and is using the results of that assessment to improve 

programs and share best practices across VISNs and facilities. VA also held mental 

health summits at each of our 151 medical centers, broadening the community dialogue between clinicians and stakeholders. 

We are developing new measures to gauge mental healthcare performance, including timeliness, patient satisfaction, capacity, and availability of evidence-based 

therapies. Evidence-based staffing guidelines are being written for specialty and 

general mental health. In addition, VA is working with the National Academy of 

Sciences to develop and implement measures and corresponding guidelines to improve the quality of mental healthcare. To help VA clinicians better manage Veteran 

patients’ mental health needs, VA is developing innovative electronic tools. For example, Clinical Reminders give clinicians timely information about patient health 

maintenance schedules, and the High-Risk Mental Health National Reminder and 

Flag system allows VA clinicians to flag patients who are at-risk for suicide. When 

an at-risk patient does not keep an appointment, Clinical Reminders prompt the clinician to follow up with the Veteran. 

Since its inception in 2007, the VA’s Veterans’ Crisis Line in Canandaigua, New 

York, answered nearly 1,000,000 and responded to more than 143,000 texts and 

chat sessions from Veterans in need. The Veterans’ Crisis line provides 24/7 crisis 

intervention services and personalized contact between VA staff, peers, and at-risk 

Veterans, which may be the difference between life and death. In the most serious 

calls, approximately 35,000 men and women have been rescued from a suicide in 

progress because of our intervention—the rough equivalent of two Army divisions. 

Eliminating the Claims Backlog 

VA has no greater responsibility than ensuring Veterans and their survivors receive timely, accurate decisions on their disability compensation and pension claims. 

Too many Veterans have waited too long to receive their benefits—and this has 

never been acceptable to VA, including the employees of VBA, over half of whom 

are Veterans. To attack this longstanding problem, we launched a historic plan to 

transform our people, processes, and technology. Our strategy advances VBA’s tools, 

streamlines claims processes, trains its workforce, improves workload management, 

and meaningfully enhances interaction with Veterans and stakeholders to deliver 

more timely and accurate benefit decisions and services to Veterans and their families. Despite an escalating workload brought about by the correct decisions for Veterans on Agent Orange, Gulf War, and combat PTSD presumptions—and successful 

outreach to Veterans informing them of their benefits—we are making steady 

progress toward our goal of eliminating the disability claims backlog in 2015. 

The 2015 Budget requests $2.5 billion for VBA, an increase of $28.8 million from 

2014. VBA projects a beneficiary caseload of 5.1 million in 2015, with more than 

$78.7 billion in disability compensation and pension benefits obligations. We expect 

to process 1.5 million compensation and pension claims in 2015, up from 1.25 million claims in 2014, an increase of nearly 17 percent over 2014. 

Through our claims transformation initiatives, the use of mandatory overtime, 

and other innovative strategies, we are making real progress in reducing the disability claims backlog. As of March 8, 2014, the backlog stood at 368,829 claims, 

down 242,244 (40 percent) from its highest point on March 25th, 2013. Additionally, 

under its Oldest Claims Initiative that began in April 2013, VA provided decisions 

to over 500,000 Veterans whose claims had been pending the longest. VA continues 

to work closely with DoD, the Internal Revenue Service, the Social Security Administration, and our other Federal partners to identify electronic data-sharing opportunities and process reforms to streamline workflows and limit paper claims filing. 

VBMS is key to VBA’s transformation and success in meeting our 2015 goal. In 

June 2013, VBA completed national deployment of VBMS—six months ahead of 

schedule—providing access to over 25,000 end-users. Approximately 80 percent of 

VA’s pending disability claims are in a digital format for electronic processing in 

VBMS. Moving to a digital environment is critical. VA anticipates there will be approximately 250,000 new Servicemembers transitioning to Veteran status each of 

the next 4 years, for a total of one million new Veterans added during the next four 

years. As a result of our increased efforts to enable more Veterans to access the benefits they have earned and deserved, many of these Veterans are likely to file a 

claim with VBA within the first year of separation. 

The 2015 Budget includes $138.7 million for continued investment in the Veterans Claims Intake Program (VCIP), which converts paper claims into an electronic 

format and enables electronic transfer of medical and personnel records. This electronic transfer is critical to creating the necessary digital environment for 

populating the eFolders and supporting end-to-end electronic claims processing for 


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each stage of the claims lifecycle. Although VA continues to accept paper claims 

from Veterans who are not familiar with or cannot access computer technology, VBA 

is working with stakeholders to increase the number of claims submitted electronically. VBA now converts paper claims to electronic format as we receive them, saving time and effort and improving accuracy. As of December 2013, over 25,000 

VBMS users could access 424 million electronic images converted from paper. The 2015 Budget includes $94.3 million for the Board of Veterans’ Appeals (the 

Board), which we are requesting as a new appropriation separate from the General 

Administration appropriation. The Board provides direct service to Veterans and 

their families by conducting hearings and issuing final appeals decisions. VA is actively pursuing initiatives to improve the appeals process and reduce wait times for 

Veterans, including a Board-led initiative that pre-screens appeals to ensure that 

the record is fully developed and ready for adjudication. The Board is also streamlining decision writing to increase output and efficiency. Expanded use of VBMS and 

the eventual incorporation of appeals functionality in VBMS will save resources currently spent handling, accessing, storing, and transporting paper claims files between the Board and VBA Regional Offices. The Board completed major technological upgrades to its video teleconference (VTC) equipment and the Board now 

conducts slightly over half of their hearings by video teleconference, a significant increase from 29 percent in 2009. We project appeals will increase to 72,786 cases in 

2015, an increase of 12 percent from 2014’s 64,941 cases. 

Ending Veteran Homelessness 

Every Veteran who has served America ought to have a home in America. We 

made great progress toward achieving our goal to end Veteran homelessness in 

2015. VA will use knowledge gained over the past four years to ensure robust prevention programs are in place for future years. The 2015 Budget request is essential 

for VA to successfully achieve an end-to-the-rescue phase, and prevent future homelessness among Veterans at-risk in the years to come. 

Since 2009, VA, together with our Federal, state, and local partners, has reduced 

the estimated number of homeless Veterans by 24 percent. We have conducted over 

six million clinical visits with over 600,000 Veterans who were homeless, at-risk of 

homelessness (including formerly homeless). In 2013 alone, VA served more than 

240,000 Veterans who were homeless or at-risk of becoming homeless—21 percent 

more than the year before. Over the past four years, the Point-in-Time (PIT) count 

of homeless Veterans declined steadily, despite challenging economic times. The PIT 

count estimate of the number of homeless Veterans dropped from 75,609 in January 

2009, to 57,849 in January 2013, a 24 percent decrease. 

VA’s programs constitute the largest integrated network of programs with components of homeless assistance in the Nation. They provide homeless Veterans with 

nearly 80,000 beds or units, including permanent supportive housing through the 

Department of Housing and Urban Development-VA Supportive Housing (HUD– 

VASH) program; link Veterans with needed mental health and other medical care; 

and provide supportive services and opportunities to reintegrate Veterans back into 

the community and workforce. VA’s cost-effective, evidence-based homeless programs produce large savings and cost avoidance in budgetary, social, and economic 

terms. Using a Housing First strategy, VA relies on research that shows that placing homeless Veterans into Housing First reduces emergency room visits, other 

forms of intensive hospitalization, and substance overdose. Medical care costs are 

roughly three times as expensive for homeless compared to Veterans who are not 

homeless. 

Despite significant progress and important accomplishments, much work remains. 

We estimate that between 2013 and 2015, approximately 200,000 Veterans will experience homelessness at some point in time. To reach our goal of ending Veteran 

homelessness in 2015, the Budget requests $1.6 billion for VA homeless-related programs, including case management support for the HUD–VASH voucher program, 

the Grant and Per Diem Program, the Supportive Services for Veteran Families 

(SSVF) program, and VA justice programs. This represents an increase of $248 million (17.8 percent) over the 2014 Budget level. This budget supports VA’s long-range 

plan to end Veteran homelessness by emphasizing rescue for those who are homeless today, and prevention for those at risk of homelessness. 

HUD—VASH provides permanent supportive housing to the most vulnerable of 

our homeless Veterans. The 2015 Budget requests $374 million for HUD–VASH, an 

increase of $47 million (14 percent) over the 2014 Budget level. This funding will 

support nearly 3,500 case managers to provide intensive wraparound services to 

nearly 80,000 Veterans. These case managers provide an average number of 12 clinical visits per year to these Veterans to ensure that they remain in housing and 

do not become homelessness again. Veterans in HUD–VASH are vulnerable; the maVerDate Aug 31 2005 11:40 Jun 12, 2015 Jkt 000000 PO 00000 Frm 00044 Fmt 6633 Sfmt 6621 Y:\87670.TXT PAT

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jority meets criteria for chronic homelessness, and suffers from serious mental illness, substance use disorders, and chronic medical conditions. This partnership remains the most responsive housing option available to VA and is a critical component of our strategy to move homeless Veterans from the streets to a safe and stable 

home. 

The Grant and Per Diem Program helps fund community agencies providing services to homeless Veterans with the goal of helping them achieve residential stability, 

increase their skill levels and/or income, obtain greater self-determination, independent living, and employment as soon as possible. The 2015 Budget requests $253 

million for the Grant and Per Diem Program, an increase of $3 million (1.1 percent) 

over the 2014 Budget level. In 2015, the program will provide over 15,500 transitional housing beds to Veterans through partnerships with more than 650 projects. 

VA’s SSVF is a critical aspect of our strategy to prevent and end Veteran homelessness. This program provides both prevention and rapid rehousing services to 

Veterans and family members. In 2013, SSVF successfully prevented over 60,000 atrisk Veterans and family members from falling into homelessness, and successfully 

placed over 84 percent of homeless Veterans and family members into permanent 

housing. In the last three years, VA awarded grants totaling $459.6 million to 324 

community agencies in all 50 states, the District of Columbia, Puerto Rico, and the 

Virgin Islands. SSVF grants to private non-profit organizations and consumer cooperatives provide a range of supportive services to include outreach, case management, assistance in obtaining VA benefits, and assistance in obtaining and coordinating other public benefits. In 2015, VA will deploy SSVF grants strategically to 

target resources to communities with concentrations of homeless Veterans. 

In addition, VA’s Justice Programs, which facilitate access to needed VA treatment for Veterans in criminal justice settings such as Veterans Treatment Courts, 

are an important prevention effort for homeless and at-risk Veterans. The goal of 

these Courts is to divert those with mental health issues and homelessness risk 

from the traditional justice system and give them treatment and tools for rehabilitation and readjustment. The first Veterans court was established in 2008 in Buffalo, 

N.Y. By the end of 2013, there were 257 courts nationwide, positively affecting the 

lives of 7,724 Veterans; VA serves Veterans in each of these courts. Many of the 

participating Veterans have avoided incarceration and the cycle of homelessness, 

that often follows incarceration. The 2015 Budget requests $35 million for Veterans 

Justice Programs, an increase of $1.5 million (4 percent) over the 2014 Budget level. 

To increase homeless Veterans’ access to benefits, care, and services, VA established the National Call Center for Homeless Veterans (NCCHV). The NCCHV provides homeless Veterans and Veterans at-risk for homelessness free, 24/7 access to 

trained counselors. The call center is intended to assist homeless Veterans and their 

families; VA medical centers; Federal, state, and local partners; community agencies; service providers; and others in the community. In 2013, the National Call 

Center for Homeless Veterans received 111,096 calls (38 percent increase over 2012) 

and made 78,622 referrals to VA Medical Centers (55 percent increase over 2012). 

The 2015 Budget requests $5.6 million for NCCHV, an increase of $1.7 million (45 

percent) over the 2014 Budget level. VA has established 28 Community Resource 

and Referral Centers (CRRC) to provide rapid assistance to homeless Veterans. 

Multi-Year Budget for Medical Care 

Due to Congress’s foresight, under the Veterans healthcare Budget Reform and 

Transparency Act of 2009, VA includes a request for an advance appropriation for 

its medical care budget. The legislation requires VA to plan its medical care budget 

using a multi-year approach, which ensures that VA requirements are reviewed and 

updated based on the most recent data available and actual program experience. 

The 2015 medical care budget of $59.1 billion, including collections, will fund treatment to over 6.7 million unique patients, an increase of 4 percent over the 2013 estimate. Of those unique patients, 4.7 million Veterans are in Priority Groups 1–6, an 

increase of more than 204,836 (4.5 percent). Additionally, VA anticipates treating 

over 757,600 Veterans from the conflicts in Iraq and Afghanistan, an increase of 

over 141,100 patients (23 percent) over the 2013 level. VA also provides medical 

care to non-Veterans through programs such as the Civilian Health and Medical 

Program of the Department of Veterans Affairs (CHAMPVA) and the Spina Bifida 

healthcare Program; we expect this population to increase by over 42,600 patients 

(6.3 percent), during the same period. 

Based on updated 2015 estimates largely derived from the Enrollee healthcare 

Projection Model, the 2015 Budget will allow VA to increase funding for programs 

to end Veteran homelessness; continue implementation of the Caregivers and Veterans Omnibus Health Services Act; fulfill multiple responsibilities under the ACA; 

provide for activation requirements for new or replacement medical facilities; and 


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invest in strategic initiatives to improve the quality and accessibility of VA 

healthcare programs. The 2015 appropriations request includes an additional $368 

million above the enacted 2015 advance appropriations level. Our multi-year budget 

plan assumes that VHA will carry over a small percentage of unobligated balances 

from 2014 into 2015 to ensure that funds are available at the beginning of the fiscal 

year to cover any unforeseen costs. 

The 2016 medical care budget of $61.9 billion, including collections, provides for 

healthcare services to treat over 6.8 million unique patients, an increase of 1.5 percent over the 2015 estimate. The 2016 request for medical care advance appropriations is an increase of $2.9 billion, or 4.9 percent, over the 2015 budget request. 

Medical care funding levels for 2016, including funding for activations, non-recurring maintenance, and initiatives, will be revisited during the 2016 budget process, 

and could be revised to reflect updated information on known funding requirements 

and unobligated balances. 

Medical and Prosthetic Research 

VA supports the President’s national action plan to guide mental health research 

across government, industry and academia, and develop more effective ways to prevent, diagnose, and treat mental health conditions like TBI and PTSD. VA’s medical 

research programs demonstrate the creativity and ingenuity of our Nation’s greatest 

minds to help save Veterans’ lives, limit their incapacitation, and build a better 

world for their families. Projects funded in 2015 will focus on identifying or developing new treatments for Gulf War Veterans, improving social reintegration following traumatic brain injury, reducing suicide, evaluating the effectiveness of complementary and alternative medicine, developing blood tests to assist in the diagnosis of PTSD and mild traumatic brain injury, and advancing genomic medicine. 

In 2015, Medical Research will be supported through a $589 million direct appropriation, and an additional $1.3 billion from VA’s medical care program, Federal 

grants, and non-Federal grants. Including Medical Care support, other Federal resources, and private resources, total funding for Medical and Prosthetic Research 

will be nearly $1.9 billion in 2015. VA’s research program benefits Veterans, their 

families, and the Nation. 

Increasing Employment Opportunities for Veterans 

Under the President’s leadership, VA, the Department of Labor, DoD, and the entire Federal government made Veterans’ employment one of their highest priorities. 

At VA, we led by example. We made great strides during the last five years and 

remain committed to meeting our goal of 40 percent of VA employees being Veterans, compared to 32.4 percent currently. During 2013, 33.8 percent of all new 

hires at VA were Veterans, including an impressive 78.5 percent of all new employees in our National Cemetery Administration (NCA). 

We continue to work to ensure that all of America’s Veterans have the support 

they need and deserve when they leave the military, look for a job, and enter the 

civilian workforce. The interagency Employment Initiative Task Force, co-led by VA 

and DOD, developed a new training and services delivery model to help strengthen 

the transition of our Veteran Servicemembers from military to civilian life. Accordingly, the 2015 Budget includes $106 million to meet VA’s responsibilities under the 

President’s Veterans Employment Initiative and the VOW to Hire Heroes Act. In 

addition, the 2015 Budget includes $1 billion in mandatory funding over 5 years to 

develop a Veterans Job Corps conservation program that will put up to 20,000 Veterans back to work over the next 5 years protecting and rebuilding America. Jobs 

will include park maintenance projects, patrolling public lands, rehabilitating natural and recreational areas, and law enforcement-related activities. Additionally, 

Veterans will help make a significant dent in the deferred maintenance of our Federal, state, local, and tribal lands, including jobs that will repair and rehabilitate 

trails, roads, levees, recreation facilities, and other assets. The program will serve 

all Veterans, but have a particular focus on post-9/11 Veterans. 

Since 2009, VA provided over $31.8 billion in Post-9/11 GI Bill benefits in the 

form of tuition and other education-related payments to cover the education and 

training of more than 1 million Servicemembers, Veterans, family members, and 

survivors. As part of this effort VBA launched an online GI Bill Comparison Tool 

to make it easier for Veterans, Servicemembers, and dependents to calculate their 

Post-9/11 GI Bill benefits and learn more about VA’s approved colleges, universities, 

and other education and training programs across the country. The GI Bill Comparison Tool provides key information about college affordability and brings together information from more than 17 online sources and 3 Federal agencies, including the 

number of students receiving VA education benefits at each school. 


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VA is also now working with Student Veterans of America to track graduation 

and training completion rates, and we expect a draft report by the end of 2014 to 

quantify program outcomes. The Post-9/11 GI Bill continues to be a focus of VBA 

transformation, as it implements the automated Long-Term Solution (LTS), VA’s 

end-to-end claims processing solution that utilizes rules-based, industry-standard 

technologies for the delivery of education benefits. At the end of January 2014, we 

had 68,215 education claims pending, 21 percent lower than the total claims pending the same time last year. The average days to process Post-9/11 GI Bill supplemental claims decreased by 9.1 days, from 16.1 days in September 2012 to 7 days 

in January 2014. The average time to process initial Post-9/11 GI Bill original education benefit decreased by 15.3 days in the same period, from 32.5 days to 17.2 

days. 

Capital Infrastructure 

The 2015 Budget requests $1.06 billion for VA’s major and minor construction 

programs, the same as the 2014 Budget level. The capital asset budget demonstrates VA’s commitment to address critical major construction projects that directly impact patient safety and seismic issues and reflects VA’s ongoing promise 

to provide safe, secure, sustainable, and accessible facilities for Veterans. The request also reflects the current fiscal climate and the great challenges VA faces in 

order to close the gaps identified in our Strategic Capital Investment Planning 

(SCIP) process. 

Major Construction 

The major construction request in 2015 is $561.8 million. The request provides 

funding for four on-going major medical facility projects. They include: (1) seismic 

corrections to renovate building 205 for homeless programs at the West Los Angeles, 

CA VA Medical Center; (2) seismic corrections and construction of a new mental 

health facility and parking structure at the Long Beach Healthcare System; (3) construction of a new community living center (CLC), domiciliary and outpatient facility in Canandaigua, NY; and (4) construction of a new spinal cord injury/CLC facility, hospice nursing unit, and upgrades to a high-risk seismic building in San Diego, 

CA. These projects represent VA’s most critical major construction projects and correct critical safety and seismic deficiencies that are currently putting Veterans, VA 

staff, and the public at risk. Once the projects are completed, Veterans seeking care 

will be served in more modern and safer facilities. 

The 2015 Budget also includes $2.5 million for NCA for advance planning activities and $7.5 million for land acquisition to support the establishment of 5 additional national cemeteries in Cape Canaveral and Tallahassee Florida; Omaha, Nebraska; southern Colorado; and western New York to meet the burial access policies 

included in the 2011 budget. 

Minor Construction 

The 2015 Budget includes a minor construction request of $495.2 million. The requested amount would provide funding for ongoing and newly identified projects 

that renovate, expand, and improve VA facilities. This year’s focus is a balance between continuing to fund minor construction projects that we can implement quickly 

to maintain and repair our aging infrastructure, while using major construction 

funding to address life-threatening safety and seismic issues that currently exist at 

multiple VA medical facilities. 

Opportunity, Growth and Security Initiative 

The Budget also includes a separate $56 billion Opportunity, Growth, and Security Initiative to spur economic progress, promote opportunity, and strengthen national security. This Initiative would increase employment, while achieving important economic outcomes in areas from education to research to manufacturing and 

public health and safety. Moreover, the Opportunity, Growth, and Security Initiative is fully paid for with a balanced package of spending cuts and tax loophole closers. 

At the Department of Veterans Affairs (VA), the Opportunity, Growth, and Security Initiative will support capital investments essential to expanding and protecting 

Veterans’ access to quality care and benefits. By providing an additional $400 million for the VA capital program, enactment of the Initiative will allow additional 

progress in addressing the Department’s highest priority capital needs, including a 

major construction project to replace a seismically deficient research facility in San 

Francisco, California. 

National Cemetery Administration 


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The NCA has the solemn duty to honor Veterans and their families with final 

resting places in national shrines and with lasting tributes that commemorate their 

service and sacrifice to our Nation. We honor those individuals’ service through our 

133 national cemeteries, which includes two national cemeteries scheduled to open 

in 2015, 33 Soldiers’ lots and monuments, the Presidential Memorial Certificate program, and through the markers and medallions that we place on the graves of Veterans around the world. The 2015 Budget includes $256.8 million for operations and 

maintenance to uphold NCA’s responsibility for this mission, including funds to 

open two new national cemeteries and to begin preparations for opening two National Veterans Burial Grounds. 

NCA projects its workload will continue to increase. For 2015, we anticipate conducting approximately 128,100 interments of Veterans or their family members, and 

maintaining and providing perpetual care for approximately 3.5 million gravesites. 

NCA will also maintain 8,882 developed acres and process approximately 362,900 

headstone and marker applications. 

NCA maintains a strong commitment to hiring Veterans. Currently, Veterans 

comprise over 74 percent of its workforce. Since 2009, NCA hired over 450 returning 

Iraq and Afghanistan Veterans. In addition, NCA awarded 66.5 percent of contract 

awards in 2013 to Veteran-owned and service-disabled, Veteran-owned small businesses. NCA’s committed, Veteran-centric workforce is the main reason it is able to 

provide a world-class level of customer service. NCA participated for the 5th time 

in the American Customer Satisfaction Index (ACSI), sponsored by the Federal Consulting Group and Claes Fornell International (CFI) Group. In the 2013 review, 

NCA received a score of 96 out of a possible 100, the highest score to date for any 

organization in the public or private sector. 

NCA continues to leverage its partnerships to increase service for Veterans and 

their families. As a complement to the national cemetery system, NCA administers 

the Veterans Cemetery Grant Service (VCGS), which provides grants to establish, 

expand, or improve state and tribal Veterans’ cemeteries. There are currently 90 

operational state and tribal cemeteries in 45 states, Guam, and Saipan, with five 

more under construction. Since 1980, VCGS awarded grants totaling more than 

$566 million to establish, expand, or improve these Veterans’ cemeteries. In 2013, 

these cemeteries conducted over 32,000 burials for Veterans and family members. 

Legislation 

In addition to presenting VA’s resource requirements, the 2015 President’s Budget 

also proposes legislative action that will benefit Veterans. These proposals build on 

VA’s legislative agenda transmitted in the First Session of the 113th Congress, as 

part of the 2014 President’s Budget. Let me highlight a few provisions: VA proposes 

a measure that will allow better coordination of care when a Veteran also receives 

other care at a non-VA hospital, by streamlining the exchange of patient information. Additionally, we propose allowing the CHAMPVA to cover children up to age 

26, to make that program consistent with benefits conferred under the ACA. We 

also are submitting a proposal that would modernize our domiciliary care program 

by removing income-based eligibility restrictions. 

To continue our priority to end Veteran homelessness, VA proposes increased 

flexibility in the Grant and Per Diem program to focus on the transition to permanent housing. Also among our proposals is a measure that would allow VA to speed 

payment of Dependency and Indemnity Compensation and other benefits to surviving spouses by eliminating the need for a formal claim when there already is sufficient evidence for VA to act. We greatly appreciate consideration of these and other 

legislative proposals included in the 2015 Budget and look forward to working with 

Congress to enact them. 

Summary 

Since the founding of our great Nation, Veterans helped our country meet all challenges; this remains true today as Veterans help rebuild the American middle class. 

At VA, we continue to implement the President’s vision and transform VA into a 

21st century leader of efficiency, effectiveness, and innovation within the Federal 

government. Our 2015 Budget supports Presidential priorities to always add value 

to the Nation, boost economic growth, strengthen the middle class, and work sideby-side with Federal partners to eliminate unnecessary overlaps or redundancies. 

Given today’s challenging fiscal environment, this Budget focuses VA resources, 

policies, and strategies on the most urgent issues facing Veterans and provides the 

resources critical to expand access, eliminate the disability claims backlog in 2015, 

and end Veteran homelessness in 2015. There is no greater mission than serving 

Veterans. Again, thank you for the opportunity to appear before you today and for 

your unwavering support of Veterans. 


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PARALYZED VETERANS OF AMERICA

Chairman Miller, Ranking Member Michaud, and Members of the Committee, as 

one of the four co-authors of The Independent Budget (IB), Paralyzed Veterans of 

America (PVA) is pleased to present the views of The Independent Budget regarding 

the funding requirements for the Department of Veterans Affairs (VA) for FY 2015. 

As Congress and the Administration continue to face immense pressure to reduce 

federal spending, we cannot emphasize enough the importance of ensuring that sufficient, timely and predictable funding is provided to the Department of Veterans 

Affairs (VA). The co-authors of The Independent Budget—AMVETS, Disabled American Veterans, Paralyzed Veterans of America, and Veterans of Foreign Wars—recognize the pressure that the Administration and Congress face; however, we believe 

that the ever-growing demand for healthcareservices certainly validates the continued need for sufficient funding. We also understand that the VA has fared better 

than most federal agencies with regards to budget proposals and appropriations. 

However, we are concerned that discretionary funding for the VA is no longer keeping pace with medical care inflation or healthcaredemand. 

That being said, we certainly appreciate the increases offered by the Administration’s budget for FY 2015 and the FY 2016 advance appropriations, particularly 

with regards to healthcare and benefits services. Unfortunately, we have real concerns that the serious lack of commitment to infrastructure funding to support the 

system will undermine the VA’s ability to deliver those services. Similarly, we remain concerned that the funding levels provided by the House and Senate Committees on Appropriations in the recently passed omnibus appropriations bill will be insufficient to address the continuously growing demand for VA healthcareservices. 

Moreover, The Independent Budget co-authors oppose the steps VA has taken in 

recent years in order to generate resources to meet ever-growing demand on the VA 

healthcare system. The Administration continues to rely upon ‘‘management improvements,’’ a popular gimmick that was used by previous Administrations to generate savings and offset the growing costs to deliver care. Unfortunately, these savings are often never realized leaving VA short of necessary funding to address evergrowing demand on the healthcare system. 

Of even greater concern is the fact that the VA continues to over project and 

underperform with its medical care collections estimates. Overestimating collections 

estimates affords Congress the opportunity to appropriate fewer discretionary dollars for the healthcaresystem. However, when the VA fails to achieve those collections estimates, it is left with insufficient funding to meet the projected demand. 

As long as this scenario continues, the VA will find itself falling farther and farther 

behind in its ability to care for those men and women who have served and sacrificed for this nation. In fact, we believe that is exactly what is happening now. 

For example, the VA originally projected collections of approximately $3.3 billion in 

FY 2013 and FY 2014 and approximately $3.2 billion in FY 2015. Congress based 

its appropriations for the VA for those fiscal years on those projected collections. 

However, the VA subsequently revised its estimates anticipating collections of $2.8 

billion in both FY 2013, $2.9 billion in FY 2014, and less than $3.1 billion for FY 

2015. The flawed projections estimates and the dollars appropriated by Congress in 

each of those fiscal years suggest that the VA may have received $1.0 billion too 

little in resources during that period. And yet, this shortfall has never been addressed through supplemental appropriations. 

Too often in meetings with congressional offices, staff members have proclaimed 

the belief that VA has received too much money. We would ask the Committee how 

that logic passes when we have clearly identified a shortfall simply based on faulty 

collections estimates. Similarly, we would ask that the Committee proceed with caution in FY 2016 as the VA has once again projected a collections estimate of $3.3 

billion despite the fact that its recent performance suggests that it will not achieve 

that level. The fact that the VA continues to experience problems with its medical 

care collections reflects an even greater need for Congress to properly analyze, and 

if necessary, revise the advance appropriations from previous years to ensure that 

the VA healthcare system is getting the resources it actually needs. 

Funding for FY 2015 

For FY 2015, The Independent Budget recommends approximately $61.1 billion 

for total medical care, an increase of approximately $3.4 billion over the FY 2014 

operating budget. Meanwhile, the Administration recommended in its FY 2015 

Budget Request a revised advance appropriation estimate for FY 2015 of approximately $56.0 billion in discretionary funding for VA medical care. This revised estimate reflected a projected increase in discretionary funding of approximately $368 

million over the recently approved advance appropriations level. When combined 


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with the approximately $3.1 billion revised projection for medical care collections 

(decreased from $3.2 billion in last year’s estimate), the total available operating 

budget recommended for FY 2015 is approximately $59.1 billion. This reflects an increase of $1.7 billion over the previously approved FY 2014 operating budget, an 

amount that we believe is inadequate to fully meet the healthcare demand. 

The medical care appropriation includes three separate accounts—Medical Services, Medical Support and Compliance, and Medical Facilities—that comprise the 

total VA health-care funding level. For FY 2015, The Independent Budget recommends approximately $49.3 billion for Medical Services. Our Medical Services 

recommendation includes the following recommendations: 

Current Services Estimate .................................................................... $47,616,189,000 

Increase in Patient Workload ............................................................... 1,171,260,000 

Additional Medical Care Program Costs ............................................. 500,000,000 

Total FY 2014 Medical Services ........................................................... $49,287,449,000 

Our growth in patient workload is based on a projected increase of approximately 

87,000 new unique patients—priority groups 1–8 veterans and covered nonveterans. 

We estimate the cost of these new unique patients to be approximately $853 million. 

The increase in patient workload also includes a projected increase of 83,350 new 

Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), as well as 

Operation New Dawn (OND) veterans at a cost of approximately $318 million. The 

increase in utilization among OEF/OIF/OND veterans is supported by the average 

annual increase in new users from FY 2002 through the 3rd quarter of FY 2013. 

The Independent Budget also believes that there are additional projected funding 

needs for VA. Specifically, we believe there is real funding needed to address the 

array of long-term care issues facing the VA, including the shortfall in institutional 

capacity, and to provide additional centralized prosthetics funding (based on actual 

expenditures and projections from the VA’s prosthetics service). The Independent 

Budget recommends $375 million directed towards VA long-term care programs. In 

order to support the rebalancing of VA long-term care in FY 2015, $125 million 

should be provided. Additionally, $95 million should be targeted at the VA’s Veteran 

Directed-Home and Community Based Services (VD–HCBS) program. The remainder of the $375 million ($155 million) should be dedicated to increasing the VA’s 

long-term care average daily census (ADC) to the level mandated by Public Law 

106–117, the ‘‘Veterans Millennium healthcare and Benefits Act.’’ In order to meet 

the increase in demand for prosthetics, the IB recommends an additional $125 million. This increase in prosthetics funding reflects an increase in expenditures from 

FY 2013 to FY 2014 and the expected continued growth in expenditures for FY 

2015. 

For Medical Support and Compliance, The Independent Budget recommends approximately $6.1 billion. Finally, for Medical Facilities, The Independent Budget 

recommends approximately $5.7 billion. Our Medical Facilities recommendation includes the addition of $650 million to the baseline for Non-Recurring Maintenance 

(NRM). The Administration’s request over the last two cycles represents a wholly 

inadequate request for NRM funding, particularly in light of the actual expenditures 

that are outlined in the budget justification. In fact, the VA’s FY 2015 and FY 2016 

advance appropriations request for infrastructure is wholly insufficient (a topic that 

will be addressed by the VFW in its statement to the Committee), particularly with 

regards to Major and Minor Construction and Non-Recurring Maintenance (NRM). 

The VA continues to slash funding for NRM as evidenced by the rapidly decreasing 

estimates for Medical Facilities. And yet, the VA admits in its own documents that 

it spends between $1.3 billion and $1.4 billion per year on NRM. Similarly, we are 

extremely disappointed that the VA has requested such a laughable funding level 

for Major and Minor Construction, particularly considering the rapidly advancing 

age and condition of its infrastructure. It is time for Congress to take the necessary 

steps to reverse this course before the VA system collapses on itself. 

The Independent Budget co-authors have ongoing concerns about the lack of investment in Medical and Prosthetic Research. While we recognize that the Administration requested an increase in the research account for FY 2015, the $3 million 

increase does not even keep pace with inflation. If the VA is to remain a world leader in research, it is imperative that the Administration get serious about requesting 

real dollars and that Congress provide adequate resources to continue those efforts. 

With this point in mind, The Independent Budget recommends $611 million for 

Medical and Prosthetic Research funding for FY 2015. Similarly, we recommend at 

least $50 million in Major Construction and $175 million in Minor Construction and 

NRM to address the deteriorating state of VA research infrastructure. Failure to 

make these investments will undermine the VA’s ability to continue to attract the 


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best medical professionals into the research field and promote cutting edge advancements to benefit the men and women who have made great physical and mental sacrifices in defense of this Nation. 

Advance Appropriations for FY 2016 

Just as we did for the first time last year, The Independent Budget once again 

offers baseline projections for funding through advance appropriations for the medical care accounts for FY 2016. While we have previously deferred to the Administration and Congress to provide sufficient funding through the advance appropriations process, we have growing concerns that this responsibility is not being taken 

seriously. For FY 2016, The Independent Budget recommends approximately $62.5 billion 

for total medical care. The Administration’s Budget Request includes approximately 

$62.0 billion for total medical care—$58.7 billion in discretionary spending and approximately $3.3 billion in medical care collections. We appreciate the fact that the 

Administration has offered a substantial increase in healthcare funding from FY 

2015 to FY 2016 (as a part of its advance appropriations request). For FY 2016, The Independent Budget recommends approximately $50.8 billion 

for Medical Services. Our Medical Services recommendation includes the following 

recommendations: 

Current Services Estimate .................................................................... $49,193,067,000 

Increase in Patient Workload ............................................................... 1,074,225,000 

Additional Medical Care Program Costs ............................................. 510,000,000 

Total FY 2015 Medical Services ........................................................... $50,777,292,000 

Our growth in patient workload is based on a projected increase of approximately 

67,000 new unique patients—priority groups 1–8 veterans and covered nonveterans. 

We estimate the cost of these new unique patients to be approximately $746 million. 

The increase in patient workload also includes a projected increase of 83,350 new 

Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), as well as 

Operation New Dawn (OND) veterans at a cost of approximately $328 million. 

Lastly, The Independent Budget believes that there are additional projected fund- ing needs for VA. For FY 2016, we believe that an additional $375 million should 

be invested to address the spectrum of long-term care issues within the VA. Additionally, we believe that a continued increase in centralized prosthetics funding will 

be essential. In order to meet the continued increase in demand for prosthetics, the 

IB recommends an additional $135 million. 

For Medical Support and Compliance, The Independent Budget recommends ap- proximately $6.0 billion. Finally, for Medical Facilities, The Independent Budget 

recommends approximately $5.7 billion. Our Medical Facilities recommendation includes the addition of $900 million to the baseline for Non-Recurring Maintenance 

(NRM). Last year, the Administration’s recommendation for NRM reflected a projection that would place the long-term viability of the healthcare system in serious 

jeopardy. 

Advance Appropriations for all VA Accounts 

The Independent Budget co-authors are concerned that the broken appropriations 

process continues to have a negative impact on the operations of the VA. Once again 

this year Congress failed to fully complete the appropriations process in the regular 

order. In fact, many federal operations were shuttered as part of a partial government shutdown in October 2013. This had a significant negative impact on many 

of the services provided by the VA. While VA healthcare was shielded from this political disaster, benefits services, research activities, and general operations for the 

rest of the VA were impacted. Additionally, many of the operations that support the 

healthcare system, particularly through the Information Technology system, were 

negatively impacted complicating the VA’s ability to delivery timely, quality 

healthcare. 

We also have real concerns about the advance appropriations process as it currently functions. Our intent for this process was for the Administration to request 

an advance appropriation for a given fiscal year (two years ahead of the start of that 

fiscal year), and then revise that recommendation in its next budget request immediately prior to the start of the fiscal year in question. We appreciate the fact that 

the Administration’s FY 2015 Budget Request does include a significant revision for 

Medical Services reflecting an increased need for funding of approximately $368 million. However, during past budget cycles, the Administration has offered very little 

revision in its advance appropriations requests essentially asking for the same funding level. Moreover, we believe that Congress has not done its due diligence to adequately analyze the advance appropriations recommendations and make any necVerDate Aug 31 2005 11:40 Jun 12, 2015 Jkt 000000 PO 00000 Frm 00051 Fmt 6633 Sfmt 6621 Y:\87670.TXT PAT

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essary changes through supplemental appropriations. In fact, once Congress has approved an advance appropriations level for VA, it has not revised its previous years’ 

decision in any appreciable way. This undermines the principle benefit of advance 

appropriations—having additional time to ensure that sufficient funds are provided. 

With this in mind, we call on Congress to immediately approve legislation that 

would extend advance appropriations to all VA discretionary and mandatory appropriations accounts. Advance appropriations have shielded VA healthcarefrom most 

of the harmful effects of the partisan bickering and political gridlock that has paralyzed Washington in recent years. Now Congress must provide the same protections 

to all remaining discretionary programs, including Medical and Prosthetic Research, 

General Operating Expenditures, Information Technology, the National Cemetery 

Administration, Inspector General, Major Construction, Minor Construction, State 

Home Construction Grants, State Cemetery Grants and other discretionary accounts, and all mandatory funded programs, including disability compensation, pension, education benefits, and dependency and indemnity compensation. 

Chairman Miller and Ranking Member Michaud, the co-authors of The Independent Budget sincerely appreciate your commitment to this effort and we applaud 

your introduction and advocacy to ensure that H.R. 813, the ‘‘Putting Veterans 

Funding First Act,’’ was passed by the House of Representatives. We commit to you 

our steadfast support to see this legislation through to final passage and enactment. 

Enactment of H.R. 813 will generally free all VA services from the political gridlock 

that has crippled the appropriations process in Congress. 

In the end, it is easy to forget that the people who are ultimately affected by 

wrangling over the budget are the men and women who have served and sacrificed 

so much for this nation. We hope that you will consider these men and women when 

you develop your budget views and estimates, and we ask that you join us in adopting the recommendations of The Independent Budget. 

This concludes our statement. We would be happy to answer any questions you 

may have. 

Information Required by rule XI 2(g)(4) of the House of Representatives 

Pursuant to rule XI 2(g)(4) of the House of Representatives, the following information is provided regarding federal grants and contracts. 

Fiscal Year 2013 

National Council on Disability—Contract for Services—$35,000. 

Fiscal Year 2012 

No federal grants or contracts received. 

Fiscal Year 2011 

Court of Appeals for Veterans Claims, Administered by the Legal Services Corporation—National Veterans Legal Services Program—$262,787. 


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STATEMENT OF RAYMOND C. KELLEY, DIRECTOR NATIONAL LEGISLATIVE SERVICE

VETERANS OF FOREIGN WARS OF THE UNITED STATES, COMMITTEE ON VETERANS’ 

AFFAIRS, UNITED STATES HOUSE OF REPRESENTATIVES

WITH RESPECT TO

VA’S BUDGET REQUEST FOR FISCAL YEAR 2015 

Mr. Chairman and Members of the Committee: 

On behalf of the men and women of the Veterans of Foreign Wars of the United 

States (VFW) and our Auxiliaries, I would like to thank you for the opportunity to 

testify today. The VFW works alongside the other members of the Independent 

Budget (IB)—AMVETS, Disabled American Veterans and Paralyzed Veterans of 

America—to produce a set of policy and budget recommendations that reflect what 

we believe would meet the needs of America’s veterans. The VFW is responsible for 

the IB’s Construction Programs, so I will limit my remarks to that portion of the 

budget. 

The vastness of the Department of Veterans Affairs’ (VA) capital infrastructure 

is rarely fully seen or understood. VA currently manages and maintains 6,016 buildings and almost 34,000 acres of land with a plant replacement value (PRV) of approximately $45 billion. Although VA has addressed a number of critical infrastructure gaps, 4,049 gaps remain that will cost between $56 and $68 billion to close, 

including $10 billion in activation costs. This is an increase of $2 billion from a year 

ago. 

With shrinking requests and appropriations from the Administration and Congress, VA is moving further behind in closing known safety, utilization, and access 

gaps and continues to fail to prevent future gaps from arising. To only maintain VA 

infrastructure in its current condition, VA’s Non-Recurring Maintenance (NRM) account would need $1.35 billion per year, based on the estimated plant replacement 

value the IB partners have calculated. The Administration has requested that NRM 

be funded at $462 million. More funds will need to be invested to prevent the documented NRM backlog of $18 billion to $22 billion from growing even larger. To address the gaps in safety, access, and utilization, VA will need to invest between $26 

billion to $31 billion in major and minor construction and leasing. 

In addition, the Strategic Capital Investment Planning (SCIP) process is intended 

to help VA make more informed decisions on capital investments. A key element 

missing from the gap analysis criteria is a comprehensive assessment of the resources that exist outside of the VA through existing contracts and sharing agreements. Unlike VA-built or VA-leased space, contracts can be amended, cancelled, or 

sited differently to respond to any geographic changes and healthcare needs of veterans eligible for this care. This difference is especially relevant in the Veterans 

Health Administration (VHA) because VA, Congress, and the IB partners have increasingly supported leveraging community resources to provide accessible care to 

veterans in rural and underserved areas. Without a comprehensive understanding 

of the healthcare resources that exist within and outside of VA, the Department 

cannot make sound decisions on capital investments and on right sizing its inventory for the near-, mid-, and long-term periods. Another apparent flaw of the SCIP 

process is the lack of transparency on the costs of VA’s future real property priorities, which hinders VA’s ability to make informed decisions. This shortcoming was 

among the findings in a report, titled VA Real Property: Realignment Progressing, 

but Greater Transparency about Future Priorities is Needed, which the Government 

Accountability Office (GAO) issued on January 31, 2011. 

The IB partners fully support the GAO’s recommendation in this report that the 

VA must enhance transparency by submitting an annual report to Congress on the 

results of the SCIP process, subsequent capital planning efforts, and details on the 

costs of future projects. The IB partners also support the inclusion of new gap-analysis criteria that consider resources that are available to the VHA through existing 

contracts and sharing agreements. The IB partners, in turn, will be monitoring the 

level of funding for each of the infrastructure accounts to ensure that all current 

gaps are met within 10 years and that emerging and future gaps will be closed by 

sufficient funding. 

Quality, accessible healthcare continues to be the focus for the IB partners, and 

to achieve and sustain that goal, large capital investments must be made. Presenting a well-articulated, completely transparent capital-asset plan, which VA has 

attempted to do, is important, but funding that plan at nearly half of the prior 

year’s appropriated level, and at a level that is only 25 percent of what is needed 

to close the access, utilization, and safety gaps, will not fulfill VA’s requirements, 

nor will it serve veterans’ best interests. 


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Major Construction Accounts: Decades of underfunding in amounts between $18.1 billion and $22.1 billion have led to a major construction backlog. Currently, the 

VHA has 21 major construction projects dating back to 2007 that have been only 

partially funded. In the Administration’s budget request for fiscal year (FY) 2015, 

VA requested funding for only four major projects that include partial funding for 

seismic corrections and extended care facility expansion, and fully fund a spinal cord 

injury center. The total unobligated amount for all currently budgeted major construction projects exceeds $2.3 billion. Yet, the total budget proposal for FY 2015 

major construction accounts is $562 million. 

To finish existing projects and to close current and future gaps, VA will need to invest more than $18 billion over the next 10 years. At current requested funding 

levels, it will take 32 years to complete VA’s 10-year plan. 

In the short-term, VA must start requesting and Congress must start funding 

major construction at a level that begins to reduce the backlog. The IB partners recommend providing VA with $2.8 billion in major construction funding in FY 2015. 

These increased funds will eliminate the most severe safety gaps and complete funding on the longest standing projects. VA must also begin presenting long-term proposals that will outline how the Department will close all major construction gaps. 

Minor Construction Accounts: To close all the minor construction gaps within a 10-year timeline, VA will need to invest between $6.7 billion and $8.2 billion. For 

several years, VA minor construction was funded at a level to meet its 10-year goal. 

However, the Administration has abandoned their long-term commitment to increased appropriations and proposed yet another drastic funding decrease for minor 

construction that would only provide $495 million for FY 2015. 

The IB partners believe that minor construction accounts can be brought back on track by investing approximately $831 million per year over the next decade to close 

existing gaps and to prevent unmanageable future gaps in minor construction. 

Additionally, for capital infrastructure, renovations, and maintenance, we rec- ommend $50 million or more for up to five major construction projects in VA research facilities and $175 million in non-recurring maintenance and Minor-Construction funding. This increase would address Priority 1 and 2 deficiencies identified in the 2012 VA research capital infrastructure report (in accounts that are separate from VA’s other major, minor, and maintenance and repair appropriations). 

Nonrecurring Maintenance Accounts: Even though non-recurring maintenance 

(NRM) is funded through VA’s Medical Facilities account, and not through a construction account, NRM is critical to VA’s capital infrastructure. NRM embodies the 

many small projects that together provide for the long-term sustainability and 

usability of VA facilities. NRM projects are one-time repairs, such as modernizing 

mechanical or electrical systems, replacing windows and equipment, and preserving 

roofs and floors. Nonrecurring maintenance is a necessary component of the care 

and stewardship of a facility. When managed responsibly, these relatively small, 

periodic investments ensure that the more substantial investments of major and 

minor construction provide real value to taxpayers and to veterans as well. 

VA is moving away from closing current NRM safety, utilization, and access gaps 

and continues to fall behind on preventing future gaps. Just to maintain in the status quo, VA’s NRM account must be funded at $1.35 billion per year, based on the 

estimated Plant Replacement Value (PRV). The Administration is requesting $462 

million for NRM in FY 2015. More will need to be invested to prevent the $21.9 

billion NRM backlog from growing larger. 

The IB partners believe VA should develop a PRV metric and publish its results. 

Adding the PRV to the SCIP will allow VA to more accurately determine the appropriate amount to request for NRM and objectively decide when a facility becomes 

more costly to maintain than to replace. Using the PRV as a tool, VA can more accurately determine the annual funding levels needed for NRM by facility, allowing for 

the reduction in the NRM backlog and fully funding future needs in a way that 

would be the most cost effective. The industry goal for NRM is around two percent 

of the PRV. At that rate, facilities can operate for 50 years or more without outspending replacement cost. Knowing what percentage of the PRV is being spent and 

taking a long view of capital planning would allow Congress and VA to assess when 

a facility will need to be replaced. 

Because NRM accounts are organized under the Medical Facilities appropriation, 

they have traditionally been apportioned using the Veterans Equitable Resource Allocation (VERA) formula. This formula was intended to allocate health-care dollars 

to those areas with the greatest demand for healthcare and is not an ideal method 

to allocate NRM funds. When dealing with maintenance needs, this formula may 

prove counterproductive by moving funds away from older medical centers and reallocating the funds to newer facilities where patient demand is greater, even if the 

maintenance needs are not as great. We are encouraged by actions the House and 


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Senate Veterans’ Affairs Committees have taken in recent years requiring NRM 

funding to be allocated outside the VERA formula, and we hope this practice will 

continue. 

Capital Leasing: The fourth cornerstone to VA’s capital planning is leasing. The current lease plan calls for a little more than $1.1 billion over the next 10 years. 

VA leases properties to use for each agency within VA, ranging from communitybased outpatient clinics (CBOC) and medical centers to research and warehouse 

space. These leases do not fall under the larger construction accounts, but under 

each Administration and staff office operating accounts. 

Since the 1990s, Congress has helped improve VA health-care access and patient 

satisfaction by authorizing and funding nearly 900 VA CBOCs. These facilities have 

provided local, convenient and cost-effective primary care for millions of veterans. 

In a 2012 policy shift, the Congressional Budget Office changed its accounting practice on how major capital leases are to be funded, effectively halting Congressional 

authorization of future leases. This is the third year without passing lease authority 

and there are now 32 major capital leases, totaling nearly $288 million, for which 

VA has requested Congressional authorization. These leases are in limbo and Congress needs to pass H.R. 3521. 

Mr. Chairman, this concludes my testimony and I look forward to any questions 

you or the Committee may have. 

Information Required by Rule XI2(g)(4) of the House of Representatives 

Pursuant to Rule XI2(g)(4) of the House of Representatives, VFW has not received 

any federal grants in Fiscal Year 2013, nor has it received any federal grants in 

the two previous Fiscal Years. 

f 

STATEMENT OF PAUL R. VARELA, DIRECTOR, 

DAV ASSISTANT NATIONAL LEGISLATIVE

Chairman Miller, Ranking Member Michaud, and Members of the Committee: 

On behalf of the DAV and our 1.2 million members, all of whom are wartime disabled veterans, I am pleased to present recommendations of The Independent Budget (IB) for the fiscal year (FY) 2015 budget related to veterans’ benefits and the Veterans Benefits Administration (VBA). The IB is jointly produced each year by DAV, 

AMVETS, Paralyzed Veterans of America and Veterans of Foreign Wars of the 

United States. This year’s IB contains numerous recommendations to improve veterans’ benefit programs and the claims processing system; however, in today’s testimony I will highlight just some of the most critical ones for this Committee to consider. 

Mr. Chairman, the timely delivery of earned benefits to the millions of men and 

women who have served in our Armed Forces is one of the most sacred obligations 

of the federal government. The award of a service-connected disability rating does 

more than provide compensation payments; it is the gateway to an array of benefits 

that support the recovery and transition of veterans, their families and survivors. 

However, when these benefits are delayed or unjustly denied, the consequences to 

veterans and their families can be devastating. For those wounded heroes who file 

claims for disability compensation, the wait to receive an accurate rating decision 

and award can take anywhere from a few months to several years; longer if they 

have to appeal incorrect decisions. 

In early 2010, Secretary Shinseki laid out an extremely ambitious goal for VBA 

to achieve by 2015: process 100 percent of claims in less than 125 days, and do so 

with 98 percent accuracy. Since that time, VBA has worked to completely transform 

their IT systems, business processes and corporate culture, while simultaneously 

continuing to process more than a million claims each year. VBA is actively rolling 

out new organizational models and practices, and continuing to develop and deploy 

new technologies almost daily. 

Today there are about 685,000 claims for compensation and pension awaiting decisions at VBA. At the beginning of 2013, there were more than 860,000 pending 

claims for disability compensation and pension. By the end of the year, that number 

had dropped by more than 20 percent, down to about 685,000 pending. The number 

of claims in the backlog—greater than 125 days pending—dropped by about a third, 

from more than 600,000 in January 2013 to just over 405,000 in January 2014. The 

VBA increased the number of claims completed each month from an average of 

about 89,000 during the first four months of the year to more than 114,000 during 

the succeeding six months prior to the government shutdown. Claims production 


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dropped significantly following the shutdown and during the subsequent holiday period. 

In the midst of this massive transformation, it can be hard to get the proper perspective to measure whether their final systems will be successful, but we believe 

there has been sufficient progress to merit continued support of the current transformation efforts. Now is not the time to stop or change direction. 

We urge this Committee and Congress to provide the support and resources necessary to complete this transformation as currently planned, while continuing to exercise strong oversight to ensure that VBA remains focused on the long-term goal 

of creating a new claims processing system that decides each claim right the first 

time. In particular, the proposed FY 2015 budget for VBA includes additional funding for scanning and conversion of existing paper claims files, absolutely critical for 

VBA to complete its transformation from an outdated, paper-based claims system 

to a modern, paperless, automated claims system. 

Mr. Chairman, one of the most important aspects needed to assure ongoing positive changes within the VBA is their willingness to remain open and partner with 

veterans service organizations. Our organizations possess significant knowledge and 

experience of the claims process and collectively we hold power of attorney (POA) 

for millions of veterans who are filing or have filed claims. VBA recognized that 

close collaboration with VSOs could not only reduce its workload, but also increase 

the quality of its work. We make VBA’s job easier by helping veterans prepare and 

submit better claims, thereby requiring less time and resources for VBA to develop 

and adjudicate them. 

The IB veterans service organizations (IBVSOs) have been consulted about initiatives proposed or underway at VBA, including Fully Developed Claims (FDC), Disability Benefit Questionnaires (DBQs), the Veterans Benefit Management System 

(VBMS), the Stakeholder Enterprise Portal (SEP), and the update of the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (VASRD). Both Secretary Shinseki and Under Secretary Hickey have reached out to consult and collaborate with VSOs and we are confident that VBA’s success going forward will require a continued and enhanced partnership that will result in better service and 

outcomes for veterans. 

Since 2009, VBA has made some significant changes in how claims are processed. 

The most important amongst these is the development of the VBMS, its new IT system. VBMS has been rolled out to all 56 Regional Offices and VBA was able to complete implementation of the VBMS ahead of schedule in June; by the end of 2013, 

nearly all of VBA’s pending claims were processed using electronic files. It is important to remember that VBMS is not yet a finished product; rather, it continues to 

be developed and perfected as it is deployed so it is still premature to judge whether 

it will ultimately deliver all of the functionality and efficiency required to meet 

VBA’s future claims processing needs. 

Another very important milestone was VBA’s decision and commitment to scan 

all paper claims files for every new or reopened claim requiring a rating-related action, and creating digital e-folders to serve as the cornerstone of the new VBMS system. E-folders facilitate instantaneous transmission and simultaneous reviewing of 

claims files. At present, there are an estimated 500,000 e-folders and that number 

will continue to grow as the remaining ROs convert to VBMS this year. 

In addition, the Appeals Management Center (AMC) is now working in VBMS and 

able to review e-folders. The Board of Veterans Appeals (BVA) will also begin receiving appeals in VBMS on a pilot basis. 

VBA also continues to strengthen its e-Benefits and SEP systems, which allow 

veterans and their representatives to file claims, upload supporting evidence and 

check on the status of pending claims. VBA has rolled out a new transformation organizational model (TOM) to every Regional Office that has reorganized workflow 

by segmenting claims into different processing lanes depending upon the complexity 

of the issues to be decided for each claim. Other key process improvements that we 

strongly support include the FDC program, which expedites ready-to-rate claims, 

and DBQs, which standardize and encourage the collection of private medical evidence to aid in rating decisions. To improve the accuracy of their work, VBA also 

fulfilled one of our long-standing recommendations by creating local Quality Review 

Teams (QRTs), whose primary function is to monitor claims processing in real time 

to catch and correct errors before rating decisions are finalized. 

Claims Processing Recommendations 

Over the next year, Congress must continue to perform aggressive oversight of 

VBA’s ongoing claims transformation efforts, particularly new IT programs, while 

actively supporting the completion and full implementation of these vital initiatives. 

In order for VBA’s current transformation plans to have any reasonable chance of 


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success, VBA must be allowed to complete and fully implement them. Congress 

must continue to fully fund the completion of VBMS, including providing sufficient 

funding for digital scanning and conversion of legacy paper files, as well as the development of new automation components for VBMS. At the same time, the IBVSOs 

recommend that Congress encourage an independent, expert review of VBMS while 

there is still time to make course corrections. 

Congress must also encourage and support VBA’s efforts to develop a new corporate culture based on quality, accuracy and accountability, as well as strengthen 

the transmission and adoption of these values and appropriate supportive policies 

throughout all VBA Regional Offices. The long-term success of all of VBA’s transformation efforts will depend on the degree to which these changes are institutionalized and disseminated from the national level to the local level. In addition to 

strengthening training, testing and quality control, VBA must be encouraged to 

properly align measuring and reporting functions with desired goals and outcomes 

for both its leadership and employees. 

For example, as long as the most widely reported metric of VBA’s success is the 

Monday Morning Workload Reports, particularly the weekly update on the size of 

the backlog, there will remain tremendous pressure throughout VBA to place production gains ahead of quality and accuracy. Similarly, if individual employee performance standards set unrealistic production goals, or fail to properly credit ancillary activity that contributes to quality but not production, those employees will be 

incentivized to focus on activities that maximize only production. VBA must develop 

more and better measures of work performance that focus on quality and accuracy, 

both for the agency as a whole and for individual employees. 

Furthermore, VBA must ensure that employee performance standards are based 

on accurate measures of the time it takes to properly perform their jobs. 

Congress must also ensure that VBA does not change its reporting or metrics for 

the sole purpose of achieving statistical gains, commonly referred to as ‘‘gaming the 

system,’’ in the absence of actual improvements to the system. For example, VBA 

recently announced that they will change how errors are scored for multi-issue 

claims. 

Previously, a claim would be considered to have an error if one mistake on at 

least one issue in the claim was detected during a STAR review. Under the new 

error policy, if there are 10 issues in the claim and a single error is found on one 

of the issues, that would now be scored as only 0.1 errors for that claim. While this 

may be a more valid way of measuring technical accuracy, it also has the effect of 

lowering the error rate without actually lowering the number of errors committed. 

For instance, if VBA measures errors by issue, then the backlog of claims would not 

be the reported 405,000, but a multiple of that based upon the total number of 

issues, which would be in the millions. Likewise, VBA’s allowance rate must be adjusted with this type of change in reporting to accurately reflect the number of 

issues allowed out of the total number of issues claimed, which would be significantly lower than the current allowance rate per claim. In essence, VBA cannot simply change the metrics to suit their need to reflect gains or improvements; they 

must change all corresponding metrics such as claims v. issues, allowances v. denials and remands or similar. 

Additionally, to make the system more efficient, Congress should enact and promote legislation and policies that maximize the use of private medical evidence to 

conserve VBA resources and enable quicker, more accurate rating decisions for veterans. The IBVSOs have long encouraged VBA to make greater use of private medical evidence when making claims decisions, which would save veterans time and 

VBA the cost of unnecessary examinations. 

DBQs, many of which were developed in consultation with IBVSO experts, are designed to allow private physicians to submit medical evidence on behalf of veterans 

they treat in a format that aids rating specialists. However, we continue to receive 

credible reports from across the country that many Veterans Service Representatives (VSRs) and Rating Veterans Service Representatives (RVSRs) do not accept 

the adequacy of DBQs submitted by private physicians, resulting in redundant VA 

medical examinations being ordered and valid evidence supporting veterans’ claims 

being rejected. 

Although there are currently 81 approved DBQs, VBA has only released 71 of 

them to the public for use by private physicians. In particular, VBA should allow 

private treating physicians to complete DBQs for medical opinions about whether 

injuries and disabilities are service connected, as well as DBQs for PTSD, which 

current VBA rules do not allow; only VA physicians can make PTSD diagnoses for 

compensation claims. Congress should work with VBA to make both of these DBQs 

available to private physicians. 


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To further encourage the use of private medical evidence, Congress should amend 

title 38, United States Code, section 5103A(d)(1) to provide that, when a claimant 

submits private medical evidence, including a private medical opinion, that is competent, credible, probative, and otherwise adequate for rating purposes, the Secretary shall not request a VA medical examination. This legislative change would 

require VSRs and RVSRs to first document that private medical evidence was inadequate for rating purposes before ordering examinations, which are often unnecessary. 

VBA Staffing and Resource Recommendations 

Compensation Service Staffing 

In recent years, VBA has seen a significant staffing increase because Congress 

recognized that rising workload, particularly claims for disability compensation, 

could not be addressed without additional personnel and thus provided additional 

resources each year to do so. More than 5,000 full-time employee equivalents 

(FTEE) were added to VBA over the past five years, a 33 percent increase, with 

most of that increase going to the Compensation Service. In FY 2013, VBA’s budget 

supported an additional 450 FTEE above the FY 2012 authorized level, and the FY 

2014 level added less than 100 new FTEE, and for FY 2015 the level of staffing remains unchanged. 

Since the early part of 2013, the VBA has clearly made positive strides toward 

increasing productivity, reducing the backlog of disability claims and, by the end of 

2015, reaching the Secretary’s goal of completing all claims in less than 125 days 

with 98 percent accuracy. Over the past year, the total number of claims pending 

dropped by about 20 percent, and the number in the backlog (over 125 days) decreased by more than a third. The VBA has employed a variety of aggressive initiatives, such as processing all claims pending longer than two years and then, when 

completed, moving to process all claims pending longer than one year. 

We believe allowing the VBA to again hire employees for a two-year temporary 

term could supplement and/or alleviate the reliance on mandatory overtime and further reduce the backlog of disability claims to help reach the Secretary’s goal by the 

end of 2015. Such an initiative would also provide an outstanding opportunity for 

VBA to have a generous pool of fully trained, qualified candidates to choose from 

as replacements for full-time VBA employees who will undoubtedly be lost over the 

next few years because of attrition. 

However, rather than hiring ‘‘new’’ employees who need training and time to become fully productive, VBA would have instantly productive replacements ready and 

would have the ability to hire only the best of these candidates. Therefore, we urge 

Congress to provide the funding and resources necessary for VBA to hire a minimum of 1,000 new employees for a temporary two-year term. 

Board of Veterans’ Appeals Staffing 

Based on historical trends, the number of new appeals to the Board averages approximately five percent of all claims received, so as the number of claims processed 

by the VBA is expected to rise significantly, so too will the Board’s workload rise 

accordingly. Yet the budget provided to the Board has been declining, forcing it to 

reduce the number of employees. Although the Board had been authorized to have 

up to 544 FTEE in FY 2011, its appropriated budget could support only 532 FTEE 

that year. In FY 2012, that number was further reduced to 510. At present, due 

to cost-saving initiatives, the Board may be able to support as many as 518 FTEE 

with the FY 2013 budget; however, this does not correct the downward trend over 

the past several years, particularly as workload continues to rise. 

The FY 2014 budget actually proposed cuts to funding for the Board and further 

reduced staffing down to 492 FTEE, despite expected workload increases each year. 

Projecting for FY 2014, the IBVSOs recommended a modest increase in staffing to 

544 FTEE. 

We are pleased Congress supported this recommendation and actually went beyond the suggested number by providing enough funding for BVA to increase staffing to approximately 640 FTEE to be in place by the end of FY 2014 and an FY 

2015 budget request to increase the number of FTEE to 650. 

Vocational Rehabilitation 

Employment Service Staffing 

In FY 2012, VA’s Vocational Rehabilitation and Employment (VR&E) program, 

also known as the VetSuccess program, had 121,000 participants in one or more of 

the five assistance tracks of VR&E’s VetSuccess program, an increase of 12.3 percent above the FY 2011 participation level of 107,925 veterans. In FY 2012, VR&E 

had a total of 1,446 FTEE, and anticipates an increase of approximately 150 FTEE 


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for FY 2013. Given the estimated 10 percent workload increases for both FY 2013 

and FY 2014, the IB estimated VR&E would need an additional 230 counselors in 

FY 2014 in order to reduce their counselor-to-client ratio down to their stated goal 

of 1:125. 

An extension for the delivery of VR&E assistance at a key transition point for veterans is through the VetSuccess on Campus program. This program provides support to student veterans in completing college or university degrees. VetSuccess on 

Campus has developed into a program that places a full-time Vocational Rehabilitation Counselor and a part-time Vet Center Outreach Coordinator at an office on 

campus specifically for the student veterans attending that college. These VA officers are there to help the transition from military to civilian and student life. The 

VetSuccess on Campus program is designed to give needed support to all student 

veterans, whether or not they are entitled to one of VA’s education benefit programs. 

In FY 2015, Congress must provide the Vocational Rehabilitation and Employment Service with sufficient funding to support an adequate number of FTEE to 

meet growing demand of the program and achieve its current caseload target of one 

counselor for every 125 veteran clients and equitably allocate resources among 

VAROs in a manner to achieve that target. This includes assuring that as other programs, such as the VetSuccess on Campus staffed with tenured VR&E counselors, 

the workforce gaps left behind at the ROs are backfilled to keep pace with local 

workload demands. 

IT Enhancements 

In addition, the VBMS was ultimately intended to include all of VBA’s business 

lines so that no matter where a veteran or survivor applied for benefits, the VBMS 

would seamlessly connect them to all benefits they may be entitled to receive. While 

some programs, such as Education Service, have developed adequate IT systems in 

recent years, others, especially the Vocational Rehabilitation and Employment 

(VR&E) service, are in dire need of a complete IT overhaul. VR&E’s processing system, called the Corporate Winston-Salem, Indianapolis, Newark, Roanoke, Seattle 

(CWINRS) system, is incapable of managing the many needs of this program. Rather than invest in short-term upgrades and patches, the IBVSOs believe that VBMS 

development for VR&E should be accelerated. 

VBA must complete the full development and integration of the VBMS to the 

AMC, BVA, and Court of Appeals for Veterans Claims as well as to the other VBA 

business lines and in particular VR&E. 

The IBVSOs are pleased that the Administration’s budget request for FY 2015 is 

approximately $200 million more than the FY 2014 IT funding, and we support that 

level of funding. More importantly, Congress must ensure that from the total IT 

funding made available to VBA, that VR&E receives the necessary resources and 

support to upgrade its antiquated IT systems. 

Recommendations for Improvements to VA Benefits 

Annual Cost-of-Living Adjustment (COLA) 

Congress has annually authorized increases in compensation and dependency and 

indemnity compensation (DIC) by the same percent as Social Security is increased. 

Under current law, the government monitors inflation throughout the year and, 

if inflation occurs, automatically increases Social Security payments by the percent 

of increase for the following year, which the Congress then applies to veterans’ programs. 

While Congress has always increased compensation and DIC based on inflation, 

there have been years when such increases were delayed, which puts unnecessary 

financial strain on veterans and their survivors. 

The IBVSOs urge Congress to enact legislation indexing compensation and DIC 

to Social Security COLA increases. 

End Rounding Down of Veterans’ and Survivors’ Benefits Payments 

In 1990, Congress, in an omnibus reconciliation act, mandated that veterans’ and 

survivors’ benefit payments be rounded down to the next lower whole dollar. While 

this policy was initially limited to a few years, Congress has continued that policy. 

The cumulative effect of this provision of the law effectively levies a tax on totally 

disabled veterans and their survivors. Congress should repeal the current policy of 

rounding down veterans’ and survivors’ benefits payments. 

On November 21, 2013, with the President’s signature, the Veterans’ Compensation Cost-of-Living Adjustment Act became Public Law 113–52. The Act provided a 

1.5% increase in veterans’ disability compensation, DIC and other related veterans 

benefits, effective December 1, 2013. Unlike COLAs in the past, this COLA did not 


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include the provision of rounding down increases to the nearest whole dollar 

amount. 

The IBVSOs urge Congress not to return to a policy of rounding down veterans’ 

and survivors’ benefits payments. 

Reject Any Proposal to Use the ‘‘Chained CPI’’ 

In the past year, there has been much discussion about replacing the current CPI 

formula used for calculating the annual Social Security COLA with the Bureau of 

Labor Statistics (BLS) new formula commonly termed the ‘‘chained CPI.’’ Such a 

change would be expected to significantly reduce the rates paid to Social Security 

recipients, and thereby help to lower the federal deficit. Since the Social Security 

COLA is also applied annually to the rates for VA disability compensation, DIC, and 

pensions for wartime veterans and survivors with limited incomes, its application 

would mean systematic reductions for millions of veterans, their dependents and 

survivors who rely on VA benefit payments. The IBVSOs urge Congress to reject 

any and all proposals to use the ‘‘chained CPI’’ for determining Social Security 

COLA increases, which would have the effect of significantly reducing the level of 

vital benefits provided to millions of veterans and their survivors. 

The IBVSOs also note that the CPI index used for Social Security does not include 

increases in the cost of food or gasoline, both of which have risen significantly in 

recent years. While no inflation index is perfect, the IBVSOs believe that VA should 

examine whether there are other inflation indices that would more appropriately 

correlate with the increased cost of living experienced by disabled veterans and their 

survivors. 

End Prohibition against Concurrent Receipt of VA Disability Compensation and 

Military Longevity Retired Pay 

Many veterans retired from the armed forces based on longevity of service must 

forfeit a portion of their retired pay, earned through faithful performance of military 

service, before they receive VA compensation for service-connected disabilities. This 

is inequitable—military retired pay is earned by virtue of a veteran’s career of service on behalf of the nation, careers of usually more than 20 years. Entitlement to 

compensation, on the other hand, is paid solely because of disability resulting from 

military service, regardless of the length of service. Most nondisabled military retirees pursue second careers after serving in order to supplement their income, thereby 

justly enjoying a full reward for completion of a military career with the added reward of full civilian employment income. In contrast, military retirees with serviceconnected disabilities do not enjoy the same full earning potential since their earning potential is reduced commensurate with the degree of service-connected disability. 

In order to place all disabled longevity military retirees on equal footing with nondisabled military retirees, there should be no offset between full military retired pay 

and VA disability compensation. To the extent that military retired pay and VA disability compensation offset each other, the disabled military retiree is treated less 

fairly than is a nondisabled military retiree by not accounting for the loss in earning 

capacity. Moreover, a disabled veteran who does not retire from military service but 

elects instead to pursue a civilian career after completing a service obligation can 

receive full VA disability compensation and full civilian retired pay—including retirement from any federal civil service position. 

While Congress has made progress in recent years in correcting this injustice, current law still provides that service-connected veterans rated less than 50 percent 

disabled who retire from the armed forces on length of service may not receive disability compensation from VA in addition to full military retired pay. The IBVSOs 

believe the time has come to remove this prohibition completely. Congress should 

enact legislation to repeal the inequitable requirement that veterans’ military longevity retired pay be offset by an amount equal to the disability compensation 

awarded to disabled veterans rated less than 50 percent, the same as exists for 

those rated 50 percent or greater. 

SURVIVOR BENEFITS 

Increase DIC for Surviving Spouses of Service Members 

The current rate of compensation paid to the survivors of certain deceased veterans rated permanently and totally disabled and deceased service members is inadequate and inequitable. Under current law, the surviving spouse of a veteran who 

had a total disability rating is entitled to the basic rate of DIC. A supplemental payment is provided to those spouses who were married for at least eight years during 

which time the veteran was rated permanently and totally disabled. 


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However, surviving spouses of veterans or military service members who die before the eight-year eligibility period, or who die on active duty, respectively, only receive the basic rate of DIC. 

Insofar as DIC payments are intended to provide surviving spouses with the 

means to maintain some semblance of financial stability after losing their loved 

ones, the rate of payment for service-related deaths of any kind should not vastly 

differ. Surviving spouses, regardless of the status of their sponsors at the time of 

death, face the same financial hardships once deceased sponsors’ incomes no longer 

exist. Congress should authorize DIC eligibility at increased rates to survivors of 

service members who died either before the eight-year eligibility period passes or 

while on active duty at the same rate paid to the eligible survivors of totally disabled service-connected veterans who die after the eight-year eligibility period. 

Repeal of the DIC–SBP Offset 

The current requirement that the amount of an annuity under the Survivor Benefit Plan (SBP) be reduced on account of, and by an amount equal to, DIC is inequitable. A veteran disabled in military service is compensated for the effects of service-connected disability. When a veteran dies of service-connected causes, or following a substantial period of total disability from service-connected causes, eligible 

survivors or dependents receive DIC from the VA. This benefit indemnifies survivors, in part, for the losses associated with the veteran’s death from service-connected causes or after a period of time when the veteran was unable, because of 

total disability, to accumulate an estate for inheritance by survivors. 

Career members of the armed forces earn entitlement to retired pay after 20 or 

more years of service. Survivors of military retirees have no entitlement to any portion of the veteran’s military retirement pay after his or her death, unlike many retirement plans in the private sector. Under the SBP, deductions are made from the 

veteran’s military retirement pay to purchase a survivor’s annuity. This is not a gratuitous benefit, but is purchased by a retiree. 

Upon the veteran’s death, the annuity is paid monthly to eligible beneficiaries 

under the plan. If the veteran died from other than service-connected causes or was 

not totally disabled by service-connected disability for the required time preceding 

death, beneficiaries receive full SBP payments. However, if the veteran’s death was 

a result of military service or after the requisite period of total service-connected 

disability, the SBP annuity is reduced by an amount equal to the DIC payment. 

When the monthly DIC rate is equal to or greater than the monthly SBP annuity, 

beneficiaries lose the SBP annuity in its entirety. 

The IBVSOs believe this offset is inequitable because no duplication of benefits 

is involved. Payments under the SBP and DIC programs are made for different purposes. Under the SBP, coverage is purchased by a veteran and at the time of death, 

paid to his or her surviving beneficiary. On the other hand, DIC is a special indemnity compensation paid to the survivor of a service member who dies while serving 

in the military, or a veteran who dies from service-connected disabilities. In such 

cases, DIC should be added to the SBP, not substituted for it. Surviving spouses 

of federal civilian retirees who are veterans are eligible for DIC without losing any 

of their purchased federal civilian survivor benefits. 

The offset penalizes survivors of military retirees whose deaths are under circumstances warranting indemnification from the government separate from the annuity funded by premiums paid by the veteran from his or her retired pay. 

Congress should repeal the inequitable offset between DIC and the SBP because 

there is no duplication between these two distinct benefits. 

Retention of Remarried Survivors’ Benefits at Age 55 

Congress should lower the age required for remarriage for survivors of veterans 

who have died on active duty or from service-connected disabilities to be eligible for 

retention of DIC to conform with the requirements of other federal programs. 

Current law allows retention of DIC on remarriage at age 57 or older for eligible 

survivors of veterans who die on active duty or of a service-connected injury or illness. Although the IBVSOs appreciate the action Congress took to allow restoration 

of this rightful benefit, the current age threshold of 57 years is arbitrary. 

Remarried survivors of retirees of the Civil Service Retirement System, for example, obtain a similar benefit at age 55. This would also bring DIC in line with SBP 

rules that allow retention with remarriage at the age of 55. Equity with beneficiaries of other federal programs should govern Congressional action for this deserving group. Congress should enact legislation to enable survivors to retain DIC 

on remarriage at age 55 for all eligible surviving spouses. 

Mr. Chairman, that concludes my statement and I would be happy to answer any 

questions you or other members of the Committee may have. 


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STATEMENT OF DIANE M. ZUMATTO, DIRECTOR, 

OF

AMVETS NATIONAL LEGISLATIVE 

Chairman Miller, Ranking Member Michaud and distinguished Members of the 

committee, as an author of The Independent Budget (IB), I appreciate this opportunity to share with you the IB’s recommendations in what we believe to be the 

most fiscally responsible way of ensuring the quality and integrity of the care and 

benefits earned by American veterans. 

The venerable and honorable history of our national cemeteries spans roughly 150 

years when the earliest military graveyards were, not surprisingly, situated at battle sites, near field or general hospitals and at former prisoner-of-war sites. With 

the passage of the National Cemeteries Act of 1973 (PL 93–43), the Department of 

Veterans’ Affairs (VA) became responsible for the majority of our national cemeteries. The single most important obligation of the National Cemetery Administration (NCA) is to honor the memory of America’s brave men and women who have 

selflessly served in this Nation’s Armed Forces. As of late 2010, there were more 

than 20,021 acres of cemetery landscape, funerary monuments, grave markers, as 

well as, other architectural features and memorial tributes, much of it historically 

significant, included within established installations in the NCA which are therefore 

representative of the very foundations of these United States. 

The signing of the Veterans Programs Enhancement Act of 1998 (PL 105–368) officially re-designated the National Cemetery System (NCS) to the now familiar National Cemetery Administration (NCA). The NCA currently maintains stewardship 

of 133 of the nation’s 147 national cemeteries, as well as 33 soldiers’ lots, including 

two new national cemeteries scheduled to open in 2015. Since 1862 when President 

Abraham Lincoln signed the first legislation establishing the national cemetery concept, more than 3.5 million burials have taken place in national cemeteries currently located in 39 states and Puerto Rico, with approximately 128,100 interments 

expected in 2015. 

There are an estimated 22.4 million veterans alive today and with the transition 

of an additional 1 million service members into veteran status over the next 12 

months, this number is expected to continue to rise until approximately 2017. On 

average, 14.4 percent of veterans choose a national or state veterans’ cemetery as 

their final resting place. As new national and state cemeteries continue to open, and 

as our aging veterans’ population continues to grow and we continue to be a nation 

at war, the demand for burial at a veterans’ cemetery will continue to increase. 

The Independent Budget veterans service organizations (IBVSOs) would like to 

acknowledge the devotion and commitment demonstrated by the NCA leadership, 

especially Undersecretary Steve Muro, and his staff in their continued dedication to 

providing the highest quality of service to veterans and their families. It is in the 

opinion of the IBVSOs that the NCA continues to meet its goals and the goals set 

forth by others because of its true dedication and care for honoring the memories 

of the men and women who have so selflessly served our nation. We applaud the 

NCA for recognizing that it must continue to be responsive to the preferences and 

expectations of the veterans’ community by adapting or adopting new interment options and ensuring access to burial options in the national, state and tribal government-operated cemeteries. We also believe it is important to recognize the NCA’s efforts in employing both disabled and homeless veterans. 

NCA Accounts 

While NCA’s operating budget has remained fairly stagnant at around $250 million for 4 out of the last 5 years, their workload has been anything but static and 

this trend is expected to continue for the foreseeable future. The IBVSOs are appreciative of the roughly $8 million increase in NCA’s overall FY 2015 budget, however, 

that increase comes with a simultaneous $8.4 million reduction in the National 

Shrine account. 

Between FY 2014 and FY 2015, the number of gravesites needing maintenance 

will increase by approximately 2.4%, while interments will increase by roughly 

1.9%. 

The NCA was also able to award 44 of its 48 minor construction projects and had 

four unobligated projects that will be moved to FY 2012. Unfortunately, due to continuing resolutions and the current budget situation, the NCA was not able to 

award the remaining four projects. 

The IBVSOs support the operational standards and measures outlined in the National Shrine Commitment (PL 106–117, Sec. 613) which was enacted in 1999 to ensure that our national cemeteries are the finest in the world. While the NCA has 


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worked diligently improving the appearance of our national cemeteries, they are still 

a long way from where they should be. 

The NCA has worked tirelessly to improve the appearance of our national ceme- teries, investing an estimated $39 million into the National Shrine Initiative in FY 

2011. According to NCA surveys, as of October 2011 the NCA has continued to make 

progress in reaching its performance measures. Since 2006, the NCA has improved 

headstone and marker height and alignment in national cemeteries from 67 percent 

to 70 percent and has improved cleanliness of tombstones, markers and niches from 

77 percent to 91 percent. Although the NCA is nearing its strategic goal of 90 percent and 95 percent, respectively, for height and alignment and cleanliness, more 

funding is needed to continue this delicate and labor-intensive work. Therefore, the 

IBVSOs recommend the NCA’s Operations and Maintenance budget to be increased 

by $20 million per year until the operational standards and measures goals are 

reached. 

The IBVSOs recommend a minimum Operational and Maintenance budget of $260 million for the National Cemetery Administration for FY 2015, so it can meet 

the demands for interment, gravesite maintenance and related essential elements 

of cemetery operations. This request includes $34.5 million for the National Shrine 

Initiative to ensure that our national cemeteries meet or exceed the highest standards of appearance required by their status as national shrines. 

The national shrine funds would be used, among other things, to maintain: 

• Occupied graves; • Developed acreage; • Historic structures; and • Cemetery infrastructure 

The IBVSOs call on the Administration and Congress to provide the resources 

needed to meet the critical nature of the NCA’s mission and to fulfill the nation’s 

commitment to all veterans who have served their country so honorably and faithfully. 

State Cemetery Grant Programs 

The State Cemetery Grants Program (SCGP) complements the National Cemetery 

Administration’s mission to establish gravesites for veterans in areas where it cannot fully respond to the burial needs of veterans. Several incentives are in place to 

assist states in this effort. For example, the NCA can provide up to 100 percent of 

the development cost for an approved cemetery project, including establishing a new 

cemetery and expanding or improving an established state or tribal organization 

veterans’ cemetery. New equipment, such as mowers and backhoes, can be provided 

for new cemeteries. In addition, the Department of Veterans’ Affairs may also provide operating grants to help cemeteries achieve national shrine standards. In FY 2011 the SCGP operated on an estimated budget of $46 million, funding 

16 state cemeteries. These 16 state cemeteries included the establishment or ground 

breaking of five new state cemeteries, three of which are located on tribal lands, 

expansions and improvements at seven state cemeteries, and four projects aimed at 

assisting state cemeteries to meet the NCA national shrine standards. Since 1978 

the Department of Veterans’ Affairs has more than doubled the available acreage 

and accommodated more than a 100 percent increase in burials through this program. 

With the enactment of the ‘‘Veterans Benefits Improvement Act of 1998,’’ the NCA 

has been able to strengthen its partnership with states and increase burial services 

to veterans, especially those living in less densely populated areas without access 

to a nearby national cemetery. Through FY 2010, the state grant program has established 75 state veteran’s cemeteries in 40 states and U.S. territories. Furthermore, in FY 2011 VA awarded its first state cemetery grant to a tribal organization. 

The Independent Budget veteran’s service organizations recommend that Con- gress fund the State Cemetery Grants Program at $48 million for FY 2015. The 

IBVSOs believe that this small increase in funding will help the National Cemetery 

Administration meet the needs of the State Cemetery Grant Program, as its expected demand will continue to rise through 2017. Furthermore, this funding level 

will allow the NCA to continue to expand in an effort of reaching its goal of serving 

94 percent of the nation’s veteran population by 2015. 

Veteran’s Burial Benefits 

Since the original parcel of land was set aside for the sacred committal of Civil 

War Veterans by President Abraham Lincoln in 1862, more than 3 million burials 

have occurred in national cemeteries under the National Cemetery Administration. 

In 1973, the Department of Veterans’ Affairs established a burial allowance that 

provided partial reimbursement for eligible funeral and burial costs. The current 


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payment is $2,000 for burial expenses for service-connected deaths, $300 for nonservice-connected deaths and a $700 plot allowance. At its inception, the payout covered 72 percent of the funeral costs for a service-connected death, 22 percent for a 

non-service-connected death and 54 percent of the cost of a burial plot. 

Burial allowance was first introduced in 1917 to prevent veterans from being buried in potter’s fields. In 1923 the allowance was modified. The benefit was determined by a means test until it was removed in 1936. In its early history the burial 

allowance was paid to all veterans, regardless of their service connectivity of death. 

In 1973, the allowance was modified to reflect the status of service connection. 

The plot allowance was introduced in 1973 as an attempt to provide a plot benefit 

for veterans who did not have reasonable access to a national cemetery. Although 

neither the plot allowance nor the burial allowance was intended to cover the full 

cost of a civilian burial in a private cemetery, the recent increase in the benefit’s 

value indicates the intent to provide a meaningful benefit. The Independent Budget 

veterans’ service organizations are pleased that the 111th Congress acted quickly 

and passed an increase in the plot allowance for certain veterans from $300 to $700 

effective October 1, 2011. However, we believe that there is still a serious deficit 

between the original value of the benefit and its current value. 

In order to bring the benefit back up to its original intended value, the payment for service-connected burial allowance should be increased to $6,160, the non-service-connected burial allowance should be increased to $1,918 and the plot allowance 

should be increased to $1,150. The IBVSOs believe Congress should divide the burial benefits into two categories: veterans within the accessibility model and veterans 

outside the accessibility model. Congress should increase the plot allowance from $700 to $1,150 for all eligible 

veterans and expand the eligibility for the plot allowance for all veterans who would 

be eligible for burial in a national cemetery, not just those who served during wartime. Congress should increase the service-connected burial benefits from $2,000 to 

$6,160 for veterans outside the radius threshold and to $2,793 for veterans inside 

the radius threshold. 

Congress should increase the non-service-connected burial benefits from $300 to $1,918 for all veterans outside the radius threshold and to $854 for all veterans inside the radius threshold. The Administration and Congress should provide the resources required to meet the critical nature of the National Cemetery Administration’s mission and to fulfill the nation’s commitment to all veterans who have served 

their country so honorably and faithfully. 

March 2014 

The Honorable Representative Jeff Miller, Chairman 

U.S. House of Representatives, 

Committee on Veterans’ Affairs, 

Cannon House Office Building, 

Washington, D.C. 20510 

Dear Chairman Miller: 

Neither AMVETS nor I have received any federal grants or contracts, during this 

year or in the last two years, from any agency or program relevant to the 12 March 

2014, House Veterans Affairs Committee hearing on the U.S. Department of Veterans Affairs Budget Request for Fiscal Year 2015. 

Sincerely, 

Diane M. Zumatto, Director 

AMVETS National Legislative Biographical Sketch 

Diane M. Zumatto of Spotsylvania, VA joined AMVETS as their National Legislative Director in August 2011. Ms. Zumatto, a native New Yorker and the daughter 

of immigrant parents decided to follow in her family’s footsteps by joining the military. Ms. Zumatto is a former Women’s Army Corps (WAC) member who was stationed in Germany. Zumatto was married to a CW4 aviator in the Washington Army 

National Guard and is the mother of four adult children. Ms. Zumatto is extremely 

proud that two of her children have chosen to follow her footsteps into military service. 

Ms. Zumatto has more than 20 years of experience working with a variety of nonprofits in increasingly more challenging positions, including: the American Museum 

of Natural History; the National Federation of Independent Business; the TacomaPierce County Board of Realtors; the Washington State Association of Fire Chiefs; 

Saint Martin’s College; the James Monroe Museum; the Friends of the Wilderness 

Battlefield and the Enlisted Association of the National Guard of the United States. 

Diane’s non-profit experience is extremely well-rounded as she has variously served 

in both staff and volunteer positions including as a board member and consultant. 


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1 Bilmes, Linda J. Harvard Kennedy School. The Financial Legacy of Iraq and Afghanistan: 

How Wartime Spending Decisions Will Constrain Future National Security Budgets Faculty Research Working Paper Series. March 2013. 

After receiving her B.A. in Historic Preservation from the University of Mary 

Washington in 2005, Diane decided to diversify her experience by spending some 

time in the ‘‘for-profit’’ community. Realizing that her creativity, energy and passion 

were not being effectively challenged, she left the world of corporate America and 

returned to non-profit organization. 

AMVETS National Headquarters, 14647 Forbes Boulevard, Lanham, Maryland 

20706–4380, Business Phone: (301) 683–4016, dzumatto@amvets.org. 

STATEMENT OF THE AMERICAN LEGION

Chairman Miller, Ranking Member Michaud, and Members of the Committee: 

On behalf of National Commander Dan Dellinger and the 2.4 million members of 

The American Legion, we welcome this opportunity to comment on the federal budget and specific funding programs of the Department of Veterans Affairs. 

The American Legion is a resolution based organization; we are directed and driven by the millions of active legionnaires who have dedicated their money, time, and 

resources to the continued service of veterans and their families. Our positions are 

guided by nearly 100 years of consistent advocacy and resolutions that originate at 

the grassroots level of the organization—the local American Legion posts and veterans in every congressional district of America. The Headquarters staff of the Legion works daily on behalf of veterans, military personnel and our communities 

through roughly 20 national programs, and hundreds of outreach programs led by 

our posts across the country. 

As thousands of troops return from deployments to Afghanistan and elsewhere in 

the world, and the United States shifts its policies in Iraq and Afghanistan, thus 

producing a new national security focus, The American Legion reminds the Committee that national security changes do not change the fact that veterans of these 

wars, as well as prior conflicts, must still be taken care of, and this care will extend 

for these veterans and their caregivers for approximately the next sixty years. 

In September of last year National Commander Dellinger provided the Committee 

The American Legion’s guidance for a robust Department of Veterans Affairs (VA) 

budget that adequately provides for the healthcare and benefits for veterans of all 

wars during this period of difficult fiscal times. The VA will continue to be faced 

with thousands of new patients and claimants even though the wars are winding 

down, and if the Department of Defense carries through in their plan to reduce the 

active and reserve forces by more than a hundred thousand troops, then the VA will 

need to prepare for one of the most significant increases in patients and claimants 

in it’s 84 year history. Active and reserve members who otherwise downplayed illnesses and injuries incurred or aggravated on active duty will now begin to seek 

treatment and file compensation claims in droves. Further, as the VA begins to 

serve veterans returning from deployment who are entitled to 5 years of VA care 

after they return, compounded by veterans who will choose VA care over Affordable 

Care Act plans, our VA system and infrastructure will be challenged much more 

than it has been for the past 10 years. 

While grateful for prior VA funding, The American Legion remains vigilant to ensure that VA is not going to be shortchanged of the funding it truly needs, because 

lack of appropriate funding will ultimately endanger veteran care and benefits. The 

American Legion has, for years, reminded Congress and the American people that 

the cost of war, especially prolonged war, is more expensive than just the cost of 

bullets and bombs; and that the true costs are only realized decades after the war 

is over. Last year the Harvard Kennedy School issued a report that projected the 

total cost of these current conflicts to cost between $4 and $6 trillion. The report 

goes on to say; 

‘‘The single largest accrued liability of the wars in Iraq and Afghanistan is the 

cost of providing medical care and disability benefits to war veterans. Historically, the bill for these costs has come due many decades later. The peak year 

for paying disability compensation to World War I veterans was in 1969—more 

than 50 years after Armistice. The largest expenditures for World War II veterans were in the late 1980s. Payments to Vietnam and first Gulf War veterans 

are still climbing. The magnitude of future expenditures will be even higher for 

the current conflicts 1 ’’ 

Ensure Adequate Oversight and Sufficient Funding for Lifetime Joint Medical Records 


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The Department of Defense (DoD) and VA have already squandered more than 

a billion dollars of taxpayer money and have wasted years in an ultimately empty 

pursuit of a joint electronic medical record system that would have streamlined and 

simplified logistics between the two agencies. The war fighter turned veteran is the 

same patient, and deserves a system that honors that person with continuous care 

and seamless transition between agencies. It is unforgivable that DoD and VA have 

spent the past several years infighting rather than actively developing a comprehensive solution that is in the best interest of the American service member. 

At the end of January VA and DoD both issued Requests for Proposals (RFPs)— 

however the problem remains that they issued these RFPs independently. It will be 

extremely difficult, if not impossible, for two separate agencies to issue two separate 

RFPs for similar projects, and end up with a single software solution unless they 

hire the same vendor. If DoD and VA aren’t forced to ensure that their respective 

vendors work together from the beginning, then Congress needs to withhold authorization of further disbursements until they can prove that their respective plans are 

in tandem and complement each other, ultimately resulting in a single electronic 

medical records keeping system that can be readily accessed by both VA and DoD 

without the need for any additional software or compatibility efforts. In February 

DoD and VA were supposed to deliver a joint plan to Congress on how they were 

going to execute this program. So far, their plan is incomplete and does not satisfy 

the full requirements of how they plan to jointly accomplish getting this system implemented. These need to be the same system that can integrate with both agencies—no substitutions, no excuses. 

VA Leased Facilities in Jeopardy 

In FY 2012 H.R. 2646 authorized the VA sufficient appropriations to continue to 

fund and operate leased facility projects that support our veterans all across the 

country. In November of 2012 the FY 2013 appropriations for the same facilities 

were eliminated from appropriations due to a ‘‘scoring change’’ initiated by the Congressional Budget Office (CBO). While the locations, projects, leases, and funding requirements did not change, the way in which CBO scored the projects did, which 

resulted in the appearance that the project would cost more than 10 times the actual needed revenue. As a result of CBO’s adjustment in scoring review, Congress 

refused to introduce the FY 2013 appropriations bill needed to keep these community based centers open. As these leases now become due, there are 27 major medical facilities that need to be authorized. 

The American Legion implores Congress to fund these centers as originally 

planned and applauds Chairman Miller and this Committee for passing the Department of Veterans Affairs Major Medical Facility Lease Authorization Act of 2013. 

Advance Appropriations for FY 2016 

The Veterans Health Administration (VHA) manages the largest integrated 

health-care system in the United States, with 152 medical centers, nearly 1,400 

community-based outpatient clinics, community living centers, Vet Centers and 

domiciliaries serving more than 8 million veterans every year. The American Legion 

believes those veterans should receive the best care possible. 

The needs of veterans continue to evolve, and VHA must ensure it is evolving to 

meet them. The rural veteran population is growing, and options such as telehealth 

medicine and clinical care must expand to better serve that population. Growing 

numbers of female veterans mean that a system that primarily provided for male 

enrollees must now evolve and adapt to meet the needs of male and female veterans, regardless whether they live in urban or rural areas. 

An integrated response to mental healthcare is necessary, as the rising rates of 

suicide and severe post-traumatic stress disorder are greatly impacting veterans and 

active-duty servicemembers alike. 

If veterans are going to receive the best possible care from VA, the system needs 

to continue to adapt to the changing demands of the population it serves. The concerns of rural veterans can be addressed through multiple measures, including expansion of the existing infrastructure through CBOCs and other innovative solutions, improvements in telehealth and telemedicine, improved staffing and enhancements to the travel system. 

Patient concerns and quality of care can be improved by better attention to VA 

strategic planning, concise and clear directives from VHA, improved hiring practices 

and retention, and better tracking of quality by VA on a national level. 

And finally, mandatory funds must be included in Advanced Appropriations along 

with full discretionary funding of all VA accounts. Veterans and dependents having 

their compensation and disability checks delayed because Congress refuses to pass 


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an annual budget before being forced to close the federal government is reprehensible. Pass full advanced appropriations now. 

Better Care for Female Veterans 

A 2011 American Legion study revealed several areas of concern about VA 

healthcare services for women. Today, VA still struggles to fulfill this need, even 

though women are the fastest-growing segment of the veteran population. Approximately 1.8 million female veterans make up 8 percent of the total veteran population, yet only 6 percent use VA services. 

VA needs to be prepared for a significant increase of younger female veterans as 

those who served in the War on Terror separate from active service. Approximately 

58 percent of women returning from Iraq and Afghanistan are ages 20 to 29, and 

they require gender-specific expertise and care. Studies suggest post-traumatic 

stress disorder is especially prevalent among women; among veterans who used VA 

in 2009, 10.2 percent of women and 7.8 percent of men were diagnosed with PTSD. 

The number of female veterans enrolled in the VA system is expected to expand 

by more than 33 percent in the next three years. Currently, 44 percent of Iraq and 

Afghanistan female veterans have enrolled in the VA health-care system. 

VA needs to develop a comprehensive health-care program for female veterans 

that extends beyond reproductive issues. Provider education needs improvement. 

Furthermore, as female veterans are the sole caregivers in some families, services 

and benefits designed to promote independent living for combat-injured veterans 

must be evaluated, and needs such as child care must be factored into the equation. 

Additionally, many female veterans cannot make appointments due to the lack of 

child-care options at VA medical centers. Since the 2011 survey, The American Legion has continued to advocate for improved delivery of timely, quality healthcare 

for women using VA. The American Legion is encouraged that the President’s budget recognizes the need for additional funding in this critical area, and has proposed 

an increase of $32 million, almost 9 percent over last year’s authorization levels, 

which combined with years 2009 through 2014 represents an increase in funding of 

nearly 240 percent to deal with this growing segment of the veteran population. 

Repair Problems in Mental Health 

During the past half decade, VA has nearly doubled their mental healthcare staff, 

jumping from just over 13,500 providers in 2005 to over 20,000 providers in 2011. 

However, during that time there has been a massive influx of veterans into the system, with a growing need for psychiatric services. With over 1.5 million veterans 

separating from service in the past decade, 690,844 have not utilized VA for treatment or evaluation. The American Legion is deeply concerned about nearly 700,000 

veterans who are slipping through the cracks unable to access the healthcare system they have earned through their service. 

Post-traumatic stress disorder and traumatic brain injury are the signature 

wounds of today’s wars. Both conditions are increasing in number, particularly 

among those who have served in Operation Iraqi Freedom and Operation Enduring 

Freedom. The President’s request for a 57 percent increase in funding in this area 

is appropriate considering that a 2011 Senate Committee on Veterans’ Affairs survey of 319 VA mental health staff revealed that services for veterans coping with 

mental health issues and TBI are lacking considerable support. Among the findings: 

• New mental health patient appointments could be scheduled within 14 days, 

according to 63 percent of respondents, but only 48.1 percent believed veterans 

referred for specialty appointments for PTSD or substance abuse would be seen 

within 14 days. 

• Seventy percent of providers said their sites had shortages of mental health 

space. 

• Forty-six percent reported that a lack of off-hours appointments was a barrier 

to care. 

• More than 26 percent reported that demand for Compensation and Pension 

(C&P) exams pulled clinicians away from direct care. 

• Just over 50 percent reported that growth in patient numbers contributed to 

mental health staff shortages. 

VHA and, at the request of Congress, VA’s Office of the Inspector General have 

studied the problem since the survey was conducted. On April 23, 2012, the VAOIG 

released the report, ‘‘Review of Veterans’ Access to Mental healthcare.’’ It found that 

VHA’s mental health performance data was neither accurate nor reliable. In VA’s 

FY 2011 Performance and Accountability Report, VHA grossly over-reported that 95 

percent of first-time patients received a full mental health evaluation within 14 

days. However, it was found that VHA completed approximately 64 percent of newpatient appointments for treatment within 14 days of their desired date, but apVerDate Aug 31 2005 11:40 Jun 12, 2015 Jkt 000000 PO 00000 Frm 00067 Fmt 6633 Sfmt 6621 Y:\87670.TXT PAT

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2Source: Department of Veterans Affairs, Veterans Health Administration, Office of the Assistant Deputy Under Secretary for Health for Policy and Planning. Prepared by the National 

Center for Veterans Analysis and Statistics 

proximately 36 percent of appointments exceeded 14 days. VHA schedulers also 

were not following procedures outlined in VHA directives, and were scheduling clinic appointments on the system’s availability rather than the patient’s clinical need. 

The American Legion believes VA must focus on head injuries and mental health 

without sacrificing awareness and concern for other conditions afflicting 

servicemembers and veterans. As an immediate priority, VA must ensure staffing 

levels are adequate to meet the need. The American Legion also urges Congress to 

invest in research, screening, diagnosis and treatment for PTSD and TBI and will 

continue to monitor VA to ensure that they remain good stewards of the people’s 

money 

Although The American Legion supports advance appropriations, we remain concerned accurate projections on population and utilization and other challenges still 

remain. 

One such challenge is with the procurement of medical equipment and Information Technology (IT) purchases. When IT within the VA was combined together 

across the entire agency it was implemented to improve efficiency, contracting, management, and other challenges inherent with three disjointed IT management 

teams. This has proved somewhat successful. However, we are hearing that procurement of medical equipment and IT is hampered at medical facilities due to budget 

implementation failures through continuing resolutions. While a VA medical center 

director might have his/her operational funding beginning October 1 because of advance appropriations, much needed IT or medical equipment might be delayed due 

to a continuing resolution impasse in Congress. This has a detrimental impact on 

the veteran and his/her care. Therefore, The American Legion recommends the IT 

portion of the budget be added to advance appropriations and help smooth those 

budget challenges. Additionally, The American Legion remains committed to working with the VA in any way possible to move the VA toward their goal of becoming 

a paperless system. We are eager to see how the VA plans to spend the $155 million 

improving the Veterans Benefits Management System, and the $136.4 million that 

is proposed to convert the paper to electronic files. 

Medical Services 

Over the past two decades, VA has dramatically transformed its medical care delivery system. Through The American Legion visits to a variety of medical facilities 

throughout the Nation during our System Worth Saving Task Force, we see firsthand this transformation and its impact on veterans in every corner of the Nation. 

While the quality of care remains exemplary, veteran healthcare will be inadequate if access is hampered. Today there are over 23 million veterans in the United 

States. While 8.3 million of these veterans are enrolled in the VA healthcare system, 

a population that has been relatively steady in the past decade, the costs associated 

with caring for these veterans has escalated dramatically. 

For example between FYs 2007 and 2010, VA enrollees increased from 7.8 million 

to 8.3 million. 2 During the same period, inpatient admissions increased from 

589,000 to 662,000. Outpatient visits also increased from 62 to 80.2 billion. Correspondingly, cost to care for these veterans increased from $29.0 billion to $39.4 

billion. This 36 percent increase during those 2 years is a trend that dramatically 

impacts the ability to care for these veterans. 

While FY 2010 numbers seemingly leveled off—to only 3 percent annual growth— 

will adequate funding exist to meet veteran care needs? If adequate funding to meet 

these needs isn’t appropriated, VA will be forced to either not meet patient needs 

or shift money from other accounts to meet the need. 

Even with the opportunity for veterans from OIF/OEF to have up to 5 years of 

care following their active duty period, we have not seen a dramatic change in overall enrollee population. Yet The American Legion remains concerned that the population estimates are dated and not reflective of the costs. If current economic woes 

and high unemployment rates for veterans remain and with the Vietnam Era veterans beginning to retire and needing healthcare that may no longer be provided 

by their employers, VA medical care will become enticing for a veteran population 

that might not have utilized those services in the past. 

Finally, ongoing implementation of programs such as the PL 111–163 ‘‘Caregiver 

Act’’ will continue to increase demands on the VA healthcare system and therefore 

result in an increased need for a budget that can adequately deal with the challenges. 


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In order to meet the increased levels of demand, even assuming that not all eligible veterans will elect to enroll for coverage, and keep pace with the cost trend identified above, there must be an increase to account for both the influx of new patients 

and increased costs of care. 

Medical Support and Compliance 

The Medical Support and Compliance account consists of expenses associated with 

administration, oversight, and support for the operation of hospitals, clinics, nursing 

homes, and domiciliaries. Although few of these activities are directly related to the 

personal care of veterans, they are essential for quality, budget management, and 

safety. Without adequate funding in these accounts, facilities will be unable to meet 

collection goals, patient safety, and quality of care guidelines. 

The American Legion has been critical of programs funded by this account. We 

remain concerned patient safety is addressed at every level. We are skeptical if patient billing is performed efficiently and accurately. Moreover, we are concerned that 

specialty advisors/counselors to implement OIF/OEF outreach, ‘‘Caregiver Act’’ implementation, and other programs are properly allocated. If no need for such individuals exists, should the position be placed within a facility? Simply throwing more 

money at this account, increasing staff and systems won’t resolve all these problems. 

During the previous budget, this account grew by nearly 8 percent to $5.31 billion. 

The American Legion questions the necessity for that rate to continue at this time. 

Medical Facilities 

During FY 2012, VA unveiled the Strategic Capital Investment Planning (SCIP) 

program. This 10-year capital construction plan was designed to address VA’s most 

critical infrastructure needs. Through the plan, VA estimated the 10-year costs for 

major and minor construction projects and non-recurring maintenance would total 

between $53 and $65 billion over 10 years. 

The American Legion is supportive of the SCIP program which empowers facility 

managers and users to evaluate needs based on patient safety, utilization, and other 

factors. While it places the onus on these individuals to justify the need, these needs 

are more reflective of the actuality as observed by our members and during our visits. Yet, VA has taken this process and effectively neutered it through budget limitations thereby underfunding the accounts and delaying delivery of critical infrastructure. 

So while failing to meet these needs, facility managers will be forced to make do 

with existing aging facilities. While seemingly saving money in construction costs, 

the VA will be expending money maintaining deteriorating facilities, paying increased utility and operational costs, and performing piecemeal renovation of properties to remain below the threshold of major or minor projects. 

This is an inefficient byproduct of budgeting priorities. Yet, as will be noted later, 

the reality remains that the SCIP program is unlikely to be funded at levels necessary to accomplish the 10 year plan. Therefore, this account must be increased 

to meet the short term needs within the existing facilities. 

Medical and Prosthetic Research 

The American Legion believes VA research must focus on improving treatment for 

medical conditions unique to veterans. Because of the unique structure of VA’s electronic medical records (VISTA), VA research has access to a great amount of longitudinal data incomparable to research outside the VA system. Because of the ongoing wars of the past decade, several areas have emerged as ‘‘signature wounds’’ of 

the Global War on Terror, specifically Traumatic Brain Injury (TBI), Post-traumatic 

Stress Disorder (PTSD) and dealing with the effects of amputated limbs. 

Much media attention has focused on TBI from blast injuries common to Improvised Explosive Devices (IEDs) and PTSD. As a result, VA has devoted extensive 

research efforts to improving the understanding and treatment of these disorders. 

Amputee medicine has received less scrutiny, but is no less a critical area of concern. Because of improvements in body armor and battlefield medicine, catastrophic 

injuries that in previous wars would have resulted in loss of life have led to substantial increases in the numbers of veterans who are coping with loss of limbs. 

As far back as 2004, statistics were emerging which indicated amputation rates 

for US troops were as much as twice that from previous wars. By January of 2007, 

news reports circulated noting the 500th amputee of the Iraq War. The Department 

of Defense response involved the creation of Traumatic Extremity Injury and Amputation Centers of Excellence, and sites such as Walter Reed have made landmark 

strides in providing the most cutting edge treatment and technology to help injured 

service members deal with these catastrophic injuries. 


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However, The American Legion remains concerned that once these veterans transition away from active duty status to become veteran members of the communities, 

there is a drop off in the level of access to these cutting edge advancements. Ongoing care for the balance of their lives is delivered through the VA healthcare system, 

and not through these concentrated active duty centers. 

Many reports indicate the state of the art technology available at DoD sites is not 

available from the average VA Medical Center. With so much focus on ‘‘seamless 

transition’’ from active duty to civilian life for veterans, this is one critical area 

where VA cannot afford to lag beyond the advancements reaching service members 

at DoD sites. If a veteran can receive a state of the art artificial limb at the new 

Walter Reed National Military Medical Center (WRNMC) they should be able to receive the exact same treatment when they return home to the VA Medical Center 

in their home community, be it in Gainesville, Battle Creek, or Fort Harrison. 

American Legion contact with senior VA healthcare officials has concluded that 

while DoD concentrates their treatment in a small number of facilities, the VA is 

tasked with providing care at 152 major medical centers and over 1,700 total facilities throughout the 50 states as well as in Puerto Rico, Guam, American Samoa and 

the Philippines. Yet, VA officials are adamant their budget figures are sufficient to 

ensure a veteran can and will receive the most cutting edge care wherever they 

choose to seek treatment in the system. 

The American Legion remains concerned about the ability to deliver this cutting 

edge care to our amputee veterans, as well as the ability of VA to fund and drive 

top research in areas of medicine related to veteran-centric disorders. There is no 

reason VA should not be seen as the world’s leading source for medical research into 

veteran injuries such as amputee medicine, PTSD and TBI. 

In FY 2011 VA received a budget of $590 million for medical and prosthetics research. Only because of the efforts of the House and Senate was this budget kept 

at that level during the FY 2012 and 2013 budgets, due to significant pressure from 

The American Legion. Even at this level, The American Legion contends this budget 

must be increased, and closely monitored to ensure the money is reaching the veteran at the local level. 

Medical Care Collections Fund (MCCF) 

In addition to the aforementioned accounts which are directly appropriated, medical care cost recovery collections are included when formulating the funding for 

VHA. Over the years, this funding has been contentious because they often included 

proposals for enrollment fees, increased prescription rates, and other costs billed directly to veterans. The American Legion has always ardently fought against these 

fees and unsubstantiated increases. 

Beyond these first party fees, VHA is authorized to bill healthcare insurers for 

nonservice-connected care provided to veterans within the system. Other income collected into this account includes parking fees and enhanced use lease revenue. The 

American Legion remains concerned that the expiration of authority to continue enhanced use leases will greatly impact not only potential revenue, but also delivery 

of care in these unique circumstances. We urge Congress to reauthorize the enhanced use lease authority with the greatest amount of flexibility allowable. 

In May 2011, the VA Office of Inspector General (OIG) issued a report auditing 

the collections of third party insurance collections within MCCF. Their audit found 

that ‘‘VHA missed opportunities to increase MCCF by . . . 46 percent.’’ Because of 

ineffective processes used to identify billable fee claims and systematic controls, it 

was estimated VHA lost over $110 million annually. In response to this audit, VHA 

assured they’d have processes in place to turn around this trend. 

Yet even if those reassurances were met, the MCCF collection would not meet the 

quarterly loss beneath the budgeted amounts. Without those collections, savings 

must be garnered elsewhere to meet these shortfalls, thereby causing facility administrators and VISN directors to make difficult choices that ultimately negatively impact veterans through a lack of hiring, delay of purchasing, or other savings methods. 

It would be unconscionable to increase this account beyond the previous levels 

that were not met. To do so without increasing co-payments or collection methods 

would be counterproductive and mere budget gimmickry. While we recognize the 

need to include this in the budget, The American Legion cannot be part of a budget 

that penalizes the veteran for administrative failures. 

Appropriations for FY 2015 

The remainder of the accounts within VA are being allocated funding for FY 2015. 

These include funding for general operation of VA Central Office (VACO), the National Cemetery Administration (NCA) and Veteran Benefits Administration (VBA). 


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3 Resolution 42–2012 ‘‘Virtual Lifetime Electronic Record’’ 

Veteran Benefits Administration 

National Commander Dellinger testified in September that when speaking to The 

American Legion National Convention in August 2010, VA Secretary Eric Shinseki 

declared VA would ‘‘break the back of the backlog by 2015’’ by committing to 98 percent accuracy, with no claim pending longer than 125 days. Over the past four 

years, VA has gone backward, not forward, in both of these key areas. 

According to VA’s own figures, over 56 percent of veterans with disability benefits 

claims have been waiting longer than 125 days for them to be processed. In contrast, when Secretary Shinseki made his promise, only 37 percent of claims had 

been pending longer than 125 days. The American Legion has found through its 

field research the problem varies greatly by regional office. While some regional offices may have an average rate of 76 days per claim, others take 336 days—a troubling inconsistency. 

Unfortunately, accuracy is also a problem, according to Legion site visits and field 

research. VA’s own accuracy metrics place the rate in the 90s. The American Legion’s Regional Office Action Review (ROAR) team typically finds a higher error 

rate, sometimes up to two thirds of all claims reviewed. 

VA is hopeful that the Veterans Benefits Management System (VBMS) will eliminate many of the woes that have led to the backlog, but electronic solutions are not 

a magic bullet. Without real reform for a culture of work that places higher priority 

on speed rather than accuracy, VA will continue to struggle, no matter the tools 

used to process claims. 

The American Legion has long argued that VA’s focus on quantity over quality 

is one of the largest contributing factors to the claims backlog. If VA employees receive the same credit for work, whether it is done properly or improperly, there is 

little incentive to take the time to process a claim correctly. When a claim is processed in error, a veteran must appeal the decision to receive benefits, and then wait 

for an appeals process that may take months and months to resolve and possibly 

years before delivery of the benefit. 

The American Legion believes VA must develop a processing model that puts as 

much emphasis on accuracy as it does on the raw number of claims completed. 

America’s veterans need to have confidence in the work done by VA. 

The VBMS system could allow VA to develop more effective means of processing 

claims, such as the ability to separate single issues that are ready to rate, starting 

a flow of relief to veterans while more complex medical issues are considered and 

decided. 

Information Technology 

In addition to the VBMS system, the greatest long awaited project is the launch 

of the joint VA and Department of Defense (DoD) lifetime record—Virtual Lifetime 

Electronic Record (VLER). The American Legion supports a single unified medical 

record for military members and veterans. 3 We have heard from VA that this initiative is still vital and an important piece of their overall solution, but The American 

Legion remains concerned that DoD has yet to commit to ensuring this project is 

completed. 

During the previous budgeting, VA was unable to provide information on the overall cost of creating such a system, but assured veteran advocates there was enough 

flexibility to address any costs associated with the project. In the meantime, several 

releases and announcements have been issued by VA towards the continued evolution of this project, but there is little to demonstrate we’re any closer to producing 

a ready model. The American Legion calls upon Congress to continue to pressure 

VA and DoD to move towards this system as expeditiously as possible. With the development and launch of VBMS nearly complete, the entire IT focus should center 

on VLER. 

In order to provide the necessary resources for the nationwide rollout of VBMS 

and still maintain efforts towards development of VLER, The American Legion believes a small increase is justified within IT. 

Major and Minor Construction 

After two years of study the VA developed the Strategic Capital Investment Planning (SCIP) program. It is a ten-year capital construction plan designed to address 

VA’s most critical infrastructure needs within the Veterans Health Administration, 

Veterans Benefits Administration, National Cemetery Administration, and Staff Offices. 

The SCIP planning process develops data for VA’s annual budget requests. These 

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struction, Minor Construction, Non-Recurring Maintenance (NRM), Enhanced-Use 

Leasing, Sharing, and Other Investments and Disposal. The VA estimated costs 

were between $53 and $65 billion. 

The American Legion is very concerned about the lack of funding in the Major 

and Minor Construction accounts. Based on VA’s SCIP plan, Congress underfunded 

these accounts. Clearly, if this underfunding continues VA will never fix its identified deficiencies within its 10-year plan. Indeed, at current rates, it will take VA 

almost sixty years to address these current deficiencies. 

The American Legion also understands there is a discussion to refer to SCIP in 

the future as a ‘‘planning document’’ rather than an actual capital investment plan. 

Under this proposal, VA will still address the deficiencies identified by the SCIP 

process for future funding requests but rather than having an annual appropriation, 

SCIP will be extended to a 5-year appropriation, similar to the appropriation process used by the Department of Defense as its construction model. Such a plan will 

have huge implications on VA’s ability to prioritize or make changes as to design 

or project specifications of its construction projects. The American Legion is against 

this 5-year appropriation model and recommends Congress continue funding VA’s 

construction needs on an annual appropriations basis. 

The American Legion recommends Congress adopt the 10-year action plan created 

by the SCIP process. Congress must appropriate sufficient funds to pay for needed 

VA construction projects and stop underfunding these accounts. In FY 2015 Congress must provide increased funding to those accounts to ensure the VA-identified 

construction deficiencies are properly funded and these needed projects can be completed in a timely fashion. 

State Veteran Home Construction Grants 

Perhaps no program facilitated by the VA has been as impacted by the decrease 

in government spending than the State Veteran Home Construction Grant program. 

This program is essential in providing services to a significant number of veterans 

throughout the country at a fraction of the daily costs of similar care in private or 

VA facilities. As the economy rebounds and states are pivoting towards resuming 

essential services, taking advantage of depressed construction costs, and meeting 

the needs of an aging veteran population, greater use of this grant program will continue. As our baby boomer population continues to transition into retirement, many 

more of these veterans are retiring to state veteran homes due to their excellent 

reputation for care and cost. The popularity of these retirement options will cause 

any surplus of space to become consumed. The American Legion encourages Congress to increase the funding level of this program. 

National Cemetery Administration (NCA) 

No aspect of the VA is as critically acclaimed as the National Cemetery Administration (NCA). In the 2010 American Customer Satisfaction Index, the NCA 

achieved the highest ranking of any public or private organization. In addition to 

meeting this customer service level, the NCA remains the highest employer of veterans within the federal government and remains the model for contracting with 

veteran owned businesses. 

While NCA met their goal of having 90 percent of veterans served within 75 miles 

of their home, their aggressive strategy to improve upon this in the coming five 

years will necessitate funding increases for new construction. Congress must provide 

sufficient major construction appropriations to permit NCA to accomplish this goal 

and open five new cemeteries in the coming five years. Moreover, funding must remain to continue to expand existing cemetery facilities as the need arises. 

While the costs of fuel, water, and contracts have risen, the NCA operations budget has remained nearly flat for the past two budgets. Unfortunately recent audits 

have shown cracks beginning to appear. Due predominantly to poor contract oversight, several cemeteries inadvertently misidentified burial locations. Although only 

one or two were willful violations of NCA protocols, the findings demonstrate a system about ready to burst. 

To meet the increased costs of fuel, equipment, and other resources as well as 

ever-increasing contract costs, The American Legion believes a small increase is necessary. In addition, we urge Congress to adequately fund the construction program 

to meet the burial needs of our nation’s veterans. 

State Cemetery Grant Program 

The NCA administers a program of grants to states to assist them in establishing 

or improving state-operated veterans’ cemeteries through VA’s State Cemetery 

Grants Program (SCGP). Established in 1978, this program funds nearly 100% of 

the costs to establish a new cemetery, or expand existing facilities. For the past two 

budgets this program has been budgeted $46 million to accomplish this mission. 


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New authority granted to VA funds Operation and Maintenance Projects at state 

veterans cemeteries to assist states in achieving the national shrine standards VA 

achieves within national cemeteries. Specifically, the new operation and maintenance grants have been targeted to help states meet VA’s national shrine standards 

with respect to cleanliness, height and alignment of headstones and markers, leveling of gravesites, and turf conditions. In addition, this law allowed VA to provide 

funding for the delivery of grants to tribal governments for native American veterans. Yet we have not seen the allocation of funding increased to not only meet 

the existing needs under the construction and expansion level, but also the needs 

from operation and maintenance and tribal nation grants. Moreover, as these cemeteries age, the $5 million limitation must be revoked to allow for better management 

of resources within the projects. 

Additional Concerns of The American Legion 

Turn Military Experience Into Careers 

Servicemembers and veterans receive some of the finest technical and professional 

training in the world. Many have experience in healthcare, electronics, computers, 

engineering, drafting, air-traffic control, nuclear energy, mechanics, carpentry, and 

other fields. Many of these military acquired skills require some type of license or 

certificate to qualify for civilian jobs. In too many cases, this license or certificate 

requires schooling already completed through military training programs. The 

American Legion is fighting for a major overhaul of the licensure and certification 

policies as they relate to military job skills, on the national and state levels alike. 

As demand for qualified workers in a diverse range of occupations continues to 

grow, veterans offer skills, training, dedication and discipline that translate well 

into specialized fields and trades. 

The American Legion is working with credentialing and licensing agencies to help 

veterans receive credit for their experiences, maximize their abilities and move 

quickly into productive careers. While the VOW to Hire Heroes Act and the Veterans Skills to Jobs Act of 2012 are important steps that The American Legion 

strongly supported and helped shape, they are only a good start in a long march 

to improve career opportunities for those who have served in uniform. 

Ensuring Quality Care to Rural Veterans 

The American Legion’s System Worth Saving task force travels the country to 

evaluate VA medical facilities and ensure they are meeting the needs of veterans. 

From November 2013 to May 2014, the task force has been conducting site visits 

to VA medical facilities and town hall meetings to receive feedback from local veterans who utilize VA to receive their healthcare. 

The Task Force, in its 10th program year, is focusing on VA’s accomplishments 

and progress over the past decade, current issues and concerns, and VA’s five-year 

strategic plan for several program areas. These areas of focus are VA’s budget, staffing, enrollment/outreach, hospital programs (e.g. mental health, intensive care unit 

(ICU), long-term services and support, homelessness programs) information technology and construction programs. 

During each site visit, a town hall meeting is hosted by an American Legion Post. 

The town hall meetings have consistently illustrated that veterans are worried VA 

has turned a deaf ear to their concerns and is intentionally ignoring their complaints. We have seen firsthand where VA has closed intensive care departments, 

downgrading emergency departments to urgent care clinics, or has proposed to 

closed or reconfiguring hospital services under the guise of ‘‘realigning services closer to where veterans live’’, such as the reconfiguration proposal at the VA Black 

Hills healthcare System, which has served the veterans of Hot Springs, South, Dakota for over 100 years. 

The American Legion urge Congress to evaluate VA’s plan in rural areas and to 

stop VA from closing hospitals and community-based outpatient clinics unless existing requisite community services are meet or exceed that VA currently provides to 

veterans. 

Ease the Military-to-Civilian Transition 

Unfortunately, this transition has been hampered by poor communication and coordination between DoD and VA. Efforts have been made to correct the process, 

which is improving, but too many veterans still slip through the cracks and fail to 

receive the benefits they earned and deserve or the support they need to restart 

their lives. Transition Assistance Programs (TAP) are now mandatory across all 

branches of military service, a change The American Legion commends. While TAP 

will require much fine tuning to accurately deliver what veterans need, implementing the program universally already is a major improvement. 


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Current DoD policy requires new inductees to enroll in the eBenefits portal, which 

will help all future generations of veterans. While VA and DoD still try to iron out 

differences in electronic data systems necessary to make the Virtual Lifetime Electronic Record (VLER) effective, the eBenefits portal holds great promise. 

Fast-tracking the VLER program to ensure seamless transfer of medical records 

must be a top priority, and necessary funds must be allocated to fulfill it. The delays 

that have plagued this program are inexcusable. The American Legion urges Congress and the administration to work together to put the program back on track. 

While The American Legion is encouraged by the progress made in TAP, the program is still new and will require dedicated oversight and attention to ensure it is 

meeting the needs of the servicemembers it is designed to help. 

Conclusion 

In conclusion, The American Legion is optimistic the President has proposed a 

budget that addresses many of the needs that the almost two million service members who are returning after deployments in support of the Global War on Terror 

will soon need. We’re hopeful savings generated through downsizing of the military 

are leveraged against the need of thousands of servicemembers who are or soon will 

be discharged to create the savings. However, The American Legion has seen in previous years, these are not used to provide the care and benefits afforded to our nation’s veterans. Too often while veteran advocates celebrate dramatically increased 

budgets, the veteran patient, claimant, or widow is left wondering where the money 

went. 

Our nation’s veterans deserve adequate and responsible funding to the fullest extent possible. After over a decade of service, our newest era of veterans will now 

join the ranks of generations of their brothers and sisters who served in prior wars 

and conflicts and all are owed a great debt. 

The American Legion looks forward to working with the Committee, as well as 

VA, to find solutions that work for America’s veterans. For additional information 

regarding this testimony, please contact Mr. Louis J. Celli, Jr. at The American Legion’s Legislative Division, (202) 861–2700 or LCelli@legion.org. 

Æ 


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