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S. HRG. 111–87, Pt. 2 

NOMINATION HEARINGS OF THE 111TH 

CONGRESS: PART 2 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

JULY 22 AND DECEMBER 9, 2009 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

ROLAND W. BURRIS, Illinois 

ARLEN SPECTER, Pennsylvania 

RICHARD BURR, North Carolina, Ranking 

Member 

LINDSEY O. GRAHAM, South Carolina 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

WILLIAM E. BREW, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

JULY 22, 2009 

NOMINATIONS OF RAYMOND M. JEFFERSON TO BE THE ASSISTANT SECRETARY FOR

VETERANS’ EMPLOYMENT AND TRAINING SERVICE, U.S. DEPARTMENT OF LABOR; 

AND JOAN M. EVANS TO BE THE ASSISTANT SECRETARY FOR CONGRESSIONAL AND

LEGISLATIVE AFFAIRS, U.S. DEPARTMENT OF VETERANS AFFAIRS

SENATORS 

Page 

Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 1 

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 2 

Murray, Hon. Patty, U.S. Senator from Washington ........................................... 5 

Prepared statement, Jefferson ......................................................................... 5 

Prepared statement, Evans ............................................................................. 52 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 7 

Isakson, Hon. Johnny, U.S. Senator from Georgia ............................................... 47 

Burris, Hon. Roland W., U.S. Senator from Illinois ............................................. 49 

WITNESSES 

Jefferson, Raymond M., III, nominee to be the Assistant Secretary for Veterans’ Employment and Training Service, U.S. Department of Labor ............ 8 

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

Response to prehearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 12 

Hon. Richard Burr ........................................................................................ 17 

Response to posthearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 23 

Hon. Jon Tester ............................................................................................. 24 

Hon. Mark Begich ......................................................................................... 24 

Hon. Roger F. Wicker ................................................................................... 26 

Questionnaire for Presidential nominees ....................................................... 27 

Letter from the Office of Government Ethics ................................................. 40 

Letter from the nominee to the Office of Legal Counsel, U.S. Department 

of Veterans Affairs ........................................................................................ 41 

Wyden, Hon. Ron, U.S. Senator from Oregon ....................................................... 53 

Prepared statement .......................................................................................... 55 

Evans, Joan M., nominee to be the Assistant Secretary for Congressional 

and Legislative Affairs, U.S. Department of Veterans Affairs ......................... 55 

Prepared statement .......................................................................................... 57 

Response to prehearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 58 

Hon. Richard Burr ........................................................................................ 64 

Response to posthearing questions submitted by Hon. Mark Begich .......... 67 

Questionnaire for Presidential nominees ....................................................... 68 

Letter from the Office of Government Ethics ................................................. 74 

Letter from the nominee to the Office of General Counsel, U.S. Department of Veterans Affairs .............................................................................. 75 

Page

IV 

DECEMBER 9, 2009 

NOMINATION OF ROBERT A. PETZEL, M.D., TO BE UNDER SECRETARY FOR HEALTH; 

AND RAUL PEREA-HENZE, M.D., M.P.H., TO BE ASSISTANT SECRETARY FOR POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

SENATORS 

Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 83 

Johanns, Hon. Mike, U.S. Senator from Nebraska ............................................... 84 

Begich, Hon. Mark, U.S. Senator from Alaska ..................................................... 85 

Murray, Hon. Patty, U.S. Senator from Washington ........................................... 86 

Burris, Hon. Roland W., U.S. Senator from Illinois ............................................. 87 

Prepared statement .......................................................................................... 87 

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 88 

Prepared statement .......................................................................................... 88 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 89 

WITNESSES 

Franken, Hon. Al, United States Senator from Minnesota .................................. 90 

Petzel, Robert A., M.D., Nominee to be Under Secretary for Health, Veterans 

Health Administration, U.S. Department of Veterans Affairs ......................... 91 

Prepared statement .......................................................................................... 92 

Response to prehearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 94 

Hon. Richard Burr ........................................................................................ 107 

Response to posthearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 113 

Hon. Patty Murray ........................................................................................ 116 

Hon. Jon Tester ............................................................................................. 119 

Hon. Mark Begich ......................................................................................... 120 

Hon. Roland W. Burris ................................................................................. 121 

Questionnaire for Presidential nominees ....................................................... 124 

Letter from the Office of Government Ethics ................................................. 133 

Letter from the nominee to the Office of General Counsel, U.S. Department of Veterans Affairs .............................................................................. 134 

Response to request arising during the hearing by Hon. Mark Begich.... 143, 144 

Perea-Henze, Raul, M.D., Nominee to be Assistant Secretary for Policy and 

Planning, U.S. Department of Veterans Affairs ................................................ 147 

Prepared statement .......................................................................................... 149 

Response to prehearing questions submitted by: 

Hon. Daniel K. Akaka .................................................................................. 150 

Hon. Richard Burr ........................................................................................ 154 

Response to posthearing questions submitted by: 

Hon. Patty Murray ........................................................................................ 157 

Hon. Jon Tester ............................................................................................. 158 

Hon. Mark Begich ......................................................................................... 159 

Hon. Roland W. Burris ................................................................................. 159 

Questionnaire for Presidential nominees ....................................................... 160 

Letter from the Office of Government Ethics ................................................. 167 

Letter from the nominee to the Office of General Counsel, U.S. Department of Veterans Affairs .............................................................................. 168 

Response to requests arising during the hearing by Hon. Mark Begich ..... 174 

APPENDIX 

Sanders, Hon. Bernard, U.S. Senator from Vermont; prepared statement ........ 177 

(1) 

HEARING ON THE NOMINATIONS OF RAYMOND M. JEFFERSON TO BE THE ASSISTANT SECRETARY FOR VETERANS’ EMPLOYMENT AND TRAINING, U.S. DEPARTMENT OF 

LABOR; AND JOAN M. EVANS TO BE THE 

ASSISTANT SECRETARY FOR CONGRESSIONAL AND LEGISLATIVE AFFAIRS, U.S. 

DEPARTMENT OF VETERANS AFFAIRS 

WEDNESDAY, JULY 22, 2009 

U.S. SENATE, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 10:06 a.m., in room 

418, Russell Senate Office Building, Hon. Daniel K. Akaka, Chairman of the Committee, presiding. 

Present: Senators Akaka, Murray, Tester, Burris, Burr, and 

Isakson. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, 

U.S. SENATOR FROM HAWAII 

Chairman AKAKA. Aloha and welcome to everyone here this 

morning. The hearing of the Senate Committee on Veterans’ Affairs 

will come to order. 

This morning’s hearing is to consider the President’s nomination 

of Raymond M. Jefferson to be Assistant Secretary of Labor for 

Veterans’ Employment and Training. Following Mr. Jefferson’s testimony and questions from the Committee, we will turn to Joan 

Evans’s nomination to be VA’s Assistant Secretary of Congressional 

and Legislative Affairs. 

I note that we have invited the Members of the Senate Committee on Health, Education, Labor, and Pensions to join with us 

this morning as the Committee considers Mr. Jefferson’s nomination. We share many common interests and issues with that Committee, including this nomination. I am hopeful that our two Committees, then the full Senate, will move expeditiously to consider 

Mr. Jefferson’s nomination. 

The position of Assistant Secretary for Veterans’ Employment 

and Training is a demanding and difficult one. If confirmed, Mr. 

Jefferson will serve as the leading advocate for efforts to meet the 

employment needs of our Nation’s veterans. He will need to bring 

2 

visibility and enthusiasm to the job in order to fulfill his job 

responsibilities. 

From the enforcement of the Uniformed Services Employment 

and Reemployment Rights Act to the alarmingly high rate of unemployment among recently separated veterans, his responsibilities 

will be significant. The myriad needs of veterans who are serviceconnected disabled, homeless, or incarcerated will confront him, as 

will the concerns of women veterans and the spouses of active duty 

personnel. He will need to work in close cooperation with those representing segments of the labor market, as well as VA and DOD, 

to ensure that veterans obtain good jobs and are able to pursue 

meaningful careers. At all times, it will be important that his office 

focuses on the difference between a career and just a job. 

Following any opening remarks, other Members may care to 

make, I have the honor of formally introducing Mr. Jefferson to the 

Committee. I will share more details on Mr. Jefferson’s exemplary 

work and military experience. I believe strongly that his combined 

service in the public sector, private sector, and military make him 

an outstanding candidate for this position. 

Mr. Jefferson, I look forward to your testimony today and your 

responses to questions from Committee Members and to any 

posthearing questions. 

Now I would like to call on my friend, the Ranking Member, Senator Burr. 

STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA 

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

Chairman AKAKA. Aloha. 

Senator BURR [continuing]. And welcome to our witnesses, our 

nominees, and their families. Congratulations on your nominations, 

and thank you for being with us today. 

Although the positions for which you have been nominated are 

in two different departments, both contribute to a very important 

goal: meeting the needs of those who have served and sacrificed on 

behalf of our Nation. I might say, Mr. Chairman, regarding your 

offer for Members of HELP to attend, I am the token representative of the HELP Committee—— 

[Laughter.] 

Senator BURR [continuing]. So just pretend that I am wearing a 

dual hat today. 

The Department of Veterans Affairs, Assistant Secretary for Congressional and Legislative Affairs, can help to advance that goal by 

fostering open communications between the VA and Congress. In 

part, that means ensuring that the Congressional requests are answered without hassle or delays. But it also means being proactive 

and alerting Congress about emerging trends, needs, or problems 

that may impact veterans in our homestates and across the Nation. 

This free flow of information will assist us in understanding what 

is working well at the VA and where improvements are needed. 

More importantly, it will allow us to work together to ensure that 

VA’s programs and services are effective and are actually helping 

to improve the lives of our country’s veterans and the lives of their 

families. 

3 

Ms. Evans, if confirmed, you will play a key role in advancing 

communications and collaboration between VA and Congress. Currently, I do have some concerns about whether VA is living up to 

President Obama’s vision of, ‘‘an unprecedented level of openness 

in government.’’ So I look forward to hearing your thoughts on how 

communication could be improved. 

Now turning to you, Mr. Jefferson, I want to first thank you for 

your service and your personal sacrifice on behalf of the country. 

As the newest member of the Board of Visitors of West Point, I look 

forward to serving in that capacity as long as they will have me. 

Also, I appreciate your willingness to take on the challenge of 

serving as the Department of Labor’s Assistant Secretary for Veterans’ Employment and Training. That organization helps meet the 

needs of those who have served by administering employment and 

training programs for veterans, providing transition assistance to 

separating servicemembers, and helping enforce laws that protect 

the employment rights of veterans and military personnel. 

With veterans now experiencing unemployment rates of over 8 

percent, it is more important than ever that veterans are provided 

with whatever assistance they need to find quality, full-time employment. To that end, Mr. Jefferson, I would be interested in your 

views on what more can be done to make sure that veterans are 

being well served by the Department of Labor’s employment and 

training programs. 

Also, our Nation currently has thousands of Guard and Reserve 

members deployed to Iraq and Afghanistan, including over 4,000 

members of the North Carolina Army National Guard right now, 

several of whom were killed in action in the past 3 weeks. Many 

of these citizen soldiers left behind valued civilian jobs when they 

answered the call from their country; and when they return, they 

deserve to be quickly and properly reinstated in their jobs as required by the Uniformed Service Employment and Reemployment 

Rights Act. 

Mr. Jefferson, if confirmed, you would be in charge of helping resolve servicemembers’ concerns if USERRA violations do occur, and 

perhaps more importantly, in helping to prevent employers from 

violating this law in the first place. For all employers, particularly 

the Federal Government—and I will tell you that I was quite 

alarmed at the number of complaints that had been filed by returning servicemembers who worked at Federal Government agencies 

prior to deployment throughout this up-tempo deployment period— 

it is important that they understand this law and are doing everything they can to protect the employment rights of those who serve. 

Mr. Jefferson, I look forward to your ideas on how we make this 

a reality nationwide. 

Mr. Chairman, I appreciate you calling this hearing to discuss 

the qualifications of both these nominees. I remain committed to 

ensuring that we have a full complement of leaders, both at VA 

and Veterans’ Employment Training Service, who will work every 

day to improve the lives of veterans and veterans’ families. I welcome both of our nominees. 

Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Burr. 

4 

It is my deep honor and privilege to introduce Ray Jefferson to 

the Committee at this time. From his military experience to his 

pursuit of a career in public service, Mr. Jefferson has demonstrated a commitment to excellence and a spirit of selflessness 

that is rarely seen. 

I have known Ray since he served as a White House Fellow in 

the year 2000, and I have enjoyed working with him immensely. 

By choosing to call Hawaii his home, he makes Hawaiians proud. 

Ray graduated from the U.S. Military Academy at West Point in 

1988 with a major in leadership. He served as an Army officer with 

the Infantry Rangers in Special Forces, holding leadership positions in the U.S. Presidential Honor Guard, Third Ranger Battalion, and First Special Forces Group. In 1995, while attempting 

to protect his teammates from a prematurely detonating hand grenade, he lost all five fingers on his left hand. 

Following treatment and recuperation at Tripler Army Medical 

Center in Honolulu, Ray attended Harvard’s Kennedy School of 

Government, where he earned an M.P.A. in strategic management. 

Subsequently, he attended Harvard Business School, where he 

earned an M.B.A. and was recognized with a Dean’s Award for Exceptional Leadership and Service. 

After graduation, Ray was selected as a White House Fellow and 

worked as a Special Assistant to the U.S. Secretary of Commerce. 

He went on to serve as a Fulbright Fellow in Singapore. In 2003, 

the Governor of Hawaii appointed him to be the Deputy Director 

for the Department of Business Economic Development and Tourism. This position involved creating jobs, facilitating business development, diversifying the economy, and creating renewable energy initiatives. 

He was selected by then-Secretary of State Colin Powell as one 

of the two inaugural recipients of the Harrison A. Schmidt Fulbright Alumni Leadership Award for Dedication to Public Service. 

Mr. Jefferson has accumulated a wealth of experience in management and leadership. He brings with him an enthusiasm and zeal 

for the position to which he has been nominated that is really 

remarkable. 

I am proud to consider him a friend and I recommend him to the 

Committee without qualification. I look forward to working closely 

with him on meeting the employment needs of this Nation’s veterans and separating servicemembers, as well. 

Mr. Jefferson, I understand that you have brought along a number of friends and associates this morning. Before I ask you to 

begin your remarks, could you please introduce them to the 

Committee. 

Senator BURR. Mr. Chairman, before he does that, could I say 

that Mr. Jefferson spent almost 3 years in North Carolina on different stints so I claim ownership of him—— 

[Laughter.] 

Senator BURR [continuing]. As you might in Hawaii, because 

North Carolina is a much more memorable stop for anybody in the 

Army. 

[Laughter.] 

5 

Chairman AKAKA. With that, and before I ask you to introduce 

your family and friends, let me ask Senator Murray for any opening remarks she may have. 

STATEMENT OF HON. PATTY MURRAY, 

U.S. SENATOR FROM WASHINGTON 

Senator MURRAY. Mr. Chairman, thank you so much. 

Raymond, it’s very nice to see you here. I have read through your 

resume ́, and I am very, very impressed in your taking on an issue 

that is extremely important to me: making sure that the men and 

women who serve us are rightfully and gainfully employed when 

they come home. I look forward to hearing your comments this 

morning and having a chance to ask a few questions. 

But really, I am looking forward to working with you. Mr. Chairman, I ask that my full statement be submitted for the record. 

[The prepared statement of Senator Murray follows:] 

PREPARED STATEMENT OF HON. PATTY MURRAY, U.S. SENATOR FROM WASHINGTON

Senator Akaka, Senator Burr, Thank you very much for holding today’s hearing 

to consider the nominations of Ray Jefferson to be the next Assistant Secretary of 

Labor for Veterans’ Employment and Training and Joan Evans to be the next VA 

Assistant Secretary for Congressional and Legislative Affairs. 

Mr. Jefferson, Ms. Evans, welcome to the Committee. I congratulate you both on 

your nominations and applaud you for your willingness to take on these challenging—and rewarding—jobs. 

I also want to thank both of you for meeting with my staff yesterday, and I apologize that I was unable to join because of a vote on the floor. 

I am looking forward to hearing from you both about your goals for serving our 

veterans. One thing that is clear to me is that finding the right people for these 

leadership jobs is absolutely critical. 

Ultimately, the VA and the Labor Department are organizations of people, and 

those in leadership roles will shape their cultures as well as their policies. 

And as all of us here know, our veterans deserve no less than the best that our 

country has to offer. 

TO RAY JEFFERSON: 

Mr. Jefferson, as a veteran yourself, you are acquainted with the characteristics 

and skills that our veterans bring to the table. They have what it takes to succeed 

in the working world—they are disciplined team players who have proven that they 

can perform under pressure. 

But when our men and women transition from the battlefield to the civilian 

world, they often find that their skills are not understood by civilian employers. 

Even in the best of times, this transition would be difficult. But when combined 

with the current economic recession, the results have been devastating. 

Nearly one million veterans are now unemployed as of February 2009. There are 

twice as many unemployed veterans as there were one year ago and there are more 

unemployed Iraq and Afghanistan veterans than there are men and women currently serving in Iraq. 

We know that helping our servicemembers transition into civilian life is a fundamental cost of war. The brave men and women who leave their jobs to serve our 

country deserve our help finding good jobs when they return. 

While there is a patchwork of Federal programs available to help veterans secure 

civilian employment and promote entrepreneurship, more needs to be done. 

This is why I am working on a bill right now which would improve job opportunities and vocational training for veterans. 

Together, we have to find a way to make the transition from soldier to citizen a 

smoother one, and I look forward to working with you to do just that. 

Thank you for appearing before the Committee today, and for your honorable 

service. 

Chairman AKAKA. Thank you. It will be included in the record. 

6 

Mr. Jefferson, will you please proceed with introducing your family and friends. 

Mr. JEFFERSON. Thank you, Senator. I would like to introduce 

my mother, Mrs. Nadia Jefferson. My mother is an Egyptian-American and a lifelong public servant. She spent her life as a teacher’s 

aide for physically challenged children, and I am very honored, 

Mom, to have you here today. Thank you. 

I have quite a few guests, so let me just briefly mention, I would 

like to thank and acknowledge a good friend, Mr. Scott Gould, the 

Honorable Scott Gould, Deputy Secretary of Veterans Affairs. We 

have been friends for quite some time, and I know we are looking 

forward, if confirmed, to just having unprecedented interagency 

collaboration. 

I would like to acknowledge many of my friends from the military academies, from West Point and also the Naval Academy, and 

we have quite a few members from both academies of the Class of 

1988. So if the Class of 1988 would kindly stand up. [Applause.] 

When I was going through the rehabilitation program, I had the 

privilege of attending the Harvard University, and the Director of 

Admissions for Harvard’s Graduate School of Government came 

down from Harvard today. I am very grateful to her for giving me 

the opportunity to attend that school and accepting my humble 

application. Alexandra Martinez, thank you for being here. 

[Applause.] 

I have two more introductions. When I was going through graduate school, I had the privilege of participating in the Department 

of Veterans Affairs Vocational Rehabilitation and Employment Program. My case officer in Boston, Rick Repucci, just retired after 29 

years with the VA. He flew down to be here today. He really helped 

me when I was getting my life back together. Rick, thank you for 

your service. [Applause.] 

Next, I would like to acknowledge two veterans who are here 

today. Both of them were severely injured in the line of duty. One 

is my West Point classmate and good friend of 25 years, Tony 

Dinallo. Tony had a rapelling accident. He was dropped 50 feet. He 

was a complete paraplegic, yet in the period of 1 year, he miraculously was able to work himself back to being fully functioning. 

Tony, thanks for being here today. [Applause.] 

Finally, it has just been a long journey from that hospital bed in 

Tripler back in 1995 to this room today. When I was in the hospital, there was a gentleman who came to visit me. He had lost his 

leg; he was an amputee. From the first days, he just gave me a lot 

of encouragement to keep going. I lost touch with him after 1995, 

and we had a reunion about a month ago, and he is here today. 

His name is Nadir Ogundi from the U.S. Navy. [Applause.] 

I just want to acknowledge the many friends and family who are 

here today who for reasons of time I haven’t introduced, but their 

unfailing support and confidence have played a huge role in my 

life, for which I am very thankful and grateful. Thank you all for 

being here. [Applause.] 

Chairman AKAKA. Thank you, Mr. Jefferson. 

In addition, I, too, want to recognize Deputy Secretary Gould, 

who is with us today. I would like to welcome you, Secretary Gould. 

7 

We appreciate you taking your valuable time to be here in support 

of these nominees. Thank you very much. 

Before I administer the oath to Mr. Jefferson, I am going to ask 

Senator Tester for any opening remarks he may have. 

STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

Senator TESTER. Well, thank you, Mr. Chairman. I very much 

appreciate you being here today, Mr. Jefferson. 

I have got to tell you that I was very impressed by you when we 

met in my office, and I am further impressed by you packing the 

Committee room. I think that speaks well of you, and it speaks 

well of your commitment to each other. Friends are the most valuable commodity you can have—easiest to lose and hardest to get. 

So I think that speaks well of you. 

I am not going to take a lot of time, Mr. Chairman. I will tell 

you that when Mr. Jefferson and I spoke in my office, we talked 

about rural America and veterans that live in rural America and 

how we can get them jobs. We have got a region in America called 

Montana that is as big as the Northeastern corridor where, quite 

honestly, we need to do a better job at helping our veterans find 

work. 

I think there are five folks there. I would typically say we need 

more, but maybe we just need a different way of utilizing other 

people that can support them. I don’t care how we do it. We just 

need to figure out ways that we can—through those positions and 

the Labor Department, but also the VA—get these veterans back 

on their feet. You know all about that. 

Mr. JEFFERSON. Yes, sir. 

Senator TESTER. So I just want to thank you for being here 

today. I think there are many programs out there that can help our 

veterans. They need to be fully maximized to take care of these 

folks and help them get good-paying jobs once they reenter the civilian lifestyle. 

So, I want to thank you for putting yourself up for this job. I will 

tell you that I have no doubt in my mind that you are going to do 

great things, and I appreciate your willingness to serve. 

Mr. JEFFERSON. Thank you, Senator, very much. 

Senator Akaka, sir, if I may humbly make one last introduction 

of some kamaaina who have come from Hawaii to be here—the 

Takamura family, Jeanette and Karl Takamura. Jeanette has previously served our Nation as the Assistant Secretary for Health 

and Human Services. They have traveled from Hawaii to be here 

today. [Applause.] 

Chairman AKAKA. Thank you very much, Mr. Jefferson. Will you 

please rise to take the oath and raise your right hand. 

Do you swear or affirm that the testimony you will give at this 

hearing and any written answers or statements you provide in connection with this hearing will be the truth, the whole truth, and 

nothing but the truth, so help you God? 

Mr. JEFFERSON. I do. 

Chairman AKAKA. Thank you. Let it be noted that the witness 

responded in the affirmative. 

Mr. Jefferson, will you please begin with your statement. 

8 

Mr. JEFFERSON. Yes, Senator, and will gladly follow up with that 

question, as well, sir. 

Chairman AKAKA. Thank you. 

Mr. JEFFERSON. Chairman Akaka, aloha. 

Chairman AKAKA. Aloha. 

STATEMENT BY RAYMOND M. JEFFERSON, NOMINATED TO BE 

THE ASSISTANT SECRETARY FOR VETERANS’ EMPLOYMENT 

AND TRAINING, U.S. DEPARTMENT OF LABOR 

Mr. JEFFERSON. Chairman Akaka, Ranking Member Burr, and 

Distinguished Members of the Committee, thank you. Thank you 

for your service to the veterans’ community, and thank you for considering my nomination here today. 

Over the past 2 weeks, I have had the opportunity to meet with 

many Members of the Committee to learn about your priorities and 

also obtain the benefit of your ideas, advice, and insights. Those 

have been tremendously helpful, and I am very appreciative. 

I am humbled and honored by President Barack Obama’s nomination to serve our country as the Assistant Secretary of Labor for 

Veterans’ Employment and Training. Both of my parents were lifelong public servants, which had a huge impact on who I am and 

how I have come to be here today. 

I have introduced my mother. I want to just acknowledge my father, who was an African American. He spent his career as the 

Deputy Director for the New York State Department of Mental 

Health and Mental Retardation. He passed away, but I know that 

he is here today in spirit. 

I am here today because of a defining moment in my life. After 

graduating from West Point, I spent 11 years as an Army officer. 

There was a pivotal moment on October 18, 1995, that put into motion a series of events that have led me to be here today. While trying to protect my teammates from a defective hand grenade detonating prematurely, I lost all fingers on my left hand. But someone 

once wrote that every crisis is an opportunity to be reborn, and my 

personal journey as a veteran and an amputee provided me with 

firsthand knowledge on the needs that our veterans face. 

In the early days of my accident, I was often worried, fearful, uncertain about my future and wondering if things would ever be all 

right again. But recuperation and moving forward have been the 

greatest, most positive journey of my life. The hardest decision that 

I had to make was believing it was possible, making a commitment 

to excellence and to continue striving to achieve my dreams. 

When I was in that hospital in Tripler, I made a commitment to 

three things: serving our Nation as a leader in the public arena; 

helping other individuals and organizations overcome challenges to 

achieve their potential; and participating in humanitarian endeavors. 

I want to acknowledge again the significant impact the Department of Veterans Affairs had in my life. The Vocational Rehabilitation and Employment Program there was instrumental in me getting my life back together. And Rick, I am so glad that you could 

be here to see this today. I can personally attest to the success that 

is possible for veterans and transitioning servicemembers when 

9 

they have the support of a committed Federal agency and its staff 

to help them. 

Transitioning from military to civilian life taught me firsthand 

the challenges that our servicemembers and veterans may face. I 

understand, and I have been a part of the communities that we 

serve and those that we partner with. I appreciate the importance 

of transitions and support to help create or recreate one’s life. 

So, my vision for VETS, if confirmed: I am completely committed 

to supporting President Barack Obama’s and Secretary Hilda 

Solis’s promises to veterans of restoring our sacred trust with them 

and ensuring that we provide them with the best possible employment services. Secretary Solis and I are especially committed to ensuring we serve populations with unique needs, populations such 

as: homeless veterans; women; veterans from rural communities; 

and veterans who have been ill, wounded, or injured. 

If confirmed, I will consider myself to have four primary responsibilities. First, leading the organization in a participative manner 

to make sure that we focus on peak performance, talent development, performance measurement and inspirational leadership. 

Second, developing the vision and creating, communicating, and 

implementing the supporting strategy to achieve that vision and 

help today’s transitioning servicemembers and veterans succeed in 

the modern economy. 

Third, advising the Secretary on relevant policy matters. 

And fourth, reporting to the Secretary and this Committee on the 

results of our efforts. 

Should I have the privilege of being confirmed, VETS will be 

committed to the following. First, increasing access, awareness, and 

participation in its programs and in improving the employment 

outcomes for those participants. 

Second, helping transitioning servicemembers to transition seamlessly into quality civilian employment and careers, with a special 

emphasis on green jobs and jobs of the future. 

Third, boosting USERRA’s impact by increasing the awareness of 

and commitment to it and reducing USERRA-related claims. 

Fourth, investing in VETS team members to increase their potential and to ensure that they can have greater capacity to serve 

veterans and transitioning servicemembers. 

And finally, communicating and collaborating with other agencies of the Department of Labor and with all of our stakeholders, 

inside and outside government, with a particular emphasis on Congress and this Committee, VSOs, State workforce agencies, the Department of Veterans Affairs, the Department of Defense, the State 

workforce agencies, the private sector, nonprofits, and other government agencies, so that we can better serve veterans and their 

employment needs. 

In conclusion, I am committed and inspired to help transitioning 

servicemembers and veterans create meaningful lives, develop rewarding careers, and become productive citizens and leaders in 

their communities. Eleanor Roosevelt once said that the future belongs to those who believe in the beauty of their dreams. I believe 

that together we can provide transitioning servicemembers and veterans with the best possible service, and together we can make 

sure when people like Cadet Sam Harrison finishes his military caVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6601 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
10 

reer and transitions to being a veteran, that he has the best possible services and resources available to him that our Nation can 

provide. 

Thank you very much. I look forward to answering your questions, and, if confirmed, the privilege of working with you. Thank 

you. 

[The prepared statement of Mr. Jefferson follows:] 

PREPARED STATEMENT OF RAYMOND M. JEFFERSON, NOMINEE TO BE THE ASSISTANT

SECRETARY FOR VETERANS’ EMPLOYMENT AND TRAINING SERVICE, U.S. DEPART- MENT OF LABOR

Good Morning Chairman Akaka, Senator Burr and Distinguished Members of the 

Committee on Veterans’ Affairs: Thank you for your service to the Nation, for your 

service to the Veterans community and for considering my nomination. I am honored to be here today seeking your endorsement for the privilege of serving as the 

Assistant Secretary of Labor for Veterans’ Employment and Training. 

Over the past few weeks, I had the opportunity to learn about the Committee’s 

priorities and benefit from your ideas, advice and insights. That has been tremendously helpful. Thank you. Your support and commitment to helping Veterans and 

Veteran-serving agencies succeed was apparent, heartfelt and inspiring. 

I am humbled and honored by President Barack Obama’s nomination to serve as 

the Assistant Secretary of Labor for Veterans’ Employment and Training. I am also 

very grateful for the confidence President Barack Obama and Secretary Hilda Solis 

have in me to help achieve their promises to Veterans in the area of employment 

and training. 

I am joined today by my mother, Mrs. Nadia Jefferson. My father passed away 

several years ago, but I know he is here in spirit and proud of what he sees. My 

mother and father were both lifelong civil servants. My mother, an Egyptian-American, spent her career as a teacher’s aide for physically challenged children. My father, an African-American, was the Deputy Director for New York State’s Department of Mental Health and Mental Retardation. I am a product of their upbringing, 

and of America’s public school system. I want to acknowledge and thank my friends 

for their unfailing support, and express my gratitude to the many teachers whom 

I have had throughout my life. They have all played a major role in my being here 

today. 

A DEFINING MOMENT

Sometimes the split-second decisions we make in life become unexpected defining 

moments and turning points. I spent 15 years in the Army, beginning as a cadet 

at West Point followed by 11 years as an Army officer with leadership positions in 

the Presidential Honor Guard (Infantry), 3rd Ranger Battalion (Airborne Ranger Infantry) and 1st Special Forces Group (Asia). October 18, 1995, is a day that I will 

always remember and which, unknown at the time, put in motion a series of events 

that led to the privilege of being here today. As I began to participate in a classified 

Special Forces training mission that day, I never thought that, within hours, my life 

would change forever. It was during that afternoon, while trying to protect my 

teammates from a defective hand grenade that was detonating prematurely, that I 

lost all five fingers on my non-dominant hand, in the line of duty. I received tremendous support during my recuperation from my family, friends, the Army and the Department of Veterans Affairs. This support, and many answered prayers, were the 

reasons that I was able to move forward and recreate a meaningful life. My mother 

and many of these friends are here today. Thank you—I will always remember what 

you did for me. 

PERSONAL JOURNEY

My personal journey as a Veteran and an amputee has provided me with firsthand understanding and appreciation for the needs that our Veterans have. In the 

early days after my accident, I was often filled with sadness, worried and uncertain 

about my future, and fearful that things would never be alright again. Recuperation 

and the journey forward has been the greatest, most challenging and positive experience of my life. My hardest decision was making the commitment to move forward 

through life, focus on the positive, and continue striving for excellence. I dedicated 

the remainder of my life to the following threefold path: (1) serving our Nation as 

a leader in the public arena; (2) helping individuals and organizations to achieve 

their potential; and (3) performing humanitarian service through global endeavors. 

11 

By participating in the Department of Veterans’ Affairs’ Vocational Rehabilitation 

and Employment Program, I was able to receive the support and financial assistance needed to achieve a dream—earning an MBA and an MPA (Master in Public 

Administration) from Harvard University. I can personally attest to the success that 

is possible when Veterans and transitioning servicemembers have the benefit of a 

committed Federal agency and its staff to assist them. 

I continued a career of public service as a White House Fellow, serving as a Special Assistant to the U.S. Secretary of Commerce, and then as a Fulbright Fellow 

in Singapore. Afterwards, I had the privilege of serving as the Deputy Director for 

Hawaii’s Department of Business, Economic Development and Tourism, a position 

equivalent to Deputy Secretary of Commerce. Most recently, I was a Leadership 

Consultant with McKinsey & Company in Asia and helped organizations develop 

their human talent and performance potential. Since my accident, I’ve also had the 

opportunity to work with and learn from many nonprofits that help underserved 

populations. 

Transitioning from military to civilian life as a Veteran-amputee taught me firsthand the challenges that Veterans and transitioning servicemembers can face upon 

entering the civilian workforce. I understand and have been a part of the communities we serve and those we partner with, and appreciate the importance of transitions and assistance to help create, or recreate, a life and career. I am inspired and 

committed to help Veterans and transitioning servicemembers create meaningful 

lives, develop rewarding careers and become productive citizens and leaders in their 

communities. 

VISION FOR VETS

If confirmed, my mission would be to support and achieve President Barack 

Obama’s and Secretary Hilda Solis’ promises to Veterans—restoring our Nation’s sacred trust with Veterans and providing them and transitioning servicemembers with 

better services. Secretary Solis makes it very clear that Veterans and VETS are a 

high priority for her. She particularly emphasizes the Department of Labor’s 

(DOL’s) responsibility to help returning servicemembers from the Iraq and Afghanistan wars obtain good jobs and create meaningful careers. Secretary Solis also 

stresses the need for cooperation among all DOL agencies. I would be a principal 

member of the DOL leadership team and would work collaboratively with the other 

Assistant Secretaries to ensure that DOL does all it can to help Veterans with their 

employment needs. Secretary Solis and I will pay special attention to ensuring we 

serve populations with unique needs, such as Veterans and transitioning servicemembers who are women, ill or injured, or who live in rural communities. 

If confirmed, I will consider my responsibilities to be the following: 

(1) Leading the organization in a participative, synergistic manner with an emphasis on inspirational leadership, talent development, peak performance, career 

satisfaction and performance measurement; 

(2) Developing the vision and creating, communicating and implementing the supporting strategy for helping Veterans and transitioning servicemembers to succeed 

in today’s economy; 

(3) Advising the Secretary on relevant policy matters; and 

(4) Reporting to the Secretary on the results of VETS’ efforts. 

Should I have the privilege of being confirmed, VETS will be committed to: 

(1) Increasing access to and participation in its programs, and improving the employment outcomes for those participants; 

(2) Helping servicemembers to transition seamlessly into quality civilian employment and careers, with a particular emphasis on ‘‘Jobs of the Future’’ and Green 

Jobs; 

(3) Boosting USERRA’s impact by increasing awareness of and commitment to it, 

while also reducing USERRA-related issues; 

(4) Investing in VETS’ team members to further develop their inherent potential 

and increase their capacity to better serve Veterans; and 

(5) Communicating and collaborating with other DOL programs and with stakeholders inside and outside the Federal Government—such as Congress, the VSOs, 

state workforce agencies, the private sector, nonprofits and other government agencies—to better serve Veterans and achieve their employment needs. 

If confirmed, success would be measured by the impact our programs have on 

helping Veterans and transitioning servicemembers succeed in today’s modern economy. I believe performance measurement and best practice benchmarking are important, continuous processes that help organizations provide the best service possible and greatest impact. These processes would further increase Veterans’ cusVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
12 

tomer satisfaction and outcomes while helping VETS continually improve service delivery, program results and ensure that public funds are well spent. 

In conclusion, if this Committee chooses to confirm me, I will work closely with 

you, with the outstanding team at VETS and with our partners and stakeholders 

to provide Veterans and transitioning servicemembers the best possible resources 

and services to enable their success in today’s economy. Thank you for your unwavering commitment to Veterans and for considering my nomination. It would be a 

privilege and an honor to serve our Nation’s Veterans and transitioning servicemembers—I hope you find me worthy. 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

RAYMOND M. JEFFERSON TO BE ASSISTANT SECRETARY FOR VETERANS’ EMPLOYMENT AND TRAINING, U.S. DEPARTMENT OF LABOR

Question 1. Have you and Secretary Solis discussed the duties and the role you 

would assume as Assistant Secretary for Veterans’ Employment and Training if you 

are confirmed? If so, what specific areas of the job were discussed? 

Response. Yes. Secretary Solis and I are committed to achieving President Barack 

Obama’s vision, goals and his promises to Veterans. Secretary Solis made it very 

clear that Veterans and VETS are a high priority for her. In particular, she emphasized our responsibility to help returning servicemembers from the Iraq and Afghanistan wars to obtain good jobs and create meaningful careers. 

Secretary Solis and I both believe that the Assistant Secretary for Veterans’ Employment and Training supports President Barack Obama’s agenda by being responsible for (1) leading the organization; (2) developing the vision; (3) creating, implementing and communicating the strategy for helping Veterans and transitioning 

servicemembers to succeed in today’s economy; (4) advising the Secretary on relevant policy matters; and (5) reporting to the Secretary on the results of VETS’ efforts. Secretary Solis emphasizes the need for seamless cooperation among all DOL 

agencies. I will be a principal member of the DOL leadership team and will work 

with the other Assistant Secretaries to ensure that DOL does all it can to help Veterans with their employment needs. 

Question 2. Have you and Secretary Shinseki discussed the relationship you would 

have with the Department of Veterans Affairs in your capacity as an Assistant Secretary within the Department of Labor? 

Response. Yes, I’ve met with Secretary Shinseki as well as Deputy Secretary Scott 

Gould and Chief of Staff John Gingrich. We also had the opportunity to work together as part of the Presidential Transition Team. We have spoken informally since 

then, and developed the foundation for a positive, productive and collaborative relationship going forward. If confirmed, I am looking forward to working seamlessly 

with VA to fulfill President Barack Obama’s promises of restoring our Nation’s sacred trust with Veterans and providing them and transitioning servicemembers with 

better services. In particular, we’re in agreement on the need to work closely together to provide the best possible employment opportunities for all Veterans. 

Question 3.What policymaking role do you anticipate having if you are confirmed? 

Response. If confirmed, my role will be to support the Secretary’s policymaking 

responsibilities by serving as her principal advisor and partner on issues relating 

to Veterans’ employment and training. I will provide her with my candid and unbiased opinion on VETS-related matters to the best of my ability and, when a decision 

is made, will ensure it is communicated and implemented effectively, efficiently and 

consistently. Secretary Solis has emphasized that I will be part of the core policymaking team and will represent Veterans’ employment and training concerns in all 

DOL activities. 

Question 4. Have you formulated any thoughts on what your job responsibilities 

will be and how you will approach these responsibilities if confirmed? 

Response. If confirmed, my mission would be to support Secretary Solis’ commitment to good jobs for everyone by providing Veterans and transitioning servicemembers the best possible resources and services to enable their success in today’s 

economy. The job responsibilities would include (1) leading the organization; (2) developing the vision; (3) creating, implementing and communicating the strategy for 

helping Veterans and transitioning servicemembers to succeed in today’s economy; 

(4) advising the Secretary on relevant policy matters; and (5) reporting to the Secretary on the results of VETS’ efforts. 

Fulfilling these responsibilities will involve (1) increasing participation in VETS 

programs and improving employment outcomes for those participants; (2) helping 

servicemembers to transition seamlessly into quality civilian employment and caVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
13 

reers, with a particular emphasis on ‘‘Jobs of the Future’’; (3) reducing USERRArelated issues and increasing USERRA’s impact; (4) investing in VETS’ team members to further develop their inherent potential and increase their capacity to better 

serve Veterans; and (5) communicating and collaborating with other DOL programs 

and with stakeholders inside and outside the Federal Government—such as Congress, the VSOs, state workforce agencies, the private sector, nonprofits and other 

government agencies—to better serve Veterans and achieve their employment 

needs. 

Question 5. If confirmed, what would you most like to accomplish in your new position? What would you hope your legacy to the Department will be? 

Response. If confirmed, I would like my legacy to be the accomplishment of four 

goals. First, serving as a focal point for the issue of Veterans’ employment, to include greater awareness and use of VETS resources as well as enhanced cooperation 

with our stakeholders, especially Congress, the VSOs and state workforce agencies. 

Second, incorporating best-practices and providing excellence in program and service 

delivery to Veterans. Third, increasing the private sector’s involvement as a partner 

in Veterans’ employment. Finally, working synergistically with VETS’ team members to become a model for inspirational leadership, talent development, peak performance and career satisfaction. 

Question 6. How would you describe your management style and how is it suited 

to this particular position? 

Response. I use a method of leading and managing that is appropriate for the situation and context, always with the goal of achieving results while developing people in the process. My preference is to use a participative style—one that involves 

stakeholders in identifying opportunities, developing options and creating an action 

plan, then delegates the implementation and supervises it by measuring results and 

personal interaction. Recognizing and appreciating team members’ contributions are 

also important leader actions. I value collaboration and consensus as ways to develop the best ideas and buy-in for solutions. Simultaneously, I recognize and accept 

the responsibility for accomplishing the mission. Serving Veterans the best way possible will be my guiding concern. 

This approach reflects the commitment to achieving Veterans’ employment needs 

while further enhancing VETS’ culture, capacity and impact. There are many stakeholders and programs in the area of Veterans’ employment. This approach, and its 

emphasis on collaboration, also recognizes and supports the need to work in partnership with VA, DOD and DHS so that together we can fulfill President Barack 

Obama’s promises to Veterans and transitioning servicemembers. 

Question 7. What in your experience do you believe contributes to your qualifications for this new position? 

Response. My personal journey has provided me with firsthand understanding 

and appreciation for the needs that our Veterans have as well as the opportunity 

to gain qualifications and skills that are ideally suited to this opportunity of service. 

I spent 15 years in DOD, beginning at West Point followed by 11 years as an Army 

officer in leadership positions with the Presidential Honor Guard (Infantry), 3rd 

Ranger Battalion (Airborne Ranger Infantry) and 1st Special Forces Group (Asia). 

On October 18, 1995, I lost all five fingers on my non-dominant hand in the line 

of duty while trying to protect my teammates from a defective hand grenade that 

was detonating prematurely. I received tremendous support from DOD and VA, 

which was instrumental to helping me move forward and create a meaningful life. 

Through participation in VA’s Vocational Rehabilitation and Employment Program, 

I was able to receive financial assistance to achieve a dream—earning an MBA and 

an MPA (Master in Public Administration) from Harvard University. 

I continued a career of public service as a White House Fellow, serving as a Special Assistant to the U.S. Secretary of Commerce and learning about interagency cooperation, leading complex Federal organizations and policy formulation. Afterwards, serving as a Fulbright Fellow in Singapore broadened my ability to work in 

multicultural environments, as does living in my homestate of Hawaii. I then had 

the privilege of serving as the Deputy Director for Hawaii’s Department of Business, 

Economic Development and Tourism, a position equivalent to Deputy Secretary of 

Commerce. This role strengthened my ability to enable organizational transformation, deliver and improve large-scale public services, formulate policy, understand private sector perspectives, promote workforce development and appreciate 

state workforce agencies. Most recently, serving as a Leadership Consultant with 

McKinsey & Company broadened and deepened my understanding of the private 

sector, leading change, developing inspirational leadership and businesses’ needs regarding hiring human talent. 

14 

I understand and have been a part of the communities we serve and partner with, 

and know the importance of transitions and assistance to help create, or recreate, 

a meaningful life. 

Question 8. What particular skills do you bring with you to this new position that 

will help you address the employment needs of Veterans? 

Response. My background in the military, public and private sectors, combined 

with some unique developmental experiences—among them transitioning from military to civilian life as a veteran-amputee—allowed me to develop a combination of 

skills that will be very helpful for serving Veterans’ employment needs. Among the 

skills that I have developed are (1) leadership, management and human relations; 

(2) public advocacy, listening and speaking; (3) understanding and incorporating private sector priorities, support and objectives; (4) the ability to develop partnerships 

and networks around shared interests; and (5) performance measurement and 

benchmarking. Additionally, I have a very personal understanding of the challenges 

that Veterans and transitioning servicemembers can face upon entering the civilian 

workforce, and can personally attest to the success that is possible when they have 

the benefit of a committed Federal agency to assist them. I am inspired and committed to help Veterans and transitioning servicemembers create meaningful lives, 

develop rewarding careers and become productive citizens and leaders in their 

communities. 

Question 9. What strategies might be implemented to ensure a higher level of visibility for issues related to Veterans’ employment needs? 

Response. Having VETS serve as a focal point for Veterans’ employment is an important first step to raise awareness and visibility of the issue. Within DOL, the 

Secretary has assured me that VETS is a priority and I will be a principal member 

of her leadership and policymaking team. Additionally, we should strengthen the dialog, relationship and collaboration with stakeholders such as Congress, the VSOs, 

state workforce agencies, our Federal partners (e.g. VA, DOD, DHS, HUD, SBA and 

others), nonprofits and the private sector to elevate the dialog and develop new 

ideas, while also communicating progress and successes. The potential of leveraging 

online social networking should be explored as well. 

Question 10. I believe much can be done to improve the coordination and cooperation between VA and DOL. What thoughts do you have as to how this might be 

achieved? 

Response. Joint DOL/VA collaboration is essential to meet Veterans’ employment 

needs and fulfill President Barack Obama’s promises of restoring our Nation’s sacred trust with Veterans and providing them and transitioning servicemembers with 

better services. I had the opportunity to work with Secretary Shinseki, Deputy Secretary Scott Gould and Chief of Staff John Gingrich while serving as a member of 

the VA Agency Review Team. We developed the foundation for a positive, productive 

and collaborative relationship going forward. If confirmed, I will meet with the VA 

leadership as soon as possible and regularly thereafter to maintain a strong partnership. Presently, there is significant coordination between the agencies—VETS works 

with VA’s Vocational Rehabilitation and Employment Service (VR&E), VA is also a 

member of the Transition Assistance Program (TAP) Steering Committee and both 

Secretaries are members of the Interagency Council on Homelessness. At the same 

time, I would like to explore ways to further improve coordination and cooperation 

at all levels and wherever services are delivered. Additionally, I would like to determine how we can have greater impact together in the many areas where we share 

common goals, such as transition assistance, homelessness, job creation, better serving women’s veterans, etc. 

Question 11. Are there any specific problems or challenges that you have already 

identified that you would like to tackle in this new position? 

Response. Since the intent to nominate, my involvement with DOL has been minimal and so my first priority will be to learn more about the agency, observe operations in the field, assess the current impact of its programs and solicit input from 

VETS’ team members, Veterans and stakeholder groups. There are many opportunities before us, to include (1) revolutionizing the TAP program; (2) increasing private 

sector involvement with VETS and Veterans’ employment; (3) strengthening 

USERRA’s impact; (4) investing in VETS’ human capital; (5) helping homeless Veterans obtain employment, with special attention to women’s particular needs; and 

(6) enhancing relationships with current stakeholders while developing relationships 

with potential partners. 

Question 12. Veterans are afforded specific protections under the Uniformed Services Employment and Reemployment Rights Act (USERRA). What emphasis will you 

place on striving to make certain that Federal agencies are role models of USERRA 

15 

compliance so that Veterans who have fought for the Nation do not have to come 

home and fight for their jobs and benefits? 

Response. The Secretary and I are committed to the President’s promise of fighting employment discrimination against Veterans and returning servicemembers. 

USERRA compliance and support will be a top priority of ours to ensure that it is 

a strong program that protects people’s rights. An important first step will be to further develop the relationship with OPM so we have a strong foundation for collaboration. We want to expand USERRA outreach to ensure that employers—particularly Federal employers—understand and comply with the law. In partnership with 

OPM, we want to ensure that executive branch agencies provide effective training 

to their human resources personnel, as required by the 2008 amendments to 

USERRA. The expertise and investigative skills of VETS USERRA investigators 

should be enhanced with a common standard. It is my understanding that VETS 

is currently participating in an OPM task force with this same objective. The 

USERRA claims process should also be analyzed to determine how it can be improved and expedited. 

Question 13. How do you believe special hiring authorities—for example, Veterans’ 

preference, Veterans Readjustment programs, Disabled Veterans affirmative action 

programs, and others—might be promoted to increase the employment of Veterans 

both within the Department of Labor and across all Federal agencies? 

Response. VETS’ responsibilities in this area complement OPM’s responsibility of 

developing and managing human capital for the Federal Government. VETS should 

work in partnership with OPM to increase awareness, understanding and support 

of these authorities within all Federal agencies, with particular outreach to human 

resources and management decisionmakers. We should also enhance the synchronization of our efforts with stakeholders such as the VSOs, state workforce agencies, 

VA’s Vocational Rehabilitation and Employment Service (VR&E), and other government entities at the Federal and state levels. It is my understanding that VETS is 

currently participating in an OPM task force with this same objective. 

Question 14. I know that you understand the value of a seamless transition. The 

transition from military to civilian life needs to be as hassle free and as beneficial 

as possible for servicemembers. I am aware the DoL has been involved with efforts 

in this area, especially through the TAP workshops, but I believe that more might 

be done. What is your assessment of DoL’s role in transition from active duty to 

Veteran status and what might be done in this regard? 

Response. Secretary Solis and I agree that servicemembers’ transitions from military to civilian life should be as seamless and beneficial as possible. The Transition 

Assistance Program (TAP) is an important way to help accomplish that goal, and 

expects to serve about 130,000 customers this year. While DOL has primary responsibility for TAP, improving it will require input from its clients—the servicemembers, DOD and DHS—and other stakeholders. I look forward to working in 

partnership with Congress, VA, DOD, DHS, the VSOs and state workforce agencies 

to ensure that TAP delivers the best possible service to our heroes in uniform. It 

will be important to review participant feedback on satisfaction and improvement 

suggestions; determine what best practices and new, relevant content should be further incorporated; increase awareness of TAP’s utility; involve private sector input 

and increase access for National Guard and Reserve personnel. Pilot programs are 

an effective vehicle for determining the impact of new ideas. 

Question 15. The employment-related needs of recently separated, younger Veterans have, over time, been particularly difficult to address as their rate of employment has been consistently higher than their peers. What ides do you have for new 

ideas that might be implemented to assist these individuals? 

Response. Transforming the TAP program to make it more effective is an important contribution that VETS can make to help younger, separating servicemembers 

transition faster, easier and more successfully to civilian life. Research conducted 

by the University of Chicago reveals that young Veterans have a very high initial 

unemployment rate that steadily decreases and, by 39 weeks after separation, approximates that of the general veteran population (which is typically lower than 

that of the overall population). We want to decrease the time it takes young Veterans to reach the rate of the general Veteran population. 

Transforming TAP needs to be done in partnership with Congress, VA, DOD, 

DHS, VSOs and state workforce agencies. It should involve input from servicemembers and Veterans as well as the private sector. TAP participants should receive best practices and the most effective transition-related training. As stated earlier, it will be important to learn from past participant feedback on satisfaction and 

improvement suggestions; determine how new, relevant content should be incorporated; increase awareness of TAP’s utility and increase access for National Guard 

16 

and Reserve personnel. Pilot programs are an effective way vehicle to demonstrate 

the impact of new training approaches and that the time to approach the unemployment rate for the general Veterans population can be reduced. The potential of 

leveraging online social networking and new media to reach more Veterans—especially the younger ones—should also be explored. 

Question 16. What emphasis will you place on the needs of Veterans who are 

homeless—particularly those who are women? 

Response. Secretary Solis and I are committed to supporting President Barack 

Obama’s promise to combat homelessness among our Nation’s Veterans by expanding proven programs and launching innovative services. Secretary Solis is presently 

serving as the Vice-Chairperson for the Interagency Council on Homelessness and 

has asked us to focus parts of our 2010 programs on homeless women Veterans. 

Effectively addressing Veterans’ homelessness will require working in partnership 

with VA, HUD, HHS and other Federal agencies. While employment is a key component of freedom from homelessness, the problem needs to be addressed in a holistic, 

interagency manner with other important stakeholders—government and nongovernmental—at the national, state and local level, such as community-based organizations and neighborhood partnerships. It is also important to identify best practices and disseminate them. VETS’ Homeless Veterans Reintegration Program has 

garnered praise as a highly successful, model program. The Secretary has directed 

us to conduct demonstration programs in 2010 to determine how we can deliver better services to women Veterans and families who are homeless. We will place a high 

emphasis on helping homeless Veterans and addressing the unique needs of those 

who are women. 

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RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO RAYMOND M. JEFFERSON, NOMINATED TO BE THE ASSISTANT SECRETARY FOR VETERANS’ EMPLOYMENT AND TRAINING SERVICE, U.S. DEPARTMENT OF LABOR


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RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

RAYMOND M. JEFFERSON, NOMINEE TO BE ASSISTANT SECRETARY FOR VETERANS’ 

EMPLOYMENT AND TRAINING SERVICE, U.S. DEPARTMENT OF LABOR

JOBS OF THE FUTURE

Question 1. You have noted a desire to focus on ‘‘Jobs of the Future’’ and ‘‘Green 

Jobs.’’ Could you please provide examples of each? 

Response. ‘‘Jobs of the Future’’ are jobs in occupations that (1) are in high demand; (2) are growing; and (3) offer good wages and opportunities. Some examples 

are the professions of health care and information technology. For example, the median hourly wage for Registered Nurses (RNs) was $29 in 2006. Demand for RNs 

is projected to increase by 18–26%, requiring over one million RNs by 2016. Many 

information technology occupations are projected to increase over 27%, and those occupations paid median hourly wages of over $30 in 2006. 

‘‘Green Jobs’’ are also ‘‘Jobs of the Future.’’ They can already be found in many 

industries, and will continue to grow in both numbers and importance. For example, 

the recently enacted economic stimulus legislation is expected to give a boost to the 

creation, retention, and transformation of up to 400,000 ‘‘Green Jobs’’ in the next 

several years. VETS recently issued grants to service providers who will assist Veterans to prepare for and obtain jobs in the following industries: construction; retrofitting; energy-efficient building; renewable electric power; energy efficient and advanced drive train vehicles; bio-fuels; deconstruction and materials usage; energy efficiency assessment for the residential, commercial, or industrial sectors; and manufacturers that produce sustainable products using environmentally sustainable processes and materials. 


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INVESTMENT

Question 2. You noted that you hope to invest in VETS’ team members ‘‘to further 

develop their inherent potential and increase their capacity to better serve Veterans.’’ If confirmed by the Senate, can you please provide—within 60 days—more 

detail on how you intend to make this investment together with goals and a timetable for moving forward? 

Response. Yes, Mr. Chairman. If confirmed, I will provide you with a more detailed plan for this investment, to include goals and a timetable, within 60 days of 

confirmation. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO RAY- MOND M. JEFFERSON, NOMINEE TO BE ASSISTANT SECRETARY FOR VETERANS’ EM- PLOYMENT AND TRAINING, U.S. DEPARTMENT OF LABOR

Effectiveness of State Grants Program for Local Veterans’ Employment Representatives (LVER) program and the Disabled Veterans’ Outreach Program (DVOP) 

The Department’s data on veteran job seekers paint an unclear picture of their 

use of employment and training services (according to GAO Reports conducted in 

2005 and 2007) making it difficult to know how many, and how well, Veterans are 

actually served. Lack of credible information diminishes the Department’s ability to 

appropriately apply resources, especially in rural communities and on Indian Reservations. I am concerned that these data gaps and antiquated State Grant formulas may have contributed to a decrease in personnel resources and effective use 

of those resources by the state. 

Question. If confirmed, will you commit to a full review of LVER and DVOP performance measures and outcomes to see if they are adequate, particularly with respect to service of rural Veterans? Will you provide an update to my office within 

one year? 

Response. Yes, if confirmed, I am committed to conducting a full review of the 

LVER and DVOP programs—to include performance measures, outcomes and service delivery models—to determine if they are adequate and how they can be improved, particularly with respect to service for rural Veterans. I will provide you 

with an update of that review within one year of confirmation. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. MARK BEGICH TO RAYMOND M. JEFFERSON, NOMINEE TO BE ASSISTANT SECRETARY FOR VETERANS’ EMPLOYMENT AND TRAINING SERVICE, U.S. DEPARTMENT OF LABOR

Question 1. In your testimony you state Secretary Solis is committed to ensuring 

returning Vets from Iraq and Afghanistan wars obtain good jobs and create meaningful careers. 

(a) Can you tell me what specific programs are in-place to track the transitioning 

Veterans to assist in implementing the goal of employment? 

(b) How does the DOL work with Department of Defense (DOD) and Department 

of Veterans Affairs (DVA) to achieve this goal? 

Response. The Transition Assistance Program (TAP) is the most important program in place to assist servicemembers transitioning from military to civilian employment. TAP is a Department of Defense (DOD) program that partners with DOL, 

the Department of Veterans Affairs (VA), and the Department of Homeland Security 

(DHS). The program is guided by a Steering Committee chaired by DOL and its 

members are the VA, DOD, DHS, and the military services. TAP has four components: 

1. Pre-separation counseling—This is mandatory for all transitioning servicemembers and is provided by the military services and DHS; 

2. TAP employment workshops—These are mandatory in the Marine Corps, voluntary in the other services, and are administered through DOL and its state partners; 

3. VA benefits briefings—These briefings are also voluntary and administered by 

the VA; and 

4. Disabled Transition Assistance Program (DTAP)—This is also voluntary and 

administered by the VA. 

Question 2. You describe performance measurement and benchmarking as important, which can assist in providing the greatest impact. According to the 2007 GAO 

report on the Disabled Veterans’ Outreach Program (DVOP) and Local Veterans’ 

Employment Representative (LVER) program; these programs have many problems 

25 

with accurately providing performance measures. What can you tell me about performance measurement in these programs and how you would strive to improve 

these? 

Response. The performance of grant programs is measured and closely monitored 

by Federal staff assigned as grant officer technical representatives. Each grantee, 

whether a state workforce agency or competitive grantee, is required to provide 

quarterly reporting. Goals, to include entered employment and retained employment, are established for each grantee and closely reviewed. Technical assistance is 

provided for any grantee that falls short of those goals. If confirmed, I am committed to conducting a full review of the LVER and DVOP programs—to include 

performance measures, outcomes and service delivery models—to determine if they 

are adequate and how they can be improved. I would be happy to provide you with 

an update of that review. 

Success can be measured by the impact our programs have on helping Veterans 

and transitioning servicemembers succeed in today’s modern economy. I believe performance tools such as best-practice benchmarking, customer satisfaction analysis, 

outcome tracking, stakeholder input and impact assessment are important processes 

that should be continuous and that help organizations provide the best service possible and achieve the greatest impact. I want to ensure that we are measuring the 

right metrics—ones that enable and determine success in VETS’ vision, mission and 

responsibilities—and incorporating the resulting information in a cyclical self-improvement process. This process should increase Veterans’ customer satisfaction and 

outcomes while helping VETS to continually improve service delivery and program 

results. 

Question 3. From the DOL Web site I note that performance outcomes for employment of Vets and disabled Vets are varied amongst the States. The national average 

is 60% employment for Vets earning an average of $32K/year. 

(a) I believe the goal of DOL is 60%, should we have a higher goal? 

Response. I understand that the entered employment goal is 62.5%. I believe we 

should continually strive to improve performance and set goals that provide relevant 

outcomes for Veterans. If confirmed, I’m committed to conducting a full review of 

all programs, performance metrics and goals to ensure that the best possible service 

is provided and the best possible outcomes are achieved. 

(b) What are we doing to focus on the States like Hawaii, Rhode Island, and California which are down in the 40% range? 

Response. If confirmed, I am committed to identifying and addressing the causes 

of employment below the national average in impacted States to the greatest extent 

possible, and doing so in collaboration with our partners, to include Congress, the 

VSOs, state workforce agencies, the private sector, nonprofits and other government 

agencies. 

Question 4. According to the Bureau of Labor and Statistics $32K/year is $10K/ 

year less than the national wage average of $42K/year. What would you explain the 

reasoning is for this 24% discrepancy in wage earnings for Vets? 

Response. The data referenced originates from two very different sources. The average $42,000/year figure refers to the average $42,270/year earnings for all occupations, as reported by the May 2008 Occupational Employment Statistics (OES) survey conducted by the Bureau of Labor Statistics (BLS). The OES is a semiannual 

survey of nonfarm establishments. The annual wage estimate represents the base 

pay for non-farm wage or salary workers assuming a full-time year-round schedule, 

with few exceptions. 

The veteran earnings data cited above refers to the earnings of Veterans who are 

employed in the first quarter after they last received Wagner-Peyser employment 

services, and who retain employment for two additional quarters. The average earnings for this population was $33,658 for the quarter ending March 31, 2009. (Source: 

ETA 9002 D Qtr Ending March 31, 2009, reported as of 6/2/2009.) This earnings 

level compares quite favorably to that of all (veteran and nonveteran) WagnerPeyser participants ($25,376); to participants in the Workforce Investment Act (WIA) 

Adult Program ($28,692); and to WIA Dislocated Worker participants ($32,180). 

(http://www.doleta.gov/performance/results/Quarterly_report / Mar_09/Quarterly_ 

Report_033109.pdf) 

It should be noted that most of the participants in these One-Stop Career Center 

programs have experienced a recent period without employment. Therefore, it is expected that it will take some time for their earnings to rebound to the levels that 

they may have experienced prior to their period without employment. 

26 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. ROGER F. WICKER TO

RAYMOND M. JEFFERSON, NOMINEE TO BE ASSISTANT SECRETARY FOR VETERANS’ 

EMPLOYMENT AND TRAINING SERVICE, U.S. DEPARTMENT OF LABOR

Mr. Jefferson, should you be confirmed, you would be responsible for overseeing 

several important programs that affect the lives of many of our Nation’s Veterans. 

The services offered through the Homeless Veterans’ Reintegration Program play an 

important role in assisting homeless Veterans find meaningful employment. 

A healthcare resource organization from my state was a recipient of the Homeless 

Veterans’ Reintegration Program for the last three years. Recently, this non-profit 

organization applied for the 2009 Veterans’ Reintegration Program grant, but ran 

into serious problems with the grants.gov Web site. This error, due to the failing 

of the grants.gov Web site, prevented the application from being accepted despite 

several attempts and calls to the appropriate help desk. In fact, my constituent was 

informed that this systematic issue had been ongoing for several days. However, I 

was informed in a letter from the Department of Labor (DOL) that the Department’s 

rules do not allow it to consider any submissions received after the deadline, even 

if it was the government’s own delivery system that failed. I am concerned that the 

DOL does not have sufficient flexibility in its rules to respond to the increasing shift 

to electronic submission of grant applications. I have been informed of other departments’ rules that allow for a two day error correction window to address submission 

errors arising under systematic issues outside of the applicant’s control. This seems 

to be a well-reasoned approach. 

Question 1. What steps will you take, if confirmed as Assistant Secretary, to ensure that safeguards are put in place to allow submissions from applicants when 

similar errors occur outside their control? 

Response. Since being nominated, my involvement with DOL has been minimal 

so I have not been able to conduct an evaluation of the program. One of my first 

priorities will be to learn more about the agency, observe operations in the field, 

assess the current impact of its programs and solicit input from VETS’ team members, Veterans and stakeholder groups. This will involve conducting an accurate, 

comprehensive assessment of the performance, effectiveness and impact of all programs, to include their service delivery models. If confirmed, I will review the rules 

pertaining to submitting applications for Homeless Veterans Reintegration Program 

grants as well as feedback about the application process. 

[The Committee questionnaire for Presidential nominees follows:] 

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[A letter from the Office of Government Ethics follows:] 


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[Letter from the nominee to the Office of Legal Counsel, U.S. Department of Veterans Affairs:] 


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Chairman AKAKA. Thank you very much, Mr. Jefferson, for your 

testimony. 

I would like to pose a question. Could you please share your 

thoughts with us on what you view as the difference between a job 

and a career and what emphasis you would place on each, if confirmed. 

Mr. JEFFERSON. Yes. Mr. Chairman, thank you very much for 

highlighting that difference for the Committee and for the Members here today. It is important that we make sure that all veterans have good jobs. That is a priority of Secretary Solis. But a 

greater service that we can provide is preparing them for careers. 

One of the differences is that careers have the opportunity for 

continuing and progressive growth, development, financial self-sufficiency, and opportunities. Emphasizing that preparation is something that we would like to do through our work with the CVOPs, 

Disabled Veterans Outreach Program, the LVERs (the Local Veterans’ Employment Representatives), and also the TAP program to 

bring in new content that will empower veterans to manage their 

careers and have a greater vision for themselves than they previously thought possible. 

Chairman AKAKA. Thank you very much for that response. 

You have indicated that you believe performance measurement 

and best practice benchmarking can help organizations provide the 

best service possible and make the greatest impact. Could you explain how these processes might be applied to LVERs and DVOPs, 

especially since they are actually employees of the various States? 

Mr. JEFFERSON. Yes. Senator, thank you for highlighting that. It 

is an issue that I have been thinking about and have some ideas 

on. From serving as Deputy Secretary of Commerce with the Department of Business, Economic Development and Tourism, or 

DBEDT, in Hawaii, I have a keen appreciation for the dynamics of 

State and local service providers. But how can we look at other 

models for service delivery? We’re scanning related service delivery 

organizations in other sectors, the private and the nonprofit. Which 

ones have the greatest outcomes? We are looking at what they do 

and then bringing that information in, teaching our DVOPs and 


J51327Q17.EPS
43 

our LVERs through the NVTI (National Veterans Training Institute) and through concurrent and refresher training; looking at 

how we can emphasize and incorporate new modalities, such as 

pure learning; maybe incorporating some new IT solutions so best 

practices are taught and disseminated and shared much more efficiently. We want to identify what is the best process out there and 

bring those to our DVOPs and LVERs. 

Chairman AKAKA. VA estimates that 131,000 veterans are homeless on any given night. Struggles with obtaining and maintaining 

suitable employment after service is one of the many factors that 

contribute to a veteran becoming homeless. If confirmed, how do 

you plan to strengthen the Veterans’ Employment and Training 

Program to combat these troubling statistics? 

Mr. JEFFERSON. Yes. Mr. Chairman, one veteran who is homeless 

is too many. I think there are several things that need to be done. 

One is strengthening the partnership with service delivery organizations, working more closely with Veterans Affairs, working more 

closely with Housing and Urban Development to take not a single 

agency approach but an interagency approach. 

Two, identifying those organizations that have the highest success rates of helping homeless veterans, learning what they are 

doing, sharing and disseminating those best practices. Some of 

those are grantees of ours, we have relationships with them. But 

looking at who has the highest outcomes for helping veterans end 

homelessness the quickest and disseminating those best practices 

in an interagency manner. 

Chairman AKAKA. Thank you very much. Have you given any 

thought to the employment needs of the spouses of active-duty servicemembers who are deployed and how VETS might address 

them? 

Mr. JEFFERSON. Yes, Mr. Chairman, we have. One of the programs that we have which could be extremely helpful to spouses 

is the Transition Assistance Program. Spouses can participate in 

that program. What I would like to do is explore the degree of 

awareness about that opportunity and to look at how we can increase awareness of the program, increase spousal involvement, 

and also highlight the success stories and the positive outcomes of 

that involvement. 

Chairman AKAKA. Thank you very much. 

Let me call on the Ranking Member for his questions. Senator 

Burr? 

Senator BURR. Thank you, Mr. Chairman. 

Again, Ray, welcome. 

Mr. JEFFERSON. Thank you, sir. 

Senator BURR. The first question, housekeeping. As Ranking 

Member, I do have some responsibilities to Members on this side 

of the aisle to actively do oversight, as does the full Committee, 

with regard to the activities of the Veterans’ Employment and 

Training Services. This tends to lead me or my staff to make certain requests at times. If confirmed, do you pledge to ensure that 

my staff and I will be provided with requested information in a 

timely manner? 

Mr. JEFFERSON. Yes, sir, I absolutely do. 

44 

Senator BURR. If confirmed, will you be proactive in alerting this 

Committee, including both sides of the aisle, to any significant 

trends, problems, or other issues regarding the law and programs 

administered by the Veterans’ Employment and Training Service? 

Mr. JEFFERSON. Yes, Senator, I will. 

Senator BURR. I thank you for those answers. 

Ray, last year, Congress passed a law that I authored that would 

require Federal executive branch agencies to ensure that their 

human resource personnel are trained in the rights and obligations 

under the Uniformed Service Employment and Reemployment 

Rights Act. In my view, this will help prevent USERRA violations 

from occurring in the first place, but it is my understanding that 

some agencies have been slow to implement this new training 

requirement. 

Do you agree that the best steps that we can take to protect 

USERRA rights of military personnel and veterans is to prevent 

them in the first place? 

Mr. JEFFERSON. Senator, I think that is critically important, and 

one of the things that we want to do is to increase awareness and 

commitment of employers’ responsibilities under USERRA. If confirmed, I would look to strengthen the relationship with OPM so 

that we can provide that training and technical assistance to Federal Government agencies, other government agencies, partner 

with the private sector to ensure that they understand and are 

committed to that, and that prevention is a key component of reducing USERRA-related claims. 

Senator BURR. Do you agree that that starts with the proper 

training of human resources personnel to ensuring that they understand the law? 

Mr. JEFFERSON. Yes, Senator. I think that is a critical component 

in the process. 

Senator BURR. I have your commitment that you will work aggressively to make sure that any agencies that might have been 

slow to take on the letter of the law actually do go through that 

training process? 

Mr. JEFFERSON. Senator, one of my first priorities will be to perform a complete evaluation of the program to identify any agencies 

which have been slow to implement that process, then to take appropriate action to encourage them to complete that process. 

Senator BURR. Great. Thank you. 

In your prehearing questions, you stated that the Department of 

Labor, ‘‘strongly opposes transferring the responsibility of investigating these USERRA cases from the Department of Labor to the 

Office of Special Counsel.’’ Yet in 25 cases this fiscal year, the Department of Labor has exceeded the statutory 60-day limit for referring cases to the Office of Special Counsel out of the 128 Federal 

USERRA cases closed in fiscal year 2009, to date. 

If transferring control of Federal USERRA claims to the Office 

of Special Counsel could help expedite a just resolution of those 

cases, wouldn’t veterans be better served to do that? 

Mr. JEFFERSON. Well, Senator, thank you for highlighting that 

issue. I actually feel that there are two points here to address. 

First is doing a complete assessment of the process to determine 

why there have been those extended procedures required and to go 

45 

ahead and streamline it so all investigations are completed in the 

appropriate period of time. 

But there is a fundamental reason why I believe that that responsibility should not be transferred. In addition to doing investigations, that also provides the veterans and transitioning servicemembers with additional programs and resources that could be 

very helpful to them in finding and obtaining not just a job, but 

a career, which is our fundamental goal. So I believe that we need 

to maintain the current responsibility because of the other services, 

resources, and benefits we provide, and to look at how that process 

can be improved, then improve it as rapidly as possible. 

Senator BURR. If a year from now we have got the same percentage number of cases that have not been referred and they exceed 

the statutory 60-day limit, what question should I ask of you then? 

Mr. JEFFERSON. Senator, our commitment is to ensure that there 

is no need to ask that question within the year, sir, because we will 

have resolved it. We will have resolved it prior to that. We also 

want to work very closely with you and your office to keep you informed every step of the way. 

Senator BURR. With your incredible passion to get this done—— 

Mr. JEFFERSON. Yes, sir. 

Senator BURR [continuing]. Can I assume that if we still do have 

a problem a year from now, then it is a territorial dispute versus 

a lack of will? 

Mr. JEFFERSON. I think, sir, if a year from now a problem still 

exists, we will look at some new and innovative approaches to resolve it. 

Senator BURR. Thank you. 

Mr. JEFFERSON. But I want to give you my full commitment, sir, 

that USERRA is a priority, that doing everything we can in every 

step of the process to ensure there is commitment to it, that all 

partners and all sectors are involved and aware, and that we 

produce the outcomes that our veterans deserve when they come 

back, which is that the job they left and the benefits are available 

to them. 

Senator BURR. I thank you for that commitment and I thank the 

Chair. 

Chairman AKAKA. Thank you very much, Senator Burr. 

Now I will call on Senator Murray for her questions. 

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

Mr. Jefferson, would you share with us what you think is the 

biggest challenge facing the VETS office in helping veterans with 

their employment goals? 

Mr. JEFFERSON. Thank you, Senator. Being very candid with you, 

since my accident, I don’t look at things in terms of challenges as 

much as I look at them as opportunities. So, I feel that we have 

some significant opportunities. 

One significant opportunity is to engage more strongly with the 

private sector. You can do all kinds of wonderful things to improve 

your programs and prepare a veteran or a transitioning servicemember for career success. But when he or she goes out, if they 

cannot find a job within a reasonable period of time, it is demoralizing. So engaging with private-sector organizations to increase 

46 

awareness of what veterans can provide and get their commitment 

to hire veterans is a huge priority. 

Second, looking at how all of our programs could be improved to 

incorporate best practices and increase the outcomes. 

And third, the partnerships. This is not a priority or a role that 

VETS can do alone. We need to engage with our friends inside and 

outside government, VSOs, State workforce agencies, nonprofits, to 

do this in partnership. 

I think those are three significant things that we can do to increase our service to veterans and transitioning servicemembers. 

Senator MURRAY. Let me focus on one of them, the private sector. 

Mr. JEFFERSON. Yes. 

Senator MURRAY. I mean, I talk to veterans all the time—— 

Mr. JEFFERSON. Yes. 

Senator MURRAY [continuing]. And they want to be employed, 

they want a job, they want to be productive. I’ve talked to Chambers of Commerce and they have no idea that veterans are even out 

there. I made a pledge to many of our Iraqi and Afghan veterans 

coming home that I would never leave a Chamber of Commerce or 

Rotary meeting without telling them they need to hire veterans. 

Mr. JEFFERSON. Yes. 

Senator MURRAY. How do we engage the private sector better? 

How do we let them know about the many men and women who 

have got great skills? 

Mr. JEFFERSON. Well, thank you, Senator. I know that is an area 

that we can collaborate on, and I also feel very strongly about. I 

think there are several things. One is looking for those organizations that private sector leaders turn to for sources of information 

and increased awareness. One is YPO-WPO, Young Presence Organization-World Presence Organization; it is a CEO organization. 

So, engaging them to find out what information they need from us: 

is it a massive resume ́ database? How can we take the tremendously talented individuals who are out there and make it easy for 

you to contact them and hire them? 

So, having dialog with organizations that represent private sector interests, going to those large organizations that have a history 

of hiring the most veterans and looking at how we can potentially 

create pilot programs to streamline veterans’ hiring. Also speaking 

to the veterans and working with the VSOs to find out where the 

veterans are experiencing challenges in the process and working it 

from both ends so together we can come toward the middle. 

Senator MURRAY. Well, it is a big challenge, but I am really glad 

that you are going to take that on because I think there are a lot 

of opportunities left simply because the two groups—veterans and 

the people who employ veterans, our private companies—don’t 

know that each other exists. 

Mr. JEFFERSON. Exactly, Senator. That is something we want to 

address; and also to encourage the assistance and the ideas of this 

Committee as we do that. 

Senator MURRAY. OK, great. You know the Federal Government 

has a huge patchwork of programs available today, including the 

one you are going to head up. You talked a little bit about streamlining and collaborating. How do you do that with the other Federal agencies so that people are working better together? 

47 

Mr. JEFFERSON. Yes. Well, Senator, I think that is a—it is an immediate priority and it is a hugely important one. I think part of 

this involves personal relationships, and I have been fortunate to 

have some existing relationships with many of these agencies— 

very grateful to have the Honorable Scott Gould here today. I think 

convening a dialog where we become aware of what one another 

are doing; how we can partner; where there is redundancy, creating 

focal points so veterans do not have to figure out what all the different opportunities available to them are, but maybe we have a 

one-stop kind of information center. 

But it is not just information. We want to make sure that it is 

easy for veterans to physically access programs and resources to 

get everything they need in an integrated, simple manner; to get 

those employment opportunities and those career opportunities 

that the Senator spoke about earlier. 

Senator MURRAY. OK, good. I look forward to hearing about your 

progress and what we can do to help. 

Mr. JEFFERSON. Thank you, Senator. I appreciate and welcome 

in advance that assistance. 

Senator MURRAY. OK, and I appreciate your comments about 

TAP and working with spouses, as well. If we are not working with 

the spouses and the families, we often lose a lot of the resources. 

So I look forward to hearing more on what you are going to be able 

to do there, as well. 

Mr. JEFFERSON. Thank you, Senator. 

Senator MURRAY. Mr. Chairman, I look forward to supporting 

this nominee, and hopefully we can move him quickly through the 

process once we have the Committee hearing so that we can get 

him to work for our veterans. 

Mr. JEFFERSON. Great, Senator. 

Chairman AKAKA. Thank you very much, Senator Murray, and 

thank you for urging us to move expeditiously, which we will. 

Mr. JEFFERSON. All right, Senator. 

Chairman AKAKA. Thank you. 

Now, I would like to call on Senator Isakson for any statement 

and questions. 

STATEMENT OF HON. JOHNNY ISAKSON, 

U.S. SENATOR FROM GEORGIA 

Senator ISAKSON. My only statement is we are lucky to have people like Mr. Jefferson who want to serve the country. You are to 

be commended on your record and you are especially to be commended on your attitude. I have listened to your remarks and attitude is directly proportionate to your altitude and you have got a 

high altitude. I like that a lot. 

Mr. JEFFERSON. Thank you, sir. 

Senator ISAKSON. Senator Murray just asked you a question and 

you gave an answer that included, to me, one of the keys to this 

whole transition to jobs. You mentioned one-stop. Senator Murray 

and I are on the Labor Committee and the Subcommittee on Occupational Safety and we oversee the Workforce Investment Act, 

where a few years ago there were pilots developed around the 

country for one-stop shops for people seeking employment and emVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00051 Fmt 6633 Sfmt 6601 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
48 

ployment training. We had a hearing just a couple of days ago on 

that. 

Right now, in my State of Georgia, for example—I just happen 

to have this on my mind because our Labor Commissioner spoke— 

of the 400,000 unemployed people that went through our Department of Labor, they had reemployed 261,000 in an economy that 

is very down because they had a one-stop place where the unemployed people could go where they could get training information, 

they could get employment information, they could get every resource they needed at one place. 

I don’t think that exists. I think there are, like Senator Murray 

said, multiple attempts to help veterans with jobs, but I don’t know 

that there is a one-stop coordinated place. I know in the transition 

from DOD health care to VA health care, we experienced a lot of 

problems with people falling through the cracks because there 

wasn’t a good transition. 

Mr. JEFFERSON. Yes, sir. 

Senator ISAKSON. That is being worked out now and it is better, 

but it is being worked out through an ombudsman or a central approach. I would like for you to comment on the concept of a onestop shop where everybody that wants to help veterans comes together to make it simple for the veteran to transition to the private 

sector. 

Mr. JEFFERSON. Senator, I really appreciate you bringing that 

point up. These are hugely valuable resources, and I had the privilege of working with a lot of them as Deputy Secretary of Commerce in Hawaii. So, one of the things I am committed to doing is 

getting the different service providers together, looking at what one 

another is doing; asking how can we work, share resources, space, 

things such as that; and developing a model so that veterans and 

transitioning servicemembers, when they go back to their home 

towns, they can go to one place, get resources, training, information 

in a way that is very simple and effective and help encourage them 

to make that transition or to find that career as quickly as possible. 

I think they are hugely important. I think it begins with dialog 

to see how can we create those partnership, then creating those 

partnerships. I think pilot programs are a very effective way to 

demonstrate the validity and feasibility of new initiatives and new 

ideas. 

Senator ISAKSON. Well, you just hit the second key word I was 

going to bring up when you said pilot programs. You talked about 

your defining moment in your personal journey. 

Mr. JEFFERSON. Yes, sir. 

Senator ISAKSON. We are in a defining moment right now in 

terms of veterans’ employment. We are in a severe recession at a 

time where we have the largest number of veterans coming back 

of any time since Vietnam—— 

Mr. JEFFERSON. Yes, sir. 

Senator ISAKSON [continuing]. I would imagine, because of the 

size of the deployment we have now. So when you combine a significant recession with double-digit unemployment and a high 

number of veterans returning, that is a defining moment for you 

and the responsibility you are nominated to take. 

Mr. JEFFERSON. Yes, sir. 

49 

Senator ISAKSON. You mentioned pilot program. You know, when 

our pilots, helicopter pilots, munitions officers, and our nuclear 

plant officers come out of the military, there is no limit to the job 

opportunities they have because of the skills they have. 

Mr. JEFFERSON. Mm-hmm. 

Senator ISAKSON. We also have a number of people down the 

skill ladder that are trained for jobs that are out there, but I don’t 

think sometimes we have the pilot programs with the private sector and the DOD to foster them. For example—I think I am correct 

on this—Marriott has a deal with the Navy with regard to KP duty 

,the kitchen police, and the chefs for culinary arts, where Naval enlisted personnel who work in the mess hall leave there with the 

skills that Marriott looks for in their food service operations. 

So one of the things I would encourage you to do is find as many 

areas as you can where you can be a catalyst for pilot programs 

in the branches of the service for training for all skill levels, not 

just the high skill levels, but down the skill level chain so those 

partnership can be open opportunities when servicemembers leave 

the service. 

Mr. JEFFERSON. Yes, sir. 

Senator ISAKSON. If you do that, I think we will provide some 

jobs. I look forward to voting for your nomination and I endorse 

Senator Murray’s comments. The sooner, the better. 

Mr. JEFFERSON. All right. Thank you, Senator. I appreciate that. 

Chairman AKAKA. Thank you very much, Senator. 

Let me call on Senator Burris for any statement and questions 

you may have. 

STATEMENT OF HON. ROLAND W. BURRIS, 

U.S. SENATOR FROM ILLINOIS 

Senator BURRIS. Thank you, Mr. Chairman. I will be rather brief, 

but I want to welcome the distinguished appointee. 

Mr. JEFFERSON. Thank you, sir. 

Senator BURRIS. You live in Hawaii now, is that correct? 

Mr. JEFFERSON. Well, I am presently in Washington, but Hawaii 

is home, and I will be going back there for Christmas, sir. Yes, that 

is home. 

[Laughter.] 

Senator BURRIS. So you take off back there during the wintertime. 

Mr. JEFFERSON. Yes, sir. 

Senator BURRIS. And you have a home there, which means you 

leave us here to freeze, right? 

Mr. JEFFERSON. Yes, sir. 

[Laughter.] 

Senator BURRIS. Tell me this. If you are confirmed, in terms of 

employment, what Senator Isakson just made mention, that 

seemed to be a major concern of our veterans. I am getting all 

kinds of requests from veterans into my office about them coming 

back, some of them the jobs might not be there. The employer may 

have promoted other people ahead of them. So I just wonder 

whether or not we can really assess, and I don’t have any specifics, 

but we will certainly be in touch with you when you are conVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00053 Fmt 6633 Sfmt 6601 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
50 

firmed—not if you are confirmed—to really work with you in this 

regard. So is that something we have agreed to here, Mr. Jefferson? 

Mr. JEFFERSON. Absolutely, Senator. 

Senator BURRIS. OK, because I am concerned about these individuals coming back who served their country, now have to try to 

take care of their families when they cannot get gainful employment. Of course, the economy is bad, too, which adds to it. Employers have to replace them when they are gone away. But we cannot 

leave them out there to suffer. 

You are also involved with training. So will you be looking at 

putting programs together in community colleges especially across 

the States? Do you have any specific programs that you are aware 

of that are going on in Veterans Affairs now? 

Mr. JEFFERSON. Senator, first of all, thank you for your comments and thank you for outlining a variety of things that we want 

to address. I genuinely appreciate that. 

I think the first thing, sir, which you touched on is that when 

transitioning servicemembers or veterans come back, its information and access, making sure they are aware of the programs and 

resources available to them and they can access those programs, 

whether they are in the inner city, in a downtown area, or in rural 

areas. So information access. 

Second, when they go into those programs, making sure we provide them with the best possible training modalities so that they 

have success. Just as the Senator said earlier, whether they have 

a lot of education or they are leaving as a senior officer or maybe 

it is someone who has less time in service, we want to make sure 

that our programs provide effective solutions for people at all levels 

in their career and all backgrounds. 

And third, making sure that we measure and monitor those outcomes plus the feedback from veterans and the VSOs, including 

them as full partners. So, we have a cyclical process of getting feedback, adjusting and incorporating the processes so that it reflects 

best practices, and continuing to do it in that manner. 

Sir, I think those things and that approach will help us provide 

the best possible service and the best possible results for veterans. 

Senator BURRIS. Now, when were you nominated by the President for this position? How long ago? 

Mr. JEFFERSON. Sir, I believe the intent to nominate was April 

17, and that the actual nomination—— 

Senator BURRIS. April, and this is now July? 

Mr. JEFFERSON. Yes, sir. The actual nomination, sir, I believe 

was in early June. I might be mistaken on the dates. 

Senator BURRIS. Early June, because I am trying to look at 

this—Mr. Chairman, I am going to look at this timetable that we 

have between nominations and confirmations. I have interviewed a 

lot of individuals who were nominated early on, some of them left 

their jobs, and the nomination process is taking so long that some 

of those people are a little concerned. Some of them did leave their 

jobs, thank goodness, because of the length of the process. But I 

just always ask this question, what is the length of the process in 

terms of getting them nominated, getting them confirmed, and getting them on the job. So I hope that somewhere down the line, we 

can take a look at that. 

51 

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

Chairman AKAKA. I thank you very much for your questions and 

concerns, Senator Burris. 

Mr. JEFFERSON. Thank you, Senator. 

Chairman AKAKA. I want to thank you very much, Mr. Jefferson, 

for your testimony and your responsiveness to the Committee. I 

again want to say how much I and the Committee are looking forward to working with you in your new position as we address the 

employment and transition needs of our Nation’s veterans. 

Mr. JEFFERSON. Yes. 

Chairman AKAKA. I will be working with my colleagues from the 

HELP Committee as we proceed on your nomination, and I intend 

to do all that I can to bring it to the full Senate during this legislative period so that you can begin your important work as soon as 

possible. I urge you to respond as soon as you can to any 

posthearing questions. 

After a short break, we will convene a second hearing on the second nomination pending before us this morning. With that, this 

hearing is adjourned. 

[Off the record.] 

Chairman AKAKA. This hearing by the Senate Committee on Veterans’ Affairs will come to order. 

We are now moving to consider the President’s nomination of 

Joan Evans for the position of Assistant Secretary of Congressional 

and Legislative Affairs at VA. This position is an important one to 

this Committee because it is a key office for promoting transparency and collaboration between VA and Congress. 

If confirmed, Ms. Evans will be responsible for advising senior 

Department officials on developing and maintaining VA’s relationship with Members of Congress and Congressional committees. She 

will provide advice on Congressional interest in VA policy, program 

development, and implementation while overseeing the management of all Congressional hearings and ensuring that Congress receives pertinent and timely information about VA programs and 

policy issues. 

The Office of Congressional and Legislative Affairs provides support and assistance with respect to specific legislative activity. It 

monitors the status of pending legislation affecting VA, and it 

works closely with the Legislative Advisor in developing the Department’s annual legislative program. In short, the office Ms. 

Evans is nominated to head is VA’s front door for those of us in 

Congress. 

Our colleague, Senator Wyden, is joining us this morning, and he 

will formally introduce Ms. Evans to the Committee. Therefore, I 

will not go into detail about her background. I do note, however, 

that her long and substantial experience on the staff of Congresswoman Hooley should serve her well. If she should be confirmed, 

she will bring with her knowledge of and appreciation for the importance that this office has in our day-to-day operations with VA. 

I am hopeful that our Committee and then the full Senate will 

move quickly to consider Ms. Evans’ nomination for this important 

job. 

As Chairman of the Senate Committee on Veterans’ Affairs, I 

welcome you, Ms. Evans, and your family. 

52 

Ms. EVANS. Thank you. 

Chairman AKAKA. Before I ask for your introductions, let me call 

on Senator Burr for any opening statements and then Senator 

Murray. 

Senator BURR. Mr. Chairman, I sort of included both of my statements in the original statement. I welcome Joan Evans’ nomination. I welcome the opportunity for her to be here for her hearing. 

I question the wisdom of having Ron Wyden introduce her—— 

[Laughter.] 

Senator BURR [continuing]. But that comes from an equal 

amount of experience with him over the years—— 

Senator WYDEN. The story of my life. 

[Laughter.] 

Senator BURR [continuing]. But we won’t hold that against her 

as she goes through this nomination hearing. I thank the Chair. 

Chairman AKAKA. Thank you very much. 

Senator Murray? 

Senator MURRAY. Thank you very much, Mr. Chairman. Ms. 

Evans, welcome to this Committee. I want to congratulate you on 

your nomination and applaud you for your willingness to take on 

this challenging and rewarding job. I can guarantee that once you 

are there, you will be hearing a lot from me. I really want to make 

sure that our veterans get the best care possible, and I know we 

will count on you to help make sure that happens. 

I just want to say one thing. The VA is an organization of people 

and those in leadership will shape the culture of the organization. 

During Secretary Shinseki’s confirmation hearing, I spoke about 

the need to overhaul the bureaucratic culture at the VA, and since 

his confirmation, he has said on numerous occasions that one of his 

top priorities really is to transform the VA into a truly 21st Century organization. While I am sure that it goes without saying, I 

did want to stress with you today how important it is that the VA 

works with Congress as part of that cultural and organizational 

shift that we are seeing. 

You know, in the past, too often the VA was reactive, not 

proactive, when they informed Congress about the publicly potentially embarrassing internal issues. I don’t care if Republicans or 

Democrats are in charge, a tendency to downplay the problems at 

the VA was a serious disservice to all the veterans who count on 

this agency to do a good job. 

So I hope that, if confirmed, you are really willing to challenge 

that culture and change that dynamic so that the VA is open, 

proactive, and is out there in front making sure we, as Members 

of Congress, know what we need to know so that we can serve our 

veterans the best way possible. 

So I look forward to hearing your opening statement and seeing 

the questions and answers. I really appreciate your taking this on 

and your willingness to help the men and women who served our 

country. Thank you. 

[The prepared statement of Senator Murray follows:] 

PREPARED STATEMENT OF HON. PATTY MURRAY, U.S. SENATOR FROM WASHINGTON

Ms. Evans, during Secretary Shinseki’s confirmation hearing I spoke about the 

need to overhaul the bureaucratic culture at the VA. And Secretary Shinseki has 

53 

said on numerous occasions that one of his top priorities is to transform the VA into 

a truly 21st century organization. 

I want to stress to you how important it is that the VA works with Congress as 

part of this cultural and organizational shift. 

Too often the VA has been reactive, not proactive, when informing Congress and 

the public about potentially embarrassing internal issues. 

This tendency to downplay problems does the VA a serious disservice. And ultimately, the erosion of trust comes at the expense of our veterans. This is why I sincerely hope that, if confirmed, you will work to promote an open and proactive approach to relations with Congress. 

I think we can all agree that our veterans our best served when the VA and Congress work as partners to deliver the health care, benefits and service they have 

earned. 

Thank you for your willingness to take on this challenge and I look forward to 

your testimony. 

Chairman AKAKA. Thank you very much, Senator Murray. 

Senator Burris, any opening statement you may have? 

Senator BURRIS. I was listening to you, Mr. Chairman. I did 

interview Ms. Evans yesterday; we had a great conversation. I expressed to Joan that we are definitely concerned about the legislative package that will be coming out of this Congress to benefit our 

veterans. We are going to continue to seek to improve the family 

relationship with veterans, the housing relationship with veterans, 

the health care relationship with veterans. You coming from the 

Congress with knowledge of how we work will be very beneficial, 

I am pretty sure, in helping us to make sure that our veterans are 

taken care of. 

As I said to you, Joan, the only way we can do what we do in 

America is because these people have done what they have done for 

us, and we have to take care of them. We cannot have them struggling, unable to get health care, unable to find decent places to live, 

unable to get jobs. So if there is something we can do legislatively, 

I am hoping that you would lead that charge. I look forward to 

your testimony and your confirmation. 

Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Burris. 

Now I will recognize our colleague and friend from Oregon, Senator Wyden, who will introduce Ms. Evans to the Committee. 

STATEMENT OF HON. RON WYDEN, 

U.S. SENATOR FROM OREGON 

Senator WYDEN. Mr. Chairman, thank you very much. I think it 

would be cruel and unusual punishment to give you and four great 

advocates for veterans a big speech. If I could, I would just put my 

prepared remarks into the record and summarize my big concerns. 

Chairman AKAKA. Aloha and welcome to the Committee. 

Senator WYDEN. Thank you, Mr. Chairman, and thank you in 

particular and your colleagues for making this Committee the bully 

pulpit for America’s veterans, the place where veterans are going 

to be heard, where there is going to be a voice for their concerns. 

Veterans are always going to be at the table because of the leadership that you provide and that of your colleagues. For that, we are 

very grateful. In particular, you and I go back well over 20 years 

being friends. Just know how much I appreciate your service to 

America’s veterans. 

Formerly known as Joan Mooney, I think I would just like to 

start by saying that I think her story is a great American story. 

54 

It represents really the best of our country’s values, and I am just 

going to highlight a few points. 

She is the daughter of a Coast Guard veteran. She is the wife 

of an Oregon National Guardsman. So she understands the kind of 

challenges facing America’s families. She has been a wife, for example, facing her husband’s deployment, multiple deployments, 

and knows the feeling of a missing link in a home and family while 

a spouse is away, and I think that is a particularly important contribution. I have heard Senator Murray talk about this over the 

years, that so often, we forget about the families, and we don’t really remember what the families are wrestling with. From the standpoint of Joan’s service to the country, she is the embodiment of the 

military families that our country is striving to protect. 

For this position, the Assistant Secretary of Veterans Affairs for 

Congressional and Legislative Affairs, I think her background is a 

textbook for what we are looking for in this particular position. She 

began working in the House, where we first met, in 1987 in the office of Congressman Terry Bruce. You probably remember Terry. 

He served on the Commerce Committee with a number of us. She 

also served as Chief of Staff to Illinois Congressman John Cox. 

In addition to that, when she joined Congresswoman Hooley is 

staff, who has been an inspiration to many veterans, she became 

the go-to person in our Congressional delegation on veterans 

issues. In fact, between Ms. Evans and Congresswoman Hooley, all 

of us together in the Oregon Congressional delegation have tried to 

step in and pick up on their work because they did so much good 

work for so long. They have left us with big shoes to fill, and suffice 

it to say, an awful lot of veterans in our State are asking now who 

is going to step up and start doing the work again that Congresswoman Hooley, particularly with Joan Evans, was able to do. 

I can’t tell you, Mr. Chairman and colleagues, how many times 

Joan Mooney came to my house in Oregon at eight o’clock in the 

morning, with kids in the back, full of ice chests for sandwiches because we were going to go off to some small town in Oregon and 

try to advocate for veterans. That is what she did. That is what her 

approach to public service is all about, riding shotgun literally and 

figuratively for the causes that are important to veterans. 

Congresswoman Hooley was a serious consensus-building lawmaker who was interested in solving problems rather than engaging in partisan politics. Congresswoman Hooley has retired. She 

has gone home to our great Northwest, where Senator Murray 

knows all former elected officials return. But the same fierce advocacy for veterans remains here in Washington, DC, with Joan 

Evans. 

So it is a great honor, not just for myself, but for Oregon, to be 

able to recommend Joan Evans for this key position. She is going 

to serve our country and our veterans very, very well, and I thank 

you for the chance to be able to come and particularly have the 

honor to introduce the next great Assistant Secretary of Veterans 

Affairs, Joan Evans. 

[The prepared statement of Senator Wyden follows:] 

55 

PREPARED STATEMENT OF HONORABLE RON WYDEN, 

U.S. SENATOR FROM OREGON

Mr. Chairman and distinguished Members of the Committee: It is a great pleasure to appear before you today to introduce the President’s nominee for Assistant 

Secretary of Veterans Affairs for Congressional and Legislative Affairs, Joan Evans. 

Throughout her career, and in fact throughout her entire life, Ms. Evans has been 

a strong voice for the causes that matter most to our Nation’s veterans. 

As the daughter of a Coast Guard veteran and the wife of an Oregon National 

Guardsmen, Ms. Evans has a working knowledge of military and veterans affairs. 

She understands its strengths and its challenges, and knows how to move the Department forward in the 21st Century as our military tackles new challenges. She 

has been a daughter seeing her father struggle with non-Hodgkin’s lymphoma that 

was caused by his service. She has been a wife facing her husband’s deployment and 

knows the feeling of a missing link in your home and family while they’re away. 

Joan Evans is the embodiment of the military families that our country strives to 

protect. Her voice is their voice. And at this important juncture in history, at this 

important time, their voice must be heard. 

In addition to her ties to our men and women in uniform, Joan’s career in Congress makes her uniquely suited for the position to which she’s been nominated— 

as the Assistant Secretary of Veterans Affairs for Congressional and Legislative Affairs. Evans began working in the House in 1987 in the office of Congressman Terry 

Bruce of Illinois, rising quickly in the ranks to serve as his Washington Co-Director. 

She also served as Chief of Staff to Illinois Congressman John Cox. But my path 

crossed with Joan’s about 12 years ago when she became the Chief of Staff for a 

former colleague and great star among Oregon legislators—Darlene Hooley. 

While serving in the House of Representatives, Congresswoman Hooley became 

the first Oregon Democrat in history to serve on the House Veterans’ Affairs Committee and the top Democrat on the Oversight and Investigations Subcommittee. 

Hooley also served as a member of the House Budget Committee for four terms. In 

that position, she helped lead the fight for the funding our Nation’s veterans deserve. 

Everyone here knows how important a Chief of Staff is to a Congressional office. 

And with Joan riding shotgun, the office was well-renowned across the state for its 

prompt, courteous and effective constituent service. It was a reflection of Hooley’s 

reputation as a serious, consensus-building lawmaker who was more interested in 

solving problems than engaging in partisan politics. 

Although Congresswoman Hooley has retired and gone back to Oregon, that same 

fierce advocacy for veterans is still here in Washington with Joan. 

Again, it has been a pleasure to appear before you today and a great honor to 

introduce the next Assistant Secretary of Veterans’ Affairs—Joan Evans. 

Ms. EVANS. Thank you. 

Chairman AKAKA. Thank you very much, Senator Wyden, for 

your introduction. It was very personal and we are very grateful 

for that. I just want you to know we will move as quickly as we 

can on the nomination confirmation. Thank you. I know you are a 

busy man, so you are free to leave. 

Ms. Evans, before you begin your testimony, I know that you 

have some family and friends with you this morning and I would 

invite you to introduce them to the Committee. 

STATEMENT OF JOAN M. EVANS, NOMINATED TO BE THE ASSISTANT SECRETARY OF CONGRESSIONAL AND LEGISLATIVE AFFAIRS, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Ms. EVANS. Thank you, sir. I have my husband here, Major Paul 

Evans of the Oregon Air National Guard; my daughter, Katherine 

Mooney; and I have a number of friends that are colleagues from 

the House and Senate: Priscilla Ross, Pam Pryor, Susan Butler, 

Will Stone, Rochelle Darnet, who is here, Perry Finney Brody, Noel 

Brazil, Christina Metzler, and Faye Frankfurt. 

I particularly want to say thank you to our team at VA for coming today: Deputy Secretary, Scott Gould; Deputy Assistant SecVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00059 Fmt 6633 Sfmt 6601 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
56 

retary, Julie Anderson; OCLA staff, Acting Assistant Secretary, 

Danny Devine, and Mary Kay Stack; and Office of the Secretary’s 

staff Peter Levin, Covey Langley, Hally Schneier, and Bill Hiers. 

I would also like to extend a thank you to the Governor of Oregon’s staff, Dan DiSimone, who is also here. Thank you. 

Chairman AKAKA. Thank you very much. 

As you know, we do administer an oath. May I ask you to please 

rise to take the oath. Raise your right hand. Do you swear or affirm that the testimony you will give at this hearing and any written answers or statements you provide in connection with this 

hearing will be the truth, the whole truth, and nothing but the 

truth, so help you God? 

Ms. EVANS. I do. 

Chairman AKAKA. Thank you. Let it be noted that the witness 

responded in the affirmative. 

Ms. Evans, will you begin with your testimony. 

Ms. EVANS. Thank you. Chairman Akaka, Ranking Member 

Burr, and distinguished Members on the Committee on Veterans’ 

Affairs, thank you for the opportunity to testify before you today 

and for your consideration of my nomination to serve as VA’s Assistant Secretary for Congressional and Legislative Affairs. 

I would also like to express my family’s gratitude to our Senator, 

Ron Wyden, for his gracious introduction and for the care and concern he extended to my family during Paul’s overseas deployments. 

Oregon veterans and their families have an outstanding advocate 

in Senator Wyden, who has ably stepped in to Congresswoman 

Hooley’s shoes to fill that void. 

I am deeply humbled by President Barack Obama’s nomination 

and the confidence both he and Secretary Shinseki have shown in 

me. If confirmed, it will be my honor to serve this Committee and 

the Congress as your chief resource in accessing information from 

the second-largest Federal agency. 

During the last few weeks, I have been privileged to meet personally with many of you and your staff, receiving invaluable guidance and beginning what I trust will be an ongoing dialog, if confirmed. I have worked on Capitol Hill for nearly two decades, from 

leading the Washington office for Illinois Congressman Terry Bruce 

through serving as Chief of Staff to Oregon Congresswoman Darlene Hooley, the first Oregon Democrat on the House Veterans’ Affairs Committee and Ranking Member of its Oversight and Investigations Panel. 

While working for Congresswoman Hooley, I met and married 

my husband, Paul Evans, who is here today with my daughter, 

Kate. Since 9/11, Paul was mobilized for 24 months in Operation 

Noble Eagle and has served in three combat missions in Iraq and 

Afghanistan with the Oregon Air National Guard. He chairs Governor Kulongoski’s Veterans Services Task Force and is the Governor’s Chief Policy Advisor for Emergency Management, Military, 

and Veterans. He remains Director of Operations at the 116th Air 

Control Squadron at Camp Rilea on the beautiful Oregon coast. 

My marriage to Paul has given me a keen appreciation for the 

sacrifices of American veterans. I was also made mindful of the 

challenges families face as a part-time caregiver for my father, an 

atomic veteran with a service-connected cancer, and for my mother, 

57 

who predeceased him, putting his health care needs above her own. 

My grandfather, a World War II veteran, found care and compassion in a VA hospital at the end of his life. 

Through these experiences, I am firmly committed to President 

Obama and Secretary Shinseki’s vision for transforming VA into a 

21st century organization that is veteran-centric, results driven, 

and forward looking. If confirmed as Secretary Shinseki’s principal 

Congressional advisor, I will work to ensure the office is a highly 

effective partner to Congress in meeting the needs of the Nation’s 

veterans. 

I understand your need for quick and complete information about 

issues and events. I also understand the frustrations of veterans 

and their families seeking services and benefits from offices that 

are overly bureaucratic and seem to take forever to process simple 

requests. 

By improving outreach to Members of Congress, their staffs, and 

Committees, OCLA can help VA leaders better understand and engage with Congress in policy matters. Our work should be based 

on a commitment to appropriate and timely responses. We should 

also shine a light on potential or upcoming issues. 

I appreciate the work of the Chairman, Ranking Member, and 

Committee Members, and I greatly value your leadership in honoring the service and sacrifice of our Nation’s veterans. If confirmed, my mission will be to ensure that Secretary Shinseki, as 

well as Congress and its authorizing and appropriating Committees, have everything they need to perform their respective roles efficiently and effectively, fulfilling the sacred trust with our Nation’s 

heroes. 

Thank you for your consideration, and I am pleased to answer 

any questions. 

[The prepared statement of Ms. Evans follows:] 

PREPARED STATEMENT OF JOAN M. EVANS, NOMINEE FOR ASSISTANT SECRETARY FOR

CONGRESSIONAL AND LEGISLATIVE AFFAIRS AT THE U.S. DEPARTMENT OF VETERANS AFFAIRS

Chairman Akaka, Ranking Member Burr, and Distinguished Members of the 

Committee on Veterans’ Affairs, thank you for the opportunity to testify before you 

today and for your consideration of my nomination to serve as the Department of 

Veterans Affairs’ Assistant Secretary for Congressional and Legislative Affairs. I am 

deeply humbled by President Barack Obama’s nomination and the confidence both 

he and Secretary Shinseki have shown in me. 

If confirmed, it will also be my honor to serve this Committee and the Congress 

as their chief resource in accessing information from the second largest agency in 

the Federal Government, the Department of Veterans Affairs. 

I have worked on Capitol Hill for nearly two decades, heading up the Washington 

office for Congressman Terry Bruce of Illinois, as chief of staff to Congressman John 

Cox of Illinois then Congresswoman Darlene Hooley, the first Oregon Democrat to 

serve on the House Veterans’ Affairs Committee. 

While working for Congresswoman Hooley, I met and married my husband, Paul 

Evans, who is here with my daughter Kate. Paul has served three tours of duty in 

Iraq and Afghanistan with the Oregon Air National Guard and was mobilized for 

24 months in Operation Noble Eagle. He chairs the Oregon Governor’s Veterans 

Services Task Force and is the Governor’s chief policy advisor on Veterans, Military 

and Emergency Management. He remains Director of Operations for the 116th Air 

Control Squadron at Camp Rilea in Warrenton, Oregon. 

My marriage to Paul has given me a keen appreciation for the sacrifices of America’s Veterans. I am also aware of the challenges families face as a part-time caregiver for my father, an atomic Veteran with a service-connected cancer, and subseVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00061 Fmt 6633 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
58 

quently my mother, who predeceased him putting his health care needs above her 

own. 

I am firmly committed to President Obama’s and Secretary Shinseki’s vision for 

transforming VA into a 21st Century organization that is Veteran-centric, resultsdriven, and forward-looking. 

If confirmed as Secretary Shinseki’s principal Congressional advisor, I will work 

to make the Office of Congressional and Legislative Affairs a highly effective partner to Congress in meeting the needs of the Nation’s Veterans. 

I understand your need for quick and complete information about issues and 

events affecting constituents. I understand the uncertainty of waiting late in the 

evening to receive needed information for the next day’s hearing or mark-up. I also 

understand the frustrations of Veterans and their families seeking services and benefits from offices that are overly bureaucratic and seem to take forever to process 

simple requests. 

By improving outreach to Members of Congress, their staff and Committees, the 

Assistant Secretary and OCLA can help VA leaders better understand and engage 

with Congress on policy matters. Our work should be based on a commitment to 

prompt and appropriate responses to Congressional requests for information and assistance. We should also shine a light on potential or upcoming issues. If confirmed, 

my mission will be to ensure Secretary Shinseki and VA leadership as well as members of the Senate and House of Representatives and the authorizing and appropriating Committees have all that they need to perform their respective roles efficiently and effectively. 

I appreciate the work of the Chairman, Ranking Member, and Committee members, and I greatly value your leadership in honoring the service and sacrifice of our 

Nation’s Veterans. I look forward to working with you, if confirmed, to make VA’s 

Office of Congressional and Legislative Affairs a more effective partner in meeting 

the needs of this Committee and the Congress, and of the Veterans we serve. 

Thank you. 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

JOAN M. EVANS TO BE ASSISTANT SECRETARY FOR OFFICE OF CONGRESSIONAL AND

LEGISLATIVE AFFAIRS, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. Have you and Secretary Shinseki discussed the duties and the role 

you would assume as Assistant Secretary for Congressional and Legislative Affairs 

if you are confirmed? If so, what specific areas of the job were discussed? 

Response. Yes, we have discussed the overall role of the Assistant Secretary as 

the Secretary’s chief advisor on Congressional and legislative matters, and ensuring 

all VA leaders are apprised of Congressional activities. The Secretary has conveyed 

to me his priority of responding to all Congressional inquiries in a complete and expeditious manner; anticipating and informing Members of Congress and Congressional staff of emerging issues; expanding outreach to all members of the Senate 

and House of Representatives and their DC and State staff; and directing VA Congressional Relations staff in a manner that will improve client satisfaction and employee fulfillment. 

Question 2. It is my understanding that you have been working directly in Secretary Shinseki’s office for the past several months on matters related to Congressional Affairs. If confirmed, do you expect that someone will be hired to perform the 

duties that you perform there or do you anticipate that all Congressional focus will 

be in through OCLA? 

Response. I do not know whether there will be another senior advisor hired in 

my place. It is the Secretary’s prerogative to have staff throughout his office coordinating on whatever issues and programs he deems appropriate. Staff throughout the 

Department work on scheduling, response to requests for information, and other 

issues that may be related to Congress. However, I have been informed that, if confirmed, I will be the primary advisor on all Congressional matters. Additionally, my 

personal goal would be to work as a team with all VA professionals who engage in 

any form of Congressional Relations wherever they may be within VA from the 

Office of the Secretary to the regional and facility level. 

Question 3. Do you anticipate having a policymaking role if you are confirmed? 

Response. The primary responsibilities involve understanding and anticipating 

the needs and interests of Members of Congress and advising the Secretary of Congressional implications of all policy decisions. If confirmed, I will work closely with 

Administration and VA staff offices to inform them of pending and newly enacted 

legislation which would require the development of policy. I will also work with ConVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00062 Fmt 6633 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
59 

gress in providing input of subject matter experts as Congress develops legislation 

that may affect VA policy. Additionally, as Assistant Secretary, I would be actively 

engaged in the VA governance process and would provide insights into the policy 

decisions of the department. 

Question 4. Have you formulated any thoughts on what your job responsibilities 

will be and how you will approach those responsibilities if confirmed? 

Response. If confirmed, my responsibilities would include advising the Secretary 

and VA leadership on Congressional and legislative matters; informing and engaging Members of Congress, Congressional Committees and staff on VA issues; leading 

and directing a team of professionals in advising and providing assessments on effects of proposed legislation and program changes; raising awareness of new trends 

in use of VA services and emerging needs of Veterans; responding promptly to Congressional requests for information and assistance; and shining a light on potential 

problems. If confirmed, I will approach all of my responsibilities in a manner that 

is Veteran-centric, forward looking and results driven. 

Question 5. If confirmed, what would you most like to accomplish in your new 

position? What would you hope your legacy to the Department would be? 

Response. If confirmed, I would work to make the Office of Congressional and 

Legislative Affairs a highly effective partner to Congress in meeting the needs of 

the Nation’s Veterans. I want to encourage a team that is aware of and understands 

Congressional policy interests, as well as the value and importance of bringing those 

interests to the attention of VA leaders for engagement. I am committed to improving outreach to members and staff; expanding the knowledge base of the Congressional Relations team and investing in the development of team members; effectively distributing staffing resources to achieve objectives; and updating technologies 

and data management processes to meet the needs of a large team with a critical 

mission in a dynamic work environment. 

Question 6. How would you describe your management style and how it is suited 

to this particular position? 

Response. My management style emphasizes collaboration whenever possible. 

Serving members in Congress for over 17 years has taught me how to meld the objectives of leadership with proactive strategies developed and executed with peers 

and staff. I believe each situation is different and the various skills and talents of 

the team must be utilized for the benefit of the mission. Much of the work in OCLA, 

as in Congressional offices themselves, is reactive to current events. Remaining forward-looking is just as important. Proactivity often prevents reactivity. In setting 

the long-term vision and annual and biennial benchmarks, staff skills can be best 

resourced and expectations are clear. 

Question 7. If confirmed, do you have any plans to bring any other political appointees with you to your new position? If so, please share details on what positions 

these other appointees would fill. 

Response. It is my understanding that there will be additional political positions 

in OCLA. I will work the Secretary and VA senior management team along with 

the White House to determine the appropriate positions and the hiring process, 

should I be confirmed. 

Question 8. What in your experience do you believe contributes to your qualifications for this new position? 

Response. After 17 years of working in Congress, I believe that I have a solid understanding of the needs of Members of Congress as they work to best represent 

their constituents. It is my view that few know the needs of local Veterans better 

than the Members of Congress who serve them. 

I have worked for a member who served on the House Budget Committee for 8 

years and led the fight for sufficient resources to meet the needs of our Veterans. 

Congresswoman Hooley was also the first Democrat from Oregon to serve on the 

House Committee on Veterans’ Affairs and the top Democrat on the Oversight and 

Investigations Subcommittee. As a result, I am familiar with the honor and privilege of working on behalf of veterans for someone who held a position of great 

influence. 

My most meaningful experiences come as the wife of a soldier who has seen first 

hand the impacts of recent conflicts and as the daughter of a 67 year old Veteran 

who died of a service-connected cancer. His primary caregiver—my 66 year old 

mother—predeceased him in part because she was so busy taking care of his health 

that she neglected her own. 

Question 9. I am aware that your husband is a member of the National Guard 

and has now been deployed. How have his experiences—and yours as the spouse of 

60 

a deployed servicemember—influenced your sense of VA’s mission and how well VA 

now is meeting the needs of deployed and returning servicemembers? 

Response. Since meeting and marrying my husband, I can say that I better understand the demands on servicemembers and their families in the deployment cycle 

and after they return. I can’t say I know it all; even for my own family, each deployment was different, and each return resulted in a marked and lasting change in all 

of us. 

Paul has served in the Armed Forces since 1992, first in the Air Force and now 

in the Oregon Air National Guard. Since we married, Paul was deployed to Iraq for 

a second time in 2005 and then to Afghanistan from 2006–7. My husband sought 

VA health care after his return from Iraq in 2003 and had to wait weeks for a response that ultimately soured him on seeking mental health care there. 

As Chair of the Oregon Governor’s Veterans Services Task Force, Paul has testified before the Oregon legislature several times about the need to be pro-active in 

establishing an effective reintegration model for our National Guard and Reserves. 

What I’ve learned is that everyone reacts differently to different treatments, and everyone’s needs are not the same. For VA staff, often you have only one chance to 

make a good impression. 

I’ve had a Tip O’Neill quote posted on my desk since working for my first boss 

on the Hill that expressed his views on constituent service. He said that for the person who comes to you for help, what they are asking of you may be the most important thing in the world to them. If they could do it themselves, they wouldn’t be 

asking for your assistance. Their request should matter to you in the same way it 

does to them, and everyone should be treated equally and respectfully no matter 

who they are. 

Through our marriage, we now share friends and family who have served in various capacities: my father in the Marshall Islands near the nuclear tests in the late 

1950s; my cousins John in Vietnam and Robert in the Vietnam-era; my Uncle Stan 

in World War II; my Grandfather in World War II and Korea. Paul’s family and 

friends range from a World War II underage veteran who played a part in Day 

Three of Overlord to his Uncle Bill, a Marine veteran of the Battle of Chosin, to 

his active duty and Guard buddies who were with him in South and Central America, the Balkans, Operation Southern Watch and Operation Noble Eagle, and multiple OEF/OIF deployments. Hearing their stories has helped me to better understand the heroes among us. I want to ensure that each Veteran is given the benefits 

they have earned from a team that is Veteran-centric, forward looking, and results 

driven. 

Question 10. What skills do you bring with you to this new position that will help 

you contribute to meeting the needs of veterans? 

Response. I believe that I bring an understanding of how Congress works, responding effectively to the needs of those we serve, and strategic planning skills to 

help build VA’s OCLA into a more effective partner with Congress in meeting the 

needs of the growing number of Veterans. I also believe I bring my own experience 

of what challenges the families of veterans, both as a spouse and as a part-time 

caregiver for my father. 

Question 11. Are there any specific problems or challenges that you have already 

identified that you would like to tackle in this new position? 

Response. I understand there are challenges in responding to Congress quickly because of the stove-piped nature of VA with its three administrations and multiple 

staff offices. There have also been challenges with decentralization, with important 

policymaking decisions taking place at the local level sometimes without input from 

VA leadership. Congressional inquiries can result in information coming before VA 

leadership for the first time. As information comes up through the bureaucracy of 

the three administrations, there is a filtering process that may make VA’s ultimate 

response to an inquiry less clear. If confirmed, I hope to address these issues. 

Question 12. In your experience as Chief of Staff for a member of the House of 

Representatives, did you have any interaction with VA’s OCLA and how would you 

characterize that experience? What did you believe could have been done differently 

or better? 

Response. I do not specifically recall having interaction with OCLA. I do remember working with VA to set up a meeting between Congresswoman Hooley and thenSecretary Tony Principi. Our House Veterans’ Affairs legislative assistant, who ultimately moved to Oregon to serve as a VA caseworker, has told me that she occasionally called on VA’s OCLA for assistance and was satisfied with the responses. 

Question 13. Please provide an organizational structure and roles and responsibilities for the staff currently employed by the Office of Congressional and Legislative 

61 

Affairs and any modifications you might have under consideration for the office in 

the future—including any needs for expansion? 

Response. The present organizational chart is attached. 

Through the process of Transformation, a group of staff within OCLA was selected 

and charged by the Office of the Secretary with making recommendations on the 

mission and function of a 21st Century OCLA. Led by Judith Sterne, OCLA’s Task 

Force consisted of Pam Balsley (Veteran), Gloria Galloway, Omar Hughes (Veteran), 

Charlie Likel (Veteran), Lesia Mandzia, Stephen McGinley (Veteran), Mary Kay 

Stack, and Stacy Vasquez (Veteran). The group provided a mix of grades, experience, military service, gender, and diversity. 

I understand this group has produced a draft plan that is currently under reviewed within VA. If confirmed, I look forward to reviewing the final proposal and 


722OCLAchart.eps
62 

sharing this with you for your feedback since OCLA’s goal should be ensuring that 

its main client is satisfied with its experience. I intend to work with OCLA staff 

and within the VA governance process to use these recommendations as a framework, adding any new input based on my experience serving in personal offices for 

17 years and feedback from those who OCLA serves. 

Question 14. How do you see the relationship between OCLA and subject matter 

experts within VA and do you believe that there are circumstances when OCLA 

would not be involved in responding to questions from Congress? 

Response. OCLA staff should have a broad knowledge of VA policies, programs 

and personnel and strong relationships with subject matter experts as well as Hill 

staff. From that vantage point, they should be better able to assist Congressional 

staff with contacts and information they may not be aware of should they contact 

a sole VA expert outside of OCLA. Contact with OCLA should be value-added; we 

should work together to make improvements and develop or add skill sets that better meet the needs of those we serve: the Members of Congress and their staff. 

Question 15. What goals do you have for timely responses to Congress for requests 

for whitepapers, information or other background materials for emerging matters? 

Response. The Secretary has set a two-week turnaround for routine correspondence, understanding that some may require immediate action—even within the 

same day. I would follow in his example by setting the bar at that level. If confirmed, once in the office I would be in a position to better assess how quickly the 

requests can be fully completed and how to appropriately resource the office to better fulfill members’ needs. 

Question 16. What relationship will you establish with the Assistant Secretary for 

Public and Intergovernmental Affairs and how do you anticipate coordinating with 

that office? 

Response. Assistant Secretary Duckworth and I have spoken often about the need 

to maintain a close working relationship, if I am confirmed, as so much of what each 

office does is dependent upon the other. Our goal is to communicate frequently, 

sharing information on hot issues and meeting regularly to plan strategic communications with the Hill. We share the objective that VA informs Veterans, Members 

of Congress, the press and intergovernmental stakeholder with the timeliest, most 

complete, accurate and up-to-date information. Assistant Secretary Duckworth has 

been a friend and tremendous resource to me at the Department, and I look forward 

to our relationship growing stronger if confirmed. 

Question 17. What do you intend to do to ensure that Members of Congress are 

advised in advance of problems, issues and emerging matters—particularly when 

those matters are specific to the area a member represents? 

Response. It is imperative that the Congressional Committees and Members of 

Congress whose Veteran constituents may be impacted are informed immediately of 

any emerging issues. That is the Secretary’s goal. The decentralization of the VA 

can make timely notification challenging. As VA moves from a stove-piped organization to ‘‘One VA,’’ we can better inform members and Committee staff of any potential issues. 

Question 18. What will OCLA’s role be in the preparation of testimony for Congressional hearings? 

Response. It is my understanding that OCLA staff’s responsibility is to offer recommendations to Committee staff for relevant witnesses or surrogates, prepare witnesses for accurate and effective testimony, ensure that testimony is delivered in advance in a timely fashion, and ensure that any follow up questions are answered 

on-time to the satisfaction of Members of the Committee. 

Question 19. Will OCLA have any role in clearing legislation that VA submits to 

Congress? 

Response. My understanding is the OCLA professional staff works the internal 

VA process to develop annual and ad hoc legislative proposals for VA to present to 

Congress. It is my hope that OCLA would also work to better identify and inform 

the Secretary of trends coming from the Hill and Veterans, allowing VA to become 

more forward-thinking and proactive in its ability to set policy. 

Question 20. Do you see any value in informal contact between OCLA and the 

staff of the appropriate authorizing and appropriating committees of Congress? 

Response. Informal communications with both the authorizing and appropriating 

Committees are essential to maintaining effective dialog between the leadership and 

staffs of the legislative and executive branches of government. I look forward to engaging with members as well as Committee and personal office staffs, and would 

encourage OCLA team members to do the same. 

63 

Question 21. Currently VHA and VBA have their own Congressional and Legislative Affairs offices. Have you reviewed how these two offices might relate to the 

structure of the Office of Congressional and Legislative Affairs? 

Response. I have not yet had the opportunity to work extensively or develop a dialog with all members of these offices. I have heard from press accounts that the 

Chairman believes that a more centralized VA structure would be most beneficial 

to Veterans. If confirmed, I would look forward to reviewing the proposed plans and 

working with Department staff through the governance structure to achieve an 

OCLA model that makes the most sense and most effectively serves Members of 

Congress and their Veteran constituents. 

Question 22. Is there a move to consolidate the three offices and if so, can you 

provide us with an organizational chart for what this consolidated office might look 

like? 

Response. Through the process of Transformation, a group of staff within OCLA 

as well as other offices have been charged by the Secretary with making recommendations for a 21st Century VA. If confirmed, I intend to work within the process 

and use Transformation Task Force’s recommendations as a framework, adding any 

new input based on my experience serving in a personal office for 17 years and on 

the input of those we are privileged to serve. 

Question 23. Have you evaluated the role and work of the Congressional Liaison 

offices located on Capitol Hill and how that fits into the work of the Office of Congressional and Legislative Affairs? 

Response. When they were initially established, the Liaison Offices were intended 

to be a convenient hub for personal interactions between VA professionals and Member of Congress and their staff. Through increased telephone and email communication, my understanding is that the Rayburn and Russell offices have evolved into 

triage centers to route requests and inquiries to the appropriate VA staff. I believe 

VA Senior Leadership and most members of OCLA see benefits in updating the 

focus and expanding the staff to a more proactive outreach to member offices. In 

remaining forward looking, it becomes easier to anticipate appropriate changes in 

order to meet the needs of our Nation’s Veterans. 

Question 24. How do you intend to identify and evaluate any trends in the concerns raised by Members of Congress and how will you present the issues raised 

for VA Senior Management so they might be addressed? 

Response. More frequent and free flowing communication within OCLA and with 

VA senior leaders will help elevate issues raised by Members of Congress within the 

Department. Second, an effective system should be developed so that good ideas flow 

to the top for decisionmaking, and are tracked until they are implemented or rejected. 

Question 25. In the past, this Committee has had a difficult time receiving timely 

submissions of testimony and timely responses to posthearing questions. Please 

comment on ways you will work to improve the timeliness of responses to this Committee. 

Response. Much of running a timely, effective and relevant OCLA will involve 

strengthening project management skills of the whole team. It is my understanding 

that with greater focus, attention and clear goals in recent years, OCLA has vastly 

improved the timeliness and relevance of responses to post hearing questions as 

well as congressionally mandated reports. I believe if timeliness is the priority of 

senior leadership in OCLA and the Department, it is an achievable goal. OCLA can 

also work with OMB to ensure that they have sufficient time to review items to 

meet all deadlines. 

Question 26. Committee staff occasionally travels under the auspices of VA and 

has reported numerous problems using FED TRAVELER—the required travel system used by VA and other Federal agencies. Specifically, Committee staff members 

have found flights that cost hundreds of dollars less than what was found in FED 

TRAVELER and have found errors in processing their expenses that would have 

cost the government additional money using FED TRAVELER. Will you pledge to 

evaluate VA’s experience with FED TRAVELER and report back on whether or not 

travel expenses have gone up since it became the sole source of travel reservations 

and reimbursements? 

Response. Concern has been expressed about the requirement of Congressional 

staff to use the Government travel contract program, Fed Traveler, when they travel 

on official government business. As noted, the argument, in part, is that less expensive commercial flights are available. Similar concerns were raised when Congressional staff was required to use the Zegato travel contract to arrange for official government travel. 

64 

In response to these concerns, in September 2009, the Department issued OF Bulletin 09047E3.08, ‘‘Use of Non-Contract Airfares,’’ a copy of which is enclosed. The 

Bulletin outlines the benefits of using contact city-pair fairs to include: (1) no advance ticket purchase is required; (2) tickets are fully refundable; (3) last seat availability; and (4) stable prices to enable travel budgeting. Despite these benefits, it 

has become apparent that the use of non-contract airfares can further reduce VA’s 

travel expenses when such fares are prudently obtained. 

To minimize costs of official travel, VA employees and Congressional staff flying 

at VA’s expense are now authorized to use non-contract airfares when it can be determined before the start of a trip that this type of service is practicable and economical to the Government. Specifically, under the authority of 41 Code of Federal 

Regulations 301–10.107, VA employees and those traveling on behalf of VA may be 

granted an exception to use a contract city-pair fare when a non-contract carrier offers a lower fare to the general public that, if used, will result in a lower total trip 

cost to the Government. Use of these non-contract fares, however, must be approved 

on an individual case-by-case basis by the employee’s Under Secretary or by the VA 

Assistant Secretary for Management. 

Question 27. Please explain in detail what you understand the function of the 

House and Senate Committees on Veterans Affairs to be and how you believe your 

office should relate, respond and interact with Congressional staff. 

Response. SVAC and HVAC are the primary authorizing committees in Congress 

on legislation affecting Veterans. Committee members work to develop areas of expertise that meet the needs of their constituents and enable them to make significant contributions to public policy debates affecting Veterans. Chairs and Ranking 

Members work to set the agendas for their respective majority and minority members. 

OCLA staff should excel in regular outreach to all Committee staff, member staff 

in DC as well as in State/District offices. If confirmed, I will work to empower OCLA 

staff so that they have the structure and resources to provide reliably consistent, 

timely and full responses to Congressional inquiries. I will support and join them 

in ensuring Members of Congress and Congressional staff are promptly notified of 

any potential problems as they arise. OCLA staff will develop strategic communications plans in concert with OPIA and OSVA to better inform members and Congressional staff about VA decisions that will affect Veterans nationally or locally. 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO JOAN

M. EVANS TO BE ASSISTANT SECRETARY FOR CONGRESSIONAL AND LEGISLATIVE AFFAIRS, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. According to the Department of Veterans Affairs (VA) Web site, the 

Office of Congressional and Legislative Affairs (OCLA) ‘‘is the focal point for Department management and coordination of all matters involving the Congress.’’ 

A. What do you see as the key functions performed by OCLA? 

Response. OCLA’s key functions are providing the Secretary and VA leadership 

with advice on Congressional and legislative matters; informing and engaging Members of Congress, Congressional Committees and staff on VA issues; providing assessments on the effects of proposed legislation and program changes; raising 

awareness of new trends in use of VA services and emerging needs of Veterans; and 

shining a light on potential problems. 

B. What do you see as the key responsibilities of the Assistant Secretary for Congressional and Legislative Affairs in carrying out those functions? 

Response. My key responsibilities would be leading a strong team of Congressional Relations professionals and serving as the principal VA Congressional Affairs 

advisor to the Secretary, VA leadership, Members of Congress, Committees, and 

staff. 

C. How has your background prepared you to take on these responsibilities? 

Response. As a long-time House Chief of Staff, I have set up new offices and reorganized existing ones to best meet the needs of constituents. I have also managed 

and directed a team of professionals who helped develop and implement strategic 

plans to meet the goals of the principal and those he/she served. 

D. How would you measure your success in fulfilling those responsibilities? Would 

it depend in part on whether you are able to establish and maintain good working 

relations with Members of Congress and their staffs? 

Response. Success would be effectively resourcing the office and moving from reactivity to proactivity within OCLA; developing and maintaining good working relaVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00068 Fmt 6633 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
65 

tionships with members and their staffs; and responding to members and staff requests in a timely and complete manner. 

Question 2. In the book The People Factor, the Deputy Secretary of Veterans Affairs, W. Scott Gould, and his co-author discussed the need to overhaul the Federal 

personnel system. As part of that effort, they stressed that ‘‘perhaps the single most 

important change that Congress could make would be to emphasize people management skills during the confirmation process for political appointees.’’ 

A. Would you please provide specific examples from prior jobs demonstrating your 

people management skills? 

Response. In dividing up office goals and responsibilities, as Chief of Staff I 

played to each person’s strengths. If someone was gifted at meeting people and socializing legislation, they were assigned those duties. Detail-oriented staff were 

heavily relied upon for scheduling, correspondence and budgeting. Good writers handled our communications; analytic thinkers crafted our legislative proposals. Everyone has a role to play and needs different levels of management. I believe in situational leadership. Each employee is unique and the various skills and talents of the 

team must be best utilized for the benefit of the mission. 

I conducted weekly after action reviews meetings with staff, and brought their efforts before the Congresswoman so she could relay her praise and appreciation. In 

Congresswoman Hooley’s office, I convened annual planning sessions to work as a 

team on legislative, communications, outreach and constituent service agendas for 

the year. In doing so, staff was able to be more proactive than many of their counterparts and was better prepared when unforeseen events arose. As staff excelled, 

they were recognized through increased levels of responsibility, pay and bonuses. If 

a staff opening occurred, new hires were rare and high performers were rewarded 

with promotions. At the American Academy of Ophthalmology I worked with hundreds of physicians as they learned to become advocates for their patients and profession. I coached and mentored them with encouragement when they had a good 

meeting or a positive outcome, and kept their spirits up when things did not go so 

well. 

B. How would you rate your people management skills and how do you think your 

prior subordinates would rate your skills? 

Response. I encourage staff to perform at the highest level, and stay mission focused and results driven providing feedback along the way. Together, we were successful in building a constituent service operation that was unparalleled in the state 

because our staff resources were well managed and consistently challenged. Many 

Congressional staff are new to a professional setting and are learning, and the feedback I have received is that I have high expectations and get excellent results in 

return. Those who have worked with me on a team would say that they have grown 

as professionals under my leadership. 

Question 3. Secretary Shinseki has pledged to have Congressional inquiries answered within a two-week time period; however, some inquiries from my staff have 

been outstanding for several months and many inquiries have not been answered 

within the two-week time period. 

A. Do you believe it is acceptable for these requests for information to remain 

pending for so long? 

Response. In general, I do not believe requests for information should remain 

pending for the time period you have described. However, I am not familiar with 

these particular requests and why the information has taken longer to produce. I 

can say that the Secretary has set a goal of responding to member requests within 

two weeks, and the Executive Secretary states that nearly all requests have been 

answered in that timeframe. My goal is to institute this within the informal request 

process in OCLA; and if requests cannot be handled in that time than regular calls 

to update the request are made until the matter is resolved. 

B. As a former Congressional staff member, what would you view as a reasonable 

time-line for responding to requests for briefings, statistics, and other information? 

Response. Depending on the urgency of the request, standard response goals 

should range from same day to two weeks. Extenuating circumstances such as complexity of request or a decisionmaking process may require more time and a flexible 

deadline. Notice should be given to the member or staff if responses run into unforeseen delays. 

C. In your view, what factors lead to delays in responding to those requests? For 

example, do you believe there is a need to change the culture at VA? 

Response. Having worked in the office of the Secretary, I have learned that some 

requests are more complex or challenging than others to answer. There is also the 

culture of a large, slowmoving institution with which to contend. 

66 

D. Are you aware of any requests for information from my staff that currently are 

pending with OCLA? If so, when do you believe my office should expect to receive 

the requested information? 

Response. I have noted this request to the Chief of Staff for review. If confirmed, 

I pledge to look into this process to ensure that information goes out as expeditiously as possible. If information is delayed, I will let you know why and when it 

may be expected. 

Question 4. According to the Questionnaire for Presidential Nominees that you 

submitted to the Senate Committee on Veterans’ Affairs (Committee), your previous 

work experience includes more than 6 years with the American Academy of Ophthalmology in Washington, D.C. 

A. What were your responsibilities during that time? Were you a lobbyist? 

Response. From 1991–1997 at the American Academy of Ophthalmology, I worked 

on policies related to Veterans and military health care and research, residency 

training, and health care reform. I also directed a grassroots advocacy program for 

physicians to advocate on behalf of their patients for access to specialty care and 

managed their political action committee in concert with their physician Board 

members in compliance with Federal election law. I was not a registered lobbyist. 

B. Are there any conflicts of interest that you believe could arise with regard to 

your prior work for the American Academy of Ophthalmology? 

Response. No. 

Question 5. In a directive to all of the heads of the Executive Departments and 

Agencies, President Obama said that his administration is ‘‘committed to creating 

an unprecedented level of openness in Government’’ and that his administration will 

‘‘disclose information rapidly.’’ That directive also stressed that ‘‘[t]ransparency promotes accountability.’’ 

A. Do you share the President’s vision that government should be open, transparent, and accountable? If so, what steps would you take to advance the President’s vision, if confirmed? 

Response. Yes, my goal is to share accurate and complete information with Members of Congress and Committees, and notify both of any problems as fully and expeditiously as possible. 

B. Do you believe this type of transparency includes providing timely, complete, 

and accurate information to Members of this Committee and their staffs? 

Response. Yes, transparency on VA matters should be extended to Congress, Veterans, and the general public. 

Question 6. The Questionnaire for Presidential Nominees that you submitted to 

the Committee reflects that you currently are serving as a Senior Advisor to the 

Secretary of Veterans Affairs. 

A. What are your responsibilities in that capacity? 

Response. As Senior Advisor, I have been working within OSVA on a number of 

important matters such as scheduling, staffing of the Secretary and VA leadership, 

preparation for meetings, and briefings on VA programs. 

B. In that capacity, have you had opportunities to interact with Members of this 

Committee or their staffs? If so, do you believe you have laid the groundwork for 

developing good working relations with the Committee Members and Committee 

staff? 

Response. As Senior Advisor to the Secretary, I have attended a few meetings 

with Members of Congress. I hope they have helped create a good foundation for 

the Secretary in those exchanges. If confirmed, I look forward to conducting a significant amount of outreach to members, Committees and their staffs and to continuing on a regular basis. Many legislative and policy ideas come from direct input 

from Veterans to member offices, and I look forward to working with Senate and 

House Offices both in the Capitol and the home state. 

C. In that capacity, have you identified any practices or procedures at OCLA that 

you believe could be improved? 

Response. If confirmed, I would work to make the Office of Congressional and 

Legislative Affairs a highly effective partner to Congress in meeting the needs of 

the Nation’s Veterans. I want to encourage a team that is aware of and understands 

Congressional policy interests, as well as the value and importance of bringing those 

interests to the attention of VA leaders for engagement. I am committed to improving outreach to members and staff; expanding the knowledge base of the Congressional Relations team and investing in the development of team members; effectively distributing staffing resources to achieve objectives; and updating technologies 

67 

and data management processes to meet the needs of a large team with a critical 

mission in a dynamic work environment. 

Question 7. According to Legistorm, you received $135,000 in salary from the 

House Budget Committee between 2000 and 2004, but that Committee is not reflected in the employment history listed in your Questionnaire for Presidential 

Nominees. 

A. Were you ever employed by the House Budget Committee? 

Response. No, I was not employed by the House Budget Committee. The House 

Budget Committee formerly allocated funds for member-office staff who served as 

Budget Associates for the member. My understanding is that, with the changes instituted by the 110th Congress, this practice was ended. 

B. If so, what were your responsibilities? 

Response. N/A 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. MARK BEGICH TO JOAN

M. EVANS, NOMINEE TO BE THE ASSISTANT SECRETARY FOR CONGRESSIONAL AND

LEGISLATIVE AFFAIRS, U.S. DEPARTMENT OF VETERANS AFFAIRS

In your testimony you state you understand the need for quick and complete information about issues and events affecting constituents. 

Question 1. In your estimate, what is a reasonable time to provide a response to 

an inquiry submitted by a Congressional Office on behalf of a constituent? 

Response. In my testimony I was referring to medical facility or regional office 

events or practices that might impact local veterans; in that case, as soon as it came 

to OCLA’s attention notifications should be made to the affected House and Senate 

offices. 

With regard to casework, some cases are more complex than others and require 

significantly more time to bring to resolution than a routine request for information, 

which should be answered within two weeks. The vast majority of constituent casework is worked at the regional office or facility level rather than in OCLA’s liaison 

office. However, when tasked with tracking a specific case, my understanding is that 

liaison staff can help serve as a forcing function to help move it toward resolution. 

Question 2. What specifically do you plan to do to improve this process and make 

this more timely and efficient? 

Response. In terms of notifications, I would encourage a culture of calls and visits 

rather than e-mails or letters that can get lost in the shuffle. In addition to contacting Committee leadership, OCLA’s personal outreach to affected members’ staff 

is preferred; in some cases, direct member contact by the Assistant Secretary or the 

Secretary may be warranted. 

With regard to casework, if confirmed my goal would be to informally survey Congressional offices to find any noticeable delays in responses, then bring patterns to 

the attention of VA leadership, including the Administrations and local offices, to 

address. 

[The Committee questionnaire for Presidential nominees follows:] 

68 


E51327Q1.EPS
69 


E51327Q2.EPS
70 


E51327Q3.EPS
71 


E51327Q4.EPS
72 


E51327Q5.EPS
73 


E51327Q6.EPS
74 

[A letter from the Office of Government Ethics follows:] 


E51327Q8.EPS
75 

[Letter from the nominee to the Office of General Counsel, U.S. 

Department of Veterans Affairs:] 


E51327Q9.EPS
76 

Chairman AKAKA. Thank you very much for your testimony, Ms. 

Evans. 

Ms. Evans, in your answers to my prehearing questions, you acknowledge the importance of informing Congress about emerging 

issues and stated that this should be done in a timely manner. 

Please tell the Committee what you would consider to be adequate 

advance notice regarding such issues. 

Ms. EVANS. I would consider as problems arise to be on the 

phone quickly to let you know, particularly as fully as we can. 

Sometimes that may mean gathering more information, but as soon 

as word comes out to get it to you for review. 

Chairman AKAKA. Would you ever consider a press release as 

adequate and timely advance notice to Congress, as was done in 

the case of the prostate cancer treatment program in Philadelphia? 

Ms. EVANS. Thank you for the question. Coming from the perspective of a House staffer, I wouldn’t consider that adequate advance notice. I know how busy staffs, Senators, and members are 

and things need to be brought to their attention, and I think personal communication is the best way to do that. 

Chairman AKAKA. In one of your answers to a prehearing question, you stated that you believe VA’s senior leadership and most 

members of OCLA see benefits in updating the focus of the office 

and expanding the staff to be more proactive in its outreach to 

member offices. Can you explain to the Committee what these benefits are? 

Ms. EVANS. Thank you. I believe that the benefits that outreach 

provides is knowing on the front lines what is going on in States 

and districts with members and with their veterans. So to me, getting as close to the veteran as you can to find out information is 

most helpful. So what I would like to do, I think, is develop close 

relationships with Committee staff here in the Senate and House 

Veterans’ Affairs Committees, as well as the appropriating committees, getting to know members of the personal office staff as well 

as folks back home in the State working in the State and district 

offices. 

Chairman AKAKA. In one of your answers to prehearing questions, you discussed your belief that VHA needs a more centralized 

structure. Do you believe that right now the central office has a 

handle on activities at the health care networks? Does it have 

knowledge of what is occurring, for instance, at VA medical centers? 


E51327Q10.EPS
77 

Ms. EVANS. Well, thank you, sir. I think under the tremendous 

leadership of Secretary Shinseki, Deputy Secretary Scott Gould, 

and the entire leadership team, they have done yeoman’s work at 

this point in bringing together all elements for a transformation. 

They have had VISN briefs with almost half the VISNs at this 

point, bringing up leadership from State and regional offices, getting to know them, discovering problems. So I think we are well 

on our way. 

Chairman AKAKA. You mention in your prehearing questions 

former Speaker Tip O’Neill’s views on constituent service. With 

this in mind, how long should a Senate office wait for responses to 

casework sent to the liaison office for assistance? 

Ms. EVANS. That, sir, depends on—I would say it depends on the 

case. I think they should be handled as expeditiously as possible 

and staff should be reviewing and forcing decisions on those. Some 

pieces of casework are more complex than others, so as timely a 

manner as possible. Right now, I would have to get into the office 

and see what the hold-ups are, and I look forward, if confirmed, to 

working with you and your staff to best meet your needs and the 

needs of veterans. 

Chairman AKAKA. Thank you for your responses. 

I call on Senator Burr for his questions. 

Senator BURR. Thank you, Mr. Chairman, and Joan, welcome. 

Ms. EVANS. Thank you. 

Senator BURR. Truly, we are delighted to have you. 

Housekeeping is the first question, if I may. As Ranking Member, I have some responsibilities to my side of the aisle from the 

standpoint of oversight as it relates to the Veterans Administration. It often leads me or my staff to ask the VA for certain information. If confirmed, do you pledge to ensure that my staff and I 

will be provided the requested information to the fullest extent permitted by law without hassle and delays? 

Ms. EVANS. Yes, I do, sir. 

Senator BURR. If confirmed, how would you ask your staff to 

prioritize requests from various Members? Would it depend at all 

on whether the request is from the majority or minority? 

Ms. EVANS. No, sir. 

Senator BURR. If confirmed, will you make it a priority to look 

into any pending requests for information from me or other Members of the Committee to ensure that those requests are fulfilled as 

soon as possible? 

Ms. EVANS. Yes, sir. 

Senator BURR. If confirmed, will you be proactive in alerting the 

Committee, including both sides of the aisle, to any significant 

trends, problems, or other issues at the VA? 

Ms. EVANS. Yes, sir. 

Senator BURR. I thank you for those answers. 

Joan, my staff recently asked the Office of Legislative Affairs for 

information about VA involvement with a company that was reported to have conducted unauthorized clinical trials. OCLA had a 

knee-jerk response that was the information could not be provided 

without, ‘‘a written request signed by the Chair and specifying the 

reasonable particularity the oversight purpose for which the 

records are sought.’’ Now, OCLA later changed its tune and said 

78 

that they couldn’t find any relevant information. My staff was able 

then to get the requested information from the Inspector General’s 

office. Do you believe this was handled correctly? 

Ms. EVANS. Well, thank you for presenting that situation. I am 

not familiar with it. My pledge to you would be, whether on a formal or informal basis, to work with you and your staff to ensure 

that you have everything that you need to do your job effectively 

and efficiently. 

Senator BURR. Can I ask, do you believe that it probably should 

have been a proper response to tell us what could be provided legally versus what cannot be? 

Ms. EVANS. Yes. 

Senator BURR. Thank you. General Shinseki has indicated that 

his goal for Congressional inquiries is to respond within 2 weeks, 

and I realize casework is significantly different than this. Over the 

past several months, it has taken VA much longer than 2 weeks 

to respond to many of the requests for information from my office. 

If confirmed, what specific steps would you take to ensure that 

these types of requests are answered in a timely manner? 

Ms. EVANS. One of the things is to establish a good tracking system to follow up with people. I think the thing that everybody— 

nobody wants any surprises and people don’t appreciate radio silence—— 

Senator BURR. How important do you believe a free flow of information is between the agency and Congress? 

Ms. EVANS. I think it is critical for both branches of government 

to do their job effectively. 

Senator BURR. Would it be your intention to foster a collaborative relationship between the VA and Congress? 

Ms. EVANS. Absolutely, sir. 

Senator BURR. In a recent letter, General Shinseki indicated that 

he asked the VA staff to review current procedures for responding 

to Congressional requests and to, ‘‘adjust them to ensure prompt 

response and follow-up.’’ Are you aware of a review of this type? 

Ms. EVANS. Well, currently, Senator Burr, I am in the Office of 

the Secretary, so I am working directly with the Secretary not on 

this issue. So I can’t comment on that. I am not familiar with it. 

Senator BURR. Well, I would ask you, upon your confirmation, 

would you make a special effort to review the status of that review? 

Ms. EVANS. Yes, sir. 

Senator BURR. Thank you. In response to prehearing questions, 

you mentioned, ‘‘the culture of a large, slow-moving institution,’’ as 

one of the factors that leads to delays in responding to Congressional inquiries. What steps would you take to ensure that this culture does not prevent the VA from meeting the Secretary’s goals 

of responding to Congress within 2 weeks? 

Ms. EVANS. Well, if confirmed, I hope to go down to OCLA, work 

in the system, get to know the processes, see the obstacles that the 

Congressional relations officers and the liaisons are faced with 

when doing their job. They are all dedicated, very hard working 

people who want to do their job efficiently and effectively. So my 

goal would be to work with Members of the Committee and their 

staffs as well as Members of Congress in personal offices who don’t 

79 

have the good fortune of being on this Committee to know what 

their concerns are and how we can best answer them. 

Senator BURR. I thank you for your honesty and candor today. 

Mr. Chairman, I look forward to the opportunity to have Ms. Evans 

before us for her confirmation. 

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

Burr. 

Now I would like to call on Senator Burris. May I say, Senator 

Burris, you made some remarks about the nomination process. I 

just want you to know that Ray Jefferson’s nomination was received by us on June 9 and Ms. Evans on June 23. That is a pretty 

rapid pace for all the paperwork that has to occur before we have 

this hearing, and so we put them together and have had this hearing set up today. I must tell you that we have to wait until we receive what we call ‘‘the official notice’’ from the White House on 

these nominations before we can proceed with the paperwork. But 

I would tell you that we have really moved it as rapidly as we 

could. 

Senator BURRIS. Thank you, Mr. Chairman. I just talked with 

her yesterday and she told me that, but there was some concern, 

and I am sorry Senator Burr left, because I was deeply concerned 

about the nomination of Tammy Duckworth that took all that time. 

That is what we were—— 

Chairman AKAKA. This is the time for your questions. 

Senator BURRIS. Yes, sir. Thank you. 

Mr. Chairman, the nominee also has an Illinois connection. She 

worked for Congressman Terry Bruce, who was a very good friend 

of mine. When she told me that, I said, well, my vote is assured. 

If she can work for Terry, she will have to have a couple of medals. 

[Laughter.] 

Ms. EVANS. No. 

Senator BURRIS. That is my buddy. 

Joan, tell me this, because I am concerned. I had requested information from one of the hearings. There was the person at the VA 

who was in charge of construction and this request was made at 

least 2 months ago in reference to minority contractors where I had 

requested that we get a breakdown of who was doing the work on 

these construction sites for the VA; not only that, but a breakdown 

of the dollar amount, the ethnicity of the contractor, whether Hispanic, Asian, black, or female. To this day, I don’t think I have received that information. You are currently at the Department of 

Veterans Affairs right now. You work for the Secretary, is that correct? 

Ms. EVANS. Yes, sir. 

Senator BURRIS. I hope that if you are confirmed, you probably 

could do that. But I just wonder, in listening to subjects Senator 

Burr raised, whether or not this is a pattern, how the VA responds 

to Congress, responds to a Senator. 

So you having come from this legislative side to the executive 

side, I just hope that there would be, as far as you are concerned, 

a little better treatment, or information flowing on a timely basis. 

Is that something, if you are confirmed, that you can state to us 

unequivocally would take place? 

80 

Ms. EVANS. Yes, sir. I will work to act as expeditiously as the 

team can get together and also to keep you informed along the 

way. 

Senator BURRIS. Because I am still looking for that information, 

and I would hope that when you would go back, my staff would be 

in touch with you, because I don’t recall specifically the young lady 

who was here—we surely have a record of who was requested the 

information. I don’t know what the hold-up is and why there is one. 

Maybe they don’t have it. If they don’t have it, then we ought to 

know because then we want to make sure that any of the construction that is to take place would open up opportunities for minority 

contractors to do a lot of that work. That is what I am concerned 

about. 

That is the end of my questioning, Mr. Chairman, because I do 

have to take leave to make another appointment. 

Good luck to you, and we look forward to working with you, 

Joan. 

Ms. EVANS. Thank you, Senator. 

Senator BURRIS. By the way, my Legislative Director, Ken Montoya, told me to come down here and make sure I asked you that 

question. 

[Laughter.] 

Ms. EVANS. Thank you. 

Senator BURRIS. So you can blame Ken for that. He told me he 

was your buddy, too. 

Ms. EVANS. Yes. Thank you, sir. 

Chairman AKAKA. Thank you very much, Senator Burris. We are 

really grateful for your role on this Committee and your thoughts 

are really welcomed. 

Ms. Evans, I would just like to ask you a few questions about— 

one of them is on outreach and another is on casework. 

Ms. EVANS. Yes, sir. 

Chairman AKAKA. On casework, do you believe constituent casework should fall within the 2-week suggested turn-around for Congressional correspondence? 

Ms. EVANS. Sir, I think that depends on the case and the complexity of it, but I think that all casework should be handled as expeditiously as any other request. 

Chairman AKAKA. Thank you. About outreach, do you plan to improve outreach to Members of Congress and their staffs? 

Ms. EVANS. Yes, sir. If confirmed, I personally would like to establish a goal of offering to meet with every member of the House 

and the Senate or their designated staff personally to find out what 

their concerns are and to evaluate those concerns as we look at 

transforming OCLA. 

Chairman AKAKA. I certainly appreciate that. 

There is something that I would like to seek clarification on, regarding subject matter experts. Can you please clarify something 

about direct communication between VA subject matter experts 

and Members of Congress and their staff. Do you believe there are 

circumstances where OCLA would not be involved in responding to 

questions from Congress, and if so, when would direct communication with VA experts be appropriate? 

81 

Ms. EVANS. Well, thank you, sir. What I would like to do, if confirmed, is to work with your staff leadership as well as the leadership in the VA to come up with an appropriate and timely system 

so that we meet your request with the depth of knowledge you are 

looking for. 

Chairman AKAKA. Well, I really appreciate that. As you know, 

we are trying real hard to do all we can for veterans across the 

country, and what we are seeking to do is to work together with 

the new administration as much as we can to do the job. If we find 

better ways to do it, we will. So we would appreciate close communications between VA and the Congress, for us particularly on the 

Committee. 

I appreciate you, your family and your friends being here, and 

I should say your supporters, too. I want to thank you for your participation in today’s hearing. I appreciate your desire to serve our 

Nation’s veterans. 

For the information of Members and staff, I would like to move 

this nomination as soon as possible. To that end, I ask that any 

posthearing questions for either nominee be sent to the Committee’s Legislative Clerk by the end of business tomorrow so we can 

move. I urge both nominees to provide answers to any posthearing 

questions as soon as possible so that the Committee can report the 

nominations to the full Senate. 

Thank you again. This hearing is adjourned. 

Ms. EVANS. Thank you. 

[Whereupon, at 11:48 a.m., the Committee was adjourned.] 

(83) 

HEARING ON NOMINATIONS OF DR. ROBERT 

A. PETZEL AND DR. RAUL PEREA-HENZE 

WEDNESDAY, DECEMBER 9, 2009 

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

The Committee met, pursuant to notice, at 9:30 a.m., in room 

418, Russell Senate Office Building, Hon. Daniel K. Akaka, Chairman of the Committee, presiding. 

Present: Senators Akaka, Murray, Tester, Begich, Burris, Burr, 

and Johanns. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, 

U.S. SENATOR FROM HAWAII 

Chairman AKAKA. The Senate Committee on Veterans’ Affairs 

will come to order. 

On November 18, the Senate received the nomination of Dr. Robert Petzel to serve as Under Secretary for Health of the Department of Veterans Affairs. Today’s hearing is an important step in 

the Committee’s process of consideration on this pending nomination. 

The nominee before us has distinguished himself as a physician, 

an educator, and an administrator. He has served in many capacities in the Veterans Health Administration, as a Chief of Staff at 

a VA medical center, as a Network Director, and most recently as 

the Acting Deputy Under Secretary for Health. Dr. Petzel has, 

through his long career in VA, acquired impressive experience in 

the VA system and demonstrated a commitment to improving 

health care for the Nation’s veterans. It is my firm belief that only 

someone with qualifications such as those possessed by Dr. Petzel 

could meet the challenges facing the next VA Under Secretary for 

Health. 

VA is the largest health care organization in the country and has 

experienced significant growth in recent years. Yet its leaders have 

been unable to plan effectively for the future because they were 

never sure how much funding VA would receive in the coming 

years. 

With advance funding for VA health care now a reality, this will 

be much less of an issue. However, since resources are sure to be 

tight during this economic downturn, appropriated funding provided to VHA must be used wisely. 

Highly publicized failures of VA to deliver quality health care, 

and a lack of accountability at high levels for those failures, have 

impacted veterans’ confidence in the system and the morale of the 

84 

dedicated men and women who work for VA. There has been significant change in the organizational structure of VHA in recent 

years. When VA’s Networks were created in the mid-1990s, they 

were envisioned as lean management structures with less than a 

dozen employees. Today, VA’s networks employ at least 1,000 individuals, many in positions without any direct responsibility for the 

delivery of health care services. 

As modern medicine is able to save more lives on the battlefield 

than ever before, VA is facing new challenges in adapting to the 

needs of the most seriously injured. Recently, the Senate unanimously passed S. 1963, the proposed Caregiver and Veterans Omnibus Health Services Act of 2009. This legislation is one part of 

a larger effort to give VA tools to address the needs of the newest 

veterans. If enacted, this measure will provide vital support for the 

caregivers of the most seriously injured veterans from the Iraq and 

Afghanistan wars and improve services to almost every group of 

veterans, including women veterans, veterans who live in rural 

areas, and homeless veterans. The caregiver provisions recognize 

the unique needs of the latest generation of veterans, providing 

health care, counseling, support, and a living stipend to those who 

care for the Nation’s wounded warriors. 

Dr. Petzel has advocated for a new structure in VA which would 

create service lines. These service lines would ensure accountability 

among senior leadership for the services provided in VA hospitals 

and clinics throughout the country. He has also stressed the need 

to work to improve the quality of services across the system so that 

the veterans receiving care from the smallest VA clinics to the largest VA hospitals will receive high-quality care. 

As a former Network Director and now Acting Principal Deputy 

Under Secretary of Health, Dr. Petzel has both the perspective and 

the credibility among his peers to succeed as VA’s Under Secretary 

for Health. I am convinced that Dr. Petzel can ensure that VA is 

the health care provider of choice. Our Committee looks forward to 

partnering with Dr. Petzel and his colleagues in VA as we move 

forward with the goal of providing the best care anywhere to the 

Nation’s veterans. My desire is that the Committee move expeditiously to confirm Dr. Petzel so that he can assume the role of 

being head of the Veterans Health Administration. 

Now I would like to call on Senator Johanns for his opening 

statement. 

STATEMENT OF HON. MIKE JOHANNS, 

U.S. SENATOR FROM NEVADA 

Senator JOHANNS. Mr. Chairman, thank you very, very much. I 

appreciate the opportunity to say just a few words. I can say to the 

Chairman that it probably would be adequate to say I agree with 

what you said there, but I do want to offer a thought or two. 

First, Dr. Petzel, I want to say thank you. Thank you for your 

many, many years of service. You have such an impressive resume ́, 

dating back to your early years at St. Olaf—and we shared a story. 

I went to a college just down the road from there, actually. But I 

look at your entire career, and it is a career of service and public 

service, which we thank you for. 

85 

I also want you to know, Doctor, as I mentioned to you briefly, 

I received on your behalf what I consider to be a very, very high 

recommendation. A gentleman by the name of Al Washko, whom 

you know very well, who is the Director of the VA Nebraska-Western Iowa health care system, gave me a call just a few days ago 

and pointed out to me that he had worked under you at some point 

in his career. He spoke of your leadership, your integrity, and what 

you brought to the job and could not have given you a more positive recommendation. That speaks highly of you, and it carries a 

lot of weight. 

I have to tell you that I am excited about your nomination and 

very pleased to have the opportunity to not only speak favorably 

about that, but to also offer my words of support. 

With the support of the Chairman, whom I publicly thank again, 

we had an opportunity to have a hearing in August at that VA facility in Omaha. They do such a great job there. Al’s leadership has 

made such a great difference. As you know, it ranks so high in 

many areas, and yet I think we all agree that the facility is just 

flat worn out. The heating, ventilation, air-conditioning system is 

rated F, I think dating back to 1999. It just simply is a facility that 

has outlived its usefulness. 

I really look forward to the opportunity to work with you on that. 

We have got some pretty serious problems there that we need to 

address, but I do not want to go into that in deep detail today because we will have an opportunity to address that facility and others around the country. 

What I do want to encourage you to do is, as you take on this 

new responsibility, hoping that you are confirmed, to reach out to 

the Members of this Committee on a regular basis. We all serve on 

a number of committees. In fact, I have often commented that one 

of challenges of becoming a new U.S. Senator is trying to figure out 

how to be in two and three places at once. 

This Committee, because of the leadership of the Chairman and 

the leadership of our Ranking Member, really is as nonpartisan as 

they come in the Senate. We do not work on this issue because it 

is a Republican issue or that issue because it concerns Democrats. 

We work on issues to try to help the lives of veterans who have 

given so much to our country. So we look forward to that opportunity to bring you on the team and to do all we can to work together with you. So I will just wrap up my comments today by 

wishing you the best and ending where I began by saying thank 

you for your many, many years of public service. 

Chairman AKAKA. Thank you very much, Senator Johanns. 

Senator Begich, your opening statement, please. 

STATEMENT OF HON. MARK BEGICH, 

U.S. SENATOR FROM ALASKA 

Senator BEGICH. Mr. Chairman, I will pass. I will just wait for 

the questions. 

Chairman AKAKA. Thank you. 

Senator Murray? 

86 

STATEMENT OF HON. PATTY MURRAY, 

U.S. SENATOR FROM WASHINGTON 

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

Johanns this morning, and all of our colleagues, for holding this 

really important hearing to consider the nominations of Dr. Robert 

Petzel to be VA Under Secretary for Health and Dr. Raul Henze 

to be Assistant Secretary for Policy and Planning. 

It goes without saying that both of these positions are vitally important both to the millions of veterans who rely on the VA for 

their health care and benefits and to the thousands of VA employees who work for our veterans. 

If confirmed, both of these nominees will face very stubborn challenges that have persisted despite the efforts of their predecessors, 

so I look forward to working with both nominees to take real steps 

forward now on behalf of our Nation’s veterans. 

Mr. Chairman, I also just want to take a moment to reiterate a 

message that I have sent many, many times to previous nominees. 

It is in your interest, it is in the VA’s interest, and it is certainly 

in the veterans’ interest for you all to be open and honest with 

Congress if you are confirmed. I guarantee that you will have a 

healthier relationship with all of us here in Congress if you are up 

front and proactive with all of us. In the past, the VA too often 

tried to minimize and cover up problems. Veterans depend on the 

VA to provide an honest accounting of its programs and its policies. 

Mr. Chairman, aside from the VA Secretary himself, there is perhaps no more important position affecting the health and wellbeing of our Nation’s veterans than the Under Secretary of Health. 

Decisions made by the Under Secretary affect how long a patient 

has to wait to receive care, the quality of care provided, and many 

other areas. If confirmed in this position, Dr. Petzel would head the 

Nation’s largest integrated health care system. He would oversee 

the delivery of care to more than 5 million veterans, and he would 

lead more than 200,000 health care professionals and support staff 

who work at more than 1,400 sites of care. 

As Under Secretary of Health, he would take the point on tackling the VA’s health care challenges. Those challenges include: providing mental health care to veterans who bear the invisible 

wounds of war, such as PTSD and TBI; preparing the VA for an 

influx of female veterans; expanding access to VA health care to 

Priority 8 veterans; and preparing the VA to care for more Iraq and 

Afghanistan veterans. Those are just some of the major challenges 

that he will face. 

I was able to speak with Dr. Petzel last week about some of these 

issues when we met in my office, and he told me about his vision— 

I am sure he will talk about it today—about bringing the VA into 

the 21st century. I look forward to hearing more from you today 

on all of that. 

I also had the chance to meet Dr. Henze last week. We talked 

about his public and private sector experience and how it would 

allow him, if confirmed, to use data analysis to drive the Office of 

Policy and Planning’s strategic planning process. By all accounts, 

Dr. Henze has a strong and varied resume ́, and he has his job cut 

out for him. The long-term challenges facing the VA are well 

known, and the Office of Policy and Planning has a central role to 

87 

play in pushing the VA forward to utilize long-term strategic planning. But too often the VA has been the victim of its own bureaucratic obstacles which delay the vital services and programs our 

veterans need. That is why I am interested to learn how Dr. Henze 

thinks the VA can creatively and realistically address the longterm challenges it faces. 

So thank you very much, Mr. Chairman, for holding this hearing, 

and I look forward to the testimony of the witnesses. 

Chairman AKAKA. Thank you very much, Senator Murray. 

Senator Burris? 

STATEMENT OF HON. ROLAND W. BURRIS, 

U.S. SENATOR FROM ILLINOIS 

Senator BURRIS. Thank you, Mr. Chairman. 

Mr. Chairman, I am going to have to make just a few comments, 

since I will not be able to stay through the entire hearing, but I 

just want to make sure that Dr. Petzel gets a couple of thoughts 

from me. One, of course, would be the problem that we are having 

with the Marion hospital, the VA hospital in Marion, IL, where 

Senator Durbin and I were about 3 weeks ago with concerns of the 

changes. Secretary Shinseki has certainly been up to visit and has 

been concerned about it, and we all want to make sure that Marion 

is on the right track. Over the years they have had several deaths 

of veterans in that facility, and the medical staff—there is a new 

Director. He had been in there only 2 weeks when we were there 

about 2 months ago or maybe a month ago. So we are just concerned about that, Doctor. And if you are confirmed, we would hope 

that you would keep a very close watch on that situation because 

there are certain specifics that take place which we raised with the 

Director. 

Rural medicine is an issue because that hospital serves a threeor four-State area—northern Kentucky, southeastern Missouri. A 

lot of those veterans come to the Marion facility, so we are deeply 

concerned about that. 

Another issue is something that I do not know, but I have heard 

a lot of complaints about, Dr. Petzel, and that is with the dental 

care for our veterans. 

Mr. Chairman, unfortunately, I will not be able to stay around 

to get details on that because I do have another engagement. I 

have to leave and be there very shortly. For the record we will be 

submitting, with your permission, Mr. Chairman, our other comments. 

Chairman AKAKA. All right. 

PREPARED STATEMENT OF HON. ROLAND W. BURRIS, U.S. SENATOR FROM ILLINOIS

Thank you Mr. Chairman, I would like to begin by extending a ‘‘Warm Welcome’’ 

to our distinguished guests, as well as fellow colleagues from the Committee. 

In addition Mr. Chairman, I would like to thank you very much for holding this 

important hearing on the nomination of Dr. Petzel to be Under Secretary of Health 

at the Veterans Health Administration (VHA) and Dr. Perea-Henze to be the Assistant Secretary for Policy and Planning. 

It goes without saying that the positions for which Dr. Petzel and Dr. PereaHenze have been nominated are critically important; both to the millions of veterans 

who rely on the VA for their healthcare and to the thousands of hard working VA 

employees who care for our veterans. 

88 

Mr. Chairman, in my estimation, aside from the VA Secretary himself, there is 

perhaps no more important position affecting the health and well being of our Nation’s veterans than the Under Secretary of Health. This position, in effect, serves 

as CEO of the VA’s entire health care system, the largest integrated health care 

system in the United States. 

Dr. Petzel has been nominated to the top VA health position at a time of great 

difficulty for the VA. The system is stretched to the limit trying to care for new veterans, while also serving existing veterans. Our Vietnam veterans are getting older, 

and many of them will be seeking care for age-related conditions at the same time 

that more and more of our newest veterans will be needing care for the wounds they 

suffered in Iraq and Afghanistan. 

In addition, at the same time the VA struggles to address these issues, it must 

also: 

• work with DOD to improve the seamless transition process, 

• reduce waiting times for veterans seeking care at VA healthcare facilities, 

• expand access to mental health services, and 

• address care for patients with TBI. 

If confirmed, the decisions made by Dr. Petzel in the Under Secretary position 

will affect how long a patient has to wait to receive care, the quality of the care 

provided, and many other areas. With this in mind, I look forward to hearing from 

Dr. Petzel on how he plans on dealing with these very important issues. 

In relation to Dr. Perea-Henze’s nomination for the Assistant Secretary of Policy 

and Planning position, if confirmed, he will be charged with the responsibility of ensuring that decisions made by the Secretary and his Deputy are made with full consideration of their impact throughout the department. The cross-cutting nature of 

this position makes it vital to the current and future well-being of the Department 

and the lives of this Nation’s veterans. 

That said I am also looking forward to hearing Dr. Perea-Henze’s plans for dealing with the issues facing the Department and what he is going to do to ensure this 

Department is competent and capable today and fully prepared for the challenges 

of tomorrow. 

Senator BURRIS. Thank you very much. We wish you well. 

Should you be confirmed, we look forward to working with you, 

Doctor. We have to take care of those individuals who took care of 

us. We can never, ever forget a veteran. 

Thank you. 

Chairman AKAKA. Thank you very much, Senator Burris. 

Before I call on Senator Tester, I would ask Ranking Member 

Burr for your opening statement. 

STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA 

Senator BURR. Mr. Chairman, thank you, and thank you for the 

indulgence of the witnesses. I have had an opportunity to meet 

with Dr. Petzel. I would like my statement to be a part of the 

record, so I am not going to hold us up. 

Chairman AKAKA. Without objection, it will be placed in the 

record. 

Senator BURR. Thank you. 

[The prepared statement of Senator Burr follows:] 

PREPARED STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA

Thank you, Mr. Chairman. Welcome to both of our nominees and your family 

members in attendance this morning. 

You both have been nominated to assume leadership positions at a critical time 

in our Nation’s history. We are a nation at war, nearly the longest the United States 

of America has ever been engaged in. 

Our advanced medical technology has made it possible for our servicemen and 

women to survive traumatic injuries that they never would have survived during 

previous wars. But when they come home, they need a state-of-the-art health care 

89 

system, as well as a hassle-free benefits system, that will help them return to civilian lives that are productive and full of promise. I have two prime examples from 

my home state: Eric Edmundson and Ted Wade. 

Both of these young men came home from war broken in mind and body. But 

thanks to the constant love and dedication of their family members, as well as a 

medical system that focused on restoring their capabilities to the fullest extent possible, they are getting better every day. 

Today’s veterans expect this of us. They want a VA that is forward looking, innovative, and responsive. That’s why both of your nominations are so vital. 

Dr. Petzel, you and I met last week in my office to discuss many of the challenges 

the Veterans Health Administration faces. I told you that I believed what VHA 

needs is a leader who will shake things up, one who is bold, and who is willing to 

challenge an entrenched bureaucracy often wedded to ideas of the past. 

I must admit, when I first heard that the nominee for this critical position was 

a career VA employee, I wondered how an insider could be the change agent of an 

administration where he has worked for 37 years. 

But after meeting you, I think your experience and record may uniquely position 

you as the right person for this job. I learned from our discussion that you and I 

both share the vision that VA must continue to evolve into a 21st Century organization. 

In the course of this hearing, I look forward to continuing the conversation we 

began in my office about what you hope to accomplish should you be confirmed. 

Dr. Perea-Henze, you too have been nominated to an important position. The office you will head, if confirmed, serves as VA’s internal ‘‘think tank’’ that can be 

the impetus behind innovation to improve VA’s service to veterans. This office needs 

someone who will not only assist in developing effective policies and plans, but also 

someone who can be a forceful advocate within the Department to put those policies 

and plans into action. 

In conclusion, congratulations to you both on your nominations. I again remind 

you of the importance of the mission you are seeking to undertake. There is perhaps 

no greater mission in government than the care of those who have worn the Nation’s uniform in service. 

I look forward to hearing from each of you about how you plan to improve the 

VA services for veterans during your tenure in VA. 

Chairman AKAKA. Senator Tester? 

STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

Senator TESTER. Well, thank you, Mr. Chairman, and thank you 

both, Dr. Petzel and Dr. Henze, for being here today. I apologize. 

You have two very, very important jobs that you are nominated for, 

and after the visit to my office and my opportunity to visit with 

both of you, I, too, believe that you are up for that challenge. 

During my tenure, I think the VA got exponentially better— 

starting with Secretary Peake—and I think that Secretary Shinseki 

continues along those lines. So I think that you have the opportunity, once in these positions, to do some real good things for veterans across America. 

Of course, you know my focus has been and continues to be on 

rural veterans. During our conversation in my office we talked 

about how we implement policies really to meet the needs of rural 

veterans. I think the home health issue and the issues that revolve 

around telehealth are issues and policies that I hope we can move 

forward on in a way that really meets the needs of the veterans 

in rural America. 

I have got a few questions for the record. I hope I can stay here 

for the entire hearing, but depending on what unfolds in another 

Committee will determine whether I can stay here or not. Regardless of that, I wish you both the best. You have two very, very imVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00093 Fmt 6601 Sfmt 6601 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
90 

portant jobs to do, and I look forward to working with both of you 

down the line. 

Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Tester. 

Now I would like to recognize the Senator from Minnesota, Senator Al Franken, who is joining us this morning to introduce our 

nominee to the Committee. Senator Franken? 

STATEMENT OF HON. AL FRANKEN, U.S. SENATOR FROM 

MINNESOTA, INTRODUCING DR. ROBERT A. PETZEL 

Senator FRANKEN. Thank you, Mr. Chairman. Chairman Akaka, 

Ranking Member Burr, and Committee Members, thank you very 

much for giving me this opportunity to introduce Dr. Robert Petzel, 

who has been nominated for the critical job as Under Secretary for 

Health in the Department of Veterans Affairs. 

As a relatively new member of the Senate, I do not think I have 

any higher priority than making sure that our veterans get the 

health care that they deserve. You might already know that my 

very first bill was to provide service dogs to wounded veterans who 

have both physical and mental wounds. I believe our veterans, our 

wounded warriors, will get tremendous benefits from those highly 

trained dogs. 

Dr. Robert Petzel went to St. Olaf, one of Minnesota’s outstanding colleges. He serves on the faculty of the medical school at 

the University of Minnesota and has long been based in Minneapolis, serving as Director of the Midwest VA Health Care Network. I am confident Dr. Petzel will bring the same dedication and 

skill to improving the health of our Nation’s veterans as he brought 

to caring for veterans in Minnesota and other midwestern States. 

I also know Dr. Petzel is committed to pursuing innovative solutions and evidence-based performance management to best provide 

that care. He has worked to expand the reach of community-based 

outpatient clinics in Minnesota without compromising the core 

functions of VA medical centers, and he has pursued the promise 

of telehealth and telemedicine within the VA. 

VA’s health care has been called the best anywhere. As the official at the head of the Veterans Health Administration, Dr. Petzel 

will be faced with the daunting task of making it even better. We 

owe our veterans nothing less. 

Dr. Petzel’s nomination is truly a source of pride for Minnesota. 

I look forward to working with him in the months and years ahead 

to make sure that our veterans have the highest possible level of 

care and quality-of-life. 

Thank you. 

Chairman AKAKA. Thank you very much, Senator Franken, for 

being here. Aloha and welcome to this Committee and also aloha 

and welcome to Dr. Petzel. 

Senator FRANKEN. Thank you, Mr. Chairman. Aloha to you. 

Chairman AKAKA. Thank you very much, Senator Franken. 

Under the rules of the Committee, the testimony of all Presidential nominees appearing before the Committee shall be taken 

under oath. Dr. Petzel, would you now stand for the administration 

of the oath? Will you raise your right hand? Do you solemnly swear 

that the testimony you are about to give, that your responses to the 

91 

Committee, the Committee’s questionnaire, your responses to all 

questions both live and in writing before the Senate Committee on 

Veterans’ Affairs will be the truth, the whole truth, and nothing 

but the truth, so help you God? 

Dr. PETZEL. I do. 

Chairman AKAKA. Thank you. 

Dr. Petzel, will you please begin with your statement? I understand your family is here. Will you please introduce them, too? 

STATEMENT OF ROBERT A. PETZEL, M.D., NOMINEE TO BE 

UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Dr. PETZEL. Chairman Akaka, Ranking Member Burr, distinguished Members of this Committee, good morning. 

Chairman AKAKA. Good morning. 

Dr. PETZEL. I want to first thank Senator Al Franken from Minnesota for his very kind introduction. Before I begin my statement, 

I would like to introduce my family and thank them for their support: my wife, Dr. Sue Petzel; our daughter Andrea; our son, Aaron, 

from Minneapolis; and our son, Erik, and his wife, Jennifer, from 

the Washington, DC, area. Without their help and support, I would 

not be here before you today. 

The Veterans Health Administration has a four-part mission: patient care, education, research, and a backup for national emergencies. But our foremost responsibility is to provide safe, effective 

patient-centered care for America’s veterans. I believe that education and research enhance the patient-care environment, and I 

believe that the presence of students and residents and the generation of new knowledge through research do stimulate better care. 

My first clinical rotation in medical school was at the VA Lakeside Medical Center in Chicago. The majority of my residency was 

spent in the Minneapolis VA medical center, and I have spent my 

entire professional life striving to provide the ‘‘Best Care Anywhere’’ to America’s veterans. 

The changes that have occurred in the Veterans Health Administration since my training 35 years ago have been stunning. A national reputation for quality and safety, an outstanding integrated 

array of mental health services, the electronic health record, and 

a sophisticated program to treat Traumatic Brain Injury are but a 

few of the accomplishments that VA has achieved over these last 

several years. We are empowering veterans to take control of their 

health care through Web applications like MyHealtheVet. We are 

adopting new models of treatment that bring care closer to home 

by emphasizing non-institutional long-term care, and we have been 

developing proposals and working with Congress to support the 

family members and friends who assume caregiving responsibilities 

for their loved ones. This is particularly important for those young 

people who are severely injured returning from Iraq and Afghanistan who will need lifelong care. Our dramatically improved collaborations with the Department of Defense will enhance and improve care and services to those people returning from the conflict. 

These are all great accomplishments, but we need to be better, 

and we can be better. 

92 

I understand health care systems, and I know the VA system 

very well. I know its strengths, its weaknesses, and its challenges. 

Its strengths are its mission, its dedicated workforce, its reputation 

for quality and safety, the electronic health record, our broad array 

of programs, and our degree of integration. Our weaknesses and 

challenges include developing a clear vision of what our health care 

system needs to be and will look like in the future, a lack of alignment of all of the elements of VA and VHA to achieve this vision, 

and the tremendous variation that occurs in our system across the 

country. Access for veterans has improved significantly, but veterans in rural areas still have to travel too long and too far for 

care. We have the largest integrated mental health care system in 

the country, but we still do not reach many veterans who need our 

services. Women are joining the military in record numbers, and 

we must ask ourselves if we have the services they need available 

to them in the manner in which they want them. 

When Secretary Shinseki spoke before you in January, he promised that veterans would be at the center of our organization. I 

know the Secretary is committed to transforming VA, and I know 

how deeply he believes in this. Building the best health care system for America’s veterans has been my life’s work. This opportunity represents the culmination of a career spent caring for those 

who have worn the uniform and borne the burden. 

If confirmed, I will bring an innovative and creative approach to 

the Veterans Health Administration. Beyond our transformation 

initiatives, I will focus on three areas: articulating and implementing a vision of what our health care system needs to look like 

in the future; more patient-centered, providing more team care and 

continuously improving itself; I will work to align the organization 

to achieve that vision, bringing all of the elements into line—our 

resource distribution methodology, our performance measurement 

system, and our huge array of programs—all, again, aligned to accomplish that vision; and, finally, reduce the variation in our organization, our structures, our business practices, and the way we deliver medical care. 

If confirmed, I promise you that I will work diligently with Secretary Shinseki, the Congress, the Veterans Service Organizations, 

and all of VA to ensure our system provides the best care anywhere. The Under Secretary for Health’s first responsibility is and 

always must be to advocate on behalf of America’s veterans. I 

promise you, this will be the basis for my every decision. 

Thank you again for the opportunity, and I look forward to answering your questions. 

[The prepared statement of Dr. Petzel follows:] 

PREPARED STATEMENT OF ROBERT A. PETZEL, M.D., NOMINEE TO BE UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF

VETERANS AFFAIRS

Chairman Akaka, Ranking Member Burr, Distinguished Members of the Committee: Good morning. 

Before I begin my statement, I would like to recognize and thank my family: my 

wife, Dr. Sue Petzel; my daughter Andrea, from Seattle; my son, Aaron, from Minneapolis; and my son, Erik and his wife Jennifer, from Washington, DC. Without 

their help and support, I would not be here before you today. 

93 

I am thankful and deeply humbled that President Obama and Secretary Shinseki 

have asked me to join their leadership team as we form a 21st Century Department 

of Veterans Affairs—one that is people-centric, results-driven, and forward-looking. 

The Veterans Health Administration has a four-part mission: patient care, education, research, and a backup for national emergencies. But our foremost responsibility is to provide safe, effective patient-centered health care for America’s Veterans. I believe that education and research enhance the patient care environment. 

The presence of students and residents and the generation of new knowledge stimulate better care. 

My first clinical rotation in medical school was at the VA Lakeside Medical Center 

in Chicago. The majority of my residency was at the Minneapolis VA Medical Center, and I have spent my entire professional life in the Veterans Health Administration striving to provide the ‘‘Best Care Anywhere’’ to America’s Veterans. 

The changes that have occurred in the Veterans Health Administration since my 

training 35 years ago have been stunning. A national reputation for quality and 

safety, an outstanding integrated array of mental health services, the electronic 

health record and a sophisticated program to treat Traumatic Brain Injury are but 

a few of VA’s accomplishments. We are empowering Veterans to take control of their 

health care decisions through applications like My HealtheVet. We are adopting 

new models of treatment that bring care closer to home by emphasizing non-institutional long-term care, and we have been developing proposals and working with 

Congress to support the family members and friends who assume caregiving responsibilities for their loved ones. This is particularly important for those young and severely injured servicemembers returning from Iraq and Afghanistan who will need 

lifelong care. Our dramatically improved collaboration with the Department of Defense will enhance and improve care and services to these returning servicemembers. These are all great accomplishments, but we need to be better, and we 

can be better. 

I understand health care systems and I know the VA system very well. I know 

its strengths, its weaknesses, and its challenges. Its strengths are its mission, dedicated workforce, reputation for quality and safety, the electronic health record, our 

broad array of programs, and our degree of integration. Our weaknesses and challenges include developing a clear vision of what our health care system should be 

in the future, a lack of alignment, and many variations within our system. Access 

for Veterans has improved significantly, but Veterans in rural areas still have to 

travel too long and too far for care. We have the largest integrated mental health 

system in the country, but we still do not reach many Veterans who need these 

services. Women are joining the military in record numbers, and we must ask ourselves if we have the services they need available in a manner they want them. 

When Secretary Shinseki spoke before you in January, he promised that Veterans 

would be at the center of our organization. I know the Secretary is committed to 

transforming VA, and I know how deeply he believes in this. Building the best 

health care system for America’s Veterans has been my life’s work. This opportunity 

would represent the culmination of a career spent caring for those who have worn 

the uniform and have borne the burden. 

If confirmed, I will bring an innovative and creative approach to the Veterans 

Health Administration. Beyond our transformation initiatives, I will focus on three 

areas: 

• Articulating a vision of what our health care system needs to become—more patient-centered, providing more team care and continuously improving; 

• Aligning the organization to achieve that vision; and 

• Reducing the variation in our organization, structures, business practices, and 

medical care. 

If confirmed, I promise you that I will work diligently with Secretary Shinseki, 

Congress, the Veterans Service Organizations, and all of VA to ensure our system 

provides the best care anywhere for America’s heroes. The Under Secretary for 

Health’s first responsibility is and always must be to advocate on behalf of America’s Veterans. I promise you, this mission will be the basis for every decision I 

make. 

Thank you again for the opportunity to appear before you today. I would be 

pleased to answer your questions now. 

94 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO DR. ROBERT PETZEL, NOMINEE TO BE UNDER SECRETARY FOR HEALTH, VETERANS

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. What do you view as the biggest challenge facing the incoming Under 

Secretary for Health? 

Response. There are three principal challenges I will confront if I am confirmed. 

First, the Department of Veterans Affairs (VA) must reduce variation. A national 

system requires national standards. Organizational structures, business practices, 

even the way we deliver medicine varies greatly. Veterans deserve consistent, high 

quality care in every location. Second, I will articulate a vision for VA as a national 

health care system that is the provider of choice for Veterans. Third, I will align 

our organizations and structures to realize this vision. We have an unmatched 

breadth and depth, but we need to marshal these resources toward implementing 

this vision. 

Question 2. If confirmed, what would you like your legacy to be? 

Response. If confirmed, I would like my legacy to be that as Under Secretary for 

Health, I articulated and implemented a new model of care to transform VA into 

a 21st century delivery system that is patient-centered, continually improves, and 

utilizes team care. This new model will improve quality and access, allow VA to 

reach more Veterans, and provide greater service that treats all Veterans’ health 

care needs. 

Question 3. What role, if any, do you believe VA should have in the national 

health care reform debate? What can be transferred from VA’s experience to a national health care reform bill? 

Response. Our principal role in the national health care reform debate will be to 

advocate on behalf of Veterans and ensure they have the best options available for 

care. As we strive to meet that challenge, VA demonstrates the value of integrated 

care, where all clinicians work for the same organization, have access to the same 

data, and have a common mission. VA’s electronic health record is also an excellent 

and tangible example of how VA can support improved health care in the country 

through integrated and coordinated care. VA has virtually unmatched experience in 

establishing performance measurements and meeting these standards; this experience can help other providers develop and improve the quality of care patients receive. 

Question 4. How do you compare VHA health care to health care available in the 

private sector? In what areas do you think VA lags behind the private sector, and 

how would you, if confirmed as Under Secretary for Health, implement improvements in those areas? 

Response. VA compares very favorably with the private sector on technical measures of the quality of hospital care processes, outpatient and preventive care, and 

risk-adjusted mortality. I also believe we are unmatched in the care of complex, 

chronic illness, including mental illness and polytrauma, which are areas that are 

not routinely measured outside of VA. However, we lag behind others in our business practices, such as billing, coding, collections, and financial management systems. We also have been perceived as less transparent than other health care organizations. Secretary Shinseki has emphasized the importance of transparency. I 

agree with the Secretary that we must do more to help Veterans make informed 

decisions. FLITE is one resource I believe will help VA and VHA better manage 

these business processes, but it is only one element; we need to align our resources 

and our structures to ensure consistency and uniformity throughout the system. 

Question 5. If confirmed, how would you propose to manage the confluence of demand for health care created by those veterans with service-connected disabilities 

and those veterans who are eligible for VA health care? 

Response. Providing care to service-connected Veterans is one of our highest priorities, but we also want to be the provider of choice for all eligible Veterans and manage their care as well. VA is expanding access to Priority 8 Veterans in a gradual 

fashion so that more Veterans can receive care from us while ensuring we maintain 

the ability to provide care for service-connected Veterans. 

Question 6. According to VA, there are more than 688 full time positions in VISN 

offices, and another 383 collateral VISN employees. That is a total of almost 1000 

employees nationwide, or four times the number originally estimated when the 

VISNs were created. What explains this growth of these offices? What direct responsibility do you believe VISNs should have to enforce VA policy and to ensure the 

quality of care at individual facilities in their VISNs? 

Response. Veterans Integrated Service Networks (VISN) are the basic operating 

units within VHA. The VISN structure encourages innovation and has been the 

95 

basis for many of the significant advances within VHA over the last 15 years. The 

responsibilities of VISNs have grown, which has in turn necessitated larger staffs. 

VISNs are responsible for all operational issues within their networks, and this is 

one area where we can reduce variation to improve the consistency of our organizational structures, business practices and medical care. For example, while I was the 

Network Director for VISN 23, we moved to a consolidated equipment purchasing 

system for imaging equipment such as CT machines. This shift resulted in savings 

of several million dollars as we were able to negotiate high volume contracts with 

lower prices per units, and we saved money on maintenance costs through uniformity throughout the VISN. 

Question 7. Do you believe that the Under Secretary for Health has adequate authority over the VISNs and overall VHA activities? 

Response. The Under Secretary for Health has adequate authority to supervise 

VISNs and other VHA activities. Network Directors are accountable to the Under 

Secretary, but accountability is a two-way street. The Under Secretary must clearly 

convey expectations and provide resources to help the VISN meet the standards set 

by Central Office. As I have said before, if confirmed, a key element of my objectives 

as Under Secretary will consist of reducing variation in our organizational structures, business practices and delivery of care. We want VISNs to be able to maintain flexibility to experiment and do what is needed at the local level, but as a 

former VISN director, I always knew that I needed to inform my supervisors in Central Office about issues and seek their approval when necessary. 

Question 8. Are you satisfied with the amount of oversight that VA headquarters 

program managers are able to conduct? In your view, is budgetary authority a prerequisite for such oversight? 

Response. The Deputy Under Secretary for Health for Operations and Management is responsible for all operational issues and overall management of our facilities. Program managers are distinct and are responsible for developing policy and 

working with the Networks to conduct oversight in their specialty areas. These offices need to work together and in close coordination with program managers to ensure that the right services are available and that facilities have the necessary resources in funding, staff and training. I believe there is an increased need for a significant clinical presence in operations and, if confirmed, plan to see this happen. 

I do not think budgetary authority is a prerequisite for oversight. 

Question 9. Currently, VHA’s quality management functions are separated from 

its patient safety functions, and both are separated from patient care services. What 

will you do, if confirmed, to ensure that these offices work together to monitor the 

quality of health care available throughout VHA’s health care system? Please explain exactly what responsibilities you believe each of these offices should have for 

ensuring that individual facilities and VISNs provide quality health care? 

Response. VHA needs an integrated approach to quality and safety. There is overlap between quality, safety, and patient care. We need to consider what we can and 

should do to better align our organizations to meet the needs of Veterans. Quality 

and safety data are necessary to supporting operations and our facilities, and if confirmed as Under Secretary for Health, I will see that this cooperation is taking 

place. The Office of Quality and Safety should be responsible for assessing our programs and gathering data that can be provided to the Office of Operations and Management and Patient Care Services to improve how we deliver health care. VHA has 

taken many actions to align quality, safety, patient care services and operations, including: 

• Establishing the Office of Quality and Safety, whose chief officer reports directly 

to the Under Secretary for Health; 

• Creating the Under Secretary’s Coordinating Committee for Quality and Safety, 

which includes VHA Senior Leadership, the Office of Quality and Safety, the Office 

of Patient Care Services, Operations and Management, and others to coordinate 

quality and safety activities within VHA; and 

• Holding a bi-weekly meeting to address quality issues with VHA senior leadership, along with the Offices of Quality and Safety, Patient Care Services, and Operations and Management. 

Question 10. While VHA has many policies and procedures in place to ensure that 

veterans receive quality care, recent failures at individual facilities such as Marion, 

Illinois, Miami, Florida, and Philadelphia, Pennsylvania to follow those policies and 

procedures shows that more needs to be done. What can you do if confirmed to ensure that individual facilities follow VA directives? A recent news article criticized 

VA’s response to problems identified in the Philadelphia VA hospital’s prostate 

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96 

able for these problems. How would you characterize VA’s response to that issue, 

and what actions do you plan to take moving forward if you are confirmed? 

Response. Although VA responded to these situations quickly upon learning about 

them, there is more we should do to improve the care we provide. VA also needs 

to do a better job of anticipating and identifying facilities that may have issues and 

resolving them before patient safety issues emerge. 

The best way to ensure that facilities follow VA directives is to clearly explain our 

expectations, because without this, we cannot maintain accountability within the 

system. It is important to recognize that accountability includes more than just dismissal or reassignment. Accountability is a two-way street, and if we haven’t provided our facilities or our staff with the resources to meet our expectations, it would 

be unfair to punish them for not meeting those standards. Accountability includes 

educating staff and connecting performance with ratings and awards to provide the 

proper incentives for compliance. The nature of our response should vary according 

to several factors, such as whether there has been an historical record of noncompliance; what impact the person’s actions had on patient safety and care; and any 

other circumstances unique to the situation. VHA leadership is responsible for providing the right structures to ensure accountability. 

Question 11. Please describe how you, if confirmed, would propose to use the Inspector General’s office, and how you will use the Office of the Medical Inspector 

to ensure accountability and adequate oversight of VHA? In general, how do you see 

the respective roles of IG and Medical Inspector? 

Response. In my view, the Office of the Inspector General (OIG) is largely independent and responds to concerns raised by the public, the Secretary, and Congress. 

The OIG’s findings provide a good basis from which we can assess our system and 

its recommendations often help strengthen VHA by identifying areas in need of further attention. This benefit is consistent with my idea, if confirmed, to reduce variation in the system with regard to our organizational structures, business practices 

and medical care. 

The Office of the Medical Inspector (OMI) reports directly to the Under Secretary 

for Health and helps VHA provide the best possible health care to Veterans by assessing the quality of their care and recommending corrective actions. The OMI possesses the experience and expertise within its staff to investigate on short notice almost any patient care concern. The OMI can also assist VHA with system-wide assessments of quality of care. If confirmed, I would plan to use the OMI to continue 

performing these functions. 

Question 12. Recently, the reports of a contractor that reviews quality of care in 

VA nursing homes were removed from the public domain. Do you believe these reports should be publicly available, and why or why not? 

Response. I agree with the Secretary that transparency is an important area 

where VA must move forward. In general, information necessary for Veterans to 

make an informed decision regarding their health care should be made public. Some 

internal quality assurance documents, such as peer review assessments, require clinicians to honestly and accurately evaluate the work of their colleagues to ensure 

Veterans receive safe, quality care. Sharing such documents with the public could 

be counterproductive, since it may induce providers to hold back or otherwise offer 

more reserved assessments, which would ultimately and adversely impact patient 

care. 

Question 13. I have received complaints from veterans that there are delays in 

getting their wheelchairs, hearing aids, and other prosthetic and orthotic aids. If 

confirmed, how will you ensure that veterans receive the assistive devices they need 

whey they need them? 

Response. Prosthetics are an essential component of patient wellness and rehabilitation, and I can assure you that, if confirmed, I will provide Veterans the devices 

they need by offering appropriate staff and resources to the Office of Prosthetics and 

Sensory Aids. More than 98 percent of all requests in the month of October were 

responded to within 5 days. VA has developed a new monitor this year to help track 

the true timeliness of procurement and to determine when Veterans are not receiving equipment within the time we expect or items are not properly documented. We 

will work to improve this process as we move forward. 

Our laboratories are nationally accredited to provide the most advanced functional 

and cosmetic prosthetics. VA has more than 600 contracts with vendors to provide 

care closer to home for Veterans, as well as 66 VA orthotic and prosthetic labs, all 

of which are nationally accredited. VA provides surgical implants, home respiratory 

care, wheeled mobility, telehealth equipment, home adaptations, vehicle adaptation, 

artificial limbs, through its Prosthetics and Sensory Aids Service. If confirmed, I 

97 

look forward to working with you and the Committee to remedy any problems experienced by Veterans or your constituents. 

Question 14. Recently, two veterans from my home state of Hawaii contacted the 

Committee because their home health care was terminated because they no longer 

met eligibility criteria. One of these veterans was an 85 year old wheelchair-bound 

veteran with cancer. If confirmed, how will you ensure that there are standards and 

processes in place so that veterans in need of home care continue to get such care? 

What process would you put in place so that if a decision is made to terminate such 

care, that efforts made to ensure help with finding alternative assistance? 

Response. I am unfamiliar with these specific cases, but in general, I think these 

services should be available to everyone who would otherwise need hospitalization 

or institutional care. If confirmed, I would look forward to working with you and 

your staff to resolve the issues mentioned above, as well as other issues that arise. 

The Secretary and I believe VA must be a more Veteran-centered organization, and 

this is an excellent example of an area where we can improve to better serve 

Veterans. 

Question 15. I continue to hear about outside health care providers who will no 

longer see veterans because of delays in receiving payment from VA. What will you 

do, if confirmed, to encourage community providers to work with VA to provide services where there are no VA facilities? 

Response. VHA needs to look closely at its business practices, and if confirmed, 

I will work to reduce variation in how we process claims and our billing procedures 

to produce greater consistency across the system. I will also look into different approaches for providing care outside VA. Our first responsibility is always to provide 

health care to Veterans and, if we are unable to offer those services directly, we 

must find a qualified provider who can. 

Question 16. If confirmed, how would you address the fact that VHA’s performance measures have a bit of a ‘‘one size fits all’’ nature to them? How would you 

keep the ‘‘good’’ part of encouraging appropriate screening while eliminating the 

‘‘harm’’ side of requiring inappropriate screening of people who would be harmed, 

or at least not benefited, by screening? An example would be screening for colon 

cancer in a patient whose life expectancy is less than the time it would take to benefit from screening that particular patient? How do you minimize the ‘‘harm?’’ 

Response. That is a good question, and one VA and the health care industry need 

to address. We have adopted a national system of evidence-based performance measurement and preventive and screening practices because the scientific evidence tells 

us that, for the vast majority of patients, these practices promote health and save 

lives. But for Veterans with complex conditions, trying to attain VA’s performance 

measure standards may not be best for the patient. For example, a patient with a 

life expectancy of less than 6 months may not benefit from screening for cholesterol 

levels. We do not want measurement standards to interfere with sound clinical judgment or physician-patient dialog essential to Veteran-centered care. VA is working 

to refine its measurement approaches and is consulting with the National Quality 

Forum to ensure national performance standards reflect patient-level considerations. Research is the best way to improve care for patients with multiple, chronic 

conditions. If confirmed, I will advance a new model of health care that uses teams 

of providers in collaborative roles who can discuss the various conditions of each patient and determine the best course of action. These interactions can reduce concerns about overlapping conflicts or competing standards. 

Question 17. What is your view of VA’s initiatives to reduce medical errors? In 

your view, what really works, and what is counterproductive? 

Response. VA has a strong system in place to reduce medical errors. We have 

adopted standard operating procedures that support patient safety. For example, 

prior to any surgery, we have a series of steps that protects the patient. The surgical site is marked in coordination with the patient, the surgical team discusses 

the operation, and prior to beginning, the team takes a time out to verify they will 

be performing the operation correctly. This time out process is also used for complex 

procedures such as cardiac catheterization and endoscopies. 

VA’s Bar Code Medication Administration system is another example that ensures 

the right patient receives the right medication, in the right dose, in the right manner. VA is a recognized leader in the Nation for identifying medical errors and developing ways to correct them. Our patient safety data help us to identify system 

vulnerabilities and trends, and to take corrective action before other organizations 

might even notice a problem or concern. VA’s reporting system for ‘‘close calls’’ lets 

us find vulnerabilities and fix them before serious harm occurs. 

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Question 18. What are your views on whether VA should fill prescriptions written 

by outside providers that are brought to VA for filling by Veterans who are not otherwise receiving any care from VA? 

Response. The safety and care of our Veterans is of primary concern. Therefore, 

if we are providing medications, we should also be providing care to ensure Veterans 

are receiving the correct treatment for their conditions. VA has unique expertise in 

Veteran-specific care and we can identify conditions that civilian physicians may 

miss. We also want to have a comprehensive picture of the patient’s medical history 

so that we can prevent any drug-drug or drug-allergy interactions that could adversely affect the Veteran. 

Question 19. What is your view of the role that VA’s labor partners play in the 

overall effort to improve VA health care delivery? 

Response. I think VA’s labor partners play a very important role in improving 

VA’s overall health care delivery. I am a strong supporter of VA’s union partnerships, and in my time as Network Director for VISN 23, I maintained very positive 

relationships with our union representatives. 

Question 20. If confirmed, what would you do to improve VA care in rural areas? 

How would you improve recruitment and retention of high quality health care providers in rural areas, increase VA telehealth and telemedicine, ensure linkages with 

community providers, and increase the use of mobile vans? 

Response. Providing care in rural areas is a challenge-not just for VA, but for the 

entire country. VHA’s Healthcare Retention and Recruitment Office has developed 

a course as part of its Recruiter University that addresses rural recruiting and is 

placing national recruiters who conduct targeted recruitment for rural areas. VHA 

is also working to develop additional training and partnerships with state offices of 

rural health. 

We have a number of opportunities to work together with community health agencies and to leverage relationships within communities, such as Tribal governments. 

Telehealth and telemedicine are two key instruments that bring care to rural Veterans, and VA is rapidly expanding these services. If confirmed, I will continue 

these efforts. VA’s Office of Rural Health has a budget of $250 million to support 

local and national initiatives through VISNs and program offices, including a pilot 

involving the use of mobile vans. If confirmed, I will see that we identify priorities 

and provide funding through a robust and prompt review process. VA will examine 

the results of this pilot prior to making any decisions about further expansion. 

Question 21. What opportunities for improvement do you see in VA’s research programs? 

Response. VA is very grateful to Congress for providing a strong budget for VA’s 

research programs. Some areas of research that I would particularly promote include investigations concerning Traumatic Brain Injury and Post Traumatic Stress 

Disorder, as well as Gulf War Veterans’ Illnesses, Agent Orange exposure, issues 

affecting women Veterans, and genomic medicine. Oversight is an essential component to a productive research program. VA is an example of an integrated system 

that incorporates both health care and research; our work in maintaining rigorous 

standards for human subject research sets the bar for the Nation. 

Question 22. If confirmed, how would you encourage research that is related to 

veterans’ health care needs? 

Response. All research VA supports benefits Veterans and contributes to their 

health care needs. For example, research into chronic conditions will benefit a substantial number of VA enrollees. We can encourage more research related to Veterans’ health care issues through partnerships with the Department of Defense, the 

National Institutes of Health, our affiliates, and other organizations. If confirmed, 

I will personally encourage more research by being a strong advocate for additional 

support for VA’s research programs. 

Question 23. In past years, there have been cost overruns in both prosthetics and 

long-term care. In light of the recent GAO report pointing out a lack of financial 

controls in VA’s Financial Management System, what will you do, if confirmed, to 

prevent similar cost overruns in the future? 

Response. If confirmed, one of my primary objectives will be to align VHA to support consistent organizational structure, business practices, and medical care to realize efficiencies. FLITE can also help us more efficiently utilize the resources we 

have. 

In the areas of prosthetics and long-term care, VA will continue to meet the needs 

of Veterans. The future for long-term care is non-institutional care that Veterans 

can receive in their homes or in the community. Through aggressive national contracts and clinical practice recommendations, VA can add value while saving taxVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00102 Fmt 6601 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
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payer dollars, and still provide the most advanced technology available in the 

market. 

If confirmed, I will review the forecasting models VA uses to project demand for 

prosthetics and long-term care, and I look forward to working with Committee to 

support these important programs. 

Question 24. Recently, Committee staff collected data on six randomly selected, 

very large CBOCs to determine whether they were providing all of the mental 

health services required under VHA’s Uniform Mental Health Services Handbook. 

This review found several instances in which CBOCs did not supply all mental 

health services required. How will you, if confirmed, ensure that all VA facilities 

provide the required mental health services to the veterans who need them? 

Response. VA’s Mental Health Services Handbook includes requirements for all 

community-based outpatient clinics (CBOC) to provide primary care and mental 

health care. CBOCs can satisfy this requirement in several ways: through VA staffing, contract care, visiting providers, in-house contractors, or telehealth. For the 

largest CBOCs, the Handbook required implementation by October 1, 2009 for VA 

to provide most mental health services on site. Most of the very large CBOCs were 

delivering most of the required services long before then. If confirmed, I will ensure 

all CBOCs have the appropriate resources to meet demand uniformly and with 

minimal variance to be certain Veterans can access the care they need. I would ensure VISN and VA medical center directors understand their obligations. If a facility 

is not meeting the necessary standards, we would require it to develop plans to 

come into compliance and regularly check on the implementation of those plans. 

Question 25. What is your view regarding the value of Vet Centers? What changes 

to Vet Centers, if any, would you propose, if confirmed? 

Response. Vet Centers are an essential component of the VA system. They are an 

alternate door through which Veterans can access VA health care and benefits. Vet 

Centers have been very successful in building relationships with local VA medical 

centers, Veterans organizations and their communities, and if confirmed, I would 

encourage them to continue building these connections. There is great value in not 

folding Vet Centers into the mainstream VA health care system-their status is a 

unique asset to be valued, not diminished. VA has been increasing the number of 

Vet Centers significantly over the last few years (including mobile Vet Centers deployed to rural areas), and if confirmed, I will evaluate our footprint and determine 

what other steps may be necessary to provide more services to more Veterans. One 

initiative that we recently began that I would like to promote, if confirmed, is greater outreach and support for women Veterans. VA has provided $25 million to hire 

and staff counselors specifically for women Veterans at 120 Vet Centers, and is expanding services for family members as well when that counseling relates to the readjustment needs of the Veteran. 

Question 26. What is your view about allowing Vet Centers to partner with outside groups, such as those involved in existing DOD programs that offer a proactive 

approach to giving families the tools they need to be healthy? 

Response. Vet Centers have been helping families with the process of a Veteran’s 

readjustment for years now, and they maintain strong working relationships with 

providers in their communities to provide further support when our statutory limitations prevent us from doing more. Dr. Al Batres, the Director of Readjustment 

Counseling, is passionate about finding new methods for reaching and helping Veterans, and we will work together to explore further options. If confirmed, I look forward to discussing this issue and hearing the Committee’s thoughts about new approaches Vet Centers can adopt to help Veterans and family members. Our Mobile 

Vet Centers have proven to be a very effective resource in reaching out to communities and helping Veterans and their family members readjust. 

Question 27. How will you, if confirmed, implement integrated health care, merging mental health services and primary care services, considering that most veterans enter VA care through primary care? 

Response. Integrating mental health and primary care is a key element of integrated care. Within the VA system, 40 percent of our primary care patients also 

have a significant mental health need, usually depression. Five years ago, VA began 

incorporating depression treatment into primary care clinics by bringing in specified 

mental health staff. This has been remarkably successful, as it helps Veterans receive the care they need without the stigma some see from seeking mental health 

care. I want to ensure every VA medical center’s primary care clinic can provide 

similar services. In VISN 23, while I was the Network Director, we piloted a project 

examining the effectiveness of integrating mental health and primary care which 

was found so successful that we required every primary care facility in the Network 

to adopt this model. 

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Question 28. Are you confident that current VHA authorities and procedures allow 

sufficiently expeditious hiring of medical personnel? Please describe any recommendations that you have for changes to the current hiring system? 

Response. As the Acting Principal Deputy Under Secretary for Health, as a Network Director, and as a Medical Center Director, I have first-hand knowledge about 

the difficulties VA sometimes faces in hiring personnel. VHA recognized the need 

to improve the efficiency of many of its processes related to recruitment and staffing 

and launched a recruitment collaborative that resulted in significant reductions in 

the average time it takes to bring an employee on board. However, there is still 

more to do in this area and VHA is continuing the effort into 2010. 

Assistant Secretary for Human Resources John SepuAE1lveda has a number of 

initiatives underway to improve the hiring process, and if confirmed, I look forward 

to working closely with him to ensure VHA is able to improve its processes. I think 

VHA can reduce the average length of time it takes to fill positions, and I would 

be very interested in hearing from the Committee as well as our union representatives on what approaches they have considered. The most important step we can 

take is to study, review and re-engineer our internal processes to expedite the hiring 

process. If confirmed, I would work with Assistant Secretary SepuAE1lveda on these 

initiatives. 

The Committee and the Senate recently passed S. 1963, the Caregiver and Veterans Omnibus Health Services Act of 2009, which contained a number of human 

resources provisions that will help VA recruit and retain clinicians. Most notable is 

the Secretarial authority to extend title 38 status to additional health care occupations. These are important tools that will help us recruit highly qualified health care 

professionals. 

Question 29. In my view, Physician Assistants play a vital and growing role in 

the delivery of health care. VA has already indicated that they will expand the role 

of the PA Advisor. What new efforts would you undertake if confirmed as Under 

Secretary for Health to ensure full participation of the PA Advisor in health care 

planning and to provide adequate resources for the position? 

Response. I agree with you that Physician Assistants (PA) play a vital and growing role in the delivery of health care in VA. VHA currently employs approximately 

1,900 PAs and is the largest single employer of PAs in the country, employing 2.5 

percent of all those practicing. VA plans to relocate the PA Advisor from a fieldbased to a VA Central Office-based full-time position at the end of the incumbent’s 

term in April 2010. If confirmed, I look forward to discussing with the new PA Advisor how VA can most effectively utilize the position and make the most use of our 

PAs to provide better care to Veterans. 

Question 30. Public Law 109–461, ‘‘The Veterans Benefits, Health Care, and Information Technology Act of 2006,’’ added Marriage and Family Therapists and Licensed Professional Mental Health Counselors to the list of health professionals that 

VA may employ. VHA has said it will begin hiring those professionals by September 2010. Is VHA on target to meet the deadline? 

Response. VA conducted a study to assess the use of marriage and family therapists (MFT) and licensed professional mental health counselors (LPC) in providing 

mental health services to Veterans. Based on the results of this study, VA has decided to develop separate hybrid title 38 qualification standards for the new occupations. VA has begun an extensive job analysis to prepare these qualification standards. Once approved, the standards will be subject to the collaboration process with 

VA’s national unions. We expect this process will be complete by summer 2010. In 

the meantime, Veterans are continuing to receive the mental health care they need 

and deserve. VA is meeting the access standard for a full evaluation and initial 

treatment within 15 days 96 percent of the time. 

There are currently 245 health care employees with an advanced degree in marriage and family therapy and 86 with a background as an LPC. VA will continue 

to hire individuals with these credentials to meet the health care needs of Veterans 

while we work through the process of establishing qualification standards for MFTs 

and LPCs. I would also note, as mentioned earlier, that Vet Centers are able to provide counseling to the families of Veterans as long as it relates to the readjustment 

of the Veteran. 

Question 31. Marriage and Family Therapists and Licensed Mental Health Counselors have similar or comparable qualifications with social workers who have been 

eligible to work with VA for years. If confirmed, how will you utilize these health 

professionals? 

Response. I think there are opportunities for further expansion of VA experts with 

these qualifications providing marriage and family therapy already. If confirmed, I 

look forward to input and recommendations from Veterans, union representatives, 

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and VA leaders on how VA could best use these health care professionals. Of course, 

I would welcome the Committee’s recommendations on this issue as well. 

Question 32. Do you see a value to establishing a position of Chief Psychologist 

at VHA headquarters to ensure that psychologists are involved in rehabilitation, 

long-term care, and primary care? 

Response. My wife is a psychologist, so I can assure you that I am quite aware 

of the abilities of psychologists and the important role they play in the delivery of 

mental health care. The Deputy Chief Consultant for Mental Health, Dr. Antonette 

Zeiss, is a psychologist and brings this perspective to the Office’s discussions and 

policy. Psychologists are well-represented throughout VHA and VA Central Office, 

and VA is the largest employer and trainer of psychologists in the country. The new 

model for health care will involve team care that brings together experts in different 

fields, and psychologists will perform an important function in this delivery model. 

If confirmed, I look forward to examining the role psychologists can fill in developing policy in VA. 

Question 33. Much has been promised in recent years about ensuring that there 

is a smooth transition between DOD and VA for separating servicemembers. What 

is the state of progress in this area, and what more needs to be done? 

Response. In the past few years, VA and DOD have made tremendous progress 

in collaborating to ease the transition of servicemembers. We have several different 

organizations nationally that support this cooperation, such as the Senior Oversight 

Committee, the Joint Executive Council, and the Health Executive Council. More 

needs to be done. Part of the long-term solution to the issue of a smooth transition 

is the Virtual Lifetime Electronic Record (VLER). VLER supports a Veteran-centered approach to health benefits and provides uniform, comprehensive services and 

consistent access to information for Veterans and providers. VLER will streamline 

the use of data and reduce the burden for beneficiaries to provide information, improve quality and support more effective and efficient delivery of care and benefits, 

and reduce costs by decreasing errors and duplicate tests. VLER will begin with a 

production pilot in San Diego that will be achieved in January and will include additional pilots by the end of FY 2010. 

In the short- to medium-term, VA should continue its efforts to transitioning Veterans returning from service in Iraq or Afghanistan. In 2008, VA expanded and enhanced outreach services to Operation Enduring Freedom/Operation Iraqi Freedom 

(OEF/OIF) servicemembers and Veterans with hands-on briefings, health care enrollment and personal interaction at: 

• Demobilization briefings at 61 sites; • Yellow Ribbon Reintegration Program events at 30–60–90 day Post-Demobilization events; • Post-Deployment Health Reassessments (PDHRA), including those conducted at 

VAMCs; • Combat Veteran Call Center to contact all separating OEF/OIF Veterans; • National Guard and VA partnership between Transition Assistance Advisors 

and state coalitions; • Individual Ready Reserve Musters at community locations or VAMCs; and • OEF/OIF Web site. 

Our outreach efforts have provided Veterans with knowledge and access to VA 

services and benefits; of the 1,070,000 who have separated from active duty since 

2002, 46 percent have used VA. VA established OEF/OIF Care Management teams 

in each VISN and has placed an OEF/OIF program manager, Transition Patient Advocate, and case managers at every Medical Center to identify OEF/OIF Veterans, 

coordinate the delivery of care and services for them, and provide case management. 

For wounded, ill and injured Veterans, VA has stationed 31 liaisons at 17 Military 

Treatment Facilities to facilitate the transfer of care to VA health care facilities. Together with DOD and VBA, VHA has actively participated in the Disability Evaluation System (DES). This program provides streamlined disability exams for wounded, ill and injured servicemembers. Jointly, we are expanding this initiative to cover 

additional DOD sites. We are expanding our call center activities to include a specific focus on women Veterans and developing strategies to identify OEF/OIF Veterans at high risk for homelessness. 

Question 34. How do you propose, if confirmed, to really create movement between 

DOD and VHA in information sharing? 

Response. VLER is part of the long-term solution for information sharing. VA 

must maintain a strong working relationship with DOD, and based on my experience in Minneapolis, I know firsthand how beneficial complete access to information 

can be. At the Minneapolis Polytrauma Rehabilitation Center (PRC) clinicians receive significantly more information now than they did 5 years ago, including imVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00105 Fmt 6601 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
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ages and data from the combat theater. By placing liaisons in each other’s facilities, 

VA and DOD are supporting patient transfers with teams of case managers and a 

warm handoff. The Federal Recovery Coordination Program has done tremendous 

work with the most severely injured and ill servicemembers and Veterans. 

VA currently has several modalities that help with information sharing. First, the 

Federal Health Information Exchange (FHIE) supports the monthly, one-time transfer of viewable historical electronic health information from DOD to VA upon a servicemember’s separation or retirement. DOD has transferred electronic health data 

on more than 5 million retired or discharged servicemembers. 

Second, the Bidirectional Health Information Exchange (BHIE) enables real-time 

sharing of viewable electronic health information between VA and DOD for shared 

patients. BHIE supports care for more than 3 million shared VA/DOD patients. 

BHIE and FHIE are viewable by VA clinicians treating patients or VBA claims staff 

adjudicating disability claims. 

Third, the Clinical Health Data Repository (CHDR) is an interface between DOD’s 

Clinical Data Repository and VA’s Health Data Repository that supports the exchange and storage of computable allergy and pharmacy information for active dual 

consumers of VA and DOD health care. CHDR computable data supports drug-drug 

and drug-allergy interaction checks. 

In September 2009, VA and DOD successfully implemented improvements to existing systems to support full interoperability of health data as mandated by the 

2008 NDAA and defined by the Interagency Clinical Informatics Board. Most recently, on November 25, 2009, VA announced a partnership with Kaiser Permanente 

to launch a pilot program that will exchange electronic health record information 

using the Nationwide Health Information Network. 

Question 35. Access to health care, especially mental health care, continues to be 

an issue for National Guard and Reserve members. If confirmed, how will you work 

to ensure that members of the Guard and Reserve get the VA health care for which 

they are eligible? 

Response. In Minnesota, the Beyond the Yellow Ribbon Program has proven highly successful in reaching members of the National Guard; VA has been able to contact almost 90 percent of Guard members and we have seen enrollment rates as 

high as 76 percent at some events. As Network Director in VISN 23, we involved 

VHA and VBA personnel at these and other events to let recently separated Veterans and their families know about the array of benefits they have earned in service to their country. VA also works closely with State Departments of Veterans Affairs. I would like to see elements of this approach adopted nationally, and if confirmed, I look forward to discussing this issue with you to learn what approaches 

you think VA could adopt to provide even better support for Veterans. 

Enrolling and working with members of the Reserve Component is more difficult 

because they are often scattered throughout the state. VA can and must visit demobilization sites to reach these members while they are still gathered in one place. 

Additionally, VA has an assortment of other national outreach efforts, including the 

Yellow Ribbon Reintegration Program, the Post-Deployment Health Reassessments, 

the Combat Veteran Call Center Initiative, National Guard and VA partnerships, 

Individual Ready Reserve Musters, and VA’s OEF/OIF Web site. VA presently has 

staff at all 61 demobilization sites for the Reserve Components and has reached out 

to over 73,000 members while offering them opportunities to enroll into VA health 

care. VA also reaches this group of Veterans and their families through social media 

(including YouTube, Facebook, Twitter, and blogs) as well as our internet presence. 

VA continues to use face-to-face encounters and personal calls to returning servicemembers to coordinate appointments for their health care needs. 

Question 36. Recently, the Committee held hearings on contract health care in 

VA. During that hearing, it was noted that VA has over 2,000 different contracts 

for health care. If confirmed, how will you ensure that VA oversees the quality of 

care provided by contract providers? 

Response. Contract care is a potential vulnerability within our system. The variation of requirements and standards is one area that will receive my close attention 

if I am confirmed as Under Secretary for Health. VA should standardize organizations and business practices to ensure quality controls are maintained with any care 

provided outside of a VA facility or by a contractor within a VA hospital. This means 

including requirements that contractors meet VA quality assurance measures and 

defining mechanisms for auditing the care provided to ensure it meets or exceeds 

our standards, among other conditions. 

Question 37. Recently, S. 1963, the proposed Caregiver and Veterans Omnibus 

Health Services Act of 2009 passed the Senate unanimously. What are your personal views on the role VA should have in assisting caregivers with their critical 

103 

role? If confirmed, what steps would you take to ensure timely implementation of 

the bill, once it becomes law? 

Response. If confirmed, I plan to implement all legislation as quickly as possible. 

The Senate voted to approve S. 1963, which contains a number of provisions for 

caregivers. VA has been working diligently with your staff, the House, and the Office of Management and Budget to develop a position on a comprehensive system 

of increased benefits and support for caregivers. VA currently has a full-time national Caregiver Support Program which is developing a system-wide approach to 

caregiver assistance in consultation with its established Caregiver Advisory Board. 

All VA medical centers have an appointed Caregiver Support Point of Contact to facilitate local activities and identify best practices. Additionally, VA concluded eight 

caregiver assistance pilot programs in August 2009. These identified best practices 

for providing caregiver training and education and support services, including a 

range of options for respite care. VA is developing national recommendations based 

on this work that will create a solid foundation for the national Caregiver Support 

Program. 

Question 38. VA has long played a significant role in training future health care 

providers through its affiliation with academic centers. What is your sense of the 

overall state of VA affiliations? 

Response. The overall state of VA affiliations is strong, but there is always room 

for improvement. The Secretary recently accepted the report of a distinguished 

panel, the Blue Ribbon Panel on VA-Medical School Affiliations, which provided 44 

specific recommendations to further enhance this important partnership. VHA is developing an implementation plan that will provide a template for taking action on 

these recommendations and is expected to provide a report to Congress on progress 

in the near future. Medical affiliations with the Nation’s health professional schools 

enhances the quality of care VA provides, as students are apt to ask questions about 

why care is provided in the manner it is; these teaching opportunities benefit Veterans, clinicians, and affiliates. 

Twenty-seven percent of VA’s clinical staff trained in a VA medical center prior 

to their employment, including nearly 60 percent of our physicians and 70 percent 

of our optometrists and psychologists. Currently, 89 percent of VA trainees would 

recommend their training to others, and 86 percent feel that their training in VA 

is equivalent or better than comparable training at other sites. Nearly two-thirds 

of VA trainees consider employment with VA after their training rotations end. VA 

is a national resource for health professions education, training over 100,000 students in more than 40 disciplines annually. VA is the only Federal agency presently 

addressing the national shortage of physicians by expanding its support for graduate medical education (GME). In October, VA awarded 254 new GME positions, 

bringing the total of new positions awarded as part of the GME Enhancement Initiative to over 1,200 of the 2,000 initially approved for distribution. Approximately 

80 percent of these new positions have gone to areas of the country with the largest 

increase in Veterans. VA also established five new partnerships for the VA Nursing 

Academy in April, for a total of 15. 

Question 39. If confirmed, how will you strengthen those affiliations, to ensure 

more training opportunities in areas such as telemedicine, nursing, and physical or 

occupational therapy? 

Response. Affiliations are a critical component of VA care. VA is developing a new 

model of care that is patient-centered, continuously improving, and utilizing a team 

approach to health care. VA is working with its academic partners to take the lead 

in creating patient-centered, team-based and inter-professional educational programs. VA is currently the largest provider of telemedicine in the country, and has 

significant opportunities for training in this area. VA is expanding training programs in areas of specific Veteran health care needs, such as mental health, rehabilitation, Traumatic Brain Injury and rural health. Nursing is another area where 

VA is helping address the national shortage of health care providers through the 

VA Nursing Academy. 

Question 40. What is your view of the VA nursing academy and the resulting 

partnerships? 

Response. The VA Nursing Academy is a concept I fully endorse. Nurses are the 

backbone of the VA system, and our care is only as good as the people who provide 

it. VA launched the VA Nursing Academy to address the nationwide shortage of 

nurses. The purpose of the Academy is to expand the number of faculty in our affiliated nursing schools, increase nursing student enrollment, increase the number of 

students who come to VA for clinical training, and promote innovations in nursing 

education and clinical practice. Four partnerships were established for the 2007– 

2008 school year. Six additional partnerships were selected in 2008. Earlier this 

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year, VA announced five new partnerships in Asheville, NC; Birmingham, AL; Honolulu, HI; New York, NY; and Pittsburgh, PA. 

Question 41. Traumatic Brain Injury has been described as one of the signature 

wounds of the Iraq and Afghanistan war. What is your view of the overall VA capacity to treat TBIs? What is your sense of how VA is working with community TBI 

programs to ensure appropriate referrals? What is your view about VA’s ability to 

fully address the blindness, hearing loss, and tinnitus that often accompany TBI? 

Response. VA has an excellent system for Traumatic Brain Injury (TBI) and polytrauma care. VISN 23 is home to the Minneapolis PRC, so I have seen firsthand 

how much this system can save and improve the lives of Veterans and their families. For almost 20 years, VA has had centers with developed expertise in military 

service related brain injuries unmatched in the civilian community. The VISN 

works closely with community providers as a complement to VA’s care if VA facilities are geographically inaccessible or VA is otherwise unable to provide the needed 

treatment. As Network Director, I approved several such requests for care outside 

the VA, despite the greater cost, because this was what the Veteran needed. VA routinely establishes cooperative agreements with private sector facilities to provide 

specialized TBI neurobehavioral care and services to Veterans. VA has integrated 

teams of clinicians, including experts in sensory loss (audiologists, ophthalmologists, 

optometrists, Blind Rehabilitation Specialists, etc.) who are available to help Veterans with TBI and polytrauma to address other symptoms such as blindness, hearing loss, or tinnitus. 

With regard to blindness and low vision, VA has an exceptional program that provides care and support in locations across the country on both an inpatient and outpatient basis. The Polytrauma System of Care provides specialized medical rehabilitation, coordinates support efforts, and provides information for patients and family 

members across the country. VA currently has 108 specialized TBI rehabilitation locations across the country. Our PRCs have telecommunications equipment where 

they can conduct video-conferences with other facilities if these locations need additional expertise or consultative support. VA is also establishing Assistive Technology 

Laboratories at the PRCs to provide the most advanced technology to Veterans and 

servicemembers. Finally, VA has a comprehensive TBI Screening and Evaluation 

program to assess all OEF/OIF Veterans entering the VA system. Since April 2007, 

any OEF/OIF Veteran seen by a VA health care provider is screened for possible 

TBI. To date, VA has screened over 354,000 OEF/OIF Veterans for mild TBI, and 

approximately seven percent (24,559) have received a confirmed diagnosis of mild 

TBI. 

Question 42. What progress has VA made in getting the Vision Centers of Excellence up and running? What remains to be done? 

Response. Over 182,000 diagnoses of ocular injury were made among active duty 

servicemembers between 1998 and 2007. The rate of injury rose after 2000 due to 

increased exposure to blast injuries. VA understands the importance of providing 

the best care possible to Veterans with these injuries, and the Vision Center of Excellence is an important resource for these Veterans and their providers. In October 2009, VA and DOD signed a Memorandum of Understanding to support the new 

Vision Center of Excellence (VCoE). Both the Director and Deputy Director have 

been appointed. Three of six VA hiring actions have been completed, and VA has 

committed $6.9 million to support staff development and educational programs 

through FY 2013. VCoE is cosponsoring a conference for providers in December 2009 

on TBI-related visual and auditory impairment, and is planning a conference on artificial vision and retinal prostheses for late FY 2010. The data fields for the Eye 

Injury Registry were defined earlier this year, and while it is being developed, VA 

data needed to populate the Registry will be accrued and stored in a VA database 

by the second quarter of FY 2010. VA anticipates it will complete recruiting for support staff by the end of the second quarter of FY 2010. 

Question 43. In 2003, VA and the Indian Health Service entered into a Memorandum of Understanding to improve care for Native American veterans. More than 

six years later, progress remains limited. What would you do if confirmed as Under 

Secretary to improve this coordination? 

Response. As Network Director for VISN 23, I have a great deal of experience in 

working closely with IHS and other organizations to provide care and outreach to 

Native American Veterans. VISN 23 has 27 Native American reservations, and has 

developed programs on many reservations to help Veterans. We worked with Tribal 

communities to develop CBOCs, Post Traumatic Stress Disorder (PTSD) treatment, 

and telehealth support sites, and developed a compensated work therapy program 

in South Dakota. This is an underserved population and we have to do more to 

reach them. In my experience, 50 percent of the adult male Native American popuVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00108 Fmt 6601 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
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lation in South Dakota was Veterans, and VA supports both national and local efforts to create a better support system for them. A key component of this effort is 

culturally appropriate training. One example of this type of training we used in 

VISN 23 was a weeklong retreat for VA employees working with the Lakota Tribe 

that proved very effective in terms of building relationships and supporting care. 

Question 44. With the increasing number of women veterans, how do you intend, 

if confirmed, to ensure that their gender specific needs are met and that VAMCs 

are accessible to them, including women veterans with catastrophic disabilities like 

spinal cord injury? 

Response. Women Veterans are increasingly enrolling in the military, and in VA. 

They are also using our services at greater and greater levels. VA must find ways 

to meet their needs through improved services, access, and privacy. VA is upgrading 

our facilities and CBOCs to ensure they are focused on safety, dignity and sensitivity to deliver comprehensive primary care for women that includes gender specific 

needs. Where feasible, VA is developing comprehensive and integrated women’s 

health care on all our campuses to provide one location for women’s care-primary, 

gynecological, mental health and all necessary services. Gender specific cases like 

breast cancer are relatively few in VHA, but they are no less important than outside 

VA. The Office of Patient Care Services and the Women’s Health Strategic 

Healthcare Group are developing a methodology to track all women with breast cancer to ensure they receive an appropriate diagnosis, treatment and follow up. 

As the Secretary has said, this is an area where VA is playing catch-up, and if 

confirmed, I will make it a priority as Under Secretary for Health. VHA facilities 

just completed implementation plans for the delivery of comprehensive primary care 

for the next five years. These plans include the resource and staffing needs to fully 

address the increasing demands for care delivery for women Veterans through a patient-centered medical home approach. 

Question 45. Providing outreach and education to women veterans are crucial 

tasks as VA transitions into a 21st Century health care system. If confirmed, how 

would you collaborate with the Center for Women Veterans to accomplish these 

tasks? 

Response. VHA’s Offices of Patient Care Services and Operations and Management are working closely with VHA’s Women Veterans Health Strategic Healthcare 

Group to identify the needs of women Veterans and institute policy changes to provide greater privacy and dignity for women Veterans. This work group also works 

closely with the Center for Women Veterans to conduct outreach and develop new 

policies and proposals, and VHA has an advisor on the Department’s Advisory Committee on Women Veterans. This means creating an environment in which women 

Veterans can feel comfortable enough to seek care. And it means responding to the 

actual needs of women Veterans. 

One area I have always wanted to see VHA do better in is encouraging direct 

input from Veterans. If confirmed, I will see that this happens. VHA should conduct 

focus groups with different populations to find out what care and services they want 

and how they want it. That includes sitting down with women Veterans and hearing 

from them about how VA can meet and exceed their expectations for care. Close collaboration with the Center for Women Veterans can make this a successful venture. 

Conducting outreach to women Veterans through the existing Combat Call center 

infrastructure will also be helpful. 

Question 46. What do you see as VHA’s role in the campaign to end homelessness 

among veterans within five years? 

Response. VHA has a major role in the President’s and the Secretary’s campaign 

to end homelessness. The vast majority of our budget to combat homelessness, approximately 80 percent, comes from VHA which finances the grant and per diem 

program, the domiciliary programs, and we conduct outreach to homeless Veterans 

or those at-risk for homelessness. The recent and ongoing expansion of the Department of Housing and Urban Development-VA Supported Housing (HUD-VASH) program helps VA offer permanent housing to Veterans and family members when they 

need it. Many of the factors that contribute to homelessness are health issues, such 

as mental health disorders, substance use disorders, and the like. Consequently, to 

end homelessness, VHA must provide Veterans the health care they need to treat 

the underlying conditions. 

Question 47. If confirmed, how will you work with the Under Secretary for Benefits to resolve information sharing issues so as to attempt to ensure that veterans 

receive all of the benefits, both monetary and health related, for which they are eligible? 

Response. VHA and the Veterans Benefits Administration (VBA) play important, 

complementary roles in supporting Veterans. While many processes and objectives 

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are distinct, there are important areas of overlap. For example, many of the examinations VBA needs completed to make assessments concerning compensation and 

pension are done by VHA providers. VHA also supports rehabilitation and compensated work therapy programs, which complement VBA’s vocational rehabilitation 

and employment programs. I think VHA and VBA must work closely together, because to Veterans, there is no distinction-there is just one VA. While I was the Network Director of VISN 23, we regularly had our medical center directors meet with 

VBA regional directors to share information and identify new ways to collaborate. 

I think this kind of cooperation at the local and national levels will strengthen the 

bonds between the two administrations and within VA, ultimately resulting in better care and services for Veterans. 

Question 48. If confirmed, how would the division of labor work between the 

USH’s office and the Chief Information Officer’s office on health technology matters? 

Response. The new Assistant Secretary for Information and Technology (OI&T), 

Roger Baker, has done an excellent job in improving cooperation and coordination 

between OI&T and VHA. The Under Secretary for Health and the Chief Information 

Officer should work together closely to identify priorities and fund these projects as 

well. VA has made significant progress in defining the areas where OI&T will have 

the lead and where VHA’s Office of Health Information will have the lead. This includes distinguishing between information technology and medical equipment, 

where VHA will set policy and priorities. This has been particularly helpful with 

regard to expanding telehealth. 

Question 49. In your view, what additional applications of VHA’s Information 

Technology capability are crucial? If confirmed, how will you work with the CIO to 

ensure the development and implementation of new applications? 

Response. It is clear that health information technology will become even more 

critical to effective health care in the future. As the Veteran population continues 

to embrace technology as a primary means of communication, we must adopt similar 

technologies to effectively reach and care for them. Veterans are increasingly using 

their personal health record, My HealtheVet, to manage their health care and interact with VA. Secure messaging is being piloted in locations across the country to 

facilitate better communication between Veterans and their providers. 

Under the leadership of Assistant Secretary Baker, VA can provide the efficiencies 

and returns on investment that Veterans, Congress and the public expects. VHA 

meets regularly with Mr. Baker to identify opportunities for partnership. 

Question 50. What is your view about allowing State Veterans Homes to draw 

upon the same revenue sources as Community Nursing Homes are able to draw 

upon for the care of highly service-connected Veterans? 

Response. State Veterans Homes are an invaluable asset, and VA complies with 

existing law with regard to payment for care for highly service-connected Veterans. 

VA is continuing discussions with the Committee and if confirmed, I look forward 

to hearing your thoughts on this subject. 

Question 51. Do you believe that the Health Care Center Facility Leasing Program is a viable alternative to major construction? When are such leases appropriate? 

Response. Health Care Center leasing can be a viable alternative to major construction, but this has to be a site-specific determination. There is a threshold below 

which it may not make sense to build a new facility, particularly given the delay 

that would result from the major construction process. Providing medical care space 

through leasing, rather than construction, results in quicker occupancy of state-ofthe-art, right-sized buildings. Leasing also provides flexibility for an exit strategy 

if required based upon changing Veteran demographics. VA can also mitigate space 

and infrastructure deficiencies, providing a consolidated, Veteran-centric, modern, 

safe health care environment. The major lease process is a two-step process where 

VA competitively preselects a site, determines the conceptual design for the new facility, and then competitively procures a developer who will purchase the site, build 

the facility, and lease it to VA. This process normally takes 16 to 18 months. Smaller facilities may be procured in a shorter timeframe using a one-step process where 

the site and developer are selected simultaneously. Once a contract is awarded, a 

new leased facility is ready for activation following an average construction period 

of two years. VA procures leases for 20 years, the maximum term allowed by General Services Administration (GSA) regulations. 

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RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO ROBERT A. PETZEL, M.D., NOMINEE TO BE UNDER SECRETARY FOR HEALTH, VETERANS

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS


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RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

ROBERT A. PETZEL, M.D., NOMINEE TO BE UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. In your responses to my prehearing questions, you indicated a desire 

to reduce variation throughout the VA health care system, while still allowing the 

networks to experiment with new approaches. Please explain what your specific 

plans are in this area. 

Response. There are many areas where we need to reduce variation and many 

methods we can use to accomplish this end, so I will outline a few I think we can 

adopt to improve the quality of care and services we provide. First, we need to reduce variation in the methodology we use to distribute resources from the network 

level to the facility level. We also need to reduce variation within our networks 

through consolidated services, such as biomedical engineering, the business office, 

and laboratory and imaging equipment. One example of a consolidated approach the 

Department of Veterans Affairs (VA) has recently adopted is with regard to 

endoscopes. By moving to a national contract with three vendors, we can both more 

effectively use resources and enhance the quality of care by simplifying the processing and re-processing of this type of medical equipment. 

We also need to look at standardizing the organization and structure of our networks. The fee care program is another area where we can reduce variation. VA 

must continue standardizing clinical care around evidence-based practices. We can 

do this by promoting clinical practice guidelines. During the beginning of his tenure, 

Secretary Shinseki asked for a briefing from each Veterans Integrated Service Network (VISN), and we can use the lessons learned from these discussions to identify 

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Question 2. As a network director, how did you respond to the ‘‘management’’ of 

your network by Central Office? For example, on one of your evaluations, you were 

encouraged to do better with regard to providing fee basis care within 30 days. As 

the Under Secretary for Health, how will you modify management approaches, 

stemming from your own experiences? 

Response. As Network Director, I responded to requests from Central Office to improve our processes by focusing on areas identified as needing improvement. For example, when Central Office informed me that we should be doing better with regard 

to providing fee basis care, we provided additional resources and attention and are 

now one of the best in the country in terms of processing fee basis requests. If confirmed as Under Secretary for Health, I will first clearly define where we are and 

where we are going as a health care system. This vision is essential to any further 

progress. Second, I would clearly explain to our Network Directors our expectations. 

Third, I would provide our leadership and facilities across the country with the resources and training necessary to meet those expectations. Finally, I would ensure 

the system monitors, measures, and maintains those expectations to verify they are 

being met. If they are not, we will hold our leadership accountable. This may mean 

providing greater education or training, connecting compliance with performance 

awards, or disciplinary action, if justified by the circumstances. 

Question 3. VA health care has been criticized lately for not being the ‘‘best.’’ My 

goal is to ensure that VA care of all kinds, but especially care for war traumas, 

should be the best. How do you answer those who wish to contract out more of VA 

care? 

Response. If we are going to be the health care provider the American people look 

to in terms of fulfilling our promise to America’s Veterans, we must be a system 

that develops and uses expertise in Veteran-specific health care conditions to ensure 

Veterans receive the best care possible. Veterans deserve no less, and I believe that 

contracting out care would reduce this specialized knowledge and ultimately result 

in worse health care for Veterans. We must maintain competencies in these Veteran-specific areas (such as Post Traumatic Stress Disorder and Traumatic Brain 

Injury) while also continuing competencies for general health care needs that Veterans will have. VA providers have specific knowledge and a sensitivity to conditions or cultural attributes specific to the Veteran population, and these represent 

a unique benefit of the VA system. Our comprehensive and integrated health care 

system also offers unmatched quality and care for Veterans. With that being said, 

there are times when VA will need to contract for care or use our fee-basis authority, and in these circumstances, it is our responsibility to ensure these community 

providers are offering the quality care our Veterans deserve. 

Question 4. Walter Reed is providing the most sophisticated artificial limbs and 

the Center for the Intrepid at the Brooke Army Medical Center is the premier rehabilitation facility for war injuries. How do you plan to bring VA prosthetics care up 

to par with these facilities? 

Response. I believe we do an excellent job with the operational aspects of providing Veterans with the prosthetic services they need. I understand your point 

about providing the latest technologies to Veterans, and if confirmed, I will ensure 

VA continues to provide state-of-the-art technology to our Veterans. VA is establishing an amputation system of care, which will include a tele-amputation system 

of care, to make available expert advice on post-amputation care widely available. 

This system will also include a link to Walter Reed Army Medical Center to access 

their expertise, when appropriate. 

Question 5. There are many VA research facilities that are in dire need of updating and renovation in order to accommodate cutting edge research. The Committee 

hears frequently about leaking roofs and pipes, inadequate ventilation, and even unsafe buildings. We have not yet seen a plan from VA to address this need. What 

is your plan for bringing VA’s research facilities into the 21st century? 

Response. VA needs a consolidated plan to address the capital needs of our research facilities. Research has long been the ‘‘crown jewel’’ of the VA system, but 

to maintain this program will require long-term investment. If confirmed, I will 

work as Under Secretary for Health to provide our research program the funds they 

need to conduct minor construction or other repairs to support these efforts. The Office of Research and Development has conducted a comprehensive analysis on 53 VA 

research facilities, and we will analyze 20 additional facilities by November 2010. 

In response to the issues we identified in these surveys, VA allocated over $41 million in FY 2009 toward upgrading our research facilities. We anticipate a similar 

level of construction for FY 2010, in addition to an anticipated expenditure of more 

than $23 million in non-recurring maintenance funds to support improvements in 

20 research facilities, including clinics and laboratories in: Boston, MA; Providence, 

115 

RI; Canandaigua, NY; Durham, NC; Columbia, SC; Lexington, KY; Cincinnati, OH; 

Ann Arbor, MI; Indianapolis, IN; Milwaukee, WI; Houston, TX; San Antonio, TX; 

Salt Lake City, UT; Portland, OR; Seattle, WA: San Diego, CA: and West Los Angeles, CA. I recognize the critical role VA’s research opportunities can fill in recruiting 

and retaining highly qualified physicians, and I will work to improve this program. 

Question 6. The challenges of reaching veterans in rural America are well documented. How will you, if confirmed, effectively conduct outreach to these veterans, 

especially when VA points of care are so far removed from their communities? 

Response. I think that if we are going to meet the needs of rural Veterans, we 

must support and advance four key areas. First, community-based outpatient clinics 

(CBOC) and Vet Centers have been an important resource over the past decade in 

bringing care closer to home for many Veterans. VA currently operates 783 CBOCs 

and 233 Vet Centers and by the end of fiscal year (FY) 2010, we will operate more 

than 850 CBOCs, while by the end of the second quarter of FY 2010, we will have 

activated an additional 39 Vet Centers. We similarly operate 40 outreach clinics in 

rural and highly rural areas. We will continue to assess the needs of other locations 

and develop resources accordingly. Second, we must support telehealth and telemedicine programs that facilitate the delivery of health care in the Veteran’s home 

or the Veteran’s community. We have been expanding these programs, and I will 

ensure continued robust support if confirmed. Telehealth-based care to rural Veterans increased by over 20 percent in FY 2009, with more than 116,000 Veterans 

receiving such care. VA is establishing a National Telemental Health Center to coordinate delivery of specialist mental health advice with an emphasis on rural locations, and has developed a Clinical Enterprise Video-Conferencing Network that 

greatly enhances the ability to deliver this care. Third, home-based primary care 

(HBPC) is another model of care VA can use to meet the needs of rural Veterans. 

Many of our VA medical centers (VAMC) offer HBPC, and we are expanding this 

program to rural and highly rural areas by supporting these teams at our larger 

CBOCs. This year, we have identified 39 new sites for HBPC care in rural and highly rural areas alone. Finally, there will be times when VA will need to contract for 

care or use its fee-basis program. When this is necessary, it is important that we 

reduce the variation across our system in how we make these arrangements and 

process payment so that these valuable partners will remain a resource for Veterans. Congress has generously provided the Office of Rural Health with resources 

to enhance these four approaches and others, and I look forward to the potential 

some of these programs have for greater use. 

Question 7. From your own experience in Network 23, what specifically did you 

learn about the best ways to reach rural veterans? 

Response. In VISN 23, a network home to many rural areas, we found the four 

approaches described in my previous response to be very effective. Rural areas are 

not all the same, though, and a ‘‘one size fits all’’ approach is unrealistic. 

Question 8. The problems at the Marion, Illinois VA are well documented and 

speak to tremendous failures in quality management. The Majority Whip here in 

the Senate wished to relay his concerns to you on Marion, and to ask about your 

plans to provide a robust quality management program at all levels and in every 

facility involved in VA health care. Please share your plans. 

Response. I am committed to ensuring that the Quality Management System 

throughout VA optimizes health care processes and outcomes through an organized, 

systematic approach to planning, delivering, measuring, and improving health care. 

Lessons from health care and other industries, as well as my personal experience, 

highlight the critical role of leaders throughout the organization, and particularly 

senior leadership, in ensuring that health care is safe, effective, patient-centered, 

timely, efficient, and equitable. The role of leaders must therefore be reflected in 

accountability structures; the flow of quality management data within and outside 

the organization; and identification, prioritization, and coordination of improvement 

activities. 

If confirmed, I will ensure that clear expectations and the resources to meet those 

expectations are provided to our Networks and facilities. One important element of 

a strong quality management program is inculcating a culture among both leadership and staff that embraces the value of quality programs. We will achieve this 

culture by providing clear messages reinforced by appropriate education and training; by connecting quality management programs to our performance assessments; 

by ensuring we have the correct personnel in place at our facilities; and finally, 

through the appropriate use of policy, guidance and oversight. For example, we are 

currently using our available recruitment and retention incentives to attract highly 

qualified providers and executives to locations like Marion. Furthermore, we are initiating steps to improve our peer review process by bringing outside experts to reVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00119 Fmt 6601 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
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view episodes of care provided at our facilities. VA recently issued revised guidance 

for quality management, peer review, and the credentialing and privileging of physicians, and we will undertake a series of educational events directed at facility leaders in 2010. Finally, as part of the Secretary’s overarching vision for transformation, 

we are working to provide Veterans, their families, and the American public with 

comparative information about VA hospital performance, including data about mortality, readmissions, and health care-associated complications. 

Question 9. During the nomination hearing you stated that you believe it is possible that we end homelessness among veterans in the next five years by addressing 

the present homeless population and by providing services to those who might become homeless. How do you believe VA can identify those veterans ‘‘who might become homeless?’’ 

Response. To identify Veterans who might become homeless requires close cooperation with a number of partners. For those Veterans already in the VA system, 

our integrated health care system provides mental health resources in primary care 

settings and can be an effective early warning system to identify Veterans with conditions such as substance use disorders or severe mental illness that could put them 

at risk for homelessness. There is a body of research that identifies risk factors for 

homelessness; these include prior episodes of homelessness, mental health issues, 

substance abuse, incarceration as an adult, and lack of income. 

VA can also work with homeowners who have used the Veterans Benefits Administration to identify Veterans who are falling behind on their mortgages and provide 

additional support to them. The bigger challenge is reaching those Veterans not 

within the VA system. To help them, VA must partner with other Federal, state and 

local groups, both governmental and non-governmental (such as our many grant and 

per diem partners) to conduct outreach and provide services to Veterans. 

Question 10. What do you envision to be ‘‘long term solutions’’ for problems, such 

as mental illness, that lead to chronic homelessness? 

Response. The President and the Secretary are committed to ending homelessness 

among Veterans in 5 years, and to do this will require long term solutions. The most 

challenging group of Veterans in this regard is the chronically mentally ill. VA will 

need to enhance its system of transitional housing and supportive services that either we provide or that we have arranged with community partners to provide, to 

ensure that housing and mental health services are available to this vulnerable population. The Secretary is committed to a review of existing VA facilities that will 

identify infrastructure we can use to support these objectives. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY TO ROB- ERT A. PETZEL, M.D., NOMINEE TO BE UNDER SECRETARY FOR HEALTH, VETERANS

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. Painful and disabling joint and back disorders continue to be reported 

as the top health problems of veterans returning from Iraq and Afghanistan, according to Department of Veterans Affairs’ (VA) statistics. Recent numbers from the VA 

now show that nearly half of these returning veterans are offered preliminary diagnoses of musculoskeletal ailments. However, the VA currently has only 28.5 chiropractors providing on-station care and services at 36 facilities, according to written 

testimony provided to this Committee by VA Acting Under Secretary for Health 

Gerald Cross earlier this year. This written testimony also states that the VA does 

not oppose eventually increasing the number of VA sites providing chiropractic care. 

a. In your experience as VISN 23 Network Director, was chiropractic care readily 

available to veterans, and especially to veterans of the wars in Iraq and Afghanistan? 

Response. In my experience in VISN 23, I was not aware of any complaints from 

Veterans about accessing chiropractic care. This care and service was available to 

Veterans at each of our facilities, whether through an in-house provider, a contract 

agreement, or through fee-basis. 

b. If confirmed, what assurances could you give that chiropractic care at VA major 

medical facilities is expanded within a reasonable timeframe? 

Response. My understanding is that VA has a policy to provide chiropractic care 

to Veterans in need of those services. If confirmed, I would ensure this policy is 

being implemented and that this care is accessible. I can assure you that if confirmed, we will periodically assess demand for chiropractic services to determine if 

additional resources are needed. 

c. What new reporting procedures or policies, if any, will you establish within the 

VA to ensure the adequate provision of chiropractic care? 

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Response. VA’s Office of Rehabilitation Services is responsible for overseeing 

chiropractic care, and if confirmed, I would ask them for quarterly updates for each 

VISN to determine patient demand and usage to determine if additional resources 

are needed. 

Question 2. I have been informed that companies known by the VA as ‘‘resellers’’ 

have experienced significant difficulties attempting to secure and maintain FSS contracts which would enable them to compete for orders to supply VA medical facilities. The departure of some of these companies from holding FSS contracts has resulted in significantly higher prices paid by VA hospitals to purchase supplies. Will 

you work with VA management in an effort to resolve this matter and thus ensure 

greater competition in the procurement process? 

Response. Yes, if confirmed I will work with VA management to explore options 

for contracting arrangements involving reusable medical equipment. 

Question 3. More and more women are separating from the uniformed services everyday and one message I hear time and time again is that the VA is ill prepared 

to deal with the needs of female veterans. 

a. How did you address this in VISN 23 and how do you aim to address this as 

head of the Veterans Health Administration? 

Response. In VISN 23, we ensured every VAMC in our network had an identified 

women Veteran’s program manager long before it was required nationally. We also 

encouraged our facilities to develop women’s health clinics at our major locations. 

One important step we took that proved quite effective was to hold women Veterans 

focus groups where we solicited information from them to determine what care they 

needed and how they wanted it to be provided. If confirmed, I will ensure all of our 

medical centers to do this as well. VA has recently conducted an extensive survey 

of women Veterans to understand their use of health care and perceived barriers 

to receiving care in VA. We will quickly analyze those results and brief the Committee on the results. In addition, we have already conducted a national evaluation 

of our health care environment to identify privacy and dignity concerns applicable 

to women Veterans based upon an evaluation by the Government Accountability Office. If confirmed, I will ensure these facilities receive the necessary resources and 

attention to resolve these issues. We also need to provide comprehensive services 

to women Veterans; I believe this can be done either through separate women’s 

health clinics that offer primary and specialty services in an exclusive clinic for 

women, or through a comprehensive primary care setting. Third, if confirmed, we 

need to increase training for our health care providers to improve their awareness 

and sensitivity to women Veterans’ health care needs. VA currently offers a miniresidency for women’s health, through which we have trained over 300 providers. 

We are committed to training at least one provider at every site, including CBOCs, 

by the end of next year. Finally, we need to adapt our programs to meet the needs 

of women Veterans by providing newborn care. We also need to work with Congress 

to find an approach that can facilitate access in the first place by providing or making available child care for all Veterans, not just women Veterans. If confirmed, I 

look forward to working with the Committee to develop just such a proposal. 

b. What is the VA currently doing to prepare for female veterans returning Afghanistan and Iraq? 

Response. VA has a number of programs underway to meet the needs of women 

Veterans, including women Veterans returning from Iraq and Afghanistan. With 86 

percent of this group under the age of 40 and of child-bearing age, we have refocused primary health care to be proficient in gender-specific care issues for 

women. Our facilities have identified deficiencies with regard to privacy and dignity 

and are working to rectify these, and we have placed full-time Women Veterans Program Managers at all 144 of our health care systems. Currently, 68 percent of VA 

providers are women, and while we have a policy that allows a Veteran to request 

a provider of the same gender, if confirmed, I would ensure this is being followed. 

We have a number of outreach programs for Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, and part of this program is focusing specifically on women Veterans to inform them of the benefits they have earned 

through service. Finally, VA has provided $25 million to hire and staff counselors 

specifically for women Veterans at 160 Vet Centers. 

Question 4. As a Senator representing a large state with many rural and tribal 

veterans, I have heard about limited access to care and concerns with the quality 

of health care provided to these veteran populations. 

a. What are your thoughts on how to increase access to those veterans who live 

in rural areas, including tribal veterans? 

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Response. I think that if we are going to meet the needs of rural Veterans and 

Veterans in tribal areas, we must support and advance four key areas. First, community-based outpatient clinics (CBOC) have been an important resource over the 

past decade in bringing care closer to home for many Veterans. VA currently operates 783 CBOCs and by the end of fiscal year (FY) 2010, we will operate more than 

850. We similarly operate 40 outreach clinics in rural and highly rural areas. We 

will continue to assess the needs of other locations and develop resources accordingly. Second, we must support telehealth and telemedicine programs that facilitate 

the delivery of health care in the Veteran’s home or the Veteran’s community. We 

have been expanding these programs, and I will ensure continued robust support 

if confirmed. VA research has substantiated the benefits of telehealth as a means 

of providing health care to the American Indian/Alaska Native (AI/AN), and Hawaiian Native Veteran population we serve. There are currently seven operational telehealth programs providing services to Tribal communities and nine programs in deployment. VA telehealth programs to tribal communities predominantly involve clinical video-conferencing to provide mental health services and home telehealth services for diabetes and mental health conditions. VA has completed a cultural competency program to ensure that providers are sensitive to the particular circumstances of using telehealth to reach into tribal communities to deliver services 

using telehealth. Third, home-based primary care (HBPC) is another model of care 

VA can use to meet the needs of rural Veterans. Many of our VA medical centers 

(VAMC) offer HBPC, and we are expanding this program to rural and highly rural 

areas by supporting these teams at our larger CBOCs. This year, we have identified 

39 new sites for HBPC care in rural and highly rural areas alone. Finally, there 

will be times when VA will need to contract for care or use its fee-basis program. 

When this is necessary, it is important that we reduce the variation across our system in how we make these arrangements and process payment so that these valuable partners will remain a resource for Veterans. Congress has generously provided 

us with resources to support rural Veterans that support these four approaches and 

others, and I look forward to the potential some of these programs have for greater 

use. 

Another key element to improving the care of Native American Veterans is culturally appropriate training. One example of this type of training we used in VISN 

23 was a weeklong retreat for VA employees working with the Lakota Tribe that 

proved very effective in terms of building relationships and supporting care. 

b. In particular, how can the VHA maximize resources within the CBOC system? 

Response. One approach VA can adopt to maximize the resources we have within 

the CBOC system and to provide better care to American Indian/Alaskan Native 

Veterans is through co-location of facilities on tribal lands. In VISN 23, we worked 

with Tribal communities to develop CBOCs, to provide Post Traumatic Stress Disorder (PTSD) treatment, and create telehealth support sites, as well as a compensated work therapy program in South Dakota. 

c. How do you intend to improve partnerships with IHS and tribes as head of the 

VHA? 

Response. As VISN 23 Director, I have a great deal of experience working closely 

with the Indian Health Service (IHS) and other organizations to provide care and 

outreach to Native American Veterans. VISN 23 has 27 Native American reservations, and has developed programs on many reservations to help Veterans. I believe 

that American Indian/Alaskan Native Veterans and Veterans from the Pacific Islands are among the most vulnerable and underserved populations within VA, and 

if confirmed, I will work to enhance the services available to this population. I will 

bring my years of experience and commitment to working with IHS and tribal governments to further this end. For example, I believe we should make services available on or proximate to large AI/AN reservations with significant Veteran populations. 

Question 5. As you know, many of the Members of the Committee believe it is 

unfair that Priority 8 veterans do not get access to the system they were promised. 

I am heartened by the President and Secretary Shinseki’s new efforts on this front, 

but I would like to obtain your thoughts on this area of veterans care. 

a. As VISN director what was your view on restricting access for Priority 8 veterans? 

Response. My view on this issue has not changed from my time as Network Director to Acting Principal Deputy Under Secretary for Health. I support the Secretary’s 

proposal to gradually expand enrollment to more Priority Group 8 Veterans. 

b. If confirmed, how do you think the VHA can continue to expand care for Priority 8 veterans so all veterans may access the VA health care system? 

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Response. I believe VA can afford to support additional Priority Group 8 Veterans 

if we continue a gradual expansion that provides the system and our infrastructure 

time to adjust. An immediate complete expansion to all eligible Priority Group 8 

Veterans would increase wait times and reduce the quality of care for Veterans already in the system. 

Question 6. During the hearing, I mentioned a worrying staffing shortfall that veterans have mentioned to me at the Port Angeles, Washington CBOC, where the VA 

has said they will be hiring a full time doctor for months. 

a. What is currently being done to ensure a full time doctor is hired in a timely 

manner? 

Response. The VA Puget Sound Health Care System has initiated processes to expedite credentialing, privileging, and human resource requirements of qualified candidates. We have flexibility and options for physician pay to offer recruitment incentives for providers in rural areas like Port Angeles. 

b. Can you assure me that veterans in the Port Angeles area will not have to wait 

any longer to see a doctor at the Port Angeles CBOC? 

Response. I can promise you I will follow this issue on your behalf and work with 

the Network and the VA Puget Sound Health Care System to ensure that Veterans 

in the Port Angeles area receive the care they need. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO ROBERT

A. PETZEL, M.D., NOMINEE TO BE UNDER SECRETARY FOR HEALTH, VETERANS

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. As we discussed in my office, the so-called ‘‘super clinic’’ model holds 

promise for providing more services to veterans closer to where the veteran lives. 

This is particularly important for Medical Centers with large numbers of rural and 

frontier veterans. One good example of this ‘‘super clinic’’ model is Billings, Montana. However, in order to expand the types of health services that can be offered 

at the CBOC in Billings, Phase II of the new clinic’s construction must not be delayed. Will you commit to reviewing the urgency of funding Phase II of this project? 

And more generally, what is your view of the potential for ‘‘super clinics’’ to provide 

better care to rural and frontier veterans? 

Response. I am not familiar with the Billings project, but if confirmed, I look forward to working with you to ensure Veterans in Montana receive the care they 

need. I can commit to you that I will review the funding for this program if confirmed. I think the health care center model may be appropriate for a number of 

locations, such as Billings, Montana, where we can provide primary care, mental 

health services, and ambulatory surgery in areas with sufficient demand and need. 

VA has formed a workgroup to define VA’s options for facilities by types of services 

provided and metrics, and I look forward to seeing what we can do to improve the 

care of rural Veterans, including those in Montana. 

Question 2. Based on your experience as Director of VISN 23, what is your view 

of how home health care can be used to improve health among rural and frontier 

veterans? Do you believe that VHA can do more to increase home health care opportunities for veterans? 

Response. Home health care is a fundamentally important program to bring care 

not only to home-bound Veterans, but also to rural Veterans. If confirmed, I will 

support the expansion of this program to offer Veterans more opportunities to participate. 

If we are going to meet the needs of rural Veterans, we must support and advance 

four key areas. First, community-based outpatient clinics (CBOC) have been an important resource over the past decade in bringing care closer to home for many Veterans. VA currently operates 783 CBOCs and by the end of fiscal year (FY) 2010, 

we will operate more than 850. We similarly operate 40 outreach clinics in rural 

and highly rural areas. We will continue to assess the needs of other locations and 

develop resources accordingly. Second, we must support telehealth and telemedicine 

programs that facilitate the delivery of health care in the Veteran’s home or the 

Veteran’s community. We have been expanding these programs, and I will ensure 

continued robust support if confirmed. Currently, more than 40,000 Veterans are 

supported in living independently through the use of home telehealth technologies. 

Third, home-based primary care (HBPC) is another model of care VA can use to 

meet the needs of rural Veterans. Many of our VA medical centers (VAMC) offer 

HBPC, and we are expanding this program to rural and highly rural areas by supporting these teams at our larger CBOCs. This year, we have identified 39 new sites 

for HBPC care in rural and highly rural areas alone. Finally, there will be times 

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when VA will need to contract for care or use its fee-basis program. For example, 

VA will continue to purchase home and community-based services from traditional 

agency providers and through the Aging Network to support Veterans with these 

needs. We anticipate expanding this program to rural counties in 15 states this 

year. When we do purchase care, it is important that we reduce the variation across 

our system in how we make these arrangements and process payment so that these 

valuable partners will remain a resource for Veterans. Congress has generously provided us with resources to support rural Veterans that support these four approaches and others, and I look forward to the potential some of these programs 

have for greater use. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. MARK BEGICH TO ROBERT A. PETZEL, M.D., NOMINEE TO BE UNDER SECRETARY FOR HEALTH, VETERANS

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. I was pleased to see in your 2006 testimony to the Subcommittee on 

Health House Committee on Veterans Affairs your focus on the ongoing efforts in 

the Veterans Health Administration (VHA) to provide safe, effective, efficient and 

compassionate health care to veterans residing in rural areas. As we have discussed 

in this Committee, rural area veterans often face additional challenges such as limited finances and fewer specialists. These combined challenges have produced a situation where veterans in remote regions experience a reduced health-related quality 

of life. Veterans in rural communities such as Alaska and Montana face the added 

burden of travel eligibility. 

What is your opinion on a waiver to the existing law to exempt those veterans 

whose only means of travel to their appointment is by air or sea or exceeds a designated certain distance? And how will you work to waive the requirements? 

Response. The Department of Veterans Affairs (VA) is committed to ensuring that 

health care services are accessible to all enrolled Veterans. VA currently offers air 

transportation to Veterans based on clinical need, and I think this is a good basis 

for our program. In Veterans Integrated Service Network (VISN) 23, some Veterans 

had to travel significant distances for care, so I understand your concern and the 

challenges Veterans face. For example, Veterans residing in Minot, ND and visiting 

a VA clinic there would have to travel approximately 6 hours to receive care at the 

Fargo VA Medical Center. I understand VA has looked at the financial costs and 

benefits of providing air travel to other VA facilities for Alaska Veterans compared 

with securing health care through contracts or fee-basis. This analysis found that 

providing air transportation was significantly less costly than seeking care in the 

community, so these proposals can make good economic sense while improving the 

health care of Veterans. 

If confirmed, I am interested in working with you and the Committee to further 

improve our ability to deliver the care Veterans need. I believe it is appropriate for 

VA to administer a program that provides air or sea transportation when no other 

mode of transportation is available (for example, in some highly rural areas or in 

the Pacific Islands), or when the Veteran’s condition necessitates travel by means 

other than driving. There are other factors that may also justify a waiver of our normal beneficiary travel requirements, and I look forward to hearing your ideas on 

this matter. 

Question 2. When you were Administrator at the VA in Upper Midwest Network 

you testified to Congress about the nursing workforce strategies and primary care 

clinics run by nurse practitioners in the U.S. Department of Veterans Affairs Upper 

Midwest Health Care Network, in the states of Minnesota, North Dakota, and South 

Dakota. Nurse Practitioners are effective as providers of safe, high-quality, cost-effective primary care in rural frontier states. How do you plan to expand this concept 

to the rest of the VA clinic system? 

Response. I believe nurse practitioners play an important role in providing direct 

primary care in VA. Nurse practitioners are licensed, independent providers capable 

of diagnosing patients, providing treatment, and prescribing medications without 

the supervision of a physician. I believe using nurse practitioners is an important 

approach to providing primary care for Veterans in rural areas, where we and the 

private sector have encountered difficulties recruiting and retaining other qualified 

professionals. Nurse practitioners currently fill primary care provider roles in many 

VA settings, and if confirmed, I am interested in expanding the use of nurse practitioners even further. Nurse practitioners will and must play a larger role in health 

care delivery in the future. I would be happy to meet with you to discuss these ideas 

in greater detail. 

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Question 3. As a member of the Blue Ribbon Panel that advised the Secretary on 

issues related to a comprehensive philosophical framework to enhance VA’s partnerships with medical schools and affiliated institutions, those affiliations were broadly 

assessed in light of changes of medical education, research priorities, and the health 

care needs of veterans. What were some of the relevant changes that have occurred 

from this Blue Ribbon Task Force? 

Response. The Secretary recently accepted the report of a distinguished panel, the 

Blue Ribbon Panel on VA-Medical School Affiliations, which provided 44 specific recommendations to further enhance this important partnership. The Veterans Health 

Administration (VHA) is developing an implementation plan that will allow us to 

take action on these recommendations, but no changes have been instituted yet. If 

confirmed, I look forward to providing Congress with a report on the Panel’s recommendations and VA’s implementation plans early next year. Our affiliations play an 

important role in delivering and enhancing patient care. VA is transforming its culture and models of care, and by working with our academic partners, we will take 

the lead in creating patient-centered, team-based and inter-professional educational 

programs. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. ROLAND W. BURRIS TO

ROBERT A. PETZEL, M.D., NOMINEE TO BE UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. Dr. Petzel, there has been a push, mostly from within VA, to encourage more cooperation and sharing agreements between VA and the Department of 

Defense (DOD). This has recently been shown with the Partnership between the 

North Chicago VA Medical Center and the Great Lakes Naval Hospital to create 

the Captain James A. Lovell Federal Health Care Center in 2010. With this in 

mind, what other areas do you see as having the most potential for new sharing 

arrangements? 

Response. I think it is correct to pursue these types of cooperative arrangements, 

as they provide an opportunity to leverage existing resources and meet the needs 

of both active servicemembers and America’s Veterans. In particular, these joint 

ventures allow for improved access, continuity, and quality of care for VA and Department of Defense (DOD) beneficiaries in settings where there are strict performance measures that are closely monitored by accountable leadership. In addition, 

joint ventures provide the opportunity for cost savings, particularly in situations 

where DOD or VA would otherwise have to purchase care within local communities. 

In addition to the facility in North Chicago, VA and DOD currently operate the 

eight joint venture sites listed below. These sites share equipment, facilities and 

human resources to provide better, cheaper care for servicemembers and Veterans. 

• North Chicago—North Chicago VA Medical Center/Naval Health Clinic Great 

Lakes 

• Las Vegas—Michael O’Callaghan Federal Hospital: VA Southern Nevada 

Health Care System/99th Medical Group, Nellis AFB 

• Anchorage—Alaska VA Health Care System/3rd Medical Group, Elmendorf AFB 

• Honolulu—VA Pacific Islands Health Care System (Spark M. Matsunaga Medical Center)/Tripler Army Medical Center 

• Albuquerque—New Mexico VA Health Care System/377th Medical Group, 

Kirtland AFB 

• Key West—Miami VA Health Care System (Community Based Outpatient Clinic)/Naval Medical Clinic Key West 

• El Paso—El Paso VA Health Care System/William Beaumont Army Medical 

Center 

• Fairfield—Northern California VA Health Care System/David Grant Medical 

Center, 60th Medical Group, Travis AFB 

In addition, the DOD/VA Health Executive Committee is developing criteria for 

a comprehensive analysis of all military treatment facilities and VA medical centers 

to determine other locations where joint ventures make sense. We intend to review 

the analysis of these sites during the second quarter of FY 2010, with the intent 

of developing action plans for execution before the end of the fiscal year. 

Question 2. Dr. Petzel, do you think the VA should rescreen or contact veterans 

that returned from OIF/OEF before the VA had a Traumatic Brain Injury (TBI) 

screening mechanism in place? 

Response. I believe we have already screened all Veterans who have come to VA 

who have returned from OEF/OIF for Traumatic Brain Injury (TBI). We began this 

screening in April 2007, and through the end of August 2009, VA screened 354,239 

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OEF/OIF Veterans for possible mild TBI. Of the 45,105 who screened positive and 

completed a follow up examination, 23,388 received a confirmed diagnosis of mild 

TBI. About 93 percent of all Veterans who are screened are determined not to have 

TBI, yet all who are screened and report current symptoms are evaluated and treated. Our current screening program identifies those Veterans who returned from 

OEF/OIF before April 2007, and once they enroll and begin receiving care, our electronic health record triggers a clinical reminder to alert all VHA providers to screen 

for TBI. 

In May 2008, VA began a Veteran Call Center Initiative to reach out to OEF/OIF 

Veterans who separated between FY 2002 and December 2008. The Call Center representatives informed Veterans of their benefits, including enhanced health care enrollment opportunities, and determine if VA can assist in any way. This effort initially focused on approximately 15,500 Veterans VA believed had injuries or illnesses that might need care management. The Call Center also contacted any combat Veteran who had never used a VA medical facility before. Almost 38 percent 

of those we spoke with requested information or assistance as a result of our outreach. The Call Center Initiative continues today, focusing on those Veterans who 

have separated since 2001. 

Question 3. Dr. Petzel, I am deeply concerned about VA’s present approach to caring for veterans suffering from PTSD and other mental health disorders. 

a. Please describe the priority that you believe VA should place on providing care 

to veterans with PTSD, and how you would ensure that priority is manifested in 

budget requests and programmatic planning. 

Response. Providing treatment for Post Traumatic Stress Disorder (PTSD) is a 

high priority for VA and for me. If confirmed, I would ensure this priority is manifested in budget requests by reviewing the information we have concerning patient 

demand, incidence rates and available services and augment our requests as needed 

to provide Veterans the care they need. 

b. From your experience as Acting Principal Deputy Under Secretary, what is 

your assessment of the unmet treatment needs among veterans with PTSD? Where 

do you see the most room for VA to improve? Response. VA has a budget of over $4 billion for mental health care, and our integrated system of primary and mental health care is unmatched. Our programs are 

deep and broad, and I believe we provide excellent evidence-based treatments for 

those Veterans we see. We do very well for those Veterans we see, but we need to 

do better in reaching out to those not already in our system. We need to improve 

our outreach with service organizations, community providers, and the friends and 

family members of Veterans to help them recognize potential issues and to let them 

know our services are available to them. Vet Centers are an excellent resource, in 

that they are a non-threatening, non-clinical environment where Veterans can receive counseling or help. Vet Centers are an alternate door to VA care. VA has been 

increasing its use of outreach approaches designed to reach Veterans, such as our 

Suicide Prevention Hotline advertisements and other public service announcements. 

These are important steps in the right direction, but we can and must do more. 

Question 4. Dr. Petzel, do you believe that the VistA system is still able to meet 

the clinical and administrative needs of VHA? 

Response. Yes, I think the Veterans Health Information System and Technology 

Architecture (VistA) is able to meet the clinical and administrative needs of VA at 

this time. We need to continue to invest in and improve the system to meet the 

needs of our patients, health care providers, and administrative professionals. I am 

confident that, in collaboration with Assistant Secretary for Information and Technology, Roger Baker, we can achieve this goal. 

Question 5. Dr. Petzel, As you may know, I am deeply concerned about issues relating to long-term care services and delivery in VA. Based on estimates, the number of veterans age 85 and older will dramatically increase—from 154,000 in 1990 

to 1.3 million in 2010. If confirmed, what changes would you seek to implement to 

allow VHA to respond to the impact of this looming change? 

Response. The future of long-term care is in non-institutional care. VA policy is 

to provide long-term care services in the least restrictive setting that is medically 

appropriate and safe for the Veteran, and whenever possible in non-institutional 

home and community-based settings. Nursing home care should be reserved for situations in which a Veteran can no longer be safely maintained in the community. 

VA is committed to continued expansion of its own capacity to provide non-institutional long-term care services to meet the full demand for such care for Veterans 

enrolled in the VA health care system by the end of fiscal year 2011. We must also 

expand telehealth and home-based primary care to meet the needs of our aging Veteran population. Currently, the average daily census for home telehealth-based servVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00126 Fmt 6601 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
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ices is 29,000 Veterans, and VA plans to provide 50 percent of its non-institutional 

care needs through home telehealth by the end of FY 2011. We are also increasing 

the use of home-based primary care and home health aide services to meet the 

needs of our aging Veteran population. VA already provides other services, such as 

respite care and adult day health care, which help older Veterans and their caregivers maintain independence, and these programs will grow in importance over the 

coming years. 

Question 6. Dr. Petzel, I commend VA’s establishment of a permanent office to address the needs of returning servicemembers. While many strides have been made 

to ensure a seamless transition from active duty to veteran status, more must be 

done to ease this integration into the VA system and reintegration into society. 

What is your view of the work that remains in this area, and how would you seek 

to accomplish a truly seamless transition? What are your plans to combat the cultural issues that accompany the transition to veteran status? 

Response. VA is doing a better job than ever before in reaching out to Veterans 

to help them in the transition process. There is still more to do, however. We must 

intensify our current efforts. In 2009, VA expanded and enhanced outreach services 

to OEF/OIF servicemembers and Veterans with hands-on briefings, health care enrollment prior to leaving the demobilization site, and personal interactions with VA 

staff at events throughout the deployment cycle. Specifically, VA staff interacts with 

Veterans and servicemembers face-to-face at military units or VA medical centers 

across the country through the following events: 

• Demobilization briefings for all of the services at 61 military sites; 

• Yellow Ribbon Reintegration Program events at 30–60–90 day Post-Demobilization events; 

• Post-Deployment Health Reassessments (PDHRA), including those conducted at 

VAMCs; 

• VA Combat Veteran Call Center staff contacts all separating OEF/OIF Veterans; 

• National Guard and VA partnership utilizing the Transition Assistance Advisors to ensure that VA and community services are coordinated through state coalitions; 

• Individual Ready Reserve Musters and VA briefings at community locations or 

VA medical centers; and 

• OEF/OIF Web site to provide access to VA information about VA benefits and 

services, as well as social media technology. 

With regard to the cultural issues you raise, there are a few examples of work 

VA is doing to address these concerns. As I mentioned before, we are using more 

social media to connect with a younger generation of Veterans and provide them information in a manner that is more familiar and satisfactory for them. Our goal is 

to reach out to Veterans seven times within their first 6 months back to change 

VA’s perception as more Veteran-centric. VA is proactive in contacting and finding 

Veterans, rather than waiting for them to come to us, and that is the approach we 

need. Our integrated health care system makes available mental health services in 

primary care settings, and our Vet Centers also offer an excellent resource for supporting Veterans in a comfortable environment near their home. If I am confirmed, 

we will do more in the coming year, such as increasing our use of social media, providing tours of VA medical centers and hosting Welcome Home events, and continuing to enhance our close ties with the National Guard and state coalitions to 

ensure that returning servicemembers can access VA services. 

[The Committee questionnaire for Presidential nominees follows:] 

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[A letter from the Office of Government Ethics follows:] 


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[Letter from Robert A. Petzel, M.D., to the Office of General 

Counsel, U.S. Department of Veterans Affairs:] 


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Chairman AKAKA. Thank you very much, Dr. Petzel, and I also 

want to add my welcome and aloha to your family gathered here. 

Dr. Petzel, without question—and you have noted it—you will be 

an advocate for veterans. I think we would all like to know what 

will you do to ensure that the best interests of veterans is behind 

each and every decision you make, so let me ask: how will you advocate for that approach as VA deals with pressure from OMB to 

limit spending in health care? 

Dr. PETZEL. Thank you, Senator Akaka. I do believe that my responsibility is, as you have put it, to advocate for veterans and that 

includes ensuring that we have adequate resources to accomplish 

the things that we are being asked by Congress and the President 

to accomplish. I have a reputation for candor, and I believe that it 

is my responsibility to speak candidly with the Secretary, who also 

believes that his first responsibility is to advocate for the resources 

necessary to take care of veterans. But to speak candidly with him 

and to speak candidly with Congress about what our needs are and 

how those needs are being met, and if confirmed, I promise you 

that I will deal openly and directly with you about what our needs 

are and whether or not those needs are being met. 


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Chairman AKAKA. Doctor, there is a tremendous need for VA to 

reach out and treat returning veterans who need mental health 

services. With each high-profile case, DOD becomes more and more 

engaged in providing PTSD care, even on the battlefield, an idea 

that many have concerns with. Can DOD and VA work together to 

ensure mental health needs are met in the active-duty servicemember and the new veteran? 

Dr. PETZEL. Thank you again, Senator Akaka. You have highlighted what I think is one of the signal problems with the present 

conflict, and that is the high incidence of behavior health and mental health problems in the veterans that are returning from this 

conflict, particularly those veterans that have been exposed, actually exposed, to combat. 

VA and DOD have a number of mechanisms set up to jointly address these problems. Recently, the Secretary for the Department 

of Defense and the Secretary of VA, Mr. Shinseki, jointly held a 

conference, a summit, if you will, on mental health issues of returning servicemembers and actually people that remain in the 

service. In addition to that, we have several structures where these 

things are discussed regularly. The Joint Executive Council, the 

Health Executive Council, and the Senior Oversight Committee are 

all places where these issues are discussed. 

I believe that VA is the premier institution, if you will, in this 

country right now when it comes to knowing and treating patients 

with PTSD, and my hope would be that we can work with the military, share our expertise, and provide perhaps some of the services 

that it needs. I believe that we will be able to accomplish this 

through these joint efforts. 

Chairman AKAKA. I am glad to hear that. I am glad to hear 

about the joint efforts. I think we need to develop this as much as 

possible and work together on this. I just want to be sure that you 

can ensure this will happen. Let me ask you that question. How 

will you ensure that this happens? 

Dr. PETZEL. Thank you, Senator. I play an important role in each 

one of those groups that I mentioned before. The mental health 

services are directly responsible to me within VHA, and I can assure you and this Committee, if confirmed, I will make certain that 

all that we have to offer is brought to bear on the issues of PTSD 

particularly, but mental health in general, of the returning servicemembers. We will work with the Department of Defense. Again, I 

think we have the expertise to offer them the kinds of things that 

returning servicemembers need and I think we should be in a position to do that. 

Chairman AKAKA. Dr. Petzel, you should know that, as Chairman, I am committed to strong oversight. Most recently, I have had 

staff look at whether facilities were actually making improvements 

to mental health care that they have been directed to make, like 

having evening and weekend hours. Committee staff determined 

that there was poor compliance overall. What will you do to ensure 

that facilities are making the requisite improvements? 

Dr. PETZEL. Thank you, Senator. Well, we have clearly—VHA 

has clearly outlined what the requirements are. There should be 

little misunderstanding on the part of people as to what needs to 

be done and should be done. I think it is our responsibility here 

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in Washington, and if confirmed, I will assume that responsibility, 

to ensure that, indeed, those things are being done. 

Are the construction projects to provide a safe mental health environment being done? Are all the programs that we have said we 

want as part of our panoply of mental health services, are they all 

in place in all of our facilities? I promise you, again, if confirmed, 

that I will assure that we are doing the things that we have promised Congress and promised the veteran community that we will 

do. 

Chairman AKAKA. I understand that for many facilities, there 

simply isn’t the physical space to expand and provide more mental 

health care. How will you reassess minor construction? 

Dr. PETZEL. Thank you. I believe that we need to review the 

minor health construction projects and see that these projects reflect the priorities within VHA. If confirmed, I would do that. We 

obviously have patient safety issues, generally speaking, at the top 

of that. But mental health is an important part of the services that 

we provide, and if there are projects on that schedule that are necessary in order to accomplish all that we need to accomplish at a 

facility in terms of mental health, then we have to assess if that 

is in the appropriate priority. 

So my promise to you, if confirmed, would be to review the minor 

construction process and the minor construction project list to ensure that those things that we have said are priorities are indeed 

reflected in that construction list. 

Chairman AKAKA. Thank you very much. 

Senator Burr? 

Senator BURR. Thank you, Mr. Chairman. 

Dr. Petzel, welcome. We had a delightful short time together—— 

Dr. PETZEL. Yes. 

Senator BURR [continuing]. But very insightful. A couple of 

housekeeping things and then a couple of serious questions. 

Dr. Petzel, do you pledge to swiftly and accurately respond to all 

requests for information made by me or my staff on my behalf? 

Dr. PETZEL. Absolutely, Senator, I do. 

Senator BURR. I thank you. VA has more tools and resources 

than ever before to end homelessness for our Nation’s veterans. Do 

you believe it is possible to actually accomplish that in the next 5 

years? 

Dr. PETZEL. I do. That is an excellent question—— 

Senator BURR. What do you think it will take? 

Dr. PETZEL. Well, I think it is going to take a number of things. 

First of all, we need to deal with the present homeless population, 

and that can be divided in several ways, one of which is the chronic 

and the not-chronic homeless veterans. I think our approach to 

those two populations is slightly different. 

Second, in order to eliminate homelessness, it is going to be absolutely essential that we prevent homelessness. So a major part of 

our effort is going to have to be directed at those people who might 

become homeless, those people who are on the edge or threatened. 

We will work with State and Federal agencies to help and internally within our organization to try and identify those people and 

provide the services they need, be it housing, be it a job, or job 

138 

training, or medical care, before the situation has reached the point 

where those people are indeed helpless. 

So if we are going to eliminate homelessness, a major effort 

needs to go toward preventing homelessness. A major effort needs 

to go toward finding long-term solutions to the problems of chronic 

homelessness. 

Senator BURR. Would you agree that homelessness and chronic 

homelessness suggest a breakdown in our ability to deliver the 

wraparound care out of the Veterans Administration that we 

should? 

Dr. PETZEL. I would agree with you, Senator; that is one of the 

issues that affects homelessness. 

Senator BURR. Doctor, in your testimony, you cite what you believe are the weaknesses of the VA’s health care system, including 

the need for a vision of what the system should be in the future, 

which is one that I agree with; lack of alignment; and too many 

variations within the system. What is your plan to correct these 

weaknesses for the entire system, if confirmed? 

Dr. PETZEL. Well, first, we need to develop a consensus within 

the VA, Senator, about what this health care system is going to 

look like in the future. I outlined three features that I think need 

to be there, though there are many others: patient-centeredness; a 

concept of team care; and the concept of continuous improvement, 

so that all of the work that we do is crafted in the nature of continuously improving that work. 

In terms of alignment, we have many wonderful programs. The 

VA probably has the broadest array of programs. Mental health is 

an excellent example of that. Nobody offers the range of services 

in mental health that the VA does. But it has been my experience 

that these programs are not always aligned toward this common vision, that they are much more interested in their particular program activities, et cetera. So we need to align everything, every activity within VHA, to accomplish this consensus vision of what our 

system is going to look like. 

In terms of variation, the Secretary had a briefing from each one 

of the 21 networks and it was really quite remarkable how different many of these networks are, how they operate differently. 

This is not necessarily good business. We need to reduce the variation in our structures and organizations at the network level. We 

need to reduce the variation in our business practices. I think everybody is aware of the VA’s fee-basis program and that there have 

been difficulties in some parts of the country collecting and paying 

fee-basis accounts. 

If you were to look across this country, you would find that those 

21 networks probably each have a different approach to fee basis. 

That is not appropriate for an integrated organization like ours. We 

need to have a system, a best practice system for administering the 

fee-basis program. 

An example in our network of reducing variation, several years 

ago we developed an imaging service line and came to an agreement amongst all the radiologists that we would buy a single vendor’s products in all of our imaging suites. So now we have a single 

vendor’s products in all of our imaging suites. It has reduced our 

cost. We had tremendous savings when it came to those purchases. 

139 

Now our biomedical engineers have a much easier job of taking 

care of just one manufacturer’s equipment. 

I think those sorts of things, with that and with laboratory 

equipment, need to be done across the country. 

Senator BURR. Let us talk about your time as the Director of the 

VISN. In your response to prehearing questions, you stated that 

addressing issues with privileging and credentialing of VA providers will require diligent and continuous review at the facility 

level. You also pledge that, if confirmed, you would ensure that 

each facility in each network meets or exceeds the VA standard. 

Well, as the new director, how do you ensure that facilities in the 

network meet or exceed the VA standards? 

Dr. PETZEL. Thank you, Senator. We have to have an oversight 

process that assures us that the mechanisms are in place to review 

and audit those credentialing processes. That is an action that obviously has to occur at the local level, and what we need to know 

and we need to be sure of is that the local leadership are doing the 

things that need to be done to ensure that the credentialing and 

privileging process is functioning correctly, and that means periodic 

audits by outside interested parties not directly related to the 

credentialing process. 

This kind of thing is not unique to credentialing and privileging. 

There are an incredible number, as you know, of processes within 

a medical center that one needs to be assured are operating correctly, and the question could be asked of any one of those processes: how are you going to ensure, or how do we ensure that those 

things are being done correctly? 

One is that we assure ourselves what the internal audit processes are. Two is that we periodically—ourselves, from a central office perspective—audit and review those processes to see if, indeed, 

they are being followed. 

Senator BURR. Do you believe that there are different standards 

today, VISN by VISN, on privileging and credentialing? 

Dr. PETZEL. No, Senator, I don’t believe there are different standards. I believe there are different—— 

Senator BURR. Different applications? 

Dr. PETZEL [continuing]. Different level of execution. 

Senator BURR. OK, thank you. 

Dr. PETZEL. Absolutely. 

Senator BURR. I thank you. I thank the Chair. 

Chairman AKAKA. Thank you very much, Senator Burr. 

Senator Murray? 

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

Dr. Petzel, as you know, last week President Obama outlined a 

change in strategy to increase troops in Afghanistan by an additional 30,000, bringing the number of troops in Afghanistan to over 

100,000. Now, Admiral Mullen pointed out on Monday that this 

will increase American casualties, and I want to make sure that 

the Department of Defense and the Department of Veterans Affairs 

have taken steps to adequately plan for that increased number of 

veterans that we know we will see seeking care, because we can’t 

afford to repeat the mistake of the last 5 years. 

140 

So given the reality of what we know is coming, do you think the 

VHA needs to change its planning to handle the increased numbers 

of OIF and OEF veterans seeking care? 

Dr. PETZEL. Thank you, Senator Murray. I cannot speak, of 

course, for the Department of Defense, but in terms of the VA, we 

have assessed what the impact would be of an additional 30,000 

troops being deployed. Obviously, not all of those people are going 

to be coming back to us immediately, but there will be casualties 

and there will be patients or people discharged from the service 

which will represent an increase in our workload. 

We have calculated what the expense of that might be and we 

are trying to include that in future budget requests. In the meantime, I am assured that we do have adequate resources to provide 

for all of the returning servicemembers from those two conflicts. As 

I said earlier, if that is not the case, you will get my candid opinion 

that it is not so. 

Senator MURRAY. OK. Well, we have had experience in the past 

where the VHA has recognized the need for increased resources, 

and somewhere between the Congressional Budget Office and here, 

it isn’t accurately reflected in VA’s budget request. I am assuming 

that if that should occur, you will be honest with us about your 

needs and tell us if a budget doesn’t adequately reflect what you 

are seeing, if that is the case. 

Dr. PETZEL. I will, Senator. I also need to point out that Secretary Shinseki’s first priority is delivering adequate resources to 

the organization. He has repeatedly talked about that being his 

major responsibility. I have confidence that if the resources aren’t 

there, that he will ask for them. 

Senator MURRAY. OK. Well, you were VISN 23 Director, so from 

that perspective, do you think that we are prepared for an increased number of OIF and OEF veterans? 

Dr. PETZEL. I do. I do. How much of that increase is going to 

occur, it is really very difficult to know. Again, this is the 2010 

budget that we are talking about—— 

Senator MURRAY. Right. 

Dr. PETZEL [continuing]. And we have yet to see what is going 

to happen with the 2011 budget. But again, if I don’t believe—if I 

am confirmed and I don’t believe that we have got adequate resources, I will be discussing that with the Secretary and I will be 

discussing that with the Committees. 

Senator MURRAY. OK. As VHA Under Secretary, what hurdles do 

you think we need to address to make sure that you have the staff 

and the resources that you are going to need to make sure that the 

veterans returning from Iraq and Afghanistan, as well as our veterans who are in the system from previous conflicts, are treated? 

Dr. PETZEL. Thank you, Senator. I think the first hurdle is assessing what the need is and being sure that we understand how 

much we need in terms of resources. 

I think second is ensuring that we have got those projections 

worked into our budget; and I know, again, for 2010, there was a 

very labored and, I believe, careful calculation as to what the impact of returning veterans would be on programs like TBI, like 

PTSD. 

141 

So, the first thing is being able to predict what that need is. The 

second barrier, if you will, is advocating for those resources with 

the various structures that we have to deal with when we are looking at our budget. I am confident that the 2010 budget does have 

in it adequate resources to do those things. 

Senator MURRAY. What you currently have, but you are working 

on the 2011 budget—or you will be—— 

Dr. PETZEL. I haven’t yet seen what the 2011 budget is going to 

look like. We are in the midst of those negotiations. So it is difficult 

for me to speak definitively about what that final budget will look 

like. 

Senator MURRAY. Let us just say, once you are confirmed, Doctor—— 

Dr. PETZEL. Once I am confirmed, I will be very candid with you. 

Senator MURRAY. We need you to be candid. If between the Congressional Budget Office and elsewhere it gets reduced from where 

you all think it ought to be, we want to know from this Committee’s perspective because that communication breakdown means 

that veterans won’t get the care they need if we are short with 

funding. 

Dr. PETZEL. Absolutely. 

Senator MURRAY. We are now ramping up and we have a number 

of folks coming home. It will impact next year’s budget. It certainly 

will impact budgets in the out years, so we need to have an honest 

figure on that. 

I am hearing a lot about staffing issues from medical centers 

around the country. You are a former VISN Director. What do you 

think we need to do in VHA to make sure that we hire the doctors, 

the mental health providers, the specialists, and all the key personnel in a timely fashion? 

Dr. PETZEL. Thank you, Senator Murray. There are two aspects 

to that question. One is the timely fashion, and I am pleased that 

Assistant Secretary Sepu ́lveda is reviewing and going to be making 

substantial changes in our H.R. processes, in our hiring process, 

because quite frankly, in my experience as a network director, it 

just took too long in many cases to hire a physician, to hire a 

nurse, et cetera. Those processes need to be reviewed, and I am 

grateful for the fact that he is doing that. If confirmed, I look forward to working with him to find the best ways and the quickest 

ways to bring qualified people on. So that is one aspect. 

The other aspect, though, is making sure that we have got the 

salary structure and the incentives that we need to attract the 

kinds of professionals that we want and need, and that particularly 

is important in rural areas, because not only us, but the outside 

world, the private sector, has trouble recruiting to some very rural 

and remote areas. 

I am pleased that S. 1963 has in it a number of processes and 

recommendations that will help us, I think, hire those people, will 

help speed the hiring process. In addition to that, as I understand 

it, Senator Durbin has proposed providing some incentives specifically for recruiting to rural areas for both health care executives 

and clinical people. I think all those things would help. 

Senator MURRAY. Well, we have a particular area, Port Angeles 

in my homestate of Washington, that has been trying to hire a docVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00145 Fmt 6601 Sfmt 6601 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
142 

tor for months. We have been told for months it is going to happen. 

So once you are confirmed, I will be calling you about that. 

Dr. PETZEL. Please. If I am confirmed, I would be delighted to 

talk with you about that. 

Senator MURRAY. OK. Mr. Chairman, I do have some questions 

I would like to submit for the record. Unfortunately, I have another 

commitment I have to make. But again, to both of our nominees, 

thank you so much for your service to our country. 

Chairman AKAKA. Thank you very much, Senator Murray. We 

will place your questions in the record. 

Now, we will have questions from Senator Begich. 

Senator BEGICH. Thank you very much, Mr. Chairman, and 

thank you, Doctor, for being here. Just for the record, I will be supporting your confirmation. I believe the President has all the rights 

to pick who he wants, but also he survives and dies based on your 

work, so it is on your shoulders. 

I just sent a letter to Secretary Shinseki regarding a report that 

just came out by the Office of Inspector General (OIG) regarding 

some significant challenges they have in Alaska, specifically in the 

Anchorage office, in regards to their management and the capacity 

for it to manage services and ensure that benefits are given in a 

timely manner. The tone of the letter was pretty dismayed, and I 

was somewhat outraged by the many findings. 

The good news is the Anchorage office recognizes these findings, 

and I want to know if you are, one, aware of the IG report, and 

two, I know it is not necessarily in your purview, but because of 

your senior staff level, you may have the capacity to assist in trying to clean this mess up. So what would be your comments, if you 

have any, at this point? 

Dr. PETZEL. Well, thank you, Senator. I do share your concerns. 

I have not read the details of the report, but I have seen the press 

release, and I have seen a summary of the report and I do share 

your concerns. While this is VBA, we are one VA. 

Senator BEGICH. That is right. 

Dr. PETZEL. VHA does provide a lot of support and services for 

people that are applying for veterans’ benefits. We do the examinations. We work with VBA to expedite these processes. So I think 

that we need to, as one VA, take some responsibility for this. 

Senator BEGICH. Well, if there is anything—I am assuming the 

Secretary and his staff will get back to me, but obviously if it 

crosses into any of your purview, I would really appreciate your efforts in ensuring that you do what you can very rapidly. Alaska 

has the highest per capita amount of veterans in the country. Seventy-thousand, 11 percent of our population are veterans, and 

growing. So I just think it is critical that we do what we can, especially in Anchorage, which is half the population of the State. 

So—— 

Dr. PETZEL. Thank you, Senator. I agree with that, and I will 

carry your concerns back to the Secretary. 

Senator BEGICH. Very good. 

Dr. PETZEL. I will carry your concerns back to Admiral Dunne 

and the Veterans’ Benefits Administration. 

Senator BEGICH. Great. Thank you very much. 

143 

I was reviewing some testimony, I think it was from 2006 in a 

subcommittee on health in the House, and your support for rural 

health care for veterans, which, as you can imagine in Alaska, is 

a very complex issue. I tried to tell Senator Tester I would represent Montana, also, in its rural concerns, because he had to 

leave. 

But one of the issues is, in Alaska, many of our veterans can get 

waivers because they have no other transportation other than air 

or sea or the land distance is significant. I am curious, on those 

travel waivers, where do you stand and how do you feel about 

those, especially in remote, rural areas. Is that a policy that you 

will continue to support? 

Dr. PETZEL. Thank you. I am not specifically familiar with the 

waiver process—— 

Senator BEGICH. OK. 

Dr. PETZEL [continuing]. So I probably can’t comment specifically. 

I will find out and get back to you about that—— 

Senator BEGICH. Can you respond for the record? 

Dr. PETZEL. But I will say that if people can’t travel, I mean, the 

whole principle behind the travel reimbursement is the fact that if 

you can’t afford to get to the health care, you can’t get the health 

care. 

Senator BEGICH. Right. 

Dr. PETZEL. So it is necessary to support. If that is the case, then 

I certainly would be supportive of providing for access to health 

care for your people in whatever way we need to do it. 

Senator BEGICH. Excellent. Well, if you could, respond in more 

detail as you look at that policy. The big issue for us is, I mean, 

literally, you don’t have roads to some of these areas. I think a lot 

of times when people think of rural communities, they think of, 

well, you have got to drive 200 miles to get to the hospital. In remote Alaska you can’t even drive two miles, let alone 200 feet, in 

some of these areas. So your review of that would be great, and obviously your support. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. MARK BEGICH TO

ROBERT A. PETZEL, M.D., NOMINEE TO BE UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Request: What is your opinion on a waiver to the existing law to exempt those 

veterans whose only means of travel to their appointment is by air or sea or exceeds 

a designated certain distance? And how will you work to waive the requirements? 

Response. The Department of Veterans Affairs (VA) is committed to ensuring that 

health care services are accessible to all enrolled Veterans. VA currently offers air 

transportation to Veterans based on clinical need, and I think this is a good basis 

for our program. In Veterans Integrated Service Network (VISN) 23, some Veterans 

had to travel significant distances for care, so I understand your concern and the 

challenges Veterans face. For example, Veterans residing in Minot, ND and visiting 

a VA clinic there would have to travel approximately 6 hours to receive care at the 

Fargo VA Medical Center. I understand VA has looked at the financial costs and 

benefits of providing air travel to other VA facilities for Alaska Veterans compared 

with securing health care through contracts or fee-basis. This analysis found that 

providing air transportation was significantly less costly than seeking care in the 

community, so these proposals can make good economic sense while improving the 

health care of Veterans. 

If confirmed, I am interested in working with you and the Committee to further 

improve our ability to deliver the care Veterans need. I believe it is appropriate for 

VA to administer a program that provides air or sea transportation when no other 

144 

mode of transportation is available (for example, in some highly rural areas or in 

the Pacific Islands), or when the Veteran’s condition necessitates travel by means 

other than driving. There are other factors that may also justify a waiver of our normal beneficiary travel requirements, and I look forward to hearing your ideas on 

this matter. 

Senator BEGICH. I want to ask one broad question, and then I 

have two quick ones. I read that your Strategic Plan expires in 

about 11 or 12 months. I am assuming the VA is in the process of 

revising that, their long-range strategic plan. Do you have any 

comment on that? 

Dr. PETZEL. Well, Senator, my understanding at the Department 

level, we went through—they went through a process that began 

late spring or early summer of developing a strategic plan and then 

developing operating plans. 

Senator BEGICH. Excellent. 

Dr. PETZEL. That for 2010 is pretty well put to bed, if you will. 

Now we are looking at execution of the operating plans. 

As a part of that process, again, it is my understanding, there 

will be a periodic review. Again, next spring or summer, there will 

be another look strategically and a revision of that plan. It is a living document. It is not cast in stone and it will be reviewed periodically, as I understand it. 

Senator BEGICH. Yes. There is an annual and then there is a 5- 

year plan. The one I am thinking of, this longer-range plan, what 

kind of a plan is there? There is a 2006 through 2011 plan, and 

now it is about to expire. So that is the one I am thinking of. So 

if you could respond back for the record on that, that will be great. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. MARK BEGICH TO

ROBERT A. PETZEL, M.D., NOMINEE TO BE UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Request: When should Congress expect the VA to publish the next long-range 

strategic plan? Is there a way to give to this Committee a report card or milestones 

of progress made, rather than waiting until the report is complete? 

Response. It is my understanding that the VA Strategic Plan for FY 2010–2014 

is in development at this time and is currently being reviewed by the Office of Management and Budget (OMB). I understand that the Department expects to publish 

the VA Strategic Plan for FY 2010–2014 in the near future. 

If confirmed, I would be happy to work with the Department to update you and 

the Committee on VA’s progress in implementing the VA Strategic Plan. VA will 

be pleased to brief you and the Committee on the results contained in this report 

each year. 

Senator BEGICH. Thank you, Mr. Chairman, I will end on this. 

If I could follow-up on Senator Murray’s question regarding staffing 

for VA and the concern with Iraq and Afghanistan veterans that 

are coming through. I want to make sure I understood what you 

said, and I appreciate that you are going to be very candid with 

the Committee as the budget process goes forward. 

My assumption is, based on your comments, there has been a calculation, a review of what this might be in the long term. So I am 

assuming that there is some sort of report that has been done to 

look out on the horizon about what is going to happen. That is 

what you are utilizing to develop your budgetary process. Is that 

a document that is available for us in this Committee to review? 

I am assuming there is no way you can plan 2–3 years out without 

145 

doing a full review. My guess is that you have and there is something that is in process. 

Dr. PETZEL. That is an excellent question, Senator Begich, and 

I don’t know. I have seen the projections, or have heard of the projections for 2011, but I don’t know what sort of a document exists. 

I would be delighted to find out and we can get back to you in the 

posthearing questions. 

Senator BEGICH. If you could share that with the Committee, I 

think that was what Senator Murray was asking, is that longterm? I just assume there is a planning document somewhere. 

Again, thank you very much. I congratulate you in advance; and 

I agree with the Chairman, the faster we can make these appointments happen, the better off the VA is and the more services we 

can deliver to our veterans. So thank you for your willingness to 

serve. 

Dr. PETZEL. Thank you, Senator. 

Chairman AKAKA. Thank you very much, Dr. Petzel, for your responses. 

Before we let you go, let me just ask this. I think we both share 

the view that the VA needs solid partnerships with its academic affiliates. You indicated that there is room for improvement in this 

area. What specific steps will you take to strengthen academic 

partnerships? 

Dr. PETZEL. That is an excellent question, because affiliations, 

Senator Akaka, in my mind, are a very important part of why VA 

is as good as it is today. 

Just a bit of background. There was a Blue Ribbon Panel that 

was empowered by previous Secretaries, the recommendations for 

which Secretary Shinseki has recently signed off on, and I believe 

there will be a briefing for this Committee sometime in the near 

future, right after the first of January. In it, there are a number 

of recommendations, and I don’t want to preempt that briefing, but 

just briefly, the idea that there will be structure set up at the network level for interacting with affiliates. Affiliates feel that as we 

develop networks, the local management’s responsibility for affiliations and power, if you will, in affiliations was somewhat diluted 

and they are looking for, and I strongly support this, some sort of 

a mechanism for interacting with affiliates at the network level. 

The second thing was the development of a national affiliations 

group, if you will, that not only includes the medical school affiliations, but nursing schools and other educational affiliates that can 

have a more national perspective and influence on what happens 

with affiliations. They are very important. We train 100,000 individuals in our medical centers each year. Seventy percent of the 

physicians and psychologists that work in the VA trained in the VA 

medical centers. They are important training resources for the Nation and they are very important recruitment tools, if you will, for 

the VA. 

So I think it is very important that we strengthen them and I 

would see this national structure and accountability for having 

working relationships with affiliates set up at the network level as 

being important steps. 

Chairman AKAKA. Thank you, Dr. Petzel. I have other questions 

I will submit for the record. 

146 

Senator Begich, do you have any second round? 

Senator BEGICH. Yes, one quick question. I am glad you mentioned the Blue Ribbon Panel. If I could just ask one, which you 

don’t have to answer now since I will put it in the record. In regards to your nurse practitioners and the program that you developed, I think it was in three or four States, that I found very interesting, and very intriguing regarding the delivery of services from 

nurse practitioners in clinics. It is much more efficient in a lot of 

ways, because you can deliver more nurses, in a sense, to the field 

quicker than doctors, obviously, because their education span is 

less than 7–9 years, so you can get them sooner. 

So I would be very interested—I am assuming with the Blue Ribbon, if we get something down the path here in January, that this 

may be part of the discussion. Am I safe to say that, or—— 

Dr. PETZEL. Yes, Senator, you are. 

Senator BEGICH. OK. Very good. That is all, Mr. Chairman. 

Thank you. 

Chairman AKAKA. Thank you. Thank you very much. 

I want to thank you again, Dr. Petzel, for your participation in 

today’s hearing. It is helpful to us. Today’s veterans will benefit 

from your experiences as an educator and administrator and a 

leader in the delivery of high-quality health care. 

But with this in mind, I would like to bring Dr. Petzel’s nomination before the Committee and full Senate as soon as possible. I ask 

that any posthearing questions for Dr. Petzel be sent to the Committee’s Legislative Clerk by noon tomorrow with the intention of 

the Committee voting on the nomination next Wednesday, the 

16th. 

So again, thank you very much, and I thank your family for joining you here. 

Dr. PETZEL. Thank you, Senator Akaka, and to the Committee, 

for the opportunity to appear. 

Chairman AKAKA. Thank you. 

Good morning and welcome, Dr. Perea-Henze. 

Dr. PEREA-HENZE. Good morning, Mr. Chairman. 

Chairman AKAKA. The Committee will now turn to the President’s nomination of Dr. Raul Perea-Henze to be Assistant Secretary of Policy and Planning at the Department of Veterans Affairs. 

I am delighted that with this nomination and Dr. Petzel’s, we are 

closer to providing Secretary Shinseki with his full leadership team 

at VA. I am hopeful that this Committee, and then the full Senate, 

will move expeditiously to consider Dr. Perea-Henze’s nomination. 

It is important that the position of Assistant Secretary for Policy 

and Planning be filled as soon as feasible. 

Dr. Perea-Henze has extensive public and private sector experience. Most recently, he was a senior executive at Pfizer and Merck. 

Earlier, he served as Deputy Assistant Secretary of Commerce for 

Management and Budget, and Senior Health Care Advisor at the 

White House during the Clinton Administration. 

Dr. Perea-Henze’s academic background includes a medical degree from the University of Mexico and a Master’s Degree in Public 

Health with a concentration in Health Policy and Management 

from Yale University’s School of Medicine. 

147 

The Assistant Secretary for Policy and Planning provides advice, 

plans, and reports to the Secretary and other VA senior leaders in 

the area of corporate policy, strategic planning and management 

improvement, to support VA’s endeavors to provide benefits and 

services to our Nation’s veterans in an effective and efficient 

manner. 

I have received every indication that Dr. Perea-Henze combined 

service in the public and private sectors is well regarded and will 

be pertinent to the position for which he has been nominated. 

Dr. Perea-Henze, I will tell you the same thing I told Secretary 

Shinseki during his confirmation hearing. Assuming your confirmation as the next Assistant Secretary for Policy and Planning, you 

will face tremendous challenges. In my view, holding a leadership 

position at VA is one of the most challenging jobs in or out of government, and that is never truer than in a time of war as we are 

in at the present time. 

I look forward to your testimony today, your responses to questions from Committee Members, and to any posthearing questions. 

Senator Burr, any opening statement? 

Senator BURR. No. I also welcome the doctor and apologize that 

with the schedule up here I have not had the opportunity to sit 

down privately with you, but certainly look forward to this hearing 

and your confirmation. 

Chairman AKAKA. Thank you very much. 

Senator Begich. 

Senator BEGICH. No statement. Again, I look forward to the question and answer period, and thank you very much for your willingness to serve. 

Chairman AKAKA. Under the rules of the Committee, Doctor, the 

testimony of all Presidential nominees appearing before the Committee shall be taken by oath. So, Doctor, will you please now 

stand and raise your right hand? 

Do you solemnly swear that the testimony you are about to give 

this Committee, your responses to the Committee’s questionnaire, 

and your responses to all questions, both live and in writing, before 

the Senate Committee on Veterans’ Affairs will be the truth, the 

whole truth and nothing but the truth, so help you, God. 

Dr. PEREA-HENZE. I do. 

Chairman AKAKA. Thank you. 

Doctor, will you please begin with your statement? 

STATEMENT OF RAUL PEREA-HENZE, MD, MPH, DESIGNATE 

TO BE THE ASSISTANT SECRETARY FOR POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Dr. PEREA-HENZE. Thank you, Mr. Chairman. Chairman Akaka, 

Senator Burr, distinguished Members of the Senate Committee on 

Veterans’ Affairs, thank you for the opportunity to appear before 

you today. I am deeply honored and humbled by President Obama’s 

nomination to serve as Assistant Secretary for Policy and Planning 

at the Department of Veterans Affairs, and I greatly appreciate the 

President’s and Secretary Shinseki’s confidence in me to lead this 

important function and help achieve their vision of transforming 

the VA into a 21st Century organization. 

148 

Although my family is not physically present here, I stand on 

their shoulders—those members of my family who served in government like my grandmother, the military, my grandfather, or as 

physicians like my father and mental health professionals like my 

mother—as I have the honor to appear in front of you today. They 

have been my inspiration to pursue a passion for finding ways to 

help others. 

As a physician and public health professional, I have strived to 

find innovative cures and secure access to medicines for those who 

need them, so they can, like me, hope to achieve their full Godgiven potential. If confirmed, I hope to bring almost 25 years of experience in planning and strategy, to serve the needs of veterans 

and contribute to their well-being and the well-being of those who 

care for them. 

First, as a physician, I began my career in policy and planning 

in New York City government where I oversaw the development of 

patient center services at one of the largest public hospitals in the 

Nation; ensured the optimization of funds and services for those affected with HIV and AIDS and other infectious diseases; and created a 10-year strategic plan for mental health and substance 

abuse services. 

At the Commerce Department, I managed policy issues as a 

White House Fellow and Chief of Staff for the Under Secretary for 

International Trade, and later I co-led an organization of close to 

700 people as the Deputy Assistant Secretary for Administration. 

These experiences provided me with a broad understanding of how 

the Federal Government works and made me aware of the value 

and expertise of those who have devoted their careers to public 

service. 

My subsequent experience in the private sector, advising and 

working for leading Fortune 100 companies in management consulting and in the health care sector, provided me with business 

acumen and a results-oriented approach driven by a long-term 

vision. 

I believe with these combined capabilities I can bring significant 

value and innovation to those served by the Department of Veterans Affairs—the veterans and those caring for the veterans. 

The Assistant Secretary for Policy and Planning is responsible 

for providing advice and counsel to the Secretary and other senior 

leaders, and helping formulate corporate policy and strategic planning. If confirmed, I commit to faithfully advise the Secretary and 

Deputy Secretary, and to work with Congress to provide better 

services and benefits for our Nation’s veterans. 

The Office of Policy and Planning is responsible for developing 

the data and analysis to drive strategic planning and policy development for the Department. This critical function is essential to 

the transformation effort as articulated by President Obama and 

Secretary Shinseki. The appropriate collection, analysis, and management of accurate data from a national survey of veterans and 

other population studies, as well as measurement of the effect of 

VA services and benefits, is essential to informing sound policy decisions. Through such efforts, the Office of Policy and Planning will 

be instrumental in helping VA achieve the President’s and Secretary Shinseki’s objectives. 

149 

In addition, if confirmed, I intend to establish and maintain 

strong working relationships with my counterparts at the Department of Defense and other key organizations to improve the delivery of health services and benefits to servicemembers and veterans. 

If confirmed, I also hope to bring stability, vision, and innovation 

to the Office of Policy and Planning. I will work to optimize data 

collection and scientific methodologies for the analysis of the veteran populations and VA services and benefits, so this information 

can transform the services they and their loved ones receive. 

I will work tirelessly to support Secretary Shinseki’s goals for a 

VA that is people-centric, results-oriented, and forward-looking. I 

believe that I can provide strong leadership and clear vision to this 

office, so it can be regarded as a model across the Federal Government. 

In closing, I would like to thank this distinguished Committee 

again for the opportunity to appear before you today. If confirmed, 

I stand ready to work with Congress and to advance President 

Obama’s and Secretary Shinseki’s goal to transform the VA into a 

21st Century organization centered on those it serves. 

I look forward to any questions you may have. 

[The prepared statement of Dr. Perea-Henze follows:] 

PREPARED STATEMENT OF RAUL PEREA-HENZE, M.D., NOMINEE TO BE ASSISTANT

SECRETARY FOR POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

Chairman Akaka, Senator Burr, Distinguished Members of the Senate Committee 

on Veterans’ Affairs, thank you for the opportunity to appear before you today. 

I am deeply honored and humbled by President Obama’s nomination to serve as 

Assistant Secretary for Policy and Planning at the Department of Veterans Affairs. 

And I greatly appreciate the President and Secretary Shinseki’s confidence in me 

to lead this important function and help achieve their vision of transforming the VA 

into a 21st century organization. 

Although my family is not physically present here, I stand on their shoulders. 

Those members of my family who served in government, the military, or as physicians and mental health professionals, as I have the honor to appear in front of you 

today. They have been my inspiration to pursue a passion for finding ways to help 

others. As a physician and public health professional, I have strived to find innovative cures and secure access to medicines for those who need them so they can, like 

me, hope to achieve their full God-given potential. 

If confirmed, I hope to bring almost 25 years of experience in planning and strategy to serve the needs of Veterans and contribute to their well-being and the wellbeing of those who care for them. I began my career in policy and planning in New 

York City Government, where I oversaw the development of patient-centered services at one of the largest public hospitals in the Nation, ensured the optimization 

of funds and services for those affected with HIV/AIDS and other infectious diseases, and created a 10-year strategic plan for mental health and substance abuse 

services. At the Commerce Department, I managed policy issues as a White House 

Fellow and Chief of Staff for the Under Secretary for International Trade, and later, 

I managed an organization of close to 700 people, as a Deputy Assistant Secretary 

for Administration. These experiences provided me with a broad understanding of 

how the Federal Government works and made me aware of the value and expertise 

of those who have devoted their careers to public service. My subsequent experience 

in the private sector, advising and working for leading Fortune 100 companies in 

management consulting and in the health care sector, provided me with business 

acumen and a results-oriented approach driven by a long-term vision. I believe with 

these combined capabilities I can bring significant value and innovation to those 

served by the Department of Veterans Affairs: Veterans and those caring for 

Veterans. 

The Assistant Secretary for Policy and Planning is responsible for providing advice and counsel to the Secretary and other senior leaders and helping formulate 

corporate policy and strategic planning. If confirmed, I commit to faithfully advise 

the Secretary and Deputy Secretary, and to work with Congress to produce better 

services and benefits for our Nation’s Veterans. 

150 

The Office of Policy and Planning is responsible for developing the data and analysis to drive strategic planning and policy development for the Department. This 

critical function is essential to the transformation effort, as articulated by President 

Obama and Secretary Shinseki. The appropriate collection, management, and analysis of accurate data from the National Survey of Veterans and other population 

studies, as well as measurement of the effect of VA’s services and benefits, is essential to informing policy decisions. Through such efforts, OPP will be instrumental 

in helping VA achieve the President and Secretary Shinseki’s objectives. 

In addition, if confirmed I intend to establish and maintain strong working relationships with my counterparts at the Department of Defense and other key organizations to improve the delivery of health care services and benefits to Servicemembers and Veterans. 

If confirmed, I hope to bring stability, vision and innovation to the Office of Policy 

and Planning. I will work to optimize data collection and scientific methodologies 

for the analysis of the Veteran population and VA services and benefits so this information can serve transform the services they and their loved ones receive. I will 

work tirelessly to support Secretary Shinseki’s goals for a VA that is people-centric, 

results-oriented and forward-looking. I believe that I will provide strong leadership 

and clear vision to this office so it can be regarded as a model across the Federal 

Government. 

In closing, I would like to thank this distinguished Committee again for the opportunity to appear before you today. If confirmed, I stand ready to work with Congress 

and to advance President Obama’s and Secretary Shinseki’s goal to transform the 

VA into a 21st Century organization centered on those it serves. I look forward to 

any questions you may have. 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO DR. 

RAUL PEREA-HENZE, NOMINEE TO BE ASSISTANT SECRETARY FOR POLICY AND

PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. Have you discussed with Secretary Shinseki and Deputy Secretary 

Gould the duties and the role you would assume as Assistant Secretary for Policy 

and Planning if you are confirmed? If so, what specific areas of the job were discussed? 

Response. Yes, both Secretary Shinseki and Deputy Secretary Gould have spoken 

with me about the role. They will be looking to me and the Office of Policy and Planning (OPP) to provide independent analysis to them and other senior leaders as they 

make Department-wide policy and planning decisions. If confirmed, I look forward 

to leading a proactive policy development process that involves multiple organizations across the Department. 

Question 2. Have you formulated any thoughts on what your new job responsibilities will be and how you will approach those responsibilities if confirmed? 

Response. If confirmed, I am committed to work on the President’s and Secretary 

Shinseki’s priorities to address homelessness, mental health, health services, and 

benefits for the Veteran population as well as enhancing the VA/DOD relationship. 

I am also committed to ensure that the Office of Policy and Planning becomes a valued partner to the senior leaders at the VA, Congress, and other agencies helping 

develop policy to transform the Department to be veteran-centered, results-oriented 

and forward-looking. 

Question 3. If confirmed, what would you most like to accomplish in your new position? What would you hope your legacy to the Department would be? 

Response. If confirmed, my efforts will be focused on ensuring that the Office of 

Policy and Planning provides the data and analysis to guide effective decisionmaking, and that the transformation strategy outlined by the Secretary is executed 

effectively. Ultimately, these two accomplishments would ensure improved services 

and benefits for Veterans. I would hope my legacy would be to achieve Departmentwide acceptance of the transformational programs for long-term and sustainable improvements in how services and benefits are delivered to Veterans and their families. 

Question 4. What are your top priorities for the office you will oversee, and what 

can Congress do to assist you in your new role? 

Response. If confirmed, I would have three top priorities for the Office of Policy 

and Planning: (1) guiding the effective execution of the transformation strategy for 

the Department; (2) providing independent analysis to enable strategic, multi-year 

planning for the Department; and (3) leading a robust policy development capability 

151 

that continually improves and refines policy to benefit Veterans. I would look forward to working with Congress to achieve these goals. 

Question 5. How would you describe your management style and how is it suited 

to this particular position? 

Response. I pride myself in being an active listener and a results-oriented 

decisionmaker; always involving others in shaping projects and defining priorities; 

encouraging consensus and the development of science-based innovative methodologies for problem solving while owning ultimate accountability for the team’s performance; and placing value in others’ expertise, nurturing a team spirit, and individual development. 

Question 6. How will you work to incorporate the expertise of career employees 

into day-to-day management decisions? 

Response. I have learned from my previous experience in government that career 

employees are valuable subject matter experts who have a lot to contribute to management decisions. They possess useful institutional knowledge about what has been 

tried before and its results. They often have great insight into how to develop and 

implement new approaches. If confirmed, I would immediately meet with the career 

staff at the Office of Policy and Planning and throughout the VA and engage them 

as partners in the policy development and implementation process. 

Question 7. What is your previous level of exposure to veterans-related issues? 

What will you do to become familiar with such issues? 

Response. Although, I will have much to learn about the Department of Veterans 

Affairs and the issues facing our Veterans, I have significant experience in corporate 

and government policy and strategic planning in large organizations similar to the 

Department of Veterans Affairs in their complexity and commitment to excellence. 

The Assistant Secretary for Policy and Planning is responsible for providing advice 

and counsel to the Secretary and other senior leaders helping formulate corporate 

policy and strategic planning. If confirmed, I commit to become thoroughly familiar 

with the issues facing our Veterans and to diligently and faithfully advise the Secretary and Deputy Secretary. 

If confirmed, and with the help of this Committee, I will bring stability, vision 

and innovation to optimize data collection and scientific methodologies for the analysis of the veteran population, so this information can serve to transform the services they and their loved ones receive. I will immediately meet with career staff and 

examine all operations in OPP in full detail. I will work tirelessly to support Secretary Shinseki’s transformation goals for VA, with a special priority on transformational initiatives residing in OPP. These initiatives will be guided by Secretary 

Shinseki’s three principles: people-centric, results-oriented and forward-looking. I 

hope to provide strong leadership and clear vision to this office so it can be regarded 

as a best practice model across the Federal Government. 

Question 8. How do your previous experiences in government contribute to your 

qualifications for this new position? 

Response. If confirmed, I will bring nearly 25 years of experience in planning and 

strategy to serve the needs of Veterans and contribute to their well-being and of 

those who care for them. My experience at the Commerce Department as a Chief 

of Staff for the Under Secretary for International Trade managing policy issues and 

later, managing an organization of over 700 people as a Deputy Assistant Secretary 

for Administration, provides me with understanding of how to accomplish goals 

within the Federal Government setting and makes me aware of the value and expertise of those who have devoted their careers to public service. My experience as 

Chief of Staff for the New York City Department of Mental Health and Associate 

Commissioner for Strategic Planning allows me to bring insights in long term strategy for mental health services, one of the key priorities for Secretary Shinseki and 

the VA. As a chief medical officer of one of the largest public hospitals in the Nation, I also bring understanding of direct patient care and regional planning to develop centers of excellence, which is another top priority for Secretary Shinseki and 

this Administration. My experience as Vice President for Medical Affairs for the 

New York City Health & Hospitals Corporation, the largest public hospital system 

in the Nation, provided me with the opportunity to work with the VA hospital system facilitating the graduate medical education agreements and joint research activities that are core functions for the Veterans Health Administration. I believe 

with these combined capabilities I can bring significant value and innovation to 

those served by the Department of Veterans Affairs. 

Question 9. If confirmed, how would you oversee certain management activities 

and processes that require coordination across the Department? 

Response. If confirmed, I look forward to working with my counterparts in the 

other staff offices and administrations through the existing governance process at 

152 

the Department. I would seek to ensure that the principles outlined by Secretary 

Shinseki—Veteran-centric, results-oriented and forward looking—guide our work together. I believe the key to managing coordination and collaboration activities across 

a large, diverse organization like VA is to first garner agreement for these principles 

and then to create a solution-focused atmosphere with a high level of accountability. 

Question 10. What do you think your role would be in VA budget formulation? 

Response. While ultimate responsibility for VA budget formulation resides with 

VA’s Office of Management, the Office of Policy and Planning (OPP) makes an important contribution to this process by developing the Department’s strategic plan. 

OPP can help make sure that the budget request is aligned with the priorities identified in the strategic plan. In addition to strategic planning, I understand that OPP 

makes other important contributions to the budget development process. By creating 

and maintaining VA’s Veteran population model and through its actuarial analysis 

capabilities, OPP provides necessary data required to make accurate cost and workload projections. If confirmed, I would work to make sure that OPP is providing useful input to the budget formulation process for the entire Department. 

Question 11. Much has been said about transforming VA into a 21st century organization. What do you see as the greatest challenges in this transformation and how 

can the Office of Policy and Planning assist VA in completing this transformation? 

Response. From my previous experience leading change within institutions, I 

know that the most difficult challenges in transformation are making sure that 

change is implemented in a meaningful and sustainable way, and that it produces 

the intended outcomes. I believe OPP can make an important contribution to the 

transformation process by helping to manage the execution of the strategy. That is, 

OPP can provide support and analysis to the integrated teams responsible for implementing change and to the Departmental leadership overseeing their efforts. OPP 

can work with the Office of Management to make sure that proper performance 

metrics are developed and useful data is gathered and analyzed to measure the 

transformation efforts. If confirmed, I intend to make transformation an important 

focus of OPP’s work. 

Question 12. Secretary Shinseki has placed emphasis on improving the level of 

collaboration and cooperation between VA and DOD. What do you believe will be 

your role in dealing with areas of concern involving the two departments? 

Response. With respect to VA/DOD collaboration and cooperation, I recognize the 

importance both departments place on the delivery of health care services and benefits for returning Servicemembers and the smooth transition from military service 

to Veteran status. If confirmed, I will work to maximize collaboration with DOD 

through the VA/DOD Collaboration Service and VA’s involvement with the VA/DOD 

Senior Oversight Committee (SOC) and Joint Executive Council (JEC). VA’s work 

through these two bodies can emphasize developing and executing clear policies and 

guidelines, promoting opportunities for sharing resources, and establishing mechanisms for enforcing accountability with its partners at DOD. 

Question 13. If confirmed, what metrics do you intend to use to determine the success of VA and DOD collaboration, and how did you arrive at those metrics? 

Response. If confirmed, I will evaluate the processes through which the Department establishes metrics for determining success in its activities with DOD. I understand that performance measures currently are being developed for VA/DOD activities for the FY 2010–2012 period through the VA/DOD Joint Strategic Plan 

(JSP). I also understand that the SOC has developed performance metrics to assist 

the Committee in its continued oversight of the delivery of benefits and services to 

the wounded, ill, and injured. Should I be confirmed, I intend to work with my counterparts at DOD to further develop meaningful performance metrics intended to 

produce real results that benefit Servicemembers and Veterans. 

Question 14. DOD and VA are expanding the Disability Evaluation System pilot 

program to more military facilities. However, the Committee has heard reports of 

some tension between VA and DOD as to who is paying for what services under that 

program. If confirmed, will you ensure that neither Department is shouldering the 

financial burden for this program? 

Response. I believe that through the Disability Evaluation System pilot program, 

VA and DOD have committed to creating a more transparent and efficient process 

for medically separated Servicemembers. It is my understanding that VA and DOD 

are currently developing policies on the respective financial responsibilities in each 

Department that will ensure fair burden sharing for the DES pilot expansion. If 

confirmed, I will evaluate these policies and work with DOD so that both departments share the burden fairly. 

153 

Question 15. What more could be done in order to ensure a smooth transition from 

Servicemembers to civilian status? 

Response. If confirmed, I will be proud to be part of a VA team that is working 

to ensure a smooth transition from military service to Veteran status. There is an 

ongoing concern about creating a smooth transition for those who are wounded, ill 

and injured from OIF and OEF and for activated Guard and Reservists transitioning from active duty to Veteran’s status. I fully appreciate that this is an extremely 

important issue for the Committee, for the Administration, for Secretary Shinseki, 

and most importantly for Servicemembers becoming Veterans. If confirmed, I will 

aggressively examine this issue and ensure that we are doing everything possible 

to make the transition to Veteran status a smooth one. 

Question 16. Are you satisfied that veterans’ data collected by the Office of Policy 

and Planning adequately safeguarded against inappropriate release? If not, what 

can be done to better safeguard sensitive information? 

Response. I understand that VA has taken extraordinary efforts over the past few 

years to ensure that data collected by the Office of Policy and Planning (OPP) is 

adequately safeguarded against inappropriate release and use. However, I do not 

know at this point whether further safeguards are needed. If confirmed, I will review the data protection policies within OPP and enact any necessary changes to 

improve data security. 

Question 17. How can the Office of Policy and Planning better support continual 

enhancement of policies, programs, benefits, and services to veterans? 

Response. I believe this is an area where the Office of Policy and Planning (OPP) 

can make important contributions. First, OPP can provide independent data analysis to help senior leaders make informed decisions about how to improve programs, 

benefits, and services. By providing useful data and analysis on an ongoing basis, 

OPP can help the Department to continually refresh and refine its approach to delivering services and benefits. Second, by continuing to conduct program evaluations 

and initiate business process reengineering for different functions, OPP can help to 

improve VA programs and benefits. Third, OPP can incorporate findings of cutting 

edge policy research and identify ways to apply it to policy and programmatic design 

at VA to support better delivery of services to Veterans and their families. If confirmed, I would like to see OPP take a more proactive role in helping the Department to continually assess and improve policies, services, and benefits. 

Question 18. How can the Office of Policy and Planning facilitate cooperative and 

collaborative data gathering and analysis across the Department? 

Response. I believe this is a natural role for OPP to play. Access to reliable, accurate, and useful data is essential to managing a large organization like VA. OPP 

can facilitate data gathering by helping the Department to develop a standardized 

data governance process. The National Center for Veterans Analysis and Statistics 

(NCVAS) within OPP can collect, validate, analyze, publish and disseminate data 

for use by the Department and other stakeholders. If confirmed, I look forward to 

working with the data experts within OPP and across the Department to identify 

ways to more effectively gather, manage, and use data to inform good decisionmaking. 

Question 19. Do you agree to appear before the Committee at such times and concerning such matters as the Committee might request for so long as you serve in 

the position for which you now seek confirmation? 

Response. Yes. If confirmed, I look forward to working with the Committee to accomplish our shared goal of improving VA services and benefits to Veterans. 

RESPONSE TO SUPPLEMENTAL PREHEARING QUESTIONS FOR DR. RAUL PEREA-HENZE, 

NOMINEE TO BE ASSISTANT SECRETARY FOR POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. In connection with you work at Pfizer, Inc., it appears that you delivered speeches at various conferences. The materials from at least some of those conferences include the attached biographical sketch of you. In light of some ofthe information in that document that does not appear to be reflected in your questionnaire 

(such as attendance at the JFK School of Govemment of Harvard), clarification 

would be helpful. 

a. Is the information in this document accurate? 

Response. The information in this document is accurate. For about three months 

in 1986, before starting my Masters in Public Health at Yale University, I audited 

courses at the Kennedy School of Government at Harvard. I had applied to Harvard 

as well as Yale, and the auditing was an informal arrangement to prepare for gradVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00157 Fmt 6601 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
154 

uate school and compare programs. I did not include this information on the Committee qiestionnaire because of the informal nature of the auditing and because I 

did not pursue a degree at Harvard. Several memberships included on the Pfizer 

document, including my memberships at New York Cares, GMHC, and the Ackerman Institute for Mental Health, were not included on the Committee questionnaire 

because they fell outside of the ten year window requested in the questionnaire. It 

appears that I inadvertently left offmy Biochemistry and Physiology Fellowship and 

my adjunct teaching role at New York University. I have revised my questionnaire 

to reflect these items. 

b. If there is accurate information reflected in that biography that is not reflected 

in your questionnaire, would you please submit and amended questionnaire reflecting that information? 

Response. Yes. 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO DR. RAUL PEREA-HENZE, M.D., M.P.H., NOMINEE TO BE ASSISTANT SECRETARY FOR

POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. The Office of Policy and Planning has a range of responsibilities. For fiscal year 2010, the President has requested $26 million for that office and a staff 

of more than 93 full-time employees to carry out those responsibilities. 

a. What do you see as the key functions performed by the Office of Policy and 

Planning and how does that office help the Department of Veterans Affairs (VA) in 

carrying out its overall mission? 

Response. The Office of Policy and Planning provides independent analysis that 

can be used by senior leaders as they make Department-wide policy and planning 

decisions. By serving in a central, coordinating role, OPP provides the data, independent analysis, and Department-wide perspective to guide policy development. 

OPP also has an important role to play in engaging external partners such as 

other Federal agencies involved in the development of policy and programs for Veterans. 

b. What do you see as the key responsibilities of the Assistant Secretary for Policy 

and Planning? 

Response. First, the Assistant Secretary for Policy and Planning is responsible for 

providing advice and counsel to the Secretary and other senior leaders and helping 

to formulate Departmental policy and strategic planning. Second, the Assistant Secretary must provide leadership to the Office of Policy and Planning and make sure 

that the Office is contributing to the Department’s mission in a meaningful and results-oriented manner. The Assistant Secretary should ensure that the Office of Policy and Planning provides independent analysis to senior leaders as they make Department-wide policy and planning decisions. Finally, I believe the Assistant Secretary should lead a proactive policy development process that involves multiple organizations across the Department 

The Office of Policy and Planning is responsible for the critical function of data 

collection and assessment to help develop policy. Accurate data from the National 

Survey of Veterans and other population studies, appropriate analysis of these data, 

and their secure dissemination throughout the Department and across sister agencies in the Federal Government and the States, are necessary foundations for the 

Department’s transformation effort. If confirmed, I want to ensure the rigor of these 

analyses so there is full trust in the results and recommendations that emanate 

from them. OPP will be instrumental in helping the VA achieve the President and 

Secretary Shinseki’s priorities, including: 

• Securing accurate and reliable data on mental health, homelessness, waiting 

times for medical care and benefit processing; 

• Understanding new comprehensive care models that include health care, 

caregiving, and benefits in a veteran-centered approach; 

• Assisting the Secretary, Deputy Secretary and the Administrations to define 

and implement metrics and a milestone approach to transformational programs; 

• Envisioning and helping to implement innovative models of services to optimize 

value for the Veterans. 

c. How has your background prepared you to take on these responsibilities and 

what prior experiences do you believe qualify you to manage a staff and budget of 

this size? 

Response. If confirmed, I will bring nearly 25 years of experience in planning and 

strategy to serve the needs of Veterans and contribute to their well-being and of 

those who care for them. My experience at the Commerce Department as a Chief 

155 

of Staff for the Under Secretary for International Trade managing policy issues and 

later, managing an organization of over 700 people as a Deputy Assistant Secretary 

for Administration, provides me with understanding of how to accomplish goals 

within the Federal Government setting and makes me aware of the value and expertise of those who have devoted their careers to public service. My experience as 

Chief of Staff for the New York City Department of Mental Health and Associate 

Commissioner for Strategic Planning allows me to bring insights in long term strategy for mental health services, one of the key priorities for Secretary Shinseki and 

the VA. As a chief medical officer of one of the largest public hospitals in the Nation, I also bring understanding of direct patient care and regional planning to develop centers of excellence, which is another top priority for Secretary Shinseki and 

this Administration. My experience in the private sector, both in management consulting and in the health industry, provides me with business acumen and a resultsoriented approach driven by a long-term vision. I believe with these combined capabilities I can bring significant value and innovation to those served by the Department of Veterans Affairs: Veterans and those taking care of Veterans. 

d. How would you measure your success in fulfilling those responsibilities? 

Response. If confirmed, my efforts will be focused on ensuring that the Office of 

Policy and Planning provides the data and analysis to guide effective decisionmaking, and that the transformation strategy outlined by the Secretary is executed 

effectively. Ultimately, I will measure my success by whether our actions result in 

improved services and benefits for Veterans. 

The transformation initiative seeks to provide measurable goals and results at 

every milestone. These goals will be defined early and I will ensure close oversight 

of milestone achievements. Stakeholder satisfaction surveys will give us a tangible 

metric as well as statistical analysis of the veteran population before and every year 

since the beginning of the Administration and the transformation initiative implementation. 

Question 2. In the book The People Factor, the Deputy Secretary of VA and his 

co-author opine that the Federal Government ‘‘is run by a revolving door of political 

appointees, many with limited management skills,’’ and that they are ‘‘[r]arely chosen for their proven skills at managing large organizations or major organizational 

changes.’’ In part, the authors recommend that Congress ‘‘emphasize people management skills during the confirmation process for political appointees.’’ 

a. Would you please describe your prior management experience? 

As outlined above, I have 25 years of experience in both the public and private 

sector managing small and large organizations, from a current team of six individuals responsible for policy matters at one of the largest global pharmaceutical companies to a group of over 700 people as a Deputy Assistant Secretary for Administration at the US Commerce Department, responsible for areas as diverse as procurement, small businesses, human resources, grants, civil rights and facilities. As 

Vice President of Medical Affairs for the New York City Public Hospital System, the 

largest in the Nation, I oversaw the creation of a department for infectious diseases 

at a time when New York City suffered severely from AIDS and Tuberculosis. I was 

responsible for developing the 10-year Strategic Plan for Mental Health Services, 

which created and strengthened a vast network of patient-centered communitybased services, relevant to Secretary Shinseki’s priority to transform the VA into a 

people-centered organization. As a management consultant, I worked with Fortune 

100 health organizations advising them in organizational and strategy issues for a 

number of years. This experience as well as managing medical operations for the 

largest pharmaceutical company in the world, have provided me with an understanding of policy and strategy in complex organizations similar in size to the VA. 

In the private sector, I have participated actively in several major reorganizations 

and mergers of large global pharmaceutical companies comparable in size and complexity to the Department of Veterans Affairs. In this capacity, I successfully managed medical operations and policy alignment in a one to two year span to realize 

billions of dollars of savings in efficiencies. 

b. Would you please provide specific examples from prior jobs demonstrating your 

people management skills? 

Several times in my career, I developed and managed new areas, for instance, the 

Department of Infectious Diseases at the public hospital system in New York City. 

In that role, I recruited, trained and developed all personnel and increased the 

budget by $14M in a year. In other cases, I have been given an established role 

where I learned that a key to success is to acknowledge and leverage people’s expertise. I took this approach at the U.S. Department of Commerce in order to enhance 

operations and produce a high-performing organization. As Chief of Staff for the Department of Mental Health in New York City and Associate Commissioner for StraVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00159 Fmt 6601 Sfmt 6621 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
156 

tegic Planning, I was entrusted to work with staff and the Mental Health Advocate 

community to build a roadmap to strengthen services for the city’s residents in mental health, mental retardation, alcoholism and substance abuse. We successfully 

completed and gained budget approval for the 10 year plan as well as critical support from advocacy organizations. 

In every assignment, I have valued individual experience and contributions as 

well as promoted a consensus approach to finding solutions to priority issues. As a 

leader, I have provided strategic leadership and ongoing hands-on management coupled with a results- oriented, long-term approach focused on measurable outcomes. 

c. If we were to ask your prior subordinates about your people management skills, 

what would they say? 

I pride myself in being an active listener and a results-oriented decisionmaker, 

always involving others in the shaping of projects and definition of priorities. I encourage consensus and the development of innovative science-based methodologies 

for problem solving while owning ultimate accountability for the team’s performance. Finally, I value others’ expertise and focus on nurturing both individual development and team spirit. 

I believe my success is measured by the continuation of the services developed 

under my leadership: the office of infectious diseases at the largest public hospital 

system in the Nation; the ongoing 10 year strategic plan for mental health services 

in New York City; the reform of credentialing for over 2,000 physicians and residents at Kings County Hospital in New York; and the development of medical policy 

departments at the top two pharmaceutical companies in the world. In many cases, 

some of the people I worked with and helped mentor are now running those operations. 

Question 3. The authors of The People Factor also opine that ‘‘[p]olitical leaders 

have a short-term horizon and are frequently ill informed about the mechanics of 

their agency.’’ In part, the authors recommend that training be required for political 

appointees. 

a. To what extent are you already familiar with VA and the programs it administers? 

Response. I will have much to learn about the Department of Veterans Affairs 

and the issues that are of concern to our Veterans. I come, however, with significant 

experience in corporate and government policy and strategic planning in large organizations similar to the Department of Veterans Affairs in their complexity and 

commitment to excellence. The Assistant Secretary for Policy and Planning is responsible for providing advice and counsel to the Secretary and other senior leaders 

helping to formulate corporate policy and strategic planning. If confirmed, I commit 

to becoming thoroughly familiar with the issues facing our veterans, and to diligently and faithfully advise the Secretary and Deputy Secretary. 

b. If confirmed, what steps would you take to enhance your knowledge regarding 

VA and its programs? 

Response. If confirmed, I will immediately meet with career staff and solicit input, 

and examine all operations in OPP in full detail. I also will meet with my counterparts within the administrations and staff offices to learn more about their operations, their priorities, and how OPP can assist them. I intend to engage in informational briefings and meetings regarding the ongoing management, planning, and 

policy functions of the Department. I also will welcome information from Veterans 

Service Organizations, special commissions, and other stakeholders. 

c. If confirmed, what types of short-term and long-term goals would you set? 

Response. If confirmed, in the short term, I would like to focus on building OPP’s 

capabilities to achieve the priorities laid out by Secretary Shinseki. I will engage 

in an accelerated onboarding effort that will get me in touch with people and priority issues at OPP in the shortest amount of time, without compromising the quality of information and interactions with staff. I will learn more about the priority 

issues for the Secretary, such as homelessness, mental health, and transformation, 

and work closely with the senior leadership to ensure that OPP is contributing to 

these efforts. I also would like to focus on developing meaningful performance 

metrics to track and measure the Department’s transformation efforts. 

In the long term, I would make sure that OPP has helped to put in place the processes and policies to sustain transformation of VA. I would work to ensure we define 

and implement new standards for quality data collection and management. I also 

would work to ensure there is measurable progress in the VA/DOD relationship that 

is fundamental for the seamless transition of the users of the system. Finally, I believe OPP can work with the administrations to provide them with data analysis, 

metrics, and useful policy advice related to providing Veteran-centered health and 

benefits for veterans and their families. 

157 

Question 4. The completed questionnaire you submitted to the Committee reflects 

that you made $9,350 in political contributions over the past 10 years. However, 

several on-line resources, including the Web sites for the Federal Election Commission and the New York State Board of Elections, appear to reflect other contributions made by you during that time period. For example, those resources reflect a 

$1,000 contribution to ‘‘Friends of Joe Mesi’’ in 2008. 

a. Would you please clarify whether you have made political contributions in the 

past 10 years in addition to those listed in your initial questionnaire? 

It appears that I inadvertently left off several contributions from my original Senate questionnaire. Below is a complete list of contributions, based on public sources. 

2009 $1,000 DNC 

2008 $2,300 Obama for America 

2008 $7,000 Obama Victory Fund 

2008 $1,500 Gil Action—NY Senate Race 

2008 $1,000 Friends of Joe Mesi 

2007 $ 250 Carlos Del Toro for VA Assembly 

1999 $ 500 Al Gore via Gore 2000 Inc. 

b. If so, would you please submit an amended questionnaire listing all contributions? Yes. 

Question 5. In response to question #12 in the questionnaire, you noted several 

organizations for which you formerly held an office. The Web sites for some of those 

organizations (which may be outdated) continue to identify you as being an officer. 

a. Would you please clarify whether you are currently an officer in any organizations? If so, what is the nature of your responsibilities? 

No, I am not currently an officer in any organization, nor have I been since January 1, 2007. 

b. Would you please clarify whether you are currently a member of any organizations? 

The only organizations of which I am currently a member are: 

1. New York Academy of Medicine 

2. World Medical Association 

3. Clinton Global Initiative 

4. Outgiving/Gil Foundation 

5. Yale Club of New York City 

c. Would you also please clarify what organizations you intend to maintain your 

membership with, if confirmed? 

Response. If confirmed, I intend to maintain my memberships in the following organizations: 

1. New York Academy of Medicine 

2. Yale Club of New York City 

3. World Medical Association 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY TO

RAUL PEREA-HENZE, M.D., M.P.H., NOMINEE TO BE ASSISTANT SECRETARY FOR

POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. VA construction is a concern that every member of the Committee 

shares. Whether through CARES or other planning processes we have a huge 

amount of construction projects we have promised our veterans, but the VA has limited funding to address these issues. In the Puget Sound Health Care System alone, 

the Seattle VA has a New Mental Health and Research Building, seismic retrofitting of a bed tower and, in Tacoma, a new hospital building at American Lake 

on its plate. 

a. What assurances can you give me that these projects will be completed in a 

timely fashion? 

Response. I am not currently familiar with these projects. If confirmed, I will look 

into these projects and evaluate their progress. In general, I believe the Office of 

Policy and Planning can work together with the Administrations and staff offices 

to evaluate and prioritize construction projects to ensure that the Department of 

Veterans Affairs (VA) directs its construction funds to the areas where it will do the 

most for Veterans. 

158 

b. How are you going to ensure major construction projects get off the ground in 

a timely manner so our veterans can be assured they are getting the investments 

we have promised them? 

Response. As referenced above, I believe the Office of Policy and Planning can assist with coordinating efforts and help ensure the prioritization of construction 

projects through analysis and planning. Funding decisions should align with agreed 

upon Departmental priorities. The Office of Policy and Planning (OPP) can work 

with organizations across VA to foster an environment of accountability with respect 

to these projects. If confirmed, I look forward to working with you to provide Veterans the benefits and services they deserve. 

Question 2. As you know, veterans have a much higher unemployment rate than 

their counterparts in the civilian world. I told the Committee in a hearing about 

veterans unemployment three weeks ago that of the nearly 2,300 members of the 

Washington National Guard’s 81st Brigade Combat Team who came back from theater this summer, about half of them requested direct job placement. In fact, only 

20 percent of those who sought this assistance have been able to obtain a job. As 

you know, maintaining employment is vital to ensuring a higher quality of life for 

our veterans and we seem to be struggling to make the connections needed to assure 

veterans obtain employment. If confirmed as the VA’s head of policy and planning, 

what do you think we can do to improve employment assistance services to veterans? 

Response. If confirmed, I look forward to working with you, both in your role as 

a member of the Senate Veterans’ Affairs Committee and as Chairman of the 

Health, Education, Labor and Pensions Subcommittee on Employment & Workplace 

Safety, to improve the current employment situation for Veterans. This is an area 

where VA can leverage its partnerships with the Department of Defense and the 

Department of Labor to improve employment opportunities for Veterans through effective outreach, job counseling, training, education, and job placement. Secretary 

Shinseki has several Veterans employment initiatives in place, and President 

Obama recently established a Council on Veterans Employment. If confirmed, I look 

forward to supporting Secretary Shinseki in his role on the President’s Council. 

While economic conditions outside of VA’s direct control contribute to unemployment, VA can evaluate and adjust its current programs to help address and overcome these obstacles. Employment is an essential part of successful transition for 

Veterans. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. JON TESTER TO RAUL

PEREA-HENZE, M.D., M.P.H., NOMINEE TO BE ASSISTANT SECRETARY FOR POLICY

AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. I am deeply concerned by the slow development of the Office of Rural 

Health (ORH). In its short history, it has not been sufficiently staffed and retention 

of leadership has been a constant problem. As a result, the ORH lacks a clear vision 

for what it should look like. I agree with you about the need to have better data 

collection on the health status of rural veterans. If confirmed, will you make this 

a priority for the ORH? What else do you see as the appropriate role for the ORH 

within the VA? 

Response. As you noted in our recent meeting, the Office of Rural Health resides 

in the Veterans Health Administration. However, I believe the Office of Policy and 

Planning (OPP) can help shape the vision and support the activities of the Office 

of Rural Health. If confirmed, I look forward to leading OPP in these efforts. OPP 

has the capacity to perform valuable analysis and research to assess the needs of 

rural Veterans. I believe it can also conduct environmental scans to determine existing best practices and determine how they might be applied to VA care delivery. 

OPP can provide valuable demographic data that can be used to establish baseline 

estimates and measure program success. 

The Office of Rural Health should serve as the VA leader in health care delivery 

to hard to reach Veterans. In support of this goal, the Office of Policy and Planning 

(OPP) can provide independent analysis of the different modalities that can be employed to serve these Veterans. OPP can evaluate the efficacy of tele-medicine and 

tele-health initiatives and identify innovative approaches to providing distance 

health care. 

Additionally, I believe it is essential to build a strong prevention element into a 

successful rural health program. The up-to-date research and analyses provided by 

OPP may help the Office of Rural Health in developing such an approach. 

Question 2. The Committee recently held a hearing on the very clear need to improve health care for American Indian veterans. This is a vital part of improving 

159 

health for rural veterans. It was clear from that hearing that we know very little 

about the problems facing American Indian veterans. We have very little data on 

the number of veterans eligible for both IHS and the VA, nor do we have any solid 

data on the particular health problems of American Indian veterans. This is an important segment of the veterans population that we are, quite frankly, missing the 

mark in terms of honoring our promise to care for those who shall have borne the 

battle. Worse, it is not at all clear to me that the VA has any sense of urgency in 

moving to better understand this issue. Can you commit to working to get a better 

handle on the challenges facing American Indian veterans? 

Response. You have my commitment that if confirmed, I will work with you, the 

Indian Health Service and others to address this issue. I appreciate the unique geographical and cultural issues involved in delivering care to these Veterans. If confirmed, I look forward to developing innovative alternatives to provide health care 

and preventive medicine to these and other minority Veterans. 

I understand VA has an Advisory Committee on Minority Veterans and I look forward to working with them and the Administrations to ensure that American Indian Veterans have access to benefits and services provided by VA. As I noted in 

my answer about rural health, a strong prevention element is essential to success. 

The research and analysis conducted by OPP can help identify innovative approaches to meet the needs of these Veterans. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. MARK BEGICH TO RAUL

PEREA-HENZE, M.D., M.P.H., NOMINEE TO BE ASSISTANT SECRETARY FOR POLICY

AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. I have reviewed the VA’s Strategic Plan for 2006–2011 and note it 

is set to ‘‘expire’’ in the next 12 months. 

• When should we expect the VA to publish it next long-range strategic plan? 

• Is there a way to give to this Committee a report card or milestones of progress 

made, rather than waiting until the report is complete? 

Response. It is my understanding that the VA Strategic Plan for FY 2010–2014 

is in development at this time and that when VA began drafting this new strategic 

plan several months ago, the Department met with senior staff of the Senate Committee on Veterans’ Affairs and the Senate and House Committees on Appropriations to get their input. This draft is currently being reviewed by the Office of Management and Budget (OMB). I understand that the Department expects to publish 

the VA Strategic Plan for FY 2010–2014 in the near future. 

If confirmed, I would be happy to work with the Department to update you and 

the Committee on VA’s progress in implementing the VA Strategic Plan. As I mentioned during the hearing, under the Government Performance and Results Act 

(GPRA), the Department must submit annual performance reports to Congress that 

document its progress toward achieving the goals and objectives contained in the 

strategic plan. VA will be pleased to brief you and the Committee on the results 

contained in this report each year. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. ROLAND W. BURRIS TO

RAUL PEREA-HENZE, M.D., M.P.H., NOMINEE TO BE ASSISTANT SECRETARY FOR

POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. Dr. Perea-Henze, I commend VA’s establishment of a permanent office 

to address the needs of returning servicemembers. While many strides have been 

made to ensure a seamless transition from active duty to veteran status, more must 

be done to ease this integration into the VA system and reintegration into society. 

What is your view of the work that remains in this area, and how would you seek 

to accomplish a truly seamless transition? What are your plans to combat the cultural issues that accompany the transition to veteran status? 

Response. As I mentioned in my opening statement, if confirmed, I intend to establish and maintain strong working relationships with my counterparts at the Department of Defense. I believe it is contingent upon VA to ensure that everyone who 

has served is aware of the benefits and services provided by VA. Those who were 

injured while serving in harm’s way and who continue to need VA’s help after their 

service has ended will be a priority. Servicemembers need the most complete information possible about benefits and services available from VA to make the best decisions upon leaving service. I appreciate that this is an important issue for the Administration, for Secretary Shinseki, and most importantly for Servicemembers becoming Veterans. I understand much is being done already, but if confirmed, I will 

160 

commit to aggressively examining the issue and ensuring that we are doing everything possible to ensure a smooth transition to Veteran status. 

[The Committee questionnaire for Presidential nominees follows:] 


HenzeQ1.EPS
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HenzeQ2.EPS
162 


HenzeQ3.EPS
163 


HenzeQ4.EPS
164 


HenzeQ5.EPS
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HenzeQ6.EPS
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HenzeQ7.EPS
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[A letter from the Office of Government Ethics follows:] 


HenzeQL1.EPS
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[Letter from Raul Perea-Henze, M.D., M.P.H., to the Office of 

General Counsel, U.S. Department of Veterans Affairs:] 


HenzeQL2.EPS
169 

Chairman AKAKA. Thank you very much, Doctor. 

Dr. Perea-Henze, if confirmed, which issues do you intend to 

prioritize in your first 60 days in office? Are there certain areas 

which, in your opinion, need to be addressed on day one? 

Dr. PEREA-HENZE. Thank you for the question, Mr. Chairman. 

I think at the top of my list, since I am coming from the outside, 

will be the most important thing that I can do: to begin a full assessment of capabilities, resources, people’s expertise, and systems 

in order to understand exactly where the Office of Policy and PlanVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00173 Fmt 6601 Sfmt 6601 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN

HenzeQL3.EPS
170 

ning stands. Along those lines also, how is the Office prepared to 

support the Secretary’s priorities in the major three areas that are 

housed, if you will, at the Office of Policy and Planning: the transformation initiative, the long-range strategic planning that Senator 

Begich was referring to, and the collaboration between the VA and 

the DOD. 

I think understanding what you have, then understanding how 

to match those resources to the priorities will produce my third 

point, which will be the ability to have a plan of action within a 

reasonable period of time, 90 to 100 days, in which I can actually 

spell out the specifics. 

I am not aware—of course, I do not have all the information— 

of any issue that at this point I can say will be a day one situation. 

But, obviously, I am happy to come back and retrace my steps if 

we do find something once, and if I am confirmed, I have the opportunity to evaluate this further. 

Chairman AKAKA. Dr. Perea-Henze, if confirmed, how do you intend to tap the expertise of career staff and ensure that they are 

brought into the decisionmaking process? 

Dr. PEREA-HENZE. Thank you for that question, Mr. Chairman. 

It is probably one of the core elements of my opening statement. 

Having worked at the Commerce Department previously, I have 

seen firsthand how the subject matter experts who deal with all of 

these issues can be so valuable for ideas and implementation. I believe that involving all of these experts at the Office of Policy and 

Planning early on will produce enough knowledge to understand 

how to move forward. If there is some transformation, for example, 

transformation will never be complete if the rank of the Department are not buying into it for the long term. So I commit to you 

that this is going to be one of the central pieces of how I will work 

with OPP, if confirmed. 

Chairman AKAKA. On October 8, this Committee held a hearing 

on various environmental exposures, two of which took place on 

military facilities—one at Camp Lejeune in North Carolina, another at Atsugi Naval Air Station in Japan. Both environmental incidents affected servicemembers and their families. Noting that 

these issues fall under the jurisdiction of both the Departments of 

Defense and Veterans Affairs, how can your office help develop a 

sensible, effective approach to dealing with the issue of military 

exposures. 

Dr. PEREA-HENZE. Mr. Chairman, I think that is a very important question. 

Again, if confirmed and I have a chance to understand what is 

already going on through the collaboration between VA and DOD— 

it is my understanding from the outside that at least they are 

aware of this issue and they are beginning to address it. However, 

there is also a very important function that the Office of Policy and 

Planning can play by looking into data evaluation, monitoring, and 

then really using all of this to understand the contamination situations in working with, across VA, as Dr. Petzel referenced before, 

as ‘‘one VA’’ to try to solve the issue. So, if I am given the opportunity, I think that will be my first evaluation. 

Chairman AKAKA. Doctor, in my opinion, the Office of Policy and 

Planning has been hindered by a lack of continuous leadership, eviVerDate Nov 24 2008 12:34 May 05, 2011 Jkt 000000 PO 00000 Frm 00174 Fmt 6601 Sfmt 6601 H:\ACTIVE\072209N.TXT SVETS PsN: PAULIN
171 

denced by long gaps between confirmed assistant secretaries. How 

will you address this issue and provide the stability that this Office 

needs? 

Dr. PEREA-HENZE. Mr. Chairman, this is also part of my opening 

statement, the acknowledgment that organizations can suffer when 

there is no stable leadership. So I commit to you to work with the 

Office and work with Congress and other stakeholders to make 

sure that the good work that is already happening there is acknowledged, and whatever improvements can happen on data collection mechanisms and utilization of that data are really enhanced. I believe that that reputation enhancement will provide a 

sense of better stability for the entire group working at the Office 

of Policy and Planning. 

Chairman AKAKA. Thank you very much. 

Senator Burr. 

Senator BURR. Thank you, Mr. Chairman. 

Doctor, again, welcome. A little housekeeping first, as Ranking 

Member, we also have oversight responsibilities as it relates to 

VA’s activities, and that leads me or my staff to make formal inquiries for information, for statistics, for briefings and materials 

from the VA. If confirmed, do I have your commitment to provide 

in a timely fashion those requests? 

Chairman AKAKA. Absolutely, Senator. 

Senator BURR. If confirmed, do I have your assurance that you 

will be proactive in notifying the Committee, both sides of the aisle, 

on any issues that deal with the Veterans Administration? 

Dr. PEREA-HENZE. Absolutely. 

Senator BURR. Doctor, in the prehearing questions, you were 

asked about efforts to improve the coordination between the VA 

and the Department of Defense, and you mentioned that VA could, 

‘‘create mechanisms for enforcing accountability with its partners 

at DOD.’’ I have seen some of the best try and only attain marginal 

success. So, if you would, share with me what you mean by those 

mechanisms. 

Dr. PEREA-HENZE. Thank you, Senator. 

There’s much that I do not know; however, in a collaboration of 

this type there is not one line of authority or one side or another 

that can cut across. So my reference there refers to the fact that 

you really have to build an equal collaboration on issues, whether 

it is health, benefits, electronic medical record, et cetera. Then and 

only then, are we able to be effective in the seamless transfer of 

information across the border. 

If given the chance to be confirmed, I will commit to you to come 

back with a more specific plan, after having an opportunity to assess what is already being done by the Joint Executive Council and 

the Strategic Operating Committee. 

Senator BURR. Well, I thank you for that, and we will hold you 

to that commitment—— 

Dr. PEREA-HENZE. That is OK, Senator. 

Senator BURR [continuing]. And suggest to you that this is going 

to be a monumental task, one that far exceeds any experience you 

had at the Commerce Department as it relates to trade and when 

all the agencies came in together to talk about, and to vote, whether we might have done something or not done something. Trust me 

172 

when I tell you, you have not seen anything as difficult as what 

you are going to run into trying to collaborate and come up with 

one system that is seamless between the Department of Defense 

and the Veterans Administration. I think Dr. Petzel knows exactly 

what I am saying. 

But I do believe that there is a willingness on both sides, at DOD 

and at VA, spearheaded by General Shinseki, to make this work. 

Unfortunately, it will take the undivided attention of a lot of people 

to accomplish that. 

Your career has already consisted of quite impressive and diverse 

experiences, I might say, ranging from the city of New York to 

White House fellow to the upper echelons of Pfizer and Merck. 

Share with me, if you will, why did you accept the Assistant Secretary of Policy and Planning at the Veterans Administration? 

Dr. PEREA-HENZE. That is a very interesting question, Senator. 

Number 1, I have tremendous respect for what the servicemembers do for this country. I do not think that I can serve this country 

that way, so they have my respect and admiration. The opportunity 

to have the honor to serve them I think is one of the best things 

that I can think of. 

Second, you talked about a team and the team vision. As you 

have said, I have seen many leadership styles, many different settings, and I really do believe that the vision that Secretary 

Shinseki and the President have articulated for the VA is one that 

can be effective and realistic. It has some ambitious goals, but I 

really do believe that this will bring enhanced lives for the veterans and their families. 

Senator BURR. At some point, this chapter in your career will 

also end, and you will go on to something else. 

Dr. PEREA-HENZE. I have no idea what that will be. 

Senator BURR. What would you like your accomplishment to be 

at VA if you are limited to one major accomplishment? 

Dr. PEREA-HENZE. Senator, I believe that the best accomplishment I could enjoy is to have the transformation initiative that is 

coordinated out of the Office of Policy and Planning trickle through 

in the best possible way, through the entirety of the VA, transforming the organization into one VA, while also leaving behind a 

lot of best practices that may be discovered as a new way of doing 

business on behalf of the veterans. 

I cannot think of all the other pieces—you know, facilitating and 

advising on policy, I think, are just under that; producing a very 

good long-range strategic plan, as referenced by Senator Begich; all 

of those have to feed into whether we can really show a difference, 

whatever the end of my tenure will be, from what it is today. 

Senator BURR. Thank you, Doctor. 

Dr. PEREA-HENZE. Thank you, Senator. 

Senator BURR. Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you, Senator Burr. 

Senator Begich. 

Senator BEGICH. Thank you very much. I appreciate your response in your opening and throughout to some of the questions in 

regards to the long-term strategic planning. If I heard you right, 

I just want to make sure I am hearing you right, that probably 90 

to 100 days or so you will have a good assessment of some of the 

173 

things that need to be done, that you could have more confidence 

in responding to how that strategic plan will unfold or develop. Did 

I hear that right? 

Dr. PEREA-HENZE. Senator, if confirmed, I will be able to give 

you much more specific information. However, I do know the cycle 

for the strategic plan has just ended. 

Senator BEGICH. Correct. 

Dr. PEREA-HENZE. There is a plan in place, the long-term plan. 

This stems from the Government Performance Review Act, that in 

fact I was actually in charge of when I was at the Commerce Department. It is quite complex, but it really aims at looking at performance indicators all through the different operations and has 

very strict milestones. 

From my perspective, what I would like to see is the VA really 

use the results of that exercise and put in practice a lot of the recommendations because it is only then you are going to see significant change. 

Senator BEGICH. Right. You led me right to my next piece of the 

question, and that is you can do a lot of great plans, and then they 

can just sit there, and everyone feels good they completed it. There 

is great celebration after completing the plan in the sense of drafting it, but then the hurdle is putting it into action. 

When I was mayor, every plan we created had measurement 

points to see how we were doing, which were then reported in the 

public arena. 

In this one, which I have no idea how this strategic plan was 

done, from 2006 to 2011, is there opportunity through your office 

18 months into the plan to be able to say, ‘‘Here is a report, here 

is how we are doing,’’ kind of a report card; and maybe using this 

Committee as a vehicle, maybe testifying or just submitting a report card for us, instead of waiting 5 years out and reporting how 

we did. Then we may have a variation of scale of success, instead, 

trying to look at it as we move along because a plan is a plan, and 

it does change based on the environment that we are working in. 

The 2006 plan may not have anticipated what we are experiencing 

now with Afghanistan and Iraq today. 

Is that a reasonable thing to actually put into the plan, if the 

plan exists? Maybe there is something already in there. If you are 

unaware of that, I am not asking you to dig deep and try to figure 

it out right now. However, I think it is an important measuring effort for us to see success as it is progressing through. 

Does that make any sense? 

Dr. PEREA-HENZE. Yes, Senator, completely. 

Senator BEGICH. OK. 

Dr. PEREA-HENZE. That is a very good point. I agree with what 

you are suggesting, which is you have to have some reporting 

times. I believe they are built into the act. 

Senator BEGICH. Could you share that with us? 

Dr. PEREA-HENZE. I will clarify that for you, hopefully, in the 

written response—— 

Senator BEGICH. That is great. 

Dr. PEREA-HENZE [continuing]. To make sure that what I am 

saying is the truth. 

174 

It is important that those milestones get examined carefully, and 

then, as you are also suggesting, you want this Committee to be 

given a report every so often. 

Senator BEGICH. Right. 

Dr. PEREA-HENZE. If confirmed, I will examine exactly what the 

mechanisms are, and, if that is one that you will like us to report 

on, I will check on that. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. MARK BEGICH TO

RAUL PEREA-HENZE, M.D., M.P.H., NOMINEE TO BE ASSISTANT SECRETARY FOR

POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

Request: Please provide me with a copy of VA’s long term strategic plan for 2006– 

2011 within 90 to 100 days of starting at the VA. 

Response. If confirmed, I would be happy to provide your staff with a copy of the 

VA Strategic Plan for FY 2006–2011. 

In addition, it is my understanding that the VA Strategic Plan for FY 2010–2014 

is in development at this time and that when VA began drafting this new strategic 

plan several months ago, the Department met with senior staff of the Senate Committee on Veterans’ Affairs and the Senate and House Committees on Appropriations to get their input. This draft is currently being reviewed by the Office of Management and Budget (OMB). I understand that the Department expects to publish 

the VA Strategic Plan for FY 2010–2014 in the near future. 

Senator BEGICH. Yes, I would. I am not going to speak on behalf 

of the Committee in total, but I would because I think it is a great 

way for us, instead of waiting for the end of the cycle, to say, why 

did you not do this? 

Dr. PEREA-HENZE. Correct. 

Senator BEGICH. Instead, saying earlier, well, here is success, 

here is where we are having some trouble, and here is why. So we 

can then work in concert with others to move forward with the efforts that you are trying to do through the strategic plan. 

I am sure my staff will tell me there are elements in this already, but I wanted to make sure we put it in the discussion here. 

So I appreciate that. 

Dr. PEREA-HENZE. Yes, Senator. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. MARK BEGICH TO

RAUL PEREA-HENZE, M.D., M.P.H., NOMINEE TO BE ASSISTANT SECRETARY FOR

POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

Request: If confirmed, please provide me with incremental benchmarks on the implementation of VA’s strategic plan. 

Response. If confirmed, I would be happy to work with the Department to update 

you and the Committee on VA’s progress in implementing the VA Strategic Plan. 

As I mentioned during the hearing, under the Government Performance and Results 

Act (GPRA), the Department must submit annual performance reports to Congress 

that document its progress toward achieving the goals and objectives contained in 

the strategic plan. VA will be pleased to brief you and the Committee on the results 

contained in this report each year. 

Senator BEGICH. My time is almost up. So I just want to mention 

one other issue which I mentioned in the last conversation, with regards to travel and some of those issues. There is authority that 

the Secretary has, especially for folks under 30 percent disability, 

to have some of those waivers. 

I am putting it on record only because everyone with the VA— 

I want to stress how important and difficult it is for very remote 

175 

veterans to get to the physical facilities for those services. It is 

very, very difficult in Alaska to do this in some areas. 

We are now learning through a lot of data that more and more 

veterans are living in more rural areas than ever before, and Alaska is one of those areas. As I mentioned, 11 percent of our population in the whole State are veterans, and that is a significant 

amount. So we are trying to reach them any way we can with 

services. 

As you think of strategic planning, long-term, how do we get to 

that rural component that is growing, and how do we ensure that 

we have quality services? 

There are a lot of innovative things we are doing in Alaska that 

the VA is very supportive of, for example, some of our work with 

Indian Health Services, some of the collaboration we are doing 

there. So, as you think of the planning efforts, please feel free to 

contact our office. We will be happy to tell you. When people say 

remote, we will tell you what remote is. Hopefully, we will help 

drive some of the discussion. 

Again, it is an honor to have you here today, and I look forward 

to supporting your confirmation, and thank you for your public 

service to this Country. 

Dr. PEREA-HENZE. Thank you, Senator. 

Chairman AKAKA. Thank you very much, Senator Begich. 

I want to thank you, Dr. Perea-Henze, for your full and open participation in today’s hearing. I view your combined experience of 

nearly 25 years in both the public and private sectors as a tremendous asset, and I believe you will be an outstanding voice for the 

Nation’s veterans in the role of Assistant Secretary for Policy and 

Planning at VA. 

With this in mind, I would like to bring Dr. Perea-Henze’s nomination before the Committee and full Senate as soon as possible. 

As I said previously for Dr. Petzel’s nomination, I ask that any 

posthearing questions for Dr. Perea-Henze be sent to the Committee’s Legislative Clerk by tomorrow at noon, with the hope of marking up next Wednesday. 

Again, I thank you very much and give our best to your family 

as well. 

Dr. PEREA-HENZE. Thank you, Mr. Chairman. 

Chairman AKAKA. This hearing is adjourned. 

[Whereupon, at 11:04 a.m., the Committee was adjourned.] 

(177) 

A P P E N D I X 

PREPARED STATEMENT OF HON. BERNARD SANDERS, U.S. SENATOR FROM VERMONT

Thank you Mr. Chairman. I want to welcome Dr. Petzel and his family and Dr. 

Perea-Henze. I very much enjoyed meeting with both of our nominees last week to 

discuss their priorities for the VA. 

Both of the nominees before us have been nominated to serve their country at a 

challenging but also rewarding time for those that care for our Nation’s veterans. 

The wars in Iraq and Afghanistan have brought hundreds of thousands of servicemembers into the VA and there will certainly be more to come with the drawn down 

in forces in Iraq and the president’s announced plans for Afghanistan. We need to 

care for this younger population while we maintain the level of care that millions 

of our older veterans depend on. As debate continues on our policy in Afghanistan, 

the VA, DOD, and the Congress must make sure that we continue to fund and staff 

the agencies responsible for caring for our injured services members and veterans 

and plan for the increased usage that is likely to come. Caring for our veterans is 

part of the cost of going to war. 

Dr. Petzel, if confirmed, you will be tasked with leading one of the largest 

healthcare systems in the world. While we all know that the VA continues to have 

challenges, it can rightly be proud of the quality of care it provides and being a leader in electronic health records, controlling costs, prosthetics and so many other 

areas. Your job will be to make it work even better. Dr. Perea-Henze, your position 

is crucial in making sure that the leadership throughout the VA has the data and 

policy ideas needed to continue to improve how the VA operates internally and how 

it delivers health care and other benefits and services to our veterans. As the second 

largest agency in the Federal Government, that is no small task. 

Let me just list a few of the areas that are a priority to me that I look forward 

to working with both of you on in your new positions: 

1. Continue Expansion of CBOCs/Vet Centers: I am working with VA officials to 

establish a health clinic in the Northeast Kingdom region of Vermont to help improve veterans’ access to health care in this part of my state. Like many of my colleagues, I am a strong supporter of CBOCs and support their expansion across the 

country, especially in rural areas. The same is true for Vet Centers which provide 

very important counseling and readjustment services to our veterans and their families. I also support the use of home tele-health and mental tele-health as other ways 

to bring VA care closer to our veterans. 

2. Continue Bringing Priority 8 Veterans Back Into the VA System: We need to 

continue to build on last year’s first step of bringing a segment of Priority 8 veterans back into the system in a responsible way with the end goal of bringing all 

Priority 8 veterans back into the system. I know this is a priority for President 

Obama and Secretary Shinseki and I commend Dr. Petzel for his recognition of the 

importance of expanding VA access to Priority 8 veterans in his prehearing responses to Committee questions. 

3. More VA Outreach and Learning from Vermont Model: VA has made improvements in the area of outreach to veterans but clearly more needs to be done to let 

them know what VA services they are entitled to. This is especially true for our 

Guard and Reserve. Top quality care and services are important but they don’t do 

veterans any good if they don’t know about them or can’t access them. We have a 

model outreach program in Vermont known as the Vermont Veterans and Family 

Outreach Program partnering the VA with the Vermont National Guard. This program uses VA-trained Outreach Specialists, many of whom are veterans themselves, 

to reach out directly to returning servicemembers and their families and help them 

get the assistance and care they may need from the VA or other Federal, state, and 

local programs. Under this reintegration program we have enrolled 77% of returning 

servicemembers into the VA and we believe that by reaching out to servicemembers 

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pro-actively, instead of waiting for them to begin to have serious health and mental 

health challenges, we are trying to get to problems before they reach a crisis level. 

This outreach and reintegration program has served as a model for a number of 

states and I believe it is worth looking into how the VA and DOD could replicate 

it in other parts of the country. 

4. Automatic Enrollment in VA for Members of the Guard and Reserve: Consistent with the idea of a seamless transition between the DOD and VA, I believe 

it makes sense to automatically enroll members of the National Guard and Reserve 

into VA health and dental care as soon as they go through discharge. This does not 

force these servicemembers to use the VA system but it does cut down on the process of applying for VA care later and allows VA care to be there if a veteran who 

doesn’t think they need the care now, realizes later in life that they want it. This 

would also remove the chance that veterans miss their sign up window for certain 

VA care such as dental benefits. The VA is already doing this enrollment assistance 

in many military installations across the country. I have introduced legislation 

(S. 1798), the Automatic Reserve Component Enrollment Act of 2009, to make this 

process uniform. This legislation is supported by the National Guard Association of 

the United States, the Paralyzed Veterans of America, and the Reserve Officers Association. This legislation is meant to support Sec. Shinseki’s concept of ‘‘uniform 

registration’’ and the Virtual Lifetime Electronic Record. 

5. Continue Research/Treatment for PTSD, TBI: We all know that PTSD and TBI 

are the signature injuries of the wars in Iraq and Afghanistan. Stanford University 

estimates that as many as 665,000 or 34 percent of Iraq and Afghanistan veterans 

are experiencing symptoms of Post Traumatic Stress Disorder. Yet only 53 percent 

suffering from PTSD or major depression have seen a physician or mental health 

provider. As of January 2009, nearly one in five Iraq and Afghanistan veterans have 

experienced a Traumatic Brain Injury. Yet only 46 percent who experienced a mild 

Traumatic Brain Injury were screened for a concussion. With more and more servicemembers coming home from Iraq and the announced escalation in Afghanistan, 

we need to continue our research efforts so that we know how to treat these injuries, especially when these injuries occur at the same time. We also need to focus 

on treating substance abuse, eye injuries, and work to prevent suicides. The VA’s 

National Center for PTSD, headquartered in Vermont, plays a crucial role in researching PTSD and educating VA and other clinicians on effective treatments and 

we need to continue to support their work. 

6. Improve Gulf War Veterans Access to VA Care, Improve Research on Treatments: In their 2008 report, the Congressionally-mandated Research Advisory Committee on Gulf War Veterans Illnesses, appointed by the Secretary of Veterans Affairs, concluded that extensive scientific evidence conclusively demonstrates that 

Gulf War illness is real and was caused by toxic exposures during the war, and that 

there are currently no effective treatments. Gulf War Illness affects at least 175,000 

veterans—one in four of those who served. Over the last few years, I have worked 

to secure funding for Gulf War Illness treatment research through the Department 

of Defense. I would like the VA to have a more aggressive research program for 

treatments and to work to find ways to make sure that every Gulf War veteran suffering from conditions related to their service gets the care they need and that that 

education of our VA clinicians and care is consistent wherever that veteran seeks 

care in the VA. Unfortunately, toxic exposures continue to be a reality of modern 

warfare and the VA needs to make sure it is a leader in treatments for veterans 

of all eras that have been exposed to harmful toxins, chemicals, and other substances during their service. 

These are just a few of the areas where I believe we need to focus our attention. 

There are many challenges that are before the VA but I believe these two nominees are qualified to tackle them and improve the care provided to our veterans. 

I look forward to working with our two nominees and my colleagues on these challenges. 

Thank you Mr. Chairman. 

Æ