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DRAFT BILL, THE DEPARTMENT OF VETERANS AFFAIRS REAL PROPERTY AND FACILITIES MANAGEMENT IMPROVEMENT ACT

HEARING

BEFORE THE

SUBCOMMITTEE ON HEALTH

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

SECOND SESSION

JUNE 24, 2004

Printed for the use of the Committee on Veterans’ Affairs

Serial No. 108–47

(
COMMITTEE ON VETERANS’ AFFAIRS 

CHRISTOPHER H. SMITH, New Jersey, Chairman 

MICHAEL BILIRAKIS, Florida 

TERRY EVERETT, Alabama 

STEVE BUYER, Indiana 

JACK QUINN, New York 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

ROB SIMMONS, Connecticut 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

JEB BRADLEY, New Hampshire 

BOB BEAUPREZ, Colorado 

GINNY BROWN-WAITE, Florida 

RICK RENZI, Arizona 

TIM MURPHY, Pennsylvania 

LANE EVANS, Illinois 

BOB FILNER, California 

LUIS V. GUTIERREZ, Illinois 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

CIRO D. RODRIGUEZ, Texas 

MICHAEL H. MICHAUD, Maine 

DARLENE HOOLEY, Oregon 

SILVESTRE REYES, Texas 

TED STRICKLAND, Ohio 

SHELLEY BERKLEY, Nevada 

TOM UDALL, New Mexico 

SUSAN A. DAVIS, California 

TIM RYAN, Ohio 

STEPHANIE HERSETH, South Dakota

PATRICK E. RYAN, Chief Counsel and Staff Director 

SUBCOMMITTEE ON HEALTH 

ROB SIMMONS, Connecticut, Chairman 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

JEB BRADLEY, New Hampshire 

BOB BEAUPREZ, Colorado 

GINNY BROWN-WAITE, Florida 

RICK RENZI, Arizona 

CLIFF STEARNS, Florida 

TIM MURPHY, Pennsylvania 

CIRO D. RODRIGUEZ, Texas 

BOB FILNER, California 

VIC SNYDER, Arkansas 

TED STRICKLAND, Ohio 

SHELLEY BERKLEY, Nevada 

TIM RYAN, Ohio 

LUIS V. GUTIERREZ, Illinois 

CORRINE BROWN, Florida 

DARLENE HOOLEY, Oregon

(II) 
(III)

C O N T E N T S 

June 24, 2004

Page

Draft Bill, the Department of Veterans Affairs Real Property and Facilities 

Management Improvement Act ........................................................................... 1

OPENING STATEMENTS 

Chairman Simmons ................................................................................................. 1

Ciro D. Rodriguez .................................................................................................... 2

Hon. Bob Beauprez .................................................................................................. 4

Hon. Shelley Berkley ............................................................................................... 5

Hon. Jerry Moran .................................................................................................... 16

Hon. Jeff Miller ........................................................................................................ 19

Hon. Jeb Bradley ..................................................................................................... 19

Hon. Tim Ryan ......................................................................................................... 20

WITNESSES 

Alvarez, Jr., Everett, Former Chairman, Capital Asset Realignment for Enhanced Services Commission ............................................................................... 9

Prepared statement of Mr. Alvarez ................................................................. 85

Biro, Lawrence A., Network Director, VISN 19: Rocky Mountain Network ....... 26

Prepared statement of Mr. Biro ...................................................................... 99

Brimhall, Dennis C. President and Chief Executive Officer, University of 

Colorado Hospital ................................................................................................. 24

Prepared statement of Mr. Brimhall .............................................................. 88

Fuller, Richard B., National Legislative Director, Paralyzed Veterans of 

America ................................................................................................................. 42

Prepared statement of Mr. Fuller ................................................................... 124

Gaytan, Peter S., Principal Deputy Director, The American Legion, prepared 

statement of .......................................................................................................... 131

Prepared statement of Mr. Gaytan ................................................................. 131

Ilem, Joy J., Assistant National Legislative Director, Disabled American Veterans ...................................................................................................................... 41

Prepared statement of Ms. Ilem ...................................................................... 121

Jones, Richard, National Legislative Director, AMVETS .................................... 40

Prepared statement of Mr. Jones .................................................................... 117

Nau, III, John L., Chairman, Advisory Council on Historic Preservation .......... 27

Prepared statement of Mr. Nau ...................................................................... 102

Principi, The Honorable Anthony J., Secretary, Department of Veterans Affairs; accompanied by Tim S. McClain, General Counsel, Department of 

Veterans Affairs; William H. Campbell, Assistant Secretary for Management, Department of Veterans Affairs; Laura Miller, Deputy Under Secretary for Health for Operations and Management, Department of Veterans 

Affairs; and James M. Sullivan, Deputy Director, Office of Asset Enterprise, 

Department of Veterans Affairs .......................................................................... 6

Prepared statement of Secretary Principi ...................................................... 65

Samic, Dennis, Treasurer, American Veterans Heritage Center, Inc. ................ 29

Prepared statement of Mr. Samic ................................................................... 107

Weidman, Rick, Director, Government Relations, Vietnam Veterans of America .......................................................................................................................... 44
Page

IV

MATERIAL SUBMITTED FOR THE RECORD 

Draft bill: 

H.R. ——, to amend title 38, United States Code, to authorize the Secretary of Veterans Affairs to enter into certain capital leases, to authorize that Secretary to transfer real property subject to certain limitations, and for other purposes ....................................................................... 53

Statement: 

Heritage Guard Preservation Society, Inc. ..................................................... 134

The Independent Budget historic preservation recommendation submitted by 

Mr. Richard Fuller ............................................................................................... 130
(1)

DRAFT BILL, THE DEPARTMENT OF VETERANS AFFAIRS REAL PROPERTY AND FACILITIES MANAGEMENT IMPROVEMENT 

ACTOF 2004

THURSDAY, JUNE 24, 2004

U.S. HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC 

The subcommittee met, pursuant to notice, at 9:30 a.m., in room 

334 Cannon House Office Building, Hon. Rob Simmons (chairman 

of the subcommittee) presiding. 

Present: Representatives Simmons, Moran, Miller, Bradley, 

Beauprez, Brown-Waite, Rodriguez, Snyder, Berkley, and Ryan. 

OPENING STATEMENT OF CHAIRMAN SIMMONS 

Mr. SIMMONS. The hearing will come to order. 

This is a legislative hearing on a draft bill, the Department of 

Veterans Affairs Real Property and Facilities Management Act of 

2004. I am happy to welcome all our witnesses, but in particular 

I am glad to see my friend and former colleague over on the Senate 

side as a staffer and fellow Vietnam veteran that is with us today, 

the very distinguished and honorable Secretary of Veterans’ Affairs, Secretary Principi. Good to have you here. 

And I think he is joined by Mr. Alvarez, also a Vietnam veteran, 

who spent a number of years in that country under circumstances 

that most of us would probably not want to share but circumstances that earned him the Silver Star, the Distinguished Flying Cross, and is one of the great stories of heroism. Welcome to 

you, Mr. Alvarez, a pleasure to have you here. 

The purpose of today’s legislative hearing is to consider draft legislation to authorize the Secretary to enter into certain capital 

leases, establish new procedures for transferring VA properties no 

longer needed for the care of veterans, and to create a new fund 

into which proceeds from such transfers would be deposited. 

In recent years, the Veterans Administration investment in its 

health care facilities has fallen below known needs. And the reason 

for this is the VA has been reluctant to commit large capital investments until the Capital Asset Realignment and Enhanced Services 

process was completed so we could avoid spending funds on facilities that would be determined no longer needed in the future. And 

I say to my friends on the subcommittee and to those listening to 

this hearing the long dry spell is over. In May of this year, the Sec-
2

retary adopted a CARES plan and it is being described as the VA 

roadmap for health care for the next 20 years. 

Beginning this year and continuing forward the VA plans to award contracts for 30 major projects at an estimated $1 billion, 

spending an additional billion each year for the next 5 years to get 

VA’s infrastructure back up to where we want it to be. It is my understanding that VA plans to re-evaluate project priorities each 

year as we go along and make appropriate adjustments which I 

personally welcome. 

Let the record show that Public Law 108-170 Congress has delegated to the Secretary the authority to select and move forward on 

capital projects within certain conditions in fiscal years 2005 and 

2006. And so we will return to the regular order of authorization 

of each major project through an act of Congress. The VA has a 

good opportunity to move forward with some efficiency and we look 

forward to seeing this happen. In particular, I know in my state, 

the West Haven VA Medical Center is in dire need of renovations, 

and we look forward to working on that project, as well. 

Many VA community clinics operate in privately-owned facilities. 

Unfortunately, Public Law 108-170 did not provide the Secretary 

authority on execution of capital leases. That is those costing 

$600,000 or more annually. The VA identified the need for authorization or renewal of 17 of these capital leases and the draft bill 

before the committee would authorize the leases in the recommended locations. The bill would also authorize the Secretary to 

enter into a long-term lease of up to 75 years for land to construct 

a new combined medical facility on the Fitzsimons Campus of the 

University of Colorado in Aurora, CO, a tremendous facility that 

has been very much the brain child and the focus of our colleague 

from Colorado, Mr. Beauprez. And I understand he will have a few 

comments to make on that at an appropriate time. 

The bill would also provide the Secretary with an additional authority to transfer unneeded real property currently in VA’s portfolio and would repeal the defunct nursing home revolving fund, replacing it with a capital asset fund. And the dollars going into that 

fund would defray the VA’s cost of transferring real property. The 

bill would include a provision to permit the construction of surface 

parking and would exempt the VA from state and local land use 

or zoning laws. 

Finally, it would extend VA’s authority to provide care to the veterans participating in special long-term care demonstration 

projects, previously authorized in the Veterans Millennium Health 

Care and Benefits Act. This is a very comprehensive piece of legislation. It is a very appropriate piece of legislation. It is legislation 

that grows out of a very comprehensive and very interesting and 

exciting report entitled, ‘‘CARES Decision.’’ And I look forward to 

hearing all of our witnesses testify on these subjects. 

At this point, I would like to defer to my colleague and friend 

from Texas, Mr. Rodriguez, and ask him if he has comments that 

he would like to make for the record. 

OPENING STATEMENT OF CIRO D. RODRIGUEZ 

Mr. RODRIGUEZ. I thank you, Mr. Chairman. Mr. Chairman, this 

hearing covers a lot of ground and many of the important issues 
3

which we must address as we consider authorizing significant improvements in the Veterans Health Administration infrastructure. 

I am pleased to welcome Secretary Principi, who will share the 

VA’s views on some of these important issues. Welcome, Mr. Secretary. And I am also pleased that Chairman Alvarez is here to 

represent the Commission on Capital Asset Realignment for Enhanced Services, CARES, and share with us some things about the 

process the Commission used in the recommendations that it made. 

Welcome. 

I have previously referenced some of my concerns about CARES 

and the strategic planning affecting infrastructure decisions for 

veterans. I am certain others share my views about the absence of 

long-term care and mental health planning in the CARES process 

and how failure to adequately address veterans’ needs for these 

two important programs might have affected the outcome of the 

process. I find it somewhat ironic that although these programs 

were reportedly off the table in making recommendations for the 

infrastructure, the facilities that house such programs seemed particularly prone to significant downsizing or closure. 

In addition, I remain with concerns about rural veterans 

throughout this country and the access to adequate services under 

the CARES process. CARES does little to address veterans’ access 

to acute hospitalization in the southern part of Texas, which includes not necessarily my district but a couple of other Members 

of Congress in south Texas, and I know that there are many others 

in rural America who also share the same concerns. I understand 

that the VA assigned a task force to develop guidance for what it 

has termed Veterans Rural Access to Hospitals. I understand its 

work was due to be completed at the beginning of this month, and 

I hope the Secretary will be able to share more information on the 

recommendations the VA will make for these types of providers 

today. 

I am also unclear about the extent to which the VA considers the 

needs of future veterans or increased enrollment in this strategic 

planning models, since we know the demographics and the number 

of our veterans that are out there. With the hundreds of thousands 

of service members that will be involved and deployed not only in 

Iraq but as well as in Afghanistan and elsewhere, this must clearly 

be a concern of all of us and of the Congress. 

In sequencing our investments in infrastructure, it is also absolutely imperative to ensure that if closures are recommended, that 

replacement facilities are readily available to pick up the workload 

that will be lost. 

Since the CARES planning exercise affects so many veterans 

around the nation, I asked Members of Congress that had previously contacted the committee to share their views with us on 

these planning processes and the concerns that they might have. 

I have asked the chairman that I be allowed the opportunity to receive their statements. Mr. Chairman, I ask that the additional 

statements be included into the hearing record. 

Mr. SIMMONS. Without objection, so ordered. 

Mr. RODRIGUEZ. Thank you, Mr. Chairman. I am also interested 

to hear the VA’s views on discussing drafts that the chairman has 

offered for our review. I know that the VA has requested many of 
4

these authorities and will be eager to hear the Department’s rationale about waiving some of our federal laws in order to establish 

a fund to renovate some of the VA under used facilities. There are 

many aspects of this bill I can readily support and there are several leases for enhanced community-based outpatient clinics in not 

only South Texas but throughout the country that are good. 

While the clinics the VA has identified will not address access to 

acute hospital care, the real access problems for the veterans in my 

district, I certainly appreciate the needs for the clinics in my area. 

And I will plan to work closely with you, Mr. Chairman, to make 

sure that we move forward on this. 

I am also supportive of the need to continue some of the pilot 

programs that we authorized under the Millennium Health Care 

and Benefits Act of 1999. While we do not yet have all of the information about the pilot programs, I certainly agree that veterans 

who have benefitted from these programs should also be able to 

continue to receive these services. 

In the meantime, I hope that the VA plans to make the required 

reports available to Congress so that we can make informed decisions about the expanding and comprehensive care of management 

services as well as assisted living to elderly veterans. 

And, once again, Mr. Secretary, Mr. Alvarez, thank you for being 

here with us. I look forward to your testimony. Thank you. 

Mr. SIMMONS. As I mentioned in my opening statement, one of 

the major projects that is considered by this legislation is the 

Fitzsimons project in Aurora, CO. I have received a special request 

from our colleague, Mr. Beauprez, who represents that area, if he 

could have an opening statement. Is there any objection to that? 

Ms. BERKLEY. I won’t object as long as I can have one, too. 

[Laughter.] 

Mr. SIMMONS. I knew that was what was going to happen. Mr. 

Beauprez, you may proceed with your opening statement. 

OPENING STATEMENT OF HON. BOB BEAUPREZ 

Mr. BEAUPREZ. Thank you, Mr. Chairman. And I thank the Congresswoman from Nevada. Thank you, Mr. Chairman, first of all, 

for holding this hearing. I am sure you can appreciate the anticipation I have had for this hearing. It is a special day. If the needs 

of our veterans continue to grow, it is certainly important to the 

VA to make intelligent investments in their infrastructure. And as 

you very well know, the needs of our veterans are all too often at 

odds with our ability to meet them. This makes it especially important for the agency to modernize its facility as well as its processes 

and procedures. Mr. Chairman, I know that you share my commitment to providing the very best care to our veterans, and I believe 

the CARES plan establishes a very solid roadmap for the accomplishment of that goal. 

It is certainly great to see our wonderful Secretary Principi again 

today. Chairman Alvarez, it is good to have you with us and other 

members of your staff, Mr. Secretary. I am especially happy and 

eager to hear the testimony of my good friend Dennis Brimhall, 

president of the University of Colorado’s Hospital and one of the 

chief architects of this exciting collaboration between the Univer-
5

sity of Colorado, the Department of Veterans Affairs, and the Department of Defense. 

I believe the partnership at Fitzsimons is and will continue to be 

a model for the rest of the country in the way we deliver health 

care to our veterans. By combining resources and taking advantage 

of economies of scale, all of the partners in this exciting project are 

winners, but most importantly, Mr. Chairman, the veterans who 

will be served by the new VA hospital at Fitzsimons, will be the 

biggest winners of all. 

I look forward to the testimony of today’s witnesses and to finding better ways to effectively and efficiently deliver services that 

American veterans have earned. 

And with that, I yield back. Thank you, Mr. Chairman. 

Mr. SIMMONS. Thank you. Do any other members of the subcommittee wish to make an opening statement? Ms. Berkley? 

Ms. BERKLEY. Thank you very much. Thank you, Mr. Chairman. 

For 5 years, this committee, and anyone else within the sound of 

my voice, has heard about the plight of my veterans in southern 

Nevada. As you all know, I am well aware of I have got the fastestgrowing veterans population in the United States there. It is about 

200,000-plus. 

Mr. SIMMONS. I think we have heard about that at least once. 

OPENING STATEMENT OF HON. SHELLEY BERKLEY 

Ms. BERKLEY. With no facilities. We had an outpatient clinic that 

was condemned as structurally unsound after only 5 years of service. I have got 80-year-old veterans standing on the corner waiting 

for a shuttle to pick them up, because as the alternative to that 

outpatient clinic, when it was condemned and closed, is that we 

now provide outpatient services at 10 different locations throughout the Las Vegas Valley, which means that I have a lot of oldsters 

and handicapped veterans standing in 110 degrees temperature 

waiting for a shuttle to pick them up to shuttle them from one location to the other. As you know and can feel, I am sure, that is totally inappropriate and unconscionable. 

In May, I had the honor to be in my district with Secretary 

Principi as he announced the final CARES initiative, which includes a long-awaiting full-service hospital, outpatient clinic, and 

comprehensive long-term care nursing home facility in southern 

Nevada. And I cannot express sincerely enough my thanks to the 

Secretary for hearing my pleas, being sensitive to the veterans that 

I represent, and making that medical complex in southern Nevada 

on his list of construction priorities. I am encouraged that the veterans in southern Nevada will soon have access to health care services they have earned. 

And I urge the VA, and I think this is my message, to expedite 

the planning and construction process for this medical complex so 

all health care services will be available to the veterans in southern Nevada from World War II veterans in need of long-term care 

to a new generation of veterans returning home from fighting overseas. And I cannot emphasize enough how much courage it took for 

the Secretary to do this. 

This CARES study was exhaustive. And I know that there are 

some colleagues that are unhappy because some of their facilities 
6

are closing, but I can assure you the Southwest, which is the fastest-growing part of our nation, is in dire need of these facilities because that is where the veterans are living. And it makes no sense 

to me, and I think the CARES study pointed out the fact, that we 

have a number of facilities located in one community that has a 

handful of veterans left, and those of us in the western United 

States that have thousands and thousands of veterans are undercared for and under-served. So I want to thank him again for having courage and strength of conviction. I know it is difficult to close 

facilities. 

And let me say since I come from a gambling town, we have a 

lot of superstitions, you know. You are not supposed to walk past 

a slot machine from the back instead of the front. And seven is a 

very lucky number. And I just want to share with you that you 

made this announcement in Las Vegas on May 7 and we are number seventh on your priority list. So this a really banner day for 

Las Vegas and the veterans that live there. And I want to thank 

you from the bottom of my heart. 

Mr. SIMMONS. Do any other members wish to make an opening 

statement? Hearing none, it is my pleasure, again, to introduce the 

Honorable Anthony J. Principi, Secretary of the Department of Veterans Affairs, who will be our principal witness, accompanied by 

the Honorable Tim S. McClain, general counsel; Honorable William 

H. Campbell, assistant secretary for management; Dr. Laura Miller, deputy under secretary for health operations and management; 

and Mr. Jim Sullivan, deputy director, Office of Asset Enterprise. 

Also at the table is our very distinguished former chairman of the 

Capital Asset Realignment for Enhanced Services Commission or 

CARES Commission, the Honorable Everett Alvarez, Jr. Gentlemen 

and lady, thank you so much for coming here today. We are obviously very, very interested in the topic and we look forward to your 

testimony. 

Mr. Secretary? 

STATEMENTS OF THE HONORABLE ANTHONY J. PRINCIPI, 

SECRETARY, DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY TIM S. MCCLAIN, GENERAL COUNSEL, DEPARTMENT OF VETERANS AFFAIRS; WILLIAM H. CAMPBELL, ASSISTANT SECRETARY FOR MANAGEMENT, DEPARTMENT OF 

VETERANS AFFAIRS; LAURA MILLER, DEPUTY UNDER SECRETARY FOR HEALTH FOR OPERATIONS AND MANAGEMENT, DEPARTMENT OF VETERANS AFFAIRS; AND JAMES M. 

SULLIVAN, DEPUTY DIRECTOR, OFFICE OF ASSET ENTERPRISE, DEPARTMENT OF VETERANS AFFAIRS; AND EVERETT 

ALVAREZ, JR., FORMER CHAIRMAN, CAPITAL ASSET REALIGNMENT FOR ENHANCED SERVICES COMMISSION 

STATEMENT OF THE HONORABLE ANTHONY J. PRINCIPI 

Secretary PRINCIPI. Thank you, Mr. Chairman, Mr. Rodriguez, 

and members of the committee. It is always a pleasure to come before you, and certainly on a subject of such great importance to our 

nation’s veterans. 

I want to publicly thank the chairman of the CARES Commission, Ev Alvarez, for his extraordinary efforts, his dedication, and 
7

commitment to this process. He took a lot of time out of his life, 

out of his business to put together what I thought was a superb 

Commission report and recommendations. And I know of no man 

or woman who is more devoted or second to their just absolute 

commitment to doing what is right for our nation’s veterans. And 

I am just very, very thankful to him as I am to everyone at the 

VA and the veteran service organizations who I believe contributed 

mightily to this effort because I can think of no more important effort than the one that we undertook and the one that we reported 

to you recently. 

So I appreciate the opportunity to discuss VA’s multi-billion plan 

to improve both access to and the quality of veterans medical care. 

And in my written statement, this subcommittee’s draft capital 

asset legislation, I am very strongly supportive of that legislation. 

There are a couple of issues that I am confident we can work 

through between our staff and committee staff to see if we can get 

a few refinements to some of the policy proposals. But by and large 

I think it will be enormously helpful to the agency in the modernization effort. 

And I ask that my written statement be made part of the record. 

Mr. SIMMONS. Without objection, so ordered. 

Secretary PRINCIPI. If enacted, the draft legislation would go into 

effect in the context of the CARES plans road map to bring the veterans health care system into the 21st century because indeed in 

my opinion we have been stuck in the 20th century for too long and 

the time to get on with the modernization effort is now—not tomorrow, but today. 

Over the past half-century, in both the practice of medicine in 

this nation and the veteran population, the demographics of the 

veteran population have changed rather dramatically. And they 

will continue to change in the future. And the veteran population 

regrettably is declining due to the passing of many of our World 

War II veterans, Korean veterans now up in that age group, 1,800 

a day in this nation we are losing. As you can see on this first 

chart, the decline in the veteran population as projected over the 

next 20 years. 

These changes are even more dramatic when evaluated on a regional basis as shown on the next two charts, which break out projected changes in veteran population and veteran enrollment for 

VA care on a state by state basis. On that chart to your left you 

see the dark, dark red in some of the northern tier states and even 

a decline in southern tier states as well. There are others the decline is relatively small but nonetheless with this passing of our elderly veteran population, which are way out in front of the general 

American population, we will have this change. And the enrollment, we also see declines in enrollment in certain states going 

from the dark red and we see increases that are highlighted in the 

dark blue. So the CARES decision, recommendations and decisions 

are designed in part to take into account these changes in the demographics of our veteran population. 

So in summary there are dramatic reductions in population nationwide and a movement, as with the general population on a 

whole, the migration movement of the nation are moving from the 

Northeast to the South, to the Southwest and certainly to the 
8

West. And I believe strongly, Mr. Chairman and members of the 

committee, that America will not keep pace with its commitment 

to veterans if we do not adapt to the changes in the population we 

serve and to the progress in the practice of medicine. 

As you can see on the next two charts, we are into the 21st Century with a legacy infrastructure that is very, very old. On the left 

you can see that the vast majority of our infrastructure is now between 51 and 75 years old. We even have some that we inherited 

from the Army at the turn of the 19th Century, 1895, after the 

Civil War. Those facilities are still part of the VA. 

But we also know that American medicine has transformed itself 

from hospital-centric to patient-centric. So whereas most of our facilities were designed and built in an era when medical care was 

synonymous with hospital care, it certainly made sense at that 

time to define our nation’s health care commitment to most veterans as access to a hospital bed to the extent that beds were available. 

And, of course in many cases, our facilities are located where veterans used to live, not where they live now. And today’s veterans, 

as I know you agree, deserve better. And VA’s medical system has 

made some changes over the past few decades. Prior to 1994 and 

1995, we had virtually no outpatient clinics in the VA health care 

system. Today, we have over 800 outpatient clinics. And we have 

closed some facilities in past years, at Fort Howard in Baltimore, 

Fort Lang, CO, for example. We dramatically changed the missions 

of others, such as Grand Island, NE, Miles City, MT. But all of 

these changes were ad hoc and incremental. 

And the CARES process was initiated by my predecessors and I 

carried it forward because it is important. It is important to the VA 

and to the veterans we serve as well as the Congress that answers 

to the American people. And because we must have a comprehensive national plan to modernize our medical facilities. In fact, as 

you can see from the next chart, the Congress has reduced funding 

for VA construction to a bear minimum until the VA came forward 

with a database national plan for updating VA facilities. 

And CARES is that plan. The draft national CARES plan was 

developed by the Veterans Health Administration based upon data 

from VA’s grassroots and input from VA stakeholders. I then established a 16-member independent commission, as I indicated, 

chaired by Ev Alvarez, a former VA deputy administrator and 

former Vietnam POW to evaluate that plan. And the Commission 

made their recommendations based upon numerous site visits, 81, 

38 formal public hearings after considering more than 200,000 comments from veterans, employees, communities, and other interested 

parties. 

And my acceptance of the Commission’s recommendations was 

the first step, and only the first step, on a journey of modernization 

and new construction such as veterans have not seen in decades. 

In summary, we will build new hospitals in Las Vegas—and 

seven is a lucky number—and Orlando, Florida. We will open 156 

new outpatient clinics throughout the country, primarily in rural 

and highly rural areas that do not meet access standards so that 

veterans do not have to drive 4 and 6 hours to get the care they 

earned. They can get that care much closer to their homes. There 
9

will be a major expansion of outpatient clinics in Columbus, OH. 

We will build new bed towers in Tampa, Florida and San Juan, 

Puerto Rico. We will open up two new blind rehabilitation centers 

and five new spinal cord injury centers. 

And the CARES plan identifies more than 100 major construction projects in 37 states, Puerto Rico, and the District of Columbia. Yes, it does call for some consolidations and change of missions 

of facilities where we can bring greater effectiveness and efficiency 

to our operations. But we will only do so when we modernize that 

receiving facility. 

I believe that veterans have waited too long for systematic nationwide modernization and improvement effort on our VA health 

care system. And CARES will transform our center, not today—I 

mean not immediately but over the next 20 years. But veterans 

will begin to see improvements much sooner than that as new 

funding, the plan identifies approximately $1 billion a year over 

the next 5 to 6 years for these new facilities. 

The next chart, Chart 7—the next chart, please. Is that the one 

that shows the increase in funding? 

So in conclusion, Mr. Chairman and members of the committee, 

I believe it is important that we move forward with this plan and 

continue to work with the Congress, with our staff, with our communities, with our stakeholders to ensure that the implementation 

is done and done well. I have established a CARES implementation 

board that report to me directly to ensure we meet our goal of improving access and quality care for the veterans we serve. When 

the process is complete, veterans will have improved access to a 

much more modern health care system. 

I thank the Chair. I thank the Ranking Member and members 

of the committee for allowing me to testify this morning. Thank 

you. 

[The prepared statement of Secretary Principi appears on p. 65.] 

Mr. SIMMONS. Thank you, Mr. Secretary. Next, we look forward 

to hearing from the Honorable Everett Alvarez, former chairman of 

the CARES Commission. Mr. Alvarez. 

STATEMENT OF EVERETT ALVAREZ, JR. 

Mr. ALVAREZ. Mr. Chairman, thank you. Mr. Chairman, I have 

submitted a statement for the record, and if I may just summarize 

it in my oral statement. 

I am pleased to be here today on behalf of the CARES Commission to discuss the CARES Commission Report, which was presented to Secretary Principi on February 12th of this year. 

I can attest that the commissioners recognized the enormity and 

importance of their task to critique and modify a blueprint for enhancing the health care of as many veterans as feasible into the 

future. And let me emphasize, sir, that the Commission viewed the 

draft national CARES plan as a blueprint for VA health care for 

the next 20 years. 

Health care delivery in this country is changing. The VA’s health 

care delivery is under change and this change needs to be managed 

carefully and respectfully. The Commission sees this blueprint as 

a road map to the future, a tool to help managing future change. 
10

The Commission, within time restraints, evaluated an enormous 

amount of data, listened to many veterans, providers of care, and 

stakeholders at 81 site visits and held 38 public hearings across 

the country and focused our collective experience and reasonableness on the task. Our report, which you have, is large and farreaching. It included important discussions and recommendations 

on issues that cut across the entire VA health care system. It also 

included hundreds of site-specific recommendations. If the plan is 

to succeed in its goals, priorities still need to be attended to and 

properly aligned. Evaluations still need to be conducted for important components of VA health care and internal processes need to 

be overhauled. 

I wish to share the key principles that served as a beacon to 

guide the Commission throughout our complex deliberations. First 

and foremost, to improve access to as many veterans as possible to 

high-quality veteran-specific health care. Many VA facilities were 

largely built 50 years ago or more, as you have heard. Population 

demographics have shifted. The delivery of health care has increasingly become an issue of access both for veterans and their families 

who need to partner in their care. 

Cost-efficiency. When the health care needs of some veterans are 

unfulfilled, particularly for the highest priority veterans with warrelated physical and mental disabilities, then efficiency is also an 

issue of access and quality of care. If we do not use resources as 

efficiently as we can, some veterans in dire need of services may 

not receive the care they need or deserve. Therefore, the Commission also looked at the cost benefit of the recommendations. 

We recognize that the cost data provided were often in need of 

further refinement, forcing us to consider the likelihood based on 

our past experience in the Veterans Health Administration and a 

test of reasonableness that an action would improve efficiency. 

The impact of change in the status quo on current recipients of 

service, current VA employees, and the communities where our facilities have been historically located was another key principle 

that guided the Commission. The Commission recognized a shifting 

of resources necessary to improve overall access would be a hardship for some. We expect that the implementation of necessary 

change will take this into account when the time lines for modifications are finalized. The Commission’s recommendations were our 

assessment of what is best for VA health care as the VA moves forward. We are not infallible. We understand that things will change 

over time and there may be factors that need to be reconsidered. 

However, this was our best effort. 

Mr. Chairman and members of the subcommittee, I would like to 

thank you for the opportunity to be here this morning. I would be 

pleased to respond to any questions you may have. Thank you. 

[The prepared statement of Mr. Alvarez appears on p. 85.] 

Mr. SIMMONS. Thank you very much. Do any of the other individuals at the table have a statement they wish to present? Hearing 

none, we will move on the question phase. Let me start with you, 

Mr. Secretary. In reviewing some of the press coverage of the 

CARES project and listening some of the discussion surrounding 

the CARES process, the issue has been raised that long-term care 

facilities and mental health services may or may not have been 
11

fully incorporated into the planning process. Could you address 

that issue, please? 

Secretary PRINCIPI. Yes, Mr. Chairman. I know that is an important issue. First, let me state from my perspective; long-term care, 

mental health programs, acute mental health, and long-term care 

for the mentally ill are critically important core programs for my 

agency. And soon we will complete and validate our utilization 

model for long-term care and for long-term mental health. The results of those models will be incorporated into our CARES plan. I 

chose not to wait with regard CARES because I believe it was too 

important. 

But at the same time, I made a commitment that we not diminish our capacity to treat veterans in need of long-term care or inpatient mental health services. The location might change, but in 

many cases the location should change. Veterans with mental illness should not be consigned to facilities that were once asylums 

when we warehoused the mentally ill in rural areas away from 

their home. Those patients should be treated closer to their home, 

in modern facilities, and where feasible on an outpatient basis. But 

at the same time until the models are completed and incorporated, 

there will be no diminution in the level of care provided to those 

populations. 

Mr. SIMMONS. Thank you. For Mr. Alvarez, there is no question 

in my mind about your distinguished service to the country in 

many different ways. And certainly taking on the task of being 

chairman of the CARES Commission was not an easy task and was 

something for which we are all very grateful and we thank you for 

that. 

The question I would like to ask goes to the issue of bias or problems. Did the Commission encounter any problems in the course of 

its hearings or its travel around the country? Did they hear any 

criticism that might raise the issue that they were biased toward 

one region or another, towards one set of recommendations or another, did that occur? 

Mr. ALVAREZ. Mr. Chairman, thank you. We conducted 38 public 

hearings but we had also 81 site visits and at each site visit we 

had lengthy discussions with stakeholders, employees, and members of the community. To be honest about it, I thought that the 

process was very open and in terms of any biases I don’t think that 

any of our commissioners were in any way biased in terms of preset notions or concepts. I believe that we did an honest evaluation 

and assessment, listened as carefully as we could, took all of these 

into consideration and our recommendations that finally resulted 

were basically a consensus. We had 16 members in our Commission 

with a very extensive array of experience both within the VA system and outside, all experts in their field. And I thought that they 

all really, really tried not only to be objective but were committed 

to doing what was right. 

And, as a result, I thought that the final product, our recommendations to the Secretary, reflected an honest evaluation of 

what was best in various areas that we covered here. The changing 

demographic needs were quite evident as we traveled around the 

country, and as we looked at the projections, the projections over 
12

the next 20 years, it was very evident where the needs were going 

to be. 

Mr. SIMMONS. I thank you for that response, because I think we 

have already heard that there are some facilities in the South and 

in the West. There are other facilities in the North and the East 

that might be closed. And I guess what you are telling me, and 

based on some of the materials you have presented, is that these 

recommendations are scientifically based, they are not politically 

based, is that correct? 

Mr. ALVAREZ. Looking at the model and the projections, these 

recommendations are definitely not politically based. We also recommended that the model be fine-tuned and improved, at each 

iteration, which I understand that the VA is doing, which would 

justify the initial thoughts and findings that we had. But looking 

at those projections down the road, it was pretty hard to argue 

with what we saw. Like Secretary Principi said, seeing a tremendous decline in the World War II population which is a major part 

of the people that are being served out there, yes, sir. 

Mr. SIMMONS. I thank you. My time has expired. Mr. Rodriguez? 

Mr. RODRIGUEZ. Thank you, Mr. Chairman. Mr. Secretary, welcome once again. Let me say that on May 7 Deputy Secretary Gordon Mansfield traveled to Waco to announce that the Waco VA 

Medical Center would not be shut down but that further studies 

would be needed to determine its future. The VA committed to 

working with the community there in Waco and the stakeholders 

on a master plan for any action that would be taken on that master 

plan. However, on May 20, I was told that a construction request 

was sent to the committee that included $56 million for a psychiatric and blind rehabilitation clinic to replace Waco. In addition 

to that, Mr. Secretary, the committee received a request for a lease 

to move the Waco outpatient clinic off the Waco VA campus. I 

would think that if you are looking at a master plan, that you 

would at least wait a while. I want to get some feedback from you 

on that. 

Secretary PRINCIPI. Certainly, certainly. That is an important 

issue. I made the decision to delay a final decision, if you will, on 

the Waco campus. I think it is a reflection of stakeholder congressional input into the process. I had a meeting with Mr. Edwards 

and others about the situation. I was unclear about the cost benefit 

of moving the psychiatric patients to the Temple campus. We do 

need a new long-term care facility in Temple. And part of the dollars in the budget reflect that. We do need to do a master plan at 

Waco. We have too much land, too much excess space. 

No one is in disagreement in Waco. The community, the veterans, members of the delegation all feel that the Waco campus 

needs to be modified somehow because we just have hundreds of 

acres of land and many empty buildings on the campus. There is 

money in the budget, a placeholder if you will. We are going to do 

a further review of the cost benefit analysis and quality of care 

issue. Quality of course is very, very important before a final decision is made whether to move the psychiatric patients over to Temple. 

Mr. RODRIGUEZ. So apparently you haven’t made that decision 

yet? 
13

Secretary PRINCIPI. No. 

Mr. RODRIGUEZ. But on the decision to start that $56 million on 

construction, wouldn’t it be wise to wait until the master plan is 

developed? 

Secretary PRINCIPI. We have a long way to go. We have requested, we submitted it up here per the notification requirement 

but we are not going to do any construction at Temple until a final 

decision is made. 

Mr. RODRIGUEZ. Thank you. Let me follow-up, Mr. Alvarez, I 

want to thank you for all your work. I know you got a big salary 

for doing that hard work and we thank you very much for all that. 

I know you are a veteran, an ex-POW and chairman of the CARES 

Commission and I know you took a lot of time and effort in putting 

this together. Let me ask you I think to follow-up on the chairman’s question about possible biases. The recommendations that 

you made, are there any ones that you thought or you feel that 

maybe should have gone in that didn’t go into the report? 

Mr. ALVAREZ. No, sir, our recommendations were all based on the 

draft national CARES plan. So we looked at all of the items in the 

draft national plan and our assessment I felt was very objective. 

In doing so, we basically had an unanimous agreement on our position on each of the recommendations. 

Mr. RODRIGUEZ. In retrospect, is there anything else that you 

feel maybe you should have done or could have done or maybe for 

future assessments? 

Mr. ALVAREZ. Well, to be honest with you, no. We worked on it 

for 13 months. And in that time frame we saw that things were 

continually changing in terms of the planning process and what 

have you. For example, the model that was re-used was continually 

being refined and updated and that is fine. And that would become 

a part of the strategic plan for the VA, that is fine. We saw the 

needs out there. There were some needs that we thought were—— Mr. RODRIGUEZ. Mr. Chairman, I wanted a little bit more time. 

Were there any items that you recommended, I know you talked 

about the consensus within the committee, but where maybe the 

Secretary or the VA might have changed. Were there any recommendations that were made by the Secretary that were not part 

of the priorities that were made by the committee? 

Mr. ALVAREZ. No, sir, none that I can point out. No, sir. 

Mr. RODRIGUEZ. Okay, thank you very much. 

Mr. SIMMONS. Mr. Beauprez? 

Mr. BEAUPREZ. Thank you, Mr. Chairman. Mr. Secretary, being 

a bit parochial if I might, talking about the Fitzsimons project, surprise, if I understand correctly, we have already authorized for this 

project to move forward to a degree. It does involve, as I am aware, 

a very long-term land lease. The VA will own the structure of the 

tower that is proposed now but a very long-term land lease. I think 

a 75 year land lease. Do we need to do anything legislatively in 

Congress to make so that happens? I want to make sure we don’t 

hit a speed bump here. 

Secretary PRINCIPI. Yes, the draft bill has a proposal to authorize 

us to enter into 75 year leases. We do not currently have that authority. We are limited to 20 years I believe, right counsel? We are 

limited to 20 years and we could not go forward with constructing 
14

a bed tower of this magnitude, of this cost, where we would be limited only to a 20 year lease. So it is critically important that the 

Congress give us the authority to get the 75 year lease period. And 

that seems to be non-controversial. And hopefully we will get it 

very soon. 

Mr. BEAUPREZ. Let me stay on that point for either you, Mr. Secretary or Mr. Alvarez. It crosses my mind I used to be a banker 

and managing the facilities assets, the capital assets of a company 

is one thing. But to anticipate it would seem to me that the facility 

needs, the flexibility if you will, of long-term assets for a very dynamic population as you already pointed out with your graph, the 

population is changing, both in where they are located as well also 

in terms of numbers. And then to complicate it even further, the 

way we are rapidly transitioning in the way we deliver health care 

in this country, if you look back historically where you got sick, you 

went to the hospital, you stayed in the hospital and now we do 

much more outpatient. 

And how do you, and I am guessing part of the answer is flexibility as we are just talking about more leasing options and perhaps more lease space. But how do you build adequate flexibility 

into your capital assets as you look forward to some how match 

those needs. So you are not so heavily invested in facility that very 

quickly becomes outdated? 

Secretary PRINCIPI. Perhaps I can defer to some of the experts 

at the table here but clearly it is really based upon demand and 

projections over the next—the life cycle, if you will, of the facility 

that we are building. Historically, we built facilities that were 

much too large even up in the recent future where you will build 

a facility to 1,000 beds and today we might have an average daily 

census of 250 or 300. And obviously part of the reason for the 

CARES process is to do it the right way. 

A lot of careful thought goes into the size of the facility, the 

trends in medicine, the demographics of the veteran population, the 

opportunity to share with the Department of Defense, which we 

will be doing at Fitzsimons. It will be a VA, federal health care 

component to this world-class campus that is being constructed at 

Fitzsimons. And it is important that we are part of it. It will bring 

high-quality health care to veterans in the Denver, CO area. 

We are very excited about it. We are going to size it appropriately, share common services with the university to keep our 

costs down. The VA will govern its facility. The governance issues 

are taken care of. I think we have a very good model on how this 

should be done. 

Mr. BEAUPREZ. If I might on my time remaining, on a more global perspective, still using Fitzsimons as maybe a reference point. 

The old 500 building that sits out there on this old Army base was 

a hospital originally, not being used as a hospital now. But thanks 

really to I think the foresight of the University of Colorado folks 

they are keeping that beautiful old historic building and it really 

is going to be a monument, a memory of the past. A room there 

where President Eisenhower recovered after a heart attack has 

been turned into a bit of a museum piece, if you will. I have had 

some of my colleagues approach me on the floor of the House concerned about historic preservation. 
15

Has that entered into the process, the CARES process, does it 

have a place in our overall long-term capital asset plan? Are there 

buildings that even if they are not going to be part of the veterans 

health care unit that we ought to have a methodology of making 

sure that the great old buildings of the past are somehow protected 

and safe? 

Secretary PRINCIPI. The answer is yes. Go ahead. 

Mr. SULLIVAN. Yes, sir, we have an authority, enhanced use authority, that we have used successfully in several places where we 

are taking that authority which lets us lease out those historic 

buildings to non-profit organizations or historic organizations and 

find a continued use for them when VA doesn’t have a use. And 

we recently are in the process of doing one in Leavenworth, KS and 

we also are looking at doing that right now in Milwaukee, WI. 

Again, it is a good tool for us to use to minimize the cost on veterans so we can spend that money towards medical care while still 

preserving those historic assets. 

Mr. BEAUPREZ. Thank you for that, and I will just close by citing 

this chart. My compliments to all of you. This is the kind of story 

we ought to be taking not only to our veterans but to our taxpayers 

that we are finding more efficient ways to utilize the limited financial resources that are always available. You are going to be returning billions of dollars over a relatively short period of time. 

Secretary PRINCIPI. Well, that is exactly right. To take that va- cant space and to save $275 million a year that is used to treat 

more veterans and not to heed or maintain excess infrastructure 

but rather to be applied to the benefit of veterans and better and 

higher quality health care. And that is really what this is all about. 

Mr. BEAUPREZ. Thank you, Mr. Chairman. 

Mr. SIMMONS. Ms. Berkley? 

Ms. BERKLEY. Okay, thank you, Mr. Chairman. First, I also 

wanted to lend my voice and thank Mr. Alvarez for his extraordinary effort on behalf of the veterans. I know it was not an easy 

task and I think he did it well and came up with an outstanding 

result and I thank you very much. 

Secretary Principi, earlier this month I sent you a letter. I suspect you haven’t even seen it yet but when I found out you were 

going to be here it was just perfect so I could ask you in person 

do you think you can give me—the content of my letter was to ask 

you for a status check and a time frame for the new VA medical 

complex in Vegas. 

Can you give me some idea of expected time for site selection, 

land purchase or land transfer, building design? And let me also 

ask if you have heard from the DOD in response to your letter regarding the O’Callahan shared facility? I am kind of curious about 

that. 

And for the record, I want to compliment you also on the way 

you have done the site selection. It has been totally non-political. 

I have absolutely no idea which pieces of land in southern Nevada 

are on the final list and that makes me very happy because every 

developer in Las Vegas has called me to tell me how they can develop this land. So I am glad it is on your shoulders and in your 

shop but I kind of would like a little indication of when we are 

going to make this grand announcement? 
16

Secretary PRINCIPI. Great. Well, I understand the staff are ready 

to come up and brief me on their proposed site for Las Vegas. So 

we are at that point now of identifying the preferred location. And 

once that decision is made we can go out and procure the land or 

if it is the parcel that we can get from Bureau of Land Management, BLM, for free, which is always my choice if it is the right 

location, that should be within the next couple of weeks and we can 

let you know about that location. 

This is a very high priority project. I have mentioned that to you, 

and I am committed to getting this medical center constructed in 

a short time frame. We have allocated $60 million for the design, 

am I correct? The design work which will begin, I understand will 

probably get underway as early as next month on selecting an architectural firm to begin the planning for it and late 2005/2006, if 

all goes well, we should be able to break ground on the new medical center. And then of course just the time of construction, I 

guess, a couple of years to get it done. But we are talking in very, 

very short time frame, Congresswoman Berkley. 

Yes, we have been in communication with the Department of Defense, with the Department of the Air Force in particular. I have 

not seen their letter but we are working through our issues with 

them and I am confident that it will all be resolved. 

Ms. BERKLEY. Okay. In conclusion, we built 5,000-room hotels in 

less 18 months in Vegas, so we can really help get this expedited. 

If I don’t have an opportunity to publicly thank you in the next 

few months, I want to tell you what a pleasure it has been not only 

working with you but getting to know you as a person. It is one 

of the true enjoyments I have had, and I thank you very much. And 

I hope that our friendship continues long after the two of us are 

no longer in our respective positions. 

Secretary PRINCIPI. The feelings are mutual. Thank you very 

much, Congresswoman Berkley. 

Mr. SIMMONS. The distinguished former chairman of this subcommittee, Mr. Moran. 

OPENING STATEMENT OF HON. JERRY MORAN 

Mr. MORAN. Thank you for not saying ‘‘the former distinguished 

chairman of this subcommittee.’’

[Laughter.] 

Mr. MORAN. Mr. Chairman, thank you very much. Mr. Secretary, 

nice to see you today. I would echo in part about Ms. Berkley’s 

comments just about the quality of service you are providing to the 

veterans of the country. Every time I talk to veterans the story is 

one of great faith in you, a recognition of your sincere interest in 

their welfare, and I just once again with you in the audience want 

to reiterate my strong belief that you are doing an admirable job 

and look forward to working with you. 

In that regard, I also met the VISN director in Denver, and I am 

very pleased to make his acquaintance. I have spent most of my 

time working with the VISN directors in Kansas City but recently 

have discovered that a number of my counties, six, perhaps those 

in the other time zone, are in the other VISN. And so we are working on a CBOC issue and your VISN director in Denver has kindly 

agreed to come to Kansas and talk to my constituents. And so Mr. 
17

Biro is certainly making a positive impression upon me, and I 

thank you for hiring and bringing about people who I deal with 

that are also very much committed to veterans. 

My question, at least initially, is a couple of kind of broad questions and then one very specific about CBOCs. My understanding 

is that the CARES Commission made a recommendation that the 

VA criteria for determining where a CBOC should be located needed adjustment. And it is an issue that I have raised with the VA 

before. It seems to me there is over emphasis upon number of veterans and a lack of at least a moderating factor dealing with distance to access, distance to health care centers. 

And so in Kansas it is easy for us to have communities that are 

long distances from a VA hospital but still may not meet the criteria of number of veterans. And my request, my suggestion is that 

there needs to be a balance. That a CBOC may be very much appropriate based upon number of veterans but when they are lacking in numbers, take into account the fact that those veterans are 

driving 4 or 5, 6 hours to a hospital. And I think there perhaps was 

a debate between Mr. Alvarez’s CARES Committee and the VA 

about that criteria. 

And then just more broadly, I am interested in knowing as you 

look to the future of meeting the needs of veterans, the prescription 

drug benefit plan that Congress passed last year that is now being 

implemented, I know one of the significant factors in driving veterans to the VA system has been the access to prescription drugs. 

Are you all taking into account, is it far enough along to have 

any kind of indication that the prescription benefit may reduce the 

pressures upon—let me say that succinctly. The prescription drug 

benefit under Medicare may reduce the demand for health care 

services under the VA? 

And then secondly, what are you seeing in regard to the current 

war on terror? Your charts and discussion involve the diminishing 

number of World War II veterans but are you seeing a corresponding increase in demand for VA services as a result of the 

current engagement our country and its servicemen and women are 

engaged in? And, if so, have you been able to determine any kind 

of specialized needs? Our subcommittee, including Mr. Simmons, 

has focused a lot of attention on how do we prevent these servicemen and women returning from the war on terror in Afghanistan 

or Iraq from encountering and suffering from the similar kinds of 

symptoms as they did in the Persian Gulf War. And is there in 

your planning process, are you looking at what kind of ailments 

these veterans may incur as a result of their current service to our 

country? 

Thank you. 

Secretary PRINCIPI. Thank you, thank you, Congressman. And I 

certainly echo your sentiments about the new network director in 

Denver, Larry Biro. He just did a phenomenal job here in the 

Northeast and I know he is going to do and is doing an equally job 

in his new network. 

I am not sure if we will see much of a diminution in demand as 

a result of Medicare reform. We probably will see some at the lower 

socio-economic levels of our society where the co-pays under the 

Medicare reform legislation are very, very low, if any. The VA ben-
18

efit is a very attractive benefit at $7 per prescription, 30-day prescription per month. And Medicare reform does not match that. So 

I think the veterans will still gravitate to the VA. 

And the other question—— Mr. MORAN. The war on terror and CBOCs. 

Secretary PRINCIPI. The war on terror. We have seen roughly 

20,000 veterans who have returned from Iraq, Afghanistan, including Guard and Reserve. Illnesses not necessarily related to their 

war-time experiences, just general ailments that they are coming 

to VA. So the numbers I think are relatively small. However, I 

think it is too early to tell what the demand will be in 3 to 5 years. 

And today we have not seen, and we are monitoring the battlefield, 

we are working closer than ever with the Department of Defense 

to understand environmental hazards of this battlefield. 

What is of great concern, of course, I know to all of you and to 

us, is the nature of the injuries, battlefield medicine and body 

armor keeping young men and women alive today, but they are 

coming back with very, very serious amputations and head trauma. 

And at some point in time they will come to VA after they are discharged from the military or retire from the military because a lot 

of them can stay on active duty which is wonderful. But we need 

to focus on amputation research, rehabilitation, and the mental 

health component that comes with those kinds of serious injuries. 

And that is of concern to me to ensure that we are ready to treat 

them with cutting-edge medicine in the areas of their needs. 

Mr. MORAN. Thank you, Mr. Secretary. My time has expired but 

I would be glad to follow up with you about CBOCs as well. 

Mr. SIMMONS. Mr. Rodriguez? 

Mr. RODRIGUEZ. Thank you very much. I want to try and be 

brief. I am going to ask you one question that I was asked by the 

nursing home people but before I do that, let me just share with 

you that one mission that I know you hold dearly is the fourth mission of the VA and that is in case of a natural disaster or manmade that we respond. 

The VA is the only system nationwide with a health care network. We have passed some legislation in the past to try to establish four response teams in case of a national disaster, and I hope 

you keep that in mind because I know I have had a little difficulty 

with Homeland Security. Because of that legislation, the VA does 

have that responsibility and if we do need any help, the VA would 

be the one more able than Homeland Security to respond from a 

health care perspective. So I hope you keep that in mind as you 

look at construction and you look at the mission. 

The question I was asked by the nursing home care people was, 

Mr. Secretary, that the facilities that are being envisioned to either 

being downsized or being converted, how will that affect the nursing home programs and will these changes allow the VA to restore 

the nursing capacity to the level required by law? 

Secretary PRINCIPI. Well, we certainly are struggling with this 

issue to be in compliance with the Millennium bill on the number 

of VA nursing home beds. At the same time VA is trying to balance 

that with the needs of our patients who tell us they want to be 

treated at home. They want non-institutional care programs, respite care, adult daycare, hospital-based home care so we are trying 
19

to move more aggressively and uniformly in that area. VA is also 

taking advantage of our community-based nursing home program 

that doesn’t count toward that millennium bill floor or our state 

home program, which has been very, very successful, a great federal/state partnership. 

So we are going to have our long-term care policy very soon and 

strive to be in compliance with the millennium bill. 

Mr. RODRIGUEZ. Thank you, Mr. Secretary, and thank you for 

being there for our veterans. Thank you. 

Mr. SIMMONS. The gentleman from Florida, Mr. Miller. 

OPENING STATEMENT OF HON. JEFF MILLER 

Mr. MILLER. Thank you, Mr. Chairman. Mr. Secretary, thank 

you for all your doing. We all appreciate the fine job that you are 

doing for our veterans and I associate myself with my remarks or 

the remarks of Mr. Rodriguez about the VA’s ability to provide 

long-term health care needs for our veterans. I think by your own 

agency’s numbers we are saying 1.3 million over the next decade, 

a tremendous amount of veterans that are going to be requiring 

that. And of course northwest Florida is no different. 

But I did want to ask about the VISNs and how they are doing 

adhering to the CARES directives and if you could talk about what 

latitudes will those VISNs have in prioritizing construction projects 

within the VISNs? 

Secretary PRINCIPI. Well, we try to give a maximum flexibility to 

our network directors consistent with policy that is developed in 

Washington, but with regard to the implementation of those policies, the locations of CBOCs within the networks, certainly try to 

leave it up to our network directors to make those decisions. 

Mr. MILLER. I want to say that it appears Pensacola is well on 

track and on target and appreciate the assistance that you and 

your staff has been giving. Remind you again a much smaller 

project at Eglin that we would like to see dirt turned as quickly 

as possible. Those veterans are very happy that it is coming and 

they do need their CBOC as soon as possible. 

Secretary PRINCIPI. Dr. Lynch is doing a phenomenal job, and I 

know he is committed to Eglin, as he is to Pensacola. 

Mr. MILLER. That is all, Mr. Chairman. 

Mr. SIMMONS. Mr. Bradley, from New Hampshire. 

OPENING STATEMENT OF HON. JEB BRADLEY 

Mr. BRADLEY. Good morning. Thank you very much, Mr. Chairman. Mr. Secretary, thank you. First of all, I just want to thank 

you again for I think three visits in the last several months to New 

Hampshire, being able to not only talk to the New Hampshire legislature, which is——

Mr. SIMMONS. You are not running for President, are you? 

[Laughter.] 

Secretary PRINCIPI. No, thank you. 

Mr. BRADLEY. The New Hampshire legislature, for those of you 

who don’t know, is the third-largest English-speaking legislature in 

the world, behind only the British parliament and our body. So we 

appreciate that. 
20

And I do have one New Hampshire-specific question that I will 

ask you offline afterwards but I just wanted to let you know that 

Dr. Levinson of the VA in Manchester I think is doing a good job 

of complying with your directive to make sure that New Hampshire 

veterans are treated to the extent possible for outpatient type of 

maladies in New Hampshire or being served by Catholic Medical 

Center or the Elliott Hospital in Manchester, as opposed to having 

to travel to Boston. So we seemed to be making progress there. 

I was here late. I don’t know if anybody has addressed this question but my one question on a more general area is the Priority 8 

situation and how you envision re-looking at your decision and 

where we may be going with that to be able to open the VA health 

care system back up to Priority 8 veterans? 

Secretary PRINCIPI. Certainly. Well, just quickly on the first 

point you made, I think it is clear to me that we were sending too 

many patients, veterans from New Hampshire down to Boston for 

some routine primary care visits, and we simply need to do a better 

job of meeting their needs closer to home. It is just too far for a 

lot of elderly veterans to make that trip. And we are monitoring 

that very, very quickly. 

We continue to focus on our disabled and our poor. And the demand for care from Categories Group 1 through 7 are basically still 

very significant, and I don’t envision opening it up for Category 8 

this year. But with the new budget in 2005, I am going to certainly 

take a look at it again and see if we are able to reopen enrollment 

to Category 8’s. It is just a year to year decision but I feel strongly 

the disabled and the poor need to get the highest priority. 

Mr. BRADLEY. Thank you, that is all I have, Mr. Chairman. But 

I will ask you the specific New Hampshire question afterwards. 

Mr. SIMMONS. Mr. Ryan, do you have any questions? 

OPENING STATEMENT OF HON. TIM RYAN 

Mr. RYAN. Thank you, Mr. Chairman. I apologize, Mr. Secretary, 

for being late. As you know, schedules are crazy. First, I want to 

thank you for all your efforts. I know you are working extremely 

hard under extremely difficult budget conditions. I represent northeast Ohio, Youngstown and Akron. And, as you know, we are beginning to talk about, and actually the decision has been made already, to close the Brecksville facility in Cleveland and consolidate 

into Wade Park. And I think it is by 2009. 

So the question I get back at home, a lot of these veterans travel 

an hour or so to get up there, and the question that I get more 

often than not is will you be able and will the VA be able to keep 

the same level of services, continuity of care, and everything that 

they have come to expect from the VA. Can you assure me that the 

level of service and services that these veterans get will not go 

down? 

Secretary PRINCIPI. I certainly commit that to you, Mr. Ryan. I 

think it is a fundamental point. It is the premise upon which this 

entire plan is based that we will improve the quality of care. Before 

any closure takes place, there will be a major investment made in 

the Wade Park facility. I don’t know the entire amount but it is an 

extremely high investment that we are going to be making in Ohio 
21

for veterans. We have recently expanded the Youngstown, OH clinic, which is in great demand. 

So it is my hope that by the consolidation, by the investment in 

construction dollars, by the expansion of our outpatient clinics, a 

new 300,000 square foot multi-specialty outpatient clinic in Columbus, we are going to expand the reach of health care in the state, 

and that is the foundation upon which this is built. 

Mr. RYAN. I appreciate that and I appreciate your confidence. 

Also, I was at an event for the dedication of a clinic in Ravenna, 

OH, which is in Portage County, just about a hour south of Cleveland, and it is a phenomenal facility. It is really something that I 

think could be showcased around the country. And the administrators there and the doctors there were just so thrilled and a lot of 

the veterans were there. So I know a lot of times we talk about 

how we can make things better. You couldn’t make that clinic any 

better. 

Secretary PRINCIPI. Well, that is great to hear. 

Mr. RYAN. From the decor, in fact I told the administrator who 

is running it, I said, ‘‘Keep my wife out of here, because this is so 

nice she is going to get ideas for our house.’’ It actually is that nice. 

So I just wanted to let you know. 

My staff and I have talked a little bit about what you have done 

in the Lakeside Hospital in Chicago. Did you learn anything in 

that process that you would improve upon as you do the consolidation with Brecksville and Wade Park and areas like Cleveland? 

Just things we should maybe be looking out for? 

Secretary PRINCIPI. I think we have learned several lessons. That 

was the pilot test for CARES, if you will. And I am not sure we 

had as much stakeholder input as we did in this process, having 

a Commission, having more hearings in the community. I believe 

the decision was the right decision. I was just in Chicago for the 

naming of the new Jesse Brown VA Medical Center in West Side. 

I saw an artist rendering of the new Bed Tower that is going to 

be built with the dollars that we are going to be getting from the 

Lakeside facility to bring really state-of-the-art health care to Chicago. 

So perhaps from the construction basis and how we go about valuing the land, what the land is worth, we have had some issues 

there. But I think we have learned a good deal and we have applied those lessons to this second phase of our CARES process. 

Mr. RYAN. One final question, I know my time is running short 

here. Are you confident with the amount of funding that you are 

getting to be able to do all of this construction and maintain the 

continuity of care and the services, are you confident that the funding will be there to accomplish the goals? 

Secretary PRINCIPI. Well, I think it is critically important, Mr. 

Ryan. I really do. I am pleased that the President, the Congress, 

the Members on both sides of the aisle have been so supportive of 

the VA and veterans. We have almost a billion dollars in the bank 

so to speak for this first round of design work in 2004 and 2005. 

I am going to do everything in my power to obtain the billion dollars a year that I believe the agency needs to modernize the VA 

health care system just in construction now. And I think it is criti-
22

cally important. I think the future of the VA depends upon us getting those dollars. 

So certainly at my end of Pennsylvania, I am going to work very 

hard to do that. And I know the members of this committee in particular will be very supportive, so I am relatively confident, and I 

think with the veterans organizations’ support we will be able to 

get there. 

Mr. RYAN. I appreciate that and let me just pledge to you that 

I certainly want to work with you and your team to make sure that 

we do that. And I think there is going to be some difficult decisions 

that we are going to have make, even opportunities this week to 

realign our budget priorities to make sure that we do have the 

money that you need. And I hope that this committee and the 

members of this committee and this Congress will take that opportunity to assure our veterans that they have the quality of care 

that they need. So thank you very much for all that you guys do. 

Secretary PRINCIPI. Thank you. Look forward to working with 

you, Mr. Ryan. 

Mr. RYAN. Thank you. 

Mr. SIMMONS. For our second round of questions, Mr. Beauprez? 

Mr. BEAUPREZ. Thank you, Mr. Chairman. 

Mr. SIMMONS. Will the chairman suspend for a moment? You appear not to be on the recording system? 

Mr. BEAUPREZ. There. It was Beauprez Unplugged there for just 

a minute. See if I could sell that one. 

I compliment you, Mr. Secretary. Your knowledge and awareness 

of your facilities across the country absolutely astound me. You obviously do your homework and are very committed to our veterans. 

Follow-up question in a little bit of the direction I think Mr. Ryan 

was going. One of the questions I get frequently, especially out 

West when I run into veterans is a concern about rural health care 

and the drive time distance. I think you mentioned in the CARES 

report, your plan, you will open 156 outpatient clinics. My question 

is what does that accomplish and are there still holes remaining 

somewhere in the big map that we have got additional concern 

about? 

Secretary PRINCIPI. Well, the CARES plan calls for 156 clinics 

over the next 7 to 10 years or so. We have identified about 50 this 

first year and there will be others. Network directors are free to 

come in with a business plan to open up a new clinic. Our goal in 

primary care is to have 70 percent of the veterans within 30 minutes of an outpatient clinic in rural areas. In highly rural areas, 

it is 60 minutes. And then of course for in-patient care it is 65 percent of the veterans within an hour in rural hours. In highly rural 

areas, it is an hour and a half. So what we are trying to do is 

achieve a level, a standard of access that is around 70 percent live 

within 30 minutes of an outpatient clinic in rural areas. 

Mr. BEAUPREZ. Any holes remaining? Do we have some parts of 

the country that will still be wanting? 

Secretary PRINCIPI. There are always some holes and we are just 

trying to close them all. And gradually we are getting to that point 

where we are accessible to the vast majority of the patient population. We do have a chart to show you that when CARES is completed, we will improve access in primary care by 7 percent, acute 
23

in-patient by 10 percent, and then of course tertiary care by 2 percent. So we are trying to close all the holes. There will still be some 

gaps and I leave it up to the network directors to identify those 

gaps and to propose a plan to close them. 

Mr. BEAUPREZ. Thank you, Mr. Secretary. Thank you, Mr. Chairman. 

Mr. SIMMONS. Thank you. I want to thank all of our witnesses 

at panel one. We have perhaps gone a little longer than we should 

have but this is a hugely important initiative for the Veterans Administration and for all our veterans. I did refer to the distinguished former chairman of the subcommittee who in fact occupied 

the chair when this process kicked off a couple of years ago, several 

years ago and it is an extraordinary process for the Congress, for 

the Veterans Administration, for all our veterans, and I, for one, 

look forward to working with my colleagues to make sure that the 

fruits of your labor are implemented on behalf of all of our veterans, and I want to thank you very much. 

I also want to note for the record that I was looking at one of 

the Secretary’s charts and this is major and minor construction 

from approximately 1983 to fiscal year 2005. There are two peaks 

of construction on this chart. One peak of course is at the period 

when Secretary Principi is heading up the Veterans Administration. The other peak is when he was staff director of the Senate 

Veterans’ Affairs Committee. Is there any correlation between 

these two peaks, Mr. Secretary? You don’t need to answer that 

question, I just point that out for the record. 

The second panel today includes Mr. Dennis Brimhall, president 

and chief executive officer, University of Colorado Hospital; Mr. 

Lawrence A. Biro, Veterans Integrated Services Network 19: Rocky 

Mountain Network. They are here to update the subcommittee on 

legislation we approved last year to authorize VA to move forward 

on its need to build facilities at the new Fitzsimons. 

Also we will hear from Mr. John L. Nau, III, chairman, Advisory 

Council on Historic Preservation; and Mr. Dennis Samic, treasurer, 

American Veterans Heritage Center. The need to protect and effectively re-use historic properties for which the VA is the legal steward, is important even as VA builds for the future. It is important 

for the Veterans Administration to meet preservation requirements 

in program and construction activities. And I look forward to the 

testimony of this panel. Speaking for myself and the State of Connecticut, we have some very old veterans facilities that have tremendous historic value. And while we wish to move our health care 

and our benefits programs well into the 21st Century, we also want 

to make sure that we preserve and protect our historic properties 

for future generations to learn from and to enjoy. 

I would now like to yield to my friend, Mr. Beauprez, to see if 

he has any particular comments that he would like to make by way 

of introduction of those members of the panel who are from his 

lovely state. 

Mr. BEAUPREZ. Thank you very much, Mr. Chairman, for your 

gracious consideration. 

President Brimhall, as you have already acknowledged is president and chief executive officer of the University of Colorado Hospital. I am going to not spend so much time on his distinguished 
24

resume, which is distinguished, but to talk about Dennis Brimhall’s 

commitment to this project. This wonderful campus, the former 

Fitzsimons Army Hospital that we are going to hear about today, 

as the University of Colorado, through his guidance, redeveloped it, 

they certainly had numerous options. Working with the Veterans 

Administration was I would submit probably not the easiest of options. To deal with the VA and the Federal Government has to be 

bit of a burden. 

But I would like to publicly commend President Brimhall for his 

tenacity, not only in trying to as I guess we would say out there 

in the business world put a deal together, but to put together a 

very wise, sound deal that is really going to be a legacy certainly 

to the University of Colorado’s hospital network. It is a great teaching hospital. Has a tremendous legacy in its own right. But to work 

with the VA to maintain a very longstanding partnership that you 

have had with the Veterans Administration and the University of 

Colorado Hospital for more than 50 years now and now to bring in 

a third partner, the Department of Defense. This would not happen, and we sometimes say these sorts of things casually but in 

this case it is 100 percent true, it would not have happened if it 

weren’t for the tenacity and dedication of President Brimhall. So it 

is wonderful to see you here today, Dennis. Look forward to your 

testimony. 

And I would be remiss if I didn’t also acknowledge the gentleman 

to your right, Mr. Biro, our new network director for VISN–19. 

Both of these gentleman have been embraced wholeheartedly by 

our VSOs in Colorado. They have immersed themselves in this 

project with the kind of professional dedication and personal involvement that we would love to see in project after project all over 

this great land. 

So gentlemen, it is wonderful to have you both here. 

Mr. SIMMONS. Thank you very much. We are in fact glad to have 

all four of you. I realize two of the four got some special and extra 

treatment but that is only because of their geographic affiliation 

with one of our members. So I thank you all for being here. 

Mr. Brimhall, why don’t you begin with your testimony. 

STATEMENTS OF DENNIS C. BRIMHALL, PRESIDENT AND 

CHIEF EXECUTIVE OFFICER, UNIVERSITY OF COLORADO 

HOSPITAL; LAWRENCE A. BIRO, NETWORK DIRECTOR, VISN 

19: ROCKY MOUNTAIN NETWORK; JOHN L. NAU, III, CHAIRMAN, ADVISORY COUNCIL ON HISTORIC PRESERVATION; 

AND DENNIS SAMIC, TREASURER, AMERICAN VETERANS 

HERITAGE CENTER, INC. 

STATEMENT OF DENNIS C. BRIMHALL 

Mr. BRIMHALL. Thank you very much. Mr. Chairman and members of the committee and especially including my good friend, Congressman Beauprez, greetings. Thank you for this opportunity to 

report to the committee on the status of this really remarkable 

project. After 80 years of serving the members of our Armed Services and their families remarkably, the Fitzsimons Army and Medical Center is now home to a 21st Century academic medical center, one that has been built from the ground up. And doing that 
25

in such a way that it solves many of the infrastructure problems 

we have in health care referenced by Secretary Principi. 

It is also home to a new and exciting partnership that will bring 

together one site, the University of Colorado, the University of Colorado Hospital, the Department of Veterans Affairs, and the Department of Defense. 

Currently at the Fitzsimons Campus there has been completed or 

is under design construction four million gross square feet of new 

construction. This includes research, educational facilities, and patient care facilities, including a new University of Colorado Hospital and another partner we have, the Denver Children’s Hospital. 

There will also be at this site, this remarkable federal tower. This 

federal tower will include a new Denver Veterans’ Affairs Medical 

Center and a new military treatment facility, which would have 

been built at the Buckley Air Force Base, but now will be part as 

part of this federal tower at the Fitzsimons Campus. 

The advantages of this partnership are truly significant. First, as 

it relates to quality. We will be able to take the very best of all of 

these partners and bring them together. Another important quality 

issue that we all know is in medicine the more you do, the better 

you get. And as we bring all of these partners together and their 

respective constituents, we are able to increase the numbers of procedures and the numbers of activities there and therefore improve 

the quality based upon the fact that we aggregate these in one 

place. 

The other great advantage is cost savings. By not having to duplicate facilities or equipment that might be located in each one of 

these three facilities we can bring them together and that saves us 

significant savings on the capital side. But probably more significantly over the long run is the savings on the operational side. The 

more we put through a fixed asset, the savings are significant. And 

they accrue to all partners equally. That is the exciting thing is everybody in this relationship benefits and that benefit continues 

over many years. 

I think the other exciting benefit of this is it is a new model, 

really an opportunity to re-think, to re-invent, to do things differently than they have ever been done before. We believe, we have 

been told, we hope that this will be a model for the future for many 

different areas of the country who will then accrue the same benefits to them that we have received in Colorado. 

In conclusion, may I just say that it has been a delight to work 

with the Department of Veterans Affairs. The senior leadership of 

the Department over the last 3 years as I have been involved in 

this have been open and innovative, been collegial. And even 

though, Congressman Beauprez, it was a daunting task to deal 

with a very, very large arm of our Federal Government, I must say 

it has been a delight and the leadership has been terrific. 

Likewise, in the Department of Defense the leadership there the 

leadership there has been open and innovative to doing new things 

and doing them in a different way and that relationship has been 

terrific as well. 

Thank you very much. 

[The prepared statement of Mr. Brimhall appears on p. 88.] 
26

Mr. SIMMONS. We thank you for your testimony, and now Mr. 

Biro, who is the network director of VISN 19, the Rocky Mountain 

Network. Welcome. 

STATEMENT OF LAWRENCE A. BIRO 

Mr. BIRO. Mr. Chairman and members of the subcommittee, 

thank you for this opportunity to appear before you to present my 

views on the potential sharing agreement with the Department of 

Defense on the Fitzsimons Campus. 

As already said several times, I am Dr. Larry Biro, director of 

the VA Rocky Mountain health network, Veterans Integrated Service Network 19. VISN 19 serves an area covering the States of 

Utah, Montana, Wyoming, Colorado, portions of Idaho, Kansas, Nevada, Nebraska, and North Dakota. This network provides health 

care for approximately 140,000 veterans at six medical centers in 

32 community-based outpatient clinics. 

In his May 2004 CARES Decision Document, Secretary Principi 

made the following decision concerning the building of a new 

health care facility in Denver. I quote from the decision document. 

‘‘VA will build a replacement VA Medical Center through a sharing 

agreement with the Department of Defense on the Fitzsimons 

Campus with some shared facilities with the University of Colorado.’’

The federal facility at Fitzsimons is a joint venture concept based 

in part on the VA/Air Force work in Las Vegas, Nevada and Albuquerque, New Mexico. As planned, this facility will be a federal 

tower housing the medical services of the Denver Medical Center 

and the medical services of the Buckley Air Force Base. The Air 

Force will occupy approximately 7 percent of the building for clinical and administrative purposes. 

The new facility will expand the capability of the Denver VA 

Medical Center by significantly increasing the amount of space 

available for clinical services. Among the services being considered, 

a new spinal cord injury center will be a part of the new facility 

and other expanded clinical services, such as a 20-bed sub-acute 

care unit. In addition, a new 60-bed VA nursing home care unit 

will be located on the Fitzsimons Campus. 

This re-location is also intended to maximize the efficiencies with 

the federal tower by working closely to share some facilities with 

the University of Colorado Hospital. To obtain these efficiencies, 

the new federal tower must be located as near as possible to existing and planned facilities of the University of Colorado Hospital. To 

that end, that University of Colorado Hospital has reserved a plot 

of land in close proximity of the existing and planned structures of 

the medical center. 

The move to the Fitzsimons campus makes complete sense. The 

University of Colorado Health Science Center and the University 

of Colorado Hospital are totally committed to this site. The outpatient complex is now complete and in operation. There is an extensive research space that is near completion. The close proximity 

in conjunction with the well-established and longstanding affiliation will allow the use of the University expertise for hyper-acute 

and highly specialized care. 
27

Acquisition of this property could occur through a long-term lease 

with the University of Colorado. VA’s general counsel has advised 

us that VA currently lacks the authority to enter into a long-term 

lease that would give the Department sufficient interest in the land 

to allow VA to build a facility here, which we estimate may cost 

as much as $328 million. For a project of this magnitude, I believe 

that the authority for a lease of much greater duration would be 

needed to ensure the government has sufficient interest in the 

land. 

If we cannot obtain the long-term lease, we will be forced to look 

for land that the government can purchase outright on or close to 

Fitzsimons. Although the new facility will continue to be a joint 

federal health care tower between VA and the Department of Defense, our opportunities to gain greater efficiencies through sharing 

arrangements with the University of Colorado might be more limited. Therefore we are grateful to the committee for introducing 

legislation that contains a provision that would assist us in re-locating to the Fitzsimons campus of the University of Colorado. 

Mr. Chairman, that concludes my statement. I would be happy 

to answer any questions you and the members of the subcommittee 

might have. I have submitted a written statement for the record. 

[The prepared statement of Mr. Biro appears on p. 99.] 

Mr. SIMMONS. Thank you very much, Doctor. Now we will hear 

from Mr. John Nau, chairman of the Advisory Council on Historic 

Preservation. Welcome. 

STATEMENT OF JOHN L. NAU, III 

Mr. NAU. Thank you. Thank you, Mr. Chairman and members of 

the subcommittee. 

Mr. SIMMONS. If you would push your microphone. 

Mr. NAU. Thank you for inviting me to testify. I am John Nau, 

chairman of the Advisory Council on Historic Preservation. The 

ACHP is an independent agency created by the National Historic 

Preservation Act of 1966. Our job is to advise the President and 

Congress on historic preservation matters. We also administer the 

Section 106 Review, the portion of the NHPA that deals with review of federal agency programs and projects that have the potential to affect historic properties. In this capacity, the ACHP has 

long been aware of the rich inventory of historic assets managed 

by the VA. In fact, approximately 40 percent of the VA’s medical 

centers are identified as historic districts and contain over 1,900 

historic structures. 

In 2003, the White House launched a major historic preservation 

initiative entitled, ‘‘Preserve America.’’ The initiative is designed to 

promote the appreciation and importantly the use of our nation’s 

heritage assets in a manner that ensures both their long-term preservation and their continued contribution to the economic vitality 

of the country. 

Of particular relevance to the VA’s management of historic properties is Executive Order 13287, Preserve America, signed by the 

President on March 3, 2003. The overall thrust of the Executive 

Order is to encourage federal agencies to manage their historic 

properties in a way that advances the economic health of the community in which they are located and also promotes the preserva-
28

tion over the years. Central to this goal is the development of partnerships with state and local governments, as well as the private 

sector for economic development. 

The historic resources in the ownership of the VA are some of the 

country’s finest heritage assets. We have recently become aware of 

H.R. 1762, introduced by Congressman Michael Turner. This bill 

proposes the creation of the Veterans National Heritage Preservation Act. The ACHP strongly supports H.R. 1762 and believes it be 

an excellent compliment to the efforts discussed here today. 

Through the effective VA CARES program and the creation of the 

Veterans National Heritage Preservation Act, we can provide the 

thoughtful stewardship of the VA’s premier heritage assets. 

We support the VA’s initiative in creating the CARES program 

but are concerned that it does not address how it would impact the 

historic properties under their management. As the Administration 

has so strongly emphasized in the issuance of the Executive Order, 

appropriate stewardship of these irreplaceable resources is a government-wide priority. There are five major issues related to the 

draft bill that I would like to bring to the committee’s attention. 

First, over the next 20 years it is anticipated that approximately $4.7 billion in capital assets will be needed to implement this program. This estimate includes $59 million earmarked specifically for 

demolition costs. We are concerned that if the VA is predisposed to 

demolition of facilities and funding for such activities is readily 

available, the VA will not be receptive to proposals for historic 

properties that involve leasing and/or adaptive re-use. 

Second, we understand that the VA intends to unilaterally transfer real property under the CARES program. We recommend that 

the VA draw the experience of other federal agencies that have 

dealt with excess historic properties, such as the Department’s of 

Defense and General Services. The transfer of real property, particularly historic properties, can prove to be very challenging, especially when the unique aspects of that historic property are not 

properly considered when negotiating covenants. 

Third, we applaud the House bill’s authorization for VA to use 

the proceeds from the transfer of real property for maintenance 

and repair, but we are concerned the bill places the use of such 

proceeds at the end of the line. 

Fourth, the draft bill is silent on the obligation of VA to comply 

for transfers with the requirements of the Section 106. The proposed legislation provides an opportunity to encourage VA to engage in the Section 106 process early in their planning to ensure 

a balanced decision process. 

Fifth, the VA needs to be aware that planning and site selection 

for new facilities may have an effect on historic properties. Since 

so many of VA’s existing facilities include historic districts, we 

strongly urge that they consider this impact. 

In closing, a properly crafted process can encourage transfer of 

historic properties where the new owner is committed to a longterm preservation strategy. Minimize neglect while properties 

await disposition, promote partnerships for creative use or cooperative management arrangements, and effectively involve the local 

community in re-use strategies that promote economic development. 
29

Again, thank you for the opportunity today for me to share the 

views of the Advisory Council on Historic Preservation with the 

committee. 

Thank you. 

[The prepared statement of Mr. Nau appears on p. 102.] 

Mr. SIMMONS. Thank you for that testimony. 

Now we will hear from Mr. Dennis Samic, treasurer, American 

Veterans Heritage Center, Inc. Welcome. 

STATEMENT OF DENNIS SAMIC 

Mr. SAMIC. Thank you, Mr. Chairman and members of the committee. My name is Dennis Samic. I appreciate the opportunity to 

appear before you today to also talk about historic preservation. I 

am a retired Air Force Brigadier General who served nearly 30 

years on active duty. And my son was born in Building 500 at 

Fitzsimons, so I was glad to hear all that this morning. 

I am here today, however, as a member of the board of trustees 

for the American Veterans Heritage Center. It is a four year old 

Dayton, OH-based nonprofit organization. The mission of our organization is to increase awareness of veterans’ issues, recognize veterans’ contributions, endorse patriotism, promote tourism, and enhance our neighborhood by preserving and developing the Dayton, 

Ohio Veterans’ Affairs Historic District. 

Individual veterans and veterans service organizations hold 

many different opinions relevant to preserving old buildings but 

there are three things all veterans agree on. They want their service and sacrifice to this nation to be appreciated. They want it to 

be remembered. And they want it to serve as a legacy for those 

who come after. Our organization believes one of the best ways to 

honor our vets and preserve their legacy is to rehabilitate and utilize many of the historic facilities on VA property. This is a national issue. 

We believe the approach our community took and continues to 

pursue could serve as a possible guideline for federal and national 

policy. We also hope our approach can be instructive for other communities as they develop their public and private partnerships. It 

is especially fitting that Dayton addressed the need for historic 

preservation because the Dayton VA campus is quite frankly the 

foundation for VA’s modern health care. When President Lincoln 

established a national home for disabled volunteer soldiers on 

March 3, 1865, there were three original facilities: Dayton, OH; 

Milwaukee, WI; and Togus, ME. Theirs was a ground-breaking approach to veterans care which for the first time brought the Federal Government into responsibility for care of the needy. 

The VA has taken initial steps to safeguard this heritage by either listing each of the now 11 national home properties on the register of historic places or determining their eligibility for listing. 

However, it is clear that the full significance of the national home 

within the context of this nation’s history has not been assessed. 

We need definitive action to stimulate national preservation and to 

establish momentum. 

Our organization supports the draft bill before us today because 

it has preservation in it. But we have basic concerns about how 

that bill will be implemented and how the capital asset fund it es-
30

tablishes will be utilized. To ensure this important part of our nation’s heritage is preserved and protected, we urge your committee 

to include in your bill an incentive, if not a requirement, for the 

Department of Veterans Affairs to more actively partner with the 

National Park Service to prepare an assessment of 11 national 

home properties to determine which of the historic facilities are the 

most historic. 

The goal is to keep these most historic buildings from being torn 

down before preservation can start. We, too, urge that as you mark 

your bill you try to incorporate as much as you can of the provisions of Congressman Turner’s H.R. 1762. We think it is a great 

piece of legislation. 

Once the assessments I mentioned earlier are complete, we urge 

your committee to require the VA to fund the creation of master 

utilization plans for these VA campuses. Dayton VA campus could 

serve as a pilot. 

We applaud the establishment of the VA capital asset fund, but 

believe the priorities that you have established will make it difficult, if not impossible, for any of this money to find its way to historic preservation. Asset transfer costs have priority and they will 

be large. We urge you to establish a guaranteed percentage, perhaps 25 percent as a floor for historic preservation. 

The draft bill gives authority to transfer property below fair market value for the purpose of benefitting homeless veterans. We urge 

you to also include historic preservation as a purpose for such a 

transfer. We can make it conditional that any building transferred 

must maintain its historic significance as a condition for anybody 

receiving that property. 

And, finally, the bill describes a process for transferring real 

property. We urge you to include in one of the notification steps a 

statement certifying that the transfer will have no impact on a 

building on the register of historic places. And if it does, the Department should state that it has found no adaptive re-use for that 

building. 

We understand Secretary Principi is about to sign a request to 

the Director of the National Park Service to begin the assessment 

I mentioned earlier. If it is completed, the VA can initiate development of master utilization plans for each facility. Creative local 

partnerships between the local VA, VSOs, state and city officials, 

nonprofit organizations like ours, the National Park Service, and 

private individuals and foundations can then be established to implement these plans. 

We have such a partnership in Dayton. Secretary Principi was 

kind enough to cut the ribbon to our AVHC office in April of last 

year and we are making great progress. We have been added to the 

national historic register and look forward to historic landmark 

status. We are, as we speak, rehabilitating the first permanent 

chapel built in the United States by the Federal Government. And 

in the long-term want to turn the Dayton VA’s historic chapel, patient library, administrative building and barracks into a National 

Veterans Hall of Fame. 

We appreciate your holding these hearings to gain stakeholder 

input. We don’t believe the VA will receive a large enough appropriation to provide for all the costs of both health care and preser-
31

vation. We do believe, however, that with your help and direction 

the VA will devote enough of the money it has to stabilize the historic facilities and formalization plans for its campuses. If the VA 

then encourages creative local partnership, which use these plans 

to build business cases to stimulate contributions, together we can 

satisfy the needs of both outstanding health care and preservation 

of these national treasures. 

Some people believe the expenses associated with these recommendations are a cost. Frankly, we view them as an investment. 

It will reduce the fiscal burden that VA faces today to maintain 

buildings that they no longer need for patient care while at the 

same time allowing our nation to provide those three things all veterans want and deserve: thanks, remembrance, and legacy. 

Thank you very much for this chance to speak. 

[The prepared statement of Mr. Samic appears on p. 107.] 

Mr. SIMMONS. Thank you very much. I would like to comment on 

the last two testimonies. I believe firmly that a partnership between multiple public and private entities is the way to go and that 

community involvement is a critical part of that. There is a tendency here in this body, in the Congress, to put dollars forward or 

re-allocate dollars for things that are supported locally and things 

that are supported by organizations such as yours, in partnership, 

and that is critically important, and I look forward to seeing how 

we can progress in that regard. 

Speaking of partnership, I would like to address my first question to Mr. Biro and Mr. Brimhall. One of our members has been 

concerned in months past that the relationship between a Defense 

Department hospital and the VA in her area has not been productive. Speaking for myself, coming from eastern Connecticut where 

we have both the Coast Guard Academy and the submarine base 

at Greton and New London, we find that they are very productive 

relationships. But it is a challenge and you have to work at it and 

things can go wrong. 

I would be interested to know from Mr. Biro how he feels he is 

getting along with Mr. Brimhall. And I would be interested to 

know from Mr. Brimhall how he feels he is getting along with Mr. 

Biro. And we are among friends. There happens to be a camera 

here but we won’t pay any attention to that. How is it going? And 

if I was to ask let’s say for a joint report to be presented to this 

subcommittee let’s say in December, would we enjoy reading that 

report? 

Mr. BIRO. Okay, first I have to say that the process of planning 

for Fitzsimons has been going on for several years. I have been in 

my position a little bit more than 8 months. So I am coming in at 

the end of it or in the middle of it, I guess not the end. And we 

have a very good working relationship. We have already worked together on a basic plan of services there. We have had several meetings. We have been limited because we haven’t had money to use 

for planning and we are just beginning to plan and so we are going 

to continue to look. In about 90 days we will have a footprint that 

we can put into the site and see how it is going to work. So we 

are working together excellent and moving the project towards its 

natural conclusion. 
32

Mr. BRIMHALL. Mr. Chairman, thank you. The relationship between the Denver Veterans’ Affairs Medical Center and the University of Colorado Health Science Center actually has been going for 

50 years. When the Department of Veterans Administration looked 

for a place to build its veterans hospital in Colorado after the Second World War, they deliberately sited it right next to the University of Colorado Health Science Center. So we have got a long tradition of that relationship. 

We are now doing some new things that have never been before 

and that is we are moving out to a new campus. We have invited 

the VAMC to move to the new campus. I will say given the magnitude of this project and the innovation of this project, I would 

have to characterize the relationship has being very, very good. We 

have gotten where we have gotten today because of the positive nature of that relationship. 

I will also say that it was the Department of Defense’s interest 

to join us at the site. They had the option of either building a new 

MTF at the Buckley Air Force Base, which they decided was not 

wise given that investment and the fact that it would be isolated 

out on the base and it was their interest to join at the base and 

they came as a willing partner, and in some ways a catalyst to help 

us move forward. So I think the proof is in the pudding. The fact 

is we have gotten to where we are today because of the relationship 

that has existed and because of a mutual desire to be there. And 

I think the best example of how well we are working together is 

the fact that we have gotten to where we are today. And we would 

look forward to the opportunity to report back in 6 months about 

our progress. 

Mr. SIMMONS. Well, I really welcome that response. And carrying 

it just a little bit further, it is my understanding that you hope to 

achieve efficiencies by sharing specialized care laboratory, dietetic, 

administrative services. To do so, do you engage in a memorandum 

of understanding? Do you have labor issues that have to be resolved from organization to organization? How does that structure 

get built and what are your challenges there? 

Mr. BIRO. Well, from the VHA side, we do that with sharing 

agreements, contracts basically that we would have to purchase the 

services from the other side. There is going to be labor issues, correct. There may be positive ones where we will be adding people 

but there will be maybe negative ones where we will be eliminating 

people and the services will be done at the university hospital. So 

it is a process, it is an acquisition process. That is as simple as I 

can put it. 

Mr. BRIMHALL. Mr. Chairman, again this is building on a tradition. The tradition is for example we have been doing transplant 

services for the VA for years. We have been sharing radiation oncology services. I think we are going to take an existing model and 

expand it. We have felt that the best thing to do is to do that when 

both parties benefit. If both parties don’t benefit, there is no reason 

for us both to do it. 

So I think it is an analysis that we will have to undergo that 

said can we do better collectively than we would do individually? 

And I suspect and I am confident as we do that analysis we will 
33

find many opportunities to save and still maintain the respective 

missions. 

So all of the challenges of contracts and arrangements and the 

issues that you have referenced we are comfortable we can work 

out because traditionally we worked them out and got us to the 

point we are now. We just have to expand that to a broader range 

of relationships but we have a good model that we think we can 

build upon. 

Mr. SIMMONS. Thank you very much. I really appreciate that testimony. And I think what you have provided us for here is really 

a model for other parts of the country where we can achieve efficiencies and really create something that is extraordinary for the 

region, for our veterans by working productively together. And I 

thank you for that. 

I would now ask my colleague, Mr. Beauprez, if he could assume 

the chair. I excuse myself, gentlemen, and ask my friend, Mr. 

Ryan, if he has questions for the record. 

Mr. RYAN. I thank the chairman. Mr. Beauprez better get over 

here quick before I jump in it. 

Mr. Brimhall, I read through your testimony a little bit that 

talked about the research and development that you guys do. Can 

you just, what are the top three or four things that you are doing 

research on at your hospital with regards to veterans? 

Mr. BRIMHALL. Mr. Ryan, thank you. The University of Colorado 

is one of the top 20 universities that are recipients of NIH funding, 

National Institutes of Health funding in the country. Much of the 

research we do focuses in two or three areas. One is cancer. Another is pulmonary disease. As you know, the Fitzsimons Army 

Medical Base was constructed originally after the First World War 

as a place for patients with lung disease to go and recover. And so 

we have always had leadership in the area of pulmonary disease 

but also cardiac research and many others. 

There is a large research component to the Veterans’ Affairs 

Medical Center that is collaborative with the University of Colorado and we expect that collaboration to be enhanced by literally 

putting the research in common buildings and increasing that 

multi-disciplinary approach to the research. 

Mr. RYAN. You don’t do anything with prosthetics at all? 

Mr. BRIMHALL. We do have a department of rehabilitative medicine. It is a full department. It is ranked as one of the top rehab 

centers in the country. We look forward, we are very excited about 

the potential of a spinal cord injury center located in the VAMC. 

We do not have one right now. They have great talents and skills 

in that area which we think we can match up with our expertise 

in rehabilitative medicine. And that is a partnership that doesn’t 

exist as well today that will be enhanced by this program. 

Mr. RYAN. That is great. Just let me how say how impressive I 

think the collaborative effort is and I am glad you guys are getting 

along just fine because we get along great on Capitol Hill here too. 

I want to ask a couple of questions regarding the historic preservation, and I don’t exactly know who to direct this to. As far as my 

own understanding, the sale of land, that money would be used to 

help fund this program, Mr. is it Samic? 
34

Mr. SAMIC. Yes, sir, our understanding of the bill you have before 

you would be to establish a revolving fund I think with an initial 

$10 million, if what I have read is correct. It spends money to prepare land for transfer, incur the cost associated with that first. 

There is a set of priorities established and when that land is in fact 

or that facility is in fact sold, the proceeds go back into the kitty. 

So it is intended to revolve. Our concern, I think expressed by Mr. 

Nau and myself in his testimony as well, is that when you look at 

priorities under which those monies would be expended, preservation, historic preservation is last of the three that are listed there. 

In my view at least, I spent my 30 years in the Air Force on a financial business. Requirements always exceed available funds. And 

when you are the last set of priorities on almost any list, it is going 

to be very difficult to get to you. Environmental clean up alone I 

would think on some of these would be substantial. 

Mr. RYAN. These facilities mostly hospitals, all hospitals, what 

are they? 

Mr. NAU. Mr. Ryan, they are mixture of residences. Many of the 

veterans for which these were originally built, Civil War veterans, 

by the time they came online were getting older, their homes. You 

heard about one church, medical facilities in the terms of the turn 

of the 19th to 20th Century. So it is a mixture. They are campuses. 

As I said, most of them are now historic districts so it isn’t a single 

facility. They were built to become a home. 

Mr. RYAN. And what would they become after we preserve them? 

Would they be museums? Would they still be working facilities to 

some degree? 

Mr. NAU. I think there are as many options as there are business 

opportunities. These buildings don’t need to be torn down. As the 

General said, this fund could be used to stabilize them and have 

the community come in and create private sector health facilities, 

low-income housing, any number of business opportunities. This 

isn’t the first time the government has de-assessed any type of facility and had it become a functioning economic engine for those 

communities. We don’t need to go build these buildings again. We 

simply need to maintain them and then have a good adaptive reuse for them. 

Mr. RYAN. I am wrapping up here. I think it is a good idea. I 

am from an older community myself and I think projects like this 

have enormous value, just one piece of a puzzle in a local community, especially smaller communities where it would have more of 

an impact than in a huge city. So I want to commend you for going 

down this road. We are dealing with a lot of issues here with funding for health and benefits and things like that. So just so you 

know the kind of competition you are up against, which I am sure 

you do. But I think there is enormous value in this kind of program 

for local communities so I commend you for your work and we will 

see how things play out. Thank you. 

Mr. Chairman? 

Mr. BEAUPREZ (presiding). I thank the gentleman. Mr. Moran? 

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

Mr. Biro and Mr. Brimhall. Kansans care a lot about what goes on 

in Denver. It somewhat pains me to say that but it is the truth. 

And in fact I have always wondered who the politicians were that 
35

gave away a good chunk of your state, the Kansas Territory used 

to include as far west as Colorado Springs. And somehow over the 

course of time, I don’t know whether we gave up, I guess in the 

position I am in I should say we gave up, we discarded part of the 

territory and left it to Colorado. 

But many veterans in our state and many patients, who are not 

necessarily veterans, rely upon Denver for their medical care. Ambulance services, air flights go west in much of my district. And so 

I also join Mr. Beauprez and others in praising the collaboration 

that is ongoing between the VA and the University and the medical 

providers in the Denver area. 

Mr. Biro, as you know, I have great interest in trying to provide 

greater access for veterans who live in rural western Kansas. And 

you and I have had conversations, and I appreciate your willingness to come and meet with my veterans and look at some health 

care facilities in western Kansas. What caught my attention in Secretary Principi’s testimony was the indication about the VISN director’s ability to bring projects to the VA here in Washington in 

regard to CBOCs. And, as I understand the CARES Report, your 

VISN, of which six Kansas counties are a part, has three priority 

CBOC projects that will in some fashion be underway in the future. 

And I just wanted to hear you confirm or at least express your 

understanding of what authority you have beyond the three CBOCs 

that are already in the CARES Report, what kind of process do you 

envision in looking at other opportunities? And is what the Secretary said this morning the way it has been described to you and 

to other VISN directors? 

Mr. BIRO. Yes, what the Secretary described is how it is going 

to work. We have three CBOCs. They are pretty small. One is in 

Utah, two in Montana that we intend to get going within the year. 

After that we will again develop a list of other places that need to 

have CBOCs and we will follow the procedures that are established 

and then work through that list as the usual variables that come 

into being, mainly money, that we will move through that list as 

quickly as possible. And so know that western Kansas is an area, 

I am driving out there, it is 3 hours from Denver. So I will be very 

sensitive as to that traveling distance. 

Mr. MORAN. And we are glad to know that you are driving. It 

will portray the distance that many Kansans travel unfortunately 

on a regular basis. We have been through the CBOC process in 

Kansas in the congressional district that I represent on three occasions now with VISN–18 in Kansas City. So I look forward to working with you as you proceed to try to better meet the needs of veterans across your VISN. 

I would only reiterate what I indicated to the Secretary, which 

is that the criteria seems to me to be balanced between distance, 

which is significant, and density of veterans, which is less of factor 

in your calculation, the VA’s calculations. But they are both equally 

important and in some fashion it seems to me the VA has to recognize that even though there is not a huge density, a large number 

of veterans, the inconvenience, and in fact that is way too shallow 

of a word, the inability for many veterans to access health care exists because of that distance even though there may not be a lot 
36

of them and they have the same rights or are entitled to the same 

benefits as men and women who served our country. 

I also would reiterate something I have pointed out to the VA before, when we do the accurate—when we do a count on the number 

of veterans in the area to be served by the CBOC, one of the things 

that has been unclear to me is whether the VA has counted the 

veterans in three states. A VISN in the northwest corner of Kansas 

would serve veterans in Colorado and would serve veterans in Nebraska. 

And I have asked this question a number of times. When we look 

at that density number are we sure we are counting veterans in 

that three state area. And so as you work through this process, as 

we work together, I just again would bring up the issue that I 

think we need to make certain that we are counting all the folks 

who would benefit from that process even though they live in a 

three state region. 

And I thank you for being here, your testimony, and look forward 

to working with you in the future. 

Thank you, Mr. Chairman. 

Mr. BEAUPREZ. I thank the gentleman. If I may, I would like to 

put forward a few questions to the panel myself. First of all, to 

President Brimhall, there has been a lot said, mostly by me today, 

about the great project out at Fitzsimons but let’s probe just a little 

bit a couple of other things. If all goes forward as planned, we are 

talking about a very long-term land lease. You might explain to the 

committee why a land lease as opposed to purchase of the land or 

some other arrangement. And, frankly, if the University is being so 

gracious in making this land available at what I think is going to 

be a reasonably favorable deal, what does the University get out 

of this? Why are you so intent on the VA being your tenant? 

Mr. BRIMHALL. Mr. Beauprez, the answer to the first question is 

a bit technical but the land, when the base realignment and closure 

process was completed and we made application to get the land, 

the land was conveyed from the Department of Defense to the Department of Education. It was then conveyed from the Department 

of Education to the University of Colorado under the terms, under 

a public benefit conveyance, which means that it was available to 

the University of Colorado as long as it was used specifically for 

educational purposes and that conveyance was a 30 year process. 

At the end of 30 years, the University has it without any covenants. 

And so because the University has that land and it is under that 

covenant, it belongs to the University and therefore will require a 

lease to the Department of Veterans Affairs. That lease is not a 

problem. We have talked with the Department of Education about 

it. They are okay with it. 

But the lease is the mechanism that needs to deal with the acquisition of the land. And the only thing we are dealing with now 

is, as Dr. Biro said, is to make sure that we have the authority to 

enter into that long-term lease, 75 years from the VA standpoint, 

not a problem from our standpoint. We can enter into a lease that 

long. 

Why would we make this land available? It is very precious land. 

It is our home. It is our future for all our programs for as long as 
37

we can predict. And when we prioritize who would get access to the 

land, that priority is made upon several criteria. One is who are 

the best partners? The VA is a crucial partner to us. The Children’s 

Hospital is another one. 

And so first of all, who are the best partners? Second is can we 

gain economies of scale? If we bring a partner to the site who does 

what we do and we can have economies of scale and savings by 

working together, that gives us an economic reason for conveying 

the land or leasing the land as opposed to putting some other program there that might have some benefit. 

So the reason that the University is willing to do this is to maintain that very important partnership and because of our expectation that we will get economies of scale and therefore operate more 

efficiently. 

Mr. BEAUPREZ. Mr. Biro, stay on that point for just a little bit 

because some of the testimony we have heard in the past in front 

of this committee about these kind of relationships that was alluded to just moments ago by the full committee or the subcommittee chairman, Mr. Simmons, is this relationship that exists. 

Now there has been a longstanding VA/University of Colorado relationship. In this case, I am going to make an assumption that that 

relationship can continue to be good. We are now bringing in a 

third partner. But some of the VSOs expressed concern, at least 

initially, I believe we have crossed that hurdle, that when you are 

getting in partnership, in bed, if you will, with a great big partner 

here, how can you make sure that the health care that we all want 

for our veterans remains priority number one and that you don’t 

get relegated to some lesser seat on the bus? 

Mr. BIRO. Well, one, when I talk to veterans’ service organizations, I make three personal promises to them and I will make it 

in terms of this project here. One, that the quality of the care that 

they receive in our VAs will be second to none and that is non-negotiable and we will stand up to any comparison. The comparison 

will be there. What I will tell them is that the care that they get 

in our tower is exactly the same care that they get at the University of Colorado Hospital across the way. And I will emphasize that 

over and over again. 

Two, that we maintain and expand services. This process will not 

go backwards. We will be going forward when we do this. And, 

third, that each and every veteran will be personally satisfied in 

the services that they receive at our facility. And that is a personal 

promise. And you may ask me how can I say that, I can just say 

because I say it and I say it over and over. I have said it for 5 

years going on six that there will be personal satisfaction. 

So that is just the standard. We set a standard. Our care is second to none. That is the first thing we look at and we will continue 

to do that. There are a lot of different ways of doing that but that 

is where we start and that is the way we continue. 

Mr. BEAUPREZ. For both of you gentlemen if you would explain 

one other thing to me. One of the concepts that was first presented 

to me that made me think this is something I want to look at was 

this economies of scale business. In fact, I think there is an underlying assumption that over a period of time, as compared to renovating and trying to operate the old facility, this new facility will 
38

essentially pay for itself if you will, that the economies of scale, the 

operating efficiencies are that significant. Would both of you opine 

on that for just a moment? 

Mr. BIRO. Sure, just quickly, with everything Mr. Brimhall has 

said, it is a win/win we will do it. We are talking everything from 

laboratory to warehousing to environmental services to clinical 

services. Anything that we can look at where, and I have laid out, 

where we either break even or save money, we are interested in 

talking about. And he said the same thing. 

Mr. BRIMHALL. Thank you. Congressman, health care facilities 

are the most expensive facilities you build today. We use a rule of 

thumb, million dollars a bed. That is $300 a square foot to construct these facilities. They are the most expensive facilities today 

you can construct. If for example we need 20 ORs, the Denver Veterans’ Affairs Medical Center needs 15 ORs, that is 35. But if together we only need 33 because we can share, then we saved a couple of million dollars right at the get go off the construction costs. 

Now that is just a simple cartooned example of the type of savings that one gets at the beginning for the construction. But, as 

Mr. Biro referenced, if you could share things such as laboratory 

equipment, which you can run 24/7, and not have duplications running 8 hours a piece but rather have a common piece of equipment 

running 16 hours and you bring the DOD in on that, then you start 

to get enormous savings in the actual operations of it. 

Now, as I have said before, the really remarkable thing about 

this is that everybody wins. And if we can identify those proper 

areas, and that is what we are discussing, for these types of savings, these savings will accrue to all of us and to our constituents 

for a very long period of time and we have high expectations that 

this will happen. 

Mr. BEAUPREZ. Mr. Biro, what happens to the old hospital, the 

one at some point here in the future you are going to be vacating? 

Mr. BIRO. I am waiting for guidance from central office and Mr. 

Principi on a process that will look at that property. I believe they 

are going to use a consultant to look at the property for its highest 

and best use that will benefit veterans. That is what we are looking at is some use of that property to benefit veterans. Obviously, 

that can go two ways. One, some sort of service remains there or, 

two, as the topic of this meeting or this hearing is that this money 

from the sale that could be used to subsidize the new facility. 

Mr. BEAUPREZ. And I will use that as a bit of a segue to Mr. 

Samic and Mr. Nau. I don’t know that this facility necessarily has 

great historical significance but, as we think about, and that is a 

personal passion of mine, I in a past life renovated some old buildings and used them for modern use and I am fairly proud of that 

actually. I am thinking that one of the challenges of any legislation 

we put forward back here to accommodate the end that both of you 

seem to be seeking, and of which I would have some sympathy for, 

would be to do what we don’t do very well at the federal level and 

that is build maximum flexibility into that kind of legislation, multiple options. 

Am I thinking correctly? You referenced Mr. Turner’s bill, H.R. 

1762, I will confess to not being intimately familiar with it just yet, 

but does it contain that kind of flexibility? 
39

Mr. NAU. Yes, Mr. Chairman, it does. It certainly encourages 

partnerships for adaptive re-use of these facilities. There are examples all over the country. There is an example of the National Trust 

for Historic Preservation partnership with the Army as a result of 

some of the BRAC deactivations over the past 20 years. Congressman Turner’s bill probably does as good a job as I have seen in encouraging those kind of partnerships and brings in the private sector. The private sector is where the capital investment needs to be. 

What VA needs to do is simply maintain the facility so that an 

investor, be it a 501(c)(3), a for-profit institution or anyone else, 

doesn’t have to go in and look at a damaged building. And our experience at the Advisory Council, and we worked with the CARES 

Committee, they actually came in, made a presentation to a formal 

Council meeting of ours in 2003. We have had particular focus on 

this activity because of the 1,900 historic facilities that are involved 

in this. 

So we are familiar with it, and I believe that Congressman Turner’s bill definitely points in the right direction on how to use these 

facilities so that the communities in which they exist have the economic development opportunities. Otherwise they become a bit of 

a problem and they go from an asset to a liability. 

Mr. BEAUPREZ. General Samic, anything to add to that? 

Mr. SAMIC. Yes, sir, let me say first thank you for being the first 

we heard today speak about historic preservation. 

Mr. BEAUPREZ. I am getting older. It is very important. 

Mr. SAMIC. And as well when you hear the testimony for disabled 

American vets and the paralyzed vets, as well as Secretary 

Principi, all of them speak of this in a positive term, speak first to 

the flexibility issue. It is important. You have got priorities established inside the law, the proposed law as it is written now and 

that is fine. If in fact you intend to have some preservation funded 

from this piece of legislation, our recommendation is that you establish some kind of floor. It may be not a large number but it is 

significant in the fact that it is there. And I think what we are 

really looking for here is seed corn, to be honest with you. There 

will not be enough money to do both of these things. You heard 

Secretary Principi say he doubts this year he is going to be addressing Category 8 with the funds he has got let alone preservation. 

But when we go address people at the standard register, Nexus/

Lexus, whoever we are talking to in the Dayton area, these are 

businesspeople who have got stockholders who are looking for a 

business case. Preservation goes so far, patriotism goes so far but 

a business case has got to be made. We are trying to get something 

in our particular case which will be the western underpinning of 

a historic corridor that already starts now with the Houghman 

Prairie where the Wright brothers flew through the Air Force Museum, downtown to the Wright Dunbar district out to the western 

side of town. It fits in the image and the vision that the city has 

got if we can just get the seed corn going. I think that is what we 

would love to see this legislation provide is that seed corn. 

Mr. BEAUPREZ. Thank you. Any further questions, Mr. Moran? 

Mr. MORAN. No, sir. 
40

Mr. BEAUPREZ. Well, if not, then I will dismiss this panel. It has 

been an exceptional panel, and I thank all four of you gentlemen 

for your contribution. 

I call in place our third panel, which consists of representatives 

from our renowned veteran service organizations. The subcommittee welcomes Mr. Richard Jones, national legislative director of AMVETS; Mr. Peter Gaytan, principal deputy director of The 

American Legion; Mr. Rick Weidman, director of government relations for the Vietnam Veterans of America; Ms. Joy Ilem, assistant 

national legislative director of the Disabled American Veterans; 

and Mr. Richard Fuller, national legislative director of the Paralyzed Veterans of America. The Veterans of Foreign Wars will be 

submitted testimony for the record. And I hope I have not butchered your names too badly. 

STATEMENTS OF RICHARD JONES, NATIONAL LEGISLATIVE 

DIRECTOR, AMVETS; JOY J. ILEM, ASSISTANT NATIONAL 

LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; 

RICHARD B. FULLER, NATIONAL LEGISLATIVE DIRECTOR, 

PARALYZED VETERANS OF AMERICA; PETER S. GAYTAN, 

PRINCIPAL DEPUTY DIRECTOR, THE AMERICAN LEGION; 

AND RICK WEIDMAN, DIRECTOR, GOVERNMENT RELATIONS, 

VIETNAM VETERANS OF AMERICA 

STATEMENT OF RICHARD JONES 

Mr. JONES. Thank you, Mr. Chairman. 

Mr. BEAUPREZ. I got Mr. Jones okay, I suppose. 

Mr. JONES. I am sorry, sir? 

Mr. BEAUPREZ. I suppose I pronounced your name correctly? 

Mr. JONES. Jones is correct, sir. We were all named Jones until 

we fell from grace. That is what I am told. 

Mr. BEAUPREZ. Well said, and it is good to see you again, sir. Go 

ahead and proceed. 

Mr. JONES. With some exceptions, Mr. Chairman. 

Mr. BEAUPREZ. You must not have talked to my mother. She 

would correct you on that one. 

Mr. JONES. It is a pleasure to present our views on this draft legislation to authorize capital leases and address related matters. 

AMVETS supports the numerous leases authorized for contract in 

the draft bill. These facilities will help maintain VA congressionally-mandated missions of sustaining health care delivery for 

American veterans, both regionally and demographically. We have 

learned important lessons over the years, that the establishment of 

health care clinics helps pave the way toward a comprehensive solution to veterans’ health care needs and strengthening clinical 

services, as this draft legislation would, should help continue VA’s 

efforts to attain the quality health care programs that will significantly affect veterans’ care. 

We trust, of course, that Congress and VA will also work together to provide a health care system, a dynamic health care system that meets the specialized needs of veterans as well. 

The draft bill also contains language to establish a Department 

of Veterans Affairs’ capital asset fund to receive proceeds from a 

disposal of VA real property by sale, transfer or exchange. Proceeds 
41

retained within the fund would be used for the cost of actual or 

planned disposals of real estate, including demolition, environmental clean up, necessary improvements, transfers and exchanges, and administrative expenses. And the fund would be 

available for use to improve non-recurring VA capital projects. 

Finally, the draft language terminates the nursing home revolving fund to transfer remaining funds to the capital asset fund and 

authorizes to be appropriated to the fund $10 million. 

AMVETS supports these provisions because they would facilitate 

VA’s completion of transfers and disposals and the provisions provide an orderly process of notice, public hearings, receipt of fair 

market value for disposals and transfers while at the same time 

providing a funding mechanism for improving current facilities. 

AMVETS is of course pleased to see the proposal contains language to use funds for the purpose of maintaining and preserving 

historic properties. As a co-author of independent budget along 

with DAV, PVA, and VFW, we of course encourage VA to work 

with nonprofits and other groups interested in protecting VA’s portfolio of historic properties. There is a need for these partnerships. 

VA certainly cannot do it alone. 

Mr. Chairman, we applaud your holding the hearing. We thank 

the subcommittee for extending us the opportunity to present our 

views. And we look forward to working with you and others to 

strengthen, enhance and improve the earned benefits for our nation’s veterans and their families. 

Thank you, sir. 

[The prepared statement of Mr. Jones appears on p. 117.] 

Mr. BEAUPREZ. Have I got that close to right? 

Ms. Ilem. Thank you. 

Ms. ILEM. Ilem. 

Mr. BEAUPREZ. Ilem, okay, thank you. I am sorry. 

STATEMENT OF JOY J. ILEM 

Ms. ILEM. Mr. Chairman and members of the subcommittee, 

thank you for the opportunity to present the views of the Disabled 

Veteran Americans on proposed legislation concerning property 

management at Department of Veterans Affairs facilities. Like 

many DAV members who have suffered catastrophic disabilities as 

a result of military service, many of the men and women serving 

today in our Armed Forces in Iraq, Afghanistan, and other trouble 

spots around the world will need and depend on the VA health care 

system for years to come. For this reason, preservation of the integrity of the VA health care system and its specialized programs are 

of the utmost importance to the DAV. 

Addressing the infrastructure, renovation, and modernization 

needs, building safety concerns, and veterans’ access issues requires innovative ideas and appropriate management of VA facilities. The implementation phase of CARES is critical to resolving 

these matters. Therefore, we are pleased to support many of the 

provisions contained in the draft legislation considered today. 

Currently the time-consuming process to implement VA’s authority for enhanced use to lease property dissuades many interested 

parties from entering into such an agreement and VA officials from 

considering this option as a potential investment opportunity. The 
42

Department of Veterans Affairs Real Property and Facilities Management Improvement Act of 2004 seeks to improve VA’s authority 

to manage the sale or lease of its physical structures. This proposed measure would eliminate the nursing home revolving fund, 

establish a capital assets fund. DAV fully supports this provision 

that would allow funds derived from the lease or sale of VA property to be reinvested for the improvement of other VA facilities. 

However, we want to ensure any funds received from the sale of 

property are used only for the intended purpose. Specifically, VA 

infrastructure reinvestment. 

One major concern we have is that the Office of Management 

and Budget and the congressional Budget and Appropriations Committees will propose that the funds received from the sale of VA 

properties be offset in the annual appropriation VA receives. For 

CARES to be successful, VA must be able to retain any funds from 

the sale of properties to pay for necessary infrastructure improvements. Likewise, VA should continue to receive funds from major 

and minor construction as well as spending for non-recurring maintenance to compensate for the years of neglect of VA infrastructure 

needs. 

DAV also supports the provisions contained in the proposed 

measure concerning the establishment of new community-based 

outpatient clinics. In many locations, CBOCs will improve access to 

health care services for veterans and lead to an overall enhancement of services. 

We thank the subcommittee for including in the proposed legislation provisions that would allow capital asset funds to be used for 

preservation of historic properties. This provision would help VA to 

begin address the need to stabilize, preserve and re-use its nearly 

2,000 historic buildings. Using the resources from the capital asset 

fund to renovate historic structures would also help to achieve 

these goals and make them more attractive properties for enhanced 

use lease and other adapted measures. 

We are also pleased about the inclusion of provisions that would 

require VA to provide Congress with a plan and certification every 

6 months of its compliance or non-compliance with the provisions 

relating to staffing and capacity levels for extended care services. 

This provision will clarify VA’s commitment to meeting the needs 

of veterans seeking long-term care services. 

In closing, we believe this draft legislation represents a good first 

step in addressing the very complex issue of facilities management. 

And we look forward to further discussion on this important proposed measure. 

Mr. Chairman, that concludes my statement, and I will be happy 

to answer any questions you or members of the subcommittee may 

have. 

Thank you. 

[The prepared statement of Ms. Ilem appears on p. 121.] 

Mr. BEAUPREZ. Thank you very much, Ms. Ilem. Mr. Fuller. 

STATEMENT OF RICHARD B. FULLER 

Mr. FULLER. On behalf of Paralyzed Veterans of America, we are 

pleased to testify before the subcommittee today. Mr. Chairman, 

this is a time for all of us to be very vigilant with the CARES proc-
43

ess beginning to unfold and VA, as in the case of this legislation 

seeking ways to re-order their infrastructure, we need to make certain that the commitment to veterans remains very clear. With 

CARES we need to be certain that any decision made regarding VA 

facilities is made with the present and future interests of veterans 

in mind. 

As a case in point, the CARES Commission routinely stated that 

its goal was to expand the specialized care programs in spinal cord 

injury, adding more centers and beds. And yet when their report 

came out, they qualified that recommendation by stipulating that 

the expansion would be based on future validation and a call for 

potential new spinal cord injury centers. This said, despite the VA’s 

own studies and projections that the expansion was fully justified 

through scientific analysis of the spinal cord injury population. 

Rightly concerned, PVA has met with Secretary Principi, who has 

agreed with us that the CARES language was wrongly written and 

would be corrected. 

The ultimate goal of the CARES process remains the enhancement of services to veterans. We should not allow any back-tracking on this point, either through the CARES process or any facility 

realignment plan. Great care must be taken to ensure that the 

value and equity in VA’s physical property is not squandered. 

With that caveat, we believe that the legislation before the subcommittee does provide the VA with improved flexibility in leasing 

unused or under used properties. Likewise, it facilitates the process 

by which VA may dispose of properties ensuring that the proceeds 

are used to the benefit of the veteran population. 

PVA strongly supports the creation of the capital assets fund, a 

provision which would allow VA to keep the equity and the income 

from property it conveys and, in the spirit of the CARES process, 

use those proceeds for the improvement of health and the benefit 

delivery of veterans. 

We have two areas of caution, however. First, VA with the proper congressional oversight must ensure that VA receives fair market value and appropriate leases for these properties. We don’t 

want fire sales going on for VA properties. And, secondly, we do not 

want to see VA major and minor construction funding or non-recurring maintenance budget line items offset by capital asset fund disbursements. Capital asset funds collection must be over and above 

the regular appropriation for these line items. 

And, finally, Mr. Chairman, we would like to actually commend 

this subcommittee for including historic preservation of VA structures as a recipient of capital asset funding. The fiscal year 2005 

Independent Budget co-authored by AMVETS, DAV and PVA and 

the Veterans of Foreign Wars makes a very direct recommendation 

on the protection and preservation of VA’s extensive inventory of 

historic structures. The Independent Budget recommended a $25 

million VA fund for fiscal year 2005 to be used to stabilize, preserve and re-use appropriate VA historic structures. Funds should 

also be provided to make grants to local and national nonprofit organizations for the preservation activities related to VA facilities. 

The CARES Commission Report also recommended that VA move 

to address this issue. 
44

And without objection, I would like to submit The Independent 

Budget historic preservation recommendations for the record, without objection. 

Mr. BEAUPREZ. So ordered. Thank you. 

[The provided material appears on p. 130.] 

Mr. FULLER. VA owns almost 2,000 historic structures, many are 

suffering from neglect and deteriorate further every year. VA has 

a moral responsibility to maintain these examples of our national 

legacy. We share in caring for the American veteran. The Department is bound by other federal statutes requiring it to care for 

these structures as well. Other federal departments and agencies 

have come to grips with this problem, finding alternative uses or 

divesting themselves of historic properties through leasing or sale. 

VA, if given the incentives, can do the same. VA must inventory 

its historic structures and establish broad classifications regarding 

their current physical condition and their potential for adaptive reuse. The capital asset fund is a logical source for renovation, funding or stabilization for enhanced use leasing and to help VA turn 

may of these structures from liabilities into assets. We strongly recommend that this legislation be amended to make historic preservation one of the optimum goals of VA’s enhanced use leasing authority. 

In closing, Mr. Chairman, I would just like to say that we have 

been working on this historic preservation issue for as many years 

as I can remember and dealing with the VA on this issue has been, 

to put it nicely, a challenge. I think that the leadership of this subcommittee can demonstrate, particularly with the CARES process 

unfolding, that there are ways to deal with these properties providing great opportunities and not problems for the Department. 

We need to fine-tune this legislation very carefully to see that that 

incentive is provided. 

That concludes my testimony. 

[The prepared statement of Mr. Fuller appears on p. 124.] 

Mr. BEAUPREZ. Thank you very much, Mr. Fuller. Mr. Weidman. 

STATEMENT OF RICK WEIDMAN 

Mr. WEIDMAN. Mr. Chairman, on behalf of Vietnam Veterans of 

America, I want to thank you for the opportunity to appear here 

today and salute the leadership of this committee yet once again. 

We support this draft legislation with a few refinements, but do 

think we need to comment about the process that produced this 

particular list of 17 properties for enhanced use. 

VVA is deeply committed to the concept of stewardship and stewardship in the Biblical sense that you leave both the physical structure as well as the organizational capacity better than when you 

found it. Our first national president was one of the veterans featured in the famous 1970 Life Magazine issue on the Bronx VA. It 

was that story that led to the momentum of the demolition of the 

old VA and construction of the fine, modern facility we have today 

in Bronx, New York. 

The concept of CARES is something we fully endorse but the 

problem is that the devil is in the details. The old country saying 

is, ‘‘You can make a silk purse out of sow’s ear but only if you start 

with a silk sow.’’ And that is the problem that lies therein when 
45

it comes to the CARES process. There was no proper needs assessment prior to the beginning of the CARES process. In other words, 

they took what was after 7 years of devastating cuts, particularly 

in the specialized services and most particularly in mental health, 

and used that as a snapshot figure on which everything else was 

based. That is number one. 

Number two, then they applied a civilian formula that was designed for healthy people, middle-class people who could afford a 

PPO or a HMO produced by Millman Associates. It did not take 

into account any of the specialized services, any of the wounds of 

war, from spinal cord injury to PTSD to general mental health to 

prosthetics to you name it. And so then it produced the original 

draft product that was supposed to be the basis for the building of 

the plans at the VISN levels. At least 11 VISNs had no consultation whatsoever with the veterans community in their VISN prior 

to submitting their particular segment of the plan to the national 

office. At least five or six additional ones it was basically a dog and 

pony show. They all assured the under secretary for health that 

they in fact had done it, but they did, as Daisy said in The Sun 

Also Rises, they did a, ‘‘Let’s not and say we did.’’ So the problem 

is it was flawed from the outset because there wasn’t a proper 

needs assessment of what really was the need out there. 

And, number two, what does that mean in terms of projections 

based on this being a veterans health care system as opposed to 

a general health care system that happens to be for veterans. And 

that led to many, many errors in the conclusions of the draft plan, 

which was then given to the Honorable Everett Alvarez and his 

distinguished colleagues. We have tremendous faith in Everett Alvarez. Frankly, personally, I believe he is one of the true American 

heroes, not just for what endured and went through in military 

service but for how he has spent his life since he returned to the 

United States. They did a great job of correcting many of the most 

egregious mistakes of the draft plan. The Secretary, as he accepted 

it, made more adjustments and knocked off more of the errors. 

The problem that we have here however is the plan did not take 

into account long-term care and it did not take into account neuropsychiatry or the mental health needs of veterans. It is no accident 

that eight of the facilities that were targeted for closure were primarily mental health facilities, even ostensibly though mental 

health wasn’t in the plan. So we have need for a fundamental overhaul of that plan for the future before it becomes the basis for strategic planning documents in the future. 

I would point out of all of the things that Secretary, and incidentally we strongly support this Secretary, we think he is doing a fabulous job with limited resources as is his deputy. The problem 

there is sometimes he doesn’t always get the straight scoop. None 

of those boards and those committees that were listed in the official 

testimony from the VA have any representation from the veteran 

service organizations whatsoever. 

It is not that we are trying to tell people how to do their job but 

we can often shed perspective and light that help the VA from 

going wrong, whether it be from the mental health strategic plan 

or the overall long-term strategic planning group. And there has 

been no informing of the veterans groups about the status or what 
46

is going into those plans at this particular point. This kind of paternalistic behavior of not consulting with the veterans’ community 

nor with the local community nor with the Congress is what has 

gotten us into such difficulty in the past. 

I would note that, because I see I am running out of time, sir, 

that when it comes to the capital asset plan we very much agree 

with that concept and applaud you for approving it. We would offer 

a caveat however. When you take the nursing home care asset fund 

and lump that together with an overall care asset fund, nursing 

home care and the development of long-term care for veterans as 

provided for in the Millennium bill may well get totally glossed 

over and none of the proper investment happen in that area, number one. 

And, number two, we would also suggest to you that instead of 

authorizing $10 million to start this fund, you should be thinking 

in much larger terms. We believe that a billion dollars a year over 

the next—for the rest of this decade is not near enough. That is 

just for the next 4 to 5 years in order to adequately begin to make 

up for poor stewardship of so many years and will take at least $10 

billion. 

So in regard to historic preservation, we commend you for including that in the bill and believe that had many of the facilities that 

we currently have today been kept up and designed for re-use, they 

in fact would be in much better shape today and we wouldn’t have 

to use them as excess property, if you will. 

Mr. Chairman, that concludes my oral remarks, and I wish to 

thank you very much again for allowing VVA to appear before this 

distinguished body. 

Mr. BEAUPREZ. I thank the gentleman. I thank all members of 

the panel. For the record, Mr. Gaytan of The American Legion 

could not remain due to a conflicting meeting, but The American 

Legion’s statement will be made part of the record of this hearing, 

without objection, as if it was given. Hearing no objection, so ordered. 

[The prepared statement of Mr. Gaytan appears on p. 131.] 

Mr. BEAUPREZ. If I might a general question of all on the panel 

and, Mr. Weidman, I appreciate your very direct comments as you 

concluded your testimony about your concerns with the CARES Report. Now all VSOs it is certainly apparent to me have followed 

this CARES process very, very carefully. And on behalf of your specific organizations or other VSOs who aren’t represented today but 

obviously, I am going to say obviously, leave it to you to comment, 

that you interact with, what summary comments, if any, might you 

have to make to help us complete our understanding from the 

VSOs where you stand relative to the CARES Report from the 

point of view of the veterans you represent? 

Ms. ILEM. I would just say on behalf of DAV, we were supportive 

of the CARES process. We think it needs to get moving. We want 

to see things start to happen but we want the focus and the emphasis of course to be on the enhanced services. And we were distressed about some of the things within the CARES process, especially about the omission of long-term care and some of the mental 

health things that happened. 
47

But VA has made a commitment to try to resolve the mental 

health issue. That is ongoing and hopefully that is going to be included in their strategic plan. And the long-term care issue must 

be addressed and resolved. It is a complex issue but many veterans 

are in need of long-term care. 

So that was distressing, that is such an important piece was not 

really considered as part of this at this time just due to time constraints and wanting to get this going. But we do appreciate that 

a lot of hard work went into the Commission Report and the VSOs, 

we have all been there through this so we want to see now through 

the implementation phase. There needs to be again strong information being put out there, both to you and to us, the VSOs and other 

interested parties, about what the VA intends to do. That is where 

again we have kind of been cut off now since the report came out. 

We would like to see more interaction between the VA and the 

VSOs just to make sure what direction they are going in and do 

we agree and do we think moving in a timely manner. 

Thank you. 

Mr. BEAUPREZ. Thank you. Anyone else? Mr. Fuller? 

Mr. FULLER. Mr. Chairman, as I stated in my oral remarks, we 

have been following the CARES process very, very carefully, particularly because of the specialized services in spinal cord injury 

that the VA is world-famous for. Indeed we were very pleased that 

they saw the need and said that there were gaps in coverage for 

spinal cord injury in various different places. Denver is one of them 

where a new center is going to go. Then, all of a sudden, the report 

came out and it wasn’t really quite firm. We have that firm commitment now from the Secretary. 

But I think, as with the entire CARES plan, there is a lot of 

paper there with a lot of recommendations on that paper, with a 

lot of things that can either help people or potentially hurt people 

too. Overall, I think the aim of CARES was to help people. The 

problem is that this process is going to unfold itself over a decade, 

and is going to overtake this Administration or the next Administration, this Secretary, the next Secretary, the next Secretary, the 

next Secretary after that. And these kinds of reports have the ability to sit on a shelf some place when other priorities become a factor. 

Noting the future generations of service on this particular committee, we need to be able to pass that torch down properly. If you 

say that you are going to close something you need to build something first before you close that. Let’s make sure that you build 

that thing before you close the other, both to maintain the continuity of service but also a continuity of the promise and the 

promise in which Tony Principi has constantly stated is the objective of the CARES process, to improve services for veterans. So I 

am sorry if I sound a little cynical, but I am. 

Mr. BEAUPREZ. I am going to guess the voice of experience, perhaps. Mr. Weidman? 

Mr. WEIDMAN. Yes, sir, Mr. Chairman, a bit of history on the 

CARES process. After the VISN–12 fiasco and we were brought in 

at the last minute to meet with the contractor who has been—was 

different than they had later, what was the first contractor they 

had? 
48

Mr. FULLER. Oh, I don’t know. 

Mr. WEIDMAN. Anyway, we brought up the issue of specialized 

services and taking of military history in that this is a veterans’ health care system. And we were informed at that point that it was 

too late to bring this up and don’t get upset at the consultants. To 

which I replied to an assistant secretary over there, ‘‘We are not 

upset with the consultant. We pay you in six figures a year. Where 

the heck have you been? Why haven’t you brought us in before and 

why haven’t you informed this individual that this is not just another general health care system? We have specialized wounds and 

diseases that you would not see and, please, God, may the civilian 

population of our great country never see the kinds of wounds and 

illnesses and conditions that America’s veterans have, particularly 

those of us who served in a combat theater of operations.’’ But we were informed by then Deputy Secretary McKay of their 

decision regarding VISN–12. Now he had worked very hard on 

comments as had all of our colleagues and not a single comma was 

changed when the final regulation for VISN–12 was changed, 

which eliminated 146 additional mental health beds on top of what 

had already been torn out. 

The point about it is this. After that -- incidentally, what he said 

to us was, ‘‘We admit the process was very flawed but we have full 

confidence in the results.’’ Now that one threw me for a bit because 

I couldn’t figure out how in the world if you know the process is 

a mess can you have full confidence in the results? And it was subsequent to that that we begin meeting the veteran service organizations at one—actually it was the PVA and we started meeting between ourselves to try and figure out how is a better way to make 

this process work. In the meantime, we had gone to, a number of 

us, to the Secretary and said, ‘‘This is not working.’’ And it was 

subsequent to that that he brought in Bob Coy and that he brought 

in a number of other folks to try and help ameliorate the process 

and brought in Fred Malvers from VISN–2 and started to try and 

get input from the veterans community. 

The problem is that the Millman people never would listen or 

even try to understand what we were talking about. And the process at every single turn we were asked for input when it was ‘‘too 

late to change it, too late to change it, too late to change it.’’ And 

the question that we continued to ask if there is not time to do it 

right the first time, exactly when do you think we are going to get 

time to do it right? 

And that is the problem that we have. The legacy that is going 

to be left for the subsequent administrations, as you pointed out, 

Mr. Chairman, is going to be that basic core process about how do 

we assess where we are, where do we need to go, and how can we 

get there, both in terms of what happens in VA facilities and what 

physical facilities do we need in order to facilitate that. 

I will begin right here with the graph that the Secretary showed 

this morning. You look at the overall veterans population and you 

will see a decline but look at the number of enrolled in that blue 

line. That blue line is not figured on who is statutorily eligible to 

use VA. That is figured on Categories One through Seven. 

If in fact you want to change who is statutorily eligible to use 

VA health care, then let’s do it above board. Let’s offer the bill to 
49

eliminate and take away the right to use VA from those above that 

certain threshold and let’s have that free and open debate. What 

is happening now is it is being done through the back door. And 

we object to that quite strenuously. And that is just one example. 

So whether it is in this legislation or in the future, Mr. Chairman, we cannot urge you too strongly to address those needs of 

stating explicitly that the Congress believes that this needs to be 

a veterans health care system, that this process needs to be thoroughly studied and the methodology shared with the Hill before we 

move toward the strategic plan, that it be done right from the outset instead of trying to re-do it later because later never comes. 

I know that was a long answer, and I thank you for your indulgence. 

Mr. BEAUPREZ. Appreciate the gentleman’s comments. 

Mr. WEIDMAN. But we think it is really important. 

Mr. BEAUPREZ. Mr. Jones, quickly, if you would. I think I have 

imposed on Mr. Moran’s time considerably already. 

Mr. JONES. Yes, sir, AMVETS has a forward view of the process. 

We recognize the stage we are in. We encourage Congress and VA 

to work together to rebuild an effective, efficient system that gives 

value to the resources that are being used to provide quality and 

timely care to American veterans. We think that what you have before you, the draft bill, helps in that process. 

Thank you, sir. 

Mr. BEAUPREZ. Thank you, Mr. Jones. Not seeing any Democrat 

members, I would ask the counsel, though, do you have any questions on behalf of your members? 

Ms. EDGERTON. Thank you, Mr. Chairman. This will be brief. I 

just want to know how you all prioritize the needs for funding the 

CARES initiative versus if we have to have choice here, how does 

it fit into medical care? That is I think what we are going to be 

having to figure out in the near future. 

Mr. JONES. The first priority should be to eliminate the backlog 

of patients, to make sure that care is given to those folks waiting 

for care. Following that, we should proceed forward as accelerated 

as we can in the CARES process, get these new systems in line. 

Mr. BEAUPREZ. I might ask if any of the other three have an answer that varies from the one just given? No? 

Mr. WEIDMAN. You can’t separate the two, sir. You can’t deliver 

quality medical care in a facility that is falling to pieces so it is 

going to have to be somewhat balanced, if you will, as we move forward because of the limited funds. But it all comes back to the 

dough to make it go, sir. 

Mr. BEAUPREZ. Thank you. Mr. Moran? 

Mr. MORAN. Mr. Chairman, thank you very much. Just a followup to the question I asked Secretary Principi, what do you see as 

a consequence to the VA from the war on terror, the soldiers now 

serving in Iraq and Afghanistan? Mr. Weidman, you talked a lot 

about mental health. So my question is really twofold, what do we 

see as far as numbers, demands upon the VA system? And then, 

secondly, what kind of care do you anticipate being required as a 

result of servicemen and women’s health care needs being met by 

the VA once they return? 
50

Mr. WEIDMAN. As the Secretary rightly pointed out, there are a 

many more catastrophic wounds, people who would have died in 

Vietnam, and I was a medic in Vietnam, who we would have lost 

are living now. And I go into Ward 57 up at Walter Reed pretty 

regularly and talk with young men and in some cases women with 

these really profound wounds and they are going to have a tough 

time. The VA in regard to some of the profound wounds is I believe 

will be there to take care of them. It is everybody else below that 

line and it is particularly those with mental health. 

The concern with mental health has been there with us from the 

outset, that you all aren’t prepared to do this correctly in all of 

health incidentally, when it comes to the environmental hazards, 

the DOD is still not requiring as a mandatory thing that all commanders have a pre-deployment physical and preservation of the 

tissue and blood sample as the law requires and to do the same 

within 3 days upon return of CONUS. And that is going to make 

it harder to track those diseases. 

But when it comes to mental health, in the Memorial Day last 

year, not this year but the year before at the White House breakfast that the President threw for the veterans’ organizations, General Myers is chairman of the Joint Chiefs of Staff and he is a life 

member of VVA and we know him because he comes to our meetings sometimes. And we were talking with him about and congratulating him on his terrific war plan that none of us would have 

bet a plugged nickel that we would take less than 200 casualties 

in the first active phase of the war. 

His comment back was that we were lucky and that he had a 

great team. And he was troubled however, that is one of the reasons why this really is the greatest country on earth, our chief military guy was deeply troubled by the civilian casualties, which were 

much more than they anticipated, and also deeply worried about 

our troops because the fire power available to our folks on the 

ground had grown so exponentially from 1991 to 2003 that the 

amount of death and destruction they would wrought as they 

moved northward was so great and the death they saw and experienced and caused was so great that he was deeply worried about 

the mental health wounds, that the PTSD wounds were going to 

be deeper and more profound and probably have greater than any 

recent conflict, certainly in the first Gulf War and possibly even 

more than Vietnam. 

And it turns out that it looks like that that is prescient, sir. The 

Army is not dealing with it very well. And, frankly, the VA, more 

than two-thirds of the organizational capacity to deal with mental 

health that existed in 1996 is gone. It is just gone. And we need 

to start reconstruction of that organizational capacity. And it won’t 

happen overnight. We are not a warm and fuzzy group to deal 

with, certainly not Vietnam vets but not even the younger people. 

And it is going to be a very tough problem and it going to result 

in physiological acute illnesses that are going to cost a heck of a 

lot of more than to have treated the PTSD properly at the beginning because we are not gearing up for it, sir. 

Mr. FULLER. I would just like to add very, very briefly, that we 

have been involved with ongoing discussions about the increased 

number in blast injuries and we are getting into traumatic brain 
51

injuries, which we are seeing as a result of these blasts in varying 

different degrees. We have been talking with White House people 

about it. I know that Senator Graham has just introduced a bill 

over in the Senate which would authorize the VA to establish blast 

injury centers of excellence in the VA to work with this problem. 

With regard to a person who is in a HMMWV and gets blown up, 

it is very obvious is what has happened with this individual. You 

can diagnose that. 

But the person in the HMMWV right behind him who wasn’t 

necessarily particularly injured but was shaken up in some way as 

well all of a sudden comes back home, is exhibiting certain odd 

signs of behavior. People say, well, it is Post-Traumatic Stress Disorder or this, that or the other thing, and they don’t really connect 

it with the actual blast injury itself. So we are working to work 

with DOD and VA to be able to coordinate the two Departments 

to address this issue. 

Ms. ILEM. I would just add one thing. You might want to speak 

to the VA’s Advisory Committee on Veterans with Serious Mental 

Illness. They have been discussing this issue. They are the frontline leaders that are out there. They have been talking about this 

issue at the last several meetings and there are real concerns about 

what they are going to be seeing and how they are going to be able 

to manage it within the VA and their ideas about coordination and 

cooperation between VA and DOD. I think you would find it very 

interesting. 

Mr. MORAN. Thank you for that suggestion, Ms. Ilem. 

Mr. JONES. The Secretary addressed several concerns during his 

testimony. One in particular is the concern about the higher rate 

of amputations due to the Kevlar protection, breast armor and the 

like, head injuries, and blindness. So these are areas where we 

need to be concerned as well. 

Mr. MORAN. I thank you all for your comments. Mr. Weidman, 

a couple of things. One, the chairman of the Joint Chiefs of Staff 

is a Kansan. I am glad to hear you compliment him. Two, I offered 

an amendment on Tuesday to the Defense Appropriations Bill to 

once again tell the Department of Defense to conduct the pre- and 

post-deployment physicals. Unfortunately, it was not allowed on a 

point of order as legislating on an appropriations bill. But I do hope 

that we have once again highlighted what Congress told DOD in 

1997 and what I believe the DOD told us they will do in testimony 

before this subcommittee over the course of several years. 

And so again, we would want to work with you and others but 

I personally am very interested in delivering this message to DOD, 

abide by the law. And every inference I can see is no one admits 

they don’t abide by the law but if you read what they say they do, 

they are passing out a questionnaire and if there are certain questions answered in a certain way, then there is additional follow-up. 

That is not a pre- and post-deployment physical as I understand 

it. It is not what I think they told me. And we will continue to beat 

the drum for that to occur. 

And, finally, I only ask permission if I can borrow your sow and 

silk story? It would be one that I wouldn’t mind using myself, it 

is a good one. I think that one works in Kansas, you are right. 

Thank you. 
52

Mr. WEIDMAN. Mr. Moran, of course, sir. My words are your 

words, sir. And it is actually a folk saying, particularly in the 

South, that is an appropriate one. 

I appreciate your efforts. I didn’t know about that. In the future, 

please call on Vietnam Veterans of America. We worked very closely with Senator James Talent on the Senate side and also Senator 

Clinton on the amendment that was accepted on the Senate side 

that got weakened somewhat by committee staff, unfortunately, 

but it is better than we had before to set up the tracking, et cetera. 

And I look forward to following up with you to make sure that it 

stays in conference, sir. 

Mr. MORAN. I would be happy to lend my efforts in that regard. 

I also point out that the gentleman from Georgia, Mr. Bishop, has 

a bill that once again tells the Department of Defense to do what 

they are told to do now 6 years ago. Thank you, Mr. Chairman. 

Mr. BEAUPREZ. I thank the gentleman and have a follow-up question for him. I have some appreciation for how the pork industry 

is in Kansas. I am a little uncertain as to how the silk industry 

is in Kansas. 

Mr. MORAN. I will leave the wit to Mr. Weidman. 

Mr. BEAUPREZ. Well, this has been I think a rather exceptional 

hearing. For the record, we have statements from Representative 

Frank LoBiondo of New Jersey, also a statement from the Heritage 

Guard Preservation Society, to be inserted in the record, and without objection, that will be so ordered. 

Mr. BEAUPREZ. One final comment. I was at least pleased, I 

think the skepticism, the concern that we all have I think is appropriate. I think as we go forward in what undoubtedly will be a 

lengthy process, it will require vigilance on the part of many future 

Members of Congress, future members of this committee, future individuals who will sit in the capacity of you all representing your 

various veteran service organizations. 

But I expect with that kind of oversight and the commitment of 

people like Secretary Principi, we will continue down the path of 

better health care for all our veterans. I was pleased to hear in his 

testimony certainly a recognition of the need for addressing the 

issues of long-term care and of mental health. I think it is perhaps 

the era of service that he comes out of as well and knowing that 

we did not do everything we should have for especially our Vietnam veterans as they came home, that this is a particularly sensitive issue, important issue, obvious issue to this Secretary. I hope 

that we do move the ball forward and we make considerable 

progress on behalf of all of our veterans. 

But I applaud you. Thank you for being with us today. And seeing no other action necessary of this subcommittee, I will declare 

this hearing adjourned. 

[Whereupon, at 12:30 p.m., the subcommittee was adjourned.] 
(53)

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