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37-533 PDF 2007

S. HRG. 110–146

SENATE-HOUSE JOINT FIELD HEARING ON ISSUES

FACING VETERANS IN THE RURAL AREAS OF

APPALACHIA

JOINT HEARING

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE

AND THE

COMMITTEE ON VETERANS’ AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

FIRST SESSION

MAY 29, 2007

Printed for the use of the Committee on Veterans’ Affairs

(

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

(II)

SENATE COMMITTEE ON VETERANS’ AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

BARACK OBAMA, Illinois 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

LARRY E. CRAIG, Idaho, Ranking Member 

ARLEN SPECTER, Pennsylvania 

RICHARD M. BURR, North Carolina 

JOHNNY ISAKSON, Georgia 

LINDSEY O. GRAHAM, South Carolina 

KAY BAILEY HUTCHISON, Texas 

JOHN ENSIGN, Nevada 

WILLIAM E. BREW, Staff Director 

LUPE WISSEL, Republican Staff Director 

HOUSE COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

CIRO RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

STEVE BUYER, Indiana, Ranking Member 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD BAKER, Louisiana 

HENRY BROWN, South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

GINNY BROWN-WAITE, Florida 

MICHAEL R. TURNER, Ohio 

BRIAN BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

MALCOM SHORTER, Staff Director 

JIM LARIVIERE, Republican Staff Director 

(III)

C O N T E N T S 

MAY 29, 2007

SENATORS 

Page 

Brown, Hon. Sherrod, U.S. Senator from Ohio ..................................................... 1

Space, Hon. Zachary, House Representative from Ohio ....................................... 3

WITNESSES 

Anderson, Frank, Government Relations Director, Buckeye Chapter, Paralyzed Veterans of America ................................................................................... 5

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

Moore, Larry D., Legislative Chairman, Department of Ohio, Veterans of 

Foreign Wars of the United States ..................................................................... 12

Prepared statement .......................................................................................... 14

Ondick, George, Executive Director, Department of Ohio, AMVETS ................. 16

Prepared statement .......................................................................................... 18

Bertschy, Robert H., Vice Commander, Department of Ohio, Disabled American Veterans ........................................................................................................ 22

Prepared statement .......................................................................................... 24

Burke, Thomas R., President, Buckeye State Council, Vietnam Veterans of 

America ................................................................................................................. 26

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

Lanthorn, Donald R., Service Director, Department of Ohio, The American 

Legion .................................................................................................................... 30

Prepared statement .......................................................................................... 32

Carson, Terry M., Chief Executive Officer, Harrison Community Hospital ....... 39

Prepared statement .......................................................................................... 41

Cross, Gerald M., M.D., FAAFP, Acting Principal Deputy Under Secretary 

for Health, Department of Veterans Affairs ...................................................... 42

Prepared statement .......................................................................................... 44

(1)

SENATE-HOUSE JOINT FIELD HEARING ON 

ISSUES FACING VETERANS IN THE RURAL 

AREAS OF APPALACHIA 

TUESDAY, MAY 29, 2007

U.S. CONGRESS, 

JOINT COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC. 

The Committees met, pursuant to notice, at 10 a.m., in Founders 

Hall Auditorium, Kent State University-Tuscarawas, 330 University Drive, NE., New Philadelphia, Ohio, Hon. Sherrod Brown 

(Member of the Senate Committee on Veterans’ Affairs) and 

Zachary Space (Member of the House Committee on Veterans’ Affairs) presiding. 

Present: Senator Brown and Representative Space. 

OPENING STATEMENT OF HON. SHERROD BROWN,

U.S. SENATOR FROM OHIO 

Senator BROWN. I’m Senator Sherrod Brown, joining with Congressman Zach Space, many representatives of the veterans community, and others here this morning, and I so appreciate your all 

being here. 

I would begin the day first by asking for a moment of silence for 

the 3,400 Americans who have died in the Iraq-Afghanistan, and 

the literally tens of thousands of Americans who have been injured, 

if we can start with a moment of silence. Thank you. I especially 

thank the veterans in the audience who are here, the veterans who 

will testify, the veterans’ advocates who are with us. Every one of 

these veteran advocates have already—I believe every single one 

has been to see me in Washington. I assume many of them have 

been to see Congressman Space with his position on the Veterans’ 

Committee. We know the importance of all of that. 

I thank Gregg Andrews, the Dean of Tuscarawas Branch of Kent 

State University, thank him and his staff for allowing us to be 

here. I want to, again, especially thank those that have come from 

all over the state to testify today. 

It’s fitting, of course, that we’re holding this hearing the day 

after Memorial Day, a date to honor our Nation’s fallen men and 

women in uniform. We’re focusing on improving services for our 

Nation’s veterans, so we may honor them, as well. We have a full 

slate of issues, and a very ambitious agenda, so I’ll keep my remarks brief. 

The purpose of the field hearing is to hear from veterans in Ohio 

so that we can make better decisions in Washington that affect our 

2

Nation’s veterans. This is an official hearing. We have people from 

the Veterans’ Committee in Washington. This is the first of its 

kind. To our knowledge, it’s the first time the House and Senate 

Veterans’ Committee have ever done a joint hearing outside of 

Washington, and we chose to do it in the heartland of sort of East 

Central Ohio, so that particularly veterans facing the unique problems that veterans do in rural Ohio, and rural parts of this country 

can be heard. 

We know that the Veterans’ Administration, a public system, not 

a privatized one. We know that the VA gives the best healthcare 

in the country, and in the world, when it’s funded properly. We 

also know the President’s budget fell about $4 billion short in funding what veterans’ organizations have asked that we fund. 

The good news is that the Congress, now the House and the Senate, are working under a recently passed budget that very closely 

mirrors the request of the Independent Budget. The Independent 

Budget was put together by all the veterans service organizations 

consulting with each other, and consulting with the VA. And we 

have very closely followed the requests of that budget. 

While not everyone in this auditorium, of course, agrees on the 

Wars in Iraq and Afghanistan, we all agree we need to do everything we can to care and provide for our veterans, not just this 

year or next year, but in the decades ahead, because we know the 

immense costs. We’re spending some $2.1 billion a week on the 

War in Iraq. Some estimates have shown that veterans’ healthcare, 

because of the War in Iraq, will cost us upwards of $600 billion in 

the years ahead. We need to prepare for that now. It’s not this 

year, next year. It’s not even this decade, next decade only. It is 

costs that we need to be responsible for as elected officials, as veterans’ advocates, as citizens, and as veterans, we need to prepare 

for, perhaps, as long as 50 years. 

Ohio is home, as we know, to more than one million veterans. 

These proud men and women and their families have sacrificed, as 

we know, to serve our Nation. There are Ohioans in this room who 

helped to defeat tyranny in World War II. There are veterans in 

this room who served in the conflicts of the cold war, enabling the 

United States to eventually defeat totalitarianism, and we have a 

new group of veterans, obviously, from the post-cold war era, from 

Bosnia, from Afghanistan, and from two conflicts in Iraq and

Kuwait. 

Some of Ohio’s veterans include Presidents Grant and Harrison, 

and Hayes and Garfield, and McKinley. Others, like John Glenn 

and Neil Armstrong, and Clark Gable, and General Sherman, and 

General Sheridan. Ohio is proud of our veterans who were our soldiers in combat today, proud of our veterans who are still living, 

proud of our veterans who are no longer with us, who served this 

country. I look forward to hearing the testimony today. We have a 

distinguished panel of witnesses. 

Before we get started, I will run through how this will work. 

First, Congressman Space will deliver his opening remarks. Then 

we’ll proceed to hear from each witness. I will introduce three of 

the witnesses, he will introduce three. We’ll do the introduction, 

then the witnesses testify. Then Congressman Space and I will 

3

take about five minutes to ask questions, and then we’ll proceed to 

the second panel. 

I want to make a handful quickly of acknowledgments of people 

that have been helpful. I mentioned Dean Andrews, Walter Gritzan 

with Administrative and Business Services with Kent State; Carla 

Barker, who is the Assistant to Dean Andrews; Kim Lipsky, with 

the Senate on Veterans’ Affairs, thank you, Kim; Bill Cahill, also 

from Senate Veterans’ Affairs Committee who’s in the back; Chris 

Austin from House Veterans’ Affairs Committee; Jean Wilson from 

my office. From Congressman Space’s office, Ken Engstrom, Cindy 

Cunningham, Mike Calevski, Barb Lawrence, Shirley Farver; and 

from Congressman Wilson’s office, Dan Craig. Also, from my office 

are Doug Babcock, Beth Thames, Nick Watt, Laura Pechaitis, and 

I believe that takes care of everybody. 

So it’s my pleasure to, not introduce because he’s your Congressman, and in his first five months in Washington, he’s done an outstanding job of convincing us to do this, convincing the Veterans’ 

Committee in both Houses to do this first of its kind in the country 

hearing. A lot of the credit for that goes to Congressman Space, 

who has started so well, especially advocating for this region. He 

just took me into Dean Andrews office to advocate for something 

on this campus, so he doesn’t miss any opportunity to fight for his 

district. 

Congressman Space. 

STATEMENT OF HON. ZACHARY T. SPACE,

HOUSE REPRESENTATIVE FROM OHIO 

Mr. SPACE. Thank you, Senator Brown, for the introduction, and 

it is a real pleasure to be here with you today. Thank you for your 

hard work, as well as that of your staff, and the staff of the Senate 

Veterans’ Affairs Committee in organizing today’s events. I would 

simply state, rather than reiterate, just thank those same folks 

that you singled out, with the addition of Jillian Carroll, who’s behind me here on my staff in Washington, DC. 

This is a truly special occasion, and I think it’s the first of its 

kind, to my knowledge, anyway. We’ve managed to bring together 

the House and the Senate Veterans’ Affairs Committees outside of 

Washington, DC, and we’ve done that here in Ohio, and right here 

in New Philadelphia in the heart of Ohio’s 18th Congressional District. This is an indication, I believe, of the importance of the topics 

that we’re going to be discussing today. And I am, indeed, delighted 

to be back here in New Philadelphia, just a few miles from my 

hometown of Dover. 

A special thank you, again, to Kent State University for allowing 

us to use these facilities. We very much appreciate their hospitality. Specifically, I’d like to thank Dean Gregg Andrews, Walt 

Gritzan, and Carla Barker, along with the rest of the staff, and the 

Tuscarawas campus community for being so accommodating and 

giving us the run of the place. 

Kent State has a special place in my heart. This, without question, serves as one of our most precious assets here in Tuscarawas 

County. It has given many, literally thousands, of young, bright, 

aspiring students the opportunity to further their education. Some 

of those bright, aspiring students are family members of mine, and 

4

we, in my family, certainly appreciate the value that this regional 

campus brings to our community. 

It’s also my privilege to be in the company of eight distinguished 

witnesses today. I’m very much looking forward to hearing your 

testimony, gentlemen, and I look forward to engaging in a question 

and answer exchange, as well. 

I’d like to take the opportunity to recognize the members of my 

Veterans Advisory Board, many of whom are here today. I’m indebted to these men and women for their commitment in assisting 

me as I advocate for the needs of our Nation’s veterans, and I cannot think of a better way, to more specifically advocate on behalf 

of Ohio’s 18th District’s veterans than to ask some of Ohio 18 veterans where they stand. I will rely upon the Vets Advisory Board 

that we created in the coming weeks, and months, to give their informed opinions, as they’ve already begun to do. I know I will continue to ask for their input on other important issues, as well. 

Can I ask those members of the Veterans Advisory Committee 

that we’ve created to please stand, and be recognized. Thank you, 

ladies and gentlemen. Can we have a round of applause for them, 

please. 

(Applause.) 

Mr. SPACE. They have traveled here to New Philadelphia from all 

parts of the 18th District, some taking more than 3 hours to get 

here today, so they should be commended, and I’d like to thank 

them for their work on behalf of our District’s veterans. 

Finally, I’d like to thank the audience for their attendance today. 

I appreciate your interest in the issues facing rural veterans, and 

I appreciate you taking the time out of your day to join us here this 

morning. I hope we all find this event to be a useful exchange of 

information, as well as a productive forum for identifying specific 

problems that rural veterans are facing, as well as crafting solutions. My personal goal is to translate the ideas we hear today into 

legislative fixes back in Washington. 

A significant number of my constituents in Ohio’s 18th District 

are veterans, which is why I was eager to serve on this Committee. 

A large number of our veterans live in rural areas around the 

country. I repeated hear from these rural veterans about the difficulties they have in accessing VA services and care. Ohio 18 is 

lucky enough to have a VA Medical Center in Chillicothe; however, 

that VAMC is about 159 miles from where we sit today. The closest 

VAMC for folks here in New Philadelphia is the Cleveland facility, 

and that’s about 72 miles from where we sit. After that, the next 

closest facility is in Pittsburgh. And we are lucky enough to have 

a CBOC here in New Philadelphia, but, of course, those CBOCs do 

not have the same capabilities as full-fledged hospitals. 

I plan on working with the VA to expand their services here in 

the 18th District. I know that will be a long, and very difficult battle, but I think that what we’ll hear today will convince many that 

these steps are necessary to better serve our rural veterans. 

I’m also concerned that rural veterans are putting off their doctors’ visits because it is such a hassle to get to their doctors. I’m 

afraid that by skipping check-ups thought to be non-essential, veterans are suffering in the long-term by not seeking preventative 

care. Often, it’s too late when a medical emergency occurs. 

5

I know Mr. Carson can speak to the problems that non-VA hospitals face when they open their doors to veterans, too. In emergencies, our veterans need immediate care. They do not have the 

luxury of traveling over an hour to a VA facility. Our private hospitals have done their best to care for these veterans in their times 

of need, but they’ve done so without the assurance that they’ll be 

reimbursed by the VA after-the-fact. I look forward to discussing 

both this problem, and solutions to it. 

And, finally, I’m also concerned that as gas prices continue to 

shoot through the roof, it’s become increasingly more difficult for 

rural veterans who, again, drive long distances, to afford trips to 

the VA facilities. The current mileage reimbursement rate of 11 

cents per mile comes nowhere near the $3.30 plus cost of gasoline 

per gallon. I believe this must be addressed, as well. 

Again, I’d like to thank you all for coming today, and I’d like to 

turn it back over to Senator Brown to introduce our first witness 

today on our first panel. 

Senator Brown. 

Senator BROWN. Thank you, Congressman Space. Our first witness will be Frank Anderson. Frank has been an advocate for veterans as long as I can remember, comes to my office at least once 

a year. I see him in Cleveland from time to time. He grew up in 

Cleveland, joined the Armed Forces in 1976, was injured in a training exercise, I believe at Fort Jackson, South Carolina. He has advocated for paralyzed veterans ever since. He and his wife, Joanna, 

wife of 34 years, have raised five children. He’s always been there 

as an advocate, and always will be there as an advocate. We appreciate so much what he’s done for veterans, generally, and specifically for the Paralyzed Veterans of America. 

Mr. Anderson. 

STATEMENT OF FRANK ANDERSON, GOVERNMENT RELATIONS DIRECTOR, BUCKEYE CHAPTER, PARALYZED

VETERANS OF AMERICA 

Mr. ANDERSON. Thank you, Mr. Chairman. Mr. Chairman, Members of the Committee, on behalf of the Buckeye Chapter of Paralyzed Veterans of America, I’d like to thank you for the opportunity 

to testify before you today on issues facing veterans who live here 

in Ohio, and surrounding states. The challenges facing veterans 

here, particularly with regards to healthcare, are not uniquely different to many of the other areas of the country. However, if the 

VA can figure out the best ways to address them here, they can 

certainly apply those actions across the board. 

Due to the broad areas of possibilities, I will limit my comments 

to a few key areas that we believe require the greatest focus, and 

that are of the utmost importance. My comments will focus on the 

broader healthcare concern, specifically for rural veterans. I will 

also address our concerns about VA long-term care services, specifically for Operation Enduring Freedom, and Operation Iraqi Freedom veterans, as well as for veterans with spinal cord injuries or 

dysfunction. Finally, I will comment on veterans’ benefits issues, 

particularly for members of the National Guard and Reserves. 

Given the attention that these Committees are faced on the 

issues of access to healthcare for rural veterans, it is only approVerDate 0ct 09 2002 07:56 Sep 26, 2007 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 H:\RD41451\DOCS\37533.TXT SENVETS PsN: ROWENA
6

priate that this joint hearing be held in the state with many veterans who live in rural areas. PVA recognizes that there is no easy 

solution to meeting the needs of these veterans who live in rural 

areas. These veterans were not originally the target of population 

of men and women that the VA expected to treat. However, the VA 

decision to expand to an outpatient network through the

community-based outpatient clinics reflected the growing demand 

on the VA systems from veterans outside of typical urban or suburban settings. 

However, PVA remains concerned that in addressing the problems of access for these veterans, the long-term viability of the VA 

healthcare system may be threatened. 

PVA members rely on the direct services provided by the VA 

healthcare facilities, recognizing the fact that they do not always 

live close to the facilities. The services provided by the VA, particularly specialized services like spinal cord injury care, are unmatched in the private sector. If a larger pool of veterans was sent 

into the private sector for healthcare, the diversity of services and 

expertise in different fields is placed in jeopardy. 

Ultimately, PVA has a serious concern about any attempts to 

give the VA additional leverage to broaden the contracting out of 

healthcare services to veterans in geographically remote or rural 

areas. If you review the early stages of PVA’s Project HERO, it is 

apparent that is a direction that some VA senior leadership would 

like to go. PVA adamantly opposes any effort to privatize the VA 

healthcare system, turning it into an insurer of care, and not a provider of care. Privatization is ultimately a means for the Federal 

Government to shift its responsibility of caring for the men and 

women who serve. 

PVA believes that any broader contracting out of healthcare service would almost certainly lead to a diminution of established quality, safety, and continuity of VA care. It is important to know that 

VA’s specialized healthcare programs authorized by Congress, and 

designed expressly to meet the needs of combat-wounded and ill 

veterans, such as the blind rehabilitation centers, prosthetic and 

sensory aid programs, readjustment counseling, polytrauma and 

spinal cord injury centers, the centers for war-related illnesses, and 

the National Center for Post-Traumatic Stress Disorder, as well as 

several others, would be irreparably affected by the loss of serviceconnected veterans to the private sector. The VA’s medical and 

prosthetic research program, designed to study and, hopefully, 

overcome the ills of disease and injury consequent to military service, would lose focus and purpose. Additionally, Title 38, U.S. Code, 

Section 1706(b)(1), requires VA to maintain the capacity of these 

specialized Medical programs, and not let their capacity fall below 

that which existed at the time when Public Law 104–262 was

enacted. 

Furthermore, veterans who are sent out to a private sector for 

care would lose many safeguards built into the VA system, through 

its patient safety program, evidence-based medicine, electronic 

medical records, and medication verification program. These 

unique VA features culminate in the highest quality care available, 

public or private. Loss of these safeguards, that are generally not 

available in private sector systems, would equate to diminished 

7

oversight and coordination of care, and ultimately may result in 

lower quality of care for those who deserve it most. 

Current law limits VA in contracting for private healthcare services to instances in which VA facilities are incapable of providing 

necessary care to a veteran; when VA facilities are geographically 

inaccessible to a veteran for necessary care; when medical emergency prevents a veteran from receiving care in a VA facility; to 

complete an episode of VA care; and for certain specialty examinations to assist VA in adjudicating disability claims. The VA could 

better meet the demands of rural veterans through more judicious 

application of its fee-for-service program. 

We also believe that the VA could address the needs of rural veteran through broad applications of the ‘‘hub-and-spoke’’ principle. 

A veteran can get his or her basic care at a community-based outpatient clinic (CBOC). However, if the veteran requires more intensive care, or a special procedure, he or she can be referred to a 

larger VA medical center. This would ensure the veteran continues 

to get the best quality care provided by the VA, thereby maintaining the viability of the system. 

Finally, we realize that it is an extremely difficult task to establish a standard for when a veteran’s home is considered to be rural. 

Attempts to define ‘‘geographically inaccessible’’ have proven to be 

a very subjective effort. Access to VA healthcare is subject not only 

to population density or distance, but time, as well. 

PVA believes that one possible way to address the concerns of 

rural veterans is to correct the mileage reimbursement inequity 

that currently exists. It is wholly unacceptable that veterans have 

to live with the 11 cents per mile reimbursement rate that the VA 

currently provides, when all federal employees receive 48 cents per 

mile. In fact, PVA believes that some of the difficulty in providing 

care to veterans in limited access areas, particularly rural areas, 

might be eliminated with a sensible reimbursement rate. 

We believe that veterans will be less likely to complain about access issues as a result of their geographic location if they know that 

they would not have to put the majority of the travel expense out 

of their own pocket. This is a change that has been long overdue, 

and we urge the Committee and all of Congress to take immediate 

action to correct this inequity. 

In the end, we believe that in order for the VA to best meet this 

need, adequate funding needs to be provided for VA healthcare in 

a timely manner. As we previously stated, placing the VA in the 

position it has dealt with for many years because Congress continues to wrangle over federal budgets, does not prepare the VA to 

properly meet demand, including demand in rural areas. 

In long-term care, one of the primary concerns for PVA and its 

membership is access to long-term care services in the VA. We 

have particular concerns about long-term care options for veterans 

of the newest conflicts in Iraq and Afghanistan. PVA believes that 

the age-appropriate VA non-institutional and institutional longterm care programming for young OEF and OIF veterans must be 

a priority for veterans and their committees. New VA noninstitutional and institutional long-term care programs must come 

on line, and existing programs must be re-engineered to meet the 

various needs of a younger veterans population. 

8

VA non-institutional long-term care program must be required to 

assist the younger injured veterans with catastrophic disabilities 

who need a wide range of support services, such as personal attendant services, programs to train attendants, peer support programs, assistive technology, hospital-based home care teams that 

are trained to treat and monitor specific disabilities, and transportation services. These younger veterans need expedited access to 

VA benefits, such as VA’s Home Improvement/Structural Alteration 

Grant, and VA’s adaptive housing, and auto programs. 

Senator BROWN. Mr. Anderson, could you try to summarize your 

testimony? You’ve gone beyond the time, but if you can sort of summarize the end. 

Mr. ANDERSON. Yes, sir. 

Senator BROWN. Thank you. 

Mr. ANDERSON. We see that our veterans in rural areas do need 

access to the system and long-term care, and operation of VA so 

that they can address these needs, and our older veterans. And we 

look forward to working with the VA and its staff to make sure 

that our veterans are receiving timely and quality care. 

[The prepared statement of Mr. Anderson follows:]

PREPARED STATEMENT OF FRANK ANDERSON, GOVERNMENT RELATIONS DIRECTOR, BUCKEYE CHAPTER, PARALYZED VETERANS OF AMERICA

Mr. Chairman and Members of the Committees, on behalf of the Buckeye Chapter 

of Paralyzed Veterans of America (PVA) I would like to thank you for the opportunity to testify before you today on the issues facing veterans who live here in Ohio 

and surrounding states. The challenges facing veterans here, particularly with regards to health care, are not uniquely different to many other areas of the country. 

However, if the VA can figure out the best way to address them here, they can certainly apply those actions across the board. 

Due to the broad array of possibilities, I will limit my comments to a few key 

areas that we believe require the greatest focus and that are of the utmost importance. My comments will focus on broader health care concerns, specifically for rural 

veterans. I will also address our concerns about VA long-term care services, specifically for Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) 

veterans as well as for veterans with spinal cord injury or dysfunction. Finally, I 

will comment on veterans’ benefits issues, particularly for members of the National 

Guard and Reserves. 

RURAL HEALTH CARE

Given the attention that these Committees have placed on the issue of access to 

health care for rural veterans, it is only appropriate that this joint hearing be held 

in a state with many veterans who live in rural areas. PVA recognizes that there 

is no easy solution to meeting the needs of veterans who live in rural areas. These 

veterans were not originally the target population of men and women that the VA 

expected to treat. However, the VA decision to expand to an outpatient network 

through the community-based outpatient clinics reflected the growing demand on 

the VA system from veterans outside of typical urban or suburban settings. 

However, PVA remains concerned that in addressing the problem of access for 

these veterans, the long-term viability of the VA health care system may be threatened. PVA members rely on the direct services provided by VA health care facilities 

recognizing the fact that they do not always live close to the facility. The services 

provided by VA, particularly specialized services like spinal cord injury care, are unmatched in the private sector. If a larger pool of veterans is sent into the private 

sector for health care, the diversity of services and expertise in different fields is 

placed in jeopardy. 

Ultimately, PVA has serious concerns about any attempt to give the VA additional 

leverage to broaden contracting out of health care services to veterans in geographically remote or rural areas. If you review the early stages of VA’s Project HERO, 

it is apparent that this is a direction that some VA senior leadership would like to 

go. PVA adamantly opposes any effort to privatize the VA health care system, turning it into an insurer of care and not a provider of care. Privatization is ultimately 

9

a means for the Federal Government to shift its responsibility of caring for the men 

and women who served. 

PVA believes that any broader contracting out of health care services would almost certainly lead to a diminution of established quality, safety and continuity of 

VA care. It is important to note that VA’s specialized health care programs, authorized by Congress and designed expressly to meet the needs of combat-wounded and 

ill veterans, such as the blind rehabilitation centers, prosthetic and sensory aid programs, readjustment counseling, polytrauma and spinal cord injury centers, the centers for war-related illnesses, and the national center for post-traumatic stress disorder, as well as several others, would be irreparably affected by the loss of serviceconnected veterans to the private sector. The VA’s medical and prosthetic research 

program, designed to study and hopefully overcome the ills of disease and injury 

consequent to military service, would lose focus and purpose. Additionally, Title 38, 

United States Code, section 1706(b)(1) requires VA to maintain the capacity of these 

specialized medical programs, and not let their capacity fall below that which existed at the time when Public Law 104–262 was enacted. 

Furthermore, veterans who are sent out to the private sector for care would lose 

the many safeguards built into the VA system through its patient safety program, 

evidence-based medicine, electronic medical records and medication verification program. These unique VA features culminate in the highest quality care available, 

public or private. Loss of these safeguards, that are generally not available in private sector systems, would equate to diminished oversight and coordination of care, 

and ultimately may result in lower quality of care for those who deserve it most. 

Current law limits VA in contracting for private health care services to instances 

in which VA facilities are incapable of providing necessary care to a veteran; when 

VA facilities are geographically inaccessible to a veteran for necessary care; when 

medical emergency prevents a veteran from receiving care in a VA facility; to complete an episode of VA care; and, for certain specialty examinations to assist VA in 

adjudicating disability claims. The VA could better meet the demands of rural veterans through more judicious application of its fee-for-service program. 

We also believe that the VA could address the needs of rural veterans through 

broad application of the ‘‘hub-and-spoke’’ principle. A veteran can get his or her 

basic care at a community-based outpatient clinic (CBOC). However, if the veteran 

requires more intensive care or a special procedure, he or she can then be referred 

to a larger VA medical center. This would ensure that the veteran continues to get 

the best quality care provided directly by the VA, thereby maintaining the viability 

of the system. 

Finally, we realize that it is an extremely difficult task to establish a standard 

for when a veteran’s home is considered to be rural. Attempts to define ‘‘geographically inaccessible’’ have proven to be a very subjective effort. Access to VA health 

care is subject not only to population density or distance, but time as well. 

PVA believes that one possible way to address the concerns of rural veterans is 

to correct the mileage reimbursement inequity that currently exists. It is wholly unacceptable that veterans have to live with the 11 cents per mile reimbursement rate 

that the VA currently provides when all Federal employees receive 48 cents per 

mile. In fact, PVA believes that some of the difficulty in providing care to veterans 

in limited access areas, particularly rural areas, might be eliminated with a sensible 

reimbursement rate. We believe that veterans would be less likely to complain about 

access issues as a result of their geographic location if they know that they will not 

have to foot the majority of the travel expense out of their own pocket. This is a 

change that has been long overdue, and we urge the Committees and all of Congress 

to take immediate action to correct this inequity. 

In the end, we believe that in order for the VA to best meet this demand, adequate funding needs to be provided for VA health care in a timely manner. As we 

previously stated, placing the VA in the position it has dealt with for many years 

because Congress continues to wrangle over Federal budgets, does not prepare the 

VA to properly meet demand, including demand in rural areas. 

LONG TERM CARE

One of the primary concerns for PVA and its membership is access to long-term 

care services in the VA. We have particular concerns about the long-term care options for veterans of the newest conflicts in Iraq and Afghanistan. PVA believes that 

age-appropriate VA non-institutional and institutional long-term care programming 

for young OEF/OIF veterans must be a priority for VA and these Committees. New 

VA non-institutional and institutional long-term care programs must come on line 

and existing programs must be re-engineered to meet the various needs of a younger 

veteran population. 

10

VA’s non-institutional long-term care programs will be required to assist younger 

injured veterans with catastrophic disabilities who need a wide range of support 

services such as: personal attendant services, programs to train attendants, peer 

support programs, assistive technology, hospital-based home care teams that are 

trained to treat and monitor specific disabilities, and transportation services. These 

younger veterans need expedited access to VA benefits such as VA’s Home Improvement/Structural Alteration (HISA) grant, and VA’s adaptive housing and auto programs so they can leave institutional settings and go home as soon as possible. PVA 

also believes that VA’s long-term care programs must be linked to VA’s new 

polytrauma centers so that younger veterans can receive injury specific annual medical evaluations and continued access to specialized rehabilitation, if required, following initial discharge. 

VA’s institutional nursing home care programs must change direction as well. 

Nursing home services created to meet the needs of aging veterans will not serve 

young veterans well. As pointed out in The Independent Budget for FY 2008, VA’s 

Geriatric and Extended Care staff must make every effort to create an environment 

for young veterans that recognizes they have different needs. Younger catastrophically injured veterans must be surrounded by forward-thinking administrators and 

staff that can adapt to youthful needs and interests. The entire nursing home culture must be changed for these individuals, not just modified. For example, therapy 

programs, living units, meals, recreation programs, and policy must be changed to 

accommodate young veterans entering the VA long-term care system. 

PVA is also concerned that many veterans with spinal cord injury and disease are 

not receiving the specialized long-term care they require. VA has reported that over 

900 veterans with SCI/D are receiving long-term care outside of VA’s four SCI/D 

designated long-term care facilities. However, VA cannot report where these veterans are located or if their need for specialized medical care is being coordinated 

with area VA SCI/D centers. 

Today’s VA SCI/D long-term care capacity cannot meet current or future demand 

for these specialized services. Waiting lists exist at the four designated SCI/D facilities. 

Currently, VA only operates 125 staffed long-term care (nursing home) beds for 

veterans with SCI/D. These facilities are located at: Brockton, Massachusetts (30 

beds); Castle Point, New York (15 beds); Hampton, Virginia (50 beds); and 30 beds 

at the Hines Residential Care Facility in Chicago, Illinois. Geographic accessibility 

is a major problem because none of these facilities are located west of the Mississippi River. New designated VA SCI/D long-term care facilities must be strategically located to achieve a national geographic balance to long-term care to meet the 

needs of veterans with SCI/D that do not live on the East coast of the United States. 

VA’s own Capital Asset Realignment for Enhanced Services (CARES) data for 

SCI/D long-term care reveals a looming gap in long-term care beds to meet future 

demand. VA data projects an SCI/D long-term care bed gap of 705 beds in 2012 and 

a larger bed gap of 1,358 for the year 2022. VA’s proposed CARES SCI/D long-term 

care projects would add needed capacity (100 beds) but are very slow to come on 

line. CARES proposes adding 30 SCI/D LTC beds at Tampa, Florida; 20 beds at 

Cleveland, Ohio; 20 beds at Memphis, Tennessee; and 30 beds at Long Beach, California. The CARES Tampa project is currently under construction but is not scheduled to open for another 2 years and the Cleveland project is currently in the design 

phase but remains years from completion. The Buckeye Chapter is particularly 

pleased that the Cleveland/Brecksville project is moving forward. This will prove to 

be a critical facility for meeting the long-term, specialized care needs of PVA members. Finally, the Memphis and Long Beach projects have not even entered the planning stage at this time. 

Methods for closing the VA SCI/D long-term care bed gap and resolving the geographic access service issue are part of the same problem for PVA. VA’s Construction Budget for 2008 includes plans for new 120 bed VA nursing homes to be located 

in Las Vegas, Nevada and at the new medical center campus in Denver, Colorado. 

Also, VA has announced construction planning of a new 140 bed nursing home care 

unit in Des Moines, Iowa. 

Mr. Chairman, PVA needs your support to ensure VA construction planning dedicates a percentage of beds at each new VA nursing home facility for veterans with 

SCI/D. PVA requests that Congress mandate that VA provide for a 15 percent bed 

set-aside in each new VA nursing home construction project to serve veterans with 

SCI/D and other catastrophic disabilities. These facilities will require some special 

architectural design improvements and trained staff to meet veteran need. However, 

much of the design work has already been accomplished by PVA and VA’s Facility 

Management team. This Congressional action will help reduce the SCI/D bed-gap 

and help meet the current and future demand for long-term care. While a 15 perVerDate 0ct 09 2002 07:56 Sep 26, 2007 Jkt 000000 PO 00000 Frm 00014 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\37533.TXT SENVETS PsN: ROWENA
11

cent bed allocation in new VA nursing home construction plus the proposed CARES 

LTC projects do not solve the looming bed gap problem in the short run it is a good 

first step and these additions will improve VA’s SCI/D long-term care capacity in 

the western portion of the country. 

Public Law 109–461 required VA to develop and publish a strategic plan for longterm care. PVA congratulates Congress on understanding the importance of this 

issue to ensure that America’s catastrophically disabled and aging veteran population is well cared for. During the organization of VA’s strategic long-term care 

plan PVA calls on VA and Congress to pay careful attention to the institutional and 

non-institutional long-term care needs of veterans with SCI/D and other catastrophic disabilities. We request that PVA and other veterans service organizations 

have an opportunity to provide input and assist VA as it moves forward in the development of this important document. 

In the past, and even today, many veterans with spinal cord injury or disease and 

other catastrophic disabilities were shunned from admittance to both VA and community nursing homes because of their high acuity needs. PVA believes that catastrophic disability must never be grounds to refuse admittance to VA or contract 

VA long-term care services. PL 109–461 requires VA to include data on, ‘‘the provision of care for catastrophically disabled veterans; and the geographic distribution 

of catastrophically disabled veterans.’’ This information is critical if VA’s strategic 

plan is to adequately address the needs of this population. 

VETERANS BENEFITS

PVA realizes that there is a desire to fix the problems with the claims backlog 

in the Veterans Benefits Administration (VBA) immediately. However, we must emphasize that there is no quick fix that can be implemented to fix these problems. 

The backlog has become too extensive to simply place some arbitrary requirement 

on VBA that will not address the long-term situation. 

We believe that the VA cannot continue to make changes in VBA, and specifically 

the claims process, sporadically. We believe that the only way the VA will ever get 

a handle on the claims process, the backlog, and associated problems is to pick a 

specific date to make major changes. It cannot implement change piecemeal. 

We realize that fixing the discharge and subsequent claims process is no easy 

task. However, we should not be shooting at individual targets to attempt to fix the 

overall problem. It will take innovative approaches focused on the broader system. 

In the end, we believe that many of the problems in the Veterans Benefits Administration are centered on proper training and accountability. Without uniform training across all of VBA on the standards established in regulations, problems will continue to arise and the claims backlog will continue to grow. Furthermore, it is absolutely essential that VBA personnel at all levels be held accountable for their own 

actions and the actions of their subordinates. Although we continue to advocate for 

adequate resources and additional staff, these steps will not go far enough if training and accountability are not a major component. Similarly, we recognize that veterans service organizations have a commensurate obligation to properly train and 

supervise their personnel. 

Finally, despite efforts by VA to address all of the needs and concerns of OEF/

OIF veterans, another population of these men and women still continue to receive 

lesser service than their active duty counterparts—National Guard and Reserves. 

We have testified many times in the past as to the importance of effective outreach, 

particularly for the National Guard and Reserves. It is only appropriate that National Guard and Reserve servicemembers be handled in the same way as active 

duty servicemembers. The level of service being required of these men and women 

in current operations more than justifies the need to inform them of all of the health 

care and benefits services available. 

Mr. Chairman and Members of the Committees, the Buckeye Chapter stands 

ready to assist you in any way to address the needs of veterans here in Ohio and 

across America. It is vitally important that we work together to ensure that the best 

improvements are made to benefit veterans and their families. 

Thank you again for the opportunity to testify. I would be happy to answer any 

questions that you might have.

Senator BROWN. Thank you. And understand, everyone’s written 

statement will be in the record in its entirety. These statements 

will be used as we use Committee hearings in Washington to move 

forward, as Congressman Space said, on legislative efforts. One of 

the efforts you mentioned, Mr. Anderson, on the mileage reimVerDate 0ct 09 2002 07:56 Sep 26, 2007 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\37533.TXT SENVETS PsN: ROWENA
12

bursement should have been fixed a long time ago. I am convinced 

it will be fixed in this Congress. Senator Tester, and I, and others 

from Montana have worked on legislation, and we will move forward on that, so thank you for that. 

Mr. Larry Moore is our next witness. Mr. Moore was in active 

duty as a U.S. Navy CB in Vietnam from 1968 to 1970, State Legislative Impact Chairman of the Veterans of Foreign Wars, Department of Ohio. He’s Director of the Richland County Veterans Service Commission, and he spoke a couple of days ago with my mother 

in Mansfield. 

So, Mr. Moore, nice to have you with us. Thank you. 

STATEMENT OF LARRY MOORE, STATE LEGISLATIVE

DIRECTOR, DEPARTMENT OF OHIO, VETERANS OF FOREIGN 

WARS OF THE UNITED STATES 

Mr. MOORE. Well, thank you. Thank you, ladies and gentlemen. 

Senator Brown, Representative Space, I am pleased to be here before you today representing the 139,000 men and women of the 

Veterans of Foreign Wars Department of Ohio, and our Ladies

Auxiliary. 

The first issue to be addressed today is access to the VA 

healthcare system by veterans living in rural areas. Continuing to 

expand VA community-based outreach clinics by either leasing existing space, or new construction, should be one of the priorities of 

the VA and Congress. The goal of these clinics is to bring 

healthcare to a local level for our veterans, and expanding these 

types of facilities in rural areas only makes good sense. 

The community-based outpatient clinics provide basic healthcare 

needs, with an emphasis on preventative measures to screen and 

test for such things as diabetes, heart conditions, prostate cancer, 

and mental health conditions. The clinics staff, registered nurses, 

and licensed social case workers, who provide medical and mental 

healthcare covering an average of six counties both in the clinic office, and at the veteran’s personal home. 

Studies have shown that the VA healthcare is less costly than 

that in the private sector. Expansion of these clinics would potentially save the taxpayers millions of dollars, and continue to bring 

medical treatments on a local level, rather than the past practice 

of a regional VA medical center. If a primary doctor feels a veteran 

needs to see a specialist, then he will make an appointment at one 

of the VA medical centers; however, this causes a problem for veterans living in rural areas, because these centers can be hundreds 

of miles from his home, with no public transportation available. 

This forces him to either provide his own transportation, rely on a 

family member or friend to transport him for his appointment. 

The VA does provide gas mileage reimbursement to VA medical 

facilities for appointments, but not at the present IRS rate of 48.5 

cents per mile currently allowed to any businessman, county, state, 

or federal employee. The VA allows only 11 cents per mile. Most 

veterans I work with find this to be a complete joke, and will not 

even bother filling out the paperwork for the reimbursement. Not 

only do I agree this is a complete joke, but I also feel it is a total 

insult to those who honorably served this country. 

13

I would ask Congress to investigate and find a solution that allows that reflects today’s high gasoline cost, not that of 1960. The 

majority of the veterans must make multiple trips to these regional 

VA medical centers. For example, on average, it takes three trips 

for hearing aids, dental crowns, and eyeglasses, and cancer treatments of radiation and chemotherapy can take ten trips. To someone living in an already economically depressed region, can you 

imagine the difficulty and personal expense to the veteran and his 

family? Is this what Congress meant in 1996 when legislation was 

passed, stating that all honorably discharged veterans would be eligible for VA healthcare as long as you can get there. 

The VA Health Administration has developed a program to provide more home care for patients. The program, which would allow 

practitioners to manage more patients, is called Care Coordination. 

This program would eliminate the need for frequent visits by patients to VA medical facilities. Through the Internet, telephone 

lines, and telemedicine units, such as the glucometer devices, VHA 

medical professionals will remotely observe patients with multiple 

chronic conditions, such as mental health, diabetes, congestive 

heart failure, and spinal cord injury. 

One such device, called a Telebuddy, attaches to a patient’s 

phone jack. The patient responds to questions about how he is feeling, and whether he took his medication. If there is no problem, the 

device flashes green. If the patient does not answer, the patient’s 

case manager is notified. This is an extremely useful tool to those 

VA staffers who make these house calls, especially on the mental 

health side. These units are programmed to ask targeted questions 

that could provide early warning that the veteran’s possible depression or PTSD condition may be at a level dangerous to himself, or 

his family. 

Construction of new CBOCs, community-based outreach clinics, 

cannot happen over night. And in the meantime, short-term solutions need to be addressed. Some of those short-term solutions 

presently being considered by Congress are the following. House 

Resolution 92, the Veterans Timely Access to Health Care Act. 

HOUSE RESOLUTION 315, THE HEALTHY VETS ACT;

HOUSE RESOLUTION 339

The VFW strongly supports the intent of these types of legislation. We do have some concerns, however, with the potential for 

overuse of contracting care, but there are certainly areas where its 

use is proper. Fee-basis care is more expensive than that of the VA, 

and we believe that it would do great harm to those veterans who 

elect to stay in the high-quality VA healthcare system by taking 

away funding for the system as a whole. 

HOUSE RESOLUTION 1426

The VFW strongly opposes this legislation, which would allow 

any veteran to elect to receive contracted care whenever they 

choose. Although this legislation aims to expand the coverage available to veterans, it would only dilute the quality and quantity of 

the services provided to new and existing veterans today, and in 

the future. That is unacceptable. 

14

DRAFT BILL, THE RURAL VETERANS HEALTH CARE ACT

The VFW supports this bill, which would make changes and improvements to the availability of healthcare for rural area veterans. 

With over 44 percent of the returning servicemembers living in 

rural areas, the access problem they, and all veterans, face are of 

increasing importance. This legislation acknowledges that, and we 

are happy to support it. 

Lastly, I would ask Congress to bear in mind the long-term cost 

of care for those wounded servicemembers returning from the War 

in Iraq. Head and limb injuries are signature wounds of this war, 

because Iraqi insurgents have made the IED their weapon of 

choice. Modern armor and rapid care mean that most of the injured 

survive, but many live with traumatic brain injuries and

amputations. 

I would point out the hidden danger with respect to head injuries. Between January 2003 and April of 2006, of the 692 traumatic 

brain injuries treated at Walter Reed Army Hospital, nearly 90 

percent had non-penetrating head injuries from the sheer concussion of the blast from an IED. Returning combat veterans may not 

know they suffer such a wound, and since this type of injury isn’t 

immediately apparent or visible to the naked eye, medical personnel may miss the diagnosis if the proper screening methods are 

not used. 

Coupled with TBI-type injuries, there’s Post Traumatic Stress 

Disorder, better known as PTSD. Many servicemembers have had 

multiple deployments to combat zones, and studies show there is 

a 50 percent greater chance these combat veterans may develop 

issues involving PTSD; and in most cases, these are young men 

and women with serious service-connected disabilities who will 

need expensive care for many years. 

My hope is more emphasis will be put on screening for TBI, depression, and PTSD. I do not wish to have another sobbing mother 

in my office personally blaming herself for her 20-year-old Marine 

reservist son’s suicide, who just returned from a tour in Iraq. 

The VA system may not be perfect, but when adequately funded 

in a timely manner by Congress, the ability to deliver quality 

healthcare and reduce lengthy claims waiting periods for serviceconnected disabilities could be achieved. 

Senator Brown, Representative Space, this concludes the VFW’s 

testimony, and I would be happy to answer any questions you may 

have. Thank you. 

[The prepared statement of Mr. Moore follows:]

PREPARED STATEMENT OF LARRY D. MOORE, LEGISLATIVE CHAIRMAN, DEPARTMENT

OF OHIO, VETERANS OF FOREIGN WARS OF THE UNITED STATES

Senator Brown and Representative Space: 

I am pleased to be here before you today representing the one hundred and thirtynine thousand men and women of the Veterans of Foreign Wars Department of Ohio 

and our Ladies Auxiliary. 

The first issue to be addressed today is access to the VA healthcare system by 

veterans living in rural areas. Continuing to expand VA community based outreach 

clinics by either leasing existing space or new construction should be one of the priorities of the VA and Congress. The goal of these clinics is to bring health care to 

a local level for our veterans, and expanding these types of facilities into rural areas 

only makes good sense. The Community Based Outpatient Clinics provide basic 

healthcare needs, with an emphasis on preventive measures to screen and test for 

15

such things as diabetes, heart conditions, prostate cancer, and mental health conditions. The clinics staff registered nurses and licensed social case workers, who provide medical and mental healthcare covering an average of six counties both in the 

clinic office and at the veterans personal home. Studies have shown that VA 

healthcare is less costly than in the private sector. Expansion of these clinics would 

potentially save the taxpayers millions of dollars, and continue to bring medical 

treatments on a local level rather than the past practice of a regional VA medical 

center. If the primary doctor feels the veteran needs to see a specialist, then he will 

make an appointment at one of the VA medical centers; however, this causes a problem for veterans living in rural areas, because these centers can be hundreds of 

miles from his home with no public transportation available. This forces him to either provide his own transportation or rely on a family member or a friend to transport him for his appointment. 

The VA does provide gas mileage reimbursement to VA medical facilities for appointments, but not at the present IRS rate of 48 cents per mile currently allowed 

to any businessman or county, state or Federal employee—the VA allows veterans 

only 11 cents per mile. Most veterans I work with find this to be a complete joke, 

and will not even bother filling out the paperwork for the reimbursement. Not only 

do I agree that this is a complete joke, but also I feel this is a total insult to those 

who honorably served this country. I would ask Congress to investigate, and find 

a solution to allow a gas reimbursement that reflects today’s high gasoline cost, not 

that of 1960. The majority of veterans must make multiple trips to these regional 

VA medical centers—for example on average it takes three trips for hearing aids, 

dental crowns, and eyeglasses, and cancer treatments of radiation and chemotherapy can take ten trips. To someone living in an already economically depressed 

region, can you imagine the difficulty and personal expense to the veteran and his 

family?! Is this what Congress meant in 1996 when legislation was passed, stating 

that all honorably discharged veterans were eligible for VA health care as long you 

can get there?! 

The VA Health Administration has developed a program to provide more home 

care to patients. The program, which would allow practitioners to manage more patients, is called care coordination. This program would help eliminate the need for 

frequent visits by patients to VA medical facilities. Through the Internet, telephone 

lines and telemedicine units such as glucometer devices, VHA medical professionals 

will remotely observe patients with multiple chronic conditions such as mental illness, diabetes, congestive heart failure, and spinal cord injury. One such device, 

called a Telebuddy, attaches to a patient’s phone jack. The patient responds to questions about how he is feeling and whether he took his medication. If there is no 

problem, the device flashes green. If the patient does not answer, the patient’s case 

manager is notified. This is an extremely useful tool to those VA staffers who make 

these house calls, especially on the mental health side, these units are programmed 

to ask targeted questions that could provide early warning that the veterans possible depression or PTSD condition maybe at a level dangerous to himself or his 

family. 

Construction of new CBOCs cannot happen over night, and in the meantime, 

short term solutions need to be addressed. Some of those short-term solutions presently being considered by Congress are the following: 

H.R. 92, THE VETERANS TIMELY ACCESS TO HEALTH CARE ACT; H.R. 315, THE HEALTHY VETS ACT; H.R. 339

The VFW strongly supports the intent of these types of legislation. We do have 

concerns, however, with the potential for overuse of contracting care but there are 

certainly areas where its use is proper. Fee-basis care is more expensive than that 

of the VA, and we believe that it would do great harm to those veterans who elect 

to stay in the high-quality VA health care system by taking away funding for the 

system as a whole. 

H.R. 1426

The VFW strongly opposes this legislation, which would allow any veteran to elect 

to receive contracted care whenever they choose. Although this legislation aims to 

expand the coverage available to veterans, it would only dilute the quality and 

quantity of the services provided to new and existing veterans today and into the 

future. That is unacceptable. 

DRAFT BILL, THE RURAL VETERANS HEALTH CARE ACT

The VFW supports this bill, which would make changes and improvements to the 

availability of health care for rural veterans. With over 44 percent of returning 

16

servicemembers living in rural areas, the access problems they and all veterans face 

are of increasing importance. This legislation acknowledges that, and we are happy 

to support it. 

Lastly, I would ask Congress to bear in mind the long-term cost of care for those 

wounded servicemembers returning from the War on Terror. Head and limb injuries 

are signature wounds of this war, because Iraqi insurgents have made the IED their 

weapon of choice. Modern armor and rapid care mean that most of the injured survive, but many live with traumatic brain injuries and amputations. I would point 

out the hidden danger with respect to head injuries—between January 2003 and 

April 2006, of the 692 traumatic brain injuries treated at Walter Reed Army Hospital, nearly 90 percent had non-penetrating head injuries from the sheer concussion 

of the blast from IEDs. Returning combat veterans may not know they have suffered 

such a wound, and since this type of injury isn’t immediately apparent or visible 

to the naked eye, medical personnel may miss the diagnosis if the proper screening 

methods are not used. Coupled with TBI type injuries is Post Traumatic Stress Disorder (PTSD). Many servicemembers have had multiple deployments to combat 

zones, and studies now show there is a 50 percent greater chance these combat veterans may develop issues involving PTSD; and in most cases these are young men 

and women with serious service-connected disabilities, who will need expensive care 

for many years. My hope is more emphasis will be put on screening for TBI, depression, and PTSD. I do not wish to have another sobbing mother sit in my office personally blaming herself for her twenty-year old marine reservist son’s suicide, who 

just returned from a tour in Iraq. 

The VA System may not be perfect, but when adequately funded in a timely manner by Congress, the ability to deliver quality healthcare and reduce lengthy claims 

waiting periods for service-connected disabilities could be achieved. 

Senator Brown and Representative Space, this concludes the VFW’s testimony, I 

would be happy to answer any questions you may have. 

Thank you.

Senator BROWN. Thank you very much, Mr. Moore. 

George Ondick, his wife, Monica, graduated from Avon High 

School, a community in Lorain County where I live. He is Executive Director of AMVETS Ohio, currently the Vice President of the 

Ohio Veterans’ Hall of Fame Foundation. He graduated from high 

school and entered the United States Marine Corps, was discharged in 1971. 

Mr. Ondick, glad to have you. Thank you. 

STATEMENT OF GEORGE ONDICK, EXECUTIVE DIRECTOR, 

DEPARTMENT OF OHIO, AMVETS 

Mr. ONDICK. Thank you, Senator. 

Mr. Chairman, Members of the Committee, I’m pleased to appear 

today to offer testimony on behalf of the Ohio AMVETS related to 

Department of Veterans’ Affairs remote and rural veterans’ issues. 

In a 2004 study of more than 767,000 veterans by Veterans’ Affairs researchers shows those in rural areas are in poorer health 

than their urban counterparts. The findings reported in the October American Journal of Public Health, validate the recent and ongoing VA efforts to expand healthcare for rural patients. 

‘‘We need to think about veterans who live in rural settings as 

a special population, and we need to carefully consider their needs 

when designing healthcare delivery systems,’’ said study leader 

William B. Weeks, a physician and researcher with White River 

Junction VA Medical Center and Dartmouth Medical School. Senior 

author on the study was Jonathan B. Perlin, VA Acting undersecretary for health. 

The study included 767,109 veterans who had used VA 

healthcare between 1996 and 1999. VA had then just begun setting 

up community-based outpatient clinics (CBOCs) to provide primary 

17

care closer to home for rural veterans. Today, there are nearly 700 

CBOCs in the VA’s nationwide system, and recent recommendations from the VA’s Capital Asset Realignment for Enhanced Services initiatives call for the establishment of more than 150 additional CBOCs. 

Many veterans living in remote areas have found several problems on reaching the VA Medical Centers and VA Clinics; some 

due to their inability to obtain transportation, and others due to inability to pay for their transportation. In Ohio, most county Veterans Service Commissions will provide transportation for ‘‘qualified’’ veterans. However, a disabled veteran going for VA 

healthcare, may receive from the VA a mileage allotment of 11 

cents per mile, with a $3 deductible each way. Compare that 11 

cents to a VA employee receiving 48.5 cents, which is considerably 

more for the same trip, and no deductible. Why is there a difference? The veteran has to pay the same $3.50 for fuel, as does 

the VA employee. 

Veterans’ Affairs community-based outpatient clinics were established to change from the centralized idea of admitting many veterans to a hospital for treatment, to smaller, more localized service 

on an outpatient basis. This, seemingly, is much better for the patient, the family, and the VA budget. It has worked quite well until 

the veterans’ healthcare outreach was stopped due to budget

restrictions. 

The VA Health Administration had an outreach program that 

worked quite well. The VAMCs would send a team, a doctor, nurse, 

technician, and an administrative clerk, to various remote areas to 

do routine healthcare. In southern Ohio, there were many examples; a team went to Pomeroy, 88 miles away from the Chillicothe 

VAMC, and Jackson, 45 miles away from the Chillicothe VAMC, as 

well as several other locations. In Jackson, they set up shop in a 

veterans service organization post. In Pomeroy, they used part of 

the Holzer Clinic. There were may outreach clinics in operations, 

until the budget problems in January 2003 caused their closing. 

The VA policy on establishing VA CBOCs was established so a 

veteran would not have to travel over 35 miles to obtain 

healthcare. It was changed to 40 miles. Now the strange thing is, 

in northern Ohio, there are VA clinics fairly well covering all geographic areas, and only one facility is scheduled to close, and it is 

within the 40 mile limit. 

Now, I was just reviewing the map with Mr. Montague, and the 

CBOCs are in a 30-mile radius; however, the drive time and distance is greater. The infrastructure in rural areas is not the same 

as in urban areas. 

Mr. ONDICK. I’d like to correct that, and move on. 

Those veterans who depended on outreach visits must now travel 

80 miles or more to visit a doctor to get their treatments, and then 

drive back 80 miles or so. For those needing radiation, they are further transferred to Cincinnati in a van. In Cincinnati, they are 

given their radiation treatment, which causes great nausea, then 

delivered back to their vehicle for the 80 miles or more drive home. 

What a way to say thank you for your service. 

The understandable rationale is that the VA facilities are set up 

in areas that will service the largest number of veterans, and thus, 

18

being cost-effective. This put us in our present conundrum of providing for veterans’s in remote and rural areas. These veterans 

served and sacrificed just as much as their counterparts in large 

populated areas. It is AMVETS’ position that we need the VA medical outreach re-established for those in remote and rural areas of 

Ohio, and the Nation. We owe our rural veterans this service, and 

more. 

The AMVETS is currently providing outreach to veterans in 

southern Ohio, filing claims on their behalf. With each claim we 

file, we create another access dilemma for the veterans we serve. 

Again, it is the AMVETS’ position that we need the VA medical 

outreached re-established for those veterans in remote and rural 

areas of Ohio and this Nation. I also believe the VA created an Office of Rural Health Care, it should be funded and supported. 

I would also like to take this time to reiterate the AMVETS legislative priorities for 2007, and they are as follows. I’m not going to 

go into great detail on this. I will headline those, because they’ve 

been brought to the Committee’s attention in the past, and you 

have the testimony. 

The President’s Budget Request for VA in Fiscal Year 2008 seeks 

approximately $86.7 billion for veterans’ benefits and services. This 

amounts to $39.4 billion in discretionary funding, and $44.9 billion 

in mandatory appropriations. In Fiscal Year 2008, AMVETS requests roughly $43.6 billion in discretionary funding. 

We seek mandatory funding for VA healthcare, extended enrollment for OEF and OIF veterans, seamless transition, Post Traumatic Stress Disorder, and Traumatic Brain Injury care for our veterans, VA burial allowance, and taking care of the VA claims

backlog. 

I’d like to thank you for this opportunity to testify, and if you 

have any questions regarding these priorities, or you need additional information, you can reach me at my office. I’d like to thank 

you for holding this hearing, and providing us the opportunity to 

present testimony. 

[The prepared statement of Mr. Ondick follows:]

PREPARED STATEMENT OF GEORGE ONDICK, EXECUTIVE DIRECTOR,

DEPARTMENT OF OHIO, AMVETS 

Mr. Chairman and Members of the Subcommittee: 

I am pleased to appear today to offer testimony on behalf of Ohio AMVETS related to Department of Veterans Affairs (VA) remote and rural veterans’ issues. 

In a 2004 study of more than 767,000 veterans by Veterans Affairs researchers 

shows those in rural areas are in poorer health than their urban counterparts. The 

findings, reported in the October American Journal of Public Health, validate recent 

and ongoing VA efforts to expand health care for rural patients. 

‘‘We need to think about veterans who live in rural settings as a special population, and we need to carefully consider their needs when designing healthcare delivery systems,’’ said study leader William B. Weeks, M.D., MBA, a physician and 

researcher with the White River Junction VA Medical Center and Dartmouth Medical School. Senior author on the study was Jonathan B. Perlin, M.D., Ph.D., VA’s 

acting Under Secretary for Health. 

The study included 767,109 veterans who had used VA healthcare between 1996 

and 1999. VA had then just begun setting up Community Based Outpatient Clinics 

(CBOCs) to provide primary care closer to home for rural veterans. Today there are 

nearly 700 CBOCs in VA’s nationwide system, and recent recommendations from 

VA’s Capital Asset Realignment for Enhanced Services (CARES) initiative call for 

the establishment of more than 150 additional CBOCs. 

19

Many veterans living in remote areas have found several problems on reaching 

the VA Medical Centers and VA Clinics; some, due to their inability to obtain transportation, and others due to inability to pay for their transportation. In Ohio, most 

County Veterans Service Commissions will provide transportation for ‘‘qualified’’ 

veterans. However, a disabled veteran going for VA Healthcare, may receive from 

the VA mileage of 11 cents per mile with a $3 deductible each way. Compare that 

11 cents to a VA employee receiving 48.5 cents which is considerably more for the 

same trip and no deductible. Why is there a difference? The veteran has to pay the 

same $3.50 for fuel as does the VA employee. 

Veterans Affairs Community Based Outpatient Clinics (VA CBOCs or CBOC) 

were established to change from the centralized idea of admitting many veterans 

to a hospital for treatment, to smaller, more localized service on a outpatient basis. 

This seemingly is much better for the patient, the family and the VA budget. It had 

worked quite well until the veterans’ healthcare outreach was stopped due to budget 

restrictions. 

The VA Health Administration had an outreach program that worked quite well. 

The VAMCs would send a team (a doctor, nurse, technician and admin clerk) to various remote areas to do the routine healthcare. In southern Ohio, there were many 

examples: a team went to Pomeroy, 88 miles away from the Chillicothe VAMC, and 

Jackson, 45 miles away from the Chillicothe VAMC, as well as several other locations. In Jackson, they set up shop in a VSO post. In Pomeroy, they used part of 

the Holzer Clinic. There were many ‘‘outreach clinics’’ in operation, until the budget 

problems in January 2003 caused their closing. 

The VA policy on establishing VA CBOCs was established so a veteran would not 

have to travel over 35 miles to obtain healthcare. It was changed to 40 miles. Now 

the strange thing is in northern Ohio, there are VA Clinics fairly well covering all 

geographic areas and only one facility is scheduled to close and it is within 40 miles 

of VA clinics on each side (see attached map showing VISN 10 only so the NW corner of Ohio appears uncovered). This gives us an idea of the problem. In the western 

portion, the Cincinnati area, there are plenty of VA facilities, many within 30 miles 

of one another. In remote/rural southeast Ohio, it is a different story. The CBOC 

program has been curtailed. There are VA CBOCs in Athens, Portsmouth and Marietta, which cover as much area as 20 facilities in other areas of Ohio. Those veterans who depended on outreach visits must now travel 80 or more miles to visit 

a doctor to get their treatments and then drive back 80 or so miles. For those needing radiation, they are further transferred to Cincinnati in a van. In Cincinnati, 

they are given their radiation treatment, which causes great nausea, then delivered 

back to their vehicle for the 80 miles or more drive home. What a way to say thank 

you for your service to our great Nation!!!

20

[Note: Since the map is not printed in color, the following describes the legend.]

Chillicothe VAMC = Blue 

Cambridge CBOC, Lancaster, Marietta, Athens, Portsmouth.

Cincinnati VAMC = Yellow 

Hamilton CBOC, Clermont County CBOC, Bellevue CBOC, Florence, KY 

Ft. Thomas, IN campus.

Louis Stokes Cleveland VAMC = Green 

Lorain CBOC, Painesville, Sandusky, McCafferty, Ravenna, Akron, Mansfield, 

Warren, Youngstown, Canton, East Liverpool, New Philadelphia.

Chalmers P. Wylie Outpatient Clinic = Red 

Marion CBOC, Grove City CBOC, Newark, Zanesville.

Dayton VAMC = Magenta 

Lima CBOC, Richmond IN CBOC, Sprinfield, Middletown.


37533.001
21

The understandable rationale is that VA facilities are set up in areas that will 

service the largest number of veterans and thus being cost effective. This put us in 

our present conundrum of providing for veterans in remote/rural areas. Those veterans served and sacrificed just as much as their counterparts in large populated 

areas. It is AMVETS’ position that we need the VA medical outreach reestablished 

for those in remote/rural areas of Ohio and the Nation. We owe our rural area veterans this service and more. 

The AMVETS is currently providing outreach to veterans in southern Ohio, filing 

claims on their behalf. With each claim we file, we create another access dilemma 

for the veterans we serve. Again, it is AMVETS’ position that we need the VA medical outreach reestablished for those in remote/rural areas of Ohio and the Nation. 

I also believe the VA created an Office of Rural Health Care it should be funded, 

and supported. 

I would also like to take the time to reiterate the AMVETS legislative priorities 

for 2007, they are as follows: 

THE DEPARTMENT VETERANS AFFAIRS (VA) FISCAL YEAR 2008 BUDGET

The President’s budget request for VA in Fiscal Year (FY) 2008 seeks approxi- mately $86.7 billion for veterans’ benefits and services. This amounts to $39.4 billion in discretionary funding and $44.9 billion in mandatory appropriations. In FY 

2008, AMVETS requests roughly $43.6 billion in discretionary funding. 

MANDATORY FUNDING FOR VA HEALTH CARE

In May 2001, President George W. Bush signed Executive Order 13214 creating 

the President’s Task Force to Improve Health Care Delivery for Our Nation’s Veterans (PTF). In May 2003, the PTF issued its final report and recommended that 

‘‘the Federal Government should provide full funding... and that full funding 

should occur through modifications to the current budget and appropriations process, 

by using a mandatory funding mechanism.’’ Recent history demonstrates why Congress should pass legislation to make VA health care funding mandatory spending. 

In FY 2005, VA faced a $1.3 billion shortfall in spending and Congress had to include additional funding in emergency appropriations. For FY 2007, Congress failed 

to pass the annual VA spending bill and the department is operating under a Continuing Resolution well below FY 2007 requested levels. 

EXTEND ENROLLMENT FOR OEF/OIF VETERANS

H.R. 612 and S. 383 introduced in the House of Representative and the Senate, 

respectively, would extend from 2 years to 5 years, following discharge or release 

from active duty, the eligibility period for veterans who served in combat during or 

after the Persian Gulf War. Continued eligibility would allow veterans to receive 

hospital care, medical services, or nursing home care provided by the Secretary of 

Veterans Affairs, notwithstanding a lack of evidence to conclude that their condition 

is attributable to such service. AMVETS fully supports the passage of legislation to 

extend the 2-year priority enrollment for OEF/OIF veterans. 

SEAMLESS TRANSITION

In March 2007, GAO testified that the Department of Defense (DOD) and VA 

were still having problems sharing the necessary medical records the VA needed to 

determine whether servicemembers’ medical conditions allowed participation in VA’s 

rehabilitation activities. Congress should require the two agencies to develop electronic medical records that are interoperable, bidirectional, and standards-based. 

Congress should also require DOD to conduct mandatory separation physicals for 

all separating service personnel and also utilize the Benefits Delivery at Discharge 

(BDD) joint separation exam that was developed and agreed to by both agencies. 

POST TRAUMATIC STRESS DISORDER (PTSD)

AND TRAUMATIC BRAIN INJURY (TBI)

VA operates a network of more than 190 specialized Post Traumatic Stress Disorder (PTSD) outpatient treatment programs throughout the country. Vet Centers 

are seeing a rapid increase in their enrollment. Equally important, AMVETS is concerned about the lack of awareness and screening among health care professionals 

for Traumatic Brain Injury (TBI). PTSD and TBI clinically present the same symptoms and the problem for medical personnel is trying to differentiate between PTSD 

and TBI. VA’s approach to PTSD is to promote early recognition of this condition 

and the same must be done for TBI. In addition, there is no medical diagnostic code 

specific to TBI. AMVETS is asking Congress to increase funding for PTSD and TBI, 

22

with an emphasis on developing improved screening techniques and assigning a new 

medical code specifically for TBI. 

VA BURIAL ALLOWANCE

VA reimbursement benefits were first instituted in 1973 and provided $150 in reimbursements for deaths that were not service-related. In 2001 the plot allowance 

was increased for the first time in more than 28 years, to $300. The non-serviceconnected burial allowance was last adjusted in 1978 and now also provides $300. 

AMVETS supports increasing the non-service-connected burial benefit from $300 to 

$1,270 and increasing the plot allowance from $300 to $745, an amount proportionally equal to the original benefit. In 2001, Congress increased the burial allowance 

for service-related deaths from $500 to $2,000. Prior to this adjustment, the allowance had been untouched since 1988. AMVETS recommends increasing the servicerelated burial benefit from $2,000 to $4,100, restoring the value of burial costs to 

its original proportionate level. 

VA CLAIMS BACKLOG

The VA Claims Backlog is now over 600,000 outstanding claims and it continues 

to grow at a rapid rate. VA’s estimates that over 263,000 OEF/OIF veterans will 

seek VA services and most will want to file a claim. At the end of FY 2006, ratingrelated compensation claims were pending an average of 127 days, which is 16 days 

more than at the end of FY 2003. During the same period, the inventory of ratingrelated claims grew by almost half, in part because of increased filing of claims, including those filed by veterans of the Iraq and Afghanistan conflicts. Meanwhile, appeals resolution remains a lengthy process, taking an average of 657 days in FY 

2006. Overall, a lack of quality control is central to this issue and VA must establish 

a long-term strategy focused on attaining quality and not merely achieving quotas 

in claims processing. AMVETS supports increased funding for VA to hire more Full 

Time Equivalents (FTEs) in order to address the backlog. AMVETS also supports 

the practice putting adjudication officers in VA offices aboard active duty military 

bases. 

If you have questions regarding these priorities, or you need additional information, I can be reached at (614) 431–6990 Again, thank you for holding this hearing 

and providing AMVETS the opportunity to present its views.

Senator BROWN. Mr. Ondick, thank you. And if you would like 

to correct the CBOCs part of your testimony and resubmit, that 

would be fine, if you would like to make those written changes. 

And I’d like to introduce Mr. Montague. Thank you for joining us 

from Stokes. He is the CEO of Stokes Medical Center which coordinates most of veterans’ care in the state. Thank you for joining us, 

Mr. Montague. 

Congressman Space. 

Mr. SPACE. Thanks, Senator Brown. I’d like to thank you, the 

first three witnesses. Before I introduce the remaining witnesses on 

this panel, I would ask or remind you to speak as closely to the 

mic as you can to eliminate feedback. And if you hear that sound, 

that means that you’ve surpassed the 7-minute limit, and we’d ask 

that you begin to wrap-up your testimony. 

I’d like to now present Mr. Robert Bertschy, who is a World War 

II and Korean era Navy veteran, and is also serving as Senior Vice 

Commander of the Disabled American Veterans for the Department 

of Ohio. 

Mr. Bertschy. 

STATEMENT OF ROBERT BERTSCHY, SENIOR VICE COMMANDER, DEPARTMENT OF OHIO, DISABLED AMERICAN 

VETERANS 

Mr. BERTSCHY. Thank you, sir. On behalf of more than 41,000 

members of the Disabled American Veterans and its Auxiliary in 

Ohio, I am honored to appear before you this morning to discuss 

23

the agenda and major concerns of our Nation’s wartime disabled 

veterans and their families. Herman Morton, DAV Department of 

Ohio Commander, sends his regrets that he could not attend this 

hearing due to another commitment. 

Senator Sherrod Brown and Representative Space, I want to personally congratulate you for hosting this hearing, and wanting to 

learn more about our veteran issues here in Ohio. The Disabled 

American Veterans mission is service to veterans. 

I am proud to report that our Ohio DAV Transportation Network 

has 43 DAV vans, with 130 volunteer drivers, transporting thousands of veterans to and from the VA Medical Centers and community-based outpatient clinics. There are five VA Medical Centers, 

29 CBOCs in Ohio, VA VISN 10. Louis Stokes Cleveland VA has 

two VA Medical Centers, and 12 CBOCs serving veterans. 

Louis Stokes Cleveland has 18 vans, and 40 drivers; Chillicothe 

has 15 vans and 40 drivers; Dayton has 3 vans with 10 drivers; Columbus has 4 vans with 11 drivers, and Cincinnati has 2 vans with 

10 drivers. 

DAV volunteer drivers are saving the VA thousands of dollars. 

Ohio Veterans Service Commission County Offices has paid drivers 

that also transport veterans to and from the VA Medical Centers. 

Although there have been cases where veterans living in rural 

areas encounter difficulty in obtaining transportation on a timely 

basis, this has been more of problem for such veterans getting to 

Cincinnati VA Medical Center than others. It is not felt that the 

lack of transportation is a real problem. 

We have a lot of veterans coming home from Iraq and Afghanistan. Are we prepared to help them? What good are all these medical centers and clinics, volunteer drivers and vans, if we aren’t getting the VA appropriations from Congress on a timely manner? Additional funds for hiring more doctors and nurses at the VA medical centers are needed to improve the delays in providing timely 

clinic appointments for our veterans. Many veterans will have serious injuries requiring long-term care. Amputations, traumatic 

brain injuries, vision loss, and mental health issues are only a few 

healthcare issues facing our veterans, as well as the VA in providing services. Our veterans must not be forgotten for their sacrifices made in time of war. Their sacrifices and service to our 

great Nation shall not be in vain. We need your commitment that 

Washington will not forget our veterans. Please make this commitment a top priority for their service. 

At the veterans’ joint meeting in Washington, DC, in February, 

we asked the new senators and representatives to support VA mandatory funding. The 2008 Fiscal Year Budget comes close to providing adequate funding. It does not guarantee that VA funds will 

be available, when needed, since even though it is in the budget, 

the majority of VA funds are subject to the legislative process 

throughout the fiscal year, and is subject to the ravages of other 

funding constraints. Mandatory funding will not cost more tax dollars, and would prompt timely, and proper management of the VA 

budget, and, thus, provide better, more timely care for our sick, 

wounded and disabled veterans. At the beginning of each fiscal 

year, mandatory funding will not force the VA to go into a shutdown fiscal mode until Congress figures it out. 

24

Also, we ask you to repeal the attorney fee provisions, Public 

Law 109–461. 

Ranking Member of the U.S. Senate Committee on Veterans’ Affairs, Senator Larry Craig, inserted provision in this bill to remove 

the bar against attorneys charging veterans a fee for filing a claim. 

Our DAV Service Officers are very well trained to assist veterans 

and their families in filing VA claims for benefits they have earned, 

and we do it for free. It has been this way since the Civil War. As 

the saying goes, why fix it if isn’t broke? 

The Disabled American Veterans is a non-partisan veterans service organization, but I personally feel that Senate Majority Leader 

Harry Reid should stop his negative attitude, and accusations of 

defeat in Iraq. 

At a press conference on Capitol Hill, he claimed that ‘‘this war 

is lost and the surge is not accomplishing anything.’’ He claims 

that the Iraqi War was a ‘‘failure’’. What kind of message does this 

send to our soldiers, Marine and Sailors overseas? This is having 

a negative impact on our troops that are in harm’s way. 

In effect, statements of this type by our elected leaders gives aid 

and comfort to our enemies, serving to prolong the conflict, and 

cause hardship and loss of lives of our brave soldiers. 

If you look at all of the cars with signs, ‘‘Support Our Troops’’, 

on them, and then have our politicians say we are losing the war 

is shameful. He would have us quit on our troops, even though 

they haven’t quit on us, or their mission in Iraq. 

Be assured, DAV will continue supporting our veterans, their 

families, and VA hospital programs. Again, DAV National Service 

Officers, professional staff are the very best trained who are representing thousands of veteran filing VA claims for earned benefits, 

and we do not charge for our services. 

The VA must hire more adjudicators to process veterans’ claims 

for benefits they have earned and are not receiving them in a reasonable time, especially for our World War II veterans. 

I want to thank you for all that your Veterans’ Committees in 

Washington, DC, have done for our disabled veterans, and for all 

you will do in the future. Thank you for allowing me to appear before you on behalf of the Disabled American Veterans, Department 

of Ohio. God Bless all of you, God Bless our American troops in 

harm’s way, and God Bless the USA. 

[The prepared statement of Mr. Bertschy follows:]

PREPARED STATEMENT OF ROBERT H. BERTSCHY, VICE COMMANDER,

DEPARTMENT OF OHIO, DISABLED AMERICAN VETERANS

On behalf of more than 41,000 members of the Disabled American Veterans 

(DAV) and its Auxiliary in Ohio, I am honored to appear before you this morning 

to discuss the agenda and major concerns of our Nation’s wartime disabled veterans 

and their families. Herman Morton, DAV Department of Ohio Commander, sends 

his regrets that he could not attend this hearing due to another commitment. 

Senator Sherrod Brown and Representative Zach Space, I want to personally congratulate you for hosting this hearing and wanting to learn more about our veterans 

issues here in Ohio. 

The Disabled American Veterans mission is service to veterans. 

I am proud to report that our Ohio DAV Transportation Network has 43 DAV 

vans with 130 volunteer drivers transporting thousands of veterans to and from the 

VA Medical Centers (VAMCs) and Community Based Outpatient Clinics (CBOCs). 

There are 5 VAMCs, 29 CBOCs in Ohio VA VISN 10. Louis Stokes Cleveland VA 

has 2 VAMCs, and 12 CBOCs serving veterans.

25

VAMC Volunteer 

drivers Vans 

Louis Stokes Cleveland ........................................................................................................................... 40 18

Chillicothe ............................................................................................................................................... 40 15

Dayton ..................................................................................................................................................... 10 3

Columbus ................................................................................................................................................ 11 4

Cincinnati ................................................................................................................................................ 10 2

DAV volunteer drivers are all volunteers saving the VA thousands of dollars. Ohio 

Veterans Service Commission County Offices has paid drivers that also transport 

veterans to and from the VAMCs. 

Although, there have been cases where veterans living in rural areas encounter 

difficulty in obtaining transportation on a timely basis. This has been more of a 

problem for such veterans getting to Cincinnati VAMC than others. It is not felt 

that lack of transportation is the REAL problem!! 

We have a lot of veterans coming home from Iraq and Afghanistan. Are we prepared to help them? What good are all of these medical centers and clinics, volunteer drivers and vans if we aren’t getting the VA appropriations from Congress on 

a timely manner? Additional funds for hiring more doctors and nurses at the VA 

medical facilities are needed to improve the delays in providing timely clinic appointments for our veterans. Many veterans will have serious injuries requiring 

long-term care. Amputations, traumatic brain injuries, vision loss and mental health 

issues are only a few healthcare issues facing our veterans as well as the VA in 

providing services. Our veterans must not be forgotten for the sacrifices made in 

time of war. Their sacrifices and service to our great Nation shall not be in vain. 

We need your commitment that Washington will not forget our veterans. Please 

make this commitment, a top priority, for their service.

At the Veterans’ joint meeting in Washington, DC, in February, we asked the new 

senators and representatives to support ‘‘VA mandatory funding’’. The 2008 Fiscal 

Year Budget comes close to providing adequate funding. It does not guarantee that 

VA funds will be available when needed since, even though it is in the budget, the 

majority of VA funds are subject to the legislative process throughout the fiscal year 

and is subject to the ravages of other funding constraints. ‘‘Mandatory Funding’’ will 

not cost more tax dollars and would prompt, timely and proper management of the 

VA budget and thus provide better, more timely care for our sick, wounded and disabled veterans. At the beginning of each fiscal year Mandatory funding will not 

force the VA to go into a shut-down fiscal mode until Congress figures it out. 

Also, we ask you to repeal the attorney fee provisions, Public Law 109–461. Ranking member of the U.S. Senate Committee on Veteran’ Affairs, Senator Larry Craig, 

inserted provisions in this bill to remove the bar against attorneys charging veterans a fee for filing a claim. Our DAV Service Officers are very well trained to assist veterans and their families in filing VA claims for benefits they have earned 

and we do it for free. It has been this way since the Civil War. Why fix it if it isn’t 

broke? 

The Disabled American Veterans is a nonpartisan veterans service organization, 

but I personally feel that Senate Majority Leader Harry Reid should stop his negative attitude and accusations of defeat in Iraq. At a press conference on Capitol Hill, 

he claimed that ‘‘this war is lost and the surge is not accomplishing anything.’’ He 

claims that the Iraqi War was a ‘‘failure.’’ What kind of message does this send to 

our soldiers, marines and sailors overseas? This is having a negative impact on our 

troops that are in harm’s way. In effect, statements of this type by our elected leaders gives ‘‘aid and comfort’’ to our enemies, serving to prolong the conflict and cause 

hardship and loss of lives of our brave soldiers. 

If you look at all of the cars with signs, ‘‘Support Our Troops,’’ on them and then 

have our politicians say we are losing the war is shameful. He would have us quit 

on our troops, even though they haven’t quit on us or their mission in Iraq. 

Be assured, DAV will continue supporting our veterans, their families and VA 

hospital programs. Again, DAV National Service Officers professional staff are the 

very best trained who are representing thousands of veterans filing VA claims for 

earned benefits and we do not charge for our services. 

The VA must hire more adjudicators to process veterans’ claims for benefits they 

have earned and are not receiving them in a reasonable time. Especially for our WW 

II veterans. 

Thank you for all that your veterans’ committees in Washington, DC, have done 

for our disabled veterans and for all you will do in the future. Thank you for allowVerDate 0ct 09 2002 07:56 Sep 26, 2007 Jkt 000000 PO 00000 Frm 00029 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\37533.TXT SENVETS PsN: ROWENA
26

ing me to appear before you on behalf of the Disabled American Veterans, Department of Ohio. God Bless all of you, God Bless our American troops in harm’s way 

and God Bless the USA.

Mr. SPACE. Thank you, Mr. Bertschy. I’d like to now introduce 

Mr. Tom Burke, President of the Vietnam Veterans of America, 

Buckeye State Council. I’m privileged to introduce Mr. Burke. Not 

only are you a panelist today, but you are also a constituent. I understand that you live just a few blocks from here, where we sit 

this morning. 

Good morning, and thank you for your anticipated testimony. 

STATEMENT OF TOM BURKE, PRESIDENT, BUCKEYE STATE 

COUNCIL, VIETNAM VETERANS OF AMERICA 

Mr. BURKE. Thank you. On behalf of the members and families 

of the Vietnam Veterans of America, Buckeye State Council, we bid 

you welcome. To Congressman Space we say, ‘‘Welcome Home.’’ 

We’d like to thank you all for what it is that you do for us. We wish 

to express our deep appreciation to you all for taking time out of 

your schedules to come to New Philadelphia for the purpose of 

hearing veterans concerns firsthand. 

It is my great privilege to speak to you today to present the 

thoughts and comments gathered from Vietnam Veterans of Ohio 

on issues that impact members of small town America. Funding 

you approve in the interest of Veterans Across America, certainly 

make us better than we were many years. The recent funding increase of $3.6 billion for the veterans Healthcare is certainly important and necessary. It goes without saying that sufficient funding 

for veterans must be met, or nothing happens. 

In preparing for today’s hearing, I have spoken to many veterans. Not surprisingly, the number one issue that comes up across 

the board is their concern for healthcare. More than half of the veterans who avail themselves of VA facilities here in Ohio are without medical insurance of any kind. VA hospital facilities located in 

the Cleveland, Cincinnati, Chillicothe, and Dayton, access to VA facilities in urban areas is practically unlimited because veterans can 

go to VA emergency wards for treatment of ailments. However, this 

is not the case for rural veterans. 

We have the VA clinics in smaller cities on this side of the state. 

The clinic here in New Philadelphia is said to be the fastest growing clinic in the state. This is due to the ever-increasing medical 

needs by not only older veterans, but by the new crop of veterans 

currently returning from the war zone. It is not secret that the 

media sources report that the VA is at the breaking point. 

These reports concern many veterans because they fear the VA 

will attempt to scale back their care because of limited funding, or 

because of the influx of current Iraq and Afghanistan veterans returning from the combat zone. VA clinic facilities are situated in 

Canton, Youngstown, Akron, each providing different specialties for 

the veterans. The medical help that these facilities provide through 

dedicated doctors, nurses, and staff is absolutely critical to the 

healthcare of veterans in non-urban areas. 

An issue that many veterans grimace at in Oho is this; veterans 

whose incomes are at the poverty level have little choice concerning 

healthcare. However, they are fortunate that the system does proVerDate 0ct 09 2002 07:56 Sep 26, 2007 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\37533.TXT SENVETS PsN: ROWENA
27

vide care for them. veterans turn to the VA for medical assistance 

for a variety of reasons. Reasons cited by veterans include those 

whose income or lack of service-related disability forces them into 

Category 7 and 8, but a majority of these veterans have no medical 

insurance. Others have no employer sponsored medical insurance, 

and still others are deemed uninsurable by the private sector. Most 

of these veterans can ill afford private insurance under any circumstances. Many veterans in Ohio and elsewhere are denied care 

by the current Administration as a matter of policy. Fortunately, 

some got in during the open enrollment period before the Administration closed the door. Estimates of these veterans now sitting out 

there are roughly 500,000 since 2003. Gentlemen, this closed door 

policy must be rescinded. It is time to reopen the VA health care 

system to Priority 8 veterans, who were restricted from enrolling 

since January of 2003. 

The closest VA hospital for us here in this area is Cleveland. To 

get to the Cleveland Wade Park VA hospital is approximately 200 

miles round trip, or more, at best, depending on the veteran’s location of residence. The VA current mileage scale allows veterans 

going to any facility 11 cents per mile. Gasoline currently is better 

than $3 a gallon. First of all, this computation does not compute. 

A majority of Priority 6, 7, and none of the Priority 8 veterans who 

are currently in the system get any mileage at all. The VA simply 

says ‘‘you make too much money’’. Yet, others of higher priority, regardless of their income, still receive mileage. This does not make 

sense to most veterans, nor do they believe it is fair. 

I have a check here from one veteran that lives in Carolton that 

was going to the VA facility at Canton. They held back $18 as a 

hold-back, and he went to the—if you don’t go to the facility more 

than three times a month, you don’t get the full pay. Well, the government issued him a check for mileage for 16 cents. It seems a 

little incredible that a veteran going to a VA facility gets a mileage 

check for 16 cents. The paper and the administration fees would 

cost more than that to put it out. It doesn’t make any sense to us. 

I’ve been in many conversations concerning veterans not only 

here in Ohio, but about everywhere I go concerning the backlog of 

VA claim adjudication. No one seems to know what the actual 

number is, four, five, six hundred thousand, but one thing is sure, 

it’s a big number, and must be dealt with as quickly as possible. 

Many veterans are concerned about the time that it takes to get 

a rating at all after there claims have been submitted. I am advised by our VSO people that waits of one to two years are not out 

of the question for initial claims. If one appeals a decision, add another two to five years. Gentlemen, this is simply not acceptable. 

With the new crop of veterans returning from our current war 

zone, there is a high concern among older veterans that their 

claims are getting lost in the bureaucratic log jam. We understand 

that new adjudicators are coming, but we need to be assured that 

the new kids on the block are properly trained, and held accountable for their work. 

Gentlemen, the balance of my comments are submitted for the 

record. That concludes my comments. Thank you. 

[The prepared statement of Mr. Burke follows:]

28

PREPARED STATEMENT OF THOMAS R. BURKE, PRESIDENT, BUCKEYE STATE COUNCIL, VIETNAM VETERANS OF AMERICA

To the distinguished Members of the House/Senate Veterans Affairs Committee 

who have come to the fair City of New Philadelphia, Ohio this morning. On behalf 

of the members and families of Vietnam Veterans of America, Buckeye State Council we bid you welcome. To Congressman Space we say ‘‘Welcome Home.’’ To all we 

thank you for what it is that you do for us. We wish to express our deep appreciation to you all for taking the time out of your schedules to come to New Philadelphia 

for the purpose of hearing veterans concerns firsthand. 

It is my great privilege to speak to you today to present the thoughts and comments gathered from Vietnam Veterans of Ohio on issues that impact our members 

of small town America. Rather than providing you with a laundry list, I will attempt 

this morning is to bring to you only those issues that arose in conversation time 

and again. We are aware that difficult decisions must be made by this Committee 

for the benefit of all veterans. Funding you approve in the interest of veterans 

across America, certainly make us better today than we were many years ago. The 

recent funding increase of $3.6 billion for veterans health care is truly important 

and necessary. It goes without saying that sufficient funding for veterans must be 

met or nothing happens. We also know that many issues remain. 

FUNDING VETERANS HEALTH CARE AND RURAL CARE

In preparing for today’s hearing, I have spoken to many veterans. Not surprisingly the number one issue that comes up across the board is their concern for 

health care. Ohio currently has one million plus veterans. Nearly 8,000 of those veterans call Tuscarawas county their home. Funding for veteran issues concerning research, toxic exposure, the effects of Traumatic Brain Injury, Post traumatic stress 

disorder, prosthetic limbs, homeless veterans, our POW/MIA’s issues, improvement 

of facilities that treat all our veterans and combat wounded. All these and more 

must be funded by money distributed from Congress from non-discretionary funding 

sources. This is the only way that veterans can be assured that their issues will 

not be lost. 

More than half of the veterans who avail themselves of VA facilities here in Ohio 

are without medical insurance of any kind. VA hospital facilities are located in 

Cleveland, Cincinnati, Chillicothe, and Dayton. Access to VA hospital facilities in 

urban areas is almost unlimited because veterans can go to the VA emergency 

wards for treatment of ailments. However, that is not the case for rural veterans. 

We have VA Clinics in smaller cities on this side of the state. The clinic here in 

New Philadelphia is said to be the fastest growing clinic in the state. This is due 

to the ever increasing medical needs by not only older veterans, but by the new crop 

of veterans currently returning from the war zone. It is no secret that media sources 

report that the VA is at the breaking point. 

These reports concern many veterans because they fear VA will attempt to scale 

back their care because of limited funding or the influx of current Iraq and Afghanistan veterans returning from the combat zone. Additional VA clinic facilities are situated in Canton, Youngstown and Akron each providing different specialties for veterans. The medical help that these facilities provide through dedicated doctors, 

nurses and staff is absolutely critical to the health care of veterans in non-urban 

areas. For the most part veterans rate services provided by clinics and hospitals as good 

to excellent. However, we find that medical clinic access seems to vary from clinic 

to clinic. A veteran will usually get in to see a doctor at a clinic about once very 

6 months as part of a routine wellness physical if he or she is in the system. Should 

you be a new patient seeking treatment you may wait a longer period of time. Many 

of the veterans stated that if they become ill between their normal visits to the clinic, that they are unable to see a VA doctor if they request appointments. All believe 

that this is a result of VA limiting staffing policies. At a time when VA should be 

gearing up personnel, i.e., current veterans returning, putting more pressure on the 

system to perform, they seem to be going the other way. Veterans who seek help 

at the VA facilities that are rated 100 percent are admitted within a couple of days. 

Others who are less than a 100 percent may not get in at all if they are sick. The 

same also holds true for dental care as well. Some veterans have come to believe 

their access to VA facilities may be based on their Priority status or lack thereof. 

Perhaps a facility that has a larger staff may afford that clinic to accommodate the 

veteran needs. Veterans note that there does not seem to be any uniformity between 

facilities. 

An issue that many veterans grimace at in Ohio is this. Veterans whose incomes 

are at the poverty level have little choices, concerning health care; however, they 

29

are fortunate that the system does provide care for them. Veterans turn to the VA 

for medical assistance for a variety of reasons. Reasons cited by veterans include 

those whose income or lack of service related disability, forces them into Priority 

7 and 8, but a majority of these veterans have no medical insurance. Others have 

no employer sponsored medical insurance and still others are deemed uninsurable 

by the private sector. Most of these veterans can ill afford private insurance under 

any circumstances. Many veterans in Ohio and elsewhere are denied health care by 

the current Administration as a matter of policy. Fortunately some got in during 

the open enrollment period before the Administration closed the door. Estimates of 

these veterans now sitting out there are roughly 500,000 since 2003. Gentlemen, 

this closed door policy must be rescinded. It is time to reopen the VA health care 

system for Priority 8 veterans, who were restricted from enrolling in January 2003. 

Additionally, insufficient funding by Congress to take care of all who were promised health care as a condition of their service, still others who are forced to private 

health care and cannot afford prescription medications they need. We add a big 

thank you for VA prescription drug service, in some cases a life saving service. Ironically, Congress always seems to be able to find funds to wage war, which is necessary to support current combat troops. We certainly need to support our troops. 

However, once home, the Congress must find the necessary funds to treat and care 

for our veterans. 

REVAMPING

A revamping of the funding for veterans health care is an overwhelming issue 

that must be dealt with. H.R. 1382 is a start, Mandatory Funding for Veterans 

Health Care 2008. Gentlemen the current discretionary funding method for VA medical care simply does not work. VVA has long maintained that accountability must 

be built into any system of funding for the VA. Simply throwing cash at a problem 

will probably not work either. We must find long term solutions. Veterans in Ohio 

are certainly willing if not eager to work with whoever it takes, to find a way to 

ensure the VA has the funding to meet its mandate to ‘‘care for them who have 

borne the battle.’’ If we cannot find a way to maintain and improve care as time 

proceeds, we may find all veterans without benefits. This is a fate that we cannot 

let happen. Perhaps a bipartisan group should be formed whether in our state or 

on a national level to study the issues, options and hopefully solutions. 

MILEAGE ISSUE

The closest VA hospital for us is Cleveland. To get to Cleveland Wade Park VA 

hospital is a 200-mile roundtrip or more at best depending on the veterans’ location 

of residence. The VA current mileage scale allows veterans going to any facility eleven (11) cents per mile. Gasoline currently is better than three dollars a gallon. First 

of all this computation does not compute. A majority of Priority six (6) seven (7) and 

none of the Priority eight (8) veterans who are currently in the system get any mileage at all. The VA says ‘‘you make too much money’’. Say what? Yet others of higher 

priority regardless of their income still receive mileage. This does not make sense 

to most veterans, nor do they believe it is fair. 

OUTREACH

In the State of Ohio, we have found that many veterans who have served honorably simply are unaware of benefits and or services that they are entitled too. Many 

were not told of available benefits or services when they left their branch of service 

and never thought another thing about it. Outreach should be an ongoing effort to 

all veterans but especially in country veterans so they become aware that their likelihood of contracting a dreadful disease is much higher than the general public. 

ADJUDICATION OF CLAIM BACKLOG

I have been involved in many conversations concerning veterans not only here in 

Ohio but about everywhere I go concerning the current backlog of VA claim adjudication. No one seems to know what the actual number is, four, five, six, and hundred thousand. But one thing is for sure. It’s a big number and must be dealt with 

as quickly as possible. Many veterans are concerned about the length of time that 

is takes to get a rating at all after claims have been submitted. I am advised by 

our VSO people that waits of 1 to 2 years are not out of the question for an initial 

claim. If one appeals a decision add another 2 to 5 years. This is simply not acceptable. With the new crop of veterans returning from our current war zone, there is 

high concern among older veterans that their claims are getting lost in the bureaucratic log jam. We understand that new adjudicators are coming, but we need to be 

30

assured that the new kids on the block are properly trained and held accountable 

for their work. 

EMPLOYMENT, TRAINING

It seems that the so called ‘‘veterans preference’’ which we all know is on the 

books nationally certainly does not appear close to being enforced. Veterans both 

National Guard and Reservists returning to Ohio have faced no job or a job that 

has been reengineered, in effect again losing their career position. To veterans who 

return with less of a body than they started with they certainly deserve to be given 

chance to maintain employment if they are physically able to do so for their own 

well being. To assist veterans who are unemployed or underemployed with new or 

additional training seems vital to us. Veterans who lose their jobs should have the 

opportunity to get a re-education and work skill upgrades. S. 22, S. 644, and H.R. 

1102 would establish educational assistance for various veterans and Reserve elements. Ohio Vietnam Veterans feel these initiatives should be supported. With respect to our older veteran population national standards now cite retirement age increasing to a minimum age of 66. Federal, state, and private employers need to 

start rethinking their priorities toward older veterans and workers in general when 

it comes to keeping them in the workforce. With the increased standards, veterans 

reaching fifty years old or older are being shelved for younger less experienced people because their income combined with group benefits provided has reached a level 

that employers increasingly are not willing to pay. Federal agencies that provide job 

services to veterans should note this reality shift and make priority changes so veterans cannot only maintain their jobs, but find new ones if necessary. 

POW/MIA

The Vietnam Veterans of Ohio, along with The POW/MIA Families, on this issue 

have the strongest possible feelings. Prisoners of War and those missing in action 

must be accounted for and not left behind. We urge the Congress pass a resolution. 

Such resolution should be presented to the government of Vietnam to give up relevant wartime documents, so the remains of war dead may be brought home and 

those listed as MIA should be accounted for. 

I speak from personal experience when I tell you that having a brother KIA in 

Korea was bad enough for my family. I cannot imagine what it would have been 

like especially for my parents if they had not known the fate of their fallen son. 

Distinguished Members of the House and Senate Veterans’ Affairs Committee 

that concludes my testimony on behalf of the Vietnam Veterans of America, Buckeye 

State Council.

Mr. SPACE. Thank you, Mr. Burke. 

And I’d like to introduce our last witness on the first panel, Mr. 

Donald Lanthorn, a Vietnam veteran, and the Department Service 

Director from The American Legion, Department of Ohio. 

Thank you, Mr. Lanthorn, for being here today, and presenting 

your testimony. 

STATEMENT OF DONALD LANTHORN, SERVICE DIRECTOR, 

DEPARTMENT OF OHIO, THE AMERICAN LEGION 

Mr. LANTHORN. Senator Brown, Representative Space, it’s my 

pleasure to be here today. Thank you for this opportunity to provide our organization’s views on VA healthcare, its accessibility, 

and needs to be considered by Congress from the point of view of 

Ohio veterans and members of our organization. 

My first experience with VA healthcare was 30 years ago. At that 

time, VA Medical Centers had long lines, inadequate waiting areas, 

and few facilities. I was appalled by patients having to sit in hallways, on the floor, waiting for their opportunity to see a doctor, 

after having traveled perhaps 100 miles within Ohio to be seen. 

However, even in those trying times, medical care was comparable to the private sector, but few with the alternatives available through health care insurance would select VA as the health 

care provider of choice. Even veterans with service-connected

31

conditions would often opt for private sector treatment for the convenience. 

The 1980s saw some improvement in access, as VA Medical Centers in Ohio expanded the ambulatory care clinics, opened a few 

outpatient clinics, and moved toward outpatient, rather than inpatient care, as the preferred method of treatment. 

Beginning in 1994, Dr. Kenneth Kizer, VA Undersecretary for 

Health, began revamping the system to his vision of accessibility, 

quality, and safety. He is arguably credited with setting in motion 

the plan that closed under-used facilities, established hundreds of 

new access points with clinics, and created a business model of efficiency utilizing available technology to digitize records, to common 

sense in informing patients about their medications. 

As word spread of the quality of VA healthcare, veterans left 

their private plans and sought VA healthcare in droves. Without 

funding to handle the patient influx, VA was forced in 2003 to 

again restrict access, as waiting lists grew, so now only serviceconnected and low income veterans were eligible to enroll, slamming the door to hundreds of thousands of veterans planning on 

using VA healthcare in retirement, or sooner. 

A vital part of the VA transformation was the accessibility created for veterans by establishing community-based outpatient Clinics. They brought healthcare closer to where veterans live, and provide mental health services, often otherwise not available in rural 

communities. 

Ohio has CBOCs in Athens, Cambridge, Lancaster, Marietta, and 

Portsmouth affiliated with Chillicothe VA Medical Center, and 

Clermont County near Cincinnati VA Medical Center. Dayton 

VAMC has CBOCs in Lima, Middletown, and Springfield. Columbus VA Outpatient Clinic serves Grove City, Marion, Newark, and 

Zanesville with CBOCs. Cleveland VAMC, the most aggressive of 

all Ohio Medical Centers in establishing VA points of access, has 

CBOCs in Akron, Canton, East Liverpool, Lorain, Mansfield, 

McCafferty in downtown, New Philadelphia, Painesville, Ravenna, 

Sandusky, Warren, and Youngstown. 

Additionally, Ohio medical facilities have established CBOCs in 

Indiana and Kentucky, which serve Ohio veterans, as does the Toledo Clinic, a satellite of Ann Arbor VAMC, and other Ohio CBOCs 

in Ashtabula and St. Clairsville, established by VA facilities in bordering states. 

The Ohio American Legion strongly supports the recommendation of the Capital Asset Realignment for Enhanced Services 

(CARES), recommendations for more CBOCs, and expanded services in those now operating, especially those in rural areas. However, limited VA discretionary funding has slowed the number of 

clinics authorized each year. Field stations partially meet access 

needs, but are not sufficient in availability or services. 

The current war and its estimated toll on veterans’ mental 

health make these services vital in CBOCs for our returning troops 

ease of access. We urge sufficient VA funding to ensure adequate 

staffing. 

Traumatic Brain Injury veterans similarly find few community 

resources in rural areas for TBI-related problems, and many cite 

transportation as a major obstacle. We have addressed the transVerDate 0ct 09 2002 07:56 Sep 26, 2007 Jkt 000000 PO 00000 Frm 00035 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\37533.TXT SENVETS PsN: ROWENA
32

portation issue in Ohio with state legislation requiring County Veterans Service Commissions to provide it. Now VA must provide the 

services with the patient at the doorstep. 

Vet Centers are another resources VA provides, which is not 

readily available in rural communities. Veterans should not be penalized or denied quality healthcare because of where they choose 

to live. We urge Congress and VA to improve access to quality primary care, specialty healthcare, and mental health services in 

rural areas. 

As important as access as may be, just as critical is timeliness 

of services. VA has established its own standards for access to primary care of 30 days. That is unacceptable to most Americans, and 

especially does not meet the obligations of VA to our veterans. 

The Ohio American Legion does not point fingers at problems 

without offering a means of resolution. We disagree with the VA 

decision to deny access to any eligible veteran. Many of these veterans have third-party insurance that could reimburse VA, or are 

Medicare-eligible, yet little has been done to improve third-party 

reimbursements for private insurers, and nothing to allow VA to 

receive reimbursement from the Nation’s largest healthcare insurer, the Centers for Medicare and Medicaid Services, as both the 

Indian Health Services and Department of Defense are authorized 

to bill, collect, and receive. 

Full funding for VA healthcare, full eligibility for all veterans, 

and Medicare reimbursement to VA is the first step needed to assure quality healthcare to rural Ohio veterans. 

Thank you, Mr. Chairman, for providing the Ohio American Legion this opportunity to address the issues of VA healthcare in 

Ohio, and the disparities that exist in access to quality healthcare 

in rural areas. 

[The prepared statement of Mr. Lanthorn follows:]

PREPARED STATEMENT OF DONALD R. LANTHORN, SERVICE DIRECTOR,

DEPARTMENT OF OHIO, THE AMERICAN LEGION

Mr. Chairman, Members of the Committee. My name is Donald R. Lanthorn. I 

am the Service Director and Legislative Agent for The Ohio American Legion. 

It is my pleasure to be here today. Thank you for this opportunity to provide our 

organization’s views on VA health care, its accessibility and needs to be considered 

by Congress from the point of view of Ohio veterans and members of our organization. 

My first experience with VA health care was thirty years ago. At that time VA 

Medical Centers had long lines, inadequate waiting areas and few facilities. I was 

appalled by patients having to sit in hallways, on the floor, waiting for their opportunity to see a doctor, after having traveled perhaps one hundred miles within Ohio 

to be seen. 

However, even in those trying times, medical care was comparable to the private 

sector, but few with the alternatives available through health care insurance would 

select VA as the health care provider of choice. Even veterans with service-connected conditions would often opt for private sector treatment for the convenience. 

The 1980s saw some improvement in access, as VA Medical Centers in Ohio expanded the ambulatory care clinics, opened a few Outpatient Clinics and moved toward outpatient, rather than inpatient care, as the preferred method of treatment. 

Beginning in 1994 Dr. Kenneth Kizer, VA Undersecretary for Health, began revamping the system to his vision of accessibility, quality, and safety. He is arguably 

credited with setting in motion the plan that closed underused facilities, established 

hundreds of new access points with clinics, and created a business model of efficiency utilizing available technology to digitize records, to common sense in informing patients about their medications. 

33

As word spread of the quality of VA health care, veterans left their private plans 

and sought VA health care in droves. Without funding to handle the patient influx, 

VA was forced in 2003 to again restrict access, as waiting lists grew, so now only 

service connected and low income veterans were eligible to enroll, slamming the 

door to hundreds of thousands of veterans planning on using VA health care in retirement or sooner. 

A vital part of the VA transformation was the accessibility created for veterans 

by establishing Community Based Outpatient Clinics (CBOCs). They brought health 

care closer to where veterans live and provide mental health services often otherwise not available in rural communities. 

Ohio has CBOCs in Athens, Cambridge, Lancaster, Marietta and Portsmouth affiliated with Chillicothe VAMC, and Clermont County near Cincinnati VAMC. Dayton VAMC has CBOCs in Lima, Middletown, and Springfield. Columbus VA Outpatient Clinic serves Grove City, Marion, Newark, and Zanesville with CBOCs. 

Cleveland VAMC, the most aggressive of all Ohio Medical Centers in establishing 

VA points of access, has CBOCs in Akron, Canton, East Liverpool, Lorain, Mansfield, McCafferty in downtown, New Philadelphia, Painesville, Ravenna, Sandusky, 

Warren and Youngstown. 

Additionally, Ohio medical facilities have established CBOCs in Indiana and Kentucky, which serve Ohio veterans, as does the Toledo Clinic, a satellite of Ann Arbor 

VAMC, and other Ohio CBOCs in Ashtabula and St. Clairsville, established by VA 

facilities in bordering states. 

The Ohio American Legion strongly supports the recommendation of the Capital 

Asset Realignment for Enhanced Services (CARES) recommendations for more 

CBOCs, and expanded services in those now operating, especially those in rural 

areas. However, limited VA discretionary funding has slowed the number of clinics 

authorized each year. Field Stations partially meet access needs, but are not sufficient in availability or services. 

The current war and its estimated toll on veterans’ mental health make these 

services vital in CBOCs for our returning troops ease of access. We urge sufficient 

VA funding to ensure adequate staffing. 

Traumatic Brain Injury (TBI) veterans similarly find few community resources in 

rural areas for TBI related problems, and many cite transportation as a major obstacle. We have addressed the transportation issue in Ohio with state legislation requiring County Veterans Service Commissions to provide it. Now VA must provide 

the services with the patient at the doorstep. 

Vet Centers are another resource VA provides, which is not readily available in 

rural communities. Veterans should not be penalized or denied quality health care 

because of where they choose to live. We urge Congress and VA to improve access 

to quality primary care, specialty health care and mental health services in rural 

areas. As important as ‘‘access’’ may be, just as critical is ‘‘timeliness’’ of services. VA 

has established its own standards for access to primary care of 30 days. That is unacceptable to most Americans, and especially does not meet the obligation of VA to 

our veterans. 

The Ohio American Legion does not point fingers at problems without offering a 

means of resolution. We disagree with the VA decision to deny access to any eligible 

veteran. Many of these veterans have third-party insurance that could reimburse 

VA, or are Medicare eligible, yet little has been done to improve third-party reimbursements from private insurers and nothing to allow VA to receive reimbursement 

from the nation’s largest health care insurer, the Centers for Medicare and Medicaid 

Services (CMS), as both the Indian Health Services (IHS) and Department of Defense (DoD) are authorized to bill, collect, and receive. 

Full funding for VA health care, full eligibility for all veterans, and Medicare reimbursement to VA is the first step needed to assure quality health care to rural 

Ohio veterans. 

Thank you, Mr. Chairman, for providing The Ohio American Legion this opportunity to address the issues of VA health care in Ohio and the disparities that exist 

in access to quality health care in rural areas.

Senator BROWN. Thank you, Mr. Lanthorn. 

I will begin the questioning, and feel free, any of you, to jump 

in if the question is directed at one of you. Feel free to also add 

your thoughts to the answers. 

Mr. Anderson, Mr. Moore talked about contracting out. I’d like 

to pursue that a bit. Mr. Moore, you said that contracted care takes 

money out of the system, and potentially dilutes quality of care. 

34

Mr. Anderson, you said that you fear that the VA will become the 

insurer of care, not the provider of care. That results in a diminution of the quality of care. Would each of you expand on that a bit? 

Mr. Moore first, then Mr. Anderson. 

Mr. MOORE. Well, again, we’re very concerned with that aspect. 

When we’re looking for our dollars, and we’re fighting for our dollars continually, that if you—in the past what I saw is simply that 

when we’ve contracted in the past to private entities, the veteran 

always end up, seems to me, to suffer. The billing system gets 

messed up. He doesn’t get his care on time, or it doesn’t get paid 

on time. He gets threatening letters continually that that private 

sector hospital is going to turn it over to a collection agency because it hasn’t been paid by the VA; and, therefore, he’s responsible 

for it. That’s one of the issues I see that bothers me with contracting care out. I’ve seen that happen several times in the Columbus area when they contracted out for some of the—University 

Hospital, a veteran came in with all kinds of problems, threats if 

the bills weren’t paid, and everybody is arguing back and forth between them and fee-basis, who’s responsible for that. Well, they 

are, they aren’t. In the end, the poor veteran is sitting there suffering, and he’s being threatened by ruining his credit and everything else. That’s one fear I have about contracting out. Unless, 

again, Congress and the VA itself, and any of these contracted out 

medicals really need to look at it and keep auditing that system, 

keep a very strong hand on it, making sure that it’s done properly. 

Senator BROWN. Have you seen an increase in the number of veterans who serve with those problems, with the problems of the mix 

of privatized or contracted out care? 

Mr. MOORE. Fortunately, most of them in Ohio, we have a very 

strong VA healthcare system in there, thanks to Director Montague 

and others that pushed that. When you look at Ohio compared to 

its sister states that in that Appalachia area that we’re talking 

about, West Virginia and Kentucky, you’re looking at roughly 20 

probably rural CBOCs and whatnot within Ohio, but in West Virginia you’re looking at six or seven CBOCs, in Kentucy about the 

same. And it’s very difficult for those individuals to get in and get 

timely healthcare appointments. I’m worried that, I think CBOCs 

and those people who reach out to the veterans who make those 

house calls on those that are house-bound, and/or have mental 

health conditions that make it difficult for them to come in, we are 

very short on those types of people. We need more of them. They 

do an excellent job. They’re very committed, but I think we’re at 

the point where we’re starting to overwork them. Mental health individuals have to make assessments of some cases in the field, supposed to be about an hour or less than that to try to make some 

kind of assessment. I would like to see more of that expansion of 

technology out in the field for those rural people, such as not only 

the Telebuddy, but they have tele-video where the mental health 

individual actually sees that individual on a screen and can make 

assessments, and they can have somewhat of a consultation right 

there at their home. 

Senator BROWN. Thank you. Mr. Anderson, about the diminution 

of quality of care. Pull the microphone a little closer. 

35

Mr. ANDERSON. When you asked me that question, Mr. Chairman, I looked at myself, and I think I’ve received some of the best 

care in the world from the VA. I am a product of that service. I’m 

specialized service intern of spinal cord injury. I’ve been receiving 

service 27 years, and I’ve gotten some of the best spinal cord injury 

service around. I’ve received three surgeries there at the VA Medical Center, and I’m going in for a third one in another month for 

Harrington rods, I’ve been experiencing some Harrington rod problems, and the service I received from the VA has been excellent. 

And as specialized service, only through the VA have I been able 

to get that quality care of services. And the veterans that I’ve 

worked with and serve with, only through the VA have we been 

able to get that kind of service. So we have received topnotch service, and nowhere have we received such quality care. 

Senator BROWN. Mr. Ondick and Mr. Lanthorn, you both talked 

about 700 CBOCs around the country, 150 cares recommended. Do 

you specifically recommend expansion? We just announced this 

week—well, I talked to the Secretary of the VA this week about the 

Hamilton and Parma new expanded CBOCs. Do you specifically 

recommend more in Ohio? And if so, does that potentially take 

money away from other things that the VA is doing? What is your 

thought about additional CBOCs in Ohio, and even specifically 

where, if you are recommending that? Your view, and I’d like to 

ask both of you, but either/or. 

Mr. Ondick. 

Mr. ONDICK. I have covered in my testimony the list of the facilities that there are in Ohio. There is a significant need for a couple 

of CBOCs in northwestern Ohio, which is not in VISN 10, but it 

is in VISN 11 out of Michigan, and Indiana fall into that VISN. 

Most significantly, that’s where our needs need to be addressed. 

However, we could use a couple of CBOCs in——

Senator BROWN. There is one in Lima now. Correct? 

Mr. ONDICK. Yes. Yes, there is. 

Senator BROWN. Nowhere between Lima and Toledo? 

Mr. ONDICK. Actually, Finley and Defiance would probably be 

two good locations, or Finley and Bryan, not knowing where there 

might be one in Michigan. 

Senator BROWN. But now there’s—outside of Toledo, there’s 

Lima, there’s Lorain, east of Toledo, nothing in Bowling Green, 

nothing in anywhere else other than Lima at this point? 

Mr. ONDICK. And Toledo, yes. 

Senator BROWN. And Toledo, yes. 

Mr. LANTHORN. If Mr. Montague would just hold up the map of 

Ohio right here, you can see the locations of all the CBOCs, and 

where the need is. 

Senator BROWN. That would be out of the Michigan Center, 

though, correct? 

Mr. ONDICK. Marion. In southeastern Ohio, we are dependent 

upon CBOCs in Huntington. 

Senator BROWN. They’re in East Liverpool, they’re here, they’re 

Athens, Chillicothe. 

Mr. ONDICK. But we are dependent upon CBOCs that are located 

in St. Clairsville, and then, of course, the VA Center in Huntington 

to service Ohio veterans, as well. 

36

Senator BROWN. So there’s one in Marion. Correct? 

Mr. ONDICK. Yes. 

Senator BROWN. So Marion and Lima, and Mansfield. 

Mr. LANTHORN. You could see the areas that need coverage, that 

northwest corner. The areas down in Cincinnati, Dayton are covered quite well. There are a few small pockets, and, again from my 

conversation with Mr. Montague earlier, some of the small pockets 

along the river, and up along the eastern part of the state are covered by—correct me if I’m wrong, Mr. Montague, but they’re covered by CBOCs in other states? 

Mr. SPACE. Mr. Lanthorn, while we’re on the subject of CBOCs, 

my understanding is there are five of them in Ohio’s 18th Congressional District. That would include one here in New Philadelphia, 

which I have been told is one of the fastest growing CBOCs in the 

state, community-based outpatient clinics. In addition, we’ve got 

one in St. Clairsville, Cambridge, Zanesville, and Newark. Is that 

correct? 

Mr. LANTHORN. Yes, sir. 

Mr. SPACE. Those are the five serving——

Mr. ONDICK. The one in St. Clairsville is not part of VISN 10. 

That’s one we’re depending on another VISN. 

Mr. SPACE. Right. Those are the five. And the principle behind 

the CBOC concept is, it’s kind of—I’ve heard the analogy ‘‘hub and 

spoke,’’ with the hubs being the medical centers, like the one we 

have in Chillicothe, or the one we have in Cleveland; with the 

spokes being the various CBOCs situated strategically around the 

state, try to serve those veterans who are not within a short drive 

to those medical centers. I mean, the concept is a good one, and 

certainly, we are encouraged by the recent announcement that 

there are going to be more CBOCs constructed, but the fact of the 

matter is that some of the CBOCs, all of them, actually, have some 

serious limitations when dealing with special needs. And I think it 

was Mr. Ondick that used the example of someone who has to travel 80 miles for radiation therapy, and then travel 80 miles back 

home. Forget about the fact that the insult of 11 cents per mile, 

the mere travel and distance, and inconvenience occasioned by that 

travel is, in and of itself, a significant problem that affects almost 

exclusively rural veterans. 

Aside from making that statement, I wanted to ask you whether—and this applies to anyone on the panel—if you’ve got some 

ideas, some creative thoughts on how we can expand access to specialized care in rural America, rural Ohio, in particular, over and 

above what’s presently being offered by the CBOC hub and spoke 

system. 

Mr. ONDICK. Mr. Chairman, it would certainly behoove the VA 

to, as they provide services in the CBOCs, to provide some specialty services at certain CBOCs so that like Women’s healthcare 

services be available, if not within the 30-mile radius at every 

CBOC, perhaps overlay those maps with 50 or 60-mile circles that 

would assure that those specialty services would be available within a certain time and transportation frame for all veterans in the 

state. This is something that could be done, I’m sure. 

Mr. SPACE. Anyone else on the panel have suggestions on how we 

could enhance specialized care for rural veterans? 

37

Mr. BURKE. Congressman, I know that some of my guys that 

have commented about the clinic here in New Philadelphia, it is 

said to be one of the fastest growing in the state. That is because 

there have been a lot of participation by the veterans in this area. 

I’m told that the clinic here will soon have eye care, and foot care, 

podiatry, and the veterans that I’ve talked to have commented that 

this is really going to be of a help to them. The more expanded care 

that can be provided in the small town clinics is certainly going to 

diminish the time that the veteran has to travel to the major hospital for whatever purpose he has to go there for. So I suggest that 

the expansion of services at the local clinics would certainly do 

much to help the veterans in the area. 

Senator BROWN. Perhaps Mr. Ondick could answer this. Are 

there five VA medical centers in the State of Ohio? How many are 

there in the State of Ohio? 

Mr. ONDICK. We have Chillicothe, Cincinnati, Dayton, Cleveland. 

Senator BROWN. It seems to me that every region of Ohio is 

served by a medical center, with the exception of the southeastern 

area of Ohio. 

Mr. BERTSCHY. You’ve got the—one of the problems is Harrison 

County. I think it’s Harrison County, and one other county, I think 

it’s Jefferson County, that have to go to Pittsburgh, and there is 

no CBOC. Steubenville has a CBOC, or close-by, but if you look at 

the ones close to the Ohio River, talking about Morton’s Ferry and 

them areas in there, they have to go to Pittsburgh. That’s the only 

place they can go. There is no CBOC within a 30-mile radius for 

them. I think if they could expand the old type, what we had, the 

fee-basis or the fee-basis where they could go to their local hospitals to get this care would help an awful lot. 

Senator BROWN. Excuse me. There’s a CBOC in East Liverpool, 

and St. Clairsville. Right? 

Mr. BERTSCHY. Right. There is——

Senator BROWN. Where? 

Mr. ONDICK. St. Clairsville, is it open yet? 

Mr. BERTSCHY. St. Clairsville is open. 

Mr. ONDICK. I was thinking it wasn’t open. 

Senator BROWN. So where are they not getting service? Steubenville doesn’t have one, but it’s served by——

Mr. BERTSCHY. Steubenville has to go to East Liverpool. 

Senator BROWN. East Liverpool, or south of there, Mango Junction maybe goes to St. Clairsville. I don’t know, but where do they 

have to go, to Pittsburgh? 

Mr. BERTSCHY. Most of them are going—anyone I talked to, I 

don’t know in Jefferson County, in Steubenville, that most of them 

will go to Pittsburgh. 

Senator BROWN. Rather than St. Clairsville, or East Liverpool. 

Mr. BERTSCHY. Yes. 

Senator BROWN. Let me pursue, and Mr. Burke, maybe this is for 

you. You all talked about the 11 cents a mile, and we all—that’s 

just an embarrassment to all of us. But my understanding is there 

are some cases where people in the community, particularly someone is driving, they simply can’t drive because of their disability, 

because of their illness, because of whatever reason, they don’t 

have car, and I know that community organizations that support 

38

veterans’ groups, sometimes, obviously, veterans service organizations and others will provide transportation. My understanding is, 

sometimes they are not eligible for reimbursement at all? Someone 

that’s helping. Mr. Burke, if you have to go and you can’t drive 

yourself, and you get some help from somebody in the community, 

they don’t get reimbursed at all. Is there a loophole in the law that 

disqualifies or some prohibition for reimbursement? 

Mr. BERTSCHY. Well, if you’re not service-connected, and if you’re 

a Category 7 or 8, if your income is above certain levels, the VA 

simply says you’re not eligible for any reimbursement as far as 

mileage goes. 

Senator BROWN. So if it’s Category 7 or 8. 

Mr. BERTSCHY. Category 7 or 8, and——

Senator BROWN. Or if you’re above a certain income level. 

Mr. BERTSCHY. And if you’re above a certain income level, and 

if you’re a veteran, but you have no service-connected disability, 

that is another obstacle to receive——

Senator BROWN. You’re eligible to go to the CBOC in East Liverpool, but you can’t get mileage. 

Mr. BERTSCHY. Correct. 

Senator BROWN. Mr. Moore. 

Mr. MOORE. You can’t get enrolled if you’re a Category 7 or 8. 

Senator BROWN. You can’t get enrolled. 

Mr. BERTSCHY. Right now, that’s correct. I’m sorry. That’s right. 

Right now, if you’re a Priority 8, you can’t even get enrolled because they’ve been locked out. 

Mr. MOORE. If I could, Senator Brown. Rural areas are basically, 

they use HUD for figuring those financial incomes for families, 

probably for a married couple you’re looking at rural areas of about 

$32,280 for a married veteran, and about $25,000–$26,000 for a 

single veteran. If he is that income or over that, then he’s Category 

7 non-service connected, and he’s not available, or he’s not eligible 

for healthcare. 

If I could, one more. You had asked earlier in regards to 

outsourcing, why it’s another reason why we wouldn’t want the VA 

to do that; because the VA has a unique ability to treat some of 

these specialized injuries in mental illness that nobody has. Nobody else there in the private sector sees the amputees, and the 

burn victims, and the PTSD. They’ve dealt with that for years, and 

they are the ones with the expertise to really handle and give the 

best healthcare to those injured individuals. 

Senator BROWN. Thank you all very much for being with us and 

sharing your thoughts, and your experience, and your wisdom. Stay 

in touch with both of us, personally, stay in touch with the Veterans’ Committee in both houses. I will see you all regularly, I’m 

sure, in the years ahead. And thank you for coming to New Philadelphia, and joining us today. Thanks very, very much. 

Mr. SPACE. If I could, before you exit the stage, I just had a couple of things I wanted to bring up. First of all, Mr. Bertschy, I 

wanted to commend you for what appears to be having logged 

85,000 volunteer miles in helping to transport veterans. I got that 

from your resume, and I wanted to commend you for that. 

And if I could just, before we leave this subject, because of the 

peculiar concerns of rural Ohio when it comes to healthcare; and, 

39

Mr. Moore, I want to address this to you, again, any others feel 

free to jump in, but I understand your concerns about privatization 

and pulling funds away from speciality treatment that the Veterans’ Administration is able to administer better than anyone 

else. I think Mr. Bertschy may have mentioned a reference to the 

prospect of providing local community care for some veterans who 

don’t have immediate access to veterans’ care. And, Mr. Moore, are 

there situations where contracting for healthcare outside of the 

Veterans’ Administration, would be appropriate, and would enhance veterans’ care? 

Mr. MOORE. Yes. Like I said, with proper use, there are areas I 

think in need, in rural areas. Obviously, as we talked about, chemotherapy treatment and radiation, even when we have transportation, even in some of our counties to the medical centers at 

Stokes, when you started getting into that eighth and tenth treatment, you get so ill that just getting on the public transportation, 

or having to wait for the other guys to come back in a van is just 

tough on them. Something like that, if we could have it specialized 

where that and a fee-basis could be outsourced, they get their—obviously, most areas there’s somebody, or a medical facility close by 

that does have chemotherapy and radiation treatment. 

Mr. SPACE. So it might be something worth studying, particularly 

with respect to rural——

Mr. MOORE. Yes, the Veterans of Foreign Wars are not totally 

against that. We think in certain particulars, it could be of use. But 

it has to be, obviously, audited and looked over very strongly when 

you’re doing that. 

Mr. SPACE. All right. Well, thank you, Mr. Moore. Thank you all 

of our panelists. I wish we had more time, but we’re on a rather 

tight schedule. When we’re through here, I’d ask that you exit the 

stage, and we have seats arranged for you in the first row. And our 

second panel will approach the stage. We’re going to take about a 

5-minute break, and we’ll launch into our second panel. Thank you. 

[Recess.] 

Mr. SPACE. We’ve got the panelists. I ask that all audience members take their seats. We’d like to move forward with our second 

panel. Our second panel this morning is Terry Carson, Chief Executive Officer of the Harrison Community Hospital in Cadiz, Ohio, 

which is in Harrison County. 

Mr. Carson, I’m privileged to introduce you this morning both as 

a panelist and, again, as a constituent. We look forward to hearing 

your remarks. 

STATEMENT OF TERRY CARSON, CHIEF EXECUTIVE OFFICER,

HARRISON COMMUNITY HOSPITAL 

Mr. CARSON. Senator Brown and Congressman Space, we thank 

you very much for taking the time this morning. Frankly, you’re 

the only two offices that responded to our letters of issues, so we 

appreciate you taking the personal time, and also the time out here 

in the field. 

I’ve been for 15 years attempting to meet the challenges of providing healthcare to rural communities. My background is primarily a big city, Cleveland boy, so when you come out to the rural, 

there are special challenges that you try to meet because you take 

40

for granted that they’re out there, and sometimes, it’s a very rude 

awakening when they’re not. 

I was drafted in 1965, and I spent my next two years at Walter 

Reed in Washington, DC. And, of course, I was sort of dismayed 

when I heard the reports in the papers not too many weeks ago 

about some of the conditions that have been developing. We know 

that as a first-class military institution. I don’t think that’s a veterans’ facility. But when I was there, I was a kid coming out of 

Cleveland, Ohio, never had a stitch, never broke anything, and we 

were treating and serving the kids that came right in from Vietnam, and many times they had their field bandages on them. So 

I think it’s a system we can be awfully proud of, and I think our 

entire VA system is one that we can be proud of. But I think the 

conditions that took place there are probably a good example of you 

just can’t pour money down a rat hole and think it’s going to develop into something. Someone has to watch it, and monitor it, and 

has to make sure that it’s working. 

And that’s really our message in my brief statement that I presented to you folks, is that there has to be a better way to tend 

to those patients who have critical issues out in the rural communities, without having them go hundreds of miles to a center, because their name happens to be registered there for their treatment. 

Sometimes you need to think out of the box, and instead of pouring money into a system that perhaps isn’t meeting everyone’s 

needs, how do you come up with ways to make it work? And I was 

listening to some of the panelists here, and it’s very humbling to 

have gone through my military time without having an injury, and 

seeing people that have had some pretty devastating things taking 

place in their lives. But if we can, perhaps, take a little chance to 

improve the system in the offering that we’re giving, maybe it’s 

time well spent. 

But it may well be something that you could have a panel of hospitals, and a panel of physicians who are willing to sign onto the 

VA program, much like we do with the Medicare program in offering these services in various communities. If you want to put your 

outpatient clinics adjacent to, or in closer proximity to rural facilities, rather than duplicate all the programs. You can just pay for—

I know darned well it cost a whole lot less to provide services in 

Cadiz, Ohio, than it does in downtown Pittsburgh in the VA Hospital. I know because I can’t hire the nurses, I can’t hire the doctors. We can’t afford to hire them away. And perhaps a decentralization approach to this whole thing is one that will make it 

work a little bit better. 

The samples I gave you were those types of patients who come 

to the hospital with an emergency or an urgent situation in their 

personal life, and they can’t get treatment at our facility because 

they’re on the VA system. We have had problems logistically getting them to the facility because either a bed wasn’t available, or 

the surgeons weren’t available to do the work. When we finally did 

get approval, it is not uncommon for that to be taken and withdrawn, so that patients have to go back to the hospital and spend 

two or three days at the hospital before they’re able to go back up. 

41

I think there’s a level of inconsistency with regard to the kind 

of information that’s provided to providers. One might tell you to 

go ahead and do the service because we’ll pay for it over the long 

haul, and I heard that issue this morning about then the hospital 

starts dunning the patients because they haven’t paid the bill. You 

could have an arrangement much like the Medicare program where 

you know what you’re going to pay for procedures, and people sign 

up to do it. That would be an acceptable payment situation. 

The other thing is actually getting patients to the facilities. Very 

often, if a community doesn’t have a van service, it is really the responsibility of a family member, or a very good friend. That’s not 

always the best time in their lives, anyway, so friendships could 

strain pretty thin, when you start going up to these long facilities, 

and getting someone to take you up and bring you back. So our approach, and our discussion really this morning is the logistics of 

how to get patients in the system, how to treat them. And when 

they present themselves as an emergency, it truly is an emergency. 

It’s one that would be an emergency for you, or anyone else who 

presented themselves with a crisis. 

I gave you a specific example of someone who broke their hip, I 

think three days later before we could ship them up to get the hip 

taken care of. So our concern is getting those patient’s services. We 

want to do it in a very positive, open way. We think there are opportunities to work together, and I’m really here on behalf of our 

fellow constituents that we both serve. And we think we do a nice 

job serving your constituency. We just want to be able to make it 

easier for their access to it. 

[The prepared statement of Mr. Carson follows:]

PREPARED STATEMENT OF TERRY M. CARSON, CHIEF EXECUTIVE OFFICER, HARRISON COMMUNITY HOSPITAL

The Harrison Community Hospital is a Critical Access Hospital serving a population of approximately 15,000 citizens in Southeast Ohio. Included in our service 

are our veterans that require various levels of care. 

The problem that we experience has to do with treating initial emergency/urgent 

situations and having little success in being able to transfer veterans to the appropriate Veterans’ Hospital Center. 

Often, we wait days to receive transfer approval, and it is not uncommon for those 

approvals to be withdrawn during the actual transfer, and change of direction midstream. 

These delays do not serve patients well, and often puts the hospital in the position 

of proceeding with treatment because the care needs to be provided. We even have 

to find alternative facilities to accept the patients, knowing that they too will have 

difficulty receiving reimbursement for the care. 

The simple solution would be for facilities such as ours to be given approval to 

treat patients in our community and have the local doctors render the necessary 

care. To be mandated to send patients 65 to 100 miles away during their crisis really doesn’t make that patient a priority, just a convenience for the VA Center. 

To offer a coordinated system seems to require better access, local treatment or 

a combination of both. 

Thank you for your interest and the opportunity to discuss this important gap in 

the system. 

ATTACHMENT

Patient, 85, was brought to the ER on 02/23/07. Patient had fallen at home and 

was brought in by ambulance. X-ray showed a fracture of the femoral neck left leg. 

He had only VA insurance. The VA Hospital in Pittsburgh was called and we were 

told it was full. Cleveland VA Hospital was also contacted regarding bed availability. They referred him to Pittsburgh since he is a patient of this area. We also 

called the VA office in St. Clairsville, Ohio, and they stated that he was a patient 

42

of theirs and Pittsburgh. Dr. Sandhu, our ER Physician, spoke with an ER physician, Dr. Ruhl, at the Pittsburgh VA, who advised him to send the patient to that 

hospital’s ER and he would see him. While transporting the patient, we received a 

call from Pittsburgh VA refusing to accept him, so we had to turn the squad around 

and bring him back. Dr. Modi accepted the patient and he was admitted here. We 

were told to call in the morning to see if there was a bed available. The VA hospital 

was called each day regarding bed availability. On 02/25/07, a comment was made 

to Pat Worrell (Nurse Manager) by Mr. Anderson, AOD, Admission’s Director, that 

‘‘possible transfer on Monday, transfer may cause further damage to fracture’’. He 

also said that ‘‘they are using too much of the OR time on bones, this is a regional 

center for kidney and liver and they are getting bones from everywhere in the region’’. Dr. Modi attempted to get another orthopedic physician to accept the patient. 

He finally got in touch with one at UPMC who agreed to accept the patient, but 

the hospital wanted the patient to be counseled and sign a form, witnessed, stating 

that he may be responsible for the bill before accepting the patient. After speaking 

with Administration at the VA Hospital and again to the St. Clairsville VA Clinic, 

we were notified that the Pittsburgh VA Hospital had a bed and the patient was 

transferred on 02/26/07. 

Patient, 75, came to the ER on 02/28/07. Found unresponsive at home with a 

blood sugar of 22 and respiratory problems. He was diagnosed with sepsis, hypotension, dehydration, hypoglycemic reaction and acute pyelonephritis. He required 

large amounts of IV fluids to maintain BP. Attempted to transfer the patient to the 

two VA hospitals but both did not have any beds. Also attempted to transfer the 

patient to several local hospitals with East Ohio Regional Medical Center agreeing 

to take the patient. 

Patient, 35, came to the ER with suicide ideation. He did not have any insurance 

and his mother stated that he had been at the VA Hospital in Pittsburgh before. 

We called that hospital and they put his name on the list, they did not have a bed 

and we were to call every day to see if a bed was available. Pam Parrish (Social 

Services) contacted Chuck at the Cadiz VA Office requesting assistance to find a 

bed. He called the VA Hospital, and also was told the same thing, no bed available, 

his name was on the list, and they would try to get him in as soon as possible. We 

also tried the Cleveland VA hospital and left a voice mail, but no one called back. 

The patient was eventually transferred to Belmont Community Hospital’s Mental 

Health Unit.

Senator BROWN. Thank you, Mr. Carson. 

Dr. Gerald Cross, who’s been with the VA for many years, is now 

the Acting Principal Deputy Under Secretary for Health. 

We appreciate your coming to New Philadelphia, and speaking 

with us today, Dr. Cross. 

STATEMENT OF GERALD M. CROSS, M.D., ACTING PRINCIPAL 

DEPUTY UNDER SECRETARY FOR HEALTH, DEPARTMENT OF 

VETERANS AFFAIRS 

Dr. CROSS. Senator Brown, thank you very much for having me 

here, and I want to say I’m a family physician. I grew up on a farm 

in a rural environment in Virginia. I was a member of the 4-H 

Club, and I guess those are my best credentials. I’m here with Jack 

Herrick, Director. Jack, can you stand up so people can see you. 

And we’ve already had a chance to talk with Mr. Carson this morning, so this meeting has already served a purpose in that we started the channels of communication to work out some of the issues 

that he’s talking about. And, by the way, we’ll continue that. 

I’ve ditched my speech, and I’ve just written down a few notes 

I want to comment on, based on what I heard this morning. Rural 

healthcare is, in fact, very important to us. It’s about 39 percent 

of our enrolled population for healthcare. And, indeed, we have established and are developing an Office of Rural Health at the Central Office in Washington. But much more than just creating a new 

office in Washington, I want to tell you what we’re really doing 

that’s making a difference. 

43

Strategically, we are doing geographic dispersion. We were very 

much a tertiary big medical center-based organization a decade or 

two ago, and we’re changing dramatically, much more to continuity, comprehensive care, outpatient care, primary care. And we 

followed through on that. We now have 717 community-based outpatient clinics. We’re planning 20 or more of them for 2007, and 

more for 2008; 207 Vet Centers, and more planned in the coming 

years. These wonderful organizations that are so accessible in 

terms of lack of bureaucracy, just walk in and say hello, and somebody there will say hey, welcome. Sit down, have a cup of coffee, 

let’s talk. 

Telemedicine and mental health, to make sure that we can do 

specialty consultation, diagnosis, follow-up even at our small community-based outpatient clinics of some our specialists, like dermatologists, or mental health, especially mental health. 

And we don’t expect our patients who get medicine every month 

for blood pressure, cholesterol, or whatever to have to come to the 

pharmacy of the big medical center, or even at the CBOC. We mail 

it to them. We deliver the medicine to the home wherever that 

home may be, month after month, year after year. 

And we’re moving into a new direction, home-based primary care, 

where we actually send providers out to the home to take care of 

people who are restricted to the home and unable to get up and 

about; $175 million in our 2008 budget just for that one program, 

and many millions of more for other similar, related programs. 

So here are the results at the moment. Within 60 minutes of care 

nationwide, 92.5 percent of our enrolled population for healthcare. 

Within 90 minutes nationwide, it’s 98.5 percent. Mental healthcare 

is especially interesting. In 1996, the average distance traveled for 

mental healthcare was 26 miles by a veteran going to a VA facility. 

It’s now 13 miles, approximately. 

Satisfaction among our patients in the rural environment exceeds that of those in our urban environment. Quality of care is 

measured by standard indicators, of which we have many. Almost 

exactly matches, on average, that’s received in urban care. 

Now, sir, I’d like to say just a word about OIF and OEF. The secretary some years back opened two years of eligibility for anyone 

returning from the combat theater, that includes OIF and OEF. 

The two years of eligibility that the secretary opened sometime 

back for OIF and OEF still makes it possible for an individual coming back from the combat theater to get the care they need, and 

gives them time, if they’re going to go through a disability process, 

to get that disability claim done. I should say that in the Senate 

right now, there is a bill to extend that two years to five years. And 

I testified, I think about two weeks ago, that we were in support

of that. 

We’re adding staff, doctors, nurses, psychologists, especially mental health staff. We’re screening everyone coming back from the 

combat theater OIF and OEF for TBI, Traumatic Brain Injury. 

This is something the VA does better than anyone else, because of 

our comprehensive electronic health record. And we’re doing the 

same thing for PTSD. We’re doing the same thing for substance 

abuse, and we’re doing the same thing for depression. 

44

We’re the only organization, I believe, that can make those statements. And then we’re going to follow-through on them. We’re 

doing research to find out more about these conditions, as we’ve 

done a tremendous amount of research, for instance, on PTSD. But 

I want to tell you about two new things, just very briefly, and that 

will be my conclusion. 

Transition Assistance Advisors are in place in every state working through the National Guard in the Office of the Adjutant General, right in the Governor’s office. The states can provide services 

that on a federal level, we don’t really do, such as providing employment, providing link-ups to the local community to find employers ready to hire these returning veterans. And these individuals in the Governor’s office also help to make sure that individual 

is aware of all the state services, and all of the federal services. 

And something very new, and I want you to know about this. 

Transition Patient Advisors, a hundred of them being GS–11s, 

don’t have to be medical care workers. We’re putting them in Ohio, 

and every other state. And when a new veteran seriously injured 

shows up at Walter Reed or Bethesda, they fly there to meet with 

them, to meet with the family, to follow them a couple of times a 

week, and to make sure that there’s no falling through the gaps. 

That concludes my statement, sir. 

[The prepared statement of Dr. Cross follows:]

PREPARED STATEMENT OF GERALD M. CROSS, M.D., ACTING PRINCIPAL DEPUTY

UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS

Good Morning, Members of Congress. Thank you for the opportunity to discuss 

VHA’s ongoing efforts to provide safe, effective, efficient and compassionate health 

care to veterans residing in rural areas. 

My remarks will briefly review the national challenge presented by rural health 

care, VHA’s strategic direction and initiatives underway. 

Among the entire enrolled VA population, 39 percent were classified as rural at 

the end of FY 2006. And among the entire enrolled VA population, 2 percent were 

classified as ‘‘highly rural.’’ Highly rural refers to counties with less than 7 citizens 

per square mile. 

Researchers have studied the rural health care experience, including a number of 

articles that looked at VA rural healthcare. Three studies have found that veterans 

living in rural areas tend to be slightly older, and more likely to qualify in Priority 

group 5—that is, non-service-connected, zero percent service connected, and low income. These same veterans were also less likely to be employed. The studies agree 

that rural veterans had slightly more physical health problems but fewer mental 

health conditions—as compared to suburban and urban veterans. 

VHA’s strategic direction is to enhance non-institutional care with less dependence on large institutions. Instead, we are providing more care at home and in the 

community. 

VHA now has 717 Community Based Outpatient Clinics or CBOCs. Of this total, 

320 or 45 percent of these are located in rural or highly rural areas. We’ve created 

Consolidated Mail-Out-Patient Pharmacies or CMOPs so that medications are delivered to the patient’s home—instead of having the patient travel to the hospital. We 

provide home based primary care—devoting more than $175 million to this program 

in FY 2008, and more than 95 million dollars for other home based programs. We 

are using tele-medicine and tele-mental health to reach into the veterans’ homes 

and into community clinics. This allows us to evaluate and follow patients without 

them having to travel to large medical centers. We are far along with our mental 

health enhancement initiative that will add resources and greater mental health expertise in primary care clinics. We are also using a special Internet site, providing 

information to veterans in their own home, including up-to-date research information, access to portions of their medical records, and the ability to refill medications 

online. 

To accomplish this, VHA is emphasizing primary care and spreading out geographically. At the end of FY 2006, 92.5 percent of our 5.4 million patients were 

45

located within 60 minutes of a VA healthcare facility. And 98.5 percent were within 

90 minutes. Among those who live outside the 60-minute range, some are those veterans in highly rural areas and some are veterans living in Tribal areas. 

In 2006 evaluations of veteran patient satisfaction, comparing rural versus urban 

veterans, we found that rural patients were more satisfied with their health clinics 

than their urban counterparts. 

We also looked at the quality of care, comparing rural versus urban clinics. Looking at 40 standard measures, quality was virtually identical overall between rural 

and urban clinics. 

To continue this strategic support for access and rural health care we have over 

20 CBOCs for 2007. Forty three percent of these CBOCs are in rural or highly rural 

areas. In addition to these clinics, VA is currently working on telecommunications 

strategies to provide Care Coordination/Home Telehealth services in rural areas. 

Since January 2004, VHA has trained over 3,500 staff nationally to provide care via 

CCHT. 

In Ohio, there are 5 VA Medical Centers and 32 Community Based Outpatient 

Clinics (CBOCs). In close proximity to Appalachia, (the region in the United States 

that includes the southern Appalachian Mountains, extending roughly from southwestern Pennsylvania through West Virginia and parts of Kentucky and Tennessee 

to northwestern Georgia) we have 9 CBOCs in Southeastern Ohio and 2 in Kentucky. Specifically, East Liverpool (Columbiana County), New Philadelphia 

(Tuscarawas County), Athens (Athens County), Lancaster (Fairfield County), Cambridge (Guernsey County), Marietta (Washington County), Portsmouth (Scioto County), Batavia (Clermont County), and Zanesville (Muskingum County). The 2 (two) 

Kentucky CBOCs are in Bellevue (Covingnton, KY) and in Florence, KY. These 

CBOCs are located in rural areas of Ohio bordering southern Pennsylvania, West 

Virginia, and parts of Kentucky. 

In addition, the Vet Center program provides quality readjustment counseling and 

removes unnecessary barriers to care for veterans and family members. Vet Centers 

engage in extensive community outreach activities to directly contact and inform 

area veterans and to maintain active community partnerships with local leaders and 

service providers to facilitate referrals for veterans in need. 

Some Vet Centers are maintained in rural areas to ensure that rural veterans and 

families have access to readjustment counseling services. Additionally, we have established Vet Center outstations in rural areas. Outstations are administratively 

connected to a full sized Vet Center, use permanently leased space and are usually 

staffed by one or two counselors who provide full time services to area veterans on 

a weekly basis. The Vet Centers also maintain nontraditional hours to accommodate 

veterans traveling in from greater distances. 

Vet Centers in Wheeling, Parkersburg and Huntington, West Virginia all located 

on the Ohio River provide outreach and readjustment counseling to veterans in 

rural Ohio. 

In addition to our internal efforts outlined earlier, VA continues to look for ways 

to collaborate with complementary Federal efforts to address the needs of health 

care for rural veterans. We also have partnerships with HHS, including the Indian 

Health Service and Office of Rural Health providing health care in rural communities. We are also working to establish relationships with other entities, such as 

with the National Rural Health Association. 

VHA recognizes the importance and the challenge of service in rural areas, and 

we believe our current and planned efforts are addressing these concerns for our 

current and emerging veterans. 

This concludes my statement. At this time I would be pleased to answer any questions that you may have.

Mr. SPACE. Thank you, Dr. Cross, and I apologize for having to 

cut you off. We are running short on time. 

Incidentally, I think the Patient Advocate Program you just referred to is still in its early stages, but I think it’s a very valuable 

addition to the Administration. 

I want to talk a little bit about the CBOCs, again. And you had 

mentioned that there are plans to build more than 20 right now. 

Do you have any indication, if the 18th Congressional District for 

the State of Ohio will receive any additional CBOCs? 

Dr. CROSS. For Ohio, I think there were two, and, Jack, you can 

help me with this. I think one is in Hamilton, and the other is——

46

Mr. HERRICK. Hamilton and Parma were announced this week. 

Mr. SPACE. Oh, Parma and Hamilton. So that will not facilitate 

or enhance the care of veterans in southeastern Ohio. And, second——

Dr. CROSS. We do have other options besides CBOCs. 

Mr. SPACE. Right. 

Dr. CROSS. Outreach Clinics that work for a CBOC, that can go 

into communities. Often they lease space, and we have a number 

of these now. And they’re not listed as CBOCs, but they can be 

open for a day a week, or a couple of days a month, and provide 

services for those very small groups of veterans in these more remote communities. And we’re doing that more and more. 

Mr. SPACE. Right. Now I understand last week we passed legislation that will allow for mobile units to enhance TBI treatment and 

care in rural areas, which is also an encouraging sign. But the fact 

remains that many veterans in rural Ohio are having to do things 

like travel 80 miles for radiation treatment, and then 80 miles back 

home again. And as Representative of this area, I’m trying to ascertain means by which to help solve those problems associated 

with veterans care. And I can’t help but get around what may be, 

to me, an apparent need, seemingly a need for the construction of 

additional medical centers, those primary care facilities that render 

services of a broad range to veterans. I understand you can’t build 

one in every county. 

We’ve got 16 counties in my District, we’ve got five CBOCs servicing those counties, and many residents in my District, who require specialized care, of course, drive 70, 80, 90, even more miles 

to receive care. Do you see a perceived need for the construction of 

a medical center in southeastern Ohio? 

Dr. CROSS. To tell you the truth, sir, I don’t know, because the 

CARES process that we’ve gone through, I want to refer to that 

and see what the findings were from that. That’s a piece of information I can certainly get for you. 

Mr. SPACE. You would agree with me that veterans in rural 

areas of America, and specifically in Ohio, do suffer from a lower 

standard of care than those veterans in urban areas, simply because of their proximity, or lack thereof, to those medical centers. 

Dr. CROSS. I don’t agree with that for the VA. We’ve done the 

statistics on the performance measures related to the quality of 

care. 

Mr. SPACE. I’m not talking about the quality of care. 

Dr. CROSS. Absolutely. I understand what you mean. I certainly 

do share that, the access issue by itself. I do need to put out one 

cautionary comment, talking about radiation therapy. Radiation 

oncologists and the equipment that goes with radiation therapy is 

something that wouldn’t be found, necessarily, in the rural environment anywhere. And so that’s a real challenge for us, and for everyone else in the civilian community, in Medicare, and so forth, 

to deal with those special circumstances. And I think the VA is, in 

fact, flexible about this. And on a case-by-case basis, can make arrangements to do what’s best for the veteran. 

Mr. SPACE. And just as a brief follow-up, I mean, it is a fact, is 

it not, that rural Americans have shouldered more than their fair 

share of not just this war, but wars past, as well. Correct? 

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Dr. CROSS. Sir, I expect that that is true. 

Senator BROWN. Thank you both, again. Monday, in celebrating 

Memorial Day, there were a couple of numbers I wanted to bounce 

off you, Dr. Cross, and ask for your thoughts on. Something along 

the lines of the Harper’s Index, that they use that as sort of the 

box, 27 percent of veterans of the War in Iraq and Afghanistan 

have filed for disability with Veterans’ Administration, and these 

are the two upcoming numbers that I think are the most significant. Ten percent of soldiers given medical discharge in 2001 were 

given permanent disability benefits, but only 3 percent of soldiers 

given medical discharges in 2005, who got permanent disability 

benefits. Why would that be, that 10 percent of those not in wartime who left the military were getting permanent disability benefits, but only 3 percent of those discharged in 2005? Do you have 

any thoughts about that?. 

Dr. CROSS. I think my response would be it’s early, and over 

time, we’ll get a better picture of what their real pattern is going 

to be. I think it may be a bit premature to say what their longterm disability outcome is going to be, at this point. 

Senator BROWN. Sir, maybe that’s right, but I’d be more likely to 

accept that if the military were not doing a bit of a better job, certainly a better job than contrast to Vietnam, when several people 

from the last panel came home from Vietnam, they, one, weren’t 

welcomed home in too many cases. But, second, certainly didn’t 

have the kind of interaction with the VA, to talk to them about any 

kind of physical or mental injury they might have had. Today, 

we’re not doing a splendid job, but we’re doing better, as you suggest with some of your outreach. So shouldn’t those numbers be 

higher as a result of that? 

Dr. CROSS. Again, I think individuals don’t apply for disability 

necessarily right away. There’s no limit, there’s no time limit on 

when a veteran can apply for disability. We’ve seen veterans applying for disability now for Vietnam. 

Senator BROWN. And we’re seeing people now from Vietnam, because of the attention paid to Iraq, I know. And I know those numbers are again going——

Mr. CROSS. So I think——

Senator BROWN. I would like to explore this more. Let me shift 

to continue questioning, for you, Dr. Cross, but particularly about 

Mr. Carson’s issue. We’ve heard from him that community hospitals and patients are faced with unreimbursed care when after 

stabilizing emergency patient, they can’t transfer them to a VA facility because there are no beds available in a county as rural as 

Cadiz and Harrison County. We’re looking at legislation to ensure 

that this doesn’t continue, but two questions. Why is this happening, in the first place? And, does the VA actually have the discretion to pay these claims? I guess a third question then, if the 

answer is no, is legislation necessary? 

Dr. CROSS. There is legislation that relates to the Mill Bill. I forget what year that was, I think it was about 2000, which sets up 

emergency care funding for situations where an enrolled veteran 

who has been seen within the previous 24 months, if I recall correctly, is eligible so that they can go to the nearest emergency room 

and get care. We didn’t want a situation to occur where a person 

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is having a heart attack and drives past the community emergency 

room to get to a VA facility which is some further distance away, 

which would not be to their advantage in that situation. So the 

Mill Bill created, as I understand it, a possibility to get that care 

delivered and covered for a period of about three days, the intent 

then being to transfer them back to a VA Medical Center. 

What I’m hearing this morning, though, I think, and that’s the 

value of this hearing, especially to make these kinds of link-ups, 

is that we have some communication issues with Mr. Carson’s hospital. And I’ve got my VISN Director here, and other staff to make 

sure that we work some of those out to deal with those issues that 

he’s pointed out, and very appropriately pointed out. 

Mr. SPACE. Given the late hour, I just simply don’t have much 

more time for questions. Your testimony will be entered into the 

record. 

Dr. Cross, I’m going to revisit, as my last question; and that is, 

given, once again, that we’ve got a very large area in southeastern 

Ohio served by, what I understand to be about 65,000 veterans who 

are living here right now. We’ve got five CBOCs in 16 counties, and 

admittedly, those rural veterans are suffering from a lower standard of care, simply because of the drive time to and from medical 

centers. My request of you is that you take measures to inquire 

with your superiors, and conduct a research study whether or not 

this area of Ohio would be a suitable and appropriate location for 

the construction of a VA medical center. 

Dr. CROSS. Yes, sir, we’ll do that. And I would like to also say 

that we will be delighted to meet with your staff, and sit down and 

discuss any issue that you’d like directly. 

Mr. SPACE. Thank you, Dr. Cross. Mr. Carson, briefly. 

Mr. CARSON. Congressman Space, just one comment on that, for 

what it’s worth. I mean, you can look at a map and say well, it’s 

just 20 miles, but for those of you who drive the District, and the 

limit is 55, I challenge you to get up to 55 miles an hour on some 

of these roads, so that really——

Mr. SPACE. Point well taken, Mr. Carson. I’d like to thank you 

both, again, for your testimony. 

Senator BROWN. One question, before you close off, if I could. 

And thank you, Congressman Space, I’ve thought for some time 

that the VA is, in fact, I think probably so the best healthcare, 

when we fund it, the best healthcare in the country in terms of 

medical, lowest numbers of medical errors, outcomes, the specialty 

and the general care that the VA gives. I’ve also seen a commitment, and with some results so far of a much better coordination. 

A commitment from the Secretary with a much better coordination 

from DOD and to veterans’ healthcare, because it’s been uneven, at 

best, over the last years, and I give the VA credit for that. 

But then I see the message that it sends to our troops, to our 

men and women in uniform, when the President and Secretary 

Nicholson ask for a budget billions of dollars less than the Independent Budget that the veterans service organizations ask for, 

and they brag to our Committees in both houses that we’re spending, I think the number they say is 77 percent more than 2001. 

Well, yes, but there’s been not, certainly new Vietnam Vets coming 

on line, coming to the VA, that weren’t coming before, and certainly 

49

from this war. So I just would ask you, Dr. Cross and Mr. Montague, to take back to the VA the message that sends to our men 

and women in uniform, when we’re willing to spend $2.1 billion a 

week on a war, and we’re not willing to fund to the level with the 

Independent Budget in mandatory funding of the VA. And I know 

you, as a physician, probably agree with much of this, but take 

that message back, how important that is. 

So I thank you both for being here, thank you to our panelists. 

And thank you all who have joined us. Why don’t you close it off, 

Congressman Space. 

Mr. SPACE. Thank you, again, Senator Brown. Thank you to the 

panelists, both in the first and second panel. And thank you to everyone who came out today in the interest of the State’s rural veterans. 

Again, I’d like to send a special thanks to Dean Andrews and his 

team here at Kent State for hosting us. Thank you to my veterans’ 

Advisory Board for their continued direction and knowledge. And 

thank you to our witnesses, once again, who have traveled to get 

here and present their views, so that we can all recognize the serious issues that stand in the way of rural veterans obtaining comprehensive care, and access to VA services. 

Where a veteran chooses to live should not affect his or her access to care. Our country is committed to provide healthcare, educational, vocational, and other services to our Nation’s veterans, 

and we must follow-through on that promise. Telling a veteran that 

his home, or her home, falls into a geographical region that is not 

cost-effective to serve is not in line with keeping the promises previously made to our country’s heroes. A veteran from rural Ohio 

gave just as much in service to our Nation, and sacrificed just as 

much, as a veteran from New York City, Los Angeles, or Cleveland, 

Ohio. 

This hearing has given us valuable knowledge about how Congress can move forward on important issues facing rural veterans. 

This hearing has brought together many of those who are directly 

involved in caring for these rural veterans, who make up approximately 40 percent of our Nation’s veterans population. I’m extremely optimistic that given the ideas that we’ve heard today, 

Senator Brown and I will be able to move forward with innovative 

solutions, including legislation. I plan on working with Members of 

the House Veterans’ Affairs Committee, as well as my colleagues 

on both sides of the aisle, to advance the agenda of rural veterans. 

Today, the day after Memorial Day, we’ve met to discuss how to 

move forward in better caring for those who have served our Nation. Let us also remember to look back on where we’ve come from. 

Let us remember those brave servicemembers who have given their 

lives in defense of our Nation; 16 from this District in this most 

recent war.

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I wish, also, to thank the veterans in our audience, the men and 

women currently serving, and their families who support them, for 

their past and continued service and sacrifice. It’s an important 

honor to work on your behalf, and please know that I will continue 

to do so for as long as I serve in Congress. Again, thank you all 

for being here. Thank you, Senator Brown. 

[Applause.] 

[Whereupon, at 12:02 p.m., the joint hearing adjourned.]

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