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S. HRG. 114–707 

HEARING ON PENDING LEGISLATION 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED FOURTEENTH CONGRESS 

SECOND SESSION 

JUNE 29, 2016 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

JOHNNY ISAKSON, Georgia, Chairman 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

DEAN HELLER, Nevada 

BILL CASSIDY, Louisiana 

MIKE ROUNDS, South Dakota 

THOM TILLIS, North Carolina 

DAN SULLIVAN, Alaska 

RICHARD BLUMENTHAL, Connecticut, Ranking 

Member 

PATTY MURRAY, Washington 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JON TESTER, Montana 

MAZIE K. HIRONO, Hawaii 

JOE MANCHIN III, West Virginia 

TOM BOWMAN, Staff Director 

JOHN KRUSE, Democratic Staff Director 

(III) 

C O N T E N T S 

JUNE 29, 2016 

SENATORS 

Page 

Isakson, Hon. Johnny, Chairman, U.S. Senator from Georgia ............................ 1 

Blumenthal, Hon. Richard, Ranking Member, U.S. Senator from Connecticut ... 32 

Murray, Hon. Patty, U.S. Senator from Washington ........................................... 13 

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

Tillis, Hon. Thom, U.S. Senator from North Carolina .......................................... 34 

Heller, Hon. Dean, U.S. Senator from Nevada ..................................................... 38 

Cassidy, Hon. Bill, U.S. Senator from Louisiana .................................................. 40 

Exhibit ............................................................................................................... 42 

Sullivan, Hon. Dan, U.S. Senator from Alaska ..................................................... 43 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 45 

WITNESSES 

Inhofe, Hon. James M. U.S. Senator from Oklahoma .......................................... 1 

Prepared statement .......................................................................................... 3 

Fischer, Hon. Deb, U.S. Senator from Nebraska .................................................. 4 

Prepared statement .......................................................................................... 6 

Franken, Hon. Al, U.S. Senator from Minnesota .................................................. 7 

Cotton, Hon. Tom, U.S. Senator from Arkansas ................................................... 8 

Exhibit ............................................................................................................... 9 

McCaskill, Hon. Claire, U.S. Senator from Missouri ............................................ 10 

Prepared statement .......................................................................................... 12 

Merkley, Hon. Jeff, U.S. Senator from Oregon ..................................................... 48 

McLenachen, David, Deputy Under Secretary for Disability Assistance, Veterans’ Benefits Administration, U.S. Department of Veterans Affairs; accompanied by Maureen McCarthy, M.D., Assistant Deputy Under Secretary 

for Health for Patient Care Services, Veterans Health Administration .......... 15 

Prepared statement .......................................................................................... 17 

Additional views dated August 3, 2016 .......................................................... 28 

Response to request arising during the hearing by: 

Hon. Dean Heller .......................................................................................... 39 

Hon. Jon Tester ............................................................................................. 47 

Response to posthearing questions submitted by Hon. Mazie K. Hirono .... 49 

Butler, Roscoe, Deputy Director of Health Care, National Veterans Affairs 

and Rehabilitation Division, The American Legion .......................................... 52 

Prepared statement .......................................................................................... 53 

Fuentes, Carlos, Deputy Director, National Legislative Service, Veterans of 

Foreign Wars ........................................................................................................ 62 

Prepared statement .......................................................................................... 63 

Weidman, Rick, Executive Director for Policy and Government Affairs, Vietnam Veterans of America .................................................................................... 69 

Prepared statement .......................................................................................... 70 

Ziober, Kevin, Member of the Reserve Component ............................................... 74 

Prepared statement .......................................................................................... 76 

APPENDIX 

Cleland, Max, Secretary, American Battle Monuments Commission (ABMC); 

prepared statement .............................................................................................. 85 

Wilson, LeAnn, Executive Director, Association for Career and Technical 

Education (ACTE); prepared statement ............................................................. 87 

Page

IV 

Kahn, Thomas S., Director, Legislative Affairs, American Federation of Government Employees, AFL-CIO (AFGE); letter ................................................... 89 

Webb, Amy, Legislative Policy Advisor, AMVETS; prepared statement ............ 89 

American Public Health Association (APHA); prepared statement .................... 98 

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

(DAV); prepared statement ................................................................................. 99 

Doederlein, Allen, President, Depression and Bipolar Support Alliance 

(DBSA); prepared statement ............................................................................... 107 

Civil Rights Division and the Servicemembers and Veterans Affairs Initiative, 

U.S. Department of Justice (DOJ); prepared statement ................................... 109 

Michaud, Hon. Michael, Assistant Secretary for Veterans’ Employment and 

Training, U.S. Department of Labor (DOL); prepared statement .................... 160 

Blumrosen, Alexander, President, The Lafayette Escadrille Memorial 

Foundation; letter ................................................................................................ 163 

Salanti, MAJ Frederick R., US Army (Ret.), Founder/Executive Director, 

Missing in America Veterans Recovery Program (MIAP); prepared statement ...................................................................................................................... 165 

Military Officers Association of America (MOAA); prepared statement ............. 171 

Military Order of the Purple Heart (MOPH); prepared statement ..................... 173 

Kiefer, Keith, Director at Large, NAAV Minnesota State Co-Commander & 

Enewetak Radiological Cleanup Veteran (1978), National Association of 

Atomic Veterans (NAAV); prepared statement ................................................. 177 

National Alliance on Mental Illness (NAMI); prepared statement ..................... 181 

Wescott, Joseph W., II, Legislative Director, National Association of State 

Approving Agencies (NASAA); prepared statement .......................................... 182 

Chaw, Terisa E., Executive Director, National Employment Lawyers Association (NELA); letter ............................................................................................... 185 

National Guard Association of the United States (NGAUS); prepared statement ...................................................................................................................... 195 

Lerner, Hon. Carolyn N., Special Counsel, U.S. Office of Special Counsel 

(OSC); prepared statement .................................................................................. 197 

Paralyzed Veterans of America (PVA); prepared statement ................................ 198 

Reserve Officers Association of the United States (ROA); prepared statement ... 202 

Southcentral Foundation (SCF); prepared statement .......................................... 205 

Fronabarger, Derek, Director of Policy, Student Veterans of America (SVA); 

prepared statement .............................................................................................. 207 

Josten, Bruce R., Executive Vice President, Government Affairs, Chamber 

of Commerce of the United States of America; letter ....................................... 209 

(1) 

HEARING ON PENDING LEGISLATION 

WEDNESDAY, JUNE 29, 2016 

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

The Committee met, pursuant to notice, at 2:28 p.m., in room 

418, Russell Senate Office Building, Hon. Johnny Isakson, Chairman of the Committee, presiding. 

Present: Senators Isakson, Heller, Cassidy, Tillis, Sullivan, 

Blumenthal, Murray, Brown, Tester, and Hirono. 

OPENING STATEMENT OF HON. JOHNNY ISAKSON, CHAIRMAN, 

U.S. SENATOR FROM GEORGIA 

Chairman ISAKSON. I call this meeting of the Senate Veterans’ 

Affairs Committee to order. 

We are going to start right on time. We have a number of members who wish to address legislation they have proposed. We have 

an agenda of 18 bills that are before the Veterans’ Affairs Committee, so it is going to be a lengthy hearing. I know there are Senators that have places to be. 

I am going to waive my own opening statement, along with 

Ranking Member Blumenthal. We will make our statements later 

in the day in respect for the Senators that are here. 

As is tradition with our Committee, we will give each Senator up 

to 5 minutes to make a presentation on their legislation. As is tradition, we do not enter into questions and answers as Committee 

Members, but once you have made your testimony, you may leave 

if you would like. If you wish to stay, you are welcome to stay. We 

are delighted that you came. 

We will start with the first testimony from Senator Inhofe. 

STATEMENT OF HON. JAMES M. INHOFE, 

U.S. SENATOR FROM OKLAHOMA 

Senator INHOFE. Thank you, Mr. Chairman. I appreciate it very 

much. 

In 2010, Congress passed the Post-9/11 Veterans Education Assistance Improvement Act. This Act authorized veterans to use 

their benefits to pursue a technical or career certificate program as 

an option instead of traditional liberal arts opportunities at a college or university. It is kind of interesting. I am the right one to 

do this, because in the State of Oklahoma, I actually introduced the 

first legislation back in the 1970s to establish these technical training areas. So, I am very partial to them. The Career and Technical 

Education Centers, or CTEs, are public, not private, not-profit, nonVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 Z:\ACTIVE\062916.TXT PAULIN
2 

degree granting institutions that provide skills and certificates important to every community and are found in over ten States. 

The city of Enid, OK, has been the home of the Autry Technology 

Center. Now, you and I may be the only two here old enough to 

remember who Gene Autry was. You, too? All right. [Laughter.] 

Well, anyway, he is an Oklahoman, in case you did not know. 

The Autry Technology Center, since 1967, has served over 10,000 

people annually through programs and services that enhance skills 

and employment opportunities. Autry currently offers 26 full-time 

career programs, from air conditioning to culinary arts, radiology, 

and several other critically-applied skills used nationwide. 

Public, not-profit centers in the Oklahoma Career Tech System, 

like Autry, in Enid, are proven to significantly contribute to the 

economic development and quality-of-life in Oklahoma, especially to 

returning veterans. Career and Technical Education Centers are 

vital as post-secondary education options and workforce training 

system for our veterans. 

The administration recently took action to block certain technical 

center benefits from our veterans. Since March, the VA is not allowing the Post-9/11 G.I. Bill to pay for any form of independent 

study from a non-degree producing institution, including CTEs. In 

many cases, this hindrance precludes veterans from utilizing these 

courses in pursuing these certificate programs. 

CTEs, much like their college and university counterparts, are 

utilizing internet-based courses as a component of their programs 

to provide flexibility for working adults in expanding those programs. Unlike colleges and universities, however, CTEs are not 

technically degree producing, so the VA is preventing the use of 

G.I. Bill funds for any CTE program that has independent study. 

Marcie Mack, the State Director of Oklahoma’s Career Technology System, told me last week that her—this is her quote—she 

said, ‘‘Oklahoma’s Career Tech System is committed to serving U.S. 

military veterans. However, with current Federal policy, there are 

obstacles for our veterans to be able to participation in the Oklahoma Career Tech System and receive their benefits.’’ 

Now, to address the current policy issues, I have introduced, and 

it is before this Committee now, S. 3021, along with Senator 

Lankford, clarifying the law to ensure accredited CTE programs 

can continue to receive G.I. Bill benefits even if a portion of the 

program is done through independent study. 

In the time since I introduced this legislation, I have heard concerns from this Committee about whether this would open the door 

for bad actors in the education space to take advantage of these 

benefits. Now, my staff has worked with your staff, your folks. 

They have explored these concerns and have modifications to the 

language that is in the bill now to ensure that the bill does not 

have negative unintended consequences. It is my hope that the 

Committee will quickly consider this legislation. 

I deeply appreciate the attention the Committee has given to my 

bill and I look forward to continuing my work to ensure that this 

problem is addressed. 

Now, there is not time to go into the other one, but I have another piece of legislation because there has been a problem with 

the VA centers in Oklahoma, the Muskogee Center, the Oklahoma 

3 

City Center, the Tulsa Center. It has only been with my office’s 

dedicated attention that these clinics have any progress being 

made. We have been helped by Ralph Gigliotti. He is the Veterans 

Integrated Service Networks, or VISN, Director for our area. He is 

really good. I sing his praises. He is outstanding. He has been very 

supportive. We have some legislation that is called S. 2554 that 

would give the VISNs more options, more authority to get things 

done, because they are the ones who are really capable of getting 

it done. 

So, while S. 2554 is in the Committee, it has not been considered 

yet. I would like to have you consider that at your earliest convenience. 

Chairman ISAKSON. Well, we appreciate your testimony on education as well as on the VISNs. We look forward to working with 

you on legislation and appreciate your interest in our veterans. 

Senator INHOFE. Thank you. 

PREPARED STATEMENT OF HON. JAMES INHOFE, U.S. SENATOR FROM OKLAHOMA

In 2010, Congress passed the Post-9/11 Veterans Educational Assistance Improvements Act. This Act authorized veterans to use their hard earned educational benefits to pursue a technical or career certificate program as an option instead of the 

traditional liberal arts opportunities at a college or university. 

Career technology centers, or CTEs are public, non-profit, non-degree granting institutions that provide skills and certificates important to every community and are 

found in over ten states. 

The city of Enid, Oklahoma has been home to the Autry Technology Center since 

1967 and serves over 10,000 people annually through programs and services that 

enhance skills and employment opportunities. 

Autry currently offers 26 full-time career programs from air conditioning to culinary arts, to radiography, to welding, and several other critical, applied skills used 

nationwide. 

Public, non-profit centers in the Oklahoma Career-Tech system, like Autry Technology Center in Enid, are proven to significantly contribute to the economic development and quality of life in Oklahoma, especially our returning veterans. 

Career and technical education centers are vital as a post-secondary education option and workforce training system for our veterans, but the administration recently 

took action to block certain tech center benefits from our vets. 

Since March, the VA has not allowed the Post-9/11 GI Bill to pay for any form 

of independent study from a non-degree producing institution, including CTEs. In 

many cases, this hindrance precludes veterans from utilizing these courses or 

pursing these certificate programs. 

CTEs, much like their college and university counterparts, are utilizing internet 

based courses as a component of their programs to provide flexibility for working 

adults and veterans to better accommodate their lifestyles and encourage learning. 

Unlike colleges and universities, however, CTEs are not technically degree producing, and so the VA is preventing the use of GI Bill funds for any CTE program 

that has an independent study component. 

Marcie Mack, the State Director of the Oklahoma Career-Tech system, told me 

last week that, ‘‘Oklahoma’s Career-Tech system is committed to serving U.S. military veterans; however, with current Federal policy there are obstacles for our veterans to be able to participate in Oklahoma’s Career-Tech system and receive their 

benefits.’’ 

To address the current policy issues, I have introduced S. 3021 along with Sen. 

Lankford, clarifying the law to ensure accredited CTE programs can continue to receive GI Bill benefits even if a portion of the program is done by independent study. 

In the time since I introduced this legislation, I have heard concerns from this 

Committee about whether this would open the door for bad actors in the education 

space to take advantage of these benefits. 

My staff, along with the staff of this Committee, have explored these concerns and 

have modifications to the language to ensure the bill does not have negative, unintended consequences, and it is my hope that the Committee will quickly consider 

this legislation so that veterans in Oklahoma can achieve career success after leaving the service. 

4 

I deeply appreciate the attention the Committee has given to my bill, and I look 

forward to continuing my work with you to ensure this issue is addressed. 

While I am here, I would also like to address the Committee on some of the VA 

health clinic challenges we have had in Oklahoma. 

We have had serious problems at both VA centers in Oklahoma—Muskogee and 

Oklahoma City. It has only been with my office’s dedicated attention to these clinics 

that any measurable progress is being made. 

We have been helped by Ralph Gigliotti, our VISN director, who is outstanding. 

He has been very supportive of ensuring the changes that need to happen on the 

ground in Oklahoma actually take place. Both centers now have new directors because of his leadership. 

Recently, the VA contracted with the Joint Commission to do an investigation of 

Oklahoma’s facilities together with the Inspector General. Having this outside entity 

come in and compare the VA facilities with private sector health care facilities is 

helping identify clear problems for the local and regional directors to go after and 

fix. It is always nice to have a second opinion. 

One section of S. 2554 provides permanent authority for VISN directors like 

Ralph Gigliotti, to contract with outside entities to do these kinds of investigations. 

I believe this is an important authority that needs to be explicitly provided to them, 

so that more of the VA health center problems, which we hear about all over the 

place, can be fully addressed. 

Thank you again for having me today. 

Chairman ISAKSON. Senator Fischer. 

STATEMENT OF HON. DEB FISCHER, 

U.S. SENATOR FROM NEBRASKA 

Senator FISCHER. Thank you, Mr. Chairman. Good afternoon and 

thank you for holding this hearing. 

This Committee has addressed some of the most difficult issues 

that have faced our veterans. Across the country, people’s confidence in the care we provide to veterans has been understandably 

shaken. As has been mentioned time and time again in this Committee, veterans deserve more from us. They expect more from us. 

They expect us to uphold our end of the bargain. The complications 

with the construction project in Denver, for example, have raised 

serious questions about our ability to provide veterans the high 

quality care that they have earned. 

Partnerships across the aisle and across the branches of government have been important to overcoming the issues facing our veterans in the past. By bringing more partnerships about between 

veterans, their communities, and the Federal Government, we have 

an opportunity to uphold our end of the bargain for our servicemembers. We can do this, and we can do this by tapping into the 

strength in our local communities. Through community partnerships, our family members, neighbors, and businesses can give 

back to those who have given so much for them. 

The VA has identified communities in Nebraska and across the 

country that are ready, willing, and able to contribute to improving 

our veterans’ access to quality care. These communities do not 

want to wait for Washington. They are ready to restore the veterans’ health care system and they want to take an active role in 

restoring our national confidence in that system. 

So, my bill, S. 2958, creates a pathway for local communities to 

do just that. Local leaders have expertise in aligning both design 

and medical teams in constructing medical facilities. Through the 

partnerships created in this bill, local leaders would have the opportunity to manage construction projects from start to finish. By 

5 

allowing the private sector experts to lead these projects, the VA 

can avoid issues that have haunted previous projects. 

Our veterans and the American people deserve transparency. 

They deserve projects that are on time. They deserve projects that 

are on budget. 

The VA has already appropriated millions of dollars to construction projects that are not yet finished. This legislation would allow 

communities to contribute the remaining finances to complete these 

projects. The VA’s financial obligation for the construction of these 

medical facilities would be limited to the previous appropriation 

and not one dollar more. This legislation can serve as a model for 

expediting the VA’s efforts to coordinate its infrastructure with the 

needs of our veteran population. 

Communities across the country are willing to help take up this 

national responsibility of caring for our veterans. It is our responsibility, I believe, to fully explore ways that empower them to do so, 

and I believe that my legislation would do that. 

Thank you, Mr. Chairman. 

Chairman ISAKSON. Having dealt with the Denver hospital debacle and gone through that, I am glad that there are thoughtful 

members of the Senate looking at solutions to our future problems 

so we do not ever have to replicate those again. Thank you very 

much for your thoughtful proposal. 

Senator FISCHER. Thank you, sir. 

[The prepared statement of Senator Fischer follows:] 

6 

PREPARED STATEMENT OF HON. DEB FISCHER, U.S. SENATOR FROM NEBRASKA


629psFIS1.eps
7 

Chairman ISAKSON. Senator Franken. 

STATEMENT OF HON. AL FRANKEN, 

U.S. SENATOR FROM MINNESOTA 

Senator FRANKEN. Thank you, Chairman Isakson, and thank 

you, Senator Murray, for the opportunity to speak on behalf of the 

Atomic Veterans Health Care Parity Act, which I introduced with 

Senator Tillis. Thank you also to Senator Coons and Senator 

Wyden for cosponsoring the bill and the others testifying on behalf 

of this important legislation. 

Like the Members of this Committee, one of my highest priorities 

as a Senator is making sure that our veterans and their families 

get every benefit that they deserve. We need to help our veterans 

find a home and a job, recover from their physical and psychological wounds, and take full advantage of the benefits that they 

were promised when they enlisted, benefits they have earned with 

their service and their sacrifices as well as the sacrifices of their 

families. 

The veterans of the cleanup of the Enewetak Atoll have not gotten the benefits that they earned. During the 1940s and the 1950s, 

the United States conducted more than 40 nuclear tests on the 

Enewetak Atoll in the Marshall Islands. Thousands of members of 

the U.S. Armed Forces participated in the clean-up of Enewetak 

between 1977 and 1980, so that was years later. Servicemembers 

removed radioactive fallout, soil, and debris, including significant 

amounts of plutonium, and dumped it into a crater on Runit Island, that was then covered with 18 inches of concrete. 

Now, we dropped so much nuclear material on Enewetak that it 

was as if we had dropped 1.6 Hiroshima bombs every day for 12 

years. That is what we are talking about. These servicemembers 

were typically without any form of protective gear. They wore Defense Department-issued T-shirts, shorts, and combat boots to remove highly contaminated material. 


629psFIS2.eps
8 

Today, half of Enewetak, of the atoll, is still considered unsuitable for human habitation. Thirty-six years after the clean-up was 

completed, residents still must be tested for radiation levels, especially those that work closely with the soil, just like our veterans 

did. 

Now, our servicemembers who were actually part of the nuclear 

tests, the ones that were part of the nuclear tests during their active service, do receive extra benefits as atomic veterans to deal 

with illnesses that are assumed to be related to radiation exposure. 

However, servicemembers that were part of the clean-up do not receive these extra benefits, despite their exposure. 

Many of the veterans who served on Enewetak Atoll have already passed away. Many more of the clean-up veterans suffer 

from various types of cancer, respiratory and heart diseases, at 

early ages and at high rates. There are reports that their children 

may also be suffering from illnesses caused by having a parent who 

was exposed to radiation. 

Clean-up veterans are forced to pay out of pocket for their medical costs because the VA does not recognize them as atomic veterans. Despite being put in harm’s way, these veterans that 

cleaned up after the nuclear tests are not being adequately compensated by their government. 

In order to right this wrong, Senator Tillis and I introduced the 

Atomic Veterans Health Care Parity Act. This bipartisan, bicameral legislation assures that the veterans who participated in 

the clean-up of the Enewetak Atoll receive the benefits they deserve, benefits that their service should have entitled to them years 

ago. 

Thank you, Mr. Chairman; thank you both Senators Murray and 

Hirono, for the opportunity to testify on this important piece of legislation. I look forward to working with you and the rest of the 

Committee to move this very important legislation along. Thank 

you very much. 

Chairman ISAKSON. Thank you very much, Senator Franken. 

Senator Cotton. 

STATEMENT OF HON. TOM COTTON, 

U.S. SENATOR FROM ARKANSAS 

Senator COTTON. Thank you, Mr. Chair. I would like to thank 

the Ranking Member, Senator Blumenthal. Thank you, Senator 

Murray and Senator Hirono, for the chance to appear before you 

today. My testimony did not require a grant of immunity. 

[Laughter.] 

I am here today to discuss my legislation, the Charles Duncan 

Buried with Honor Act, which would expand the cemetery burial 

options offered by the VA to financially insolvent veterans. 

I want to begin by telling a story about the bill’s namesake, Mr. 

Charles Duncan, a Navy veteran from Little Rock, AR. Mr. Duncan 

died last year at the age of 66. He was financially insolvent and 

his family could not afford his funeral costs. Thanks to the past efforts of this Committee in passing the Dignified Burial and Other 

Veterans Benefits Improvement Act of 2012, Mr. Duncan was eligible for VA assistance with his burial costs. Unfortunately, because 

of a small gap in the law, Mr. Duncan and other veterans like him 

9 

can only receive this assistance if they are buried in a national 

cemetery. 

In Arkansas, as I suspect in other States, this rule can necessitate hours of travel to reach the closest cemetery. For instance, 

we have three national cemeteries, one in Little Rock, one in Fort 

Smith, and one in Fayetteville. But the national cemetery in Little 

Rock is full, leaving Fort Smith and Fayetteville in the west as the 

only options. 

In Mr. Duncan’s case, his adult daughter has no means of transportation and was unable to make the drive to Fort Smith from 

Little Rock and missed her father’s funeral. Since then, she has 

been unable to visit her father’s grave. Would it not make more 

sense to allow these veterans the option of a State veterans’ cemetery if that cemetery is closer to the veteran’s home? 

In Arkansas, we have two State cemeteries, one in Little Rock 

and one in east Arkansas at Birdeye. Both of them have plenty of 

room for more veterans, and as you can see, a large part of my 

State is closer to Little Rock and Birdeye than it is to either Fort 

Smith or Fayetteville. 

[Graphic follows:] 


629Cotten.eps
10 

Senator COTTON. Mr. Duncan could have been laid to rest in the 

Little Rock State cemetery, saving taxpayer money and allowing 

friends and families to attend the service or visit the gravesite. 

This is a small but important change. 

Since Senator Murray’s bill took effect, the VA has reimbursed claims totaling almost $240,000 for the interment of 203 veterans. 

The costs associated with this legislation as estimated at only $2 

million over 10 years. I would suggest the cost is minimal when 

you consider the sacrifices our veterans have made and the solace 

this could provide their loved ones. 

Additionally, this change would not add additional stress to the 

VA or distract from their other efforts. It is a simple, straightforward change that the VA Veterans’ Cemeteries Grant Program 

is well equipped to handle, and I would note that the VA submitted 

a no benefit cost or savings legislative proposal to make this type 

of change in its fiscal year 2017 budget submission, indicating its 

willingness to implement this legislation. 

Finally, in the interest of moving the bill forward, it retains the 

‘‘no next of kin’’ provision in current law, which maintains the VA’s 

commitment to our Homeless Veterans Initiative. This provision 

holds no cost, but also requires indigent veterans to disavow loved 

ones to be eligible for burial benefits. I hope there is a way to resolve that matter at a later date, and I look forward to working 

with the Committee and the VA on it. 

Charles Duncan was not the first veteran in this position, but we 

can help ensure that he is the last. 

Thank you for your time and thank you for your continued support for our veterans. 

Chairman ISAKSON. Thank you very much, Senator Cotton, for 

your thoughtful recommendation and presentation. 

Senator McCaskill. 

STATEMENT OF HON. CLAIRE McCASKILL, 

U.S. SENATOR FROM MISSOURI 

Senator MCCASKILL. Thank you, Mr. Chairman, and thank you 

to Senator Murray and Senator Hirono for being here today. 

I would like to address a very important topic with you today. 

I am here to speak in support of the Arla Harrell Act, legislation 

which I introduced to address a very serious injustice that has been 

perpetrated against veterans that were purposely exposed through 

our own military to chemical agents as part of U.S. Government experiments during World War II. 

The U.S. Government conducted classified chemical tests of mustard agents, including mustard gas and lewisite, on thousands of 

its own servicemembers. Mustard agents can cause painful blisters 

on exposed skin as well as damage to the eyes and respiratory system, leading to a lifetime of adverse health impacts. In total, 

60,000 servicemembers are estimated to have participated in the 

tests, with about 4,000 of them facing the most extreme forms of 

full body exposure. 

One of these servicemembers is a constituent of mine, Arla Harrell, who was twice exposed to mustard gas while stationed for 

basic training at Camp Crowder in Neosho, MO, in 1945. Arla and 

his fellow subjects were told they would be helping the military, 

11 

‘‘test summer clothing,’’ in exchange for additional leave. It was not 

until they arrived at the testing site that they were told they would 

be exposed to mustard agents. Servicemembers who participated in 

chamber tests were repeatedly exposed to mustard agents until 

they developed moderate to intense erythema, a painful skin 

disorder. 

The servicemembers were threatened with court-martial if they 

did not continue with the testing. To make matters worse, they 

were sworn to an oath of secrecy, leaving them unable to share 

what had happened to them with anyone, including their own 

health care providers. 

Following his exposure, Arla was hospitalized twice, first at 

Camp Crowder while still in basic training, and again at the 98th 

General Hospital in Munich, Germany. Due to the classified nature 

of the testing and the oath of secrecy, this meant decades of suffering and frustration for the impacted veterans as they sought 

medical care from doctors who were in the dark about their 

exposure. 

Seventy years after the experiments took place, the government 

has yet to appropriately assist and compensate many of these veterans. The VA finally established a process 25 years ago to compensate these veterans, but it puts the burden on the veterans to 

prove that they were exposed to mustard gas in order to make a 

successful claim. These tests were classified. The young servicemembers were held to an oath of secrecy for more than 40 years. 

Records are incomplete, and for some veterans, a massive 1973 fire 

destroyed their entire service files. The VA established a burden of 

proof that is insurmountable to many impacted veterans. 

The VA has rejected approximately 90 percent of the applicants 

for VA benefits connected to exposure of mustard gas or lewisite. 

Of the thousands of veterans who were exposed during World War 

II during this testing, only 40 percent are receiving benefits today. 

Arla Harrell himself has been denied benefits multiple times, 

most recently just this month. The VA says it cannot confirm that 

mustard gas testing occurred at Camp Crowder and, therefore, cannot approve his benefits. This comes despite the clear statements 

from Arla regarding his treatment and the health effects he has 

suffered, and it comes despite the fact that the Army recovered 

mustard gas in vials in Camp Crowder more than 30 years ago and 

an Army Corps of Engineers report identifies gas chambers at 

Camp Crowder. 

I have put a document up on the easel that was made by the 

Army Corps of Engineers. They went to tear down Camp Crowder 

and someone operating the bulldozer had a smoke of something 

come up from the air and began coughing. They then recovered 

both the vials of mustard gas and found the actual gas chambers 

on the property. 

The Arla Harrell Act would improve the VA’s consideration of 

mustard agent exposure claims and address this terrible situation. 

Simply, the bill would flip the burden of proof for veterans who 

have already been denied these benefits. And keep in mind, it only 

flips the benefit of who has to prove this for the people who have 

already applied, which there are less than 400 of these folks still 

alive. So, for 400 individuals who have already applied, it would 

12 

flip the burden of proof, but it would not open up claims for anyone 

else who has not previously applied. So, it is a very limited application. 

It would require the VA to reconsider all previously rejected 

claims for benefits under this program with the presumption that 

the veteran was exposed to mustard gas. Rather than require the 

veteran to prove exposure of a program classified for decades and 

decades and, frankly, only really known about within the bowels of 

the Department of Defense, or DOD, for many years, the bill would 

require the VA to prove that he was not. This is not a large universe of individuals and all of them have previously made a claim 

for benefits. 

Additionally, the bill would require the VA and DOD to establish 

a new policy for the processing of future mustard agent benefit 

claims so that other veterans do not go through what Arla Harrell 

has gone through. 

Arla and his wife, Betty, and their five children have fought for 

compensation for a service-related illness for almost 25 years. They 

just want somebody to believe them. 

After more than 70 years, Arla and veterans like him deserve 

recognition for their selfless service. I urge the Committee to support this legislation so we can keep our commitment and ensure 

that all veterans receive the respect, care, and benefits they have 

earned. 

Thank you, Mr. Chairman and Senators for being here, and I 

hope that this is something that would not be controversial and 

that we could move fairly quickly through the process. 

Chairman ISAKSON. Well, thank you for your testimony. I enjoyed 

our conversations during the markup on National Defense Authorization Act on this very subject, and we will continue to do the 

same thing here. 

Senator MCCASKILL. Thank you so much. 

[The prepared statement of Senator McCaskill follows:] 

PREPARED STATEMENT OF HON. CLAIRE MCCASKILL, U.S. SENATOR FROM MISSOURI

Chairman Isakson, Ranking Member Blumenthal, thank you for the opportunity 

to address the Committee on this important topic. I am here today to speak in support of the Arla Harrell Act, legislation I introduced to address a serious injustice 

perpetrated against veterans exposed to chemical agents as part of US government 

experiments during World War II. 

The U.S. Government conducted classified chemical tests of mustard agents—including mustard gas and lewisite—on thousands of its own servicemembers. Mustard agents can cause painful blisters on exposed skin as well as damage to the eyes 

and respiratory system, leading to a lifetime of adverse health impacts. In total, 

60,000 servicemembers are estimated to have participated in the tests, with about 

4,000 of them facing the most extreme forms of full body exposure. 

One of these servicemembers is a constituent of mine, Arla Harrell, who was twice 

exposed to mustard gas while stationed for basic training at Camp Crowder in Neosho, MO in 1945. Arla and his fellow subjects were told they would be helping the 

military ‘‘test summer clothing’’ in exchange for additional leave. It was not until 

they arrived at the testing site that they were told they would be exposed to mustard agents. Servicemembers who participated in chamber testes were repeatedly 

exposed to mustard agents until they developed moderate to intense erythema, a 

painful skin disorder. 

The Servicemembers were threatened with court martial if they did not continue 

with the testing. To make matters worse, they were sworn to an oath of secrecy, 

leaving them unable to share what had happened to them with anyone, including 

their healthcare providers. Following his exposure, Arla was hospitalized twice, first 

13 

at Camp Crowder while still in basic training and again at the 98th General Hospital in Munich, Germany. 

Due to the classified nature of the testing and the oath of secrecy, this meant decades of suffering and frustration for the impacted veterans as they sought medical 

care from doctors who were in the dark about their exposure. Seventy years after 

the experiments took place, the government has yet to appropriately assist and compensate many of these veterans. 

The VA established a process 25 years ago to compensate these veterans, but it 

puts the burden on the veterans to prove they were exposed to mustard gas in order 

to make successful claims. These tests were classified. The young servicemembers 

were held to an oath of secrecy for more than 40 years. Records are incomplete. And 

for some veterans, a massive 1973 fire destroyed their entire service case files. The 

VA established a burden of proof that is insurmountable for too many impacted veterans. 

The VA has rejected approximately 90 percent of applicants for VA benefits connected to exposure to mustard gas or lewisite. Of the thousands of veterans who 

were exposed during World War II, only 40 are receiving these benefits today. 

Arla Harrell himself has been denied benefits multiple times, most recently just 

this month. The VA says that it cannot confirm that mustard gas testing occurred 

at Camp Crowder and therefore cannot approve his benefits. This comes despite the 

clear statements from Arla regarding his treatment and the health effects that he 

has suffered. And it comes despite the fact that the Army recovered mustard gas 

in vials at Camp Crowder more than 30 years ago, and an Army Corps of Engineers 

report identifies gas chambers at Camp Crowder. 

The Arla Harrell Act would improve the VA’s consideration of mustard agent exposure claims and address this terrible situation. Simply, the bill would flip the burden of proof for veterans who have already been denied these benefits. It would require the VA to reconsider all previously rejected claims for benefits under this program with a presumption that the veteran was exposed to mustard gas. Rather than 

require the veteran to prove exposure, the bill would require the VA to prove that 

he was not. This is not a large universe of individuals—and all of them have previously made a claim for these benefits. 

Additionally, the bill would require the VA and DOD to establish a new policy 

for the processing of future mustard agent benefit claims so that other veterans do 

not go through what Arla Harrell and others have been through. 

Arla, his wife Betty, and their five children have fought for compensation for his 

service-related illness for almost 25 years. After more than seventy years, Arla, and 

veterans like him, deserve recognition for their selfless service. I urge the Committee to support this legislation so we may keep our commitment and ensure all 

veterans receive the respect, care, and benefits they have earned. 

Chairman ISAKSON. Thank you, Senator McCaskill. 

We have one other member of the Senate, Senator Merkley, who 

has asked to testify, but he has not shown up yet. I do not know 

if we have a message that he is coming, so in his absence, we will 

go ahead and go to panel number 1. 

In the absence of Senator Blumenthal, we have a much more attractive Senator as Ranking Member, Senator Murray, and I recognize Senator Murray first. 

OPENING STATEMENT OF HON. PATTY MURRAY, 

U.S. SENATOR FROM WASHINGTON 

Senator MURRAY. Well, Mr. Chairman, thank you. I want to 

thank you for holding this hearing on some really important pieces 

of legislation. 

I wanted to say, it is not on the agenda today, but I do want to 

take a moment to talk about my Servicemembers Civil Relief Act 

(SCRA) Enhancement and Improvement Act of 2016, which I believe is really important to upholding our country’s commitment to 

veteran families. Part of that is making sure servicemembers have 

important legal protections so they can focus on their mission, and 

those protections recognize that while they are deployed or away 

14 

from home, servicemembers often do not have the resources to respond to a range of financial and legal issues. 

Despite these protections, I am disappointed to learn that servicemembers continue today to be subjected to predatory practices 

and unfair treatment on their student loans, on their mortgages, 

and on their credit cards. It is why I have introduced the SCRA 

Enhancement and Improvement Act, which would put an end to 

many of these predatory practices and give servicemembers and 

our agencies the tools they need to fight back when banks and student loan servicers deny servicemembers their rights. 

I will put my statement into the record which explains what this 

does, Mr. Chairman, but it is about student loans, and it goes beyond that. 

I was concerned when, several years ago, some of our Nation’s 

largest mortgage servicers improperly overcharged and foreclosed 

upon thousands of deployed servicemembers in violation of those 

current laws. So, our legislation deals with that, too. I just do not 

believe we should let our servicemembers be taken advantage of. 

Many of the provisions in our legislation have been considered by 

this Committee over the past years. Much of it is derived from requests by the Department of Justice for the tools it needs to protect 

our servicemembers. 

So, Mr. Chairman, it is not on the agenda today, but I really 

hope that our Committee can put it on a future agenda and deal 

with this important issue. 

[The prepared statement of Senator Murray follows:] 

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

Mr. Chairman, Thank you for holding this hearing on some important pieces of 

legislation. 

It is not on the agenda today, but I want to take a moment to talk about my 

SCRA Enhancement and Improvement Act of 2016, which I believe is so important 

to upholding our country’s commitment to military families. 

Part of that is making sure servicemembers have important legal protections so 

they can focus on their mission. These protections also recognize that while they are 

deployed or away from home servicemembers often do not have the resources to respond to a range of financial and legal issues. 

Despite these protections, I’ve been disappointed to learn that servicemembers 

continue to be subjected to predatory practices and unfair treatment on their student loans, on their mortgages, and on their credit cards. 

That is so wrong. 

And, that is why I introduced the SCRA Enhancement and Improvement Act, 

which will help put an end to many of these predatory practices and give servicemembers and our agencies the tools they need to fight back when banks and student 

loan servicers deny servicemembers their rights. 

My bill will: 

• Require automatic application of the interest rate cap, timely responses to all 

inquiries, retention of communications with servicemembers, and a full explanation 

of any denial of an SCRA protection. 

• It will require student loan servicers to have a designated service representative 

or point of contact for servicemembers and ensure these individuals are properly 

trained. 

• It will reduce the interest rate cap to provide meaningful protection to servicemembers, including a zero percent cap for servicemembers eligible for hostile fire 

or imminent danger pay. 

• It will mandate that sufficient notice is given when a loan is transferred or sold, 

and that all benefits or protections seamlessly transfer to the new loan servicer. 

• And it will forgive all Federal and private student loan debt in the event the 

servicemember dies in the line of duty. 

15 

The SCRA Enhancement and Improvement Act also expands protections beyond 

student loans. 

I was concerned when several years ago some of the Nation’s largest mortgage 

servicers improperly overcharged and foreclosed upon thousands of deployed servicemembers, in violation of the current law. 

To address those problems, and in addition to the interest rate cap, the bill would 

expand the interest rate protection to all of a servicemember’s debt, regardless of 

when it was incurred, in order to cover consolidation loans and in recognition that 

the same challenges exist for military borrowers regardless of when a debt was first 

incurred. 

My bill will also give servicemembers and our agencies the legal and oversight 

tools they need to hold entities accountable, including giving the Attorney General 

greater authority for investigations and enforcement of the SCRA and doubling the 

fines against bad actors. 

Like everyone here I believe protecting our military men and women from predatory practices is an absolutely essential commitment. We will not allow our servicemembers to be taken advantage of. 

Many of these provisions have been considered by this Committee over the past 

few years, and much of it is derived from requests by the Department of Justice 

for the tools it needs to protect servicemembers. 

I look forward to working with you, Mr. Chairman, and my colleagues to advance 

this important bill. 

Chairman ISAKSON. For the record, the distinguished lady from 

Washington asked me to try to get it on the agenda for today. We 

were so, first of all, full, that was impossible. Second of all, I talked 

about a jurisdictional issue with Senator Alexander with regard to 

student loans, which I will talk to you about that after the meeting, 

but we will pursue it for you. 

Senator MURRAY. OK. Thank you. 

Chairman ISAKSON. Thank you for being here today. 

With that said, our first panel, Mr. David McLenachen, Deputy 

Under Secretary for Disability Assistance, Veterans Benefits Administration (VBA), U.S. Department of Veterans Affairs, accompanied by Dr. Maureen McCarthy, Assistant Deputy Under Secretary for Health for Patient Care Services, Veterans Health Administration (VHA). 

Mr. McLenachen, you are recognized. 

STATEMENT OF DAVID McLENACHEN, DEPUTY UNDER SECRETARY FOR DISABILITY ASSISTANCE, VETERANS BENEFITS 

ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY MAUREEN McCARTHY, M.D., ASSISTANT DEPUTY UNDER SECRETARY FOR HEALTH FOR 

PATIENT CARE SERVICES, VETERANS HEALTH ADMINISTRATION 

Mr. MCLENACHEN. Mr. Chairman and Members of the Committee, thank you for the opportunity to present the views of the 

Department of Veterans Affairs on several bills that are pending 

before the Committee. 

As you said, joining me today is Dr. Maureen McCarthy, Assistant Deputy Under Secretary for Health for Patient Care at VHA. 

Because there are so many bills under consideration during this 

hearing, I am unable to address each one individually, Mr. Chairman. VA has indicated support for or concern with these bills in 

my accompanying written testimony. 

We provided cost projections for these bills as we can and we will 

provide projections for the remainder as we compile the necessary 

data. We will do that as soon as we possibly can. 

16 

I would like to highlight a few of the bills that VA strongly supports that are on the agenda today. S. 2316, which affects a provision in current law that prevents VA from adequately compensating our most vulnerable beneficiaries when the fiduciary that 

serves them misuses their benefits. It would also allow VA to more 

easily and thoroughly investigate financial records in cases where 

a fiduciary misuse is suspected. 

S. 3021 would provide veterans with more flexibility in using 

their Post-9/11 G.I. Bill benefits to pursue independent study in a 

program at an institution that is not an institution of higher learning. VA recognizes the importance of career and technical education courses and the growth of online and other forms of modern 

non-degree training and supports expanding educational assistance 

to cover these programs. 

S. 3055 would make permanent a successful VHA dental insurance pilot program. VA welcomes the opportunity to continue offering dental insurance to interested veterans and hopes to see the 

program grow. 

S. 3076, the Charles Duncan Buried with Honor Act, which you 

just heard about, would allow VA to provide caskets and urns to 

indigent veterans with no next of kin who are laid to rest in State 

and tribal cemeteries. VA strongly supports this cost neutral expansion of benefits, but suggests clarifying that it would apply to 

veterans’ cemeteries of a State or Indian tribe. 

S. 603 would expand travel benefits for rural veterans. VA 

strongly supports Sections 2 and 4, but would like to work with the 

Committee regarding Section 3. 

We would also like to work with the Committee to make some 

clarifying edits to S. 2210, the Veteran Partners’ Efforts to Enhance Reintegration or Veteran PEER Act, and would like to discuss with the Committee S. 2279, the Veterans Health Care Staffing Improvement Act. 

VA strongly supports S. 2958, which would enable the Secretary 

to establish a pilot program to accept donations of real property 

that address needs identified through VA’s long-range capital planning process. VA welcomes strategic partnerships such as the partnership proposed in this legislation. We look forward to working 

with the Committee and the bill’s sponsors to address VA’s technical concerns regarding the bill. 

VA has more difficulty supporting some of the other bills under 

consideration today. We fully support delivering benefits to veterans and survivors as quickly as possible, but we cannot support 

S. 3023, the Arla Harrell Act, which would create a presumption 

of full-body mustard gas exposure and resulting service connection 

for every World War II veteran who files a claim for related disability benefits. Nonetheless, these claims remain a high priority 

for VA and we will continue to fully and sympathetically develop 

and adjudicate every mustard gas claim that we receive. 

Delivering benefits to veterans exposed to radiation is also a high 

priority for VA, but we cannot support S. 2791, the Atomic Veterans Health Care Parity Act. Historical records and scientific evidence available to VA indicate that radiation exposure among servicemembers participating in the clean-up of the atoll were well 

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ease. While VA is extremely grateful for every veteran’s service and 

sacrifice, we believe that the paternalistic claim principles codified 

in current law and VA’s mustard gas and radiation claim regulations already provide for fair and accurate resolution of these complicated claims. 

Finally, like several of our Veterans Service Organization partners, we cannot support S. 3081, Working to Integrate Networks 

Guaranteeing Member Access Now or the WINGMAN Act, which 

would give Congressional staff unprecedented access to veterans’ 

personal records, even in the absence of those veterans’ consent. 

We have outlined additional concerns with the WINGMAN Act and 

other bills in my written testimony. 

Mr. Chairman, this concludes my statement. We are happy to entertain any questions that you or other Members of the Committee 

may have. Thank you. 

[The prepared statement of Mr. McLenachen follows:] 

PREPARED STATEMENT OF DAVID MCLENACHEN, DEPUTY UNDER SECRETARY FOR DISABILITY ASSISTANCE, VETERANS BENEFITS ADMINISTRATION, DEPARTMENT OF VETERANS AFFAIRS

Good morning, Chairman Isakson, Ranking Member Blumenthal, and Members of 

the Committee. Thank you for inviting us here today to present our views on several 

bills that would affect the Department of Veterans Affairs’ (VA) programs and services. Joining me today is Dr. Maureen McCarthy, Assistant Deputy Under Secretary 

for Health for Patient Care Services, Veterans Health Administration (VHA). While 

VA makes every effort to provide views on all bills that are on the hearing agenda, 

due to the time of receipt of the draft bill to authorize payment by VA for the costs 

associated with service by medical residents and interns at facilities operated by Indian tribes and tribal organizations, we are unable to provide views at this time. 

We look forward to sharing our views on the draft bill in a follow-up letter. 

S. 2316—TO EXPAND THE REQUIREMENTS FOR REISSUANCE OF VETERANS BENEFITS IN

CASES OF MISUSE OF BENEFITS BY CERTAIN FIDUCIARIES TO INCLUDE MISUSE BY ALL

FIDUCIARIES, TO IMPROVE OVERSIGHT OF FIDUCIARIES, AND FOR OTHER PURPOSES. 

This bill would amend Chapters 55 and 61 of Title 38, United States Code 

(U.S.C.), to expand the requirements for reissuance of Veterans’ benefits in cases 

of misuse of benefits by certain fiduciaries to include misuse by all fiduciaries and 

improve access to financial records for purposes of oversight of fiduciaries. 

Section 1 of S. 2316 would amend 38 U.S.C. § 6107, to authorize the VA to reissue 

benefits to a beneficiary in all cases of fiduciary misuse. This bill would extend VA’s 

reissuance authority to include misuse by individual fiduciaries who manage benefits for fewer than 10 beneficiaries, without regard to VA negligence in appointing 

or overseeing such fiduciaries. The bill would prescribe that VA will pay the beneficiary or the beneficiary’s successor fiduciary an amount equal to the misused benefits in any case in which a fiduciary misuses a beneficiary’s VA benefits. 

Section 2 of S. 2316 would add a new subsection to 38 U.S.C. § 5502, which contains VA’s authority to oversee and monitor the activities of fiduciaries. This new 

subsection would increase VA access to fiduciary-held financial accounts by requiring every fiduciary to authorize VA to obtain any record held by any financial institution regarding the fiduciary or the beneficiary whenever VA determines that such 

record is necessary: 

• for the administration of a VA program; or 

• to safeguard the beneficiary’s benefits against neglect, misappropriation, embezzlement, or fraud. 

VA supports this bill. It would ensure equal treatment of all fiduciary misuse victims regardless of the nature and scope of the fiduciary’s business or the fiduciary’s 

relationship with the beneficiary. This bill would allow VA to promptly reissue benefits that have been misused, thereby avoiding any financial hardship to beneficiaries 

caused by the misuse or delays in obtaining restitution or VA determining negligence. It would also provide an additional measure of oversight and improve the 

accountability of fiduciaries serving our most vulnerable beneficiaries by facilitating 

18 

VA’s inspection of financial records when necessary. Any fiduciary who is found to 

have misused VA benefits is barred from future service. 

During calendar year (CY) 2015, VA reissued $2,507,657 to 76 beneficiaries whose fiduciaries misused benefits as a result of VA’s negligence, an average of $32,995 

per beneficiary. Pension and Fiduciary Service estimates that, on average, an additional $2 million in VA benefits are misused annually by individual fiduciaries 

where the fiduciary managed the benefits of fewer than 10 beneficiaries, and VA 

was not negligent in its appointment or oversight. Based on the average reissuance 

amount of $32,995, $2 million in benefits would represent approximately 61 beneficiaries per year. Under this proposal, VA would make these Veterans or survivors 

whole by reissuing benefits without regard to the number of beneficiaries an individual fiduciary managed or VA’s negligence in its appointment or oversight. 

There would be no additional full-time employee (FTE) costs or general operating 

expenses (GOE) associated with enactment of this proposed legislation. 

S. 2958—TO ESTABLISH A PILOT PROGRAM ON PARTNERSHIP AGREEMENTS TO

CONSTRUCT NEW FACILITIES FOR THE DEPARTMENT OF VETERANS AFFAIRS

S. 2958 would authorize the VA Secretary to enter into up to five partnership 

agreements with a State or local authority; a 501(c)(3) corporation; a limited liability 

corporation; a private entity; a donor or donor group; or another non-Federal entity 

in order to secure donations of health care facilities and/or national cemetery assets. 

VA strongly supports this legislation, but seeks a critical change needed to preserve civil rights protections. It would enable VA to enter into agreements that 

could potentially assist in providing high priority assets that have been identified 

as a need through our long-range capital planning process and are considered to be 

important in order to serve Veterans in safe, modern, and secure facilities. VA believes that the proposed partnerships will enable the Department to use alternative 

financing mechanisms, beyond VA’s traditional appropriations, to deliver needed facilities for our Veteran population. 

We strongly support the bill’s authorization of these partnership agreements provided that the legislation preserves civil rights protections for Veterans and other 

employees who will be working to construct the facilities resulting from these partnership agreements. We look forward to working with the Committee to revise the 

language in section 1(b), which as currently drafted could be interpreted as excluding equal opportunity and employment protections. 

VA estimates that S. 2958 would be cost-neutral because it provides for the donation of assets at no additional cost to the Federal Government beyond funds that 

have been previously appropriated for a project at the time of the agreement. The 

bill would not create an obligation by VA to fund the construction of the facilities 

contemplated by the bill. There would also be no obligation for VA to use future appropriations to fund capital costs related to the partnerships authorized by this section. VA would be pleased to work with the Committee to address technical edits 

to the bill as drafted. 

S. 3021—TO AUTHORIZE THE USE OF POST-9/11 EDUCATIONAL ASSISTANCE TO PURSUE

INDEPENDENT STUDY PROGRAMS AT CERTAIN EDUCATIONAL INSTITUTIONS THAT ARE

NOT INSTITUTIONS OF HIGHER LEARNING

The proposed legislation would amend paragraph (4) of section 3680A(a) to authorize the use of Post-9/11 educational assistance to pursue independent study programs at certain educational institutions that are not institutions of higher learning. Currently, under section 3680A(a)(4), the Secretary is explicitly prohibited from 

approving enrollment in ‘‘any independent study programs except an accredited 

independent study program (including open circuit television) leading (A) to a standard college degree, or (B) to a certificate that reflects educational attainment offered 

by an institution of higher learning.’’ As such, VA is not authorized to pay educational assistance for independent study courses at an institution not considered 

an institution of higher learning (IHL), or for any non-accredited independent study 

courses. 

VA supports the proposed legislation that would expand VA’s approval authority 

to pay Post-9/11 GI Bill benefits for enrollment in accredited independent study certificate programs at educational institutions that are not IHLs. More specifically, 

VA supports non-IHL independent study programs that are accredited by an 

accreditor recognized by the Secretary of Education (which would help ensure the 

integrity of the accreditor) and, if career and technical, that lead to industry-recognized credentials and certificates for employment. VA understands and appreciates 

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19 

struction for both degree and non-degree programs. As such, expanding the approval 

authority for certain independent study programs would be in the best interests of 

VA education beneficiaries. 

We note that because this bill would amend 38 U.S.C. Chapter 36, the expansion 

of benefits would not be limited to Post-9/11 GI Bill benefits. Benefit costs are estimated to be $49.2 million in the first year, $266 million over five years, and $599.4 

million over ten years. There would be no additional FTE or GOE associated with 

enactment of this proposed legislation. 

S. 3032—VETERANS’ COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 2016

S. 3032, the ‘‘Veterans’ Compensation Cost-of-Living Adjustment Act of 2016,’’ 

would require the Secretary of Veterans Affairs to increase, effective December 1, 

2016, the rates of disability compensation for service-disabled Veterans and the 

rates of dependency and indemnity compensation (DIC) for survivors of Veterans. 

This bill would increase these rates by the same percentage as the percentage by 

which Social Security benefits are increased effective December 1, 2016. Consistent 

with VA’s processing of these benefit payments under current law, the bill would 

prescribe an increase in each benefit dollar amount without rounding down to the 

next whole dollar amount. The bill would also require VA to publish the resulting 

increased rates in the Federal Register. 

VA supports this Cost-of-Living Adjustment (COLA) bill because it would express, 

in a tangible way, this Nation’s gratitude for the sacrifices made by our service-disabled Veterans and their surviving spouses and children and would ensure that the 

value of their well-deserved benefits will keep pace with increases in consumer 

prices. Although not included in S. 3032, VA would also support inclusion of the 

round-down provision in effect before December 1, 2013, which provided that ‘‘each 

dollar amount, if not a whole dollar amount, be rounded down to the next lower dollar amount.’’ This round-down methodology would provide the desired benefit increases, and ensure VA’s fiscal responsibility. The 2017 President’s Budget includes 

a legislative proposal to reinstate the round-down provision for five years, which 

would result in benefit savings of $21.5 million in 2017, $63.5 million in 2018, and 

$599.3 million over five years. Although the proposal would reinstate the rounddown for five years, the cumulative effect of rounding-down COLAs for five years 

would total $2.0 billion in savings over ten years 

Benefits costs that would result from the COLA increase are estimated to be 

$490.8 million during the first year, $3.0 billion for five years, and $6.6 billion over 

ten years. The 2017 President’s budget assumes annual COLA increases for disability compensation and DIC in its baseline estimate. There would be no increases 

to costs above the current baseline budget associated with the COLA. 

The current COLA estimate from the 2017 President’s Budget, effective December 1, 2016, is 0.8 percent. The impact of the COLA was calculated by applying the 

0.8 percent increase in payments to the projected caseloads in the fiscal year (FY) 

2016 President’s budget. The total cost was then compared to the estimated cost 

without COLA increases to calculate the impact of the COLA. 

There would be no FTE or GOE costs associated with enactment of this proposed 

legislation. 

S. 3055—DEPARTMENT OF VETERANS AFFAIRS DENTAL INSURANCE REAUTHORIZATION

ACT OF 2016

S. 3055 would make the VA Dental Insurance Program (VADIP) permanent, 

which was initially implemented as a pilot program on November 15, 2013, through 

Section 510 of the Caregivers and Veterans Omnibus Health Services Act of 2010 

(Public Law 111–163). The VADIP program offers enrolled Veterans and beneficiaries of VA’s Civilian Health and Medical Program (CHAMPVA) the opportunity 

to purchase dental insurance at a reduced cost. Each participant pays a fixed 

monthly premium for coverage, in addition to any copayments required by his or 

her plan. Through the pilot, over 75,000 Veterans and CHAMPVA beneficiaries purchased plans as of December 31, 2014. In the 4th quarter of CY 2014, VA conducted 

a survey of Veterans who have purchased and utilized the insurance plans, and over 

92 percent said they would renew and recommend the program to other Veterans, 

indicating strong overall satisfaction with the program. Providing Veterans, their 

families, and beneficiaries an opportunity to purchase dental insurance that contains coverage and quality defined by the VA Office of Dentistry at discounted rates 

is one step in improving the overall health of the Veteran population. 

VA supports S. 3055. 

20 

S. 3076—CHARLES DUNCAN BURIED WITH HONOR ACT OF 2016

This bill would amend 38 U.S.C. § 2306(f) which currently authorizes the VA Secretary to furnish a casket or urn, of such quality as the Secretary considers appropriate for a dignified burial, for burial in a national cemetery of a deceased Veteran 

in any case in which the Secretary is unable to identify the Veterans’ next-of-kin, 

if any; and determines that sufficient resources for the furnishing of a casket or urn 

for the burial of the Veteran in a national cemetery are not otherwise available. By 

regulation, VA administers this benefit through a reimbursement program. 

S. 3076 would change the current authority by expanding the availability of the 

benefit to Veterans buried in a State or tribal organization cemetery. VA fully supports the bill. We suggest one minor amendment to the language in subsection (1); 

to add ‘‘veterans’’ before ‘‘cemetery of a State or Indian tribe.’’ 

The authority to furnish caskets and urns was included in Public Law 112–260, 

the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012. This 

vehicle was used to highlight the issue of Veterans without next-of-kin and without 

sufficient resources for burial, and the need for expanded benefits for this disadvantaged group. In addition to the new authority to furnish a casket or urn for Veterans without next-of-kin and without sufficient resources for burial who are buried 

in VA national cemeteries, the public law expanded the plot allowance and transportation allowance and directed specific procedural requirements for national cemetery 

officials to confirm remains were unclaimed and the final disposition of those 

remains. 

After publishing its final regulation on the casket and urn reimbursement program, on May 13, 2015, VA began accepting requests for reimbursement for caskets 

or urns purchased for the interment of deceased Veterans who died on or after January 10, 2014, without next of kin and sufficient resources for burial. Currently, any 

individual or entity may request reimbursement if they purchase a casket or urn 

to inter in a VA national cemetery an eligible Veteran who died on or after January 10, 2014, without next of kin and without sufficient resources to purchase a burial receptacle. VA will reimburse the actual cost of such a casket or urn, not to exceed an annually established rate based on the average cost of caskets and urns in 

any given CY. For claims received in CY 2016, the maximum reimbursement rates 

are $2,421.00 for caskets and $244 for urns. The maximum reimbursement amounts 

are adjusted for inflation on an annual basis. 

Regarding the amendment’s change to provide the benefit for Veterans interred 

in a State or tribal organization Veterans cemetery, VA submitted a legislative proposal concept to make such a change in its FY 2017 budget submission, indicating 

the Department’s willingness to implement this expansion to its current authorities. 

Through a grants program to establish, expand, and improve State and tribal organization Veteran cemeteries, NCA maintains a valuable partnership with States and 

tribal organizations to provide a final resting place to those who may not have access to a VA national cemetery burial option. Extending the casket and urn reimbursement benefit for the burial of Veterans without next-of-kin and without sufficient resources for burial who are in State or tribal Veterans cemeteries would support VA’s efforts to ensure the unclaimed remains of Veterans receive a dignified 

burial. VA grant-funded State and tribal Veterans cemeteries conducted nearly 

36,000 burials of Veterans and their families in FY 2015. These cemeteries provide 

the same services and benefits to Veterans and their eligible family members and 

are required to comply with the same national shrine appearance standards as national cemeteries. 

There would be no benefit costs or savings associated with enactment of the provision to expand the benefit to State and tribal organization cemeteries. 

S. 2210—VETERAN PEER ACT

S. 2210 would require the Secretary to phase in and conduct a program whereby 

peer specialists would be included in patient aligned care teams at VA medical centers (VAMC), to promote the use and integration of mental health services in a primary care setting. Not later than 180 days after the date of enactment, this program would have to be established at not fewer than ten VAMCs. By not later than 

two years (from this same date), it would have to be in place at not fewer than 25 

VAMCs. Under the bill, the Secretary would be directed to consider specified factors 

when selecting sites for this program, but, not fewer than five would have to be established at VA designated Polytrauma Centers, and not fewer than ten would need 

to be established at VAMCs not so designated. S. 2210 would also require that all 

peer specialist programs established under this mandate: (1) ensure that the needs 

of female veterans are considered and addressed; and (2) include female peer speVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00024 Fmt 6633 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
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cialists. Finally, this measure would establish initial, periodic, and final Congressional reporting requirements, as detailed in the bill. 

VA supports S. 2210 subject to the availability of additional funding, noting a few 

technical changes are needed for clarity. This legislation, if enacted, would complement VA’s ongoing pilot program (commenced in 2014) whereby peer support 

through peer specialists has been extended beyond traditional mental health sites 

of care to include Veterans receiving mental health care in primary care settings. 

Under the pilot program, trained peer specialists work with VA primary care teams 

to, in general terms, help improve the health and well-being of other Veterans being 

treated in VA primary care settings. To date, seven medical centers have volunteered for the pilot, composing the first cohort of sites to deploy peers to primary 

care. Two more cohorts are being recruited for implementation in July 2016, and 

January 2017. Peers provide services for ten hours per week, and that time may be 

divided among two peers. As with VA’s long established mental health peer support 

model, the pilot program recognizes the therapeutic value of having peer specialists 

share their own past recovery experiences with Veterans receiving mental health 

care in the primary care setting, particularly those who are experiencing challenges 

similar to what the peer specialist experienced. 

As mentioned, female peer specialists would have to be included in the program 

mandated by S. 2210. This is not necessary, however, as women peer specialists are 

already well represented, with 18 percent of the national peer specialist workforce 

being women. While at first glance 18 percent may seem a low rate, please bear in 

mind that this figure is higher than the percentage of Veterans seeking services 

through VA who are women. We do recognize, however, that the current number 

of women Veteran peer specialists in the pilot is unevenly distributed across the 

country, with some medical centers having greater difficulty than others in attracting qualified applicants. 

Also, it is unclear if the peers will address substance use disorders under the umbrella of their mental health duties. Given the comorbidity of these issues, the need 

for integration of substance use disorder identification and care, the need for overdose prevention and linkage as needed to Medication Assisted Treatment for opioid 

use disorder, and the need to increase the numbers of veterans achieving long term 

recovery, we recommend that this be clarified and if possible included. 

S. 603—RURAL VETERANS TRAVEL ENHANCEMENT ACT OF 2015

S. 603, the Rural Veterans Travel Enhancement Act of 2015, would make amendments to VA’s legal authorities governing transportation benefits. 

Section 2 would make permanent VA’s authority under 38 U.S.C. § 111A(a) to 

transport any person to or from a VA facility or other place in connection with vocational rehabilitation, counseling required pursuant to Chapter 34 or 35 of Title 38 

U.S.C., or for the purpose of examination, treatment, or care. 

Section 3 would amend 38 U.S.C. § 111 to authorize beneficiary travel benefits for 

travel to and from Vet Centers for readjustment counseling and related mental 

health services under 38 U.S.C. § 1712A. As a technical matter, we note that counseling under 38 U.S.C. § 1712A is also available to certain Servicemembers and family members. 

Finally, Section 4 would extend the authorization of appropriations for the Grants 

for Transportation of Veterans in Highly Rural Areas program through 2020. 

VA supports Sections 2 and 4 of S. 603, assuming resources are provided to continue the operation of these programs. These provisions of the legislation would provide extended transportation authority for Veterans, particularly rural Veterans. 

VA does not support Section 3 of the bill. The historic nature of the Readjustment 

Counseling Service and the concept of ready access with minimal administrative 

and bureaucratic processing, together with the separate location of Vet Centers and 

the lack of infrastructure to support consideration payment of BT, are all factors 

VA considered in choosing not to support this bill. 

VA is, however, currently conducting a pilot program, as required in Section 104 

of Public Law 112–154, to assess the feasibility and advisability of paying beneficiary travel under 38 U.S.C. § 111 for travel from a residence located in an area 

that is designated by the Secretary as highly rural to the nearest Vet Center and 

from such Vet Center to such residence. Based on experience with this pilot, VA 

does not agree that Veterans traveling to Vet Centers should be reimbursed using 

the Beneficiary Travel (BT) Program. 

The pilot has demonstrated that a significant amount of coordination is necessary 

between the Vet Centers and corresponding VA medical centers. Because Vet Center 

visits are not entered into the Veteran’s electronic medical record, increased paper 

documentation and communication with the VA medical center is required. Risk of 

22 

improper payments would increase with the complexity of this process, as traditional methods of paying BT could not be used. 

Feedback from Veterans indicates that they find Vet Centers are more therapeutic 

and less bureaucratic than VA medical centers, and Veterans are afforded anonymity and the ability to speak freely without fear of repercussion. Participants cautioned that privacy was an issue, especially for police officers, fire fighters, and National Guardsmen, and expressed concerns that the information included in their 

file may negatively affect their employment. Some participants said they would be 

comfortable having VA medical center administrative staff see that a Veteran was 

a Vet Center client, but all participants agreed that they do not want the staff to 

have access to visit details, such as notes or specific diagnoses. This information is 

required in order to process most BT claims. 

Over time, as travel benefits have improved, VA health care facilities have noted 

a significant increase in the number of Veterans claiming travel, as well as visits 

by those Veterans. We anticipate that, if enacted, Vet Centers would see similar 

changes that could affect provision of services at those facilities or require additional 

staffing resources to handle the increase of visits. These Vet Center staff would have 

increased administrative burdens, including documentation of visits and determinations of whether treatment related to service-connected condition(s), which are not 

currently required. VA estimates the cost of this bill would be over $11 million in FY 2017, nearly 

$12 million in FY 2018, $61 million over five years, and $136 million over ten years. 

S. 2279—VETERANS HEALTH CARE STAFFING IMPROVEMENT ACT

Section 2 of S. 2279 would require the VA Secretary, in coordination with the Secretary of Defense, to carry out a program to increase efficiency in the recruitment 

and hiring by VA of health care workers that are undergoing separation from the 

Armed Forces. Under Section 2, the Department of Defense (DOD) would have to 

provide VA a list of members of the Armed Forces, including the reserve components, who served in a health care capacity in the Armed Forces, are undergoing 

or have undergone separation from the Armed Forces, and will be discharged or 

have been discharged under honorable conditions. 

Section 2 will support VA’s ability to recruit qualified and trained health care professionals from the Armed Forces. 

VA anticipates that the costs for implementing Section 2 for FY 2017 would likely 

amount to $4.9 million, and for a five-year period, from FY 2017 to FY 2021, the 

costs for implementing Section 2 would likely amount to $27.3 million. 

Section 3 of S. 2279 would require VA to create uniform credentialing standards 

for positions specified in 38 U.S.C. § 7421(b). VA does not support this section as 

it already has uniform credentialing standards for its health care providers. VA prescribes these standards and the process for obtaining and retaining them through 

VA and VHA policy, including VHA Handbook 1100.19, Credentialing and Privileging, and VHA Directive 2012.030, Credentialing of Health Care Professionals. All 

credentialing occurs in VHA’s electronic credentialing software platform, VetPro, 

and credentialing files can be easily shared and transferred throughout VA. At this 

time, VA does not have a cost estimate for this section. 

Section 4 of S. 2279 would require VA to provide full practice authority to advanced practice registered nurses (APRN), physician assistants (PA), and other licensed health care professionals. The Rulemaking for APRNs is currently open for 

public comment until July 25, 2016, and we have received many public comments 

on this regulation. VA will consider and respond to the issues raised by these comments in the final rulemaking 

At this time, VA does not have a cost estimate for this section. 

S. 244—INDEPENDENT COMPREHENSIVE REVIEW OF VA ASSESSMENT OF

TRAUMATIC BRAIN INJURIES

S. 244 would require VA, within a reasonable period of time, to enter into an 

agreement with the Institute of Medicine (IOM) or another organization, if VA is 

unable to enter into an agreement with IOM, to conduct a comprehensive review 

of examinations provided by VA to individuals who submit claims to the Secretary 

for compensation under Chapter 11 of Title 38, U.S.C., for Traumatic Brain Injury 

(TBI). The comprehensive review would be required to include a determination of 

the adequacy of the tools and protocols used by VA to provide examinations for compensation claims for TBI and a determination of the credentials necessary for health 

care providers and specialists to perform such portions of such examinations that 

relate to assessment of cognitive functions. The IOM would be required to convene 

a group of experts in clinical neuropsychology and other related disciplines. VA 

23 

would be required to submit a report to Congress within 540 days of entering into 

an agreement with IOM detailing the findings of the IOM with respect to the comprehensive review it would conduct and recommendations of the IOM for legislative 

or administrative action that could improve the adjudication of these claims. 

While VA appreciates the objective of this bill, we do not believe it is necessary. 

We are committed to ensuring that all Veterans receive comprehensive, quality compensation and pension (C&P) examinations by qualified professional health care 

providers in a timely manner. Mental health professionals must make a clinical determination when conducting a C&P examination as to whether any psychometric 

testing is to be done; if the examiner determines that testing should be utilized, it 

is up to the examiner to determine what test to administer, based on the specifics 

of the Veteran’s case. VA subject matter experts have thoroughly reviewed the policies regarding TBI examinations and, based on best clinical practices and protocols, 

do not believe that TBI C&P examinations are insufficient. VA’s existing regulations 

reflect the special nature of complicated TBI claims and the unique criteria and 

process used to evaluate TBI. Under these rules, VA employs a holistic approach 

using cognitive, emotional/behavioral, and physical criteria to evaluate TBI. Notably, S. 244 would direct the IOM to analyze VA’s criteria for evaluating cognitive 

function, with no mention of emotional, behavioral, and physical symptoms. VA 

would characterize such a limited analysis as a step backwards. In an effort to provide continuous process improvement to evaluating disability under the VA Schedule for Rating Disability, VA employs legal, medical, and administrative experts who 

routinely review the sufficiency of examination and rating criteria and recommend 

changes necessary to maintain accuracy, fairness, and efficiency in the claims resolution process. Establishing an external reviewing body would essentially duplicate 

VA’s existing process. 

VA currently has authority to work with IOM or others, and if we determine that 

such input is necessary, we will not hesitate to do so. 

S. 2791—ATOMIC VETERANS HEALTHCARE PARITY ACT

This bill would amend Title 38, U.S.C. to provide for the treatment of Veterans 

who participated in the cleanup of Enewetak Atoll, as radiation exposed Veterans 

for purposes of the presumption of service-connection of certain disabilities by the 

Secretary of Veterans Affairs. 

DOD conducted atomic bomb testing on Enewetak Atoll in the Pacific Marshall 

Islands during the 1950s. Senate bill 2791 would provide that Veterans who participated in the cleanup effort on Enewetak Atoll from January 1, 1977, through December 31, 1980, engaged in a ‘‘radiation-risk activity’’ and will be classified as radiation-exposed Veterans for purposes of establishing a presumption of service connection for certain enumerated radiation-related diseases. 

When considering the creation of benefits presumptions, VA relies on sciencebased models that can be used to establish association between an in-service event 

and a post-service disability. VA has thoroughly reviewed the best available analysis 

of Enewetak cleanup exposure data, the 1981 Defense Nuclear Agency (DNA) Report, The Radiological Cleanup of Enewetak Atoll, and other available evidence. 

That evidence establishes that radiation doses among servicemembers participating 

in the cleanup were well below recommended thresholds for both acute and latent 

health effects, such as cancers. Since the best available evidence found radiation exposure among those individuals involved with the cleanup well below acceptable 

thresholds, there is no factual basis that would warrant a determination that this 

group of Veterans engaged in a radiation-risk activity sufficient to justify a presumption of service connection. 

VA continues to evaluate any individual Veteran involved with the Enewetak 

Atoll cleanup on a direct facts-found basis under the ionizing radiation dose-evaluation regulations at 38 Coode of Federal Regulations (CFR) § 3.311. While the VA appreciates the Committee’s attention and efforts to address this very important matter, the VA is unable to support S. 2791 as the proposed policy is inconsistent with 

known Enewetak Atoll exposure data and associated scientific analysis. 

The costs that would be associated with enactment of this bill are to be 

determined. 

S. 3023—THE ARLA HARRELL ACT

S. 3023 would (1) provide for reconsideration of claims for disability compensation 

from Veterans who allege mustard gas or lewisite exposure during World War II 

(WWII) that were previously denied by VA; (2) create a presumption of full-body exposure to mustard gas or lewisite if VA or the Secretary of Defense makes a determination regarding such exposure; (3) preclude use of information in the DOD and 

24 

VA Chemical Biological Data base or any list of known testing sites as the sole reason for finding that such veteran did not have full-body exposure; (4) require development by DOD and VA of a policy for processing future claims; (5) require a report 

by DOD regarding mustard-gas or lewisite experiments conducted by DOD during 

WWII, including each testing location, dates of experiments and number of members 

of the Armed Forces who were exposed; and (6) require VA to investigate and assess 

actions taken to notify exposed Veterans and investigate and assess the mustardgas and lewisite claims from WWII Veterans that are filed and the percentage of 

these claims that are denied by VA. 

Section 2(a)(3) of the bill would provide that, in reconsidering claims for VA disability compensation based on exposure to mustard gas or lewisite, if VA or DOD 

‘‘makes a determination regarding whether’’ a Veteran experienced full-body exposure to those substances, VA or DOD ‘‘shall presume’’ that the Veteran experienced 

such exposure. Section 2(a)(3)(B), would prohibit VA from denying a claim based 

‘‘solely’’ on the presence or absence of information in the DOD and VA Chemical Biological Warfare Data base, which was compiled based upon information available to 

DOD, or other lists maintained by the Departments. 

The VA appreciates the Committee’s attention to this very important issue. Providing Veterans with the care they need when they need it remains VA’s top priority. We owe it to Veterans to ensure our decisions are fair, clear, and consistent 

across the board. Due to a number of concerns, we are unable to support S. 3023. 

The direction that VA ignore certain evidence, which may already be in the Veteran’s claims file, would not only be unfair to other Veterans, but would conflict 

with other applicable provisions of law. Under 38 U.S.C. § 1154(a), in determining 

whether a condition is related to service, VA must give ‘‘due consideration’’ to the 

‘‘places, types, and circumstances of’’ a Veteran’s service ‘‘as shown by such 

[V]eteran’s service record, [and] the official history of each organization in which 

such [V]eteran served.’’ In addition, 38 U.S.C. § 5107(b) requires VA to ‘‘consider all 

information and law and medical evidence of record in a case before the Secretary 

with respect to benefits under laws administered by the Secretary.’’ Finally, under 

38 U.S.C. § 1154(b), in the case of a Veteran who engaged in combat with the 

enemy, VA must accept lay or other evidence of service regarding service incurrence 

of a disease or injury, notwithstanding the absence of an official record of such incurrence. However, the Veteran must first establish that he or she engaged in combat with the enemy, which usually involves consideration of service department 

records, and the lay or other evidence must be ‘‘consistent with the circumstances, 

conditions, or hardships of such service.’’ 

The proposed presumption of exposure to mustard gas and lewisite, which would 

not be supported by service department records or other objective evidence, would 

be unprecedented if enacted. It appears that the presumption would be invoked solely on the basis of a Veteran’s statement that such exposure occurred and generally 

would be irrebuttable. Existing presumptions of an in-service exposure or event 

apply to discrete groups of Veterans whose service records reflect unique circumstances of service. Examples include Vietnam and Korean Veterans who are 

presumed exposed to Agent Orange during certain time periods, Veterans whose 

records indicate participation in WWII and cold war nuclear weapon detonations 

who are presumed exposed to ionizing radiation, and combat Veterans of all eras 

who are presumed exposed to the sort of traumatic stressor that can cause Post 

Traumatic Stress Disorder. Each of these sets of Veterans will have service department evidence of an in-service event or circumstance that may have triggered postservice disability. 

Under the standard proposed in the bill, any WWII Veteran who has claimed participation in a mustard gas or lewisite test would be entitled to a presumption of 

full body exposure. This includes Veterans who may be confusing exposure to mustard gas or lewisite, with more routine agents such as tear gas, or even to placebo 

agents. All WWII claimants would essentially be presumed exposed to mustard 

gas—even Veterans who participated in no chemical testing. 

Section 2(b) of the bill proposes a joint VA/DOD policy for processing future disability compensation claims based on exposure to mustard gas or lewisite. VA notes 

that mustard gas and lewisite claim policies and procedures are already in place 

and have and continue to lead to fair and equitable outcomes. VA promulgated a 

regulation in 1994 to address full-body mustard gas and lewisite claims (see 38 

CFR. § 3.316) and recently updated procedural guidance directing VA claims processors to consider all relevant evidence, including both service department data and 

information from outside sources. 

We share the Committees concern for these Veterans and we will continue to do 

everything we can, within the scope of the law, to provide care for those who have 

been identified by DOD as having had full body exposure to Mustard Gas and have 

25 

been diagnosed with conditions due to that exposure. Changing the rules for one set 

of individuals is simply unfair for the thousands of other Veterans seeking care at 

VA. We value our Veterans lives equally and want to ensure that each and every 

Veteran seeking care is treated fairly under the law. 

Costs that would be associated with enactment of this proposed legislation are to 

be determined. 

S. 3081—WORKING TO INTEGRATE NETWORKS GUARANTEEING MEMBER ACCESS NOW ACT

(WINGMAN ACT)

Section 2 of this bill would amend Chapter 59 of Title 38, U.S.C. by adding new 

Section 5906 to direct the Secretary to, within 180 days, provide ‘‘accredited,’’ permanent congressional staffers designated by a Member of Congress with remote, 

read-only access to Veterans Benefits Administration’s (VBA) electronic records of 

Veterans who reside in the area represented by the Member, regardless of whether 

the Veteran whose record is accessed has consented to the disclosure of information. 

The bill also clearly states that the provision of access to the congressional staffer 

is not for purposes of representing Veterans in the preparation, presentation, and 

prosecution of claims for Veterans’ benefits. 

VA understands the interest of Members in Congress in having current casework 

information for their Veteran constituents. However, VA strongly opposes this bill 

because it would provide congressional employees with unprecedented access to the 

records of Veterans and other VA claimants, raising significant privacy concerns, 

and because it improperly conflates the concept of access to claims records with the 

distinct mission and function of VA’s Accreditation Program in ensuring that Veterans have access to competent and qualified claims representation. 

Regarding the nature of the access provided, the bill would provide congressional 

staff who assist constituents of a Member of Congress with greater access to VA 

records than is provided to a VA employee or contractor. Under the Privacy Act, 

Federal employees generally may access private records only when necessary to perform their duties. This bill would impose no similar restriction on access by congressional staff. From a privacy and information security standpoint, granting congressional staff unrestricted access to the medical records of Veterans and other VA 

claimants is not in the best interest of Veterans and their families. VA patients and 

claimants entrust VA with their personal, medical, and other information, and they 

do not generally expect that such information could be viewed by Congress without 

their explicit consent. To the extent that congressional staffers require access to an 

electronic claims record for which the Member possesses an appropriate release 

from the individual, access may be provided in the form of a disc or under supervision at a VA facility because those types of access are within the current capabilities of VA systems. 

Regarding how the bill conflates the concepts of access to claims records and representation of claimants, accreditation by VA as attorneys, claims agents, and Veterans Service Organization (VSO) representatives is not done for purposes of providing access to VBA’s electronic records system. Rather, as stated at 38 CFR 

§ 14.626, ‘‘the purpose of [VA’s accreditation and oversight] of representatives, 

agents, attorneys, and other individuals is to ensure that claimants for [VA] benefits 

have responsible, qualified representation in the preparation, presentation, and 

prosecution of claims for veterans’ benefits.’’ In contrast, as specifically stated in 

draft § 5906(d), this bill is unrelated to that purpose. The laws governing accreditation do not address the issue of access to claimants’ records, which are governed separately by other laws. Instead, the provisions in Chapter 59 address the authority 

for regulation and oversight of representation before VA, including the ethical 

standards of professional conduct for representatives, and whether fees charged in 

a particular case may be considered reasonable. VA’s Accreditation Program serves 

the important function of ensuring that Veterans have information on and access 

to qualified and competent representatives who can assist with their claims for benefits and who are subject to appropriate VA regulation and oversight in that role. 

Making congressional employees’ access to claimant records a function of VA’s accreditation program would unnecessarily complicate the operation of that program. 

Referring to congressional staff as ‘‘accredited’’ can only create confusion about 

whether staffers are accredited by VA for purposes of claims representation and 

what their role is in the claims process. 

Access to claims records is authorized under Chapter 57 of Title 38, U.S.C., as 

well as other privacy and information laws. Specifically, 38 U.S.C. § 5701(b)(1) authorizes VA to disclose records to a ‘‘duly authorized agent or representative of a 

claimant.’’ There are numerous provisions in Chapter 57 that provide for release of 

VA records and that have nothing to do with representation and or the status of 

26 

being a VA-accredited representative. Because the bill pertains to congressional access to Veterans’ records, placing this new authorization in Chapter 59 would be an 

additional source of confusion. 

Additionally, there are serious technological obstacles to implementing this bill. 

The bill would impose on VA a substantial burden to accommodate the contemplated 

access. Our system provides access to one representative per Veteran or claim and 

for only the records of a Veteran who has specifically authorized access. VA would 

need to re-design its system architecture to allow more than one representative per 

Veteran or claim. Absent such system changes, in order to provide the type of electronic access to congressional staff contemplated by the bill, VA would have to displace the electronic access of current representatives—VSO representatives, private 

attorneys, and claims agents—causing substantial administrative burdens on VA 

and hardships on those representing Veterans and the Veterans they represent, 

while also interfering with the relationship between Veterans and their 

representatives. 

Finally, Members of Congress and their employees already have access to claims 

status information through VA’s regional offices and central office when specifically 

authorized by a Veteran constituent or when they have proper authority to conduct 

oversight. Each VA regional office has a Congressional Liaison, who may be contacted for claims information assistance, and VA’s Office of Government Relations 

serves as a central point of contact for inquiries originating from Capitol Hill. If enacted, this bill would delay both the development of information technology components critical to VA’s electronic claim process transformation, and the resolution of 

pending claims for benefits. 

Due to the short time-frame and the magnitude of the system changes needed, 

we are unable to provide an accurate cost-estimate at this time, although costs associated with changes to VA information systems would likely be substantial. VA is 

always ready to discuss with the Committee other ways VA can improve a Member 

of Congress’ ability to effectively work with VA to resolve casework issues on behalf 

of their constituents. 

S. 3035—MAXIMIZING EFFICIENCY AND IMPROVING ACCESS TO PROVIDERS AT THE

DEPARTMENT OF VETERANS AFFAIRS ACT OF 2016

Section 2 of S. 3035 would require VA, within 120 days of the date of the enactment of the bill, to carry out a pilot program to increase the use of medical scribes 

to maximize the efficiency of physicians at VA medical facilities. The pilot program 

would be carried out for a period of 18 months and would be located at not fewer 

than five VA medical facilities that VA has determined have a high volume of patients or that are located in rural areas at which the Secretary has determined 

there is a shortage of physicians and each physician has a high caseload. VA would 

be required to enter into contracts with one or more appropriate non-governmental 

entities, defined as an entity that trains and employs professional medical scribes 

who specialize in medical data collection and entry, to carry out the pilot program. 

VA would be required to collect various data on the pilot program to determine the 

effectiveness of the program. VA would be required within 180 days after the commencement of the pilot program, and not less frequently than once every 180 days 

thereafter, to submit to Congress a report on the pilot program. 

VA does not support this bill. Currently, VHA has an Enterprise Wide Front End 

Speech Recognition contract that includes unlimited licenses for clinical end users 

for the Nuance Dragon Medical 360 Network Edition (DMNE) Version 2.3, which 

is the current version. DMNE provides advanced, secure, speech recognition solutions that allow clinicians to document the complete patient story using voice while 

allowing healthcare organizations to deploy and administer medical speech recognition across the enterprise. VHA is in the process of administering a request for proposals that includes the use of scribes (contracted or hired) and transcription, as 

well as a health advocate. An evaluation plan of all methods of provider documentation support has been developed as well. The pilot should commence by end of this 

FY. 

VA estimates this bill would cost $464,427 in FY 2017, and $475,899 in FY 2018. 

DRAFT BILL—READJUSTMENT COUNSELING SERVICES FOR MEMBERS OF THE SELECTED

RESERVE OF THE ARMED FORCES

The draft bill would authorize VA, in consultation with the Secretary of Defense, 

to provide VA readjustment counseling services to any member of the Selected Reserve of the Armed Forces who has a behavioral health condition or psychological 

trauma, to assist the individual in readjusting to civilian life. These services may 

include a comprehensive individual assessment of the member’s psychological, soVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
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cial, and other characteristics to ascertain whether he or she has difficulties associated with readjusting to civilian life. Such a member would not be required to obtain a referral before receiving these services. If enacted, these amendments would 

become effective one year after the date of the Act’s enactment. 

VA does not support this bill. The Readjustment Counseling Service (RCS) was 

created in 1979 to provide the specific and unique function of assisting individuals 

to life after combat related military service. This bill would authorize VA to expand 

RCS services related to assisting the individual in readjusting to civilian life to all 

members of the Selected Reserve of the Armed Forces who have behavioral health 

conditions or psychological trauma, regardless of connection to combat related service. VA currently has authority to provide readjustment counseling services to members of the Selected Reserve who meet other qualifying criteria; namely: (1) having 

served on active military duty in any combat theater or an area at a time during 

which hostilities occurred in that area; (2) having experienced military sexual trauma while serving on active military duty, active duty for training, or inactive duty 

training; (3) having provided direct emergency medical or mental health care or 

mortuary services to the casualties of combat operations or hostilities; (4) having engaged in combat with an enemy of the United States or against an opposing military 

force in a theater of combat operations or an area at a time during which hostilities 

occurred in that area by remotely controlling an unmanned aerial vehicle; or (5) 

having received readjustment counseling before January 2, 2013. We are concerned 

that this bill would expand the scope of RCS and would be inconsistent with the 

intended design of RCS. 

DRAFT BILL—TO CLARIFY THE SCOPE OF PROCEDURAL RIGHTS OF MEMBERS OF THE

UNIFORMED SERVICES WITH RESPECT TO THEIR EMPLOYMENT AND REEMPLOYMENT

RIGHTS, TO IMPROVE THE ENFORCEMENT OF SUCH EMPLOYMENT AND REEMPLOYMENT RIGHTS, AND FOR OTHER PURPOSES. 

The draft legislation on employment rights for the uniformed services would 

amend Chapter 43 of Title 38 to clarify the scope of employment and reemployment 

rights of members of the uniformed services and to amend the enforcement of employment and reemployment rights of members of uniformed services with respect 

to a State or private employer. VA respectfully defers to the Department of Justice 

and the Department of Labor for views on this draft legislation. 

DISCUSSION DRAFT—TO AUTHORIZE THE AMERICAN BATTLE MONUMENTS COMMISSION

TO ACQUIRE, OPERATE, AND MAINTAIN THE LAFAYETTE ESCADRILL MEMORIAL IN

MARNES-LA-COQUETTE, FRANCE. 

The discussion draft would authorize the American Battle Monuments Commission to enter into an agreement to acquire, operate, and maintain the Lafayette Escadrille Memorial in Marne-la-Coquette, France. Because this bill concerns responsibilities under the purview of the American Battle Monuments Commission, VA defers to the views of that agency on the discussion draft. 

Mr. Chairman, this concludes my statement. Thank you for the opportunity to appear before you today. We would be pleased to respond to questions you or other 

Members may have. 

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ADDITIONAL VIEWS OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS


629VA2ndViews1.eps
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629VA2ndViews2.eps
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Chairman ISAKSON. Well, thank you very much for your 

testimony. 

I will start off with the questions. We will go with a round of 5 

minutes for questions for each Member. 

Let us go back to the WINGMAN Act and your last statement. 

Would you walk us through how the information may be obtained 

by caseworkers now and how long it generally takes to get that information. 

Mr. MCLENACHEN. Mr. Chairman, I do not have information on 

how long it takes. I can tell you that each of our regional offices 

has a Congressional liaison, that their specific job is to work with 

local Congressional caseworkers to provide that information as 

quickly as possible, and we are definitely willing to work with the 

Committee and other Members of Congress to speed that process 

up. 


629VA2ndViews3.eps
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What happens now is VA receives a release from the claimant, 

generally through the Congressional staff, that authorizes us to 

disclose information to the caseworker; we try to do that as quickly 

and as efficiently as we can, as well as to provide other information 

that the caseworker may need regarding what do these records 

mean. 

I will tell you that although we have concerns about, on behalf 

of veterans, privacy, we are working hard right now to do something that may help in this area, and that is exposing the e-folder 

in our Veterans Benefits Management System, or VBMS, to veterans and also to third parties that they may authorize for us to 

disclose that information to. So, that is a goal that we are actively 

working on now, where that information would be available electronically to veterans and the individuals that they authorize to 

have access. 

Chairman ISAKSON. Does not every inquiry on a benefit or appeal 

on a disability claim or any other benefit from the VA require a 

privacy release from the veteran? 

Mr. MCLENACHEN. Yes, unless it is the veteran themselves asking for it. They have a right to it under the—— 

Chairman ISAKSON. I understand that. But in terms of this deals 

with Congressional staff—— 

Mr. MCLENACHEN. Right. 

Chairman ISAKSON [continuing]. And every one of them, the first 

thing we are instructed to do, or we instruct our staff to do, is to 

get a privacy release before anything else happens. That is true nationwide, is it not? 

Mr. MCLENACHEN. That is true with an exception of yourself, I 

believe, on behalf of the Committee asking for information. I believe the Committee has that authority to ask us for information. 

Chairman ISAKSON. And you said your objection to this bill was 

what? 

Mr. MCLENACHEN. Well, this bill would essentially authorize all 

Congressional personnel to have access to our systems, regardless 

of the consent or authorization of the claimant. So, we think the 

veteran’s privacy right is paramount to everything and they should 

have the ability to determine who they are going to—who VA 

should disclose their records to. 

Chairman ISAKSON. So, you want to maintain the privacy release 

signed by the veteran. But once you get the privacy release, how 

difficult is it for staff to get the information they need to assist the 

veteran? 

Mr. MCLENACHEN. As long as we have that authorization, it 

should not be difficult. 

Chairman ISAKSON. Are you aware that Senator Rounds and 

Senator Manchin will be conducting a roundtable, if you will, for 

lack of a better term, here at the Committee during the break over 

the next 2 weeks to talk about this very issue? 

Mr. MCLENACHEN. I am not aware of that. 

Chairman ISAKSON. A number of offices, and I have received as 

Chairman a number of complaints, if you will, for the lack of speed 

in responding to Congressional inquiries from the VA. I think part 

of the genesis of this particular legislation is some of the frustration with the response time it takes for many caseworkers to get 

32 

veterans’ information. So, I hope you will participate with whomever the Secretary decides to come and testify at that particular 

event. 

Mr. MCLENACHEN. I would be happy to. I would like to say, Mr. 

Chairman, I am not downplaying the delay, and specifically in responding to veterans’ own requests for Privacy Act information, 

their own records. We are working hard to address that particular 

problem. It does exist and we are working hard to address it. Veterans should be able to go online and see their own record. 

Chairman ISAKSON. One other question. You said that you were 

opposed to Senator Cotton’s proposal with regard to burial of indigent veterans? 

Mr. MCLENACHEN. No. We strongly support it. 

Chairman ISAKSON. You strongly support it? 

Mr. MCLENACHEN. Yes, sir. 

Chairman ISAKSON. I am sorry. I misheard that. 

Senator Blumenthal. 

HON. RICHARD BLUMENTHAL, 

U.S. SENATOR FROM CONNECTICUT 

Senator BLUMENTHAL. Thank you very much, Mr. Chairman, and 

thanks for having this hearing on a number of separate bills. If I 

count correctly, we have 18 bills on our agenda and they are extremely important to advance the interests of our veterans. 

One of them is the Veteran PEER Act, which complements the 

VA’s ongoing efforts that I have strongly supported. The measure 

would expand the use of peer support specialists beyond traditional 

mental health sites of care. The VA has indicated support for the 

measure, ‘‘subject to the availability of additional funding.’’ Dr. 

McCarthy, can you tell us what the VA currently spends on the 

peer support program. 

Dr. MCCARTHY. Well, let me start by saying we currently have 

a peer support program in mental health and we have a pilot going 

on for encouraging individuals that are receiving mental health 

care right in primary care. So, we have seven sites that are up 

now, six more that will be starting in July, and nine more in January, and potentially four additional, where we would have peer 

support to encourage the veterans in the primary care clinics to receive mental health services that are embedded. 

As for the current costs, I am not sure I have those figures handy 

at this point for what we are spending right now on that particular 

pilot, but that would bring us to a total of 26 sites that we currently have ongoing, and the bill is—— 

Senator BLUMENTHAL. The bill would bring to 26. 

Dr. MCCARTHY. No. We already have twenty—— 

Senator BLUMENTHAL. OK. Tell me—— 

Dr. MCCARTHY. We have 13—— 

Senator BLUMENTHAL. Since we are short on time, let me just 

ask very directly. 

Dr. MCCARTHY. Sure. 

Senator BLUMENTHAL. How much more spending would it cost to 

implement the Veteran PEER Act? 

Dr. MCCARTHY. So, the total for 3 years is projected to be $2.8 

million. 

33 

Senator BLUMENTHAL. Two-point-eight million with an ‘‘M.’’ 

Dr. MCCARTHY. Million with an ‘‘M.’’ 

Senator BLUMENTHAL. OK. Let me ask you, Mr. McLenachen, I 

was proud to introduce the FRAUD Act (Fiduciary Responsibility 

and Accountability for Unpaid Debts) with my colleagues, Senators 

Brown and Moran, to address the misuse—I think it is rampant— 

of VA benefits. That misuse is not by the veterans, it is by fiduciaries that are appointed to safeguard the finances of our veterans. Those fiduciaries all too often commit fraud. The misuse of 

these benefits is rampant. 

In your testimony, you state that during the calendar year 2015, 

the VA reissued more than $2 million in benefits to veterans who 

have experienced the misuse of funds at the hands of fiduciaries, 

and that $2 million covers only the ones you know about and who 

have been processed, so there may be many, many more, as I understand it, that $2 million covers only ten veterans. 

This legislation is fruitful to ensure that the VA can reissue benefits in all cases of fiduciary misuse, which I think we need to do 

more to protect our most vulnerable veterans. They can be at the 

mercy of family, caregivers, all kinds of potential abuse. 

Would you please explain the process that is used to appoint a 

fiduciary for a veteran receiving these benefits, and how do you 

evaluate whether a fiduciary is going to be equipped in terms of expertise, but also be trustworthy, to administer those benefits. 

Mr. MCLENACHEN. I would be happy to. Back in about 2004, 

Congress amended the law to require VA to use a specific investigation method when we appoint a fiduciary, with the standard 

being that we have to make a best interest determination on behalf 

of the beneficiary. Actually, the law requires us to do a number of 

things, such as a background check, a credit check, check character 

references, and so the statute itself establishes that standard for 

us. 

In our policy, we have determined that the first thing that we 

will look at for appointing a fiduciary is a family member. We are 

transitioning the program from one where, in the past, veterans, a 

lot of their benefits were used to pay fees to professional fiduciaries. We are shifting the program toward more family and friend 

caregiver-type oriented program and we have been very successful 

at that. The program is growing extremely fast. 

But our really important role that we play is oversight to detect 

misuse, and although I regret that there is any misuse in our program, the fact that we are doing sufficient oversight to detect misuse and provide reissuance of benefits according to the authority 

that we have now in one way is a sign that we are doing good oversight. 

Yes, I hope that we can do more to diminish that by appointing 

appropriate people to provide these services for these veterans and 

survivors, but it does happen. I respectfully disagree with you that 

it is rampant in our program. You are right, we do not know what 

is happening that we have not found, but we make every effort to 

find the misuse that is occurring. We do audits. We do follow-up 

field examinations. We do on-site visits of fiduciaries. This bill, in 

particular, will expand our authority for doing oversight because it 

34 

would allow us to have access to financial records that we currently 

do not have. 

So that, in addition to the provision to reissue benefits, would 

strengthen our oversight. It is very important legislation. 

Senator BLUMENTHAL. Thank you. Thank you for your response. 

My time has expired, but I hope to follow up in written questions. 

Thank you. 

Mr. MCLENACHEN. Thank you. 

Chairman ISAKSON. Senator Tillis. 

HON. THOM TILLIS, U.S. SENATOR FROM NORTH CAROLINA 

Senator TILLIS. Thank you, Mr. Chair. Thank you all for being 

here. 

I guess before I get started on questions about two bills, I do 

think that the Department’s position on a bill that is sponsored by 

my senior Senator, the Department of Veterans Affairs Dental Insurance Reauthorization Act, you support? 

[Witness nodding.] 

Senator TILLIS. Good. Thank you, on Senator Burr’s behalf. 

I want to go back first to the Veterans Health Care Staffing Improvement Act. I think that there is a qualified support there. And 

before I ask you all to go through the areas that you have as concerns, there are a few pieces of the bill that I feel like we need to 

work on. One of them relates to—I know that the Department is 

making a decision, or has made a policy decision to extend or make 

some staffing decisions with respect to nurse anesthetists, for 

example. 

One thing that I think we have to be mindful of is that in States 

that have clear scope of practice laws, I hope that the Department 

is looking at instances where you have a bona fide shortage of the 

most qualified people before you would move that route, because I 

think that could create a slippery slope to where it is more of a 

lower-cost alternative rather than a most-qualified alternative. So, 

I recognize there are places in the country where you have the deficiencies and you may have to do them, but could you give me a reaction to that? 

Dr. MCCARTHY. Absolutely. As you noted, we have the final rule 

out for comment, and when we reached 10,000 comments, well, it 

was like nothing we had ever received before. We are now at 

48,000 comments; the comment period extends until July 28. 

I think the Certified Registered Nurse Anesthetist part of it is 

the one that has brought a lot of controversy. In VA, nurse anesthetists work closely with anesthesiologists and our model of care 

is team-based care. Teams define a lot of what we do. If you look 

across our system, we do have access challenges in primary care, 

in mental health, specialty care, and so forth, but we have not 

identified significant shortages of anesthesiologists, for instance. 

So, at this point, the proposed rulemaking is all inclusive with the 

idea that we would not necessarily implement all the changes in 

the rulemaking until it is clear what is needed. So, we would have 

flexibility. 

Senator TILLIS. Well, thank you, because, again, it just speaks to 

a capability and training that if it is available, we want it in the 

hospital setting to make sure the veterans are getting the best posVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00038 Fmt 6633 Sfmt 6601 Z:\ACTIVE\062916.TXT PAULIN
35 

sible care. That is taking nothing away from the nurse anesthetists. It is just making certain that this does not just change a 

model that is based more on business factors than medical outcomes. So, I appreciate that. 

Can you tell me other aspects, areas of concern, that you have? 

I do not think you necessarily had a concern with that aspect of 

it, but other areas where you are having problems with the Staffing Improvement Act. 

Dr. MCCARTHY. There were a couple of concerns. One was the desire to have a separate credentialing program. We do have a national program we call VetPro, which is actually quite functional 

and allows credentialing to be across our system. So, we do not 

need to really change that. 

We are excited about what we are doing with DOD in helping 

people come into our system now, all the possibilities for how we 

can partner and have folks supported with training options, and 

make the transition into VA easier. It is a win-win for those veterans who are being discharged and for us. 

So, the main concern, really, for us is to let the rulemaking comments happen. That is the main section that we are concerned 

about. 

Senator TILLIS. All right. In my limited time, I want to get to the 

other one, which has to do with the Atomic Veterans Health Care 

Parity Act, and in some ways—there is no way we are going to get 

this done in 48 seconds, but I have been in the battles and, obviously, I think I have established good relationships within the VA. 

I am trying to do everything I can to support you all in efforts that 

I think are right minded. 

But, I almost feel like we are at a point where we were with the 

Camp Lejeune toxic substances, where people were saying there is 

not quite enough data for us to give the benefit of the doubt to the 

veteran. I am wondering whether or not the full complement of 

medical research, people that are looking at this, share the same 

position that the VA does right now, which is there is no presumption that their exposure—I am not a doctor, not a lawyer, but if we 

put these people on an island in T-shirts in close proximity to a 

mushroom cloud which is the aftermath of an atomic bomb, common sense says there may have been some exposure there that 

could have caused a condition. 

I am not going to ask you to respond to it because I am out of 

time, but I would like to maybe find a time to meet, as we did— 

and we got to a pretty good place with the Camp Lejeune toxic substances—to show me how that data would lead you to that position. 

Thank you, Mr. Chair. 

Chairman ISAKSON. Thank you, Senator Tillis. 

For a clarification for my purposes, with regard to the nurse anesthetists, you had a record response in terms of public input when 

you published that. 

Dr. MCCARTHY. Mm-hmm. 

Chairman ISAKSON. Now, my understanding is that you have determined that you have enough licensed and trained anesthesiologists to meet the demands of the Veterans Administration, so you 

are not going to be implementing at the present time a nurse anesVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00039 Fmt 6633 Sfmt 6601 Z:\ACTIVE\062916.TXT PAULIN
36 

thetist program to replace any anesthesiologists anywhere, is that 

correct? 

Dr. MCCARTHY. That is where we are right now, sir. Dr. Shulkin 

has talked about the fact that it took 6 years for us to bring it to 

the final rule at this point and a future Under Secretary, he would 

not want them to have to go through another 6 years of waiting 

to bring that particular rule. He feels like having the rule published would be useful to us should we need to implement it in the 

future. But, it is really going to be facility-specific, what are the 

needs of that individual facility and the veterans that come there 

in terms of who are the right people to be prescribing or treating 

the veterans with anesthesia. 

Chairman ISAKSON. Given that the rule would allow at a future 

date a Secretary to determine to use some nurse anesthetists, what 

would be the requirement to let this Committee know about that 

before they make that decision? Is there anything in the rulemaking that determines that? 

Dr. MCCARTHY. I do not know that that is in the rulemaking, but 

in the spirit of cooperation, I think it makes a lot of sense for people to talk about that together. 

Chairman ISAKSON. My point is, I think the Committee should 

be made aware in advance of the rule being amended by the Secretary, and I wish you would share that with Dr. Shulkin. 

Dr. MCCARTHY. I will. 

Chairman ISAKSON. I appreciate that. 

Dr. MCCARTHY. Thank you. 

Chairman ISAKSON. Senator Murray. 

Senator MURRAY. Thank you very much. 

Dr. McCarthy, Vet Centers are one of the most successful programs VA runs, with some really high satisfaction scores. I strongly believe that this is really an important service that would help 

greatly our Guard and Reserve members when they return home 

from deployments, and as we do so, we want to protect the Vet 

Center system and make sure it can meet the demand. 

In Lacey, WA, in my home State, we created a new satellite office of our Tacoma Vet Center to meet the needs of the veterans 

in the area. It is already at full capacity and needs more staff and 

expanded hours, which I hope the Department will address. 

But, I wanted to ask you, if we expand eligibility for Vet Centers 

to members of the Guard and Reserve, how much additional resources will the VA need and will you make that in your request 

for your next budget? 

Dr. MCCARTHY. OK. Let me just address the specific legislation 

about rehab counseling services. It talks about members of the 

Guard and Reserve who are not otherwise eligible, so we are not 

talking about combat veterans or veterans who may have experienced military sexual trauma (MST) or been involved with emergency medical care or mortuary services. That is the highlight of 

this particular proposed legislation that we are a little bit concerned about. 

We do not want to destroy the special nature or culture of the 

Vet Centers. We do want to expand the role more. We have a staff 

that have been built up around trauma, counseling, and so forth, 

where this expands the roles of the Vet Centers to cover more than 

37 

just trauma counseling, which is our concern. It is not that we do 

not want to do it, but it would be a major mission shift for those 

in the Vet Centers. About 80 percent of the staff are themselves 

people who have been trauma counselors for quite a while. 

We feel like the Guard and Reserves, they have eligibility for 

care for MST and for those who have combat services and even 

those who have been discharged dishonorably can come to the Vet 

Centers, as you know. We are really proud of the Vet Centers. 

They do have some capacity to help us with our access for mental 

health and we are really looking to partner with them to do more. 

But we really do not want to change the culture and the mission. 

There is a special clientele that go to the Vet Centers, often people that do not want to have, for instance, a trail of medical records 

about the care that they are receiving; people that might be police, 

National Guard, active duty, Reservists. And there is a culture of 

combat veterans and veterans with MST. So, changing it to allow 

those that are not part of that group in particular is the part of 

that bill that we have concerns about. 

Senator MURRAY. I also wanted to ask you, as you know, veterans living in our rural communities often experience barriers to 

accessing the health care that they need. The Veterans Travel Enhancement Act would permanently authorize the Veterans Transportation Service (VTS) to improve veterans’ ability to access care 

and expand the definition of VA facilities to include Vet Centers. 

The Veterans Transportation Service has been very popular in my 

homestate of Washington and I understand it is also very cost effective for the VA. If this legislation is enacted, how much will you 

be able to expand VTS services? 

Dr. MCCARTHY. I want to first of all thank our VSO partners, 

who themselves have quite a transportation network. 

Senator MURRAY. Yes, they do. 

Dr. MCCARTHY. I would not want us to not thank them. 

Second, we are really excited about making that permanent. For 

us, the VTS made over 400,000 trips averaging 54 miles. It has 

been really quite significant for us. There has been a decrease in 

cost compared to beneficiary travel of 4 percent. That resulted in 

$1.7 million savings anticipated for fiscal year 2017. 

There is some concern about expanding to the Vet Centers. There 

is a pilot program going on that has allowed for transportation for 

rural veterans to Vet Centers and the reaction to it has been somewhat negative and not what we expected. The concerns are twofold. 

First of all, from the point of view of the veterans, again, when I 

talked about the culture, the people that like the anonymity of 

coming to the Vet Centers, to process claims related to travel requires listing diagnosis and treatment and so forth, which is something that they do not want to be revealed in particular. So, that 

is one administrative function. 

Then, there is the other side of the coin, the Vet Centers. I mean, 

they are set up for quick access, easy availability. They do not have 

a lot of overhead people that would be involved in all the fiduciary 

responsibilities, so it has been a concern for them, as well. 

We are really supportive of the bill, but we do question the Vet 

Centers being included, although we understand the needs for help 

38 

with veterans being transported to the rural Vet Centers, in particular. 

Senator MURRAY. I am out of time. Thank you very much, Mr. 

Chairman. 

Chairman ISAKSON. Thank you, Senator Murray. 

Senator Heller. 

HON. DEAN HELLER, U.S. SENATOR FROM NEVADA 

Senator HELLER. Mr. Chairman, thank you, and to our panelists, 

also, thank you for being here. 

I just had a couple of questions. I want to thank the Chairman 

for including my legislation, S. 3035 with Senator Tester. I certainly do appreciate his support on this. The title on the bill is 

Maximizing Efficiency and Improving Access to Providers at the 

Department of Veterans Affairs Act of 2016. It is a long title, Mr. 

Chairman. It was not my first choice, but I will take it. 

I think the bill is somewhat unique. It conducts a pilot program 

using medical scribes at the VA so that doctors can spend more 

time with their veteran patients. I am pleased that I have got the 

support of the VFW, the Disabled American Veterans organization, 

and The American Legion. Unfortunately, we do not have the VA 

on board yet. In fact, I am looking at some of the testimony. Doctor, you said the VA does not support this bill. Then you go on to 

say that the VHA is in the process of administering a request for 

proposals that includes the use of scribes. So, one, you say you are 

not for it, but then you say within the same paragraph that you 

have a proposal. Could you explain to me what your proposal is for 

the use of scribes and what the VA is envisioning here. 

Dr. MCCARTHY. First of all, thank you. I think most clinicians 

who work with electronic medical records worry about the time 

taken away from patients in documenting and how much typing 

goes on versus scribes and so forth. So, we understand what is behind this. 

Right now, VA has an enterprise-wide contract so that all frontend providers can use what is called a speech recognition contract, 

where it is Nuance® Dragon Medical 360 Network Edition Version 

2.3. 

Senator HELLER. Another long title. 

Dr. MCCARTHY. I know. I am sorry about the long name, too—— 

Senator HELLER. That is OK. 

Dr. MCCARTHY. But, you know, I used this a long time ago, 

which was probably version negative one or something, and when 

you do the Dragon dictate, you actually have to teach the device 

that is recording your voice and translating it into what is typed. 

You have to train it to your own personal voice or accent or whatever. But, this is available nationwide currently. 

Our Request for Proposal (RFP), which is what you asked about, 

includes for scribes, transcription, and a health advocate at the 

same time that might be able to help us with some of the public 

health screening kind of measures that we do at the same time. It 

is a kind of tweak on what this bill proposes, so that is why. 

We have a couple of pilots going on right now, but we also have 

that national contract and we are encouraging the use, as well. 

39 

Senator HELLER. Doctor, I spent some time in Las Vegas and 

Reno this March and hosted two military and veterans roundtables. I heard from these veterans both in Northern Nevada and 

Southern Nevada, and probably one of the biggest complaints I got 

was they are concerned with how little time they actually got to 

spend with their doctor. So, obviously what you are trying to propose and what we are trying to propose, hopefully, we can somewhat come together on this and understand that these patients, 

these veterans, need more eye-to-eye time with their doctors. 

I guess the question I have right now is, do you have any statistics that show how much time a doctor does spend with their patients at a VA facility? 

Dr. MCCARTHY. We have statistics about expectations and we include a typical primary care visit would be 30 minutes. I sympathize with what the veterans are saying. Do not treat the computer, treat me. 

Senator HELLER. Yes. 

Dr. MCCARTHY. I fully understand that. We have worked to get 

our rooms set up so that you do not have to turn your back on the 

patient to enter things into the computer. 

A lot of our screening happens in the initial primary care visit, 

but in that 20- to 30-minute visit, there is a lot that goes on. I can 

get you statistics about average amount of time spent if that would 

be helpful to you. 

Senator HELLER. Well, let me ask you this question. When you 

measure patient satisfaction, do you consider the time with the 

doctor as part of that satisfaction? 

Dr. MCCARTHY. There are measures that ask things like: did you 

feel like your need got met? Did you feel like the doctor understood 

what you were saying as what you brought to the appointment and 

so forth—— 

Senator HELLER. It is open-ended, also—— 

Dr. MCCARTHY. Yes. 

Senator HELLER [continuing]. For any comments that they may 

have? 

Dr. MCCARTHY. Yes, sir. 

Senator HELLER. Do you have any statistics also that show how 

much time these doctors spend with these electronic health 

records? 

Dr. MCCARTHY. I do not, but I can look for them. I would be 

happy to take that for the record. 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. DEAN HELLER TO

THE U.S. DEPARTMENT OF VETERANS AFFAIRS

Response. VA does not currently collect this type of data as it is not easy to obtain. Simply asking physicians often leads to inaccurate estimates and there is no 

easy way to track this electronically. The research on this has general involved direct observation, ‘‘time-motion’’ studies which are expensive to conduct. 

Senator HELLER. OK. My time has run out. 

Dr. MCCARTHY. OK. 

Senator HELLER. Chairman, thank you very much. 

Chairman ISAKSON. Senator Cassidy. 

40 

HON. BILL CASSIDY, U.S. SENATOR FROM LOUISIANA 

Senator CASSIDY. Thank you, Mr. Chair. 

Dr. McCarthy, I am interested in the WINGMAN Act, which I 

gather you all oppose, but when I read the nature of your opposition, I am not quite sure why you oppose. For those who—in short, 

when my folks are working to try and facilitate something with the 

VA, they sometimes wait weeks and months to get the record from 

the VA. My chief, the person who is my guru on how to make work 

all things, she just kind of says, ‘‘Bill, sometimes we cannot get 

anything from the VA and there is nothing I can do except drive 

down there.’’ 

Now, here, I look at your testimony as to why you oppose allowing our staff read-only access to the records contingent upon the 

veteran signing a release that that may occur, which is referenced 

in the bill; I think you raised privacy concerns. Let me be explicit. 

What we reference, which is 552(a)(B) of Title V, explicitly says 

there has to be an informed consent by the patient to allow this 

access. So, I guess that is one thing. The privacy concern does not 

seem to work with me. 

Second, we would expect that they would have the same training 

in use of these records as the VA folks. I understand that there is 

an online course that VA employees take to kind of do this sort of 

review, which is what we presume would be for the Congressional 

staff. Is there something besides this online course which makes 

someone working for the VA specially qualified, and if so, why 

could not the Congressional staff have access to the same training? 

Dr. MCCARTHY. I am going to pass that to my partner in VBA 

to answer that question. 

Mr. MCLENACHEN. Yes, Senator. I will take the question. Thank 

you. 

Actually, Senator, our reading of the bill is apparently not the 

same as yours. We read the bill to mean that Congressional staff 

would actually have unprecedented access—— 

Senator CASSIDY. Now, you define unprecedented, which is somewhat pejorative, so what do you base upon—it is unprecedented, 

right, in the sense that before, we have had to wait for somebody 

to send it to us—— 

Mr. MCLENACHEN. Sure. 

Senator CASSIDY [continuing]. But it is—— 

Mr. MCLENACHEN. Let me explain. They would have access 

greater than the VA employees. VA employees currently have access to records only if they have a need in working a particular veteran’s claim. The bill would allow—— 

Senator CASSIDY. That would be the case—let me interrupt, 

please—because the person would only have access if the veteran 

himself or herself signed a release. So, they would only have access 

for people in their district who had explicitly said, ‘‘I need help 

with my benefits and I am not getting it,’’ sort of thing. 

Mr. MCLENACHEN. Actually, our reading of the bill indicates that 

the access would be regardless of the individual’s consent. 

Senator CASSIDY. No, that is wrong, and that is where I refer 

to—I can give it to you if you wish—552(a)(B) of Title V, and I will 

read from here, ‘‘except pursuant to a written request or with a 

41 

prior written consent of the individual to whom the record pertains,’’ et cetera. So, I think I win on that one—— 

Mr. MCLENACHEN. Well—— 

Senator CASSIDY [continuing]. But go ahead. 

Mr. MCLENACHEN. I will certainly go back and take a look at it, 

but our position is authorization from the veteran has to be there. 

If the legislation provides for that, then yes, there may be some 

change to our views on the bill. 

That is not the only issue in the bill. The bill creates some confusion about VA’s accreditation program. VA accredits representatives for the purpose of providing representation on claims, not for 

purpose of access to our systems. 

As I said before, and I apologize, it may have been before you 

came in, but we feel the solution to this problem—and I do not disagree with you that we are too slow in providing veterans’ records 

even to veterans themselves. So, to address that, we are going to 

make veterans’ records available to them through e-Benefits, as 

well as to other individuals that the veteran authorizes to have access. I think that is the solution to this problem. 

Senator CASSIDY. I guess I am not following. If the veteran authorizes Johnny Isakson’s staff person who is working on their veteran’s benefit claim to have access to the record and it is—you can 

trust me, I am right on this one, because we explicitly said it had 

to be approved—I am not sure that is different from what you just 

said. Oh, we are going to release the records to whomever the veteran tells us to release the records to. Did I miss something there? 

It seems substantially the same. 

Mr. MCLENACHEN. The bill concerns electronic access, and we 

currently do not provide—— 

Senator CASSIDY. Oh. So, now we have to go back to waiting for 

you all to generate it. That is incredibly frustrating, let me tell you 

that. 

Now, you are drawing a distinction between our aides accessing 

this record to look up, OK, they say you have a hepatitis claim and 

you say you were exposed and they say not, and you are saying 

that that is somehow with claims. I do not quite follow why allowing someone to do a PDF search for the word ‘‘hepatitis’’—I am not 

following the distinction you are making, which is not to say there 

is not a distinction. I just do not follow it. 

Mr. MCLENACHEN. I think you will hear some concerns from the 

next panel, as well. You know, simply providing access to a record 

does not really interpret what that record means. I would hope that 

some engagement between our Congressional liaison and your 

staffs is helpful, as well as engagement with representatives such 

as the VSO representatives for a particular claimant. We would be 

very happy to work with the Committee and any other member of 

Congress to figure out how we can get that information to you 

more quickly. 

Senator CASSIDY. I know I am out of time, so I will just finish 

by saying this, I have not yet heard an objection that actually 

sounds like it is firm. We have the privacy addressed. That is clearly addressed in this section. I will submit this for the record, Mr. 

Chairman. 

[The information from Senator Cassidy follows:] 

42 

5 U.S.C.—UNITED STATES CODE, 2010 EDITION

Title 5. Government Organization and Employees 

Part I. The Agencies Generally 

Chapter 5. Administrative Procedure 

Subchapter II. Administrative Procedure 

SEC. 552a. RECORDS MAINTAINED ON INDIVIDUALS 

(b) CONDITIONS OF DISCLOSURE.—No agency shall disclose any record which is 

contained in a system of records by any means of communication to any person, or 

to another agency, except pursuant to a written request by, or with the prior written 

consent of, the individual to whom the record pertains, unless disclosure of the 

record would be— 

(1) to those officers and employees of the agency which maintains the record 

who have a need for the record in the performance of their duties; 

(2) required under section 552 of this title; 

(3) for a routine use as defined in subsection (a)(7) of this section and described under subsection (e)(4)(D) of this section; 

(4) to the Bureau of the Census for purposes of planning or carrying out a 

census or survey or related activity pursuant to the provisions of title 13; 

(5) to a recipient who has provided the agency with advance adequate written 

assurance that the record will be used solely as a statistical research or reporting record, and the record is to be transferred in a form that is not individually 

identifiable; 

(6) to the National Archives and Records Administration as a record which 

has sufficient historical or other value to warrant its continued preservation by 

the United States Government, or for evaluation by the Archivist of the United 

States or the designee of the Archivist to determine whether the record has 

such value; 

(7) to another agency or to an instrumentality of any governmental jurisdiction within or under the control of the United States for a civil or criminal law 

enforcement activity if the activity is authorized by law, and if the head of the 

agency or instrumentality has made a written request to the agency which 

maintains the record specifying the particular portion desired and the law enforcement activity for which the record is sought; 

(8) to a person pursuant to a showing of compelling circumstances affecting 

the health or safety of an individual if upon such disclosure notification is 

transmitted to the last known address of such individual; 

(9) to either House of Congress, or, to the extent of matter within its jurisdiction, any committee or subcommittee thereof, any joint committee of Congress 

or subcommittee of any such joint committee; 

(10) to the Comptroller General, or any of his authorized representatives, in 

the course of the performance of the duties of the Government Accountability 

Office; 

(11) pursuant to the order of a court of competent jurisdiction; or 

(12) to a consumer reporting agency in accordance with section 3711(e) of 

title 31. 

Senator CASSIDY. The other just seems to be kind of a nebulous 

sort of, well, we do not want them in our record, even though it 

is read-only, ‘‘because.’’ I do not know if you can—and I am out of 

time—respond maybe for the record as to why it is more than ‘‘because.’’ 

Mr. MCLENACHEN. I would be happy to. 

[See the Chairman’s remarks below addressing this issue.] 

Senator CASSIDY. That is all I get right now. I yield back. 

Chairman ISAKSON. Let me acknowledge how important your 

comments are. Before you arrived here, I raised exactly the same 

issues with the VA and reminded them that we are going to have 

a scheduled roundtable here with representatives from each Member’s office back home and the VA to talk about the intercommuniVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00046 Fmt 6633 Sfmt 6601 Z:\ACTIVE\062916.TXT PAULIN
43 

cation between the VA and us in terms of case work matters with 

the Veterans Administration. 

And I, like you, am a WINGMAN supporter. I would like to see 

us work through the difficulties that the agency has to make sure 

we improve access to information so we can improve the speed with 

which we get back to our veterans who have claims. So, your time 

was well spent and I thank you for your input. 

Senator Sullivan. 

HON. DAN SULLIVAN, U.S. SENATOR FROM ALASKA 

Senator SULLIVAN. Thank you, Mr. Chairman, and I appreciate 

the witnesses coming today. 

I wanted to talk a little bit about a draft bill that I have been 

working on with the VA. It actually stemmed from a visit that 

Under Secretary Shulkin and I had in Alaska where we were out 

in several different communities. One of the big take-aways I believe he had from that trip was some of the big challenges that, not 

just Alaska, but rural States who have big veteran populations who 

do not have enough providers to actually help with regard to a lot 

of the challenges that the VA has. 

As you all probably know, there was a recent Association of 

American Medical Colleges survey that said close to 45 percent of 

doctors who do their residencies at certain medical schools end up 

staying there. Well, if you have a State like mine where you do not 

have a medical school, you kind of start with a challenge. 

So, we have been working closely with the VA for months now— 

it was actually really in many ways Dr. Shulkin’s idea last year— 

to have a pilot program for the VA to work with tribal organizations, particularly in States with heavy veteran populations but are 

very rural States. So, not just Alaska, but Montana, Wyoming, 

other places like that. 

I know that—I guess that we were just outside of the timeframe 

to get your guys’ official view on that. You said you needed 3 

weeks. I think we got it to you 2 weeks and 3 days ago. So, if we 

did not make it under the deadline, I get that, though it would be 

nice to be able to get the response. I am almost certain that the 

VA is supportive, since in many ways it was Dr. Shulkin’s idea, 

which we have been working with you and some of the other organizations interested in this for months now. 

So, Dr. McCarthy, would you mind just giving a view on that, 

whether it is official or not. I think we are very close and I would 

like to get your view. Then we are going to work hard to get others 

from other States, other Members on this Committee to be cosponsors of that, but we want to make sure the VA was good to go with 

it first. 

Dr. MCCARTHY. We would really like to get to yes. There are a 

few items that we want to work with you about. I totally agree 

with you about the training and where people stay. You are exactly 

right, and I do think that this would be really important. 

We are also, as part of the Choice Act, trying to expand residency 

programs significantly—— 

Senator SULLIVAN. Yes. Right. 

44 

Dr. MCCARTHY [continuing]. So, this is a good fit for us. There 

are some other regulations that we have to get through. I do not 

want to speak for all of them—— 

Senator SULLIVAN. OK. 

Dr. MCCARTHY [continuing]. But I would be happy to talk to you 

more about it. 

Senator SULLIVAN. OK. Well, let us remember, though, we are 

also looking at statute, so obviously a law would trump a regulation. 

Dr. MCCARTHY. Yes. 

Senator SULLIVAN. I do not think, ‘‘we do not want to violate any 

regulations,’’ but we also want to make sure that we understand 

the hierarchy here. This is a pretty important issue and I know 

even Secretary McDonald has met with different Alaska groups—— 

Dr. MCCARTHY. Right. 

Senator SULLIVAN [continuing]. And has been supportive of it. 

So, already, I know that we have top cover—— 

Dr. MCCARTHY. Right. 

Senator SULLIVAN [continuing]. Support from Under Secretary 

Shulkin, Secretary McDonald. For me, it is just really important to 

move this, and if we can get your commitment to move this, I think 

the Chairman is aware of what we are trying to do on this. 

Let me ask—and you touched on it—let me ask a related question. There were 1,500 new graduate medical education spots given 

to the VA through the Choice Act, and I think only 372 of those 

spots have been filled to date. So, what is the issue there? Why 

have so few—relative to the number that Congress authorized— 

been filled; and is there anything we should be doing on that? Or, 

what should you be doing to make sure you take full advantage of 

the Choice Act provisions which you referenced and that, again, I 

think, dovetail nicely with the bill that we are working on with you 

guys? 

Dr. MCCARTHY. The Choice Act gives us a 5-year limitation and 

we really believe that building the relationships and building residency programs is going to take more than 5 years. So, there is a 

significant amount of lead time. 

I was involved in building residency programs in the site where 

I used to be a chief of staff and it is not something that is done 

overnight. I am a psychiatrist by training. I was working to partner 

on psychiatry residency programs. You have to set up, you know, 

relationships with child psychiatry programs and so forth, because 

we do not have that in VA. You have to get people that are willing 

to partner with you and so forth. So, it is not something that can 

happen overnight; those programs have to build their capacity and 

so forth. So, it takes a while to build. 

I do think that expanding the Choice recommendations to 10 

years would help us a lot, but that said, there are a lot of efforts 

underway right now to try to partner as much as we can. 

I, personally, have a heart for doing that, especially in the rural 

areas, particularly for what you said about when people train in an 

area, they stay. There are a number of, for instance, osteopathic 

medical schools that have set up residency programs in rural areas 

and that is exactly what is happening. More of them are staying 

45 

in the area, which is, you know, not something that happened overnight; it does take a lot of time. 

So, when you set up one residency program, you know, family 

practice or mental health or whatever, there are other parts of the 

residency that you need to get going at the same time. So, it takes 

building relationships with community partners, which is very important work to do. There is a lot of good will out there. Some of 

the community partners are not of the—interested necessarily in 

building their own residency program, so there is convincing going 

on back and forth, and that is where we are right now. 

Senator SULLIVAN. Thank you. 

Thank you, Mr. Chairman. 

Chairman ISAKSON. Thank you, Senator Sullivan. 

Senator Tester. 

HON. JON TESTER, U.S. SENATOR FROM MONTANA 

Senator TESTER. Thank you. 

I would like to follow on. In the bill that we are trying to get 

through the Senate right now, I think there is a component to extend it to 10 years from 5, and I also think there is a component 

in it, if my memory serves me correctly, there are CMS caps right 

now and it will take those caps off, which will also help in a big, 

big way. So, once we get that done, then we are really going to get 

you if they are not filled up. 

Look, we appreciate the testimony. Sorry I was late, but I had 

two other committee meetings, Senator Tillis, just to let you know. 

In September 2014, I wrote a letter to Secretary McDonald. It 

was brought to my attention that the Montana Board of Psychologists had reprimanded a VA psychologist for practicing outside the 

scope of his qualifications when performing a compensation and 

pension exam for a Montana veteran with traumatic brain injury 

(TBI). I was and I still remain concerned about the implications of 

these exams not being carried out properly. What ultimately led to 

the VA conducting a national review of medical exams of veterans 

who have filed disability claims related to TBI? 

Mr. MCLENACHEN. Senator, I will take that question. A while 

back, our facility in Minneapolis, on their own initiative, took a 

look to see if they were following VA policy about the specialists 

that are required to do the initial TBI exam. There are four specialists that VA requires to do those initial TBI exams, not the followon exams. What they learned was that, in fact, there were about 

300 veterans who did not receive that type of exam. 

Senator TESTER. OK. 

Mr. MCLENACHEN. Based on that information, the Deputy Secretary asked us to do a nationwide review. 

Senator TESTER. Mm-hmm. 

Mr. MCLENACHEN. We did that. We recently discovered as a result of that review that there are about 24,000 veterans that did 

not receive an initial TBI exam by one of those specialists. About 

70 percent of those veterans—actually, about 17,000 of those veterans—are already service-connected for TBI. 

Senator TESTER. OK. 

Mr. MCLENACHEN. Nonetheless, looking back at the policy that 

we had issued over the years, starting in about 2007, we concluded 

46 

that the guidance was sufficiently unclear and perhaps confusing, 

that to be fair to all veterans, we needed to go back and offer them 

all an opportunity for a new exam. 

Senator TESTER. So, would it be fair to say that the VA protocol 

was inadequate? 

Mr. MCLENACHEN. It would be fair to say that if it created confusion, yes—— 

Senator TESTER. OK. 

Mr. MCLENACHEN [continuing]. It would be fair to say that. 

Senator TESTER. So, what are we doing? I mean, what, moving 

forward? 

Mr. MCLENACHEN. Well, that guidance has been clarified. VHA 

has gone out and checked with each of its facilities that do these 

type of exams and confirmed that that guidance is being followed. 

Senator TESTER. OK. 

Mr. MCLENACHEN. One noteworthy point is that the overwhelming majority of these exams were done by a VBA contractor—— 

Senator TESTER. Yeah. 

Mr. MCLENACHEN [continuing]. And the contract was amended in 

2014 to specifically require that these type of exams be done. 

Senator TESTER. OK. 

Mr. MCLENACHEN. So—— 

Senator TESTER. So, let me ask you this, because there is a bill 

called S. 244 that we are taking up today that an independent assessment of these protocols would be done by a medical expert. Do 

you think this would be helpful? 

Mr. MCLENACHEN. Senator, I think it is our view that it is unnecessary, given what I just explained about the specialists that 

are required to do these exams. In addition, and it is my understanding—I am not a physician—but the bill would require, or ask 

the Institute of Medicine to focus on cognitive issues, where we use 

a more holistic approach—— 

Senator TESTER. Yeah—— 

Mr. MCLENACHEN [continuing]. That is broader than that. 

Senator TESTER. Even though it is my bill, I actually kind of like 

that. The question is, what do I do next time it happens—— 

Mr. MCLENACHEN. Well—— 

Senator TESTER [continuing]. When the exam is done improperly? 

Mr. MCLENACHEN. I think—— 

Senator TESTER. Then—— 

Mr. MCLENACHEN. Our commitment to you should be that this— 

we have solved this problem and it should not happen again. 

Senator TESTER. And if it happens again, does somebody’s head 

roll? 

Mr. MCLENACHEN. Well, if somebody was not following the policy 

that we have in place, there should be accountability. 

Senator TESTER. OK. All right. OK. 

Well, I have got time for one more question. The Veterans Transportation Service program has been successful in connecting veterans to care. I think it is efficient from a taxpayer standpoint and 

I think it is good for a veteran. The VA has previously said that 

reauthorizing this program would save taxpayer dollars, maybe as 

much as $200 million over 5 years—that is a fair amount of money 

47 

in my book—because it is cheaper to hire drivers than to contract 

with an ambulance service. Would you agree with that? 

Dr. MCCARTHY. Yes, sir. We are very excited about the opportunity to extend this bill, but I am not sure the estimates that I 

have been given are of the level that you have talked about. 

Senator TESTER. You do not think it saves that much? 

Dr. MCCARTHY. The most recent number I have been given is 

$1.7 million in fiscal year 2017. 

Senator TESTER. OK. So, let me ask you this. Would it help with 

the veterans that might be missing exams now that would not miss 

them if you had this service? 

Dr. MCCARTHY. My understanding is this is more about care. 

Senator TESTER. Is it not about—OK, yes, transportation to care, 

right? 

Dr. MCCARTHY. Yes. Yes, sir. 

Senator TESTER. I guess the point was not made very well by me. 

If a veteran has transportation, it would seem to me that they are 

much more likely to meet an appointment for care—— 

Dr. MCCARTHY. Right. 

Senator TESTER [continuing]. Than if they did not. 

Dr. MCCARTHY. Right. 

Senator TESTER. So, would this help reduce that number? 

Dr. MCCARTHY. One would expect that to be the case. When I 

heard exam, I was thinking VBA. I am sorry—— 

Senator TESTER. Yes, that is right. So, can you tell me what percentage of—I am sure it varies by region—what percentage of appointments are not met by the veteran? 

Dr. MCCARTHY. That does vary. I would not want to make a 

number. I would be happy to get back with you—— 

Senator TESTER. It would be really good to know from my perspective, and it is my bill, that if, in fact, the percentage is higher 

than it ought to be and if they are being missed because of transportation reasons. 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. JOHN TESTER TO THE

U.S. DEPARTMENT OF VETERANS AFFAIRS

Veteran Missed Appointments by Fiscal Year 

FY Total # 

Appointments* 

# Appts 

Veteran 

Missed 

% Veteran 

Missed 

2013 ................. 60,632,327 6,582,090 10.86 % 

2014 ................. 63,461,668 7,293,636 11.49 % 

2015 ................. 66,495,855 7,560,539 11.37 % 

2016* ............... 51,875,904 5,823,699 11.23 % 

* Total Appointments = Checked Out + No Show Combined 

** 2016 is FYTD through 07/07/2016 

Note: ‘‘Checked out’’ appointments means that the scheduled appointment occurred as planned and that the required check-out elements of provider, procedure, 

and diagnosis were all entered into the record. This makes the appointment complete with a status of checked out. 

Dr. MCCARTHY. I am familiar more with by specialty—— 

Senator TESTER. I am sorry. I took way too much time now. 

Sorry, Mr. Chairman. 

48 

Chairman ISAKSON. No apology necessary, Senator Tester. Thank 

you for coming. 

For the edification of the Members that are present as well as 

the audience, we have one other Senator who had asked to be recognized, Senator Merkley, who was supposed to be on the way, but 

he is not here yet—— 

Senator TESTER. He is right there. 

Chairman ISAKSON. Oh, I am sorry. Well, the Chairman’s eyesight is getting bad, Senator Merkley. 

We will let the first panel be excused. Thank you for your time. 

I am going to give Senator Merkley up to 5 minutes to make his 

presentation, then we will go immediately to the second panel. 

There is a classified briefing at 4 p.m. for members of the Senate, 

so if you have only me left in the room, that would be the reason 

why. 

Senator Merkley, you are recognized for up to 5 minutes. As is 

the tradition of the Committee, there will be no exchange of questions at this time. We welcome hearing about your legislation. 

STATEMENT OF HON. JEFF MERKLEY, 

U.S. SENATOR FROM OREGON 

Senator MERKLEY. Thank you very much, Mr. Chairman. It is an 

honor to be able to introduce S. 2279, the Veterans Health Care 

Staffing Improvement Act. I want to thank my colleague, Senator 

Rounds, for co-leading this bill and to thank the Members of this 

Committee who are sponsoring it, including Senator Rounds, Senator Tillis, Senator Murray, Senator Brown, Senator Tester, as well 

as cosponsors who do not sit on this Committee. 

Our servicemen and women are the very best demonstration of 

our Nation’s greatness, folks who have stepped up, taken the oath, 

and put on the uniform so the rest of us can live in a country that 

is safer and more secure. While we often offer warm words of 

thanks, we should be looking for ways to do more, and that is what 

our bill aims to do. 

Every day, hundreds of thousands of dedicated public servants at 

the VA help us honor that commitment. In VA hospitals across the 

country, many doctors and nurses work hard to deliver world class 

care. But we all recognize that we have more to do, we have further to go to improve VA hospitals, to reduce long wait times, to 

ensure that all of our veterans, every single one, gets the care they 

need, the care they deserve. And this bill, the Veterans Health 

Care Staffing Improvement Act, will help us meet that goal. 

This legislation makes common sense changes in staffing policies 

to improve veterans’ care and working conditions at VA health care 

facilities. It would increase the ability of the VA to recruit veterans 

who served as health care providers while they are in the military. 

We call this the Docs-to-Doctors program. It makes common sense. 

We hear again and again from returning veterans that they want 

to have a new mission. They want to be able to continue helping 

their fellow Americans and their fellow soldiers. What better way 

than allowing veterans with a medical background to continue 

serving in the VA system, to streamline the red tape so these doctors and other health care providers can transition seamlessly into 

the VA system. That is a win-win. 

49 

This legislation also creates uniform credentialing rules for medical professionals so VA doctors and other licensed health care providers do not have to wait weeks or months to recredential if they 

want to move hospitals or split their time and work at multiple VA 

facilities. 

It provides full practice authority to Advance Practice Registered 

Nurses (APRNs), nurses with post-graduate education, and physician assistants in the VA health system. This will help to make 

more primary care providers available, and certainly this is important in rural areas. 

That is why this bill is needed now more than ever, to ensure 

our veterans can get the care they need and staff can practice to 

the full extent of their education and training. Writing these measures into law will make the VA more effective, more efficient. It 

will make it easier for the VA to achieve the staffing levels they 

need and to ensure the VA can better carry out its mission and to 

put veterans first. 

Caring for our veterans is an area where Democrats and Republicans have worked together and should always be working together, and this bill represents that. 

This bill is endorsed by many veterans organizations and 37 different nursing groups. The veterans groups include the Veterans of 

Foreign Wars, the Vietnam Veterans of America, the Iraq and Afghanistan Veterans of America, the National Guard Association, 

the Reserve Officers Association, The American Legion Department 

of Oregon. 

I am delighted to be able to come and testify on behalf of this 

bill. We have a huge problem affecting our entire health care system, which is so many of our practitioners are Baby Boomers and 

they are retiring. And so many of us are Baby Boomers and need 

more medical care. And, therefore, we have an increase in demand 

and a decrease in supply, and we see that affecting our VA system 

as it competes with the rest of the health care system. 

So, we have all of these soldiers coming home with experience, 

with the desire to have a significant mission, with the skills to be 

able to help in our VA health care system. Let us streamline that 

path, and that is what this bill does, and I would appreciate the 

support of the entire committee. 

Thank you, Mr. Chairman. 

Chairman ISAKSON. Thank you, Senator Merkley. We appreciate 

your interest and your testimony. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. MAZIE K. HIRONO TO

DAVID MCLENACHEN, DEPUTY UNDER SECRETARY FOR DISABILITY ASSISTANCE, 

VETERANS’ BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. Mr. McLenachen, in your written testimony, you express concerns 

about the WINGMAN Act, which would provide congressional staffers ‘‘with greater 

access to VA records than is provided to VA employees or contractors’’ (p. 28). Can 

you elaborate on how expanded access to these records for congressional staffers, as 

outlined under the WINGMAN Act, would provide them with greater access than 

is currently provided to VA employees and contractors? 

Response. As stated in the Department of Veterans Affairs’ (VA) written testimony, this bill would provide Congressional employees with unprecedented access 

to the records of Veterans and other VA claimants, raising significant privacy concerns. The bill also improperly conflates the concept of access to claims records with 

50 

the distinct mission and function of VA’s Accreditation Program in ensuring that 

Veterans have access to competent and qualified claims representation. 

Regarding the nature of the access provided, the bill would allow Congressional 

staff, who assist constituents of a Member of Congress, with greater access to VA 

records than is provided to a VA employee or contractor. Under the Privacy Act, 

Federal employees generally may access private records only when necessary to perform their duties. This bill would impose no similar restriction on access by Congressional staff. From a privacy and information security standpoint, granting Congressional staff unrestricted access to the medical records of Veterans and other VA 

claimants is not in the best interest of Veterans and their families. VA patients and 

claimants entrust VA with their personal, medical, and other information, and they 

do not generally expect that such information could be viewed by Congress without 

their explicit consent. To the extent that Congressional staffers require access to an 

electronic claims record for which the Member of Congress possesses an appropriate 

release from the individual, access may be provided in the form of a disc or under 

supervision at a VA facility because those types of access are within the current capabilities of VA systems. 

Question 2. Mr. McLenachen, we know that nearly one in three veterans live in 

rural areas, and that rural veterans have been underserved due to a lack of access 

to health care, which can be caused by greater travel barriers and other factors. The 

permanent reauthorization of the Veterans Transportation Service (VTS) program, 

through the Rural Veterans Travel Enhancement Act of 2015, would address this 

issue, and would provide veterans with reliable transportation to health care. Can 

you elaborate on why it’s so important to permanently reauthorize this program? 

Response. The Veterans Transportation Service (VTS) has historically been a voluntary participation program for VA medical centers. The VTS Program is currently 

operating at 99 VA medical centers across the Nation. Currently, 53 VA medical 

centers do not participate in the VTS program. Participation has been less than 100 

percent largely due to uncertainty regarding future authorization for the program. 

Each year since its enactment in 2013, Congress has extended the expiration date 

for the program for an additional year, but the legal authority for the program is 

currently set to expire on December 31, 2016. Granting permanent authority for 

VTS to operate provides reassurance of continued program support, which cannot 

otherwise be assured. VTS can transport any Veteran; however, disabled, aged, frail, 

and critically ill Veterans face the largest transportation challenges in accessing 

care. VTS specializes in transporting Veterans with these challenges. 

Question 3. Mr. McLenachen, in your written testimony, you mention that VA 

would support the reauthorization of the VTS program assuming that resources are 

provided to continue its operations. What kinds of resources are you referring to? 

Would this be an appropriation? If so, then how much are we talking about? 

Response. As with VA Medical Care in general, resources would need to be provided in the annual appropriation. VA would then allocate funds to cover the following costs of the VTS program, as follows: 

• Salaries for Mobility Managers, Transportation Coordinators (schedulers/dispatchers) and Drivers; 

• Funds for purchase of Americans with Disabilities Act compliant wheelchair vehicles, stretcher vans (ambulettes), and ambulances; 

• Fuel and maintenance; 

• Expansion of current Vet Ride System, which provides transport scheduling; 

metrics reporting; vehicle on-board mobile data computer with Veteran Health Identification Card swipe for safe patient tracking and monitoring; Veteran web-based 

trip request portal; a Third-Party Vendor portal for assigning, as appropriate, Beneficiary Travel Special Mode Transports to contractors when VTS cannot perform the 

transport; and a Special Mode Tracker feature for tracking all Special Mode Transports from the medical authorization through the claims reconciliation and payment 

process. 

The VTS Program has demonstrated significant cost avoidance in Beneficiary 

Travel Special Mode Transport contract provider costs and a significant reduction 

in Beneficiary Travel mileage reimbursement payments. Table 1 below indicates the 

costs required to implement and operate the VTS program at all 152 VA medical 

centers through fiscal year 2026. VA proposed an extension of the VTS Program in 

its FY 2017 Budget (see Volume I, page Leg Sum–11, FY 2017 Budget Submission 

of the Department of Veterans Affairs). 

51 

Table 1: Resources Required for VTS for all 152 VA medical centers reflecting Special Mode cost offset 


629q3vaHq3.eps
52 

Chairman ISAKSON. Now it is time to recognize the second panel, 

if you will come forward and sit according to the nameplates as 

they are placed. [Pause.] 

Our second panel includes Roscoe Butler, Deputy Director of 

Health Care, National Veterans Affairs and Rehabilitation Division 

of The American Legion; Carlos Fuentes, Deputy Director, National 

Legislative Service, Veterans of Foreign Wars; Rick Weidman, Executive Director for Policy and Government Affairs, Vietnam Veterans of America; and Kevin Ziober, member of the Reserve Component. 

We welcome all of you and look forward to your testimony. You 

have got 5 minutes. We will start with Roscoe Butler. 

Senator TILLIS. Mr. Chairman, if I just may—I am sorry to interrupt, but you all are one of the main reasons why I like coming 

to these meetings. I appreciate the VA, yet I do have to go off to 

this other meeting. So, with respect to bills that I am working on, 

I would appreciate your offices contacting mine so that we can 

work together. 

Thank you, Mr. Chair. Sorry for the interruption. 

Chairman ISAKSON. Well, thank you, Senator Tillis. 

I would advise everybody, we do have a secure briefing which begins in 4 minutes. 

Roscoe Butler, welcome. 

STATEMENT OF ROSCOE BUTLER, DEPUTY DIRECTOR OF 

HEALTH CARE, NATIONAL VETERANS AFFAIRS AND REHABILITATION DIVISION, THE AMERICAN LEGION 

Mr. BUTLER. Thank you. On March 4, 1865, during President 

Lincoln’s second Inaugural Address, the President addressed our 

Nation’s veterans and called upon the Nation to care for him who 

shall have borne the battle, and for his widow and his orphan, 

which affirmed the government’s obligation to care for those injured during the war and to provide for the family of those who 

perished on the battlefield. This became the Department of Veterans Affairs trademark motto. Across the Nation, from Maine to 

Washington State, veterans, their families, and Veterans Service 

Organizations have called out again for affirming the government’s 

obligation to care for our Nation’s heroes and their families. 

Chairman Isakson, Ranking Member Blumenthal, and distinguished Members of the Committee, on behalf of the National Commander, Dale Barnett, and The American Legion, the country’s 

largest patriotic wartime service organization for veterans, comprising over two million members and serving every man and 

woman who has worn the uniform for this country, we thank you 

for the opportunity to testify regarding The American Legion’s positions on the pending draft bills. 

There are several bills on the agenda today and you have our full 

written remarks for the record. Therefore, I will focus only on a 

couple of key bills. 

Operation Iraqi Freedom, Enduring Freedom, and New Dawn 

veterans are returning home in alarming numbers with Traumatic 

Brain Injuries. TBI has become one of the signature injuries of the 

current war on terror. Recently, VA acknowledged that it may have 

under-evaluated nearly 25,000 veterans suffering from TBI. In a 

53 

June 2016 press release, VA stated veterans whose initial examination for TBI was not conducted by one of four designated medical 

specialists and provides them with the opportunity to have their 

claims reprocessed. TBI is an inherently complex medical condition 

and requires the opinions of specialized medical professionals to determine the level of severity and disability. 

S. 244 would require an independent comprehensive review of 

the process by which VA assesses cognitive impairments that result 

from TBI for purposes of awarding disability compensation and for 

other purposes. The American Legion believes that it is imperative 

that Congress ensure that veterans suffering from the devastating 

and debilitating effects of TBI are properly evaluated for the conditions and any symptoms associated with the conditions for those 

reasons mentioned. The American Legion supports S. 244. 

In 2014, The American Legion System Worth Saving program 

issued a report on rural health care and in 2014 issued a report 

on women veterans’ health care. Both reports identified significant 

challenges veterans face in obtaining health care in rural locations 

as well as health care challenges women veterans face. 

S. 2210, the PEER Act, calls on the Department of Veterans Affairs to establish peer specialists to be assigned in patient-aligned 

care teams at designated VA medical centers, to include female 

peer specialists. Peer specialists in the private sector have become 

an integral part of health care teams and are vital in promoting 

the recovery of patients. 

The American Legion believes this bill will improve health care 

for male and female veterans living in rural areas. The American 

Legion supports developing a national program to provide peer-topeer rehabilitation services based on the recovery model tailored to 

meet the specialized need of current generation’s combat affected 

veterans and their families. Therefore, The American Legion 

strongly believes the Secretary of Veterans Affairs should utilize 

returning servicemembers for positions as peer support specialists 

in the effort to provide treatment, support services, and readjustment counseling for those veterans requiring these services. Therefore, The American Legion supports S. 2210. 

I want to thank you, Chairman Isakson, Ranking Member 

Blumenthal, and Members of the Committee. I appreciate the opportunity to present The American Legion’s views and look forward 

to answering any questions you may have. 

[The prepared statement of Mr. Butler follows:] 

PREPARED STATEMENT OF ROSCOE G. BUTLER, DEPUTY DIRECTOR OF HEALTH CARE, 

NATIONAL VETERANS AFFAIRS AND REHABILITATION DIVISION, THE AMERICAN LEGION

Chairman Isakson, Ranking Member Blumenthal, and distinguished Members of 

the Committee: On behalf of National Commander Dale Barnett and The American 

Legion; the country’s largest patriotic wartime service organization for veterans, 

comprising over 2 million members and serving every man and woman who has 

worn the uniform for this country; we thank you for the opportunity to testify regarding The American Legion’s position on the pending and draft legislation. 

54 

1 VA Office of Public and Intergovernmental Affairs: VA Secretary Provides Relief for Veterans 

with Traumatic Brain Injuries (June 1, 2016) 2 American Legion Resolution No. 148 (August 2014): Request Congress Provide the Department of Veterans Affairs Adequate Funding for Medical and Prosthetic Research 

S. 244

A bill to require an independent comprehensive review of the process by which the 

Department of Veterans Affairs assesses cognitive impairments that result from 

Traumatic Brain Injury for purposes of awarding disability compensation, and 

for other purposes. 

Traumatic Brain Injury (TBI) has been identified as the ‘‘signature injury’’ of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation 

New Dawn (OND). Servicemembers have experienced injuries related to their combat experiences that will likely negatively impact their earnings post-service. As a 

result, it is imperative that we ensure that veterans suffering from the devastating 

and debilitating effects of TBI are properly evaluated for the condition and any 

symptoms associated with the conditions. 

Recently, VA acknowledged that it may have under evaluated nearly 25,000 veterans suffering from TBI. In a June 2016 press release, VA stated, ‘‘Veterans whose 

initial examination for TBI was not conducted by one of four designated medical 

specialists and provides them with the opportunity to have their claims reprocessed.’’ 1 TBI is an inherently complex medical condition and requires the opinions 

of specialized medical professionals to determine the level of severity and disability. 

S. 244 directs VA to work with the Institute of Medicine (IOM) to conduct a comprehensive review of VA examinations to ensure that they are appropriately targeting symptoms and levels of disability by TBI sufferers. Additionally, it directs 

IOM to convene medical experts to determine the required credentials necessary to 

assess cognitive functions and provide recommendations to improve the adjudications of claims. 

The American Legion has over 3,000 accredited representatives responsible for the 

effective advocacy of veterans’ benefits throughout the Nation. It is not uncommon 

to hear reports from these representatives of the under evaluation of claims associated with TBI; despite their determined efforts to have these claims adjudicated 

properly by a VA rater, they often are compelled to appeal these decisions and have 

veterans who suffer from the pain and trauma associated with TBI wait for years 

to finally have their claims properly adjudicated. 

The American Legion by resolution stated, ‘‘That Congress and the Administration encourage acceleration in the development and initiation of needed research on 

conditions that significantly affect veterans, such as prostate cancer, addictive disorders, trauma and wound healing, Post-Traumatic Stress Disorder, Traumatic 

Brain Injury, rehabilitation, and others, jointly with the Department of Defense, the 

National Institutes of Health, other Federal agencies, academic institutions and the 

Department of Veterans Affairs.’’ 2

The American Legion supports S. 244. 

S. 603: RURAL VETERANS TRAVEL ENHANCEMENT ACT OF 2015

A bill to make permanent the authority of the Secretary of Veterans Affairs to transport individuals to and from facilities of the Department of Veterans Affairs in 

connection with rehabilitation, counseling, examination, treatment, and care, 

and for other purposes. 

One out of every three veterans treated by the Department of Veterans Affairs 

(VA) lives in rural communities and rural veterans have been underserved due to 

a lack of access to health care, which can be attributed to greater travel barriers 

and a lack of public transportation. S. 603 would make it easier for veterans who 

live in rural areas to be reimbursed for expenses occurred as a result of traveling 

long distances for their medical and mental health appointments. This bill would 

permanently reauthorize the Department of Veterans Affairs (VA) Veterans Transportation Program (VTS). The VTS program provides funding to local VA healthcare 

systems to hire transportation coordinators and purchase vehicles that staff can utilize to transport veterans to the care they need. The Rural Veterans Travel Enhancement Act of 2015 would also provide mileage reimbursement for combat veterans traveling to receive mental health care at Vet Centers, and would amend the 

Caregivers and Veterans Omnibus Health Services Act of 2010 to reauthorize 

through FY 2020 a grant program to provide innovative transportation options to 

veterans in highly rural areas. 

55 

3 American Legion Resolution No. 106 (August 2014): Veterans Transportation System & Benefits Travel 4 American Legion Resolution No. 284 (August 2014): Department of Veterans Affairs to Develop Outreach and Peer to Peer Programs for Rehabilitation 

Based on VA’s interpretation of titles 38 U.S.C. § 111, Beneficiary Travel, and 38 

U.S.C. § 1712A, entitled ‘‘Eligibility for readjustment counseling and related mental 

health services,’’ VA has interpreted these laws to mean they do not allow payment 

of beneficiary travel benefits to veterans traveling to Vet Centers. Veterans traveling to Vet Centers should be eligible for beneficiary travel benefits on the same 

basis as other veterans. 

The American Legion urges the Secretary to seek adequate funding to accommodate the needs of the increasing demand for care, to include the need for a Veterans 

Transportation System (VTS), accompanied by an increase in the beneficiary travel 

rate.3

The American Legion supports S. 603. 

S. 2210: VETERAN PARTNERS’ EFFORTS TO ENHANCE REINTEGRATION (PEER) ACT

A bill to require the Secretary of Veterans Affairs to carry out a program to establish 

peer specialists in patient aligned care teams at medical centers of the Department of Veterans Affairs, and for other purposes. 

A peer support specialist is a person with significant life altering experience who 

works to assist individuals with chemical dependency, mental disorder or domestic 

abuse and other life effecting issues. Due to their life experiences, such persons have 

expertise that professional training cannot replicate. This is not to be confused with 

peer educators who may not consider recovery a suitable goal for everyone and may 

focus instead on the principles of harm reduction. There are many tasks performed 

by peer support specialists that may include assisting their peers in articulating 

their goals for recovery, learning and practicing new skills, helping them monitor 

their progress, assisting them in their treatment, modeling effective coping techniques and self-help strategies based on the specialist’s own recovery experience, 

and supporting them in advocating for themselves to obtain effective services. 

S. 2210 would expand VA’s current use of peer specialists from mental health clinics to be utilized in primary care settings. The PEER Act would require the Department of Veterans Affairs (VA) to establish a pilot program of peer specialists to 

work as members of VA’s patient-aligned care teams (PACT), for the purpose of promoting the integration of mental health services in a VA primary care setting. This 

bill would authorize the establishment of this pilot program in 25 VA sites, to include the five VA’s Polytrauma centers across the country. The bill would also require a series of reports, including a final report to recommend whether the program should be expanded beyond the pilot program sites. 

The American Legion urges the President of the United States and the U.S. Congress to call on the Secretary of Veterans Affairs to develop a national program to 

provide peer to peer rehabilitation services based on the recovery model tailored to 

meet the specialized needs of current generation combat-affected veterans and their 

families.4

The American Legion supports S. 2210. 

S. 2279 VETERANS HEALTH CARE STAFFING IMPROVEMENT ACT

A bill to require the Secretary of Veterans Affairs to carry out a program to increase efficiency in the recruitment and hiring by the Department of Veterans Affairs of health care workers that are undergoing separation from the Armed Forces, 

to create uniform credentialing standards for certain health care professionals of the 

Department, and for other purposes. 

S. 2279 would make changes in staffing policies throughout the VA healthcare 

system to improve the recruitment of health care workers who are transitioning 

from military service. Throughout the country veterans are faced with waiting 

weeks or even months for a health care appointment. These barriers to receiving 

quality care can be attributed to a shortfall of tens of thousands of medical professionals to provide that care. This bill would decrease the bureaucratic red tape by 

making it easier for the VA to increase staffing throughout the VA healthcare system and ultimately reduce wait times for thousands of veterans. This bill also includes the ‘‘Docs-to-Doctors’’ program which allows servicemembers who have served 

in the medical field to transition directly into the VA which would allow veterans 

access to health care they need in a timely manner. 

56 

5The Federal Bureau of Investigation: Veterans’ Benefit Fiduciary and Former U.S. Department of Veterans Affairs Employee Plead Guilty to Embezzling Nearly $900,000 (August 10, 

2011) 6 VA OIG report (May 28, 2014): Review of Alleged Mismanagement at the Eastern Area Fiduciary Hub 7 American Legion Resolution No. 103 (September 2015): Fiduciary Responsibility 8 American Legion Resolution No. 125 (August 2014): Environmental Exposures 

The American Legion supports Sections 2 and 3 of S. 2279; however, at this 

time The American Legion does not have a position on Section 4, which is granting 

Nurses and Physicians Assistants full practice authority. 

S. 2316

A bill to expand the requirements for reissuance of veterans benefits in cases of misuse of benefits by certain fiduciaries to include misuse by all fiduciaries, to improve oversight of fiduciaries, and for other purposes. 

Without question, veterans requiring a fiduciary are some of our Nation’s most 

vulnerable. Unable to manage their financial affairs, VA will appoint a fiduciary to 

ensure that payments for bills are provided from their VA benefits. Due to their vulnerable states, veterans are exposed to abuse by their fiduciary and may face 

daunting challenges to recover lost payments. 

The American Legion has previously testified regarding the need to reform the fiduciary program. Repeatedly, we have heard from our accredited representatives 

about veterans being financially harmed by their appointed fiduciary. 

In 2011, the Federal Bureau of Investigation (FBI) detailed a conviction of two 

individuals, to include one former VA employee, of defrauding veterans of nearly 

$900,000 between 1999–2008.5 Based upon allegations received by VA’s Office of Inspector General (VAOIG) in May 2013, an investigation of the Eastern Area Fiduciary Hub was conducted; as stated in the May 2014 VAOIG report, there were 12 

incidents of fiduciaries misusing funds, costing veterans approximately $944,000 in 

benefits.6

Unfortunately, it is often noticed after years of a fiduciary’s abuse of a veteran’s 

funds. This can amount to hundreds of thousands of dollars lost by the veteran. 

Currently, the only way that a veteran can pursue the lost benefits are through civil 

court proceedings. 

S. 2316 removes the requirement of these vulnerable veterans to have to pursue 

civil litigation to recover the lost benefits. It places the requirement on VA; considering that VA is responsible for assigning a fiduciary, it stands to reason that they 

should inherit the responsibility of recovering the lost benefits by unscrupulous fiduciaries. Through this bill, we can move to protecting beneficiaries from the unlawful 

taking of benefits by unscrupulous fiduciaries from our Nation’s veterans. 

Recognizing that veterans requiring fiduciaries are often some of our Nation’s 

most vulnerable veterans, The American Legion supports legislation requiring the 

Department of Veterans Affairs to provide oversight over their fiduciary program 

and that it protects veterans and their beneficiaries who are unable to manage their 

financial affairs.7

The American Legion supports S. 2316. 

S. 2791—ATOMIC VETERANS HEALTHCARE PARITY ACT

A bill to provide for the treatment of veterans who participated in the cleanup of 

Enewetak Atoll as radiation exposed veterans for purposes of the presumption of 

service-connection of certain disabilities by the Secretary of Veterans Affairs. 

From 1977 to 1980, thousands of members of the United States Armed Forces 

participated in a radiation cleanup of United States nuclear test sites in the Marshall Islands. S. 2791 would provide for the treatment and service-connection presumption of certain disabilities related to those veterans who participated in the 

cleanup of the Enewetak Atoll and other areas that conducted nuclear testing. The 

Atomic Veterans Healthcare Parity Act would help veterans who were exposed 

through the cleanup at these atomic sites to access the benefits and treatment they 

earned. 

The American Legion highlighted the plight of these veterans, left behind and 

struggling to gain access to treatment and benefits due to the way the laws are written, in the March 2016 issue of The American Legion Magazine entitled, ‘‘Toxic Paradise,’’ as well as on our website. 

The American Legion urges ensuring medical examinations, compassionate treatment and just compensation for veterans exposed to environmental hazards 

‘‘through testing, transportation, storage, and disposal.’’ 8

57 

9 American Legion Resolution No. 24 (May 2015): Department of Veterans Affairs Construction 

Programs 10 American Legion Resolution No. 312 (August 2014): Ensuring the Quality of Servicemember 

and Veteran Student’s Education at Institutions of Higher Learning 11St. Louis Post Dispatch (May 27, 2016): ‘‘World War II vet’s mustard gas claim again denied, but VA boss pledges look at new evidence’’ 

The American Legion supports S. 2791. 

S. 2958

A bill to establish a pilot program on partnership agreements to construct new facilities for the Department of Veterans Affairs. 

Veterans are frustrated and concerned with VA’s construction processes and the 

continued delays and cost overruns and unsure whether VA’s improvements will ensure VA major construction in the future will be within schedule and budget. 

S. 2958 would allow the VA to enter into public-private partnerships for the planning, design and construction of new buildings for the use by the Department of 

Veterans Affairs. This bill would allow improvements to be made to VA medical centers to better serve veterans by creating a pilot program that would allow the VA 

to create up to five partnerships to assist with their VA construction projects. 

The American Legion urges VA to consider all available options, both within the 

agency and externally, to include, but not limited to, the Army Corps of Engineers 

to ensure major construction programs are completed on time and within budget.9

The American Legion supports S. 2958. 

S. 3021

A bill to authorize the use of Post-9/11 Educational Assistance to pursue independent study programs at certain educational institutions that are not institutions of higher learning. 

This bill would provide student-veterans with expanded scope and usage of the 

Post-9/11 GI Bill education benefits to other forms of postsecondary institutions. 

This legislation adds needed options to student-veterans in the pursuit of their educational goals. The Post-9/11 GI Bill passed by Congress in 2008 has been an effective upgrade for 21st century veterans using their college education benefits. It was 

not, nor can it be, a law so static that it cannot continue evolving to best meet the 

needs of student-veterans in an ever-shifting landscape of higher education and career training. 

Last, The American Legion has been encouraged by the growing recognition within Congress of the need to make basic, but critical information about the return on 

investment in higher education available to student-veterans. 

The American Legion seeks and supports any legislative or administrative proposal that improves, but not limited to, the GI Bill, Department of Defense Tuition 

Assistance (TA), Higher Education Title IV funding (i.e., Pell Grants, Student 

Loans, etc.) and education benefits so servicemembers, veterans, and their families 

can maximize its usage.10

The American Legion supports S. 3021. 

S. 3023—THE ARLA HARRELL ACT

A bill to provide for the reconsideration of claims for disability compensation for veterans who were the subjects of experiments by the Department of Defense during 

World War II that were conducted to assess the effects of mustard gas or lewisite 

on people, and for other purposes. 

For 10 years, Arla Harrell has sought VA disability compensation for conditions 

he attributes to his military service. While stationed at Camp Crowder, Missouri, 

during the waning days of World War II, he reports being subjected to mustard gas 

exposure as part of a secret experimental program. The exposure led to a lifetime 

of respiratory ailments. 

Unfortunately, like many World War II veterans, his military records were burned 

in the National Personnel Records fire of 1973. To further complicate the matter, 

neither the Department of Defense (DOD) nor VA have been able to produce accurate records indicating the impacted veterans. According to an article published on 

May 27, 2016, in the St. Louis Post Dispatch, National Public Radio uncovered in 

November 2015 that 3,900 veterans were exposed to mustard gas experiments, a list 

six times greater than VA previously acknowledged.11

38 CFR § 3.316 identifies a host of medical conditions, to include respiratory conditions that are presumptively related to mustard gas exposure. The issue is not 

58 

12 American Legion Resolution No. 125 (August 2016): Environmental Exposures 13 American Legion Resolution No. 18 (August 2014): Department of Veterans Affairs Disability 

Compensation 

what conditions to service connect presumptively; S. 3023 will allow VA to presumptively service connect veterans for exposure to mustard gas based upon participating 

in mustard gas testing. 

The American Legion has long supported service connecting veterans presumptively due to environmental exposures. The American Legion supports ‘‘the liberalization of the rules relating to the evaluation of studies involving exposure to any 

environmental hazard and that all necessary action be taken by the Federal Government, both administratively and legislatively as appropriate, to ensure that veterans 

are properly compensated for diseases and other disabilities scientifically associated 

with a particular exposure’’ 12

The American Legion supports S. 3023. 

S. 3032—VETERANS’ COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 2016

A bill to provide for an increase, effective December 1, 2016, in the rates of compensation for veterans with service-connected disabilities and the rates of dependency 

and indemnity compensation for the survivors of certain disabled veterans, and 

for other purposes. 

This bill will provide a Cost of Living Allowance (COLA) effective December 1, 

2016. Disability compensation and pension benefits awarded by the Department of 

Veterans Affairs (VA) are designed to compensate veterans for medical conditions 

due to service or who earn below an income threshold. With annual increases to 

costs of living, it is only appropriate that veterans’ benefits increase commensurate 

with those increases. 

For nearly 100 years, The American Legion has advocated on behalf of our Nation’s veterans, to include the awarding of disability benefits associated with chronic 

medical conditions that manifest related to selfless service to this Nation. Annually, 

veterans and their family members are subjects in the debate regarding the annual 

cost of living adjustment (COLA) for these disability benefits. For these veterans 

and their family members, COLA is not simply an acronym or a minor adjustment 

in benefits; instead, it is a tangible benefit that meets the needs of the increasing 

costs of living in a nation that they bravely defended. 

The American Legion would like to commend the members on this bill. Previous 

bills introduced have had ‘‘round-down’’ provisions, where veterans’ benefits were 

rounded-down to the next whole dollar. This is a frustrating practice that has an 

insidious effect over years of receiving benefits. 

The American Legion supports legislation to provide a periodic cost-of-living adjustment increase and to increase the monthly rates of disability compensation.13

The American Legion supports S. 3032. 

S. 3035—MAXIMIZING EFFICIENCY AND IMPROVING ACCESS TO PROVIDERS AT THE

DEPARTMENT OF VETERANS AFFAIRS ACT OF 2016

A bill to require the Secretary of Veterans Affairs to carry out a pilot program to increase the use of medical scribes to maximize the efficiency of physicians at medical facilities of the Department of Veterans Affairs. 

Veterans are experiencing long wait times for VA health care for a variety of reasons, but in part due to high patient load and not enough doctors to serve the population. This shortage is a nationwide problem. 

A medical scribe is a paraprofessional who specializes in charting physician-patient encounters in real time, such as during medical examinations. Depending on 

which area of practice the scribe works in, the position may also be called clinical 

scribe, ER scribe or ED scribe (in the emergency department), or just scribe (when 

the context is implicit). A scribe is trained in health information management and 

the use of health information technology to support it. A scribe can work on-site (at 

a hospital or clinic) or remotely from a Health Insurance Portability and Accountability Act (HIPAA) secure facility. Medical scribes who work at an offsite location 

are known as virtual medical scribes and normally work in clinical settings. 

A medical scribe’s primary duties are to follow a physician through his or her 

work day and chart patient encounters in real-time using a medical office’s electronic health record (EHR) and existing templates. Medical scribes also generate referral letters for physicians, manage and sort medical documents within the EHR 

system, and assist with e-prescribing. Medical scribes can be thought of as data care 

managers, enabling physicians, medical assistants, and nurses to focus on patient 

59 

14 American Legion Resolution No. 23 (May 2016):Support for Veteran Quality of Life 15 American Legion Resolution No. 23 (May 2016): Support for Veteran Quality of Life 16 American Legion Resolution No. 23: (May 2016): Support for Veteran Quality of Life 

in-take and care during clinic hours. Medical scribes, by handling data management 

tasks for physicians in real-time, free the physician to increase patient contact time, 

give more thought to complex cases, better manage patient flow through the department, and increase productivity to see more patients. 

S. 3035 would require VA to carry out an 18 month pilot program in no less than 

five high-volume VA medical centers for the contract hiring of medical scribes to assist VA physicians with workload. This bill will ensure doctors have more time to 

see patients rather than entering in medical data and will serve as a recruitment 

tool for doctors who want a package comparable to the private sector. 

The American Legion supports any legislation and programs within the VA that 

will enhance, promote, restore or preserve benefits for veterans and their dependents, including timely access to quality VA health care.14

The American Legion supports S. 3035. 

S. 3055—DEPARTMENT OF VETERANS AFFAIRS DENTAL INSURANCE REAUTHORIZATION

ACT OF 2016

A bill to provide a dental insurance plan to veterans and survivors and dependents 

of veterans. 

S. 3055 would reauthorize the current veteran dental insurance pilot program 

that was included in the Caregiver and Veterans Omnibus Health Services Act of 

2010. This bill would ensure that eligible veterans, survivors and dependents of veterans continue to access quality dental insurance at a low cost. 

Under current VA’s dental authority, only certain enrolled veterans are eligible 

for outpatient dental care from the VA. If this bill was enacted into law, veterans 

not eligible for VA benefits would be also able to enroll in the VA Dental Insurance 

Program (VADIP). Each veteran enrolled in the plan shall pay the entire premium 

for coverage under the dental insurance plan, in addition to the full cost of any copayment. 

The American Legion urges Congress and the VA to enact legislation and programs within the VA that will enhance benefits for veterans and their dependents.15

The American Legion supports S. 3055. 

S. 3076—CHARLES DUNCAN BURIED WITH HONOR ACT OF 2016

A bill to authorize the Secretary of Veterans Affairs to furnish caskets and urns for 

burial in cemeteries of States and Indian tribes of veterans without sufficient resources to provide for caskets or urns. 

The draft bill would amend Title 38 United States Code (U.S.C) Section 2306 entitled Headstones, markers, and burial receptacles subsection (f). Under current law, 

Title 38 U.S.C. § 2306(f), the Secretary may furnish a casket or urn, of such quality 

as the Secretary considers appropriate for a dignified burial, for burial in a national 

cemetery of a deceased veteran in any case in which the Secretary is unable to identify the veteran’s next of kin, if any; and determines that sufficient resources for 

the furnishing of a casket or urn for the burial of the veteran in a national cemetery 

are not otherwise available. The bill would allow for such burial in cemeteries of 

States and Native American Indian tribes of veterans without sufficient resources 

to provide for caskets or urns. 

The American Legion urges Congress and the Department of Veterans Affairs 

(VA) to enact legislation and programs within the VA that will enhance, promote, 

restore or preserve benefits for veterans and their dependents with final resting 

places in national shrines and with lasting tributes that commemorates their 

service.16

The American Legion supports S. 3076. 

S. 3081—WORKING TO INTEGRATE NETWORKS GUARANTEEING MEMBER ACCESS NOW ACT

(‘‘WINGMAN ACT’’)

To amend title 38, United States Code, to provide certain employees of Members of 

Congress and certain employees of State or local governmental agencies with access to case-tracking information of the Department of Veterans Affairs. 

The WINGMAN Act would grant access to the Department of Veterans Affairs 

(VA) Veterans Benefits Management System (VBMS) for the purpose of assisting 

constituents. According to the bill, Members could select an employee, and at a cost 

to the employee or member, would receive the necessary training to gain accreditaVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00063 Fmt 6633 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
60 

17 American Legion Resolution No. 301 (August 2014): Enforcing Veterans’ Preference Hiring 

Practices in Federal Civil Service 18 American Legion Resolution No. 341 (August 2014): Resolution No. 341: Support Legislation 

to Amend Title 38 United States Code, to Prohibit Discrimination and Acts of Reprisal by Employers against Veterans that Seek Treatment for Their Service-Connected Disabilities 

tion to legally review veterans’ records within VBMS. The American Legion has over 

3,000 accredited representatives located throughout the Nation. These professionals 

receive regular professional training to ensure they have the most current understanding of the impact of changes in statutes, regulations, and case law. It is simply 

not a matter of receiving initial training and meeting the requirement of being accredited; like many professions, it requires on-going, thorough training. Additionally, veterans are repeatedly advised of their opportunity to elect to have a Veterans 

Service Organization (VSO) represent them in their quest to receive VA disability 

benefits without a cost to the veteran. The American Legion does not have a resolution to support the enactment of this bill; however, we urge Congress to consider 

the long-term ramifications of supporting legislation that only requires their own 

employees to have the minimal level of understanding in veterans’ law assisting 

their constituents. To ensure their constituents receive the assistance they deserve, 

we highly recommend that a VSO advocate on their veterans’ behalf. 

The American Legion Opposes the S. 3081. 

DRAFT BILL

A bill to clarify the scope of procedural rights of members of the uniformed services 

with respect to their employment and reemployment rights, to improve the enforcement of such employment and reemployment rights, and for other purposes. 

With the number of Uniformed Services Employment and Reemployment Rights 

Act of 1994 (USERRA) cases across the country, The American Legion is deeply concerned with the protection of the servicemember and the prevention of the servicemember not being reemployed by their previous employer after deployment(s). 

USERRA cases have become more complex than in the past and frequently involve 

multiple issues. This is due to longer and more frequent deployments of National 

Guard and Reserve members. As currently drafted, USERRA fails to adequately 

support military personnel upon their return to civilian employment as numerous 

employers have violated the rules laid out in Title 38 of the United States Code. 

This bill would improve USERRA by clarifying the scope of USERRA rights and 

expand the enforcement authority of the Department of Justice (DOJ). This legislation adds essential authority to DOJ that provides the kind of protection for servicemembers’ employment—which includes compensatory and punitive damages—which 

servicemembers have earned through their honorable service for the United States 

of America. 

The American Legion seeks and supports any legislative or administrative proposal that will mandate the use of automated recruitment, hiring and retention system that safeguard against hiring malpractice in the application and the hiring 

process.17 The American Legion supports legislation to amend Title 38, U.S.C., to 

prohibit discrimination and acts of reprisals by employers against veterans that 

seek treatment for their service-connected disabilities.18

The American Legion supports the Draft Bill. 

DRAFT BILL

A bill to expand eligibility for readjustment counseling to certain members of the Selected Reserve of the Armed Forces. 

Readjustment counseling is made up of a wide range of psychosocial services offered to eligible veterans and their families in the effort to make a successful transition from military to civilian life. The draft bill would amend Title 38 United States 

Code Section 1712A entitled Eligibility for readjustment counseling and related 

mental health services by adding new subparagraphs under the current law that includes: (D)(i) The Secretary, in consultation with the Secretary of Defense, may furnish to any member of the Selected Reserve of the Armed Forces who has a behavioral health condition or psychological trauma, counseling under subparagraph 

(A)(i),which may include a comprehensive individual assessment under subparagraph (B)(i) and (ii) A member of the Selected Reserve of the Armed Forces described in clause (i) shall not be required to obtain a referral before being furnished 

counseling or an assessment under this subparagraph.’’ 

The American Legion urges Congress and the Department of Veterans Affairs 

(VA) to enact legislation and programs within the VA that will enhance, promote, 

61 

19 American Legion Resolution No. 23 (May 2016): Support for Veterans Quality of Life 20 American Legion Resolution No. 23 (May 2016): Support for Veterans Quality of Life 21 American Legion Resolution No. 50 (August 2014): Support for the American Battle Monuments Commission 

restore or preserve benefits for veterans and their dependents, including, but not 

limited to, the following: timely access to quality VA health care.19

The American Legion supports the Draft Bill. 

DRAFT BILL

A bill to authorize payment by the Department of Veterans Affairs for the costs associated with service by medical residents and interns at facilities operated by Indian tribes and tribal organizations, to require the Secretary of Veterans Affairs 

to carry out a pilot program to expand medical residencies and internships at 

such facilities, and for other purposes. 

This bill would require the Secretary of Veterans Affairs to implement a pilot program to establish graduate medical education (GME) residency training programs 

at covered facilities. According to Title 25 U.S. Code Subchapter II—Indian Self-Determination and Education Assistance 450b Section 4 of the Indian Self-Determination and Education Assistance Act—VA defines a covered facility to mean a department facility, or a facility operated by an Indian tribe or a tribal organization. 

The American Legion supports any legislation or policies that will enhance, promote, restore, or preserve benefits for veterans and their dependents.20

The American Legion supports the Draft Bill. 

DISCUSSION DRAFT

To authorize the American Battle Monuments Commission to acquire, operate, and 

maintain the Lafayette Escadrille memorial in Marnes-la-Coquette, France 

The Lafayette Escadrille Memorial is dedicated to the memory of the American 

pilots who volunteered to assist the Allied Army in 1914. The central platform is 

crowned with a triumphal arch and flanked with porticos leading to the underground crypt. The ‘‘art deco’’ style highlights the pilots’ sacrifice and the FrancoAmerican friendship. 

There are statues of Lafayette and Washington facing one another and, on the 

ground, a mosaic of the famous Sioux warrior’s head, the squadron’s ensign. The 

crypt holds the ashes of 66 American pilots. It is decorated with 13 stained glass 

windows depicting the great aerial combats of the war. The monument was inaugurated on American Independence Day, July 4, 1928. 

The discussion draft would authorize the American Battle Monuments Commission (ABMC), which was established by the Congress in 1923, as the guardian of 

America’s overseas commemorative cemeteries and memorials and honors the service, achievements and sacrifices of the United States Armed Forces by overseeing 

the operations of the memorial which has been erected to honor those who gave the 

ultimate sacrifice for their country. 

The American Legion urges Congress to appropriate adequate funding and human 

resources to the American Battle Monuments Commission in order to properly 

maintain and preserve the final resting place of America’s war dead located on foreign soil.21

The American Legion supports the Discussion Draft. 

CONCLUSION

As always, The American Legion thanks this Committee for the opportunity to explain the position of the over 2 million veteran members of this organization. For 

additional information regarding this testimony, please contact Mr. Warren J. Goldstein at The American Legion’s Legislative Division at (202) 861–2700 or 

wgoldstein@legion.org. 

Chairman ISAKSON. Roscoe, you are always thorough and we appreciate your input on the Committee’s work all the time. Thank 

you for coming today. 

Mr. Fuentes. 

62 

STATEMENT OF CARLOS FUENTES, DEPUTY DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN 

WARS 

Mr. FUENTES. Mr. Chairman, Ranking Member Blumenthal, and 

Members of the Committee, on behalf of the men and women of the 

VFW and our Auxiliaries, I would like to thank you for the opportunity to present our views on legislation pending before the Committee. 

The VFW supports most of the bills being considered today, but 

I will limit my remarks to those we urge the Committee to amend. 

The VFW supports the Maximizing Efficiency and Improving Access to Providers Act. However, we urge the Committee to require 

contractors hired as medical scribes to help VA providers locate 

medical documents in a veteran’s electronic health care record, 

such as labs and private sector health records. This would ensure 

VA providers spend less time navigating electronic health care 

records and more time treating veterans. 

The VFW supports the VA Dental Insurance Reauthorization Act 

of 2016 but urges the Committee to consider expanding VA dental 

care eligibility instead of passing on the costs of dental coverage 

onto the veterans. Oral health has a direct impact on overall 

health. Additionally, several health care conditions prevalent 

among veterans, such as diabetes, have been found to directly impact oral health. Until January 2014, veterans enrolled in VA 

health care have little to no options for receiving dental care. While 

the VA dental insurance program provides dental care options to 

100,000 veterans and their eligible families, VFW members consider this program as better than nothing. The VFW believes veterans have earned the best, not better than nothing. 

Additionally, veterans who participate in the dental insurance 

program do not have their dental records integrated into their VA 

electronic health care records. Thus, VA providers are unable to determine if these veterans have dental conditions that may impact 

their overall health. That is why the VFW supports expanding eligibility for VA dental care to all veterans who are enrolled in—who 

are eligible for VA health care. 

While the VFW agrees with the need to improve the ability of 

Congressional staff to assist veterans with their claims, we cannot 

support the WINGMAN Act at this time. We have several concerns 

that would need to be addressed before we could support this bill, 

and like VA, our reading of the bill did not require Congressional 

staff to have signed releases before having access to the records. 

We agree with VA and Senator Cassidy that that is necessary. 

When a power of attorney is held by an individual or organization, that entity must be notified of Congressional involvement. 

Congressional staff must pass VA certification tests and level-sensitive restrictions that apply to VA employees and service officers 

must also apply to Congressional staff, including consequences for 

staff found to have abused their authority. 

The VFW acknowledges the need for improved access to mental 

health care for Guard and Reserve servicemembers, but we cannot 

support the expansion of Vet Center eligibility to non-combat veterans. The rate of suicide among our servicemembers is equally as 

troubling as the rate of suicide among veterans. While DOD’s suiVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00066 Fmt 6633 Sfmt 6601 Z:\ACTIVE\062916.TXT PAULIN
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cide prevention programs have successfully reduced the rate of suicides among our active duty force, it has not been able to replicate 

those efforts in its Reserve components. To address this need, the 

VFW urges Congress and DOD to devote more efforts and resources to combat the rate of suicide among Guardsmen and Reservists. Additionally, DOD must leverage shared agreements with 

VA to ensure Guardsmen and Reservists who live in rural and remote areas have access to the mental health care they need. 

Mr. Chairman, this concludes my remarks. I am happy to answer 

any questions you or the Members of the Committee may have. 

[The prepared statement of Mr. Fuentes follows:] 

PREPARED STATEMENT OF CARLOS FUENTES, DEPUTY DIRECTOR, NATIONAL

LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES

Chairman Isakson, Ranking Member Blumenthal and Members of the Committee, 

on behalf of the men and women of the Veterans of Foreign Wars of the United 

States (VFW) and our Auxiliaries, I would like to thank you for the opportunity to 

testify on today’s pending legislation. 

S. 244

A bill to require an independent comprehensive review of the process by which the 

Department of Veterans Affairs assesses cognitive impairments that result from 

Traumatic Brain Injury for purposes of awarding disability compensation. 

The VFW supports this legislation and its efforts to address incorrect assessments 

of cognitive impairments suffered by veterans with Traumatic Brain Injury (TBI). 

With the current shallow understanding of TBI, it is of utmost importance we 

properly handle and treat the portions we do comprehend. If underqualified Department of Veterans Affairs (VA) doctors have possibly misdiagnosed thousands of veterans who may have cognitive impairments from TBI, then that issue must be addressed and those veterans need to be given the opportunity to receive treatment 

and disability compensation. VA must be sure it is delivering the highest quality 

of care to veterans. By bringing in an outside source such as the Institute of Medicine, there will be opportunity for unbiased assessment of protocols for VA psychologists carrying out physiological exams related to TBI. 

S. 603, RURAL VETERANS TRAVEL ENHANCEMENT ACT OF 2015

The VFW strongly supports this legislation, which would authorize VA to continue 

a number of successful transportation programs to help veterans travel to their VA 

health care appointments. The lack of reliable transportation is a significant barrier 

to access for veterans throughout the country, especially in rural areas. The VFW 

strongly supports efforts to eliminate such barriers. 

Section 2 would permanently extend VA’s authority to administer the Veterans 

Transportation Service (VTS). This program was commissioned by the Veterans 

Health Administration’s Office of Rural Health in 2010, and greatly improved access 

to care for rural and severely disabled veterans by allowing VA facilities to establish 

and coordinate networks of local transportation providers, including community, 

commercial and government transportation services. 

VTS suffered a major setback in 2012 when it was temporarily suspended following a determination by the VA Office of General Counsel that VA lacked the 

statutory authority to hire paid drivers to transport veterans. Congress has passed 

one-year authorizations of the VTS program since January 2013, but a long term fix 

is still needed. The VFW supports permanently expanding this successful program. 

Section 3 would authorize VA to reimburse veterans for travel to Vet Centers. 

With the significant shortage of culturally competent and evidence-based mental 

health care available to veterans, we must do what is needed to ensure veterans 

have access to programs tailored to their unique needs. The combat-specific readjustment services offered at Vet Centers makes them a great source for mental 

health care for veterans struggling to readjust back to civilian life after their experiences during war. Unfortunately, accessing such readjustment centers may be difficult for certain veterans who cannot afford the transportation to and from Vet 

Centers. This bill would rightfully remove that barrier by expanding eligibility for 

VA beneficiary travel benefits. 

64 

Section 4 would reauthorize grants which enable Veterans Service Organizations 

to transport veterans who live in highly rural areas to their VA and community care 

appointments. VFW posts and departments in California, Texas, Maine and North 

Dakota use these grants to help thousands of veterans access the health care and 

services they need. The VFW supports reauthorizing such grants to allow these successful programs to continue. 

S. 2210, VETERANS PEER ACT

The VFW supports this legislation, which would require VA to integrate peer support specialists into Primary Care Patient Align Care Teams (PACT). 

Peer support specialists provide a valuable service to veterans coping with mental 

health conditions. Such veterans often look for guidance from fellow veterans who 

have successfully completed treatment and have learned to cope with conditions 

they are experiencing. While current law requires each VA medical center to hire 

a minimum of two peer support specialists, it does not require VA medical facilities 

to incorporate them into the clinical settings. As a result, many peer support specialists are not used to their full potential. Many peer support specialists currently 

lead successful mental health care programs and services. The VFW supports efforts 

to expand such best practices. 

The VFW is glad to see this legislation would require each medical center that 

participates in the pilot program to consider the gender-specific needs of women veterans when carrying out the pilot program. In our survey of women veterans, survey 

participants identified the lack of gender-specific services as the greatest need in VA 

health care facilities. Survey participants also indicated their desire to select a provider of the same gender, specifically for veterans who have mental health conditions that may be a result of military sexual trauma. The VFW supports efforts to 

hire women peer support specialists to ensure women veterans have the opportunity 

to seek guidance from women veterans who have learned to cope with military sexual trauma related mental health conditions. 

S. 2279, VETERANS HEALTH CARE STAFFING IMPROVEMENT ACT

This legislation would improve the transition of health care providers between the 

Department of Defense (DOD) and VA, streamline the process for transferring 

health care professionals between VA facilities and expand the practice authority for 

certain health care providers. The VFW supports sections 2 and 3 and takes no position on section 4. 

Section 2 would streamline the VA hiring process for transitioning servicemembers who practice medicine in the Military Health System. Servicemembers 

with years of clinical experience with the Military Health System have the skills 

and cultural competency needed to treat service-connected injuries as VA health 

care providers. The VFW believes veterans who choose to continue serving their 

country and their fellow veterans must have access to expedited hiring authorities 

that enable them to seamlessly transition from military service to the civil service. 

This legislation would rightfully ensure applications for VA health care employment 

from transitioning servicemembers are given priority. 

Section 3 would eliminate the requirement for VA health care professionals to undergo credentialing every time such employees transfer to a new VA medical facility. 

During our site visits of VA medical facilities throughout the country, the VFW has 

heard from VA physicians that VA credentialing requirements delay their ability to 

begin treating veterans when they transfer between VA medical facilities. The VFW 

does not see a reason for VA physicians to endure the VA credentialing process 

every time they transition to a new VA medical facility. We support efforts to 

streamline this process to ensure VA is able to seamlessly transfer its health care 

professionals to areas of greatest need. 

Section 4 would grant independent practice authority for advanced practice registered nurses and physician assistants employed by the Department. VA recently 

published a proposed rule to grant its advance practice nurses full practice authority. The VFW does not take a position on scope of practice issues. The VFW defers 

to VA in determining the most efficient and effective scope of practice of its providers. However, we will hold VA accountable for providing timely access to high 

quality health care, regardless if such care is provided by an advance practice registered nurse or a physician. 

65 

S. 2316

A bill to expand the requirements for reissuance of veterans benefits in cases of misuse of benefits by certain fiduciaries. 

This legislation would ensure a veteran who is defrauded by his or her fiduciary 

can be fully reimbursed, regardless of VA negligence or the amount the fiduciary 

manages. Today, veterans can only be made whole if VA does not respond to the 

notification of fraud within 60 days. For all other beneficiaries who have been defrauded, they can only be reimbursed the amount VA can collect back through fines 

placed on the fiduciary. This legislation would ensure that every veteran who has 

been defrauded can be made whole. 

This legislation would also require all fiduciaries to provide authorization for the 

Secretary to obtain the financial records of all accounts held by a fiduciary. This 

measure will provide VA with enhanced access to bank accounts held by fiduciaries 

for beneficiaries in its oversite function of safeguarding veterans’ benefits. 

The VFW supports this legislation. 

S. 2791, ATOMIC VETERANS HEALTHCARE PARITY ACT

When servicemembers answer the call of duty without hesitation, it is our duty 

to take care of the repercussions of their military service. The VFW supports this 

legislation, which would expand VA disability compensation to veterans who were 

exposed to nuclear radiation from 1977 to 1980 during the atomic cleanup of 

Enewetak Atoll. The VFW sees this as one more example of military toxic exposure 

causing adverse health conditions which has been ignored for far too long. 

S. 2958

A bill to establish a pilot program on partnership agreements to construct new facilities for the Department of Veterans Affairs. 

This legislation would authorize a pilot program for VA to enter into five publicprivate partnerships (P3) for the funding and construction of major construction 

projects. This bill will allow ‘‘entities’’ to apply for and enter into a contract with 

VA. These entities would be made up of a board of directors that will submit an 

application to the Secretary that will describe the name and experience of the 

project manager; the proposed contributions and how funding will be secured; a description of the management plan and monitoring process that will be used; and finally the total cost and timeline for completion. 

The VFW has called on Congress to allow VA to enter into P3s for several years 

and fully believes that these partnerships are the future for VA major construction 

projects. That is why we fully support this legislation. 

S. 3021

A bill to authorize the use of Post-9/11 Educational Assistance to pursue independent study programs at certain educational institutions that are not institutions of higher learning. 

Post-secondary education comes in various forms and is vital to the successful 

transition from military to civilian life. The VFW supports this legislation to expand 

the Post-9/11 Education Assistance Program. Current legislation does not allow veterans to use their education benefits to earn accredited certificates through independent study programs at institutions that are not deemed those of higher learning. Yet, there are institutions that offer these accredited programs for areas such 

as career and technical education. Allowing veterans to use their education benefits 

to earn such certificates would incentivize veterans to purse secondary education 

and open more windows of opportunity for their futures. 

S. 3023, THE ARLA HARRELL ACT

During WWII, 60,000 servicemembers were human subjects of the military’s 

chemical defense research program——some 4,000 of those servicemembers were exposed to high levels of mustard agents. Until the early 1990s, these veterans where 

forbidden to speak of the experiments, even though the program was declassified in 

1975. 

Because of the classified nature of these exposures and the reliance on incomplete 

and conflicting data, the ability to accurately determine the level of exposure to 

mustard gas and Lewisite each veteran endured is difficult at best. Because of these 

facts, the VFW believes those veterans who have previously applied for benefits related to exposure to mustard gas and Lewisite and were denied because the eviVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00069 Fmt 6633 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
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dence of ‘‘full body’’ exposure could not be proven, should be given the benefit of the 

doubt and have their claims adjudicated with the presumption of full body exposure. 

The VFW supports requiring VA to reconsider previously denied claims for mustard gas and Lewisite exposure with the presumption that the exposure was full 

body, unless available evidence proves otherwise. 

S. 3032, VETERANS’ COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 2016

The VFW strongly supports this legislation, which would increase VA compensation for veterans and survivors, and adjust other benefits beginning December 1, 

2016. 

Disabled veterans, along with their surviving spouses and children, depend on 

their disability and dependency and indemnity compensation to bridge the gap of 

lost earnings and savings caused by service-connected injuries and illnesses. Each 

year, veterans wait anxiously to find out if they will receive a cost-of-living adjustment (COLA). There is no automatic trigger that increases these forms of compensation for veterans and their dependents. Annually, veterans wait for a separate Act 

of Congress to provide the same adjustment that is automatically granted to Social 

Security beneficiaries. 

The VFW thanks the Committee for providing veterans the opportunity to receive 

their full COLA increase, by not including a ‘‘round down,’’ which is nothing more 

than a money-saving gimmick that asked veterans and their survivors to bear the 

burden of budget austerity measures. 

S. 3035, MAXIMIZING EFFICIENCY AND IMPROVING ACCESS TO PROVIDERS AT THE

DEPARTMENT OF VETERANS AFFAIRS ACT OF 2016

The VFW supports this legislation, which would require VA to carry out a pilot 

program to evaluate the efficacy of using medical scribes. 

A recent VA study evaluating common challenges faced by clinicians in their dayto-day environments, conducted by VA’s Emerging Health Technology Service, concluded that burdensome non-clinician-centered electronic health care systems have 

a significant impact on morale and retention of VA physicians and the veteran’s experience due to reduced facetime with providers. This legislation would reduce the 

time physicians spend on the keyboard and maximize face to face time with their 

patients. 

This legislation requires VA to contract with a nongovernmental entity that specializes in the collection of medical data and data entry into electronic health care 

records. The VFW urges the Committee to require the contractors to undergo training on VA’s Computerized Patient Record System or the Enterprise Health Management Platform, including training on how to research required medical documents, 

such as labs and non-department health care records which have been scanned into 

a veteran’s electronic health care record. The ‘‘Day in the Life’’ assessment determined that searching and navigating disparate data systems consumes vast 

amounts of time that VA clinicians can spend interacting with their patients. The 

VFW believes medical scribes could assist VA providers in locating necessary medical records and spend less time navigating electronic health care records and more 

time treating veterans. 

S. 3055, DEPARTMENT OF VETERANS AFFAIRS DENTAL INSURANCE

REAUTHORIZATION ACT OF 2016

This legislation would reauthorize the VA Dental Insurance Program (VADIP) for 

five years. While the VFW believes dental must be included in the health care benefits package for all veterans enrolled in VA health care, we support expanding the 

current program to ensure current beneficiaries do not have a gap in dental coverage. 

Dental care is a vital aspect of general health care. According to the Mayo Clinic 

and a myriad of peer-reviewed medical studies, oral health has a direct impact on 

severe diseases and conditions, such as heart disease and adverse birth conditions. 

Conversely, several health conditions which are prevalent among veterans, such as 

diabetes and Alzheimer’s disease, have been found to directly impact oral health. 

Until the VADIP was implemented in January 2014, veterans enrolled in VA health 

care had little to no options for receiving dental coverage. 

Additionally, there is a large disparity between VA and DOD dental coverage, 

which can have a significant impact on the health care and quality of life for veterans. While in uniform, veterans were required to maintain a high level of dental 

readiness, to the extent that they would be placed on a non-deployable status if they 

failed to receive a dental evaluation every year. However, only veterans who were 

67 

100 percent service-connected disabled, certain homeless veterans, and those who 

had a service-connected dental condition were eligible for VA dental care. 

While the VADIP provides dental care options for 100,000 veterans and their eligible families, VFW members consider this program as ‘‘better than nothing.’’ The 

VFW believes veterans have earned and deserve the best, not ‘‘better than nothing.’’ 

According to VFW members who have used or currently use this program, it provides lower coverage for higher costs than most dental plans, including dental plans 

available through TRICARE and the Affordable Care Act health care exchanges. 

Like many of my peers, I decided to terminate my VADIP coverage as soon as I became eligible for the VFW’s dental coverage. I now pay lower monthly premiums 

and cost shares and have better dental coverage than when I participated in the 

Delta Dental’s Comprehensive VADIP plan, which is the highest plan Delta Dental 

offers under the VADIP contract. 

However, similarly to the 100,000 veterans and eligible family members who participate in the VADIP, my dental records are not integrated into my VA electronic 

health care record. Thus, VA health care providers are unable to determine whether 

veterans who participate in the VADIP have dental conditions that may impact 

their overall health care conditions. Such disparate care could have a negative impact on the health care and quality of life of the veterans who participate in the 

VADIP program. That is why the VFW fully supports expanding eligibility for VA 

dental care to all veterans who are eligible for VA health care. Doing so would ensure veterans have access to needed dental care without having to bear the full cost 

of such care. 

The VFW understands the need for some form of dental coverage while Congress 

and VA work to expand VA dental care, thus we support expanding the current program for an additional five years to allow VA to rebid the contract and hopefully 

negotiate better coverage options than the current contract. 

S. 3076, CHARLES DUNCAN BURIED WITH HONOR ACT OF 2016

The VFW support this legislation, which would ensure deceased veterans without 

a next of kin who are buried in a state or tribal cemetery receive the same benefits 

as those buried in a national cemetery. 

The National Cemetery Administration’s (NCA) strategic goal is for 96 percent of 

all veterans to have interment options within 75 miles of their home. This includes 

viable burial options at cemeteries that have been built, expanded, or improved 

through NCA cemetery grants. 

When the demand exists, NCA proposes the construction of new national cemeteries. However, NCA also uses agreements and grants with states, United States 

territories and federally recognized tribal organizations to establish, expand, or improve veterans’ cemeteries in areas where NCA has no plans to build or maintain 

a national cemetery. Cemeteries assisted by an NCA grant are required to be exclusively reserved for veterans and eligible family members and maintained by the 

same standards as an NCA managed national cemetery——meaning that veterans 

interred in NCA assisted state, territorial, or tribal cemeteries must be afforded the 

same honors as those interred in a national cemetery. 

However, VA can only furnish a casket or urn for veterans without a next of kin 

and without the means to purchase a casket or urn who are buried in a national 

cemetery. This bill would rightfully extend the right to a dignified burial to veterans 

who are buried or inurned in a tribal or state cemetery. 

S. 3081, WINGMAN ACT

The VFW does not support this legislation at this time. While we agree there 

should be a more efficient way for congressional constituent services staff to assist 

veterans, there are current controls in place to limit access to veterans’ records, and 

those controls must be preserved under any expansion of access. 

The VFW would insist that a release must still be signed before any access to 

records can be granted. There must be a limitation on access to only veterans who 

are constituents of the Member of Congress. When a Power of Attorney (POA) is 

held by an individual or organization, that POA must be notified of the request. Any 

‘‘accredited’’ congressional employee must be viewed as an ‘‘agent’’ regardless of that 

employee’s status with a State Bar Association. This will ensure the employee’s certification includes passing a certification test. Currently, VA provides background 

checks at no cost to Veterans Service Organizations. If this will also be the case 

with accredited employees, funding must be provided. If the intent is for congressional offices to reimburse VA for the cost of such background checks, it must be 

explicitly defined in legislation. 

68 

Under current law, there are level-sensitive restrictions on most VA employees, 

preventing them from viewing certain files without expressed consent. These restrictions must extend to these accredited employees as well. Last, VA must have a 

tracking system to ensure these employees are only assisting their congressional 

constituents. Additionally, there must be a consequence for congressional staff found 

to have abused any aspect of their authority. 

DISCUSSION DRAFT

To clarify the scope of procedural rights of members of the uniformed services with 

respect to their employment and reemployment rights, to improve the enforcement 

of such employment and reemployment rights, and for other purposes. 

When servicemembers receive orders to deploy or for active duty responsibilities, 

they should not be burdened with the stress factor of not knowing if they will still 

be employed when they return home. Unfortunately, some employers have found 

ways to avoid current law protecting veterans from repercussions from job providers 

due to completion of orders. The VFW supports this legislation to protect employment rights of servicemembers by closing legal loopholes some employers have chosen to exploit. More specifically, this would allow servicemembers who signed forced 

arbitration agreements with their employers to not forgo their work contract, but 

still be able to void any forced arbitration written in. Also, if investigating attorneys 

general find wrongdoings by employers trying to evade the Uniformed Services Employment and Reemployment Act of 1994, this legislation lays out the groundwork 

for appropriate damages and compensation of servicemembers. Employers should 

not be able to require servicemembers to forgo their rights as a condition of employment. Those affected by this injustice should have the option to void this portion 

of these contracts, as well as receive compensation for punitive damages. 

DRAFT BILL

To expand eligibility for readjustment counseling to certain members of the Selected 

Reserve of the Armed Forces. 

This legislation would expand eligibility for Vet Centers to members of the Selected Reserve who have not deployed in support of combat operations. While the 

VFW acknowledges the need for more mental health care and services for our Guard 

and Reserve servicemembers, we cannot support expanding Vet Center eligibility to 

non-combat veterans. 

Vet Centers have a sacred mission to assist combat veterans in coping with their 

experiences at war. These veterans face readjustment issues and concerns that are 

not faced by their non-combat veteran peers, and necessitates the confidential and 

high quality services provided at Vet Centers—especially servicemembers who are 

still in uniform and fear seeking mental health care could impact their careers. That 

is why the VFW has supported efforts to expand eligibility to servicemembers, including Guardsmen and Reservists, who have deployed to combat zones. 

The VFW agrees that suicide rates in our Armed Forces are equally as troubling 

as veteran suicides. While the DOD’s suicide prevention programs have successfully 

reduced the rate of suicides among our active duty forces, it has not be able to replicate such efforts with its reserve components. Recent data from the Defense Suicide Prevention Office shows an increase in the number of suicides among Guardsmen and Reservists in the past year. This is due in large part to the fact that Guard 

and Reserve units often operate in rural and remote areas, without access to military treatment facilities. To address this need, the VFW urges Congress and DOD 

to devote more effort and resources to combat the rate of suicides among DOD’s reserve components. To assist DOD in reducing the rate of suicide among Guardsmen 

and Reservists, the VFW would support authorizing DOD to enter into sharing 

agreements with VA to provide mental health care to Guard and Reserve servicemembers who live too far from a military treatment facility, but near a VA medical 

facility with excess mental health care capacity. To be clear, such agreements must 

not limit or erode the mental health care and services VA provides eligible veterans. 

DRAFT LEGISLATION

To authorize payment by the Department of Veterans Affairs for the costs associated 

with services by medical residents and interns at facilities operated by Indian 

tribes and tribal organization. 

The VFW supports this legislation, which would expand partnership opportunities 

with medical facilities administered by tribal organizations. 

For more than 75 years, VA has partnered with medical schools around the country to train and teach America’s health care workforce. This legislation would reVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00072 Fmt 6633 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
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quire VA to establish a pilot program to evaluate the feasibility of developing similar relationships with tribal health care facilities to incentivize health care professionals to practice medicine in tribal areas. The VFW believes this legislation would 

expand access to high quality care to our Native American veterans. 

DISCUSSION DRAFT

To authorize the American Battle Monuments Commission to acquire, operate and 

maintain the Lafayette Escadrille Memorial in Marne-la-Coquette, France. 

The Lafayette Escadrille Memorial was built to honor U.S. pilots who flew combat 

missions with the French military prior to U.S. entry into WWI. As a result of the 

reduction in funds available through the Lafayette Escadrille Memorial Foundation, 

the memorial has fallen into a state of disrepair. To supplement the depleted foundation, the American Battle Monuments Commission (ABMC) provided $2.1 million 

to the project. However, a long-term care plan for this important monument is still 

uncertain. To ensure the memorial receives the care and recognition it deserves, the 

VFW supports placing it under the care of the ABMC. 

Mr. Chairman, this concludes my testimony. I will be happy to answer any questions you or the Committee members may have. 

Chairman ISAKSON. Thank you, Mr. Fuentes. We appreciate your 

testimony. 

Mr. Rick Weidman, Executive Director for Policy and Government Affairs, VVA. 

STATEMENT OF RICK WEIDMAN, EXECUTIVE DIRECTOR FOR 

POLICY AND GOVERNMENT AFFAIRS, VIETNAM VETERANS 

OF AMERICA 

Mr. WEIDMAN. Thank you, Mr. Chairman. I appreciate the opportunity for VBA to share some of our views today. 

S. 244, Senator Tester’s bill, we would strongly endorse that. 

One of the problems that VA has always had is consistency across 

the board and working to do quality assurance of every VA hospital. It is no different in this case than anything else. One of the 

things we would point out, however, that has never been mentioned by VA, is nobody ever tested previous generations of veterans no matter what other symptoms they might have. Vietnam 

veterans were subject to the same kinds of explosions as those of 

the more recent wars. 

The Rural Veterans Travel Enhancement Act, we are very 

strongly for. The Veterans’ Partners Efforts to Enhance Reintegration Act, Senator Blumenthal’s bill and others, we are strongly in 

favor of a patient having the peer review—excuse me—having the 

peer specialists but think it should not end there. There should be 

a ladder for young veterans to move up into any medical profession 

without regard to cost, even if they do not have available the 21st 

Century G.I. Bill, on a condition that they give back at least year 

for year in tuition. We are going to have to do many imaginative 

things in the next 10 years. Otherwise, we are not going to have 

the clinical resources we need to operate the system properly. 

In regard to the Atomic Veterans Health Care Parity Act, I 

would respectfully strongly disagree with the VA on this. I would 

point out that the VA has been wrong about every single darn toxic 

exposure in my adult lifetime. They are always wrong. They always 

say there is no problem. They always say, do not worry about it, 

and almost invariably, they are proven wrong. So, this bill is very 

much needed and we need to look at the whole area of VA of toxic 

exposures and what is happening with staff there and with policy 

70 

about how they are carrying it out, because it is not right, what 

they are doing. 

Senator Fischer’s bill, we have always been—VVA has been 

strongly in favor of giving as much private capital into the game 

as possible, particularly when it comes to capital construction, and 

think we should look not only to Senator Fischer’s bill, but look to 

do the same when it comes to housing and permanent housing as 

well as transition housing for homeless veterans. 

S. 3021, we will take the Senator at his word that this is a great 

outfit, but it needs monitoring, and particularly if people want to 

do the same thing elsewhere. 

The Arla Harrell Act by Senator McCaskill, this is yet another 

place where we need to look hard and, frankly, do not trust VA’s 

judgment when it comes to whether or not these veterans have 

been affected adversely, either, and it is something that oversight 

really needs to look closely at, Mr. Chairman. I am not sure what 

we do about that bill, or about that problem systemically, but I 

know it systemically needs to be adjusted, because the one thing 

that will be a constant from now until long after we are gone is 

toxic exposures of our military forces of one kind or another and 

we need to start to figure out how to do a better job and not just 

the answer of ‘‘no’’ and ‘‘no problem.’’ 

The Veterans Compensation Cost of Living Act—frankly, we 

think the Consumer Price Index (CPI) is busted, and anybody who 

looks at what the CPI says about advance increases for the cost of 

living and then looks at their own household budget does not have 

any respect for it because it does not square with the reality that 

people see in front of them. So, while that is bigger than this Committee, to have compensation cost of living indexed to the CPI is 

always going to fall short on the part of our veterans. 

The dental insurance, we are in favor of it, since Congress has 

thus far been reluctant to move in that direction and VA just says 

no. But, frankly, VVA agrees with the VFW on this issue. We are 

long past the time when we consider dental health a frill and it is 

essential to health and moving forward. 

I do not have time to comment on the other bills, but the Integrate Networks Guaranteeing Member Access, we have significant 

problems with and we will be happy to discuss it with Senator 

Cassidy and his staff. 

Mr. Chairman, thank you for the opportunity to speak here 

today. 

[The prepared statement of Mr. Weidman follows:] 

PREPARED STATEMENT OF RICHARD WEIDMAN, EXECUTIVE DIRECTOR, POLICY AND

GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA

Good afternoon Chairman Isakson, Ranking Member Blumenthal, and other distinguished Members of the Senate Veterans’ Affairs Committee. On behalf of the 

members of Vietnam Veterans of America [VVA] and our families, we very much 

appreciate the opportunity to express our views regarding legislation pending before 

this very vital committee. 

S. 244, introduced by Senator Tester, would require an independent and comprehensive review of the process by which the Department of Veterans Affairs assesses cognitive impairments that result from Traumatic Brain Injury for purposes 

of awarding disability compensation. 

It is our understanding that troops who have returned from deployments to Iraq 

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ceive varying clinical assessments for the same injury, assessments which, obviously, affect the award of disability compensation from the VA. This bill would— 

at least it should—set the stage for determining if what VA clinicians are doing is 

consistent, and equitable, across the board and, if not, what the VA must do to rectify this situation. 

VVA strongly supports enactment of S. 244. 

S. 603, the Rural Veterans Travel Enhancement Act, introduced by Senators 

Tester and Murray, would make permanent the authority of the Secretary of Veterans Affairs to transport individuals to and from VA in conjunction with rehabilitation, counseling, examination, treatment, and care. 

There is nothing not to like about S. 603; in fact, what it calls for should continue 

to be standard operating procedure for every VA healthcare facility. Therefore, VVA 

supports enactment of S. 603. 

S. 2210, the Veteran Partners’ Efforts to Enhance Reintegration Act, introduced by Senator Blumenthal for himself and Senators Baldwin and Markey, would 

require the VA Secretary to carry out a program to establish peer specialists in the 

Patient Aligned Care Teams at VA medical centers. The bill stipulates that female 

peer specialists must be included in this program. 

The purpose of the PEER Act, which is essentially a pilot program, is ‘‘to promote 

the use and integration of mental health services in a primary care setting.’’ Because we believe that enactment and implementation of this bill can lead to a significant advancement in melding mental with physical health services, VVA fully 

supports the passage of the PEER Act. 

S. 2279, the Veterans Health Care Staffing Improvement Act, a bipartisan 

bill introduced by Senator Merkley along with Senators Brown, Rounds, Shaheen, 

Tester, Warner, Wyden, and Tillis, would require the SecVA to initiate and carry 

out a program to increase efficiency in the recruitment and hiring by the VA of 

health care workers in the process of exiting from the Armed Forces; and would create uniform credentialing standards for certain health care professionals in the department. 

It certainly is no secret that the VA is in dire need of additional medical professionals to handle an increasing demand for the healthcare services it provides eligible veterans. The unfilled vacancies for these clinicians in VAMCs and CBOCS 

across the country is a prime reason that VA personnel cut corners by finagling appointments with both primary care clinicians and specialists. 

VVA has long believed that the VA must do more—a lot more—to attract and retain health care workers leaving active duty to ‘‘sign on’’ with the VA. 

While we have long urged VA to do a much better job of recruiting and hiring 

physicians, as well as all of the allied health care professionals. 

S. 2316, introduced by Senator Blumenthal for himself and Senators Moran and 

Brown, would ‘‘expand the requirements for reissuance of veterans’ benefits in cases 

of misuse of benefits by certain fiduciaries to include misuse by all fiduciaries, [and] 

to improve oversight of fiduciaries.’’ 

Fiduciaries have what we consider to be a sacred obligation to assist honestly and 

transparently the veterans whose financial interests they take responsibility for. 

Unfortunately, there are some who are entrusted with this charge who are neither 

honest nor transparent, who in essence betray the veterans whom they represent. 

Because S. 2316 will give the VA Secretary the legal authority to reimburse veterans who have been ripped off by their fiduciary, as well as additional oversight 

powers to help ensure the honesty and integrity of fiduciaries, VVA enthusiastically 

supports enactment of this bill. 

S. 2791, the Atomic Veterans Healthcare Parity Act, introduced by Senators 

Franken and Tillis, would provide for the treatment of radiation-exposed veterans 

who participated in the cleanup of Eniwetok Atoll for purposes of the presumption 

of service-connection for certain disabilities. 

Far too many veterans who have been exposed to radiation and other toxic substances in the performance of their duties while in uniform have been denied 

healthcare benefits and disability compensation by the VA. Why? Because they cannot show a nexus between their exposure(s) and particular health conditions that 

erupt years after exposure. 

VVA supports enactment of this bill. Although S. 2791 is focused on a relatively 

small group of veterans who participated in the cleanup of Eniwetok Atoll between 

January 1, 1977, and December 31, 1980, we remind the honorable Members of this 

Committee that other veterans are suffering from a variety of maladies that can be 

associated with their exposure to toxic substances while in uniform; and that the 

72 

progeny of many of these veterans have health conditions that may be caused by 

a parent’s exposure to certain toxins; and that they, too, need additional protections 

under the law to access healthcare and disability compensation. Hence, we make a 

plea to those who serve on this most important committee to insist that S. 901, the 

Toxic Exposure Research Act, be voted upon by the whole Senate. 

S. 2958, introduced by Senator Fischer, would establish a pilot program on partnership agreements to construct new facilities for the Department of Veterans Affairs. 

Although we do not object to this pilot program, we question why it is limited to 

‘‘not more than five partnership agreements.’’ 

So, if this distinguished committee sees the wisdom of voting for the enactment 

of S. 2958, VVA would support this bill. 

S. 3021, introduced by Senators Inhofe and Lankford, would authorize the use of 

Post-9/11 Educational Assistance for independent study programs at certain institutions that are not institutions of higher learning. 

VVA has little doubt that the sponsors have in mind a particular institution in 

the state that they represent that will benefit from the enactment of this bill. Still, 

if a veteran can improve his/her chances to achieve their American Dream, and if 

any ‘‘educational institution’’ that stands to benefit should this bill become law is 

legitimate and not one of the predatory institutions—most of which are colleges 

whose bottom line is profit and not the education of the students they ostensibly 

serve—then we may be able to endorse the enactment of S. 3021 in the future. 

S. 3023, the Arla Harrell Act, introduced by Senator McCaskill, would provide 

for the reconsideration of claims for disability compensation for veterans who were 

the subjects of experiments by the Department of Defense during the Second World 

War that were conducted to assess the effects of mustard gas or Lewisite on humans. There are not many of the 60,000 or so veterans left who participated in these 

experiments. Still, because they are deserving of a measure of justice long denied 

them, VVA strongly supports passage of this bill, and thanks Senator McCaskill for 

taking the lead on ameliorating this historic wrong. 

S. 3032, the Veterans’ Compensation Cost-of-Living Adjustment Act of 

2016, introduced by Chairman Isakson, Ranking Member Blumenthal, and most of 

the Members of this Committee, would provide for an increase, effective December 1, 

2016, in the rates of compensation for veterans with service-connected disabilities 

and the rates of dependency and indemnity compensation for the survivors of certain disabled veterans. 

VVA of course joins in the chorus of support for passage of this bill. We would 

like to see, however, that the compensation adjustment for service-connected disabilities not be an annual affair but rather be added to black-letter law in perpetuity. 

S. 3035, Maximizing Efficiency and Improving Access to Providers at the 

Department of Veterans Affairs Act, introduced by Senators Heller and Tester, 

would require the Secretary of Veterans Affairs to carry out a pilot program to increase the use of medical scribes to maximize the efficiency of physicians at VA 

medical facilities. 

Instead of clinicians having to type up their notes, conclusions, and recommendations for each patient they see, this pilot program would test the efficacy of the use 

of ‘‘medical scribes’’ to assist them in this ‘‘onerous’’ task. Surely, a pilot might be 

worthy, particularly for those clinicians who are not particularly adept at writing 

and those surgeons who, obviously, cannot write up their conclusions in the middle 

of an operation. Yet even if a pilot program illustrated the value, however limited 

or extensive, of the use of such scribes, how many would have to be hired and 

trained across the VA healthcare system to be truly effective? 

Hence, VVA supports the concept but we have significant doubts that any future 

Congress will provide significant enough additional resources to ever realize the potential impact of this concept. 

S. 3055, the Department of Veterans Affairs Dental Insurance Reauthorization Act of 2016, introduced by Senators Burr and Tester, would provide a dental insurance plan for veterans and their survivors and dependents. 

Although full implementation of such a plan effectively puts the VA in the position of becoming an insurance agency, VVA supports the passage of S. 3055 because, 

for many veterans, it may be the insurer of last resort. VVA would further argue 

that dental health care is not a ‘‘frill,’’ but rather an integral part of overall health. 

If a person’s dental health is a mess, it should come as no surprise that that veteran’s overall health is not good. 

73 

Given the reluctance of the Executive branch and the Congress to include dental 

health (with the notable exception of 100% service-connected disabled veterans and 

certain veterans who are homeless), providing this opportunity to purchase dental 

insurance through the VA is a good alternative. 

Speaking of insurance, the option for those who are 50% or more service-connected disabled to buy additional life insurance should be extended to the same 

higher level of insurance as that accorded to 100% disabled veterans. This problem 

of finding affordable life insurance is really a significant problem for those who have 

PTSD as part of their service-connected disability rating. 

S. 3076, the Charles Duncan Buried with Honor Act, introduced by Senator 

Cotton, would authorize the SecVA to furnish caskets and urns for burial in cemeteries of states and Indian tribes for veterans without sufficient resources to provide 

for caskets or urns. 

Just as the VA provides caskets or urns for the remains of veterans to be laid 

to rest in national cemeteries, this bill would extend this service to veterans to be 

buried in state and Indian cemeteries. As such, VVA strongly endorses enactment 

of this bill. 

S. 3081, the Working to Integrate Networks Guaranteeing Member Access 

Now Act, introduced by Senator Cassidy, would provide certain employees of Members of Congress with access to case-tracking information of the Department of Veterans Affairs. 

VVA does not advocate for this bill. Will this effectively speed up the adjudication 

of claims? We have our doubts. The VA is obligated to provide any Member of Congress who asks with the status of a veteran’s claim for compensation. To give ‘‘certain employees’’ direct access to such information, however, opens up the unfortunate possibility that, by citing potential outlier cases, just puts the department in 

a bad light and does little to improve the efficiency of the adjudication process. 

S. , introduced by Senator Blumenthal, would clarify the scope of procedural rights of members of the uniformed services with respect to their employment 

and reemployment rights, and would improve enforcement of these rights. 

Members of the National Guard and the Reserves now comprise just about half 

of the Nation’s active duty Armed Forces on any given day. Since 9/11, more than 

900,000 members of the Reserve components have been mobilized in the Global War 

on Terrorism. Despite the protections afforded them under the Uniformed Services 

Employment and Reemployment Rights Act (USERRA), there have been far too 

many instances in which a Reservist or Guardsman returns from a deployment to 

find that the job s/he has left to serve our Nation is no longer there for him/her. 

This is wrong. This is something USERRA has sought to provide protection for 

these Reservists and members of the National Guard. Because the Blumenthal bill 

would strengthen enforcement of USERRA, because it would provide additional protections for those who have served our Nation in uniform, often at great personal 

and professional cost, VVA supports swift passage of this bill. 

VVA would also urge that USERRA protection be in place from time/date of the 

first public knowledge of a deployment of a unit, instead of the date the orders are 

cut for an individual. Some employers are currently doing layoffs of workers at the 

first notice of a unit being deployed, which skirts the current law, and leaves these 

Reservists and National Guard members with no protection whatsoever. 

S. , introduced by Senator Tester, would expand eligibility for readjustment 

counseling to certain members of the Selected Reserve. 

It is only right that those who serve in uniform and who are afflicted with ‘‘a behavioral health condition or psychological trauma’’ ought to be able to avail themselves of the readjustment counseling available in the VA’s Vet Centers. Hence, 

VVA applauds and supports the swift enactment of this bill. 

S. , introduced by Senator Sullivan, would authorize payment by the Department of Veterans Affairs for the costs associated with service by medical residents and interns at facilities operated by Indian tribes and tribal organizations, 

and would require the Secretary to carry out a pilot program to expand medical 

residencies and internships at such facilities. 

It should come as no surprise to anyone that the VA is in need of qualified, competent medical professionals. Because this bill has the potential of increasing the 

pool of these clinicians to serve veterans enrolled for VA health care, VVA supports 

enactment of this bill. 

A Discussion Draft, companion legislation to H.R. 5420 introduced by HVAC 

Chairman Miller, would authorize the American Battle Monuments Commission to 

74 

acquire, operate, and maintain the Lafayette Escadrille Memorial in Marne-la-Coquette, France. 

Monuments and memorials to our men and women in uniform speak to their service and their sacrifices and, in many cases, to their last true measure of devotion. 

If the commission sees a need to take responsibility for this memorial, subject ‘‘to 

the consent of the Government of France,’’ VVA stands with the commission, and 

with the enactment of this bill. 

Vietnam Veterans of America appreciates the opportunity to present our views on 

this pending legislation before this Committee and will be pleased to respond to any 

question you may have. And we want to thank you for the work you do for the Nation’s veterans. 

Chairman ISAKSON. Thank you, Mr. Weidman, very much. 

Kevin Ziober, member of the Reserve Component. Kevin, you are 

welcomed. 

STATEMENT OF KEVIN ZIOBER, 

MEMBER OF THE RESERVE COMPONENT 

Mr. ZIOBER. Mr. Chairman, Ranking Member Blumenthal, thank 

you for this opportunity to testify in support of S. 3042, the Justice 

for Servicemembers Act, and to share my personal views and experiences on the importance of strong Uniformed Services Employment and Reemployment Rights Act (USERRA) law. 

I applaud Senator Blumenthal for introducing this much needed 

legislation that would clarify that servicemembers and veterans 

cannot waive their substantive or procedural rights under 

USERRA, consistent with the original intent of Congress when it 

enacted USERRA in 1994. 

As a private citizen, a combat veteran and Reservist, I stand 

with the 32 Veterans Service Organizations in the military coalition who support this legislation. Without USERRA’s strong substantive and procedural protections, it would be impossible for millions of Americans to serve in the Guard and Reserve to help protect our homeland and advance America’s interests abroad. 

As the Committee is aware, USERRA guarantees servicemembers the right to return from their civilian jobs after serving in the 

military and prohibits employment discrimination based on military service or status. USERRA makes it possible for Reservists 

like me to serve our Nation in the Armed Forces. 

Several years ago, I lost a job that I loved because I chose to 

serve my country. But sadly, my story is not unique. Each year, 

thousands of Reservists lose their jobs or miss out on benefits because employers are not aware of USERRA or they find our military service to be inconvenient. 

In July 2010, I was hired by a Federal contractor called BLB Resources. From 2010 to 2012, as a manager, I helped BLB expand 

its operations and workforce from 18 employees to over 90. In November 2012, I received active duty orders to deploy to Afghanistan 

for 12 months. As soon as I learned of the upcoming deployment, 

I gave BLB notice. On my last day of work, BLB hosted a lunchtime party to honor my military service. Forty coworkers gave me 

a standing ovation. I was presented with a large cake with an 

American flag and the inscription, ‘‘Best Wishes Kevin,’’ and my 

colleagues decorated my office with camouflage netting along with 

cards and gifts that were stacked on my desk. 

Around 4:45 on that same afternoon, I was called into the 

Human Resources Department, where I was promptly fired and 

75 

told that my position would not be available upon my return from 

active duty. I was shocked to learn that I was being terminated 

from my job on the eve of my deployment to a combat zone. It created an unimaginable amount of concern and anxiety about how I 

would earn a living once my military orders had ended. 

Upon returning home from Afghanistan in 2014, I was further 

surprised by what happened when I tried to enforce my rights. 

After I filed a USERRA claim in Federal Court, BLB asked the 

court to compel me to arbitrate my USERRA case and the court 

agreed. This was shocking, because I knew that when Congress 

passed USERRA, it explicitly stated that veterans and servicemembers cannot waive any of their rights, that they are entitled to enforce their rights in Federal Court, and that they cannot be required to arbitrate their claim. 

Fortunately, my story did not end there. I found legal advocates 

who agreed to take my case to the U.S. Court of Appeals and, if 

necessary, to the U.S. Supreme Court. But the Nation’s highest 

court should not need to decide whether servicemembers can waive 

their procedural rights under USERRA. By passing the Justice for 

Servicemembers Act now, Congress can clarify that all USERRA 

rights are protected against waiver and ensure once and for all 

that no servicemember is forced to choose his USERRA rights and 

a job that puts food on the table. 

Today, servicemembers face uncertainty when they enforce their 

USERRA rights. In 2005, the Bush administration issued a final 

rule stating that servicemembers cannot be forced to arbitrate their 

USERRA claims. Some courts have faithfully followed the intent of 

Congress on this issue while others have not. Due to this split 

within the courts, it is much harder for servicemembers to leave 

their civilian jobs with confidence when they are called to duty because they do not know what to expect if they ever need to enforce 

their USERRA rights. 

When servicemembers are required to arbitrate their USERRA 

claims, they do not just lose the right to file an action in court. 

They also lose many of the enforcement tools that make USERRA 

a strong law, such as the right to file in any district where the employer has a place of business, the lack of a statute of limitations 

period, and a ban on making servicemembers pay filing fees or an 

employer’s fees and costs. 

By enacting the Justice for Servicemembers Act, Congress can 

send a powerful bipartisan message to all those who have served 

or are thinking about serving in the future. Congress can make 

clear that it understands the challenges we face and supports us 

so that no servicemember or veteran will ever again experience 

what happened to me. No warfighter who is asked to leave his job 

and risk his life for his country should ever need to worry about 

fighting for his job when he returns home. 

Thank you very much for your time and consideration of my 

views. I look forward to answering your questions. 

[The prepared statement of Mr. Ziober follows:] 

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PREPARED STATEMENT OF KEVIN ZIOBER, MEMBER OF THE RESERVE COMPONENT


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Chairman ISAKSON. Well, thanks to all of you for your testimony. 

I will make a couple of comments probably rather than questions. I do have a couple questions, too. 

Comment number 1—and I think Mr. Weidman talked about the 

Consumer Price Index adjustment—Senator Blumenthal and I, 

along with every Member of the Committee, Republican and Democrat alike, have cosponsored the cost of living adjustment for this 

year. Your concerns about the calculations of CPI are duly noted 


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and I am pleased that we have made it the unanimous recommendation of the Senate to adjust compensation wherever it is 

indexable by CPI, and there will be an increase in those benefits 

at the end of this fiscal year for next fiscal year. That was approved by everybody on the Committee. 

Second, Mr. Fuentes, as I understood it, you and a number of 

others, the way you read the WINGMAN Act was that it did not 

require a privacy release before the staffer could get the information, is that right? 

Mr. FUENTES. That is correct, Mr. Chairman. 

Chairman ISAKSON. But I also heard you say, if it did require the 

privacy release, you did not have any problem with the legislation, 

is that correct? 

Mr. FUENTES. Well, there are a couple other concerns that we 

have with the legislation, mainly that the restriction levels have to 

apply to Congressional staff, as well, meaning that they could only 

view records for folks for whom they have a privacy release from. 

Also, as a Veterans Service Organization, we hold power of attorney for a number of veterans and we would like Congressional staff 

to either notify—or VA to notify Veterans Service Organizations of 

any individual that holds a power of attorney for that veteran. And 

I have a couple other ones. Overall, I think there are four recommendations that are included in my written testimony. 

Chairman ISAKSON. We have that, and all that testimony will be 

made a part of the record, without objection. 

Mr. FUENTES. Thank you, Mr. Chairman. 

Chairman ISAKSON. I had one other point. We will deal with each 

of these pieces of legislation in the near future. As we have in the 

past, this Committee tries to do due diligence to the maximum extent possible before we act, just as we did in the Veterans First 

Act, which is a consolidation of 148 recommendations that came 

out of Members of this Committee. We are looking forward to moving that legislation in the near future. 

I want to make an editorial comment and a plea to each of your 

Service Organizations, all of whom have been supportive of what 

we have done with Veterans First, to help continue to express that 

support to members of the U.S. Senate and the U.S. House so that 

we can get that legislation passed. 

With the decision of Loretta Lynch, who is the Attorney General 

of the United States, not to enforce the government’s position 

granted to the government under the Veterans Choice Act, we have 

a serious problem of accountability with no remedy whatsoever, either from the Secretary or from the Attorney General’s Office. The 

Veterans First bill which Senator Blumenthal and I worked very 

hard on, along with every Member of the Committee, has a complete, comprehensive accountability piece to it. It may not be everything everybody would have liked to have had, but it is one heck 

of a lot better than what they have got right now, which is absolutely zero. 

So, help from your organizations to support us with the other 

members of Congress would be greatly appreciated. I thank you for 

your input. 

Senator Blumenthal. 

Senator BLUMENTHAL. Thanks, Mr. Chairman. 

84 

I want to thank you, Mr. Ziober, for being here and for your participation earlier today in support of an event spreading awareness 

and raising concern. I am hoping that we will have bipartisan support on this Committee for the USERRA clarification that is in the 

legislation that I have proposed. I want to thank all of the Veterans Service Organizations that are supporting this measure—in 

fact, they all are—and I think it will make a significant difference 

in the lives of our Reservists and National Guard. I thank you and 

your attorney for being here today. 

Mr. ZIOBER. Yes, sir. Thank you. 

Senator BLUMENTHAL. I want to thank the other witnesses. I appreciated your testimony. In the interests of time, since we have 

a classified briefing ongoing right now, I am going to talk to you 

individually about any questions that I might have. You have all 

been very generous with your time when I do have questions, so 

I thank you very much. 

Thanks, Mr. Chairman. 

Chairman ISAKSON. Thank you, Senator Blumenthal, and thanks 

to all of you for your attendance today. 

We will stand adjourned. 

[Whereupon, at 4:20 p.m., the Committee was adjourned.] 

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A P P E N D I X 

PREPARED STATEMENT OF MAX CLELAND, SECRETARY, AMERICAN BATTLE MONUMENTS COMMISSION

Thank you for this opportunity to offer written testimony on behalf of the proposed legislation to authorize the American Battle Monuments Commission to acquire, operate and maintain the Lafayette Escadrille Memorial in Marne-la-Coquette, France, a suburb of Paris. We submitted this legislative proposal with the 

concurrence of the Administration, following review by the Department of Defense, 

the Department of Veterans Affairs, and other interested agencies. 

The Lafayette Squadron was created on 16 April 1916, one year prior to U.S. 

entry into World War I. Forty-two fliers composed the original Escadrille (thirtyeight Americans and four French officers in command). As the number of American 

volunteers grew, Americans flew for several French units known collectively as the 

Lafayette Flying Corps, in which 269 fliers served in total. Out of the 269 total 

American volunteers, 68 died in the air war over France. Some of the best known 

fliers were Kiffin Rockwell, Norman Prince, Raoul Lufbery and Eugene Jacques 

Bullard, the only African-American fighter pilot in World War I. When the United 

States entered the war in 1917, most of the Escadrille pilots joined the U.S. Air 

Service, teaching air combat tactics to those who followed them to France. The Lafayette Escadrille ceased to exist on February 18, 1918 and the U.S. 103d Pursuit 

Squadron took on its symbols and traditions. 

The memorial to these air combat pioneers was constructed in the 1926–28 period 

and inaugurated on July 4, 1928. The Lafayette Escadrille Memorial is a private 

memorial about five miles west of Paris. It honors these 269 American volunteers 

who flew for French and United States units during the Great War. But it is more 

than a memorial; it is a burial ground. A crypt beneath the memorial contains 68 

sarcophagi, one for each of the 68 Americans of the Lafayette Escadrille who died 

in the skies over France; 49 Americans and two French officers rest there in honor 

today. Seventeen sarcophagi have remained empty because either the remains could 

not be found or were transferred. 

ABMC has a history of involvement with the Lafayette Escadrille Memorial, approving the Foundation’s construction plans in 1924, a predicate for any administrative agency of the U.S. Government, such as the State Department, to assist the 

founders. ABMC also managed the maintenance of the memorial for the Foundation 

from 1971 to 1983, using Foundation funds under the authority of our Monument 

Maintenance Program. The Foundation ended this arrangement in 1983 and over 

the years the original trust fund established to maintain the memorial dwindled and 

the memorial fell into a state of disrepair. As a World War I Centennial initiative, 

ABMC and the French Ministry of Defense partnered with the Foundation to complete a $1.7M restoration project, using funds provided by the Foundation, by private donors in the United States, and by the French government. The memorial was 

rededicated on a beautiful spring day in Paris, on the occasion of the Centennial 

Anniversary of the Escadrille’s establishment on April 20, 1916. It again stands as 

a beautiful tribute to service and sacrifice, but the Foundation is no longer able to 

maintain the memorial to a standard commensurate to the American sacrifice it 

honors. 

It is time to bring the memorial and the pioneering airmen buried beneath it 

under the perpetual care of the U.S. Government. There are several compelling reasons to do so. 

1. The vision for the Lafayette Escadrille Memorial was to have the American pilots resting together in a memorial that allowed the spirit of their enlistment to live 

on. This spirit reflects the historical cooperation between the United States and 

France. Just as France came to the aid of the United States during our revolution, 

the United States came to France’s aid in two world wars. The memorial has beVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00089 Fmt 6601 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
86 

come an important part of the U.S. Ambassador’s Memorial Day commemorations 

and in other ceremonies within the American community, such as the high school 

graduation of the American School of Paris. 

2. Since American participation in World War I began unofficially with volunteers 

in units such as the Lafayette Escadrille, the memorial could serve as a point-ofentry for ABMC’s World War I interpretation efforts. Its location near Paris facilitates that purpose. 

3. The U.S. Air Force considers the Lafayette Escadrille to be an important part 

of its tactical origins. The Air Force ties it history to the American men who flew 

with that unit and later joined the U.S. Air Service. The American pilots of the Lafayette Escadrille were combat veterans, whose wartime experiences were extremely 

valuable to the newly-arrived American units and the development of combat tactics 

within the Air Service. The Marine Corps considers Belleau Wood, which is part of 

the Aisne-Marne American Cemetery, to be an important part of its heritage. The 

continued support of the Marine Corps and its active participation at Memorial Day 

ceremonies is a highlight for Aisne-Marne and ABMC. The Lafayette Escadrille Memorial will serve a similar purpose for the Air Force. 

4. Most importantly it’s the right thing to do. The Foundation passed a resolution 

approving transfer to ABMC of full legal title to the memorial site, including the 

land, memorial, crypt and caretaker’s cottage, by gift or in exchange for symbolic 

consideration. We have assurances that the French government is prepared to incorporate the Memorial into the bilateral treaty granting the U.S. perpetual use of 

French lands, at no cost or taxation, for the commemorative cemeteries and memorials that ABMC maintains in France. Representatives of the French Ministries of 

Defense and Interior sit on the LEM Foundation Board and voted to approve the 

Foundation resolution. 

With the concurrence of the Foundation and the Government of France, it is appropriate that ABMC, on behalf of the American people, assume responsibility for 

preserving and protecting in perpetuity this memorial tribute and final resting place 

for pioneering combat Airmen who gave their lives in one of the most pivotal wars 

of the twentieth century. ABMC will incur no costs to acquire or transfer the memorial. The Commission will operate and maintain the memorial within existing appropriations. 

Mr. Chairman, the American Battle Monuments Commission appreciates very 

much the Committee’s support of our sacred mission. We believe it is time for the 

Lafayette Escadrille Memorial to become an important and significant addition to 

that mission, so that, in the words of General John J. Pershing, Commander of the 

World War I American Expeditionary Forces and our first Chairman, ‘‘Time Will 

Not Dim the Glory of Their Deeds.’’ 

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PREPARED STATEMENT OF LEANN WILSON, EXECUTIVE DIRECTOR, ASSOCIATION FOR

CAREER AND TECHNICAL EDUCATION


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LETTER FROM THOMAS S. KAHN, DIRECTOR, LEGISLATIVE AFFAIRS, AMERICAN

FEDERATION OF GOVERNMENT EMPLOYEES, AFL-CIO 

PREPARED STATEMENT OF AMY WEBB, LEGISLATIVE POLICY ADVISOR, AMVETS 

Chairman Isakson, Ranking Member Blumenthal, and distinguished Members of 

the Committee: Since 1944, AMVETS (American Veterans) has been one of the largest congressionally-chartered veterans’ service organizations in the United States 

and includes members from each branch of the military, including the National 

Guard, Reserves, and Merchant Marine. We provide support for the active military 

and all veterans in procuring their earned entitlements, and appreciate the opportunity to present our views on the pending legislation being considered today. 


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S. 244—A BILL TO REQUIRE AN INDEPENDENT COMPREHENSIVE REVIEW OF THE PROCESS

BY WHICH THE DEPARTMENT OF VETERANS AFFAIRS ASSESSES COGNITIVE IMPAIRMENTS THAT RESULT FROM TRAUMATIC BRAIN INJURY FOR PURPOSES OF AWARDING

DISABILITY COMPENSATION, AND FOR OTHER PURPOSES. 

This measure would require an agreement between the VA Secretary and the Institute of Medicine (IOM) for the performance of an independent comprehensive review of Department of Veterans Affairs (VA) examinations that assess cognitive impairments of those who submit VA disability compensation claims for Traumatic 

Brain Injury (TBI). 

The goals of the comprehensive review would be to determine the adequacy of the 

tools and protocols used by VA in providing cognitive examinations, and to study 

the credentials necessary for health care providers to perform assessments of cognitive function. The IOM would convene a group of experts in clinical 

neuropsychology and other related disciplines to carry out the wide-ranging review. 

Within 540 days of the agreement, the Secretary would submit a report to Congress outlining the IOM findings and recommendations for legislative or administrative action required to improve the adjudication of TBI claims. 

If an acceptable agreement between the Secretary and the IOM were unable to 

be reached, the Secretary would make an agreement with another organization that 

is not part of the Government, operates as a not-for-profit entity, and has expertise 

and objectivity comparable to that of the Institute of Medicine. In this case, any reference in the bill to the IOM would be treated as a reference to the other organization. 

It seems prescient that Senator Tester introduced this bill almost a year and a 

half prior to the recent VA news that Secretary McDonald has granted equitable relief to more than 24,000 veterans who received VA medical exams processed between 2007 and 2015 related to disability compensation claims for TBI. This group 

of veterans whose first TBI examination was not performed by one of four medical 

specialists qualified to diagnose the condition, now has the option to receive a new 

exam. 

The Secretary noted in the VA News Release that, ‘‘We let these veterans down,’’ 

and that VA was taking every step to ensure this group of veterans receives the 

full benefits they are entitled to. AMVETS is encouraged that VA publicly admitted 

the inconsistencies and mistakes made from 2007 to 2015, and that it believes the 

current TBI policy is clear and being followed. 

AMVETS supports this measure pursuant to our National Resolution on Traumatic Brain Injuries, and supports the additional oversight from an independent entity such as the IOM to ensure that there are vetted protocols in place with the correct type of physician for this type of diagnosis, which can be nuanced. 

S. 603—RURAL VETERANS TRAVEL ENHANCEMENT ACT OF 2015

Section 2 of this Act would make permanent the authority of the Department of 

Veterans Affairs (VA) to transport individuals to and from VA facilities in connection with rehabilitation, counseling, examination, treatment, and care. 

Section 3 would include Vet Centers as VA facilities for the purpose of providing 

payment of actual expenses of travel, or allowance for travel, to or from a VA facility. A Vet Center is defined as a center for readjustment counseling and related 

mental health services, and the travel reimbursement allowed for under this new 

subsection would begin on or after the date of enactment. 

Section 4 would amend Section 307(d) of Public Law 111–163 to reauthorize 

grants for veterans’ service organizations to provide transportation of highly rural 

veterans to and from VA facilities for appointments through 2020. 

AMVETS supports this Act based on our National Resolution for Services for 

Rural & Remote Veteran Populations which urges an increase of the travel reimbursement allowance to the actual cost of expenses. We are particularly pleased 

with the inclusion of Vet Centers as VA facilities, and support making the authority 

permanent for VA to provide transportation to and from medical facilities as well 

as reauthorizing the grants for VSOs to continue providing rides to veterans in 

highly rural areas. This transportation assistance can literally save lives, and 

AMVETS supports that this Act increases veterans’ access to physical and mental 

health care. 

S. 2210—VETERAN PARTNERS’ EFFORTS TO ENHANCE REINTEGRATION (PEER) ACT

The PEER Act would establish a peer specialist program in patient aligned care 

teams (PACTs) at medical centers of the Department of Veterans Affairs (VA) to 

promote the use and integration of mental health services in a primary care setting. 

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This would occur in at least ten VA medical centers within 180 days after date of 

enactment. Within two years of enactment peer specialists in PACTs would be 

present in at least twenty-five VA medical centers. 

The selection of medical centers would represent a balance of geographic locations; 

at least five medical centers that specialize in polytrauma and at least ten that do 

not; those in rural and underserved areas; and those not in close proximity to an 

active duty military installation. 

Each location selected would ensure that the needs of women veterans were specifically considered and addressed, and female peer specialists would be included in 

the program. 

Within 180 days of enactment, and at least once every following 180 days until 

the program was fully implemented, the Secretary would submit a report to Congress detailing findings, conclusions, and an assessment of the benefits to veterans 

and their family members. Within 180 days of the last location being selected, the 

Secretary would submit an additional report to Congress containing recommendations on the feasibility and advisability of expanding the program to additional 

locations. 

Peer specialists are noted for being engaged in their own recovery, and who provide peer support services to others engaged in mental health treatment. AMVETS 

supports the integration of mental health services into primary care, and also the 

patient-centric approach of the PACT model of care. Peer Specialist delivered interventions have been shown to improve patient activation in multiple studies. It is 

also important that women veterans receive access to care that specifically addresses their needs. 

AMVETS has a National Resolution on Mental Health Care Services and supports 

the PEER Act, but notes that in August 2014, the White House issued an Executive 

Action mandating that twenty-five VA medical centers place Peer Specialists on Primary Care Teams. An update from VA’s Office of Research and Development, in collaboration with the National Center for Health Promotion and Disease Prevention, 

shows that the, ‘‘Evaluation of Peer Specialists on VA PACTs (Peers on PACT)’’ officially began in January 2016, final data is projected to be collected in January 2018, 

and in September 2019 the study and findings are expected to be complete. 

S. 2279—VETERANS HEALTH CARE STAFFING IMPROVEMENT ACT

Section 2 of this Act would require the Secretaries of Defense and Veterans Affairs to develop a ‘‘Docs-to-Doctors Program’’ aimed at recruiting those separating 

honorably from the Armed Forces and Reserves who have served in a health care 

capacity. Individuals in veteran status would be included if separation occurred during the period outlined. 

At least once a year the Secretary of Defense would submit a recruitment list to 

the Secretary of Veterans Affairs which would include, as available, contact information; military rank at separation; and a description of health care experience including any relevant credential, certificate, certification, or license. 

The Secretaries would work to resolve barriers related to credentialing or to specific hiring rules, procedures, and processes of the Department of Veterans Affairs 

(VA) that would potentially delay or prevent a qualified person’s hiring, including 

reconciling different credentialing processes and standards between the VA and the 

Department of Defense. 

If the VA Secretary determined that a barrier was unable to be resolved, within 

90 days a report would be submitted to Congress detailing recommendations for legislative and administrative action suitable to resolve the issue. 

Section 3 of this Act would implement a uniform credentialing process for each 

position held by Veterans Health Administration employees within one year of 

enactment. 

If a VA employee was credentialed under this section for purposes of practicing 

in a VA location, the credential would be sufficient for any VA location. VA would 

provide for renewal of credentials, which would not be required solely because an 

employee moved from one VA facility to another. 

Section 4 of this Act would provide full practice authority to advanced practice 

registered nurses (APRNs), physician assistants (PAs), and other licensed VA health 

care professionals as considered appropriate consistent with their education, training, and certification. Full practice authority would be provided without state limitations that would otherwise be imposed. 

All three sections of this Act support VA recruitment and retention. In the past, 

AMVETS has stated that VA must improve its recruitment, hiring and retention 

policies to ensure the timely delivery of high quality healthcare to our veterans. We 

appreciate the intent of this Act which works toward this goal. 

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1https://marshallislands.llnl.gov/ 

AMVETS has a National Resolution supporting Civilian Credentials for Military 

Training & Experience, and believes as a nation we need to be prepared to do our 

part to assist transitioning servicemembers obtain living-wage employment opportunities based on the experience and skills they developed in the military. We note 

that Section 2 pertains just to the medical field, and while AMVETS would hope 

that a broader measure would include all types of military occupation specialties for 

work inside and outside the VA, we do not oppose this program since the end result 

would be excellent providers of medical care inside VA, and quality treatment of veterans who receive VA medical care. 

AMVETS supports providing full practice authority to advanced practice registered nurses (APRNs), physician assistants (PAs), and other licensed VA health 

care professionals to allow them to provide care to the full extent of their training. 

VA has an access to care issue. This is a zero cost solution that would provide veterans with the access, continuity and quality of care, and reduce wait times for veterans needing care. 

A 2014 Federal Trade Commission report concluded ‘‘that empirical research and 

on-the-ground experience demonstrate that APRNs provide safe and effective care 

within the scope of their training, and licensure.’’ APRNs are not doctors, nor do 

they want to be doctors, but they are highly trained with more than 97 percent having graduate degrees and 99 percent having attained national certifications in specialty areas of healthcare. They want to take care of patients and they should be 

allowed to practice to their full scope to the advantage of veterans receiving care. 

S. 2316—A BILL TO EXPAND THE REQUIREMENTS FOR REISSUANCE OF VETERANS BENE- FITS IN CASES OF MISUSE OF BENEFITS BY CERTAIN FIDUCIARIES TO INCLUDE MISUSE

BY ALL FIDUCIARIES, TO IMPROVE OVERSIGHT OF FIDUCIARIES, AND FOR OTHER PUR- POSES. 

S. 2316 authorizes the Department of Veterans Affairs (VA) to reissue veterans’ 

benefits to a beneficiary in all cases of fiduciary misuse. The VA would pay the beneficiary or the successor fiduciary an amount equal to the misused benefits. VA access to fiduciary-held financial accounts would be increased and require VA access 

in order to obtain any financial records related to the fiduciary or the beneficiary 

whenever the VA determined that the financial records would be beneficial to view 

for the administration of a VA program, or to safeguard the beneficiary’s benefits 

against neglect, misappropriation, embezzlement, or fraud. 

AMVETS does not have a National Resolution on this bill, and has taken no formal position at this time. 

S. 2791—ATOMIC VETERANS HEALTHCARE PARITY ACT

This act would provide for the treatment of veterans who participated in the 

cleanup of Enewetak Atoll between January 1, 1977 and December 31, 1980 as radiation exposed veterans for purposes of the presumption of Department of Veterans 

Affairs (VA) service-connection for certain disabilities. 

It has been historically documented that from 1946 through the Cold War, the 

U.S. military tested nuclear weapons in the Marshall Islands, including detonations 

over 1,000 times stronger than the atomic bombs dropped on Hiroshima and Nagasaki. Radioactive and other fallout remained and natives sued the Federal Government in 1962 for compensation for losing their homeland, or for its return. In 1977 

the U.S. military began the clean-up in preparation to return the land to Marshall 

Island natives. 

Approximately 4,000 American servicemen assisted in what became known as the 

Enewetak Radiological Support Project between 1977 and 1980, working to scrape 

73,000 cubic meters of surface soil off six different islands on the atoll. They deposited the radioactive soil into the Cactus Crater on Runit Island, part of the atoll, 

and then capped the crater with a thick layer of concrete.1

AMVETS has two National Resolutions addressing toxic wounds, and advocating 

for those who suffer chronic conditions as a result of exposure to various contaminants while serving their country remains a top priority. The definition of a Toxic 

Wound is any adverse health condition, chronic or terminal, suffered by military 

personnel resulting from, or associated with, exposure to toxic substances or environmental hazards during their military service, the effects of which may not 

emerge until months or years after initial exposure. 

The veterans who served as part of the Enewetak Radiological Support Project are 

small in number, and evidence of their exposure to contamination is large. AMVETS 

supports swift passage of this Act. 

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S. 2958—A BILL TO ESTABLISH A PILOT PROGRAM ON PARTNERSHIP AGREEMENTS TO

CONSTRUCT NEW FACILITIES FOR THE DEPARTMENT OF VETERANS AFFAIRS. 

This bill would authorize partnership agreements between Secretary of Veterans 

Affairs and up to five entities defined as a state or local authority, a 501c3 nonprofit 

organization, a limited liability corporation, a private entity, a donor or donor group, 

or any other non-Federal Government entity. 

The purpose would be to conduct at least one super construction project; major 

medical facility projects; or major construction projects of new cemeteries or to develop additional gravesites or columbarium niches at existing cemeteries. Projects 

selected would already be partially funded by Congress or those that the Department of Veterans Affairs (VA) identified on the Major Construction Strategic Capital 

Investment Planning priority list. Approved partners would be required to enter into 

a formal agreement with the Secretary to independently finance or donate project 

funds leaving no additional cost to the Federal Government. 

The program would fall under Federal laws relating to environmental and historic 

preservation, and the Davis—Bacon Act of 1931 which established the requirement 

for paying the local prevailing wages on public works projects for laborers and mechanics. 

One of the five partnership agreements authorized is to design, finance, and construct a new ambulatory care center in Omaha, Nebraska. 

The Secretary may contribute up to $56,000,000 for the projects and the contribution or liability of the Secretary would not exceed this except to the extent that additional funds are appropriated. 

Each partnership agreement would provide that the entity: 

• Practice due diligence and conduct any necessary environmental or historic 

preservation; comply with local zoning requirements except for studies and consultations required of VA under Federal law; and obtain any permits required before beginning construction. 

• Use VA construction standards when designing and building the project, except 

to the extent the Secretary determines otherwise. 

• Establish a Board of Directors to oversee the conduct of the project which would 

be comprised of five to ten members. At least one member would be a veteran who 

is not a VA employee, at least one would be a VA employee and function as a nonvoting member of the Board; a Chair would be designated to oversee the activities 

of the Board. All current or proposed members of the Board would promptly disclose 

any actual or potential conflicts to the Secretary and would agree to remove themselves from Board membership if the Chair and Secretary agreed that it was appropriate due to an actual or potential conflict. 

• Within 180 days of inception of the Board, or another timeframe the Secretary 

approves, a written charter to describe the roles, responsibilities, policies, and procedures of operation of the Board would be created to ensure successful project management, design, construction, and completion of the designated project. 

• In addition, the Board would be responsible for overseeing the activities needed 

to finance, design, and construct the designated project for the Department, and 

would submit written updates regarding the status of the designated project to the 

Secretary in a manner the Secretary specifies. 

• The Board would defer to the Secretary on all matters inherent to the mission 

and operations of VA, including conditional or final acceptance of the designated 

project. 

• The Board would not dissolve until after the Secretary provided final acceptance 

of completion of the designated project to the Board, plus such additional time or 

contingencies as the Board and the Secretary may jointly approve. 

To be eligible to participate in the program, entities would submit a detailed and 

thorough application to the Secretary to address needs relating to VA facilities identified in VA’s Construction and Long-Range Capital Plan. 

The Secretary would include in the budget submitted to Congress by the President information regarding any projects conducted under this section during the 

year preceding the submittal of the budget. Each report would provide a detailed 

status of projects, including the percentage of completion of the project. 

The Comptroller General of the United States would submit a biennial report on 

the partnership agreements to Congress. 

There are many aspects to this complex bill, and AMVETS does not have a formal 

position at this time. 

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S. 3021—A BILL TO AUTHORIZE THE USE OF POST-9/11 EDUCATIONAL ASSISTANCE TO

PURSUE INDEPENDENT STUDY PROGRAMS AT CERTAIN EDUCATIONAL INSTITUTIONS

THAT ARE NOT INSTITUTIONS OF HIGHER LEARNING. 

This bill would authorize the use of Post-9/11 Educational Assistance to pursue 

independent study programs at certain educational institutions that are not institutions of higher learning. The independent study program would provide a certificate 

that reflects completion of a course of study, such as an area career or technical education school or vocational institution providing education at the postsecondary 

level. 

AMVETS does not have a National Resolution on this measure, but favors its passage. It is important that a veteran be able to utilize their earned educational assistance to learn a trade or to develop skills required for a career that are from facilities other than institutes of higher learning. 

S. 3023—THE ARLA HARRELL ACT

The Arla Harrell Act would require the Secretaries of Defense and Veterans Affairs to reconsider all compensation claims related to exposure to mustard gas or 

lewisite during active military, naval, or air service during World War II, and make 

a new determination on claims denied before the date of enactment. 

In carrying this out, the Secretaries would determine if a veteran experienced fullbody exposure to mustard gas or lewisite with a presumption that they did, unless 

it could be proven otherwise. The Secretaries would not use information contained 

in the Department of Defense (DOD) and Department of Veterans Affairs (VA) 

Chemical Biological Warfare Data base or any other VA or DOD list of known mustard gas or lewisite testing sites as the sole reason for determining whether this exposure occurred. 

Within 90 days of enactment, and at least once every 90 days thereafter, the VA 

Secretary would submit a report to Congress specifying any reconsidered claims that 

were denied during the preceding 90-days, including the rationale for each denial. 

Within one year of enactment, the Secretaries would jointly establish a policy for 

processing future compensation claims that VA determines are in connection with 

exposure to mustard gas or lewisite during active military, naval, or air service during World War II. 

Within than 180 days of enactment, the Secretary of Defense would, for purposes 

of determining whether a site should be added to the list of DOD sites where mustard gas or lewisite testing occurred, investigate and assess sites where the Army 

Corps of Engineers uncovered evidence of mustard gas or lewisite testing or where 

more than two veterans submitted claims for compensation where claims were 

denied. 

A report to Congress would be required covering experiments conducted by the 

DOD during World War II to assess the effects of mustard gas and lewisite on people and would include a list of each location where experiments occurred, including 

locations investigated and assessed related to review of claims; the dates of each experiment; and the number of members of the Armed Forces who were exposed to 

mustard gas or lewisite in each experiment. 

Within 80 days of enactment, the Secretary of Veterans Affairs would investigate 

and assess the outreach to individuals who had been exposed to mustard gas or lewisite in experiments; the claims for disability compensation that were filed, and the 

percentage of such claims that were denied. A report to Congress would be required 

related to findings of the investigations and assessments carried out under this bill, 

and a comprehensive list of each location where an experiment was conducted. 

According to Senator McCaskill, who AMVETS thanks for introducing this legislation, the military has acknowledged for decades that secret mustard gas tests were 

performed on troops at the end of World War II. A recent U.S. Senate investigation 

found that 90 percent of related disability compensation claims have been rejected 

by the Department of Veterans Affairs. This is an astounding statistic. 

AMVETS has two National Resolutions addressing toxic wounds, and advocating 

for those who suffer chronic conditions as a result of exposure to various contaminants while serving their country remains a top priority. The definition of a Toxic 

Wound is any adverse health condition, chronic or terminal, suffered by military 

personnel resulting from, or associated with, exposure to toxic substances or environmental hazards during their military service, the effects of which may not 

emerge until months or years after initial exposure. 

AMVETS supports swift passage of the Arla Harrell Act. 

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S. 3032—VETERANS’ COMPENSATION COST-OF-LIVING ADJUSTMENT (COLA) ACT OF 2016

The COLA Act would provide for an increase in the rates of compensation for veterans with service-connected disabilities and the rates of dependency and indemnity 

compensation for the survivors of certain disabled veterans effective December 1, 

2016. 

The dollar amounts to be increased would be wartime disability compensation, additional compensation for dependents, clothing allowance, dependency and indemnity compensation to surviving spouse, and to children. 

Each dollar amount would be increased by the same percentage as the Social Security Act, effective December 1, 2016. 

The Secretary of Veterans Affairs would publish the amounts specified as increased in the Federal Register no later than the date on which those pertaining 

to the Social Security Act are required to be published. 

AMVETS supports this COLA Act, and encourages its swift passage. 

S. 3035—MAXIMIZING EFFICIENCY AND IMPROVING ACCESS TO PROVIDERS AT THE

DEPARTMENT OF VETERANS AFFAIRS ACT OF 2016

This act would establish an eighteen-month pilot program increasing the use of 

medical scribes to maximize the efficiency of physicians in at least five medical facilities of the Department of Veterans Affairs (VA). A medical scribe is a member 

of the medical team trained exclusively to perform documentation in an electronic 

health record to maximize productivity of a physician. 

The facilities chosen would have a high volume of patients, or be rurally located 

in areas determined to have a shortage of physicians which high caseloads. 

In carrying out the pilot program, the Secretary would enter into a contract with 

one or more appropriate nongovernmental entities that train and employ professional medical scribes. 

Data would be collected to determine the effectiveness of the pilot program in increasing the efficiency of physicians at VA medical facilities and would measure the 

following, both before and after implementation of the program: 

• The average wait-time for a veteran to receive care from a physician. 

• The average number of patients that such a physician is able to see on a daily 

basis. 

• The average amount of time such a physician spends on documentation on a 

daily basis. 

• The satisfaction and retention scores of each such physician. 

• The patient satisfaction scores for each such physician. 

• The patient satisfaction scores for their health care experience. 

Within 180 days after the start of the pilot program, and at least once every 180 

days thereafter, the Secretary would submit a report to Congress including the 

number of VA medical facilities participating in the pilot, and an assessment of the 

effects that participation has had on maximizing the efficiency of physicians; reducing average appointment wait times; improving access of patients to electronic medical records; mitigating physician shortages by increasing the productivity of physicians as well as all of the data collected as part of the program. The report would 

also include recommendations with respect to the extension or expansion of the 

pilot. 

AMVETS does not have a National Resolution on this measure, but does not oppose its passage as it relates to increasing a physician’s patient load with the goal 

of providing veterans more ready access to care. 

S. 3042—JUSTICE FOR SERVICEMEMBERS ACT OF 2016

As part of the Military Coalition (TMC), which is a consortium of uniformed services and veterans’ associations representing more than 5.5 million current and 

former servicemembers, their families and survivors, AMVETS recently signed a 

strong support letter for this bill. 

It was noted that this concise, straightforward bill ensures that our servicemembers and veterans can enforce the rights afforded to them under the Uniformed 

Services Employment and Reemployment Rights Act (USERRA). 

Some servicemembers have been unable to exercise their USERRA rights due to 

increased use of forced arbitration clauses. Usually presented on a take-it-or-leaveit basis, these clauses preclude access to the judicial system and instead funnel servicemembers’ employment discrimination or wrongful termination USERRA claims 

into private, costly arbitration systems set up by the employers. The ‘‘Justice for 

Servicemembers Act’’ gives servicemembers the ability to pursue their USERRA 

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claims in court while preserving the option to enter into an arbitration agreement 

after a dispute arises. 

AMVETS supports passage of this important legislation. 

S. 3055—DEPARTMENT OF VETERANS AFFAIRS DENTAL INSURANCE

REAUTHORIZATION ACT OF 2016

This act would provide dental insurance to veterans and survivors and dependents of veterans who could enroll on a voluntary basis. This beneficiary group is defined as any veteran who is enrolled in the Department of Veterans Affairs (VA) 

system or any survivor or dependent of a veteran who is eligible for medical care 

under section 1781 of this title which is: 

• the spouse or child of a veteran who has a total disability, permanent in nature, 

resulting from a service-connected disability, 

• the surviving spouse or child of a veteran who (A) died as a result of a serviceconnected disability, or (B) at the time of death had a total disability permanent 

in nature, resulting from a service-connected disability, 

• the surviving spouse or child of a person who died in the active military, naval, 

or air service in the line of duty and not due to such person’s own misconduct, and 

• an individual designated as a primary provider of personal care services under 

the caregiver program who is not entitled to care or services under a health-plan 

contract who are not otherwise eligible for medical care under chapter 55 of title 

10 (CHAMPUS). 

VA would establish a contract with a dental insurer to administer the plan, and 

provide benefits for dental care and treatment as considered appropriate, diagnostic 

services, preventative services, endodontics and other restorative services, surgical 

services, and emergency services. 

Premiums for the dental insurance would adjust annually, and each person covered at the time of adjustment would be notified of the new amount and effective 

date. The entire premium would be paid by the individuals covered, in addition to 

the full cost of any copayments. 

Voluntary disenrollment would be allowed if it occurred within 30-days of enrollment, or in circumstances where disenrollment did not jeopardize the fiscal integrity 

of the dental insurance plan. Such circumstances include if an enrollee relocates 

outside the jurisdiction of the dental insurance plan which prevents use of the benefits, or if they have a serious medical condition preventing them from obtaining benefits. The Secretary would also establish procedures for determining permission for 

voluntary disenrollment in order to ensure timely decisions. 

This program would terminate on December 31, 2021. 

AMVETS does not have a National Resolution on this bill, and has taken no formal position at this time. 

S. 3076—CHARLES DUNCAN BURIED WITH HONOR ACT OF 2016

The Charles Duncan Buried with Honor Act would authorize the Secretary of Veterans Affairs to furnish caskets and urns for burial in cemeteries of states and Indian tribes of veterans without sufficient resources to provide for caskets or urns. 

It is noted that in 2013 Congress enacted the ‘‘Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012’’ which authorizes the U.S. Department of 

Veterans Affairs (VA) to furnish a casket or urn of such quality as the Secretary 

considers appropriate for a dignified burial in a national cemetery of a deceased eligible veteran who died with no known next of kin and without sufficient financial 

resources to furnish a casket or urn. While AMVETS does not have a National Resolution on this issue, we support this Act and believe that those who serve this country should be provided the dignity of having a proper burial if they or their survivors do not have the means to provide for a casket or urn. 

S. 3081—WORKING TO INTEGRATE NETWORKS GUARANTEEING MEMBER ACCESS NOW

(WINGMAN) ACT

WINGMAN seeks to streamline the benefit claims procedure between the Department of Veterans Affairs (VA) and Congressional constituent advocates who process 

claims on behalf of veterans and their families. 

Under WINGMAN, an accredited, permanent Congressional employee would have 

access to electronic Veterans Benefits Administration (VBA) records in a read-only 

fashion in order to review the status of a pending claim, medical records, compensation and pension records, rating decisions, statement of the case, supplementary 

statement of the case, notice of disagreement, and Form–9 files. This eliminates the 

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time-consuming step of using the VA as a middle-man to receive files the Congressional employee already has permission to possess. 

AMVETS supports this bill, which is in line with our National Resolution addressing the claims and appeals backlog which calls for improving the timeliness of all 

disability claims and appeals, and agrees that it is unacceptable for weeks or 

months pass before advocates are able to receive files they requested to help 

veterans. 

DISCUSSION DRAFT TO EXPAND ELIGIBILITY FOR READJUSTMENT COUNSELING TO

CERTAIN MEMBERS OF THE SELECTED RESERVE OF THE ARMED FORCES. 

This bill would allow any member of the Selected Reserve of the Armed Forces 

who has a behavioral health condition or psychological trauma to receive counseling 

provided by the Department of Veterans Affairs (VA) which may include a comprehensive individual assessment. No patient referral would be required and this 

would take effect one year after date of the enactment Act. 

The Selected Reserve includes the Army, Navy, Air Force, Marine Corps and 

Coast Guard Reserves, and the Army and Air National Guard. These groups have 

served in unprecedented numbers since 2001, and of the nearly 2 million Iraq and 

Afghanistan veterans who have become eligible for VA Health Care in that time, 

nearly 40 percent served in the Reserves or National Guard. This group of veterans 

present with a wide range of health conditions, and mental disorders are among the 

top three. 

We must do all that we can to provide access for readjustment services and counseling for those who serve in the Armed Forces of the United States, to include 

those in the Selected Reserve. AMVETS has a National Resolution on Mental 

Health Services and supports this draft measure. 

DISCUSSION DRAFT TO AUTHORIZE THE AMERICAN BATTLE MONUMENTS COMMISSION TO

ACQUIRE, OPERATE, AND MAINTAIN THE LAFAYETTE ESCADRILLE MEMORIAL IN

MARNES-LA-COQUETTE, FRANCE. 

This bill would authorize the American Battle Monuments Commission to acquire, 

operate, and maintain the Lafayette Escadrille Memorial in Marne-la-Coquette, 

France. 

The Commission would carry out its duties pursuant to an agreement with the 

Lafayette Escadrille Memorial Foundation and would be subject to the consent of 

the Government of France. Additionally, the Commission could only employ the personnel needed to carry out this Act. 

AMVETS has no National Resolution on this issue, but supports passage of this 

bill and believes that this memorial should be properly maintained in honor of the 

U.S. troops who served in WWI and the forty-nine American heroes who are entombed at this location. 

Mr. Chairman and Members of the Committee, this concludes my testimony and 

would be happy to answer any questions the Committee may have. 

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PREPARED STATEMENT OF AMERICAN PUBLIC HEALTH ASSOCIATION


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PREPARED STATEMENT OF JOY J. ILEM, NATIONAL LEGISLATIVE DIRECTOR, 

DISABLED AMERICAN VETERANS

Thank you for inviting DAV (Disabled American Veterans) to submit testimony 

for the record of this legislative hearing, and to present our views on the bills under 

consideration. As you know, DAV is a non-profit veterans service organization comprised of 1.3 million wartime service-disabled veterans that is dedicated to a single 

purpose: empowering veterans to lead high-quality lives with respect and dignity. 

S. 244, TO REQUIRE AN INDEPENDENT COMPREHENSIVE REVIEW OF THE PROCESS BY

WHICH THE DEPARTMENT OF VETERANS AFFAIRS ASSESSES COGNITIVE IMPAIRMENTS

THAT RESULT FROM TRAUMATIC BRAIN INJURY FOR PURPOSES OF AWARDING DISABILITY COMPENSATION

This measure would require VA to enter into an agreement with the Institute of 

Medicine (IOM) to conduct an independent review of the process by which the Department of Veterans Affairs (VA) assesses cognitive impairments that result from 

a Traumatic Brain Injury (TBI) for purposes of awarding disability compensation. 

The independent review committee would include a group of experts in clinical 

neuropsychology and other related disciplines and would be charged with determining the adequacy of the tools and protocols used by VA for examinations relating 

to assessment of cognitive functions and the required credentials of the clinicians 

who perform such examinations. Finally, the bill would allow VA to contract with 

an alternate organization to perform the above mentioned review. 

According to VA, following revision of its Schedule for Rating Disabilities addressing neurological conditions and convulsive disorders and the related examination 

protocol for residuals of TBI, guidance on using certain clinicians for compensation 

examinations on the residuals of TBI was sent to field operations of the Veterans 

Health Administration (VHA) and Veterans Benefits Administration (VBA). 

VA conducted a review of VHA and contractor examinations for 24,588 veterans 

from 2007 through 2015, which revealed psychiatrists, physiatrists, neurologists, or 

neurosurgeons were not accustomed to performing initial TBI examinations. Consequently, VA granted equitable relief on May 3, 2016, to affected veterans who are 

invited to exercise this remedy to include the ordering of a new initial TBI examination with one of the four designated specialists, submission of additional supporting 

evidence, leading to readjudication of the previous claim for residuals of TBI using 

the new examination and evidence. 

DAV has no resolution on this specific issue. Notably however, we commend VA 

for revising its Schedule for Rating Disabilities in order to provide more detailed 

and updated criteria for evaluating residuals of TBI. The previous version did not 

recognize TBI as a signature injury of the conflict in Iraq and Afghanistan, and did 

not properly address the needs of a statistically larger number of veterans returning 

from these conflicts with residuals of TBI. In addition, the effects of injuries stemming from blasts resulting from roadside explosions of improvised explosive devices, 

which have been common sources of injury in these conflicts, appeared to be different from the effects of brain trauma observed from other explosive sources. 

VA’s new rating schedule for residuals of TBI and corresponding examination criteria focuses on three main areas of dysfunction that may result from TBI with serious effects: cognitive dysfunction; emotional/behavioral dysfunction, and physical 

dysfunction. However, this measure would require the independent review be limited to VA’s process in assessing only cognitive impairments. This measure, if acted 

on favorably, should include in its requirements the processes of assessing physical 

and emotional/behavioral dysfunction, and that the convening groups of subject matter experts established in the bill should include individuals in the appropriately related disciplines. 

S. 603, RURAL VETERANS TRAVEL ENHANCEMENT ACT OF 2015

Section 2 of this bill would make permanent the authority set to expire December 31, 2016, for VA to operate the Veterans Transportation Service (VTS) program. 

DAV opposes this measure and asks for the opportunity to work with the sponsors 

of this legislation and the Committee to find a resolution. 

As the Committee may be aware, our organization began our free transportation 

program in 1987. Since then, the DAV National Transportation Network continues 

to show tremendous growth as an indispensable resource for veterans. Across the 

Nation, 190 DAV Hospital Service Coordinators operate nearly 197 active programs, 

in which our volunteer drivers have logged over 24.7 million miles last year, providing over 700,000 rides for veterans to and from VA healthcare facilities. To date, 

DAV has purchased and donated 2,967 vehicles to the VA, at a cost of $65.1 million. 

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The Ford Motor Company has also donated 207 vehicles at a cost of over 4.7 million 

dollars. Thus far our vans have carried veterans more than 642 million miles to and 

from their medical appointments. 

The VTS provides an invaluable service in meeting the transportation needs of 

a special subset of the VA patient population that the DAV Transportation Network 

is not equipped to serve—veterans in need of special modes of transportation and 

accommodation due to severe disabilities. We believe that with a truly collaborative 

relationship, the DAV Transportation Network and VTS will be able to meet the 

growing transportation needs of ill and injured veterans in a cost-effective manner. 

DAV Resolution No. 113 urges the VA to operate an effective and efficient transportation program for all service-connected veterans and to simplify access to transportation benefits and services so they may receive timely and high-quality VA 

health care, benefits and services. Accordingly, we have been working with the VHA 

Chief Business Office, as well as VA medical facilities across the country to resolve 

weaknesses that we have observed in the VTS program, which operates on resources 

that would otherwise go to direct medical care and services for veterans. 

As one of the strongest advocates of sufficient and predictable funding for VA, we 

believe these precious resources should be used judiciously for ancillary programs 

to ensure veterans are not denied care when they most need it. Ensuring VTS works 

in concert with other existing and emerging transportation resources will help maximize the ability of veterans to access VA care while guarding against fraud, waste 

and abuse of these limited resources. 

Section 3 of this bill would require VA to treat Vet Centers as department facilities in connection with payments for beneficiary travel. DAV has a special connection to the VA Vet Center program and the counseling services it provides. In 1976, 

the DAV funded the groundbreaking Forgotten Warrior Project, which first defined 

the issue of Post Traumatic Stress Disorder (PTSD) among Vietnam War veterans. 

Vietnam veterans were experiencing serious post-war problems at that time, and 

DAV hoped our new study would make it impossible for Congress, the VA, and the 

American public to continue to ignore the lingering dilemma that prevented many 

of these veterans from gaining normal lives after serving in a very unpopular and 

difficult war. 

DAV initiated our own Vietnam Veterans Outreach Program in 1978. This DAVsponsored study and the DAV’s clinical outreach work spurred new, broad realization and additional research by others that forced the Federal Government to confront the psychological impact of war on veterans of Vietnam, and subsequently of 

all wars. When that movement finally occurred, the DAV Vietnam Veterans Outreach Program was already there to serve as an effective counseling model to be 

adopted by the VA’s Vet Center program as we know it today. 

Since the Readjustment Counseling Service program was established by Congress 

in 1979, eligibility for Vet Center readjustment counseling services has expanded 

from Vietnam-era veterans to include all combat veterans, to veterans who experienced military sexual trauma, to certain family members, and to survivors of veterans who die in combat or on active duty. Vet Centers also offer other vital services, including counseling for Post Traumatic Stress Disorder (PTSD) and other readjustment challenges; marriage and family counseling; and family bereavement 

counseling. 

DAV supports this section based on Resolution No. 117, which calls on Congress 

to enact legislation to change beneficiary travel policies to meet the specialized clinical needs of veterans receiving MST-related treatment. 

Mr. Chairman, one key policy of Vet Centers is to ensure veterans seeking help 

are not required to wait to receive it. Vet Centers are known for minimal barriers 

with almost no bureaucracy and provide a non-medical setting in a safe environment with confidentiality and an emphasis on informed consent. Because of this 

type of delivery model, VA’s current policy—to pay travel expenses for one-way travel to veterans who receive VA care for unscheduled appointments—needs to be adjusted to meet the full intent of this measure if enacted. 

Section 4 would extend the existing VA grant program to provide innovative 

transportation options to veterans in highly rural areas. DAV supports this section 

based on Resolution no. 226 calling for innovative improvements in providing health 

care to veterans living in rural and remote areas of the United States. We also urge 

the Committee to make appropriations to provide enhanced VA health care access 

to rural veterans. 

Finally, we recommend changing the language to be stricken from ‘‘through 2014’’ 

to ‘‘through 2016’’ to reflect current law as amended by Public Law 114–58, Title 

I, Section 106. 

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S. 2210, VETERAN PEER ACT

Enactment of the Veteran PEER Act would require VA to establish a program 

that includes peer specialists within patient aligned care teams (PACT) in medical 

centers of the VA to promote better integration of mental health services into the 

primary care setting. VA must carry out this program in at least 10 VA medical 

centers within the first 180 days of the Act passing and in no less than 25 locations 

after two years of the enactment of the bill, including within five polytrauma center 

locations. 

The bill also would require VA to consider the feasibility of locating peer specialists in rural areas and other locations that are underserved by the Department. VA 

would be required to ensure that the unique needs of women veterans are considered and that female peer specialists are included in the program. The measure includes requirements for routine reporting to include findings and conclusions with 

respect to the program and recommendations related to the feasibility of expansion 

of the program. 

When a veteran is experiencing a mental health crisis and asking for help, there 

must be ready access to a mental health specialist and services must be provided. 

However, even when in crisis, many veterans are reluctant to reach out for help and 

are reluctant to seek the mental health services they need. Since 2012, VA has hired 

over 900 Peer Specialists, and we have heard from mental health providers that 

peer-to-peer interactions have been extremely helpful to both patients and treating 

clinicians. Making that first contact with another veteran who has had a similar experience seems to lessen the stigma and has been a successful method for coaching 

veterans into care. 

We are pleased the bill also includes provisions that would require VA to address 

the needs of women veterans. Findings show that when women return from deployment, the camaraderie and support from their male peers is often short-lived, resulting in isolation for many. Studies have shown that peer support is important 

to a successful transition, but women report they often cannot find a network of 

women who can relate to their military or wartime service. Including the requirement that VA focus on hiring female peer specialists helps ensure the unique needs 

of women veterans will be addressed and that women veterans can benefit from access to peer-to-peer interactions. 

DAV is pleased to support S. 2210, which is consistent with the following DAV 

resolutions: DAV Resolution No. 103, which calls for program improvements for VA 

mental health services to include increased staffing levels, improved outreach to veterans with a focus on reducing stigma when seeking post-deployment readjustment 

and other mental health services; DAV Resolution No. 104, which calls for enhanced 

medical services for women veterans as well as additional methods to address barriers to care. Also, the bill is consistent with recommendations in DAV’s 2014 report, 

Women Veterans: The Long Journey Home. 

S. 2279, VETERANS HEALTH CARE STAFFING IMPROVEMENT ACT

This bill would require the VA, in conjunction with the Department of Defense, 

to recruit military medical service personnel to VA health care positions following 

their service. To promote this outcome, the bill would require DOD to submit to VA 

a list once each year (or more often if agreed) of such individuals, including reservists and Coast Guardsmen, who are approaching the discharge point, or afterwards, 

along with contact and other relevant information to identify these individuals and 

their prior duties in military health care, including credentials, licensure and related information. 

In respect to this program, the bill would require VA to work to resolve barriers 

in credentialing or other rules that could delay or prevent such VA hiring. In the 

event that an identified barrier cannot be resolved by VA, the bill would require VA 

to report its existence and nature to Congress, with recommendations for legislation 

or administrative action (including any barrier imposed by a state). 

The bill would require VA to treat applications for VA employment by the individuals contemplated by this authority as Federal civilian employees rather than outside applicants, if applications were made within one year of discharge. 

The bill would require VA to establish a national, uniform credentialing policy for 

any VA employee who needs credentials to practice, and that once an individual is 

VA-credentialed in one site, the bill would enable such an employee to practice anywhere in the VA health care system without further credentialing. 

The bill would authorize full practice authority for advance practice nurses, physician assistants (PA), and other categories of health personnel as identified by the 

Secretary. The bill would empower these individuals to conduct independent pracVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00105 Fmt 6601 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
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tices in VA health care, irrespective of limitations that might be imposed by state 

laws. The bill would define a number of terms associated with these authorities. 

With regard to easing transition from military careers to civilian careers, DAV 

strongly supports the intent of this bill on the basis of DAV National Resolution 

130, which urges continuing support for veterans’ preference in Federal, state and 

local employment. While the resolution does not specify employment in VA itself, 

the bill is a logical method of aiding VA’s recruitment efforts for medical professionals and, therefore, DAV supports this provision. 

With respect to the credentialing provisions of this bill, setting aside differing requirements from state to state, or from VA facility to VA facility, could produce unintended consequences. While it is true that credentialing may often delay or complicate the employment of clinical professionals in VA health care (and elsewhere), 

such policies are put in place to protect the quality of care and health of patients 

and to ensure individual practitioners are in fact capable of providing patients the 

type and intensity of care they are licensed to provide. In VA, credentialing in a 

major, affiliated VA academic health center, generally a teaching center of health 

professions, is considerably different than in a secondary, non-affiliated VA facility, 

and these differences exist for good reason. 

Finally, on the issue of independent practice authority of advance practice nurses, 

PAs and others that might be identified by the Secretary, VA recently proposed new 

regulations affecting these groups. While DAV has no resolution specific to these 

issues in the bill, or in VA’s proposed regulation, we ask the sponsors to consider 

the implications of setting aside VA’s proposal and any public comment that it may 

generate, with such sweeping Federal supremacy legislation. 

S. 2316, TO EXPAND THE REQUIREMENTS FOR REISSUANCE OF VETERANS BENEFITS IN

CASES OF MISUSE OF BENEFITS BY CERTAIN FIDUCIARIES TO INCLUDE MISUSE BY ALL

FIDUCIARIES, TO IMPROVE OVERSIGHT OF FIDUCIARIES, AND FOR OTHER PURPOSES

The bill would authorize the Department of Veteran Affairs (VA) to reissue benefits to veterans within the fiduciary program when fiduciaries are found to have 

misused or mishandled the administration of their benefits. 

VA would require that any person or entity appointed or recognized as a fiduciary 

for a beneficiary to provide VA with authorization to obtain from any financial institution any record held by the institution with respect to the fiduciary or beneficiary. 

This authorization would be utilized whenever a financial record is necessary for the 

administration of a VA program. The authorization could also be executed when it 

becomes necessary to safeguard a beneficiary’s benefits against neglect, misappropriation, misuse, embezzlement, or fraud. 

Under this bill, in instances when a fiduciary refuses to provide or revokes an authorization to permit VA access to financial institution information concerning benefits paid to a beneficiary, VA would have the authority to revoke the appointment 

or the recognition of the fiduciary for each beneficiary for whom such fiduciary had 

been appointed or recognized. 

Although we not have a resolution specific to fiduciary matters, DAV appreciates 

the importance of safeguarding benefits of veterans within the fiduciary program; 

therefore, DAV supports the intent of this legislation because it protects the rights 

and benefits of ill and injured veterans. 

S. 2791, ATOMIC VETERANS HEALTHCARE PARITY ACT

The Atomic Veterans Healthcare Parity Act would provide health care parity for 

veterans who participated in the atomic debris cleanup mission on Enewetak Atoll 

in the Marshall Islands between 1977–1980. Currently these veterans are not included in the definition of ‘‘atomic veterans’’ and are not considered to have experienced at-risk exposure to radiation while relocating radioactive materials contaminated by 43 atomic tests at Enewetak Atoll. This measure would require VA to consider such veterans to be radiation exposed for presumption of service connection 

for recognized radiogenic diseases. 

DAV is pleased to support S. 2791 because it is consistent with DAV Resolution 

No. 089, which supports legislation authorizing presumptive service connection for 

atomic veterans with a recognized radiogenic disease including any veteran involved 

in clean-up operations following the detonation of a nuclear device. We urge the 

Committee to expeditiously pass this legislation that would establish eligibility for 

personnel who participated in this specific radiation-risk activity during military 

service to receive presumptive service connection for recognized radiogenic diseases. 

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S. 2958, A BILL TO ESTABLISH A PILOT PROGRAM ON PARTNERSHIP AGREEMENTS TO

CONSTRUCT NEW FACILITIES FOR THE DEPARTMENT OF VETERANS AFFAIRS

This bill would provide VA a discretionary authority to enter into not more than 

five public-private partnerships to construct major VA medical facilities, new cemeteries, and expanded cemeteries. Under the bill, VA could choose any qualified entity to carry out this construction, including ‘‘a donor group,’’ an undefined term. The 

bill would require in each instance that a board of directors were chosen to guide 

each project, and the project chosen for this pilot program would come either from 

projects partially funded by Congress, or from VA’s internal capital planning process 

and its priority list submitted annually to Congress as a part of VA’s budget request. 

One of the five sites that would be authorized and required to participate in this 

pilot program would be located in Omaha, Nebraska, and would include a new ambulatory care clinic with sufficient space and parking facilities, and would be limited 

in cost to $56 million, unless Congress appropriated additional funds for this project. 

The bill would set rules for the conduct of the pilot program, including activities, 

actions, reports and dissolutions of these boards of directors, as well as for the entities chosen to partner with VA on the projects chosen, and would prescribe various 

terms and conditions applicable to both the five entities and VA. Finally, the bill 

would specify required elements in the application process, and would prescribe required reports to Congress by VA and the Government Accountability Office. 

DAV National Resolution No. 100 urges VA to request adequate funding to fulfill 

the intent of its strategic capital planning initiative; that Congress carefully monitor 

any intended VA changes in infrastructure that could jeopardize VA’s ability to 

meet veterans’ needs; and, that Congress continue to provide appropriated funding 

sufficient to fulfill the needs for infrastructure identified through the strategic capital planning process. Enactment of this bill would introduce a major change in VA’s 

capital planning and construction management programs. This new approach may 

hold promise in reforming VA’s capital infrastructure program. Nevertheless, because it is an untested concept, before advancing this bill in the legislative process, 

we would urge further discussions with VA officials on the impact and intent of the 

measure on normal VA construction operations, especially given that VA is currently managing 49 major construction projects system-wide. 

S. 3021, A BILL TO AUTHORIZE THE USE OF POST-9/11 EDUCATIONAL ASSISTANCE TO PURSUE INDEPENDENT STUDY PROGRAMS AT CERTAIN EDUCATIONAL INSTITUTIONS THAT

ARE NOT INSTITUTIONS OF HIGHER LEARNING

This bill would authorize the use of Post-9/11 Educational Assistance to pursue 

independent study programs at certain educational institutions that are not institutions of higher learning as currently defined by law. 

Section 3452 of title 38 defines an ‘‘institution of higher learning’’ as one that 

grants an associate degree or higher degree. Post-secondary career and technical 

education (CTE) centers, which are public, non-profit, non-degree-granting institutions that award certificates, are an integral part of the postsecondary education 

and workforce training systems in many states—offering alternative routes for nontraditional students to obtain a postsecondary credential. To better accommodate 

working adult students, some CTE centers are utilizing technology by incorporating 

distance learning online. However, under current law, any independent study program offered through these institutions that includes an online component is ineligible because CTE centers are non-degree-granting and are therefore not considered 

institutions of higher learning. 

This bill would update existing law to mirror the Post-9/11 Veterans Educational 

Assistance Improvement Act’s incorporation of non-degree-granting institutions as 

an option for veterans, while also recognizing the expanding role of technology in 

these institutions. This legislation would accomplish this much-needed update by 

providing an exception for accredited independent study programs that lead to certificates from non-degree-granting institutions. 

DAV has no resolution concerning this issue; however, we would not oppose its 

enactment because it would appear to be beneficial to veterans. 

S. 3023, THE ARIA HARRELL ACT

This bill would establish procedures to address mustard gas or lewisite testing 

done on servicemembers by the Department of Defense during World War II. 

This legislation would require the Secretary of Veterans Affairs, in consultation 

with the Secretary of Defense, to reconsider claims for compensation relative to 

these experiments and render new determinations. The legislation would establish 

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a presumption of exposure, unless proven otherwise, thus creating a lower evidentiary standard to demonstrate exposure to mustard gas or lewisite. 

DAV is pleased to offer our support for this legislation consistent with Resolution 

No. 010, which calls on Congress to vigorously support VA’s expeditious handling 

of veterans’ claims and payment of fair and just compensation for all conditions associated with exposure to toxic and environmental hazards. 

S. 3032, VETERANS’ COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 2016

This bill would provide for an increase in the rates of compensation, commensurate with an increase for Social Security recipients with no ‘‘round down,’’ effective 

December 1, 2016. 

Mr. Chairman, DAV strongly supports this legislation, especially since it does not 

mandate that the cost-of-living adjustment (COLA) it would authorize be rounded 

down to the next lowest whole dollar amount. 

Many disabled veterans and their families rely heavily, or solely, on VA disability 

compensation, or DIC payments, as their only means of financial support, and they 

have struggled during recent years. Their personal economic circumstances have 

been negatively affected by rising costs of many essential items, including food, 

medicines and gasoline. 

In FY 2016, no COLA increase was authorized due to depressed inflation, so it 

seems only fitting that no round-down be imposed in 2017 to help offset the loss 

of COLA in 2016. It is imperative that veterans and their dependents receive a full 

COLA; on the strength of DAV Resolution No. 013, DAV supports enactment of this 

legislation. 

S. 3035, Maximizing Efficiency and Improving Access to Providers at the Department of Veterans Affairs Act of 2016 

DAV supports this legislation that would require VA to carry out an 18-month 

pilot program in at least five VA medical centers to use medical scribes to transcribe 

provider comments during visits with patients, thereby saving the provider time to 

manage the medical documentation process while also allowing more visual contact 

and better communication between provider and patient. 

DAV resolution 126 calls for quality care for veterans to be achieved when health 

care providers are given the freedom and resources to provide the most effective and 

evidence-based care available. In response to the growing complexity of health care 

and the electronic medical record, medical scribes have been used in the private sector to improve productivity, clinical documentation, completion of medical records, 

as well as provider satisfaction. 

We understand VA has been exploring the scope of responsibilities for medical 

scribes. DAV believes this bill, if enacted, would help provide a wider scope through 

which meaningful information could be produced to help determine the most effective integration of scribes within the various patient aligned care teams and across 

care settings in VA. 

S. 3042, THE JUSTICE FOR SERVICEMEMBERS ACT OF 2016

This bill would improve the scope of procedural rights under the Uniformed Services Employment and Reemployment Rights Act (USERRA), and improve the enforcement authority of the Department of Justice. 

Section 1 would clarify employment and reemployment rights of servicemembers 

by proposing any agreement to arbitrate a claim under USERRA is unenforceable, 

unless all parties consent to arbitration after a complaint on the specific claim has 

been filed in court or with the Merit Systems Protection Board and all parties knowingly and voluntarily consent to have that particular claim subjected to arbitration. 

Under the bill, consent would not be considered voluntary when a person is required 

to agree to arbitrate an action, complaint, or claim alleging a violation under 

USERRA as a condition of future or continued employment, advancement in employment, or receipt of any right or benefit of employment. 

Section 2 would enhance enforcement of employment and reemployment rights of 

servicemembers with respect to employment with State or private employers. This 

section would provide that the Attorney General may commence an action for relief 

under USERRA, further clarifying Congressional intent to effectively protect servicemembers. 

DAV has no specific resolution pertaining to the issues addressed by this bill; 

however, these changes would appear to improve servicemembers’ employment and 

reemployment rights; thus, we would not oppose its favorable consideration. 

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S. 3055, DEPARTMENT OF VETERANS AFFAIRS DENTAL INSURANCE

REAUTHORIZATION ACT OF 2016

If enacted, this measure would make permanent and existing pilot program of VA 

dental insurance for veterans, survivors and dependents of veterans as mandated 

under Section 510 of Public Law 111–163, by allowing eligible veterans plus family 

members receiving care under the Civilian Health and Medical Program of VA 

(CHAMPVA), to purchase dental insurance. 

DAV recognizes that oral health is integral to the general health and wellbeing 

of a patient, and is part of comprehensive health care irrespective of service-connected disability. The law defines preventive health services as a broad collection 

of VA health services that improve, protect and sustain the general health and wellbeing of veterans enrolled in VA health care, to include ‘‘such other health care services as the Secretary may determine to be necessary to provide effective and economical preventive health care.’’ It is for this reason that DAV supports the intent 

of this bill in accordance with DAV resolution 049, which supports providing VA 

outpatient dental care to all enrolled veterans. However, DAV opposes any copayments that this program would require. DAV resolution 114, adopted at our most 

recent convention, calls for legislation to eliminate or reduce VA and DOD health 

care out-of-pocket costs for service-connected disabled veterans. 

Veterans, through service to their Nation, have made extraordinary sacrifices and 

contributions, and have earned the right to certain benefits in return. Premiums, 

health care cost sharing and deductibles are features of health care systems in 

which some costs are shared by the insured and the insurer in a contractual relationship between the patient and the insurer. 

S. 3076, CHARLES DUNCAN BURIED WITH HONOR ACT OF 2016

Currently, VA reimburses the purchase of a casket or urn used only when the deceased veteran is interred in a VA National Cemetery. The veteran must have no 

identifiable next of kin and insufficient resources to pay for a casket or urn. This 

bill would extend the benefit to such veterans interred in state and tribal 

cemeteries. 

DAV has no resolution pertaining to this issue; however, we would not oppose 

passage of this legislation because it appears to be beneficial to veterans. 

S. 3081, WORKING TO INTEGRATE NETWORKS GUARANTEEING MEMBER ACCESS NOW ACT

This bill would provide certain permanent Congressional employees with readonly remote access to the electronic VBA claims records of veterans who are constituents of Members. These employees would be prohibited from modifying any 

data, processing, preparing or prosecuting of claims. 

These designated Congressional staff members could utilize this system to provide 

their constituents with information relevant to the processing of their claims or appeals. Designated staff members would require certification by the VA in order to 

access this system in the same manner currently required for agents or attorneys. 

Any costs associated with gaining access to these VA systems would be incurred by 

the particular Member of Congress whose staff accessed these records. 

DAV has no resolution relative to this issue, but would not oppose passage of the 

legislation. 

DRAFT BILL, TO EXPAND ELIGIBILITY FOR READJUSTMENT COUNSELING TO CERTAIN

MEMBERS OF THE SELECTED RESERVE OF THE ARMED FORCES (JOHN B.)

This bill, if enacted, would authorize VA Readjustment Counseling Centers to provide counseling in Vet Centers to members of the Selected Reserve, for psychological 

trauma or behavioral conditions, and would protect the privacy of these individuals 

in seeking out such counseling by not requiring them to obtain referrals, presumably from their commands or military medical authorities, before seeking counseling. 

VA Resolution No. 103 urges Congress, the Administration and VA to enable Vet 

Centers to continue expanding and extending their rehabilitative and readjustment 

services, including in more rural communities, to veterans of past, present and future military service, and to their family members when necessary to aid in the recovery of veterans suffering the latent effects of combat exposure. Therefore, DAV 

strongly supports this proposal. 

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DRAFT BILL, TO AUTHORIZE PAYMENT BY THE DEPARTMENT OF VETERANS AFFAIRS FOR

THE COSTS ASSOCIATED WITH SERVICE BY MEDICAL RESIDENTS AND INTERNS AT FACILITIES OPERATED BY INDIAN TRIBES AND TRIBAL ORGANIZATIONS, TO REQUIRE THE

SECRETARY OF VETERANS AFFAIRS TO CARRY OUT A PILOT PROGRAM TO EXPAND MEDICAL RESIDENCIES AND INTERNSHIPS AT SUCH FACILITIES

This bill would expand into health care facilities of Indian tribal organizations 

VA’s current responsibilities and costs incurred in its graduate medical education 

programs. The bill would require VA to establish a five-year program of residency 

training in Alaska and two as-yet unidentified locations, and to reimburse tribal facilities selected for some of their costs in hosting VA medical residencies as specified 

in the bill. After three years of operation, the bill would require VA to report to Congress on the feasibility and advisability of expanding the pilot program to additional 

tribal health care sites, and on making the program or any aspect of it permanent. 

VA has executed an extensive memorandum of agreement with the Indian Health 

Service to ensure that veterans of Indian ancestry receive adequate health care and 

other services. It is unclear from the language of this bill whether this new academic program would impact this agreement, and to what extent. Also, an authorization of $20 million per year over a five-year period for a three-site pilot program 

seems excessive; we recommend the amount be reconsidered. 

While DAV has no resolution supporting this concept of VA medical residencies 

in Indian tribal facilities, we would not offer opposition to this bill; nevertheless, we 

recommend the sponsor consult with the VA Office of Rural Health, as well as the 

Office of Academic Affiliations, on the implications of the bill prior to its further advancement through the legislative process. 

DISCUSSION DRAFT TO AUTHORIZE THE AMERICAN BATTLE MONUMENTS COMMISSION TO

ACQUIRE, OPERATE, AND MAINTAIN THE LAFAYETTE ESCADRILLE MEMORIAL IN

MARNES-LA-COQUETTE, FRANCE

This bill would authorize the American Battle Monuments Commission to take 

ownership and operational control of an important World War I memorial in France. 

DAV has received no resolution dealing with this particular topic and takes no position on this bill. 

Mr. Chairman, this concludes DAV’s testimony. We thank the Committee for inviting DAV to submit this testimony for the record. DAV is prepared to respond to 

any questions by Committee Members on the positions we have taken with respect 

to the bills under consideration. 

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PREPARED STATEMENT OF ALLEN DOEDERLEIN, PRESIDENT, 

DEPRESSION AND BIPOLAR SUPPORT ALLIANCE


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PREPARED STATEMENT OF THE CIVIL RIGHTS DIVISION AND THE SERVICEMEMBERS

AND VETERANS AFFAIRS INITIATIVE, U.S. DEPARTMENT OF JUSTICE


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[The Clark 50-page brief can be seen here:] 

https://www.justice.gov/archives/opa/blog-entry/file/861466/download 


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PREPARED STATEMENT OF MICHAEL MICHAUD, ASSISTANT SECRETARY FOR VETERANS’ 

EMPLOYMENT AND TRAINING, U.S. DEPARTMENT OF LABOR

Chairman Isakson, Ranking Member Blumenthal, and Members of the Committee, Thank you for the opportunity to provide the views of the Department of 

Labor (DOL) on pending legislation aimed at helping the men and women who 

served, or are serving, this country succeed in the civilian workforce. As Assistant 

Secretary of the Veterans’ Employment and Training Service (VETS), I look forward 

to working with the Committee to ensure that these brave and committed individuals have the employment support, assistance and opportunities they deserve. 

While this hearing will address numerous bills pending before the Committee, my 

statement will focus on Ranking Member Blumenthal’s draft legislation, which 

would make a number of important amendments to the Uniformed Services Employment and Reemployment Rights Act of 1994, 38 U.S.C. §§ 4301–4335, (USERRA or 

the Act), which is enforced by VETS, the Department of Justice (DOJ), and the U.S. 

Office of Special Counsel (OSC). My statement also will briefly discuss S. 2958, 

which would ‘‘establish a pilot program on partnership agreements to construct new 

facilities for the Department of Veterans’ Affairs.’’ 

USERRA prohibits discrimination in employment based on an individual’s prior 

service in the uniformed services; current service in the uniformed services; or intent to join the uniformed services. An employer is also prohibited from discriminating against a person because of such person’s attempt to enforce his or her rights 

under the Act. In addition, an employer may not retaliate against an individual for 

filing a USERRA claim or testifying or otherwise providing assistance in any proceeding under the Act. USERRA also provides reemployment rights with the preservice employer following qualifying service in the uniformed services. In general, 

the protected person is entitled to be reemployed with the status, seniority, and rate 

of pay as if he or she had been continuously employed during the period of service. 

USERRA applies to private employers, the Federal Government, and State and local 

governments. It also applies to United States employers operating overseas and foreign employers operating within the United States. 

USERRA protects civilian job rights and benefits for veterans and members of the 

Uniformed Services. VETS provides assistance to those persons experiencing service-connected problems with their civilian employment, and provides information 

about USERRA to employers. In Fiscal Year (FY) 2015, the Department reviewed 

a total of 1,288 USERRA cases. 77 of those cases were referred to DOJ and OSC 

for further review and possible litigation in either U.S. District Court or before the 

Merit Systems Protection Board (MSPB). In addition, DOL staff provided technical 

assistance to more than 10,000 servicemembers and other individuals in FY 2015, 

and well over a million individuals since September 11, 2001. The rights USERRA 

affords our servicemembers and veterans are critical, and we are committed to doing 

everything possible to ensure those rights are protected and preserved. 

S. XXXX—A BILL TO AMEND TITLE 38, UNITED STATES CODE, TO CLARIFY THE SCOPE OF

PROCEDURAL RIGHTS OF MEMBERS OF THE UNIFORMED SERVICES WITH RESPECT TO

THEIR EMPLOYMENT AND REEMPLOYMENT RIGHTS, TO IMPROVE THE ENFORCEMENT

OF SUCH EMPLOYMENT AND REEMPLOYMENT RIGHTS, AND FOR OTHER PURPOSES. 

DOL strongly supports the Ranking Member’s draft bill. The significant USERRA 

improvements it would provide mirror those we have urged the Congress to enact, 

as reflected both in the Administration’s recent legislative proposal, and in several 

of our USERRA Annual Reports to Congress. We applaud this effort to strengthen 

enforcement of USERRA, and believe the proposed statutory amendments, some of 

which are discussed in more detail, below, will address several critical issues. 

Section 1 of the draft bill is intended to make clear the scope of employment and 

reemployment rights of covered individuals, by clarifying the definitions of ‘‘rights’’ 

and ‘‘benefits’’ under USERRA, and by clarifying the status of arbitration agreements under the Act. These amendments guarantee the availability and protection 

of procedural rights included in the statute, ensuring that USERRA operates to 

safeguard both substantive and procedural rights and benefits from reduction, limitation, or elimination. We are particularly grateful that, to ensure the procedural 

right of adjudication of USERRA claims, the bill expressly provides that agreements 

to arbitrate are unenforceable ‘‘unless all parties consent to arbitration after a complaint on the specific claim has been filed in court or with the MSPB and all parties 

knowingly and voluntarily consent to have that particular claim subjected to arbitration.’’ 

DOL supports limiting the ability to consent to arbitration until after a claim is 

filed in court or with the MSPB because, at that stage of the adjudication process, 

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claimants already have a sense of their rights and likely have consulted with an 

attorney. Section 1(c)(2) is not necessary, and is potentially harmful, because there 

may well be other circumstances, not specifically provided for, where a claimant’s 

agreement might not be voluntary. DOL believes that the determination as to 

whether a USERRA claimant’s consent to arbitrate is voluntary is best left to the 

adjudicator, who will decide that question based upon the particular facts and circumstances of the case. 

Federal judicial circuits are presently divided as to whether USERRA protections 

apply to procedural as well as substantive rights. It has long been the Department’s 

interpretation of USERRA, as well as that of DOJ and OSC, that USERRA applies 

to procedural rights, regardless of how such rights may be construed. Clarifying that 

USERRA applies to both procedural and substantive rights provides certainty 

in legal interpretation, and would resolve the ambiguity that currently exists among 

Federal judicial circuits. It also reassures our servicemembers and veterans that 

they have proper recourse when they believe their USERRA rights have been 

violated. 

The amendments contained in Section 2 of the bill would make a number of substantial improvements to the enforcement of employment and reemployment rights 

with respect to a State or private employer. Significantly, subsection (a) would 

strengthen enforcement under USERRA by allowing the United States to serve as 

a plaintiff in all suits filed by the Attorney General (AG), rather than only in those 

suits filed against State employers. This amendment would ensure that USERRA 

is consistent with other civil rights laws by allowing the United States to bring suit 

in its own name as the plaintiff, to vindicate the public interest in ensuring the statute is enforced. The aggrieved person on whose behalf the AG files suit would retain 

the right to intervene in such suits, or to bring his or her own action if the AG declines to file suit. 

This section also grants independent authority to the AG to investigate and file 

suit to challenge employment policies or practices that establish a pattern or practice of violating USERRA. This amendment, modeled after Title VII of the Civil 

Rights Act of 1964 (42 U.S.C. § 2000e–6(a)), would strengthen significantly DOJ’s 

ability to enforce USERRA to address a systemic violation (such as an employer policy prohibiting extended absences, including absences for military service) that could 

adversely affect the employment rights of multiple servicemembers. 

In support of this new pattern-or-practice authority, the bill also would amend 

USERRA to provide the AG with the authority to issue civil investigative demands 

to compel the production of relevant documentary materials and unsworn answers 

to written questions from the custodian of such documents. DOL has the power to 

issue subpoenas in the conduct of its investigations under USERRA. However, with 

no investigatory role under current law, the AG has no authority to compel the production of evidence prior to filing suit. Because the section now empowers the AG 

to initiate an investigation, this further amendment would provide appropriate and 

much-needed investigative tools. 

Finally, DOL also supports other amendments section 2 would make to enable 

servicemembers and veterans to more ably exercise their USERRA rights, and to 

enhance the available remedies for violations of USERRA rights. For instance, subsection (b) explicitly abrogates sovereign immunity to eliminate any question whether Congress intends that USERRA claimants be able to bring an action against a 

State employer in State court or Federal district court. And, subsection (d) adds 

compensatory and punitive damage provisions that are similar to damages provisions in Title VII of the Civil Rights Act of 1964. 

S. 2958—A BILL TO ESTABLISH A PILOT PROGRAM ON PARTNERSHIP AGREEMENTS TO

CONSTRUCT NEW FACILITIES FOR THE DEPARTMENT OF VETERANS’ AFFAIRS

This bill would authorize the Secretary of Veterans’ Affairs to enter into up to five 

partnership agreements with certain designated entities to conduct one or more 

super construction projects; major medical facility projects; or major construction 

projects to construct new cemeteries, or develop additional gravesites or columbarium niches at existing cemeteries. Section 1(b) of the bill provides that this authority may be carried out ‘‘notwithstanding any other provision of law (including section 8103(e) of title 38, Untied States Code), except for Federal laws relating to environmental and historic preservation; and, subchapter IV of chapter 31 of title 40, 

United States Code (commonly referred to as the ’Davis Bacon Act’).’’ 

Like VA, DOL strongly supports the bill’s authorization of these partnership 

agreements, provided the legislation does not roll back key civil rights protections 

for veterans and other employees who will be working to construct the facilities resulting from these partnership agreements. These safeguards protect millions of 

162 

workers, including veterans. DOL looks forward to working with the Committee to 

revise the language of section 1(b) to ensure that S. 2958 provides VA the authority 

it needs while maintaining the applicability of laws that protect against employment 

discrimination or that otherwise ensure equal employment opportunities. 

CONCLUSION

Every day, we at DOL do our best to serve the civilian employment needs of our 

veterans, transitioning servicemembers, and military families. It is the least we can 

do to honor the tremendous sacrifices made by our service men and women and 

their families. Secretary Perez and VETS strongly believe that the reforms included 

in Ranking Member Blumenthal’s draft bill to amend USERRA will not only help 

our veterans and servicemembers find good jobs, but also ensure that they can retain their civilian employment when they must leave it to serve our Nation. We look 

forward to working with the Committee on these important issues and are available 

to provide any technical assistance you request with respect to these proposed 

amendments. DOL also stands ready to assist the Committee and VA to make certain that S. 2958 does not operate to exclude veterans and other workers from important equal opportunity and employment protections. 

I again thank the Committee for your commitment to our Nation’s veterans and 

servicemembers and for the opportunity to submit this statement for the record. 

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LETTER FROM ALEXANDER BLUMROSEN, PRESIDENT, THE LAFAYETTE ESCADRILLE

MEMORIAL FOUNDATION


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PREPARED STATEMENT OF FREDERICK R. SALANTI, MAJ, US ARMY (USAR), FOUNDER/ 

EXECUTIVE DIRECTOR, MISSING IN AMERICA VETERANS RECOVERY PROGRAM


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PREPARED STATEMENT OF MILITARY OFFICERS ASSOCIATION OF AMERICA

Chairman Isakson, Ranking Member Blumenthal, and Members of the Committee, The Military Officers Association of America (MOAA) is pleased to present 

its views on veterans’ health care and benefits legislation under consideration by the 

Committee. 

MOAA does not receive any grants or contracts from the Federal Government. 

EXECUTIVE SUMMARY

On behalf of our more than 390,000 members, MOAA thanks the Committee for 

holding this important hearing and for your continued support of our Nation’s servicemembers, veterans and their families. MOAA is especially grateful for the Committee’s leadership in introducing S. 2921, the Veterans First Act, a comprehensive 

bill to improve the delivery of health care and benefits in the Department of Veterans Affairs (VA). 

We believe many of the bills being considered today will buildupon the work of 

the Committee in the Veterans First Act, further enhancing VA’s health and benefits systems. Our Association looks forward to working with the Members and staff 

to strengthen and improve the legislation for enactment this year. 

MOAA’s position and recommendations are provided on the following bills: 

• S. 603, Rural Veterans Travel Enhancement Act of 2015 

• S. 2210, Veteran Partners’ Efforts to Enhance Reintegration (PEER) Act 

• S. 2279, Veterans Health Care Staffing Improvement Act 

• S. 3035, Maximizing Efficiency and Improving Access to Providers at the Department of Veterans Affairs Act of 2016 

• S. 244, Review of the Disability Compensation Process for Traumatic Brain Injuries 

• S. 2791, Atomic Veterans Healthcare Parity Act 

• S. 3023, The Arla Harrell Act 

• S. 3032, Veterans’ Compensation Cost-of-Living Adjustment Act of 2016 

• Draft Bill, Clarification of Procedural Rights Under the Uniform Services Employment and Reemployment Rights Act (USERRA) 

HEALTH CARE

S. 603, Rural Veterans Travel Enhancement Act of 2015. The bill would give the 

Secretary of VA permanent authority to transport individuals to and from any VA 

facility which provides rehabilitation, counseling, examination, treatment, and care. 

The measure specifically authorizes the Secretary to cover the actual expenses of 

travel or allowances for a veteran using a VA Veterans Readjustment and Counseling Program or ‘Vet Center’ facility. 

Vet Centers provide important services to help guide veterans and their family 

members through the major life changes that often occur when a member returns 

from combat. Services include individual, group and family counseling in such areas 

as post-traumatic stress, alcohol and drug assessment, and suicide prevention. 

Currently VA covers travel expenses for care at VA medical centers and community-based outpatient clinics. Vet Centers provide a critical capability within VA’s 

health system, thus inclusion of these facilities for purposes of payments for beneficiary travel and allowances should also be a covered benefit for consistency and 

continuity of care throughout the system. 

MOAA supports S. 603, but recommends funds be appropriated to support the bill. 

We would urge against trading funding from other medical programs to offset these 

costs as MOAA believes medical care and services, including associated travel expenses and allowances, are central components to opening up access and delivering 

high quality health care to our veterans. 

S. 2210, Veteran Partners’ Efforts to Enhance Reintegration (PEER) Act. MOAA 

strongly supports this measure which would establish a two-year pilot program to 

incorporate peer specialists in patient aligned care teams at 25 VA medical centers 

to promote the use and integration of mental health services in the primary care 

setting. 

MOAA has long endorsed peer support programs as a means to enhance the delivery of health care services. Extending VA’s existing mental health peer support 

model into the primary care setting will help to further reduce barriers in accessing 

mental health services while concurrently increasing system capacity. 

We greatly appreciate Senator Richard Blumenthal’s (D-CT) leadership on this 

significant issue. We are particularly grateful for the legislation’s special consideration of gender specific peer support services for female veterans and focus on veterans living in rural or underserved areas. 

172 

S. 2279, Veterans Health Care Staffing Improvement Act. This bill would increase 

efficiency in the recruitment and hiring of health care professionals in VA. The bill 

contains a number of innovative and much needed solutions to addressing critical 

health care staffing shortfalls and veterans’ access to care. 

The Department of Defense (DOD) would be required, at least annually, to submit 

a list of transitioning military members serving in health care fields to the VA for 

recruitment and hiring consideration. 

Additionally, the measure would create uniform credentialing standards for certain health care professionals working in the agency so employees are allowed to 

practice in any location in the VA Health Administration (VHA) system. 

MOAA is also pleased to see a provision granting full practice authority to Advanced Practice Nurses and Physician Assistants, bringing VHA in line with other 

practicing professionals in the DOD, Indian Health Service, and the Public Health 

Service systems. 

Our Veterans need all the skills Advanced Practice Nurses can provide them. The 

implementation of the Veterans Health Care Staffing Improvement Act would help 

fill a critical system need today. 

VA’s current health system, where 10 Advanced Practice Nurses in a single medical facility have 10 different state licensures, and 10 different scopes of practice, 

imposes unnecessary supervision requirements, further limiting system capability 

and capacity. This aspect of the system needs to be corrected. 

By aligning VA nurse workforce with other Federal healthcare services, we better 

serve and honor our veterans. 

MOAA fully supports S. 2279 and urges immediate passage of the bill. 

S. 3035, Maximizing Efficiency and Improving Access to Providers at the Department of Veterans Affairs Act of 2016. MOAA also supports this measure which would 

require the Department to carry out an 18-month pilot program using medical 

scribes to support physicians in at least five VHA facilities. 

The purpose of the pilot is to collect data to determine the effectiveness of the 

program in increasing efficiency of physicians, reduce average wait times for appointments, improve access of patients to electronic medical records, and mitigate 

physician shortages through increased productivity. 

Medical scribes are a health care innovation broadly used outside of VHA to assist 

physicians by alleviating paperwork and electronic health record burdens, allowing 

physicians to spend more time treating patients while at the same time being able 

to see more patients. 

MOAA urges the Committee to support funding of this important program and 

swift passage of the bill. VA needs innovative solutions like S. 3035 to address its 

current physician shortages and growing demand for health care in the coming 

years. 

BENEFITS

S. 244, Review of the Disability Compensation Process for Traumatic Brain Injuries. MOAA supports this bill, which would fund research into Traumatic Brain Injuries. Traumatic Brain Injuries are tremendously complex, and a recent study 

found brain injuries incurred due to war-related events such as blasts differ from 

those incurred during sports-related activities. War-related brain injury requires 

further study, and VA should be provided the resources to buildupon current expertise in this arena and provide veterans with the most up-to-date options in treatment. 

S. 2791, Atomic Veterans Healthcare Parity Act. MOAA supports the inclusion of 

veterans who participated in the cleanup of Enewetak Atoll as radiation-exposed 

veterans. The nuclear testing performed at Enewetak Atoll should entitle these veterans to the same presumptions for radiation-related illnesses when applying for VA 

disability compensation as in other incidents of service-related toxic exposure. There 

is no discernable reason why these veterans should be denied equal treatment under 

the law. 

S. 3023, The Arla Harrell Act. MOAA supports the passage of this bill, which 

would require VA to reconsider claims that have previously been denied for veterans 

exposed to mustard gas or lewisite testing by the DOD. It is a matter of fairness 

to these veterans that our government should be obligated to compensate these 

human test subjects for the resulting effects of those studies. The bill would close 

this loophole for this group of veterans seeking relief. 

S. 3032, Veterans’ Compensation Cost-of-Living Adjustment Act of 2016. MOAA 

supports the passage of this bill to provide veterans with the same type of cost-ofliving increases in their disability compensation and survivor annuities that Social 

Security recipients receive in theirs. 

173 

1Leisha Self, A Guide to the Uniformed Services Employment and Reemployment Rights Act 

and the Recent Hostile Work Environment Amendment, 28 ABA J. Lab. & Emp. L. 449 (2013) 2 38 U.S.C. § 4323(a) (2). 

3 38 U.S.C. § 4302(b). 

Draft Bill, Clarification of Procedural Rights Under the Uniform Services Employment and Reemployment Rights Act (USERRA). MOAA supports passage of this bill 

to close the loophole that currently exists in USERRA. Presently, servicemembers 

returning to their civilian jobs who find their employer has violated USERRA may 

not be fully protected if he or she has signed an employment contract that requires 

disputes be mediated by an arbitrator vice litigated in court. 

Arbitration provides no opportunity for a servicemember to appeal an unfavorable 

decision and places the employer in a much more advantageous position than the 

servicemember. Closing this loophole is important to ensure our servicemembers are 

fully protected, as Congress intended in enacting USERRA. 

MOAA thanks the Committee for considering this important legislation and for 

your continued support of our veterans and their families. 

PREPARED STATEMENT OF THE MILITARY ORDER OF THE PURPLE HEART

Chairman Isakson, Ranking Member Blumenthal and Members of the Committee, 

on behalf of the Military Order of the Purple Heart of the U.S.A. (MOPH) we would 

like to thank you for including S. 3042, the Justice for Servicemembers Act of 2016 

on today’s hearing agenda. We are grateful for the opportunity to provide written 

testimony in support of this legislation and in support of restoring the rights of servicemembers in the face of forced arbitration. We would like to urge Congress to 

quickly pass this important legislation on behalf of all of our brave men and women 

who serve. 

Throughout history, Congress has enacted laws that provide additional rights and 

protections for the men and women who serve our country. Congress did so in recognition of the significant, additional burdens that being called away from your family and your job to serve our country places on these brave individuals; burdens that 

civilians do not face. One of these landmark laws is the Uniformed Services Employment and Reemployment Act (USERRA). Passed in 1994, the USERRA protects our 

servicemembers from employment discrimination and guarantees that when called 

for military service, they can perform their duties with the knowledge and security 

that they have the right to return to their jobs with the same pay, benefits, and 

status they would have attained had they not been called away.1 This law is one 

of the most important protections for members of the uniformed services and one 

of the strongest employment-protection laws in our country. 

Just as important as the substantive rights afforded by USERRA are the procedural and enforcement rights guaranteed under the law. Under USERRA, when servicemembers’ rights are violated, they have the right to bring a USERRA claim to 

court.2 The bill expressly dictates that any employment agreement that limits or 

eliminates a right or benefit provided by USERRA, including the establishment of 

additional prerequisites to the exercise of any such right, is facially void.3

Nevertheless, servicemembers and veterans are increasingly unable to enforce 

their rights under USERRA for one specific reason: forced arbitration clauses buried 

in the fine print of their employment contracts. Presented on a take-it-or-leave-it 

basis, employers across the country are requiring servicemembers to sign forced arbitration agreements that effectively eliminate the important rights afforded by 

USERRA. Forced arbitration clauses undermine the very protections of USERRA, 

and other laws that Congress has deemed necessary and appropriate to afford to 

our military, by kicking claims out of court, and funneling them into a rigged, secretive system where all the rules, including who decides the outcome of the forced arbitration, are chosen by the employer that violated the law in the first place. 

While forced arbitration clauses used in employment contracts can be harmful and 

oppressive for all employees, the ramifications are even more serious when these 

clauses are enforced against our men and women in uniform. When servicemembers 

become distracted from the mission at hand due to fears of unemployment, paying 

bills, providing for their family and other financial stresses upon returning home 

from duty, it directly impacts our national security. 

Congress intended for USERRA to ensure servicemembers did not lose their right 

to take an employer who wronged them to a court of law in order to have their story 

heard. This bill would honor that intent. Given the expansive use of these clauses 

by financial institutions and employers in contracts with servicemembers, prohibiting the use of forced arbitration clauses is now more critical than ever. We strongVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00177 Fmt 6601 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
174 

ly urge you to support the Justice for Servicemembers Act and any other legislative 

efforts to prohibit the use of forced arbitration clauses against our Nation’s heroes: 

our servicemembers and veterans. 

MOPH would also like to add our comments on several other pieces of legislation 

on today’s agenda. 

MOPH supports S. 244, a bill to require an independent comprehensive review of 

the process by which the Department of Veterans Affairs assesses cognitive impairments that result from Traumatic Brain Injury for purposes of awarding disability 

compensation. Due in part to the devastating effects of improvised explosive devices 

used on the battlefields of Iraq and Afghanistan, more veterans than ever are claiming disabilities associated with Traumatic Brain Injuries (TBI). Still, not enough is 

currently known about TBI, and the way it affects veterans’ abilities to function 

properly. By requiring the Institute of Medicine to conduct a review of TBI examinations provided by the Department of Veterans Affairs (VA), this bill will help ensure 

that injured veterans receive the proper health care and compensation they need. 

MOPH supports S. 603, the Rural Veterans Travel Enhancement Act of 2015, which would improve transportation options for veterans traveling to and from VA 

for medical appointments. It would do so by permanently authorizing the Veterans 

Transportation Service program, which allows VA to offer rides to veterans that 

need them; allowing veterans to receive travel reimbursement for episodes of care 

received at Vet Centers; and reauthorizing grants for Veterans Service Organizations that provide veterans with transportation. These provisions are critical to ensuring that no veteran is forced to forgo VA medical care, simply because they cannot provide their own transportation due to impairment or financial reasons. 

MOPH supports S. 2210, the Veteran PEER Act, which would require VA to establish peer specialists in patient aligned care teams at medical centers of the department. The utilization of peer specialists at VA is a proven model of success. Veterans consistently report that having access to peer support greatly improves their 

comfort level at VA facilities, as well as their ability to navigate the often confusing 

processes they encounter there when newly enrolled. Adding peer specialists to patient aligned care teams would help grant veterans access to this important resource 

at every stage of their medical care. 

MOPH supports some provisions of S. 2279, the Veterans Health Care Staffing Improvement Act. We strongly support section 2, which would require VA and the Department of Defense (DOD) to cooperatively facilitate the recruitment of recently 

separated veterans who served in medical fields in the military as VA health care 

professionals, known as the ‘‘Docs-to-Doctors Program.’’ Not only have these personnel received superior training in the military, they have also proven their leadership and desire to serve their country, which can only benefit VA. Further, they are 

uniquely qualified to provide care to their fellow veterans, as they have a first-hand 

understanding of their military experience. We believe that this program will improve VA’s ability to recruit top talent, while simultaneously increasing patient satisfaction. MOPH also supports section 3, which would require VA to implement a 

uniform credentialing process for employees of the Veterans Health Administration. 

MOPH does not support section 4 of S. 2279, which would require VA to provide 

full practice authority to advanced practice registered nurses (APRN), physician assistants (PA), and such other licensed health care professionals of the department. 

While we fully appreciate the importance of APRNs and PAs in in the modern 

health care industry, we would defer to VA on this matter. We note that VA recently published regulations to allow flexibility in full practice authority to meet the 

access needs of the department. This would allow VA to implement full practice authority in specialties where it is needed, but not require them to do so in specialties 

where it is not. Accordingly, we do not believe a legislative fix to this issue is necessary or appropriate at this time. 

MOPH supports S. 2316, which would improve VA oversight of fiduciaries, and 

allow for the reissuance of veterans benefits in cases of misuse by fiduciaries. Generally speaking, fiduciaries provide an invaluable service to veterans who are incapable of handling their own finances due to disability. However, there have been 

cases where fiduciaries, both family members and professional firms, have misused 

veterans’ benefits for their own personal gain. MOPH believes it is critically important that vulnerable veterans in need of assistance with their finances be properly 

protected from theses unscrupulous actors. For this reason, we believe it is fully reasonable that all fiduciaries be subject to robust oversight, to include the auditing 

of their bank accounts. Furthermore, we believe it is the right thing to do to restore 

benefits that are found to have been intentionally misused, to ensure that veterans 

who are taken advantage of are made whole in those unfortunate cases. 

MOPH supports S. 2791, the Atomic Veterans Parity Act, which would grant a presumption of service connection for certain cancers to veterans who participated in 

175 

the cleanup of Enewetak Atoll and the Marshall Islands between January 1, 1977 

and December 31, 1980. These veterans would be treated the same as other veterans who were exposed to known sources of radiation for the purposes of VA benefits. Current law provides presumptive service connection for veterans who participated in atomic testing between 1944 and 1958, but not those who were assigned 

to clean up the debris years later. MOPH strongly believes that toxic wounds incurred in service are wounds just the same, and should be treated with the same 

urgency as physical or mental wounds. We are aware that many of these veterans 

are now suffering from tell-tale cancers associated with radiation exposure, and believe that granting them access to VA health care and benefits as a result is long 

overdue. 

MOPH supports S. 3021, which would allow veterans to use their GI Bill benefits 

to pursue programs of independent study at schools that do not meet the industry 

definition of an ‘‘institution of higher learning,’’ such as a state university or a community college. This bill would provide veterans with more options by allowing them 

to use their benefits to obtain certificates and professional credentials from institutions such as area career and technical education schools. We note that these programs would still be accredited and subject to review by State Approval Agencies, 

as provided in statute for all courses of study approved for GI Bill use. 

MOPH supports S. 3023, the Arla Harrell Act, which would provide for the reconsideration of claims for disability compensation for veterans who participated in 

DOD experiments with mustard gas and lewisite on a presumptive basis. During 

World War II, thousands of servicemembers were used as subjects in experiments 

to test the effects of these harmful agents on the human body. Not surprisingly, this 

left many of them with chronic health issues. However, most veterans were routinely denied disability compensation for these conditions, as the experiments remained classified for decades. MOPH strongly believes that these claims should be 

reconsidered on a presumptive basis in order to finally grant these veterans the 

health care and benefits they need and deserve. 

MOPH supports S. 3032, the Veterans’ Compensation Cost-of Living Adjustment 

Act of 2016, which would increase the rate of compensation for disabled veterans 

and their survivors, effective December 1, 2016. Unlike Social Security benefits, 

which are automatically increased by statute, Congress must pass a bill each year 

to ensure that the benefits that disabled veterans and their survivors have earned 

are increased to keep pace with inflation. This is absolutely critical, given the ever 

rising prices of food, housing, health care, and other essential goods and services. 

By providing reasonable increases to those benefits, your legislation would ensure 

that the most basic needs of disabled veterans and their survivors are met. MOPH 

is especially pleased that your legislation does not include the ‘‘round down’’ provision of previous years, which is nothing more than a cost-saving device that requires 

veterans to pay for their own benefits. 

MOPH supports S. 3035, the Maximizing Efficiency and Improving Access to Providers at the Department of Veterans Affairs Act of 2016, which require the Department of Veterans Affairs (VA) to carry out an 18 month pilot program to increase 

the use of medical scribes at no fewer than five medical facilities in rural areas 

where there is a shortage of physicians and each physician has a high caseload. 

These medical scribes would be responsible for assisting VA physicians with administrative tasks that are normally done by support staff in the private sector. 

It is well documented that rural areas across the country suffer from physician 

shortages. This affects the ability of VA to recruit and retain an adequate number 

of physicians, resulting in longer appointment wait times. For this reason, MOPH 

believes that it is absolutely critical that VA physicians in these areas are able to 

practice medicine as efficiently as possible. The increased use of medical scribes 

would accomplish this by allowing VA doctors to spend less time on administrative 

tasks such as data entry and more time doing what is most important; providing 

care to veterans. 

MOPH supports S. 3055, the Department of Veterans’ Affairs Dental Insurance Reauthorization Act of 2016, which would require VA to contract with a private insurance company to offer a voluntary dental insurance plan to veterans and certain dependents. Generally, VA only provides dental care to veterans who incurred dental 

trauma while in service, or who are rated 100 percent service-connected. Veterans 

who are service-connected but rated less than 100 percent are generally not offered 

dental care at VA. MOPH believes that dental care should be considered the same 

as health care, as a number of serious comorbidities affecting a veterans’ overall 

health can arise from dental neglect, including diabetes and heart disease. These 

conditions, which may have been preventable with routine dental care, then have 

to be treated at far greater expense by VA. While MOPH would rather see full VA 

dental care eligibility extended to all service-connected veterans, we would still supVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00179 Fmt 6601 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
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port the establishment of a voluntary, reasonably priced dental insurance program 

for veterans and their families, as envisioned by this legislation. 

Finally, MOPH opposes the draft bill entitled the Working to Integrate Networks 

Guaranteeing Member Access Now Act, or WINGMAN Act. While we appreciate Senator Cassidy’s intent to provide faster service to veteran constituents who request 

assistance from congressional offices, we are concerned that there would be unintended consequences to allowing congressional staff access to veterans’ VA claims 

files. It is yet unclear to us how VA would ensure that staff only gains access to 

the records of veterans who have provided them with privacy releases. Further, we 

are concerned that granting congressional staff this access would create confusion 

in their role in the claims process as it relates to veterans, VA and Veterans Service 

Organizations. While we cannot support the bill as written, we would be happy to 

work with Senator Cassidy and his staff on ways to improve congressional offices’ 

ability to provide veteran constituents with more timely responses. 

Chairman Isakson, Ranking Member Blumenthal, and Members of the Committee, once again, we thank you for the opportunity to submit our views on these 

important bills. 

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PREPARED STATEMENT OF KEITH KIEFER, DIRECTOR AT LARGE, NAAV MINNESOTA

STATE CO-COMMANDER & ENEWETAK RADIOLOGICAL CLEANUP VETERAN (1978), 

NATIONAL ASSOCIATION OF ATOMIC VETERANS


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PREPARED STATEMENT OF NATIONAL ALLIANCE ON MENTAL ILLNESS


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PREPARED STATEMENT OF JOSEPH W. WESCOTT II, LEGISLATIVE DIRECTOR, NATIONAL

ASSOCIATION OF STATE APPROVING AGENCIES

Chairman Isakson, Ranking Member Blumenthal, and Members of the Committee: The National Association of State Approving Agencies (NASAA) is pleased 

to provide its views on certain education benefits legislation under consideration by 

the Committee today, June 29, 2016, particularly S. 3021. 

NASAA does not receive any grants or contracts directly from the Federal Government, though its member organizations are state agencies operating in whole or in 

part under Federal contracts funded by Congress and administered by the Department of Veterans Affairs (VA). 


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On behalf of fifty-five SAAs in 49 states and the territory of Puerto Rico, NASAA 

thanks the Senate Committee on Veterans Affairs for its strong commitment to a 

better future for all servicemembers, veterans and their families through its continued support of the GI Bill® educational program. 

S. 3021, A BILL TO AUTHORIZE THE USE OF POST-9/11 EDUCATIONAL ASSISTANCE TO PURSUE INDEPENDENT STUDY PROGRAMS AT CERTAIN EDUCATIONAL INSTITUTIONS THAT

ARE NOT INSTITUTIONS OF HIGHER LEARNING

State approving agencies take seriously our role as ‘‘the gatekeepers of quality’’ 

and the ‘‘boots on the ground’’ defending the integrity of the GI Bill and making 

sure that only quality programs are approved by applying Federal and state law and 

regulation. An additional and equally important role is the continued oversight of 

these programs after their initial approval. We do so in conjunction with other 

stakeholders in veteran and higher education, including state licensing agencies, 

state higher education departments, the Department of Veterans Affairs, the Department of Education and national and regional accrediting agencies. 

Congress, in establishing the laws and regulations governing the manner and 

method by which education could be approved for veterans, wisely provided that 

Non College Degree training could be delivered by way of independent study (online education) only when affiliated with or provided by an accredited institution of 

higher learning (IHL). Certainly, in view of the uncertain quality of distance learning in the early years of its development, it made sense to make sure that regionally 

accredited IHLs were the only places that online NCD training would be approved. 

This also recognized the fact that many unaccredited NCD programs are offered in 

a clock-hour as opposed to a credit hour format and as such, it is virtually impossible to ensure that veterans met approved program attendance standards outside 

of the classroom. 

S. 3021 seeks to expand Post-911 GI Bill to provide for the approval of independent study programs at certain educational institutions that are not institutions 

of higher learning, namely stand-alone NCD granting institutions. Though this bill 

does include language to restrict the extent of this expansion somewhat, some of 

that language could be problematical. As this is a radical departure from the inherent safeguard provided in the code of disallowing the approval of ‘‘any independent 

study program except an accredited independent study program (including open circuit television) leading (A) to a standard college degree, or (B) to a certificate that 

reflects educational attainment offered by an institution of higher learning,’’ NASAA 

cannot support this legislation. However, we would not oppose it as long as the following concerns are addressed. 

First, as regards proposed subsection (C)(ii): The definition of a ‘‘postsecondary vocational institution’’ as defined in the Higher Education Act, does seem to contain 

adequate parameters to protect the integrity of the GI Bill. The institution must be 

limited to high school graduates or equivalent; authorized by the State to offer the 

program; is public or nonprofit; and is accredited by a nationally recognized accrediting agency or granted preaccreditation status by an agency authorized to grant 

such status. This definition would seem to bar predatory institutions providing 

training of questionable quality which might or might not lead to a job or career 

from seeking approval. 

However, NASAA is concerned that proposed subsection (C)(i) is problematical. If 

you solely look at the definition that is cited, the Perkins Act limits the institutions 

covered to public and nonprofit institutions, but it does not require that the institutions be accredited, nor does it require that the institution be authorized by the 

State. So, upon reviewing the definition that the proposed language cites, the 

schools might not be required to have a license to operate. Also, although the leadin provision in 3680A(4) requires the independent study program to be accredited, 

there is nothing that requires the accrediting agency for career and technical education schools to be nationally or regionally recognized, as, unlike the definition of 

a ‘‘postsecondary vocational institution,’’ the definition of an ‘‘area career and technical education school’’ does not mention accreditation. Therefore, as the proposed 

language currently stands, an area career and technical education school could be 

accredited by an unrecognized accrediting entity, and still be able to qualify for the 

GI Bill. Finally, the Perkins Act definition of ‘‘career and technical education’’ includes entrepreneurship, which, as you’ll recall, is currently restricted under the GI 

Bill when the program is a non-degree program. 

We would also seek to point out to the Committee that though we would not expect that a large number of proprietary schools would rush to become non-profits 

accredited by unrecognized accrediting entities, some predatory institutions might 

seek to do so in order to fit into the otherwise broad definition of an ‘‘area career 

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and technical education school.’’ Also, some institutions might seek to provide programs of questionable quality under contract with institutions granted access under 

this proposed legislation. For these and other reasons cited above, NASAA respectfully requests that the language of this bill be changed so that only NCD institutions that are either public or not-for-profit institutions AND are accredited by a nationally recognized accredited agency be allowed to seek approval. 

Finally, we would respectfully remind the Committee that even with the passage 

of this legislation, it is important to note that programs would still have to meet 

appropriate statutory approval criteria in order for an SAA to grant approval. We 

are concerned that some CTE programs do not maintain appropriate standards of 

academic progress and that in other cases some CTE programs could not be approved as they are self-paced without any fixed limitation as to how long a student 

takes to complete the program. Given our very generous housing allowance under 

the Post-9/11 GI Bill, such policies would provide a disincentive for students to complete such a program in a reasonable time. 

Today, SAAs throughout our Nation, composed of approximately 175 professional 

and support personnel, are supervising over 10,000 active facilities with 100,000 

programs. We pledge to you that we will not fail in our critical mission and in our 

commitment to safeguard the public trust, to protect the GI Bill and to defend the 

future of those who have so nobly defended us. 

Mr. Chairman, NASAA thanks the Committee for the opportunity to share our 

concerns and suggestions and we commit to working together with you and your 

staff to enhance the pending legislation. 

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LETTER FROM TERISA E. CHAW, EXECUTIVE DIRECTOR, NATIONAL EMPLOYMENT

LAWYERS ASSOCIATION


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PREPARED STATEMENT OF THE NATIONAL GUARD ASSOCIATION

OF THE UNITED STATES

Dear Chairman Isakson and Ranking Member Blumenthal and other distinguished Senators of the Veterans Committee: On behalf of the almost 45,000 members of the National Guard Association of the United States and the nearly 500,000 

soldiers and airmen of the National Guard, we deeply appreciate this opportunity 

to share with you our thoughts on today’s hearing topics for the record. We also 

thank you for the tireless oversight you have provided to ensure accountability and 

improve our Nation’s services to veterans and their families. 

Today’s slate of bills under consideration bears witness to the importance of continuing reforms that improve choice, access and standard of care to our Nation’s veteran population. In our testimony to the Committee in March, we have provided our 

views on some of these bills, so this testimony will focus on those bills that are specifically focused on veterans within the National Guard, as requested. 

Since 9/11, National Guardsmen have mobilized roughly 780,000 times in support 

of the Nation’s national security objectives abroad, creating possibly the largest 

number of National Guard veterans since World War II. 

The vast majority of these deployments involve members of the Guard who also 

have civilian or government employers making the Veterans’ Reemployment Rights 

statute and the Uniformed Services Employment and Reemployment Rights Act of 

1994 two of the most important laws protecting the National Guard members who 

step away from their jobs to serve their country. Under USERRA, all uniformed servicemembers are protected within their civilian employment. Guard members may 

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ing training or deployment. USERRA establishes a right to prompt reinstatement 

after service and ensures certain health care benefits during and after. 

At NGAUS, we receive calls from our members asking about their civilian employment rights as well as from citizens considering enlisting in the National Guard. 

USERRA enforcement offices of the Department of Labor and the Office of Special 

Counsel receive tens of thousands of calls annually asking for assistance. The National Guard is also heavily reliant on Employer Support for the Guard and Reserve 

(ESGR), a Department of Defense program established in 1972 to promote cooperation and understanding between reserve-component servicemembers and their civilian employers and to assist in the resolution of conflicts arising from an employee’s 

military commitment. Many employers have rightfully received awards for their 

commitment to their National Guard employees, but there are still many instances 

where lack of understanding has caused problems. 

We strongly support Senator Blumenthal’s efforts under S. 3042, legislation that 

will clarify in law the procedural rights of Guard members within USERRA. Unfortunately, current USERRA language surrounding forced arbitration is not clear, and 

there are conflicting court decisions that do not always protect Guard members’ procedural rights. NGAUS asks you champion changes in law to clarify congressional 

intent, stop misinterpretations, protect our Guard members and grant them due 

process in these workplace circumstances. 

NGAUS also strongly supports Senator Tester’s bill, S. 832 to amend Title 10, 

United States Code, to authorize the provision of behavioral-health readiness services to certain members of the Selected Reserve of the Armed Forces based on need 

and to expand eligibility to such members for readjustment counseling from the Department of Veterans Affairs. 

Guardsmen and Reservists struggle to access the same care as their active-component counterparts because they often live far from military installations. Additionally, outreach efforts to address mental-health conditions may not always reach 

those in need. The suicide rate for members of the National Guard and Reserve is 

consistently much higher than the rate for civilians and the rate for active-duty 

military as a result. Currently, members of the National Guard and Reserves undergo annual health assessments to identify medical issues that could impact their ability to deploy, but any follow-up care is often pursued at their own expense. Senator 

Tester’s legislation would allow Guardsmen and Reservists to access Vet Centers for 

mental-health screening and counseling, employment assessments, education training, and other services to help them. 

We strongly urge you to champion language that will address the military’s highest suicide rates...those men and women in the National Guard who have never 

deployed, yet stand ready and trained to serve when called. 

Although today this Committee is only considering part of Senator Tester’s bill, 

NGAUS strongly supports the entire bill. 

Thank you again, Chairman Isakson and Ranking Member Blumenthal, for allowing NGAUS to submit testimony for this hearing, and for your interest and commitment to the members of the National Guard. 

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PREPARED STATEMENT OF HON. CAROLYN N. LERNER, SPECIAL COUNSEL, 

U.S. OFFICE OF SPECIAL COUNSEL


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PREPARED STATEMENT OF PARALYZED VETERANS OF AMERICA

Chairman Isakson, Ranking Member Blumenthal, and Members of the Committee, on behalf of Paralyzed Veterans of America (PVA), we would like to thank 

you for the opportunity to submit our views on pending legislation before the Committee. 

S. 244

PVA recognizes that the effects of Traumatic Brain Injuries (TBI) are under-studied, and there is a significant need with the current population of veterans for care 

and treatment. This bill seeks to ensure that when veterans submit disability claims 

related to TBI, VA is using the appropriate personnel and protocols to conduct the 

examinations. This measure is a common sense step toward ensuring veterans with 

TBI receive a fair analysis of their disability claim. 

Unfortunately, if implemented, this bill will likely be prevented from reaching its 

full potential because of current VA practices. Too often we see doctors doing Compensation and Pension exams outside of their practice area. For example, a claimant 

might have a podiatrist conduct an exam for a vascular disease, and this exam in 

turn forms the basis of his or her disability claim. Sometimes, an appropriate specialist is simply not available to provide an opinion, but more often it is because 

VA is inundated with the backlog of claims and appeals which creates an overwhelming incentive to complete as many exams as possible rather than ensure the 

right type of doctor is conducting the exam. Naturally, claims appeals based on 

faulty exams are an outcropping of this policy failure, and until issues like these 

are addressed we will continue to struggle to fix the bigger problems, such as appeals reform, that pervade VA. 

S. 603, ‘‘THE RURAL VETERANS TRAVEL ENHANCEMENT ACT OF 2015’’ 

PVA supports S. 603, the ‘‘Rural Veterans Travel Enhancement Act of 2015,’’ a 

bill that would increase access to transportation options for veterans with disabilities who need vocational rehabilitation, counseling, and medical care from the Department of Veterans Affairs. This legislation includes three important components. 

First, it would make permanent the Secretary’s authority to transport veterans to 

and from VA facilities. Second, it would make veterans who use the services provided by Vet Centers eligible for beneficiary travel. Finally, it would extend the authorization for grants to veterans service organizations and state departments of 

veterans’ affairs for transporting veterans in highly rural areas. 

Paralyzed Veterans supports extension of VA’s authority to transport veterans to 

and from VA facilities as these services are critical for veterans who have mobility 

impairments and benefit from the accessible transportation options available 

through VA. We also support allowing veterans to access needed financial assistance 

to help them benefit from the services provided through Vet Centers. Without this 

assistance, some veterans may be forced to forgo this important resource. Last, we 

also support the extension of the Highly Rural Transportation Grants. These grants 

provide additional transportation options for veterans with disabilities who live in 

hard to reach areas, particularly those with mobility impairments, because all vehicles must operate under Department of Transportation standards for accessibility 

under the Americans with Disabilities Act. 

S. 2210, THE ‘‘VETERAN PEER ACT’’ 

PVA supports S. 2210, the ‘‘Veterans Partners’ Efforts to Enhance Reintegration 

(PEER) Act.’’ This bill would carry out a program to establish peer specialists in patient aligned care teams (PACTs) at VA polytrauma and rural medical centers. The 

effectiveness of the peer support model has been an overall success. These specialists help veterans access mental health services, navigate the healthcare system, 

and perhaps most importantly, they offer familiarity and acceptance to veterans 

who may find those experiences lacking. While the stigma surrounding mental 

health care is declining, for older veterans it can remain a firm barrier to care. In 

the wake of the jarring statistic that veterans over 50 are committing suicide in 

greater numbers than the post-9/11 generation, this bill is aptly timed, and necessary. 

S. 2279, THE ‘‘VETERANS HEALTH CARE STAFFING IMPROVEMENT ACT’’ 

PVA supports S. 2279, the ‘‘Veterans Health Care Staffing Improvement Act.’’ 

This bill would carry out a program to allow servicemembers who have served in 

medical roles to transition directly into the VA. By rapidly absorbing qualified, experienced health care providers, this bill could ease some of the strains on VA’s hiring 

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process. VA would be entitled to a list of recently separated servicemembers who 

have served in a health care capacity, allowing them direct access to recruit in a 

more expeditious hiring process. Further, it would allow for Advanced Practice Registered Nurses and Physicians Assistants to provide a wider range of health care, 

through full practice authority, based on the scope of practice recommended by the 

appropriate professional organizations. This in turn, would help expand care in 

rural areas. 

S. 2316

S. 2316 would make changes to the Department of Veterans Affairs’ fiduciary program by requiring the Secretary to reissue or promptly remit as recouped to beneficiaries any benefits misused by their fiduciaries in a broader range of situations 

than currently required under the statute. According to the VA’s Office of Inspector 

General’s August 27, 2015, report titled ‘‘Audit of Fiduciary Program Controls Addressing Beneficiary Fund Misuse,’’ in 16 of 16 cases reviewed, fiduciary hubs failed 

to restore approximately $347,000 of misused funds to beneficiaries. Some of the 

delay in restoring those funds appears to have been due to misunderstanding when 

a determination of negligence is currently required prior to reissuance. In all of 

those cases, a negligence determination was not required. We hope that simplifying 

the requirement for reissuing benefits to all beneficiaries when those funds are misused, without requiring a negligence determination in certain cases, will lead to 

prompt restoration of needed financial resources for these beneficiaries. This legislation would also provide increased access to the financial records of fiduciaries in an 

effort to improve oversight of the use of beneficiary’s funds. Overall, these changes 

would likely be helpful to beneficiaries who have been harmed due to the actions 

of their fiduciaries. 

S. 2791, THE ‘‘ATOMIC VETERANS HEALTH CARE PARITY ACT’’ 

While PVA has no formal position on this issue, we believe that this a clearly reasonable proposal. Over the years, significant numbers of veterans have been denied 

access to VA health care and benefits due to participation in highly classified and 

secret activities. Atomic testing and subsequent clean-up activities are no exception. 

These veterans should be afforded access necessary health care and benefits as a 

result of their service. Denying these men this opportunity simply because the Department of Defense would never admit to these secret activities at atomic sites is 

morally unjust. 

S. 2958

PVA generally supports this proposed bill. Late last year, PVA, along with our 

partners in The Independent Budget—DAV and VFW—provided a framework for 

veterans health care reform that included a recommendation that Congress and the 

Administration consider the development of public-private partnerships to improve 

and expedite the process for major medical facility construction. It is a well-established fact that the process for designing and building new facilities currently takes 

far too long to complete. By leveraging public-private partnerships, VA can align its 

already limited capital infrastructure dollars to ensure adequate services are provided in given locations while allowing the efficiency of private sector capital planning and building to position the VA to actually provide those services. Ultimately, 

public-private partnerships will allow VA to bring new health care facilities online 

faster thereby assuring faster access to critically needed services. 

S. 3021

PVA supports this legislation. Not all military members wish to pursue a standard college degree when they leave service. Career and Technical Education (CTE) 

at area career and technical centers comprise an important part of our education 

system. Credential-granting programs offered at these institutions span across 

many industries, from health care to information technology, and provide a solid 

pathway to employment for many of our veterans. 

S. 3023, ‘‘THE ARLA HARRELL ACT’’ 

PVA supports the ‘‘Arla Harrell Act.’’ Veterans who have for so long quietly suffered the effects of Mustard Gas or Lewisite exposure as a result of Department of 

Defense testing deserve to receive critically need care from the VA. Senator 

McCaskill’s report indicates that the number of servicemembers exposed numbers 

around 4,000, and yet only 610 have been identified. Currently, only 40 veterans 

have successfully filed claims and are receiving related benefits. The fact that only 

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1 percent of the veterans exposed are receiving benefits is attributed to the 90 percent rejection rate of claims. Shifting the burden of proof relating to events that occurred so long ago from the veteran to VA is an appropriate and deserved step toward rectifying the failure to fully identify this population and ensure they are receiving their earned benefits. We would also note that with a new presumption 

comes increased stress on VA resources. It is imperative that Congress ensure resources are appropriately adjusted to prevent VA from having to rob Peter to pay 

Paul. 

S. 3032, THE ‘‘VETERANS’ COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 2016’’ 

PVA supports S. 3032, the ‘‘Veterans’ Compensation Cost-of-Living Adjustment 

(COLA) Act of 2016,’’ which would increase, effective as of December 1, 2016, the 

rates of compensation for veterans with service-connected disabilities and the rates 

of dependency and indemnity compensation (DIC) for the survivors of certain disabled veterans. This would include increases in wartime disability compensation, 

additional compensation for dependents, clothing allowance, and dependency and indemnity compensation for children. 

S. 3035, THE ‘‘MAXIMIZING EFFICIENCY AND IMPROVING ACCESS TO PROVIDERS AT THE

DEPARTMENT OF VETERANS AFFAIRS ACT OF 2016’’ 

PVA supports S. 3035, the ‘‘Maximizing Efficiency and Improving Access to Providers at the Department of Veterans Affairs Act of 2016.’’ This legislation would 

allow for a pilot program to increase the use of medical scribes to maximize the efficiency of physicians at medical facilities of the Department of Veterans Affairs. A 

medical scribe helps to decrease the burden of data entry on the part of the medical 

provider. They accompany a provider to document the physician-patient interaction, 

and enter it into the Electronic Health Record (EHR) at that time. The physician 

later reviews and approves the data entry. This dynamic allows for the physician 

to spend more uninterrupted time interacting with the patient, and less time dictating notes. Multiple studies have indicated that medical scribes increase physician-patient satisfaction. Further, because the physician is relieved of data entry, 

they are able to see more patients, thus impacting wait times. We see no reason 

why VA would should not avail themselves of this pilot program. In a time when 

VHA is struggling to hire and retain physicians, allowing for medical scribes to help 

existing providers carry the patient volume is essential. 

S. 3055, THE ‘‘DEPARTMENT OF VETERANS AFFAIRS DENTAL INSURANCE

REAUTHORIZATION ACT OF 2016’’ 

PVA supports S. 3055, the ‘‘Department of Veterans Affairs Dental Insurance Reauthorization Act of 2016.’’ This bill would reauthorize the VA administered dental 

insurance program for five years, allowing current users to maintain their care. The 

original pilot program began in 2014 and will expire in 2017 without action. While 

PVA previously expressed concerns about the cost of the program, and the role of 

VA as insurer, the success of the program is unquestionable. Veterans and their 

families markedly agree that the care is high quality and low cost. As researchers 

are beginning to more clearly identify the links between dental care and overall 

care, particularly cardiac care, this program can only be considered a sound investment into the lifelong well-being of veterans and their families. 

S. 3076, THE ‘‘CHARLES DUNCAN BURIED WITH HONOR ACT OF 2016’’ 

PVA supports this draft bill to furnish caskets and urns for burial in cemeteries 

of States and Indian tribes of veterans without next of kin or sufficient resources. 

Currently, veterans without next of kin or sufficient resources who are buried in 

state of tribal cemeteries are not furnished a casket or urn. These veterans buried 

in state and tribal cemetery are no less deserving of a dignified resting place than 

those in a national cemetery. This bill is, without question, the decent thing to do. 

S. 3081, THE ‘‘WINGMAN ACT’’ 

PVA supports the goal of ensuring veterans receive timely information regarding 

the status of their claims. We appreciate that this bill ensures that Congressional 

employees granted access to such a program undergo the same training and certification program that VA currently uses to certify VSO representatives and attorneys 

representing claimants. This legislation, however, allows access to a claimant’s information regardless of whether the covered employees are acting under a power of 

attorney. Claims files contain the most private information about that particular 

veteran and, often times, information of other individuals consulted during the 

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1Gilmer v. Interstate/Johnson Lane Corp., 500 U.S. 20, 23 (1991) (citing Moses H. Cone Memorial Hospital v. Mercury Construction Corp., 460 U.S. 1, 24 (1983)). 2See Garrett v. Circuit City Stores, Inc., 449 F.3d 672 (5th Cir. 2006) and Landis v. Pinnacle 

EyeCare, LLC, 537 F.3d 559 (6th Cir. 2008). 3Mitsubishi Motors Corp. v. Soler Chrysler-Plymouth, Inc., 473 U.S. 614, 626–27 (1985). 

claim’s development. PVA believes that in the interest of maintaining strict protection of such private information, this legislation should be limited to those who hold 

a power of attorney. Other logistical issues may also arise in the form of the added 

administrative burden on VA of managing the certification process and tracking 

users. Certainly we do not want to see resources that should be applied to adjudicating claims shifted to facilitating Congressional involvement unless it produces a 

significant increase in productivity. Finally, we believe that VSO national service officers and VBA employees are best suited to answering questions regarding a claimant’s file. Unlike a Congressional aide viewing the file in isolation, they have the 

ability to view the file in context and identify the issues holding up the claim. 

DISCUSSION DRAFT, ‘‘USERRA’’ 

PVA supports strengthening the Uniformed Services Employment and Reemployment Rights Act (USERRA). The Supreme Court of the United States has firmly established a ‘‘liberal policy of favoring arbitration agreements.’’ 1 Courts of inferior jurisdiction have examined servicemembers’ employment and reemployment rights 

under USERRA and determined that the forum in which a claim is adjudicated is 

a procedural consideration.2 Case law holds that whether the claim is adjudicated 

through arbitration or the U.S. District Courts has no bearing on the substantive 

statutory rights meant to be protected. While the Courts are free to believe enforcement of substantive rights is equally effected by arbitration and the courts, the servicemember may not be so persuaded and should be free to determine his forum. 

One might argue that a servicemember exercised a choice by waiving his or her 

right to avail themselves of the court when they signed the arbitration clause. But 

this implies that job prospects are elastic to the extent that employees hold a bargaining position strong enough to reject a job solely on the basis of that clause. More 

and more employers are beginning to require arbitration clauses as conditions of 

employment. Current employment conditions effectively make that choice for the 

servicemember; few, if any, walk away from a job on this basis. As this pattern 

evolves, the servicemember is slowly being stripped of his or her choice to employ 

the court system. To put the choice back in the hands of the servicemember, Congress must specifically indicate its intent to preclude a waiver of judicial remedies 

for the statutory rights at issue.3 This bill would accomplish this by rendering arbitration agreements enforceable only after a complaint has been filed in court. There 

is an additional threshold requirement of the parties making a knowing and voluntary decision. We also support the additional touch of expanding the venue options to be more in line with those applied in the Federal Rules of Civil Procedure. 

DISCUSSION DRAFT, ‘‘TO EXPAND ELIGIBILITY TO CERTAIN MEMBERS OF THE SELECTED

RESERVE OF THE ARMED FORCES FOR READJUSTMENT COUNSELING FROM THE DE- PARTMENT OF VETERANS AFFAIRS.’’ 

While we appreciate the intent of this bill, PVA has concerns with this legislation 

as written because it extends the intended benefits to any and all members of the 

Selected Reserve but does not equally include veterans who served on active duty. 

The current law under 38 U.S.C. 1712A provides certain mental health services to 

delineated groups of veterans or members of the Armed Forces, including a reserve 

component of the Armed Forces. To qualify for these services, individuals must meet 

one of the listed qualifications, such as deploying to a theatre of combat operations 

or participating in mortuary services to casualties of combat operations. In essence, 

current law requires a triggering event or circumstance which demonstrates a nexus 

between the servicemember or veteran’s mental health condition and their military 

service. This bill would allow Selected Reserve members to avoid this requirement 

while still subjecting those who served on active duty to the existing requirements. 

DRAFT BILL ON MEDICAL RESIDENTS AT FACILITIES OPERATED BY TRIBES

PVA supports the draft bill to authorize payment by the Department of Veterans 

Affairs for the costs associated with service by medical residents and interns at facilities operated by Indian tribes and tribal organizations, and to carry out a pilot 

program to expand such residencies and internships at those facilities. While recruiting and retaining capable providers continues to be a struggle for VA, rural 

communities feel these vacancies two fold. In Indian Country particularly, the miniVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00205 Fmt 6601 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
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mal availability of consistent high quality health care has resulted in some of the 

worst health care outcomes in the United States. The United States government has 

a centuries-old legal obligation to provide health care to two groups—Native Americans and veterans. The overlapping, and at times inter-reliability of these two systems is necessary, as Native Americans serve the Armed Forces at the highest rate 

of any demographic. In Alaska, where this health care system interoperability is 

most prevalent, the need for primary care providers is critical. Vacancies are expected to increase in the coming decade, leaving health care systems with a high 

volume need and little capacity. 

This bill would likely provide some relief, by incentivizing medical residents and 

interns to work at tribal facilities that have existing reimbursement agreements 

with VA. The five-year pilot program would have VA reimburse the tribal facilities 

for the recruitment and training of residents. These participants would then be eligible for loan forgiveness through the Indian Health Services Loan Repayment Program. This bill offers a sound step forward to ensuring we meet the needs of those 

who have served, no matter their zip code. 

DISCUSSION DRAFT ON AMERICAN BATTLE MONUMENTS COMMISSION

PVA has no formal position on this issue. 

This concludes our statement for the record. We appreciate the opportunity to 

submit our views before this Committee. 

PREPARED STATEMENT OF RESERVE OFFICERS ASSOCIATION OF THE UNITED STATES

STATEMENT

ROA appreciates the opportunity to discuss S. 3042, Justice for Servicemembers 

Act, which is proposed legislation to clarify the scope of procedural rights of members of the uniformed services with respect to their employment and reemployment 

rights, to improve the enforcement of such employment and reemployment rights, 

and for other purposes. 

The Justice for Servicemembers Act would amend section 4302 by adding a new 

subsection (c) to the Uniformed Services Employment and Reemployment Rights Act 

(USERRA), as follows: 

(1) Pursuant to this section and the procedural rights afforded by Subchapter III of this chapter [USERRA], any agreement to arbitrate a claim 

under this chapter is unenforceable, unless all parties consent to arbitration 

after a complaint on the specific claim has been filed in court or with the 

Merit Systems Protection Board and all parties knowingly and voluntarily 

consent to have that particular claim subjected to arbitration. 

(2) For purposes of this subsection, consent shall not be considered voluntary when a person is required to agree to arbitrate an action, complaint, 

or claim alleging a violation of this chapter as a condition of future or continued employment or receipt of any right or benefit of employment. 

USERRA

Section 4302 makes it clear that USERRA is a floor and not a ceiling on 

serevicemember’s rights as a person who is serving or has served. USERRA does 

not supersede or nullify any other law, policy, agreement, practice, or other matter 

that gives greater or additional rights. 38 U.S.C. 4302(a). 

Section 4302(a) of USERRA provides: 

Nothing in this chapter [USERRA] shall supersede, nullify, or diminish any 

Federal or State law (including any local law or ordinance), contract, agreement, policy, plan, practice, or other matter that establishes a right or benefit that is more beneficial to, or is in addition to, a right or benefit provided for such person in this chapter. 

USERRA does supersede state laws, contracts, policies, agreements, etc. that reduce, limit, or eliminate USERRA rights or that impose additional prerequisites on 

a servicemember’s exercise of those rights. 38 U.S.C. 4302(b). 

Section 4302(b) provides: 

This chapter supersedes any State law (including any local law or ordinance) contract, agreement, policy, plan, practice, or other matter that reduces, limits, or eliminates in any manner any right or benefit provided by 

this chapter, including the establishment of additional prerequisites to the 

exercise of any such right or the enjoyment of any such benefit. 

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Despite section 4302(b), both the 5th Circuit and the 6th Circuit have held that 

USERRA does not override employer-employee agreements that purport to bind employees to submit future disputes about USERRA rights to binding arbitration, in 

lieu of filing suit or filing a formal complaint with the Veterans’ Employment and 

Training Service of the United States Department of Labor (DOL-VETS). See Garrett v. Circuit City Stores, Inc., 449 F.3d 672 (5th Cir. 2006) and Landis v. Pinnacle 

Eye Care LLC, 537 F.3d 559 (6th Cir. 2008). 

ROA member, and USERRA drafter, Mr. Samuel F. Wright explains, ‘‘Employers 

can make a mockery of USERRA by demanding that individuals agree to binding 

arbitration as a condition of initial employment or continued employment. S. 3042 

is necessary to ensure effective enforcement of USERRA.’’ 

BINDING ARBITRATION

Arbitration is defined as, ‘‘The settling of disputes (especially labor disputes) between two parties by an impartial third party, whose decision the contending parties agree to accept. Arbitration is often used to resolve conflict diplomatically to 

prevent a more serious confrontation,’’ as defined by dictionary.com. In and of itself 

this is not a bad thing. There are times when the problem between employee and 

employer does not rise to the level or complexity requiring court review. 

The problem is that binding arbitration takes away the employee’s choice to pursue the level of resolution they consider necessary with their employment. If an employee believes his or her case should be reviewed by the courts and he or she is 

willing to accept the time, cost, and complexity of this legal review that should be 

the employee’s choice. If an employee believes the case is not complicated but believes an independent person or body should settle the dispute, then arbitration 

should also be a choice. 

What is not right is when employees do not have a choice on resolution of future 

employment issues based on a boiler plate provision in an agreement he or she was 

required to sign as a condition of employment; especially as these decisions affect 

his or her ability to provide for their family. 

The Bill of Rights includes the right to ‘‘life, liberty and the pursuit of happiness.’’ 

In the decision of S. 3042, we should be reminded that liberty requires that no one 

can rule citizens without consent—each of us, whether as individuals or as companies, should respect the equal rights of others. 

RESERVE COMPONENT PARTICIPATION

During the present war, nearly a million Guard and Reserve members have been 

mobilized, proving essential to the war effort. The reliance of the Nation on its Reserve Components will not diminish. 

Since September 11, 2001, more than 900,000 members of our reserve components—the National Guard and Reserves of our Army, Navy, Air Force, Marines 

and Coast Guard—have served in support of the war on terrorism. According to 

DOD more than 10,000 Guard and Reserve members were casualties in that fight. 

https://www.dmdc.osd.mil/dcas/pages/report—sum—comp.xhtml 

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‘‘War is a national challenge, and, for our part, we cannot execute without the 

Guard and the Reserve,’’ said Army Chief of Staff Gen. Mark Milley. ‘‘You can’t talk 

to a general or admiral for more than five minutes without hearing a variation on 

that theme,’’ according to ROA Executive Director, Jeff Phillips. 

The chart below shows that the Guard and Reserve have been used in increasingly higher amounts per year. While usage is dropping it will not go down to previous peacetime levels because threats to the Nation and world have increased. 

Usage of the Reserve Components 

Fiscal Year Man-Days 

Per Year 

1986-1989 .......................... 1 million 

1996-2001 .......................... 13 million 

2002 ................................... 41.3 million 

2005 ................................... 68.3 million 

2012 ................................... 25.8 million 

Data from the Office of the Assistant Secretary of Defense for Reserve Affairs (OASD/RA). 

The reserves are now considered ‘‘operational.’’ They are used continually, like the 

active force. In the late 1980s, usage of the reserves was 1 million man-days per 

year; it is now about 25 million man-days. 

Guard and Reserve members will continue to face employment issues as they support increased operational levels. They should not be penalized for serving their nation by being forced into binding arbitration. 

CONCLUSION

The Reserve Officers Association supports the enactment of S. 3042 which would 

make clear that the individual servicemember cannot be forced to submit his or her 

USERRA complaint to binding arbitration. The matter of using arbitration or not 

should remain the employee’s option. The choice should be made when a dispute has 

arisen—not 10 years earlier when the servicemember is hired or rehired. 


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PREPARED STATEMENT OF SOUTHCENTRAL FOUNDATION

Chairman Isakson, Ranking Member Blumenthal, and Members of the Committee: Thank you for the opportunity to submit testimony on behalf of the 

Southcentral Foundation (‘‘SCF’’) Thank you also to Senator Sullivan, for championing legislation today that will help SCF make important progress toward bridging the provider gap in isolated geographic communities and helping the next generation of doctors learn the holistic, customer-centered, and relationship-based systems of care we believe are vital to high-quality healthcare in our communities. 

BACKGROUND

SCF is an Alaska Native owned and governed tribal health organization in Anchorage, Alaska. We provide medical, dental, optometry, a range of maternal child 

health services, behavioral health, and substance abuse treatment services to over 

52,000 Alaska Native and American Indian beneficiaries living within the Municipality of Anchorage, the Matanuska-Susitna Borough to the north, and nearby villages. SCF also provides services to an additional 13,000 residents of 55 rural Alaska villages covering an area exceeding 100,000 square miles, extending from near 

the Canadian border in the east to the Pribilof Islands in the west. Finally, SCF 

provides statewide tertiary OB/GYN and pediatric services for approximately 

150,000 Alaska Native people. We also co-manage the Alaska Native Medical Center, a 167 bed hospital, which is the tertiary care referral point for all IHS facilities 

in the state. We employ over 1900 people to do this work. 

SCF’s Nuka System of Care is a name given to the whole health care system created, managed and owned by Alaska Native people to achieve physical, mental, 

emotional and spiritual wellness. This relationship-based Nuka System of Care is 

comprised of organizational strategies and medical, behavioral, dental, and traditional practices processes and supporting infrastructure that work together—in relationship—to support wellness. By putting relationships at the forefront of what we 

do we and how we do it, the Nuka System of Care will continue to develop and improve healthcare delivery for future generations. 

Our Nuka System of Care is acclaimed nationally and internationally for its numerous innovative practices including: same day access to an individual’s own primary care provider; patient-centered medical home services that have received the 

highest level of certification; and provision of primary care through interprofessional 

teams that include behavioral health, health education, and pharmacy consultants. 

In 2011, we received the National Malcolm Baldrige Award for Performance Excellence from the United States Department of Commerce. SCF is the only Native organization to ever be honored with this distinction, and one of only about 20 United 

States healthcare organizations of any type to receive this difficult-to-achieve award. 

DISCUSSION

The Veterans’ Administration (‘‘VA’’) medical residency legislation being discussed 

today is intended to address several interlocking issues. In general, providing quality healthcare for veterans in rural areas is challenging for a number of reasons, 

but central to the issue is the lack of physicians. This legislation would increase the 

number of primary care physicians serving rural and remote areas by adding a new 

section to the existing provisions found in 38 U.S.C. § 7406 authorizing a pilot program that would make specific tribal health care providers eligible to work with the 

VA to expand or create new medical residency programs. The bill would allow nonVA facilities to access this critical funding and allow for additional expenses. SCF 

supports this effort and this legislation because we understand the need for more— 

and better trained—physicians to serve the veterans in the communities we serve, 

and communities like it. 

As this Committee well knows, the Nation is facing a shortage of primary care 

physicians, and this gap is exacerbated throughout rural Alaska. This shortage exists nationally, and is likely to increase over time. According to the Department of 

Health and Human Services, if changes do not occur to meet the physician demand, 

reports indicate a projected shortage by 2020 of 20,400 physicians. The Association 

of American Medical Colleges predicts a shortage of 12,500–31,100 primary care 

physicians by 2025. This provider shortage is likely to hit hardest in places like 

Alaska and Native American communities that are already struggling to attract primary care and other physicians to practice. In Alaska, for example, there will need 

to be a 40% increase in the total number of primary care physicians, an increase 

of 237 positions, by 2030. 

One of the single most effective ways to increase the number of physicians practicing in our communities would be to train them in our communities. This legislaVerDate Mar 15 2010 14:18 Jan 02, 2018 Jkt 000000 PO 00000 Frm 00209 Fmt 6601 Sfmt 6621 Z:\ACTIVE\062916.TXT PAULIN
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tion provides VA the authority to do just that. The VA system is uniquely situated 

to partner with Native American community healthcare providers because medical 

residents who train in these programs will help reduce this provider gap by serving 

multiple, overlapping underserved communities to whom the country has significant 

healthcare obligations: veterans and Native Americans. In addition, studies show 

that doctors who train in certain communities are more likely to stay, and we are 

confident that the opportunity to train directly in the Nuka System of Care both 

will not only increase the number of physicians who are likely to practice in rural 

and Native American communities, but will also enhance the quality of care they 

will be providing to veterans and other patients throughout their careers. 

Through the Nuka System of Care, SCF has been able to decrease the per-capita 

use of the Emergency Department by over 36% between 2000 and 2015. In addition: 

• SCF’s diabetes management measures put SCF among the top 5% of health 

care organizations in the country; 

• SCF ranks in the top 10% for per-capita use of the Emergency Department and 

hospital admissions measures; 

• SCF’s customer-owner satisfaction ratings consistently are 96–99% positive, 

well above the average compared to other health care organizations; 

• SCF’s total employee turnover is one quarter of earlier levels, and is now in the 

top 25% nationally, despite SCF’s difficult location for recruiting and retention; 

• SCF’s Alaska Native Medical Center received magnet status in 2011 for nursing 

excellence, an honor bestowed only to 5 percent of hospitals, nationally; and 

• SCF has had a Level III certified Patient Centered Medical Home since 2009. 

Despite these successes, workforce development is one of the major challenges 

SCF faces as an innovative, constantly-improving organization. And given the provider shortage, it is not likely to get any easier. Exacerbating the challenge is the 

gap between the knowledge and skills needed to perform in our health care system 

and the knowledge and skills of graduates from health professional training programs at United States colleges and universities. However, medical residents who 

are trained in the Nuka System of Care and similar systems will be able to help 

to transform health care throughout the United States by bringing the innovations 

SCF and other programs have developed to the VA and to healthcare systems 

around the country. The pilot program authorized by this legislation would serve 

as an incubator for positive change in our healthcare systems, and is worthy of your 

support. 

CONCLUSION

The Southcentral Foundation is an innovative healthcare organization on the cutting edge of holistic, customer centered, and relationship based healthcare delivery. 

We would be thrilled to participate in the pilot program authorized by this legislation, and are confident that the legislation would be a strong step in the right direction for the VA and rural healthcare providers. We thank the Committee for its consideration of this bill, and Senator Sullivan for his leadership on it. 

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PREPARED STATEMENT OF DEREK FRONABARGER, DIRECTOR OF POLICY, STUDENT

VETERANS OF AMERICA


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LETTER FROM BRUCE R. JOSTEN, EXECUTIVE VICE PRESIDENT, GOVERNMENT AFFAIRS, 

CHAMBER OF COMMERCE OF THE UNITED STATES OF AMERICA


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Æ 


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