U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

82–244 2014

LEGISLATIVE HEARING ON ‘DRAFT LEGISLATION, 

THE LONG–TERM CARE VETERANS CHOICE 

ACT’; H.R. 1443; H.R. 1612; H.R. 1702; H.R. 

2065 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

TUESDAY, JULY 9, 2013 

Serial No. 113–28 

Printed for the use of the Committee on Veterans’ Affairs 

( 

VACREP180 with DISTILLER

ii 

COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

DAVID P. ROE, Tennessee 

BILL FLORES, Texas 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MARK E. AMODEI, Nevada 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

PAUL COOK, California 

JACKIE WALORSKI, Indiana 

MICHAEL H. MICHAUD, Maine, Ranking 

Minority Member 

CORRINE BROWN, Florida 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

ANN KIRKPATRICK, Arizona 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

HELEN W. TOLAR, Staff Director and Chief Counsel 

SUBCOMMITTEE ON HEALTH 

DAN BENISHEK, Michigan, Chairman 

DAVE P. ROE, Tennessee 

JEFF DENHAM, California 

TIM HUELSKAMP, Kansas 

JACKIE WALORSKI, Indiana 

BRAD R. WENSTRUP, Ohio 

VACANCY 

JULIA BROWNLEY, California, Ranking 

Minority Member 

CORRINE BROWN, Florida 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

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

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

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

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

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

is further refined. 

VACREP180 with DISTILLER

iii 

C O N T E N T S 

July 9, 2013 

Page 

Legislative Hearing On ‘Draft Legislation, The Long-Term Care Veterans 

Choice Act’; H.R. 1443; H.R. 1612; H.R. 1702; H.R. 2065 ................................ 1 

OPENING STATEMENTS 

Hon. Dan Benishek, Chairman, Subcommittee on Health ................................... 1 

Prepared Statement of Hon. Benishek ........................................................... 32 

Hon. Julia Brownley, Ranking Minority Member, Subcommittee on Health ..... 2 

Prepared Statement of Hon. Brownley ........................................................... 32 

Hon. Jeff Miller, Chairman, Full Committee on Veterans’ Affairs, U.S. House 

of Representatives ................................................................................................ 18 

Prepared Statement of Chairman Miller ........................................................ 33 

Hon. Jackie Walorski, Member, Committee on Veterans’ Affairs, U.S. House 

of Representatives, Prepared Statement only ................................................... 34 

WITNESSES 

Hon. Mike Rogers, U.S. House of Representatives, 3rd District, Alabama ........ 3 

Prepared Statement of Hon. Rogers ............................................................... 34 

Hon. David McKinley, U.S. House of Representatives, 1st District, West Virginia ....................................................................................................................... 4 

Prepared Statement of Hon. McKinley ........................................................... 34 

Jacob Gadd, Deputy Director for Health Care, Veterans Affairs and Rehabilitation Commission, The American Legion ......................................................... 9 

Prepared Statement of Mr. Gadd .................................................................... 35 

Susan E. Shore, Ph.D., Chair, Scientific Advisory Committee, American 

Tinnitus Association ............................................................................................ 11 

Prepared Statement of Ms. Shore ................................................................... 38 

Adrian Atizado, Assistant National Legislative Director, Disabled American 

Veterans ................................................................................................................ 12 

Prepared Statement of Mr. Adrian Atizado ................................................... 42 

Robert Drexler, Member, Board of Directors, International Code Council ......... 14 

Prepared Statement of Mr. Drexler ................................................................ 45 

Raymond C. Kelley, Director, National Legislative Service, Veterans of Foreign Wars .............................................................................................................. 16 

Prepared Statement of Mr. Kelley .................................................................. 46 

Robert L. Jesse, M.D., Ph.D., Principal Deputy Under Secretary for Health, 

Veterans Health Administration, U.S. Department of Veterans Affairs ......... 26 

Prepared Statement of Dr. Jesse .................................................................... 48 

Accompanied by: 

Susan Blauert, Deputy Assistant General Counsel, U.S. Department 

of Veterans Affairs 

STATEMENTS FOR THE RECORD 

Hon. Ron Barber, 2nd District, Arizona, U.S. House of Representatives ........... 51 

National Association of State Fire Marshals ......................................................... 52 

National Coalition for Homeless Veterans ............................................................ 53 

Paralyzed Veterans of America .............................................................................. 55 

Vietnam Veterans of America ................................................................................. 57 

Wounded Warrior Project ........................................................................................ 58 

VACREP180 with DISTILLER

VACREP180 with DISTILLER

(1) 

LEGISLATIVE HEARING ON ‘DRAFT LEGISLATION, THE LONG–TERM CARE VETERANS 

CHOICE ACT’; H.R. 1443; H.R. 1612; H.R. 1702; 

H.R. 2065 

Tuesday, July 9, 2013 

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

The Subcommittee met, pursuant to notice, at 10:08 a.m., in 

Room 334, Cannon House Office Building, Hon. Dan Benishek 

[Chairman of the Subcommittee] presiding. 

Present: Representatives Benishek, Huelskamp, Brownley, Ruiz, 

Kuster. 

Also Present: Representative Miller. 

OPENING STATEMENT OF CHAIRMAN DAN BENISHEK 

Mr. BENISHEK. Good morning. The Subcommittee will come to 

order. 

Thank you all for joining us this morning to discuss pieces of legislation concerning health care and services available to the Department of Veterans Affairs’ VA health care system. 

The five bills that we will discuss today are draft legislation, the 

Long-Term Care Veterans Choice Act; H.R. 1443, the Tinnitus Research and Treatment Act of 2013; H.R. 1612, to direct the secretary of Veterans Affairs to convey a parcel of land in Tuskegee, 

Alabama, to Tuskegee University; H.R. 1702, the Veterans Transportation Service Act; and H.R. 2065, the Safe Housing for Homeless Veterans Act. 

From ensuring the safety of homeless veterans residing in VA 

homeless grant and per diem facilities to ensuring that veterans eligible for VA-paid nursing home care are able to receive care in certified medical foster homes should they choose, these five bills address a number of critical issues facing today’s veterans and all of 

us charged with caring for them. 

I am eager to discuss each of these proposals in depth to ensure 

a thorough understanding of their purpose, intended benefits, and 

unintended consequences. 

I am grateful to my colleagues who sponsored these bills and to 

our witnesses for being here to discuss them with us. I look forward to our conversation. 

With that, I now yield to Ranking Member Brownley for any 

opening statement she may have. 

[THE PREPARED STATEMENT OF HON. BENISHEK APPEARS IN THE

APPENDIX]

VACREP180 with DISTILLER

2 

OPENING STATEMENT OF HON. JULIA BROWNLEY 

Ms. BROWNLEY. Thank you, Mr. Chairman. 

And we do have five important bills here today and look forward 

to the discussion. And to allow maximum time for that discussion, 

I will limit my opening remarks primarily to H.R. 1443 and H.R. 

1702. 

H.R. 1443, the Tinnitus Research and Treatment Act of 2013, as 

offered by Ranking Member Michaud, according to the VA, tinnitus 

is the number one service-connected disability for veterans from all 

periods of service affecting over 840,000 veterans. 

Since 2005, the number of veterans receiving service-connected 

disability for tinnitus has increased by at least 15 percent each 

year and the VA has been paying out over $1.2 billion annually to 

veterans for tinnitus disability compensation. 

At the current rate of increase, service-connected disability payments to veterans for tinnitus will cost $2.26 billion annually by 

2014. Nevertheless only about $10 million is dedicated to researching tinnitus in the public and private sectors. 

H.R. 1443 will allow for appropriate research time and resources 

by directing the VA to recognize tinnitus as a mandatory condition 

for research and treatment by the VA auditory centers for excellence. 

This will make certain that research is conducted at the VA facilities on the prevention and treatment of this condition and that 

the VA cooperates with the Department of Defense’s hearing center 

of excellence to further research on tinnitus. 

H.R. 1443 would ensure that we remain on the cutting edge for 

research and treatment of this issue facing veterans of all ages. 

Next, H.R. 1702, introduced by Mr. Barber of Arizona, would permanently authorize the VA to operate the Veterans Transportation 

Service which provides transportation for individuals to and from 

the VA medical facilities in connection with vocational rehabilitation, counseling, examination, treatment, or care. 

VTS was launched in 2010 and the VA’s current authority to operate the program is set to expire in January of next year. I did 

want to emphasize the critical need for this legislation in helping 

to increase access to care for those who would otherwise face challenges in getting to and from their appointments at the VA. 

I also wanted to highlight that VA has estimated VTS to save up 

to $19.2 million in fiscal year 2014 and $102.7 million over five 

years because it is less expensive for the VA to hire drivers 

through VTS than to contract with ambulance services or to provide mileage reimbursement. So this is simply a common-sense initiative. 

Thank you, Mr. Chairman, for including these bills in the agenda 

and I look forward to hearing the views of our witnesses on the legislation before us today. And I yield back my time. 

[THE PREPARED STATEMENT OF HON. BROWNLEY APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you. 

The Chairman of the Full Committee, Jeff Miller from Florida’s 

1st Congressional District, will be joining us later this morning to 

VACREP180 with DISTILLER

3 

discuss his draft legislation, the Long-Term Care Veterans Choice 

Act. I will yield to him when he arrives. 

In the meantime, it is an honor to be joined by my friends and 

colleagues, Mike Rogers, Representative from Alabama’s 3rd Congressional District, and David McKinley, Representative from West 

Virginia’s 1st Congressional District. 

Thank you for your leadership on behalf of our veterans and for 

being with us this morning to discuss your proposals. It is an honor 

and pleasure to have you here this morning. 

I would like to mention for the record that Mr. Barber will not 

be with us today due to the tragic circumstances that have taken 

place in Arizona and our thoughts and prayers are with the families of the first responders there who have perished. Their loved 

ones are true heroes and their sacrifice will never be forgotten. 

Mike, we will begin with you. Please proceed with your testimony. You have five minutes. 

STATEMENTS OF HON. MIKE ROGERS, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF ALABAMA; HON. DAVID 

MCKINLEY, A REPRESENTATIVE IN CONGRESS FROM THE 

STATE OF WEST VIRGINIA 

STATEMENT OF HON. MIKE ROGERS 

Mr. ROGERS. Thank you, Mr. Chairman and Ranking Member 

Brownley. 

First I want to thank the Chairman and the staff for holding this 

hearing. I also want to thank the Full Committee Chairman, Jeff 

Miller, for his leadership on behalf of our Nation’s veterans. 

Mr. Chairman, H.R. 1612 will benefit the Department of Veterans Affairs and the people of Tuskegee, Alabama. 

In 1922, the Board of Tuskegee University voted to donate 300 

acres of land to the Federal Government for a veterans’ hospital. 

Since that time, Tuskegee VA Hospital and Tuskegee University 

have grown into integral parts of the community and serve important roles for our Nation. 

Now as the VA refocuses its mission to better serve our veterans, 

some of the donated land near the university’s campus no longer 

fits the VA’s needs. 

My bill would transfer back 64.5 acres of land at 2400 Hospital 

Road back to Tuskegee University so that the land can better serve 

the community. 

This transfer also creates new opportunities for the VA by reducing substantial overhead and maintenance costs and providing cooperative authority to leverage the strengths of both institutions. 

This bill is supported by the VFW, the Vietnam Veterans of 

America. Both organizations know well Tuskegee’s place in our history and I appreciate their continued support for the community. 

I thank you again, Mr. Chairman and Ranking Member 

Brownley. And with that, I will yield back. 

[THE PREPARED STATEMENT OF HON. ROGERS APPEARS IN THE AP- PENDIX]

Mr. BENISHEK. Thank you very much. 

David. 

VACREP180 with DISTILLER

4 

STATEMENT OF HON. DAVID MCKINLEY 

Mr. MCKINLEY. Thank you, Mr. Chairman. 

Ranking Member Brownley and the rest of you on the Subcommittee, thank you for holding this hearing. I appreciate the opportunity to give these remarks about H.R. 2065 called the Safe 

Housing for Homeless Veterans Act. 

This is the same bill that we passed last year, slightly modified, 

but it is essentially the same bill for the homeless veterans. 

Currently, there are over 2,100 community-based homeless veteran service providers across the country and many other homeless 

assistance programs that have all demonstrated an effort to try to 

take care of our homeless veterans. 

I visited some of these shelters throughout West Virginia, not 

only in my district, but elsewhere. 

You have to understand my background. I come from the construction industry. I am one of two licensed engineers in Washington, in Congress. So it does not take me long to walk into a 

building and I can tell you whether or not that building meets 

code. 

And when I walked into some of these shelters, I was appalled 

with what we have done to our veterans. They have been in harm’s 

way and they come back and their lives are challenged in some of 

these facilities. 

There is no current law. There is a policy within the VA to comply with building codes. Think about that. It is a policy, not a requirement. It is a policy. I think this is an omission governing our 

veterans’ homeless program funds. 

H.R. 2065 would require that any organization that seeks funding from VA for services to homeless veterans have documentation 

that their building meets or exceeds building code. Not a policy. It 

shall. These men and women sacrificed for our country, they must 

have a safe home. 

This bill makes it easier for facilities to be certified as we open 

up these requirements beyond just the life safety code, which is 

101, NFPA–101, to international building code and the fire codes 

and other versions of these codes. 

Essentially what the local jurisdiction has adopted, work with 

them, but make it a requirement, not a policy. 

Furthermore, the legislation would require adding a section to 

VA annual report to Congress that would report the number of 

grant recipients or eligible entities who have submitted a certification, that their facility will meet all building codes. 

I understand there is some concern over the undue burden for 

these facilities, but as you will see in the questions, I will be able 

to expound a little bit further about that, that is not quite accurate. 

When you travel, do your research in other facilities around the 

country, annual inspections are expected and demanded. And it is 

not an undue burden. 

In West Virginia, it is at no cost to the facility provider to have 

an inspection done to see that you are in compliance. 

I am pleased. I want you to know that we have already begun 

our discussions with those individuals that may have some concerns with this, particularly the VA and others, that may have a 

concern that we are undue burden. 

VACREP180 with DISTILLER

5 

Quite frankly, Mr. Chairman, I am more interested in the veterans than I am about bureaucracy. If we are going to put these 

men and women in harm’s way, I want to take care of the problem. 

And if it costs us $100 a year to have an inspection, then that is 

the least of my concerns. 

These men and women deserve to have a focus for them so that 

when they come home and they have, for whatever the circumstances are that they have to live in a homeless shelter, they 

should feel comfortable that they are going to wake up in the morning and there is not going to be a catastrophe wrapping around 

them. 

So with that, I will yield back my time and hope that we have 

an opportunity to have further discussion and I hope you will be 

able to support this effort to take care of our homeless veterans. 

Thanks you. 

[THE PREPARED STATEMENT OF HON. MCKINLEY APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you, Mr. McKinley. 

I will now yield to Ms. Brownley who will provide testimony on 

H.R. 1443. No? 

Ms. BROWNLEY. No. 

Mr. BENISHEK. Well, I think that I will proceed with the questions. And I will start out. 

Mr. Rogers, what is the key benefit for this piece of legislation? 

Mr. ROGERS. Well, it is twofold. The university needs the land 

back for its expansion, but more importantly the VA does not need 

it and it has just been a maintenance burden for them financially. 

There is a large part of their campus that has not been used for 

years. It is deteriorating. They are going to have to spend money 

to either bring those buildings back or at least make them safe or 

tear them down. And they do not really want to do either. 

Mr. BENISHEK. So there are some unused buildings there? 

Mr. ROGERS. That is exactly what it is, as well as land. 

Mr. BENISHEK. Does the university have plans to do something 

right away with the land? 

Mr. ROGERS. Not right away, but they would like to use it for 

long-term plans. 

Mr. BENISHEK. All right. Thank you. 

Mr. McKinley, I appreciate your continued advocacy on this issue 

and I completely agree with the need for safe shelters. 

Can you comment on the scope of the problem and tell me what 

you see as the lack of VA oversight? 

Mr. MCKINLEY. Thank you. 

I do not want to speak necessarily for the VA. I think they can 

speak for themselves. But it is my understanding that there is an 

effort. They think they are handling these issues internally. They 

may believe that. 

But, again, my training, and I started in construction in 1965. 

Think about that, the age. That gives me away a little bit, doesn’t 

it, Ms. Brownley? 

But it does not take me long to understand there is a violation. 

And if they, Chairman, have that knowledge, then why didn’t they 

correct it? 

VACREP180 with DISTILLER

6 

Example could be down in Atlanta. We have from the Joint Commission this report in Atlanta that says the Atlanta Medical Center 

was supposed to take care of their facility, that they have violations that are listed on page nine, insufficient compliance on meeting the requirements under the NFPA–101. 101 is life safety. 

Under the door category, insufficient compliance, space around 

pipes, conduit where fire and smoke and gases, insufficient compliance. I could go on. But here it is a facility that should have the 

knowledge and they are not fulfilling that. 

We have examples around the country of fires. 

Mr. BENISHEK. May I ask a question? 

Mr. MCKINLEY. Five people were killed in a Texas shelter. 

Mr. BENISHEK. Mr. McKinley, let me ask you this question. 

Mr. MCKINLEY. I could go on. There are just examples like that, 

Mr. Chairman—of examples where people have not followed the 

code. They do a wink and a nod. But there are people that are 

dying every day and there is needless deaths that are occurring or 

harm coming to individuals because they are not following the 

building code. 

Mr. BENISHEK. Can you give me a couple examples of the things 

that you saw yourself when you were there? You mentioned that 

you are an engineer and you noticed some things right away. What 

were some of the things that you noticed? 

Mr. MCKINLEY. I have seen lack of sprinkler systems and I know 

that if you are going to have a combined-use where you have counseling and housing, there is a requirement to have a fire separation, a two-hour separation, as well as sprinkler systems required 

by 101. Not what is happening time and time again. 

You are fortunate if you get an alarm system. I saw doors that 

are not rated. When I mean rated doors, you can have ratings that 

maybe have to be as long as two hours before the door will burn. 

I can tell you these doors are not rated because on the inside panel 

on the door, there is a chip that is affixed. They have a label and 

it will tell you whether it is rated. I went through, I do not know 

how many facilities and I have looked for those labels and they are 

not there. 

We see fire exit ways. They are supposed to be lit. There are 

strobe lights that were not there at these facilities. 

These people, Mr. Chairman, are trying to help out the veterans, 

but in so doing they are cutting corners. And I just want them to 

comply with the standards. This is not going to cost the VA one additional dollar. But the owners of these facilities are going to have 

to have proper compliance with the code, not a wink and a nod, so 

our men and women are safe when they go to bed at night. 

Mr. BENISHEK. Thank you. 

Ranking Member Brownley, do you have any questions? 

Ms. BROWNLEY. No. 

Mr. BENISHEK. Dr. Ruiz. 

Mr. RUIZ. Thank you both for your work and your support for 

veterans. 

I have a question for you, Honorable McKinley. The veterans, do 

we now have a sense of how many go to veteran-specific shelters 

versus general homeless shelters? 

VACREP180 with DISTILLER

7 

Mr. MCKINLEY. That is a fair question. No, I do not know. It is 

just a troubling statistic that anyone winds up in a homeless shelter. 

But when I have talked to some of them that are there, keeping 

it certainly anonymous to keep their identify, just for whatever has 

happened, whether it can be they are having post-traumatic, they 

cannot keep a job, they have lost their family life because of their 

issues, series of issues. Unfortunately, they are there. 

The VAs do not have the bed capacity to be able to keep them 

there, so they are providing space for them here at, I guess, a per 

diem basis for them to be able to stay at these facilities. 

So I do not know how many would be there in a VA sponsored 

versus one that might be just a non-veterans’ homeless shelter. But 

I can tell you, Congressman, I am seeing the problems in both. It 

is not just the VAs. The VAs, I think, want to do what is right, but 

they want to use a policy. 

I think we ought to make it statutory so that it does not vary 

from state to state to state and municipality where there is a wink 

and a nod that they will let them stay there. Let’s give people ability to have safe housing whether they are in a public one or in a 

VA sponsored facility. 

Mr. RUIZ. And that is the point of my question was to figure out 

if—you know, our primary concern with this bill is to make sure 

that veterans themselves have a safe place to rest given the special 

covenant that we have with our veterans. And in general, we 

should strive to make sure that any homeless could have a safe 

place to stay at night as well. 

But in this special case, if the majority go to private or non-profit 

shelters, which is usually the case, the non-profit organizations, 

then my concern is are we still reaching out to those homeless shelters for them so they can have their place to sleep? 

Mr. MCKINLEY. In my jurisdiction, in the 1st district of West Virginia, whenever I see one of these in a non-VA related facility, I 

talk to the municipality about whether or not to make them in 

compliance. 

Mr. RUIZ. Okay. 

Mr. MCKINLEY. But we do not have jurisdiction over those facilities. We have the jurisdiction where there is Federal money being 

used to help these individuals. That is why I am dealing with it 

here, but I am dealing with the other in another matter. And it has 

to be done on a case by case, municipality by municipality. 

Mr. RUIZ. Thank you very much. 

Mr. MCKINLEY. Thank you. 

Mr. BENISHEK. Ms. Kuster, you have any questions? 

Ms. KUSTER. Just briefly. Thank you very much. 

Thank you very much for your testimony and for bringing these 

bills forward. And I just want to address a question to Mr. McKinley. 

And you seem well-versed in this, so I just want to understand. 

I have worked in the past in my State of New Hampshire with colleges and universities in dormitories and housing and trying to 

comply with local codes. And I know that there is a distinction between the international building and fire codes and the life safety 

codes. 

VACREP180 with DISTILLER

8 

Mr. MCKINLEY. Yes. 

Ms. KUSTER. And I am just wondering what the impact—I agree 

with your intent and I want homeless veterans to be in safe conditions. 

In New Hampshire, the facilities that I have seen have been very 

safe. But my concern is not to add to the burden and have an unintended consequence of inadvertently making housing less available 

to homeless veterans. 

So if you could comment on how this will work with the international code, the life safety code, and that there is local approvals 

that might be required. 

Mr. MCKINLEY. Let me see. I will try to answer that. 

Ms. KUSTER. For the layperson. 

Mr. MCKINLEY. We took some time yesterday and I think it also 

began on Friday trying to contact some other states to find out how 

they deal with these shelters because if the concern is over the 

$100 or whatever the cost, $200, if that is going to be a burden. 

Ms. KUSTER. We can deal with it. 

Mr. MCKINLEY. Think about it. Think about that. 

Ms. KUSTER. Yes. 

Mr. MCKINLEY. An annual cost of $100 spread out over your facility or $200. We found out again in West Virginia, those inspections to see that they are in compliance are done at no cost. In Virginia, they have an annual state requirement that no one is complaining about in Virginia. 

In New York, there is an annual local level for all publicly 

accessed buildings and Utah performs the same thing, fire safety. 

In fact, in Utah, they have to fill out this 60-page document every 

year to give everyone a comfort level that the buildings are safe 

and that we can put human occupants in that building and they 

can walk out the next day. 

So I think the little bit of burden of having to do paperwork once 

a year, I think, is certainly appropriate given that we are putting 

people that are hurting emotionally to give them the comfort that 

their living conditions and their environment, that they will be 

safe. 

And I think we will find if we continue doing the research, we 

will find that all across America there are those requirements either to comply with life safety, the 101 and the National Fire Protection Agency or some of these other codes, the ICC which is generally observed for most of the states around the country, but I 

think every state has to comply with the NFPA–101. 

Ms. KUSTER. Good. Thank you. 

Mr. MCKINLEY. That is what we are asking for here. Do not 

make it a policy. 

Ms. KUSTER. Uh-huh. 

Mr. MCKINLEY. Make it a requirement when they get their license every year and it may not cost anything depending upon your 

state. 

Ms. KUSTER. Okay. Thank you very much. 

I yield back. 

Mr. BENISHEK. Mr. Huelskamp, do you have any questions? 

Mr. HUELSKAMP. No thanks. 

VACREP180 with DISTILLER

9 

Mr. BENISHEK. Well, thank you. Thank you again for coming. 

Since there are no further questions, the first panel is now excused. 

I welcome our second panel to the witness table. Joining us on 

the second panel is Mr. Jacob Gadd, the Deputy Director for Health 

Care for the Veterans Affairs and Rehabilitation Division in The 

American Legion; Dr. Susan Shore, Chair of the Scientific Advisory 

Committee for the American Tinnitus Association; Mr. Adrian 

Atizado, the Assistant National Legislative Director for the Disabled American Veterans; Robert Drexler, member of the Board of 

Directors for the International Code Council; and Mr. Raymond 

Kelley, the Director of the National Legislative Service for the Veterans of Foreign Wars. 

Thank you all for being here this morning and for your hard 

work and advocacy for our veterans. I appreciate you coming here 

to present your views of your members and I anticipate your testimony with eagerness. 

We will begin with Mr. Gadd. Please begin your testimony. You 

have five minutes. 

STATEMENTS OF JACOB B. GADD, DEPUTY DIRECTOR FOR 

HEALTH CARE, NATIONAL VETERANS AFFAIRS AND REHABILITATION DIVISION, THE AMERICAN LEGION; SUSAN E. 

SHORE, CHAIR, SCIENTIFIC ADVISORY COMMITTEE, AMERICAN TINNITUS ASSOCIATION; ADRIAN ATIZADO, ASSISTANT 

NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN 

VETERANS; ROBERT DREXLER, MEMBER, BOARD OF DIRECTORS, INTERNATIONAL CODE COUNCIL; RAYMOND C. 

KELLEY, DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS 

STATEMENT OF JACOB B. GADD 

Mr. GADD. On behalf of the 2.4 million members of The American 

Legion, I would like to thank you, Chairman Benishek, Ranking 

Member Brownley, and Members of the Committee, for the opportunity to provide comments on these health care bills. 

H.R. 1702 is needed to ensure that Veterans Transportation 

Service program is authorized as a permanent authority. For years, 

VA transportation programs and initiatives have been viewed as an 

ancillary or secondary service area, but The American Legion recognizes that veterans’ transportation programs are vital and often 

the difference between whether a veteran is seen for care or not. 

VTS originated as a VA transformation initiative to ensure veterans with serious injury, illness, and those who live in remote 

areas receive travel. 

In May 2012, VA general counsel rendered an opinion which 

found that VA only has the authority to use volunteer drivers to 

provide veterans transportation to and from VA health facilities, 

not paid employees. 

The American Legion became involved after the general counsel 

ruling as we had just finished up our system worth saving report 

on rural health care. 

In this report, we visited VA medical centers and hosted town 

hall meetings with veterans to understand firsthand what chalVACREP180 with DISTILLER

10 

lenges veterans face in highly remote areas such as in Maine, Kansas, Missouri, New Mexico, and Wyoming. 

We found that for many veterans driving long distances were a 

disincentive and barrier to them receiving care. We found that VTS 

was a viable solution as it offered veterans a secondary option to 

supplement current VA transportation programs. 

We found concerns with VA’s current organizational structure of 

transportation programs in VA medical facilities which is fragmented and disjointed with different transportation programs located throughout the hospital instead of in one central place. 

Based on the findings of the report and in response to VA’s general counsel ruling, The American Legion adopted Resolution 293, 

the veterans transportation system and benefits travel. This resolution urged VA to establish a transportation department within each 

VA medical center to coordinate and oversee all transportation programs in the hospitals such as conducting transportation 

catchment analysis, Veterans Transportation Service program initiatives, volunteer transportation drivers, beneficiary travel programs, and valet programs. 

As one veteran recently told us in Nevada, veterans travel as far 

as 200 miles to the VA medical center for required appointments 

as the service is not available in their CBOCs. 

These van pools require them to leave their residence very early 

in the morning and not return home until later in the day. Due to 

medical conditions, not all veterans can withstand this type of travel and instead take their personal vehicles. A number of these veterans are subjected to a fixed budget and often find the cost of 

travel for medical care a rather large burden. 

Veterans have a choice where they want to receive their health 

care. If their transportation needs are not met or fulfilled by VA, 

they may not receive care at VA or worse not receive care at all. 

The American Legion supports this legislation but urges this 

Committee to include provisions requiring the VA to establish veterans’ transportation departments within VA medical centers to 

maximize coordination, efficiency, and availability of transportation 

options for veterans. 

Regarding draft legislation on the Long-Term Care of Veterans 

Choice Act, while The American Legion does not have an official 

position on medical foster programs, we have noted VA’s trend in 

several years of reducing institutional care beds in lieu of other 

community options. 

American Legion Resolution 121 has three actions that we stated 

VA be required by the 1998 Millennium Health Care Act to maintain and restore its in-house nursing home capacity to 13,391 beds; 

second that VA create incentives and receive appropriate funding 

to maintain its nursing home beds rather than abandon them to alternative sources; third that Congress appropriate sufficient funds 

to support the provisions of the Millennium Health Care Act so VA 

is not forced to reduce its nursing home care unit capacity. 

Understanding that not every veteran requires long-term care or 

skilled nursing in an institutionalized setting, it is important to 

The American Legion and America’s veterans that the availability 

is there if the need in the VA exists, particularly as the number 

VACREP180 with DISTILLER

11 

of World War II veterans and Vietnam veterans needing skilled 

care is poised to increase over the coming years. 

Now is not the time to be reducing capacity or availability of 

long-term care. The consequence of not having availability of longterm beds is that state veterans’ homes and other non-VA longterm care options will be overtaxed and unable to admit veteran 

patients. 

Once again, American Legion thanks you for this opportunity to 

testify on these important bills today. 

[THE PREPARED STATEMENT OF JACOB B. GADD APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you very much. I appreciate your testimony. 

Dr. Shore, why don’t you please start. 

STATEMENT OF SUSAN E. SHORE 

Ms. SHORE. Good morning. Thank you for this opportunity to 

give testimony on H.R. 1443, the Tinnitus Research and Treatment 

Act of 2013. 

Good morning, Chairman Benishek and Ranking Member 

Brownley and the rest of the distinguished Members of the Health 

Subcommittee. 

My name is Dr. Susan Shore and I am the chair of the Scientific 

Advisory Board for the American Tinnitus Association often called 

ATA. 

This is a very important issue, the issue of tinnitus sometimes 

pronounced tinnitus, and it is especially important because it is 

often ignored as it is viewed as an invisible disorder, an invisible 

disorder because nobody but the people who are suffering from it 

know that it is there. It is a subjective phenomenon. 

And because of this, I think this is one of the reasons that it is 

underfunded. So on behalf of the ATA and the 50 million Americans afflicted with tinnitus, I am going to give you some background on why I think it is so important to get more money for research. 

So the ATA funds research grants and it is the only memberbased and non-profit organization dedicated to finding a cure for 

tinnitus in the United States. Since 1980, we funded grants towards better understanding of the mechanisms that are responsible 

and underlying the genesis of tinnitus. 

The advances in tinnitus research over the past decade have 

been extraordinary. One of the most important advances has been 

the ability to visualize tinnitus through the use of advanced functional imaging technologies and also through the development of 

animal models that can behaviorally assess the presence of tinnitus 

in animals. These methods allow us to pinpoint tinnitus to certain 

regions of the brain. 

Another important advancement that has occurred mostly 

through the use of animal models is the discovery that tinnitus is 

a result of brain plasticity or disorganization of the brain. And 

these developments have led the scientific community to understand that tinnitus is a disorder of brain function and not a disVACREP180 with DISTILLER

12 

order of the ear that has been the common misconception for decades. 

So while noise overexposure is still the number one cause of 

tinnitus, it can also develop in the absence of hearing loss and absence of hearing damage and because of the result of head and 

neck injury. 

Tinnitus is the number one service-connected disability for returning veterans from Iraq and Afghanistan and elsewhere and as 

mentioned in the introduction, tinnitus in these veterans is most 

often the result of extreme noise exposure from either a single impulse or the accumulation of noise exposures. 

However, head and neck injuries are also a leading complaint of 

these veterans. In fact, lumbosacral and cervical strain account for 

23 percent of service-connected disabilities for Iraq and Afghanistan veterans. 

And so in addition to these factors that cause hearing loss, there 

are other factors that result from somatic insults including 

lumbosacral and cervical strain. 

Research into how these systems interact in the brain has the 

potential to lead to treatment such as tailored devices that aim to 

ameliorate the aberrant brain circuitries resulting from both a combination of hearing loss and head and neck injuries. 

When you consider the costs that have already been mentioned 

for disabilities and in comparison to what is being spent on 

tinnitus research in the U.S., there is a severe disconnect. 

Up until very recently, the amount of money being spent on tinnitus research has been negligible and amounts to about $10 

million most recently which is up from $5 million in 2005, but still 

it is not nearly enough to address a disorder that affects so many 

millions of people. 

I would like to just quickly address the current treatments that 

are offered in the VA. And while we applaud the efforts of the VA, 

current treatments that are offered as part of the progressive 

tinnitus management program, while applaudable are not addressing issues that have been highlighted through research. 

For example, they use sound therapy as their only treatment 

which is not effective for many patients. And so because of this, 

this is why expanded research is necessary to move forward and 

use the discoveries that are being made throughout the United 

States in laboratories as we speak. 

So I would like to urge you to passage this legislation and this 

important one, H.R. 1443. This will go a long way to helping us 

achieve our goals of improving tinnitus treatment and ultimately 

finding a cure for this disorder. 

Thank you. 

[THE PREPARED STATEMENT OF SUSAN E. SHORE APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you very much for your testimony. I really 

appreciate it. 

Mr. Atizado, I think you are up next. 

STATEMENT OF ADRIAN ATIZADO 

Mr. ATIZADO. Thank you, Chairman. 

VACREP180 with DISTILLER

13 

Ranking Member Brownley, Members of the Subcommittee, on 

behalf of DAV and our 1.2 million members who are wounded and 

injured veterans, I am pleased to provide our views on the legislation that is on today’s agenda. 

I would like to highlight two bills to the Subcommittee, the first 

of which is H.R. 1702. This bill would provide VA a renewed and 

permanent authority to transport individuals in connection with receiving VA benefits and services. 

As mentioned earlier, previously enacted law prompted VA to initiate the Veterans Transportation Service or VTS which were it not 

for the expiration of its one-year statutory authority would have extended to all VA locations by 2015. 

Now, DAV believes VTS can be an ideal partner with our transportation network, the DAV transportation network or DAVTN. 

While the DAVTN continues to show tremendous growth as an indispensable resource for veterans, VTS serves a special subset of 

the veteran patient population, one which our transportation network is unable to serve. And that deals specifically with veterans 

in need of special mode of transportation because of certain aspects 

of their conditions. 

We believe that with a truly collaborative relationship that 

DAVTN and VTS will meet the growing transportation needs of ill 

and injured veterans in a cost-effective manner. 

Now, as this Subcommittee may be aware, VTS operates on 

funds that would otherwise go directly to medical care for veterans. 

Thus, our current support for this bill is based on the progress 

gained through our working relationship with VA to resolve weaknesses that we have observed with VTS. 

Like VA, we want to ensure VTS will indeed work in concert 

with all existing and emerging transportation resources for veterans who need VA care and to guard against fraud, waste, and 

abuse of these limited resources. 

The second bill is the Long-Term Care Veterans Choice Act 

which we support based on our national resolution calling for legislation to expand VA’s long-term services and supports for serviceconnected disabled veterans. 

Established in 2000 and operating under the same authority as 

VA’s community residential care program, VA’s medical foster 

home approves a private home and the caregiver to care for no 

more than three veteran residents in any one location. 

Caregiver support is provided by the medical foster home attendant. They are provided training and it is required that these attendants have a secondary respite option. 

Medical care under the medical foster home is supervised 

through VA’s home-based primary care program or VA’s spinal cord 

injury home care program. Patient participation in this program is 

voluntary and veteran residents report very high satisfaction ratings. 

A lot of veterans that we hear from who would like to go in a 

medical foster home are not able to do so simply because veterans 

must pay out of pocket for both room, board, as well as caregiver 

services. And that amount ranges anywhere from $1,500 to $4,000 

a month. 

VACREP180 with DISTILLER

14 

Even veterans who are otherwise entitled to the more costly 

long-term nursing home care paid fully for by VA either by law or 

policy cannot get in because they have no means to pay. 

DAV is pleased with VA’s innovation by offering the medical foster home program as one part of its long-term services and support 

portfolio and we applaud the intent of this draft legislation to give 

VA the authority to enter into agreement or contract with a VA approved medical foster home as well as pay for the room, board, and 

caregiver services. 

Mr. Chairman, DAV believes favorable consideration of this draft 

bill is a good first step for this Subcommittee to ensure veterans 

have access to a full array of home and community-based long-term 

services and supports. 

Oversight by this Subcommittee is sorely needed as VA endeavors to shift more of its resources away from nursing home care in 

order to serve more veterans in a cost-effective manner while honoring their preferences in how they live the rest of their lives in 

light of their impairments. 

We urge this Subcommittee to ensure VA innovations and home 

and community-based services are not stifled and that VA’s longterm services and supports provide the broadest array of assistance 

as possible regardless of age to those veterans who have lost the 

ability to function or maintain independence in their community. 

Mr. Chairman, we look forward to working with the Subcommittee on these two bills and for its passage. I would be happy 

to answer any questions that you or other Members of the Subcommittee may have. 

Thank you. 

[THE PREPARED STATEMENT OF ADRIAN ATIZADO APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you, Mr. Atizado. 

Mr. Drexler, your testimony, please. 

STATEMENT OF ROBERT DREXLER 

Mr. DREXLER. Good morning, Mr. Chair and Members of the Subcommittee. My name is Rob Drexler, member of the Board of Directors for the International Code Council. I also serve as Fire Marshal for the town of Greece in New York. 

With 26 years in the building and fire code profession and have 

participated in both the NFPA and ICC code development process, 

I am pleased to be here today to discuss the importance of compliance with building and fire codes, speaking on behalf of over 50,000 

building and fire code officials and other professionals across the 

United States who are the members of the code council. 

The code council was formed in 1994 as a non-profit organization 

dedicated to developing a single set of comprehensive and coordinated national model construction codes. 

The founders of the ICC were BOCA, ICBO, and SBCCI. We 

joined these three groups together and published a single code for 

the United States called the international codes. 

In 2003, the International Code Council became the successor organization to the three legacy code groups. We now celebrate our 

tenth anniversary. 

VACREP180 with DISTILLER

15 

Today our international model codes have been adopted at the 

state or local level in all 50 states and the District of Columbia. 

Numerous Federal agencies including General Service Administration, the Department of Defense, and the Architect of Capitol have 

implemented the I codes as have Puerto Rico and the U.S. Virgin 

Islands. 

The code council’s 50,000 members and over 300 chapters include 

state, county, municipal code enforcement, fire officials, architects, 

engineers, builders, contractors, elected officials, manufacturers, 

and other construction industry professionals. 

I come before you today to encourage support of H.R. 2065, the 

Safe Housing for Homeless Veterans Act, sponsored by Representative David McKinley of West Virginia and Representative Grace 

Napolitano of California. 

Those of us who work to achieve building safety at both the state 

and local level appreciate the concern that this bill has for the welfare of our veterans who are living in housing subsidized by the 

Department of Veterans Affairs. 

In the building sector, the IRC, the IBC, and the IFC established 

basic requirements for building safety at the time of construction 

and in the case of the fire code at the time of annual inspections. 

The codes assure that when faced with hazards including fire, 

windstorm, flooding, and normal or daily use, the building will 

allow for residents and users to survive and the first responders to 

safely rescue building occupants and minimize property damage. 

Around the country either at the state or at the local level, both 

the IBC and the IFC assure that buildings used for residential care 

and housing are safe. Local code officials around the country inspect veterans’ homes and assure that they meet current code requirements just as they do with any other building within their 

community. 

Michigan as well as 42 other states have adopted both the IBC 

and the IFC. In fact, all 50 states have adopted the IBC while a 

significant number also adopt the life safety code which is the LSC. 

H.R. 2065 wisely does not attempt to mandate one code or the 

other for compliance in facilities approved by the Department of 

Veterans Affairs for reimbursement but requires a certification for 

all homes that they meet either the IBC, the IFC, or the LSC 

which are functionally and for a safety standpoint equivalent code 

requirements. 

In addition, the bill does not impose any onerous administrative 

burden on the Department of Veterans Affairs, only to assure that 

each facility receiving reimbursement has obtained a certificate of 

compliance from the local code official or from a competent third 

party. This requirement mirrors similar requirements for other 

medical facilities that must provide assurance to the centers for 

Medicaid and Medicare. 

I only had a few moments this morning to review the statements 

that will be presented by the VA today, but I would respectfully 

disagree with many of the talking points in that statement. 

It is true that veterans’ homes covered by this requirement that 

are located in jurisdictions that does not adopt and enforce either 

the IFC or the LSC, there will be a small additional burden of obtaining an annual inspection. 

VACREP180 with DISTILLER

16 

However, it is the clear intent of the bill’s sponsors and a worthy 

goal in our opinion that our veterans who sacrificed so much for 

our freedoms should be provided with safe housing, especially when 

the taxpayer is subsidizing that housing. 

It is hard to argue that our veterans should not be assured of 

minimal safety in their home when the cost of assuring safety is 

only a couple of hundred dollars. 

In closing, the International Code Council is proud of our work 

in developing the model codes to assure basic level of safety in the 

built environment and we applaud your efforts to use those codes 

to protect the safety of our veterans. 

I respect the work of your Subcommittee and encourage continued collaboration between the public and private sectors to achieve 

the important goal of increased safety in our Nation’s buildings. 

Thank you very much for the opportunity today and I would be 

happy to answer any questions. 

[THE PREPARED STATEMENT OF ROBERT DREXLER APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you, Mr. Drexler. 

Mr. Kelley. 

STATEMENT OF RAYMOND KELLEY 

Mr. KELLEY. Mr. Chairman, Members of the Committee, on behalf of the men and women of the Veterans of Foreign Wars, thank 

you for the opportunity to testify today. 

The VFW supports H.R. 1443 which would require the Department of Veterans Affairs to recognize tinnitus as a mandatory condition for research and treatment by the VA auditory center of excellence in coordination with the Department of Defense hearing 

center of excellence. 

Although there is no known cure for tinnitus, it should not be assumed that the condition is untreatable. VA’s progressive tinnitus 

management approach which assists tinnitus sufferers through individual counseling and support is helping veterans better manage 

their symptoms. Still more research is needed in order to identify 

truly effective treatments in alleviating these symptoms. This bill 

represents a positive first step towards achieving that goal. 

The VFW supports H.R. 1612, a bill that directs the secretary of 

VA to convey a parcel of land to Tuskegee University. More than 

90 years ago, Tuskegee University donated the land, nearly 300 

acres, to the United States Government to build a veterans’ hospital. Today 21 of those buildings accounting for nearly 280,000 

square foot of space sit vacant on that property. 

Annually, VA spends approximately $2.00 a square foot to maintain vacant space. For the buildings that fall within this land 

transfer, VA spends more than $500,000 a year in maintenance. 

Reducing the financial burden for upkeep of these buildings and 

grounds will allow VA to better use those funds to ensure the highest level of maintenance for the facilities to provide care and services to our veterans and not to buildings that are sitting vacant. 

The VFW supports H.R. 1702 which permanently authorizes the 

Veterans Transportation Service or VTS. This program commissioned by the Office of Rural Health in 2010 has greatly improved 

VACREP180 with DISTILLER

17 

access to care for rural and seriously-disabled veterans by allowing 

VA facilities to establish and coordinate a network of local transportation providers. 

In 2012, the program was temporarily suspended following a determination by VA Office of General Counsel that VA lacked the 

statutory authority to hire paid drivers to transport veterans. 

Congress wisely passed a one-year authorization of the VTS program in January of 2013, but a long-term fix is still needed. This 

legislation would guarantee the continuation of and further expansion of VTS which plays a critical role in minimizing the challenges 

many veterans face in traveling to their appointments due to physical disabilities or great distances. 

The VFW supports H.R. 2065 which would require facilities that 

house homeless veterans to meet the relevant local building codes 

in order to receive per diem payments under VA homeless providers grant and per diem program. 

Currently the VA is required to check housing certificates before 

awarding grants for housing services provided to homeless veterans. However, thorough checks of fire and safety requirements as 

well as structural conditions of buildings are often overlooked. 

This bill requires that current recipients of the per diem payment submit a certification of compliance with local codes within 

two years of the enactment of this act, giving them ample time to 

make the necessary improvements. 

The VFW believes that VA-funded transitional housing must be 

safe, secure, and sanitary. This bill will ensure that those standards are met, providing homeless veterans with the best chance of 

successful community reintegration. 

The VFW supports the Long-Term Care Veterans Choice Act 

which would add language to Section 1720 of Title 38 to allow veterans to receive VA care and require a protracted period of nursing 

care to provide transfer into adult foster home at their request. 

To grant VA the authority to reimburse adult foster homes would 

provide veterans with the additional residency choice, potentially 

improving the quality of life for those who would prefer this option. 

The VFW strongly believes that all non-VA services should be 

provided in conjunction with proper care coordination. Currently 

VA handbook 1141.02, the medical foster home procedures, establishes the policies and standards for VA care coordination for veterans who choose to live in medical foster homes. 

The VFW feels that these procedures would ensure adequate care 

coordination for veterans who choose to participate in fully-funded 

adult foster care programs. However, these procedures are now set 

to expire in 2014 and the VFW recommends the care coordination 

policies outlined in that document should be made permanent by 

adding them to the language of this legislation. 

Mr. Chairman, this concludes my testimony. I look forward to 

any questions from you or the Committee. 

[THE PREPARED STATEMENT OF RAYMOND C. KELLEY APPEARS IN

THE APPENDIX]

Mr. BENISHEK. Thank you very much for your testimony. 

VACREP180 with DISTILLER

18 

Well, we have the Chairman of the Full Committee. Would you 

like to discuss your piece of legislation before we get to the questions? 

STATEMENT OF CHAIRMAN JEFF MILLER 

Mr. MILLER. If I could. I appreciate it. I did not walk in here to 

automatically start talking about my piece of legislation, but—— 

Mr. BENISHEK. If it is all right with the Committee, we will let 

the Chairman go for five minutes. 

Mr. MILLER. Thank you very much. I appreciate it, Mr. Chairman. 

Thank you to the witnesses. 

I apologize for stepping in front of the questioning, but I want 

to talk to you about the Long-Term Veteran Care Choice Act and 

I think it is something that this Committee can certainly get behind and support because this act would authorize the Department 

of Veterans Affairs to enter into a contract or agreement with a 

certified medical foster home to pay for the residential long-term 

care of service-connected veterans who are eligible for VA-paid 

nursing home care. 

As a component of such care, eligible veterans would also be required to receive VA home health services. 

VA medical foster homes for those of you who do not know are 

private homes in which a trained caregiver provides 24-hour 

around-the-clock care to a few individuals. They are designed to 

provide a non-institutional long-term care alternative to those who 

prefer a smaller, more like home setting, one that they are more 

accustomed to in their own homes than traditional nursing homes 

are able to provide. 

VA has been helping to place veterans in medical foster homes 

now for well over a decade. MFH are limited to no more than three 

veterans at a time and veterans living in such homes are provided 

with VA, with home-based primary care services. 

They also provide safeguards to ensure that veterans themselves 

are safe, that they receive high-quality care by requiring the MFH 

caregivers to pass a Federal background check and VA screening 

and agree to undergo annual training. And they also allow VA 

adult foster home coordinators and members of a VA home care 

team to make both announced and unannounced visits. 

Today, according to VA, over 400 approved caregivers provide 

this type of care in their homes to over 500 veterans daily in over 

35 states. 

The problem is, however, that VA does not have the authority to 

pay for the cost of this care. So the veteran who chooses to live in 

an MFH must pay out-of-pocket with their own personal funds regardless of whether or not such veteran is eligible for VA-paid 

nursing home care. 

What this does is create a situation where many service-connected veterans with limited financial resources who would prefer 

to live in a medical foster home go to a nursing home institution 

instead because VA will cover the cost of the nursing home but not 

the foster home. 

VACREP180 with DISTILLER

19 

And while traditional nursing homes will always be a vital component of long-term care, medical foster homes provide a worthy alternative for many of our veterans. 

According to the department itself, many more veterans would 

elect to receive care in a medical foster home should VA be granted 

the authority to pay for such care. 

And I am sure we all agree that one thing we owe our veterans, 

particularly those who are service-connected and in need of longterm care, is the luxury of choice, the choice to decide where, 

whether, and how they receive care. 

As the veteran population continues to age, the need for longterm care services will, in fact, continue to grow. The Long-Term 

Care Veterans Choice Act would expand the long-term care choices 

that are currently offered to veterans beyond traditional services. 

In addition to being beneficial for the health and the well-being 

of veterans, the average cost of a medical foster home is less than 

half the monthly cost of a nursing home, making this legislation a 

very cost-effective health care option. 

This is a common-sense veteran-centric bill that will free many 

veterans from financial turmoil and allow them to make their own 

decisions about what kind of long-term care they themselves want 

to receive. 

I looked forward to working with all the interested parties to resolve any issues they may have during today’s discussion. 

And, Mr. Chairman, thank you so much for allowing me the opportunity to talk about this particular piece of legislation at today’s 

hearing. 

And I also want to personally thank you for your hard work as 

Chairman of this Subcommittee. It is very critical work for the veterans of this country and your leadership is greatly appreciated, 

and I yield back. 

[THE PREPARED STATEMENT OF CHAIRMAN JEFF MILLER APPEARS

IN THE APPENDIX]

Mr. BENISHEK. Thank you, Mr. Chairman. 

I am going to yield myself five minutes for a few questions for 

the panel. 

Dr. Shore, I have a great interest in tinnitus as well because I 

realize it is a very prominent and probably the most frequent disability that we see from our veterans returning home now. 

Several veteran service organizations with the Independent 

Budget raised concerns about protecting and preserving the VA research funding decisions by the scientific merit-based peer review 

process without interference from outside stakeholders. 

Please comment on that concern. Do you feel that this would 

compromise in any way the current peer review system already in 

place? 

Ms. SHORE. I am not sure what you are referring to by outside—— 

Mr. BENISHEK. Well, I think the VA contends that they have a 

peer review process for determining how to fund research and they 

feel that, outside influences like Congress directing the way that 

we conduct research would take away from, the peer reviewed medVACREP180 with DISTILLER

20 

ical decision-making process of determining where the funds should 

go. 

Ms. SHORE. Right. No, I do not agree, but I would——Yeah, I see 

where you are coming from. I do not think that it would interfere 

with that. I think it would enhance that process as long as you 

have people that you are deferring to or consulting with who know 

something about the way tinnitus works. 

Mr. BENISHEK. Right. 

Ms. SHORE. So—— 

Mr. BENISHEK. What is the current funding level for tinnitus research? 

Ms. SHORE. It is about $10 million everywhere. 

Mr. BENISHEK. That is the total—— 

Ms. SHORE. Yeah. 

Mr. BENISHEK. —for this country, $10 million a year for the research in tinnitus or is that just the VA? 

Ms. SHORE. Yes, it is—no, no. That is the total. So that is much, 

much, much lower than it should be. So we have increased the 

funding from what it used to be five years ago. 

NIH is now recognizing tinnitus as a separate disorder that 

needs to be considered for funding. The DoD is also putting forth 

opportunities for people to submit grants to study tinnitus. But it 

still is not nearly enough to bring the research into reality because 

it takes a long time for our research finding to then be taken into 

a clinical trial. 

And we do not want to take research findings into clinical trials 

unless they have been proven in the laboratory. So it takes a lot 

of money for research to end up helping patients. 

Mr. BENISHEK. No, I realize that amount seems very small considering the number of veterans that are coming home with the 

problem. 

Ms. SHORE. Oh, it is extraordinarily small, yeah. 

Mr. BENISHEK. Especially due to the fact that we do not really 

have much in the way of treatment or understanding of the disease. 

Ms. SHORE. Right. 

Mr. BENISHEK. So—— 

Ms. SHORE. Well, I think it is progressing, but we are not there 

yet. I mean, there has been a lot of progress in the last decade. And 

as I said, one of the big jumps was in recognizing tinnitus as a 

brain disorder and not just a disorder of the ear. 

Mr. BENISHEK. Right. Right. I did not realize that myself. 

Ms. SHORE. Yeah. So it is often triggered by damage to the ear, 

but the reason that it is a brain disorder is because the brain reacts to the lack of input from the ear and it starts doing its own 

thing which is what produces the tinnitus. 

Mr. BENISHEK. Right. 

Ms. SHORE. And many systems within the brain are acting together and so treatments have to involve things other than just 

sound therapy which is the most available treatment, but not really very effective and in some people, not even effective at all. 

Mr. BENISHEK. Right. 

Ms. SHORE. So now there is the development of devices that take 

into account other etiologies than just the ear. For example, the 

VACREP180 with DISTILLER

21 

somatosensory side of things which is going to be even more prevalent in the veterans’ population than it is even in the normal population because they get head and neck injuries as well. 

Mr. BENISHEK. Right. 

Ms. SHORE. And so the hearing loss combined with the head and 

neck injuries which themselves can cause tinnitus makes, you 

know, that the reason—— 

Mr. BENISHEK. I think you explained that we need a little more 

research in this department—— 

Ms. SHORE. Yeah. 

Mr. BENISHEK. —pretty well. I want to get to one other topic before my time runs out. I thank you for your answer. 

Mr. Gadd or Mr. Kelley, I have an issue with VA transportation 

in rural areas. I am representative of rural northern Michigan. And 

the DAV vans are being manned by more and more elderly veterans and we have difficulty in providing adequate transportation 

for veterans. 

I guess my concern about VA—I want to be sure that we use that 

money very efficiently. Like some of you mentioned, that money is 

being diverted for transportation away from patient care. 

So how do you think that we should do oversight? I am concerned about the fact that we hire a driver, we buy a van, and then 

they sit there for 80 percent of the time, How do we conduct of 

oversight that to ensure it is an efficient system within the VA? 

Mr. Gadd, do you have an idea or Mr. Kelley? 

Mr. GADD. Sure, I can respond to that. And thank you for the 

question. 

So I believe it was mentioned earlier and the VA will have their 

particular figures on the cost savings, but when these mobility 

managers came in with the VTS program, they really aligned, they 

worked together with beneficiary travel. And so there are some reduced cost savings from beneficiary travel. And, you know, in addition to that, they were developing a tool to be able to manage the 

cost and looking at cost and trying to reduce the cost. 

The other point that was mentioned earlier was about special 

mode transportation. And the VA would have to contract with 

third-party providers to, you know, provide that transportation. 

But if they are able to have the ability through the VTS program 

to do that in-house, there would be some reductions in cost there. 

And then, too, it just makes sense because it is one additional 

option that, you know, if veteran service organization drivers cannot take that, you know, van to that veteran, you know, and they 

are outside of an area where transportation is not offered, it could 

reach those particular veterans. 

So we see it as a win-win for veterans. 

Mr. BENISHEK. Right. Mr. Kelley, you have any input there? 

Mr. KELLEY. I will just echo a sentiment. Beneficiary travel is 

hard to have oversight of. Veterans come in and make a claim that 

they traveled to their appointment. VA receives the claim and then 

provides a check in return. 

With this, I think it would be easier to do accountability if you 

have a contractor who says we went to pick up these ten. There 

is evidence of that, that they brought them to their appointment 

and then took them home. 

VACREP180 with DISTILLER

22 

So I think in the long run, the oversight would be much easier 

doing this VTS than beneficiary travel. And I think Mr. Gadd said 

there is evidence that it will be a cost savings. 

Mr. BENISHEK. Thank you, gentlemen. 

I have overstepped my time a bit, but, Ms. Brownley, do you 

have questions? 

Ms. BROWNLEY. Yes. Thank you, Mr. Chair. 

I wanted to go back, Dr. Shore, and ask you a few more questions about tinnitus. 

So I am happy to hear that actually NIH and DoD are getting 

involved in recognizing this as a serious problem. I am interested 

to know. You talked a little bit about the research or the lack 

thereof, but I am interested to know where the promising research 

is. You talked about, you know, damage to the ear, the brain being 

two possible causes for this disease. 

Is the research going more towards, being more directed to brain 

research or—— 

Ms. SHORE. Yeah. I think the strong research that has begun 

over the past decade or so has been targeting brain mechanisms. 

And so there are many laboratories now around the country. Some 

of them do imaging studies with humans. Many of them use animal 

models because with the animal models, you can go into the brain 

and record from single cells and see what happens to those single 

cells after a noise exposure or after a head and neck injury. 

And so a lot of our understanding has come from those animal 

models that show that after, especially after noise exposure which 

is a lot of where the studies focus on, the neurons in certain specific parts of the brain become hyperactive. 

So they are firing along as if there were a sound there and higher neurons up there are interpreting that as a sound whereas, in 

fact, there is no sound. 

And then another thing that is being discovered is that it is not 

only auditory centers in the brain that are involved in tinnitus but 

non-auditory centers as well. Some of those I have already mentioned such as the somatosensory system. 

So many people who have tinnitus, if they clench their jaw or 

push on their face, they can make their tinnitus louder or softer 

or change the frequency or even make it go away. And that highlights this interaction between the touch sensitive neurons and the 

auditory neurons. 

Another area of strong research over the past few years has been 

the connection between tinnitus and depression. And it is often comorbid and it is often comorbid again in disorders such as PTSD. 

And it could be that the reason for that is because the brain mechanisms are targeting both of these centers. 

So it is, you know, not necessarily, you know, the chicken and 

the egg stories. It may be that these conditions developed together 

and you do not just get depressed because you have tinnitus, but 

that depression and tinnitus sort of exhibit themselves together. 

And so some of the research is targeting those areas. I could go 

on for a long time. 

Ms. BROWNLEY. But the damage to the ear then, it seems to me 

as someone who does not have a medical background or a science 

background really at all, it seems if there was damage to the ear 

VACREP180 with DISTILLER

23 

that that is something that could be fixed, that perhaps would be 

a cure. So it seems to me that it is much more on the brain sensory 

side. 

Ms. SHORE. Yeah. So one of the big questions with tinnitus is 

that even some people who have noise damage and hearing loss do 

not get tinnitus and why is that? We need to understand that because if we understand that, maybe we could prevent the people 

who do get tinnitus from getting it. 

But even if somebody does not have a hearing loss, they can get 

tinnitus. And that has been a big area of research recently because 

audiology clinics, you know, can measure and they can show that 

people do not have hearing loss. But if you do more sophisticated 

hearing tests, you can show that hearing actually is affected at a 

much milder level, enough to trigger a tinnitus in the brain. 

Ms. BROWNLEY. Thank you. 

And any research, we have talked about the research in the 

United States, is there any research outside of the United States 

internationally that is any different than what you have just discussed? 

Ms. SHORE. Well, there are some research organizations outside 

of the U.S. that have actually been very instrumental in pushing 

tinnitus researchers forward even within the U.S. And some of 

them are based in Germany and England. And they are trying 

their best as well separately and together to try to push tinnitus 

research forward so that we can find a cure. 

Ms. BROWNLEY. And is there some coordination that we are doing 

between investments in the research now that other agencies, NIH 

and you said DoD is providing some grants and what the VA is 

doing? 

Ms. SHORE. Coordination in what sense? 

Ms. BROWNLEY. Well, coordination in terms of, you know, 

progress or the research that needs to be done before, you know, 

to pursue a clinical trial. 

Ms. SHORE. Right. Well, there are scientific meetings that are 

very important that, you know, most people who do research in 

tinnitus will go to those meetings and present their findings and 

have discussions, set up collaborations. 

And that is the major source of information transfer as well as 

publication of papers. And that is going to be available to everybody, not just within a certain organization. 

Ms. BROWNLEY. And of our veteran population that is suffering 

from this, do you have some percentage of our veterans who we 

just have not provided any kind of successful treatment for it? 

Ms. SHORE. Well, I think the majority is not getting really successful treatment because there is no cure. And like, you know, I 

mentioned that there is a treatment program that is available that 

does help, I think, to some extent because even a person who comes 

in who has tinnitus, if they are told that this is not due to some 

life-threatening condition, that makes them feel better. But that 

does not make their tinnitus go away. 

Sound therapy is like masking. It sort of masks out the tinnitus 

for some people some of the time, but it is not actually getting rid 

of the tinnitus. And so currently there are not any standard treatVACREP180 with DISTILLER

24 

ments that we could say everybody should use this and their 

tinnitus will go away. 

But there are a number of tinnitus treatments that are being developed in research labs that are being tried out in animal models 

and that are being moved for clinical trials. And some of those are 

extremely promising because they are targeting the root of the disorder and trying to change brain circuitry. 

Ms. BROWNLEY. Thank you. 

And thank you for the additional time. I yield back. 

Mr. BENISHEK. Mr. Huelskamp. 

Mr. HUELSKAMP. Thank you, Mr. Chairman. 

A quick question first for Mr. Drexler. You do mention a few of 

the rural areas might not have a code that you referred to. 

And then how are those situations handled and in your mind, 

how should they be handled in terms of these inspections? Who 

would inspect and what would be the basis for those inspections? 

Mr. DREXLER. Essentially, the firm would hire a third-party inspection agency and that is becoming very common across the 

country. 

A simple example would be the State of California. We have all 

gone through, you know, the economic downturn. And California 

really took a big hit and they were forced to reduce numbers within 

their building and fire prevention staffs, inspection staffs, and went 

and began hiring third-party inspection agencies. 

Third-party inspection agencies would provide those inspections. 

They meet the certain qualifications that are established by and 

within the municipality and would ensure that—— 

Mr. HUELSKAMP. Mr. Drexler, a quick question. If there is no 

code specified by the municipality or the county or the state as a 

mandate, what should be the code, the basis of the inspection then? 

Mr. DREXLER. What should be the code if there is no code within 

that municipality? I think the legislation here would draw the need 

to require either the I codes or the life safety codes and recommend 

and require those codes to be in place within the municipalities 

that do not have building and fire prevention codes. 

Mr. HUELSKAMP. So the municipality would be forced to adopt 

those? 

Mr. DREXLER. Yes. 

Mr. HUELSKAMP. Under this legislation. Okay. Well, thank you. 

One other question though. I appreciate that. 

Follow-up, a little bit more on the transportation issue. I did a 

town hall in Syracuse, Kansas one week ago or eight days ago. 

Same gentleman that was there a year ago brought up the same 

story again. I am sure you hear that from rural areas. 

In this case, he was asked to drive 524 miles to have blood 

drawn. And it is just crazy. Cannot get the VA to figure out that 

there are a dozen hospitals along the way including one in his 

hometown. And here we are talking about encouraging transportation, although we are encouraging to allow him to go a few blocks 

to the local hospital. 

What should I tell this veteran? What do I need to be doing? 

I cannot seem to get the VA to figure this out. He has mentioned 

that to them again, 524 miles to get his blood drawn. And it does 

not matter whether you have a contract issue of who drives him. 

VACREP180 with DISTILLER

25 

It is himself. And as long as he drives what, three times a month, 

he can be reimbursed but not if he drives less. 

Any thoughts on that from the veteran service organizations? 

What are we supposed to be doing here? This is just unacceptable 

and I cannot get an answer for him that works. 

Mr. Gadd. 

Mr. GADD. I can answer that question. We testified, The American Legion did in the fall last year about fee-basis and non-VA 

care coordination. And, you know, we said that the VA should exercise discretion based on patient-centered approach. 

And that approach is that, you know, we can understand if they 

go for a major procedure within a VISN or near an area, but to 

have multiple trips a couple days a week, you know, for dialysis, 

you know, look at other options closer to that veteran’s community. 

And I think that that is a perfect way to—in this case, what was 

the local options? What was the closest community-based outpatient clinic? Is there a demand for laboratory services there in 

that area? Maybe that is something that the gentleman from the 

VA could address this morning. 

But we would argue that if it is multiple trips, and it is inconvenient, that the VA does have that authority to allow that veteran 

to be treated there locally near his home. 

Mr. HUELSKAMP. Do you think that in your mind they do not 

want to allow that or it gets lost in the shuffle or they just generally do not want to allow that? What is your thought on the 

VA’s—— 

Mr. GADD. They implemented the non-VA care coordination is 

the new rollout of that program. And they are trying to standardize 

procedures and how they formulate those decision-making abilities. 

You know, but we have argued that the veteran should have a 

say in that process and that there should be some recourse that the 

veteran has to appeal that decision, you know, and not have to 

drive 500 miles to get a blood draw. You know, that is ridiculous. 

Mr. HUELSKAMP. Mr. Kelley or Mr. Atizado, any thoughts? 

Mr. ATIZADO. I am just going to echo what Mr. Gadd mentioned. 

That local VA facility, the parent facility that that veteran is driving to, has the authority to pay for that service or that lab service 

at the closest location to the veteran’s residence. 

There are various reasons why a facility would choose not to exercise that authority. And I do not think we can discuss that at 

this point without all the information in front of us. 

But, nonetheless, that veteran should be able to speak to their 

primary care physician or social worker and hopefully that health 

care team will say, you know, 500 miles is a little too much. 

But, again, I cannot answer one way or the other why that is, 

just to say that VA does have the authority. 

Mr. HUELSKAMP. Is this a situation you hear about with regularity? How often does it happen? Is it just one guy in Syracuse, 

Kansas or is it something that you continue to hear from your constituents about as well? 

Mr. ATIZADO. Well, as far as getting care in the community, we 

hear it more often simply because it is an issue that is brought up 

as opposed to a veteran who does get care in the community and 

VACREP180 with DISTILLER

26 

does not say, hey, I got care in the community, it is great. They 

have nothing to contact and complain to us about. 

So, yeah. So there are issues like that where a veteran is not 

being allowed by VA to go to a local or community service and have 

VA pay, which is not to say that the issue of transportation is without issues as well, but this is an issue. 

That is why VA, as Jacob mentioned, has a non-VA care coordination office set up to establish some semblance of compassion in 

the fee-care program to make it more patient centered. 

Mr. HUELSKAMP. Okay. Thank you, Mr. Chairman, unless Mr. 

Kelley had some thoughts. Thank you. I yield back. 

Mr. BENISHEK. Well, I would like to thank the Members of the 

panel for their testimony today. It was very enlightening and I do 

appreciate your comments and look forward to any further input 

you want to give to me in the future on this bill. 

So thank you very much for your participation and you are excused. 

We will now call Dr. Jesse as he is the sole member of the third 

panel. 

You can begin when you are ready, Dr. Jesse. 

STATEMENT OF ROBERT L. JESSE, PRINCIPAL DEPUTY UNDER 

SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY SUSAN BLAUERT, DEPUTY ASSISTANT GENERAL 

COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Dr. JESSE. Good morning, Mr. Chairman and Ranking Member 

Brownley and Members of the Subcommittee. 

We do appreciate your continuing efforts to support and improve 

veterans’ health care and we thank you for the opportunity to address the bills on today’s agenda along with their impact on VHA’s 

health care operations. 

Joining me today is Deputy Assistant General Counsel Susan 

Blauert. 

And I would also like to thank Chairman Miller for coming by 

earlier. 

VA recognizes the importance of each one of these bills and we 

are committed to work with you and the Members of the Subcommittee and Congress on legislation that can enhance our ability 

to provide health care to our Nation’s veterans. 

I am going to address a few key points on each of the bills today, 

but the more detailed explanations are available in my written 

statement. 

Regarding the draft, Long-Term Care Veterans Choice Act, VA 

supports the concept of medical foster homes as an alternative to 

long-term institutional care as requested in VHA’s fiscal year 2014 

budget submission. 

We appreciate your interest in the concept, but we do need additional time to continue technical assistance to the Committee and 

particularly on details pertaining to the term adult foster home 

versus medical foster home, the payment methods, and cost analysis. 

VA strongly supports H.R. 1702 which would make permanent 

the authority to hire qualified drivers to expand access to VA 

VACREP180 with DISTILLER

27 

health care for individuals traveling to and from VA health care 

appointments. 

In 2012, though, Veterans Transportation Service or VTS provided more than 199,000 one-way trips totaling more than 9.7 million miles. The average length of a one-way trip is over 48 miles 

and it is a considerable distance and often would be prohibitive for 

those with poor health were transportation not available. 

Veteran service organizations are invaluable in providing volunteers to drive veterans to their appointments. However, there are 

often not enough volunteers to meet the level of need. More importantly, they are often precluded from transporting veterans with 

various clinical issues such as portable oxygen, as you heard. We 

do not see VTS as competitive, but rather supplemental to the important role played by the VSOs. 

VA is in agreement with the goal of H.R. 1443, the Tinnitus Research and Treatment Act of 2013, which would recognize tinnitus 

as a mandatory condition for research and treatment and require 

cooperation with DoD to perform further research. 

However, the bill describes programs and operations that already 

exist within VA. Our audiology clinics already provide tinnitus 

treatment through a progressive tinnitus management program 

which includes group educational counseling treatment and individualized management. 

VA has active projects underway in researching the efficacy of 

this multidisciplinary tinnitus treatment, the underlying etiology of 

tinnitus, and the co-occurrence of hearing loss along with tinnitus. 

VA is also collaborating with DoD on the development of a registry of the critical information to track the diagnosis, surgical 

interventions, or medical treatments for tinnitus and to follow-up 

for each case of hearing loss and auditory system injury incurred 

by servicemembers while on active duty. 

Currently, VA has the responsibility to ensure the safety of veterans cared for in its grant and per diem or GPD facilities through 

on-site inspections of each facility by staff from the local VA medical center. Inspections are focused on compliance with the requirements of the life safety code of the National Fire Protection Association. 

The inspection team is responsible for ensuring that general operating requirements as noted in GPD regulations are met. 

VA believes these measures ensure the safety of those properties 

and recognizing that as the intent of H.R. 2065, we do have some 

concerns with the bill as written. Specifically, we are concerned 

that H.R. 2065 will shift the cost of certifying compliance with life 

safety code or other applicable codes to the GPD grantees. 

Currently, VA covers the cost by inspecting the GPD facilities for 

compliance with life safety code at no charge to the grantee. Over 

96 percent of current GPD projects are operated by non-profit community-based providers. Any increased operating costs for these 

grantees could have a negative impact on the type and quality of 

services provided to veterans. 

We are also concerned that H.R. 2065 could have an inequitable 

impact on GPD providers in rural areas because of the difficulties 

of assessing qualified inspectors to certify compliance in those 

areas. 

VACREP180 with DISTILLER

28 

We do not yet have testimony on H.R. 1612 which would authorize VA to transfer a 64.5 acre tract to Tuskegee University or as 

noted previously from the draft, Long-Term Care Veterans Choice 

Act. 

However, we look forward to working with the Committee in providing technical assistance on these and any other bills before the 

Committee today. 

This concludes my remarks. On behalf of the department, thank 

you again for the opportunity to provide our views and be pleased 

to answer questions. 

[THE PREPARED STATEMENT OF ROBERT L. JESSE APPEARS IN THE

APPENDIX]

Mr. BENISHEK. Thank you, Dr. Jesse. It is a pleasure to see you 

once again before the—— 

Dr. JESSE. Thank you, sir. 

Mr. BENISHEK. —Committee. I have a couple of questions. I will 

yield myself five minutes. 

Is there a difference in what you are saying about the amount 

of research in tinnitus? 

You said you are already doing research because I think this $10 

million number is what keeps sticking in my mind, that there are 

so many episodes of tinnitus and you have $10 million for a multibillion dollar problem. It does not seem like much. So you seem to 

say something that you are already doing something about it. 

Is that $10 million number wrong then? 

Dr. JESSE. Well, that $10 million number, I think, was nationally, not just VA, nationally. VA’s investment is about $1.2 million, 

so about a tenth of that is in VA, mostly in four projects, three of 

which are really focused on the clinical assessments, one specifically which was called for in the bill to look at the efficacy of this 

multi-step treatment program. 

Mr. BENISHEK. You do not dispute that number then? That number seems reasonable to you? 

Dr. JESSE. Oh, no. Actually, I think that is a pretty small number compared to what we spend on a lot of other things. 

And I think what is interesting is, as Dr. Shore noted, that there 

has really been, I think, a dramatic change in the past, I will just 

say a couple of years, through new imaging modalities that are 

really beginning to describe the functional changes within the 

brain in patients with tinnitus historically which has really focused 

on it being an ear problem. 

But those technologies are relatively new and it takes time to get 

that kind of work into the, you know, the life cycle of research. 

But, yeah, I think it is—I guess I do not know that I can say it 

is underfunded because there is not enough money for the research 

or it is underfunded because there has not been the kind of highquality grants proposals coming through the system in order to get 

them funded. 

Mr. BENISHEK. So it is not like you are in favor of the legislation. 

Dr. JESSE. Well, we have no problems with the legislation. I 

think basically what is described in the legislation is stuff that we 

are already doing. 

VACREP180 with DISTILLER

29 

I guess the one issue, and just to be very clear because of the 

dynamics of research, is remember that VA is only authorized to 

do intramural research. We cannot fund extramural research. That 

is one of the reasons why we value the research partnerships with 

DoD who can. 

Mr. BENISHEK. Okay. 

Dr. JESSE. And I do not have the numbers for DoD. 

Mr. BENISHEK. Well, that is an interesting point there. 

I have another question for you, too, and that is this transportation issue. 

Dr. JESSE. Uh-huh. 

Mr. BENISHEK. And that is something I think we may have 

talked about before, and that is the fact that it came out here in 

the earlier panel with Mr. Huelskamp pointing out the fact that— 

are we going to transport more patients, make it easier to transport the patient 500 miles or are we going to use, the local community access mode and how are we going to balance that. 

I have been to town hall meetings myself where veterans have 

said to me, I cannot get to the place I want to go to get my x-ray 

and the other guy said, well, I can get the x-ray right here. So one 

veteran wants to go the 100 miles to get the chest x-ray. The next 

veteran does not want to go the 100 miles to get the x-ray. 

So I know there is a lot of individual variability in the patient 

preference. And I do not really know the best answer to that myself. I think now it all happens at the VA. 

My concern is the fact that, does the patient have an opportunity 

to call back once he gets an order to come in for an x-ray or a blood 

test, he can just call the VA back and say can I get the test done 

at my local hospital without having to go back to the initial doctor 

because sometimes that can be the problem? 

And the person who is answering the phone cannot get a hold 

of the regular doctor, or does not have the authority to make that 

decision. 

I think in the practical terms of how that gets done, there may 

be some problem, when the patient says I would rather get it done 

in my hometown and then the person they talk to on the phone 

does not have the authority to do that and cannot get a hold of the 

person that does. 

How does that actually occur and how do we make it better for 

the patient? 

Dr. JESSE. So I think this is one of the reasons why we are, as 

Jacob Gadd mentioned, the notion of having the coordinator for 

non-VA care, so there actually is a person who could make these 

kinds of decisions without somebody getting into the swirl of administrative phone tag. 

I know my patients, some that live still in Richmond where I still 

have my clinic, we draw from northern, you know, down into Roanoke Rapids areas of North Carolina and the far south West Virginia, some people have to travel fair distances. I mean, I think 

that common-sense is the thing that will prevail here. 

And I have patients who, for instance, are on Warfarin who have 

to have their INRs checked. Most of them will get it checked locally 

and they will also get it managed locally. Occasionally people will 

VACREP180 with DISTILLER

30 

get it done at the VA because they are coming up for a lot of other 

things and we can coordinate the visits around that. 

I think traveling 500 miles to get a blood drawn is kind of beyond common sense. I mean, if you are looking at a cost-basis, 

what we pay for benny travel, far exceeds the cost of that test. 

And the other piece that comes in here and one of our real fears 

many times is that the lack of coherence of the information, meaning if it is done in the VA, we can track it through our electronic 

medical record. It is there for everybody to see. There really is the 

continuity of care-based on the information. When it is done outside and gets reported, it often gets lost. 

And, you know, obviously a lot of what is going on nationally 

around health IT is meant to take some of those things into place. 

But I think we really try to do what is best for the patient and, 

you know, I am sorry to hear that some people have problems like 

this. I think that we need to be doing better in those cases. 

Mr. BENISHEK. Do you think that this coordinator, this person is 

going to make the difference then? That is what you are telling me. 

Dr. JESSE. Well, I think the primary care, you know, as we move 

to team-based care, as we move to the idea that you now have actually a direct connection in and you should not be having these, I 

cannot get my provider type of things, and those decisions can get 

made and taken care of that way. 

Mr. BENISHEK. My time is up here. I will leave it to Ms. 

Brownley. 

Ms. BROWNLEY. Thank you, Mr. Chair. 

I just also wanted to follow-up again on this tinnitus and the role of the VA in it. I mean, it seems to me that, you know, $1.2 million 

is not enough for the VA’s participation. 

And it seems to me if this is something, and clearly it is, that 

our veterans are suffering from, that the VA should be taking a 

significant leadership role in trying to lead the research to find 

cures for this. 

It is clearly costing the VA a lot of money for treatment that does 

not seem to necessarily have great outcomes. And I think always 

with research, if there is a will, there is a way. And it seems to 

me that the VA should be the leader in this area. 

Dr. JESSE. So I think from a clinical perspective in the treatment 

of tinnitus, we are. In terms of the basic research, I do not know 

that we are not because obviously there is not a lot going on in the 

country as it is. 

But as I mentioned, I think one of the issues is it has been a 

problem because we cannot quantitate it. We do not have a biomarker for it. And so we do not have a cure for it because we do 

not really understand in many cases what causes it. And so we 

have had to focus on the treatment and amelioration of the symptoms. 

Now with newer imaging modalities and better science, I think 

we are going to get a much better handle on the basis of the disease. And then when one can understand that, you can begin to define treatments that get to the root source rather than treating the 

symptom. 

Ms. BROWNLEY. Well, I mean, in Dr. Shore’s testimony anyway, 

it seemed as though the treatments generally are not as successful, 

VACREP180 with DISTILLER

31 

I guess, as we would like them to be. And if that is our leadership, 

it does not seem to me to be adequate because we are not necessarily treating the condition successfully and, yet, we also do not 

have a cure. 

So it just feels to me very much like we should be in a better 

leadership role around this because it is our customers, it is our 

constituents who are suffering from it and we should not be dependent on sort of outside research in hopes of, in hopes of coming 

up with a cure. 

I also just wanted to ask why at this moment you do not have 

a position on H.R. 1612? Is that what I heard you say, that you 

did not have a position? 

Dr. JESSE. Oh, it is for Tuskegee. 

Ms. BROWNLEY. Yes. 

Dr. JESSE. So just to be clear, we have no issue with transferring 

the land. It is a technical issue about what is required before we 

can do that. And so my understanding without stepping over my 

knowledge-base or bounds on this is that in order for us to transfer 

land back, certain assurances have to be made. And those are already existent in other Federal statutes. And so those have to be 

completely vetted and understood and then we will work through 

the process. 

Our objection is not in the transferring of the property. It is making it happen in a way that meets all the requirements and we just 

have not fully understood all of them yet. And also what that is 

going to mean is, there is going to be some cost associated with it 

that will have to be borne by somebody. We just do not know what 

that is yet and that is why we do not have the views. 

Ms. BROWNLEY. Thank you. I yield back. 

Mr. BENISHEK. Thank you, Ms. Brownley. 

Well, I think I have so many questions I could go on for a couple 

more hours. To tell you the truth, there was a lot of interesting 

things that came up in all the panels today. I may put some written questions—— 

Dr. JESSE. Sure. 

Mr. BENISHEK. —for the record to even some of the previous panels because these are such an interesting subjects and I think deserve a little more thought. 

So I want to thank you for your testimony today, Dr. Jesse, and 

thanks to all the other people that testified today. You are excused, 

Dr. Jesse. 

I ask unanimous consent that all the Members have five legislative days to revise and extend their remarks and include extraneous material. Without objection, so ordered. 

I would like once again to thank all the witnesses and the audience members for joining us in today’s conversation. 

The hearing is now adjourned. 

[Whereupon, at 11:46 a.m., the Subcommittee was adjourned.] 

VACREP180 with DISTILLER

(32) 

A P P E N D I X 

Prepared Statement of Hon. Dan Benishek, Chairman 

Good morning. The Subcommittee will come to order. 

Thank you all for joining us this morning to discuss five pieces of legislation concerning the health care and services available to our honored veterans through the 

Department of Veterans Affairs’ (VA’s) health care system. 

The five bills we will discuss today are: 

- Draft legislation, the Long-Term Care Veterans Choice Act; 

- H.R. 1443, the Tinnitus Research and Treatment Act of 2013; 

- H.R. 1612, to direct the Secretary of Veterans Affairs to convey a parcel of land 

in Tuskegee, Alabama, to Tuskegee University; 

- H.R. 1702, the Veterans Transportation Service Act; and, 

- H.R. 2065, the Safe Housing for Homeless Veterans Act. 

From ensuring the safety of homeless veterans residing in VA Homeless Grant 

and Per Diem facilities to ensuring that veterans eligible for VA-paid nursing home 

care are able to receive care in certified medical foster homes should they choose, 

these five bills address a number of critical issues facing today’s veterans and all 

of us charged with caring for them. 

I am eager to discuss each of these proposals in-depth to ensure a thorough understanding of their purpose, intended benefits, and unintended consequences. 

I am grateful to my colleagues who sponsored these bills and to our witnesses for 

being here to discuss them with us. 

I look forward our conversation. 

With that, I now yield to Ranking Member Brownley for any opening statement 

she may have. 

f 

Prepared Statement of Hon. Julia Brownley 

Thank you, Mr. Chairman. 

The purpose of today’s hearing will be to explore the policy implications of five 

bills before us today which cover a wide range of topics that would expand and enhance VA’s health care programs and services. To allow maximum time for discussion, I will limit my opening remarks primarily to H.R. 1443 and H.R. 1702. 

H.R. 1443, Tinnitus Research and Treatment Act of 2013, is offered by Ranking 

Member Michaud. 

According to the VA, tinnitus is the number one service-connected disability for 

veterans from all periods of service, affecting over 840,000 veterans. Since 2005, the 

number of veterans receiving service-connected disability for tinnitus has increased 

by at least 15 percent each year, and VA has been paying out over $1.2 billion annually to veterans for tinnitus disability compensation. At the current rate of increase, 

service-connected disability payments to veterans for tinnitus will cost $2.26 billion 

annually by 2014. Nevertheless, only about $10 million is dedicated to researching 

tinnitus in the public and private sectors. 

H.R. 1443 will allow for appropriate research time and resources by directing VA 

to recognize tinnitus as a mandatory condition for research and treatment by the 

VA Auditory Centers of Excellence. This will make certain that research is conducted at VA facilities on the prevention and treatment of this condition, and that 

VA cooperates with the Department of Defense’s Hearing Center of Excellence to 

further research on tinnitus. H.R. 1443 would ensure that we remain on the cutting 

edge for research and treatment of this issue facing veterans of all ages. 

VACREP180 with DISTILLER

33 

Next, H.R. 1702, introduced by Mr. Barber of Arizona, would permanently authorize VA to operate the Veterans Transportation Service (or VTS), which provides 

transportation for individuals to and from VA medical facilities in connection with 

vocational rehabilitation, counseling, examination, treatment, or care. VTS was 

launched in 2010, and VA’s current authority to operate the program is set to expire 

in January of next year. 

I did want to emphasize the critical need for this legislation in helping to increase 

access to care for those who would otherwise face challenges in getting to and from 

their appointments at VA. I also wanted to highlight that VA has estimated VTS 

to save up to $19.2 million in FY14 and $102.7 million over five years, because it 

is less expensive for the VA to hire drivers through VTS than to contract with ambulance services or to provide mileage reimbursements. So this is simply a commonsense initiative. 

Thank you, Mr. Chairman, for including these bills on the agenda. I look forward 

to hearing the views of our witnesses on the legislation before us today. 

Thank you, and I yield back. 

f 

Prepared Statement of Hon. Jeff Miller 

Thank you, Dan. 

It is a pleasure to be here again with you, the Subcommittee on Health, and all 

of our witnesses, stakeholders, and audience members to discuss my draft bill, the 

Long-Term Care Veterans Choice Act. 

The Long-Term Care Veterans Choice Act would authorize the Department of Veterans Affairs (VA) to enter into a contract or agreement with a certified Medical 

Foster Home (MFH) to pay for the residential long-term care of service-connected 

veterans who are eligible for VA-paid nursing home care. As a component of such 

care, eligible veterans would also be required to receive VA home health services. 

Medical foster homes (M–F-Hs) are private homes in which a trained caregiver 

provides twenty four hour, around-the-clock, care to a few individuals. They are designed to provide a non-institutional long-term care alternative to those who prefer 

a smaller, more home-like and familial care setting than many traditional nursing 

homes are able to provide. 

VA has been helping to place veterans in medical foster homes for over a decade. 

VA, as part of the placement process, inspects and approves all MFH’s, limits care 

to no more than three veterans at a time, and provides veterans living in such 

homes with home based primary care services. VA also provides safeguards to ensure veterans receive safe, high-quality care by requiring MFH caregivers to pass 

a Federal background check and VA screening, agree to undergo annual training, 

and allow VA adult foster home coordinators and members of a VA home care team 

to make both announced and unannounced home visits. 

Today, according to VA, over four hundred approved caregivers provide MFH care 

in their homes to over five hundred veterans daily in over thirty five states. 

The problem, however, is that VA does not have the authority to pay for the cost 

of the MFH. So, the veteran who chooses to live in a MFH must pay out of pocket 

with personal funds – regardless of whether or not such veteran is eligible for VApaid nursing home care. 

This creates a situation where many service-connected veterans with limited financial resources, who would prefer to live in a medical foster home, go to a nursing 

home institution instead because VA will cover the cost of the nursing home, but 

not the MFH. 

And, while traditional nursing homes will always be a vital component of longterm care, medical foster homes provide a worthy alternative for many veterans. 

According to the Department, many more veterans would elect to receive care in 

a medical foster home should VA be granted the authority to pay for such care. 

I am sure we all agree that one thing we owe our veterans, particularly those who 

are service-connected and in need of long-term care, is the luxury of choice - the 

choice to decide where and how to receive the care they need. 

As the veteran population continues to age, the need for long-term care services 

will continue to grow. The Long-Term Care Veterans Choice Act would expand the 

long term care choices offered to veterans beyond traditional services. Additionally, 

in addition to being beneficial for the health and well-being of veterans, the average 

cost of a MFH is more than half the monthly cost of a nursing home, making this 

legislation a very cost effective health care option. 

VACREP180 with DISTILLER

34 

1 U.S. Department of Veterans Affairs, National Center for Veterans Analysis and Statistics, 

‘‘Department of Veterans Affairs Statistics at a Glance Pocket Card.’’ Updated 17 April 2013. 

http://www.va.gov/vetdata/docs/Quickfacts/Spring—13—sharepoint.pdf. 

This is a common-sense, veteran-centric bill that will free many veterans from financial turmoil, and allow them to make their own decisions about what kind of 

long-term care they want to receive. 

I look forward to working closely with all interested parties to resolve any issues 

that may arise during today’s discussion. 

Thank you once again, Dan, for holding this hearing today and for the hard work 

and leadership shown by you and all of the Members of this Subcommittee. And, 

with that, I yield back the remainder of my time. 

f 

Prepared Statement of Hon. Jackie Walorski 

Mr. Chairman and Ranking Member, it’s an honor to serve on this Committee. 

I thank you for holding this legislative hearing to enable relevant stakeholders 

the opportunity to improve legislation directly impacting them. 

I also want to thank the veteran service organizations testifying today and those 

in attendance. The selfless work your organizations perform continues to inspire 

Members, such as me, to remain steadfast in our commitment to improving veteran 

health care. 

The Veteran Health Administration oversees an extensive integrated health care 

system. In fiscal year 2012, approximately 8.76 million veterans were enrolled in the 

VA health care system—with approximately 6.33 million unique patients treated. 1

While these are impressive numbers, we must not get buried in statistics and lose 

sight of what is most important—the veterans who have earned their right to quality and accessible health care. 

I look forward to working with my colleagues and our panelists on this legislation 

before us. 

Thank you. 

f 

Prepared Statement of U.S. Rep. Mike D. Rogers 

H.R. 1612 

Thank you Chairman Benishek and Ranking Member Brownley. 

First, I would like to thank you Mr. Chairman and your staff for holding this 

hearing today. I also want to thank the Full Committee Chairman, Jeff Miller, for 

his leadership on behalf of our Nation’s veterans. 

Mr. Chairman, H.R. 1612 will benefit the Department of Veterans Affairs (VA), 

the people of Tuskegee, Alabama and the taxpayer. 

In 1922, the board of Tuskegee University voted to donate 300 acres of land to 

the federal government for a veterans’ hospital. Since that time, the Tuskegee VA 

hospital and Tuskegee University have grown into integral parts of the community 

and serve important roles for our nation. Now, as the VA refocuses its mission to 

better serve our veterans, some of the donated land near the University’s campus 

no longer fits the VA’s needs. 

My bill would transfer 64.5 acres of land at 2400 Hospital Road back to Tuskegee 

University so that the land can better serve the community. This transfer also creates new opportunities for the VA by reducing substantial overhead and maintenance costs and providing cooperative authority to leverage the strengths of both institutions. 

This bill has been scored at no cost to the federal government and is a prudent 

use of our federal resources. Thank you again for the opportunity to testify Mr. 

Chairman and appreciate your leadership and strong support for this legislation. 

f 

Prepared Statement of Honorable David B. McKinley, P.E. 

Chairman Benishek, Ranking Member Brownley and Members of the Subcommittee, thank you for holding this legislative hearing today on important issues 

that affect our nation’s veterans. I appreciate the opportunity to give remarks on 

my bill, H.R. 2065, the Safe Housing for Homeless Veterans Act. This is the same 

VACREP180 with DISTILLER

35 

bill, with some modifications, that I testified for before the Subcommittee in the last 

Congress and that passed the House. 

Currently, there are over 2,100 community-based homeless veteran service providers across the country and many other homeless assistance programs that have 

demonstrated impressive success reaching homeless veterans. I have visited some 

of the shelters in my home district in West Virginia and was struck by how many 

seemed to not be in compliance with state, local or federal safety codes. 

Consequently, we began to investigate how widespread this problem was. It was 

unsettling to learn about shelter fires where lives have been lost. We read stories 

of a homeless shelter fire where occupants were killed because there was no sprinkler system at the facility and another where homeless veterans were injured because a sprinkler system was not working properly and the fire exits were blocked. 

These types of tragedies could have been avoided. 

This common sense legislation would ensure the wellbeing of veterans who have 

fallen on hard times and are in the most need of assistance. There is no current 

law mandating VA homeless shelters meet code. There is only a loosely defined policy that is not universally being followed. As a licensed professional engineer, I 

found this to be an egregious omission in the law governing VA homeless program 

funds. 

H.R. 2065 would require any organization that seeks funding from VA for services 

to homeless veterans to have documentation that their building meets or exceeds 

all building Codes. Since last Congress we made some modifications to the bill after 

meeting with stake-holder groups including the International Code Council. The 

current draft actually makes it easier for facilities to be certified as we open up the 

requirements beyond only Life Safety Codes to International Building and Fire 

Codes or any version of these codes that a local jurisdiction has adopted. Furthermore, the legislation would require adding a section in the VA annual report to Congress that would report the number of grant recipients or eligible entities who have 

submitted a certification that their facility met all building Codes. 

I understand that there is some concern over an undue burden for facilities to be 

certified that they meet or exceed the building codes. We welcome a continued dialogue on possible amendments to the legislation to make sure that this bill is simply 

requiring the facilities to follow what is already state and local law in most jurisdictions. I am pleased to let you know that we have already begun these discussions 

with the concerned parties and we are well on our way to a solution. 

After passing the House last year, this language was dropped from the final package that became law at the end of the year. As a nation, it should be unacceptable 

for us to allow homeless veterans be housed in potentially unsafe conditions. In defense of our country, these men and women were put in harm’s way; they should 

not be in doubt about their own safety now that they are home again. These homeless veterans are experiencing a difficult phase of their lives and should be able to 

trust that they will be safe each night as they continue their return to being productive members of society. 

I appreciate the testimony in support of H.R. 2065 from other witnesses testifying 

here today and I thank you for your concern for the safety and living environment 

of our veterans. 

f 

Prepared Statement of Jacob Gadd 

Chairman Benishek, Ranking Member Brownley and distinguished Members of 

the Subcommittee, on behalf of Commander Koutz and the 2.4 million members of 

The American Legion, I thank you and your colleagues for the work you do in support of our service members and veterans as well as their families. The hard work 

of this Subcommittee in addressing the health care needs of the veterans’ community makes a substantial impact on the ability for veterans to receive, as they deserve, the best care anywhere. 

H.R. 1443: Tinnitus Research and Treatment Act of 2013 

To direct the Secretary of Veterans Affairs to recognize tinnitus as a mandatory 

condition for research and treatment by the Department of Veterans Affairs, and for 

other purposes. 

It is no secret that the men and women who serve in the armed forces are potentially subjected to some of the most devastating noise trauma in the occupational 

world. From noisy jet engines to gunfire and artillery, to say nothing of the potentially damaging shock waves from Improvised Explosive Devices (IEDs), the ubiquitous threat of the recent and ongoing wars in Iraq and Afghanistan, veterans 

VACREP180 with DISTILLER

36 

1 US Department of Veterans Affairs Annual Benefits Report, FY 2011. 

2 Resolution 108: Request Congress Provide the Department of Veterans Affairs Adequate Funding for Research and Prosthetic Research, - AUG 2012. 3 Resolution 293: Veterans Transportation System (VTS) & Benefits Travel – AUG 2012. 4 Ibid. 

again and again place their ears and hearing at risk in service to this country. 

Tinnitus, which can stem from multiple causes, is often characterized as a persistent ringing in the ears, ranging from the distracting to severely disruptive to the 

ability to concentrate and focus on tasks. 

The American Legion provides accreditation for over 2,600 service officers nationwide who work with veterans to assist with claims for disability benefits. As such, 

this dedicated network is intimately familiar with the types of disorders affecting 

the nation’s veterans. Tinnitus represents the most prevalent service connected disability, with over 840,000 veterans receiving compensation for the disorder as of 

2011 1. With so many veterans affected, research into the disorder is critical. 

This bill would ensure a full spectrum of research would be conducted through 

the Department of Veterans Affairs (VA) into such varied topics as multidisciplinary 

treatment modalities, underlying etiological studies of the disorder, contrasting 

types of tinnitus with and without accompanying hearing loss, and other factors. 

The bill also prompts close cooperation between VA and the Department of Defense, 

perhaps a key component in preventing future incidences of the disorder. The American Legion ‘‘encourages acceleration in the development and initiation of needed research on conditions that significantly affect veterans. 2’’ All hearing trauma, be it 

tinnitus or hearing loss, is a scourge veterans are quite familiar with. Increased research into mitigating the effects of such traumas is a boon not solely to today’s veterans, but to generations to come. 

The American Legion supports the passage of H.R. 1443. 

H.R. 1612: 

To direct the Secretary of Veterans Affairs to convey a parcel of land in Tuskegee, 

Alabama, to Tuskegee University, and for other purposes. 

This bill addresses land conveyance between the VA and Tuskegee University. 

The American Legion has no position on H.R. 1612. 

H.R. 1702: Veterans Transportation Service Act 

To amend title 38, United States Code, 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. 

This bill provides a technical amendment to the existing law in 38 United States 

Code §111A, eliminating the provision in the current law which causes the authority 

of VA to expire and making the authority permanent. The authority in question allows VA to provide transportation services, increasing access to their facilities and 

health services. 

The American Legion believes there is a vital need for the Veterans Transportation System 3 to ensure all veterans receive access to the care they have earned 

through their service and sacrifice. Through the conduct of our many System Worth 

Saving (SWS) visits to VA health care facilities nationwide each year, our field staff 

and task force members have seen firsthand the importance of this program in getting veterans to the facilities. Whether through volunteer efforts or the VTS program, many veterans need help to reach treatment and disruption in the ability to 

provide that help results in a loss of care. Making this authority permanent would 

help provide stability for planning purposes. The American Legion would further 

urge Congress to continue to monitor this program and to consider raises as appropriate for beneficiary travel rates 4 as that is also a key component of getting veterans to the hospitals for treatment. 

The American Legion supports the passage of H.R. 1702. 

H.R. 2065: Safe Housing for Homeless Veterans Act 

To amend title 38, United States Code, to require recipients of per diem payments 

from the Secretary of Veterans Affairs for the provision of services for homeless veterans to comply with codes relevant to operations and level of care provided, and for 

other purposes. 

VACREP180 with DISTILLER

37 

5 Resolution 306: Funding for Homeless Veterans – AUG 2012 6Title 38, Code of Federal Regulations (CFR) Section 17.38 (a)(1)(ix)). 

This legislation requires veterans’ homeless shelters to meet all appropriate building and fire codes. Veterans’ homelessness is a critical problem. That veterans 

should have to contend with homelessness is a national shame. Secretary Eric 

Shinseki has been steadfast in his efforts to bring to bear the resources of VA to 

combat this issue, and great strides have been made in the last several years in 

reducing the numbers of homeless veterans on the streets every night. 

The American Legion supports the efforts of public and private sector agencies 

and organizations that aid homeless veterans and their families 5. Additionally, the 

Legion supports legislative proposals to provide medical, rehabilitative, and employment assistance to homeless veterans and their families. The American Legion 

places special priority on the issue of veteran homelessness. To help our struggling 

brothers and sisters-in-arms, the Legion works on a global level, lobbying for legislation affecting veteran homelessness, and acts on a local level, directly assisting veterans who have fallen on tough times and are without a place to live or facing the 

prospect of it. 

This direct assistance is coordinated by the Legion’s Homeless Veterans Task 

Force, which works to ensure local services and resources are available to homeless 

veterans and their families. The Task Force, which has chairpersons in each department, collaborates with government agencies, homeless service providers and veterans service organizations to develop and implement initiatives that will help 

homeless veterans. 

The Legion recognizes that aiding homeless veterans requires a sustained coordinated effort, which should provide secure housing and nutritious meals; essential 

physical health care, substance abuse aftercare and mental-health counseling, as 

well as personal development and empowerment. Homeless veterans also need job 

assessment, training, and placement assistance. The ultimate goal is total self management for the homeless veteran. 

Homeless veterans cannot be considered to have ‘‘secure housing’’ if they must 

contend with facilities that don’t even meet basic building codes and place these 

uniquely vulnerable veterans at risk of serious injury or death from fires and substandard building materials. If these veterans have lost their homes and livelihoods, 

we cannot in good conscience place them at risk to life and limb in unsafe facilities. 

This legislation would ensure the facilities designated to serve the needs of homeless veterans comply with appropriate codes and regulations, and give them a stable 

and safe environment to help piece their lives together as they move forward. 

The American Legion supports the passage of H.R. 2065. 

DRAFT LEGISLATION: Long Term Care Veterans Choice Act 

To amend title 38, United States Code, to authorize the Secretary of Veterans Affairs to enter into contracts for the transfer of veterans to non-Department adult foster homes for certain veterans who are unable to live independently. 

Adult Foster Care homes provide an alternative in some situations to traditional 

nursing home elder care. In general, these are single family homes which provide 

room, board and supervision as well as personal care services. These types of facilities provide for the needs of the elderly who, though they may require periodic or 

regular assistance with the activities of daily living, do not require full time nursing 

services. 

Individual states have a variety of rules and regulations related to the governance 

and approval of such facilities. This draft legislation would modify the United States 

Code to allow for veterans ‘‘for whom the Secretary is required to provide nursing 

care under section 1710A of [Title 38], the Secretary may transfer the veteran to 

an adult foster home that meets Department standards, at the expense of the 

United States, pursuant to a contract or agreement entered into between the Secretary and the adult foster home for such purpose.’’ In essence, this legislation 

would allow VA to place veterans in these adult foster homes and pay for the services provided. Veterans can currently utilize such homes if they so choose, but they 

must pay out of their own pocket for the services, even if VA is authorized to pay 

for nursing care for the veteran. 

VA is authorized 6 to provide a comprehensive array of medically necessary inhome services to enrolled veterans. This bill seeks to add a provision in title 38, 

United States Code (U.S.C.), Section 1720 that VA would be authorized to transfer 

veterans needing long-term care services to ‘‘Foster Homes,’’ upon the request of the 

veteran or Secretary of Veterans Affairs. 

VACREP180 with DISTILLER

38 

VA issued VHA Handbook 1141.02, Medical Foster Home Procedures, in November 2009, which outlined the Department’s policy on definition, responsibilities, selection, training, quality monitoring and financial arrangements for this program. 

VA defines a Medical Foster Home (MFH) in VHA Handbook 1141.02 as: 

1) MFH is an adult foster home combined with a VA interdisciplinary home care 

team, such as VA Home Based Primary Care (HBPC) or Spinal Cord Injury – Home 

Care (SCI–HC), to provide non-institutional long-term care for veterans who are unable to live independently and prefer a family setting. 

2) MFH is a form of Community Residential Care (CRC) for the more medically 

complex and disabled veterans, and is generally distinguished from other CRC 

homes by the following: 

(a) the home is owned or rented by the MFH caregiver; 

(b) the MFH caregiver lives in the MFH and provides personal care and supervision, 

(c) There are not more than three residents receiving care in the MFH, including 

both veterans and non-veterans, 

(d) veteran MFH residents are enrolled in a VA HBPC or SCI–HC Program. 

Each VA Medical Center facility appoints a MFH Coordinator which oversees the 

recruitment of staff, new applications for MFH in the community, training, quality 

assurance and inspections, and maintaining files of patients and MFH caregivers. 

While this program has been highlighted and encouraged because of the additional cost savings and access to care options for the veteran and VA, The American 

Legion seeks additional feedback from users of this MFH program about the level 

of patient safety and feedback on their quality of care that would be provided in 

a non-traditional care setting. We are continuing to study and monitor this situation 

to determine the best solution for veterans. 

The American Legion has no position on this legislation. 

For further questions or comments about this or other legislation affecting America’s veterans please contact The American Legion through Ian de Planque, Deputy 

Legislative Director at ideplanque@legion.org 

f 

Prepared Statement of Susan Shore 

Good morning Chairman Benishek, Ranking Member Brownley, and distinguished 

members of the Health Subcommittee. My name is Dr. Susan Shore, and I am the 

Chair of the Scientific Advisory Committee of the American Tinnitus Association. 

Thank you for holding this important hearing on an issue of concern to our nation’s 

armed forces and those members returning from combat – Tin-night-us or tinn-itus, most commonly referred to as ‘‘ringing in the ears.’’ Tinnitus has long been 

called the ‘‘invisible injury,’’ so because of this, and many other reasons which I will 

be addressing, it is extremely relevant and timely that tinnitus is recognized as a 

mandatory condition for research and treatment by the Department of Veterans Affairs. On behalf of the American Tinnitus Association and the 50 million Americans 

afflicted with tinnitus I appreciate the opportunity to speak to you today and respectfully urge your support for H.R. 1443, the Tinnitus Research and Treatment 

Act of 2013. 

The American Tinnitus Association focuses on curing tinnitus through the development of resources that advance tinnitus research. Founded in 1971, ATA is the 

only member- based and supported, national non-profit organization, dedicated to 

finding a cure for tinnitus. Since 1980 we have funded grants toward better understanding the mechanisms responsible for and underlying the genesis of tinnitus. 

Our Scientific Advisory Committee, comprised of 17 tinnitus investigators from multiple disciplines across the U.S., conduct peer reviews of all the grant proposals received at ATA. The most meritorious proposals with promise to help us get to that 

cure, are then forwarded to members of our Board of Directors who make the final 

funding decisions on these grants. 

The advances in tinnitus research over the past decade have been extraordinary. 

Many researchers across the country are breaking down barriers as I speak, in their 

own laboratories. One of the most important advances through research in recent 

years is the ability to ‘‘visualize’’ tinnitus, through the use of advanced functional 

imaging technologies and through the development of animal models that can behaviorally assess the presence of tinnitus. These methods allow us to pinpoint 

tinnitus to certain regions of the brain. Another important advancement that has 

VACREP180 with DISTILLER

39 

occurred mainly through the use of animal models is the discovery that tinnitus is 

a result of brain plasticity that occurs in response to outside insults such as noise 

damage or head and neck injury. In layman’s terms, brain plasticity refers to the 

ability of neurons in the brain to change their responsiveness and connectivity in 

the face of environmental influences. These developments have led the scientific 

community to understand that tinnitus is a disorder of brain function. 

For decades, tinnitus was thought of as a disease of the ear, or simply a symptom 

of hearing loss. Because of research we now know that in most instances, tinnitus 

does not originate in the ear but rather in the brain. And we also know that you 

do not need to have a measurable hearing loss in order to have tinnitus. While noise 

overexposure is still the number one cause of tinnitus, it can also develop in the 

absence of hearing damage as the result of a head or neck injury. So, while the relationship between hearing loss and tinnitus is high, we still do not understand well 

why some people with hearing loss develop tinnitus and others do not. This is an 

important area of research for both human and animal models because if we understand why certain vulnerabilities exist, we can come up with more appropriate 

treatments. 

Tinnitus also does not discriminate. It can happen to anyone at any time. 50 million Americans experience tinnitus and of those, 16 million seek medical attention 

for recurrent or chronic tinnitus. Two to three million are completely debilitated 

from their tinnitus rendering them unable to work, interact with family and friends, 

or sometimes even leave their home, degrading their quality of life. In addition to 

tinnitus, these people often have feelings of anxiety, depression and loneliness which 

can be directly attributed to their condition. Research has uncovered that depression 

and anxiety are comorbid conditions with tinnitus and may be part of the brain circuitry that is misdirected in bothersome tinnitus. 

Specific groups of people are disproportionately impacted by tinnitus. These 

groups include, factory workers, police officers and firefighters, emergency medical 

technicians, musicians, and, the reason we are here today – our military personnel 

and veterans. 

Tinnitus is the number one service-connected disability for returning veterans 

from Iraq and Afghanistan. As I mentioned before, in addition to hearing loss, head 

and neck injury can also contribute to tinnitus. So while tinnitus in these veterans 

is most often the result of extreme noise exposure from either a single impulse noise 

or the accumulation of noise exposure, head and neck injury is also a leading complaint of these veterans. In fact, lumbosacral or cervical strain account for 23% of 

service-connected disabilities for Iraq and Afghanistan veterans as of July 2009. In 

addition to factors that cause hearing loss, such as noise over-exposure, the generation and maintenance of tinnitus can occur as a result of temporal-mandibular joint 

disorder, or somatic insults, including lumbosacral or cervical strain. Research into 

how these systems interact in the brain has the potential to lead to treatments such 

as tailored devices that aim to ameliorate aberrant brain circuitries resulting from 

a combination of hearing loss and head and neck injuries. 

Since 2006, service-connected disability payments to veterans from all periods of 

service for tinnitus, has been increasing at a rate of 15% per year. In 2012, the VA 

paid out $1.5 billion in disability compensation to over 971,000 veterans for tinnitus 

alone. At the current rate of increase the cost will exceed $3 billion annually by 

2017. This dollar amount does not take into account the extreme suffering and necessary clinical care for veterans with tinnitus or the economic loss to society for 

those who are unable to work as a result of their tinnitus. 

When you consider that cost, in comparison to what is being spent on tinnitus research in the U.S., there is a severe disconnect. Up until very recently the amount 

of money being spent on tinnitus research has been negligible. At the end of 2012, 

between all public and private funding in the U.S., approximately $10 million was 

spent on funding research toward a tinnitus cure. Though still a small number, this 

is up from a mere $1.5 million in 2005, and that increase has been all due to Congressional interest in this matter. 

What have we learned as a result of recent increased research on tinnitus? And 

where do we need to go from here? 

• It is now well-established that alterations in neural plasticity in distinct parts 

of the brain are changed in patient and animal models of tinnitus. This opens 

the way for stimulation treatments that alter the aberrant neural circuitry. 

Some examples of this are special devices that provide tailored auditorysomatosensory or vagal nerve stimulation with the aim of returning the circuits 

to a normal state. 

VACREP180 with DISTILLER

40 

• Other treatments aim to target changes in the molecular environment with targeted drug therapies but at present there is no drug treatment that is specific 

to tinnitus. • The involvement of non-auditory systems in tinnitus is increasingly becoming 

apparent through animal and human tinnitus experimental models. Understanding these interactions in the brain is crucial for the development of treatments for alleviating this often debilitating condition. 

Several studies have been conducted by both the Department of Defense and the 

Department of Veterans Affairs as a result of the growing need to address tinnitus 

in the military. Those studies directly connect tinnitus as co-morbidity to both Traumatic Brain injury and Post Traumatic Stress Disorder as well as indicate that 

tinnitus is a larger problem than hearing loss in the blast exposed population. This 

is why our organization has advocated for the inclusion of tinnitus as a research 

condition in tandem with both TBI and PTSD. 

In particular, mild Traumatic Brain Injury or mTBI often includes tinnitus as a 

manifestation of injury. mTBI as defined by the Department of Defense Policy for 

Mild Traumatic Brain Injury is the presence of a documented head trauma or blast 

exposure event, followed by a change in mental status which could include nausea, 

dizziness/balance problems, temporary headache, sensitivity to noise or lights, vomiting, fatigue, insomnia and sleep disturbances, drowsiness, blurred vision, memory 

problems, poor concentration and tinnitus. A recent DoD study on Iraq veterans exposed to blast indicated that 70% of those exposed to blast reported tinnitus within 

the first 72 hours after the incident. 43% of those seen one-month after exposure 

to blast continued to report tinnitus. While the rate decreases over time, tinnitus 

rates exceeded hearing loss rates at all the time points. These findings also demonstrate the need for more comprehensive diagnostics and broader range of therapeutic approaches for tinnitus which can only be achieved by continued and additional research on the condition. 

There have been some important bipartisan legislative steps taken by Congress 

in recent years to address the growing problem of tinnitus in veterans and active 

duty military personnel, including the addition of tinnitus as a researchable condition in the DoD Congressionally Directed Medical Research Program. The American 

Tinnitus Association applauds these efforts, and we very much appreciate the efforts 

of the Department of Veterans Affairs through the Portland VA Medical Center’s 

National Center for Rehabilitative Auditory Research (NCRAR) to support tinnitus 

treatment. At the same time, we respectfully believe that tinnitus, which is so often 

associated with both TBI and PTSD deserves additional scrutiny. Improving 

tinnitus treatment with the goal of curing this disorder will almost assuredly impact 

treatment modalities for these other invisible wounds of war. 

Through passage of legislation such as H.R. 1443, the lives of veterans will be improved. And every research dollar spent, each discovery, and every step toward a 

cure for tinnitus benefits all Americans who suffer with this disorder.’’ 

I would like to close by sharing with you an email (one of hundreds I receive) that 

exemplifies the impact of research in the life of a veteran: 

‘‘Dear Dr. Shore 

Like many vets I have suffered from tinnitus ever since I was exposed through 

my line of work during the four years I served in the USAF servicing F–4 Phantom 

Jets from 1966 to 1970. They had massive engines running nearby and ear protection was often lacking or in need of repair. My ears would often ring after work but 

after a few years began to ring more often until, as now, they ring 24–7. It is now 

to the point of changing much of my life through constant use of masking devices, 

insomnia and general aggravation. The VA will sometimes allow a very small 10% 

disability for tinnitus but has made it very difficult and time consuming to all but 

those who can afford an attorney to represent them. That level of disability amounts 

to a small pittance of about 100 bucks a month but can be helpful with hearing aids 

later in life. 

However, I did file a claim with the VA which after many, many months was denied, the reason being according to their reviewing officer is that although I have 

some reduction in hearing (and had a reduction from my initial entrance to my discharge exam) it’s not enough under VA standards PLUS they stand by statement 

quoted from and publication called the NOISE MANUAL (Fifth Edition, Berger, 

AIHA Press 2000, P125) ‘‘only seldom does noise cause a permanent tinnitus without also causing hearing loss’’. Aside from the fact that ‘‘hearing loss’’ is an arbitrary 

term and by the VA standard I have none, I am living proof that this statement 

is not always true and is not a valid criteria for denial of claims. Thank you greatly 

for your time and for your research into what has become for me a lifelong constant 

aggravation. 

VACREP180 with DISTILLER

41 

Yours sincerely, DCS’’ 

This patient is correct in that tinnitus does not always have to occur in the presence of hearing loss detectable by conventional clinical methods. However recent research has indicated that more extensive hearing tests than are performed in the 

clinic may unveil hidden abnormality in the auditory system that may contribute 

to the brain plasticity underlying tinnitus. Even conventional hearing tests indicate 

that up to 19% of adolescents in the United States show evidence of mild hearing 

impairment caused by exposure to loud environmental and recreational sounds. Because peripheral hearing damage tends to worsen over the years, tinnitus is a looming public health challenge for citizens of all ages as well as a major disability affecting thousands of veterans in our armed forces. 

Thank you again for the opportunity to be here and bring attention to tinnitus, 

a condition that has been far too long neglected. Passage of legislation such as H.R. 

1443 will go a long way to helping us achieve our goals of improving tinnitus treatment and ultimately, finding a cure for this disorder. ATA is happy to provide any 

additional technical information on existing tinnitus research efforts as well as our 

suggestions for future activities, as embodied in the ATA ‘‘Roadmap’’ which is included as an addendum to my testimony. 

VACREP180 with DISTILLER


82244.001
42 

1 38, United States Code § 1730. 

2 (1) The veteran is unable to live independently safely or is in need of nursing home level 

care; (2) The veteran must be enrolled in, or agree to be enrolled in, either a VA Home Based 

Primary Care or VA Spinal Cord Injury Homecare program, or a similar VA interdisciplinary 

program designed to assist medically complex veterans living in the home; and (3) The medical 

foster home has been approved in accordance with 38 C.F.R. § 17.73(d). 3 38 U.S.C. § 1730(a)(3). 

4P.L. 106–117, 113 Stat. 1545 (1999) required that through December 31, 2003, VA provide 

nursing home care to those veterans with a service-connected disability rated at 70 percent or 

greater, those requiring nursing home care because of a condition related to their military service who do not have a service-connected disability rating of 70 percent or greater, and those who 

were admitted to VA nursing homes on or before the effective date of the act. Subsequent law 

extended these provisions. 5 VA’s policy on nursing home eligibility required that VISNs provide nursing home care to 

veterans with 60 percent service-connected disability ratings who are also classified as unemployable or permanent and total disabled. 

f 

Prepared Statement of Adrian M. Atizado 

Chairman Benishek, Ranking Member Brownley, and Members of the Subcommittee: 

On behalf of the DAV (Disabled American Veterans) and our 1.2 million members, 

all of whom are wartime wounded and injured veterans, I am pleased to present 

our views on legislative measures that are the focus of the Subcommittee today. 

Draft Bill, the Long Term Care Veterans Choice Act 

Many veterans who are disabled due to complex, chronic disease or traumatic injury may be unable to live safely and independently, or may have health care needs 

that exceed the capabilities of their families. While many of these veterans are 

placed in nursing homes, others can remain in their community of choice with proper support, delaying or avoiding nursing home care. Since 1951, the VA’s Community Residential Care (CRC) Program has provided health care and sheltered supervision to many of these veterans. This program has evolved through the years to 

encompass Psychiatric CRC Home, Assisted Living, Personal Care Home, Family 

Care Home, and Medical Foster Home (MFH). 

Established in 2000, VA’s Medical Foster Home (MFH) program currently operates under the same authority 1 as the CRC program. A type of community residential care facility limited to no more than three eligible 2 veteran residents in a private home, caregiver support is provided by the MFH attendant, and health care 

supervision is provided through VA’s Home-Based Primary Care program or VA spinal cord injury home care program. 

Patient participation in the MFH program is voluntary and veteran residents report very high satisfaction ratings. Furthermore, the administrative costs for VHA 

are less than $10 per day, and the cost of Home Based Primary Care, medications 

and supplies averages less than $50 per day. VA perceives this program as a costeffective alternative to nursing home placement, and it is gaining popularity as evidenced by the program’s expansion at the initiative of local VA providers with support from local VA facility leadership and VA Central Office. 

However, because MHF operates under the CRC authority, participating veterans 

must pay the MFH caregiver approximately $1,500 to $4,000 per month for room 

and board, 24-hour supervision, assistance with medications, and whatever personal 

care may be needed. 3 Even veterans, who are otherwise entitled to nursing home 

care fully reimbursed by VA under the Veterans Millennium Health Care and Benefits Act (Millennium Act) 4 or under VA’s policy on nursing home eligibility, 5 must 

pay to live independently in a CRC or MFH. 

Were it not for the MFH program, veterans who meet the nursing home level of 

care standards would qualify for VA paid care to receive it at a significant cost to 

the Department. In addition, veterans who do not have the resources to personally 

pay for room, board, and caregiver services are not able to avail themselves of this 

benefit. 

DAV is pleased with VA’s innovation by offering the MFH program as part of its 

long-term services and supports (LTSS) portfolio, and we applaud the intent of this 

draft legislation to give VA authority to enter into an agreement or contract with 

or a VA approved MFH and pay for room, board, and caregiver services of veterans 

already eligible for VA paid nursing home care. 

VACREP180 with DISTILLER

43 

6Kaiser Commission on Medicaid and the Uninsured. ‘‘Medicaid and Long-Term Care Services 

and Supports.’’ 2012. Available at http://www.kff.org/medicaid/upload/2186-09.pdf. 

Accordingly, we support this draft measure based on DAV National Resolution 

No. 214, calling for legislation to expand the comprehensive program of LTSS for 

service-connected disabled veterans regardless of their disability ratings. 

Mr. Chairman, DAV believes favorable consideration of this draft bill is a good 

first step for this subcommittee to assist VA in its effort to ‘‘rebalance’’ its LTSS 

portfolio. VA is and will continue to be challenged in providing appropriate LTSS 

due to the diversity, increasing number, and medical complexity of the veteran population who will need these services. 

Research on consumer preferences and well-being—together with the 1999 

Olmstead decision in which the Supreme Court upheld an individual’s right to receive services ‘‘in the most integrated setting appropriate’’—has motivated states to 

pursue rebalancing initiatives to shift LTSS systems away from institutional care 

and toward a system that embraces consumer choice and care in the home or community, and to reduce cost. The federal government’s most recent commitment to 

rebalancing is found in numerous provisions in the Patient Protection and Affordable Care Act, where new authorities offer financial incentives to states to shift rebalancing efforts to the next level in order to continue to transform the LTSS system. 

Though concern about the financing and delivery of LTSS is a recurring issue 

among policymakers, states have utilized a variety of innovative programs and services to rebalance their LTSS services, and spending for Medicaid Home and Community-Based Services (HCBS) has increased, accounting for 45 percent of total Medicaid long-term care services in 2010, up from just 13 percent in 1995. 6

Today, VA lags behind States in offering and providing HCBS. The proportion of 

VA LTSS expenditures devoted to HCBS is little more than 20 percent for FY 2012. 

Oversight by this Subcommittee is sorely needed as VA endeavors to shift resources 

from nursing home care to more cost effective HCBS in order to serve more veterans 

while honoring their preferences. We urge is subcommittee to ensure VA HCBS innovations are not stifled and VA LTSS encompass a broad range of assistance to 

veterans regardless of age who have lost the ability to function independently thus 

preventing them to be active participants in their community. 

H.R. 1443, the Tinnitus Research and Treatment Act of 2013 

If enacted this bill would require VA to recognize tinnitus as a ‘‘mandatory condition’’ for purposes of research and treatment, led by VA’s Auditory Centers of Excellence. The bill also would specify and define such research to include various assessments and studies of the condition of tinnitus. Finally, the bill would require cooperation between VA and the Department of Defense Hearing Center of Excellence 

with respect to tinnitus. 

Despite tinnitus being the top service-connected condition in the veteran population today, our members have not approved a DAV national resolution specific to 

research about, or treatment of, the condition. However, as a partner organization 

of the Independent Budget for Fiscal Year 2014, DAV believes that nothing should 

be permitted to interfere with the scientific merit review process within the VA’s 

research program, whether for tinnitus or for any other particular condition, disease, illness or injury. 

While we are sensitive to the sponsor’s expression of need for more research into 

tinnitus, as we would be for any condition endemic in the veteran population, as 

we indicated in the Independent Budget, ‘‘Ultimately, scientific merit based on careful peer review must be the determining factor in whether a [VA research] project 

is funded, not pressure from interest groups or interference in the selection of peer 

reviewers. The IBVSOs [Independent Budget veterans service organizations] and 

FOVA [Friends of VA Medical Care and Health Research, a 60-organization coalition] contend that between VA’s current peer-review system and the public status 

of this federally funded activity, sufficient accountability is present and that no further outside interference or influence is warranted. The Independent Budget veterans service organizations urge Congress and VA to take assertive steps to preserve and protect the quality and transparency of VA’s research funding decisions.’’ 

On the basis of these concerns, expressed collectively by DAV, AMVETS, Paralyzed Veterans of America and Veterans of Foreign Wars of the United States, we 

believe the purpose and requirements imposed by this bill should be reconsidered 

by its sponsor. 

VACREP180 with DISTILLER

44 

H.R. 1612, to direct the Secretary of Veterans Affairs to convey a parcel of 

land in Tuskegee, Alabama, to Tuskegee University, and for other purposes 

This bill would require the VA to convey 64.5 acres of the present VA Medical 

Center in Tuskegee, Alabama, comprising 20 structures, to the Tuskegee University, 

for the university’s purposes. 

We have received no resolution on this specific matter from our members, and 

thus, DAV takes no position on this legislation. 

H.R. 1702, Veterans Transportation Service Act 

This bill would provide VA a renewed authority to transport individuals in connection with their vocational rehabilitation, counseling, examination, treatment, or 

care, and make permanent an important transportation program after only one year 

of life. 

Notably, VA has implemented the provisions of Section 202 of Public Law 112– 

260, the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012, 

except for eliminating the authority granted under Section 111A of title 38, United 

States Code, to create a VA-operated transportation program one year after enactment. That act had prompted VA to initiate the Veterans Transportation Service 

(VTS), supported by the Veterans Health Administration (VHA) Chief Business Office (CBO). The VTS was established to provide veterans with convenient and timely 

access to transportation services and to overcome access barriers certain veterans 

may have experienced, and in particular to increase transportation options for veterans who need specialized forms of transportation to VA facilities. The VTS transportation services to VA medical centers include the use of technology and mobility 

management training for medical center staff that in turn enable VTS services to 

better interface with other community transportation resources. 

VA medical centers and sites where VTS is operating can be ideal partners with 

the DAV National Transportation Network and for the Veterans Transportation and 

Community Living Initiative grant projects establishing One-Call/One-Click Transportation Resource Centers. Based on our review of this situation, were it not for 

the expiration of statutory authority from Public Law 112–260, VTS would have 

grown from its current 45 sites to all remaining VA locations by 2015. 

The DAV National Transportation Network continues to show tremendous growth 

as an indispensable resource for veterans. Across the nation, DAV Hospital Service 

Coordinators operate 200 active programs. They have recruited 9,249 volunteer drivers who logged over 27 million miles last year, providing almost 721,000 rides for 

veterans to and from VA health care facilities. These veterans rode in vans DAV 

purchased and donated to VA health care facilities for use in the DAV National 

Transportation Network. DAV Departments and Chapters, together with our national organization, have now donated 2,586 vans to VA health care centers nationwide at a cost to DAV of $56.7 million. 

DAV believes VTS serves the transportation needs of a special subset of the veteran patient population that the DAV National Transportation Network is unable 

to serve—veterans in need of special modes of transportation due to certain severe 

disabilities. We believe that with a truly collaborative relationship, the DAV National Transportation Network and VTS will meet the growing transportation needs 

of ill and injured veterans in a cost-effective manner. 

Currently, DAV supports enactment of this bill; however, our support is based on 

the progress gained through our collaborative working relationship with VHA and 

CBO to resolve weaknesses we have observed in the VTS program. As you may be 

aware, VTS operates with resources that would otherwise go to direct medical care 

and services for veterans. These resources should be used carefully for all extraneous programs to ensure veterans are not denied care when they most need it. 

We thank VHA and CBO for their commitment and continuing efforts in working 

with DAV to ensure VTS will indeed work in concert with all existing and emerging 

transportation resources for veterans who need VA care, and to guard against fraud, 

waste and abuse of these limited resources. 

We look forward to continuing our work with the Committee on this measure, and 

to work for its passage. 

H.R. 2065, Safe Housing for Homeless Veterans Act 

The Safe Housing for Homeless Veterans Act would amend Title 38, United States 

Code, to require entities that receive per diem payments through the Department 

of Veterans Affairs (VA), for the provision of services to homeless veterans, to submit an annual certification to the Secretary of Veterans Affairs proving that the 

VACREP180 with DISTILLER

45 

building where the entity provides housing or services is in compliance with codes 

relevant to the operations and level of care provided. 

The certification would include compliance with requirements outlined in the recently published version of the Life Safety Code, International Building Code and 

International Fire Code, or similar codes that have been adopted as State or local 

codes in the jurisdiction of the project. In addition, all licensing requirements regarding the condition of the structure and the operation of supportive housing or 

service center, including fire and safety requirements, must be provided. 

For entities that receive per diem payments during the year in which the legislation is enacted, the recipient must submit all certifications required no later than 

two years after the date of enactment to the Secretary, or additional per diem payments will be halted until certification is received. 

DAV previously testified on a similar bill, H.R. 4079 introduced in the 112th Congress, that while we did not have a National Resolution from our membership specifically covering the state of the housing provided to veterans or the safety of the 

facilities where homeless services are provided, we did not oppose favorable consideration of the legislation. Since that hearing, it has been brought to our attention 

that the requirements outlined in H.R. 2065 may adversely impact Grant and Per 

Diem providers, which could leave many homeless veterans and their family without 

the services they need. 

While DAV agrees with the intent of the measure to provide safe shelters for our 

homeless veterans, we urge the Subcommittee work with VA and Homeless Grant 

and Per Diem providers, to mitigate any detrimental effects this bill may have while 

meeting the needs of homeless veterans in a safe environment. 

DAV appreciates the opportunity to submit our views on the legislative measures 

under consideration at this hearing. This concludes my testimony, Mr. Chairman. 

I would be pleased to answer any questions related to my statement and the views 

I have expressed on behalf of DAV. 

f 

Prepared Statement of Robert Drexler 

Good morning, Mr. Chairman, and distinguished Members of the Subcommittee. 

My name is Robert Drexler, Member of the Board of Directors of the International 

Code Council. I also serve as Fire Marshal for the town of Greece, New York . I 

am pleased to be here to discuss the importance of compliance with building and 

fire codes, speaking on behalf of the over fifty thousand building, fire code officials 

and other professionals across the United States who are the members of the Code 

Council. 

The Code Council was formed in 1994 as a nonprofit organization dedicated to developing a single set of comprehensive and coordinated national model construction 

codes. The founders of the ICC were the Building Officials and Code Administrators 

International, Inc. (BOCA), International Conference of Building Officials (ICBO), 

and Southern Building Code Congress International, Inc. (SBCCI). Since the early 

1900s, these nonprofit organizations developed three separate sets of regional model 

codes used throughout the United States. We joined these three groups together, 

and published a single code for the United States- the International Codes- beginning in 2000. In 2003, the International Code Council became the successor organization to the three legacy code groups, and so we are celebrating our tenth anniversary as an organization in 2013. 

Today our International Model Codes have been adopted at the state or local level 

in all 50 states and the District of Columbia. Numerous federal agencies, including 

the General Services Administration, the Department of Defense and the Architect 

of the Capitol have implemented the I–Codes, as have Puerto Rico and the U.S. Virgin Islands. The Code Council’s 50,000 members and over 300 chapters include 

state, county and municipal code enforcement and fire officials, architects, engineers, builders, contractors, elected officials, manufacturers and other construction 

industry professionals. 

I come before you today to encourage support for HR 2065, the Safe Housing for 

Homeless Veterans Act, sponsored by Rep. David McKinley of West Virginia and 

Rep. Grace Napolitano of California. Those of us who work in the realm of building 

safety at both the state and local level appreciate the concern that this bill has for 

the welfare of our veterans, who are living in housing subsidized by the Department 

of Veterans Affairs. 

In the building sector, the International Residential Code, the International 

Building Code, and the International Fire Code establish the basic requirements for 

building safety at the time of construction, and in the case of the Fire Code, at the 

VACREP180 with DISTILLER

46 

time of the annual inspection. These codes do not guarantee that a building will be 

safe from any and all hazards, as destructive forces can bring down any building 

if enough force is applied. But the codes do assure that when faced with the typical 

hazards that buildings are expected to encounter, including fire, windstorm, flooding, and even normal or even somewhat careless daily use, the building will allow 

for building residents and users to survive, and for first responders to safely rescue 

building occupants, and minimize property damage. 

In most jurisdictions around the country, either at the state level, or at the local 

jurisdictional level, both the International Building Code (IBC) and the International Fire Code (IFC) assure that buildings used for residential care and housing 

are safe. Our local code officials around the country inspect veterans’ homes and assure that they meet currently adopted codes, just as they do other commercial buildings. This is true in California, as well as 42 other states that have adopted both 

the IBC and the IFC. In fact all 50 states have adopted the IBC at either the state 

or local level, and 43 states adopt the IFC, while a significant number also adopt 

the Life Safety Code(LSC), at either the state or local level. 

HR 2065 wisely does not attempt to mandate one code or the other for compliance 

by facilities approved by the Department of Veterans Affairs for reimbursement, but 

requires a certification from all homes that they meet either the IBC and IFC, or 

the LSC, which are functionally, and from a safety standpoint, equivalent code requirements. 

In addition, the bill does not impose any onerous administrative burden on the 

Department of Veterans Affairs, other than to assure that each facility receiving reimbursement has filed a certification, either from the local code official, or from a 

competent third party, that code requirements are met. This is a reasonable and 

very workable requirement that mirrors similar requirements in place for other 

medical facilities that must provide very similar assurances to the Centers for Medicaid and Medicare (CMS), in the Department of Health and Human Services. 

It is true that for veterans’ homes covered by this requirement that are located 

in a jurisdiction that does not adopt and enforce either the IFC or LSC, there will 

be a small additional burden of obtaining an annual inspection to show compliance 

with the relevant code provisions. However, it is the clear intent of the bill sponsors, 

and a worthy goal in our opinion, that the safety of our veterans, who sacrificed so 

much for our freedoms, should be provided with safe housing, especially when the 

taxpayer is subsidizing that housing. It’s hard to argue that our veterans should not 

be assured of minimal safety in their housing, when the cost of assuring safety is 

a few hundred dollars or less. 

In closing, the International Code Council is proud of our work in developing the 

model codes used by most jurisdictions to assure a basic level of safety in the built 

environment, and we applaud your efforts to use those codes to protect the safety 

of our veterans. We continue to work to update and improve the codes, issuing revised codes every three years, through our governmental consensus process for the 

regulation of building construction. I applaud the work of your Subcommittee and 

encourage continued collaboration between the public and private sectors to achieve 

the important goal of increased safety in our nation’s buildings. Thank you again 

for the opportunity to appear before you today. I will gladly answer any questions. 

f 

Prepared Statement of Raymond C. Kelley 

MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE: 

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 

offer testimony on today’s pending legislation. 

H.R. 1443, the Tinnitus Research and Treatment Act of 2013 

The VFW supports this legislation which would require the Department of Veterans Affairs (VA) to recognize tinnitus as a mandatory condition for research and 

treatment by the VA Auditory Centers of Excellence in cooperation with the Department of Defense Hearing Center of Excellence. Characterized by a steady or intermittent ringing of the ears, tinnitus can cause sleep disruption, cognitive impairment and employment difficulties, and can worsen the symptoms of depression and 

anxiety disorders. Tinnitus is the most frequent service-connected disability awarded by VA among veterans of all eras. The common causes of tinnitus are acoustic 

trauma and traumatic brain injury, placing Iraq and Afghanistan veterans at particularly high risk due to IED blast exposure. Since 2000, the number of veterans 

VACREP180 with DISTILLER

47 

who are service-connected for tinnitus has increased by at least 16.5 percent each 

year. 

Although there is no known cure for tinnitus, it should not be assumed that the 

condition is untreatable. VA’s Progressive Tinnitus Management approach, which 

assists tinnitus suffers through individual counseling and support, is helping veterans better manage their symptoms. Still, more research is needed in order to identify truly effective treatments to alleviate those symptoms. This bill represents a 

positive first step towards achieving that goal. 

H.R. 1612, to direct the Secretary of Veterans Affairs to convey a parcel of 

land in Tuskegee, Alabama, to Tuskegee University. 

The VFW supports H.R. 1612, a bill that directs the Secretary of VA to convey 

a parcel of land in Tuskegee, Alabama, to Tuskegee University. More than 90 years 

ago, Tuskegee University, a land grant university, voted to donate 300 acres of land 

so the United States government could build a veterans hospital. Today, 21 of the 

buildings, accounting for nearly 280,000 square feet of space, sit vacant on that 

property. Nearly half of the buildings that would accompany the transfer are former 

quarters for employees who worked in housekeeping within the hospital, while several others are small 500 square feet or less storage buildings. 

Annually, VA spends approximately $2 per square foot to maintain vacant space. 

For the buildings that fall within this land transfer, VA spends more than $500,000 

per year in maintenance. Reducing the financial burden for upkeep of these buildings and grounds will allow VA to better use those non-recurring maintenance funds 

to ensure the highest level of maintenance for the facilities that provide care and 

service to our veterans and not on buildings that are sitting vacant. 

With nearly 1000 vacant or underutilized buildings within their system, the VA 

must work to right-size its property inventory, decreasing its footprint in some areas 

and increasing it in others. In doing so, VA must ensure they can provide a full continuum of care for veterans. At the Tuskegee VA Campus, programs and services 

have been expanded to include homeless shelters, community living facilities and 

women veterans services. Knowing VA has utilized as much of the property as possible, it is a financially responsible decision to return 64.5 acres of the original 300 

acres land and improvements back to Tuskegee University. 

H.R. 1702, the Veterans Transportation Service Act 

The VFW supports this legislation to permanently authorize the Veterans Transportation Service (VTS). This program, commissioned by the VHA Office of Rural 

Health in 2010, has greatly improved access to care for rural and seriously disabled 

veterans by allowing VA facilities to establish and coordinate networks of local 

transportation providers, including community and commercial transportation providers, and government transportation services. The VTS augments veterans service 

organizations’ volunteer-based transportation services, which are limited to transporting ambulatory veterans, and supplements the existing beneficiary travel programs of mileage reimbursement, which does not provide assistance with the coordination of transportation for those who need it, and special mode travel, for which 

few veterans medically qualify. 

The 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 wisely 

passed a one-year authorization of the VTS program in January 2013, but a longterm fix is still needed. 

The VFW believes that unnecessary hardships associated with accessing VA 

health care should be eliminated at every opportunity. This legislation would guarantee the continuation and future expansion of VTS, which plays a critical role in 

minimizing the challenges many veterans face in traveling to their appointments 

due to physical disabilities or great distances. 

H.R. 2065, the Safe Housing for Homeless Veterans Act 

The VFW supports this legislation which would require facilities that house homeless veterans to meet all relevant local building codes in order to receive per diem 

payments under the VA Homeless Providers Grant Per Diem Program. Currently, 

VA is required to check housing certificates before awarding grants for housing services provided to homeless veterans. However, thorough checks of fire and safety requirements, as well as structural conditions of the building, are often overlooked. 

The bill requires that current recipients of per diem payments submit certification 

VACREP180 with DISTILLER

48 

of compliance with local codes within two years of the enactment of this act, giving 

them ample time to make any necessary improvements. 

The VFW believes that VA funded transitional housing must be safe, secure, and 

sanitary. This bill would ensure that those standards are met, providing homeless 

veterans with the best chances of successful community reintegration. 

Draft Bill, the Long-Term Care Veterans Choice Act 

The VFW supports this legislation, which would add language to Section 1720 of 

Title 38 to allow veterans who receive VA care and require a protracted period of 

nursing home care to transfer into an adult foster home at their request. Under the 

bill, such homes must be ‘‘designed to provide non-institutional, long-term, supportive care for veterans who are unable to live independently and prefer a family 

setting.’’ VA currently has the authority to reimburse institutional care facilities 

such as nursing homes for long-term domiciliary care, but veterans who choose to 

live in adult foster homes must do so at their own expense. To grant VA the authority to reimburse adult foster homes would provide veterans with an additional residency choice, potentially improving the quality of life for those who would prefer 

this option. 

The VFW strongly believes that all non-VA services should be provided in conjunction with proper care coordination. VA Handbook 1141.02, Medical Foster Home 

Procedures, establishes the policies and standards of VA care coordination for veterans who choose to live in medical foster home settings. It requires an interdisciplinary VA Home Care Team to provide the veteran with primary care, regularly communicate with the foster home caregiver, and monitor the care provided by the foster home with frequent unannounced visits. The VFW feels that these would ensure 

adequate care coordination for veterans who chose to participate in a fully-funded 

adult foster care program. VA Handbook 1411.02 is scheduled for recertification in 

2014, and the VFW recommends that the care coordination policies outlined in that 

document should be made permanent by adding them to the language of this legislation. 

Mr. Chairman, this concludes my statement. I am happy to answer any questions 

you or other Members of the Committee may have. 

Information Required by Rule XI2(g)(4) of the House of Representatives 

Pursuant to Rule XI2(g)(4) of the House of Representatives, VFW has not received 

any federal grants in Fiscal Year 2013, nor has it received any federal grants in 

the two previous Fiscal Years. 

f 

Prepared Statement of Robert L. Jesse 

Good Morning Chairman Benishek, Ranking Member Brownley, and Members of 

the Subcommittee. Thank you for inviting me here today to present our views on 

several bills that would affect Department of Veterans Affairs (VA) health programs 

and services. Joining me today is Susan Blauert, Deputy Assistant General Counsel. 

We do not yet have cleared views on H.R. 1612, a bill that would direct VA to 

convey a parcel of land to Tuskegee University. We will forward views and any estimated costs to you as soon as they are available. 

H.R. 1443 Tinnitus Research and Treatment Act of 2013 

Section 2 of H.R. 1443 would require VA to recognize tinnitus as a mandatory 

condition for research and treatment by VA Auditory Centers of Excellence. Section 

3 of the bill would require the Secretary to ensure that research on the prevention 

and treatment of tinnitus is conducted at VA facilities. Required research would include an assessment of the efficacy of multidisciplinary tinnitus treatment modalities on different subsets of patients; studies on the underlying etiology of tinnitus 

in Veteran populations that occur as a result of different causal factors, including 

blast-related tinnitus, where there is no measurable hearing loss, versus other forms 

of noise-induced tinnitus, where there is hearing loss; and a study of the underlying 

mechanisms between hearing loss and tinnitus, including cases in which one or the 

other condition is present, but not both. VA would be required to ensure VA cooperation with the Hearing Center of Excellence established by the Department of 

Defense (DoD) to perform further research on tinnitus. 

This bill appears to be consistent with existing programs and operations within 

the Veterans Health Administration. Therefore, we do not believe this legislation is 

necessary. 

VACREP180 with DISTILLER

49 

VA Audiology Clinics currently provide tinnitus treatment through VA’s Progressive Tinnitus Management Program, a five-level program that provides education 

and treatment services to Veterans tailored to the degree of the disabling effects of 

tinnitus. Basic tinnitus intervention involves group educational counseling focused 

on providing Veterans with the knowledge and skills to self-manage their tinnitus. 

This group counseling involves interdisciplinary collaboration between audiology 

and psychology. For those Veterans who do not obtain relief from hearing aids or 

group educational counseling, VA offers treatment, including a comprehensive assessment and individualized counseling. If none of the above services are beneficial, 

VA begins treatment involving individualized management including relaxation 

techniques, cognitive behavioral therapy, drug therapy, sound-based therapy, and 

combined techniques. VA has also developed patient education materials and clinical training materials to advise clinicians on how best to identify, diagnose, and 

treat tinnitus and other auditory conditions. 

VA’s National Center for Rehabilitative Auditory Research (NCRAR), a VA Rehabilitation Research and Development Center of Excellence, has active research 

projects underway on the efficacy of multidisciplinary tinnitus treatment (e.g., Progressive Tinnitus Management) as referenced in Subsection (1) of Section 3 of the 

bill. NCRAR is also collaborating with the VA Audiology Program to develop and 

evaluate Progressive Tinnitus Management at VA medical centers. 

VA has active research projects underway addressing the underlying etiology of 

tinnitus, as well as the mechanisms underlying the co-occurrence of hearing loss 

and tinnitus, as referenced in Subsections (2) and (3) of Section 3. 

VA is also collaborating with DoD on the development of the Defense Center of 

Excellence for Hearing Loss and Auditory System Injuries, as mandated by Congress in section 721 of Public Law 110–417. The Center will develop a registry of 

information to track the diagnosis, surgical intervention, or other operative procedure, or treatment, and follow up for each case of hearing loss and auditory system 

injury incurred by Servicemembers while on active duty. This registry will also facilitate an electronic data exchange with VA. The law further requires the Center 

to collaborate with NCRAR and VA to ensure coordination of ongoing auditory system rehabilitation benefits and services by VA. 

VA believes that implementation of H.R. 1443 would be cost-neutral, if enacted, 

because VA already complies with the provisions of the bill. 

H.R. 1702 Veterans Transportation Service Act 

VA supports this legislation which would permanently extend the Secretary’s authority to hire qualified drivers to transport any person to or from a Department 

facility or other place in connection with vocational rehabilitation or counseling required by the Secretary pursuant to chapter 34 or 35 of title 38, or for the purpose 

of examination, treatment, or care. The Veterans Transportation Service (VTS) depends on paid drivers to provide transportation services. Section 111A of title 38 of 

the United States Code (U.S.C.) currently provides authority for use of paid drivers 

until January 9, 2014. 

Through the VTS program, VA provides funding to local VA facilities for mobility 

managers, transportation coordinators, and vehicles to complement the existing 

services that volunteers already provide. The service provides Veterans with transportation to and from their VA health care appointments, improving both access to 

care and continuity of care for many who would otherwise be limited in mobility. 

In 2012, VTS provided Veterans with more than 199,000 one-way trips totaling 

more than 9.7 million miles. The average length of a one-way trip is over 48 miles— 

a considerable distance and a prohibitive one for those with poor health if transportation were not available. Veterans with prostheses or those who use wheelchairs 

have particularly benefited from the VTS program. 

Veterans Service Organizations such as Disabled American Veterans are invaluable in providing volunteers for VA’s Volunteer Transportation Network. However, 

with increasing numbers of transportation-disadvantaged Veterans, there simply are 

not enough volunteers in all regions of the country to serve the level of need. Furthermore, volunteer drivers are generally precluded from transporting Veterans who 

are not ambulatory, require portable oxygen, have undergone a procedure involving 

sedation, or have other clinical issues. Some volunteers, for valid reasons, are reluctant to transport non-ambulatory or very ill Veterans. Without paid drivers, many 

Veterans would not have transportation to get to their medical appointments to receive the care they need. 

VA was grateful for enactment of the temporary authority to ensure we could continue to use paid drivers in the VTS program. The temporary nature of the authority, however, has impacted expansion of VTS, as VA facilities have been cautious 

in adding staff in light of the expiration that would occur early next year without 

VACREP180 with DISTILLER

50 

legislative action. This has understandably dampened our ability to expand the program. Permanent authority will provide this beneficial program with the stable 

foundation it merits. 

VA is unable to provide an accurate estimate of the cost savings associated with 

this bill at this time. However, since VTS became operational, savings have resulted 

from the use of paid VA drivers over Beneficiary Travel Special Mode transportation. VA paid drivers are a less expensive option than Special Mode transport. VA 

is closely examining the cost data across locations where VTS is implemented and 

will provide this information for the record as soon as we are able. 

H.R. 2065 Safe Housing for Homeless Veterans Act 

H.R. 2065 would amend 38 U.S.C. 2012(c)(1), which requires that Grant and Per 

Diem (GPD) grantees or eligible entities comply with specified fire and safety rules. 

In place of the current section 2012(c)(1), H.R. 2065 would impose a new requirement that would limit per diem payments to grant recipients or eligible entities who 

submit an annual certification (that has been approved or verified by the ‘‘authority 

having jurisdiction or a qualified third party’’) that the building where the entity 

provides housing or services is in compliance with codes ‘‘relevant to the operations 

and level of care provided.’’ 

VA does not support H.R. 2065. We are concerned it would fundamentally shift 

VA’s role in inspecting and overseeing GPD facilities and would shift some of the 

costs of facility inspections from VA to the GPD grantee. Currently, VA ensures that 

GPD facilities meet the requirements of the Life Safety Code (LSC) of the National 

Fire Protection Association through on-site inspections of each facility by staff from 

the local VA medical center. The inspection team includes representatives from the 

local VA medical center, who are responsible for ensuring that general operating requirements as noted in GPD regulations are met. The inspection team members are 

responsible for the review of the project in the following areas: clinical, facilities 

management, security/law enforcement, and nutrition and food services. The facilities management portion of the inspection includes a requirement for VA staff to 

evaluate compliance with the LSC. These projects must pass an initial inspection 

prior to per diem being awarded. Any deficiencies (e.g., nutrition, security, clinical, 

safety) noted by the inspection team must be corrected by the GPD-funded organization before the project can become operational. A completed initial inspection is 

signed by the VA medical center Director, approving the placement of Veterans 

within the project. The inspection packet is then reviewed by the Veterans Integrated Service Network (VISN) Homeless Coordinator for completeness and sent to 

the GPD National Program Office. GPD providers are also subject to annual re-inspection. The annual inspections are conducted in the same manner as the initial 

inspection. VA is concerned that merely requiring a certification of compliance with 

the LSC would remove an essential component of VA’s GPD facility inspection process making homeless Veteran transitional housing less safe and secure. 

Presently, the cost of inspecting a GPD facility for compliance of the LSC currently falls on VA. Ostensibly, section 2(a)(1) of H.R. 2065 would shift the cost of 

LSC compliance to the GPD provider. Because section 2(a)(1) merely specifies that 

the annual certification must be ‘‘approved or verified by the authority having jurisdiction or a qualified third party,’’ the concern is that a GPD provider would receive 

certifications of compliance from individuals or entities who are not truly qualified 

to certify compliance. Under the current statute and regulations, VA officials inspect 

and determine whether GPD facilities comply with the LSC. VA inspectors are directly accountable to the Department, and there are no concerns about the suitability or qualifications of third parties providing ‘‘certifications.’’ However, VA notes 

that many of the concerns addressed by section 2(a)(1) could be resolved through 

regulation. 

Furthermore, VA does not agree with the suggestion in section 2(a)(1) that the 

‘‘International Building Code and International Fire Code’’ are a suitable alternative 

to the LSC. VA is not aware of any single standard that is comparable to the LSC. 

The LSC is unique in that it is organized with chapters that address each occupancy 

type, has specific infrastructure requirements for existing as well as new facilities, 

and also provides operational requirements. The LSC accomplishes by itself what 

it would require multiple other codes to accomplish. For example, if the International Code Council (ICC) Family of codes was utilized, it would require use of 

the International Building Code, International Residential Code, International Fire 

Code, and International Existing Building Code in order to encompass the same 

scope as the LSC. 

While a different set of standards (other than the LSC) could be utilized to provide a comparable set of fire and safety requirements, VA believes that introducing 

another set of codes and standards would not benefit Veterans or VA in any mateVACREP180 with DISTILLER

51 

rial way. It would also not likely result in increasing the number of facilities that 

could be approved for the GPD program, and it could create an added burden for 

VA by potentially requiring VA staff to be trained on two sets of codes and standards instead of one. 

It should also be noted that VA facilities receive accreditation from The Joint 

Commission, which requires compliance with the LSC. VA uses the LSC for all VA 

facilities (including accredited facilities) to establish consistency across the country 

for minimum life safety requirements, code interpretation, and fire safety training 

for VA staff. Finally, section 2(b)(2) could be an extremely burdensome and costly 

reporting requirement. Although section 2(b)(2) gives little guidance on the extent 

and scope of these reporting requirements, it requires an evaluation of all facilities 

receiving per diem payments. Since VA has an active and robust cadre of GPD Liaisons, individuals at the local VA medical center who liaise with GPD grantees and 

ensure compliance with inspection findings, VA does not believe these potentially 

burdensome reporting requirements are necessary. 

If enacted, this bill would be cost neutral to VA; however the cost to VA’s community-based providers could be substantial. 

Draft bill entitled the ‘‘Long-Term Care Veterans Choice Act’’ 

The draft bill would allow Veterans, for whom VA is required to provide nursing 

home care by law, to request a transfer to homes designed to provide non-institutional long-term supportive care for Veterans, who are unable to live independently 

and prefer to live in a family setting. VA would pay the expenses by a contract or 

agreement with the home. One condition upon the transfer would be the Veteran’s 

agreement to accept home health care services furnished by VA. 

VA supports the Medical Foster Home (MFH) concept, where eligible Veterans 

who would otherwise need nursing home care could get, when clinically appropriate, 

long-term care in a more personal home setting. VA endorsed this idea in its fiscal 

year 2014 budget submission. Our experience has shown that VA-approved MFHs 

can offer safe, highly Veteran-centric care that is preferred by many Veterans at a 

lower cost than traditional nursing home care. While endorsing the MFH concept, 

VA cannot today offer a complete evaluation of the text of the draft bill. We have 

been working with the Subcommittee on technical assistance and look forward to 

further discussion. 

Mr. Chairman, thank you for the opportunity to present VA views on these bills, 

and we will be glad to answer any questions you or the other Members may have. 

f 

Statements For The Record 

U.S. REP. RON BARBER 

H.R. 1702 the Veterans Transportation Service Act 

Mr. Chairman and Ranking Member Brownley, thank you for your leadership on 

this subcommittee, which is so vital to meeting the health care needs of America’s 

veterans. 

Thank you for the opportunity to attend this hearing and to offer testimony on 

H.R. 1702, the Veterans Transportation Service Act. I apologize that I cannot be 

here in person, as I am with the Arizona Congressional Delegation attending the 

funerals of nineteen firefighters who perished fighting the Yarnell Hill Fire. 

Mr. Chairman, according to data provided by the Department of Veterans Affairs 

and Veterans Service Organizations, about six million veterans reside in rural areas 

of the United States. 

Of these six million veterans, more than half are enrolled in the Department of 

Veterans Affairs healthcare system. 

In my district alone, there are nearly ninety thousand veterans, many of whom 

live outside of the major cities in communities very far away from VA clinics or 

service centers. My office receives a significant number of calls every week from veterans who live in rural areas and who need medical services from the VA and for 

whom transportation is a major problem. 

The stories that I hear from rural veterans are no different, I imagine, from those 

that you are hearing from veterans in your districts as well. 

Those who live in rural areas are not the only veterans who need assistance. 

Thousands of veterans who live in the cities and towns across this nation need help 

with transportation as well. 

VACREP180 with DISTILLER

52 

In 2010, the Department of Veterans Affairs launched a Veterans Transportation 

Service (VTS) initiative to enhance transportation options for veterans who were 

seeking health care at VA facilities. 

Through the Veterans Transportation Service, funding is provided to local VA facilities to hire transportation coordinators and purchase vehicles driven by VAtrained staff. 

Over the course of the last two years, VTS has provided veterans with more than 

199,000 trips to medical facilities, totaling more than 9.7 million miles in 37 states. 

As you can tell from these numbers, this is a service that plays an important role 

in supporting our veterans. I believe we need to expand it so that we may assist 

transportation-disadvantaged veterans in other un-served or underserved areas of 

the country. 

I have introduced H.R. 1702, along with my colleague and Vice Chairman of the 

House Armed Services Committee, Mac Thornberry, to enact a permanent reauthorization for the VTS service. 

I would be remiss if I did not also mention the leadership provided by Senator 

Jon Tester on this issue as well; he is a champion in the Senate where this legislation also has strong bipartisan support. 

Last year, the VA’s Office of General Counsel raised questions as to whether the 

VA could hire drivers to operate the VTS without specific Congressional authorization. The program was discontinued as a direct function of the VA. 

Luckily, with Senator Tester’s leadership, the Congress moved quickly at the end 

of last year to provide the authorization needed to get the program back in operation. 

That authorization will only run until the end of 2013. 

Questions have been raised about the possibility of volunteers providing transportation. 

We all appreciate the invaluable volunteer transportation assistance the Disabled 

American Veterans provide to veterans, but there are many veterans who need a 

service different from the one provided by the DAV. The VTS is therefore complementary, not competitive, to the DAV program. 

VA Mobility Managers are trained to help make transportation decisions that are 

in the best interest of the veteran, often directing veterans to DAV services when 

appropriate and available. 

VTS drivers operate Americans with Disabilities Act compliant wheelchair and 

stretcher vehicles. 

For those veterans who are not ambulatory, who require portable oxygen, who 

have undergone a procedure involving sedation, or who have other clinical issues, 

these transportation services are critical to ensure their safe transportation to medical appointments and facilities. 

One of the most important aspects of the Veterans Transportation Service Act is 

that it saves the taxpayers money. 

The Department of Veterans Affairs has projected that they will save 19.2 million 

dollars in fiscal year 2014 alone by using the VTS for appropriate patients. 

This legislation is estimated to save the VA over 100 million dollars in five years. 

This is money that could be well spent on other aspects of veteran care. 

I believe HR 1702 is critical to the care of veterans in my Southern Arizona district and across this nation. 

I urge the Committee to take up this needed legislation so that the VA can continue and expand the VTS program. Thank you again for the opportunity to present 

this testimony, and I look forward to answering your questions. Thank you. 

f 

NATIONAL ASSOCIATION OF STATE FIRE MARSHALS 

Mr. Chairman and Honorable Members of the House Committee on Veterans’ Affairs Subcommittee on Health, the National Association of State Fire Marshals 

(NASFM) is pleased to submit this statement for the record in support of HR 2065, 

the Safe Housing for Homeless Veterans Act. NASFM applauds Congressman 

McKinley’s leadership on this issue. 

NASFM’s mission is to protect life, property and the environment from fire and 

related hazards. NASFM’s members are the senior fire safety officials in the United 

States and the District of Columbia. State Fire Marshals’ responsibilities vary from 

state to state, but most State Fire Marshals are responsible for fire safety code 

adoption and enforcement, fire and arson investigation, fire incident data reporting 

and analysis, public education and advising Governors and State Legislatures on 

fire protection matters. Some State Fire Marshals are responsible for fire fighter 

VACREP180 with DISTILLER

53 

training, hazardous materials incident responses, wildland fires and the regulation 

of natural gas and other pipelines. 

In connection with their code adoption and enforcement responsibilities, State 

Fire Marshals care deeply that occupancies of all kinds meet minimum safety code 

requirements—particularly those in which groups of individuals, at least some of 

whom may be challenged physically, gather and spend the night. We have learned 

from HR 2065’s sponsor, Congressman McKinley, that more than 67,000 veterans 

are homeless on any given night, and, over the course of a year, approximately twice 

that many experience homelessness. Just as our veterans helped to ensure the safety of Americans during their active service, the United States should do no less for 

them now, especially if they are experiencing the hardship of homelessness. 

Without HR 2065, homeless veteran shelters are subject to whatever fire and 

building codes apply in their particular jurisdiction. In some places, the existing 

codes establish minimum requirements that are enforced. However, in some states, 

no minimum building or fire code requirements exist, except in the larger cities. 

And within states, code requirements can vary from jurisdiction to jurisdiction, as 

do the capabilities of code enforcement entities. 

This is why it is crucial to include a provision in HR 2065 that would require any 

state or local code to provide an equivalent or higher level of safety than is provided 

by the Life Safety Code. According to the National Fire Protection Association, the 

scope of the Life Safety Code (also known as NFPA 101) is as follows: ‘‘The Code 

addresses those construction, protection, and occupancy features necessary to minimize danger to life from the effects of fire, including smoke, heat, and toxic gases 

created during a fire. The Code establishes minimum criteria for the design of 

egress facilities so as to allow prompt escape of occupants from buildings or, where 

desirable, into safe areas within buildings. The Code addresses other considerations 

that are essential to life safety in recognition of the fact that life safety is more than 

a matter of egress. The Code also addresses protective features and systems, building services, operating features, maintenance activities, and other provisions in recognition of the fact that achieving an acceptable degree of life safety depends on additional safeguards to provide adequate egress time or protection for people exposed 

to fire. The Code also addresses other considerations that, while important in fire 

conditions, provide an ongoing benefit in other conditions of use, including non-fire 

emergencies. The Code does not address . . . general fire prevention or building construction features that are normally a function of fire prevention codes and building 

codes.’’ 

NASFM believes that the Life Safety Code is an appropriate code to cite in HR 

2065 for minimum safety criteria, because it not only contains both fire and building 

safety provisions, but it also addresses both new and existing buildings in the same 

code. Another Federal agency, the Centers for Medicare & Medicaid Services, requires compliance with the Life Safety Code by health care organizations in order 

to begin and continue participating in the Medicare and Medicaid programs, so 

there is precedence for its use in this situation. By referencing the most current edition of the Life Safety Code (the 2012 edition being the most recent), HR 2065 would 

help ensure that homeless veterans are protected with a consistent fire protection 

code if they are sheltered in occupancies that receive grants from the Secretary of 

Veterans Affairs, no matter where in the United States they may be. 

Applicable provisions of the International Building Code and the International 

Fire Code – or the versions of those codes that have been adopted at the state or 

local levels by the jurisdiction in which the project is located – may be appropriately 

applied instead of the Life Safety Code, as long as they are demonstrated to provide 

equivalent or higher levels of safety than is provided by the Life Safety Code. We 

know from our discussions with Congressman McKinley’s staff that this bill does not 

intend to preempt any state or local codes that may provide an equivalent or higher 

level of life safety than HR 2065 would provide. Fire and building safety codes are 

an intricate subject, to say the least. As the debate on HR 2065 continues, NASFM 

stands ready to work with the U.S. Congress and the U.S. Department of Veterans 

Affairs if questions arise regarding the implementation of the code-related provisions of this bill. 

f 

NATIONAL COALITION FOR HOMELESS VETERANS 

Chairman Dan Benishek, Ranking Member Julia Brownley, and distinguished members of the House Committee on Veterans’ Affairs, Subcommittee on Health: 

VACREP180 with DISTILLER

54 

1http://thomas.loc.gov/cgi-bin/bdquery/z?d112:h.r.004079: 

2http://veterans.house.gov/witness-testimony/robert-l-jesse-md-phd-0 

3http://www.law.cornell.edu/uscode/text/38/2012 

4http://www.gpo.gov/fdsys/pkg/BILLS–113hr2065ih/pdf/BILLS–113hr2065ih.pdf 

The National Coalition for Homeless Veterans (NCHV) is honored to present this 

Statement for the Record for the legislative hearing on July 9, 2013. On behalf of 

the 2,100 community- and faith-based organizations NCHV represents, we thank 

you for your steadfast commitment to serving our nation’s most vulnerable heroes. 

This statement will focus on Rep. David McKinley’s H.R. 2065, the ‘‘Safe Housing 

for Homeless Veterans Act.’’ While we are appreciative of any effort to protect homeless veterans from unnecessary harm as they work to reintegrate into society, 

NCHV believes that this bill as currently written could adversely impact organizations that seek to serve those veterans. Therefore, NCHV does not support H.R. 

2065 at this time. 

Evolution of ‘‘Safe Housing’’ Legislation 

The original ‘‘Safe Housing for Homeless Veterans Act,’’ introduced in the second 

session of the 112th Congress by Rep. McKinley, would have required entities to 

perform the following in order to receive funding under Title 38 U.S. Code Chapter 

20 to house or serve homeless veterans: 

‘‘(Submit) to the Secretary a certification that the building where the entity proposes to provide such housing or services is in compliance with codes relevant to 

operations and level of care provided, including the most current Life Safety Code 

and all applicable State and local housing codes, licensing requirements, fire and 

safety requirements, and any other requirements in the jurisdiction in which the 

project is located regarding the condition of the structure and the operation of the 

supportive housing or service center.’’ 1

In its testimony before this Subcommittee on April 16, 2012, the Department of 

Veterans Affairs correctly noted that this legislation would have a very broad application, affecting such programs as the Supportive Services for Veteran Families 

(SSVF) Program, ‘‘even when veterans are not cared for in these structures.’’ 2

NCHV appreciates that the present version of the ‘‘Safe Housing for Homeless 

Veterans Act,’’ introduced by Rep. McKinley in May 2013, would no longer affect 

programs that do not necessarily involve housing for homeless veterans. However, 

we are concerned about this bill’s potential impact on community- and faith-based 

organizations. 

Need to Clarify Who Bears the Burden of Certification 

The Department of Veterans Affairs is barred by law from making per diem payments under Title 38 U.S. Code § 2012 unless an organization has shown that its 

facilities ‘‘meet applicable fire and safety requirements under the Life Safety Code 

of the National Fire Protection Association or such other comparable fire and safety 

requirements as the Secretary may specify.’’ 3 VA abides by this statute by conducting thorough inspections before making an initial per diem award to a service 

provider. 

If this initial inspection is successful and per diem funding is awarded, VA will 

continue to monitor the facility in question as well as provide regular re-inspections 

to ensure that, among other things, it continues to meet the applicable fire and safety requirements. 

H.R. 2065 introduces the concept of an ‘‘annual certification’’ that would require 

all per diem recipients to demonstrate the following: 

‘‘That the building where the entity provides such housing or services is in compliance with codes relevant to the operations and level of care provided, including applicable provisions of the most recently published version of the Life Safety Code 

or International Building Code and International Fire Code (or such versions of 

such codes that have been adopted as State or local codes by the jurisdiction in 

which the project is located), licensing requirements, fire and safety requirements, 

and any other requirements in the jurisdiction in which the project is located regarding the condition of the structure and the operation of the supportive housing 

or service center.’’ 4

NCHV is concerned that H.R. 2065 – as currently written – could discontinue 

VA’s current practices, in which the department determines whether facilities are 

in Life Safety Code compliance during its regular re-inspections. 

Do these current practices constitute ‘‘annual certification,’’ as described in this 

bill? If so, H.R. 2065 should be amended to clarify that VA maintains responsibility 

VACREP180 with DISTILLER

55 

for conducting all such inspections and providing certification. If not, this bill could 

place a significant burden on service providers to orchestrate and pay for these rigorous inspections out-of-pocket. This issue must be addressed before NCHV could 

consider making an endorsement. 

On the topic of whether or not International Building and Fire Codes should be 

used interchangeably with the Life Safety Code, as this bill would allow, NCHV defers to VA for its expertise in this area. 

In Summation 

While NCHV does not support H.R. 2065 at this time, we are hopeful that the 

appropriate changes can be made to ensure that veteran service providers are not 

adversely impacted by this legislation. 

Thank you for the opportunity to submit this Statement for the Record. It is a 

privilege to work with the House Committee on Veterans’ Affairs, Subcommittee on 

Health, to ensure that every veteran in crisis has reasonable access to the support 

services they have earned through their service to our country. 

Matt Gornick 

NCHV Policy Director 

202–546–1969 

mgornick@nchv.org 

NCHV Disclosure of Federal Grants 

Grantor: U.S. Department of Labor 

Subagency: Veterans’ Employment and Training Service 

Grant/contract amount: $350,000 

Performance period: 8/13/2012 - 8/12/2013 

Indirect costs limitations or CAP limitations: 20% total award 

Grant/contract award notice provided as part of proposal: Yes 

Grantor: U.S. Department of Labor 

Subagency: Veterans’ Employment and Training Service 

Grant/contract amount: $350,000 

Performance period: 8/13/2011 - 8/12/2012 

Indirect costs limitations or CAP limitations: 20% total award 

Grant/contract award notice provided as part of proposal: 

f 

Yes 

PARALYZED VETERANS OF AMERICA 

Chairman Benishek, Ranking Member Brownley, and members of the Subcommittee, Paralyzed Veterans of America (PVA) thanks you for the opportunity to 

submit a statement for the record regarding the five pieces of proposed legislation 

being considered today. PVA appreciates that you are addressing these important 

issues involving the health of our nation’s veterans. 

The ‘‘Long-Term Care Veterans Choice Act’’ 

PVA generally supports the ‘‘Long-Term Care Veterans Choice Act.’’ This bill proposes to amend title 38, United States Code to authorize the Department of Veterans Affairs (VA) to enter into contracts or agreements for the transfer of veterans 

to non-VA adult foster homes for certain veterans who are unable to live independently. PVA believes that VA’s primary obligation involving long-term support services is to provide veterans with quality medical care in a healthy and safe environment. 

As it relates to veterans with a catastrophic injury or disability, it is PVA’s position that adult foster homes are only appropriate for disabled veterans who do not 

require regular monitoring by licensed providers, but rather have a catastrophic injury or disability and are able to sustain a high level of independence. When these 

veterans are transferred to adult foster homes, care coordination with VA specialized systems of care is vital to the veterans’ overall health and well-being. The 

drafted text of this bill requires the veteran to receive VA home health services as 

a condition to be transferred. As such, PVA believes that if a veteran with a spinal 

cord injury or disorder is eligible and willing to be transferred to an adult foster 

home, the VA must have an established system in place that requires the VA home 

based primary care team to coordinate care with the VA SCI/D Center and the SCI/ 

D primary care team that is within the closest proximity to the adult foster home. 

When caring for a veteran with a catastrophic injury or disability this specialized 

VACREP180 with DISTILLER

56 

expertise is extremely important to prevent and treat associated illnesses that can 

quickly manifest and jeopardize the health of the veteran. 

When catastrophically injured or disabled veterans who receive services from one 

of the VA’s specialized systems of care are placed in a non-VA adult foster home 

they must be regularly evaluated by specialized providers who are trained to meet 

the needs of their specific conditions. PVA also believes that as this draft legislation 

is aptly titled the, ‘‘Long Term Care Veterans Choice Act,’’ veterans should only be 

transferred from a VA facility to a non-VA adult foster home with the full consent 

of the veteran, pursuant to title 38 U.S.C., Section 1710A(b)(1). 

H.R. 1443, the ‘‘Tinnitus Research and Treatment Act’’ 

PVA does not have a position on H.R. 1443, the ‘‘Tinnitus Research and Treatment Act of 2013,’’ a bill that proposes to direct the VA to recognize tinnitus as a 

mandatory condition for research and treatment. PVA supports VA research efforts 

involving hearing loss and conditions such as tinnitus, however, we believe that the 

selection of research subject areas and projects should be done through the VA scientific peer review process. 

H.R. 1612 

PVA does not have a position on H.R. 1612, a bill to direct the VA to convey a 

parcel of land in Tuskegee, Alabama, to Tuskegee University. 

H.R. 1702, the ‘‘Veterans Transportation Service Act’’ 

PVA supports H.R. 1702, the ‘‘Veterans Transportation Service Act,’’ a bill to 

amend title 38 United States Code to make permanent the authority of the VA to 

transport individuals to and from VA facilities when it is in connection with rehabilitation, counseling, examination treatment, and care. Too often lack of transportation is a barrier to veterans’ access to medical care. This is frequently the case 

for disabled veterans who do not have a personal means of transportation. Arranging for accessible transportation can be very arduous and time consuming, and as 

a result it is common for disabled veterans who are not able to drive themselves 

to medical appointments to delay health care until transportation can be arranged, 

or forgo medical attention completely. It is for this reason that PVA strongly supports H.R. 1702 and encourages Congress and VA to further improve veterans’ access to care by providing accessible transportation for disabled veterans, specifically 

veterans who have incurred a spinal cord injury or disorder, or veterans who use 

a wheelchair. 

H.R. 2065, the ‘‘Safe Housing for Homeless Veterans Act’’ 

PVA does not have a position on H.R. 2065, the ‘‘Safe Housing for Homeless Veterans Act.’’ If enacted this legislation would amend title 38, United States Code, to 

require entities that provide services to homeless veterans and receive per diem 

payments from the VA to comply with codes relevant to operations and level of care 

provided to veterans. PVA supports Secretary Shinseki’s goal of eradicating homelessness among America’s veterans, and believes that the safety of facilities that 

offer services to homeless veterans is of extreme importance. 

Paralyzed Veterans of America appreciates this opportunity to express our views 

on the proposed bills being reviewed. We look forward to working with the Subcommittee on these and other issues in the future, and are happy to answer any 

questions. 

Information Required by Rule XI 2(g)(4) of the House of Representatives 

Pursuant to Rule XI 2(g)(4) of the House of Representatives, the following information is provided regarding federal grants and contracts. 

Fiscal Year 2013 

No federal grants or contracts received. 

Fiscal Year 2012 

No federal grants or contracts received. 

VACREP180 with DISTILLER

57 

Fiscal Year 2011 

Court of Appeals for Veterans Claims, administered by the Legal Services Cor- poration—National Veterans Legal Services Program— $262,787. 

f 

VIETNAM VETERANS of AMERICA 

Chairman Benishek, Ranking Member Brownley, and distinguished members of 

the House Veterans’ Affairs Subcommittee on Health, Vietnam Veterans of America 

(VVA) appreciates the opportunity to offer this Statement for the Record on pending 

legislation before this subcommittee. 

Draft legislation: Long-Term Care Veterans Choice Act: Would authorize 

the Secretary of Veterans Affairs to enter into contracts for the transfer of certain 

veterans who are unable to live independently into non-Department adult foster 

homes. 

This seems like a good idea on the face of it, but there just isn’t enough 

detail for VVA to support this bill at this juncture. For example, what is the 

meaning of the phrase ‘‘. . . for certain veterans who are unable to live independently’’? 

Furthermore, the proposed legislation states that ‘‘At the request of a veteran for 

whom the Secretary is required to provide nursing home care under 1710A of this 

title, the Secretary may transfer the veteran to an adult foster home that meets Department standards at the expense of the United States . . . ’’ Who will decide which 

type of facility (and where) the veteran can choose to be transferred to? Currently 

there is a variety of facility options currently recognized by the VA, such as an adult 

family home, an assisted living facility, a community nursing home, a medical foster 

home, a state veterans home, or a community living center, and each of these options has separate eligibility criteria, including the veteran’s income level. 

This proposed draft legislation needs far more detail before VVA can give further 

consideration of support. The issue, though, is of high import to us, inasmuch as 

Vietnam-era veterans now constitute the largest living cohort of elderly American 

veterans. 

H.R.1443: Tinnitus Research and Treatment Act of 2013; introduced by 

Congressman Michael Michaud (ME–2): would direct the Secretary of Veterans 

Affairs to: 1) recognize tinnitus as a mandatory condition for research and treatment 

by Department of Veterans Affairs Auditory Centers of Excellence; 2) ensure that 

research is conducted at VA facilities on the prevention and treatment of tinnitus; 

and 3) ensure VA cooperation with the Hearing Center of Excellence established by 

the Department of Defense (DoD) to further research on tinnitus. VVA supports 

H.R. 1443. 

H.R.1612: To direct the Secretary of Veterans Affairs to convey a specified parcel 

real property at 2400 Hospital Road in Tuskegee, Alabama, to Tuskegee University, 

for the purpose of permitting the university to use the property to further the educational and general welfare of its students; introduced by Congressman Mike 

Rogers, (AL–3). 

The Tuskegee Airmen were the most highly respected African American troops of 

World War II, the University of Alabama donated 300 acres of land to build a hospital solely to care for black veterans in the South and today that hospital is the 

Tuskegee Veterans Affairs Medical Center. In February 2013 the Tuskegee VAMC 

celebrated 90 years of service to veterans and their families. In honor of the 

Tuskegee Airmen’s service and sacrifice to our nation, VVA supports H.R. 1612. 

H.R.1702: Veterans Transportation Service Act; introduced by Congressman Ron Barber (AZ–2); makes permanent (under current law, expires on January 10, 2014) the authority of the Secretary of Veterans Affairs to transport individuals to and from facilities of the Department of Veterans Affairs in connection with 

vocational rehabilitation, counseling, examination, treatment, or care. VVA supports making this provision of the law permanent. 

H.R.2065: Safe Housing for Homeless Veterans Act; introduced by Congressman David McKinley (WV–1); would require recipients of per diem payments for the provision of services for homeless veterans to comply with codes relevant to operations and level of care provided. 

The VA Homeless Providers Grant and Per Diem Program provides grants and 

per diem payment assisting public and nonprofit organizations in establishing and 

operating supportive housing and service centers for homeless veterans. When enacted into law, H.R 2065 would mandate that these public and nonprofits organizations are in compliance with Life Safety Code of the National Fire Protection Association and other requirements as stated in Section 61.20 Life Safety Code Capital 

VACREP180 with DISTILLER

58 

1 A 2012 report on deinstitutionalized disabled individuals by the National Council on Disability cited studies based on the National Core Indicators 2009–10 Survey to assess their preferences for housing, dividing responses into independent living, living with family members, living in a community-based setting (such as a small group home or foster care with a host family) 

or living in an institution (nursing home or large group home). Overall, ninety percent responded that they liked where they lived, but those surveyed expressed the most satisfaction 

with living with family members (96%) and the least with institutional settings (83%). Those 

in individual homes (90%) and in community based settings (87%) were in the middle. When 

asked if they would like to live somewhere else findings were somewhat consistent. Only 20% 

of those living with parents expressed a desire to live elsewhere compared with 39% of institutionalized respondents. Twenty-six percent of those in individual homes and 30% of those in 

community settings responded positively. Human Services Research Institute/ National Association of State Directors of Developmental Disabilities Services, National Core Indicators, 2011 as 

Grants in the VA Homeless Providers Grant and Per Diem Program regulations. 

VVA applauds Congressman McKinley for introducing this legislation and 

supports H.R. 2065 as written. 

Mr. Chairman and members of the House Veterans Affairs Subcommittee on 

Health VVA would like to thank you for the opportunity to submit our Statement 

for the Record on legislation that would improve the quality of life for veterans and 

their families before this subcommittee today. 

VIETNAM VETERANS OF AMERICA 

Funding Statement 

July 9, 2013 

The national organization Vietnam Veterans of America (VVA) is a non-profit veterans’ membership organization registered as a 501(c) (19) with the Internal Revenue Service. VVA is also appropriately registered with the Secretary of the Senate 

and the Clerk of the House of Representatives in compliance with the Lobbying Disclosure Act of 1995. 

VVA is not currently in receipt of any federal grant or contract, other than the 

routine allocation of office space and associated resources in VA Regional Offices for 

outreach and direct services through its Veterans Benefits Program (Service Representatives). 

This is also true of the previous two fiscal years. 

For Further Information, Contact: 

Executive Director of Policy and Government Affairs 

Vietnam Veterans of America. 

(301) 585–4000, extension 127 

f 

WOUNDED WARRIOR PROJECT 

Chairman Benishek, Ranking Member Brownley, and Members of the Subcommittee: 

Thank you for inviting Wounded Warrior Project (WWP) to provide views on pending health-related legislation. We welcome this opportunity to address two of the 

measures before you. 

LONG TERM CARE VETERANS CHOICE ACT

A draft bill under consideration is apparently intended to authorize VA to contract 

for room, board, and caregiver services in adult foster homes for veterans for whom 

VA would have an obligation to provide needed nursing home care. The measure 

would also provide for a participating veteran to receive VA home health services. 

Wounded Warrior Project welcomes the proposal to add medical foster home care 

to the continuum of long-term care options for wounded warriors. Almost without 

exception, our work with wounded warriors and their families has underscored how 

important it is to enable the individual to live in the community and avoid institutionalization. The comprehensive caregiver assistance program established in Public 

Law 111–163 has proven enormously helpful in realizing that goal for those who 

were seriously injured on or after 9/11 and need personal care services. But we do 

encounter parents and other family members who worry about a time when they 

might no longer be able to sustain caregiving, as well as seriously injured warriors 

who have no family to provide care. Given wide-ranging needs and preferences 

among those who cannot live independently, 1 there is merit to fostering new apVACREP180 with DISTILLER

59 

cited in Deinstitutionalization Toolkit: Community in Detail, National Council on Disability, 

2012, Figures 2–6. 2 2013 Wounded Warrior Project Survey Results 

3Tzounopoulos, T. 2013. Mechanisms underlying Noise- Induced Tinnitus. Retrieved from 

http://cdmrp.army.mil/prmrp/research—highlights/2013.shtml 

proaches. In sum, we applaud the effort to develop a statutory framework to enable 

VA to provide a community-based, home-like alternative to institutional care that 

includes needed home-health services. 

The legislation would vest the Department with broad authority to set standards 

for these homes. It is our understanding that adult medical foster homes are generally subject to state licensing requirements. But the draft bill sets no express expectations of VA with regard to those standards, which in our view should not simply default to a state licensure requirement, given the very vulnerable individuals 

covered under the draft bill. We do understand that VA has worked for some time 

with foster-home care providers under arrangements where the veteran has borne 

the costs of that care. It seems likely that the number of veterans who might choose 

a foster home option would grow were such legislation enacted. That scenario does 

raise questions as to how the program would operate, and what kind of oversight 

would be provided. What kind of training would caregivers receive? What precautions would be taken to ensure placements were clinically and age appropriate 

for the veteran? How would VA ensure that medical foster homes have appropriate 

oversight and that veterans and their families are satisfied with the services they 

receive there? We would encourage the Subcommittee to press VA to address those 

questions early on and clearly define expectations regarding standards of care, as 

well as outline how they would evaluate a potential residence’s ability to provide 

for younger generations of veterans who have unique rehabilitative needs. 

Finally, while we welcome this initiative, we would be remiss if we failed to note 

that VA still has important work to do as it relates to the long term rehabilitative 

care for those with moderate to severe traumatic brain injury, and particularly with 

implementation of section 107 of Public Law 112–154. Those provisions of law require that rehabilitative care for traumatic brain injury focus not only on achieving 

functional gains but on sustaining them, and that veterans be afforded communitybased rehabilitative services or supports that contribute to maximizing an individual’s independence. While Wounded Warrior Project, through our Independence Program, is working every day to help warriors with severe traumatic brain injury 

reach their fullest potential in their communities, we have not seen VA take comparable steps to implement a now year-old law requiring such action. 

Without ongoing rehabilitative care and community supports that Congress directed VA to provide, many post 9/11 Warriors with severe brain trauma will be relegated to lives of greater dependency, and without the social networks or employment options their non-disabled peers take for granted. VA must make significant 

improvements to ensure an adequate rehabilitative services continuum is available 

before placement of younger gravely injured veterans in residential settings other 

than their own or family homes will be acceptable. 

TINNITUS RESEARCH AND TREATMENT ACT OF 2013 

H.R. 1443 would direct VA to recognize tinnitus as a mandatory condition for research and treatment by VA Auditory Centers of Excellence and for that research 

to include the study of treatments, etiology, and underlying mechanisms of the disorder. The bill also directs VA to work with the Department of Defense’s Hearing 

Center of Excellence to advance research on tinnitus. 

With 52% of Wounded Warrior Project Alumni reporting tinnitus and 17% experiencing severe hearing loss, we welcome the focus on exploring improved prevention 

and treatment of hearing disorders. 2 As a very common health problem with limited 

treatment options, advancing research in this area could have a significant impact 

in improving care for wounded veterans. We see particular value in fostering the 

study and evaluation of prevention, assessment, and treatment of tinnitus through 

collaboration between the VA and the Department of Defense since it is strongly associated with service and exposure to a combat zone. 3 Advancements in preventing 

hearing loss and tinnitus will have to happen within the military, so it is important 

to ensure gains in knowledge and understanding are translated into improvements 

on the battlefield and in training. 

We are supportive of continuing research and improvements in the treatment of 

tinnitus, as well as other forms of hearing loss. Tinnitus is an often very disabling 

problem that affects many warriors frustrated by the fact that there are as yet no 

effective treatments. We urge that continuing research also explore the varying imVACREP180 with DISTILLER

60 

pact tinnitus can have on different people. As a chronic condition, the level of disability can differ significantly and improved understanding could better describe the 

spectrum of the condition and contribute to scientific and medical knowledge, as 

well as better prevention and care in the future and increased accuracy in disability 

ratings. Tinnitus merits robust research efforts and WWP would support legislation 

to advance understanding in this area. 

Thank you for your consideration of WWP’s views on these issues. 

Æ 

VACREP180 with DISTILLER