U.S. GOVERNMENT PUBLISHING OFFICE

30–304 PDF WASHINGTON : 2018

S. HRG. 115–387 

THE STATE OF VA SERVICES IN OHIO 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

NOVEMBER 21, 2017 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

JOHNNY ISAKSON, Georgia, Chairman 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

DEAN HELLER, Nevada 

BILL CASSIDY, Louisiana 

MIKE ROUNDS, South Dakota 

THOM TILLIS, North Carolina 

DAN SULLIVAN, Alaska 

JON TESTER, Montana, Ranking Member 

PATTY MURRAY, Washington 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

RICHARD BLUMENTHAL, Connecticut 

MAZIE K. HIRONO, Hawaii 

JOE MANCHIN III, West Virginia 

THOMAS G. BOWMAN, Staff Director 1

ROBERT J. HENKE, Staff Director 2

TONY MCCLAIN, Democratic Staff Director 

Majority Professional Staff 

Amanda Meredith 

Gretchan Blum 

Leslie Campbell 

Maureen O’Neill 

Adam Reece 

David Shearman 

Jillian Workman 

Minority Professional Staff 

Dahlia Melendrez 

Cassandra Byerly 

Jon Coen 

Steve Colley 

Simon Coon 

Michelle Dominguez 

Eric Gardener 

Carla Lott 

Jorge Rueda 

1Thomas G. Bowman served as Committee majority Staff Director through September 5, 

2017, after being confirmed as Deputy Secretary of Veterans Affairs on August 3, 2017. 2 Robert J. Henke became the Committee majority Staff Director on September 6, 2017. 

(III) 

C O N T E N T S 

NOVEMBER 21, 2017 

SENATORS 

Page 

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

WITNESSES 

Hon. Beatty, Joyce, Congressional Representative, 3rd District of Ohio ............ 5 

Tansill, Chip, Director, Ohio Department of Veterans Services .......................... 7 

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

Supplemental statement ........................................................................... 10 

Harman, Keith, Commander-in-Chief, Veterans of Foreign Wars of the United 

States .................................................................................................................... 12 

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

Twine, Melissa M., Veteran, Batavia, OH ............................................................. 19 

Prepared statement .......................................................................................... 21 

Powers, James, Veteran, Massillon, OH ................................................................ 22 

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

Burke, Ronald, Assistant Deputy Under Secretary for Field Operations, Veterans Benefits Administration, U.S. Department of Veterans Affairs; accompanied by Robert Worley, Director of Education Service, Veterans Benefits 

Administration; Robert McDivitt, Director of Veterans Integrated Service 

Network 10, Veterans Health Administration; Kameron Matthews, M.D., 

Deputy Executive Director, Provider Relations and Services, Veterans 

Health Administration ......................................................................................... 36 

Prepared statement .......................................................................................... 39 

Response to posthearing questions submitted by Hon. Sherrod Brown ...... 57 

APPENDIX 

Fitzgerald, Benjamin, Veteran, Westlake, OH; prepared statement ................... 67 

(1) 

THE STATE OF VA SERVICES IN OHIO 

TUESDAY, NOVEMBER 21, 2017 

U.S. SENATE

COMMITTEE ON VETERANS’ AFFAIRS

Columbus, OH. 

The Committee met, pursuant to notice, at 1:15 p.m., at the Columbus Metropolitan Library, Columbus, OH, Hon. Sherrod Brown 

presiding. 

Present: Senator Brown [presiding]. 

HON. SHERROD BROWN, U.S. SENATOR FROM OHIO 

Senator BROWN. Thank you again. I introduced the head of the 

library, Patrick. Thank you. 

Thanks for all of you to join us. It is the first hearing I have done 

with the Senate Veterans’ Affairs Committee here in Columbus, so 

thank you all for joining us. 

I will make an opening statement, an official opening statement 

for the Committee, followed by one from Congresswoman Beatty. 

We are in her district. She represents a district in most of the center of Columbus, representing some 700,000-plus people. She has 

been an ally to me on veterans’ issues and other things. I am very 

appreciative that she is here with us today. 

Then, we will ask for opening statements from our four witnesses 

to tell us what you want to tell us, and then I will begin questioning each of the you. That is the way we do a Washington, DC, 

hearing with Senate Veterans’ Affairs. Then, I will have a couple 

questions, then Joyce will ask questions. 

Joyce is having a meeting with the Speaker later today about a 

project in Columbus, and we will be glad if that meeting is successful. Joyce will not be here as long as I will, because I want to stay, 

obviously, through the whole hearing. 

OPENING STATEMENT 

Hearings like this are important because the best ideas, frankly, 

do not come out of Washington. They come from conversations like 

the ones we will have today with the women and men who served 

this country, and the VA officials who serve them. 

For today’s hearing, we not only invited veterans to testify, we 

solicited questions online. I have spent much of the last week, as 

Anna and Amber in my office have, asking veterans all over to 

come to Brown.Senate.gov to express concerns, ideas, and thoughts 

they have about the services, health, and education benefits that 

the VA provides. 

2 

If there are veterans in the audience who need assistance to access health care benefits, please get in touch with Anna or Amber 

or anybody on my staff, and John in the back. John and Anna are 

here from our Washington, DC, staff. John himself is a veteran. 

We will hear first from Ohio veterans, including Director Chip 

Tansill. Mr. Tansill, thank you for being here for the Department 

of Veteran Services. Next, Keith Harman, who is commander-inchief of the VFW. Later we will hear from VA officials. The two 

veterans I will introduce in a moment will give their remarks. 

Ohio, as you probably know, has almost 800,000 veterans, where 

we proudly have one of the largest veteran populations of any of 

the 50 States. The majority of veterans in our State, like in our 

country, are over the age 55. 

I thank every veteran in this room. Could all veterans raise their 

hands, please? Thank you. I thank all of you. 

I also never forget to thank the families of soldiers, sailors, Marines, and air men, because their sacrifice maybe just about as 

great when their loved ones are overseas. The anxiety and the 

worry and the financial struggles that family members have are always there. Thank you for supporting your men and women, your 

loved ones, who serve our country. 

Many veterans describe hurdles when transitioning from active 

duty to civilian life. Whether it relates to claims processing or simply obtaining a medical appointment, or using education benefits, 

veterans and their families face far too many obstacles in using the 

benefits that they have earned serving our country. We should be 

doing more to ease that transition for those who have served. 

I will be asking both of you about your transitions, because I 

know that is something particularly you and I have worked on, Ms. 

Twine, that is so important and that needs improvement. 

That is really why the Committee is here, to hear firsthand from 

Ohioans about the experiences they are facing as veterans, so we 

can do better. 

We must continue to fight to ensure the VA is delivering the 

highest quality health care, that veterans have the flexibility to receive care in the community when it is in their clinical interests 

to do so. I have heard from veterans who believe that only the VA 

can give them the comprehensive care to meet their specific needs. 

I was asked on the way in about the privatization efforts. Some 

people want to privatize the VA. I think that is just simply wrong, 

and I know that most veterans’ organizations agree with that. If 

people want to speak about that, I am certainly open to talking 

about it. 

Many VA employees, as we know, are veterans themselves. They 

have a shared experience. Go to the Chillicothe VA, you will walk 

down the hall, and many, many of the people you meet taking care 

of patients are veterans themselves. 

We must do what we can to shore up service lines at medical facilities, so veterans have access to more timely, quality care that 

meets their specific needs. We must work to shorten the time it 

takes for a veteran or a family member to receive a response to a 

claim or to an appeal. VA has made strides in the last few years 

to reducing the claims processing time, but 97 days is simply, without doubt, too long to wait. 

3 

We made improvements in VA education programs, like the Fry 

Scholarship and the Yellow Ribbon Program. But too often, veterans fall prey to predatory, for-profit recruiting tactics. For-profit 

schools that have closed abruptly have left men and women who 

served our country unable to secure the good-paying jobs that those 

schools and their fancy marketing have promised. They have left 

too many veterans trapped under a mountain of debt. They have 

defrauded too many veterans out of their G.I. education benefits. 

The Forever G.I. Bill took steps to help veterans recoup their 

losses, but we must do more to protect them on the front end. 

With congressional support, the VA has made inroads to combat 

veterans’ homelessness. One of the best programs in the country is 

just 60 miles or so south of here in Chillicothe. 

There are many other topics we will cover during the hearing, including steps the VA has taken to combat the opioid epidemic; toxic 

exposure, especially in Vietnam from Agent Orange; and health implications for veterans and their families; and to never forget the 

burden that caregivers face taking care of veterans and their illnesses in their older age. 

As I said earlier, if there are veterans in the audience who need 

assistance to access health care benefits, get in touch with me directly or with Jonathan or with Anna behind me. 

Most importantly, I want to continue this conversation to hear 

directly from you. 

I will turn it over to Congresswoman Beatty. 

STATEMENT OF HON. JOYCE BEATTY, CONGRESSIONAL 

REPRESENTATIVE FROM 3RD DISTRICT OF OHIO 

Ms. BEATTY. Thank you so much, Senator Brown. 

First, let me just say welcome to the Third Congressional District. You are sitting in the heart of my district, but I am here because there is a great Senator; a Senator who is not afraid to stand 

up for people; a Senator, as you heard, who has served on the Veterans’ Committee and continues to fight and advocate for veterans. 

It was a delight for me when I received his call telling me that 

he wanted to do this field hearing. First of all, I would have probably driven to Chillicothe, to Cleveland, or anywhere else to spend 

some time with those who have served and make it possible for me 

to be here today. 

Earlier, I saw a gentleman as we were coming in, a veteran. He 

had been in my office in Washington. I want to thank him because 

he remembered me telling the story about my father who served, 

and served with honor, and said to me before he passed, ‘‘Always 

make sure that you fight for those who fight for you.’’ When he said 

that, it was interesting because he said sometimes those are not 

the people who are sitting at the head of the table. It is the folks 

who are out in the trenches. It is the folks who could be doing 

something else, but they put their lives on the line. 

I am here today to not only say thank you and to join our Senator, but I am also here because I think it is important for you all 

to understand that we need you, and we need you more than ever 

now, because, certainly, as you know, our Nation has made a commitment to those who serve. I believe that we must honor that obliVerDate Mar 15 2010 21:17 Nov 29, 2018 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 Z:\ACTIVE\112117.TXT PAULIN
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gation by providing the best benefits, the best education, the best 

health care possible. 

Now, with that said, there are predators everywhere. As Senator 

Brown talked about higher education, we have to make sure that 

we protect the G.I. Bill funds from institutions that would want to 

take those dollars and not provide appropriate education. 

While I want to be positive and give hope and say that there is 

great opportunity, I also have to be honest and say that we have 

fallen short. That is another reason that we are here to hear from 

you. 

In the Third Congressional District—as you heard Senator 

Brown say, we have some 800,000 veterans in Ohio—we have some 

45,000 who live right here in the Third Congressional District. So, 

we must do better for all veterans. 

I was so pleased when the Senator asked you to raise your hands 

and I saw women power. Would the women just raise your hands 

again? Thank you for your service, and thank you for being here. 

We must do better about women’s health and access for you as 

well. 

Today, we are going to ask a lot of questions, and I will be here, 

as the Senator said, for most of the first panel. I want you to know, 

I am not just showing up today. I want you to know that I have 

been a strong advocate. I serve on the Financial Services Committee, but the subcommittee that is equally as important to me is 

the Subcommittee on Housing. 

I have only been in Congress for three terms, so to some, I am 

the baby on the Hill. But, I can tell you that I have introduced and 

signed on as a cosponsor to bills, and I can tell you a large number 

of those bills are centered around Veterans Affairs, making sure 

that there are adequate and appropriate legal services for veterans, 

housing for homeless veterans. 

So often, people only look at veterans like those of you who are 

here on the panel and in the audience. Far too many of our veterans were not able to get up this morning. They will not be thankful as we will be tomorrow on Thanksgiving because they have not 

had all of the benefits that we have had. 

That has not gone unnoticed by us, which is why having a voice 

like Senator Brown’s voice there speaking up—he is making a difference. That is one of the reasons I am here. 

This is not a gender or race or ethnicity or partisan issue. One 

of the first things I did was I went to my two colleagues, my two 

white, male, Republican colleagues, and asked how can I be part 

of the partnership to make a difference for veterans? We introduced a bill to help veterans. 

Last, let me just say one of the greatest honors for me that will 

go down in the history of my term as a Member of the U.S. Congress will be that, right here in my district, I played a major part 

in the writing, the orchestrating, the going and testifying this 

month, that we passed in the House to have right here in the Third 

Congressional District the National Veterans Memorial and Museum—one of a kind, the first and only one in the country. We 

know that is going to go over to the Senate, and Senator Brown 

will probably just single-handedly walk it through. [Laughter.] 

We will get that signed. 

5 

We have started it and got it through the House, and it will be 

a wonderful museum of artifacts for people to come and live part 

of the history, to say thank you to you for your service. 

Thank you. Again, I am Congresswoman Joyce Beatty from the 

Third Congressional District. I have my deputy outreach director, 

Larry Seward, with me. We want to say thank you, thank you, and 

thank you. 

Senator BROWN. This hearing will begin. 

Thank you, Congresswoman Beatty, for your serious and sometimes humorous introduction. I appreciate that. 

I will ask the four of you to give opening statements. I will introduce all four of you right now. 

Mr. Tansill, we will start with you, and then on the questions, 

I am going to start with the two veterans who are here as veterans, 

not as what you do with Veteran Services. 

Chip Tansill is Governor Kasich’s director of the Ohio Department of Veteran Services, a relatively new department, 10 years 

old maybe, something like that. He will testify. 

Keith Harman, Commander-in-Chief of the Veterans of Foreign 

Wars, one of our great veterans’ service organizations that really 

keeps the VA—always gives guidance to me personally, to my staff, 

and to the VA. Thank you for the work you do. 

James Powers is a veteran from Massillon, OH, Northeast Ohio. 

And, Melissa Twine, my office has worked with Melissa Twine on 

a number of issues, and I appreciate seeing you here in person. She 

is from Batavia, which is a community just east of Cincinnati. 

Mr. Tansill, we will start with you. 

STATEMENT OF CHIP TANSILL, DIRECTOR, 

OHIO DEPARTMENT OF VETERANS SERVICES 

Mr. TANSILL. Senator Brown, Congresswoman Beatty, thank you 

so much for allowing me to testify today. 

I had the privilege of serving in the U.S. Army for 32 years, including serving as chief of staff for the Ohio National Guard. Following my military retirement, I served as the executive director 

of the Franklin County Veterans Service Commission. 

I am proud to continue serving former members of our military 

as the director for the Ohio Department of Veteran Services under 

Governor John Kasich. Our department is a State Cabinet agency, 

which was created in 2008 to partner with county veterans service 

commissions and the U.S. Department of Veterans Affairs in order 

to serve those who have served our country. 

Ohio is home to nearly 800,000 veterans and their families, the 

sixth-largest population of veterans in the United States. 

Our team actively identifies, advocates for, and connects Ohio’s 

veterans with jobs, education, and the local, State, and Federal 

benefits for which they are eligible. 

Last fall, we established a Regional Veterans Workforce Team. 

They engage businesses across the State to highlight the unique 

and advantageous skill sets veterans contribute to our workforce. 

The team provides customized training for employers on areas such 

as understanding military culture, how to interview veterans, how 

to review their resumes, and how to create a veterans hiring process. In their first year alone, our Regional Workforce Team conVerDate Mar 15 2010 21:17 Nov 29, 2018 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 Z:\ACTIVE\112117.TXT PAULIN
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ducted nearly 100 trainings for representatives from nearly 800 of 

Ohio’s employers. 

I have had the pleasure of visiting some of the employers that 

they have worked with who have truly embraced the concept our 

team introduces to recognize their significant improvement in veteran hiring processes. 

During one of these visits at a veteran-owned business, I was 

told that if we could connect them with 50 qualified veterans, they 

would hire them that very day. We commonly see this type of incredible support and demand for hiring veterans across Ohio. 

Our trainings also make a big impact on human resources directors who experience first-hand what a huge contribution Ohio’s veterans make to their team. 

Ohio employers’ efforts to recruit and retain veterans go a long 

way in developing a framework for the successful transition of military members back into civilian life. Building a network of military-friendly employers across the State, currently totaling over 

2,800 businesses, is just one way that our department seeks out 

ways to ease the often-stressful transition back to civilian life. 

Our department also works in collaboration with the Department 

of Defense and other veteran and military support organizations to 

examine opportunities for improved coordination between Federal, 

State, and local resources to help servicemembers transition to civilian life. I am aware the discussions surrounding ways to improve 

this process are well-established and ongoing. 

Currently, most State resources for recently-transitioned veterans and their families require the veterans themselves to be 

proactive in seeking out services and benefits. This is problematic 

because many veterans are unaware that resources are available 

and, therefore, are not inclined to seek them out, especially while 

they are balancing the many other challenges that accompany 

transitioning from the military to civilian life. 

Going from an environment where lifestyle and career paths are 

very predictable to suddenly being on your own is not something 

that comes with an instruction manual. The transition experience 

would be improved if State veteran support agencies like our department were provided with the contact information for individuals as early as possible prior to their separation from the military, 

primarily by sharing the nonmilitary civilian email address they 

intend to use. 

If this email address were included as part of the DD–214 discharge document, it could better facilitate not only rapid and successful transition to civilian life with support from State and local 

services, but also improve communication with veterans who still 

have an Individual Ready Reserve commitment. 

This new method of communication would enable the Ohio Department of Veteran Services to proactively inform military members about services and benefits relevant to their experiences, 

health concerns, and other personal interests. These might include: 

targeted career and education opportunities; veterans’ claims and 

financial assistance locally available; and enrollment in VA health 

care facilities. 

We hear frequently from stakeholders and peers in other States 

that increased avenues for communication would make a big imVerDate Mar 15 2010 21:17 Nov 29, 2018 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 Z:\ACTIVE\112117.TXT PAULIN
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pact on our ability to ensure that veterans are presented with significant opportunities for success instead of ambiguity upon their 

military discharge. 

Our experiences have demonstrated that the most successful 

transitions are those in which the veteran and their family are 

quickly connected to employment, education, housing, benefits, 

healthcare, and veterans service organizations that empower them 

to thrive in their new community. 

It is my hope that by contributing to continuing conversations, 

the next generation of veterans can garner the benefits of improved 

procedures. 

I understand that there are many topics of interest today, and 

I will be glad to answer any questions regarding the other services, 

benefits, and resources available to Ohio’s veterans or the areas 

outlined in the supplemental information that I submitted with my 

testimony. 

[The prepared statement of Mr. Tansill follows:] 

8 

PREPARED STATEMENT OF CHIP TANSILL, DIRECTOR, 

OHIO DEPARTMENT OF VETERANS SERVICES


1121psTAN1.eps
9 


1121psTAN2.eps

Ohio I 

John R. Kasich , Governor 

Chip Tansill , Director 

Department of 

Veterans Services 

of military-friendly employers across the state, currently totaling over 2,800 businesses, is just 

one way that ODVS seeks out ways to ease this often stressful time of transition. 

ODVS also works in collaboration with the Department of Defense and other veteran and 

military support organizations to examine opportunities for improved coordination between 

federal, state, and local resources to help service members transition to civilian life. I am aware 

that discussions surrounding ways to improve this process are well established and ongoing. 

Currently, most state resources for recently transitioned veterans and their families require the 

veterans themselves to be proactive in seeking out services and benefits. This is problematic 

because many veterans are unaware that resources are available and therefore are not 

inclined to seek them out, especially while they are balancing the many other challenges that 

accompany transitioning from military to civilian life. 

Going from an environment where lifestyle and career paths are very predictable, to suddenly 

being on your own is not something that comes with an instruction manual. 

The transition experience would be improved if state veteran support agencies like ODVS were 

provided with contact information for individuals as early as possible prior to their separation 

from the military, primarily by sharing the non-military civilian email address they intend to use. 

If this email address were included as part of the DD-214 discharge document, it could better 

facilitate not only rapid and successful transition to civilian life with support from state and local 

services, but also improve communication with veterans who still have an Individual Ready 

Reserve commitment. 

This new method of communication would enable ODVS to proactively inform military 

members about services and benefits relevant to their experiences, health concerns and other 

personal interests. These might include targeted career and education opportunities, veterans' 

claims and financial assistance locally available and enrollment in VA healthcare facilities. 

We hear frequently from stakeholders and peers in other states that increased avenues for 

communication would make a big impact on our ability to ensure that veterans are presented 

with significant opportunities for success instead of ambiguity upon their military discharge. 

Our experiences have demonstrated that the most successful transitions are those in which 

the veteran and their family are quickly connected to employment, education, housing, 

benefits, healthcare, and veterans organizations that empower them to thrive in their new 

community. It is my hope that by contributing to continuing conversations, the next generation 

of veterans can garner the benefits of improved procedures. 

I understand that there are many topics of interest to discuss today, and I am glad to answer 

questions regarding any of the other services, benefits and resources available to Ohio's 

veterans or the areas outlined in the supplemental information submitted with my testimony. 
10 

SUPPLEMENTAL INFORMATION


1121psTANs1.eps

Ohio I 

John R. Kasich , Governor 

Chip Tansill , Director 

Department of 

Veterans Services 

Supplemental Information on Resources for Ohio's Veterans 

VA Healthcare in Ohio 

Ohio is fortunate to have significant access to VA healthcare services through five 

Medical Centers, 33 Community-Based Outpatient Clinics, and eight Vet Centers. Vet 

Centers are VA behavioral health care centers set apart in a non-institutional setting 

and operate largely independently of the local VA healthcare infrastructure. 

The Ohio Department of Veterans Services (ODVS) is supportive of efforts to broaden 

access to healthcare services for veterans. VA initiatives in this arena are closely 

monitored including the Choice replacement, titled the Veterans Coordinated Access 

and Rewarding Experiences Program. As changes are made to VA procedures, this 

information is shared with stakeholders and county veterans service offices. 

Mental Health and Suicide Prevention Resources 

Left untreated, mental illnesses and addictions shorten lives and take an emotional and 

economic toll on families and communities. ODVS, the Ohio Department of Mental 

Health and Addiction Services, the Ohio National Guard and several other collaborators 

have established the Star Behavioral Health Providers (SBHP) certification that is a 

training, dissemination and referral system aimed at expanding access to trained 

behavioral health providers for service members, veterans and their families. 

According to a recently released VA veteran suicide study, in Ohio 17 percent of 

suicides are veterans although only seven percent of the population are veterans. This 

type of dramatic imbalance holds true in all states across the nation. ODVS promotes 

resources from the VA for mental health providers including VA and community mental 

health providers and a confidential Veterans Crisis Line available through toll-free 

hotline, online chat or text. 

Ending Veteran Homelessness in Ohio 

Ohio has been proud to partner with the VA in ensuring that veteran homelessness is 

rare, brief, and non-recurring. Through collaboration between the VA, ODVS, county 

veterans services offices, public housing agencies and a myriad of community support 

organizations, the number of homeless veterans in Ohio has dropped from 1 ,244 in 

2012 to 903 in 2016 according to U.S. Department of Housing and Urban Development 

(HUD) statistics. 

Of the nine homeless Continuums of Care Programs across Ohio, two locations, Dayton 

and Akron, have already been certified by HUD and the VA as reaching "functional 

zero" for veterans homelessness (when the number of veterans who are homeless, 

whether sheltered or unsheltered, is no greater than the monthly housing placement 
11 


1121psTANs2.eps

Ohio I 

John R. Kasich , Governor 

Chip Tansill , Director 

Department of 

Veterans Services 

rate for veterans). Two others have submitted data to HUD to support certification of 

"functional zero," and three will submit data for certification in the near future. ODVS 

and the VA also have partnered with the Ohio Housing and Homelessness 

Collaborative to provide insights on how the processes implemented to eliminate 

veteran homelessness in Ohio can be applied toward ending all chronic homelessness 

throughout the state. 

Filing Veterans Benefits Claims 

ODVS maintains a strong collaborative relationship with the VA Regional Office in 

Cleveland through the ODVS Liaison Office that facilitates communication between 

Veterans Benefits Administration (VBA) staff and all county veterans service offices. 

Along these lines, ODVS collaborated with the Cleveland VA Regional Office and Ohio's 

88 county veterans services offices to established a "Fully-Developed Claim Checklist" 

that allows for claims filed under that program to be adjudicated within 140 days. In 

coordination with the Department of Defense, ODVS proposed and hosted the pilot 

system that resulting in making Defense Personnel Record Information System files 

(military personnel records) accessible to state veteran agencies and certain county 

veterans services offices. In recognition of these efforts, ODVS received a 2015 Pillars 

of Excellence Award from the VA Secretary for Elimination of the Disability Claims 

Backlog. 

Higher Education Opportunities for Ohio's Veterans 

Ohio's public colleges and universities are committed to the acceptance and awarding 

of college credit for military training, experience, and coursework. In 2014, Governor 

John Kasich signed two pieces of legislation (HB98, 2013 and HB488, 2014) that 

created the most expansive opportunities in the country for veterans to leverage their 

military experience, education and training in gaining access to college credit and 

professional licensing and certification. 

In accordance with this legislation, the Chancellor of the Ohio Department of Higher 

Education signed a directive providing a baseline set of standards and procedures for 

the application of military credit. Having one set of standards and procedures serves to 

provide consistency to the process, makes it easier to communicate with a wider 

audience, and highlights the priority the higher education community places on assisting 

veterans and active duty service members with their educational and career goals. 

This includes translating training, experience and coursework from serving in the U.S. 

Armed Forces Guard into college credit. All training, experience, and coursework first 

must be recognized by the American Council on Education or a regional accrediting 
12 

Senator BROWN. Thank you, Mr. Tansill, especially your comments about transition and how important that is. We know that 

the VA and the Department of Defense do not always work together as well as they should. I think we are seeing improvements, 

but not enough yet. 

Commander Harman, thank you for your service and for being 

here. 

STATEMENT OF KEITH HARMAN, COMMANDER-IN-CHIEF, 

VETERANS OF FOREIGN WARS 

Mr. HARMAN. Senator Brown, Congresswoman Beatty, on behalf 

of the Veterans of Foreign Wars of the United States, the Nation’s 

largest organization of combat veterans, and its Auxiliary, thank 

you for giving us the opportunity to discuss issues important to 

Ohio’s veterans. 

In the past 3 years, the VFW has assisted hundreds of veterans 

who have faced delays receiving care through the Choice Program, 

identified issues with the program, and compiled several reports 

with common-sense recommendations on how to address these 

issues. The VFW must commend the VA, Congress, and the program administrator for resolving or addressing most of the issues 

that we have identified. 

However, the Choice Program continues to face several challenges that must be addressed, to include ensuring that the decision of whether a veteran will receive care with the VA or the comVerDate Mar 15 2010 21:17 Nov 29, 2018 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6601 Z:\ACTIVE\112117.TXT PAULIN

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13 

munity is determined by the veteran and their health care team, 

consolidating all community care programs into one easy to understand and to administer program, and establishing one appropriations account. 

The VFW urges this Committee to quickly pass a community 

care bill that will develop a consolidated care program that supplements, not supplants, the VA’s health care system. 

In September 2016, the VFW partnered with five excellent organizations to launch our mental wellness campaign, which helps 

servicemembers, veterans, and their families, with mental health 

conditions. We did so to address the stigma associated with seeking 

metal health care, but this is not new. 

Thirty years ago, people were ashamed to talk about cancer. It 

was a shameful word. Today, people are ashamed to admit they 

have a mental health condition. Why? The brain is an organ. It is 

part of our body. It needs treatment to address injuries, but can recover just as any other part of the body can. 

The VFW has worked tirelessly in the past 2 years to get people 

talking about mental health, to notice when someone may be in a 

mental health crisis, and to finally eliminate the stigma our society 

has placed on mental health. VFW posts around the world have 

hosted nearly 300 events within their communities to share with 

their members about the resources available to veterans and family 

members suffering from mental health conditions, and it is working. Just 2 weeks ago, I had a veteran tell me at a Veterans Day 

event in our Nation’s capital that the VFW had saved his life. 

In order to completely eliminate veteran suicides, VA must increase access to military competent health care and conduct more 

studies to find innovative ways to treat mental health conditions. 

The VA has conducted research on therapies such as service animals, but other therapeutic alternatives, such as medical marijuana, must be studied. 

Women veterans are the fastest growing population within the 

military and veteran community. There are currently 2 million female veterans, with nearly 68,000 of them in Ohio. Now more than 

ever, it is important that the VA and Congress address their gender-specific needs. 

The most common recommendation the VFW has received from 

Ohio women veterans is that the VA must increase access to gender-specific VA providers. We also hear from women veterans that 

VA outreach efforts are increasingly ineffective because the VA relies heavily on electronic communications such as social media. The 

VA must reach all generations of women veterans who have earned 

the ability to receive their health care at the VA. 

While the VFW applauds Congress for passing S. 1025, the Veterans Appeals Improvement and Modernization Act of 2017, we 

have significant concerns with regard to how the VA intends to implement the prescribed changes by way of the Rapid Appeals Modernization Program, and we would call on Congress to conduct 

oversight on this process. 

The VFW would like to thank this Committee for its hard work 

and dedication on the swift passage for the Forever G.I. Bill, which 

will make a difference for countless veterans in Ohio and throughout the country. Specifically, we would like to thank Senator Brown 

14 

for his continued push to ensure survivors can achieve their educational goals without accruing large student debt. 

With more than 187,000 overpayment notices being sent to veterans nationwide in this past year alone, one would hope that the 

VA would not only be prepared to share the most precise information that triggered that notice in the first place, but also be prepared to assist the veteran in a timely manner. Sadly, this is not 

the case. 

In our experience, we have found legitimate overpayments most 

often occur with G.I. Bill benefits when a veteran’s enrollment status changes at his or her college. If a student decides they are having a difficult time meeting their educational obligation and chooses to switch to part time, it is the responsibility of the school, not 

the student, to notify the VA. 

To address the overpayment issues, the VFW urges passage of 

H.R. 3705, the Veterans Fair Debt Notice Act of 2017, which would 

require VA to use certified mail to notify veterans about the collection of debt. 

Ending sequestration has been the top priority for the VFW since 

it was created by the Budget Control Act of 2011. It has forced VA 

and DOD to work within the confines of outdated spending caps 

that fail to account for increased demands for VA benefits and services, or for the cost required to man and equip a force capable of 

deterring and defeating emerging global threats. While Congress 

has negotiated temporary deals in the past to avoid dangerous cuts, 

the issue of sequestration has not been addressed, and it continues 

to impact our servicemembers, veterans, and their families. 

In my travels across the country and the world, I have seen firsthand the impact sequestration is having on our troops: pilots barely flying enough to maintain their certifications; a shortage of replacement parts to maintain equipment; and the lack of troop 

training needed to combat the ever-increasing threats to national 

security. Congress must end sequestration once and for all. 

Mr. Chairman, this concludes my remarks. I would be happy to 

answer any questions that you or Members of the Committee may 

have. Thank you. 

[The prepared statement of Mr. Harman follows:] 

PREPARED STATEMENT OF KEITH HARMAN, COMMANDER-IN-CHIEF, VETERANS OF

FOREIGN WARS OF THE UNITED STATES

CHAIRMAN ISAKSON, RANKING MEMBER TESTER AND MEMBERS OF THE COMMITTEE, 

On behalf of the men and women of the Veterans of Foreign Wars of the United 

States (VFW) and its Auxiliary, thank you for the opportunity to discuss the issues 

important to Ohio’s veterans, which also impact veterans throughout the country. 

Community Care: In the past three years, the VFW has assisted hundreds of veterans who have faced delays receiving care through the Choice Program, and has 

surveyed more than 8,000 veterans specifically on their experiences using Department of Veterans Affairs (VA) community care. Through this work, the VFW has 

identified a number of issues and has proposed more than 15 common sense recommendations on how to improve this important program. Some of these common 

sense recommendations include making VA the primary payer for Choice Program 

care, removing restrictions on when VA is able to share medical records with Choice 

providers and making clinical necessity the trigger for community care. 

The VFW must also commend VA and the third party administers for their willingness to work with us to address issues veterans encounter when obtaining care 

through the Choice Program. VA has made more than 70 modifications to the 

Choice Program’s contract to address many of the pitfalls that have plagued the proVerDate Mar 15 2010 21:17 Nov 29, 2018 Jkt 000000 PO 00000 Frm 00018 Fmt 6633 Sfmt 6621 Z:\ACTIVE\112117.TXT PAULIN
15 

gram, such as allowing the contractors to conduct outbound calls when they have 

the proper authorization to begin the scheduling process. 

However, the Choice Program continues to face several challenges that must be 

addressed. Some of these challenges include assuring the decision of whether a veteran will receive care within VA or the community is determined by a patient and 

their provider, consolidating all community care programs to one and making the 

program discretionary instead of mandatory. 

The VA health care system delivers high quality care and has consistently outperformed private sector health care systems in independent assessments. The 

VFW’s numerous health care surveys have also validated that veterans who use VA 

health care are satisfied with the care they receive. In fact, our latest survey found 

that 77 percent of veterans report being at least somewhat satisfied with their VA 

health care experience. When asked why they turn to VA for their health care 

needs, veterans report that VA delivers high quality care which is tailored to their 

unique needs and because VA health care is an earned benefit. 

VA has made significant strides since the access crisis erupted in 2014 when 

whistleblowers across the county exposed how long veterans were waiting for the 

care they have earned and deserve. However, VA still has a lot of work to do to 

ensure all veterans have timely access to high quality and veteran-centric care. Veterans deserve reduced wait times and shorter commutes to their medical appointments. This means turning to community care when needed, but also means improving VA’s ability to provide direct care. 

The VFW urges this Committee to quickly pass a community care bill that would 

continue to invest in VA’s ability to improve its internal system and develop a consolidated care program that supplements, not supplants, the VA health care system. 

The VFW looks forward to working with this Committee to pass veteran-centric reforms to VA’s community care programs. 

Mental Health: In September 2016, the VFW launched our mental wellness campaign. We partnered with five organizations in our efforts to help servicemembers, 

veterans and their families cope with their mental health conditions. During this 

process we consistently heard from our members that the biggest barrier they face 

when trying to address the health of their brains is stigma, but this is not new. 

Thirty years ago people were ashamed to talk about cancer. It was a shameful word. 

Nobody used to talk about diabetes either. It was embarrassing to admit you had 

a health condition people wrongly associated with an improper diet. Today, people 

are ashamed to admit they have a mental health condition. Why? The brain is an 

organ. It is part of our body. It needs treatment to address injuries and illnesses, 

but can recover just as any other part of the body can. 

The VFW has worked tirelessly in the past two years to get people talking about 

mental health; to notice when someone may be in a mental health crisis; and to finally eliminate the stigma our society has placed on mental health. The more we 

talk about it, educate people about it and address the actualities of mental health 

and suicide, the more comfortable society and individuals suffering from mental 

health conditions are going to become with accessing the care they need. Most citizens can identify somebody experiencing a heart attack. People who have a heart 

attack know they must seek medical treatment. Now it is time for people to recognize the five signs of mental distress and to know when to seek help. 

This is why VFW Posts throughout the world have hosted nearly 300 events in 

the past two years in partnership with the Campaign to Change Direction. Many 

of these Posts partnered with VA, Given an Hour providers and Walgreen pharmacies to ensure their communities know about the resources available to veterans 

and family members suffering from mental health conditions. Now they know to 

identify the five signs of mental distress: personality change, agitation, withdrawn 

behavior, poor self-care and feelings of hopelessness. 

This past year VA released the most extensive study ever conducted on veteran 

suicide. This study was possible thanks to interagency cooperation and the necessity 

for VA, the Department of Defense (DOD) and more than 30 states to fully understand the details such as who is more at risk, how many veterans are dying by suicide and where these veterans reside. 

The study found that on average, twenty veterans die by suicide each day, yet 

only six out of these twenty use VA health care. To the surprise of many, 65 percent 

of veterans who die from suicide are 50 years old or older. Additionally, the risk 

for suicide in the female veteran population is 2.4 times higher when compared to 

their civilian counterparts. While these numbers are all alarming, they are also incredibly insightful for purposes of helping Congress and VA work toward eliminating this current plague of suicide in the veteran population. 

This summer, VA released a more thorough analysis of last year’s study. This 

analysis focused on the data broken down at a state level. With the national veteran 

16 

suicide rate being 38.4, the state of Ohio is doing better than the national average 

at 32.1, but is not a statistically significant difference. In 2014, 244 veterans died 

by suicide in the state of Ohio. 

In order to eliminate veteran suicides, VA must increase access to competent mental health care that is individualized to the patient. While the data shows VA mental health care is making a positive impact on those who use it, there is still room 

for improvement. More studies must be conducted to find more innovative ways to 

treat mental health conditions. VA has conducted research pertaining to areas such 

as service animals and emerging technologies, but other therapeutic alternatives, 

such as medicinal marijuana, need to be studied. 

The VFW continues to hear from veterans that VA needs to hire more mental 

health care providers. This shortage of providers has been continually highlighted 

by Government Accountability Office and VA Office of Inspector General (OIG) reports in past years. Specifically, the VAOIG’s yearly determination of occupational 

staffing shortages across the VA health care system has placed psychologists among 

the top five VA health care professions’ staffing shortages. This is due in large part 

to a general lack of mental health care professionals in the United States. 

But we must not forget about the importance of public-private partnerships. Providing veterans with resources such as Ohio’s Star Providers is absolutely crucial 

in addressing needs for veterans who may not trust VA or be able to access the care 

they need and want in a timely manner. 

Whether PTSD or any other mental health conditions stem from combat in Afghanistan or rape, veterans deserve the treatments that work best for them. Yet, 

VA struggles to arrange group therapy sessions for sexual trauma survivors, simply 

due to the lack of patients willing to partake in group therapy. Though there may 

only be one, two or three veterans wanting group therapy, it does not mean they 

should be denied access or placed in uncomfortable group therapy sessions. That is 

why the VFW supports expanding VA’s telemedicine authorities to ensure sexual assault patients within VA have the opportunity to talk comfortably in a virtual group 

setting of people who endured the same traumas. 

Women Veterans: Women veterans are the fastest growing population within the 

military and veteran community. There are currently two million female veterans, 

with nearly 68,000 of them in Ohio. Of the women who have served in Iraq and 

Afghanistan, more than 160 of them have paid the ultimate sacrifice and, as of 

2016, women servicemembers are able to serve in any career field they desire. Now 

more than ever, as their population and roles in the military continue to increase, 

it is important VA and Congress address their gender-specific needs. 

There are certain gender-specific needs for both men and women. Our Nation’s 

women veterans are younger than the average male veteran. They are more likely 

to have served in Gulf War or Post-9/11 eras than in previous conflicts. Women veterans are also more likely to come from diverse racial backgrounds. They are more 

likely to have a service-connected disability and are more likely to use VA health 

care when compared to their male counterparts. 

VA reports that more than 447,000 women veterans used the VA health care system in fiscal year 2015, which is a 123 percent increase since fiscal year 2003. VA 

has worked to improve their gender-specific care for this population of veterans, but 

more work needs to be done. In 2016, the VFW conducted a survey of nearly 2,000 

women veterans as a way to identify the most important issues they were facing 

in VA. Of those respondents, three percent were from Ohio. The most common feedback the VFW received from Ohio respondents was clear—increase the number and 

accessibility to gender-specific providers. With 58 percent of Ohio’s women veterans 

using VA’s gender-specific care, this concern must be addressed. 

To make sure these issues are addressed, and the voices of women veterans are 

heard, the Ohio Department of Veterans Affairs hosts a quarterly women veteran’s 

advisory committee meeting. The Committee also hosts a statewide conference every 

two years, which is open to all veterans and has seen turnouts of as many as 750 

attendees. 

This Committee has found that funding and outreach are the largest barriers for 

VA’s gender-specific care in Ohio. When outreach is conducted to women, the outreach does not appear to the population as being targeted specifically toward them. 

The Committee commonly hears back that outreach to get women veterans into VA 

seems to be heavily reliant on electronic outreach and social media, when women 

veterans in Ohio report to the Committee that they would rather have face-to-face 

outreach conducted. This makes sense as 46 percent of VFW’s survey respondents 

from Ohio were 55 or older. VA must ensure its outreach efforts are effective with 

all generations of women veterans. 

Last, the Ohio committee has found recognition of women veterans within VA to 

be a continuing struggle. As one member put it, ‘‘Women are not as likely to have 

17 

on a ball hat or t-shirt that states she is a veteran.’’ Women veterans who use women’s clinics in Ohio VA medical facilities have reported an increase in recognition 

of their service, but for women not using women’s clinics there are still continuous 

battles. When a woman walks into a clinic there is no reason for VA staff to ask 

what her spouse’s information is—it should be assumed that she is a veteran. 

Oversight: Earlier this year, a damning report was released by the VA Office of 

Inspector General concerning the Louis Stokes Cleveland VA Medical Center 

(VAMC). The report identified discrepancies regarding patient safety, environmental 

cleanliness, and VAMC staff training related to disruptive and violent behavior, just 

to name a few. Even more reprehensible was that the report concludes by stating 

that the VAOIG was not confident that the facility employees were properly trained; 

that clinicians were effectively monitoring patients receiving high-risk medications, 

such as anticoagulants; nor that patient equipment was clean. 

To be frank, this is beyond unsatisfactory. A facility with a yearly budget of ap- proximately $1B which serves more than 110,000 veterans per year should not have 

untrained staff and dirty equipment. 

Since 2014, VA has told us the situation is improving, but to the veterans’ community, this is not good enough. VA’s obligation is to provide our veterans with the 

best health care our Nation has to offer. This investigation only adds to the hundreds of concerns we heard from veterans at VA facilities from coast to coast over 

the past three years. 

In light of these findings, we must reject any urge to paint Veterans Health Administration (VHA) as an overall failure that should be abandoned in exchange for 

privatized care. If the system is failing, it is the duty of the leadership to fix it. 

While this task at one time was daunting and yielded little in the way of results, 

thanks to the recent passage of the Department of Veterans Affairs Accountability 

and Whistleblower Protection Act, leaders now are empowered to hold underperforming employees accountable, regardless of seniority. 

Appeals Modernization: Currently, Ohio is home to 769,267 veterans of which 

470,192 are receiving VA benefits in some form or another. An all-out push by the 

Veterans Benefits Administration (VBA) in the past few years has reduced the disability compensation and pension workload by more than 164,000 claims. In doing 

so, VBA continued to define its ‘‘workload’’ and ‘‘backlog’’ as only initial disability 

and pension claims, diverting nearly all its people to working on those cases. 

As a result, the significant backlog reduction came at the expense of more difficult 

work. Appeals soared by more than 28,000 during this period, bringing the total 

number of appeals pending to more than 300,000. Appeals continue to average more 

than three years before the Board of Veterans Appeals makes its first decision. Initial pension claims continue to rise, and disability claims with eight or more conditions remain unreasonably high at nearly 43,000. Pending dependency claims remain unreasonably high at over 231,000—up from 40,000 just a few years ago. 

In 2015 alone, the Cleveland VA Regional Office processed 32,187 claims. Since 

the first discussions on appeals reform with VA, the VFW has been very clear that 

any changes to the system must be coupled with aggressive initiatives to adjudicate 

legacy appeals in a timely manner through both legislative authority and proper 

resourcing. 

While VFW applauds Congress for passing S. 1024, the Veterans Appeals Improvement and Modernization Act of 2017, we have significant concerns with regard 

to how VA intends to implement these prescribed changes by way of the Rapid Appeals Modernization Program. Furthermore, the VFW urges Congress and VA to 

properly resource VBA and the Board of Veterans Appeals to ensure they are able 

to timely adjudicate appeals from veterans who do not opt into the new appeals 

process, and the potential influx of supplemental claims and higher level review requests at VA Regional Offices. VA must be empowered to manage its workload if 

the new framework to expected to succeed. 

Forever G.I. Bill: The VFW would like to thank this Committee for its hard work 

and dedication on the swift passage of the Forever G.I Bill, which will make a difference for countless veterans in Ohio and throughout the country. Specifically, we 

would like to thank Senator Brown for his continued push to ensure survivors who 

use the Marine Gunnery Sergeant John D. Fry Scholarship can achieve their educational goals without accruing large student loan debts. The VFW is particularly 

proud that the G.I. Bill is now a lifetime benefit. Veterans who were discharged 

after 2013 no longer have to worry about an expiration date for their G.I. Bill benefits. This rightfully recognizes that many transitioning servicemembers do not need 

to use their G.I Bill benefits immediately after separating from military service. The 

VFW will closely monitor the implementation of the Forever G.I. Bill to ensure veterans are aware of their expanded educational benefits and ensure VA meets its obligations to America’s student veterans. 

18 

Overpayments: With more than 187,000 overpayment notices being sent to veterans nationwide in the past year alone, one would hope that VA would not only 

be prepared to share the most precise information that triggered the notice in the 

first place, but also be prepared to assist the veteran in a timely fashion. Sadly, this 

is not the case. 

In the past year, the VFW’s National Veterans Service (NVS) has directly assisted 

more than 200 veterans who have experienced issues stemming from overpayments. 

According to our estimates, about 60 percent of the cases where NVS has intervened 

have resulted in the veteran being granted either partial or full relief from the debt 

from VA’s Debt Management Center. 

In our experience, we have found that legitimate overpayments most often occur 

with G.I. Bill benefits when a veteran’s enrollment status changes at his or her college. If a student decides that they are having a difficult time meeting their educational obligations and chooses to switch to part-time, it is the responsibility of the 

school, not the student, to notify VA. In the event that the school fails to notify VA 

of the change in status, the veteran will continue to receive the full living stipend 

and the school will continue to be paid the full-time rate for tuition. 

Once the error is noticed, VA will send an ambiguously worded notification of 

overpayment, which also provides options for repayment. If the veteran is unable 

to contact VA to establish that the debt is erroneous, make a repayment in a timely 

manner, or enter into a payment agreement with VA, their debt is sent to collections and VA will garnish payments from their disability compensation benefits 

until the debt is satisfied. 

The VFW understands that overpayments must be recouped in order for benefit 

programs to work efficiently. However, it is important to state that not only must 

debt notices be clear and provide the proper information regarding what steps veterans need to take in order to resolve any outstanding debts as soon as possible; 

but it is also imperative that these notices actually reach the veterans in the first 

place. 

That is why the VFW fully supports H.R. 3705, the Veterans Fair Debt Notice 

Act of 2017, which directs VA to require that certified mail be used to send a veteran any debt demand or debt information notification concerning collection of debts 

resulting from the veteran’s participation in a VA benefit or home loan program. 

This piece of legislation passed the House earlier this month and we urge a swift 

passage by the Senate. 

Sequestration: Ending sequestration has been a top priority for the VFW since it 

was created by the Budget Control Act of 2011, which set spending caps for the Federal budget through fiscal year 2022 and included a provision to activate automatic 

cuts if such spending caps are exceeded. As a result, VA and DOD are forced to 

work within the confines of spending caps that were set more than six years ago 

which fail to account for increased demand for VA benefits and services, or for the 

costs required to man and equip a force capable of deterring and defeating emerging 

global threats. While Congress has negotiated temporary deals in the past to avoid 

the dangerous cuts, the issue of sequestration has not been addressed and continues 

to impact the resources afforded to DOD and VA. 

Compounding the problem is Congress’ increasing reliance on continuing resolutions (CRs) to fund the government. CRs bring instability and uncertainty into the 

funding process by limiting long-term decisionmaking, preventing new acquisitions 

and constraining spending to predetermined category levels. For DOD, this means 

canceled training, penalties on contracts, delayed maintenance on weapons systems, 

lack of equipment, cuts to quality of life programs, longer deployments, wear on materials, and an overall decreased readiness status. 

In my travels across the country and the world, I have seen firsthand the impact 

sequestration is having on our troops stationed overseas. Pilots barely fly enough 

hours to maintain their certifications and troops lack the training needed to combat 

the ever-increasing threats to our national security. The effect mandatory sequestration will have on recruiting and retention, when combined with better job opportunities in a healthy civilian market, could jeopardize the continued viability of the allvolunteer force. For example, the Army Reserve has nearly 5,800 soldiers and more 

than 2,600 civilians employed (DOD and non-DOD combined) in Ohio. It is projected 

that sequestration has an impact of $16.7 million for fiscal year 2018 just in Ohio 

as it relates to the Army Reserve. 

What this means for veterans is that the resources VA is given to care for our 

Nation’s veterans has increased in past years, but outdated and arbitrary budget 

caps on Federal discretionary spending have prevented budget increases from keeping pace with the growing demand on the VA health care system. Budget caps have 

forced VA to request less resources than needed to accomplish its mission and reVerDate Mar 15 2010 21:17 Nov 29, 2018 Jkt 000000 PO 00000 Frm 00022 Fmt 6633 Sfmt 6621 Z:\ACTIVE\112117.TXT PAULIN
19 

quired Congress to provide VA less resources than it has requested, which hinders 

VA’s ability to meet its obligation to our Nation’s veterans. 

Until now, VA has been exempt from sequestration, but no one said that will be 

the case in the future since nearly half of VA’s budget comes through the discretionary process. Despite recent legislative victories, sequestration could dramatically 

affect VA’s ability to reduce the claims backlog or improve hospital infrastructure 

that is already in rapid decline, potentially diminishing access and timeliness of 

care. Additionally, programs that have not been exempt from sequestration would 

have a direct impact on our Nation’s veterans, such as services the Department of 

Labor-VETS provides for veterans seeking employment, as well as the number and 

size of housing grants that the Department of Housing and Urban Development 

would have available for homeless veterans. 

Blue Water Navy: When asking my fellow Ohio veterans what issues are important to them, one that continued to come up is the frustration with continued inaction to provide Blue Water Navy veterans the benefits they deserve. The VFW 

strongly supports S. 422, the Blue Water Navy Vietnam Veterans Act of 2017, which 

would expand disability compensation benefits to veterans who were exposed to 

Agent Orange while serving in the territorial seas of the Republic of Vietnam in 

support of ground operations during the Vietnam War. 

Currently, VA relies on what the Court of Appeals for Veterans Claims has called 

an ‘‘arbitrary and capricious’’ interpretation of inland waterways, which unjustly denies veterans who served aboard ships in the coastal waters of Vietnam the benefits 

they deserve. The VFW calls on Congress to swiftly pass the Blue Water Navy Vietnam Veterans Act of 2017. However, we recognize the position that Congress is in 

concerning the cost of this legislation. To help move this issue forward, the VFW 

has written a letter to President Trump asking him to change the regulations associated with Title 38 of the United States Code. Doing so would alleviate the need 

for congressional action or reduce the cost associated with the passage of S. 422. The 

VFW call on this Committee to move this important bill as soon as possible. 

Burn Pits: The use of open air burn pits in combat zones has caused invisible but 

grave health complications for many servicemembers, past and present. Particulate 

matter, polycyclic aromatic hydrocarbons, volatile organic compounds and dioxins— 

the destructive compound found in Agent Orange—and other harmful materials are 

all present in burn pits, creating clouds of hazardous chemical compounds that are 

unavoidable to those in close proximity. 

The VFW is glad to see that nearly 100,000 veterans have enrolled in VA’s burn 

pit registry. The VFW is also anxiously awaiting the results of the National Academies of Science’s study on the burn pit registry which will serve to determine 

whether veterans exposed to airborne hazards from burn pits experience certain pulmonary conditions. The VFW urges VA and Congress to act swiftly on recommendations from this important study. 

VA must also take measures to improve the Airborne Hazards and Open Burn 

Pits Registry. For example, a similar registry operated by Burn Pit 360 allows the 

spouse or next of kin of registered veterans to report the cause of death for veterans. 

VA must add a similar feature to its registry to ensure VA is able to track trends. 

Other improvements include streamlining the registration process, updating duty locations, and eliminating technical glitches to ensure veterans are able to register. 

While the VFW is glad to see VA has commissioned independent research on the 

burn pit registry, more independent research is necessary. That is why the VFW 

supports funding for research through the Congressional Directed Medical Research 

Program (CDMRP) specifically for burn pit related conditions. The CDMRP for Gulf 

War Illness has shown some progress in identifying causes, effective treatments and 

biomarkers for Gulf War Illness, and the VFW is confident that similar research for 

burn pits will help veterans finally determine whether their exposure to burn pits 

during combat is associated with their negative health care outcomes. 

Senator BROWN. It is an honor to have the national Commanderin-Chief of VFW, and thank you especially for your comments 

about the stigma of mental health. That issue is so important, and 

women veterans, and veteran student debt. Thank you. 

Next, we would like to hear from Melissa Twine. 

Ms. Twine, thank you for joining us. 

STATEMENT OF MELISSA TWINE, VETERAN, BATAVIA, OH 

Ms. TWINE. First, I would like to thank Senator Brown for inviting me to participate in today’s hearing, sharing my experiences 

20 

with the Veterans’ departments here in Ohio, both in Cincinnati 

and in Dayton, where my husband is buried. 

There is nothing more important than gaining insight from customers—in this case, the actual veterans. Having State or regional 

hearings to gain this valuable information can only lead to the betterment of the entire VA program, from educational services, 

health care access, and all entities in between. In addition, these 

hearings afford a collaborative bridge between the veterans and 

their lawmakers. 

A little about myself: I was a military brat and brought up in the 

military way of life, as my father was retired Air Force and a Vietnam veteran. When I was 17, I entered the U.S. Air Force and 

served for 10 years. I separated from the Air Force in 1998 with 

the label of a disabled veteran with 40 percent service connection. 

My husband, who was Active Duty Air Force, died at Langley Air 

Force Base in August 2002. I then gained a new label of a surviving spouse, a military widow, and a Gold Star wife. Our fourth 

child arrived 3 weeks later, and I moved myself and all four children home to Ohio to the Cincinnati area. 

I have been an advocate in supporting the initiatives brought 

forth by Senator Brown and many others for increasing survivors 

benefits via the VA’s Forever G.I. Bill in conjunction with the Fry 

Scholarship for surviving spouses, and I hope to go back to school 

to continue my education, which was halted when I became a 

widow raising four children alone. 

Regarding access to the VA health care here in Ohio, I personally 

try to avoid the VA system at all costs. When I did try to utilize 

the VA system several years ago, over 12 years ago, I experienced 

only hassle and frustration. I quickly learned that using my survivors benefits for TRICARE was much easier and allowed for 

many more options, even though it came with a higher monetary 

cost to myself and family. Any attempt to see a VA medical provider was met with long wait times and a run-around when attempting to get medications for my diabetes, high blood pressure, 

and high cholesterol. When I did get an appointment, I waited a 

long time through a confusing process of lab testing and shuffling 

around through several hallways and departments. 

Additionally, I have a very close friend that tried to get help for 

substance addiction last year, which is a huge issue here in Ohio, 

a former marine. He was put through a month-long process of 

three appointments to different departments and tons of paperwork 

only to be told he did not qualify in the VA program because his 

wife had insurance, so he would not qualify for VA help, something 

that could have been identified up front in the very first appointment and not have caused a delay in him obtaining treatment that 

he so desperately needed. 

This only reiterated to me that avoiding the VA medical system 

was a no-brainer. 

I will continue to assist in the fight for increased awareness in 

the VA medical system struggle, fairness for survivor benefits for 

all surviving family members, and increased availability to all veterans’ benefits that we earned while serving our country. 

Again, thank you for allowing me to appear here and testify 

today, and to achieve the previously mentioned topics. 

21 

Thank you, Senator Brown and Congresswoman Beatty, for inviting me to appear today; for all the work that you do and that your 

office does; for helping military families, military veterans, and surviving spouses. 

[The prepared statement of Ms. Twine follows:] 

PREPARED STATEMENT OF MELISSA M. TWINE, VETERAN, BATAVIA, OH 

First, I would like to thank Sen. Brown for inviting me to participate in today’s 

hearing by sharing my experiences with the VA departments here in Ohio, both in 

Cincinnati and in Dayton. 

A little about myself: I was brought up in the military way of life, as my father 

retired from the USAF. When I was 17, I entered the USAF and served for 10 years. 

I separated from the AF in 1998 and am a Disabled Veteran of over 40% service 

related. My husband, who was ADAF died at Langley AFB, VA in Aug of 2002. I 

then gained a new title or label of a Surviving Spouse. Our 4th child arrived 3 

weeks after his death. I moved myself and all 4 children home to Ohio. 

Before separating from the AF, I gained an Associate’s Degree in Allied Health 

Sciences. I then returned to school at the University of Cincinnati, where I earned 

my Undergraduate Degree in Biology, pre-med while taking care of 3 children; my 

husband was sent overseas without the family during this timeframe, also serving 

a tour with the United Nations in the Western Sahara. The VA helped me achieve 

this degree from UC via the VocRehab Program for DAVs. 

I have been an advocate in supporting the initiatives brought forth by Sen. Brown 

and many others for increasing Survivor’s Benefits in Education via the VA’s Fry 

Scholarship Program and hope to go back to school to continue my education that 

was halted when I became a widow raising 4 children alone. 

Regarding access to VA Healthcare in Ohio, I personally try to avoid the VA system at all costs. When I did try to utilize the VA system several years ago, I experienced only hassle and frustration. I quickly learned that using my Survivor’s benefits for TRICARE was much easier and allowed for many more options, even though 

it came with a higher monetary cost to myself. Any attempt to see the VA medical 

provider was met with long wait times and a run-around when attempting to get 

medications for Diabetes, Hypertension, and high cholesterol. When I did get an appointment, I waited for a long time through a confusing process of lab testing and 

shuffling around through several hallways and departments . . . all the while being 

handed donuts and coffee from a push cart by volunteers . . . not exactly what Diabetics and patients with heart disease should be eating! 

I have a very close friend that tried to get help for substance addiction last year; 

a former Marine. He was put through a month-long process of 3 appointments to 

different departments and tons of paperwork only to be told that because his wife 

had insurance, he did not qualify for VA help . . . something that could have been 

identified up front and not have caused a delay in him obtaining treatment he so 

desperately needed. This reiterated to me that avoiding the VA Medical system is 

a no-brainer. 

I will continue to assist in the fight for: 

• increased awareness in the VA Medical System struggle 

• fairness in Survivor Benefits for all Surviving Family Members 

• and increased availability to all Veterans benefits that we earned while serving 

our country 

Again, thank you for allowing me to appear and testify today to help achieve the 

previously mentioned topics. Thank you, Sen. Brown, for inviting me to appear 

today and for all of the work that you and your office does to help the military and 

their families. 

Senator BROWN. Thank you, Ms. Twine. Thank you for your testimony. [Applause.] 

Thank you for pointing out to us what happens with benefits expiring. It is ideas like that that come from veterans in places like 

Batavia that really help me do this job. Thank you so much for 

that. 

Mr. Powers, welcome. We would love to hear your testimony. 

22 

STATEMENT OF JAMES POWERS, VETERAN, MASSILLON, OH 

Mr. POWERS. Thank you, Senator. Let me begin by thanking 

yourself and this Committee for an invitation to testify regarding 

topics concerning veterans. 

Of the over 850,000, of course, 8 percent of the State’s population, the sixth most here nationally, veterans here in Ohio, and 

over 20 million nationally, this Committee has given me, of all people, the opportunity to give testimony regarding veteran issues. 

I personally view this as a great honor but also a great responsibility to tell my story and to be a voice for veterans that need to 

be heard. 

Senator BROWN. Take your time. 

Mr. POWERS. My name is James Powers. I served in the U.S. 

Army and the Ohio Army National Guard for a combined 12 years. 

I deployed in support of Operation Iraqi Freedom in 2009 to 2010. 

During my career, I served as an infantryman, an instructor, and 

a recruiter. I achieved the rank of sergeant E–5. And I, like any 

good soldier, held our creeds, our oaths, our ethos sacred and 

served to the best of my abilities. 

During my service, I, like over 3.8 million other veterans, became 

injured. The majority of my injuries I sustained over my military 

career, they are not easily visible, but one of them almost cost me 

my life, PTSD. 

When I came home from Iraq in 2010, my transition, like many 

others, did not go well. My life for the next 4 years slowly spiraled 

out of control. It was like quicksand. The more I tried to fix it, the 

worse things got. 

I let it consume everything, my livelihood, my military career, relationships, and my overall well-being. I turned to drugs and alcohol. I would do anything to numb what I still today trouble to describe until, finally, on a Tuesday morning in May 2014, when I 

had no other choice, I thought, put a pistol in my mouth and pulled 

the trigger. Click. A misfire occurred. I had improperly loaded a 

pistol that I had loaded and unloaded millions of times in my career because of how drunk I was. 

Fortunately, for me in that moment, something else clicked in 

my mind and I said something is not right. This is not you. Three 

and a half years later, I sit here before this Committee. 

It has been a bumpy road, to say the least. I completed an intensive 10-week residential treatment program. Had it not been for 

the PTSD substance use disorder residential treatment program at 

the Wade Park VA, I do not think I would be here to testify today. 

That program and the providers involved should serve as the 

standard of care for veterans with mental health issues, especially 

PTSD. 

It is unfortunate that VA funding and availability for programs 

like this are next to none. 

I have had to learn the art of finding a parking spot at overcrowded VA facilities. I have gotten used to going back and forth 

with the VA about trying to double collect on a debt. I got to experience the Integrated Disability Evaluation System. I spent 9 

months at the Warrior Transition Unit in Fort Knox, Kentucky, for 

that. At least it seemed more efficient to me than the VA’s traditional claim processing. 

23 

I finally got the torn ligament in my wrist repaired. It only took 

5 years from when I originally presented with pain. 

I continued to try things to ease the chronic pain in my left foot 

during that time, too. I drove 6 hours back home on the weekends, 

as my wife was expecting our now 2-year-old son. 

Finally, in February 2016, my military career ended, and I was 

medically discharged retired. Since then, I keep to myself. I am 

Sergeant Powers turned Mr. Mom to my little man Connor and my 

soon-to-be-little dude Luke. 

I strive to be a good husband to my wife, Shannon. She keeps 

me grounded and coolheaded. I only wish that the VA would do a 

better job with the caregiver program. At times, too, she has questioned the VA’s shortcomings, which at least helps me feel validated my issues and not that I am just losing my mind. 

She was even understanding and simply said, ‘‘Drive safe and 

call me when you get there,’’ when I made the spur-of-the- moment 

decision and drove all the way to D.C. in July to see my elected 

officials about the congressional inquiry that the VA seemed to be 

stalling on. To my luck, Senator Brown and his staff were able to 

finally get answers about a grossly inaccurate $11,000 VA overpayment debt. The VA’s eventual response was that the debt was miscalculated due to a ‘‘manual processing system failing to properly 

communicate with an automated system.’’ If you ask me, it sounds 

like a fancy way of saying human error. 

I just keep my routines, and I try to stay mindful. I still struggle 

daily, but not nearly what I used to. For that, I am happy. 

I surround myself with a small group of veterans, some that I 

have known since childhood, others that I have had the pleasure 

of meeting along the way in my life. Two of them, fortunately, join 

me here today. We look out for each other just like we did in the 

service, covering each other’s six. I think I did this for them just 

as much as for myself. 

I have been prescribed medications over the years, at times 

three-to-five medications, some requiring routine lab work, some 

that would be to counteract side effects of the other medications, 

which cause new side effects. I began to feel like the VA doctrine 

was increase the dosage or increase the number of medications, 

and that will fix any problem. 

All of this became too much for me. I finally broke down and 

turned to medical marijuana. I figured that it cannot be any worse 

than all the pills. For the last 10 months, I have been using it. I 

only hope the Federal Government might change the law and see 

the medical benefits of marijuana, like the 29 States that have 

medical marijuana programs in place. I have no adverse side effects, and I feel the combination of therapy has been far greater 

managing my symptoms than the traditional medication regimens 

that the VA prescribes. 

Some things that I and veterans all across this country would 

like for this Committee to think about: Tonight, when we go to 

sleep, around 40,000 veterans will go to bed homeless. Men and 

women this great Nation of ours hold in such high regard for the 

selfless service are being lost to suicide at a rate of 22 per day. 

That is 18.5 percent of all daily suicides. Thirty-plus day wait 

times are still happening for appointments. Female veterans, who 

24 

account for 10 percent, about 2 million, as has been said here 

today, of all veterans, still struggle to get access to women’s health 

services. The VA is still unable to provide the same quality of care 

that is available in the private sector. Evening and weekend primary mental health care appointments, and access to the urgent, 

convenient, and emergency services, are next to nonexistent. 

Claims are still taking too long for initial processing, being improperly processed, and taking even longer to be reviewed in the appeals process. Automated phone systems and Web services are 

helpful, but still need improvement. How hard would it be to ensure all needed phone extensions are available online when you 

pull up a VA facility, or printing the extension on the appointment 

reminder when you need to reschedule? The Choice Program concept is great; however, implementation and execution of it were illconceived and lackluster. Disability claims and issues regarding 

burn pit exposure are beginning to seem just like Vietnam veterans 

who are still fighting about Agent Orange. 

This list is far from inclusive, not to mention these things are far 

from anything new. These issues continue to be echoed by veterans 

of all generations. 

If this Committee really wants to know about the issues that are 

facing veterans, it is not hard. Go back to your homestates, walk 

in the nearest VA facility, and ask the nearest veteran. Talk to 20 

percent of your States law enforcement and first responders who 

are veterans. Walk into a VFW and American Legion or AMVETS 

post. Heck, talk amongst yourselves. Twenty percent of politicians 

are veterans. Get on social media. Listen to the veterans’ organizations in D.C. who represent us. 

Now, I know that only so much can come from my testimony 

here today. I know this will not be the turning point in the care 

of this Nation’s veterans. Effective change and progress do not happen overnight. I more than anything hope this testimony and any 

results it produces helps even one veteran. This is my measure of 

success: that my words have not fallen on deaf ears and blind eyes, 

that this Committee has been reminded of how big of a responsibility they have in ensuring this country’s veterans are not forgotten. 

[The prepared statement of Mr. Powers follows:] 

PREPARED STATEMENT OF JAMES POWERS, U.S. ARMY AND

OHIO ARMY NATIONAL GUARD (RET.) 

Let me begin by thanking both Senator Brown and this Committee for the invitation to testify regarding topics concerning veterans. 

Of the over 850,000+ (8% of population 6th most nationally) veterans here in Ohio 

and over 20 million nationally, this Committee is giving ME the opportunity to give 

testimony regarding veteran issues. I personally view this as a great honor but an 

even greater responsibility. To tell my story and to be a voice of veterans that need 

to be heard. 

My name is James Powers. I served in the U.S Army and Ohio Army National 

Guard for a combined 12 years. I deployed in support of Operation Iraqi Freedom 

in 2009–2010. During my career I served as an Infantryman, Instructor, and Recruiter. I achieved the rank of SGT/E5. I, like any good soldier, held our creeds, 

oaths, and ethos scared and served to the best of my abilities. During my service 

I, like over 3.8 million other veterans, became injured. 

The majority of my injuries I sustained over my military career are not easily visible. But one has almost cost me my life. PTSD. When I came home from Iraq in 

2010 my transition back didn’t go well. My life for the next 4 years slowly spiraled 

out of control. It was like quicksand. The more I tried to fix what was wrong the 

25 

worse I made things. I let it consume everything. My livelihood, military career, relationships, and my overall well-being. I turned to alcohol and drugs. I would do 

anything to numb what I still to this day find trouble describing. Until finally on 

a Tuesday morning in May 2014 when I felt I had no other choice but to put my 

pistol in my mouth and pull the trigger. CLICK! A misfire occurred, I had improperly loaded the pistol because of how drunk I was. Fortune for me in that moment 

something else ‘‘clicked’’ in my mind and said ‘‘something isn’t right, this isn’t you.’’ 

Three–1⁄2 years later and here I sit before this Committee. It has been a bumpy 

road to say the least. I completed an intensive 10 week residential treatment program. Had it not been for the PTSD/SUD residential treatment program at the 

Wade Park VA Medical Center I don’t think I would be here to testify before you 

today. That program and the providers involved should serve as the standard of care 

for veterans with mental health problems especially PTSD. It is unfortunate that 

VA funding and availability for programs like this one are next to none. I have 

learned the art of finding a parking spot at crowded VA facilities. I have gotten used 

to going back and forth with the VA about them trying to double collect on a debt. 

Got to experience the Integrated Disability Evaluation System (IDES) process. 

Spent 9 months at the Warrior Transition unit in Fort Knox, KY for that. At least 

it seemed more efficient that traditional VA claim processing. I finally got the torn 

ligament in my wrist repaired. Only took 5 years from when I originally presented 

with pain. I continued to try things to ease the chronic pain in my left foot during 

that time too. I drove 6 hours back home on the weekends as my wife was expecting 

our now almost 2 year old son. But finally my military career ended when I was 

medically discharged/ retired in February 2016. 

Since then I keep to myself. I’m SGT Powers turned Mr. Mom to my little man 

Connor and soon to be little dude Luke who is expected to join us in February. I 

strive to be a good husband to my wife Shanon. She keeps me grounded and cool 

headed. I only wish that the VA would do a better job with the caregiver program. 

At times she too has questioned the VA shortcomings, which at least helps me feel 

valid in my issues and it not be me just losing my mind. She even was understanding simply saying ‘‘drive safe and call me when you get there’’ when I made 

the spur of the moment decision and drove all the way to D.C. in July to see my 

elected officials about a Congressional Inquiry that the VA seemed to be stalling on 

responding to. To my luck Senator Brown and his staff were able to help finally get 

answers about a grossly inaccurate $11,000 VA overpayment debt. The VA’s eventual response was that the debt was ‘‘miscalculated’’ due to a ‘‘manual processing 

system failing to properly communicate with an automated system.’’ If you ask me 

it sounds like a fancy way to say human error. I keep routines so to help me stay 

mindful. I still struggle daily. But not nearly what I used to and for that I am 

happy. 

I surround myself with a small group of veterans. Some that I have known since 

childhood and others I have had the pleasure to meet along the course of my life. 

We look out for each other. We know each other’s signs and symptoms. Many times 

they are just like our own. Just like in the service we are covering each other’s six 

o’clock. I think I agreed to this for them more than for myself. 

I have been prescribed medication over the years. At times being on 3–5 medications. Some requiring routine lab work. Some that would be to counteract side effects of other medications while causing new side effects. It began to feel as if VA 

doctrine was increased dosage or increase number of medications that will fix any 

problem. All of this became too much for me. I ended up turning to medical marijuana. I figured it can’t be any worse than all of the pills. For the last 10 months 

I have been using it. I only hope the Federal Government might change the law and 

see the medical benefits of marijuana like the 29 states that have medical marijuana programs. I have no adverse side effects and feel with in combination with 

therapy has been far better at managing my symptoms than with traditional medication regimens. 

Some things that I and veterans all across this country would like for this Committee to think about: 

• Tonight when we all go to sleep, around 40,000 veterans will go to bed homeless. • Men and women this great nation of ours holds to such high regard for their 

selfless service are being lost to suicide at a rate of 22 a day (18.5% of all daily suicides). 30+ day wait times are still happening for appointments. 

• Female veterans who account for 10 percent (about 10 million) of all veterans 

still struggle to get access to Women’s Health services. The VA is still unable to provide the same quality of care that is available in the private sector. 

• Evening and weekend primary or mental health care appointments, Access to 

urgent, convenience, and emergency services are next to nonexistent. 

26 

• Claims are still taking too long for initial processing, being improperly processed, and taking even longer to be reviewed in the appeals process. Automated 

phone systems and web services are helpful but still need improvement. Like how 

hard would it be to ensure all needed phone extensions are available online when 

you pull up a VA Facility. Or printing the extension on an Appointment reminder 

should we need to call and reschedule. 

• The CHOICE program conception is great. However implementation and execution of it were ill conceived and lack luster. 

• Disability claims/issues with Burn pit exposure are beginning to seem just like 

Vietnam veterans who are still fighting about Agent Orange. 

This list is far from being all inclusive. Not to mention these things are far from 

anything new. These issues continue to be echoed by veterans. 

If this Committee really wants to know about the issues that are facing veterans 

it’s not hard. Go back to your home state’s, walk into the nearest VA facility and 

ask the nearest veteran. Talk to the 20% of your state’s law enforcement and first 

responders that are veterans. Walk into a VFW, American Legion, or AMVETS post. 

Heck talk amongst yourselves. 20% of politicians are veterans. Get on social media. 

Listen to the veterans organizations in DC who represent us. 

Now I know that only so much can really come from my testimony here today. 

I know this won’t be the turning point in the care of this Nation’s veterans. Effective 

change and progress don’t happen overnight. I more than anything hope this testimony and any results it produces helps even 1 veteran. That is my measure of success . That my words haven’t fallen on deaf ears and blind eyes. That this Committee has been reminded of just how big of a responsibility they have in ensuring 

this country’s veterans are never forgotten. 

Senator BROWN. Thank you, Mr. Powers. 

Thank you for talking about transition. Your survival has meant 

a better life for a lot of veterans and especially, obviously, for Shannon, Connor, and soon, I understand, for Luke. 

Mr. POWERS. Super Bowl Sunday—I only hope that it is slightly 

before kickoff. [Laughter.] 

Senator BROWN. I assume you do not expect the Browns or the 

Bengals to be in that game either. Just guessing. Just guessing. 

Mr. POWERS. I am expecting to be at the—parade. 

Senator BROWN. Yes, since where you come from, there is a tradition in your city, isn’t there, in Massillon, OH? 

Mr. POWERS. In Massillon, of course, football is everything down 

there. They are getting ready to play in the State semifinals 

against another team, but if they win, unfortunately, they will be 

losing to my alma mater—— 

Senator BROWN. Glad you pointed that out. Thank you. 

Also, I want to recognize two people: Mike Dustman from Senator Portman’s office and Luke Crumley from Congressman Tiberi’s 

office. Thank you for joining us also. 

I want to start with the two of you, Mr. Powers and Ms. Twine. 

I want to read you—we asked earlier, a couple weeks ago, in anticipation of this hearing, just for veterans to go on Brown.Senate.gov, 

go on my Web site and give us thoughts, ideas, and questions. I 

want to just read you a few kind of random thoughts from about 

a half dozen different veterans, and I would like you to listen to 

these statements. Then, starting with you, Ms. Twine, tell me what 

you think. 

Just react in any way you want, in terms of: is the VA doing 

what it should? What about our obligation? Just any kind of 

thoughts you have on any of these statements. I will just read the 

half dozen of them. 

‘‘It was very hard to come from killing in a jungle to adjusting 

into life. The demons never go away.’’ 

27 

‘‘It was a long time ago, but I remember it as being OK.’’ 

‘‘Difficult. I was medically discharged, felt like I wasn’t given 

enough guidance on what to do next, especially with the 

disability.’’ 

‘‘I went from Active Duty to Reserves then civilian completely, 

so not too bad.’’ 

‘‘Several employers told me I just wasted 8 years of my life 

due to PTSD. I had many altercations with strangers. I once 

hit my wife when she bent over me while I was sleeping. I still 

sleep with a spotlight and a gun.’’ 

‘‘It sucked. While no one would come out and say it, no one 

would hire a vet or even someone that was on drill status. I 

was unemployed for a bit over 2 years because of this.’’ And, 

‘‘I am still in transition in some ways. It will never leave you.’ 

Ms. Twine, any thoughts about any of that? 

Ms. TWINE. I think it is very representative of the veterans of 

today. What you just said speaks to 80 percent of veterans who 

were having issues and problems, not only transitioning but also 

with continued care, while 10 to 20 percent say, ‘‘I served my time. 

I’m OK. I don’t need any other services.’’ So, I think those are absolutely very representative of what we are seeing today. 

Senator BROWN. If I could follow up, how many of those, you just 

said 20 percent who come back do not need to use services. I hear 

so many stories in part from what the two gentlemen here said of 

soldiers that come back: they do not know, Mr. Tansill, they do not 

know the veterans service organization, the veterans service office, 

the commissioners in Delaware or Newark or Circleville. They do 

not get in touch with anybody. Then their sister calls and says, 

‘‘My brother is having problems.’’ They came back without needing 

anything. How often do you hear that? 

Ms. TWINE. I hear it all the time. I was just explaining to him 

earlier that I had never been approached by any of the veterans 

organizations except the Gold Star Wives organization. 

Senator BROWN. Even though you are a veteran yourself. 

Ms. TWINE. I am a veteran, and I live in Clermont County, which 

tends to be one of the highest counties in the State of Ohio for loss 

of veterans. I have not been approached by VFW, the VA, Disabled 

American Veterans, other than for a donation when I leave Sam’s 

Club. I have not been approached by The American Legion, any of 

those organizations. 

I absolutely agree that there is a huge disconnect in communication. In fact, it took them 1.5 years to find me to give me more benefits from the changing of life insurance for my husband after he 

died, and I go to Wright-Patterson all the time. But, because Langley could not connect with Wright-Patterson to know anything, I 

was in a hole. 

I agree. When I separated from the service, I was a captain’s 

wife. I went back to school. I did what I needed to do. I did not 

need any services from the VA at that point—until my husband 

died, until I got a letter from the VA saying you have a primary 

care provider. It may take you 6 months to see him, but here is 

your letter with who your PCP is. 

28 

I think it is a huge disconnect. There are veterans who are welladjusted, do not need any services. But then, you have veterans 

that obviously need help and services and cannot get that access. 

Senator BROWN. I would argue that Ohio is better served than 

many States because we have Mr. Tansill’s previous job, we have 

a Franklin County Veteran Services office, and I believe half the 

States do not have that, more or less, something like that. 

Mr. TANSILL. Senator, most States do not have a county-specific 

office. They may have people who work out in a county, but not a 

specific county office for every county. 

Senator BROWN. Mr. Powers, those five or six statements I was 

reading, what comes to mind for you as you heard those? 

Mr. POWERS. For me, those statements, I mean, they are nothing 

new. I have said them myself or have heard my friends say them. 

Transition is rough. When it comes to the VA, I feel like you get 

the benefits book, which I call the VA bible. To try reading through 

that and understanding the programs and everything else, it is dry, 

it is bland, and if you can make it past 10 pages trying to find 

something in there, you are doing better than me. 

You have that book, and that is about it. I mean, you try asking 

about programs from the VA, and it is, ‘‘Fill out a form,’’ not information about the program or anything. 

My wife did try doing the caregiver program, and it almost felt 

like they were more concerned with eliminating her for a caregiver’s stipend, which we were not interested in, as opposed to really providing her with the support that she realistically needs to 

deal with my symptoms. I am not always the most pleasant person. 

Prior to today, in grocery shopping, the last time I went out and 

did something for myself was probably about a month ago. 

I keep to myself. I have a small circle, which shouldn’t be the 

case. Organizations, myself, personally, when I came home from 

Iraq, I was telling Colonel Tansill before this that I took my DD– 

214 and ran to the VFW like I was Charlie and I got the golden 

ticket to go to the chocolate factory. That is what the VFW was for 

me. That is what I thought it was going to be. 

For the year that I was a quartermaster of a post up in Sandusky, it was an extension of being in the military, the brotherhood, the tribe, so to speak. There needs to be a continuity of that 

when you move from the service back into the civilian world, because if you spend even 3 years away from what you called home 

for the first 18 years of your life, you come home and everybody 

has changed, but you still feel like the same person. I mean, kids 

get older, you lose friends, friends move away. What was once your 

life is not anymore, and now you are trying to jump right back into 

it. 

We need to ensure that the availability is there for us to connect. 

Some of the veterans’ service organizations, they do fantastic work 

both in their communities and nationally, but their active ranks, 

they are aging and declining, unfortunately. The younger generations are not coming in. 

I get it, to some extent. I mean, reaching out to a whole different 

generation of veterans, it is different every time. It was different 

for World War II veterans who were welcomed home with parades, 

and different for Vietnam veterans who were welcomed home to 

29 

protest. We have to find a way, both as veterans and veterans’ organizations, of how to stay connected to the guy to the right and 

the guy to the left, and look out for each other. 

Also, Congress and this country needs to step up and have realworld solutions for looking out for us, because I know when I 

served, and everyone that I have known, that I have had the pleasure of knowing, who has served, we served this country no questions asked. We took oaths that still to this day I can recite it verbatim, and most still probably can, too. It is time for this country 

to be reminded that we are here, and we are equals, and sometimes we need help. 

Some of us do not. Some of us always land on her feet. But, even 

when you land on your feet enough, you are liable to break a leg. 

It happens. 

It is time for the transition to be eased. 

Senator BROWN. Thank you, Mr. Powers. 

Mr. Tansill, Mr. Powers mentioned one of the challenges is employment, obviously. Employment is difficult for a whole lot of reasons, coming back, obviously, in civilian life. Talk to us about your 

role now, what you see now and what you saw when you were in 

Franklin County. Talk about the specific challenges that veterans 

face, particularly newly returned veterans, about employment. 

Maybe give us a short, little scenario of what a veteran faces 

when looking for a job coming home, especially maybe if they were 

a medic in Iraq; they come back and they could maybe get certified 

a little quicker if they had done it right—we still have not done it 

quite right—to be a first responder, and those that do not have sort 

of a specific skill that translates, other than serving their country 

really well and being a good soldier. 

Talk that through, if you would. 

Mr. TANSILL. A couple of things, Senator. 

First, the transition is the most difficult for a veteran when they 

come home, the first 120 days, typically, especially if they have a 

family, because they are assimilating back into what they had as 

a civilian life prior to that. That is a very critical time, the biggest 

transition. Just like if you move from one country to another, the 

first few months is a very difficult time. 

The issue is no one knows they are coming back until they are 

here. They are actually home 3 months to 4 months before we actually know that they are home, so there is 3 or 4 months that they 

have not had any contact to get jobs because they do not know 

where to go. 

Right now, we receive the DD–214s from DOD when they come 

home. The problem is the average length of time to receive those 

is 120 days. That means they have been home 120 days. That is 

the struggle they have to find out where they need to go for jobs. 

One of the biggest problems—— 

Senator BROWN. What do they do for money in those 120 days? 

Mr. TANSILL. Many of them have some terminal leave, so they 

have built up some leave and they are using it. For the most part, 

they go on unemployment, and DOD is paying them unemployment. 

Senator BROWN. Unemployment, I assume, is never contested by 

the government, I hope? 

30 

Mr. TANSILL. I do not know the answer to that. I have not heard 

of anyone complaining. 

Senator BROWN. Let me ask it this way. Do you know of men and 

women who have had trouble getting unemployment? 

Mr. TANSILL. I personally do not. I personally do not. 

Senator BROWN. OK. If any of you in the audience know, particularly those in veterans’ service organizations like VFW, if you hear 

of those stories, you should always contact Congresswoman Beatty 

or me or Senator Portman. We will go to bat on that. That should 

never happen. 

Go ahead. I am sorry. 

Mr. TANSILL. There are many vets who come home and do not 

know what they want to do. They have served their country in 

whatever capacity, an infantryman or whether they were a medic. 

Many veterans come home and do not want to use those same 

skills. They want to get a different skill. 

One of the things that has been really advantageous to veterans 

coming home to Ohio is our apprenticeship programs. 

They come home. They do not want to be a medic anymore. They 

want to be a carpenter. The problem is they do not know about 

those programs until they are here a year because they have no 

visibility of those things while they are still on Active Duty 

transitioning back. 

Senator BROWN. Are the union apprenticeship programs, if you 

decide you want to be a carpenter, you want to be a union carpenter, or you want to be a union electrician, and you go through 

the apprenticeship program being paid a decent wage while you are 

going through it—it is a several years’ prospect, but you make a 

living doing it—newly returned veterans, how do they find out 

about those? 

Mr. TANSILL. In the cases that I know of, they have heard it from 

a friend or a family member who is part of a union and tells them 

to go to that apprenticeship program. 

Senator BROWN. Nothing more formal than that? 

Mr. TANSILL. Nothing more formal than that. 

Senator BROWN. There is a program Helmets to Hardhats. 

Mr. TANSILL. There is a program. 

Senator BROWN. But, that does not reach far enough that enough 

people know about it, I assume? 

Mr. TANSILL. It does not. It is very difficult, again, when a veteran comes home, they are here for 120 days before most people 

know that they are here. That is a real challenge. 

If the availability to reach them before they leave, let’s say, Fort 

Sill, Oklahoma, to say, ‘‘Hey, we know you are coming home in 6 

months. Here are all the educational opportunities. Here are all the 

job opportunities. If you go to Ohio, it means veterans jobs’’—— 

Senator BROWN. Why are we not doing that? 

Mr. TANSILL. We have no way of knowing that they are coming 

home, at this point. 

Senator BROWN. Who is responsible? Is the DOD the problem? 

The local veterans’ service commission, could they play a role? Why 

is this not happening? 

Mr. TANSILL. Senator, we can all play a role. Right now, the communication needs to be greatly improved between the Department 

31 

of Defense, the branches of the military, and the States that these 

folks are returning to. 

My counterparts and I across the country are looking for ways 

to reach out to the servicemember before they become our veteran, 

so we can help them understand what is available to them. 

One of the common problems that we have is a veteran will come 

home, and most veterans go where? Back to mom and dad’s or the 

same town that mom and dad lived in. Well, there may not be a 

lot of great jobs in the hometown. Yet, they have a skill set that 

they could have moved three towns over and utilized that skill set 

to get a job. But, they did not know that until they moved home, 

and now they are out of money, and now they are trying to figure 

out how to get a job. 

Getting information to these folks before they come back to 

Ohio’s borders is the best way to help them transition into their civilian life, not after they have been here 3 months to 4 months. 

Senator BROWN. Thank you. 

Commander Harman, Mr. Powers said, rightly, that veterans, 

soldiers, air men, sailors, and Marines coming home now may see 

a parade, while your era of veteran too often saw a protest. 

Talk to us, if you would, about Agent Orange exposure, everything from Navy veterans to burn pit exposure in Iraq and Afghanistan, too, for that matter. 

What steps should this Committee, this Congress, and the Administration take to improve the lives of veterans suffering from 

exposure to toxic materials? 

Mr. HARMAN. Any veteran exposed to any type of toxin, whether 

it is burn pits, Agent Orange, radiation, or whatever, during their 

time of service must be given the benefits and care that they have 

earned. To deny those individuals that care and medical benefits 

forces them to incur sometimes insurmountable amounts of medical 

expenses to treat those illnesses and injuries. 

We have heard reports of many veterans dying because they 

have been denied that particular benefit, again, which just 

amounts to a huge amount of huge expense incurred by that family 

when it should have been the government’s responsibility to pay 

them for that disability or award them a disability rating due to 

that exposure to any toxin. 

Senator BROWN. You have been an advocate. You would not be 

the national commander if you had not been an advocate for pretty 

much your whole life for veterans. You went through a period 

where government, because Congress did not respond quickly 

enough, where soldiers that developed cancer from Agent Orange 

in Vietnam in the 1990s were seeing that become more and more 

common. They had to go to the VA and prove it was connected to 

Agent Orange. Congress then responded, in the right way, and put 

those illnesses on a presumptive eligibility list, right? 

Mr. HARMAN. Correct. 

Senator BROWN. Is that list, I think most people here know that, 

but there is a list of, how many? Sixteen or 18, something like that, 

illnesses that are connected that are believed to have been contributed to or caused by Agent Orange, are now eligibilities for any soldier, sailor, air man, or Marine who put a foot on the ground that 

were on a ship that docked in Saigon or whatever. 

32 

That list, we have added some illnesses to it over time. 

Mr. HARMAN. Correct. 

Senator BROWN. Is that list up-to-date? First question. 

Second question, does that list reflect Iraq and Afghanistan? Or 

is that list really just too reflective of Vietnam and not more recent 

history? 

Mr. HARMAN. I think, for the most part, it is pretty much reflective of Vietnam and exposure to Agent Orange. There are some 

presumptive conditions as a result of burn pit exposure, and I 

know that Secretary Shulkin is looking at some potential new presumptive conditions due to exposure to Agent Orange and toxic 

exposure. 

Senator BROWN. I would ask you, with your prestige and reach 

around the country, to update us as much as you can, and really 

you too, Mr. Tansill, and the two of you also, Ms. Twine and Mr. 

Powers. I mean, I think we are always looking to perfect this. 

Mr. HARMAN. Sure. 

Senator BROWN. We have not done that. But, when medical 

science connects an illness to an environmental condition like burn 

pits or Agent Orange, that Congress needs to know it and move 

quickly. Anything you know that you feed to us is really important. 

Mr. HARMAN. I will have our Washington office be in touch with 

you. 

Senator BROWN. Thank you, Commander. 

Congresswoman Beatty for questions. 

Ms. BEATTY. Thank you, Senator. 

Let me say thank you to all our witnesses for your powerful 

testimony. 

As I was sitting here, I had a list of questions, Senator, but I 

want to go to one that just came to me as I listened to the testimony. I guess it becomes a question that it seems like we are hearing a lot about the lack of access when there is a need, first, just 

maneuvering through getting access and then the timeliness of 

access. 

Certainly, for all of us, whether you are a veteran or served in 

the military, when you are in crises, you need quick intervention. 

I guess the question becomes, maybe Mr. Tansill, or even to us, are 

there exit plans? Are there counseling sessions, exit plans? 

I am thinking about the biggest thing young folks do today if 

they are not going into the military, let’s say they are going to college. In addition to having their commanders who are their professors and who are their lab tech folks, they have counselors. You 

know, people change their majors. They get ready to graduate. 

They find out a month before graduation or the quarter before that 

they have to take another class. 

Should we in Congress be looking at what is there along the way. 

Whether I am here or in the district, I hear this constantly. ‘‘I 

could not get access to my X, Y, Z. I was in depression,’’ or, ‘‘My 

wife couldn’t,’’ or my spouse couldn’t. We know this; this is not 

new. I am hearing powerful stories that I have heard before. 

What is it that we need to put in place that helps us to have 

quicker and better access for those who have served who are coming back? What should I be looking at as a Member of Congress 

for getting that access? Is it more of something? Is it simplifying 

33 

something? We know eventually somebody is going to leave. If they 

are here for 120 days, even if someone has a medical crisis and 

they are injured, they are in the hospital, they cannot get released—let me give you a good one. 

If you are home, I had a relative who went to the hospital the 

other day, and the outcome was not good, but they would not release them until I went out and found a rehab center. They would 

not release them to go home. We had to have a rehab center for 

them to go to, so they would not be in crisis at home. 

It seems like we could have some plan that says Jane and John 

Doe are going to be released whether it is for medical reasons, 

whether it is they have served their time, that there is some type 

of 30-day, 120-day exit plan. 

If I knew that I was going to mom’s but I could go 60 miles up 

the street and get in a program, why didn’t somebody know that 

to tell me that? 

Mr. TANSILL. Congresswoman, the military does out-process the 

folks. It is called Transition Assistance Program. TAP is the acronym for it. It is typically done within the last 12 months of their 

service that they start going through this process. 

The process is more about getting them to understand that they 

are going to need to look for a job. They need to get connected to 

the VA. They need to do different programs like that. 

I will circle back to the best way to help a veteran coming home 

is to get them information before they get here. 

DOD installations do a pretty good job of out-processing them, 

but it ends at the front gate. We need to make sure we get to them 

before they leave whatever installation under DOD they are stationed at to ask them: Are you coming back to whatever State? 

What are you going to do? Are you going to college? If you are 

going to look for a job; what are you interested in? If you are looking for an apprenticeship program, here is where you can go to find 

out all the apprenticeship programs in all of the cities. 

Finding out at the 120-day mark that someone has returned to 

Ohio has put them at an extreme disadvantage to get their life 

jump-started back as a civilian. Being able to reach them prior to 

their exit from the military, to allow them to understand all the 

things that are available to them back in whatever State they are 

going to—by the way, we want every veteran to come to Ohio even 

if they are not from Ohio. They need to know what is available. 

Most people coming out of the military getting ready to go to college, they already know that. They know what college they want 

to go to. They have already done most of the work online. But, it 

is the jobs and the apprenticeship programs and those folks that 

have not figured out yet what they are going to do. 

A lot of people leave the military and say, ‘‘I need time to figure 

out what I want to do.’’ If we are able to frontload them with all 

the available opportunities for them, it sure might make their decision a little easier when they get home. 

Ms. BEATTY. Thank you. 

Senator BROWN. Thank you very much. 

Ms. BEATTY. Let me just say thank you for allowing me to participate. We will follow up, our staff with your staff. 

Senator BROWN. Good. 

34 

Ms. BEATTY. Thank you for being here. 

Senator BROWN. Thank you, Congresswoman. [Applause.] 

Thank you for changing your day around to join us. I really appreciate it. 

I would add, I was just informed there are 14 illnesses, 14 diseases, that are presumptive eligibility with Agent Orange. Secretary Shulkin is making a decision on three more, so there will 

likely be up to 17 illnesses that are connected, that someone is 

automatically eligible for benefits if diagnosed with that illness. 

One more question for this panel, and for you specifically, Ms. 

Twine. I know you do not speak for all women veterans. I understand that you do not speak for all Gold Star wives, but I want to 

ask you two things. 

One is, talk about, if you would, how the VA can improve services and health care outcomes for veterans, for female veterans. 

About 10 percent of Ohio veterans now, slightly under 10, are female. That percentage, obviously, is going up because among young 

veterans, the percentages are obviously higher. Talk about that. 

Talk about, if you would, if you have thoughts on what we should 

do to reduce sexual violence in the military, if you feel comfortable 

answering that. You have been out for a while, I understand. 

Ms. TWINE. That is huge, open-ended—— 

Senator BROWN. Yes, I know those are two really broad 

questions. 

Ms. TWINE. Personally, I did not experience sexual violence as a 

veteran, and as an Active Duty military person, so I cannot speak 

for those people. However, being a woman in the military and also 

in the medical field, even today, there is always a good old boys 

club. Unfortunately, that has been the accepted norm for many, 

many and thousands of years. So, overcoming that—— 

Senator BROWN. It is not just the military, is it? 

Ms. TWINE. No, it is everywhere. You turn the TV on and all you 

are going to hear, every update on your iPhone is going to be some 

new person coming out because they were kissed hard. It is going 

to be a huge issue. 

Unfortunately, the lack of communication and the lack of holding 

those accountable has created an environment that allows for that 

type of behavior to be considered the norm. 

I do not have a good answer to that other than people need to 

step up and do what is right. They also not only need to step up 

and do what is right, they need to speak up. 

That is a huge problem with women and men, is speaking up 

when there is a problem. We are seeing now, you turn the TV on, 

‘‘Twelve years ago, I had a problem.’’ ‘‘Thirty years ago, I had a 

problem.’’ ‘‘Forty years ago, I had a problem.’’ But, nobody spoke 

up. 

Now we are looking at this issue that was an issue 30, 40 years 

ago. It is a huge problem. 

It creates a huge problem in the mental health field for women 

who have PTSD because of those issues. I can only assume that 

that is another area of major concern for women. 

Personally, the issues that I have heard about from patients that 

I treat or from people that I know personally is that the VA has 

very little tolerance for women’s health issues, such as annual Pap 

35 

smears or birth control or the need for different surgeries for birth 

control or for hysterectomies and different type of programs. And, 

getting access to those from the VA is difficult. 

Senator BROWN. We will hear from the VA in a moment. 

Ms. TWINE. My understanding, my experience with the VA, like 

I said, I have avoided it like the plague, and I will go civilian. But, 

then again, in the civilian world, it is not always easy either, if you 

go to a Catholic hospital versus a regular hospital. 

I cannot really answer to a lot of those questions, unfortunately. 

Senator BROWN. Thank you. 

Did you want to add something? 

Mr. POWERS. Yes, Senator Brown. 

As a member of the IAVA, our major bill initiative, your cosponsor on it, I believe. I think it is S. 681. That would be the Deborah 

Sampson Act. It is common-sense legislation to get the VA priority 

funding for peer-to-peer-women’s programs for the mental health 

care, for the primary care. 

There is a common-sense bill in Congress right now, both in the 

House and in the Senate. Fortunately, there are 21 cosigners to it, 

I believe, right now. I am wondering, I mean, what is it going to 

take to get the rest to do this? This should be common-sense legislation, getting 10 percent of our veterans the care that they need. 

Unfortunately, short of you guys holding a hearing on it over 6 

months ago, it almost feels as if it has stalled. I mean, commonsense legislation for appropriations for veterans should be a nobrainer, as long as it is going to be effective. 

Given the fact of the scarcity of the resources to female veterans 

for their care, I could not see any more of an urgency for a bill like 

that to get passed. 

The solutions are out there, and the VA has the programs, depending on where you live, to help address this for veterans, like 

the 10-week program I spoke of in my opening statement. That program in Cleveland helps 50 veterans a year. That is it, 50 veterans. 

There is another one, I believe, in San Diego. The other one recently closed in Baltimore. 

That is all they can help. They have an 80 percent reduction in 

symptoms for PTSD and substance abuse. They have the military 

sexual trauma group and individual programs that are there, but 

most of them tend to be pilot programs. There are 3-, 5-, 6-, and 

10-year pilot programs. If it is effective after a year, we have frontline issues with PTSD, with military sexual trauma, with substance abuse, if the treatments seem effective, it would only make 

sense to get them out there further to where you have a larger veteran population being treated so we can find out for sure that it 

is going to work, to where we can get the help that is needed for 

whatever our veterans issue is. 

It should not be so hard for us to access care, especially female 

veterans. I mean, my own sister, my own little sister, she was a 

medic in the National Guard. She hurt herself during her initial 

training with her hip, and I know that she still has problems with 

fighting with the VA for treatment on a host of things related to 

women’s health. 

I personally can say that I have been affected by it, and it did 

not even pass my mind sitting here. I mean, it is affecting everyVerDate Mar 15 2010 21:17 Nov 29, 2018 Jkt 000000 PO 00000 Frm 00039 Fmt 6633 Sfmt 6601 Z:\ACTIVE\112117.TXT PAULIN
36 

body, and it needs addressing. That is why we are here right now 

having this hearing. 

Senator BROWN. All right. 

Ms. Twine, thank you for serving, and thank you for your activism, and thank you for testifying. Mr. Tansill, thank you. Commander Harman, you make us proud—over near the Indiana 

border. Thanks to all four of you. 

I will call up the next panel. Thank you. [Applause.] 

It is my honor to resume the Senate Veterans’ Affairs Committee. Thank you all again for joining us in the audience. 

I asked the others if they wanted to stay. I know Mr. Powers is 

staying. Thank you all for all of that. 

The second panel, only Mr. Burke will speak, but I will have 

questions of all four of the panelists. We will start with Ronald 

Burke, who is Assistant Deputy Under Secretary for field operations with the Veteran Benefits Administration, Department of 

Veterans Affairs. Welcome to Columbus. 

He is accompanied by Robert Worley, who is the director of education service, Veterans Benefits Administration, Department of 

Veterans Affairs. Mr. Worley, welcome to Ohio. 

Robert McDivitt, who is director of Veterans Integrated Service 

Network 10, Veterans Health Administration, Department of Veterans Affairs, I see Mr. McDivitt pretty often. Welcome. 

Dr. Kameron Matthews, deputy executive director, provider relations and services with Veterans Health Administration, Department of Veterans Affairs. Welcome to Ohio to you, too. 

Mr. Burke, give us your statement, and then I will begin the 

question period of all of you. Thank you. 

STATEMENT OF RONALD BURKE, ASSISTANT DEPUTY UNDER 

SECRETARY FOR FIELD OPERATIONS, VETERANS BENEFITS 

ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY ROBERT WORLEY, DIRECTOR OF 

EDUCATION SERVICE, VETERANS BENEFITS, ADMINISTRATION; ROBERT MCDIVITT, DIRECTOR OF VETERANS INTEGRATED SERVICE NETWORK 10, VETERANS HEALTH ADMINISTRATION; AND KAMERON MATTHEWS, M.D., DEPUTY EXECUTIVE DIRECTOR, PROVIDER RELATIONS AND SERVICES, 

VETERANS HEALTH ADMINISTRATION 

Mr. BURKE. Good afternoon, Senator Brown. Thank you for inviting the VA to this important hearing to discuss topics that affect 

veterans nationwide and here in Ohio. 

My colleagues have already been introduced. We are here today 

and happy to discuss the topics included in your invitation. 

As you know, on August 16, 2017, the President signed the 

Harry W. Colmery Veterans Educational Assistance Act of 2017, 

commonly referred to as the Forever G.I. Bill, which made numerous changes to the post-9/11 G.I. bill. This new law enhances or expands education benefits for veterans, servicemembers, families, 

and survivors. 

This law will, however, require a significant IT effort. Rough esti- mates place this number up to $40 million in addition to the authorized $30 million, bringing the IT costs to $70 million. 

37 

The implementation of the Forever G.I. Bill will require approximately 200 additional claims examiners at the regional processing 

offices. The VA has begun the process of bringing those full-time 

equivalents on-board in the form of temporary employees. All employees are expected to be on-board by May 30, 2018. 

With regard to overpayments, VA makes every attempt to timely 

and accurately process payments to veterans and their family 

members based on benefits to which they are entitled to receive 

under the law. However, in certain instances where an individual 

is not entitled to a benefit payment, such as changes in life events 

or dual payments for multiple agencies, the VA is required by law 

to recoup these payments. 

VA’s policy for recovering these types of overpayments includes 

notifying veterans and beneficiaries about the reasons for and 

amounts of overpayment, along with the steps they must take to 

make repayment. The VA also take steps to minimize the overpayment amounts and has established recoupment policies that allow 

veterans to request repayment plans or waivers of these amounts. 

VBA is also committed to providing veterans with the care and 

services they have earned and deserve. For the eighth consecutive 

year, VBA has completed over 1 million disability claims and anticipates completing a record number of claims in 2018. As of October 28, 2017, VBA had 321,208 compensation and pension claims 

pending, with an average age of 93.8 days; 22.4 percent of that inventory has been pending for over 125 days. For Ohio veterans, the 

average age of a pending claim for compensation was 97.5 days, 

with 22 percent pending over 125 days. 

VA’s modernization efforts focus on improving its performance to 

better serve veterans, their families, caregivers, and survivors, 

while being good stewards of taxpayer dollars. As such, VBA has 

initiated several process improvements, leveraged operational tools 

such as its National Work Queue, and implemented new employee 

performance standards to improve claims processing timeliness and 

quality. 

Another way that VBA is striving to improve the veteran’s overall experience is through realignment of its appeals policy and operations under its appeals management office and its work with the 

Board of Veterans Appeals, veterans’ service organizations, and 

other stakeholders to design a modern appeals process for veterans. 

The current VA appeals process, which is set in law, is broken 

and is providing veterans a frustrating experience. In the current 

process, appeals have no defined endpoint and require continuance 

evidence-gathering and re-adjudication. Veterans wait much too 

long for final resolution of their appeals. 

With the current legal framework, the average processing time 

for all appeals resolved in fiscal year 2017 was 3 years. For those 

appeals that reach the Board of Veterans Appeals, on average, veterans waited 7 years from the date they filed their notices of disagreement for a decision, which means that many are waiting 

much longer. 

We appreciate the Committee’s work on this issue, which was enacted as the Veterans Appeals Improvement and Modernization Act 

of 2017, and signed into law by the President on August 23, 2017. 

38 

Although the appeals modernization act ensures that veterans 

who disagree with the VA’s benefit decisions after February 2019 

will have all of the benefits of the new modern review process, the 

VA is also committed to addressing the 470,000 appeals that are 

currently pending in the legacy process. 

On November 1, 2017, VBA initiated its Rapid Appeals Modernization Program, otherwise known as RAMP, for veterans with 

pending appeals. This program allows participants the option to 

have their decisions reviewed in the higher level review or supplemental claim lanes outlined in the new law. Participation in RAMP 

is voluntary. However, veterans can expect to receive a review of 

VA’s initial decision on their claim much faster in RAMP than if 

they were to remain in the legacy appeals process. 

The program will continue through monthly invitation mailings 

to eligible veterans until February 2019, when VA expects to fully 

implement the appeals modernization act. 

Now to the health-related issues that face VA. Recent research 

suggests that 20 veterans die by suicide every day, putting veterans at even greater risk than the general public. The VA is committed to ensuring the safety of our veterans, especially when they 

are in crisis. Losing a veteran to suicide shatters their family, loved 

ones, and caregivers. Veterans who are at-risk or reach out for help 

must receive assistance when and where they need it in the terms 

that they value. Our commitment is to do everything possible to 

prevent suicide among the veterans who we serve. 

The VA has developed the largest integrated suicide prevention 

program in the country. We have more than 1,100 dedicated and 

passionate employees, including suicide prevention coordinators, 

mental health providers, veterans crisis line staff, epidemiologists, 

and researchers who spend each and every day working on suicide 

prevention efforts and care for our veterans. 

Every veterans suicide is a tragic outcome. Regardless of the 

number or rates, one veterans suicide is too many. 

We continue to spread the word throughout VA that suicide prevention is everyone’s business. The ultimate goal is to eliminate 

suicide among veterans via strategic community partnerships, 

identification of risks, training, treatment engagement, effective 

treatment, lethal means education, research, and data science. 

Although we understand why some veterans may be at increased 

risk, we continue to investigate and take proactive steps to understand all risk factors for all veterans. 

The VA is also committed to providing timely access to high-quality, evidence-based mental health care that anticipates and responds to veterans’ needs and supports the reintegration of returning servicemembers into their communities. 

While focusing on suicide prevention, we know that preventing 

suicide for the population we serve does not begin with an intervention as someone is about to take an action that could end his 

or her life. Just as we work to prevent fatal heart attacks, we must 

similarly focus on prevention, which includes addressing many factors that contribute to someone feeling suicidal. 

We are aware that access to mental health care is one significant 

part of preventing suicide. VA is determined to address systemic 

39 

problems with access to care, in general, and to mental health care, 

in particular. 

VA has recommitted to a culture that puts the veteran first. 

Making it easier for veterans to receive care from mental health 

providers has allowed more veterans to receive care. Furthermore, 

VA is leveraging telehealth by establishing 11 regional tele-mental 

health hubs across the VA’s health care system. 

The VA remains focused on providing the highest quality care 

our veterans have earned and deserve, and which our Nation trusts 

us to provide. 

The VA appreciates the support of Congress, and we look forward 

to responding to any questions that you may have. Thank you. 

[The prepared statement of Mr. Burke follows:] 

PREPARED STATEMENT OF RONALD BURKE, ASSISTANT DEPUTY UNDER SECRETARY

FOR FIELD OPERATIONS, U.S. DEPARTMENT OF VETERANS AFFAIRS

GOOD AFTERNOON, SENATOR BROWN, AND DISTINGUISHED MEMBERS OF THE COMMITTEE. Thank you for inviting us to discuss Veterans health care, educational, and 

disability benefits. I am accompanied today by Robert Worley, Director of Education 

Services, Mr. Robert McDivitt, Network Director for the Veterans Integrated Service 

Network (VISN) 10, and Dr. Kameron Matthews, Deputy Executive Director, Provider Relations and Services. We have provided a brief background and important 

context for all of the topics that this hearing will cover since there are a wide range 

of issues. 

POST-9/11 GI BILL

The Post-9/11 GI Bill (Chapter 33) provides eligible Veterans, Servicemembers, 

dependents, and survivors with educational assistance, generally in the form of tuition and fees, monthly housing allowance, and a stipend for books-and-supplies all 

to assist these men and women in reaching their educational or vocational goals. 

This program also assists in the Veteran’s readjustment to civilian life, supports the 

armed services recruitment and retention efforts, and enhances the Nation’s competitiveness through the development of a more highly educated and productive 

workforce. 

Since inception of this benefit in August 2009, VA has issued over $80 billion in 

benefit payments on behalf of approximately 1.8 million individuals. In fiscal year 

(FY) 2017 alone, all of VA’s education programs (chapters 30, 32, 33, 35, 1606 and 

1607) provided 1 million beneficiaries with educational assistance. Of those, 21,000 

direct beneficiaries received education benefits in the state of Ohio. Further, VA provided Post-9/11 GI Bill benefits to approximately 790,000 Veterans, Servicemembers 

and dependents in this same period; of those, approximately 15,000 were in Ohio. 

Since FY 2013, VA has processed an average of 4 million education claims per year. 

In fiscal year 2017, the average time to process all education claims was approximately 25 days for original claims and nine days for enrollment certifications. 

Colmery Act 

On August 16, 2017, the President signed the Harry W. Colmery Veterans Educational Assistance Act of 2017, also referred to as the ‘‘Forever GI Bill.’’ This law 

made numerous changes to the Post-9/11 GI Bill. The Harry W. Colmery Veterans 

Educational Assistance Act of 2017 contains 34 new provisions, the vast majority 

of which will enhance or expand education benefits for Veterans, Servicemembers, 

Families and Survivors. Most notably, the new law eliminates the 15-year time limit 

on the use of Post-9/11 GI Bill benefits for Veterans who transitioned out of the 

military on or after January 1, 2013. This law also restores benefits to Veterans impacted by school closures since 2015, expands benefits for certain Reservists, surviving dependents, Purple Heart recipients, and provides many other enhancements 

to education benefits. 13 of the 34 provisions were effective on the date of enactment, while the remaining provisions have future effective dates ranging from January 1, 2018, to August 1, 2022. 

VA is utilizing social media to inform individuals about these changes. In addition, VA has launched a multifaceted campaign (social media, website, targeted 

emails, and traditional media) to highlight the Colmery Act. The campaign will 

heavily focus on restoration of entitlement, Reserve Educational Assistance Program 

40 

(REAP), work-study permanent authorization, and expansion of independent study 

to career and technical education schools. 

The implementation of the Forever GI Bill will require additional claims examiners at regional processing offices. VA has begun the process of bringing those full 

time equivalents on board in the form of temporary employees. All employees are 

expected to be on board by May 30, 2018. 

To manage the overall process for implementing this legislation, VA Education 

Service established a program executive office comprised of business-line managers, 

management analysts, individuals with program and project management experience, and contract support. This office is responsible for monitoring and coordinating 

all Forever GI Bill implementation activities. In addition, we will need to make targeted investments in our IT infrastructure to support the expanded access to education benefits the new law provides. We look forward to working with the Administration and the Congress to ensure these initiatives are properly resourced. 

OVERPAYMENT/DEBT ISSUES

VA makes every attempt to timely and accurately process benefit payments to 

Veterans and their family members, based on benefits to which they are entitled 

to receive under the law. However, in certain instances where the Veteran is not 

entitled to receive payments, such as those resulting from life events or dual payments from multiple agencies, VA is required by law to recoup payments in excess 

of what is allowable. VA’s policy for recouping such overpayments includes notifying 

Veterans and beneficiaries regarding the reason(s) for and amounts of overpayment, 

along with the steps they must take to make repayment. VA also takes steps to 

minimize overpayments and has established policy regarding the recoupment processes by which Veterans can arrange repayment or waivers. 

Reasons for Overpayments 

In general, VA identifies an overpayment when it finds a Veteran or other beneficiary has received monetary payment for benefits to which he or she was not entitled. Overpayments are considered improper payments under the Improper Payments Elimination and Recovery Act of 2010. VA is required by law to retroactively 

recover overpayments to the extent the Veteran or beneficiary was not entitled to 

them. Title 38 of the U.S. Code § 5112, and Title 38 of the Code of Federal Regulations § 3.500, directs the effective dates of reduction or discontinuance of an award. 

Overpayments may occur when Veterans or beneficiaries, receiving disability compensation or pension benefits, fail to timely notify VA of certain circumstances or 

life events such as divorce, incarceration, return to active duty, or other loss of dependent status. They may also occur when Veterans or beneficiaries advise VA of 

changes but VA is untimely in processing the claim. It is important to note VA does 

not require repayment when VA employees make claims processing errors. Such 

cases are resolved as administrative errors and are not required to be recouped. 

Process of Notifying Beneficiaries of Overpayments 

Before a debt can be established, VA is required by law to provide due process 

notice to the Veteran or beneficiary, advising him or her of the proposed adjustment 

to his or her benefits. The beneficiary then has 60 days to submit evidence regarding why VA should not make the proposed adjustment to the award. Veterans or 

beneficiaries may also request a predetermination hearing to provide information 

pertaining to this proposed action. After the due process period expires, VA reviews 

all evidence submitted and makes the final decision to create a debt or to adjust 

the proposed action based on the evidence received. VA notifies the Veteran or beneficiary of the decision or date of benefit termination, and provides applicable appeal 

rights. If VA determines there has been an overpayment, the beneficiary also receives a letter explaining the debt owed and repayment options. 

Steps VA is Taking to Prevent Overpayments 

VA employs a number of measures to minimize overpayments. First, the Veterans 

Benefits Administration (VBA) includes important reminders in benefit decision notification letters about the need for Veterans and beneficiaries to inform VA immediately of issues or life events that could impact monthly payment amounts. 

Second, VA has data matching agreements with the Social Security Administration, Federal Bureau of Prisons, and other Federal agencies to minimize individuals 

receiving benefits that are not statutorily permissible. VA also works with these 

agencies to ensure critical data feeds, such as information for dates of death, dates 

of incarceration, etc., are transmitted to VA as timely and efficiently as possible. 

Third, VBA is deploying technological solutions and leveraging automation to reduce overpayments. For example, drill pay from the Department of Defense (DOD) 

41 

1Source: 30 October 2017—Monday Morning Workload Report—WHCO: Please provide a full 

citation and a link. 

has been a major contributor to VA overpayments. By law, Servicemembers are not 

entitled to receive both drill pay and VA disability compensation for the same periods of time. In 2016, VA automated the notification process required when Guardsmen and Reservists receiving VA compensation actively drill and receive pay. The 

new process, with DOD collaboration, has improved VA’s management of drill pay 

adjustments. Prior to the new process, drill pay claims took a monthly average of 

308 days (May 2016) to complete compared to a current monthly average of 97 days 

(August 2017) to complete. This progress results in Veterans receiving more timely 

adjustments. 

VA’s Policy Regarding Recouping Overpayments and Potential Waivers 

VA’s Debt Management Center (DMC) provides the collection guidelines and practices for recouping overpayments that have been established against a beneficiary. 

VA navigates recoupment of the overpayment (or debt collection process) in a manner that provides the best care to our Veterans and beneficiaries and complies with 

Federal debt collection statutes and policy. The DMC services beneficiary debts 

through a centralized debt collection program while offering all Federal collection 

tools provided by the Department of the Treasury. Most importantly, DMC counselor’s work with Veterans and beneficiaries individually to resolve debts through 

extended payment plans, benefit offsets, waivers, compromises, dispute resolution 

and hardship refunds. 

A Veteran can request a waiver of his/her debt within 180 days of receiving the 

debt notice. If the Veteran requests a waiver outside of the 180 day timeframe, the 

debtor receives appeal rights. If received timely, the waiver request goes to the VBA 

Committee on Waivers and Compromises (COWC) at the Regional Offices in St. 

Paul, MN, or Milwaukee, WI. Once the COWC receives a waiver request, elements 

such as fault, unjust enrichment, and financial hardship are considered when deciding to grant, partially grant, or deny the request following the principles of equity 

and good conscience.VA will not demand payment when it would be unfair, unconscionable, or unjust. However, the COWC will automatically deny a waiver if there 

is any indication of fraud, misrepresentation, or bad faith. If the waiver is not approved, the debtor receives applicable appeal rights. Completed waiver decisions are 

returned to DMC for processing. If denied, the debt collection process resumes. If 

the waiver is granted, collection action is terminated, and any collections received 

are refunded, if required. 

A separate process also enables Veterans and/or beneficiaries to submit a compromise offer for acceptance of a partial payment in settlement and full satisfaction 

of the offeror’s indebtedness. 

DISABILITY CLAIMS BACKLOG

VBA is committed to providing Veterans with the care and services they have 

earned and deserve. For the eighth consecutive year, VBA has completed over a million disability compensation claims and anticipates sustaining this effort in FY 

2017. As of October 28, 2017, the average age of pending compensation and pension 

(C&P) claims was 93.8 days. For Ohio Veterans, the average age of pending C&P 

was 97.5 days. 321,208 C&P claims were pending nationally, with 23.1 percent 

pending over 125 days. In Ohio, there are 8,945 compensation claims pending, with 

22.4 percent pending over 125 days.1

VA’s claims modernization efforts focus on improving its performance to better 

serve Veterans, their families, caregivers, and Survivors while being good stewards 

of taxpayer dollars. As such, VA has initiated several claims process improvements 

and leveraged operational levers to improve claims timeliness. 

Overtime 

Mandatory overtime was re-instituted at all VBA regional offices effective 

March 7, 2017, in a strategic effort aimed at reducing the number of claims pending 

longer than 125 days. Overtime requirements are assessed every 30 days and guidance provided to the regional offices based on workload management needs. 

VA executed $114.6M in Compensation and Pension overtime nationally in FY 

2017, while executing $2.6M at the Cleveland Regional Office. 

Through October 28, 2017, VA has executed nearly $10M in C&P overtime nationally in FY 2018, while executing $208.SK at the Cleveland Regional Office. 

42 

National Work Queue 

In 2016, VBA transitioned to the National Work Queue (NWQ), which nationally 

prioritizes and distributes rating claims to VBA’s network of stations, matching 

their capacity with resources available, and minimizing the time to adjudicate a 

claim. . Implementation of NWQ has improved timeliness for several phases of the 

claim processing process. Average time for initial development of a claim has improved from 25 days in January 2016 to 8 days is September 2017. In the rating 

phrase, average time for rating decisions on claims has improved from 29 days in 

January 2016 to 3 days in September 2017. In award and authorization, NWQ has 

improved timeliness by 2.9 days, down to 5.9 days. Combined, these improvements 

result in more timely service for Veterans and move VBA closer to the goal of processing 90 percent of claims within 125 days. 

These administrative adjustments are part of VBA’s non-rating workload. During 

FY 2017, VBA made several changes to allow for a more balanced approach to the 

overall workload. VBA appreciates Congress’ support in providing resources to staff 

specific teams across the Nation dedicated to the non-rating workload, and we have 

prudently used these additional resources to lower the non-rating claims inventory. 

As of April 2017, NWQ is distributing non-rating claims, which allows this work to 

be moved efficiently based on capacity. Additionally, VBA has adapted a strategic 

approach to how we use our overtime resources. We now target specific claims and 

steps within the claims process to ensure we direct our overtime expenditures on 

where we receive the most benefit. These enhancements have led to improvements 

in performance. Overall non-rating inventory dropped by 23 percent with a 19 percent decrease in the average number of days pending for these claims. The inventory of Dependency claims decreased by 26 percent with a 50 percent improvement 

in timeliness, and the inventory of Drill pay claims dropped by 58 percent. We still 

have work to do and will remain focused on continuing our work on appropriate preventative measures. 

Decision Ready Claims 

Beginning in May 2017, VBA initiated a pilot program in the St. Paul Regional 

Office (RO) called Decision Ready Claims (DRC), an expedited claims submission option available to Veterans who have elected accredited Veterans Service Organizations (VSOs) to assist them with preparing and submitting their supplemental disability claims. , National implementation of this program was completed in September 1, 2017. 

Under the DRC Program, VSOs work with Veterans to ensure all supporting evidence for a claim is included at the time of submission. This program will also enhance partnerships with VSOs by improving access and capabilities to assist with 

gathering all required evidence and information to accelerate claims decisions. 

Claims submitted in the DRC Program will result in a supplemental claims decision 

within 30 days of submission to VA. 

Centralized Mail 

VBA completed deployment of the Centralized Mail Program to all ROs in 2015, 

and to the Pension Management Centers in FY 2016. Since deployment, VBA has 

gained proficiency in electronic mail processing and is now able to provide assistance with virtual mail processing, as needed across ROs. In FY 2017, VBA focused 

on File Bank Extraction (FBE), an effort to rapidly extract all inactive paper claims 

from ROs on a national level while having the Office of Business Process Integration 

and its Veterans Claims Intake Program assume logistical tracking control at the 

point of origin. FBE is a continuation of VBA’s transformation and transition from 

paper-based to electronic claims processing. The benefits of FBE are it ensures claim 

materials are in the Veterans Benefits Management System (VBMS) on day 1 of future claims, as well as reduces the overall amount of space dedicated to storage and 

directly supports VBA’s strategic transformation goal to become completely 

paperless. 

APPEALS MODERNIZATION

VBA is striving to improve its appeals processing, support appeals modernization, 

and provide relief for Veterans with pending appeals particularly in light of recently 

enacted legislation. The system is complex, inefficient, ineffective, confusing, and 

splits jurisdiction of appeals processing between VBA and the Board of Veterans’ 

Appeals (Board). Veterans wait much too long for final resolution of an appeal. 

Within the current legal framework, the average processing time for all appeals resolved in FY 2017 was 3 years. For those appeals that reach the Board, on average, 

Veterans are waiting at least 7 years from the date that they filed their notice of 

disagreement for a decision, which means that many are waiting much longer. In 

43 

an effort to maximize its appeals resources, effective January 4, 2017, VBA realigned its appeals policy and operational control under a single responsible office, 

the Appeals Management Office (AMO). This realignment provides direct control of 

appeals policy activities, field staffing and resource allocation, the appeals budget, 

and program performance by AMO. Critical to VBA’s success in transforming its administration of appeals is the ability to quickly and directly influence operational 

staffing and resource allocation, and accountability for policy implementation, program performance, and Veterans’ and stakeholders’ satisfaction with the program. 

By the end of FY 2017, VBA had processed 272,986 appeal actions and resolved 

124,666 appeals, which was 24 percent above its appeals production in FY 2016. 

Moreover, despite receiving approximately 160,000 new appeals in 2016, VBA reduced its total appeals inventory by 10 percent. 

The Cleveland VA RO, which serves approximately 800,000 Ohio Veterans and 

their families, has shown significant progress in its appeals processing metrics since 

the realignment. Consistent with the AMO’s guidance of processing the oldest appeals first, the RO has decreased its appeals inventory in each appeal stage, to include a 62 percent decrease in its inventory of Veterans waiting for certification of 

their appeal to the Board and a reduction of remands by 29 percent. 

VA was aware that increased oversight and accountability alone would not resolve 

the pending legacy appeals inventory. Accordingly, VA also sought legislation to replace the current VA appeals process with a new legislative framework that makes 

sense for Veterans, their advocates, VA and other stakeholders. On August 23, 2017, 

President Trump signed into law, the Veterans Appeals Improvement and Modernization Act of 2017 (Appeals Modernization Act), creating a new claims and appeals process for disagreements with VA’s decisions on benefit claims. The new process provides streamlined choices for claimants seeking review of a VA decision. The 

framework for the new process features three lanes: a higher-level review lane, 

which consists of an entirely new review of the claim by a senior adjudicator, a supplemental claim lane, which provides an opportunity to submit additional evidence, 

and an appeal lane that provides an opportunity to appeal directly to the Board. 

VA’s goals in this new process are an average of 125 days in the supplemental claim 

and higher-level review lanes and 1year in the Board’s appeal lane for those Veterans who do not seek a hearing or wish to submit additional evidence. 

In an effort to provide some of the benefits of the new law’s streamlined process, 

VA has initiated the Rapid Appeals Modernization Program (RAMP) for Veterans 

with pending appeals. This program allows participants the option to have their decisions reviewed in the higher-level or supplemental claim lanes outlined in the new 

law. Participation in RAMP is voluntary; however, Veterans can expect to receive 

a review of VA’s initial decision on their claim much faster in RAMP than if they 

were to remain in the legacy appeals process. The program began on November 1, 

2017, and will continue through monthly invitation mailings to eligible Veterans 

until February 2019 when VA expects to fully implement the Appeals Modernization 

Act. 

SUICIDE PREVENTION

Recent research suggests that 20 Veterans die by suicide each day, putting Veterans at even greater risk than the general public . After adjusting for age and sex, 

the risk for suicide is 22% higher among Veterans than among non-Veterans. (The 

National suicide rate is 17.0 suicides per 100,000 and the Ohio Veteran suicide rate 

is 32.1 suicides per 100,000). VA is committed to ensuring the safety of our Veterans, especially when they are in crisis. Losing a Veteran to suicide shatters their 

family, loved ones and caregivers. Veterans who are at risk or reach out for help 

must receive assistance when and where they need it in terms that they value. Our 

commitment is to do everything possible to prevent suicide among the Veterans we 

serve and to reach all Veterans. To accomplish this objective, VA is instituting public health approach to reach all Veterans, whether or not they are enrolled in VA 

care, through partnerships and collaboration. 

VA has developed the largest integrated suicide prevention program in the country. We have over 1,100 dedicated employees, including Suicide Prevention Coordinators, Mental Health providers, Veterans Crisis Line staff, epidemiologists and researchers, who spend each and every day working on suicide prevention efforts and 

care for our Veterans. Screening and assessment processes have been set up 

throughout the system to assist in the identification of patients at risk for suicide. 

VA also has developed a chart ‘‘flagging’’ system to ensure continuity of care and 

provide awareness among providers about Veterans with known high risk of suicide. 

Patients who have been identified as being at high risk receive an enhanced level 

44 

of care, including missed appointment follow ups, safety planning, weekly follow-up 

visits and care plans that directly address their suicidality. 

We also have two centers devoted to research, education, and clinical practice in 

the area of suicide prevention. VA’s Veterans Integrated Service Network (VISN) 2 

Center of Excellence in Canandaigua, New York, develops and tests clinical and 

public health intervention strategies for suicide prevention. VA’s VISN 19 Mental 

Illness Research Education and Clinical Center in Denver, Colorado, focuses on: (1) 

clinical conditions and neurobiological underpinnings that can lead to increased suicide risk; (2) the implementation of interventions aimed at decreasing negative outcomes; and (3) training future leaders in the area of VA suicide prevention. 

Every Veteran suicide is a tragic outcome, regardless of the numbers or rates; one 

Veteran suicide is too many. We continue to spread the word throughout VA that 

‘‘Suicide Prevention Is Everyone’s Business.’’ The ultimate goal is to eliminate suicide among Veterans via public health strategies, which include initiatives focusing 

on strategic community partnerships, identification of risk, training, treatment engagement, effective treatment, safe storage of lethal means (such as medications 

and firearms), research, and data science. Although we understand why some Veterans may be at increased risk, we continue to investigate and take proactive steps 

to understand all risk factors for all Veterans. VA’s strategy for suicide prevention 

addresses suicide prevention as a public health issue for all Veterans. This requires 

programs designed to help individuals and families problem solve effectively, and to 

engage in care when needed, with ready access to high-quality mental health 

services. 

Suicide prevention is VA’s highest clinical priority. As part of VA’s commitment 

to make resources, services, and technology available to reduce Veteran suicide, VA 

initiated Recovery Engagement and Coordination for Health Veterans Enhanced 

Treatment (REACH VET) in November 2016, and fully implemented it by February 2017. REACH VET uses a new predictive model to analyze existing data from 

Veterans’ health records to identify those who are at a statistically elevated risk for 

suicide, hospitalization, illnesses, and other adverse outcomes. Once a Veteran is 

identified, his or her mental health or primary care provider reviews the Veteran’s 

treatment plan and current condition(s) to determine if any enhanced care options 

are indicated. The provider will then reach out to Veterans to check on their wellbeing and inform them that they have been identified as a patient who may benefit 

from enhanced care. This allows the Veteran to participate in a collaborative discussion about his or her health care, including specific clinical interventions to help reduce suicidal risk. 

DOD and VA have a new joint effort to institute a public health approach to suicide prevention, intervention, and post intervention using a range of medical and 

non-medical resources through data and surveillance, messaging and outreach, evidence-based practices, workforce development, and Federal and non-government organization partnerships. We know that 14 of the 20 Veterans who die by suicide 

on average each day did not receive care within VA in the past two years. We need 

to find a way to provide care or assistance to all of these individuals. Therefore, VA 

is expanding access to emergent mental health care for former Servicemembers with 

other than honorable (OTH) administrative discharges. This initiative specifically focuses on expanding access to assist former Servicemembers with OTH administrative discharges who are in mental health distress and may be at risk for suicide 

or other adverse behaviors. It is estimated that there are a little more than 500,000 

former Servicemembers with OTH administrative discharges. 

VA has authority to furnish care for service-connected conditions for former Servicemembers with OTH administrative discharges if those individuals are not subject to a statutory bar to benefits. Individuals with OTH discharges may access the 

system for emergency mental health services by visiting a VA emergency room, outpatient clinic, Vet Center or by calling the Veterans Crisis Line. Services may include assessment, medication management/pharmacotherapy, lab work, case management, psycho-education, and psychotherapy. We may also provide services via 

telehealth. 

VA, we have the opportunity and the responsibility, to anticipate the needs of returning Veterans. As they reintegrate into their communities, we must ensure that 

all Veterans have access to quality mental health care. To serve the growing number of Veterans seeking mental health care, VA has deployed significant resources 

and increased its staff for mental health services. The number of Veterans receiving 

specialized mental health treatment from VA has risen each year, from over 900,000 

in FY 2006, to more than 1.65 million in FY 2016 Executive Leadership Board within VISN 10 founded a time-limited workgroup entitled: Suicide Prevention—Overdose Prevention (SPODP). The workgroup was designed to enhance regional VA capabilities and collaboration among State and community partners to improve outVerDate Mar 15 2010 21:17 Nov 29, 2018 Jkt 000000 PO 00000 Frm 00048 Fmt 6633 Sfmt 6621 Z:\ACTIVE\112117.TXT PAULIN
45 

comes for Veterans at high risk of death from suicide or accidental opioid overdose. 

Several strong practices have been identified and shared throughout the VISN via 

this group. For example, efforts are underway to spread practices such as: Community based outreach workers carrying naloxone kits, Community Police training on 

Veteran issues, and public displays focused on suicide prevention (e.g. https:// 

www.facebook.com/CincinnatiVAMC/photos/pcb.1440977745941595/ 14409756059418 

09/?type=3&theater). Furthermore, all facilities are participating in ‘‘REACH Vet’’ 

which is designed to identify, and escalate care, for the most vulnerable Veterans 

we serve. 

MENTAL HEALTH

VA is committed to providing timely access to high-quality; recovery-oriented, evidence-based mental health care that anticipates and responds to Veterans’ needs 

and supports the reintegration of returning Servicemembers into their communities. 

While focusing on suicide prevention, we know that preventing suicide for the 

population we serve does not begin with an intervention as someone is about to take 

an action that could end his or her life. Just as we work to prevent fatal heart attacks, we must similarly focus on prevention, which includes addressing many factors that contribute to someone feeling suicidal. We are aware that access to mental 

health care is one significant part of preventing suicide. VA is determined to address systemic problems with access to care in general and to mental health care 

in particular. VA has recommitted to a culture that puts the Veteran first. To serve 

the growing number of Veterans seeking mental health care, VA has deployed significant resources and increased staff in mental health services. Between 2005 and 

2016, the number of Veterans who received mental health care from VA grew by 

more than 80 percent. This rate of increase is more than three times that seen in 

the overall number of VA users. This reflects VA’s concerted efforts to engage Veterans who are new to our system and stimulate better access to mental health services for Veterans within our system. In addition, this reflects VA’s efforts to eliminate barriers to receiving mental health care, including reducing the stigma associated with receiving mental health care. 

Making it easier for Veterans to receive care from mental health providers also 

has allowed more Veterans to receive care. VA is leveraging telemental health care 

by establishing eleven regional telemental health hubs across the VA health care 

system. 

Hubs are located in Seattle, WA; Long Beach, CA; Salt Lake City, UT; Harlingen, 

TX; Charleston, SC; Sioux Falls, SD; Battle Creek, Ml; Pittsburgh, PA; Brooklyn, 

NY; West Haven, CT; and Honolulu, HI. VA telemental health provided more than 

427,000 encounters to over 133,500 Veterans in 2016. 

Telemental health reaches Veterans where and when they are best served. VA is 

a leader across the United States and internationally in these efforts. 

VA’swww.MaketheConnection.net, Suicide Prevention campaigns, and the PTSD 

mobile app (which has been downloaded over 280,000 times) contribute to increasing 

mental health access and utilization. VA has also created a suite of award-winning 

tools that can be utilized as self-help resources or as an adjunct to active mental 

health services. 

Additionally, in 2007, VA began national implementation of integrated mental 

health services in primary care clinics. Primary Care-Mental Health Integration 

(PC-MHI) services include co-located collaborative functions and evidence-based care 

management, as well as a telephone-based modality of care. By co-locating mental 

health providers within primary care clinics, VA is able to introduce Veterans on 

the same day to their primary care team and a mental health provider in the clinic, 

thereby reducing wait times and no show rates for mental health services. Additionally, integration of mental health providers within primary care has been shown to 

improve the identification of mental health disorders and increase the rates of treatment. Several studies of the program have also shown that treatment within PCMHI increases the likelihood of attending future mental health appointments and 

engaging in specialty mental health treatment. Finally, the integration of primary 

care and mental health has shown consistent improvement of quality of care and 

outcomes, including patient satisfaction. The PC-MHI program continues to expand, 

and through May 2017, VA has provided over 7.2 million PC-MHI clinic encounters, 

serving over 1.6 million individuals since October 1, 2007. 

VA recognizes the importance of the Veterans Crisis Line (VCL) as a life-saving 

resource for our Nation’s Veterans who find themselves at risk of suicide. Of all the 

Veterans we serve, we most want those in crisis to know that dedicated, expert VA 

staff, many of whom are Veterans themselves, will be there when they are needed. 

The primary mission of VCL is to provide 24/7, world class, suicide prevention and 

46 

crisis intervention services to Veterans, Servicemembers, and their family members. 

However, any person concerned for a Veteran’s or Servicemember’s safety or crisis 

status may call VCL. 

VCL is the strongest it has been since its inception in 2007. VCL staff has forwarded over 504,000 referrals to local Suicide Prevention Coordinators on behalf of 

Veterans to ensure continuity of care with their local VA providers. Initially housed 

in 2007 at the Canandaigua VA Medical Center (VAMC) in New York, it began with 

14 responders and two health care technicians answering four phone lines. Since 

2007, VCL has answered over 3 million calls and dispatched emergency services to 

callers in crisis more than 84,000 times. Consistent with our mission, we have implemented a series of initiatives to provide the best customer service for every caller, 

making notable advances to improve access and the quality of crisis care available 

to our Veterans, such as: 

• Launching ‘‘Veterans Chat’’ in 2009, an online, one-to-one chat service for Veterans who prefer reaching out for assistance using the Internet. Since its inception, 

we have answered nearly 359,000 requests for chat. 

• Expanding modalities to our Veteran population by adding text services in November 2011, resulting in nearly 78,000 requests for text services. 

• Opening a second VCL site in Atlanta in October 2016, with over 250 crisis responders and support staff. 

• Hiring a permanent VCL Director in July 2017, psychologist, Dr. Matthew 

Miller. 

Prior to the opening of our new Atlanta call center in October 2016, VCL had a 

call rollover rate to back-up call centers of more than 30 percent. Currently, the average rate is 1.24 percent, with calls being answered by the VCL within an average 

of 8 seconds. Overall, VCL performance is above the National Emergency Number 

Association service level standard of answering greater than 95 percent of calls in 

less than 20 seconds; specifically, the VCL’s average service level exceeds 98 

percent. 

VCL continues to exceed these metrics, despite overall call volume continuing to 

rise. Overall call volume has increased 12 percent since April 2017, and increased 

15 percent over the course of the 2 weeks marked by notable adverse weather 

events earlier this month. 

Today, the combined VCL facilities employ more than 500 professionals, and VA 

is hiring more to handle the growing volume of calls. VA will also be opening a third 

VCL site in Topeka, Kansas, which will give VCL the additional capacity needed 

as we expand the ’automatic transfer’ function, Press 7, to all of its communitybased outpatient clinics (CBOC) and Vet Centers. Despite all of these accomplishments and plans, there still is more that we can do. 

The No Veterans Crisis Line Call Should Go Unanswered Act (Public Law 114– 

247) directed VA to develop a quality assurance document to use in carrying out 

VCL. It also required VA to develop a plan to ensure that each telephone call, text 

message, and other communication received by VCL, including at a backup call center, is answered in a timely manner by a person. This is consistent with the guidance established by the American Association of Suicidology. In addition to adhering 

to the requirements of the law, VCL has enhanced the workforce with qualified responders to eliminate routine rollover of calls to the contracted backup center. VA 

also implemented a quality management system, to monitor the effectiveness of the 

services provided by VCL. This will enable VA to identify opportunities for continued improvement. As required by law, VA submitted a report containing this document and the required plan to the House and Senate Veterans’ Affairs Committees 

on May 23, 2017. The Veterans Crisis line can be reached by dialing 1–800–273– 

8255, Press 1. 

VA’s Office of Readjustment Counseling Service (RCS) operates VA Vet Centers 

(www.vetcenter.va.gov), which are welcoming community-based counseling centers 

situated apart from larger VA medical facilities and placed in convenient, easily accessible locations. Based on the Veteran peer model, clinical staff at these Centers 

provide confidential professional mental health services and psychosocial counseling 

services as needed to help assist Veterans and active duty Servicemembers (ADSM) 

(including members of the National Guard and Reserve components) who served in 

a combat-theater or area of hostilities achieve a successful readjustment to civilian 

life. Readjustment counseling services and other services (e.g., consultation, counseling, training, and mental health services) are available to their family members 

if essential to the effective treatment and readjustment of the Veteran or ADSM. 

Readjustment counseling services include, but are not limited to, individual counseling, group counseling, marital and family counseling for military-related readjustment issues. Use of non-professional Veteran peer counselors at the Vet Centers 

47 

also helps contribute to the RCS mission. Readjustment counseling services are provided through 300 Vet Centers, 80 Mobile Vet Centers, and the Vet Center Call 

Center. In FY 2016, Vet Centers provided over 258,000 Veterans, ADSMs, and their 

families with 1,797,000 visits. 

In addition, Vet Center staff facilitates community outreach and the brokering of 

services with community agencies that link Veterans and ADSMs with other VA 

and non-VA services that can help with their successful readjustment to civilian life. 

One of the Vet Center core values is reducing barriers to access to readjustment 

counseling services. To this end, all Vet Centers offer services during non-traditional 

times such as early mornings, evenings, and weekends. Barriers to access based on 

distance (i.e., communities distant from the 300 ‘‘brick and mortar’’ Vet Centers) are 

ameliorated by having Vet Center staff regularly deliver readjustment counseling 

services in Vet Center Community Access Points (CAP). Generally speaking, CAPs 

are established when community partners, pursuant to a no-cost arrangement, permit Vet Center counselors to provide readjustment counseling services on their 

premises on a regular recurring schedule (ranging from service provision once a 

month to several times a week). CAPs allow Vet Center clinicians to provide services at a level that is in line with the fluid readjustment demands and needs of that 

community. Currently, Vet Center staff operates over 820 CAPs. In FY 2016, Vet 

Center CAPs provided 236, 435 readjustment counseling visits, a 6% increase over 

FY 2015. 

RCS leadership is also working in close collaboration with the Veterans Health 

Administration’s Office of Mental Health and Suicide Prevention to implement improved collaboration to better improve coordination and referral between Vet Centers and VA medical facilities. A memorandum of understanding was signed in August 2017 to formalize this relationship and outline improved communication processes, training, collaboration, and access to important suicide predictive data to help 

decrease suicide within the Veteran population. Vet Center counselors are trained, 

as part of assessment, to identify Veterans or ADSMs who are at high risk of harm 

or suicide. They refer these clients to their treating mental health providers (or for 

emergency services, if appropriate). And if a Veteran client is getting his/her care 

through VA, Vet Center staff refers the shared Veteran client to the local VAMC 

and the Vet Center counselor also contacts the facility’s Suicide Prevention Coordinator to ensure that enhanced care delivery procedures for suicide prevention are 

in effect. 

In 2017, VISN 10, whose average was 2.62 percent, exceeded national averages 

of 1.9 percent in the provision of Evidence-Based Psychotherapy to Veterans suffering from PTSD, Depression, and Serious Mental Illness. 

COMMUNITY CARE

VA is extremely grateful the House and Senate Committees on Veterans’ Affairs 

are actively working on legislation concerning the future of VA’s community care 

program. We appreciate the Committees willingness to meet with VA and discuss 

the various proposals, including the Department’s Veteran CARE Act, and look forward to seeing the swift enactment of legislation to this effect. While progress has 

been made, there is still more work to be done to serve our Nation’s Veterans. VA 

needs a different approach to ensure we can fully care for Veterans. We believe that 

a redesigned community care program will not only improve access and provider 

greater convenience for Veterans, but will also transform how VA delivers care within our facilities. 

This redesigned program must have several key elements. First, we need to move 

from a system where eligibility for community care is based on wait times and geography to one focused on clinical need and quality of care. This will give Veterans 

real choice in getting the care they need and ensure it is of the highest quality. At 

a minimum, where VA does not offer a service, Veterans will have the choice to receive care in their communities. Second, we need to make it easier for Veterans to 

access convenient care services when they need it. This will ensure that Veterans 

will always have a choice and pathway to get more immediate needs addressed. 

Third, the new program must maintain a high performing integrated network that 

includes VA, Federal partners, academic affiliates, and community providers. We 

need to ensure that VA is partnering with the best providers across the country to 

take care of our Nation’s Veterans. Fourth, it must assist in coordination of care 

for Veterans served by multiple providers. Finally, we must apply industry standards for quality, patient satisfaction, payment models, health care outcomes, and exchange of health information. By doing so, Veterans can make informed decisions 

about their care and VA can have the tools to better compete within communities. 

48 

We believe redesigning community care will result in a strong VA that can meet 

the special needs of our Veteran population. Where VA excels, we want to make 

sure that the tools exist to continue performing well in those areas. Veterans need 

the VA and for that reason, community care access must be guided by principles 

based on clinical need and quality. VA needs the support of Congress to level the 

playing field with industry by making it easier to modernize our infrastructure, leverage IT technologies, hire the best talent, and operate more like the private sector. A good example is management of our real property and infrastructure portfolio, 

where numerous barriers prevent VA from being agile in response to Veterans 

health care needs in different geographic areas. We want to work with Congress to 

discuss the best ways to bring common sense to this area. 

VA also needs tools to improve our recruitment, hiring and retention of the best 

professionals to serve our Veterans. These tools could include improvements to hiring and pay authorities to better address vacancies in our medical center and VISN 

director positions, to help at least in part address disparities with the private sector. 

As a final example, there is Federal law that requires VA facilities to have a smoking area. We all know the impact on health from smoking, and smoking cessation 

is the most immediate and dramatic step a Veteran, or anyone, can take to improve 

their health. VA strongly supports H.R. 1662 which would repeal this requirement. 

Action in these areas will make VA more modern, and be an enabler for our dedicated workforce to be more effective in their service to Veterans. 

VA is committed to moving care into the community where it makes sense for the 

Veteran. Finally, I want to make sure that everyone understands that making better use of community care must be done in a fiscally responsible way. We cannot 

continue to grow our funding in the same way we have done over this past decade. 

And, I want to be clear that I am committed to strengthening the VA system and 

will not support efforts to privatize this much needed and essential system. The ultimate judge of our success will be our Veterans. With your help, VA can continue 

to improve Veteran’s care, in both VA and the community. 

VA continued to maintain exceptional management in the area of Community 

Care throughout the fiscal year despite many program challenges and system wide 

changes to program model. These challenges coupled with re-work challenges due 

to contractor inefficiencies; have had great impact on expediency of care coordination for Veterans. 

Despite these challenges, VISN 10 has performed well; specifically leveraging our 

internally created network of community providers through our robust use of provider agreements. VA is able to quickly coordinate care through this network when 

our contractor support fails to make the Veteran’s appointment. In FY 2017, VISN 

10 coordinated the care of over 34,000 Veterans using our robust community provider network of over 1,600 providers in the VISN; second in the Nation in terms 

of volume and third in use. 

In addition, VA has formed a robust partnership with our DOD sharing partner, 

Wright Patterson Air Force Base; establishing a consortium designed and developed 

to standardize business processes to increase the quality of care for Veterans, reduce 

the overall cost of care, expedite Veteran access to care, and support Air Force combat preparedness. VISN 10 has successfully referred over 4,600 Veterans to Wright 

Patterson over the last 2 years from VA facilities in Cincinnati, Dayton, Chillicothe 

and Columbus. VA has realized substantial cost avoidance using VA/DOD partnership over traditional NVCC -Saving realized over $3M through July 2017. 

There are also weekly community care huddles to share strong practices, implement changes and provide VISN level support to each VISN 10 facility to support 

our Veterans. VISN 10 strongly supports learning, sharing, and growing together 

to support Veterans in the delivery of their care needs. 

In 2017 the VA Central Office made a change in the distribution and participation 

in the formulation of policies, memorandums and handbooks which have greatly enhanced field staff ownership and accountability. These documents are distributed for 

field input and subsequently finalized and distributed. VISN program leads share 

and discuss the direction and subsequently cascade it down to the field for implementation. 

CONCLUSION

VA remains focused on providing the highest quality care our Veterans have 

earned and deserve and which our Nation trusts us to provide. VA appreciates the 

support of Congress and look forward to responding to any questions you may have. 

Senator BROWN. Thank you, Mr. Burke. 

49 

You said in your testimony Ohio averages 97 days to decide a 

claim. Twenty-two percent of Ohioans wait at least 125 days. Walk 

through the claims process. It is pretty hard to understand why we 

cannot do better. 

A veteran walks in and what happens? 

Mr. BURKE. There are actually five distinct points in our claims 

process, Senator, that transpire. 

The first is actually putting the veteran’s claim under control 

and initiating the first phase of development. This is where we 

start to go out to private treatment facilities, obtain records, or 

even in some cases request a VA examination. 

The second step in our process is the largest part of our overall 

inventory. It is also the most time-consuming. About 85 percent of 

our 125-day window takes place is step two. This is where we continue to develop evidence. We go out to obtain every piece of information, whether it is private records, VA exam results, clarification 

of medical opinions, et cetera, before we make a claim what we call 

ready for decision. 

Once a claim gets to step three out of five, that is the ready for 

decision, we can actually move those claims from start to finish in 

less than 30 days. 

To that end, VA just kicked off a campaign we call decision-ready 

claims. That decision-ready claim initiative is designed to bypass 

the first two steps in the claims process. 

We are celebrating progress. We have not celebrated completion 

because 97 days, we are not content with that. 

Senator BROWN. How long should it take? 

Mr. BURKE. There are some claims, Senator, that we would disadvantage a veteran if we rushed to a decision in less than 125 

days. There are some complex claims. There are those that we need 

verification from other agencies, other entities, that do require 

longer than 125 days. 

Senator BROWN. Is there anything like an ordinary, routine 

claim? I guess nothing fits exactly if it is you, right? But, how long 

should it take in a case like that? 

Mr. BURKE. If we can change the dynamics of claim filing to 

where the claim comes into VA fully developed with all the evidence there at that third step, our guarantee on decision- ready 

claims is that we will render that start to finish in less than 30 

days. 

Senator BROWN. How long should it take for an appeal? 

Mr. BURKE. Our goal under the new appeals framework, if you 

take the higher level review path or the supplemental claim path, 

is to have that done on an average of 125 days, and for claims 

going to the Board of Veterans Appeals in under a year. 

Senator BROWN. Your comments about suicide are troubling, as 

all comments about veteran suicide are troubling. My understanding is that a veteran in Ohio is twice as likely to commit suicide as a nonveteran. Ohio’s numbers are slightly better maybe 

than the national average, but every suicide, as you say, is a 

tragedy. 

What can this Committee do to help? 

Mr. BURKE. I think I would like to engage my partners from 

VHA, as they are the experts in VA’s efforts on suicide prevention. 

50 

So, if anyone from VHA would like to chime in, that would be 

great. 

Mr. MCDIVITT. Sure. Thank you, Mr. Worley and Senator. 

The tragedy of veteran suicide, as you know, is one of Secretary 

Shulkin’s five priorities. His only clinical priority is to prevent veteran suicide. 

There are a lot of initiatives going on in the State of Ohio, as you 

indicated. For those of us in the Veterans Health Administration, 

we are part of the #BeThere initiative to make sure that both our 

staff, our community members, our partners are aware of the 

symptoms of suicide, are aware of what to look for, are aware of 

the questions that they should be asking veterans. 

We do save training of all our staff and of community partners. 

We utilize the REACH-VET tool to identify veterans at high-risk 

and provide special support to them. 

We have the veterans’ crisis line, 1–800–273–TALK, where we 

encourage any veteran in crisis, family members, or others to call. 

The next day after the crisis is resolved, they are connected with 

a suicide prevention coordinator at one of our VA medical centers. 

We have initiated a program—— 

Senator BROWN. Let me interrupt. 

Mr. MCDIVITT. Yes. Go ahead, Senator. 

Senator BROWN. I appreciate that litany, and that is important. 

Mr. MCDIVITT. Sure. 

Senator BROWN. When Mr. Powers talked about his attempted 

suicide, would anybody at the VA have known that that happened? 

I do not mean him personally, but if someone attempts suicide, 

something like his situation happened, there is a good chance the 

VA would not know that happened, I assume? I am not pointing 

fingers here. 

Mr. MCDIVITT. Yes, it is certainly possible. It depends. As I said, 

we have veterans who are on the suicide watch list. We have veterans who are part of the REACH program. We try to connect—— 

Senator BROWN. He might have been on the watchlist? It is possible? 

Mr. MCDIVITT. I do not know that. 

Senator BROWN. He might have been. 

One thing that really stood out as I prepared for this hearing, 

and just what I have learned being on this Committee for a decade, 

is that my understanding is that most of the suicides that happen, 

when veterans commit suicide, most of them have not had contact 

with the VA in a couple years. Correct? 

Mr. MCDIVITT. Of the 20 veterans who commit suicide a day, 

only six are part of the Veterans Health Administration. 

Senator BROWN. So, isn’t the most important thing for all of you 

is to find those 14? 

Mr. MCDIVITT. Right. That is a key part of our initiative. We 

have a pilot program in this vision, which rolled out in the Toledo 

area to connect with churches. We are working with over 100 

churches in Northwest Ohio to, again, make members of the church 

aware of what they should be looking for in terms of veteran suicide, aware of VA resources that are available, and to make those 

connections. 

51 

We are doing it across-the-board, whether it be working with Mr. 

Tansill and the Ohio Department of Veteran Services, with the 

service organizations who are represented here, with many, many 

community health care partners. We do mental health forums at 

our all our facilities and oftentimes have 100 partners come, and 

at every one of those, we talk about suicide prevention and how we 

can better connect with the community. 

Senator BROWN. Dr. Matthews, obviously, you know this country 

well and you know the VA from the inside well. You probably know 

that Ohio has more opioid deaths than any State in the country. 

We are not the highest per capita, but we are pretty damn high, 

and we literally had the most 2 years in a row. I assume that 

means we have some of the highest opioid addiction among 

veterans. 

Can you teach sort of civilian Ohio what works? When you answer the question of what is unique or interesting or particularly 

successful things that the VA is doing on opioid addiction, understanding the State Legislature has pretty much been absent on 

scaling up opioid treatments in this State, understanding Congress 

makes good speeches but does not really fund scaling up opioid 

treatment programs. 

Right now, in Ohio, literally in Ohio, 200,000 Ohioans right now 

are getting opioid treatment because they have insurance from the 

Affordable Care Act. I understand that component. 

What can you tell me the VA is doing well? What are your plans 

in the future? And, how can civilian Ohio learn from what you are 

doing in the VA? 

Dr. MATTHEWS. Sure. Thank you so much, Senator. It is an excellent question. 

I am actually a primary care physician as well who actually does 

opioid treatment. I am very familiar with this, even during my 

time prior to the VA. 

I can definitely say up front that no State has this right yet, but 

one thing that I am quite proud of within the VA is that we have 

jumped leaps and bounds ahead of a lot of larger health systems 

in the private industry with our opioid safety initiative. We have 

really added processes and performance metrics to what is otherwise becoming the standard of care within health care, which is 

based on the CDC guidelines for approaching opioid prescribing. 

We are monitoring our veterans. We are monitoring the prescribing practices of our providers. We are approaching it from a 

clinical perspective, as far as history-taking and actually dealing 

with pain as a larger concept, as opposed to just throwing a medication at it, but dealing with causes of it, looking at non-pharmacological approaches to actually treating pain. 

We are actually quite advanced and actually do have a lower rate 

of prescription for opioid than most of the private industry. What 

we are now trying to do—— 

Senator BROWN. Is that long term? There is a book that I recommend to anybody here. It is much about Ohio, unfortunately, 

from Portsmouth to Columbus especially, called Dreamland. Much 

of the opioid addiction in this country sort of began—the writer 

really does kind of tag Portsmouth, OH—I do not think that is entirely fair—as the beginning over 30 years, 20 years, I guess. 

52 

Is that a long-term thing that? Clearly, the drug companies are 

guilty as hell in this in how they peddled these drugs, saying they 

were not addictive, OxyContin, oxycodone, Vicodin, other drugs, 

Percocet and all. Doctors overprescribe. We can point fingers. We 

are all guilty, I guess. 

Have you sort of set examples, in terms of prescribing, in terms 

of this? 

Dr. MATTHEWS. Yes. 

Senator BROWN. Tell me how that has worked. 

Dr. MATTHEWS. It has actually worked quite well. One of our expectations for VA prescribers and soon-to-be, hopefully, in our community network as we work with other States, is the checking of 

State prescription drug monitoring programs. This is for all controlled substances typically, so more than even just opioids, are actually in a State-level registry, so that providers can look to see 

when the last time prescriptions were written in a specific veteran’s name, can have information so that they know that perhaps 

there might be potential for any overprescription or just acknowledgment that treatment is already in place, perhaps with another 

provider, so that a new prescription is not necessary. 

Our pharmacy records now feed into these State programs, so 

that even outside providers can see that the VA prescribers now 

have opioid prescriptions in a specific veteran’s name. 

Senator BROWN. Is there a uniform policy on not overprescribing? 

Dr. MATTHEWS. Yes. 

Senator BROWN. It would be every bit as good in Ann Arbor, or 

it would be pretty similar in Ann Arbor to Chillicothe to Dayton 

to Cincinnati? 

Dr. MATTHEWS. We have a national clinical guideline on opioid 

treatment that is expected across the Nation. It is really equivalent 

to a lot of the standards of care that other health systems—in fact, 

in Ann Arbor, the University of Michigan has a similar set of pain 

policies that other private health systems adopt as well. 

Yes, our expectation is that VA providers are following those 

guidelines, that our pharmacy records are looking into any prescriptions that are coming in from community providers that may 

be seeing our veterans, so that we can attack the issue proactively. 

Senator BROWN. Thank you for that, Dr. Matthews. 

Mr. McDivitt, talk about VA hiring and how you anticipate staffing shortages. One of the things that this Committee has taught 

me is to stay in touch closely not just with directors in Chillicothe 

or Dayton or Cincinnati or Wade Park, or even the communitybased clinics in Springfield and Mansfield and Zanesville and all, 

but also to stay in touch with the work staff, the medical personnel 

and the personnel that are not as well-paid and perhaps not as 

highly skilled as Dr. Matthews. 

One of the things we see is medical staff shortages sometimes 

are not filled quickly enough. What you do in Cleveland or what 

you do in Dayton to anticipate medical staff shortages so the wait 

times for people coming into the VA do not get longer because there 

are not enough medical personnel? How do you anticipate that? 

How do you fill those jobs more quickly? 

Mr. MCDIVITT. Sure. Absolutely. Thank you, Senator. 

Senator BROWN. I know it is a huge system, and it is difficult. 

53 

Mr. MCDIVITT. In our VISN, the three-State area, we have 

around 30,000 employees. Yet, I think as you said, it really goes 

to the frontline. We hire directors, and we have three of our directors here, Ms. Hepker from Columbus, Mr. Murdoch from Chillicothe, and Ms. Hudson from Cincinnati. 

We hire directors who do not spend all their time in the board 

room. They spend a lot of time out in the clinic or on the frontlines 

talking to staff, as you do when you do town halls, seeing where 

the pressure points are in the organization. 

We do have an overall human resource strategy. We have professions that are challenging to recruit. We try to make sure that we 

are ahead of the game on that, whether it be ICU nurses, some 

medical specialty areas. 

In the last year, I am pleased to report, that in the State of Ohio, 

we added over 380 full-time equivalent employees from the beginning of fiscal year 2017 to the end, and pretty much across-theboard. Here in Columbus, Cleveland, Cincinnati, and Dayton. 

We try not to be a market-leader in our hiring process, but we 

try to be competitive across-the-board. 

I would also say, with Dr. Matthews here, on occasions when we 

have short-term vacancies, and we had a short-term vacancy for orthopedic surgeons here in Columbus, we can turn to community 

care now. Community care can fill a gap while we are recruiting 

in the VA. 

Senator BROWN. Pay, I assume, the same job at every VA I assume does not pay the most. Dayton’s cost-of-living is less than San 

Francisco’s. Do they get paid more for those jobs in San Francisco 

because the cost-of-living is higher? 

Mr. MCDIVITT. There are geographic adjustments for larger markets in places like New York City and San Francisco and so on. 

However, our physician pay package has two components. One is 

a base pay, and the second is a market pay, knowing that the salaries for certain physicians—it may be more challenging to recruit 

someone in Toledo as opposed to Columbus or Chillicothe. We try 

to make adjustments, so we can compete in that market. 

Senator BROWN. This is not typical in a congressional hearing, 

but would you introduce the directors you mentioned so people can 

see them? 

Mr. MCDIVITT. Of course. Wendy Hepker, Vivian Hudson, and 

Mark Murdoch are directors here representing the VAs in Ohio. 

[Applause.] 

Both Mark and Vivian are military retirees. Mark retired from 

the Air Force. Vivian just retired last year from the U.S. Army. 

Senator BROWN. Thank you. Two of you, thank you for welcoming both me and my staff to your hospitals and for the work 

you do. 

We have seen major progress in all three of those hospitals. It 

is always a challenge. Thank you for your service. 

Thanks for taking that question. 

Let me shift to something very different, Mr. Worley. This will 

be mostly for you, but may be Mr. Burke, too. 

I am concerned that the VA was seeking blanket waivers to conflict-of-interest rules that would allow VA employees to benefit financially from for-profit colleges and universities. I was glad that 

54 

Secretary Shulkin listened to veterans and VSOs and educators 

and policymakers who opposed this decision. 

Why was VA interested in waiving this requirement? 

Mr. WORLEY. Senator, I think as was stated in the Federal Register notice originally, we believe that the statute had unintended 

and illogical consequences in its full application, meaning someone 

who had a job at a hospital that had entirely nothing to do with 

educational benefits going to a for-profit school would have to be 

fired, or waived under this provision, for attending a for-profit 

school where the G.I. Bill was being used. 

I think it was in that context. That I think was a large part of 

the motivation. 

Senator BROWN. Did this waiver request come out of the White 

House? 

Mr. WORLEY. I cannot speak to that, Senator. I don’t know. 

Senator BROWN. You do not know or you cannot speak to it? 

Mr. WORLEY. I do not know. 

Senator BROWN. Mr. Burke, do you know? 

Mr. WORLEY. This was handled primarily out of our—— 

Mr. BURKE. I do not know, sir. 

Senator BROWN. There has been, as more and more veterans 

have been cheated by some of these for-profit colleges and universities—and ‘‘cheated’’ is the right word, not just veterans but lots 

and lots of people have been cheated. These for-profit schools spend 

lots of money recruiting, lots of money helping you find financial 

aid. Then they spend almost no money helping you find a job. 

When these for-profit colleges go out of business, or even if they 

do not go out of business, people rack up huge student debt, and 

the diploma is not worth as much. 

There is some political movement in this country to and in Washington to protect these for-profit colleges and to protect their profits. I am just always concerned, as concerned as I am about the 

VAs. 

You begin to hear more and more on the news that some people 

inside the government want to privatize the VA. I do not know exactly what direction that is and what that means, but you always 

hear those warning bells come from my office and from a lot of us 

in Congress, and I hope in both parties. 

Thank you for that answer. 

I want to talk about the 90/10 loophole used to crack down on 

for-profit colleges and universities that use abusive, deceptive practices to recruit veterans, servicemembers, and their families. As 

you know, veterans especially, they have gamed the loophole to 

count veterans in that number, which I find pretty despicable. That 

is why I have reintroduced the Military and Veterans Education 

Protection Act. 

My question to both of you, are there other improvements in the 

G.I. Bill not included in the Forever G.I. that would help the VA 

better serve veterans pursuing higher education? 

Mr. Worley? 

Mr. WORLEY. First of all, I would thank you and the Committee 

for all the incredible improvements that have been made just in my 

time in this job, which has been about 5 years. We have seen the 

educational provisions out of the Choice Act of 2014, the 

55 

Blumenthal-Miller Benefits Improvement Act had 15 provisions, 

and, of course, the Forever G.I. Bill. These are huge improvements 

to so many of our beneficiaries and have really addressed numerous of VA’s legislative proposals as well as, of course, numerous 

VSOs. 

I think there are a few things left to do, as I think you are no 

doubt aware. I think it is called the Valor Act that was recently 

passed, which will help us with apprenticeships. 

Off the top my head, I would have to go back to our 2018 budget 

proposal where we had various legislative proposals. But, there are 

fewer of those out there because the Forever G.I. Bill covered so 

many of them. 

Senator BROWN. Thanks. 

Do you want to add anything, Mr. Burke? 

Mr. BURKE. No, sir. Nothing else to add. I think Mr. Worley is 

the expert with the G.I. bill. 

I would like to echo the appreciation for the support in getting 

the large overhaul done that Rob mentioned. Thank you. 

Senator BROWN. My last question of the hearing, and if any of 

you want to add anything else, I am certainly open to that. One 

of the real successes—I think hearings like this and reading newspapers and going online, we hear only about the problems and the 

waiting lists and the people who fell through the cracks, or when 

government does not do a good job. 

Well, some years ago, the VA—I believe it was Secretary 

Shinseki; it may have been Principi, I am not sure—set a goal on 

homelessness to eliminate homelessness among vets, understanding actually getting it to zero was virtually impossible. 

Since 2010, we have reduced veterans’ homelessness by 47 percent. The HUD-VASH voucher program has been instrumental in 

making this progress. It helps veterans. We know, as I said before, 

and Shinseki actually told me this when he was Secretary of the 

VA, that Chillicothe may be the single best homelessness program 

center of any of the VA hospitals anywhere. 

Unfortunately, in September, the VA decided to take dedicated 

HUD-VASH supported services funds and combine them with other 

funding needs in general purpose funds, which meant housing and 

veterans’ service organizations in our State—I think our directors 

could probably speak to that—and across the country are concerned 

that this decision will undermine the success of the HUD-VASH 

program and set back our efforts as we have made measurable, significant progress in reducing the homeless veteran population since 

2010. 

Is there any chance, Mr. Burke, the VA would reconsider this decision? If not, how do you plan to ensure that they are going to remain steady to support the struggling veterans across Ohio that 

are on the edge of homelessness? 

Mr. BURKE. Sir, that is a great question. I am going to ask my 

colleagues from VHA to chime in as well. 

I will say, we have not given up the fight on trying to eradicate 

veterans’ homelessness. In fact, we are using tools and technology, 

such as our National Work Queue, to move those veterans with 

pending claims that we know are homeless kind of to the front of 

the line to expedite decisions on that. 

56 

Mr. McDivitt, if you want to add anything? 

Mr. MCDIVITT. Sure. Thank you, Mr. Burke. 

This is a very important issue to us, Senator, as you know. The 

decision you talked about is actually on hold right now. I think the 

Committee had asked that it be reconsidered, so it is on hold. 

Regardless of how it plays out—— 

Senator BROWN. The decision to move the funds out of the 

VA—— 

Mr. MCDIVITT. The decision to move the money from special-purpose into the general purpose fund. 

Regardless of how—— 

Senator BROWN. I am sorry to interrupt. How do we get that 

from putting it on hold to putting it in the trash, for want of a better term? You said that decision is on hold to make the move. How 

do we get that decision to be permanently on hold? 

Mr. MCDIVITT. There is an active debate with the CFO in the 

Veterans Health Administration about that. My network director 

colleagues and I had a chance to talk with him last week. 

I would say, ultimately, whether the money comes as special purpose or it comes as part of the overall appropriation, it will come 

here to Ohio, and it will be part of our overall homeless program. 

Dr. Jessie Burgard, our mental health lead for the division, oversees those programs. We have a coordinator for the State of Ohio, 

Jim Kennelly. We have homeless veteran coordinators at all our 

facilities. 

The HUD-VASH funding will continue to come here. It may not 

come as what we call special-purpose dollars, but it would come as 

part of the overall general appropriation. The commitment to 

homeless veterans continues to be very strong here in Ohio. 

Senator BROWN. I think about two things that have been brought 

up here. Congresswoman Beatty in her opening statement said 

something very passionately, that it is our duty to serve those who 

served us. I do not know if that is a slogan at the VA, but it should 

be. 

I know that all four of you have dedicated a big part of your lives 

to serving veterans. I know on our previous panel that every witness had served this country and was now serving veterans either 

in a voluntary or a paid capacity. 

When you think of two things, in particular, to measure us as a 

Nation, when you think of the veteran suicide rate and the veteran 

homelessness rate, it really has to be more than a goal of our country to eradicate homelessness, of course, for everybody, and to 

eradicate suicide for everybody, but especially when we fall short 

so that the number among veterans is higher, it is something that 

we always need to work to ameliorate. 

Thank you for the work that the four of you are doing. 

Thank you all for joining us today. Anybody that has comments, 

certainly, outside the process of this Committee, come to 

Brown.Senate.gov and give any comments you have, any questions, 

any of you as veterans. Those of you who represent other veterans, 

if you are from the local DAV or Polish American Veterans or VFW 

or American Legion or any other veterans group, or if you are in 

a Veterans Services commission office in a county, certainly feed 

any information directly to Jonathan or Anna in my office, or 

57 

Amber in the back, or directly to me. That is my job to represent 

you in that way. 

I so appreciate all of you who came. The three directors, thank 

you for joining us. The four of you up here, thank you so much. 

The Committee is adjourned. 

[Whereupon, at 3:20 p.m., the hearing was adjourned.] 

[Responses to posthearing questions follow:] 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. SHERROD BROWN TO

RONALD BURKE, ASSISTANT DEPUTY UNDER SECRETARY FOR FIELD OPERATIONS, 

VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Despite progress in recent years, the suicides among veterans remain a critical 

issue. In the testimony, you note that the suicide rate among Ohio veterans specifically is nearly double that national rate. I hear from the families of Ohio veterans 

who have committed suicide far too often. 

Their heartbreaking stories vary but each is tragic. You note that a majority of 

the 20 veterans on average that we lose to suicide each day have not received care 

from VA in at least two years. 

This is evidence that VA care contributes to a decreased risk of suicide and I commend the employees—often veterans themselves—who are on the front lines working every day to support veterans in crisis. However, there have to be ways for the 

Department to do better. 

Mr. Burke, you’ve highlighted improvements VA has made in its approach to suicide prevention. 

Question 1. What specific weaknesses remain and what steps are being taken to 

mitigate those shortfalls? 

Department of Veterans Affairs (VA) Response: Approximately 70 percent of Veteran suicides are among Veterans who have not been recently engaged in our 

healthcare system. The Veterans Health Administration (VHA) provides excellent 

care to Veterans at risk for suicide through enhanced care from facility Suicide Prevention Coordinators, and predictive risk programs like REACH VET; however, Veterans who do not receive care at VA cannot avail themselves of these programs. We 

are committed to building a national network of partnerships to ensure that all Veterans have the care and support they have earned, whether or not they are enrolled 

in VA healthcare. Solving Veteran suicide will take a community based approach 

across the Nation. One example of that approach is VA’s work with the Substance 

Abuse and Mental Health Services Administration (SAMHSA) on a Mayor’s Challenge in 7 communities, in order to enable that each of these communities to identify unique local solutions to Veteran suicide. That is the type of approach we think 

is necessary to reduce suicide rates for all Veterans. 

Question 2. How can this Committee help? 

Response. We ask for Senate Veteran Affairs’ Committee support in engaging 

communities to address Veteran suicide through expansion of the Mayor’s Challenge 

program to include grant making authority. 

Question 3. Mr. Burke, the first panel of witnesses discussed the barriers veterans 

and their families face transitioning to civilian life and accessing the benefits they 

earned and deserve. 

What are your goals for VBA’s distribution of education benefits and how will you 

measure success? 

Response. The Department is working to exceed our timeliness goals of 28 days 

for original claims and 14 days for supplemental claims, and to automate original 

claims as part of the Colmery Act implementation. Veterans Benefits Administration (VBA) works to ensure beneficiaries make informed decisions concerning their 

education and training benefits, and to protect GI Bill beneficiaries in other ways. 

VBA’s Education Service is collaborating with the Veterans Experience Office to utilize a new Customer Experience Management System to collect Veteran feedback 

via surveys and electronic comment cards, and to use the latest data to identify 

emerging patterns to improve value to Veterans. This will help VBA modernize, 

prioritize, and focus on issues impacting Veterans’ experience. Additionally, our academic progress measures are being developed and will report on a more complete 

picture of an individual’s use of the GI Bill and their outcome (in line with Public 

Law 114–315, Section 404–7). These, combined efforts will allow VBA’s Education 

58 

Service to make data-driven decisions to achieve program and policy successes, 

while providing avenues for stakeholder engagement. 

Question 4. From a veterans and military family education and work-readiness 

perspective, how can this Committee work with the Department to meet the needs 

of those who served and their loved ones? 

Response. Recent legislation introduced by the Committee and signed into law by 

the President significantly improves educational and work-readiness opportunities 

for Veterans and their loved ones. Specifically, on August 16, 2017, the President 

signed the Harry W. Colmery Veterans Educational Assistance Act of 2017, also referred to as the ‘‘Forever GI Bill.’’ This law contains 34 new provisions, the vast majority of which will enhance or expand education benefits for Veterans, Servicemembers, Families and Survivors. On November 21, 2017, the President signed H.R. 

3949, the Veterans Apprenticeship and Labor Opportunity Reform Act (VALOR 

Act), into law. This law will make it easier for multi-state companies and organizations (that operate apprenticeship programs) to provide veteran apprentices with access to their earned GI bill benefits. VA is working hard to successfully implement 

both laws and remains committed to working closely with the Committee as we deliver the accurate and timely educational benefits our Veterans have earned. 

Question 5. Mr. Burke, I have heard from many veterans who are ineligible for 

VA-provided healthcare because their income is considered too high. Additionally, 

former reserve component members whose service did not involve combat deployments and did not retire, medically or otherwise, have noted their ineligibility because their service does not meet VA’s stated criteria for Veteran status. 

Please take a moment to explain how VA considers eligibility and how it relates 

to income, time in service, and deployments. And, how will veteran status relate to 

eligibility for the Department’s eventual roll-out of a veteran’s ID card program? 

Response. For the purposes of VA health benefits and services, a person who 

served in the active military service and was discharged or released under conditions other than dishonorable is considered a Veteran and may quality for VA 

health care benefits. Current and former members of the Reserves or National 

Guard who were called to active duty by a Federal order and completed the full period for which they were called or ordered to active duty may be eligible for VA 

health benefits as well. Reserves or National Guard members with active duty for 

training purposes only do not meet the basic eligibility requirements. 

NOTE: Most Veterans who enlisted after September 7, 1980, or entered active 

duty after October 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible. This minimum 

duty requirement may not apply to Veterans who were discharged for a disability 

incurred or aggravated in the line of duty, for a hardship or ‘‘early out,’’ or those 

who served prior to September 7, 1980. Since there are a number of other exceptions 

to the minimum duty requirements, VA encourages all Veterans to apply so that 

we may determine their enrollment eligibility. 

Veterans who do not have a VA-rated service-connected disability and who do not 

receive a VA pension payment or have a special eligibility, such as a recently discharged Combat Veteran or a Purple Heart recipient, may also receive VA health 

care if their income is below VA’s National Income or Geographical-Adjusted 

Thresholds. To see if they qualify, Veterans must provide their gross household income (which includes spouse/partner and dependent children, if applicable) for the 

previous year when applying for enrollment for VA health care. This part of the application process is called an ‘‘income assessment or financial assessment’’ (also formerly called a means test) and is used to determine if these Veterans are eligible 

for enrollment and whether or not they have to pay copays for their health care or 

prescription medication. Additional information regarding healthcare eligibility is 

available online at: https://www.va.gov/HEALTHBENEFITS/index.asp. 

For the Veteran ID card, only those Veterans with honorable service will be able 

to apply. The Veteran ID card provides proof of military service, and may be accepted by retailers in lieu of the standard military discharge documents (DD214) to obtain promotional discounts and other services. 

Question 6. Mr. Burke, you heard from the previous panel about their experience 

with VA regarding debt collection. I have heard from many Ohio veterans about 

this, and subsequently sent a letter to Secretary Shulkin. Can you answer the following questions for me: 

How does VA ensure that veterans are receiving an accurate determination of 

benefits, and what processes and safeguards are in place to mitigate the risk of 

overpayment and subsequent debt collection? 

Response. VA makes every attempt to accurately and expeditiously process benefit 

payments to Veterans and their Survivors. VA authorization experts review all monVerDate Mar 15 2010 21:17 Nov 29, 2018 Jkt 000000 PO 00000 Frm 00062 Fmt 6633 Sfmt 6621 Z:\ACTIVE\112117.TXT PAULIN
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etary awards before approving decisions. National quality experts routinely assess 

the accuracy of regional office (RO) actions while local quality experts review the 

actions of individual adjudicators. Regular enforcements, such as mandatory training, consistency studies, and Systematic Analyses of Operations by management, 

also help ensure timeliness and accuracy of decisions. VA has also deployed the National Work Queue to manage workload nationally and take full advantage of RO 

capacity. 

Question 7. Has VA identified any circumstances or sources that account for the 

sharp increase in the rate of overpayment notices in the last few years? 

Response. Department of Defense (DOD) drill pay to Veterans has substantially 

contributed to the number of VA overpayments in VA’s disability compensation program. By law, Veterans may not receive both drill pay and disability or the same 

periods. Prior to February 25, 2016, when VBA processed drill pay adjustments, the 

adjustments were applied to future disability payments. This caused the Veteran’s 

future payments to be reduced or stopped for a period of time and may have caused 

financial hardship to the Veteran. Accomplishing drill pay adjustments from this 

perspective, only allowed the Veteran to request relief from the repayment by requesting a hardship waiver. Effective February 25, 2016, VBA changed its policies 

and began processing drill pay adjustments retroactively verses prospectively. This 

process created a debt in VA systems but allowed Veterans additional options to 

repay the overpayment based on their financial situation. Veterans with overpayments related to drill pay adjustments are automatically placed on a 12-month repayment plan. Other options available once overpayments are established, include: 

• Request a waiver for the overpayment due to financial hardship; • Request a payment plan for the overpayment; • Request a compromise of the overpayment due to financial hardship; • Have the amount repaid with future disability payments; or • Pay the full amount of the overpayment and continue receiving their disability 

payments. 

The success of the Rules-Based Processing System, which automatically processes 

dependency claims without user intervention, as well as increased automation of 

drill-pay adjustments, have helped increase overpayments because VA is completing 

these types of claims, which can generate overpayments, in greater numbers. 

Additionally, VBA is working collaboratively with DOD to receive drill pay information monthly so we can process these drill pay adjustments more frequently resulting in Veterans receiving this information in a timelier manner. Currently, VBA 

receives this data annually through an electronic data sharing agreement with the 

DOD. However, VBA’s ability to process these monthly adjustments is dependent 

upon a regulation change that would allow an upfront issuance of due process for 

military payment adjustments. The regulation change is currently undergoing legal 

review as part of VA’s internal concurrence process. We do not have an anticipated 

date of publication at this time. 

Question 8. What is VA doing to ensure that veterans know their responsibilities 

in reporting a change to their status, especially in complicated circumstance when 

benefits overlap with other departments, such as DOD? 

Response. A number of measures alert Veterans to report circumstances that may 

affect their VA benefits. Benefit decision letters include paragraphs about the need 

for beneficiaries to immediately inform VA of specific situations that could impact 

their monthly payments. In December 2017, VA clarified these conditions that may 

affect Veterans’ rights to continued payment. VA also informs Veterans of conditions 

impacting benefits using such forms as VA Form 8764, Disability Compensation 

Award Attachment Important Information, and cost-of-living adjustment letters. 

In addition, VA has data matching agreements with the Social Security Administration, Federal Bureau of Prisons, and other Federal agencies to reduce both the 

number of individuals receiving dual benefits contrary to law and the time during 

which they receive such benefits. VA also works with these agencies to ensure VA 

receives critical data, such as dates of death, dates of incarceration, etc., as timely 

and efficiently as possible. 

Finally, VA is deploying technological solutions and leveraging automation to reduce overpayments. For example, in 2016 VA worked with DOD to automate notifications required when Guardsmen and Reservists receive both VA compensation 

and DOD drill pay. This new automation process improves VA’s management of drill 

pay adjustments. 

Question 9. Mr. Burke, The HUD-VASH voucher program helps veterans escape 

homelessness through a combination of HUD-funded housing vouchers and VA supportive services and case management. Since 2010, we have reduced veterans’ homelessness by 47 percent and HUD-VASH has been instrumental in that progress. In 

60 

September, the VA decided to take dedicated HUD-VASH supportive services funds 

and combine them with other funding needs in a General Purpose Fund. Housing 

and veterans’ services organizations in Ohio and across the country are concerned 

that this administrative decision will undermine the success of the coordinated 

HUD-VASH model and set back our efforts to end veteran homelessness. 

Will the VA reconsider this decision? How do you plan to ensure that VA will remain ready to support struggling veterans across Ohio? 

Response. As of December 7, 2017, the decision to move Special Purpose Funds 

to the General Purpose budget is on hold for this fiscal year (FY). All Special Purpose funding will go through the Veterans Integrated Services Network (VISN) as 

previously allocated. VISN 10’s commitment to homeless Veterans in Ohio, and in 

the other states we serve will remain strong. 

Question 10. Mr. Burke, the Department of Veterans Affairs recently released its 

first ‘‘WARNO’’ or ‘‘warning order’’ jointly with the Consumer Financial Protection 

Bureau to notify veterans about VA mortgage refinance scams. Illegal and misleading advertising for these products includes claims of lower interest rates or 

thousands of dollars in cash back. In reality, borrowers have received much less 

cash than they were promised, or the overall balance of their loan has gone up. According to the CFPB, mortgage refinances accounts for as much as 14 percent of the 

complaints submitted to the Bureau by servicemembers and veterans. 

Why is it common for predatory financial firms like these to target veterans and 

servicemembers? 

Response. Based upon our knowledge concerning advertisements referred to us by 

Veterans and Veteran employees, VA believes the number of lenders engaging in 

questionable or misleading advertising practices is small, relative to the total number of lenders approved to make VA loans. This small group of lenders may view 

the recent boom in VA-guaranteed home loans as an opportunity to expand their 

refinance lending businesses through solicitation of Veteran borrowers with print 

ads. Consequently, these lenders may have targeted Veterans with mortgages without clear and transparent terms. 

VA plans to address churning practices by issuing a proposed rulemaking. In determining what policy actions to take, VA is evaluating a range of possible measures—such as net tangible benefit tests, seasoning requirements, recoupment requirements, and others—and the effects that the measures might have on Servicemembers’ or Veterans’ access to their earned benefits, as well as, the impact on 

lenders, servicers, and mortgage investors. 

In addition to longer-term measures like regulatory action, VA has also focused 

attention on policy changes that can be implemented rather quickly. On October 12, 

2017, Government National Mortgage Association (GNMA) and VA released a joint 

statement that addresses lenders whose patterns of behavior are potentially harming Veterans and/or increasing risks and costs to our programs. VA and GNMA 

meet regularly to discuss areas of concern and potential next steps. GNMA issued 

additional guidance on December 7, 2017, to strengthen the seasoning requirements 

for GNMA pool mortgage-back securities. In addition, on February 1, 2018, VA 

issued policy guidance regarding initial and closing disclosures for IRRRLs to provide Veteran advance notification of the terms of the refinance. On February 8, 

2018, GNMA issued a statement and worked with VA to release letters to nine lenders who are outliers among market participants regarding prepayment speeds, and 

are seeking corrective action plans from those lenders. (https://www.ginniemae.gov/ 

newsroom/Pages/PressReleaseDispPage.aspx? ParamID=129). 

Question 11. While this is the first ‘‘WARNO,’’ has the VA worked with the CFPB 

to provide other consumer education and assistance to veterans? 

Response. VA’s Loan Guaranty Service (LGY) partners with stakeholders both inside government and in the private sector to ensure that Veterans are getting access 

to the benefits they have earned through their service to our country. VA’s LGY and 

the Consumer Financial Protection Bureau (CFPB) collaborate frequently to ensure 

Veterans are well-served when shopping for or obtaining a home loan. Examples of 

that collaboration is the sharing of data on complaints received. VA and CFPB are 

looking at additional messaging through social media and through their websites. 

Question 12. Does the VA work with the CFPB to make sure Ohio veterans get 

responses from their banks or lenders if they believe they’ve been harmed in some 

way? 

Response. VA does provide information, such as misleading advertisements, to the 

CFPB Office of Enforcement and encourages VA Loan Specialists to refer Veterans 

to the CFPB complaint line and/or website. VA works with CFPB on a wide range 

of issues important to borrowers using their VA home loan benefit. VA has met with 

CFPB officials to discuss topics such as refinancing, lender refinancing marketing 

61 

policies and laws, and tools available through CFPB to help Veteran borrowers determine their financial health and ability to take out a loan for a home. 

Question 13. How does the VA ensure that important consumer education resources like this are made available to veterans in Ohio? Have you worked with the 

Office of Servicemember Affairs directly? 

Response. VA has a forward facing website which contains information about the 

VA Home Loan Guaranty program. As with the recent warning order (WARNO), in 

addition to the CFPB distribution, VA distributed this document to 1.8 million Servicemembers and Veterans through a listserv e-mail distribution. VA has 8 Regional 

Loan Centers and Loan Guaranty personnel in Honolulu, Hawaii to provide Veterans and Servicemembers with verbal and written correspondence on how to obtain, retain, and adapt a home through VA’s Home Loan program. 

VA collaborated with the Division of Servicemember Affairs on the CFPB WARNO 

message. In 2012, VA established a relationship with the CFPB Division of Servicemember Affairs, which resulted in consistent communication between the agencies. 

In 2017, a new Director was appointed for Servicemembers Affairs and VA renewed 

its engagement with the Division and presently meets on a monthly basis. 

Question 14. Does the VA have the capacity to make sure veterans have access 

to financial education and that their consumer rights are being protected, or do you 

think it has been helpful to have the CFPB dedicated to that task? 

Response. VA currently relies on entities such as the CFPB and the Department 

of Housing and Urban Development to deliver financial education and protect consumer rights regarding homeownership. It has been a tremendous help to have 

CFPB dedicated to this task with regards to our Veteran borrowers. The CFPB 

‘‘Know Before You Owe’’ campaign is beneficial to all potential homeowners, including Veterans. 

Question 15. Mr. Burke, your testimony mentions a social media campaign to inform individuals of the changes in the Forever GI [sic]. 

What kind of communication has VA had with defrauded veterans who attended 

ITT Tech and Corinthian Colleges regarding the restoration of benefits since the 

Forever GI Bill passed? 

Response. VA notified approximately 8,000 individuals regarding their potential 

eligibility for entitlement restoration, of which, nearly 6,000 were ITT Tech or Corinthian students. The notification included an application form to seek restoration 

of entitlement. As of December 16, 2017, approximately 400 applications for restoration have been received, of which 209 have been approved for a total of 1,800 

months. In circumstances where VA does not have a beneficiary’s email or an email 

is undeliverable, VA is sending notifications through direct mail. 

VA created a dedicated webpage (https://benefits.va.gov/gibill/fgib/ restoration.asp) 

that speaks specifically to Restoration of Entitlement. It includes the form that 

beneficiaries can use to apply for benefit restoration, and VA is using social media 

including Facebook and Twitter to let beneficiaries know that VA can now restore 

entitlement and encourage those potentially eligible to apply. 

Question 16. Has that included direct email and mail in addition to social media? 

Response. In circumstances, where VA does not have a beneficiary’s email or an 

email is undeliverable, VA sends notifications through direct mail. 

Question 17. What is the projected timeline for future communication regarding 

restoration and when can these veterans expect to have their GI Bill benefits restored? 

Response. This communication effort will remain ongoing as VA is committed to 

restoring entitlement to all eligible beneficiaries. VA will continue to leverage social 

media platforms and its website to encourage and instruct those potentially eligible 

to apply. 

Question 18. Dr. Matthews, I have heard from several veterans about the onerous 

referral and authorization process for the Veterans Choice Program. Some veterans 

saying that it take weeks or months to receive authorization for an appointment. 

Can you walk me through why it might take this long? 

Response. After a Veteran has been referred for community care under the Veterans Choice Program (VCP), the VA staff must ensure the Veteran understands the 

process. VA staff members discuss VCP with the Veteran and offer the option for 

the Veteran to Opt In. Once a Veteran has opted in, the referral and supporting 

medical documentation is uploaded to the contractor’s portal electronically. The contracting partner then contacts the Veteran to discuss scheduling with the Veteran, 

after they have accepted the referral which can take up to two days after the referral has been uploaded. The contracting partner will then work with a network provider to obtain an appointment. In certain circumstances the provider will request 

62 

to review supporting medical documentation before an appointment can be given. 

After an appointment has been given, the Veteran is notified. This process takes on 

average 27.2 days from consult to authorization, which is below the 30-day target. 

Question 19. What is VA doing to ensure that the TPAs- Healthnet in Ohio- don’t 

become a bottleneck in the process? 

Response. VHA has taken additional steps to show how the Veteran experience 

has improved through streamlined processes. VHA has implemented 22 total processes and procedures since FY 2015. These have significantly streamlined or 

otherwiseimproved processes, and reduced the burden on Veterans when requesting, 

scheduling, and receiving care. VHA links the improvements to the five fundamentals supporting VA care: Eligibility, Referral and Authorizations, Care Coordination, 

Community Care Network, and Provider Payment. 

VA nationally deployed a new Operating Model on October 17, 2017. The model 

is a key component to the delivery of VA’s goal for community care. It is a standardized model for how resources (people, process, technology, and data) should be organized within local VA Community Care departments to enable access and the future 

state community care vision. The model clarifies eligibility requirements, builds on 

existing infrastructure to develop a high-performing network, streamlines clinical 

and administrative processes, and implements a continuum of care coordination 

services. The Operating Model is comprised of the foundational elements of clear 

roles and responsibilities, consistent processes, active partnerships, standardized 

care coordination, and responsive customer service. 

Question 20. Dr. Matthews, Southern Ohio is ground zero in the opioid epidemic. 

How does VA currently educate community providers about VA policy regarding 

opioid prescribing and documentation? I have a fear that with veterans using both 

VA and community providers there could be a lack of consistency and accountability 

in how our veterans are treated within the system and beyond. 

Response. The VA Office of Community Care has developed a training module for 

community providers in an online educational system that provides evidence-based 

guidelines for prescribing opioids as outlined in the VA Opioid Safety Initiative 

(OSI). The module and additional information are being distributed by thes VA’s 

third party administrators (TPA) as well as to providers who have contracted directly with a VA Medical Center (e.g., sharing agreements, affiliate agreements, and 

direct contracts). VHA Office of Community Care will also ensure availability of evidence-based guidelines as outlined in the Opioid Safety Initiative through online access. 

Question 21. Dr. Matthews, building on that last question, 

Are there things that you think the VA has done particularly well in addressing 

the opioid epidemic that we could replicate across other programs to address the 

epidemic more broadly? 

Response. OSI by the Department of Veterans Affairs (VA) aims to reduce overreliance on opioid analgesics for pain management and to promote safe and effective 

use of opioid therapy when clinically indicated. 

OSI was implemented nationwide in August 2013, and is producing the intended results. The basis for the OSI is to make the totality of opioid use visible 

at all levels in the organization. The OSI includes key clinical indicators such 

as the number of VA pharmacy users dispensed an opioid, the number of VA 

pharmacy users receiving long-term opioids who also receive a urine drug 

screen, the number of VA pharmacy users receiving an opioid and a benzodiazepine (which puts them at a higher risk of adverse events) and the average morphine equivalent daily dose (MEDD) of opioids. Overall, VA has seen a 41 percent reduction in the number of Veterans who have received opioids for greater 

than or equal to 90 days. 

In order to assist community providers in replicating our successes through 

OSI, VA has released a STOP PAIN tool kit described below. 

STOP PAIN stands for: 

• Stepped Care Model—Adapted from the National Institutes of Health, this 

model encourages a continuum of care with effective monitoring and management 

of the condition from onset through treatment. It incorporates self-management 

through participation in such groups as Narcotics or Alcoholics Anonymous; counseling; treatment programs; involvement of primary care; and other medical specialists. 

• Treatment alternatives/complementary care—Complementary and Integrative 

health expands the availability of provider options beyond the use of standard care 

in the treatment of chronic pain. Complementary Health may include such evidencebased treatments as acupuncture, yoga, and progressive relaxation. 

63 

• Ongoing monitoring of usage, which relies on multiple tools for tracking and 

monitoring individual usage of and risk of opioid therapy. • Practice Guidelines—Key Clinical Practice Guidelines updated and utilized in 

VA for combating the opioid epidemic include both the VA/DOD Clinical Practice 

Guidelines for Management of Substance Use Disorder (SUD) and the VA/DOD 

Clinical Practical Guidelines for Management of Opioid Therapy for Chronic Pain. 

These guidelines provide clear and comprehensive evidence-based recommendations 

for practitioners to minimize harm and increase patient safety in patients requiring 

SUD treatment and opioid therapy. They can be found online at https:// 

www.healthquality.va.gov/guidelines/MH/sud/and https://www.healthquality.va.gov/ 

guidelines/Pain/cot/. Prescription monitoring—VA has a number of data sources to 

allow it to monitor opioid use to target specific education in real time. The practice 

patterns of providers differ, along with the case mixes, so a provider with relatively 

high opioid prescribing may have an appropriate practice, or be someone who could 

benefit from education. These tools allow the VA to drill down to the patient level 

to evaluate use. Other tools can evaluate the treatment of patient panels and the 

Veterans risk of potential abuse. Together, these allow identification of potential 

problems, educational targeting, and tracking of progress. • Academic Detailing—The academic detailing program is a one-to-one peer education program targeted to front line providers. It gives specific information on practice alternative and resources, opioid safety, and can compare the practice of the 

provider to that of their peers. Veterans have improved pain control as a result of 

it. Information about this may be found at: https://www.pbm.va.gov/PBM/academic 

detailingservicehome.asp and https://www.pbm.va.gov/PBM/academicdetailingservice 

/Pain_and_Opioid_Safety.asp. • Informed consent for patients—VA requires an informed consent process prior 

to long-term opioid therapy. This process includes the risks of opioid therapy, discusses opioid interactions with other medicines, and reviews safe prescribing practices such as urine drug screens. • Naloxone distribution—The Opioid Overdose Education & Naloxone Distribution, has focused on education of providers on Naloxone distribution to Veterans on 

long-term opioid therapy. 

Question 22. Does VA need any additional authority from Congress to play a larger role to address this epidemic among veterans? 

Response. VA is in constant collaboration with public and private health care entities to explore and investigate all opportunities to improve our practices and where 

applicable apply them to our own programs. A key example of this is our work on 

Clinical Practice Guidelines. VHA, in collaborations with DOD and other leading 

professional organizations, has been developing clinical practice guidelines since the 

early 1990s. In 2010, the Institute of Medicine identified VA/DOD as leaders in clinical practice guideline development. 

Implementation of evidence-based clinical practice guidelines is one strategy VHA 

has embraced to improve care by reducing variation in practice and systematizing 

‘‘best practices.’’ Guidelines address patient cohorts, serve to reduce errors, and provide consistent quality of care and utilization of resources throughout and between 

the VA and DOD health care systems. Guidelines are also cornerstones for accountability and facilitate learning and the conduct of research. 

Question 23. Mr. McDivitt, a common issue I hear from veterans is the inconsistent information and quality of care they receive from different VA medical facilities. 

How do you ensure consistent, quality care and services across VSN 10 facilities? 

Response. As a healthcare enterprise, we work from all points of patient care and 

services to the VISN office to ensure the delivery of the highest quality care to Veterans. Components include, but are not limited to the following: 

• Quality Management Systems and Internal Controls 

• Continuous improvement, redesign, systems engineering and efficiency management 

• Patient Safety 

• Internal and External Reviews 

• Utilization Management 

• Risk Management 

• Performance Measurement and Evaluation 

• Veteran and family engagement, activation, satisfaction and transparency 

• Credentialing and Privileging 

• Environment of Care Safety and Engineering 

Each of these components is operationalized at the facility and VISN levels to 

maximize outcomes for Veterans. As a VA health care system, ‘‘VA hospitals had 

64 

better outcomes than non-VA hospitals for 6 of 9 patient safety indicators. There 

were no significant differences for the other three indicators. In addition, VA hospitals had better outcomes for all mortality and readmission metrics.’’ (Atkins, 

David, Clancy, Carolyn, Advancing High Performance in Veterans Affairs Health 

Care. JAMA, Nov 2017. Volume 318, Number 19, 1927, 1928P). VISN 10 has a robust system of continuous improvement efforts monitored locally, regionally and nationally. 

We are considered a 5 Star VISN (on a 5 Star system called SAIL, a compendium 

of patient outcome measures) which is the highest rating obtainable. We excel in 

the following outcomes: patient safety (low rate of complications), standardized mortality rate, mental health population coverage. The Joint Commission performance 

outcomes, Registered Nurse turnover and call responsiveness. We work at all levels 

of the organization to ensure consistency; compliance and excellence; and have robust systems in place to monitor and support staff to achieve the best outcomes for 

Veterans. We seek Veteran input and use it to improve quality of care and Veteran 

outcomes throughout the VISN. VISN 10 has a Veteran representative on the Executive Leadership Board who is active, engaged and passionate about improving outcomes to Veterans. 

Question 24. What is your process for identifying and expanding best practices 

from one facility to others? 

Response. Fortunately, the VISN 10 network has a strong, well-established system of sharing and spreading strong practices. We sponsor workgroups where outstanding outcomes are highlighted and shared openly, as well as committees that 

spread strong practices throughout the system. We openly share best practices at 

the Executive Leadership Board that are subsequently spread throughout the system. A recent example of shared strong practices includes our medication reconciliation process. Additionally, we have a strong mentoring process that allows leaders 

to openly share their experiences with newer facility leaders 

Question 25. Mr. McDivitt, veterans have brought to me their concerns over VA 

hiring practices, specifically the medical staff shortages. 

What methods do you use to anticipate employee shortages? 

Response. Each facility has a resource management forum that includes executive 

leadership and service chiefs. All resources are discussed in the context of immediate critical, clinical needs, future vacancies, and supply and demand for resources, 

new development, retention and attrition. Critical, clinical needs are highly 

prioritized and strategies to recruit and retain these positions are developed and executed. We have had some issues in rural areas of the VISN, as well as some medical sub-specialty areas, and as such have aggressively implemented telehealth 

strategies throughout the network. Additionally, when the demand for services exceeds our capacity we have coordinated care in the community for Veterans in need. 

Methods to recruit and retain staff include, but are not limited to, recruitment and 

retention bonuses, education payback and incentives, active, engaged workforce and 

environment and a shared governance model. Our dedicated staff is passionate and 

committed to the mission, often attracting and recruiting their peers and colleagues 

from outside of the VA health care system. 

Question 26. Have these strategies proven to be accurate when forecasting vacancies for critical positions across the VISN? 

Response. The process is generally accurate for forecasting vacancies, but does not 

resolve the issues related to the scarcity of providers, specifically certain specialties 

in some areas of the VISN. Operating as a large network with telehealth capacities 

has helped with the supply and demand issues raised by a scarcity of candidates. 

The VA is not allowed to be the highest payor, but offers a highly competitive salary 

and benefits package which can be enticing to potential candidates. 

Question 27. How do you ensure that VA remains a competitive work environment 

that retains talented medical professionals? The last thing we want to do for our 

veterans is to push bright, accomplished workers out of the agency meant to help 

vets the most. 

Response. Retention is critical to the maintenance of a dedicated, passionate 

workforce. Numerous mechanisms are in place to foster retention including retention incentives, repayment of educational debts, and an engaged workforce using a 

shared governance model. 

In the event an employee chooses to leave VA, we conduct a comprehensive exit 

interview. These interviews track and trend reasons for employees leaving and help 

us strengthen our resources and commitment to each and every employee. 

There are many educational and advancement opportunities within the VA. Many 

leaders within the VA started at entry-level positions and through education and 

experiences have become service, facility, and network level leaders. 

65 

Question 28. How many Ohio vets will have their GI Bill benefits restored as a 

result of the Forever GI bill? Please provide my office with updated numbers, 

disaggregated by institution, of veterans and their families from Ohio who will be 

eligible for GI Bill benefits restoration in light of the Forever GI bill. 

Response. For the Special Application provision VA has identified three Ohio 

schools where students are eligible for restoration as follows: 

Name of School 

Number of 

students 

Brown Mackie College-North Canton .................................... 12 

Miami-Jacobs Career College-Sharonville ............................. 1 

Sanford Brown College .......................................................... 3 

This number does not include beneficiaries who may have resided in Ohio, and 

attended a school that closed out of state or online. 

Question 29. Mr. Worley, Forever GI Bill will allow the restoration of Post-9/11 

GI Bill benefits to veterans who were impacted by schools that closed from 2015 

until the date of enactment. 

What will happen to veterans’ GI Bill benefits if vets are using their benefits and 

their school closes suddenly in the future? 

Response. The Forever GI Bill provisions in Section 109 allow restoration of entitlement for VA students if a school closes from date of enactment (August 16, 2017) 

and continues into the future. This means that VA will not make a charge against 

a student’s entitlement for the portion of the period that the student did not receive 

credit toward a program (or lost training time toward the completion of a program). 

For example, if a student was enrolled in a semester full-time, and the school closed 

60 days after the semester started, the student would have used two months of their 

entitlement. VA will restore those two months allowing the student to use them at 

another time. 

Additionally, for school closings on or after August 16, 2017, VA may continue the 

housing allowance for Post-9/11 GI Bill students beyond the date of closure up to 

the end of the term, quarter or semester, not to exceed 120 days. The law requires 

VA begin making housing allowance payments on August 1, 2018. No charge to a 

student’s entitlement will be made for the extended period of eligibility for housing 

allowance. 

Question 30. Are they currently eligible for benefits restoration? 

Response. Yes, the restoration of entitlement provisions in the Forever GI Bill 

took effect 90 days after the date of the enactment (August 16, 2017), and apply 

retroactively to school closures on or after January 1, 2015. 

Question 31. Mr. Worley, the Forever GI Bill allows for additional funding for 

State Approving Agencies and instructs SAAs to include risk-based surveys in their 

oversight tasks. 

How can strong oversight from SAAs protect veterans pursuing their education? 

Response. Strong oversight by the State Approving Agencies (SAAs) helps protect 

Veterans in several ways. First, oversight ensures approved programs meet all statutory approval criteria in 38 U.S.C. chapter 36, as well as any individual state requirements the SAAs used in their assessment to initially approve a course for Veteran’s training. 

Second, SAAs are familiar with the responsibilities of School Certifying Officials 

(SCO’s). SCOs certify students’ enrollments to VA to ensure proper payment of benefits. Through oversight, SAAs can identify out of line situations that require additional training that VA or SAAs can provide, ensuring VA students are certified 

properly for payment, are in courses necessary for completion of their program, and 

that appropriate credit has been granted for their prior training. In that oversight 

review, the SAA may identify violations that could result in disapproved programs. 

Finally, using information VA obtains from students through VA’s GI Bill complaint system, SAAs can conduct an immediate risk-based unscheduled school visit 

to resolve issues, or assess potential violations that may require program disapproval or suspension of VA student enrollment. The following are areas of focus 

in the complaint system: 

Recruiting/Marketing Practices Quality of Education 

Accreditation .......................................................................... Grade Policy 

Financial Issues (e.g. Tuition/Fee charges) .......................... Release of transcripts 

Student Loans ........................................................................ Transfer of Credits 

66 

Recruiting/Marketing Practices Quality of Education 

Post-Job Opportunities .......................................................... Other (as identified by student) 

The SAAs assisting in oversight visits for approval compliance, reviews of SCO 

reporting, and conducting risk based surveys helps ensure VA students are in proper programs for their educational objective, and receive proper payment. The SAAs 

strong oversight also assists by identifying and resolving issues. The VA’s GI Bill 

complaint system is an important tool for early detection of potential problems. 

Question 32. Mr. Worley, I know I would like to see the 90/10 loophole closed to 

crack down on for-profit colleges and universities using abusive and deceptive practices to recruit veterans, servicemembers, and their families. That is why I reintroduced the Military and Veterans Education Protection Act this year. 

Are there other improvements to the GI Bill, not included in the Forever GI that 

would help VA better serve veterans pursuing higher education? 

Response. While VA defers to the Department of Education on the 90/10 rule, the 

FY 2019 President’s Budget contains two proposals that would help VA better serve 

Veterans pursuing higher education. The first proposal would amend title 38 U.S.C. 

section 3313(c) and add a new section (j) to impose tuition and fee payment caps 

at institutions of higher learning offering flight training programs and establish a 

maximum allowable fee structure for all VA-funded flight programs. Savings for this 

proposal are estimated to be $43 million in 2019, $230 million over five years, and 

$540 million over ten years. The second proposal would amend 38 U.S.C. section 

3002(3)(B), to add a preparatory course for a test that is required to enter into, 

maintain, or advance in a given vocation or profession. Costs are estimated to be 

$1 million in 2019, $7 million over five years, and $16 million over 10 years. 

Question 33. What kind of oversight efforts has VA anticipated needing to ensure 

that new offerings from Forever GI, including the STEM Scholarship and the High 

Tech pilot program, are actually serving veterans? 

Response. The Department is actively reviewing, planning, and preparing for implementation of these two Colmery Act sections in 2019. This includes hiring additional temporary full-time employees to support standing these initiatives up, processing related claims, and providing the necessary oversight to ensure statutory requirements are met. 

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A P P E N D I X 

PREPARED STATEMENT OF BENJAMIN FITZGERALD, VETERAN, WESTLAKE, OH 

I truly appreciate Senator Brown for inviting me to talk on behalf of veterans, 

like myself, about topics of discussion concerning Veteran Affairs. 

Today I want to highlight some of the questions and concerns that I have heard 

while working as a VA Work/Study at Cuyahoga Community College, and through 

Team RWB Cleveland, Akron, and Columbus Chapters. 

One of the biggest concerns is the transition from military to civilian lifestyle. 

When processing out there is so much on your mind, and there are only a few hours 

that you have learning about benefits, and addressing concerns, during this transition. It can become quite confusing, stressful, and exciting all at the same time. 

Knowing this, when we return home, you forget what was available to you... and 

it happens very easily. I will say however, that Team RWB, a nonprofit veterans 

organization, whose mission is to enrich the lives of Veterans through Exercise, Volunteer work, and social interaction, has been the greatest thing I have the pleasure 

to be a part of since coming out of service 9 years ago. 

I joined the Cleveland Team about a year and a half ago now, and I’ve never felt 

more at home. The Team greeted me with open arms, and as fellow veterans, that 

comradery and sense of understanding made me feel at home. What’s even better, 

is the team consist of civilian members as well, and with their help, we are able 

to bridge that gap between those who serve, have served, and the civilian population. The problem is, I didn’t even know about Team RWB until 7.5 years after 

I had already got out. In fact, other than the GI Bill, which we appreciate Senator 

Brown making the Forever GI Bill, I had no idea so much was available for veterans 

and their families. 

Next, and quickly, I want to see if there is a solution where our medical records 

aren’t taking up to a year to get from our perspective Regional Center’s? 

Though there are more questions and concerns, which I hope will be brought up, 

I truly appreciate your time, and allowing me to speak on behalf of my brothers, 

sisters, and myself. Thank you! 

Æ