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28-177 PDF 2006

S. HRG. 109–564

LEGISLATIVE PRESENTATIONS OF THE NATIONAL

ASSOCIATION OF STATE DIRECTORS OF VETERANS AFFAIRS, THE AMVETS, THE AMERICAN

EX-PRISONERS OF WAR, AND THE VIETNAM

VETERANS OF AMERICA

HEARING

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS

UNITED STATES SENATE

ONE HUNDRED NINTH CONGRESS

SECOND SESSION

MARCH 30, 2006

Printed for the use of the Committee on Veterans’ Affairs

(

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

(II)

COMMITTEE ON VETERANS’ AFFAIRS

LARRY CRAIG, Idaho, Chairman

ARLEN SPECTER, Pennsylvania

KAY BAILEY HUTCHISON, Texas

LINDSEY O. GRAHAM, South Carolina

RICHARD BURR, North Carolina

JOHN ENSIGN, Nevada

JOHN THUNE, South Dakota

JOHNNY ISAKSON, Georgia

DANIEL K. AKAKA, Ranking Member, Hawaii

JOHN D. ROCKEFELLER IV, West Virginia

JAMES M. JEFFORDS, (I) Vermont

PATTY MURRAY, Washington

BARACK OBAMA, Illinois

KEN SALAZAR, Colorado

LUPE WISSEL, Majority Staff Director

D. NOELANI KALIPI, Minority Staff Director

(III)

CONTENTS

MARCH 30, 2006

SENATORS

Page

Craig, Hon. Larry, Chairman, U.S. Senator from Idaho ...................................... 1

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

Akaka, Hon. Daniel K., U.S. Senator from Hawaii .............................................. 4

Prepared statement .......................................................................................... 5

Salazar, Hon. Ken, U.S. Senator from Colorado ................................................... 13

Prepared statement .......................................................................................... 13

Obama, Hon. Barack, U.S. Senator from Illinois .................................................. 34

WITNESSES

Basker, George, President, National Association of State Directors of Veterans

Affairs .................................................................................................................... 7

Prepared statement .......................................................................................... 9

Harvey, Gerald S., National Commander, American Ex-Prisoner of War .......... 14

Prepared statement .......................................................................................... 16

Rowan, John, National President, Vietnam Veterans of America ....................... 17

Prepared statement .......................................................................................... 19

Kemp, Edward W., National Commander, AMVETS ........................................... 25

Prepared statement .......................................................................................... 26

APPENDIX

The VVA 2006 Legislative Agenda & Policy Initiatives brochure ....................... 43

(1)

LEGISLATIVE PRESENTATIONS OF THE NATIONAL ASSOCIATION OF STATE DIRECTORS OF VETERANS AFFAIRS, THE AMVETS,

THE AMERICAN EX-PRISONERS OF WAR,

AND THE VIETNAM VETERANS OF AMERICA

THURSDAY, MARCH 30, 2006

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

The Committee met, pursuant to notice, at 10:00 a.m., in room

SD–106, Dirksen Senate Office Building, Hon. Larry E. Craig

(Chairman of the Committee) presiding.

Present: Senators Craig, Akaka, Salazar, and Obama.

OPENING STATEMENT OF HON. LARRY E. CRAIG,

U.S. SENATOR FROM IDAHO

Chairman CRAIG. Well, good morning, ladies and gentlemen and

fellow Americans. Welcome to the Committee on Veterans’ Affairs.

The Committee will now be in order.

It is my pleasure to welcome all of you here today. I would like

to single out a person in your membership who is a personal friend

of mine that we have worked with over the years who represents

my home State all so well. I said hello to him a few moments ago,

Herb Kerchoff, National Director of the Northwest Region, American Ex-Prisoners of War. Herb, thank you.

Herb is from beautiful Couer d’Alene, Idaho. For those of you

who have not been there, this is a personal invitation from Herb

to visit him.

I wish to thank all of you for your fine service and that service

that you have rendered veterans in your respective communities

over the years. Your valuable contributions of service to many of

our veterans is greatly appreciated.

The past year has been an extremely gratifying one for me, my

first as Chairman of the Veterans’ Affairs Committee here in the

Senate. I sincerely believe that this Committee and its Members,

while sometimes differing in approach, are all united in one common mission: ensuring that our Nation’s veterans, particularly veterans wounded in the line of duty receive the highest quality

health care and benefits that they need. By any measure, we have

had a very busy and productive first session, convening 23 hearings

here in Washington, nine field hearings, and four mark-ups.

More importantly, the committee-related activity has led to several what I think are extremely important accomplishments. I am

2

going to single out one of those accomplishments in particular that

deserves special attention because some of you were instrumental

in securing its enactment. About a year ago, I walked into my office

to meet three veterans of Operation Iraqi Freedom. One of them

was missing a leg. Another was missing both legs, and the third

had lost his sight. They asked that I sponsor legislation to create

a new insurance benefit for traumatic injuries such as theirs, but

not for them, mind you, but for their fellow compatriots and for future severely wounded service Members, and here is the result that

we can all be proud of:

Earlier this month, VA has now paid out to almost 1,500 traumatically injured members from OIF and OEF. These are young

men and women with amputations, severe burns, total blindness,

total deafness, paralysis, and a host of other disabilities, all of

them sustained in defense of America. Going forward, Wounded

Warriors Insurance will fill the gap in financial help that these heroes need and faced during their convalescence. Thank you for

helping us get that done.

Let me touch on what has consumed much of our attention of

late, the fiscal year 2007 VA budget. I believe this record budget

is extraordinary. The Senate-passed budget resolution would provide VA health care systems a 12.4 percent increase in direct appropriations. That would mean that since 2001, VA health care

budgets have increased by nearly 70 percent. At these rates, the

cost of VA medical care will double every 6 years. There is almost

no other area of the Federal budget that has experienced that kind

of increase.

Yes, if what is demonstrated continues in a fiscal austere climate, the President and us and you have a challenge to sustain

this level of spending—a top budget priority of this President, a top

budget priority of ours. That said, I am concerned that at the

present spending rates, VA budgets will soon collide with spending

demands in other areas of the government. Although we may wish

that VA funding exists in a vacuum, you and I both know it does

not and I am sure that everyone here is aware that the President

has proposed one way for us to respond to some of these realities,

by asking Priority Seven and Eight veterans with no servicerelated disabilities to contribute about $21 per month to enroll in

the VA health care system and to pay $15 for a 30-day supply of

medicine.

While these proposals did not survive in the budget resolution,

they reflect a fiscal reality of limited resources that we must face

someday. I personally find these proposals to be reasonable, and

while I know that many in your organizations voiced concern and

even opposed, I reiterate, my hope is that VSOs and others will engage this Committee in serious and candid discussion if not about

the President’s proposal, then about other options.

It is our collective responsibility to sustain this incredible VA

health care system today and for future needs. If we begin addressing these issues now, we can help ensure that future veterans will

not be faced with even bigger challenges and more radical changes

to meet those challenges. Personally, I do not want to pass this

issue on to the next guy or gal that may chair this Committee. I

want to pass on to tomorrow’s veterans what we have collectively

3

created, a health care system that provides quality care, that is accessible to those who need it, but affordable to those who want it.

I hope you agree with my goals and are willing to work with me

and my colleagues on this effort.

Today, we have four distinguished members of the veterans community testifying. They are George Basher, National President,

National Association of State Directors of Veterans Affairs; Gerald

S. Harvey, National Commander, American Ex-Prisoners of War;

John Rowan, National President, Vietnam Veterans of America;

and Edward Kemp, National Commander for AMVETS.

[The prepared statement of Senator Craig follows:]

PREPARED STATEMENT OF HON. LARRY E. CRAIG, U.S. SENATOR FROM IDAHO

Good morning, ladies and gentlemen. The Committee on Veterans’ Affairs will

now come to order. It is my pleasure to welcome all of you here today. I’d like to

single out a person of your membership from my home State of Idaho who is in attendance:

Mr. Herb Kirchhoff, National Director of the Northwest Region, American ExPrisoners of War. He is from Coeur D’Alene, Idaho. I wish to thank all of you for

the fine service you render the veterans in your respective communities. Your valuable contributions of service to many of our veterans is greatly appreciated.

The past year has been an extremely gratifying one for me . . . my first as Chairman of the Veterans’ Affairs Committee. I sincerely believe that this Committee and

its Members, while sometimes differing in approach, are all united in one, common

mission: ensuring that our nation’s veterans—particularly veterans wounded in the

line of duty—receive the highest quality of health care and benefits that they need.

By any measure, we have had a busy and productive first session, convening

twenty-three hearings here in Washington, nine field hearings, and four markups.

More importantly, committee-related activity has led to several important accomplishments.

I am going to single out one accomplishment in particular that deserves special

attention because some of you were instrumental in securing its enactment. About

a year ago, I walked into my office to meet with three veterans of Operation Iraqi

Freedom: one was missing a leg; another was missing two legs; and the third had

lost his sight. They asked that I sponsor legislation to create a new insurance benefit for traumatic injuries such as theirs. Not for them, mind you. But for their fellow compatriots, for future severely wounded service members.

And here is the result we can all be proud of: Earlier, this month, VA had paid

almost 1,500 traumatically injured service members from OIF/OEF. These are

young men and women with amputations, severe burns, total blindness, total deafness, paralysis, and a host of other disabilities . . . all of them sustained in defense

of America. Going forward, ‘‘Wounded Warrior’’ insurance will fill the ‘‘gap’’ in financial help these heroes face during their convalescence.

Let me touch on what has consumed much of our attention of late . . . the fiscal

year 2007 VA budget. I believe this record budget is extraordinary. The Senate

passed budget resolution will provide VA’s health care system with 12.4 percent increase in direct appropriations. That would mean that since 2001, VA’s health budget has increased by nearly 70 percent. At this rate the cost of VA medical care will

double every 6 years. Yes, it conclusively demonstrates that in this fiscally austere

climate, both the Senate and the President have chosen to make veterans, once

again, a top budget priority.

That said, I am concerned that at present spending rates, VA’s budget will soon

collide with spending demands in other areas of government. Although we may wish

that VA funding existed in a vacuum, it simply does not.

As I am sure everyone here is aware, the President had proposed one way for us

to respond to these fiscal realities . . . by asking priority 7 and 8 veterans—with

no service-related disabilities to contribute about $21 per month to enroll in the VA

health care system and pay $15 for a 30-day supply of medicine. While these proposals did not survive in the Budget Resolution they reflect a fiscal reality of limited

resources that we must face someday. I personally find these proposals to be reasonable, and while I know that many in your organizations voiced concern and even

opposition I reiterate my hope that the VSOs and others will engage this Committee

in serious and candid discussions . . . if not about the President’s proposals, then

4

about other options. It is our collective responsibility to sustain this incredible VA

health care system into the future.

If we begin addressing these issues now, we can help ensure that future veterans

will not be faced with even bigger challenges and more radical changes to meet

those challenges. Personally, I do not want to pass this issue on to the next guy.

I want to pass on to tomorrow’s veterans what we have collectively created, a health

care system that provides quality care that is accessible to those who need it, but

affordable to those who want it. I hope you agree with my goals and are willing to

work with me and my colleagues in our efforts.

Today we have four distinguished members of the veteran community testifying.

They are: Mr. George Basher, President, National Association of State Directors

of Veterans Affairs; Mr. Gerald S. Harvey, National Commander, American Ex-Prisoners of War; Mr. John Rowan, National President, Vietnam Veterans of America;

and Mr. EDWARD W. Kemp, National Commander, AMVETS.

Chairman CRAIG. Before I turn to our panelists this morning and

testifiers, let me turn to the Ranking Member, Senator Danny

Akaka of Hawaii. Danny and I work very closely together on all of

the issues that pertain to veterans.

Danny.

STATEMENT OF HON. DANIEL K. AKAKA,

U.S. SENATOR FROM HAWAII

Senator AKAKA. Thank you very much, Mr. Chairman. It has always been a pleasure for me to be part of this Committee and to

work with you.

Before I proceed with my statement, I just want to comment on

the news we received this week. My counterpart in the House,

Congressman Lane Evans, will be retiring at the end of this year.

Congressman Evans is a true champion for veterans and I will

greatly miss working with him. As a Vietnam-era Marine and an

unyielding advocate for veterans and their families, Mr. Evans has

done so much for our country’s veterans. He is a true patriot and

we will all miss his great leadership. I look forward to continuing

to work with him this year and wish him my warmest aloha for

the future.

Mr. Chairman, it is certainly a pleasure to be here with our veterans. I want to thank the commanders and national presidents

who are testifying here today, and my thanks go as well to all veterans and their families who have made the journey to the Nation’s

Capital to express their concerns. This truly is the democracy in action.

Your organizations have a long and proud tradition of public

service, and your advocacy on behalf of veterans is truly exemplary.

This Committee relies heavily on your concerns and agendas for

the coming year.

I would like to share some of my concerns and priorities. During

this time last year, many of us here in Congress were sounding the

alarm that the VA budget was facing a crisis situation. Many

months later, the Administration acknowledged this fact and Congress took action to provide emergency funding. Chairman Craig

kept his promise and was a driving force behind that emergency

funding.

When we started working together last year, we pledged to work

in a bipartisan manner, and we have done so. There are times,

however, when we agreed to disagree. We both agree that veterans

deserve to have the best health care, the best services, and the best

5

benefits, though we sometimes disagree on how to pay for it. I want

to be clear, however, that we have the same goal and that is to ensure that VA is provided with the resources to provide quality care

and services to our Nation’s veterans. I remain dedicated to ensuring that VA has the resources it needs to care for all veterans.

We must learn a lesson from last year’s budget crisis and do everything we can to ensure that veterans and their family members

have access to the health care and benefits they have earned. VA’s

budget has increased for the past 6 years, as mentioned by the

Chairman, since 2001. It has increased by 70 percent, and this is

as it should be.

The cost of caring for our veterans is in my opinion a cost of war.

If the Department of Defense’s budget can grow exponentially and

we fund it yearly out of supplementals, it makes sense that VA’s

budget needs to grow exponentially as well. It is no secret that

each service member that we so readily fund out of DOD will eventually seek services from VA. It follows, then, that if DOD’s budget

grows steadily, VA’s budget must grow steadily as well.

For me, it is a matter of priorities. We must stand by our veterans and ensure that they receive the care and services that they

have earned through their service to our country and we must ensure that we care for all veterans. We cannot fund the VA system

out of the pockets of the middle income veterans as many of these

men and women make as little as $27,000 a year. Higher copayments and enrollment fees are not justified. To date, over a quarter

of a million veterans have been excluded from VA health care. We

must work to overturn this Administration’s decision and open the

VA system up to those who need it.

I also am concerned about the VA research program being slated

for a cut under this budget. Since its inception, the VA research

program has made landmark contributions to the welfare of not

only veterans, but the entire Nation. Illustrating the unique importance of keeping it adequately funded with thousands of military

personnel engaged in conflict overseas, it is vital that Congress invest in research that could have a direct impact on their postdeployment quality of life.

With regard to VBA budget, I am concerned whether or not this

budget provides an adequate level of staffing for compensation

claims rating. VA must be ready to adjudicate claims in a timely

and accurate manner. I believe that VA must begin to hire additional staff now to handle the anticipated influx of new claims from

recently separated service members.

In closing, I would like again to thank the witnesses and all who

are here with us today. Your service, your dedication to this Nation

and its veterans is unquestionable. I look forward to your presentation and working with you in the future.

Thank you very much, Mr. Chairman.

[The prepared statement of Senator Akaka follows:]

PREPARED STATEMENT OF HON. DANIEL K. AKAKA, U.S. SENATOR FROM HAWAII

It is certainly a pleasure to be here today. I want to thank the Commanders and

National Presidents testifying today. My thanks go as well to all the veterans and

their families who have made the journey to the Nation’s capital to express their

concerns. This is truly democracy in action. Your organizations have a long and

proud tradition of public service and your advocacy on behalf of veterans is truly

6

exemplary. This Committee relies heavily on your concerns and agendas for the

coming year.

I would like to share some of my concerns and priorities. During this time last

year, many of us here in Congress were sounding the alarm that the VA budget was

facing a crisis situation. Many months later, the Administration acknowledged this

fact and Congress took action to provide emergency funding. Chairman Craig kept

his promise and was a driving force behind the emergency funding. When we started working together last year, we pledged to work in a bipartisan manner. And we

have done so.

There are times, however, when we agree to disagree. We both agree that veterans deserve to have the best health care, services, and benefits. Though, we sometimes disagree on how to pay for it. I want to be clear, however, that we have the

same goal and that is to ensure that VA is provided with the resources to provide

quality care and services to our Nation’s veterans.

I remain dedicated to ensuring that VA has the resources it needs to care for all

veterans. We must learn a lesson from last year’s budget crisis and do everything

we can to ensure that veterans and their family members have access to the health

care and benefits they have earned.

VA’s budget has increased over the past 6 years. This is as it should be. The cost

of caring for our veterans is, in my opinion, a cost of war. If the Department of Defense’s budget can grow exponentially, and be funded yearly out of supplementals,

it only makes sense that VA’s budget needs to grow exponentially as well. It is no

secret that each servicemember that we so readily fund out of DOD will eventually

seek services from VA. It follows then, that if DOD’s budget grows steadily, VA’s

budget must grow steadily as well. For me, it is a matter of priorities—we must

stand by our veterans and ensure that they receive the care and services that they

have earned through their service to our country. And we must ensure that we care

for all veterans.

We cannot fund the VA system out of the pockets of ‘‘middle-income’’ veterans,

as many of these men and women make as little as $27,000 a year. Higher copayments and enrollment fees are not justified. To date, over a quarter of a million veterans have been excluded from VA health care. We must work to overturn this Administration’s decision and open the VA system up to those who need it.

I also am concerned about the VA Research program being slated for a cut under

this budget. Since its inception, the VA research program has made landmark contributions to the welfare of not only veterans, but the entire Nation, illustrating the

unique importance of keeping it adequately funded. With thousands of military personnel engaged in conflict overseas, it is vital that Congress invest in research that

could have a direct impact on their post-deployment quality of life.

With regard to the VBA budget, I am concerned whether or not this budget provides an adequate level of staffing for compensation claims’ rating. VA must be

ready to adjudicate claims in a timely and accurate manner. I believe that VA must

begin to hire additional staff now to handle the anticipated influx of new claims

from recently separated servicemembers.

In closing, I would like once again to thank the witnesses and all who are here

with us today. Your service and dedication to this Nation and its veterans is unquestionable. I look forward to your presentation and working with you in the future.

Chairman CRAIG. Senator Akaka, thank you, and let me join

with the Senator in his expression and recognition of Congressman

Lane Evans and his retirement. He clearly has been a dedicated

public servant with veterans foremost in his mind almost his entire

service period here, and we have had the opportunity to work with

him. We will miss him in his retirement.

Let me also add before we turn to our panelists, Senator Akaka

and I insisted last year with the budget difficulties we had with the

VA that they change their practices and their habits and that they

report to us on a quarterly basis of their spend-down and their

needs, and they are now doing that. Yesterday before the Subcommittee of MILCON, which is MILCON and Veterans Affairs

that I serve on in Appropriations, we took testimony from the Secretary. Not only did he refer to that effort that Senator Akaka and

7

I insisted upon, but they are now reporting monthly to OMB, the

Office of Management and Budget.

This is without question a new precedent for them. It will help

us shape and understand their needs much more clearly. It will

allow us to read trend lines of growth and demand or the lack of

demand. It will show all of those factors, and I think that that is

a very positive step, and Senator Akaka and I insisted that that

be a part of the way that we would deal with VA and the only way

we would deal with VA when it came to budget matters, open,

transparent, and timely reporting as to their fiscal needs.

Now let us turn to all of you witnesses and, again, we thank you

so very much for being with us this morning. Let me first turn to

George Basher, President, National Association for State Directors

of Veterans Affairs.

George, welcome before the Committee.

STATEMENT OF GEORGE BASHER, PRESIDENT, NATIONAL

ASSOCIATION OF STATE DIRECTORS OF VETERANS AFFAIRS

Mr. BASHER. Thank you, Mr. Chairman.

Mr. Chairman and distinguished Members of the Committee, as

President of the National Association of State Directors of Veterans

Affairs, I thank you for the opportunity to testify and present the

views of the State Directors of all 50 States, our commonwealths

and our territories. As the Nation’s second largest provider of services to veterans, spending over three and a half billion dollars this

year, State Government’s role continues to grow. We believe it is

essential for Congress to understand this role and ensure we have

the resources to carry out our responsibilities. We partner very

closely with the Federal Government in order to best serve our veterans, and as partners, we are continuously striving to be more efficient in delivering services to veterans.

We greatly appreciate the leadership of Chairman Craig and

Ranking Member Akaka and the entire membership of the Senate

Veterans’ Affairs Committee for their past support of building on

the Administration’s budget and hope that it continues. Because of

the war on terror, we are now serving a new generation of veterans. They will need our help as they return to civilian life, and

we believe, therefore, that there will be an increased demand for

certain benefits and services, and the overall level of health care

funding proposed by the Administration must meet that demand

while continuing to serve those veterans already under VA care.

The State Directors support the Capital Asset Realignment for

Enhanced Services, CARES, process, and we urge that the capital

funding required for implementation be included over a reasonable

period of time to enable these recommendations to be realized. We

recommend an in-depth examination of long-term care of mental

health services. The CARES Commission review did not include

long-term care of mental health services, but it did recommend further study of both areas. To that end, we ask again that a study

be done to thoroughly examine veterans’ long-term care and continue the study currently being done in mental health service

needs to include gap analysis clearly identifying where services are

lacking.

8

The CARES report recognized State veteran homes as a critical

component of veteran long-term health care and a model of cost efficient partnership between Federal and State Governments. These

State nursing care facilities and domiciliaries bear over half the national long-term health care workload for our infirm and aging veteran population. Forty-eight States provide care for more than

27,500 veterans in 120 homes.

We urge you to continue to oppose proposals that jeopardize the

viability of our State veteran homes. State tax payers have supported the State homes through their 35 percent share of construction costs with an understanding that the Federal Government will

continue to make its contribution through per diem payments.

Since 1977, State construction grant requests have consistently

exceeded congressional appropriations for the program. According

to the fiscal year 2006 priority list, pending programs, there are 80

projects in Priority Group One with State matching funds of $226

million for a Federal match of $420 million. Any grant moratorium

or lessening only exacerbates an already underfunded program

where the fiscal year 2006 appropriation is only 85 million.

The success of VA’s effort to meet the current and future longterm care needs of veterans is contingent on resolving the current

mismatch between demand and available funding. We recommend

this issue be included in any long-term care study undertaken.

We support increasing the per diem payment to one-half of the

national average annualized for cost in State veteran homes. Current law allows VA to pay per diem up to one-half the cost of care

of a veteran in a State home; however, in the first quarter of 2005,

the VA per diem payment amounted to only 31 percent of the daily

average cost of nursing home care. We ask that the per diem for

both programs be increased to one-half the national average

annualized cost of providing care.

We support Medicare subvention. We recommend veterans medication purchase option be implemented for Priority Group 7 and 8

enrollees. Under the compensation and pension benefits area, we

support consideration of a greater role for State Director Divisions

of Veteran Affairs in the overall efforts to manage and administer

claims processing regardless of whether the State uses State employees, veteran service organizations, or county veteran service officers. As noted in the recent VA Inspector General review of

variances, veteran access to competent claim assistance is still very

much an action of geography, and this organization stands ready

to assist VA in alleviating that condition.

We strongly support improving and providing a seamless transition and help our returning service members’ transition back into

civilian life and also support veterans preference with regard to

employment.

Mr. Chairman and distinguished Members of the Committee, we

respect the important work that you have done to improve and support veterans who have answered the call to serve our Nation.

State Directors of Veterans’ Affairs remain dedicated to doing our

part. We urge you to be mindful of the increasing financial challenge that States face just as you address the fiscal challenges at

the Federal level. We are dedicated to our partnership with the VA

in the delivery of service and care to our Nation’s veterans.

9

This concludes my statement, and I am ready to answer any

questions you might have.

[The prepared statement of Mr. Basher follows:]

PREPARED STATEMENT OF GEORGE BASHER, PRESIDENT, NATIONAL ASSOCIATION

OF STATE DIRECTORS OF VETERANS AFFAIRS

INTRODUCTION

Mr. Chairman and distinguished Members of the Committee, as President of the

National Association of State Directors of Veterans Affairs (NASDVA) I thank you

for the opportunity to testify and present the views of the State Directors of all 50

states, commonwealths, and territories.

As the nation’s second largest provider of services to Veterans, State governments’

role continues to grow. We believe it is essential for Congress to understand this

role and ensure we have the resources to carry out our responsibilities. We partner

very closely with the Federal Government in order to best serve our veterans and

as partners, we are continuously striving to be more efficient in delivering services

to veterans.

We greatly appreciate the leadership of Chairman Craig and Ranking Member

Akaka and the entire Membership of the Senate VA Committee for their past support of building upon the administration’s budget and hope that it continues. Because of the War on Terror, we are now serving a new generation of veterans. They

are going to need our help as they return to civilian life. We believe, therefore, that

there will be an increased demand for certain benefits and services and the overall

level of health care funding proposed by the administration must meet that demand

while continuing to serve those veterans already under VA care.

VETERANS HEALTH BENEFITS AND SERVICES

NASDVA supports the Capital Asset Realignment for Enhanced Services (CARES)

process.

Capital Asset Realignment for Enhanced Services (CARES): We were generally

pleased with the report and recommendations made in the final plan. We also support the process for planning at the remaining 18 sites and the direction it will

move VA as a national system. We urge that capital funding required for implementation be included over a reasonable period of time to enable these recommendations

to be realized.

NASDVA supports the opening of additional Community-Based Outpatient Clinics

(CBOCs). We would like to see the new priority CBOCs deployed rapidly with appropriate VA Medical Center (VAMC) funding.

Community-Based Outpatient Clinics (CBOCs): Continued development of CBOCs

has greatly improved veterans’ access to VA health care. We continue to encourage

rapid deployment of new priority clinics over the next few years with the corresponding budget support to VAMCs. VA needs to quickly develop these additional

clinics, to include mental health services. We encourage the investment of capital

funding to support the many projects recommended by CARES. We support VA contracting-out some specialty care to private-sector facilities where access is difficult.

Likewise we would like to see this process continue in fiscal year 2007, with sufficient funding in the budget.

NASDVA recommends an in-depth examination of long-term care and mental

health services.

Long-Term Care and Mental Health Services in CARES Initiatives: The CARES

Commission review did not include long-term care or mental health services, but did

recommend further study of both areas. To that end, we again ask that a study be

done to thoroughly examine veterans’ long-term care and continue the study currently being done on mental health care needs, to include gap analysis clearly identifying where services are lacking. The CARES report recognized State Veterans

Homes (SVHs) as a critical component of veterans’ long-term health care and a

model of cost-efficient partnership between Federal and State governments. These

State nursing care facilities and domiciliaries bear over half of the national longterm health care workload for our infirm and aging veteran population. Forty-eight

(48) States provide care for more than 27,500 veterans in 120 SVHs. We urge you

to continue to oppose proposals that jeopardize the viability of our SVHs. State taxpayers have supported the SVHs through its 35 percent share of construction costs

with an understanding that the Federal Government would continue to make its

contribution through per diem payments. The Federal Government should continue

10

to fulfill its important commitment to the states and ultimately to the individual

veterans in need of care.

NASDVA continues its strong support for the State Home Construction Grant

Program. The annual appropriation for this program should be continued and increased. Based on the reduction in funding in fiscal year 2006, we recommend that

the amount in fiscal year 2007 be increased to $115 million. Re-ranking of projects

should be eliminated once a project is established as Priority group 1 (state matching funds are available).

Funding of the State Homes Construction Grant Program. Since 1977, state construction grant requests have consistently exceeded Congressional appropriations

for the program. According to the fiscal year 2006 Priority List of Pending State

Home Construction Grant Applications, there are 80 projects in Priority group 1

with state matching funds of $226M for a Federal match of $420M. Any grant moratorium only exacerbates an already under-funded program, where the fiscal year

2006 appropriation was only $85M. This deficit in Federal program support causes

long delays in the establishment of long-term care beds in areas where these services are badly needed by an aging veteran population. We recommend rejection of

any proposed moratorium and an increase in funding.

The success of VA’s efforts to meet the current and future long-term care needs

of veterans is contingent upon resolving the current mismatch between demand and

available funding. We recommend this issue be included in any long-term care study

undertaken.

Ranking of State Home Construction Projects. Priority groups for construction or

acquisition of SVHs are established in 38 CFR, Chapter 59.50. States that have applied and made matching funds available for projects are ranked Priority group 1.

Due to insufficient funding each budget year, some Priority group 1 projects do not

receive Federal funding and are then subject to reprioritization the following budget

year. Since these projects have state funds committed, they should maintain their

ranking in Priority group 1 except for new projects that are for ‘‘life and safety’’

issues.

NASDVA supports full reimbursement for care in SVHs for veterans who have a

70 percent or more service-connected disability or who require nursing home care

because of a service-connected disability.

Full Reimbursement for Cost of Care for Qualifying Veterans in SVHs: The November 1999 Millennium Act requires VA to provide nursing home care to those veterans who have a 70 percent or more service-connected disability or who require

nursing home care because of a service-connected disability. VA provides nursing

home services through three national programs: VA owned and operated nursing

homes, SVHs owned and operated by the state, and contract community nursing

homes. VA General Counsel interpretation of the law allows only contract community facilities to be reimbursed for full cost of care. SVHs merely receive per diem

towards the cost of care, requiring the veteran to make a co-payment. This is unfair

to those veterans who are eligible for full cost of care, but prefer to reside in a SVH.

NASDVA supports increasing per diem to provide one-half of the national average

annualized cost of care in a SVH.

Increase in Per Diem Payments to SVHs. Current law allows VA to pay per diem

up to one-half of the cost of care each day a veteran is in a SVH. However, in 1QTR

fiscal year 2005, VA per diem amounted to only 31 percent of the average daily cost

of nursing home care ($185.56) and only 25 percent of the average daily cost of

domiciliary care ($119.94) in a SVH. We ask that per diem for both programs be

increased to one-half of the national average annualized cost of providing care, as

the SVH program is the most cost effective nursing care alternative used by VA.

NASDVA supports VA Medicare Subvention. We recommend a veterans’ medication purchase option be implemented for Priority group 7 and 8 enrollees who only

seek medications. We request continued protection of the Federal Supply Schedule

for VA/DOD pharmaceuticals.

Medicare Subvention. We recommend that VA implement a Medicare Subvention

program similar to the unrealized ‘‘VA Advantage’’ Program. Working with the Department of Health and Human Services, this program will allow Priority group 8

veterans aged 65 and older to use their Medicare benefits to obtain VA health care.

VA would receive Medicare payments to cover its costs. This is an HMO concept we

have supported, however, we are concerned about the delay in implementation of

a pilot. It was our understanding 2 years ago that this program would be available

to veterans within a few months. Another year has now passed without implementation.

Optional Purchase of VA Medications. NASDVA requests Secretary Nicholson consider a veterans’ medication purchase option. Large numbers of Priority group 7 and

8 enrollees are seeking prescription drugs; they do not necessarily seek access to the

11

VA health care system. A medication only purchase program could separate this

population from the enrollee lists and reduce backlogs, assisting VA in delivering

services to the core constituency of service-connected veterans. Such a plan would

provide veterans an attractive alternative to Medicare Part D funding for pharmaceuticals.

Protection of VA Pharmaceutical Costs. NASDVA requests continued protection of

the Federal Supply Schedule ’FSS) for VA/DOD pharmaceuticals. While we support

the goal of reduced drug prices for all Americans, we are concerned that if the FSS

prices were extended to Medicare recipients or other entities, it would result in increased prices for VA/DOD, diverting millions of dollars from health care funding

for veterans.

NASDVA supports continued efforts to reach out to veterans. This should be a

partnership between VA and the State Departments of Veterans Affairs (SDVAs).

Outreach to Veterans. While growth has occurred in VA health care due to improved access to CBOCs, many areas of the country are still short-changed due to

geography and/or due to veterans’ lack of information and awareness of their benefits. VA and SDVAs must reduce this inequity by reaching out to veterans regarding

their rights and entitlements. NASDVA supports implementation of a grant program that would allow VA to partner with the SDVAs to perform outreach at the

local level. There is no excuse for veterans not receiving benefits to which they’re

entitled simply because they are unaware of those benefits.

COMPENSATION AND PENSION BENEFITS

NASDVA supports considerations of a greater role for SDVAs in the overall effort

to manage and administer claims processing, regardless of whether the state uses

state employees, Veterans Service Organizations ’VSOs), and /or County Veterans

Service Officers ’CVSOs).

Restructured Claims Management. Recent studies regarding claims processing

have all noted that VA needs to make better use of the assets of the State government and VSOs to assist in claim processing. One example is the October 2001

Claim Processing Task Force Report to the Secretary, which stated:

‘‘The full partnership and cooperation of VBA and Veterans Service Organizations ’VSOs) are vital elements in assuring timely service to the veteran. A welldeveloped network of VSOs and State Departments of Veteran’s Affairs

(SDVAs) should be encouraged to cooperatively enhance the delivery of services

to veterans. Service organizations can help improve service to beneficiaries and

increase veteran satisfaction by providing assistance in gathering evidence for

the development of a well documented and ‘‘ready-to-rate’’ claim, helping deter

frivolous claims, and by providing timely information on claim status.’’

Additionally, as noted in the recent VA Inspector General’s Review of State

Variances in VA Compensation Payments, veteran access to competent claim assistance is still very much an accident of geography. Effective advocacy for veterans

from initiation of a claim to a VA decision can improve sufficiency and timeliness

of claims. Numerous studies indicate ‘‘well-developed’’ claims produce better outcomes for veterans in a shorter time and at a lower cost to VA.

The SDVAs, nationally chartered VSOs, and county veteran service officers have

the capacity and capability to assist VA. NASDVA can be an effective partner with

VA to establish and achieve higher performance standards in claims preparation.

SDVAs could assume a role in more effective and comprehensive training programs

and certification of service officers to ensure competence and technical proficiency

in claims preparation. We can support VA in its ‘‘duty to assist’’ without diminishing

our role as the veterans’ advocate.

For all the reports and testimony to the contrary, VBA has not been very successful in making effective use of the state/county/VSO system of service officers and

counselors. Under the current system of claims processing, the interface between

VBA and those who represent veterans is clumsy and poorly integrated. We recommend VBA explore methods of integrating its existing and future applications

and its business process with those state, county, and VSO personnel supporting

claim processing. We further recommend the establishment and enforcement of uniform training programs and performance measures for all personnel involved in the

preparation of veteran claims.

NASDVA strongly supports passage of legislation to eliminate the time-phased

concurrent receipt of military retirement pay and service-connected disability compensation.

We appreciate the fiscal year 2005 Defense Authorization Act authorizing full concurrent receipt of retired pay and disability compensation for retirees with 100 percent VA disability ratings. We are disheartened, however, by the DoD decision to

12

exclude the 30,000 retirees currently rated as ‘‘unemployable’’ and receiving disability compensation at the 100 percent rate. This decision should be based on fairness, not budgetary constraints.

NASDVA strongly supports passage of legislation to eliminate the time-phased

concurrent receipt of military retirement pay and service-connected disability compensation. These are both earned entitlements and should apply to all retired veterans, regardless of their level of disability.

BURIAL AND MEMORIAL BENEFITS

NASDVA recommends and increase in the plot allowance for all veterans to $1000

per interment. We strongly support an increase in funding for the State Cemetery

Grant Program. A new Federal/State national Cemetery Administration ’NCA) grant

program could be established to support state costs.

Increase in Burial Plot Allowance. The average operational cost of interment in

a state veterans’ cemetery is $2000. This adds to the fiscal burden of many SDVAs.

The current burial plot allowance of $300 per qualified interment provides 15 percent of the average cost of interment. NASDVA recommends the Plot Allowance be

increased to $1000 in order to offset operational costs. The increase should also

apply to the plot allowance for veterans’ interment in private cemeteries.

Increased Funding for State Veterans Cemetery Grant Program (SCGP). The State

Veterans Cemetery Grant Program (SCGP) has greatly expanded the SDVAs’ ability

to provide gravesites for veterans and their eligible family members in those areas

where national cemeteries cannot fully satisfy burial needs, particularly in rural

and remote areas of the country. The existing State Cemetery Grant Program has

allowed the number of state cemeteries to grow by nearly 40 percent over the past

5 years with a corresponding increase in interments. Currently there are some 40

project pre-applications pending totaling $160M. We ask that SCGP funding be increased to $50M.

Establishment of a State Veterans Cemetery Operations Grant Program. SDVAs

are provided construction grants for veterans’ cemeteries and a limited burial plot

allowance as discussed above to partially offset the cost of interment. Operational

costs for both state and national veterans’ cemeteries continue to rise. However,

once a state establishes a state veterans’ cemetery there is no further source of Federal funding to defer operational costs. NASDVA recommends the establishment of

a Federal grant program to assist state veterans’ cemeteries with operational costs.

HOMELESSNESS AMONG VETERANS

NASDVA supports efforts to diminish the national disgrace of homelessness

among veterans. SDVAs would prefer an active role in allocating and distributing

per diem funds for homeless veterans to non-profit organizations, ensuring greater

coordination, fiscal accountability, and local oversight of the services provided.

Homeless Providers Grant and Per Diem Program: VA grants greatly assist states

in reducing homelessness among veterans and we urge an increase in per diem ’currently $27.44) to ensure appropriate support services at transition facilities. Additionally, NASDVA recommends VA partner with SDVAs in the process of allocating

and distributing per diem funds to non-profit organizations. This would create an

appropriate level of accountability and collaboration between non-profit agencies

and SDVAs, ensuring funding is used to provide care to veterans in the program

in a most effective manner.

SEAMLESS TRANSITION AND JOBS

NASDVA strongly supports improving upon and providing ‘‘Seamless Transition’’

to help our service members’ transition into civilian life.

We support the expansion of the Transition Assistance Program ’TAP). Efforts

need to be made to maximize the integration of services provided by the DoD, VA

and State and Local Governments. It must be recognized that no single agency can

adequately meet the transition needs of our returning service members.

NASDVA strongly supports Veterans’ preference with regard to employment.

We support full implementation of existing programs and laws with regard to veterans’ preference to ensure our returning veterans have every opportunity available

in their transition into civilian life. We also support incentives to businesses that

hire veterans.

CONCLUSION

Mr. Chairman and distinguished Members of the Committee, we respect the important work that you have done to improve support to veterans who have answered

13

the call to serve our nation. NASDVA remains dedicated to doing our part, but we

urge you to be mindful of the increasing financial challenge that states face, just

as you address the fiscal challenge at the Federal level. We are dedicated to our

partnership with the VA in the delivery of services and care to our Nations Veterans.

This concludes my statement and I am ready to answer any questions you may

have.

Chairman CRAIG. George, thank you very much for that statement, and to all of our panelists, your full written statements will

be a part of the record.

Before I turn to you, Gerald, let me recognize one of our colleagues that has joined us for any opening comments he would like

to make, Senator Ken Salazar of the State of Colorado.

Ken.

STATEMENT OF HON. KEN SALAZAR, U.S. SENATOR FROM

COLORADO

Senator SALAZAR. Thank you very much, Chairman Craig and

Senator Akaka, for holding today’s hearing. I want to thank the

members of the National Association of State Directors of Veterans

Affairs, the AMVETS, the American Ex-Prisoners of War, and the

Vietnam Veterans of America for coming here today. Your presence

here today and your testimony will ensure that we here at the

United States Senate do the very best that we can to fulfill our Nation’s promise to the veterans of America.

I have a longer statement, Mr. Chairman, and I will submit that

for the record, but again, I just want to welcome all of you and say

thank you for being here to provide your testimony today.

[The prepared statement of Senator Salazar follows:]

PREPARED STATEMENT OF HON. KEN SALAZAR, U.S. SENATOR FROM COLORADO

Thank you, Chairman Craig and Senator Akaka for holding today’s hearing. As

a relatively new Member of this Committee, I have found these hearings incredibly

helpful as I further my understanding of the issues that are uniquely important to

our veterans.

With that in mind, I want to thank the members of the National Association of

State Directors of Veterans Affairs, the AMVETS, the American Ex-Prisoners of

War, and the Vietnam Veterans of America for coming here today to talk about the

legislative issues that are so important to them—and to us as Members of this Committee. We certainly value what you have to say; we are here to represent you by

doing everything we can to ensure that you receive the best support our nation can

provide.

We’ve now had several hearings on this year’s budget proposal for the Department

of Veterans’ Affairs, and we’ve had an opportunity to evaluate the budget from the

varied perspectives of a diverse range of our nation’s prominent veterans’ groups.

Yet at each of these hearings, we seem to be hearing the same thing—that while

the 2007 budget proposal for Veterans’ Affairs is better than last year, it remains

deficient in a number of critical respects.

For example, this Administration wants to generate revenue and decrease costs

by establishing enrollment fees and doubling prescription drug co-payments for Priority 7 and 8 veterans. As I’ve said before, this is an unacceptable solution. While

I certainly understand the need to focus our services on those veterans who need

the most help, we cannot turn our backs on the promises we have made to provide

all our veterans with the high-quality healthcare they deserve. For that reason, I

oppose these enrollment fees and co-pay increases.

Another troubling aspect of this budget proposal is the revelation that, beyond fiscal year 2008, it projects drastic cuts in VA funding. Whether or not this is an accurate reflection of the intentions of this Administration, the fact remains: deep budget cuts for veterans’ services and cynical budget shell games are equally unacceptable. We need to provide for our veterans each and every year. We also need to be

14

honest about the challenges we face when it comes to future deficits and their potential impact on the quality of healthcare services we can provide.

In my view, the way to solve this problem is to provide mandatory funding for

VA healthcare. I have co-sponsored legislation that would make this goal a reality,

and I will continue to push for mandatory funding for VA because I believe it is

the best way to provide for the ever-growing needs of our veterans.

In addition, there are a number of benefits issues that must be addressed immediately. We need to end the disability tax on veterans and allow full concurrent receipt immediately. And we must support our military survivors by allowing them

to receive compensation in the event that their spouse passes away due to servicerelated causes—compensation that does not interfere with the survivors’ insurance

their spouse paid into while he or she was alive.

Finally, I’d like to express a general concern about our national veterans’ policies.

Specifically, I am concerned that these policies fail to meet the needs of a particularly vulnerable veterans’ population—veterans living in rural communities. In my

home state of Colorado, some veterans have to travel hundreds of miles to receive

treatment from VA facilities. We need to be aware of the challenges our rural veterans face, and we need to make sure the Federal agencies responsible for assisting

them are adequately equipped to meet their needs. That’s why I recently introduced

legislation with Senator Thune and several other Members of this Committee to ensure the VA is sufficiently targeting its efforts toward rural veterans.

As we continue to face these and other challenges, I want to again thank Chairman Craig and Senator Akaka for all they do as leaders of this Committee. I also

want to thank you, our veterans, for your continued diligence in working to help

us serve you better.

Thank you.

Chairman CRAIG. Ken, thank you very much.

Now let us turn to Gerald Harvey, National Commander, American Ex-Prisoners of War.

Gerald, welcome before the Committee.

STATEMENT OF GERALD S. HARVEY, NATIONAL COMMANDER,

AMERICAN EX-PRISONERS OF WAR

Mr. HARVEY. Chairman Craig, Ranking Member Akaka, distinguished Members of the Senate Veterans’ Affairs Committee, and

guests. I welcome the opportunity to speak on behalf of American

Ex-Prisoners of War. We are deeply grateful for all that Congress

and the VA have done for prisoners of war over the last 30 years.

As you know, prior to that, POWs were an invisible part of this

Nation’s veterans. It has been incorrectly stated that we preferred

it this way out of shame over being captured. This is not true. We

are proud to have lost our liberty while defending the rights of all

Americans to be free. We were so happy to be free, we simply wanted to enjoy that freedom at home with our families. As a result,

we made few requests upon our government at that time.

Public awareness about the plight of aging POWs in general was

reawakened by the plight of Americans held for months and years

by North Vietnam. Max Cleland—then VA Administrator and later

Senator from Georgia, took the lead in correcting our country’s failure to remember POWs from earlier wars, including World War II.

For the first time, the identities of those captured, re-patriated,

and currently alive were obtained from original military records.

VA then immediately took steps to identify all POWs receiving

health care or disability benefits. Congress too responded promptly

and directed VA to conduct a review of all policies and procedures

related to POWs. In a very real sense, POWs were changed to a

high-priority group within VA and Congress.

Over the past 30 years, many presumptives were established to

simplify the process by which POWs could obtain needed disability

15

benefits and medical care. The ongoing research conducted on

POWs by the National Academy of Science provided the basis for

these congressional and VA actions.

At present, most of the long-term health problems associated

with brutal and inhumane conditions of captivity have been identified and are presumptive. We urge Congress to act on the several

remaining medical conditions identified in current legislation. The

first of these, chronic liver disease, is simply a clarification of a current presumptive, cirrhosis of the liver. The National Academy of

Science has stated in writing that this more accurately reflects

their finding. Cirrhosis is simply the final stages of chronic liver

disease.

The second is diabetes. It has already been established for Vietnam Veterans exposed to certain chemicals and other factors,

POWs were also exposed to adverse factors while in captivity that

are related to diabetes.

Third, osteoporosis, this is directly related to the absence of the

calcium needed to maintain bone structure, a common situation for

POWs. This condition becomes apparent after a bone break. Adjudicators typically already decide these claims for POWs. Making it

a presumptive simplifies the process for adjudicators and POWs

alike.

H.R. 1598, introduced by Representative Michael Bilirakis, and

S. 1271, introduced by Senator Patty Murray cover these

presumptives. We call to your attention that there is virtually no

increased cost to any of these proposed presumptives. Costs are

more than offset by rapidly diminishing numbers of POWs already

on the disability rolls or favorably acted on by VA adjudicators by

a longer process of evaluation.

Earlier this month, Senator Harry Reid introduced A. 2385,

known as the Combat-Related Special Compensation Act. Representative Michael Bilirakis, a long-time advocate of concurrent

receipt legislation, previously introduced the companion bill,

H.R. 1366, in the House. It is currently before the Armed Services

Committee. This legislation will amend some parts of the CombatRelated Special Compensation Act, Chapter 61 of the Defense Authorization Act, to an earlier effective date of January 1, 2006.

With a concurrent effective date of 2014 and their advanced age,

it is a statistical possibility World War II military retirees will not

live to receive this deserved compensation.

Representative Bob Filner introduced H.R. 2363 to provide for

the Purple Heart to be awarded to prisoners of war who die in captivity. We ask the Committee to give their full support to these

bills.

In closing, I want to again express our deep appreciation for

identifying POWs as a high priority and worthy segment of the veteran population. We are also grateful for VA’s ongoing efforts to

identify every POW and for them to be processed for VA benefits

by adjudicators specially trained to handle POW claims.

Thank you.

[The prepared statement of Mr. Harvey follows:]

16

PREPARED STATEMENT OF GERALD S. HARVEY, NATIONAL COMMANDER,

AMERICAN EX-PRISONERS OF WAR

Chairman Craig, Ranking Member Akaka, Distinguished Members of the Senate

Veterans Affairs Committee and Guests: I welcome the opportunity to again speak

on behalf of American Ex-Prisoners of War (POWs). We are deeply grateful for all

that Congress and VA have done for POWs over the last 30 years. As you know,

prior to that, POWs were an invisible part of this nation’s veterans. It has been incorrectly stated we preferred it ‘‘this way’’ out of shame over being captured. This

is not true, we are proud to have lost our liberty while defending the right of all

Americans to be free. We were so happy to be free we simply wanted to again enjoy

that freedom with our homes and families. As a result, we made few requests upon

our government at that time.

Public awareness about the plight of aging POWs in general was re-awakened by

the plight of the Americans held for months and years by North Vietnam. Max

Cleland, then VA Administrator and, later, Senator from Georgia—took the lead in

correcting our country’s failure to remember POWs from earlier wars, including

WWII. For the first time, Total Captured, Repatriated, and Currently Alive were obtained from original military records.

VA then immediately took steps to identify all POWs receiving health care or disability benefits. Congress, too, responded promptly and directed VA to conduct a review of all policies and procedures relevant to POWs and established a POW Advisory Committee to review and advise VA and Congress on matters related to POWs.

In a very real sense, POWs were changed to a high priority group within VA and

Congress.

Over the past 30 years many presumptives were established to simplify the process by which POWs could obtain needed disability benefits and medical care. The

ongoing research conducted on POWs by the National Academy of Sciences provided

the basis for these Congressional and VA actions. At present most of the long term

health problems causally associated with the brutal and inhumane conditions of

captivity have been identified and made presumptive.

We urge Congress to act on the several remaining medical conditions identified

in current legislation. The first of these, ‘‘chronic liver disease’’ is simply a clarification of a current presumptive—‘‘cirrhosis of the liver’’. The National Academy of

Sciences has stated in writing, this more accurately reflects their findings—cirrhosis

is simply the final stage of chronic liver disease.

The second is diabetes. It has already been established for Vietnam veterans exposed to certain chemicals and other factors. POWs were similarly exposed to adverse factors while in captivity that are causally related to diabetes.

Third, osteoporosis. This is directly related to the absence of the calcium needed

to maintain bone structure, a common situation for POWs. This condition becomes

apparent after a bone break. Adjudicators typically already decide these claims for

POWs. Making it a presumptive simplifies the process for adjudicators and POWs

alike.

H.R. 1598 introduced by Rep. Michael Bilirakis and S. 1271 introduced by Senator

Patty Murray cover these presumptives. We call to your attention that there is virtually no increased cost to any of these proposed presumptives. Costs are more than

off-set by rapidly diminishing numbers of POWs already on the disability rolls or

favorably acted on by VA adjudicators via a longer process of evaluation.

Senator Harry Reid introduced S. 2385 earlier this month known as the Combat

Related Special Compensation Act. Rep. Michael Bilirakis, a long time advocate of

concurrent receipt legislation, previously introduced the companion bill H.R. 1366 in

the House. It is currently before the Armed Services Committee. This legislation

will amend some parts of The Combat Related Special Compensation Act chapter

61 of the Defense Authorization Act to an earlier effective date of January 1, 2006.

With the current effective date of 2014 and their current advanced age it is a statistical probability WWII military retirees will not live to receive this deserved compensation. Rep. Bob Filner introduced H.R. 2369 to provide for the Purple Heart to

be awarded to prisoners of war who die in captivity. We ask the Committee to give

their full support to these bills.

In closing, I want to again express our deep appreciation for identifying POWs

as a high priority and worthy segment of the veterans population. We are also gratified for VA’s ongoing efforts to identify every POW and be processed for applicable

VA benefits by adjudicators specially trained to handle POW claims.

Note: ’1) AXPOW receives no grants or funds from the Federal Government; ’2)

My curriculum vitae is that of service as a member and officer of AXPOW.

17

Chairman CRAIG. Gerald, thank you. Thank you very much, Gerald.

Now let us turn to John Rowan, National President of Vietnam

Veterans of America. John, welcome again before the Committee.

Good to see you.

STATEMENT OF JOHN ROWAN, NATIONAL PRESIDENT,

VIETNAM VETERANS OF AMERICA

Mr. ROWAN. Thank you, Chairman Craig. Thank you, Member

Akaka.

Chairman CRAIG. Is your microphone on, John?

Mr. ROWAN. Now, it is.

Chairman CRAIG. There you go. Thank you.

Mr. ROWAN. I thought it was automatic. I was watching everything else.

Anyway, starting again, thank you, Senator Craig, Chairman of

the Committee, and Ranking Member Akaka and Senator Salazar

for allowing us to testify here this morning. I am appreciative to

be able to join my distinguished colleagues, and hearing their

words, we support what they said before and I am sure what the

gentleman from the AMVETS will say as well and, of course, the

veterans that are here joining us this morning and their families

and friends.

Our testimony this year, our legislative agenda this year, was a

little bit different. We really focused on three overarching issues,

basically funding, which you had mentioned earlier, accountability,

and outreach, and while we appreciate the increases that have

been coming down the VA budget over the last several years, we

believe it has only been a start to recoup from the losses we had

suffered in the late nineties over several years of flat-line budgets.

We also believe, quite honestly, that we predicate all of our discussions on what we believe is the looming health crisis and benefit

crisis in the VA. Obviously the VA was not ready for a new war

and all of the new men and women coming home from Iraq and Afghanistan and elsewhere around the world. More importantly, they

weren’t ready for the Vietnam Veterans. They weren’t ready for our

agent orange-related service-connected disabilities that are now

showing up as we get into our fifties and early sixties. All of the

diseases that are now presumptive, diabetes, prostate cancer, lung

cancer, all of the many cancers are ravaging the Vietnam Veterans.

Everybody talks, of course, because of the age of the World War

II Veterans and how quickly they are dying off. We are dying off

at a faster rate than any veterans previously ever recorded in the

history of this country because of agent orange. ‘‘The Veteran’’,

which is our national newspaper, every month comes out with hundreds of names of our own members, just our members, who are

dying every month, and if you look at the ages and you look at the

results and why, it is cancer, heart attack, cancer, cancer, diabeticrelated problems, cancer, on and on.

This is creating a health crisis, I believe, in the VA because they

are not ready for us. The reason why they are not ready for us is

because they never finished the National Vietnam Veterans Longitudinal Study that should have been finished 3 years ago that was

mandated by Congress, which the VA has totally disobeyed. They

18

disobeyed your order to do this study to find out what has been

happening with Vietnam Veterans over time. The Australians did

their study and they showed what happened, and they have been

dealing with their veterans, but we haven’t been dealing with ours.

We think that our issues, our health care issues, are putting a

substantial burden on the VA and will continue to do so over the

next several years. What is really concerning to us is they are not

doing outreach to these Vietnam Veterans. Many veterans don’t belong to VSOs, don’t belong to the VA and, therefore, don’t understand when they get that prostate cancer, it has something to do

with where they were 35 years earlier.

It is not just the fiscal issue. It is a health care issue. We need

to tell Vietnam Veterans in particular that they need to go to their

doctors, whether they are VA or private, and get annual exams, detailed exams for all of the myriad of things that we unfortunately

suffer from, and while the budget may be a problem and we understand the fiscal realities of life—everybody has to go home and

write a checkbook every month—the problem is this is the continuing cost of national defense, as Senator Akaka said earlier.

Like it or not, this is just a bill that was left over from Vietnam

from 35 years ago. We may have left there in 1975 in the last helicopters off the roof of the embassy, but that bill is still being paid

every day by Vietnam Veterans, and we need to make sure that the

VA has the resources to cover that bill not only on the health care

side, but on the benefit side. In a weird perverse way, the Vietnam

Veterans are affecting that too. The Vietnam Veterans are retiring

from the VA in droves. They are reaching retirement age. They

came to work for the VA and they are sitting there as adjudicators

or senior adjudicators or appeals officers, and all of those people in

the VA are going to march out the door over the next several years

because they reached retirement age and they are not being

backfilled with newer veterans. We hope they do. We need to do

a lot more of that, and they are not prepared for that either.

So all of those cases, while we understand fiscal realities, as we

said, this is a cost. We didn’t ask for it. It is a cost that has to be

bourne by this country because they sent us off to war and just as

they are sending the new veterans off to war, and while I focused

mainly on the Vietnam Veterans issues, I would not relieve our colleagues who are following us in any way either. We still don’t know

what is going on with the Persian Gulf War Veterans. They still

have all these unknown ailments. We are starting to find out more

science about what happened to them. We don’t know what the

health effects are of the Marines who stood next to those burning

oil wells for month after month. We don’t know what is happening

to the new veterans.

We see from our service representatives, which I have been one

for the last several years, people coming into our system that we

see who have been injured. The most visible ones are sitting in

Walter Reed in Bethesda, but there are thousands more that get

hurt from not just IADs, but from accidents, vehicle mishaps, helicopter crashes, all kinds of things, and many of them are being

taken off the field for disease, but we have no idea what that is

about. So we are looking to see all of those things, and unfortuVerDate 11-MAY-2000 13:19 Sep 14, 2006 Jkt 028177 PO 00000 Frm 00022 Fmt 6633 Sfmt 6601 C:\VA\28177.TXT CarolB PsN: CarolB
19

nately it is going to cost money, and money is the issue. I am sorry.

They are just going to have to bear the burden.

Thank you for your listening to us and listening to my colleagues. Thank you.

[The prepared statement of Mr. Rowan follows:]

PREPARED STATEMENT OF JOHN ROWAN, NATIONAL PRESIDENT, VIETNAM VETERANS

OF AMERICA

Good morning Chairman Craig, Senator Akaka, and other distinguished Members

of this Committee. It is my privilege this morning to present to you the thoughts

and views of Vietnam Veterans of America ’VVA) on the funding priorities and

issues of significance for veterans and our families.

It has been said many times, only half-jokingly, that Americans have the shortest

attention span of all mammals. What makes headlines today most of us forget about

6 months from now. Remember Chandra Levy?

Veterans, though, have long memories. We remember why we served, what we

saw, what we did when we donned the uniform to serve our country. We remember

our comrades, those who died and most of the rest who were forever changed by

having donned the uniform.

We also remember last July, when Congress and the Administration were embarrassed by the revelation that the Department of Veterans Affairs was $800 million

in the hole in meeting its health care obligations. After a flurry of meetings and

a spate of publicity, Congress moved quickly, if belatedly, to do the right thing for

veterans, even as this shortfall grew by several hundred million dollars as the VA

suddenly ‘‘discovered’’ it was treating 103,000 OEF and OIF veterans rather than

26,000. Some 144,000 of our newest veterans are now being treated at VA facilities.

To your credit, and for this we thank you, you closed this budget gap by adding

$1.5 billion to the VA’s FY 2005 operating budget. And you added another $1.2 billion in ‘‘emergency funds’’ for the current fiscal year which, we fear will still not

be enough for the VA to maintain its current level of care, even with a reported $1.1

billion carryover in the VA’s budget. You cited, correctly, some of the problems inherent in how the VA predicts the usage and attendant costs of its health care operations. While we are hardly omniscient, VVA’s budget projections and those of the

Independent Budget were right on the money, again.

FY 2007 BUDGET

This year, we believe the Administration’s budget request, despite the hype, is

short by at least $4.2 billion, $1.9 billion of which would open enrollment to Priority

8 veterans who were ‘‘temporarily’’ restricted from enrolling in the VA’s health care

system in January 2003. If the ban on statutorily eligible Priority 8s continues, VVA

believes the budget for health care is still short by some $2.3 billion.

The real effect of this shortfall is felt in the VISNs, in the VA medical centers,

where the real work—patient care—is done. Next time you are back home, next

time you visit one of the VA medical centers in your state, ask around how they’re

doing with the current budget constraints. We think you’ll be surprised by what you

learn.

VVA believes that the budget for veterans’ health care should not be capped by

the need to control the deficit—a need that is exacerbated by tax cuts that benefit

the wealthiest among us—but by the needs of the eligible veterans who choose to

utilize the VA for their health care.

We’ve said this before and we’ll say this again: Had the VA’s health care budget

not been flat-lined for 4 years just as eligibility reform was opening the system to

hundreds of thousands of deserving veterans, we would be discussing a budget $8-

to $10-billion greater than it has been, than what is proposed for FY 2007.

This year, yet again, we dispute the numbers in the Administration’s budget request. It is not enough money, even to properly take care of those already in the

system. Along with the other veterans’ service organizations, VVA will expend

countless hours and considerable energy arguing about and fighting for funding that

is sufficient to meet the needs of the veterans the VA serves.

This is one battle we should not have to wage. Instead, we should be working together to fashion a formula for funding the VA’s health care operations. We challenge Congress here and now: Form a bipartisan group to meet, study the issues

and options, hold hearings, and recommend legislation that would fundamentally

change the way in which veterans health care is funded to ensure adequate funding

for veterans’ health care.

20

VVA believes, in concert with other eight VSOs that comprise The Partnership for

Veterans Health Care Budget Reform, that a fair funding formula can be arrived

at, one that won’t bust the budget, one that recognizes our nation’s obligations to

veterans and is indexed to medical inflation and the per capita use of the VA health

care system.

ADJUDICATION BACKLOG

What sometimes gets lost in the debate over sufficient funding for veterans’

health care is the continuing backlog in the adjudication of claims at the Veterans

Benefits Administration. More than 525,000 cases have been in various stages of adjudication for far too long now. The VA projects this situation will get worse, yet

only requests funding for 130 new employees for all of the VBA for fiscal year 2007.

Congress needs to ensure that the new platoon of adjudicators is properly trained,

supervised, and, along with their supervisors and managers, held accountable for

their work.

We believe that Congress must demand an explanation from the VA as to why

it takes upwards of 21⁄2 years to adjudicate cases. Congress must demand that the

VA not only develop but put into practice a real strategy for unclogging the system.

’The VA might try to triage cases, akin to what military medical personnel do as

casualties are brought in from the field of battle.) There’s no reason why a veteran

who has all of his paperwork in order in making a claim for, say, tinnitus must wait

a year or more. There should be no reason why his claim can’t be adjudicated in

60 to 90 days.

GREATER ACCOUNTABILITY

We do not make the argument, however, that budget reform is an end in and of

itself. It is, rather, a means to an end. It must be accomplished hand-in-hand with

real changes in how VA senior managers and middle managers perform. Give

‘‘attaboys’’ and bonuses to those who have earned them; give warnings and sanctions

to those who have not done their jobs well. Please do not get us wrong: The overwhelming number of those who work at the VA are dedicated to helping veterans,

and we applaud the efforts they make every day. But better management—and

training—is needed if efficiencies are to be increased.

EXPANDED OUTREACH

According to the U.S. Bureau of the Census, there are more than 25 million veterans in the United States today. Only around one-fifth of them have any real interaction with the Department of Veterans Affairs. However, many of them, particularly in-country Vietnam veterans, are eligible for compensation for several maladies

incurred during their military service—and far too many remain unaware of the

benefits to which their service entitles them.

These are not just veterans who have been having difficulties coping with life. As

an example, in speaking with one Navy veteran, we learned that he had served incountry in Vietnam. When he mentioned that he had suffered with prostate cancer,

we asked if he knew that this was service-connected compensable, presumptive to

exposure to Agent Orange. This was news to him. And he is a lawyer with the IRS

here in Washington, D.C.

VVA believes that the VA has an obligation to reach out to all veterans to ensure

to the maximum extent possible that they know what benefits they have earned,

and they know how to access these benefits. This is starting to happen as VA personnel are assigned to the bases where active-duty personnel transition to civilian

life and veteran status. This, however, is hardly enough.

We commend to you legislation—S. 1342—introduced by Mr. Feingold that would

require the Secretary of Veterans Affairs to establish a separate account for the

funding of the outreach activities of his department—and a sub-account for the

funding of the outreach activities of each element within the department. This legislation would assist states in carrying out programs that offer a high probability of

improving outreach and assistance to veterans—and to their spouses, children, and

parents who may be eligible to receive veterans’ benefits. We urge Members of this

Committee to seriously consider holding hearings on this bill.

This morning, rather than offer a laundry list of issues and priorities, VVA is focusing on specific issues that demand our best efforts to achieve and warrant your

attention and support.

21

FEE-BASIS HEALTH CARE

Approximately 60 percent of OEF/OIF service members, particularly in the National Guard and the Reserves, come from rural areas. Despite the VA’s network

of clinics, too many of these returnees and other veterans do not live near a VA clinic or medical center. They are at a distinct disadvantage in accessing VA health

care. When the VA cannot provide the highest quality care, within a reasonable distance or travel time from a veteran’s home, the VA has a duty to provide care via

a fee-basis provider of choice for service-disabled veterans. VA personnel who deal

with these veterans must be aware of their duty in this regard.

This most assuredly does not mean that the VA should begin to dismantle its network of healthcare facilities and outsource, or privatize, VA services, as some might

encourage. It does mean that Congress must ensure that every effort is made so

that veterans—particularly our newest veterans—receive timely care from providers.

MILITARY HISTORY

The Veterans Health Administration ’VHA) must become a true ‘‘veterans health

care system’’ instead of a general health care system that happens to be for veterans. Without taking a complete military history of its patients, this is just not possible. We cannot state emphatically enough the need for VA clinicians to take a complete military history as a matter of course for all veterans currently in or entering

the VA health care system. This must be part of the automated patient treatment

record, so that it can be keyed to training, be the basis of clinical reminders based

on the veterans’ military record, and focus the general mindset of all clinicians at

VA toward being a true ‘‘veterans health care system.’’

What is true for VA clinicians is true as well for private clinicians. A medical professional who knows a patient is a veteran, and knows a patient’s military history,

should have a better idea about what that patient may have been exposed to, what

emotional trauma were faced that will have ongoing physical and/or mental repercussions.

MILITARY SEXUAL TRAUMA

It has become clear in the last decade that sexual harassment and sexual abuse

are far more rampant than what had been acknowledged by the military. Reported

instances of sexual harassment and abuse represent only the tip of the proverbial

iceberg. While we are gladdened that both the Departments of Defense and Veterans Affairs seem now to be taking this seriously, even acknowledging sexual trauma as a crime in the Defense Authorization Act of 2005, there is still a long road

to travel to change the current atmosphere that conditions victims of sexual abuse

to not report this abuse to authorities. We urge Congress to call for a review of the

penalties for military sexual trauma under the Uniform Code of Military Justice to

determine if the penalties are commensurate with the offenses, and to act to ensure

uniform enforcement in all branches of the military.

VVA also shall seek, via legislation or regulation, to re-authorize the biennial report of the Advisory Committee on Women Veterans, to be submitted to the Secretary of Veterans Affairs for response and then to Members of Congress; and we

shall seek as well legislation to provide contract care, for up to 14 days post-delivery, for infants born to women veterans who receive delivery benefits through the

VA.

VA RESEARCH

Perhaps the coalition of Friends of VA Medical Care and Health Research endorsing a $48 million increase in appropriations for medical and prosthetics research—

and $45 million for facilities improvements—did not reach the right ears yet. It

should be clear to all, however, that the $13 million ‘‘hit’’ the VA research budget

will take if the Administration’s proposal is approved is unconscionable, particularly

in a time of war. Research may not reap immediate benefits, but research is critical

in finding answers to the unique medical problems of veterans, and treatments that

ease pain and save lives. The VA research program results in discoveries that advance the fields of mental and physical rehabilitation, increase research on blast injuries and burns, study means to improve the quality of health care delivery, and

continue investigation on addressing chronic diseases and their complications.

VVA urges a significant increase, not any decrease, in funding VA research. VVA

also calls for a separate line item of $25 million in Research & Development funds

to fund the National Vietnam Veterans Longitudinal Study ’NVVLS), with report

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language compelling the rapid resumption and early completion of this vital study.

(ee further explication below.)

AGENT ORANGE

Far too many in-country Vietnam veterans are afflicted with serious, life-threatening diseases at a relatively young age, diseases that we believe are borne of exposure to Agent Orange and other herbicides, defoliants, and desiccants during their

tour of duty in the jungles and rice paddies of Southeast Asia. Congress must provide the funds for study by reputable scientists into the long-term health effects of

dioxin, the culprit element in Agent Orange. Some of this research must focus on

the intergenerational effects of exposure on the children—and on future generations—of Vietnam veterans.

Even though VVA agrees that funds should no longer be expended on the flawed

Air Force Ranch Hand Study, we fully intend to work to ensure that the data

gleaned from this study, as well as the tissue samples, are properly stored and accessible for legitimate scientific study.

LUNG CANCER AND VETERANS

As the VA acknowledged in 1994, there is mounting evidence of a ‘‘positive association’’ between exposure to herbicides—like Agent Orange—and the subsequent

development of respiratory cancers. Additionally, a series of studies over the past

20 years has linked military service to higher smoking rates and smoking-related

diseases and deaths. Because lung cancer is usually not diagnosed until late stage,

making treatment costly and not very effective—the mortality rate for lung cancer

is 85 percent—VVA urges Congress to mandate that the VA institute an early detection and screening program for all veterans—and especially Vietnam veterans—at

high risk for this lethal cancer.

PROJECT 112/SHAD

VVA has been and will continue to work diligently to ensure the passage of The

Veterans’ Right to Know Commission Act ’H.R. 4259). This legislation, introduced by

Reps. Mike Thompson ’D-California) and Denny Rehberg ’R-Montana), would empower an independent commission to delve into the history and non-disclosure of information to American service members who participated in the testing of chemical

and biological substances as part of the Project 112/SHAD program.

This bill is about achieving justice for those Americans whose health may have

been compromised by toxic elements to which they were exposed. Most were exposed

unwittingly. The VA acknowledges that at least 70,000 service members may have

been exposed in tests that go back to the end of World War II. Those still living,

and the survivors of those no longer with us, should be provided with the information they need to resolve questions about their health, and to make claims for service-connected disabilities derived from their participation in these tests.

Additionally, the legislation entitling a veteran who was in one of the Project 112/

SHAD tests to medical services at the VA must be reauthorized and extended; and

we extend our thanks to Senator Brownback for his leadership in this realm. VVA

strongly recommends that the VA be required to issue a national protocol for these

physicals based on the agents, simulants, tracers, and decontaminants to which 112/

SHAD veterans were potentially exposed.

PTSD AND SUBSTANCE ABUSE

VVA believes that the National Vietnam Veterans Longitudinal Study ’NVVLS),

a follow-up to a study done some 20 years ago, must be funded—and the VA compelled to immediately re-initiate this statutorily mandated study and bring it to an

early and proper conclusion. The NVVLS represents the last best chance we have

of understanding the scope of the health of Vietnam veterans. Line-item funding for

this study and strong explicit report language are needed to compel the VA to fulfill

its responsibility to comply with the mandate set by Congress in Public Law 106-

419, The Veterans’ Benefits and Health Care Improvement Act of 2000.

Just as important, Congress must take the necessary steps to ensure that the organizational capacity and funding of the VA’s mental health programs for the diagnosis and treatment of the neuro-psychiatric wounds of war are restored to at least

the level of effort that existed in FY 1996. So many veterans of the fighting in Afghanistan and Iraq are returning home haunted by their experiences. We do a disservice to them if we do not provide the necessary mental health services that they

require.

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As all of us are aware, PTSD has been a hot topic of late. The 108th Congress

authorized and funded the Veterans’ Disability Benefits Commission to research and

make recommendations as to how service-connected disability compensation is adjudicated, if the manner in which the VA adjudicates claims is in accord with the intent and will of Congress. The very existence of this commission, combined with the

VA’s ill-advised—and now revoked—decision to conduct a retrospective review of

some 72,000 cases in which veterans were granted 100 percent disability compensation for PTSD, has left many veterans fearing that their benefits will somehow be

reduced or taken away.

The VA is obliged to use as a guidepost for the diagnosis of PTSD the mental

health standards set forth in the current edition of the Diagnostic and Statistical

Manual of the American Psychiatric Association. VVA believes strongly that if VA

adjudicators are properly trained and supervised, if they follow the VA’s own ‘‘Best

Practices’’ manual, the hubbub surrounding the variation in awards for PTSD would

be silenced. The VA specifically and firmly refuses to utilize its own ‘‘Best Practices’’

for PTSD adjudication. Now, 4 years after the completion of the manual, and having

refused to use it to train clinical or adjudication staff, or to issue a directive on its

use—or to even distribute a copy of the manual—the VA is awaiting the results of

a study by the Institute of Medicine to let VA officials know if how they adjudicate

PTSD claims is the ‘‘gold standard’’ or if they need to do things differently. We have

been monitoring this closely, and we will continue to monitor it to ensure that veterans whose lives have never been quite the same since they came home from a

war—from a jungle or desert or rice paddy or metropolis—are protected from any

undue or hasty changes in the rules.

EMPLOYMENT, TRAINING, AND BUSINESS OPPORTUNITIES

VVA will continue to work to ensure that all provisions of executive orders, public

laws, and legislation pertaining to the employment, training, and business opportunities for all veterans, and especially for service-disabled veterans, be enforced.

State, local, and Federal agencies that work diligently to meet the spirit and intent

of these provisions should be rewarded; any attempts to weaken the provisions

should receive appropriate sanctions.

For the Secretary of Labor to continue to implement the Jobs for Veterans Act

as it has been is astonishing. A recent Government Accountability Office report is

far too kind to the Department of Labor, which has made no progress in the past

3 years to put in place a system to gather information to learn if the Jobs for Veterans Act is actually working and meeting the intent of Congress. In fact, the DOL

has done nothing of consequence to implement ‘‘priority of service’’ for veterans, particularly disabled veterans and returning service members.

In fact, there is no real national strategy to assist returning veterans, including

National Guard and Reservists, who are unemployed or under-employed—and some

15 percent of our newest veterans have yet to find gainful employment. Similarly,

there is no effective mechanism in place for enforcing veterans’ preference, and we

have an Administration that appeals a case against a disabled veteran who had finally won his case before the Merit System Protection Board pursuant to The Veterans Employment Opportunities Act of 1998.

It is imperative that re-education and work skills upgrades, including self-employment, be made a priority by those agencies of government that provide these services, especially considering the battalions of seriously and permanently disabled veterans returning from Afghanistan and Iraq.

Additionally, VVA implores Congress to begin an investigation into the disparities

of the Compensated Work Therapy programs in the Veterans Health Administration, which we believe is just not doing the job they were created to do, of creating

a bridge to permanent employment.

HOMELESS VETERANS

It is a national scandal that so many men—and, increasingly, women—who have

served our nation now do not have a roof over their head, a place to call home. Although there are many reasons that have caused them to become homeless, they

deserve our best efforts to help them salvage their lives.

Public Law 107–95, The Homeless Veterans Assistance Act of 2000, must be sufficiently funded and its provisions fully implemented—including the maximum appropriations stipulated in a variety of homeless assistance programs. Furthermore, we

believe that congressional action is necessary to readdress what has emerged as a

difficulty: VA Homeless Grant and Per Diem funding must be considered a payment

rather than a reimbursement for expenses, an important change that will enable the

community-based organizations that deliver the majority of these services to operate

24

1The VVA 2006 Legislative Agenda & Policy Initiatives brochure can be found in the Appendix section on page 43.

effectively and to require that the Department of Housing and Urban Development

comply with section 12 of P.L. 107–95 authorizing 500, additional HUD/VASH

vouchers in fiscal year 2003, fiscal year 2004, fiscal year 2005 and fiscal year 2006.

HUD acknowledges in a letter of December 5, that these funds have not been appropriated and that housing needs of homeless American is one of the top priorities,

of the department, if this is so, then why are they leaving about 2,000 homeless veterans’ without the most vial resources they need a safe and secure place to live by

not asking Congress to appropriate these vouchers.

COMPENSATION AND PENSION

To promote uniform claims decisions, current policy must be changed to permit

VA staff and VSO service representatives to collaborate in developing uniform training materials, programs, and competency-based re-certification exams.

VVA also seeks to secure a pension for Gold Star parents, many of whom are in

dire financial straits and have lost the son or daughter who might have been able

to assist them in their old age.

For currently deployed or soon-to-be deployed troops, VVA believes that greater

financial protections are warranted for their security and the security of their loved

ones. For the survivors of those who die in military service, we seek a permanent

prohibition of offsets of Survivor’s Benefit Plan and Dependency & Indemnity Compensation.

Finally, a change in the law is necessary to permit service members wounded in

combat and placed on temporary disability status to be considered as remaining on

active duty for the purpose of computing leave and retirement benefits.

A NEW GENERATION OF VETERANS

The force readiness plan being developed by the Pentagon at the behest of Congress must include a full medical examination, to include a blood draw and a psychosocial history by a qualified clinician, for all troops prior to their deployment

overseas and upon their redeployment.

Because our newest veterans appear to be suffering the psychological stresses and

disorders in far greater numbers than even we of the Vietnam generation, it is imperative that a system of acute stress counseling and PTSD counseling be emplaced,

a system funded by DoD and delivered by VA personnel and private practitioners.

This counseling must be made available to Reservists and members of the National

Guard and their families in addition to active-duty troops.

POW/MIA

The fullest possible accounting of the fate of American service members who had

been Prisoners of War or who had been declared Missing in Action has long been

a keynote of Vietnam Veterans of America. To further VVA’s long-standing efforts

in this regard, we urge Congress to appropriate additional funds to put more teams

on the ground to conduct searches for remains in Vietnam, Laos, and Cambodia.

VVA also urges that all documents relevant to the status of POW/MIAs be declassified and released to the public; and we ask Congress to pass a resolution urging

the government of Vietnam to provide all relevant wartime records and to continue

to repatriate the remains of American service members that have been recovered.

Finally, we seek funding for a public awareness program to inform all the families

of those still listed as POW/MIA of the need to provide DNA family reference samples for potential identification of recovered remains.

To lose a son or daughter, father or sister or mother or brother is difficult enough

for families to deal with. To not know the fate of their loved ones places these families in emotional limbo. We must do all that we can to bring closure to them. And

to all of us.

Attach please find as an addendum the VVA 2006 Legislative Agenda & Policy

Initiatives brochure.1

Thank You.

To conclude, the members and their families of Vietnam Veterans of America, and

the Associates of Vietnam Veterans of America, thank all of you in Congress who

have served our nation, and those of you who continue to serve veterans and their

families as Members of this Committee. I will be more happy to answer any question you may have.

25

Chairman CRAIG. John, thank you very much for that testimony

for the record.

Now let me turn to Ed Kemp, National Commander, AMVETS.

Welcome before the Committee.

STATEMENT OF EDWARD W. KEMP, NATIONAL COMMANDER,

AMVETS

Mr. KEMP. Thank you, sir.

Mr. Chairman, Members of the Committee, this distinguished

Committee has a fine tradition of working in a bipartisan manner

and is a real example of how members of opposing parties and opposing views can work together to reach a common goal. I thank

you for your support of veterans.

We are here today to speak about issues that are near and dear

to us, but most importantly, we are here to let the Senate know

that we mean business when we say veterans deserve the benefits

they were promised when they put on the uniform. AMVETS is

concerned about future veterans’ benefits, so we are doing something about this.

This October, AMVETS is holding a national symposium for

needs of young veterans in Chicago. The symposium’s goal is to

draw attention to the challenges of modernizing VA benefits specifically for younger veterans.

Just before Veterans Day this November, we will publish an action plan that will define and prioritize the steps needed to bring

VA into the 21st century. We ask for your support in this endeavor.

The need for this forum could not be more timely, given that we

have a new generation of brave Americans deployed around the

world. VA has seen more and more younger veterans, a lot of them

from OEF and OIF.

I just got back from a trip to Iraq. When I talked to the troops,

not one single soldier had a negative thing to say about their mission. Our soldiers are there to do a job and are confident that they

will win and restore order, but they need assurance that VA is

there for them. No serviceman in harm’s way should ever question

the Nation’s commitment to veterans, but as things now stand, veterans are continuing to suffer because the system they depend on

has been routinely underfunded.

Members of the Senate, you are provided with a benefit that you

earned representing the people. I would imagine that you would

never vote for any bill that would underfund those benefits. We ask

that you do the same for veterans.

VA budget for fiscal year 2007 still falls short, and like most

years, funding may be late or delayed. We feel the best way to ensure stable and dependable funding of VA is to make it mandatory.

That way, there is never a question of how much or when funds

will be in place. Our Nation’s veterans deserve nothing less.

Mr. Chairman, you said you would want to begin a serious dialogue on how to best develop sustainable and long-term VA budgets. We are here to help you attain that mission. We appreciate

your leadership and look forward to working with you on this.

Another issue that needs our immediate attention is the growing

backlog of claims. Many claims processors are retiring and being

replaced with less experienced ones. This type of job requires

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months of training and years of experience to fully understand the

system. VBA needs to hire and train additional full-time employees, not cut them, but you can only do so if the Senate does its

part. We need your help in getting the funds.

AMVETS supports legislation that awards a military service

medal to Cold War veterans. We were disappointed that the service

metal was not passed last year. We encourage you to pass it this

year.

AMVETS will not waiver on its efforts to protect the flag from

being dishonored. We believe our children and grandchildren

should be raised patriots full of respect for the flag and the constitutional values it represents. Senate Majority Leader Frisk

promised us that the flag amendment would come before the Senate in June. We urge you to stand up and support our veterans on

this important bill.

AMVETS also wants the fullest possible accounting of our missing service personnel. We ask for your support in funding and identifying the remains.

One last point concerns the Joint Session Committee on Veterans’ Affairs. AMVETS feels that the tradition of the Joint Session

should continue. We encourage you to talk to your counterpart in

the House and ask him to re-instate the Joint Session.

I would like to invite everyone here to attend our reception tonight at 5:30 in room 369 in the Rayburn House Office Building.

This concludes my testimony, and I thank you for allowing me

to testify and for your support of veterans.

[The prepared statement of Mr. Kemp follows:]

PREPARED STATEMENT OF EDWARD W. KEMP, NATIONAL COMMANDER, AMVETS

Chairman Craig, Ranking Member Akaka and Members of the Senate Veterans’

Affairs Committee. I am Edward W. Kemp, national commander of AMVETS, and

it is my honor to present to you our legislative agenda for 2006. On behalf of

AMVETS, the AMVETS Ladies Auxiliary, the Sons of AMVETS and our other subsidiary organizations, thank you for giving us this opportunity.

I am from the great state of Iowa and proudly joined AMVETS in 1982. For more

than 60 years, this organization has taken to heart the doctrine of service set forth

by its founders. In so doing, we endeavor to provide our fellow veterans with the

type of support they truly deserve. This outreach effort takes many forms, from the

professional advice of our service officers, to our legislative efforts on Capitol Hill,

to the work done by our hospital volunteers. Other AMVETS members involve

themselves in a wide range of initiatives aimed at contributing to the quality of life

in their local communities. These two areas—veterans service and community service—drive our commitment to make a difference in the lives of others.

Before presenting our agenda for this year, I’d like to speak for a moment about

an ambitious project we are working on, and kindly ask for your support. AMVETS

is hosting a National Symposium For the Needs of Young Veterans this October in

Chicago, Illinois. The Symposium—the first of its kind—is designed to draw attention to the critical challenge of modernizing the VA benefits system. We will bring

together a diverse array of veterans and speakers to examine what changes are

needed to make the system more responsive to veterans. The Symposium will publish an action plan that will define, describe and prioritize the steps needed to provide a modern benefits program and an effective delivery system. I am very pleased

that General Tommy Franks has agreed to keynote the Symposium. Given his distinguished career of military service and recent experiences in Iraq and Afghanistan, General Franks is ideally suited to talk about the need to ensure our nation

keeps its promise to those who serve.

We are well underway, but I ask for your help in making the Symposium a successful endeavor. I’d also like to thank our co-chairs, former VA Secretary Anthony

Principi and AMVETS Past National Commander Bill Boettcher for keeping our

agenda on a straight and true course.

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Mr. Chairman, the timing of this important forum could not be more relevant,

given that we have a new generation of brave Americans once again deployed

around the world, answering the nation’s call to arms. Our soldiers are doing everything right, everything that we ask of them and much more. Our country fights, not

for land or fortune, but for freedom. In past conflicts, America has fought to secure

liberty, abolish slavery, and crush communism. Our cause today is equally just. We

are fighting to conquer those evil forces who would rule by fear and, in the process,

are helping to spread freedom and democracy around the world.

In mid-February, I had the unique opportunity to go to Iraq with my colleagues

in the veterans community. It is an experience I will never forget. I met and talked

with U.S. and British generals, Iraqi officers and dozens of front-line soldiers. The

most amazing part of my trip was not one soldier had a negative thing to say about

being there. Despite all we hear and read in the news, our soldiers are there to do

a job, and are confident they will win and restore order. I am extremely proud of

them. Without a doubt they are the most dedicated, courageous and passionate

troops in the world, and I want each of them to know that I appreciate all they do

to protect the freedoms I enjoy as an American. God bless them all.

Almost half of the military servicemen and women returning from operations

overseas will need healthcare services for the physical and psychological traumas

of war that may never heal. Seventeen percent of them, in fact, have been diagnosed

with post-traumatic stress disorder. I encourage you to go and visit these injured

soldiers. Talk with them and listen to what they have to say. You will leave with

a renewed perspective of your obligations to veterans. We are spending $6.8 billion a month for operations in Afghanistan and Iraq, yet

trying to nickel and dime veterans’ health care here at home. This year alone, the

President is expected to request an additional $92.2 billion for the war. We certainly

support additional monies to support our troops, but I can’t understand why there

is never enough to fully fund VA. If Congress can find nearly a hundred billion more

for these operations, I believe it should be able to come up with enough money to

totally care for those charged with carrying them out.

As things now stand, our veterans are continuing to suffer because the system

they depend on has been routinely underfunded and is now ill equipped to handle

the large influx of those waiting and wanting to use its services. I ask you to take

a look at what the real needs are. These are real people with real needs. They

should not be subject to political accounting games or petty disputes.

As Members of the United States Senate, you are provided with certain benefits—

paid for at taxpayer expense—that you earn as representatives of the people. I

would imagine that you would never vote for any proposal or initiative that would

underfund or undermine the integrity of that delivery system. We ask that you do

the same for veterans.

For 20 years, AMVETS—together with the Disabled American Veterans, the Paralyzed Veterans of America, and the Veterans of Foreign Wars—have co-authored

The Independent Budget, our blueprint for building the kind of programs veterans

deserve. Indeed, we are proud that more than 60 veteran, military and medical service organizations endorse these recommendations. We believe it is a balanced and

responsible analysis of VA’s funding requirements. In years past, however, budget

requests fell woefully short of our recommendations, and we all know about last

year’s funding shortfall. If that crisis didn’t do anything else, at least it validated

The Independent Budget recommendations. The IB was right on target, and I ask

that you follow our recommendations this fiscal year. We were right then, and we

are right now.

Looking at the administration’s VA request for fiscal year 2007, I must say it is

much better than last year’s pitiful recommended increase of $110 million. This

year, thanks in large measure to the leadership and commitment of this Committee,

VA fared better. The request, however, still falls short.

We recommend Congress provide $32.4 billion to fund VA medical care, approximately $1 billion over the President’s request, without collections. We ask that you

recognize that the VA healthcare system can only provide quality health care if it

receives adequate and timely funding.

As the Senate moves forward in the budget process, we ask that you not divert

precious monies already scheduled for VA medical centers, construction projects and

other purposes. We understand the total devastation in Louisiana and Mississippi,

and we fully support the rebuilding and reconstruction efforts there. But we do not

support re-routing funds that have already been approved for VA projects. This policy is taking a step backwards. Fund the emergency with emergency funds, not VA

monies.

As you understand, Mr. Chairman, it is very difficult to manage programs as complex as those within VA based solely on current fiscal-year appropriations. It is our

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hope that we can work with you and the Committee to create a process that brings

increased consistency to VA’s budgetary requirements by recognizing the need for

a more efficient fiscal plan. Frankly, the current system of funding veterans’ health

care is broken. It doesn’t work. AMVETS will continue to pursue legislation with

eight VSO partners for assured, or mandatory, funding of VA’s healthcare system.

Under the current process, VA health care competes with other non-veterans priorities for adequate appropriations. Over the years, this process has proven to be

unsatisfactory in adequately providing for the needs of enrolled veterans. Shifting

to a mandatory funding system will provide a stable and timely system of funding

for VA. Mr. Chairman, we understand your position on this issue, but we ask that

you begin a serious dialogue to explore alternative ways to fund VA. Compromise

is the cornerstone of this democracy, and we are certainly willing to work with you

to find a way to make VA funding more stable.

While assured funding remains our core legislative goal and objective, there are

several other areas we believe the Committee needs to address this year. Let me

briefly discuss them.

AMVETS believes increasing TRICARE premiums and deductibles will have a

negative impact on military retirees. While we understand that health care costs are

on the rise, DoD health care programs are part of the on-going cost of war. Our Nation’s military retirees have given so much to this country. They deserve fair treatment.

No veteran leaving military service should fall through the bureaucratic cracks.

AMVETS believes DoD and VA have no greater responsibility than to properly care

for returning soldiers and provide as many tools as possible to assist them in settling back into civilian life. For some war wounded and their families, navigating

between these systems is pure frustration. In order to provide a seamless transition,

AMVETS recommends that veterans’ basic service information, as contained in the

DD–214, be made available electronically—and we ask that you explore ways to

make this possible.

I do not think we realize how fortunate we are as a nation to have a highly skilled

veteran population able to lend its talents to the workforce. Veterans have the skills

that make them assets in a variety of occupations. Leadership, integrity, and teamwork—all of which the military teaches—are universal qualities for every industry.

While the Senate has done a good job in reauthorizing training, education and job

programs, I encourage you to take a look at the Transition Assistance Program

’TAP) and other related programs to ensure all our returning troops get the assistance they need. DoD discharges approximately 25,000 service members annually.

Recently separated service personnel are likely to seek immediate employment or

continue their formal vocational education. But they need to know all that’s available to them.

The Department of Defense estimates that 68 percent of separating service members attend the full TAP seminars, but only 35 percent of the Reserve Components

attend. Countless numbers of National Guard and Reserve troops return from the

war only to encounter difficulties with their Federal and civilian employers at home.

AMVETS encourages you to explore ways to make TAP participation mandatory for

active duty military as well as for those in the Guard and Reserves.

While speaking about returning troops, we ask that you continue to adequately

fund the Department of Labor’s Disabled Veterans’ Outreach Program ’DVOP) and

the Local Veterans’ Employment Representatives ’LVER) Program. Through the implementation of these programs, DOL–VETS assists, not only veterans, but also

helps reservists and Guard members in securing employment and protecting their

re-employment rights and benefits.

Furthermore, AMVETS asks you to closely monitor legislative attempts to consolidate and block grant the DVOP and LVER programs. We firmly believe that this

type of veteran-oriented program should remain separate and distinct to ensure that

these brave men and women are given the assistance their country owes them for

their military service. It would be a grave error to downgrade employment services

that specifically help troops returning to the country they fought to defend.

For decades, DVOPs and LVERs have been the foundation of employment services

for veterans. We believe it is important that states continue to be required to hire

veterans for these positions. One example of just how important it is for veterans

to advocate for veterans exists within our own organization.

The AMVETS Department of Ohio developed and fully operates a 501’c)’3) career

center designed to assist veterans in their career needs. The AMVETS Career Center provides a range of services to help veterans find employment in a substantial

career, or assists them in refreshing and/or upgrading their skills. The Center, for

instance, can help a veteran learn more about computers, business math, business

grammar, business management, word processing or database management. It proVerDate 11-MAY-2000 13:19 Sep 14, 2006 Jkt 028177 PO 00000 Frm 00032 Fmt 6633 Sfmt 6621 C:\VA\28177.TXT CarolB PsN: CarolB
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vides these services to veterans who are homeless, unemployed or underemployed;

to those who want to prepare for a new career or better job; and to recently separated veterans making the transition to the civilian workforce. The center also provides services to non-veterans from the community for a small fee of $50.00. There

is no cost to the veteran.

Regarding claims, AMVETS is very concerned about the growing backlog that

leaves many veterans without due compensation. Veterans Benefits Administration

’VBA) budgets have routinely come up short and can’t stretch to cover the needs.

Many claims processors are retiring and being replaced by those less experienced

who require years of training. This is no ordinary job. It requires months of training

and years of experience to fully understand and navigate the system. If VBA is

going to reduce the claims backlog to zero, VBA needs to hire and train additional

fulltime employees. But it can only do this if the Senate does its part. We need your

help to get the funds.

AMVETS supports legislation that would award a military service medal to members of the Armed Forces who served honorably during the Cold War Era. We are

disappointed that the Cold War Service Medal did not survive the House-Senate

conference on the fiscal year 2006 National Defense Authorization Act. Presidents

going back to Truman have recognized the significance of the Cold War. By creating

the Cold War Victory Medal, this nation would certainly demonstrate its great respect and appreciation for the men and women who carried the burden of this policy.

For veterans, though, one issue transcends all others. It involves the desecration

of the United States flag. AMVETS will not waiver in its efforts to protect the flag

from being dishonored. As a member of the Citizens Flag Alliance, we continue to

strongly support a constitutional amendment to protect our most sacred symbol. But

the flag is much more than a piece of cloth that drapes the coffins of those who died

so others might live; that covers the bodies of first-responders who gave their lives

in the line of duty; and that flies at half mast in recognition of honorable Americans.

Indeed, the flag stands for all that is good about our country and the values on

which it was founded.

All 50 state legislatures have passed resolutions asking Congress to submit the

flag amendment for ratification. More than 80 percent of the American people support such an amendment. If someone desecrated the Halls of Congress, the Lincoln

Memorial, or any other of our national monuments, lawful action would be taken

against the offenders. We ask nothing less for our flag. We now ask you, our Senators, to stand up and be counted and bring the flag protection bill to the Senate

floor as soon as possible.

Additionally, as the Committee is aware, there is a growing need for long-term

care in VA. Veterans 85 years and older, who are in most need of these services,

are expected to total 1.3 million over the next decade. With the sharp increase in

the projected number of elderly veterans, AMVETS believes that VA’s extended care

services are indispensable to its overall mission in providing veteran health care.

We urge you to explore the challenge ahead for providing long-term assistance to

veterans. And we seek action that will provide enrolled veterans with affordable access to a continuum of extended care services that include nursing home care and

domiciliary care, as well as home and community-based extended care services. This

way we can assure improved healthcare delivery and enhance the measure of care

for elderly veteran patients.

I would be remiss if I did not mention and acknowledge the fine work VA nurses

provide to wounded veterans. VA nurses care for more than 5 million American veterans nationwide. The Veterans Healthy Administration ’VHA) has the largest nursing workforce in the country with nearly 59,000 registered nurses, licensed practical

nurses, and other nursing personnel. But VA staffing levels are so precarious that

even the loss of a single nurse can result in a critical staffing shortage. Veterans

are much more comfortable receiving treatment from nurses who understand their

service; who speak the same language; and who know what they went through.

AMVETS encourages this Committee and VA to actively address the factors known

to affect recruitment and retention of VA nurses.

We also want the fullest possible accounting of our missing service personnel and

ask for your support in finding and identifying their remains. This is important. It

is a duty we owe the families of those still missing—and an endeavor that honors

the value of an American’s service to the nation.

AMVETS understands many Gulf War and younger veterans are reporting illnesses stemming from weapons containing depleted uranium ’DU). This material

can remain in the human body for decades, if not life, causing cancers and other

unknown illnesses. AMVETS encourages Congress to pass H.R. 4183 and H.R. 4184,

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which would locate, assist, and compensate veterans affected by exposure to DU,

and help them file a claim.

Lastly, just as we care for veterans when they are alive, we must not forget them

when they die. We need to ensure that our national cemeteries remain dignified and

respectful settings for honoring deceased veterans. We are encouraged that the administration earmarked $28 million for the National Shrine Commitment, and we

are thankful for the recommended increases above that figure. The National Cemetery Administration ’NCA) has done a tremendous job of improving the character

and condition of our nation’s cemeteries, but we have a long way to go to get us

where we need to be. AMVETS also feels it is time to review a series of burial benefits that seriously eroded in value over time. With a few modest adjustments, these

benefits will make a more meaningful contribution to the burial costs for our veterans.

Our commitment to make a difference in the lives of others, though, doesn’t stop

there. Since its inception in the 1950s, for example, the AMVETS National Scholarship Program has awarded more than $2 million in scholarships to graduating high

school students. And for the past 17 years, AMVETS has sponsored a youth leadership program in cooperation with Freedoms Foundation at Valley Forge, Pennsylvania, that has served more than 700 youth to date. At VA, AMVETS is proud to

serve on the National Advisory Committee of Veterans Affairs Voluntary Service

Program. Last year, more than 3,000 AMVETS, Ladies Auxiliary and Sons volunteers tallied over 200,000 hours of voluntary service at 146 VA Medical Centers. In

addition, some 10,000 AMVETS from across the country invested more than 700,000

hours in helping veterans and providing an array of community services to enhance

the quality of life for our nation’s citizens. I am pleased to report that based on The

Independent Sector statistics, AMVETS provided in excess of $23 million in voluntary service to the local community.

One last point I’ll mention, Mr. Chairman, concerns the Joint Session of the Committees on Veterans’ Affairs. First, we thank you for extending us the opportunity

to appear before you today and we thank the Members of the House who are

present here. We feel, however, that the long-standing tradition of the Joint Session

should continue. We believe it is a more efficient and valuable way of presenting

our agenda to Congress. A Joint Session provides you the opportunity to address

the many constituents who are present from your respective States, and it provides

AMVETS members with the opportunity to see their elected officials respond to

issues important to them. We encourage you to talk with your counterpart in the

House and ask him to reconsider his decision. Great decisions and challenges await

us in the months ahead. The membership of AMVETS looks forward to working

with you to establish a clear policy of national recognition for those who serve. We

have much to do, but we are encouraged in knowing that our work will help the

heroes who have borne the battle and lived to tell about it.

This concludes my testimony. Again, thank you for extending me the opportunity

to appear before you today, and thank you for your support of veterans. I hope all

of you will be able to join us tonight for our annual congressional reception and Silver Helmet presentation to The Honorable Bob Filner of California, to be held in

room B–369 of the Rayburn House Office Building from 5:30 to 7:00 p.m.

Thank you.

Chairman CRAIG. Ed, thank you very much for that testimony.

I am going to ask a series of questions. I may direct it at any

one of you, but if others feel they can add to it or have something

to say specific to that question, please do so. Many of you have expressed your concerns about VA claim processing, and I think we

all have that concern about its timeliness and its responsiveness.

George, you mentioned in your testimony that State Veterans’

Affairs Departments can give help in VA claims processing. Could

you please explain what types of help could be forthcoming and

what efforts might be provided at the level that you are responsible

for?

Mr. BASHER. Yes, sir. When the claim is processed, initially most

claims are filed, and if you look at the Inspector General’s report

that came out last summer, claims that veterans file that are not

represented by any service organization, State organization, or

county organization, the average annual award totaled something

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around $3,200 a year. Any representation for a veteran filing a

claim resulted in an annual award of $10,500 a year. So there is

a terrific spread in the level of benefits received whether or not you

are represented.

The front end of the claim process, essentially the outreach, the

development of the claim, the gathering of the story, and the evidentiary documents is all part and parcel of what State organizations, service organizations, and county service officers provide.

Submitting that claim package in an organized logical manner to

the VA and then letting them make the determination of service

connection and a subsequent award seems to me to be a logical division of work, but under the current regulations and current process, essentially VA picks up that pile of paper that we have submitted, starts all over again gathering the same evidence, developing the same story, and then coming to the same conclusion

again, which is to my mind a very inefficient process.

There are 4,000 people working in State and local government

who are accredited to do benefits claims or support people who are

accredited. VBA has got about 8,500 people processing benefit

claims nationwide. So it seems to me to be sensible to leverage

those State and local government employees with the Federal employees to make it a seamless process that expedites the whole deal

instead of some places doing the work twice.

Yes, John.

Mr. ROWAN. Yes, Mr. Chairman. One of the other problems, quite

frankly, is the antiquated structure that the VA processing is. It

is still all paper, pen and paper. It’s amazing the counterbalance

between the VBA and the VHA. Here you have got on the health

care side this wonderful computer system where I can walk into

any VA hospital in the country and they can punch up my records

and tell me exactly what my health care looks like, whereas the

VBA can’t do anything like that.

I went through a training for virtual reality of VA, a Virtual VA

that they have been talking about proposing over a year and a half

ago that has not even been close to seeing the light of day. They

have got to get away from that paper and put it back into a scan

system. Before I retired, I worked for the controller of the city of

New York and I worked in contracts administration. I was able to

read 1,500-page contracts in about 2 minutes using a scan system,

a computer system, and a data base that I could pull up, and I

can’t see why the VA can’t do the same. I understand it is a capital

expense to try to get that system up and running, but the cost savings over time and, more importantly, the savings to the veteran

of anguish of waiting for the return on their claim is worth whatever money it takes up front.

Chairman CRAIG. As all of you currently know, a veteran is not

permitted to hire an attorney to assist in filing claims for VA benefits. A recent editorial in the Washington Post posed this question:

If American soldiers are mature and responsible enough to choose

to risk their lives for their country, shouldn’t they be considered

competent to hire an attorney where necessary? How would you answer that question? Would any of you like to respond to that?

John.

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Mr. ROWAN. I will leap into the breach. Quite frankly, Mr. Chairman, lawyers are nice, but unless the lawyer is trained in the veterans’ benefits field, frankly all of the people that work for all of

the people sitting at this table and all of the people in the other

VSOs and the county agencies and everybody else, they may not

have gone to law school, but their knowledge of the system is better than any lawyer that I know of. That is the issue that needs

to be done. Those people are really good at what they do.

I think George’s point is well taken.

Chairman CRAIG. John, I was just going to say I am sure your

comments were not taken as anti-lawyer, not that I am one, because I am not, but please comment about what George has talked

about, because that is a level of expertise that if it is being relatively ignored at this moment doesn’t seem to make a lot of sense.

Mr. ROWAN. I don’t think it is so much ignored. I mean, George

has a better viewpoint of that than I do, but the problem is, again,

the structural system that the VA works in, and I guess it is a

legal mandate that they have to verify everything that is handed

to them, and I understand that, but I think if we had a better way

of flowing the information in, if the Veterans Service Officers were

able to utilize computers today to be able to do the work that they

were doing, and I am sure George, I know—I happen to come from

New York where George is, and I know his system and his people

can utilize computers quite well. They could have all of that data

and everything entered into a system that could be easily accessed

by an adjudicator inside the VA if it was able to be electronically

filed.

We do it for taxes. We do it for everything under the sun. Federal procurement, I know is all done that way because, again, I

used to be a procurement person. If we can do that with $10 billion

worth of contracts, we can do it with the VA system of filing

claims.

Chairman CRAIG. Thank you. My time is up.

Let me turn to Senator Akaka. We have been joined by Senator

Obama. Danny, I have got to step out and meet with folks. I will

be back. Why don’t you finish your round and turn it over to the

Senator, if you would.

Thank you.

Senator AKAKA. Thank you, Mr. Chairman.

Mr. Rowan, I want you to know that I really appreciate your candid comments about what we need to focus on to help Vietnam veterans and all veterans. You raise an excellent point regarding staffing for VBA. I have been working to address this issue for several

years now as a Member of the Homeland Security and Governmental Affairs Committee where I serve as Ranking Member on

the Oversight of Government Management Subcommittee with

Senator Voinovich.

You can be assured that I will continue to address this matter,

and I want to say that if you have further comments regarding this

matter, I welcome them.

Yes, George.

Mr. BASHER. Senator, with respect to the staffing levels at VBA,

when they have retirements, it is not necessarily you are hiring to

backfill those jobs. It is a three-tiered process, basically. Your senVerDate 11-MAY-2000 13:19 Sep 14, 2006 Jkt 028177 PO 00000 Frm 00036 Fmt 6633 Sfmt 6601 C:\VA\28177.TXT CarolB PsN: CarolB
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ior people who leave tend to be the rating specialists who have the

most knowledge and the most expertise and the most demand on

them, and when they retire, those positions are backfilled by service reps who typically do development and the mid-level work, and

when they get promoted, they are then backfilled by people who

are doing triage and mail room work and phone unit work and essentially entry-level jobs.

So when VA has to fill a gap due to retirement, they are actually

training in three different tiers simultaneously and essentially taking the best people they have left in the unit to train at all three

levels. So it really is a difficult process and it should be done on

a continuing basis, not just when, oh, my god; we have got a crisis

and we have got to fill it today. If you hired them today, it will still

take 3 to 5 years to get them up to speed.

Senator AKAKA. Well, Mr. Basher, we are talking about a growing problem in our Nation, and that is replacing people with other

good personnel, and it is something that this Committee, that I

mentioned that I am on, is really looking at and throughout our

system, Federal system, we really have to do something about this,

and all together, all of us, have to join in on trying to take care

of this problem.

Commander Kemp, while I still have some time, in your testimony, you address the large numbers of returning veterans who

are suffering from readjustment issues or more debilitating PTSD.

Unfortunately, we know that in some cases, service members are

reticent to seek help for mental health care because of the stigma,

the stigma attached to mental illness. Do you or any of you other

witnesses have insight on what can be done to encourage service

members and veterans to seek mental health care?

Mr. KEMP. Yes, sir. AMVETS, we have in place right now for the

National Garden and State personnel coming back, we have a predeployment briefing and a post-deployment, and that is to get them

into the system so they are in the system. We also have outreach

to the family so that they can start to recognize some of these

issues that come up prior to it getting to be an emergency, and that

is what AMVETS is doing for the veterans coming back.

Senator AKAKA. Mr. Rowan.

Mr. ROWAN. If I might add, I heard during our meetings with the

various elected officials over the last few years that there was some

talk about extending the 2-year free VA to 5 years. We believe that

is an important issue because we know from the history, unfortunately, from Vietnam Vets, the first 5 years were very crucial when

it came to PTSD to determine whether or not somebody committed

suicide. Most of the suicides involved with the Vietnam Veterans,

which were usually PTSD-related, occurred within the first 5 years

of their coming home, and we all know—everybody that has been

in the service—it takes you a couple of years to debrief, basically,

and come back into the civilian world and just try to understand

what it is you need to deal with in your life.

So if they are in the system, and that gets to the Category 8 and

7 issue to some extent, if they are in the system, they will get the

information they need to come back into the system and to get the

health care and help that they need when they need it.

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Senator AKAKA. I just want to mention that I authored the legislation which would extend the 2-year period to 5 years, and I am

so glad to hear what you just mentioned. We are finding that PTSD

help really is needed within the period when they return and become veterans, at least the first 5 years. So I am glad to hear you

mention it, and I will continue to work to enact this bill.

My time has expired, Mr. Chairman.

Chairman CRAIG. Senator, thank you very much.

Now let me turn to Senator Obama. Welcome.

STATEMENT OF HON. BARACK OBAMA,

U.S. SENATOR FROM ILLINOIS

Senator OBAMA. Thank you very much, Mr. Chairman, and

thanks to not just the panelists, but to all the veterans in the room

for your outstanding service to our country. We greatly appreciate

it.

You know, I have been so impressed by the work that the VSOs

have done to make sure that veterans are being properly served at

every level of government. I particularly appreciate the work that

you have done, helping to cut through VA red tape when it comes

to issues like the claims processing. Some of you are aware that in

Illinois, we have had some problems with respect to disability payments, speed of claims being turned around. There has been a

sense that many have been shortchanged, and so I just am grateful

to all of you for the outstanding work that you have done.

I just have a couple of questions because several of my questions

have already been answered. The first one—and anybody can take

a stab at it—Mr. Rowan, if you want to start off, the VBA has been

very active in assistance to homeless vets, many of whom served

in Vietnam. We know that a lot of the problems that homeless vets

face have a mental health component as well as a lack of job training and access to jobs. I understand that some community-based

organizations serving homeless veterans are doing excellent work

in integrated housing assistance with job training and mental

health assistance and treatment. I am wondering if you could just

talk a little bit about some of the programs that you have seen that

have been most successful and how we can expand on those programs and scale up to meet the enormous need.

Mr. ROWAN. Yes, Senator. It is good to see you.

When we first got involved with homeless veterans, and I was involved in this very early on in 1983 when, frankly, the controller

of the city of New York did a study of homelessness and found all

these veterans in the system and couldn’t believe it. We kind of differed from some of the homeless advocates. It wasn’t just about

housing. We, frankly, believed that it was about getting services,

and you are correct. Many of them were PTSD people, people with

problems, addiction issues which are often, again, related to PTSD

amongst the Vietnam Veterans, and we have seen that, unfortunately, in the more recent veterans as well.

So it wasn’t just housing them. You had to treat them with social

services, rehabilitation programs, detox programs if necessary. One

of the problems we have seen in the VA is the alcohol and substance abuse programs that disappeared when the budget got cut.

The first thing the VISN directors cut was all the alcohol and subVerDate 11-MAY-2000 13:19 Sep 14, 2006 Jkt 028177 PO 00000 Frm 00038 Fmt 6633 Sfmt 6601 C:\VA\28177.TXT CarolB PsN: CarolB
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stance abuse services. Bad move. It is what created the homeless

group in the first place.

We see that today still and we see the high unemployment

amongst the new veterans, which is very disturbing to us. It, again,

reminds me of a flashback to the seventies when we had trouble

with the Vietnam Veterans’ high unemployment rate.

The key is services associated with housing, and we know that

there are many transitional services programs that are run across

the countries. Many of my chapters are involved with that. We

have a Vietnam Veterans Assistance Fund that is our foundation.

We have houses in Connecticut that we have been operating in association with the VA up there and the State of Connecticut Veterans Agency, again a transitional housing program. The idea is

bring them in, bring them off the streets, because that is the first

step.

We actually give them a lot of tough love though. One of the nice

things about having veterans help veterans is we have the ability

to say to somebody sitting across the table, ‘‘Yeah, you are a veteran, you deserve help, but that is not enough of a reason, you

have got to get your own help, you have got to be willing to help

yourself,’’ and we were able to work with many of them and get

them off the streets, and we believe over the years we have been

very successful, but who is going to provide the programs.

We believe, first of all, that HUD needs to provide a lot more

Section 8 housing programs. We need to provide a lot more per

diem payment programs for the housing programs that are out

there, and for all of those programs, again not just the housing, but

to provide them with the services they need. Hook them up with

the VA rehab centers. Get the VA to start to re-establish the inpatient PTSD programs that they wiped out years ago. There are only

a few of them left scattered around the country now with only 30-

day inpatient programs. Ten-day detox programs are almost all

gone. Everything is outpatient. Well, it doesn’t always work that

way, especially when you have homeless veterans. The transitional

housing facilities that the VA does operate are very successful, and

I have seen several of them up close and personal because I work

with a lot of the veterans that have gone through them.

It can be done, but it is going to take some direction of resources,

and if we do this short term, and this is one of the things with the

PTSD issue—if I could take just a second, the reason why we have

100 percent PTSD Vietnam veterans today is because we didn’t

treat them 35 years ago, and we are going to have 100 percent Iraq

PTSD cases 20 years from now if we don’t treat them today, and

it is very simple. Take care of them now. The vet center program

needs to be expanded into rural areas where all of these guards

and reservists are coming from. We need to bring the Iraq and Afghanistan Veterans into that system as peer counselors like they

did with the Vietnam Veterans program. We remember when the

VA hated that program and wanted to bring it inside, and we said,

‘‘no, keep it on the streets where it belongs.’’ It was very successful,

still is to this day, and we think it is the only way we are going

to succeed with the newer veterans.

The one thing about them I would say, at least they know what

PTSD is. We didn’t. They are still not quite sure what to do about

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it, and I do agree with your earlier statements that there is still

a stigma attached with mental health issues and PTSD that, unfortunately, keeps them from getting the care that they need.

Senator OBAMA. Mr. Chairman, I know that a couple of the panelists just wanted to respond. Would that be okay?

Chairman CRAIG. Sure.

Senator OBAMA. Mr. Basher and Mr. Kemp, please feel free to

chime in.

Mr. BASHER. As a member of the Secretary’s Advisory Committee

on Homeless Veterans, and we are actually meeting up in Baltimore today and tomorrow, one of the issues that revolves around

homelessness is the fact that a lot of the services are provided by

community-based organizations and a lot of the support they get is

a very fragmented package. You have got the Department of Labor

providing homeless veteran re-integration program money. You

have got the Department of Veterans’ Affairs providing grant per

diem money. Both programs operate under very different premises

and very different sets of rules, but those CBOs are required to

learn both sets and become facile with that, and none of this actually provides what the Committee is now concluding is an important element of this, and that is permanent support of housing for

veterans.

VA specifically doesn’t provide any of it. HVAP is going away

from that, and HUD is now looking at providing only housing, but

they don’t want to talk about any veteran-specific programs.

Senator OBAMA. Mr. Kemp.

Mr. KEMP. Senator, as you know, we are having a symposium for

the young veterans’ needs in Chicago this October. So far, we have

identified we have 60 work groups to look at different issues that

are facing the veterans, and I would invite each and every one of

you to participate so that we can come down and have a true veterans’ issues forum. The veterans will be giving us the issues and

trying to find the answers so that we can best serve them.

It is not funding. It is being more effective and efficient.

Senator OBAMA. Thank you, Mr. Chairman.

Chairman CRAIG. Thank you.

I have got a couple more questions, and then if any others do,

we will certainly continue. We thank you again for your patience

and your responses.

John, the next question I am going to ask is not intended to put

you on the spot. You are a very nimble fellow. So I doubt that I

could do that. But I think it is important that the record show a

little bit of time and place and history in relation to where we were

and where we are. At a hearing on eligibility reform before the

Senate Veterans Committee 10 years ago, in unified testimony,

VSOs testified regarding how eligibility reform could be accomplished so that it would be cost neutral. That was the argument of

that time. Your organization suggested some veterans could contribute insurance and copay dollars to VA and that high-income

non-service-connected Vietnam Veterans could bring substantial

new funding streams to VA in order to sustain care for serviceconnected and indigent veterans, expand access to cost effective

primary and preventive care, and reduce VA reliance on federallyappropriate rated dollars.

37

Doesn’t the President’s budget at a 9.6 increase in direct appropriations and additional revenue generated through fees proposals

on lower priority veterans strike the kind of balance that your organization espoused 10 years ago?

Mr. ROWAN. Not exactly.

Chairman CRAIG. Okay. Please explain.

Mr. ROWAN. I am not as much of a budget expert as I would like

to be and, frankly, we are working on another revised white paper

that we will present to the Congress reviewing all the budgetary

aspects. One of the problems with the whole Category 8 thing is

this whole idea of those bringing health care into the system, their

own insurance and the problem the VA seems to have with dealing

with that and making that work. I guess the issue would become

those wealthier veterans who don’t have insurance and would have

to somehow pay some copayments, and I think we could talk about

that as well.

Again, I am not against sitting down and talking about working

on a whole development of how we fund the VA and especially

about the needs of the VA, and we call on Congress to set up a bipartisan, bi-house committee to exactly do that. We have done that

for welfare reform. We have done it for Medicare reform. We have

done it for all kinds of things. Perhaps it is time for you and your

colleagues across the street to sit down and both parties hammer

out a bipartisan proposal with the input of the Veterans Service

Organization to exactly how we can look at reasonably funding the

VA.

One of the disturbing things to me, however, is this idea of going

after the sevens. The sevens are the zeros, the zero-service connected. The example of those people is one I had not too long ago

as a client of mine. He came in with lung cancer. As a serviceconnected Vietnam Veteran, he got 100 disability immediately for

his lung cancer. He went into chemotherapy. He went into all kinds

of extensive treatment programs. Thank God, they cured him or

put him in remission. I hate to even use the word ‘‘cured’’, but they

put him into remission.

Immediately, he drops to zero, rightfully so, no cancer, no compensation, no problem; however his private health insurance, which

he had, would not cover the super-MRI that he needed on an annual basis to make sure that his cancer wasn’t coming back. The

VA did, and thankfully he is in the system, but if he had been

kicked out as a seven, he would not be in the system and would

be in serious, serious harm.

We need to re-evaluate all of those nuances that go on with those

sevens and, again, as I pointed out, with even the eights. Frankly,

4 years ago, I wasn’t in the system until they came up with the

presumption on diabetes. I had been a diabetic from 1994, but they

wouldn’t give it to me in my claim until 2003, I think it was. I am

a 90-percent rated disabled veteran today because, unfortunately,

I have got neuropathy and a few other things, as has many Vietnam Veterans. I am in the system. I am a category one. You can’t

touch me, but unfortunately there are many people——

Chairman CRAIG. I am not hunting for you.

Mr. ROWAN. But unfortunately there are many who if they were

eights, unfortunately if they got information, might in fact turn

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into ones, twos, threes, and fours, and that is what we are concerned about, again, as we point out with this outreach effort.

So, Senator, I think everybody in this room would be more than

happy to sit down with you and your colleagues to hammer out a

way to make sure that the veterans’ health care got funded as long

as it is understood exactly what that means when we talk about

our health care needs, not our desires, our needs, and that is all

we are looking for. I actually had somebody tell me all you are

looking for is new members and more money, and it really got me

annoyed. We are not.

Chairman CRAIG. That is a responsible and a legitimate request.

Thank you.

Does anyone else wish to comment?

George?

Mr. BASHER. Sir, one of the problems I think we have with this

whole issue is we tend to look at it as a VA issue, and if you look

at it as a national health care issue, you have to design a VA system that is big enough to handle the 25 million veterans we have

got in this country and you have to design a Medicare system that

is a certain size, and you have to design a Medicaid system that

is a certain size, and you have a private insurance program that

covers a certain number of people. A lot of the people we are talking about are dual and triple eligibles. So in my mind, one or more

of those systems is too big if we are truly trying to design the most

efficient and effective way to do this.

I think maybe what is also needed here is to have a responsible

conversation about the global issues of health care and where VA

fits into that. As you are well aware, medicare is the one place—

you can’t spend your medicare dollars with a VA hospital, and to

me, that makes no sense. Congress took a whack at solving that

a number of years ago with VA Advantage, and the thing just disappeared in a morass of conflicting regulations, and people gave

up. I think we should take another stab at that.

Chairman CRAIG. Good suggestion.

Gerald, you had a comment? Please.

Mr. HARVEY. One of the things that we need to remember is that

anybody who has been to war, no matter when or whose side he

is on, suffers from post-traumatic stress, no matter what you call

it. It is built in. So when we first come back, we are young. We

say don’t talk to us about it. We want to forget all of that, and of

course that is the biggest mistake we did, not talk about it, not

work through it, not come out of it.

So some way or other, we need to think through a system so

when these men come back to get out of the service, they get into

the system right then so that you can say, ‘‘When you start seeing

these signals, come back; you are already in the system, and it is

going to happen to you; you don’t think so, but it is.’’

Chairman CRAIG. Well, those are very valuable suggestions, yes.

Well, I appreciate this dialogue beyond the questions because it

is a very important dialogue to have, and one of my frustrations,

and it is a frustration that is spread nationwide at this moment,

when we look at Federal spending as a whole, whether it be entitled or discretionary, and of course some are advocates that all VA

spending become entitled, and of course there is a reality out there

39

that I and Danny have to deal with, and that is that Social Security, Medicare, and Medicaid, entitled definitions, without substantial adjustments over the next decade and a half will consume the

entire Federal budget based on demographics and current movement in the system of aging Americans by the year 2028 or 2030,

depending on the robustness of our economy, literally consume all

of the budget, and that includes your budget, defense budget, all

budgets. Those are very important issues that Congress has not

just yet decided to deal with, although liberal and conservative

economists and demographics and all of that argue the same argument. So it is all there and we understand it. So there is a reality

check we have to deal with.

Today, those who have made a career of the military who have

been in multiple theaters of war, the professional soldier, if you

will, who retired out who has TRICARE are being asked to pay

substantially more in their premiums. Obviously, they are concerned. They will pay some more. The question is how much more,

and yet in sevens and eights, in all fairness, who may have spent

4 years in the service alone might never have seen a theater of war

and may well have seen a theater of war, we are asking a little bit.

It is very important we get to a dialogue of balance and of fairness, because I want veterans to have access to the health care system. There is no question about that. That is not a question in my

mind. The question is eligibility, affordability, and a concern about,

as Danny has expressed, making sure that we extend out time and

look for and try to deal with those coming out of our current theaters, because I agree with you, Gerald. I think anyone who has

been there who spends time there and leaves the streets of America for the streets of Baghdad or Kabul is going to experience some

form of adjustment to some degree, depending on his or her experience or association with that particular environment. I don’t think

there is any doubt about that, and how we deal with that or how

we cause them or help them to deal with it in the long term is

going to be tremendously more beneficial to them, their families,

and to society as a whole.

So, gentlemen, thank you all very, very much.

Danny, do you have any additional questions?

Senator AKAKA. I do, Senator.

Chairman CRAIG. Please proceed.

Senator AKAKA. Thank you, Mr. Chairman. You certainly made

an eloquent statement there.

I just want to add this, George, that what you mentioned is so

important. We have talked about what we call seamless movements from active duty to the veteran status. We need to work on

this. I feel sometimes that VA or the VSOs need to deal with this

by taking all those recently separated servicemembers. We need to

reach out to those people that are afraid to come forward for help.

Director Basher, as you well know, each State has its own

unique populations and culture, and when I say culture, I feel each

war has had its culture. The rural area is its culture. The urban

area is its culture. So the culture makes a huge difference in how

we deal with those problems.

My question to you is what are the State directors doing to cater

their outreach efforts to reach certain cultures where coming forVerDate 11-MAY-2000 13:19 Sep 14, 2006 Jkt 028177 PO 00000 Frm 00043 Fmt 6633 Sfmt 6601 C:\VA\28177.TXT CarolB PsN: CarolB
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ward to seek treatment is frowned upon and what role do you play

in crafting VA’s outreach efforts in particular States?

Mr. BASHER. Thank you for the question, Senator. One of the

things that everybody I think is aware of is that when people are

returning from the theater now and being demobilized or separating from service, they are getting transition assistance programs

and they are getting—everybody is meeting the planes at the

tarmac and everybody is having the welcome home celebration, and

what we found is that most veterans—and my fellow Vietnam Vet

John and I remember what it was like when we came home—paying attention to all that benefit stuff was something that we didn’t

even hear when you were telling us, and it takes more than one

time to deliver the message.

So what we are trying to do is push awareness of veterans and

veteran issues and returning veteran issues down to State and

local level, because these are going to occur over time. One letter

from me or from my Governor or from the Secretary of the VA is

another piece of junk mail in that veteran’s mailbox, but a continued presence—veterans are real messy. They are not going to show

up in the community-based clinic or in the VA hospital when they

finally have an issue. They are going to come in to the community

mental health clinic, the local hospital, the police station with

whatever that issue is, and what State directors are doing is trying

to engage State and county governments to when they get clients

at intake, whether that is a prisoner, a client, a patient, or whatever you want to call it, the first question you ask them is: Were

you ever in the military?, and make those local and State institutions aware of what the issues are surrounding military people.

If the answer is yes, we refer them back to some of our counselors, to the local county veteran service agency, or to the VA, and

let us screen them at that point for the appropriate level of treatment and get them referred to the appropriate system, and whether that is done at the local level in Manhattan or Harlem or the

Oneida Reservation up in northern New York, it is being delivered

by local folks who understand the local culture and in most cases

probably know the people who are affected.

So that is something that we are working very, very hard at, is

to make that connection push out all the way across the State and

local level of government.

Senator AKAKA. John.

Mr. ROWAN. If I might add real quick, one of the problems we

have had is the VA has built a wall around itself and said we don’t

want anybody coming in anymore, stay away. They don’t do any

outreach whatsoever, none, and it is left, unfortunately, to the

States and the VSOs and everybody else to try to do that, and they

are doing their best efforts, but the VA needs to take some more

generic national kind of outreach, an E.R. program, if you will, to

try to explain some of these situations.

One of the things my organization is working on, we are trying

to develop a proposal to go out to the private sector, to the medical

community, to tell the doctors and nurses and health care people

out there, Ask that person across the table, man or woman, because there are a lot of women today, are you a veteran, did you

serve somewhere, and if they answer the first question yes, then

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you have got to go up to the next laundry list, Were you in a combat theater, etc., etc., to elicit those responses to enable them to do

better health care. In 30 years in a private HMO, nobody ever

asked me the question are you a veteran, ever, despite the fact of

what I ended up with all my disabilities.

So it is a real problem, and actually I was meeting with Congressman Buyer yesterday, and he came up with a really good

issue, and I am going to run with it. That is to go to the medical

schools who teach all these doctors who often also associated with

VA hospitals, to teach them about veterans’ medical care, what it

means when you are a veteran as compared to a private citizen,

and I think we can work wonders over the long term of dealing

with that kind of program.

Senator AKAKA. Thank you. Thank you very much. This has been

valuable for me and for the Committee, and I really thank you for

your testimony, and my time has expired.

Thank you very much, Mr. Chairman.

Chairman CRAIG. Danny, thank you.

I have offered up to the challenge and, John, you have responded

appropriately, and other VSOs are doing the same. I have not yet,

nor have we collectively, decided how to shape an evaluation of and

a method by which we bring forth proposals as it relates to the reality of VA funding and its appropriateness.

I look at the current trend lines, and it is obvious that probably

during my tenure of this Committee, I will preside over the first

$100 billion budget for the VA, a phenomenal amount of money. I

am not disputing its need, not in any sense of the word. What I

am doing is placing it up against other realities as it relates to

overall funding of government and our needs, and some of the

questions, some of the proposals that you just mentioned, George,

are perfect examples of an effort to look at this again to see if

medicare subvention and all those kinds of things fit, because back

then, the reason it didn’t work was because there were too many

people who didn’t want it to work, because the Medicare folks

versus the VA and versus veterans didn’t really see that as appropriate because it might be an offset and therefore it would discontinue certain funding lines, and all of that game gets played

when we start breaking across these budgetary walls and lines that

we may necessarily have to do if we are interested in delivering the

kind of health care that is necessary and funding it appropriately.

We have a good thing going. We have a quality health care system, and we have invested heavily in it, and that is appropriate

and the question is how does it serve now and how does it serve

in the future in a way that I think encompasses all of the needs

that Danny and I are concerned about and that you have expressed. So I would suggest, but I don’t have to worry about you

doing it, that you stay tuned because we are going to look at this.

I think we have to as a Congress and as a country to be responsible

to America’s veteran in a way that is appropriate and acceptable.

Gentlemen, thank you all for your testimony today. The record

will remain open for any additional comment for a period of up to

5 days, and we thank you all very much for being here.

The Committee will stand adjourned.

[Whereupon, at 11:25 a.m., the Committee was adjourned.]

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APPENDIX

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