THE FISCAL YEAR 2012 BUDGET FOR 

VETERANS’ PROGRAMS 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

TOGETHER WITH

ADDITIONAL STATEMENTS SUBMITTED FOR THE RECORD 

( 

MARCH 2, 2011 

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THE FISCAL YEAR 2012 BUDGET FOR VETERANS’ PROGRAMS 

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THE FISCAL YEAR 2012 BUDGET FOR 

VETERANS’ PROGRAMS 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

MARCH 2, 2011 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

PATTY MURRAY, Washington, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

DANIEL K. AKAKA, Hawaii 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

RICHARD BURR, North Carolina, Ranking 

Member 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

SCOTT P. BROWN, Massachusetts 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

KIM LIPSKY, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

MARCH 2, 2011 

SENATORS 

Page 

Murray, Hon. Patty, Chairman, U.S. Senator from Washington ........................ 1 

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

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 4 

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

Brown, Hon. Sherrod, U.S. Senator from Ohio ..................................................... 8 

Johanns, Hon. Mike, U.S. Senator from Nebraska ............................................... 9 

Sanders, Hon. Bernard, U.S. Senator from Vermont ........................................... 10 

Brown, Hon. Scott P., U.S. Senator from Massachusetts ..................................... 12 

Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia ........................ 390 

Boozman, Hon. John, U.S. Senator from Arkansas .............................................. 393 

WITNESSES 

Shinseki, Hon. Eric K., Secretary of U.S. Department of Veterans Affairs; 

accompanied by Hon. Robert A. Petzel, M.D., Under Secretary for Health; 

Michael Walcoff, Acting Under Secretary for Benefits; Steve L. Muro, Acting Under Secretary for Memorial Affairs; Hon. Roger W. Baker, Assistant 

Secretary for Information and Technology; W. Todd Grams, Acting Assistant Secretary for Management ........................................................................... 13 

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

Response to prehearing questions submitted by Hon. Patty Murray .......... 26 

Response to posthearing questions submitted by: 

Hon. Patty Murray ........................................................................................ 43 

Hon. Richard Burr ........................................................................................ 175 

Follow-up questions to posthearing responses ........................................ 377 

Hon. Mark Begich ......................................................................................... 381 

Hon. Mike Johanns ....................................................................................... 383 

Hon. Scott P. Brown ..................................................................................... 384 

Response to request arising during the hearing by Hon. Patty 

Murray ....................................................................................................... 395, 400 

INDEPENDENT BUDGET REPRESENTATIVES

Blake, Carl, National Legislative Director, Paralyzed Veterans of America ...... 401 

Prepared statement .......................................................................................... 403 

Violante, Joe, National Legislative Director, Disabled American Veterans ....... 406 

Prepared statement .......................................................................................... 407 

Roof, Christina, National Acting Legislative Director, AMVETS ........................ 414 

Prepared statement .......................................................................................... 416 

Kelley, Ray, National Legislative Director for Veterans of Foreign Wars .......... 422 

Prepared statement .......................................................................................... 423 

OTHER WITNESSES

Tetz, Tim, Director, National Legislative Commission, The American Legion .. 436 

Prepared statement .......................................................................................... 437 

Hooker, Maryann D., M.D., Lead Neurologist, Wilmington, Delaware, VA 

medical center; and Secretary, American Federation of Government Employees Local 342, AFL–CIO ............................................................................... 442 

Prepared statement .......................................................................................... 444 

Additional information submitted ............................................................ 447 

(1) 

THE FISCAL YEAR 2012 BUDGET FOR 

VETERANS’ PROGRAMS 

WEDNESDAY, MARCH 2, 2011 

U.S. SENATE, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 10:33 a.m., in room 

418, Russell Senate Office Building, Hon. Patty Murray, Chairman 

of the Committee, presiding. 

Present: Senators Murray, Rockefeller, Brown from Ohio, Sanders, Burr, Johanns, Brown from Massachusetts, and Boozman. 

OPENING STATEMENT OF HON. PATTY MURRAY, CHAIRMAN, 

U.S. SENATOR FROM WASHINGTON 

Chairman MURRAY. Good morning. This hearing will come to 

order. Thank you all for joining us here today. 

This morning our Committee is going to begin our work on the 

VA’s 2012 budget. I am very delighted to be here with Senator 

Burr, the Ranking Member. I look forward to working with you on 

this Committee. 

Before we begin, I want to first recognize and thank Senator 

Akaka, who ran this Committee so well for the last 4 years. I appreciate his tremendous service. As all of us on this Committee 

know those 4 years were filled with a lot of major accomplishments 

for our Nation’s veterans. 

I would be really remiss if I did not mention one accomplishment 

that Senator Akaka led the way on, which takes on great meaning 

right now as the Senate and House feud over current fiscal year 

spending. Through Senator Akaka’s efforts, VA spending for health 

care is now appropriated one year in advance, protecting it from an 

imperfect budget process that is so often affected by politics. I want 

to say that we are all thankful for Senator Akaka’s efforts, particularly those who have been given peace of mind that because of advance appropriations the VA health care system is on track. 

I am so pleased today to begin my work as Chairman of this 

Committee, which is about truly working for all of our Nation’s veterans. Throughout my life, whether it was watching my own dad, 

who was a Purple Heart recipient, who raised a family of seven despite being wheelchair bound, or whether it was in college as an 

intern helping to care for wounded Vietnam veterans even younger 

than me, or in my 16 years as a Member of this Committee, I have 

time and time again been awed and astounded by the spirit, the 

determination, and the perseverance of our veterans. 

2 

I have also gained a keen, personal understanding of the consequences of sending our servicemembers into combat and of the 

sacred obligation we have to care for those who are injured in 

service. 

With that in mind, I am delighted to take on this tremendous responsibility and look forward to working with all of you on the 

budget and on all other issues affecting veterans. 

At the outset, let me say that on balance, and given that other 

agencies are facing budget cuts, this VA budget is a very good 

starting place from which to work. The President has requested an 

overall increase of $5.9 billion in discretionary spending over Fiscal 

Year 2011 levels. While health care spending is in good shape, 

there are some weaker points in the budget. 

For example, the proposed cuts in spending for construction and 

non-recurring maintenance are very troubling. The budget documents lay out VA’s vision for a 10-year construction plan, but what 

is missing in this budget is detail on how to close that gap between 

the funding we need to bring facilities up to date and the funding 

requested of the Congress. I also want to call attention to the proposed $70 million cut for 

VA research funding. I am very worried that such a cut would imperil some critical projects and shove physician researchers out the 

door. 

Topping anyone’s list of problems the VA is facing is how disability benefits claims are processed. The claims backlog has gone 

on too long, and addressing it will be a top priority for the Committee and the Congress. 

As we continue to work on this, some things do need to be acknowledged. More veterans are filing claims and more are filing increasingly complex claims. There is nothing that can be done to 

change that reality. That said, we need to really focus our attention 

on solutions, including viable IT support if we are to reach the 

shared goal of timely, accurate decisions on benefits claims. I expect to hear from VA, in detail, what exactly its plan is to transform this broken system. 

I am also concerned that VA may not have adequately addressed 

the need for sufficient resources for administering the GI Bill education benefits. In light of a substantial increase in the workload 

and in the number of new students, the budget would reduce fulltime employees, or FTE. 

On the positive side, the proposed budget reflects the VA’s very 

real commitment to end homelessness. I am encouraged to see that 

the Administration has increased funding for homeless programs. 

I am hopeful that we will continue to see significant effort to reduce the number of homeless veterans and prevent those at risk 

from becoming homeless. 

Likewise, I am pleased that the budget reflects the Administration’s continuing effort to make sure that gender-specific care for 

women is readily available throughout the system. 

I would also note that I am as committed today as I was during 

my early years on the Committee to the belief that the Government 

can be fiscally responsible while still fulfilling its commitments to 

the most deserving among us, including, of course, our Nation’s 

veterans. 

3 

This budget request includes a series of cost-saving initiatives, 

including better controls on contract health care, better strategies 

for contracting, and cutting administrative overhead, all of which 

I will review with an open mind. 

But we must always remember that like all budgets, the VA 

budget is a reflection of our values, and that each of those values 

has a direct impact on the lives of thousands, if not millions, of our 

veterans. 

Last week, I sat down with veterans from across my homestate 

and heard from the very men and women whose lives this budget 

will touch. I heard from a Vietnam veteran with PTSD whose son, 

a National Guard soldier, just recently committed suicide after returning from the battlefield with PTSD. 

I heard from a female Iraq veteran who told me when she calls 

the VA she continually gets asked if she is calling for her husband. 

I heard from veterans about the claims backlog, barriers to employment, access to care, holes in the education benefit, and a lot more. 

We have work to do for these veterans, and work that begins 

today. It begins with this budget. I look forward to working with 

my colleagues on this Committee. 

We have a number of new Members, who I am delighted to see 

join us on this Committee. I will continue to work on the Budget 

and Appropriations Committees on which I also sit, and, of course 

with you, Secretary Shinseki, all your team, and the leaders from 

the veterans community. 

With that, I will turn it over to the Ranking Member, Senator 

Burr. 

[The prepared statement of Chairman Murray follows:] 

PREPARED STATEMENT OF HON. PATTY MURRAY, CHAIRMAN, 

U.S. SENATOR FROM WASHINGTON

This morning, the Committee begins work on VA’s 2012 budget. Before we begin, 

I want to first thank Senator Akaka who led this Committee so well over the last 

four years. As all of us on this Committee know, those four years were filled with 

many major accomplishments for our Nation’s veterans. But I would be remiss if 

I didn’t mention one accomplishment that Senator Akaka led the way on that takes 

on great meaning right now—as the Senate and the House feud over spending for 

the current fiscal year. Through Senator Akaka’s efforts, VA spending for health 

care is now appropriated a year in advance—protecting it from an imperfect budget 

process that is so often affected by politics. We are all thankful for Senator Akaka’s 

work—particularly all those who have been given peace of mind that through advance appropriations the VA health care system is on track. 

I am so pleased today to begin my work as Chairman of this vital Committee, on 

behalf of all American veterans. Throughout my life, whether it was watching my 

father, a purple-heart recipient, raise a family of seven despite being wheelchair 

bound, or whether it was in college as an intern helping to care for wounded Vietnam veterans even younger than me, or in my 16 years as a Member of this Committee, I have time and again been awed and astounded by the spirit, determination, and perseverance of our veterans. 

I have also gained a keen, personal understanding of the consequences of sending 

our servicemembers into combat and of the sacred obligation we have to care for 

those injured in service. With that in mind, I am delighted to take on this tremendous responsibility and look forward to working with all of you in the time to 

come—on the budget and on all other issues affecting veterans. 

At the outset, let me say that on balance, and given that other agencies are facing 

budget cuts, this VA budget is a very good starting place from which to work. The 

President has requested an overall increase of $5.9 billion in discretionary spending 

over Fiscal Year 2011 levels. While health care spending is in good shape, there are 

some weaker points in the budget. For example, the proposed cuts in spending for 

construction and non-recurring maintenance are very troubling. 

4 

The budget documents lay out VA’s vision for a ten-year construction plan, but 

what is missing in this budget is detail on how to close the gap between the funding 

we need to bring facilities up to date and the funding requested of the Congress. 

I must also call attention to the proposed $70 million cut for VA research funding. 

I am worried that such a cut would imperil some critical projects and shove physician researchers out the door. 

Topping anyone’s list of problems the VA is facing is how disability benefits 

claims are processed. The claims backlog has gone on too long and addressing it will 

be a top priority for the Committee and the Congress. As we continue to work on 

this, some things must be acknowledged: more veterans are filing claims and more 

are filing increasingly complex claims. There is nothing that can be done to change 

that reality. That said, we need to really focus our attention on solutions—including 

viable IT support—if we are to reach the shared goal of timely, accurate decisions 

on benefits claims. I expect to hear from VA, in detail, what exactly its plan is to 

transform this broken system. 

I am also concerned that VA may not have adequately addressed the need for sufficient resources for administering GI Bill education benefits. In light of a substantial increase in the workload and in the number of new students, the budget would 

reduce FTE. 

On the positive side, the proposed budget reflects the VA’s very real commitment 

to end homelessness. I am encouraged to see that the Administration has increased 

funding for homeless programs and am hopeful that we will continue to see significant effort to reduce the number of homeless veterans and prevent those ‘‘at risk’’ 

from becoming homeless. Likewise, I am pleased that the budget reflects the Administration’s continuing effort to ensure that gender-specific care for women is readily 

available throughout the system. 

I would also note that I am as committed today, as I was during my early years 

on the VA Committee, to the belief that the Government can be fiscally responsible 

while still fulfilling its commitments to the most deserving among us, including, of 

course, our Nation’s veterans. This budget request includes a series of cost-saving 

initiatives, including better controls on contract health care, better strategies for 

contracting, and cutting administrative overhead, all of which I will review with an 

open mind. But we must always remember that like all budgets, the VA budget is 

a reflection of our values. And that each of those values has a direct impact on the 

lives of thousands, if not millions of our veterans. 

Last week, I sat down with veterans from across my home state and heard from 

the very men and women whose lives this budget will touch. I heard from a Vietnam veteran with PTSD whose son—a National Guard member—just recently committed suicide after returning from the battlefield with PTSD. I heard from a female 

Iraq veteran who told me that when she calls the VA she continually gets asked 

if she’s calling for her husband. I heard from veterans about the claims backlog, barriers to employment, access to care, holes in the education benefit, and much, much 

more. 

We have work to do for these veterans, work that begins today, work that begins 

with this budget. I look forward to working with my colleagues on this Committee, 

and on the Budget and Appropriations Committees on which I also sit, and of 

course, Secretary Shinseki, his team, and the leaders from the veterans’ community. 

STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA 

Senator BURR. Thank you, Madam Chairman. Good morning and 

more importantly congratulations on your new role. As I realize 

and most in the room probably do, this is an historic day. Senator 

Murray is the first female to chair the VA Committee. 

Chairman MURRAY. I’m the only female on this Committee, so I 

have a world on my shoulders. 

Senator BURR. Affirmative action works. 

Chairman MURRAY. I wrote that down. 

[Laughter.] 

Senator BURR. I do congratulate you on not only your leading the 

Committee but your fine work in the United States and for the 

American people. 

5 

Mr. Secretary, welcome to you and your team of professionals. 

More importantly, thank you for the work and the effort that you 

and your professional staff put into the care of our Nation’s veterans. 

We are grateful to the veterans’ service organizations and the 

American Federation of Government Employees. We welcome you, 

as well, as part of this hearing. 

I think we will run into a little glitch on votes today at 11 o’clock, 

but we will try to deal with them as smoothly and as quickly as 

we can. 

Of course, we are here today to talk about the President’s 2012 

budget. In a time of record high debt and deficits, my priority is 

not only to ensure that veterans of every generation receive the 

care and benefits that they need and deserve, but also to analyze 

every area of the budget to ensure we maximize all options to 

spend the taxpayer’s money wisely. 

As President Obama states in his budget message, ‘‘Even in 

areas outside the freeze, we are looking for ways to save money 

and cut unnecessary costs.’’ 

The fiscal year 2012 Veterans Affairs budget requests an 11 percent increase over the 2010 enacted levels in discretionary spending. In examining the VA budget request, one observation I made 

is the growth in the budget of the staff offices in your DC central 

office over the last 2 years. 

If this budget were to be approved, both the funding levels and 

the number of staff will have grown at a very high rate since 2010. 

The general administration budget has increased 13 percent since 

2010 and the staff, or FTE’s, request for 2012 reflects a 20 percent 

increase. 

This large boost in spending led me to look closer at the FTE requests of the individual offices within general administration. Here 

is what I found: a 2-year staffing increase of 7 percent in the Office 

of the Secretary; a 2-year staffing increase of 34 percent for the Office of Public and Intergovernmental Affairs; a 2-year staffing increase of 44 percent for the Office of Congressional and Legislative 

Affairs. 

Other examples of spending we may want to take a closer look 

at include: VA continuing to operate and publish a law review that 

has articles and book reviews; and the hiring of a speech writer for 

the Assistant Secretary. 

How are these funding increases essential to our Nation’s veterans? That is a questions we should ask. Do these additional staff 

directly benefit the veterans who use the VA system? 

Another item I found very interesting is the $1 billion contingency fund in the Medical Services account, which would essentially provide a buffer in case poor economic conditions were to 

drive up the demand for VA services. 

The Secretary and I talked about that earlier this week. It 

caught my eye because the first line of the President’s Budget message says this, ‘‘America is emerging from the worst recession in 

generations. In 2010, an economy that had been shrinking began 

to grow again.’’ 

Now, what I find interesting is the seeming difference of opinion 

of the strength of the economy between the President and those 

6 

who forecasted the budget, and the need for a contingency fund. I 

have been assured by the Secretary that the contingency fund is 

designed for the delivery of health care, and I think as long as we 

stay within those parameters, we are all comfortable. 

The Medical Care Collections Fund, or MCCF, is of particular interest to me. Recently, VA’s Chief Business Officer informed my 

staff that the VA was downgrading from what it was expecting to 

collect in 2012 from $3.1 to $2.8 billion. 

I am interested to learn more about this sudden change in the 

collections forecast and the actuarial model that was used to calculate it. I am also interested to know whether we are collecting 

everything the VA is owed under MCCF. 

When my staff asked VA what percentage of available money is 

being collected, the Chief Business Officer could not give them a 

definitive answer. While VA has done an excellent job in recent 

years collecting what it forecasts, is there money being left on the 

table? 

Another concern is the claims backlog which Senator Murray has 

raised in her opening statement and has been a continual topic of 

conversation. Veterans from North Carolina and across the country 

cannot wait so long for decisions that too often are wrong. 

For years, the primary response to these problems has been to 

add more staff. In fact, since 2001, claims processing staff has more 

than doubled. But the problems of large backlogs and long delays 

continue. They are expected to get even worse. 

Although I appreciate that the VA is now focusing on IT improvements and other initiatives rather than simply adding more 

staff, new ideas and good intentions are not enough. We must 

make sure VA has the tools and resources it needs to succeed in 

these efforts. 

More importantly, we must make sure there is a realistic, comprehensive plan to get the backlogs under control so veterans and 

their families will not face delays or frustrations in accessing their 

VA benefits. I look forward to a productive discussion today about 

whether this budget would bring us closer to that reality. 

In the end, we need to ask ourselves if spending money on bureaucrats, speech writers, and publishing book reviews are consistent with being good stewards of the taxpayer’s money in providing benefits to veterans. More importantly, we should ask ourselves if we are fulfilling President Lincoln’s promise: ‘‘To care for 

him who shall have borne the battle, and for his widow, and his 

orphan.’’ 

Mr. Secretary, welcome. 

Madam Chairman, I thank you. 

[The prepared statement of Senator Burr follows:] 

PREPARED STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA

Good morning, Madam Chairman. Congratulations on your new position as Chairman of this Committee. I look forward to working with you and with all of our members in improving the lives of our Nation’s veterans, their families, and their survivors. 

Secretary Shinseki, welcome to you and your senior leadership team. And welcome to the representatives of the Veterans Service Organizations and the American 

Federation of Government Employees. 

7 

We are here today to review the President’s budget request for the Department 

of Veterans Affairs for fiscal year 2012. 

In a time of record high debt and deficits, my priority is not only to ensure that 

veterans of every generation receive the care and benefits they need and deserve 

but also to analyze every area of the budget to ensure we maximize all options to 

spend the taxpayer’s money wisely. As President Obama states in his Budget Message, ‘‘Even in areas outside the freeze, we are looking for ways to save money and 

cut unnecessary costs.’’ 

The fiscal year 2012 Veterans Affairs budget requests an 11% increase over the 

2010 enacted level in discretionary spending. 

In examining the VA budget request, one observation I have is the growth over 

the last 2 years in the budget of the staff offices in your D.C. central office. If this 

budget were to be approved, both the funding levels and the number of staff will 

have grown at a very high rate since 2010. The general administration budget has 

increased 13% since 2010 and the staff—or FTE’s—request for 2012 reflects a 20% 

increase. 

This large boost in spending led me to take a closer look at the FTE requests of 

the individual offices within general administration. Here is what I found: 

• A two-year staffing increase of 7% for the Office of the Secretary; 

• A two-year staffing increase of 34% for the Office of Public and Intergovernmental Affairs; and 

• A two-year staffing increase of 44% for the Office of Congressional and Legislative Affairs. 

Other examples of spending we may want to take a closer look at include: VA continuing to operate and publish a law review that has articles and book reviews and 

the hiring of a speech writer for an Assistant Secretary. 

How are these funding increases essential to our Nation’s veterans? Do these additional staff directly benefit the veterans who use the VA system? 

Another item I found very interesting is the $1 billion contingency fund in the 

Medical Services account, which would essentially provide a buffer in case poor economic conditions drive up demand for VA services. This caught my eye because of 

the first lines of the President’s Budget Message: ‘‘America is emerging from the 

worst recession in generations. In 2010, an economy that had been shrinking began 

to grow again.’’ What I find interesting is the seemingly difference of opinion on the 

strength of the economy between the President and VA. 

The Medical Care Collections Fund—or MCCF—is of particular interest to me. 

Recently, VA’s Chief Business Officer informed my staff VA was downgrading what 

it was expecting to collect in 2012 from $3.1 billion to $2.8 billion. I am interested 

to learn more about this sudden change in the collections forecast and the actuarial 

model being used. 

I am also interested to know whether we are collecting everything VA is owed 

under MCCF. When my staff asked VA what percentage of available money is being 

collected, the Chief Business Officer could not give them a definitive answer. While 

VA has done an excellent job in recent years collecting what it forecasts, is there 

money being left on the table? 

Another concern is the claims backlog. Veterans from North Carolina and across 

the country can wait far too long for decisions that too often are wrong. For years, 

the primary response to these problems has been to add more staff. In fact, since 

2001, claims processing staff has more than doubled. But the problems of large 

backlogs and long delays continue. And they are expected to get even worse next 

year. 

Although I appreciate that VA is now focusing on IT improvements and other initiatives—rather than simply adding more staff—new ideas and good intentions are 

not enough. We must make sure VA has the tools and resources it needs to succeed 

in these efforts. More importantly, we must make sure there is a realistic, comprehensive plan to get the backlog under control, so veterans and their families will 

not face delays or frustrations in accessing their VA benefits. I look forward to a 

productive discussion today about whether this budget would bring us closer to that 

reality. 

In the end, we need to ask ourselves if spending money on bureaucrats, speech 

writers, and publishing book reviews are consistent with being good stewards of the 

taxpayer’s money. More importantly, we should ask ourselves if we are fulfilling 

President Lincoln’s promise: ‘‘To care for him who shall have borne the battle, and 

for his widow, and his orphan.’’ 

Thank you Madam Chairman, I yield back. 

Chairman MURRAY. Thank you very much. 

8 

We will now turn to our other Senators for opening statements. 

Senator Brown. 

STATEMENT OF HON. SHERROD BROWN, 

U.S. SENATOR FROM OHIO 

Senator BROWN OF OHIO. Thank you, Madam Chair, Senator 

Burr, and Members of the Committee. 

Congratulations, Senator Murray, on your Chairmanship. I know 

how important that is to you. I was watching you before I was in 

the Senate and have worked alongside you since. Your concern and 

empathy while fighting for veterans is impressive. 

Secretary Shinseki, welcome. All members of the panel, thank 

you for stopping by. Mr. Secretary, you are always patiently answering questions and advocating for veterans all the time. 

We know about the President’s Budget. We have talked about 

that among us and with the panelists separately in many cases. 

I wanted to look at it in a slightly different way, which is to consider how potential cuts to other agencies and programs will affect 

veterans and whether these cuts will lead to a higher proportion 

of veterans turning to the VA for assistance. 

For example, H.R. 1 in the House proposes devastating cuts to 

the workforce investment programs in Ohio and other places. There 

are 95 one-stops in Ohio and 3,000 nationwide. Many, if not all of 

them, will have to close their doors if the proposed $3.8 billion in 

cuts to workforce investment pass Congress. 

Senator Murray has been very involved in that issue from her 

position on the Health, Education, Labor, and Pension Committee. 

We need to work through how those kinds of cuts would affect veteran services at the same time. 

The Veterans’ Workforce Investment Program is funded through 

WIA (Workforce Investment Act). Will those proposed cuts impact 

this program? It is estimated that veterans will increasingly turn 

to the VA, to VA’s contingency fund. Will advanced appropriation 

requests reflect this prediction? 

I am pleased to see the VA has incorporated a contingency fund 

for medical care for 2012 in its advance appropriations for 2013. 

This will help Congress and the VA to more accurately plan for the 

VA’s future and continue to improve care and services. 

Secretary Shinseki, I applaud you for taking on three of the VA’s 

most pressing issues: the claims backlog, as Senators Murray and 

Burr mentioned; veteran homelessness; and expanding access to 

VA health care and benefits. You have done outstanding work in 

my State, especially in Chillicothe and southern Ohio, and I trust 

that your efforts will bear fruit. 

Like many of my colleagues, I have concerns obviously regarding 

the backlog. Over the past several years, Congress has provided the 

resources to hire nearly 4,000 additional adjudicators to address 

the backlog, yet as of January 31 of this year, pending claims had 

increased over last year’s level. And, that is not including new 

Agent Orange claims for the three new presumptive conditions established in 2010: ischemic heart disease; B-cell leukemia; and Parkinson’s. 

Not only is the backlog continuing to grow, but the accuracy of 

claims is approximately 80 percent and the Board of Veterans’ ApVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00014 Fmt 6633 Sfmt 6601 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
9 

peals expects a 63-percent increase in case receipts over a 4-year 

period. 

In a minute or two I will share a letter. On June 2010, a Navy 

veteran from Hamilton, OH, near Cincinnati, wrote my office for 

assistance with his VA claim. He was exposed to radiation during 

his service. He developed thyroid cancer. 

His initial VA claim was filed in 2005. It was denied. It was not 

until his Notice of Disagreement was upheld that his case actually 

made it to the VBA. They remanded the case for dose reconstruction. It was sent to Nashville, and then sent back to the Appeals 

management center, and then the appeals management center sent 

it to the VA regional office in Cleveland, citing lack of jurisdiction. 

This veteran from southern Ohio, his dose reconstruction is yet 

to be constructed. His claim will still have to go back to the VBA 

once it is determined. It has been 5 years since he started the 

process. 

In addition, Mr. Secretary, we need to address the disparity in 

disability compensation, and we have not gotten any real understanding of why this is. Ohio is consistently at the bottom of benefit ratings. There is no reason that a bum knee in Lima, OH, 

should not be worth the same as a bum knee in San Diego, CA. 

I hope the panelists can discuss how this year’s budget will fix 

that. 

The last point, Madam Chair: I am concerned with the President’s Budgets request for VA major and minor construction. The 

request is $757 million less than fiscal year 2011, approximately 

$1.65 billion less than the amount proposed by the VSOs’ Independent Budget. VA has a $24 billion construction backlog. We 

know that. We need to pay attention to that too. 

I appreciate your service. Thank you, Madam Chair. 

Chairman MURRAY. Thank you very much. 

Senator Johanns. 

STATEMENT OF HON. MIKE JOHANNS, 

U.S. SENATOR FROM NEVADA 

Senator JOHANNS. Madam Chairman, congratulations to you. It 

is a pleasure for me to be back on what I consider to be one of the 

Senate’s most important Committees. 

As I was thinking about my opening statement today, which I 

promise will be very brief, Mr. Secretary, it occurred to me that in 

your mission area, the Federal Government has asked you and 

your team to manage an enormous health care system, a very complicated one I might add; run a disability benefit programs, again, 

very, very complex; a home loan program; an insurance program; 

an education assistance program; and the largest national cemetery 

system in the entire Nation. You see my point. I could go on and 

on. 

This is an area where through various decisions made by policymakers we have asked the Veterans’ Administration to strap on yet 

another agenda item and another agenda item, which is quite easy 

to do over time. The challenge you and your team face is how to 

deliver all of these services in an efficient, prompt way while dealing with the budget constraints that we all face. 

10 

Now, I am going to offer a positive comment or two. I think you 

and your team probably deserve the award for the folks that are 

the most accessible to me. I have never had a situation where I 

needed to see somebody, including you, Mr. Secretary, that I had 

to even wait. Typically, it was my schedule that we were working 

around to schedule that kind of meeting, and I appreciate that. 

Second, as a very new member, it was my first year here, I asked 

if we could do a field hearing back home in Nebraska, and that was 

arranged. It was an excellent hearing. We got out information that 

I thought was very important. Again, the response was just so positive from your office. 

The challenge we face, however, is there are still many things 

that need to be done, and we are also mindful of the budget issues 

that we face. 

So, in today’s hearing I hope we really concentrate on what 

progress has been made with the resources you have been given, 

why those are important, and how we might think about alternatives, whether it is a different approach or whatever, that we 

might try to be more efficient. 

I think at the end of the day, no matter which side of the table 

we sit on here, we want to deliver excellent service to our veterans 

and to families that need those services. 

Sometimes those services are very extensive, as you know. We 

are bringing people back home that have suffered enormous injuries. Trying to do all we can to help can cost in so many ways, and 

the burden is on you folks to try to make that work. 

Well, let me just wrap up and say as somebody who has been a 

mayor and a Governor and had to struggle with budgets, coming 

from a State where we do not borrow money—we balance the State 

budget without borrowing money, doing it in a way where literally 

we have to make cuts sometimes—we have to deal with the reality 

of providing services without going to the credit card. 

I just think that all of us in the Federal Government need to be 

mindful that our credit card is getting maxed-out, and we have got 

to figure out how we do these things in an efficient way. 

So, I am going to be looking to you and pressing you on how we 

can deliver these services to the these wonderful people, our veterans, and do it in the most cost-efficient way we can. Thank you. 

Chairman MURRAY. Thank you very much. 

Senator Sanders. 

STATEMENT OF HON. BERNARD SANDERS, 

U.S. SENATOR FROM VERMONT 

Senator SANDERS. Thank you very much, Madam Chairman. Let 

me just pick up on what Senator Johanns said and applaud you, 

Mr. Secretary, and your staff. I talked to a lot of veterans in the 

State of Vermont, and we talk to veterans’ organizations; yesterday, I spoke with the DAV. 

I think there is a pretty widespread agreement that we are making progress, that a number of years ago the VA had a significant 

set of problems. We still have a long way to go; no question about 

it. But I do think there is an understanding that we are making 

some progress, and I want to thank you for your diligence and 

focus on issue after issue that are of concern to so many veterans. 

11 

Now, we know that in terms of health care, we are faced with 

a dual problem. We have older veterans, who we are absolutely 

going to provide the best quality care for. On the other hand, we 

have a lot of young people returning from Iraq and Afghanistan 

with a lot of serious problems. We are going to do that, and I applaud you for efforts in that area. 

You have made the point when you came before this Committee 

that it is a national disgrace that a significant number of the people who are homeless in America are veterans. You made that 

point, and you pledged to us that you would address that issue, 

which you are doing. 

I can tell you that in the State of Vermont right now we are seeing shelters going up, facilities going up, some of them quite beautiful, which are giving our veterans the kind of dignity and security 

that they need. I thank you for that as well. 

A problem that everybody on this Committee knows has plagued 

the VA year after year after year is the length of time it takes to 

process disability claims. We have not solved it yet, but I know you 

are working on a number of pilots to try to address it, using technology in a way that makes a lot of sense, and I applaud you for 

that as well. 

In Vermont, I am happy to tell you, Mr. Secretary, that we have 

added two new CBOCs, and I believe that the CBOC program is 

one of the jewels of the VA system. The fact that veterans do not 

have to drive long distances to a large hospital to get the primary 

health care they need is a huge benefit to them. 

We have established one in Brattleboro, one in the southern part 

of our State, and one in the Newport area in the northern part of 

our State. I want to tell you that the veterans of the State of 

Vermont are very grateful for that. 

We are making progress improving our main facility in White 

River Junction. We got some money to go in there and improve 

that facility, which we are grateful for, as well. 

I know that you are also focusing on two of the major signature 

problems of our time, and that is PTSD, a very, very serious problem, and TBI. How do we address those issues? 

We have thousands and thousands of veterans who are hurting 

from those problems, among others. When we worked on a model 

program in Vermont, you and I talked about that even if you had 

the best facilities in the world providing the best care in the world, 

it does not mean anything unless veterans are able to access that 

care. 

So, how do we do better outreach? How do we make sure every 

veteran, especially those struggling with problems like PTSD access those facilities and that care? How do we improve outreach efforts? 

So the bottom line, Mr. Secretary: I want to applaud you for 

what you are doing. You are doing a great job, and I look forward 

to continuing to work with you. 

Chairman MURRAY. Thank you very much. 

Senator Brown. 

12 

STATEMENT OF HON. SCOTT P. BROWN, 

U.S. SENATOR FROM MASSACHUSETTS 

Senator BROWN OF MASSACHUSETTS. Thank you, Madam Chair, 

and welcome back to the Committee. I look forward to your leadership. It is good to be back on the Committee, as well. 

I want to echo what Senator Johanns said, that a lot of good is 

getting to a lot of challenges. I want to hear from you more than 

I want to hear from us. 

I know we are going to be bouncing back and forth to votes, but 

I am very concerned about veterans finding work, the homelessness 

issue, and construction. For example, in Massachusetts we have 

the West Roxbury Hospital of the VA, which is basically the northeast region care facility. It is at the point now that they cannot 

even perform modern operations, cannot get the equipment in the 

outdated operating rooms. 

So we are trying to address some of those issues, finding out 

what you need, what resources and help you need. 

As somebody who still serves, you know, obviously I take these 

issues very seriously like every Member of this Committee regardless of their service. 

I have found that there are some good citizen groups and nonprofit organizations that are actually working with the soldiers to 

process claims applications. My understanding is that part of the 

delay and breakdown is the fact that the applications are incomplete. 

I have a group in Massachusetts that has had a hundred percent 

success rate when they have submitted their claims, and they have 

a hundred percent return, and I think that is important. Maybe 

having more entities like that throughout the country so when you 

get the claim you see that the packet is complete, versus having 

to send it back. The delay is what is really crushing our soldiers 

and their morale when it comes to getting the care and service that 

they need. 

So, I look forward to your testimony. We will be bouncing back 

and forth, so no disrespect intended. Thank you. 

Chairman MURRAY. Thank you very much. 

With that, I want to welcome Secretary Eric Shinseki to the 

Committee. I really appreciate your joining us today to give us your 

perspective on the Department’s Fiscal Year 2012 Budget. We look 

forward to your testimony. 

Secretary Shinseki is accompanied today by Dr. Robert Petzel, 

Under Secretary for Health. We also have Mike Walcoff, Acting 

Under Secretary for Benefits; Steve L. Muro, Acting Under Secretary for Memorial Affairs; Roger W. Baker, Assistant Secretary 

for Information and Technology; and Todd Grams, Acting Assistant 

Secretary for Management. 

Mr. Secretary, your prepared remarks will be, of course, in the 

record but we appreciate your testimony today. 

13 

STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY HON. 

ROBERT A. PETZEL, M.D., UNDER SECRETARY FOR HEALTH; 

MICHAEL WALCOFF, ACTING UNDER SECRETARY FOR BENEFITS; STEVE L. MURO, ACTING UNDER SECRETARY FOR MEMORIAL AFFAIRS; HONORABLE ROGER W. BAKER, ASSISTANT SECRETARY FOR INFORMATION AND TECHNOLOGY; W. 

TODD GRAMS, ACTING ASSISTANT SECRETARY FOR MANAGEMENT 

Secretary SHINSEKI. Thank you, Madam Chairman, and I add my 

congratulations to you as well and look forward to working with 

you and your leadership on this Committee. Ranking Member 

Burr, who has since departed, and other distinguished Members of 

the Senate Committee on Veterans’ Affairs, thank you again. I say 

that genuinely. 

Thank you again for this opportunity to present the President’s 

2012 budget and 2013 advanced appropriations request for this Department. 

This Committee’s support of our Nation’s veterans has always 

been unequivocal and unwavering. That is my experience for 2 

years. I wish to express my appreciation to all the Members on behalf of the professional workforce that comes to work everyday in 

the VA and the 8.3 million veterans who come to us for service. 

Let me also acknowledge the representatives of some of our veterans’ organizations in attendance today. They provide insights 

into veterans’ needs and suggest ways in which VA can better address them. Those insights are helpful as we deliberate how to best 

resource our programs. 

Madam Chairman, thank you for recognizing the other members 

of the panel. Let me just point them out so that I get faces and 

names aligned. Roger Baker, IT, is to my extreme left. Todd 

Grams, our Chief Financial Officer, is to my left. The young man 

to my right, Dr. Randy Petzel, is our Chief Medical Officer. Mike 

Walcoff, Benefits; and Steve Muro, who is the Acting Under Secretary for Memorial Affairs and the President’s nominee to be the 

Under Secretary for the National Cemetery Administration. 

Thank you, Madam Chairman, for admitting my written statement for the record. 

The VA budget is large and complex and important, to be sure, 

because it cares for those, as several have already suggested, who 

safeguard our Nation so that the rest of us can do what Americans 

do best, and that is out think, out work, out create, out produce the 

rest of the world. 

I say that realizing that the economy has lost some of its sparkle 

at the moment, but I trust the instincts, the energy, the intellect, 

and the ingenuity of Americans to get that back and to get us and 

our economy back on track. 

It has been noted several times that less than 1 percent of our 

citizens serve in the military. But let me just tie together the two 

statements I just made. Those that do, these men and women who 

serve in uniform, enable the rest of the Nation to unleash the potential in that economic engine to do what Americans have historically done, and that is create the best economy in the world and 

win in this competitive area. 

14 

When those members of the military transition back to their 

communities to add their skills, their knowledge, and their experience to that economic engine, VA’s mission is pretty clear. As Senator Burr cited, our mission goes back to President Lincoln’s admonition to care for those who have borne the battle and for their 

spouses and orphans. 

To keep that promise, VA is a large integrated health care system, the largest in the country. It is also our largest national cemetery system, repeatedly recognized as the country’s top performer 

in customer satisfaction over the past 10 years. 

The VA also manages the country’s second-largest education assistance program. It guarantees nearly 1.4 million individual home 

loans at zero down payment with the lowest foreclosure rates in all 

categories of mortgage loans. 

Finally, it is the country’s eighth largest life insurance enterprise 

with a 96 percent customer satisfaction rating. 

I often get asked the question, why is the VA enterprise so complex? Why is it so large? And the answer that I usually end up giving is fairly simplistic. It is because in times past those who wore 

the Nation’s uniforms were often unable to either acquire or afford 

those services elsewhere on their own. In honoring their service, it 

was found important that they not be left unattended. For that reason we have this complex series of missions. 

Our mission, to provide, or arrange for, the care of veterans who 

need us once the uniforms come off, again, remains rooted in President Lincoln’s promise of 1865. 

We deliver on the promises of Presidents and fulfill the obligations of the American people to those who have borne the battle. 

Today the Nation’s military remains deployed in two different 

operational theaters, conflicts that have been underway for most of 

the past decade in Afghanistan and Iraq. The burden on our magnificent all-volunteer force and their families in accomplishing 

those missions without failure, without fanfare, without complaint 

has been enormous, and they have been magnificent. 

VA’s requirements have grown over that time as we address 

long-standing issues from past wars and watch the requirements 

for those fighting the current conflicts grow significantly. 

These numbers will continue to rise for years, maybe even decades, after the last American combatant departs Afghanistan and 

Iraq. That is the history of what has happened inside VA. 

As a reminder of the duration of those obligations and a tribute 

to his life of service, let me acknowledge the passing of Mr. Frank 

Buckles just this past Sunday at 110 years of age. 

Mr. Buckles was the last known American veteran of World War 

I. Our thoughts and prayers are with his family, and I have expressed them as they mourn the loss of this very special American 

more than 92 years after the armistice that ended the great war 

was signed. 

This budget request is the Department’s plan for meeting those 

obligations to all generations of our veterans effectively, accountably, and efficiently. 

At present, about 8.3 million veterans depend on VA for medical 

care and benefits, but over 22 million veterans and another 35 million spouses and adult children see themselves as either veterans 

15 

or part of veterans’ families whether or not they visit our medical 

centers or ever apply for benefits. 

They all expect us to get things right for the veterans we do 

serve, and we rely on the leadership, Madam Chairman, your leadership and the leadership of this Committee and your support in 

helping us determine how best to serve those veterans. 

To resource VA’s efforts, the President’s Budget request would provide $132.2 billion in 2012, $61 billion in discretionary resources, about $70.3 billion in mandatory funding. 

Our discretionary budget request represents, as the Chairman pointed out, a $5.9 billion increase, which is about a 10.6 percent 

increase over the 2010 enacted level. 

Since I appeared before this Committee last year, we have published and implemented a strategic plan to continue transforming 

VA into an innovative 21st-century organization, that is—and these 

are sort of our tag lines—a people-centric; results-driven, if you 

cannot measure it, you cannot declare progress; and forward-looking. 

Our 2012 and 2013 budget plans are based on four goals in our 

strategic plan: first, continue improving the quality and accessibility of VA health care benefits and services. Second, increase veterans’ satisfaction with the care and services we provide. Third, 

raise readiness to continue the provision of care and services in a 

time of crisis. Finally, improve VA’s internal management systems. 

Achievement of these goals mandates our constant and consistent 

good stewardship of the financial resources entrusted to us by this 

Committee and the Congress. 

Every dollar counts. That is my repeated phrase. Every dollar 

counts always, both in the current constrained fiscal environment, 

but also during less stressful times. Every dollar counts. 

We have designed management systems and initiatives to maximize the effectiveness and eliminate waste, including VA’s Project 

Management Accountability System, PMAS, a new acquisition 

strategy to make more effective use of our IT resources. 

VA’s Transformation Twenty-One Total Technology, our bumper 

sticker for that is T4. T4 consolidates our IT requirements into 15 

prime contracts and leverages economies of scale to save both time 

and money, enabling greater oversight and accountability. 

Our Strategic Capital Investment Planning, SCIP, defines and 

assesses VA’s large capital portfolio and enables improved efficiency of operations. 

Last November we launched two online metric systems, one 

called LinKS (Linking Information, Knowledge, and Systems), and 

the other one called Aspire. Together these systems allow VA to increase our quality of health care against private-sector benchmarks 

transparently. 

VA successfully remediated three of four long-standing material 

weaknesses in 2010 and earned our 12th consecutive clean audit 

opinion on our consolidated financial statements. 

Finally, we have implemented Medicare’s standard payment 

rates and consolidated contracting requirements to reduce cost and 

waste. 

A recent independent study, which covered a 10-year period, 

found that VA’s health IT investments between 1997 and 2007 

16 

amounted to $4 billion while savings from those investments came 

to over $7 billion. More than 86 percent of the savings resulted 

from the elimination of duplicate tests and reduced medical errors, 

contributing overall to reduced workload and lowered operating 

costs. 

The 2012 budget continues to focus on our three key transformational priorities: expanding access; reducing and ultimately 

eliminating the backlog; and ending veterans’ homelessness by the 

year 2015—three visible and urgent priorities. 

A comprehensive review is underway to use VA’s inventory of vacant or underutilized buildings to house homeless and at-risk veterans and their families, where practical. 

Congress allocated $50 million to renovate unused VA buildings. 

We have identified 94 sites with the potential to add approximately 

6,300 units of housing through public-private ventures using VA’s 

enhanced use lease authority. 

As we discussed, Madam Chairman, this enhanced-use lease authority is scheduled to lapse at the end of 2011, and its reauthorization is important to us and vital to our plans to increase housing 

for homeless veterans and families. 

Today, the most flexible housing option is a HUD voucher. We 

work quite closely with the Department of Housing and Urban Development. Both Secretary Donovan and I endorse the importance 

of this joint effort to care for our homeless veterans, our only option 

at the moment for housing veterans with families. 

As advocates for veterans and their families, VA is committed to 

providing the very best services. I will do everything possible to ensure that we wisely use the funds Congress appropriates for VA to 

improve the quality-of-life for veterans innovatively and transparently as we deliver on enduring promises of Presidents and the 

obligations of the American people to veterans. 

Again, Madam Chairman, thank you for this opportunity to appear before this Committee and for your continued unwavering 

support. I look forward to your questions. 

[The prepared statement of Secretary Shinseki follows:] 

PREPARED STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY, 

U.S. DEPARTMENT OF VETERANS AFFAIRS

Chairman Murray, Ranking Member Burr, Distinguished Members of the Senate 

Committee on Veterans’ Affairs: Thank you for the opportunity to present the President’s 2012 Budget and 2013 Advance Appropriations Requests for the Department 

of Veterans Affairs (VA). Budget requests for this Department deliver the promises 

of Presidents and fulfill the obligations of the American People to those who have 

safeguarded us in times of war and peace. 

Today, the Nation’s military remains deployed overseas as it has during the last 

9 years of major conflict. Our requirements have grown over the past two years as 

we addressed longstanding issues from past wars and watched the requirements for 

those fighting the current conflicts grow significantly. These needs will continue 

long after the last American combatant departs Iraq and Afghanistan. It is our intent to continue to uphold our obligations to our Veterans when these conflicts have 

subsided, something that we have not always done in the past. Not upholding these 

obligations in the past has left at least one generation of Veterans struggling in anonymity for decades. We, who sent them, owe them better. 

VA has an obligation to track, communicate to stakeholders, and take decisive action to consistently meet the requirements of our Nation’s Veterans for care and 

services. We pay great attention to detail but there are many factors in the health 

care market that we cannot control. We must mitigate the risk inherent when requirements for Veterans’ care and services, and costs in the healthcare market, exVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00022 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
17 

ceed our estimates. This request is the Department’s plan for managing that risk 

and meeting our obligations to all Veterans effectively, accountably, and efficiently. 

The President’s budget for 2012 requests $132 billion—$62 billion in discretionary 

funds and $70 billion in mandatory funding. Our discretionary budget request represents an increase of $5.9 billion, or 10.6 percent, over the 2010 enacted level. 

Our plans for 2012 and 2013 pursue strategic goals we established two years ago 

to transform VA into an innovative, 21st century organization that is people-centric, 

results-driven, and forward-looking. These strategic goals seek to reverse in-effective 

decisionmaking, systematic inefficiency, and poor business practices in order to improve quality and accessibility to VA healthcare, benefits, and services; increase Veteran satisfaction; raise readiness to serve and protect in a time of crisis; and improve VA internal management systems to successfully perform our mission. We 

seek to serve as a model of governance, and this budget is shaped to provide VA 

both the tools and the management structure to achieve that distinction. 

For almost 146 years now, VA and its predecessor institutions have had the singular mission of caring for those who have ‘‘borne the battle’’ and their survivors. 

This is our only mission, and to do that well, we operate the largest integrated 

healthcare system in the country; the eighth largest life insurance entity covering 

both active duty members as well as enrolled Veterans; a sizable education assistance program; a home mortgage enterprise which guarantees over 1.4 million Veterans’ home loans with the lowest foreclosure rate in the Nation; and the largest 

national cemetery system, which continues to lead the country as a high performing 

institution. 

For two years now, we have disciplined ourselves to understand that successful 

execution of any strategic plan, especially one for a Department as large as ours, 

requires good stewardship of resources entrusted to us by the Congress. Every dollar counts, both in the current constrained fiscal environment and during less 

stressful times. Accountability and efficiency are behaviors consistent with our philosophy of leadership and management. The responsibility of caring for America’s 

Veterans on behalf of the American people demands unwavering commitment to effectiveness, accountability, and in the process, efficiency. In the past two years, we 

have established and created management systems, disciplines, processes, and initiatives that help us eliminate waste. 

STEWARDSHIP OF RESOURCES

VA has made great progress instilling accountability and disciplined processes by 

establishing our Project Management Accountability System (PMAS). This approach 

has created an information technology (IT) organization that can rapidly deliver 

technology to transform VA. PMAS is a disciplined approach to IT project development whereby we hold ourselves and our private-sector partners accountable for 

cost, schedule and performance. In just one year, PMAS exceeded an 80% success 

rate of meeting customers’ milestones. 

In addition to PMAS, we adopted a new acquisition strategy to make more effective use of our IT resources. This new strategy, Transformation Twenty-One Total 

Technology (T4, for short), will consolidate our IT requirements into 15 prime contracts, leveraging economies of scale to save both time and money and enable greater oversight and accountability. T4 also includes significant goals for subcontractors 

and other protections to make sure Veteran-owned small businesses get a substantial share of the work. Seven of the 15 prime contracts are reserved for Veteranowned small businesses, and four of the seven are reserved for service-disabled 

small businesses. 

In developing the 2012 budget, VA used an innovative, Department-wide process 

to define and assess VA’s capital portfolio. This process for Strategic Capital Investment Planning (SCIP) is a transformative tool enabling VA to deliver the highest 

quality of services by investing in the future and improving efficiency of operations. 

SCIP has captured the full extent of VA infrastructure and service gaps and developed both capital and non-capital solutions to address these gaps through 2021. 

SCIP also produced VA’s first-ever Department-wide integrated and prioritized list 

of capital projects, which is being used to ensure that the most critical infrastructure needs are met, particularly in correcting safety, security, and seismic deficiencies, and creating consistent standards across the system. 

The use of metrics to monitor and assess performance is another key strategy we 

employ to ensure the effective use of resources and accountability. For example, in 

November 2010, VA launched two online dashboards to offer transparency of the 

clinical performance of our healthcare system to the general public. First, VA’s Linking Information Knowledge and Systems (LinKS) provides outcome measurement 

data in areas such as acute, intensive, and outpatient care. This allows management 

18 

1The Value From Investments In Health Information Technology at the U.S. Department of 

Veterans Affairs, Colene M. Byrne, Lauren M. Mercincavage, Eric C. Pan, Adam G. Vincent, 

Douglas S. Johnston, and Blackford Middleton, Health Aff April 2010 29:4629–638. 

to assess a specific medical facility’s performance against other facilities while, at 

the same time, serving as a motivational tool to improve performance. The dashboard, Aspire, compiles data from VA’s individual hospitals and hospital systems to 

measure performance against national private-sector benchmarks. Financial and 

performance metrics also provide the foundation for monthly performance reviews 

that are chaired by the Deputy Secretary. These monthly meetings play a vital role 

in monitoring performance throughout the Department, and are designed to ensure 

both operational efficiency and the achievement of key performance targets. 

We also demonstrated our ongoing commitment to effective stewardship of our financial resources by obtaining our 12th consecutive unqualified (clean) audit opinion on VA’s consolidated financial statements. In 2010, we were successful in remediating 3 of 4 longstanding material weaknesses, a 75 percent reduction in just one 

year. We also began implementation of a number of key management initiatives 

that will allow us to better serve Veterans by getting the most out of our available 

resources: 

• Reducing improper payments and improving operational efficiencies in our medical fee care program will result in estimated savings of $150 million in 2011. This 

includes continued expansion of the Consolidated Patient Account Centers to standardize VA’s billing and collection activities. 

• Implementing Medicare’s standard payment rates will allow VA to better plan 

and redirect more funding into the provision of healthcare services. The estimated 

savings of this change in business practices in 2011 is $275 million. 

• Consolidating contracting requirements, adopting strategic sourcing and other 

initiatives will reduce acquisition costs by an estimated $177 million in 2011. 

The effective use of information technology is critical to achieving efficient 

healthcare and benefits delivery systems for Veterans. To accelerate the process for 

adjudicating disability claims for new service-connected presumptive conditions associated with exposure to Agent Orange, we implemented a new on-line claims application and processing system. 

A recent independent study, which covered a 10-year period between 1997 and 

2007, found that VA’s health IT investment during the period was $4 billion, while 

savings were more than $7 billion.1 More than 86 percent of the savings were due 

to the elimination of duplicated tests and reduced medical errors. The rest of the 

savings came from lower operating expenses and reduced workload. VA is continuing to modernize its electronic medical records to optimally support healthcare 

delivery and management in a variety of settings. This effort includes migrating the 

current computerized patient record system into a modern, Web-based electronic 

health record. 

Advance appropriations for VA medical care require a multi-year approach to 

budget planning whereby one year builds off the previous year. This provides opportunities to more effectively use resources in a constrained fiscal environment as well 

as to update requirements. 

MULTI-YEAR PLAN FOR MEDICAL CARE BUDGET

The 2012 budget request for VA medical care of $50.9 billion is a net increase of 

$240 million over the 2012 advance appropriations request of $50.6 billion in the 

2011 budget. This is the result of an increase of $953 million associated with potential increased reliance on the VA healthcare system due to economic employment 

conditions, partially offset by a rescission of $713 million which reflects the cumulative impact of the statutory freeze on pay raises for Federal employees in 2011 

and 2012. The 2013 request of advance appropriations is $52.5 billion, an increase 

of $1.7 billion over the 2012 budget request. 

The establishment of a Contingency Fund of $953 million for medical care is requested in 2012. These contingency funds would become available for obligation if 

the Administration determines that additional costs, due to changes in economic 

conditions as estimated by VA’s Enrollee Health Care Projection Model, materialize 

in 2012. This economic impact variable was incorporated into the Model for the first 

time this year. Based on experience from 2010, the need for this fund will be carefully monitored in 2011 and 2012. This cautious approach recognizes the potential 

impact of economic conditions as estimated by the Model to ensure funds are available to care for Veterans, while acknowledging the uncertainty associated with the 

new methodology incorporated into the Model estimates. 

19 

Another key building block in developing the 2012 and 2013 budget request for 

medical care is the use of unobligated balances, or carryover, from 2011 to meet projected patient demand. This carryover of more than $1 billion, which includes savings from operational improvements, supports anticipated costs for providing medical care to Veterans in 2012 and 2013 and is factored into VA’s request for appropriations. This is a vital component of our multi-year budget and any reductions in 

the amount of 2011 projected carryover funding would require increased appropriations in 2012 and 2013. 

TRANSFORMING VA

The Department faces an increasingly challenging operating environment as a result of the changing population of Veterans and their families and the new and 

more complex needs and expectations for their care and services. Transforming VA 

into a 21st-century organization involves a commitment to many broad challenges: 

to stay on the cutting edge of healthcare delivery; to lay the foundation for safe, secure, and authentic health record interoperability; to deliver excellent service for 

Veterans who apply for disability and education benefits; and to create a modern, 

efficient, and customer-friendly interface that better-serves Veterans. In this journey, we are focusing on opportunities to improve our efficiency and effectiveness and 

the individual performance of our employees. 

Our health informatics initiative is a foundational component for VA’s transition 

from a medical model to a patient-centered model of care. The delivery of healthcare 

will be better tailored to the individual Veteran, yet utilize treatment regimens validated through population studies. Veterans will receive fewer unnecessary tests and 

procedures and more standardized care based on best practices and empirical data. 

The purpose of the VA Innovation Initiative (VAi2) is to identify, fund, and test 

new ideas from VA employees, academia, and the private sector. The focus is on improving access, quality, performance, and cost. VA remains committed to the best 

system of delivering quality care and benefits to Veterans. VAi2 plays an important 

role by enabling the use of promising technologies in the design of cost-effective solutions. For example, TBI Toolbox pilot, located at McGuire VA Medical Center in 

Richmond, Virginia, will test a software tool to standardize data gathered from 

brain injury treatments. The strategy will allow sharing of rapidly evolving treatment guidelines at VA polytrauma centers and Department of Defense medical facilities, as well as patient progress and outcomes. 

The 2012 budget continues our focus on three key transformational priorities I established when I became Secretary: Expanding access to benefits and services; reducing the claims backlog; and eliminating Veteran homelessness by 2015. These 

priorities address the most visible and urgent issues in VA. 

EXPANDING ACCESS TO BENEFITS AND SERVICES

Expanding access to healthcare and benefits for underserved Veterans is vital to 

VA’s success in best-serving Veterans of all eras. 

The Veterans Relationship Management (VRM) initiative will provide Veterans, 

their families, and survivors with direct, easy, and secure access to the full range 

of VA programs through an efficient and responsive multi-channel program, including phone and Web services. VRM will provide VA employees with up-to-date tools 

to better serve VA clients, and empower clients through enhanced self-service capabilities. Expanding the self-service capabilities of the eBenefits on-line portal is one 

of the early successes of the VRM program in 2010, and expansion of eBenefits 

functionality continues through quarterly releases and programs to engage new 

users. 

VA also saw significant progress in expanding access to Veterans. In July 2010, 

the Center for Women Veterans sponsored a forum to highlight enhancements in VA 

services and benefits for women Veterans which resulted in an information toolkit 

tor advocates such as Veteran Service Organizations to share with their constituencies. 

Outreach was extended directly to women when, for the first time in 25 years, 

VA surveyed women Veterans across the country to (1) identify in a national sample 

the current status, demographics, healthcare needs, and VA experiences of women 

Veterans; (2) determine how healthcare needs and barriers to VA healthcare differ 

among women Veterans of different generations; and (3) assess women Veterans’ 

healthcare preferences in order to address VA barriers and healthcare needs. The 

interim report, released in summer 2010, informs policy and planning and provides 

a new baseline for program evaluation with regard to Veterans’ perceptions of VA 

health services. The final report will be released in spring 2011. 

20 

The Enhancing the Veteran Experience and Access to Healthcare (EVEAH) initiative will expand healthcare for Veterans, including women and rural populations. 

Care alternatives will be created to meet these special population access needs, including the use of new technology. Where technology solutions safely permit, VA has 

already transitioned from inpatient to outpatient settings through the use of telemedicine, in-home care, and other delivery innovations. 

One area of success is our expansion of telehome health-based clinical services in 

rural areas, which increases access, and reduces avoidable travel for patients and 

clinicians. In 2010, the total average daily census in telehome health was 31,155. 

This program will continue to expand to an estimated average daily census of 

50,147 in 2012, an increase of 60 percent over 2010. 

Through the Improve Veteran Mental Health (IVMH) initiative more Veterans 

will have access to the appropriate mental health services for which they are eligible, regardless of their geographic location. VA is leveraging the virtual environment 

with services such as the Veterans’ Suicide Prevention Chat Line and real-time clinical video conferences. 

REDUCING THE CLAIMS BACKLOG

One of VA’s highest priority goals is to eliminate the disability claims backlog by 

2015 and ensure all Veterans receive a quality decision (98 percent accuracy rate) 

in no more than 125 days. VBA is attacking the claims backlog through a focused 

and multi-pronged approach. At its core, our transformational approach relies on 

three pillars: a culture change inside VA to one that is centered on advocacy for Veterans; collaborating with stakeholders to constantly improve our claims process 

using best practices and ideas; and deploying powerful 21st century IT solutions to 

simplify and improve claims processing for timely and accurate decisions the first 

time. 

The Veterans Benefits Management System (VBMS) initiative is the cornerstone 

of VA’s claims transformation strategy. It integrates a business transformation 

strategy to address process and people with a paperless claims processing system. 

Combining a paperless claims processing system with improved business processes 

is the key to eliminating the backlog and providing Veterans with timely and quality decisions. The Virtual Regional Office, completed in May 2010, engaged employees and subject-matter experts to determine system specifications and business requirements for VBMS. The first VBMS pilot began in Providence in November 2010. 

Nationwide deployment of VBMS is expected to begin in 2012. 

VA is encouraging Veterans to file their Agent Orange-related claims through a 

new on-line claims application and processing system. Vietnam Veterans are the 

first users of this convenient automated claims processing system, which guides 

them through Web-based menus to capture information and medical evidence for 

faster claims decisions. While the new system is currently limited to claims related 

to the new Agent Orange presumptive conditions of Parkinson’s Disease, Ischemic 

Heart Disease, and Hairy Cell Leukemia’s, we will expand it to include claims for 

other conditions. 

VA also published the first set of streamlined forms capturing medical information essential to prompt evaluation of disability compensation and pension claims, 

and dozens more of these forms are in development for various disabilities. The content of these disability benefit questionnaires is being built into VA’s own medical 

information system to guide in-house examinations. Veterans can provide them to 

private doctors as an evidence guide that will speed their claims decisions. 

Another initiative to reduce the time needed to obtain private medical records utilizes a private contractor to retrieve the records from the provider, scan them into 

a digital format, and send them to VA through a secure transmission. This contract 

frees VA staff to focus on processing claims more quickly. 

Additional claims transformation efforts deployed nationwide in 2010 include the 

Fully Developed Claims initiative to promptly rate claims submitted with all required evidence and an initiative to proactively reach out to Veterans via telephone 

to quickly resolve claims issues. 

VA needs these innovative systems and initiatives to expedite claims processing 

as the number of claims continue to climb. The disability claims workload from returning war Veterans, as well as from Veterans of earlier periods, is increasing each 

year. Annual claims receipts increased 51 percent when comparing receipts from 

2005 to 2010 (788,298 to 1,192,346). We anticipate claims receipts of nearly 1.5 million in 2011 (including new Agent Orange presumptive) and more than 1.3 million 

claims in 2012. The funding request in the President’s budget for VBA is essential 

to meet the increasing workload and put VA on a path to achieve our ultimate goal 

of no claims over 125 days by 2015. 

21 

ELIMINATING VETERAN HOMELESSNESS

VA has an exceptionally strong track record in decreasing the number of homeless 

Veterans. Six years ago, there were approximately 195,000 homeless Veterans on 

any given night; today, there are about 75,600. VA uses a multi-faceted approach 

by providing safe housing; outreach; educational opportunities; mental healthcare 

and treatment; support services; homeless prevention services, and opportunities to 

return to employment. The National Call Center for Homeless has received 13,000 

calls since March 2010, and 18,000 Veterans and families of Veterans have been 

provided permanent housing through VA and Housing and Urban Development Department programs. These Veterans were also provided with dedicated case managers and access to high-quality VA healthcare. 

The Building Utilization Review and Repurpose (BURR) study is using VA’s inventory of vacant/underutilized buildings to house homeless and at-risk Veterans 

and their families, where practical. Congress allocated $50 million to renovate unused VA buildings and VA has identified 94 sites with the potential to add approximately 6,300 units of housing through public/private ventures using VA’s enhanceduse lease authority. This legislative authority is scheduled to lapse at the end of calendar year 2011. The Administration remains committed to this important program, 

and a proposal to address the expiration will accompany the Department’s legislative package submitted through the President’s Program. In addition to helping reduce homelessness, vacant building reuse is being considered for housing for OEF/ 

OIF/OND Veterans, poly-trauma patients, assisted living, and seniors. 

Homelessness is both a housing and healthcare issue, heavily burdened by depression and substance abuse. Our 2012 budget plan also supports a comprehensive approach to eliminating Veteran homelessness by making key investments in mental 

health programs. 

The 2012 budget includes $939 million for specific programs to prevent and reduce homelessness among Veterans. This is an increase of 17.5 percent, or $140 million over the 2011 level of $799 million. This increase includes an additional $50.4 

million to enhance case management for permanent housing solutions offered 

through the Housing Urban Development-VA Supported Housing (HUD-VASH) program. These funds are required to maintain the services that keep Veterans rescued 

from homelessness sheltered; get the remaining men and women off the streets 

whom we have not reached in the past; and, prevent additional Veterans from becoming homeless during a time of war and difficult economic conditions. 

MENTAL HEALTH

The mental health of Veterans is a more important issue now than ever before, 

as increasing numbers of Veterans are diagnosed with mental health conditions, 

often coexisting with other medical problems. More than 1.2 million of the 5.2 million Veterans seen in 2009 in VA had a mental health diagnosis. This represents 

about a 40 percent increase since 2004. 

Veterans of Iraq and Afghanistan rely on mental healthcare from VA to a greater 

degree than earlier groups of Veterans. Diagnosis of PTSD is on the rise as the contemporary nature of warfare increases both the chance for injuries that affect mental health and the difficulties facing Veterans upon their return home. In addition, 

mental health issues are often contributing factors to Veterans’ homelessness. 

In order to address this challenge, VA has significantly invested in our mental 

healthcare workforce, hiring more than 6,000 new mental healthcare workers since 

2005. In 2010, VA hired more than 1,500 clinicians to conduct screenings and provide treatment as well as trained over 1,000 clinicians in evidenced-based practices. 

The Department has also established high standards for the provision of mental 

healthcare services through the recent publication of our Handbook on Uniform 

Mental Health Services in VA medical centers and clinics, and we have developed 

an integrated mental health plan with DOD to ensure better continuity of care— 

especially for Veterans of Iraq and Afghanistan. The 2012 budget includes $6.2 billion for mental healthcare programs, an increase of $450 million, or 8 percent over 

the 2011 level of $5.7 billion. 

MEDICAL CARE PROGRAM

We expect to provide medical care to over 6.2 million unique patients in 2012, a 

1.4 percent increase over 2011. Among this community are nearly 536,000 Veterans 

of Iraq and Afghanistan, an increase of over 59,000 (or 12.6 percent) above 2011. 

The 2012 budget will support several new initiatives in addition to our efforts to 

eliminate Veteran homelessness. For example, $344 million is provided for the activation of newly constructed medical facilities. In addition, we provide $208 million 

22 

to implement provisions of the Caregivers and Veterans Omnibus Health Services 

Act and improve the quality of life for Veterans and their families. 

The 2012 budget also includes operational improvements that will make VA more 

effective and efficient in this challenging fiscal and economic environment. VA is 

proposing $1.2 billion of operational improvements which include aligning fees that 

VA pays with Medicare rates, reducing and improving the administration of our feebased care program, clinical staff realignments, reducing indirect medical and administrative support costs, and achieving significant acquisition improvements to increase our purchasing power. 

Beginning in 2010, VHA embarked on a multi-year journey to enhance significantly the experience of Veterans and their families in their interactions with VA 

while continuing to focus on quality and safety. This journey required the VHA to 

develop new models of healthcare that educated and empowered patients and their 

families, focused not only on the technical aspects of healthcare but also designed 

for a more holistic, Veteran-centered system, with improved access and coordination 

of care. New Models of Healthcare is a portfolio of initiatives created to achieve 

these objectives. We are re-designing our systems around the needs of our patients 

and improving care coordination and virtual access through enhanced secure messaging, social networking, telehealth, and telephone access. 

An essential component of this approach is transforming our primary care programs to increase our focus on health promotion, disease prevention, and chronic 

disease management through multidisciplinary teams. The new model of care will 

improve health outcomes and the care experience for our Veterans and their families. The model will standardize healthcare policies, practices and infrastructure to 

consistently prioritize Veterans’ healthcare over any other factor without increasing 

cost or adversely affecting the quality of care. This important initiative will enable 

VA to become a national leader in transforming primary care services to a medical 

home model of healthcare delivery that improves patient satisfaction, clinical quality, safety and efficiencies. VA Tele-Health and the Home Care Model will develop 

a new generation of communication tools (i.e. social networking, micro-blogging, text 

messaging, and self management groups) that VA will use to disseminate and collect 

critical information related to health, benefits and other VA services. 

VA is taking this historic step in redefining medical care for Veterans with the 

adoption of a modern healthcare approach called PACT, which stands for Patient 

Aligned Care Team. PACT is VA’s adaptation of the popular contemporary teambased model of healthcare known as Patient Centered Medical Home designed to 

provide continuous and coordinated care throughout a patient’s lifetime. 

MEDICAL RESEARCH

VA’s many trailblazing research accomplishments are a source of great pride to 

our department and the Nation. Today’s committed VA researchers are focusing on 

Traumatic Brain Injury, Post Traumatic Stress Disorder, post-deployment health, 

women’s health and a host of other issues key to the well-being of our Veterans. 

As one of the world’s largest integrated healthcare systems, VA is uniquely positioned to not only conduct and fund research, but to develop solutions and implement them more quickly than other healthcare systems—turning hope into reality 

for Veterans and all Americans. 

VA’s budget request for 2012 includes $509 million for research, a decrease of $72 

million below the 2010 level. In addition, VA’s research program will receive approximately $1.2 billion from medical care funding and Federal and non-Federal 

grants. These research funds will continue support for genomic medicine, point of 

care research, and medical informatics and information technology. Genomic medicine, also referred to as personalized medicine, uses information on a patient’s genetic make-up to tailor prevention and treatment for that individual. The Million 

Veteran Program invites users of the VA healthcare system nationwide to participate in a longitudinal study with the aim of better understanding the relationship 

between genetic characteristics, behaviors and environmental factors, and Veteran 

health. 

To leverage data in the electronic health record, VA Informatics and Computing 

Infrastructure (VINCI) is creating a powerful and secure environment within the 

Austin Information Technology Center. This environment will allow VA researchers 

to access more easily a wide array of VHA databases using custom and off-the-shelf 

analytical tools. The Consortium for Healthcare Informatics Research (CHIR) will 

provide research access to patient information in VA’s Computerized Patient Record 

System (CPRS) narrative text and laboratory reports. Together, VINCI and CHIR 

will allow data mining to accelerate findings and identify emerging trends. UltiVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00028 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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mately, this critical work will lead to greater effectiveness of our medical system— 

improving value by assisting in the prevention and cure of disease. 

VETERAN BENEFITS

The 2012 budget request for the Veterans Benefits Administration is $2.0 billion, an increase of $330 million, or 19.5 percent, over the 2010 enacted level of $1.7 billion. This budget supports ongoing and new initiatives to reduce disability claims 

processing time, including development and implementation of further redesigned 

business processes. It funds an increase in FTE of 716 over 2010 to 20,321 to assist 

in reducing the benefits claims backlog. It also supports the administration of expanded education benefits eligibility under the Post-9/11 GI Bill, which now includes 

benefits for non-college degree programs, such as on-the-job training, flight training, 

and correspondence courses. In addition, the 2012 budget request supports the following initiatives: 

Integrated Disability Evaluation System (IDES) Program 

IDES simplifies the process for disabled servicemembers transitioning to Veteran 

status, improves the consistency of disability ratings, and improves customer satisfaction. An IDES claim is completed in an average of 309 days; 43 percent faster 

than in the legacy system. VA and DOD worked together to increase the number 

of sites for the IDES program from 21 to 27 in 2010. The six new sites are Fort 

Riley, Fort Benning, Fort Lewis, Fort Hood, Fort Bragg and Portsmouth Naval Hospital, and VA and DOD will continue to expand the IDES program. 

IDES is being expanded to provide Vocational Rehabilitation and Employment 

(VR&E) services to active duty Servicemembers transitioning through the IDES. 

These services range from a comprehensive rehabilitation evaluation to determine 

abilities, skills, and interests for employment purposes as well as support services 

to identify and maintain employment. The budget request includes $16.2 million for 

110 FTE for the VR&E program to support IDES. 

Veterans Benefits Management System (VBMS) 

In 2011, we will conduct two of three planned pilot programs to test VBMS, the 

new paperless claims processing system. Each pilot will expand on the success of 

the first pilot by adding additional software components. In the 2012 budget request 

for information technology, we will invest $148 million to complete pilot testing and 

initiate a national rollout. 

VetSuccess on Campus 

In July 2009, VA established a pilot program at the University of South Florida 

called VetSuccess on Campus to improve graduation rates by providing outreach 

and supportive services to Veterans entering colleges and universities and ensuring 

that their health, education and benefit needs are met. The program has since expanded to include an additional seven campuses, serving approximately 8,000 Veterans. The campus Vocational Rehabilitation Counselor (VRC) and the Vet Center 

Outreach Coordinator liaise with school certifying officials, perform outreach, and 

communicate with Veteran-students to ensure their health, education, and benefit 

needs are met. This will enable Veterans to stay in college to complete their degrees 

and enter career employment. In addition, it provides Veterans the skills necessary 

to gain employment after graduation, which can help prevent Veteran homelessness. 

The 2012 budget includes $1.1 million to expand the program to serve an additional 

9,000 Veteran students on nine campuses, more than doubling the size of the current program. 

NATIONAL CEMETERY ADMINISTRATION

The budget plan includes $250.9 million in operations and maintenance funding 

for the National Cemetery Administration (NCA). The funding will allow us to provide more than 89.8 percent of the Veteran population a burial option within 75 

miles of their residences by keeping existing national cemeteries open and establishing new state Veterans cemeteries, as well as increasing outreach efforts. 

VA expects to perform 115,500 interments in 2012, a 1.0 percent increase over 

2011. In 2012, NCA will provide maintenance of 8,759 developed acres, 3.0 percent 

over the 2011 estimate, while 3,228,000 or 2.6 percent more gravesites will be given 

perpetual care. 

The budget request will allow NCA to maintain unprecedented levels of customer 

satisfaction. NCA achieved the top rating in the Nation four consecutive times on 

the prestigious American Customer Satisfaction Index (ACSI) established by the 

University of Michigan. ACSI is the only national, cross-industry measure of satisfaction in the United States. On the most recent 2010 survey and over the past decVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00029 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
24 

ade, NCA’s scores bested over 100 Federal agencies and the Nation’s top corporations including Ford, FedEx and Coca Cola, to name a few. Our own internal surveys confirm this exceptional level of performance. For 2010, 98% of the survey respondents rated the appearance of national cemeteries as excellent; 95% rated the 

quality of service as excellent. 

NCA has implemented innovative approaches to cemetery operations: the use of 

pre-placed crypts, that preserve land and reduce operating costs; application of 

‘‘water-wise’’ landscaping that conserves water and other resources; and installation 

of alternative energy products such as windmills and solar panels that supply power 

for facilities. NCA has also utilized biobased fuels that are homegrown and less 

damaging to the environment. NCA is developing an independent study of emerging 

burial practices throughout the world to inform its planning for the future. 

Support for the Veterans Cemetery Grants Program continues in 2012 with $46 

million to fund the highest priority Veterans cemetery grant requests ready for 

award. In addition to state cemetery grants, NCA is engaged in discussions with 

tribal governments regarding the construction of Veterans’ cemeteries on their land 

and is awarding six such grants in 2011. The inclusion of tribal governments as 

grant recipients recognizes and empowers the authority of these groups to represent 

a unique group of Veterans and respond to their needs. 

CAPITAL INFRASTRUCTURE

Congressional support of VA has resulted in 63 major construction projects funded 

in whole, or in part, since 2004. When combined with investments in our minor construction and major lease programs, this has contributed to a plant inventory which 

includes 5,541 owned facilities, 1,629 leased facilities, 155 million square feet of occupied space (owned and leased) and 33,718 acres of owned real property. 

To best utilize resources, VA has reduced its inventory of owned vacant space by 

34 percent, from 8.6 million square feet in 2001 to 5.7 million square feet in 2010. 

As discussed previously, we are using the Building Utilization Review and Repurpose (BURR) effort to reuse vacant space for homeless Veterans and their families. 

BURR also identifies other potential reuses of vacant and underutilized space and 

land within VA’s inventory such as assisted living, senior housing, and housing for 

Veterans of Iraq and Afghanistan and their families. VA also houses homeless Veterans in public/private ventures through enhanced-use leasing. 

Major Construction 

The major construction request in 2012 is $589.6 million in new budget authority. 

In addition, VA has been the beneficiary of a favorable construction market and, as 

a result, is able to reallocate $135.6 million from previously authorized and appropriated projects to accomplish additional project work—resulting in a total of $725.2 

million for the major construction program. This reflects the Department’s continued commitment to provide quality healthcare and benefits through improving its 

infrastructure to provide for modern, safe, and secure facilities for Veterans. It includes seven ongoing medical facility projects (New Orleans, Denver, San Juan, St. 

Louis, Palo Alto, Bay Pines, and Seattle) and design for three new projects (Reno, 

West Los Angeles and San Francisco) primarily focused on safety and security corrections. One cemetery expansion will be completed to maintain and improve burial 

service in Honolulu, HI. 

Minor Construction 

In 2012, the minor construction request is $550.1 million. In support of the medical care and medical research programs, minor construction funds permit VA to realign critical services, make seismic corrections, improve patient safety, enhance access to healthcare and patient privacy, increase capacity for dental care, improve 

treatment of special emphasis programs, and, expand our research capability. We 

also use minor construction funds to improve the appearance of our national cemeteries. Further, minor construction resources will be used to comply with energy efficiency and sustainability design requirements. 

Greening VA 

The ‘‘greening VA’’ effort continues to be strong. There are 21 facilities Green 

Globe-certified and four LEED-certified. We have completed energy efficiency 

benchmarking for 99% of VA-owned facilities and obtained the Energy Star label for 

30 VA sites since 2003. Electric meter installations were completed for 60% of targeted buildings and we are installing solar energy systems at 35 sites for a total 

capacity of 30 megawatts. VA has installed wind turbines at two sites, awarded two 

ground source heat pump projects, awarded five renewably fueled cogeneration 

projects, and completed one fuel cell project. 

25 

In 2012, we plan to invest $27 million for solar photovoltaic projects, $51 million 

in energy infrastructure improvements, $21 million in renewably fueled cogeneration using biomass (wood waste) or biogas (waste methane), $1 million in sustainable building, $14 million for wind projects, and $10 million for alternative fueling 

projects and expansion of environmental management systems. 

INFORMATION TECHNOLOGY

Information Technology (IT) is integral to the delivery of efficient and effective 

service to Veterans. IT is not a supplementary function—it is key to the delivery 

of efficient, modern healthcare. The 2012 budget includes $3.161 billion to support 

Information Technology (IT) development, operations and maintenance expenses. 

The 2012 budget will fund the Department’s highest IT priorities as well as information security programs, which protect privacy and provide secure IT operations 

across VA. Under our disciplined development program, PMAS, the delivery of customer software milestones exceeds 80% which is up from just 20% before the implementation of PMAS. The budget request will also fund systems that VA will develop 

and implement under the Caregivers and Veterans Omnibus Health Services Act of 

2010. 

In 2010, VA made the sound business decision to discontinue the Integrated Financial Accounting System (IFAS) and the data warehouse component of the Financial and Logistics Integrated Technology Enterprise (FLITE). OI&T will fund other 

continuing projects such as Compensation and Pension Records Interchange 

(CAPRI) which offers VBA Rating Veteran Service Representatives and Decision Review Officers help in building the rating decision. CAPRI does this by creating a 

more efficient means of requesting compensation and pension examinations and 

navigating existing patient records. 

Veterans Relationship Management (VRM) 

The 2012 IT budget for VRM is $108 million, and will support continued development of the on-line portal as well as the development of Customer Relationship 

Management capabilities. 

Virtual Lifetime Electronic Record (VLER) 

The Virtual Lifetime Electronic Record (VLER) is a Federal, inter-agency initiative to provide portability, accessibility and complete health, benefits, and administrative data for every Servicemember, Veteran, and their beneficiaries. The goal of 

this major initiative is to establish the interoperability and communication environment necessary to facilitate the rapid exchange of patient and beneficiary information that will yield consolidated, coherent and consistent access to electronic records 

between DOD, VA, and the private sector. 

VLER will not create a new data record, but it will ensure availability of reliable 

data from the best possible source. The VLER health component of this initiative 

is in operation at two pilot sites with a plan to add nine more pilots this fiscal year. 

VLER will work closely with other major initiatives including the Veterans Benefits 

Management System (VBMS) and the Veterans Relationship Management (VRM). 

A total of $70 million in IT funds in 2012 is required to complete the effort and 

move to national production and deployment of initial VLER capabilities. The VLER 

partnership between VA and the Department of Defense will serve as a positive 

model for electronic health record interoperability in the country, which has been 

an Administration priority. 

SUMMARY

VA is the second largest Federal department and has over 300,000 employees. 

Among the many professions represented in the vast VA workforce are physicians, 

nurses, counselors, claims processors, cemetery groundskeepers, statisticians, engineers, architects, computer specialists, budget analysts, police, and educators—all 

working with the greatest determination to best serve all generations of Veterans. 

In addition, VA has approximately 140,000 volunteers serving Veterans at our hospitals, Vet centers and cemeteries. There are things that they do that cannot be converted into dollar values—patience, dignity and respect for Veterans, some of whom 

are heavily challenged by the memories of their wars. 

As advocates for Veterans and their families, VA is committed to providing the 

very best services. I will do everything possible to ensure that we wisely use the 

funds Congress appropriates for VA to improve the quality of life for Veterans and 

the efficiency of our operations—innovatively and transparently—as we deliver on 

the enduring promises of Presidents and the obligations of the American people to 

our Veterans. 

26 

I am honored to present the President’s 2012 budget request for VA, and to represent all VA employees and the interests of those outside of VA, who share our 

commitment to Veterans. 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY TO

HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. Please provide a list of the medical centers that are experiencing a 

budget shortfall in the current fiscal year, or which experienced a shortfall in FY 

2010, the amounts of those shortfalls, whether or not a request has been made to 

the corresponding VISN for financial relief, and the response to any such request. 

Response. All Department of Veterans Affairs medical center (VAMC) requirements have been addressed within resources allocated to the Veterans Integrated 

Service Networks (VISN) in both fiscal year (FY) 2010 and to date in FY 2011. All 

VISN Directors meet with the Secretary during the year to discuss their resource 

needs. No VISN Directors have indicated that they will not be able to accomplish 

their missions without additional resources in FY 2011. 

Question 2. The President’s budget requests a drastic cut in the Medical and Prosthetic Research account of $72.2 million, or almost 12.5 percent. What impact will 

this have on VA’s research program and what specific programmatic cuts are being 

planned? How will this impact the prioritization of research programs? 

Response. VA supports research projects based on merit review, and within the 

FY 2012 budget, VA will support approximately 135 fewer projects from all services 

when compared with the FY 2010 level. While there will be fewer projects, VA will 

continue to emphasize research on deployment and Veteran-specific health issues. 

Areas of particular focus, such as Gulf War Veterans Illnesses, women Veterans and 

mental health, will be preserved or increased, with the reductions being realized 

across the board in other areas. 

VA’s Office of Research and Development is adopting ISO 9001 principles to increase management efficiencies in conducting clinical trials. The International Organization of Standardization (ISO) is widely considered to be the standard for efficient and effective management systems. These improvements will further reduce 

the cost of performing clinical trials by reducing administrative costs and streamlining processes 

Question 3. Does the VERA model sufficiently accounts for a variety of anomalies 

in hospital operations including seasonal workload changes, historic campuses, split 

campuses and the associated maintenance costs? 

Response. The Veterans Equitable Resource Allocation (VERA) model is designed 

to equitably distribute resources to the VISNs. In FY 2011, the Veterans Health Administration (VHA) is now using a standard model to further allocate funds from 

the VISN level to VAMCs. VISN Directors have the discretion to make appropriate 

adjustments to that model to reflect local realities, such as the activation of a new 

community-based outpatient clinic (CBOC). These adjustments are left to the VISN 

Director’s discretion because he or she has the best knowledge of and insight into 

what a specific facility needs. 

It should be noted that the VERA Model is designed to fund a full year of operation, so seasonal variations are accommodated within its allocations. Likewise the 

workload that drives VERA is measured over multiple years, so seasonal variation 

is also accommodated within that process. 

Question 4. Projections for the Medical Care Collections Fund have historically 

been very inaccurate. Why is the projected increase—from FY 2011 to FY 12—so 

low, relative to the growth in previous years? 

Response. VA recently instituted a scientifically-derived collections model including multiple variables such as projected workload, Veteran demographics, insurance 

status and economic conditions, to more accurately forecast collections. In FY 2010, 

VA experienced only a 1.4 percent increase in collections versus FY 2009 ($2.773B 

vs. $2.734B); based on our model output, there are a number of factors continuing 

to impact lower growth rates in FY 2011 and FY 2012: 

• Poor economic conditions—Growth in national unemployment (from 7.7 percent 

in the First Quarter of FY 2009 to 9.8 percent at the end of the First Quarter of 

FY 2011) will continue to impact both first party collections (Veteran out-of-pocket 

costs) and third party collections (unemployment and resultant loss of health insurance coverage). 

• Hardship waivers and exemptions from copayments are increasing—Veteran 

first party copayment economic hardship waivers and exemptions were at their 

27 

highest levels in FY 2010 (the most recent completed year) than in any prior year 

and this is expected to continue with the current economic conditions. • Third party ‘‘Collections to Billings’’ (CtB) ratios are down nationally—CtB ratios are expected to continue a downward trend impacting third party collections. 

CtB decreased from 43.1 percent in January 2009 to 39.1 percent in January 2011, 

and was influenced by the continued shift by insurers of payment responsibility to 

the patient (i.e., higher deductibles, increased copayments, etc.). Section 1729 of title 

38 prevents VA from billing the Veteran if the insurance company does not pay. 

Each one percent decrease in CtB represents a $55 million loss in revenue. • Priority Group migration from lower to higher status—National Priority Group 

migration over the past 2 years has shown a sharp decrease in collections for Veterans in Priority Group 8 which are the primary drivers of both first and third party 

collections. 

Question 5. Please provide a breakdown of funding to be spent on implementing 

the Caregivers and Veterans Omnibus Health Services Act of 2010 (PL 111–163). 

Please include a specific breakdown of funding to be spent on the family caregiver 

program, including dates by which the funds are projected to be spent. 

Response. VA has identified below a general timeline with goals for implementing 

the family caregiver program required by title I of Public Law (PL) 111–163, the 

Caregivers and Veterans Omnibus Health Services Act of 2010. VA’s planning and 

work on regulations has been ongoing since before the Caregivers and Veterans Omnibus Health Services Act of 2010 was signed into law. This work has continued 

throughout the time the implementation plan was under development. VA is working as quickly and responsibly as possible to deliver these enhanced benefits to eligible Veterans and their caregivers and will keep the Committee closely apprised of 

its progress. 

Create Caregiver Support Line February 1, 2011 (completed) 

Hire All Caregiver Support Coordinators April 2011 

New State-of-the-Art Web Site May 2011 

A breakdown of funding to be spent on implementing Pub. L. 111–163 is displayed 

below. 

Description FY 2011 

Estimate FY 2012 Estimate FY 2013 Estimate 

Total Caregivers and Veterans Omnibus Health Services Act of 2010 

(PL 111-163) ......................................................................................... $132 million $208 million $248 million 

Caregiver Support (Title I) (non-add) ........................................................ $30 million $66 million $71 million 

Question 6. Please provide a breakdown of the proposed clinical staff and resource 

realignment. What efficiencies does the Department anticipate achieving and how 

will this impact the quality of and access to patient care? 

Response. As positions currently filled by professional physicians and registered 

nurses become vacant, VA is filling these positions with more clinically appropriate 

and cost effective personnel, thereby ensuring the quality of care while reducing 

costs. Continued access will be ensured because this transition in clinical staff mix 

is occurring gradually and in conjunction with an increasing emphasis on appropriate task assignments and more efficient approaches to providing care. Some examples of these approaches include reliance on telephone contacts, secure messaging, and group visits. VA expects this transition will improve the quality of care 

through implementation of Patient Aligned Care Teams (PACT) and features such 

as disease registries, population approaches toward disease prevention and chronic 

disease management, and focused emphasis on higher risk patients. 

Question 7. How does VHA’s current salary and incentive pay structure affect the 

willingness of top leaders to assume higher levels of responsibility, such as moving 

to more complex medical centers or to VISN offices? How does this structure compare with the private sector and what impact is it having on VHA’s ability to recruit 

and retain top-level managers? 

Response. The 2006 modifications to compensation for VHA medical professionals 

have helped the Department recruit, retain, and promote skilled individuals it otherwise would not have been able to hire or would have lost. Compensation for VHA’s 

professionals still lags behind that of their private sector counterparts, but these 

modifications have helped bring more care in-house as part of the Department’s efforts to reduce Fee Basis and Contract Care without compromising timeliness or 

quality. It’s worth noting, however, that the new compensation structure has exacerbated the pay inequity between VHA’s medical professionals and senior managers 

28 

that are not physicians, dentists, or nurses, whose compensation also lags behind 

their private sector counterparts. VHA shares this challenge recruiting and retaining these top-level managers with many other agencies across government. VHA 

will continue to monitor the extent to which this challenge impair our recruitment 

and retention of top-level managers, and will work with the Office of Personnel 

Management to address this issue. 

Question 8. Please provide a breakdown of the operating budgets and staffing levels for each VISN office. 

Response. The table below provides the operating budget and staffing levels for 

each VISN. 

VISN 

FY 2011 

Operating 

Budget 

Staffing 

Level 

(FTE) 

1 .............................. $4,522,000 30 .0 

2 .............................. $4,027,013 22 .7 

3 .............................. $9,590,840 43 .0 

4 .............................. $11,618,654 69 .0 

5 .............................. $10,300,000 54 .0 

6 .............................. $9,916,086 52 .0 

7 .............................. $9,000,000 58 .5 

8 .............................. $17,200,000 100 .8 

9 .............................. $13,200,000 63 .0 

10 .............................. $7,300,000 51 .0 

11 .............................. $10,950,353 57 .0 

12 .............................. $7,982,147 44 .0 

15 .............................. $6,271,017 40 .0 

16 .............................. $9,514,253 57 .0 

17 .............................. $13,216,139 76 .0 

18 .............................. $10,757,900 52 .0 

19 .............................. $8,311,641 46 .5 

20 .............................. $13,243,476 55 .0 

21 .............................. $7,442,950 52 .0 

22 .............................. $7,371,021 41 .5 

23 .............................. $6,531,485 47 .0 

Question 9. Please provide an estimate of the cost avoidance of expanded use of 

telehealth and tele-mental health technologies. 

Response. Telehealth technologies will realize cost avoidance through reduced utilization of health care resources in hospitalizations, reduced average length of stay, 

and decreased travel needs. This cost avoidance will allow VA more effective stewardship of health care resources and improve access for our Veterans. The actual 

cost avoidance is difficult to measure because in many instances it allows VA to provide more health care services within the same level of resources. 

Question 10. Given the increase in beneficiary travel, is there any concern that 

fraudulent claims are being paid out and, if so, to what extent? What can the Department do to improve enforcement to ensure only legitimate claims are paid? 

Response. As stewards of the taxpayers’ funds, VA is always vigilant in monitoring the claims it receives and preventing the fraudulent use of resources. VA is 

implementing various initiatives to monitor and manage the Beneficiary Travel program to ensure the appropriate use and provision of Beneficiary Travel benefits. 

These efforts include: 

• Distribution of communication material to assist Veterans in understanding 

their responsibilities related to this benefit. 

• Regulatory changes to eliminate or clarify areas of confusion regarding travel 

eligibility and payment requirements. 

• Identification of strong practices, including procedures and systems that effectively control this benefit. A national workgroup of subject matter experts has identified system-wide issues and potential solutions. Identified practices include a locally developed automated patient behavior and clinic utilization evaluation tool 

that allows stations to determine areas of local concern. This is currently being used 

in approximately 20 locations, and VA has scheduled a national release and training 

effort beginning in March 2011. VA is developing an automated tool that will standardize claims processing and payment procedures (and will include an audit capability) for national release this fiscal year. VA is gathering real cases of inapproVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00034 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
29 

priate use of Beneficiary Travel for use in a training program that will be offered 

in March and April 2011. • Initiation of projects to identify national level data patterns that merit further 

review. This effort will allow VA to identify reimbursement transactions that are of 

a suspicious nature. This, in turn, will allow VA to identify various types of patterns 

and reimbursements within each pattern that merit further review. • Definition and implementation of automated management systems that will improve and standardize internal controls of this benefit. VA is developing automated 

claims processing and audit tools to standardize procedures with an expected release date this fiscal year. VA is also in the initial stage of developing longer term 

solutions that are tentatively scheduled for initial development in the first quarter 

of FY 2012. 

Question 11. What adjustment was made in the level of resources requested for 

CHAMPVA to account for the incorporation of family caregivers under Public Law 

111–163? 

Response. VA included estimates for the impact on the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) in its budget request for FY 2012 under the request for funds to support implementation of Public 

Law 111–163 rather than in the CHAMPVA-specific funds. 

Question 12. Legislation was introduced last Congress to extend a dependant 

child’s CHAMPVA eligibility until age 26, in congruence with the health care reform 

legislation. Are the resources requested for CHAMPVA sufficient to accommodate 

this change? 

Response. VA has estimated the potential impact of changes to CHAMPVA eligibility based upon this legislation and provided this information to the Committee 

last Congress. The current budget estimates do not include these resources because 

no legislation has been enacted. 

Question 13. The President’s FY 2011 budget included $217.6 million to enhance 

primary care for women veterans. Were any of these funds obligated to fixing the 

deficiencies identified in GAO’s report, VA Has Taken Steps to Make Services Available to Women Veterans, but Needs to Revise Key Policies and Improve Oversight 

Processes, from last March? Please provide an accounting of these expenditures. 

Response. Following the Government Accountability Office’s (GAO) report, ‘‘VA 

Has Taken Steps to Make Services Available to Women Veterans, but Needs to Revise Key Policies and Improve Oversight Processes,’’ (March 2010), VA has undertaken an extensive evaluation of its facilities, identifying existing deficiencies in the 

environment of care, including bathrooms, privacy curtains, locks, and other areas. 

These deficiencies have been prioritized and tracked for correction. In FY 2011, VA 

has budgeted $17 million in non-recurring maintenance (NRM) projects that will be 

used at the facility level to correct privacy deficiencies in addition to the $241.8 million of gender-specific care (from treatment funds) and $2.89 billion for total care 

for women Veterans. In FY 2010, VA spent over $214 million in gender-specific care 

and nearly $2.6 billion in total care for women Veterans. 

Question 14. The recently released 2010 Hospital Quality Report Card measured 

timeliness of care by presenting a table of wait times for completed appointments 

at each facility. Although the Report Card classifies patients as either new or established, there is no data presented on the differences in wait times between these 

two cohorts. Also, the data divided such wait times between primary and specialty 

care, but it is unclear whether there were differences in wait times across the varied 

types of specialty care. Further, there is no information provided on wait times for 

compensation and pension exams. Please provide supplementary information on 

wait times in terms of new and established patients, the subdivisions of specialty 

care, and compensation and pension exams both by contractors and VA providers, 

at each medical facility. 

Response. The enclosed spreadsheet includes data for each VA health care system. 

These data include wait times for new and established patients across the top 50 

subdivisions of specialty care (clinical areas), as well as compensation and pension 

exams. [The enclosed spreadsheet is being held in the Committee files.] 

VA does not currently track and collect data on wait times from all contracted 

or other forms of purchased care. We are conducting a pilot program to develop 

greater management, control and oversight of the processes VA uses when we purchase care. This pilot is using standardized templates for ‘‘ordering’’ care, ensuring 

assessment of other VA options, and controlling and managing the care we do purchase. Specifically, we are instituting controls to track appointment dates, no-shows, 

and waiting times. We will also ensure we send the right clinical information prior 

to appointments and that we receive the appropriate clinical information after appointments. We will also track when and where Veterans receive emergent care to 

30 

monitor from the time we first receive notification from an emergency room or hospital, throughout the Veteran’s hospital stay, to the Veteran’s transfer to a VA facility when appropriate and all other administrative elements associated with claims 

payments. We are conducting this pilot in VISN 11 (Michigan), with one site in production and two others in development. VA will then expand this to VISN 18 (South 

West). We expect the results of the pilot to be available by the end of FY 2011. 

Question 15. Last year’s budget included almost $800 million for specific programs 

to assist homeless veterans in continued efforts to reduce homelessness. Please provide detailed analysis of how this money was utilized in each of the various programs and what impact it had on the reduction of the number of veterans who are 

homeless. 

Response. The Department of Housing and Urban Development (HUD) recently 

released the Veterans Homelessness Supplemental Report to the 2009 Annual 

Homeless Assessment Report (AHAR), which states there are 75,609 homeless Veterans on a single night in January 2009. Our goal is to reduce the homeless population to 59,000 by June 2012. These reductions are attributable to the collective efforts of VA, the Department of Housing and Urban Development (HUD), our community partners and Congress. 

The $800 million represented the 2011 estimate in the FY 2011 President’s submission. In 2010, VA spent over $622 million in specific programs to assist homeless 

Veterans. An itemized list of the $622 million is shown below. The breakout of 

spending by major category is as follows: Permanent Housing and Supportive Services, $71 million; Transitional Housing, nearly $285 million; Prevention Services, 

$11 million; Treatment, nearly $176 million; Employment and Job Training, $61 

million; and Administrative Costs, $18 million. 

FY 2010 Actual 

(Dollars in Thousands) 

2010 

Permanent Housing/Supportive Services 

HUD-VASH case management ................................................................................................................................. $71,137 

Subtotal ............................................................................................................................................................... $71,137 

Transitional Housing 

Grant and Per Diem ................................................................................................................................................. $175,057 

Health Care for Homeless Vets (HCHV) ................................................................................................................... $109,727 

Subtotal ............................................................................................................................................................... $284,784 

Prevention Services 

Supportive Services Low Income Vets & Families (Exit) ......................................................................................... $3,881 

National Call Center for Homeless Veterans (NCCHV) ............................................................................................ $2,410 

Justice Outreach Homelessness Prevention Initiative ............................................................................................. $4,803 

Subtotal ............................................................................................................................................................... $11,094 

Treatment 

Domiciliary Care for Homeless Veterans ................................................................................................................. $175,979 

Subtotal ............................................................................................................................................................... $175,979 

Employment/Job Training 

CWT/Vocational training .......................................................................................................................................... $61,205 

Subtotal ............................................................................................................................................................... $61,205 

Administrative 

Other ........................................................................................................................................................................ $18,509 

Subtotal ............................................................................................................................................................... $18,509 

Grand Total ................................................................................................................................................................... $622,708 

The Department of Housing and Urban Development-VA Supported Housing 

(HUD-VASH) program provides permanent housing and ongoing case management 

31 

treatment services for homeless Veterans who require this assistance to live independently. Cumulatively, HUD has allocated over 30,000 ‘‘Housing Choice’’ Section 

8 vouchers to Public Housing Authorities (PHA) throughout the country for eligible 

homeless Veterans. In FY 2010, this program enabled 20,101 Veterans to receive 

permanent housing. 

VA’s Health Care for Homeless Veterans (HCHV) program provides ‘‘in place’’ residential treatment beds through contracts with community partners. It also provides 

VA outreach and clinical assessments to homeless Veterans who have serious psychiatric and substance use disorders. In FY 2010, HCHV supported a 12.5 percent 

increase in the number of Homeless Stand Downs held (217 in 2010 versus 190 in 

2009). HCHV teams conducted 42,371 initial clinical assessments of Veterans nationally and established 44 new HCHV contracts providing more than 1,300 community residential treatment beds. More than 90,000 Veterans were contacted through 

VA’s outreach efforts, resulting in 3,519 Veterans being provided community-based 

housing and residential care. 

VA’s Grant and Per Diem (GPD) program funds community-based agencies that 

provide transitional housing or service centers for homeless Veterans. VA awarded 

approximately $41 million through this program to community-based agencies ($26 

million in capital funds and $15 million in per diem awards), which operationalized 

an additional 971 transitional housing beds nationwide; collectively, more than 

17,000 Veterans were housed in these programs during FY 2010. 

VA’s Mental Health Residential Rehabilitation and Treatment Programs (MH 

RRTP) support the Domiciliary Care for Homeless Veterans (DCHV) programs, 

which provide homeless Veterans with 24 hour-per-day, 7 day-per-week (24/7), timelimited, residential rehabilitation and treatment services that include medical, psychiatric, substance abuse treatment, and sobriety maintenance. This program targets homeless Veterans or those at risk for homelessness. MH RRTPs improved access to residential care as evidenced by the increased bed census from 66 percent 

in FY 2005 to approximately 81 percent in FY 2010. This increase was achieved at 

the same time the average length of stay across programs decreased. With FY 2010 

funding, five new 40-bed domiciliaries were authorized for a total of 200 new beds. 

By the end of FY 2010, VA supported 2,233 homeless domiciliary beds and provided 

residential, mental health and health care services to more than 8,445 Veterans. 

VA offers two programs for justice involved Veterans: the Veterans Justice Outreach (VJO) and Healthcare for Reentry Veterans (HCRV). Both of these programs 

focus on homeless prevention efforts and link Veterans with health care services. 

Formally launched in 2009, VJO aims to prevent homelessness by providing outreach and linkage to VA services for Veterans at early stages of the justice system, 

including Veterans’ courts, drug courts, and mental health courts. VJO is designed 

to avoid the unnecessary criminalization of mental illness and extended incarceration for Veterans by ensuring that eligible Veterans have timely access to VA mental health and substance abuse services when clinically indicated, and other services 

and benefits as appropriate. Using FY 2010 funds, VA hired 120 full-time VJO specialists across the country. Fifty (50) operational Veterans Courts were also established in FY 2010, and 5,849 Veterans received VJO services that year. The HCRV 

program is designed to address the community re-entry needs of incarcerated Veterans. HCRV’s goals are to prevent homelessness, reduce the impact of medical, psychiatric, and substance abuse problems among Veterans undergoing community readjustment, and reduce the likelihood of re-incarceration. In FY 2010, 44 full-time 

HCRV specialists saw Veterans in 955 of the 1,319 prisons across the country. VA 

provided 9,622 incarcerated Veterans with reentry services in FY 2010, and since 

August 2007, more than 24,000 have received assistance. 

VA’s National Call Center for Homeless Veterans (877–4AID-VET) connects homeless Veterans, their families, and other interested parties with appropriate VA and 

community-based resources. This Center, co-located with VA’s Suicide Prevention 

Hotline, began accepting calls in March 2010 and includes 30 staff members who 

provide 24/7 coverage. All staff are trained in crisis intervention for homelessness 

issues and mental health services or issues. By the end of FY 2010, VA received 

more than 18,000 calls from 14,000 identified Veterans; 8,500 of these individuals 

were provided ‘‘warm handoffs’’ to medical centers for engagement in treatment and 

housing services. 

VA’s new homeless prevention initiative, the Support Services for Veteran Families (SSVF) Grant Program, will establish and provide grants and technical assistance to community non-profit organizations to provide supportive services to Veterans and their families to help them maintain their current housing. This program 

was developed in FY 2010, and the first applications from community providers will 

be reviewed in March 2011. 

32 

The Substance Use Disorder (SUD) Enhancement Program is designed to provide 

SUD case management and services to homeless Veterans in the community. The 

end goal is to treat the Veteran’s SUD, removing these obstacles to obtaining or 

maintaining housing. In FY 2010, VA funded 146 SUD specialists in the HCVH and 

HUD-VASH programs. These specialists are providing SUD case management and 

services to homeless Veterans in the community to enhance access to care and opportunities for recovery. 

Question 16. In September 2010, VA’s development of a new information technology procurement process for VA was halted. With the Secretary’s vision for a 

more centralized and efficient acquisition process, what impact will the delay in replacing procurement software have on realizing this vision? 

Response. In early calendar year 2010, VA undertook an extensive re-evaluation 

of its financial management challenges, risks and critical priorities. The re-evaluation, which included consideration of available resources, the clean audit opinions 

on VA’s financial statements for 11 years in a row and the relative low risk with 

maintaining VA’s legacy financial management system for the foreseeable future, resulted in a decision by the Secretary to end the FLITE Program in favor of pursuing 

several other lower risk and less costly financial management improvement initiatives. The Department’s goal of improving financial management remains unchanged, only the path has changed. As a result other smaller, less costly, flexible 

and agile financial management initiatives have been undertaken to strengthen internal controls and oversight, reduce operating costs, address improper payments 

and improve data and analysis. These initiatives will also set the stage for a lowerrisk financial management system replacement in the future. To date these actions 

have helped to eliminate three financial material weaknesses and significantly improved internal controls over the processing of miscellaneous obligation transactions 

using form 1358. 

Question 17. In February 2011 the Government Accountability Office released a 

report critical of Virtual Lifetime Electronic Record (VLER). The report found the 

Departments of Defense and Veterans Affairs have failed to jointly articulate explicit plans, goals, and timeframes in creating a joint electronic health record. 

Please provide the Committee with itemized VLER expenditures for FY 2009, FY 

2010, and FY 2011. Also, provide the Committee with the FTE allocated to the 

VLER project—by Department and by year—since the project was conceived. In addition, please provide the numbers of those employed through contractor support. 

Finally, please provide a progress report on each of the IT projects and pilots involved in fulfilling the President’s vision of VLER. 

Response. The Virtual Lifetime Electronic Record (VLER) program has often been 

so closely linked to the Electronic Health Record (EHR) modernization initiative as 

to become synonymous. It is important to understand that VLER is closely aligned 

with but unique from the EHR initiative. VLER is an interoperable and communication environment whereby health, benefits and administrative information may be 

electronically accessed by every Servicemember, Veteran, and/or their beneficiary. 

The VLER environment is structured to support the secure exchange of health, benefits and administrative information between public and private partners. Health, 

benefits, and administrative information resides in many DOD and VA systems, including the electronic health record system and various personnel systems. VLER 

ensures that regardless of the information source, policies, regulations and, procedures are put into place to secure and protect the information accessed or exchanged, and the terminologies, definitions, and terms are clearly presented. 

The table below provides information on the FY 2009, FY 2010 obligations and 

total FY 2011 budget dollars allocated for VLER related activities and the FTEs associated with this initiative. Contracted services are firm fixed prices so there is not 

a specific FTE for the contracted support. Support contracts are included in the nonpay dollars in the supporting table. 

Year FTE (Auth/Filled) Contract support 

(total) IT Budget (non-pay) VHA Budget (non-pay) 

FY09 EPMO: 0/0 EPMO: NA NwHIN Adptor: $3.5M $0 

IT: 1/1 IT: NA 

VHA: 2/2 VHA: NA 

FY10 EPMO: 8/0 EPMO: NA NwHIN Adaptor: $11.852M $0 

IT: 40/9 IT: NA IT Infrastructure: $7.113M 

VHA: 26/5 VHA: NA VLER EPMO Support: $1.85M 

IT PMO: $4.506M 

33 

Year FTE (Auth/Filled) Contract support 

(total) IT Budget (non-pay) VHA Budget (non-pay) 

FY11 EPMO: 8/6 EPMO: NA NwHIN Adaptor: $31.761M $11.7M 

IT: 46/10 IT: NA Health Legacy: $23.716M 

VHA: 27/16 VHA: NA Warrior Support: $20.623M 

IT PMO: $5M 

VLER EPMO Support: $2.4 

EPMO—Executive Program Management Office (the VLER business sponsor PM office) 

PMO—Program Management Office (the OI&T Product Delivery PM office) 

VLER will deliver the foundational clinical encounter data capability in July 2012. 

This foundational capability will be enhanced to support disability adjudication 

within the VA and in conjunction with the Social Security Administration (SSA) in 

December 2012. There are four joint pilots to achieve the initial health components 

of VLER. The initial health data exchange joint pilot with DOD and a private 

healthcare partner in San Diego went into operational status December 2009; the 

second pilot with expanded health data element exchanges achieved at Hampton 

Road/Tidewater, Virginia went into operation in September 2010; the third joint 

pilot planned to increase points of care and health elements exchanged is on target 

to go into operation in March 2011 in Spokane, Washington; and the fourth joint 

health pilot planned for September 2011 is on target to begin shortly at Puget 

Sound, Washington. Following a measurement and analysis phase for all pilots 

planned for October 2011 through March 2012, the implementation of VLER health 

capability VA-wide will begin in July 2012. 

Requirements, design and development of initial capability in support of the adjudication of VA disability claims has begun and is on target to provide health information exchange for use in benefits administration with initial capability by end of 

2012. Additionally, a proof of concept demonstration is on target with SSA to begin 

in the first quarter of Fiscal Year 2012. 

Question 18. The office of OI&T is carrying over $675 million from FY 2011. How 

does VA plan to use this carryover? Please provide a specific listing of projects and 

the expenditure rate for each. 

Response. The carry forward funding from FY 2011 into FY 2012 is a planned 

$78M which will be used for Staffing and Administration. The carry forward funding from FY 2010 to FY 2011 was $675M. The complete listing of carry forward 

funding by program from FY 2010 to FY 2011 can be found starting on page 5B– 

1 of the Congressional Budget justification volume 2 of 4. 

OI&T faced a substantial challenge in IT when we started in 2009, assuming control of an organization that was failing to deliver on large IT projects costing hundreds of millions of dollars. Over the last two years, the Assistant Secretary for I&T 

has implemented a number of strong IT disciplines; disciplines aimed at correcting 

the delivery problems and increasing our capacity to deliver on transformational initiatives. These disciplined approaches are largely behind our recent successful delivery of the new software system to automate payments under the GI Bill. 

A side effect of those disciplines has been to eliminate spending on many programs we deemed ineffective, and slowing spending on most of our programs as we 

worked to ensure they were meeting their goals. The change has been dramatic. For 

example, under the Program Management Accountability System (PMAS), OI&T is 

now meeting over 80% of its software delivery milestones. 

However, the main purpose has been to build a strong IT capability that can reliably deliver the IT solutions we need to transform VA. We believe we have done 

that. The FY 2010 carryover funds of $675M into FY 2011 will build the technology 

systems that will enable the transformation of VA; that will allow us break the back 

of the benefit claims backlog, and to implement further improvements to our medical automation systems. 

Projects are now reviewed to ensure they have a plan, defined business requirements, appropriate staff, etc. and then given seed money to ensure the plan can be 

executed. As such, all projects are now subject to the Project Management Accountability System. 

Question 19. The following questions relate to OI&T funding levels for VA’s Major 

Transformative Initiatives: 

A. VBMS—please provide rationale for the proposed reduction below the FY 2011 

level. 

Response. The proposed reduction in funding below the FY 2011 level is due to 

a decrease in system development activities in FY 2012. Development costs decreased by more than $50 million from FY 2011 to FY 2012 while sustainment rates 

34 

increased at a lower cost of $35 million. The majority of system capability is proceeding as scheduled for development and implementation as part of the FY 2011 

funding stream. Funding for FY 2012 supports sustainment activities and the additional capacity for a national rollout of VBMS. A small amount is included for integration activities with other VBA benefit systems. 

B. GI Bill—given that there is no funding allocated for further development of 

requisite software, how does VA plan to fund any needed changes due, in part, to 

Public Law 111–377? 

Response. The new legislative requirements will be funded using FY 2011 dollars 

originally targeted for additional system functionality and optional tasks on the 

SPAWAR interagency agreement. There is no negative budget impact for FY 2011. 

C. VLER—given the planned expansion of the program in FY 2012, why is the 

request for this initiative $13.5 million less that the FY 2011 level? 

Response. The VLER Initiative continues on a steady course in FY 2012 with additional interoperability enhancements while meeting the planned initial operating 

capability and enacting the national rollout to all VA medical centers as local health 

information exchanges are available. These efforts will be achieved within the funding requested. 

D. Improvements in Mental Health—please elaborate on the need for a doubling 

in OI&T funding for this initiative from FY 2011 to FY 12. 

Response. The increase in the OI&T budget for mental health improvements from 

FY 2011 ($5,900,000) to FY 2012 ($12,000,000) is based on increased project development costs in the Improving Veterans Mental Health operating plan. In conjunction with OI&T, mental health has a prioritized list of projects that must be completed to develop the Mental Health Informatics Infrastructure required to fully 

support the implementation of the Uniform Mental Health Services Handbook 

through projects that increase patient safety; allow collection of population-based 

outcome measures; and support development of Web-based patient-centered programming. In FY 2011, the operating plan initiated projects to improve better tracking of Veterans deemed to be at high risk for suicide, enhancements in tools to track 

outcomes, and Web-based programming to allow Veterans to develop goals for treatment. FY 2012 will continue the development of the FY 2011 projects, and commence the following projects: 

• $2.25 million—Methadone Dispense Tracking 

• $1 million—Development of patient oriented Web-based educational objects to 

support evidence-based therapy, using My HealtheVet—Op 

• $1 million—Promoting Resilience and Prevention 

• $0.5 million—National Clozapine Coordination 

E. VRM—the request for FY 2012 is $48.4 less than the FY 2011 level. What 

functionality was realized in FY 2011 to justify the reduction? 

Response. A significant portion of the VRM FY 2011 budget is devoted to Voice 

Access Modernization. Most of this effort is scheduled to be completed in FY 2011. 

It is also anticipated that Identity Access Modernization (IAM) will complete a large 

portion of work in FY 2011, completing the remainder in FY12. 

F. Integrated Operating Model—given the proposed increase for IOM, what 

metrics will VA use to gage the impact of this program on VA’s corporate functions? 

Response. The mission of the Integrated Operating Model (IOM) is to implement 

a management infrastructure that focuses on improving the integration and management across VA’s departmental management functions. By improving the integration across its Acquisition, Construction and Facilities Management, Financial 

Management, Human Resources, and Information Technology functions, a well-managed and highly-effective VA corporate back office is better enabled to support the 

Administrations in enhancing direct service delivery to Veterans. 

The impact of IOM is gauged through metrics related to milestone deliverables 

and impact on operations. Example of deliverables and impact to date include: 

1. Acquisitions 

Implemented the Supplier Relationship Transformation (SRT) Initiative. The 

Office of Acquisition, Logistics, and Construction (OALC) developed two-way dialog with suppliers and found many suppliers to be dissatisfied with VA’s order 

fulfillment processes. As such, OALC aimed to establish a more effective relationship with VA’s suppliers. By instituting Perfect Order Fulfillment (POF), 

OALC enhanced the Department’s relationship with its vendors to deliver the 

right service or product, at the right place, at the right time, with the right 

quality and with proper documentation. Developing more meaningful relationships with VA suppliers to achieve ‘‘Best in Class’’ POF improved VA’s internal 

35 

capacity to serve Veterans, their families, our employees, and other stakeholders efficiently and effectively. 

2. Financial Management 

a. Implemented MyPay for all VA employees. The Office of Finance (OF) successfully implemented MyPay, an enhanced self-service employee benefit portal, 

for all VA employees. MyPay is an innovative, automated system that allows 

VA employees to electronically manage certain discretionary pay data items and 

allows them to view, print, and save Leave and Earning Statements (LES) and 

W–2s. OF’s implementation of MyPay, allowed the Department to migrate from 

its legacy system, Employee Express, resulting in the elimination of annual fee 

of approximately $1,370,250. Since MyPay allows VA the ability to completely 

eliminate hard copy LES, there is an additional annual cost savings of approximately $1,287,000. MyPay enhances the Department’s ability to manage human 

capital and save money that can be used for other purposes to serve Veterans. 

b. Trained 2,375 VA employees through various financial management training venues in FY 2010. OF implemented an ambitious plan to train VA’s financial management workforce to be better able to meet Federal appropriations, accounting, internal controls, and improper payments requirements and regulations. In one example, OF executed the August 2010 Financial Management 

Training Conference, which trained 1,311 employees, many of whom had never 

taken formal financial management training. To evaluate the effectiveness of 

this training, VA tested employees before and after training. The result was a 

43 percent increase in average scores after training. 

3. Information Technology 

Implemented Program Management Accountability System (PMAS) prototype 

and training. VA began implementing PMAS to manage all IT development, 

modernization, and enhancement programs and projects in order to increase the 

Department’s accountability for IT projects and minimize the impact of IT 

projects which are either behind schedule or over budget. As a part of IOM, the 

Office of Information and Technology (OI&T) implemented the PMAS prototype 

that requires (1) an incremental development approach requiring frequent delivery (every six months) of new functionality to ensure customers’ mission needs 

are met on time and within budget and (2) a rigorous management approach, 

involving customers, project staff, and vendors, accountable for ensuring early 

identification and correction of IT program milestones. To support PMAS, OI&T 

also implemented PMAS training, developed and published a PMAS Guide, and 

finalized draft requirements for a PMAS dashboard. 

4. Human Resources 

Implemented Direct-Hire Authority (DHA) for Acquisition Positions. The Office of Human Resources & Administration (HRA) implemented the use of DHA 

to fill critical GS–1102 (contracting) series positions in the Washington, DC 

metropolitan area at grade level GS–12 through GS–15 or equivalent. There is 

a shortage of highly qualified candidates for contract specialists in the 1102 series that exists at VA in the Washington, DC area. This impeded VA from recruiting highly qualified candidates to fill critical acquisition positions in VA, 

thus impacting VA’s acquisition operations and ultimately, Veterans. HRA 

worked with the Office of Acquisition, Logistics, and Construction (OALC) and 

Office of Personnel Management to implement this authorization and greatly 

enhance OALC’s ability to recruit acquisition professionals. 

G. Health Informatics—while this is a relatively new initiative, what is the expected expense over the life of this program? How does VA see this application being 

used in the future to cut costs within VA? 

Response. Transforming Health Care Delivery through Health Informatics 

(Health Informatics) is a new VA Major Initiative (Initiative) that was formally 

launched on October 1, 2010. The purpose of the Initiative is two-fold: 1) assist with 

VHA’s transition from a medical model of care to a patient-centered model of care; 

and 2) enhance collaboration between VHA and OI&T. The Initiative is the vehicle 

for promoting and fostering open, transparent communication between health care 

providers and software development teams through shared responsibility and accountability. The Health Informatics Initiative is composed of three major projects: 

1. Establish a Health/IT Collaborative Supporting Rapid Product Development and Delivery. This effort restructures the working relationship between 

VHA and OI&T and provides an organizational foundation for reengineering existing processes and piloting VHA clinical software prototypes in a rapid, agile 

and iterative fashion. 

2. Create a Health Management Platform to Transform Patient Care. This effort integrates informatics and health information technology (IT) in the delivVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00041 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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1 Byrne, et al. The Value From Investments In Health Information Technology At The U.S. Department Of Veterans Affairs. Health Affairs; April 2010. 

ery of health care. It provides a succession plan to transition the Computerized 

Patient Record System (CPRS) to the next generation of browser-based Electronic Health Record (EHR). 

3. Build Health Informatics Capacity. This effort develops the Health 

Informatics workforce and enhances organizational informatics literacy through 

competency, career and community development. 

The Health Informatics Initiative total lifecycle costs are estimated to be $41.6 

million over the 3-year life of the Initiative, after which business functions will be 

integrated into VHA’s Office of Informatics and Analytics (OIA). The funding will 

support the establishment of cross-cutting health informatics tools designed by 

health professionals to optimize performance in terms of quality, efficiency and increased job satisfaction, to encourage and facilitate increased patient and family engagement in care and decisionmaking, and support population and evidence-based 

care focused on preventive health care and chronic disease management. 

The Initiative will develop a predominantly Web-based Electronic Health Management Platform enabling contributions from other software development sources. Additionally, it will establish a sustainable workforce capacity to support healthcare 

modernization and improved care delivery. The workforce capacities component will 

build on agency successes with continued development of curriculum, delivery of 

coursework and assessment of coordination strategies amongst health informaticists. 

Building upon the award winning quality and cost-savings improvements of VA’s 

Electronic Health Record CPRS, the Health Informatics Initiative has reassembled 

the CPRS team to take the next evolutionary step—creating Web-based, standardscompliant, extensible Health Management IT Platforms for: 

• Health Care Teams: Modules that are health care team-driven to decrease cognitive load, effectively manage relationships between conditions, interventions and 

observations, acquire data (including documentation) as a by-product of workflow 

and ultimately support higher quality, safe patient care and clinician satisfaction; 

• Veterans: Solutions that achieve meaningful patient use, population reach and 

impact, giving Veterans more responsibility and control over their own health care; 

and 

• Systems: Products that look across VA’s IT systems and patient populations to 

improve health care delivery and system performance. 

According to a recent independent study,1 reductions in unnecessary care from 

current VA IT systems will result in an estimated savings of $4.64 billion. Initiative 

products and outcomes will expand these savings by: 1) providing better team-based 

coordination of care to Veterans, reducing costs from complications due to poor coordination (redundant laboratory tests and medications orders, adverse drugs interactions and reactions), 2) implementing comprehensive, integrated decision support 

across all patient data sources to reduce diagnostic errors and associated costs as 

well as medication errors and over-prescription, 3) engaging patients in their own 

care resulting in fewer hospital admissions and clinic visits as well as more effective 

‘‘self-treatment’’ (such as diabetes and blood pressure control), 4) providing the 

framework for VA population-wide epidemiological studies to enable VA researchers 

to identify patterns between diseases, outcomes and treatments leading to more 

proactive and less costly Veteran care, and 5) allowing real-time visibility into IT 

systems with transparency across the enterprise with regard to managing patienthealth system interactions (e.g. waits and delays, flow, etc.), patient-staff relationships (e.g. handoffs) and tests and procedures. 

Question 20. Please account for the decrease in overall funding in the President’s 

request, by business line, for the Veterans Benefits Administration in the General 

Operating Expenses Account. 

Response. The decrease in the compensation and pension budget request is due 

to plans by the Veterans Benefits Administration to realign $75 million in FY 2011 

from personal services and from one-time items within the other services category 

for exploration of alternatives to FTE to address the backlog. This contractor funding is not continued in the FY 2012 request. 

Also affecting the C&P decrease in FY 2012 is a reduction in funding for one-time 

needs (e.g., training, supplies) for the additional hires that were funded in FY 2011. 

The Education budget request decreases due to the implementation of the automated long-term claims processing solution for the Post-9/11 GI Bill, which will decrease VBA’s reliance on FTE. Education’s FTE request decreases by 366 in FY 

2012. 

37 

Question 21. Given the increased reliance on contract services in VR&E, please 

comment on the FTE dedicated to management and oversight, as well as the costs 

associated with the contract services as envisioned in the President’s budget. 

Response. VR&E Service is working to decrease reliance on contract services 

through increased staffing. VA was able to redirect funding requested for contracts 

under the FY 2011 budget level to support VR&E staffing increases, and additional 

staffing increases are included in the FY 2012 budget request. The FY 2012 budget 

includes $4.4 million for contract counseling services. Nationwide, 28 contract specialists support contract oversight. VR&E Officers serve as Contracting Officer Technical Representatives (COTRs). 

Question 22. To adequately staff the VR&E program, what is the target case load 

per caseworker and is VA currently meeting this goal at each regional office? Please 

provide a detailed discussion of the resources needed to meet this goal and comment 

on the estimated number of total FTE needed. 

Response. VR&E Service is currently evaluating optimal performance in relation 

to workload through a work measurement study. The study is anticipated to be complete by the 3rd quarter FY 2011. Study deliverables include a model for optimal 

staffing projections. It should be noted that some regional offices rely on contract 

services to supplement staffing levels. Stations that rely on contract services would 

tend to have higher caseload ratios. The current nationwide average ratio is 134 

Veterans per counselor. 

Question 23. The President’s budget increased Chapter 31 funding by $32 million 

from FY 2010 to FY 2011. During the same time, there was an increase of 3,645 

new VR&E recipients. The FY 2012 budget calls for a $37 million increase over FY 

2011, but estimates just 1,860 new users. Please explain why there is a higher 

budget request given that VA estimates lower utilization. 

Response. Funding levels related to the payments to Chapter 31 beneficiaries are 

driven by several factors. Chapter 31 assists Veterans with service-connected disabilities to prepare for, find, and keep suitable jobs as well as achieve independence 

in daily living. The total increase in chapter 31 obligations is $36.4 million from 

2010 to 2011. The Cost of Living Adjustment (COLA), an economic assumption applied to prior year average costs, is expected to increase obligations by $32.9 million. 

An increase in subsistence allowance trainees yields a $4.8 million increase in program costs. The average cost unrelated to the COLA decreases slightly for subsistence allowance and/or tuition, books, and supplies, which decrease obligations $1.3 

million. 

The increase in chapter 31 obligations is expected to be $42.6 million from 2011 to 2012. The COLA is expected to increase obligations by $35.4 million. A rise in 

caseload for those trainees receiving subsistence and/or tuition, books, and supplies 

is expected to increase obligations by $7.3 million. Average payment unrelated to 

the COLA will decrease slightly, lowering obligations by $78 thousand. 

Question 24. Please provide the cost—for both the current and next fiscal year— 

of disability examination contracts to support the Integrated Disability Evaluation 

System. Please provide the costs to VBA and VHA separately. 

Response. VHA began the acquisition process for a potential contract vehicle to 

supplement required disability examinations and released a Request for Proposals 

for disability examination services. VA has received submissions from several bidders and is currently reviewing the submissions, but no final determination or selections have been made at this time. The solicitation documents did not specify certain minimum task order amounts, and it is possible that there will be more than 

one award made. Since this acquisition is still in the evaluation stage, it is not possible to provide a cost estimate for VHA. 

Estimated costs for VBA are $13 million in fiscal year 2011 and $20 million in 

fiscal year 2012. If additional IDES sites are added to the contract, the cost will increase. The current estimated cost for IDES examinations is approximately $1,000 

per examination. 

Question 25. VA has announced an expansion of VR&E’s mission to include IDES 

and the ‘‘Veterans Success on Campus’’ programs. Please describe the role VR&E 

counselors would fulfill in each of these programs, their anticipated workload, and 

the number of FTE that will be needed to staff these programs. 

Response. IDES—This initiative will provide VR&E outreach and transition services to active duty Servicemembers transitioning from military to civilian life 

through the IDES system. These on-base services will include one mandatory counseling appointment with a Vocational Rehabilitation Counselor, as well as services 

ranging from a comprehensive rehabilitation evaluation to determine abilities, 

skills, and interests for employment purposes to case-management services to assist 

Veterans to identify and maintain employment and achieve a successful transition 

38 

to a civilian career. VR&E will use 110 new FTE in the IDES process to help approximately 12,000 Servicemembers by providing the aforementioned services. 

The VetSuccess on Campus (VSOC) program supports Veterans’ transition from 

military to campus life. Veterans attending college, including those using the Post9/11 GI Bill or other VA education benefits, are provided with a wide range of rehabilitation and personal adjustment counseling services, including referrals to VA 

medical facilities as needed. VSOC staff also provide assistance with general benefits issues and can assist with peer counseling and mental health referrals. The 

VSOC program is currently operating on 8 campuses. The budget requests supports 

9 additional FTE to target 9 more campuses, providing an estimated 9,000 Veterans 

with on-campus benefits assistance and adjustment counseling. 

Question 26. How will VA determine eligibility for VR&E services among those 

going through IDES? 

Response. The first step in the Vocational Rehabilitation and Employment 

(VR&E) process is to evaluate the Servicemember’s eligibility. Servicemembers must 

meet the following criteria: have received, or will receive, a discharge that is other 

than dishonorable; have a service-connected disability rating of at least 10 percent; 

and must complete an application for VR&E services. The basic period of eligibility 

in which VR&E services may be used is 12 years from the date of separation from 

active military service, or the date the Veteran was first notified by VA of a serviceconnected disability rating, which comes later. 

Servicemembers going through IDES are eligible for VR&E services if they expect 

to receive an honorable discharge from active duty and if they obtain a memorandum rating or IDES proposed rating of 20% or more when referred to the Physical Evaluation Board (PEB). All IDES participants will receive a mandatory initial 

counseling session in which a VR&E counselor will work with the separating Servicemember to determine whether and how further program participation can benefit them in their transition process. 

Question 27. Employee training is one of the most crucial efforts VA can put forth 

to improve the quality and timeliness of claims processing. What is provided in the 

budget for training of C&P staff? Please provide a breakdown of the types of training that will be provided. 

Response. The FY 2012 budget request for VBA’s Office of Employee Training and 

Development includes $12.9M for training of C&P personnel. This funding supports 

entry-level training for new claims processors, on-line training for new and experienced claims processors, nationally standardized lesson materials for local delivery 

to experienced claims processors, and electronic performance support systems to accelerate claims-processing decisions. 

Question 28. The President’s Budget request makes note of a claims transformation plan and systemwide transformation that will expand quality review procedures. Please describe these initiatives in detail. 

Response. In support of the Secretary’s commitment to eliminate the claims backlog and improve quality to 98% by 2015, VA has undertaken a comprehensive 

Transformation Plan focused on providing timely and quality service to Veterans. 

Specialized quality review positions are being created in each Regional Office to 

focus on the improvement of quality. Employees in these positions will form part 

of a dedicated quality review team. The members of this team will attend training 

provided by the C&P Service quality assurance staff to enhance consistency between 

national and local quality reviews. 

Additionally, logic-based tools are being developed to aid VA decisionmakers and 

improve consistency and accuracy. Tools to support disability evaluation calculations 

for hearing loss and entitlement to special monthly compensation have been implemented nationwide, and development of additional tools is underway. 

Question 29. The President’s Budget request states that there are an increasing 

number of Individual Unemployability cases. Please describe any identifiable trends 

in the caseload and any explanation for these trends. 

Response. The number of veterans receiving Individual Unemployability (IU) benefits increased by 5.2% between 2009 and 2010. The increase was 4.2% between 

2007 and 2008, and 4.4% between 2008 and 2009. VBA expects a continued increase 

in FY 2011 and FY 2012 as the number of Veterans receiving compensation is projected to increase. VBA completed 10.2% more claims in FY 2010 than in FY 2009 

(1,076,983 vs. 977,219), and it is reasonable to conclude that this also included additional grants of compensation based on unemployability. 

Question 30. Given the pending reorganization of VBA, which includes the creation of a new business line for pension and fiduciary, how will the FY 2012 budget 

be affected by the planned changes? 

39 

Response. The FY 2012 budget includes funding requirements for Compensation 

and Pension (C&P) Service. Those funds also support the fiduciary activities of the 

VA. Since staffing for new Pension and Fiduciary Service will come out of existing 

C&P Service and VBA staffing, it will not impact the FY 2012 budget 

Question 31. The budget submission notes that the funding level for education 

benefits do not reflect the changes made by Public Law 111–252, the Post-9/11 Veterans Educational Assistance Improvements Act of 2010. However, the General Operating Expenses account for education projects a decrease of $29.1 million that is 

based in part on the need to incorporate changes made by the new public law. Are 

you satisfied that you will have sufficient FTE to support the changes made in the 

program and that timeliness and accuracy will not be adversely impacted? 

Response. Public Law 111–377, the Veterans Educational Improvements Act of 

2010, modifies certain aspects of the Post-9/11 GI Bill, with most modifications effective on August 1, 2011. The enactment of this law has impacts the development of 

the Long Term Solution (LTS) for processing Post-9/11 GI Bill claims and our ability 

to fully automate the delivery of benefits. The capability to conduct automated endto-end processing on some supplemental claims was tentatively planned for 

June 2011. This capability would create a subset of claims that do not require manual intervention. Implementation of the LTS was expected to address the increased 

workload and improve claims processing timeliness while negating the need for temporary claims processors. Because all efforts will not be directed to implementing 

the changes in the new law, we now anticipate this functionality will not be available until the third quarter of FY 2012. The delay in the implementation of the enhanced functionality planned for the LTS affected the number of FTE needed to 

process education claims. Our budget request of 1,429 FTE reflects the need to retain 324 of the 530 temporary claims examiners through FY 2012 to maintain current claims processing efficiencies. 

Question 32. VA’s most recent 10-year action plan for construction notes that full 

implementation of Strategic Capital Investment Planning (SCIP) would require between $53 and $65 billion for capital infrastructure costs to remediate identified 

gaps. Please explain VA’s strategy to deal with the construction backlog, including 

planned expenditures over the ten years. 

Response. The 2012 10-year Capital Plan identified between $53B–65B in magnitude estimate costs to close Departmental gaps over 10-years. This estimate includes $4.1B needed to complete all existing partially funded major construction 

projects. Each year, VA determines which partially funded projects to fund based 

on the projects’ original priority score, ability to obligate, and available funding. The 

total level of capital resources is reassessed each year in the annual budget process, 

where hard choices are made balancing between operating costs and capital needs. 

In addition, VA will continuously assess the need for projects based on space, condition, access, safety, and utilization/workload gaps and determine the best methods 

to resolve these gaps. Annual updates of the 10-Year Action Plan will help to track 

the progress of approved and in-process capital projects and their impact on gaps. 

The 10-Year Action Plan will inform decisions on the most critical gaps to address 

and the best method to address those gaps. In addition to the Department’s three 

construction programs—major construction, minor construction, and non-recurring 

maintenance—it also relies on leasing and a variety of non-capital solutions to resolve gaps. Tele-health care, contract care, extending hours of operations, sharing 

agreements, mobile clinics, virtual call centers, telecommuting, and enhanced-use 

leasing (EUL) are examples of non-capital solutions that are employed to address 

gaps. 

Question 33. Please provide the mathematical formula used to arrive at the ‘‘total 

score’’ used to prioritize funding decisions under SCIP. 

Response. Capital projects are scored by the SCIP Panel, which is a sub-group of 

the SCIP Board and comprised of representatives from across the Department. The 

SCIP Panel and Board work within the VA Governance process, which provides a 

framework within which the SCIP process functions and culminates with the selection of capital projects for inclusion in the annual budget request. The structure of 

governance begins with the SCIP Board and proceeds through the Strategic Management Council/Senior Review Group (SMC/SRG) to the Veterans Affairs Executive 

Board (VAEB), with an increasing level of authority at each step. The SMC/SRG is 

chaired by the Deputy Secretary and is comprised of senior management representatives from across the VA. The final level in the VA Governance process is the VAEB, 

which is also a cross-Departmental group of senior management officials and 

chaired by the Secretary. 

The decision methodology used to score projects is the Analytic Hierarchy Process 

(AHP). The AHP provides a structure, or ‘‘model,’’ to determine which projects conVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00045 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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tribute the most to addressing Departmental priorities. The SCIP decision model is 

comprised of the major criteria, sub-criteria, and their priority weights. Each project 

is scored on how well it addresses the each sub-criterion. The total score of a project 

is calculated by multiplying the project’s ‘‘score’’ for each sub-criterion by the priority weight of the sub-criterion and then by the priority weight of the major criterion. Each sub-criterion ‘‘score’’ is the average of the rating (on a scale of 0 to 1) 

chosen by the scoring participants. A project’s ‘‘Total Score’’ is the sum of the 

weighted scores for each sub-criterion. 

This is simplified illustration; priority weights, ratings, and the resulting total 

score are fictitious. The 2012 SCIP decision criteria model consists of six major criteria and 18 sub-criteria. Each capital project was scored by SCIP Panels based on 

that project’s contribution to each of the 18 sub-criteria. The calculation shown 

above would be done 18 times (once for each sub-criterion) and those 18 totals would 

be summed to calculate the total combined score. The scoring process is supported 

by the use of decision support software to record the participant’s ratings and calculate the total combined scores. 

More information on the 2012 decision criteria and the scoring process can be 

found in the FY 2012 Budget Submission, Construction and 10-Year Capital Plan, 

Volume 4 of 4, February 2011, which can be found at http://www.va.gov/budget/products.asp, pages 10–3, 10–5, and 8.2–1. 

Question 34. As one of the largest real-property holders in the Federal Government, VA has 5.7 million vacant square feet. Knowing of the difficulties involved 

in disposing of unused or underutilized property, and the challenges present when 

attempting to repurpose a building, what is VA’s strategy for right-sizing its capital 

asset inventory? 

Response. Significant reductions in vacant space have already occurred, as the VA 

has reduced its inventory of owned vacant space by 34 percent, from 8.6 million 

square feet in 2001 to 5.7 million square feet in 2010. This 5.7 million vacant square 

feet accounts for less than 4% of the VA’s real property inventory. VA continues to 

aggressively pursue reuse or disposal of assets in our inventory that are deemed unneeded. This, along with improvements in the capital planning phase contributes, 

to right sizing our capital inventory. VA’s strategy encompasses the following elements: 

1. Improving space planning for the long term—As a component of the VA’s 

new Strategic Capital Investment Planning (SCIP) process, a detailed space 

analysis is performed. This analysis targets long term needs, allowing facilities 

to plan well in advance for the potential reuse or disposal of property. This long 

term planning utilizes future workload projections as a major input, ensuring 

that the services rendered to our Veteran’s are not impacted by infrastructure 

challenges. By planning for potential unused space in out years, VA hopes to 

avoid adding vacant space to its inventory. 


030211_pg24.eps
41 

2. Advocating for internal and external reuse—Although reusing properties 

presents challenges, it is a valuable option to VA and Veterans by providing 

needed services, such as Homeless housing, and allowing VA to transfer the financial liability of unused property through Enhanced-Used Leasing (EUL). 

This legislative authority is scheduled to lapse at the end of calendar year 2011. 

The Administration remains committed to this important program, and a proposal to address the expiration will accompany the Department’s legislative 

package submitted through the President’s Program. VA continues to expand 

opportunities for reuse, including EULs, identifying collocation opportunities 

among VA’s Administrations, sharing of space and/or services with DOD, and 

additional public/private partnerships. Reuse also encompasses the renovation 

of space to be repurposed to directly serve our Veterans, which is also stressed 

as part of the SCIP process. 

3. Disposing of assets—The disposal of assets is often necessary when the age, 

condition, and campus location buildings make them poor candidates for reuse. 

The major challenges faced when disposing of property are historic considerations and abiding by all necessary Historic Property laws. Improvements can 

be made to address those challenges, such as early engagement of the VA’s Historic Preservation officer in the planning phases of the SCIP process to ensure 

due diligence, identification of reuse opportunities, and coordination with the 

preservation office to ensure proper documentation is in place well before the 

actual disposal is planned. VA expects the end result is a more efficient and 

effective disposal process. 

Question 35. Please provide an estimate of the cost avoidance achieved by the implementation of VA’s green management program. 

Response. Starting in 2008 and for approximately the next 25 years, VA’s green 

management program projects implemented awarded through 2012 will have an estimated total avoided costs of $892.5M with an estimated annual cost avoidance of 

$56.1M. The cost-avoiding green projects VA plans to award in FY 2012, avoidance 

of $12.8 million annually, is estimated over each of the next four to 25 years. These 

estimates combine cost avoidance due to projects of varying lifetimes, such as renewable energy systems that last more than 25 years, air conditioning system upgrades that last an average of 15 years, and building systems retuning that provides 

cost savings persisting for four years. The level of cost avoidance experienced will 

depend primarily on how energy prices fluctuate over the lifetime of each project. 

Question 36. In FY 2011, funding for the housing account was slightly over $1.4 

million. However, for FY 2012, the funding is only $319,000. Please explain this decrease. 

Response. The mandatory funding in the Housing Program Account includes the 

loan subsidy estimate for new loans, which includes loans made in the budget year 

(FY 2012), and the reestimate of loan subsidies for all existing loans, which includes 

all outstanding loans made prior to the budget year. 

The FY 2011 funding of $1.4 billion represents both the loan subsidy estimate for 

new loans and the reestimate of loan subsidies for all existing loans. The 2012 figure represents only the loan subsidy estimate for new loans. 

The two years are subject to different estimation techniques and timelines. The 

loan subsidy estimate for new loans is based on current economic assumptions and 

is included in the 2012 budget request. However, the reestimate of loan subsidies 

for all existing loans is not completed until after the close of a fiscal year. The reestimate will be completed in November 2011, in accordance with the OMB Circular 

A–11 and the Federal Credit Reform Act of 1990, and sent to Congress in the 2013 

Budget Submission. 

Question 37. The budget request notes that 147 Native American Direct Loans are 

anticipated to be made in FY 2011. However, the Agency estimates that it will make 

just 60 loans through this program during FY 2012. Please explain the disparity between the two numbers. 

Response. The FY 2011 estimate of 147 Native American Direct loans (NADLs) 

reflects increased refinance loan activity due to the historically low interest rate environment of the past few years. When interest rates started dropping in FY 2009, 

NADL refinance activity increased as Native American Veteran borrowers took advantage of the opportunity to lower the interest rate on their home loans. VA experienced increased NADL refinance activity in FY 2009 and FY 2010, and VA expects 

this number to begin tapering off in FY 2011 as interest rates increase. As interest 

rates are expected to continue to increase, the number of NADL refinances is expected to decrease, lowering NADL activity to approximately 60 loans in FY 2012. 

42 

Question 38. The President’s FY 2012 budget estimates a savings of $200 million 

in the area of fee care savings. Please provide details on each of the elements included within this proposal. 

Response. VA has developed a plan in FY 2011 of cost savings estimates; this plan 

is the basis for our estimates for the FY 2012 cost savings. The elements include 

business process changes and the use of additional fraud, waste and abuse tools to 

avoid improper payments. Specifically, VA developed cost initiatives including decreased duplicate claims payments, increased use of re-pricing contracts (which 

allow VA lower prices for services), increased possible Medical Care Collections 

Fund (MCCF) collections for purchased services, and decreased interest charges applied due to delay in processing of these health care claims. 

Question 39. The President’s FY 2012 budget estimates a savings of $355 million 

by improving acquisitions in five target areas. Please list specific and separate examples where VA has identified real savings in each of these eight areas: Consolidated Contracting, Increased Competition, a return to In-House Contracting, Reverse Auction Utilities, MED PDB/EZ Save, Reduce Contracts, Property Re-utilization, and Prime Vendor. 

Response. The following is a list of examples where VHA has identified real savings in the eight areas identified in the question: 

1. Consolidated Contracting—VISN Chief Logistics Officers track previous 

pricing paid for supplies and services and compare those rates to current pricing 

to determine savings. In some cases, the vendors provide additional information 

on savings related to the achievement of tiered pricing discounts. The majority 

of savings in this category are attributable to Blanket Purchase Agreements 

(BPA) that provide discounted tiered pricing at the VISN or Regional level, and 

national contracts at the program office level. 

2. Increasing Competition—VISN staff members determine either the amount 

previously paid when procuring similar services competitively or they utilize the 

government estimate to calculate the savings. Savings in this category primarily 

come from construction contracts that have been converted from sole source to 

competitive. 

3. Bring Contracting Back into VA—VISNs report the dollar amount of Army 

Corps of Engineers fees no longer being paid. 

4. Reverse Auctioning VISN/Facility Utilities—VISNs obtain utilities savings 

from the General Services Administration (GSA). 

5. MED PDB/EZ Save Methodology—VISNs use the MED/PDB pricing data 

to determine the most favorable price and then calculate the difference between 

the old price and the new price to determine savings. This initiative is applicable to medical and surgical supplies. 

6. Reducing Unnecessary Contracts—The contract cost avoidance is manually 

tracked and reported by VISN. One example is the cancellation of clinical contracts by hiring in-house staff. 

7. Re-Utilizing Excess Property—VISNs calculate the dollar value of the avoided procurement as the contract savings. 

8. Prime Vendors Charge Us Only the Discounted Price—VISNs manually calculate the dollar amount of price reductions and also calculate savings related 

to inventory reduction. 

Question 40. VA plans to achieve lower unit pricing by consolidating contracting. 

Please explain how the Secretary’s vision for the future of VA acquisitions will encourage lower unit pricing. 

Response. On April 27, 2010, Secretary Shinseki approved an Executive Decision 

Memorandum to implement a new acquisition model for VA. Implementation of this 

new model enables VA to take a disciplined and collaborative approach in resolving 

the root causes of acquisition deficiencies; allows for the consolidation of complex, 

high-dollar value procurements under a single organization, thereby positioning VA 

to better leverage its acquisition spend. Critical to this acquisition business model 

is establishment of VA’s Strategic Acquisition Center (SAC) within the Office of Acquisition, Logistics, and Construction (OALC), to implement strategic sourcing initiatives and handle contracting requirements exceeding field purchasing parameters. VA is pushing toward this future model with by taking actions now. For example, VA has committed 100% of its purchasing power to the new strategically 

sourced General Services Administration (GSA) Federal Supply Schedule Office 

Supply contract which offers tiered discounts and provides savings averaging 7–19% 

less than GSA schedule prices. Additionally, VA is identifying and developing business cases for strategic sourcing opportunities. Once fully operational, by spring of 

2012, the SAC will centralize execution of these business cases that will likely lower 

unit prices and improve quality. 

43 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY TO

U.S. DEPARTMENT OF VETERANS AFFAIRS

HEALTH CARE

Question 1. The budget submission proposes to realign clinical staff to get to a 

$150 million savings—by cutting physicians and registered nurses and replacing 

them with other clinical positions. What positive changes will be evident at an average facility after this change? 

Response. The Team Care model supports each professional working at the ‘‘top 

of his/her professional skills and abilities’’ to provide health care that is optimally 

safe and cost-effective. There will be no ‘‘cuts’’ but, through attrition, we will replace 

some physicians with non-physician providers (nurse practitioners and/or physician 

assistants). Registered nurses will be supplemented by licensed practical nurses and 

other allied health support staff (pharmacists, social workers, dieticians and others) 

to further enhance the effectiveness of the team. This model will promote the provision of accessible, comprehensive, continuous and coordinated high quality health 

care while judiciously utilizing resources. 

Question 2. One of the problems at the Marion, Illinois VA was a provider performing procedures for which he was not qualified or credentialed. If this realignment proceeds, what will the Department do to ensure only the right providers are 

giving care and that they are appropriately credentialed for those procedures? 

Response. Since 2007, VHA has focused attention on the roles and responsibilities 

of local hospital medical staff leadership to ensure proper documentation and provider competency in the credentialing and privileging process, and has facilitated 

closer oversight by implementing continuous monitoring of credentials through the 

National Practitioner Data Bank’s Continuous Query (previously known as the 

Proactive Disclosure Service). The new Central Office realignment will extend these 

efforts by bringing the Credentialing and Privileging program together with the National Center for Patient Safety, Risk Management, and the Office of Medical Legal 

Affairs, thereby enhancing internal communication and collaboration to ensure that 

only appropriately qualified clinicians are delivering care to our Nation’s Veterans. 

Question 3. The budget submission predicts $200 million in savings in the next 

two fiscal years after a variety of initiatives to cut the costs associated with buying 

care in communities. One of the initiatives is to decrease the average daily census 

at contract hospitals. How will you ensure that veterans can receive timely access 

to care close to their homes? 

Response. Monitoring and assessing Non-VA Bed Days of Care was one of many 

initiatives associated with potential savings in this program. The intent of this component of the initiative was to provide broader oversight for both the inpatient care 

services where VA refers the Veteran as well as the emergent inpatient services 

that are initiated by the Veteran. It is not intended to limit access but to assure 

that we are purchasing inpatient care at the right time and the right location. VA 

is also assessing timeliness of appropriate transfers back to the VA. Each component of this initiative includes a clinical assessment to assure we have neither impacted access nor underutilized VA facilities. 

Question 4. The budget submission states that most networks have implemented 

90 percent of the Uniformed Mental Health Services Handbook. When does the Department anticipate all networks being 100 percent complete? Are there networks 

that currently are significantly below percent complete? 

Response. To date, the rate of implementation of the Uniform Mental Health 

Services Handbook across networks is 91.68 percent. Currently, two VISNS have 

more than 95 percent implementation, sixteen VISNS are between 89 and 95 percent implementation, and three VISNs are between 83–89 percent implementation. 

While Veterans Health Administration (VHA) recognizes that 100 percent implementation of the Uniform Mental Health Services Handbook is a goal, VHA has set 

an internal standard of 95 percent implementation at 100 percent of VA facilities. 

This is a more realistic, achievable goal, as these objectives are moving targets due 

to staff turnover and changing needs of the Veterans we serve. Of note, implementation rates of the Uniform Services Handbook have increased steadily over time, with 

national implementation rates increasing 5.8 percent between August 2009 and 

June 2010. While some networks are below others in terms of implementation rates, 

the Office of Mental Health Services, the Office of Mental Health Operations, and 

the Improve Veterans Mental Health Initiative provide technical assistance to ensure that all networks achieve at least 95 percent implementation by second quarter, Fiscal Year 2012. 

44 

Question 5. A January 2009 VHA report found that over 49 percent of veterans 

returning from the Middle East and Southwest Asia who have sought VA health 

care were treated for symptoms associated with musculoskeletal ailments. Additionally, according to a recent VHA analysis of VA health care utilization among OEF/ 

OIF veterans, musculoskeletal system and connective system diseases were the 

leading possible diagnosis, totaling more than 53 percent. Chiropractic services are 

available in at least one facility per VISN. However there are more than 120 facilities without a doctor of chiropractic medicine on staff and a few major metropolitan 

areas such as Detroit, Denver, and Chicago, without a doctor of chiropractic medicine in close proximity. What action is being taken to further accommodate the increasing number of Servicemembers in need of such care? 

Response. VA currently provides chiropractic services on-station at 43 facilities, 

of which 7 are CBOCs. When the residence of a Veteran is geographically distant 

from a VA site providing on-station chiropractic care, the fee-basis program is utilized. VA continues to assess utilization and resources to further develop the chiropractic program to best serve Veterans’ needs, expanding the VA chiropractic program from 24 sites in fiscal year 2005 to 43 sites in current fiscal year 2011. 

Question 6. The President’s budget request includes $52 million for FY 2012 and a FY 2013 advance appropriation of $57 million to fund care for American Indian/ 

Alaska Native Veterans. How did VA arrive at these funding amounts? 

Response. VA had previously received population and cost of care information 

from the Office of Management and Budget for the American Indian/Alaska Native 

(AI/AN) Veterans. The $52 million and $57 million requests were based on an estimate of the AI/AN Veterans that were Indian Health Service (IHS) users only and 

dual eligible users to get total potential VA cost. Based on the data provided by 

OMB, the following assumptions were made: 

• Only IHS cost for care provided in non-IHS facilities would be shifted to VA. 

• The OMB IHS cost per user was $4,386 in FY 2012 and $4,710 in FY 2013. 

• 25% of dual eligible AI/AN Veterans in given year will use IHS only and 50% 

of the IHS cost would shift to VA. 

• 50% of dual eligible AI/AN Veterans in given year will split VA/IHS care 50/ 

50 and 25% of IHS cost will shift to VA. 

Question 7. The contingency fund that is included in the budget request raises 

several concerns. If the models project a given level of need, why does the request 

not ask to be directly funded at that level? 

Response. The $953 million contingency fund was requested to address the potential demand increase for medical care services due to changes in economic conditions, which was estimated for the first time in the VA’s Enrollee Health Care Projection Model. Recent studies have shown that unemployment rates among Veterans 

are approximately double those of non-Veterans. As Veterans lose access to other 

health care options, such as employee health insurance, they increasingly seek VA 

care. However, because this economic impact was incorporated into the model for 

the first time, the estimated need was proposed to be funded through the contingency fund. Under this funding mechanism, the funds will only become available for 

obligation if the Administration determines that the estimated changes in economic 

conditions materialize in 2012. The contingency fund ensures the resources are 

available for the potential need, while monitoring the consistency between this firsttime projection and latest available data. 

Question 8. What guarantees are there that the dollars in the contingency fund 

will be released, and released on time, if the determination is made that they will 

be needed? 

Response. Section 226 of the Administrative Provisions state that ‘‘* * * such 

funds shall only be available upon a determination by the Secretary of Veterans Affairs, with the concurrence of the Director of the Office of Management and Budget, 

that: 

(a) The most recent data available for: 

(1) National unemployment rates, 

(2) Enrollees’ utilization rates, and 

(3) Obligations for Medical Services, 

validates the economic conditions project in the Enrollee Health Care Projection 

Model, and 

(b) Additional funding is required to offset the impact of such factors.’’ 

VA and the Administration will work closely together to determine if the estimated economic impact materializes and, if so, to ensure that the funds are released 

promptly to the VISNs and VA medical centers to meet the increased demand for 

health care. 

45 

CLAIMS PROCESSING

Question 9. Please describe what criteria are used in forecasting claims workload. 

How confident are you that the forecast for FY 2012 is correct? 

Response. VBA uses historical trend analysis of VA disability claim receipts, to 

include information such as, but not limited to, total amount of claims received, 

types of claims received, regional office of jurisdiction from where claims are received, as well as an estimate of the average number of disabilities and types of disabilities claimed on an annual basis. This data is captured and stored with the centralized VBA claims corporate database. VBA also uses external information such 

as actual and forecasted Servicemember discharges provided by the Department of 

Defense in order to help in the estimation of new Veterans potentially seeking VBA 

services. Furthermore, VBA also uses external data from both government and private organizations such as the Centers for Disease Control and Prevention and the 

American Heart Association to estimate the number of potentially eligible Veterans 

when proposed changes to legislation and/or internal updates to regulations are introduced that impact VA disability benefits. VBA has a high degree of confidence 

that the workload forecast of ∼1,326,000 incoming disability compensation and pension claims is valid. 

Question 10. Please provide data on the status of the Agent Orange Fast Track 

program, including the number of claims filed and the average time to process a 

claim that has been filed through that system. 

Response. The Fast Track Claims Processing System has been operational since 

October 29, 2010. The Fast Track System accepts claims for the three Agent Orange 

presumptive conditions of Parkinson’s disease, ischemic heart disease, and B-cell 

leukemia. Veterans may file claims for these conditions electronically through the 

Fast Track web-based portal or by mail or fax to the regional offices or the Fast 

Track intake facility in Rocket Center, WV. Through the use of Disability Benefits 

Questionnaires, the system automatically generates recommended rating decisions 

to assist VA decisionmakers. 

As of March 15, the Fast Track System has 17,712 cases entered—2,540 filed online by Veterans and 15,172 entered by VA employees (non-Nehmer claims received 

after publication of the final rule). Fast Track claims rated through March 15 total 

2,294. 

Average time to complete claims processed through the system is not available at 

this time. VA continues to work with our support contractor to refine the Fast Track 

System, including a more robust reporting functionality. The scheduled reporting 

enhancements will allow Fast Track to directly interface with the VBA corporate 

database, ensuring consistent data reporting across both systems. 

Question 11. Please provide data on the usage of disability benefits questionnaires. To date, how many DBQs have been received by VA? Of the DBQs that have 

been received, how many VA medical examinations have been provided for the same 

condition? 

Response. As of March 14, 2011, VBA has received 14,434 Disability Benefits 

Questionnaires (DBQs) from C&P Exams performed by VHA. VBA received an additional 2,441 DBQs from other sources. No additional analysis is currently available 

regarding how many VA examinations were provided in cases where a DBQ was 

also submitted. An in-depth case by case analysis would be required to parse out 

when and why a VA examination may have been subsequently requested in a case 

involving a DBQ received as private medical evidence. 

Question 12. What measures is VA taking to prevent fraud in the use of DBQs? 

For example, are there controls in place to prevent VA employees or veterans from 

modifying the DBQs that are given to VA after being filled out by a provider? Does 

VA have a system in place that will recognize whether a provider is routinely giving 

favorable, and perhaps unwarranted, assessments of veterans? 

Response. VA has a program in place to prevent fraud. Recently, VA’s Office of 

Inspector General (OIG) conducted an evaluation of this oversight program. The Director of Compensation and Pension (C&P) Service is currently awaiting feedback 

from OIG about this program, which involves surveying a representative sample of 

submitted DBQs and validating the information with the clinician identified on the 

form. This validation is meant to ensure that the clinician is appropriately identified 

and that the submitted information has not been altered after the clinician signed 

the form. However, we note that the completed DBQ is merely a statement from 

a private physician providing relevant medical information. VA’s current regulations 

at 38 CFR 3.326(c), regarding the validation of statements from private physicians 

remain applicable. However, the level of scrutiny being applied to the DBQ far exceeds the standards currently applicable to other statements from private physiVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00051 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
46 

cians. The provisions of § 3.326(c) stipulate that, provided that it is otherwise adequate for rating purposes, a statement from a private physician may be accepted 

for rating a claim without further examination. VA accepts private medical evidence 

(non-VA sources) at face value unless there is reason to question it. If questionable, 

the statement will either be returned to the provider for clarification or a medical 

opinion may be requested from VHA. VA’s systemic review process to actively review DBQs for validity far exceeds the current system of validation. 

Question 13. Please describe all existing claims processing pilots. What are the 

specifics of each pilot in terms of location, size, purpose, timeframe for completion, 

and other relevant elements? What are the measures of success for each pilot? Who 

within VA is responsible for the overall management and evaluation of each pilot 

and for compiling the lessons learned from the various pilots? 

Response. Attached is information on the nearly four dozen pilots that have been 

nationally tracked. This includes 19 that have run their course and are no longer 

active pilots, some of them becoming permanent tools, best practices, or implemented nationally. For the remaining pilots, VA is using a project management tool 

to set schedules with key milestones and decision points and develop plans for potential pilot implementation and future rollout. This approach will provide a more 

uniform guide to defining project metrics. 

In general, pilot success is measured against the overarching principles of providing greater efficiency and improving the delivery of services. This includes, but 

is not limited to, more timely decisions of higher quality and increased capacity to 

provide more claims decisions. 

Responsibility for overall management, evaluation, and compilation of lessons 

learned lies with VBA’s Office of Strategic Planning (OSP). Initiative leaders and 

OSP staff regularly brief VBA leadership on pilots’ status, with recommendations 

for next steps at key junctures. 

Question 14. VA does not appear to have a systemic way of incorporating current 

laws, including precedential case law, into the manuals relied upon or the text used 

in rating decisions. How can veterans expect to obtain correct decisions when adjudicators are instructed to apply incorrect laws? What actions can you take to ensure 

that the legal information relied upon by rating employees is correct and reflects 

current law? 

Response. VBA’s methods of incorporating current laws, including case law, into 

its procedures follow. 

Daily, the C&P Service Policy Staff review legislative enactments, decisions by the 

Court of Appeals for Veterans Claims, and relevant decisions by the United States 

Court of Appeals for the Federal Circuit. If a new law or court decision impacts VA 

procedures or requires a regulatory or other change, a written assessment identifying any needed amendments is drafted within days of the decision date. The assessment document is forwarded to the appropriate C&P Service staffs for action. 

The assessment and the text of the court decision are immediately made available 

to all field offices. Regarding legislative amendments and court decisions mandating 

substantive policy or procedural changes, Fast Letters, which are binding on VA 

decisionmakers, are issued to the field offices to provide guidance in advance of 

amendments to the adjudication procedures manual M21–1MR or VA regulations. 

Simultaneously, recommendations based on the legislation or court decision are provided to the C&P Regulations or Procedures Staffs for necessary amendment. All 

Fast Letters, Training Letters, and assessments of court decisions are posted on the 

C&P Service Calendar page. The individual regional offices identify new postings affecting the adjudication process, and provide local training in accordance with the 

published guidance. Compliance with newly released guidance is assessed through 

both regional office Quality Review programs and the C&P Service’s nationwide Systematic Technical Accuracy Review program. 

If the Policy Staff determines that a change to the rating text is required, the decision assessment document is forwarded to C&P Service’s Business Process Staff 

for incorporation into the Rating Board Automation (RBA) system. The C&P Service 

RBA business analyst submits a change request to the Hines Information Technology Center through the VBA Office of Business Process Integration for the next 

available VETSNET release. This may take an extended period of time, as the requirements for a release must be submitted 6 months in advance of the release. As 

noted above, if the text is needed immediately, the C&P service issues a Fast Letter 

to inform the field that until RBA2000 changes are made, they must insert approved text into the rating decision. 

Question 15. How many FTE of the Compensation and Pension Service Quality 

Assurance program will be supported in the FY 2012 budget request? 

47 

Response. Compensation and Pension Service currently has 49 employees dedicated to quality assurance. At this time there are no plans to increase the number 

of employees in the National Quality Assurance Program. 

Question 16. The Secretary has a commitment to eliminate the claims backlog and 

improve quality to 98 percent by 2015. Please explain how the level of quality of 

decisions is determined. How does VA intend to reach 98 percent? 

Response. The Systematic Technical Accuracy Review (STAR) system is VBA’s national program for measuring compensation and pension claims processing accuracy. 

The STAR system includes review of work in three areas: claims that usually require a rating decision, claims that generally do not require a rating decision, and 

fiduciary work. Audit-style case reviews are conducted after completion of all required processing actions on a claim. The review is outcome-based and includes all 

elements of processing that claim. STAR accuracy review results are generated for 

all VBA regional offices, brokering centers, the Tiger Team, which process claims 

from Veterans over 70 years old or pending over one year, and Pension Management 

Centers, and are included in the regional office directors’ annual performance evaluations. 

Under the STAR program, a statistically valid random sample of completed work 

is reviewed from each processing center. The benefit entitlement accuracy rate is 

the official measure of a station’s quality performance. Benefit entitlement accuracy 

for rating claims includes: addressing all issues, compliance with Duty to Assist (38 

CFR 3.159), correct decision to grant or deny, and proper award action (correct payment rates and effective dates). 

In addition to STAR assessments, VBA has a number of other methods of assessing quality, including consistency assessments, site surveys, and special reviews. 

The results of these assessments are analyzed and used to develop both local and 

national training. 

In support of the Secretary’s commitment to eliminate the claims backlog and improve quality to 98 percent by 2015, VA has undertaken a comprehensive Claims 

Transformation Plan. (See attached Claims Transformation Initiatives dated 

March 2011.) Specialized quality review positions are being created in each regional 

office to focus solely on the improvement of quality. The employees selected for these 

positions will be part of dedicated quality review teams at each Regional Office. 

During fiscal year 2011, the STAR Staff is conducting training for the employees 

from each regional office currently responsible for conducting local quality reviews. 

This training is designed to help achieve consistency between national and local 

quality reviews. The STAR Staff is scheduled to complete the training for employees 

currently assigned to these duties in May 2011. 

Logic-based tools have been developed to aid VA decisionmakers by automating 

simple decisions to provide more accurate and consistent decisions for Veterans. 

Hearing loss and Special Monthly Compensation calculators have been implemented 

nationwide, and additional logic-based tools are currently in the works. 

Through the use of sound training programs, information technology job aids, and 

enhancements to decision support systems, VBA decisionmakers are being provided 

the tools needed to make consistent, quality decisions. 

Question 17. Please define the amount of money in the President’s budget request 

that is allocated for the administration of the Integrated Disability Evaluations System for those based overseas but going through the program. Please provide the 

plan for this program overseas. 

Response. Expansion of the Integrated Disability Evaluation System is still in the 

planning phase with the Department of Defense. Therefore, no specific amount of 

money has been allocated for this population of servicemembers. 

CONSTRUCTION

Question 18. Please provide a list of priority weights for the 6 major criteria and 

18 subcriteria in the Analytic Hierarchy Process used to inform the Strategic Capital Investment Plan decision plan. 

Response. Priority weights for the 6 major criteria and 18 sub-criteria used to 

prioritize capital projects in the FY 2012 Strategic Capital Investment Planning 

(SCIP) cycle are provided in the table below. 

48 

Question 19. Please explain the 81 percent reduction in funding requested for the facility security projects account, from $42.5 million in FY 2011 to $8 million in 

FY12. 

Response. The reduced funding requested in FY 2012 is directly related to the reduction of facility security requirements of the projects included in the FY 2012 

budget. 

Question 20. How is VA measuring the impact of the $24 million that funded costs 

associated with on-site supervision of major construction projects by 140 resident 

engineers? 

Response. The 140 resident engineers requested in FY 2012 is the same level requested in FY 2011. VA determines the number of resident engineers (RE) needed 

on construction projects based on the size and complexity of the project, the amount 

of shift work the contractor is proposing and the number of contracts that will be 

on-going simultaneously. Resident engineers are evaluated based on several factors: 

the timeliness of responses to requests for information from the contractor, monitoring how well the contractor builds the facility in accordance with the drawings 

and specifications for the project, and monitoring schedule performance. Additionally, the establishment of a robust project management culture will increase project 

visibility and accountability for managing the capital program and decrease the risk 

currently assumed by having minimal government representation on complex construction projects valued in the hundreds of millions of dollars. 

Question 21. VA has a variety of capital planning mechanisms. According to the 

FY 2012 budget request, Strategic Capital Investment Plan lays out each VISN’s 

capital needs through a ten-year action plan; the Building Utilization and Review 

and Repurposing initiative identifies underutilized real estate to develop housing opportunities through the Enhanced Use Lease program; and the Real Property Cost 

Savings and Innovation Plan seems to include repurposing, demolition, mothballing, 

and a number of other initiatives. Please provide more information on each program, their synergies, and their differences. Also, please explain how each fits in 

to a larger national vision on capital planning, especially in the context of health 

care delivery. 

Response. VA’s Strategic Capital Investment Planning (SCIP) process is the data 

driven approach that systematically identifies VA service or infrastructure ‘‘gaps’’ 

and prioritizes capital investment projects in terms of their ability to close these 

gaps. SCIP is a forward-looking strategic plan to meet VA’s current and future infrastructure needs and is inclusive of the many other on-going efforts to improve 


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real property utilization and meet strategic departmental objectives. Within SCIP, 

two of the tactical program means to close these gaps are BURR and the Real Property Cost Savings and Innovation Plan. Other tactical means include major construction, minor construction, non-recurring maintenance, leasing, and use of noncapital solutions. SCIP includes the results of many planning processes and is the 

collection of all activities that impact the VA real property portfolio and its performance. Projects that are identified in these planning processes must be included in 

the SCIP 10-year action plan on how the VISN plans to address their service or infrastructure gaps. The following is a more detailed discussion of the two tactical efforts requested in the question. 

VA’s Building Utilization Review and Repurposing (BURR) initiative is a targeted 

nationwide effort to reuse or repurpose underperforming capital assets to address 

strategic objectives, such as ending Veteran Homelessness and consolidating/realigning assets for direct services to the Veterans VA serves. The Department’s EUL authority and the BURR initiative allow VA to match supply (available buildings and 

land) and demand among Veterans for housing with third-party development, financing, and supportive services. These activities affect VA’s real property inventory 

and therefore would be part of the Strategic Capital Investment Plan (SCIP) as a 

means to address unused space, meet increased service demands, and provide enhanced services to Veterans. 

The Real Property Cost Savings and Innovation Plan identifies cost savings expected from current and new initiatives. The expected savings from repurposing, 

demolition, and mothballing, reported in the Real Property Cost Savings and Innovation Plan, is a quantification of expected savings from actions planned under 

BURR and other disposal planning activities. Other actions, such as telework and 

energy conservation measures, are also part of the cost savings plan. These actions 

impact VA’s real property portfolio and therefore would be part of the SCIP process. 

There are additional items in the cost savings plan that are purely operational in 

nature, such as commodity purchasing, that does not impact capital investments 

and would not be part of SCIP. 

Question 22. The VA Real Property Cost Savings and Innovation Plan proposes $18.5 million in savings through several different mechanisms. Please provide the 

amount of savings projected for each portion of the plan. 

Response. VA continues to look for innovative ways to save operational costs related to its real property inventory while maintaining a high level of service. The 

Cost Savings plan has a number of key initiatives that span all VA Administrations 

and continues to be refined as new initiatives and legislation occur. VA currently 

has projected the following preliminary estimates for real property cost savings for 

VHA. 

Potential Cost Savings for VHA in FY 2012 $ in millions 

Repurpose Vacant and Underutilized Assets .............................. 3 

Demolition and Mothballing ........................................................ 3 

Energy and Sustainability ............................................................ 10 

Telework ....................................................................................... 2 

Renegotiate GSA Lease Costs ...................................................... 0.5 

Total ................................................................................ $18.5 

Question 23. Why was renewing the enhanced use lease authority not among the 

Department’s legislative requests? 

Response. VA is developing an improved request to address the imminent expiration of its enhanced-use lease (EUL) authority that will be submitted to Congress 

soon. 

Question 24. How much would it cost to renew the enhanced use lease authority 

and, separately, what cost avoidance would be realized by renewing this authority? 

Response. The EUL program has been active in VA for close to 20 years. No new 

or additional costs are associated with the renewal of the authority. VA currently 

has the authority to offset its costs to administer the program with proceeds/revenue 

generated through EUL projects. VA’s EUL authority also allows the Department 

to transfer the operations and maintenance costs to a third party (developer/lessee) 

for an extended term (up to 75 years), accounting for annual cost savings to VA that 

are directed to providing services to Veterans. In addition, VA generated cost revenue of $3.1 million, cost avoidance of $32.6 million, and cost savings of $ 5.8million 

in 2010. Since 2006, the EUL program has cumulatively generated $266.1 million 

in total consideration to VA. We believe that the continuation of the EUL program 

50 

would allow the Department to realize similar cost avoidance and savings in the future. 

Question 25. Please provide the most recent copy of the VA Seismic Inventory Report developed in consultation with Degenkolb Engineers. 

Response. See Attachment. 


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HOMELESSNESS

Question 26. The President’s budget request notes that VA is developing research 

on health conditions and risk factors that relate to homelessness and on the effectiveness of VA homeless services. Are there any preliminary findings from this research that you can share with the Committee? When can Congress expect to see 

the results of these studies? 

Response. The VA National Center on Homelessness Among Veterans (NCHV) 

has adopted a research agenda with a focus on the epidemiology of homelessness 

among Veterans and the effectiveness of services intended to prevent and end homelessness among Veterans. These studies are aimed at closing gaps in the research 

related to the prevalence of homelessness among Veterans, characteristics of Veterans who experience homelessness, and factors that predict homelessness among 

Veterans as well as Veterans’ utilization of services and whether these services are 

both efficient and effective. 

The initial studies conducted by the NCHV have focused on developing a definitive count of homeless Veterans. To this end, the NCHV collaborated with the U.S. 

Department of Housing and Urban Development (HUD) to develop Veteran Homelessness: A Supplemental Report to the 2009 Annual Homeless Assessment Report 

to Congress, which provides point-in-time and annual counts of homeless Veterans 

in the United States—75,609 and 135,334, respectively—as well as the characteristics and locations of homeless Veterans. An additional investigation of the prevalence and risk of homelessness among Veterans in a selection of communities provides more detailed analyses of homelessness risk. Taken together, these studies indicate that Veterans are overrepresented within the homeless population. Specifically, the multi-site investigation found that, after controlling for poverty, age, race, 

and geographic variation, female Veterans were three times as likely as female nonVeterans to become homeless, and male Veterans were twice as likely as male nonVeterans to become homeless. 

There is another study underway to identify specific risk factors for homelessness 

among Veterans and to accurately prioritize prevention resources for those who are 

at imminent risk of homelessness. The NCHV is developing a Homelessness Risk 

Assessment, which will be piloted in a variety of settings and tested for reliability 

and validity. The instrument is a brief, two-stage assessment that first assesses 

whether a Veteran has a safe and stable place to stay for at least 90 days. If the 

Veteran appears to be at risk, the second stage of the instrument assesses the Veteran’s current living situation, barriers to living independently, and supports that 

the Veteran may have or require to access and maintain safe and stable housing. 

The assessment will inform appropriate referrals to homelessness prevention or 

other services. In addition, data collected through the assessment process will guide 

decisions regarding need for and targeting of resources moving forward, including 

specific characteristics that may pose risk for homelessness. 

While homelessness among Veterans in the OEF/OIF/OND service era is a priority concern, there is limited empirical data about the extent to which or dynamics 

whereby they do become homeless. To address this, the NCHV is examining the 

onset of homelessness among recent Veterans, including those returning from the 

OEF and OIF conflicts. Working in conjunction with the VA Office of the Inspector 

General and municipal shelter providers in Columbus, Ohio, New York City, New 

York and Philadelphia, Pennsylvania, researchers at the NCHV are compiling an 

array of data that will facilitate identifying risk factors for homelessness among 

OEF/OIF Veterans at the time of their separation from the military. This promises 

to inform prevention programs and increase their efficiency. Services use patterns 

among this group will also be examined to assess the extent to which they use VA 

services, community services, or a combination of the two. This will increase the understanding of how Veterans access the services available to them, and will facilitate better coordination of services between VA and mainstream homeless service 

systems. 

The NCHV is also organizing a series of studies around the general topics of mortality, morbidity, and aging among homeless Veterans. The overall goal of this 

project is to assess the demographic trends among the homeless Veteran population 

to project future trends in the size and makeup of this population, and to anticipate 

future demand for services. Research conducted by study investigators has shown 

the overall single adult (i.e., not family) homeless population to be steadily aging. 

If these trends continue, this would lead to higher risk for early mortality and greater needs for long-term care. Research is currently underway to assess whether these 

trends also hold for homeless Veterans, and the impact that providing homeless Veterans with housing has on subsequent health and mortality. 

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Additionally, an examination of the intersection of suicide and homelessness has 

produced preliminary findings which show that 24 percent of Veterans in a registry 

of suicide attempters also had records of receiving VA homeless services. 

Another project is examining the life course of elderly Veterans with records of 

homelessness, and their uses of VA and non-VA health care services. 

Several of these studies are in the initial phases. We anticipate preliminary data 

on most of them to be available by the end of Fiscal Year 2011, and final reports 

by the end of Fiscal Year 2012. 

Question 27. The Department has a number of programs with the goal of preventing veteran homelessness before it starts and ending it once veterans are on the 

streets. For each program, please share how many veterans are helped annually and 

how many have been helped since the program started. Of these programs, which 

have led to the largest reductions in homeless populations? 

Response. The Department of Veterans Affairs (VA) operates the largest system 

of homeless treatment and assistance programs in the Nation. In 2010, VA’s specialized homeless programs served more than 116,000 Veterans. The hallmark of VA’s 

homeless programs are that they provide comprehensive care and benefits including 

medical, psychiatric, substance abuse, rehabilitation, dental care and expedited 

claim processing for these Veterans. In addition, VA case management and supportive services are focused on preventing and ending homelessness. The following 

programs represent VA’s homeless continuum of care. All programs in the continuum are part of VA’s plan to end homelessness and contribute to the overall reduction of the homeless Veteran population. Each program represents a different 

part of the continuum and no program is more efficacious than another. 

Prevention Programs: 

The primary VA prevention program, Supportive Services for Veteran Families 

(SSVF), is in the process of being implemented. The grant application period closed 

on March 11, 2011 and VA is in the process of reviewing these applications and 

awarding these grants. VA expects to announce these awards in June 2011. 

A second prevention program is the Veterans Homelessness Prevention Demonstration (VHPD) also referred to as the HUD-VA Pilot. The HUD-VA Pilot program is designed to explore ways for the Federal Government to offer early intervention homeless prevention, primarily to Veterans returning from wars in Iraq and 

Afghanistan. This demonstration program will provide an opportunity to understand 

the unique needs of this new cohort of Veterans, and will support efforts to identify, 

outreach, and assist them to regain and maintain housing stability. This three year 

HUD-VA prevention pilot is a partnership among the Department of Veterans Affairs (VA), the Department of Housing and Urban Development (HUD), the Department of Labor (DOL), and local community agencies. VHPD will serve the following 

locations: MacDill Air Force Base in Tampa, Florida; Camp Pendleton in San Diego, 

California; Fort Hood in Killeen, Texas; Fort Drum in Watertown, New York; and 

Joint Base Lewis-McChord near Tacoma, Washington. As the lead agency, HUD is 

awarding grants for the provision of housing assistance and supportive services to 

prevent Veterans and their families from becoming homeless, or reduce the length 

of time Veterans and their families are homeless. HUD’s Office of Special Needs Assistance Programs (SNAPS) executed the grant agreements with the pilot site Continuums of Care grantees on February 3, 2011. VA case management and outreach 

staff have been hired at each of the sites and are working with Department of Labor 

staff and the Continuum of Care grantees to implement the program. The HUD-VA 

pilot sites are expected to start delivering services to Veterans no later than 

March 2011. 

The National Call Center for Homeless Veterans (NCCHV) was founded to ensure 

that homeless Veterans or Veterans at risk for homelessness have free, 24/7 access 

to trained counselors. The hotline is intended to assist homeless Veterans and their 

families, VA medical centers, Federal, state and local partners, community agencies, 

service providers and others in the community. The NCCHV call number (1–877– 

4AID VET) was activated the week of December 21, 2009 and full implementation 

commenced on March 1, 2010. From March 1, 2010 to February 28, 2011, there have 

been 25,771 calls to the NCCHV. Of the calls received, 20,831 callers identified as 

Veterans; 6,578 Veteran callers identified as being homeless; and 11,769 Veteran 

callers identified as being at risk of homelessness. 

As part of the Plan to End Homelessness Among Veterans, VA is focused on serving Veterans involved with the criminal justice system, who may be homeless or at 

risk for homelessness. Studies have shown that for adult males, incarceration is the 

most powerful predictor of homelessness (Burt et al., 2001). The Health Care for Reentry Veterans (HCRV) program provides outreach and linkage to post-release services for Veterans in state and Federal prisons; HCRV Specialists have provided reVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00156 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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entry services to 24,244 reentry Veterans since Fiscal Year (FY) 2008, including 

9,622 Veterans in FY 2010. The Veterans Justice Outreach (VJO) program focuses 

on Veterans in contact with law enforcement, jails, and courts, including the rapidly 

expanding Veterans Treatment Courts (VTC). VJO Specialists have served a total 

of 8,004 justice-involved Veterans since the start of the program, including 5,849 so 

far in FY 2011. 

Rehabilitation, Treatment, Transitional Housing and Permanent Supportive Housing 

Programs: 

Grant and Per Diem Program (GPD): The GPD program allows VA to award 

grants to community-based agencies to create transitional housing programs, and 

provides per diem payments to the programs to support operational costs. The purpose is to promote the development and provision of supportive housing and/or supportive services with the goal of helping homeless Veterans achieve residential stability, increase their skill levels and/or income, and obtain greater self-determination. GPD-funded projects offer communities a way to help homeless Veterans with 

housing and services while assisting VA medical centers by augmenting or 

supplementing care. The GPD program has provided services for 98,493 unique Veterans since 1995, including 15,706 Veterans in FY 2009, 17,305 Veterans in FY 

2010, and 4,174 Veterans during the first quarter of FY 2011 (data from NEPEC 

annual report). 

Health Care for Homeless Veterans (HCHV): The central goal of the HCHV programs is to reduce homelessness among Veterans by conducting outreach to those 

who are the most vulnerable and are not currently receiving services and engaging 

them in treatment and rehabilitative programs. The HCHV Outreach program has 

served 383,362 unique Veterans since 1987; this includes 81,212 Veterans in FY 

2009, 90,237 Veterans in FY 2010, and 36,371 Veterans during the first quarter of 

FY 2011. 

The HCHV Contract Residential Treatment Program ensures that Veterans with 

serious mental health diagnoses can be placed in community-based programs which 

provide quality housing and services. HCHV provides ‘‘in place’’ residential treatment beds through contracts with community partners and VA outreach and clinical 

assessments to homeless Veterans who have serious psychiatric and substance use 

disorders. The HCHV Contract Residential Treatment Program has served 54,723 

unique Veterans since 1987; this includes 2,870 Veterans in FY 2009, 3,541 Veterans in FY 2010, and 1,592 Veterans during the first quarter of FY 2011. 

Domiciliary Care for Homeless Veterans (DCHV): The DCHV Program provides 

time-limited residential treatment to homeless Veterans with health care and socialvocational deficits. DCHV programs provide homeless Veterans access to medical, 

psychiatric, and substance use disorder treatment in addition to social and vocational rehabilitation programs. The DCHV program has served 76,289 unique Veterans since 1988; this includes 8,605 Veterans in FY 2009, 8,445 Veterans in FY 

2010, and 3,267 Veterans during the first quarter of FY 2011. 

Housing and Urban Development-VA Supported Housing (HUD-VASH): This is a 

collaborative program between HUD and VA where eligible homeless Veterans receive VA-provided case management and supportive services to support stability and 

recovery from physical and mental health, substance use, and functional concerns 

contributing to or resulting from homelessness. HUD-VASH is the Nation’s largest 

supported permanent housing initiative. As of February 28, 2011, 19,834 Veterans 

are currently under lease, 6,667 Veterans have vouchers assigned to them, and are 

in process of getting housed and 3,936 vouchers are at the Public Housing Authority 

waiting to be assigned to a Veteran. Since 2008, a total of 23,011 Veterans have 

been housed through this program. 

Question 28. The new homeless veteran call center is a vital tool for centralizing 

and standardizing the information VA provides to the public. 

A. Who typically calls this center? 

Response. From March 1, 2010 to February 28, 2011, there have been 25,771 calls 

to the NCCHV. As of February 28, 2011, there have been 20,831 callers identified 

as Veterans; 6,578 Veteran callers identified as being homeless; and 11,769 Veteran 

callers identified as being at risk of homelessness. 

Additionally family members and friends of Veterans, community agencies, military/Veteran service providers and other interested parties have been identified as 

calling the National Call Center for Homeless Veterans (NCCHV) to help Veterans. 

B. What type of information is provided to callers? 

Response. Callers are provided the location of their nearest VA Medical Center 

as well as the names and phone numbers of the VA Medical Center’s identified primary and secondary Homeless Program Points of Contact Callers are provided information, referral and intervention based on their presenting needs. Information reVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00157 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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garding names and numbers of community agencies and local community resources 

are provided, as well as national Web sites and other hotline numbers. 

C. What is the average wait time to reach a staff member? 

Response. The National Call Center for Homeless Veterans (NCCHV) answers 

calls 24 hours a day, 7 days a week. All calls are answered immediately by trained 

responders at the NCCHV who conduct a brief screen to determine need and severity of need. Responders at the NCCHV then link those callers needing referral and 

linkage to the nearest VA Medical Center Homeless Program Point of Contact anywhere in the country. Emergency calls are linked immediately to the VA Medical 

Center’s identified Homeless Program Point of Contact or after hour/weekend staff 

for assistance and intervention. Responders at the NCCHV can contact the Point 

of Contact or the after hour/weekend staff to consult on any call that may be urgent 

in nature to determine a course of action and develop a plan. For routine calls, the 

Point of Contact will respond within 24 hours or the next business day. All consult 

reports are completed by the Point of Contact within 5 business days and includes 

the Homeless Team’s update on how they assisted the Veteran as well as any ongoing plan of care. 

WOMEN VETERANS

Question 29. What funds are being specifically directed toward expanding hours 

at women’s clinics? 

Access to care, including making care available outside of typical operating hours, 

continues to be a part of the prospective changes to support ever increasing patientcenteredness of VA health care. According to information gathered in March, 2011, 

29 facilities across 24 states currently offer extended primary care hours for women. 

Overall, 20.4% of facilities offer extended primary care hours (operating hours outside of usual operating hours 8am–4:30pm) for women and 24% offer extended primary care hours for men. It is anticipated that these numbers will continue to increase as the transformation to patient-aligned care teams and the focus on more 

patient-centered care continues. In FY 2011, the VISNs received approximately $410 

million in Major Strategic Initiative/Transformation Initiative funds which could be 

used to expand primary care hours for women, among other purposes. 

Question 30. Please provide detailed information on the childcare pilot program. 

Where will these pilots occur? 

Response. VA recognizes that Veterans may need childcare options during health 

appointments and research confirms that lack of childcare may be a barrier to utilization of VA care by women Veterans. However, because childcare is not considered 

medical care, VA does not have authority to provide it. Currently, VA facilities may 

not use resources or personnel to provide childcare to Veterans attending appointments. Section 205 of Public Law 111–163, the Caregivers and Veterans Omnibus 

Health Services Act of 2010, signed May 5, 2010, requires VA to conduct a 2 year 

pilot program in at least three Veterans Integrated Service Networks (VISN) that 

offers eligible Veterans childcare when seeking a medical appointment. VA is currently working to determine the mechanism for pilot sites and to determine the definition of ‘‘primary caretaker’’ as provided in the legislation. We plan to initiate pilot 

childcare projects through three VISNs later this year, with initial pilot sites becoming operational this summer. 

Question 31. VA’s response to pre-hearing questions noted that $17 million in FY 

2011 non-recurring maintenance funding has been budgeted for correcting patient 

privacy deficiencies. Is this amount sufficient to cover all of the construction recommendations identified in GAO’s report, VA Has Taken Steps to Make Services Available to Women Veterans, but Needs to Revise Key Policies and Improve Oversight 

Processes? If not, please provide an estimate as to how much funding is needed to 

make VA facilities accessible to women veterans. 

Response. The attachment follows. 

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INFORMATION TECHNOLOGY

Question 32. The President’s budget request includes $5 million for the development of both short-term and long-term Strategic Capital Investment Plan Automation tools. Please explain what functionalities will be included in each. 

Response. Strategic Capital Investment Plan (SCIP) Automation Tool (SAT) 

SAT Short Term Solution: The SAT Short Term tool is the first stage in automating the data collection that serves as the basis for developing the 10-year Action 

Plans. The tool also provides for more efficient collection and analysis of data due 

to tool business rules and criteria as well as the ability to auto generate reports, 

which assist in synthesizing gap mitigation based on Action Plan submissions. The 

implementation of the SAT Short Term tool significantly reduced the manual and 

redundant data collection process that was used during the first year of the SCIP 

process. 

SAT Long Term Solution: The SAT Long Term tool will continue to enhance the 

automation of the Action Plan data collection process. The SAT Long Term is also 

a comprehensive tool that will continue to automate the collection of data during 

the Action Plan phase through the Business Case development and OMB budget formulation phases. The long term may also include modules for improved formulation 

and tracking of VA construction operating plans. 

The SAT Short Term tool solution serves as a functionality bridge between data 

collection requirements during the Action Plan phase and the additional data collection/analysis requirements during subsequent SCIP process phases. The full implementation of the SAT Long Term tool solution will incorporate all Action Plan data 

collection requirements as a one of several modules included in the included SAT 

Long Term tool. 

Question 33. The budget request includes two new IT systems: the Homeless Operations and Management Evaluation System and the VA Homeless Management 

Information System. Please explain the purpose of these new programs. 

Response. The Homeless Operations and Management Evaluation System is a 

case management system which specifically addresses the needs of the Homeless 

Veteran. As a case management system, it will register and administer benefits to 

the Homeless Veteran. Included in this program is the pilot and implementation of 

handheld devices that will be used by field outreach and case workers to interact 

with Homeless Veterans. 

The VA Homeless Management Information System program aims to gather information about Homeless Veterans receiving benefits and forwards that information 

to VA’s Homeless Registry. The information gathered provides VA with information 

about the individual Veteran receiving benefits, and measures the effectiveness of 

various homeless programs. 

Question 34. How much of the Veterans Benefits Management System’s long-term 

success hinges on the success of other programs such as the Virtual Lifetime Electronic Record? 

Response. One of the primary goals of the Virtual Lifetime Electronic Record 

(VLER) is to provide access to electronic health records, which are essential to VA’s 

strategic goal of achieving the paperless administration of benefits. Capability to 

electronically access Veterans’ health records through a secure, reliable, and accessible system will improve Veterans’ experiences by increasing timeliness and predictability of claims decisions. In the short term, VBMS plans to scan the health 

records received as paper documents. In the longer term as VLER matures and approaches full operational capability, it will serve as a source of health and benefits 

data from not only VA but also from DOD, the Social Security Administration, other 

government agencies and the private sector, to make benefits delivery more efficient 

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Question 35. Are there decisionmaking quality measures that exist in VBMS and 

how will this software track errors in the long-term and at what level of granularity? 

Response. As VBMS moves VBA from paper-based to electronic claim processing, 

it will improve quality by ensuring adherence to processes, policies and procedures. 

Utilizing automated workflows and business-rules engines will prevent common errors, thereby improving overall claim quality. Error checking, data validation and 

checks for completeness will help ensure that the claim is correct before it is finished, thereby reducing the need for costly rework. Additionally, it will provide more 

discreet claim-level information to VBA quality systems, enhancing end-of-line quality controls. 

Question 36. Please describe the major milestones for VBMS. For example, when 

will the system be truly paperless? 

Response. The VBMS initiative involves business transformation efforts coupled 

with incremental technology releases to modernize the benefits adjudication process. 

There are three successive phases that are designed to develop and test process improvements and VBMS technology solutions in a production claims setting. 

Phase 1 (November 2010–May 2011) delivers the first iteration of VBMS, including a new graphical user interface, an electronic claims repository and a scanning 

solution, which integrates with existing core business applications in the current 

legacy platform (VETSNET). The first iteration of the software is being tested at 

the VBA Regional Office in Providence, Rhode Island. 

Phase 2 (May 2011–November 2011) and Phase 3 (November 2011–May 2012) are 

intended to provide capability and capacity for national deployment of an end-to-end 

paperless claims processing system. In addition to building out the core and a sustainable system, both phases will increase the number of regional offices, the number of users, the types of claims, and the number of claims processed using VBMS. 

Full national deployment is scheduled to begin in calendar year 2012. 

VA will continue to accept paper claims. Paper claims received will be scanned 

and processed in VBMS. 

Question 37. What efforts has VA planned, in working with DOD, to further articulate a shared set of goals for VLER? 

Response. The Department of Defense (DOD) and Department of Veterans Affairs 

(VA), in collaboration with the Interagency Program Office, have agreed to implement VLER by four (4) functional areas, called VLER Capability Areas (VCAs). 

Completion of a VCA indicates the availability of specific information sets in electronic form for authorized users, Veterans who have provided their consent, Servicemembers, and their beneficiaries and/or designees. 

VCA 1—represents the exchange and availability of clinical information needed 

for the delivery of health care in a clinical setting. 

VCA 2—expands health information from the initial set exchanged in VCA 1 to 

include the exchange of additional electronic health information for disability adjudication. 

VCA 3—completes the information needed for the delivery of the remaining benefits services, including other compensation, housing, insurance, education, and memorial benefits. 

VCA 4—ensures online access to benefits information via a single portal. 

Though work is progressing in all VCAs, DOD and VA are heavily focused on the 

implementation of VCA 1. The plan is to continue to expand pilot testing the exchange of subsets of clinical data, via the Nationwide Health Information Network, 

between DOD, VA and private health care providers, in 2011–2012. Lessons learned 

from these pilot tests will be used to determine scalability, usability, security, and 

reliability of the architecture for broader application, and implementation. 

Question 38. In response to prehearing questions, VA stated, ‘‘In early calendar 

year 2010, VA undertook an extensive re-evaluation of its financial management 

challenges, risks and critical priorities. The re-evaluation, which included consideration of available resources, the clean audit opinions on VA’s financial statements 

for 11 years in a row.’’ Who performs these audits? Please provide the previous two 

years audits. 

Response. In FY 2010, the Department of Veterans Affairs was pleased to have 

received our 12th consecutive unqualified (‘‘clean’’) audit opinion on the Department’s consolidated financial statements. The auditors were Clifton Gunderson LLP 

and their clean audit opinion is found on page III–59 of the Department’s FY 2010 

Performance and Accountability Report (http://www.va.gov/budget/report/). In FY 

2009, the Department also received our unqualified (‘‘clean’’) audit opinion (11th 

consecutive clean opinion) on the Department’s consolidated financial statements. 

The auditors were Deloitte and their clean audit opinion is found on page III–52 

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of the Department’s FY 2009 Performance and Accountability Report (http:// 

www.va.gov/budget/report/) for this link, you will need to page down and click on 

the 2009 PAR). 

Question 39. Is VLER under the Project Management and Accountability System 

and is it on target for meeting its goals for 2012 and beyond? 

Response. In July 2009, the Veterans Affairs Chief Information Officer mandated 

that all funded information technology (IT) projects comply with Project Management and Accountability System (PMAS) guidelines. All VLER IT projects, including 

the VA adaptor to the Nationwide Health Information Network (NwHIN), which enable the VLER mission, are fully compliant with PMAS guidelines. 

Yes, established goals are on target for being met. 

Question 40. What role does DOD have in VA’s recent public Request for Information on evolving VistA in an open source environment? 

Response. VA and DOD have ongoing, extensive discussions regarding Electronic 

Health Records, including the possible use of open source models for the development of the VistA EHR. The Electronic Health Record Open Source Custodial Agent 

Request for Information, prepared and released by VA with the full awareness of 

DOD, was informed by those discussions. 

VOCATIONAL REHABILITATION AND EMPLOYMENT

Question 41. VA’s budget request anticipates a 10 percent increase in the use of 

VR&E in FY 2012. Has this anticipated increase in workload taken into account the 

downturn in the economy and your planned outreach activities? 

Response. Yes, the projected increase is based, in part, on the downturn in the 

economy and our planned outreach activities. However, these increases are also projected based upon new compensation presumptive conditions, VR&E’s participation 

in the IDES process, and Congress’s recent changes to the Post-9/11 GI Bill that 

will now allow Veterans eligible for both Chapter 31 and Chapter 33 benefits to 

elect the higher Chapter 33 housing allowance. 

Question 42. Has VA designed outreach to specifically target Guard and Reserve 

units to educate them about VR&E? 

Response. Yes, VR&E’s Coming Home to Work Program provides services to active duty Servicemembers, to include National Guard and Reservists. The program 

provides opportunities for Servicemembers and Veterans to obtain work experience, 

develop skills needed to transition to civilian employment, determine potential career opportunities, and return to suitable employment. VR&E’s Coming Home to 

Work Coordinators also provide outreach services specifically for Guard and Reserve 

through the Yellow Ribbon and Post-Deployment Health Reassessment (PDHRA) 

events, which occur at 30, 60, 90 day intervals for returning Guard members and 

Reservists. 

Question 43. What effect, if any, do you expect the increased number of VR&E 

applicants will have on timely entitlement decisions? Will it have an effect on rehabilitation rates? 

Response. With the increase in FTE requested, VR&E projects improvements in 

the national rehabilitation rate and the speed of entitlement decisions. VR&E’s request for additional FTE to support expansion of IDES is expected to provide early 

engagement in services with Servicemembers by physically placing Vocational Rehabilitation Counselors (VRC) at IDES locations. This will result in a more timely entitlement decisions. Servicemembers will spend less time in the transition period 

from eligibility to entitlement services and will have more timely access to VR&E 

benefits. 

Question 44. Are you confident that the increased staffing request will be sufficient to meet the higher demand for VR&E services? 

Response. Yes. 

Question 45. Please provide a copy of the VR&E work measurement study, for 

which the contract expired on February 25, 2011. 

Response. The VR&E Work Measurement Study final contract deliverable was rejected by VR&E for being incomplete. The contractor submitted a revised deliverable 

on March 25, but the study was again rejected. VR&E Service continues to work 

with the contractor to revise the final deliverable. Once an acceptable deliverable 

is provided, VR&E will review report for final concurrence, brief VBA leadership on 

the results, and submit a copy of the study to the Committee. 

Question 46. In response to a pre-hearing question on the Integrated Disability 

Evaluation System, the Department stated, ‘‘All IDES participants will receive a 

mandatory initial counseling session in which a VR&E counselor will work with the 

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pation can benefit them in their transition process.’’ For clarification, will all IDES 

participants receive the mandatory counseling session, or just those who apply for 

VR&E services? 

Response. All IDES participants will receive the mandatory counseling session, 

not just those that apply for VR&E services. This face-to-face meeting will inform 

the Servicemember of the benefits available through the VR&E program. The Servicemember can then make an informed decision about whether or not to pursue 

VR&E program services. 

OTHER

Question 47. The President’s Budget reflects a substantial decrease in the amount 

of funding for advanced planning within the National Cemetery Administration— 

from over $25 million in FY 2011 to only $4.3 million in FY 2012. This reduction 

is proposed despite rather ambitious plans to expand operations in six different new 

cemeteries and to move forward with ‘‘urban satellite cemeteries’’ in four locations 

across the country. Are you satisfied that the budget will permit NCA to move forward to continue to plan to meet the needs of veterans and their families in their 

time of need? 

Response. If the FY 2011 President’s budget request is approved, we will have 

$23.4 million available in the Advance Planning Fund (APF). An additional $4.5 

million is requested in FY 2012. 

APF requirements are based on anticipated major construction needs. Available 

and requested APF funds are sufficient to cover the five new national cemeteries 

and planned gravesite expansion projects. The urban satellite cemeteries will be 

funded through minor construction. 

Question 48. Implementation of the Post-9/11 Veterans Educational Assistance 

Program and the timely and accurate payment of benefits are critical. The President’s budget, however, decreases the number of FTE for the Education Service by 

over 200—despite the fact that there is also a 73 percent projected increase in 

claims since the program’s inception and that significant changes were made early 

this year with the 2010 Improvements Act that could easily impact the timeframe 

for implementing the long-term automated processing system. Please give me VA’s 

commitment to advise the Committee at the very first sign that there might be 

problems with available staffing. There are concerns that by releasing more than 

200 employees who have over the past two years have developed skills in processing 

education claims, VA will be losing valuable expertise that might be utilized elsewhere in the Department. To what degree will the reduction in FTE be achieved 

by attrition rather than by dismissal? 

Response. To support Post-9/11 GI Bill claims processing, VA hired 530 term employees as GI Bill claims examiners in February 2009. The term employees were 

part of VA’s short-term solution until the Office of Information and Technology delivered the Long-Term Solution (LTS) for Post-9/11 GI Bill claims processing. VA 

anticipated all term employees would be retained through the end of FY 2011. 

The enactment of the Veterans Educational Improvements Act of 2010 (P.L. 111– 

377) has impacted the development of the LTS for processing Post-9/11 GI Bill 

claims and our ability to fully automate the delivery of benefits. The capability for 

automated end-to-end processing of some supplemental claims was planned for 

June 2011. This capability would create a subset of claims that do not require manual intervention. Implementation of the LTS was expected to address the increased 

workload and improve claims processing timeliness while negating the need for temporary claims processors. Because all LTS development efforts will now be directed 

to implementing the changes in the new law, we anticipate this LTS functionality 

will not be available until the third quarter of FY 2012. 

The delay in the implementation of the enhanced functionality planned for the 

LTS impacts the number of FTE needed to process education claims. Our budget 

request of 1,429 FTE reflects the need to retain 324 of the 530 temporary claims 

examiners through FY 2012 to maintain current claims processing efficiencies. 

While there is a 73 percent projected increase in claims since the inception of the 

Post-9/11 GI Bill, VA anticipates only a 3.1 percent increase in claims from FY 2011 

to 2012. We anticipate any reduction in FTE in FY 2012 will be accomplished 

through attrition. 

VA is committed to providing the best possible service to our Veterans. We will 

carefully measure the impact the LTS has on our ability to accurately and timely 

process Post-9/11 GI Bill claims, and we will continue to engage in dialog with Congress on issues that impact our ability to effectively and efficiently administer the 

Post-9/11 GI Bill. 

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Question 49. The budget request notes that VA plans to increase teleworkers by 

250 percent over the next two years to realize savings. How many teleworkers does 

VA have currently, and how does VA plan to increase the number of employees who 

choose to telework? 

Response. VA records reflect a total of 4,669 employees’ teleworking 1 or more 

days per week. VA has developed a multi-year strategy to increase telework to 

16,636 employees’ teleworking 1 or more days per week by the end of 2012. As part 

of this strategy, VA issued agency wide guidance in accordance with the Telework 

Enhancement Act of 2010 which includes the assignment of telework coordinators 

within each administration, all VISNs and VA’s Central Offices. In addition VA has 

designed a multi-year strategy to promote the full utilization of telework through: 

• a telework education program, • promotion of best practices • issuance of guidelines regarding suitability • establishment of tracking mechanisms • development of ‘‘touchdown space’’ guidelines; and • assuring the necessary IT infrastructure is in place to support remote access users 

Question 50. Under the acquisition reorganization, what is the procurement dollar 

level authority at the Centralized Mail Order Pharmacy level? Please also submit 

the outline of the plan that shifts the buying authority from lower level entities into 

National Acquisition Center. 

Response. Currently the Office of Acquisition, Logistics, and Constructions’ 

(OALC) National Acquisition Center (NAC) is providing acquisition support to the 

Consolidated Mail Outpatient Pharmacy (CMOP) and has warranted Contract Specialists supporting each of the seven CMOP facilities. Each of these contract specialists has senior level warrant authority which is unlimited. CMOP personnel will retain purchase card authority limiting purchases to $3,000 for goods; $2,500 for services; and $2,000 for construction. CMOP personnel also may be delegated ‘‘ordering 

officer’’ authority allowing them only to issue delivery and/or task orders against 

specific contracts awarded by a VA contracting officer. Limitations will vary based 

on the ordering officer delegation. 

In that the NAC is currently providing buying authority to support CMOP operations, there is no plan that shifts buying authority. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO

U.S. DEPARTMENT OF VETERANS AFFAIRS

GENERAL

Question 1. The December 2010 report from the National Commission on Fiscal 

Responsibility and Reform included this recommendation: 

Reduce Federal travel, printing, and vehicle budgets. Despite advances in 

technology, Federal travel costs have ballooned in recent years, growing 56 

percent between 2001 and 2006 alone. Government fleets, meanwhile, have 

grown by 20,000 over the last four years. Printing costs are still higher 

than necessary despite technological advancement. We propose prohibiting 

each agency from spending more than 80 percent of its [Fiscal Year (FY)] 

2010 travel budget and requiring them to do more through teleconferencing 

and telecommuting. We also recommend a 20 percent reduction in the nearly $4 billion annual Federal vehicle budget, excluding the Department of 

Defense and the Postal Service. Additionally, we recommend allowing certain documents to be released in electronic-only form, and capping total 

government printing expenditures. 

A. In fiscal year 2008, how much in total was expended by the Department of Veterans Affairs (VA) on travel costs; how much in total was expended on printing 

costs; and how much in total was expended to purchase, operate, or maintain vehicles? 

B. In fiscal year 2009, how much in total was expended by VA on travel costs; 

how much in total was expended on printing costs; and how much in total was expended to purchase, operate, or maintain vehicles? 

C. In fiscal year 2010, how much in total was expended by VA on travel costs; 

how much in total was expended on printing costs; and how much in total was expended to purchase, operate, or maintain vehicles? 

D. For fiscal year 2011, how much in total is projected to be expended by VA on 

travel costs; how much in total is projected to be expended on printing costs; and 

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how much in total is projected to be expended to purchase, operate, or maintain vehicles? 

E. For fiscal year 2012, how much in total is requested for travel costs; how much 

in total is requested for printing costs; and how much in total is requested to purchase, operate, or maintain vehicles? 

Response. 

Question 2. In addressing the Commission on Fiscal Responsibility and Reform on 

April 27, 2010, President Obama stated, ‘‘Now, I’ve said that it’s important that we 

not restrict the review or the recommendations that this commission comes up with 

in any way. Everything has to be on the table.’’ The Commission, itself, reiterated 

that sentiment in their December 2010 report: ‘‘There is no easy way out. Everything must be on the table.’’ (The Moment of Truth, page 6.) 

A. How has VA taken this sentiment into account in formulating the fiscal year 

2012 budget request? 

Response. In developing the 2012 budget request VA was and remains, attentive 

to the themes of eliminating wasteful or unnecessary spending. VA has conducted 

a review of the efficiencies to be gained, and the savings to be achieved within the 

agency. These improvements are estimated to total $745 million in FY 2011. Similar 

improvements are included in VA’s budget request for 2012 at estimated savings of 

$1.2 billion. 

The VA is firmly committed to increasing the value of every dollar entrusted by 

the Congress and the American taxpayer to this Department for the delivery of benefits and services to Veterans, their families and survivors. For example, in 2011, 

we are implementing several operational improvements in our medical care programs that will save money while improving the quality of health care. These 

include: 

• Reducing indirect costs by adopting uniform standards for administrative and 

support services; 

• Reducing the costs of non-VA provided dialysis by implementing Medicare’s 

standard payment rates; 

• Reducing acquisition costs by consolidating contracting requirements, adopting 

strategic sourcing and other initiatives; 

• Reducing improper payments and improving operational efficiencies in the administration of the medical fee program; and 

• Reducing payroll costs by increasing capabilities and productivity of healthcare 

professionals through more appropriate alignment of the mix of physician and nursing staff, and other non-physician providers, to meet patient demand. 

In developing the 2012 budget, we also carefully reviewed requirements in our non-medical programs. As a result, we will reduce spending by $1.1 billion below 

current 2011 estimates in several program areas. For example, by prioritizing our 

most critical safety and security capital infrastructure needs, funding for major and 

minor construction will be reduced. Investments in information technology will 

begin to pay dividends as deployment of the Veterans Benefits Management System 

(VBMS) begins in 2012, allowing for increased productivity and reduced operating 

costs in processing disability compensation claims in the Veterans Benefits Administration. In addition, we are adopting new acquisition strategies to make more effective use of our information technology resources, including consolidating requirements into 15 prime contracts that will allow VA to leverage economies of scale and 

reduce IT spending. 

VA has also instituted a number of innovative practices to improve our energy efficiency and make more effective use of our resources. For example, the National 

Cemetery Administration (NCA) has implemented creative approaches to cemetery 

operations: the use of pre-placed crypts, that preserve land and reduce operating 

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sources; and installation of alternative energy products such as windmills and solar 

panels that supply power for facilities. NCA has also utilized biobased fuels that are 

homegrown and less damaging to the environment. NCA is developing an independent study of emerging burial practices throughout the world to inform its planning for the future. 

In the past two years, we have established and created management systems, disciplines, processes, and initiatives that help us eliminate waste. Financial and performance metrics provide the foundation for monthly performance reviews that are 

chaired by the Deputy Secretary. These monthly meetings play a vital role in monitoring performance throughout the Department, and are designed to ensure both 

operational efficiency and the achievement of key performance targets. In addition, 

a new budget review cycle was established to further strengthen stewardship of our 

financial resources. This cycle has three components: pre-year review; mid-year review; and post-year review. The Secretary chairs meetings in each review cycle to 

assess budget and operational efficiency and effectiveness. 

We also demonstrated our ongoing commitment to effective stewardship of our financial resources by obtaining our 12th consecutive unqualified (clean) audit opinion on VA’s consolidated financial statements. In 2010, we were successful in remediating 3 of 4 longstanding material weaknesses, a 75 percent reduction in just one 

year. 

Question 3. One of VA’s integrated objectives is to ‘‘educate and empower veterans 

and their families through outreach and advocacy.’’ 

A. VA-wide, how much in total was spent on outreach activities during fiscal year 

2010, how much in total is expected to be spent on outreach activities during fiscal 

year 2011, and how much in total is requested for purposes of outreach activities 

during fiscal year 2012? 

Response. VA created the National Outreach Office within the Office of Public and 

Intergovernmental Affairs (OPIA) in FY 2010 to standardize how outreach is being 

conducted throughout VA. While we are not currently able to extract the total 

spending for outreach across the department for FY 2010 and FY 2011, we are 

working diligently toward that goal for FY 2012. VA has made considerable progress 

in researching and analyzing VA’s outreach programs and activities and have developed a framework to guide us through creating a more efficient and effective approach to conducting outreach department-wide, in support of VA’s major initiatives. 

Key to the final plan is building a process that helps VA’s administrations (Veterans 

Health Administration, Veterans Benefits Administration and National Cemetery 

Administration) and program offices: 

• provide Veterans with high-quality products and activities that are consistent, 

• provide outreach coordinators with training, 

• evaluate and measure the effectiveness of outreach programs, 

• track costs associated with outreach programs. 

B. What metrics are used by VA to gauge whether outreach efforts are effective? 

Response. Currently, VA’s administrations and program offices coordinate and 

conduct their own outreach efforts. This includes the use of numerous methods to 

ensure it reaches the greatest number of Veterans, including the use of: direct mail, 

news media, paid advertising, community-based activities, and partnerships with 

other Federal agencies; Internet and social media (such as YouTube, Facebook, and 

Twitter); phone centers; and personal briefings to Veterans, Veterans Service Organizations (VSO), Military Service Organizations (MSO), state, regional and local 

governments, 200,000 dedicated VA volunteers, and other interested stakeholders. 

C. For fiscal year 2010, please provide VA’s performance outcomes in terms of 

those metrics. 

Response. As referenced in Question B, ‘‘What metrics are used by VA to gauge 

whether outreach efforts are effective?,’’ the attached document, delivered to Congress December 2010, is the first step in analyzing VA’s multitude of outreach activities and is serving as a baseline to develop a plan to yield the performance 

metrics necessary to determine the level of success of individual program efforts. 

What the report shows so far is the need to build a standard approach so each office 

conducting outreach can easily measure the value of their initiatives in serving Veterans. Again, building this process is necessary to providing data on VA’s performance in outreach. 

D. For fiscal years 2011 and 2012, please provide VA’s projected performance outcomes in terms of those metrics. 

Response. The Outreach Office established a workgroup made up of representatives from VHA, VBA and NCA and program offices like the Center for Women Veterans, OIF/OEF Case Management, Center for Minority Veterans, Small and Disadvantaged Business Utilization, Homeless Veterans and many others. The 

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workgroup holds monthly meetings to coordinate input, solicit ideas and build buyin for development and implementation of the overall outreach plan. Additionally, 

to ensure future outreach program success, the National Outreach Office will hold 

‘‘Outreach Day’’ at the 2011 National Office of Public and Intergovernmental Training Conference, to orient VA’s directors responsible for outreach to the new standard—VA’s outreach efforts are fiscally responsible, success is measurable and outreach efforts are based on sound research and well-planned strategies. 

E. Does VA collect and analyze any data or information that would allow a comparison of the effectiveness of one outreach approach over another? If so, please explain what information or data has been collected, what conclusions have been 

drawn from that information, and what has been done with respect to any activities 

found to be ineffective. 

Response. No. Currently, the only report on outreach available, the 2010 Biennial 

Report to Congress on the Department of Veterans Affairs Outreach Activities, was 

submitted December 2010. 

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Question 4. VA’s FY 2010 Performance and Accountability Report reflects that 

independent auditors provided this assessment: 

Interest and administrative costs are required to be charged to VA’s delinquent debtors * * *. However, for 87 sample items out of a total of 90 sample selections tested, [the Veterans Benefits Administration (VBA)] did not 

charge interest or administrative costs on delinquent payments * * *. 

The auditors concluded that VA is ‘‘noncompliant with the Debt Collection Improvement Act of 1996’’ and recommended that VA ‘‘[i]implement policies and proceVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00268 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN

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dures to assess applicable interest and administrative costs or propose a legislative 

remedy to request waiver of these requirements.’’ 

A. What actions has VA taken or does VA plan to take in response to that recommendation? 

Response. In accordance with 31 U.S.C. § 3717 and 38 U.S.C. § 5315, as well as 

the Federal Claims Collection Standards (31 CFR Parts 900–904), VA has published 

both regulation (38 CFR § 1.915) and internal policy (VA Financial Policies and Procedures, Volume XII, Chapter 1A), which require that VA charge interest and administrative costs on all delinquent debts, including those that arise out of participation in VA benefit, medical care, or home loan programs. However, in 1992, the 

Deputy Secretary of Veterans Affairs made a decision not to implement the statutory interest and administrative charges on Compensation and Pension debts. This 

decision continues to be VA policy, which is referenced in Volume XII, Chapter 1A, 

and is also reported annually in VA’s notes to the Consolidated Financial Statements. However, in 1992, the Deputy Secretary of Veterans Affairs made a decision 

not to implement interest and administrative charges on Compensation and Pension 

debts. This decision continues to be VA policy; it is referenced in Volume XII, Chapter 1A, and is also reported annually in VA’s notes to the Consolidated Financial 

Statements. 

B. Currently, what is the total amount of outstanding delinquent debts? 

Response. At the end of FY 2010, VA’s total outstanding delinquent debt was $1.3 

billion. Of this total, $784 million was attributable to delinquent benefit debts. 

As of Feb 28, 2011, the outstanding debt balance for the C&P account is 

$1,145,841,464; for the Readjustment Benefits account, the debt balance is 

$368,171,435. 

As of December 31, 2010 the outstanding delinquent debt balance for the C&P account was $511,955,867. The majority of debts created for compensation are due to 

beneficiary death, incarceration and fugitive felons. The majority of pension debt is 

due to death of the beneficiary and change in income status. For the Readjustment 

Benefits account, the debt balance is $270,203,419. The majority of debt for the Readjustment account is due to changes in enrollment after tuition has been paid and 

delinquent debt on advance payments. 

Question 5. It is my understanding that, if an individual receives an overpayment 

of VA benefits, those funds might not be recouped by VA for a number of reasons, 

such as in circumstances where the debt to VA is waived or if efforts to recoup the 

overpayment are not successful. 

A. During fiscal year 2010, what was the total value of overpayments of benefits 

and what percentage of those overpayments were not recovered by VA for any reason? 

Response. In FY 2010, VBA recorded $1,552,691,000 in new debt. Including overpayments that were still open from prior fiscal years, the total available for collection was $2,812,152,000. During FY 2010, VA collected $1,232,819,000. This leaves 

57 percent of the total debt available for collection. Of the total amount remaining, 

50 percent is considered delinquent where VA is not currently recouping these funds 

through payment plans or offsets. However, when a debt is delinquent, VA continues to take action to recoup the funds by referring the debt to the Treasury Offset Program. 

B. For those overpayments of benefits that were not recouped by VA during fiscal 

year 2010, how many of the overpayments were the result of VA errors and what 

is the total value of un-recouped debts attributable to those errors? 

Response. VA systems do not track the source of the overpayment with the resolution of the overpayment. However, when an administrative error generates an overpayment, typically VA would have the means to recoup the overpayment from future payments to the recipient. In the 2010 Performance and Accountability Report, 

VA reported 64 percent of our compensation improper payments and 34 percent of 

the pension improper payments were due to documentation and administrative errors. These percentages include both over and under payments. 

C. During fiscal year 2011, what is the total value of benefit overpayments that 

are not expected to be recouped? 

Response. For FY 2009 and FY 2010, around 20% of established debt for C&P has 

been deemed uncollectable. If this figure remains constant for FY 2011, this would 

be $234 million deemed uncollectable for C&P. For Education, the rate is around 

8%, which would equate to $22 million. It should be noted that although a debt is 

currently deemed uncollectable, it can be re-established and collected if benefits resume. 

264 

D. Does the budget request for fiscal year 2012 include funding for benefits that 

are projected to be overpaid and not recouped? If so, what is that amount and where 

is it accounted for in the budget request? 

Response. In the calculation for the FY 2012 President’ Budget request, the Read- justment Benefits account is projecting a net increase of $7.2 million in obligations 

associated with overpayments. This projection is based on historical trends and updated each budget cycle. This $7.2 million obligation is included in the chapter 33- 

obligation estimate of $8,481.2 million found on page 2B–2 of the budget. While obligations for the net increase are incorporated into the budget, these amounts may 

be collected in the future and are not identified as funds that VA does not expect 

to recoup. Although there is no specific line item for overpayments in the budget 

request for the Compensation and Pension account, these payments are accounted 

for in the baseline budget estimates and are not identified as funds that VA does 

not expect to recoup. 

E. Do any performance measures for claims processing staff, service center managers, or regional office directors take directly into account the amount of un-recouped benefit overpayments attributable to their errors or errors of their subordinates? 

Response. No, VA systems do not track this information. 

Question 6. VA’s Central Office is located in Washington, DC, and houses a number of different entities, such as the Office of the Secretary, the Office of Congressional and Legislative Affairs, and other support offices. 

A. How many employees were assigned or detailed to VA’s Central Office during 

fiscal year 2008, during fiscal year 2009, and during fiscal year 2010? 

Response. Employees assigned to VA’s Central office. (Identified employees at station 101 or 101 with any duty station). 

FY 08: 4991 

FY 09: 4518 

FY 10: 4997 

The reasons for the drop from FY 2008 to FY 2009 is that OIT lost 249 employees 

at the VA Central Office and OIG had 462 employees transferred out of PAID because PAID/VA was no longer servicing them for H.R. or payroll. Note: FY 2009 and 

FY 2010 totals do not include OIG. 

B. How many employees currently are assigned or detailed to VA’s Central Office? 

Response. As of the 3/13/2011 PAID Master File, there are 4861 employees assigned to VA’s Central office. 

C. If VA’s fiscal year 2012 budget request is adopted, how many employees would 

be assigned or detailed to VA’s Central Office during fiscal year 2012? 

Response. VA does not project the number of employees that will be funded in 

budget requests, but rather estimates the number of full time equivalents (FTE) 

that can be supported by the budget. During FY 2012, VA estimates the General 

Administration Account will have 2,442 FTE at headquarters and 873 FTE in the 

field. In a normal year, one FTE generally equals 2,088 hours of work per year. The 

number of employees will be higher than the FTE reported in the budget due to 

the fact that VA employs both full time and part time employees. 

D. In total, how many contractors and consultants are providing services directly 

to the staff offices at VA Central Office? 

Response. The number of contractors that serve staff offices at VACO is 771. 

i. What percentage and dollar amount of these contracts does VA Central Office 

award to veteran-owned small businesses and service-disabled veteran-owned small 

businesses? 

Response to 6D and 6Di: At this time, VA is unable to provide a complete response to this question as a data analysis of VA’s service contracts is currently underway as part of a requirement set by section 743 of the FY 2010 Consolidated Appropriations Act (Public Law 111–117), which require civilian agencies subject to the 

Federal Activities Inventory Reform Act of 1998 (Public Law 105–270; 31 U.S.C. 

501) to prepare an annual inventory of their service contracts. 

On November 5, 2010, the Office of Management & Budget’s (OMB) issued guidance to Federal agencies on preparing their inventories of service contracts for fiscal 

year (FY) 2010 which included the requirement to analyze the inventory data to determine if contract labor is being used appropriately and effectively and if the mix 

of Federal employees and contractors is effectively balanced. VA identified 27,810 

number of service contracts Nation-wide and summary information of FY 2010 inventory is currently available to the public at: www.va.gov/oamm/rlib/ 

scainventory.cfm. The inventories include all service contract actions over $25,000 

awarded in the specified fiscal year. The inventories consist of funded contract actions including contract actions made on the Department’s behalf by other agencies. 

265 

Similarly, the lists exclude contract actions made by the Department on another 

agency’s behalf with the other agency’s funding. 

The analysis of this data is ongoing and will be supplemented with the specific 

request of information regarding the VA Central Office awards to veteran-owned 

and service-disabled veteran-owned small businesses. In accordance with the OMB 

guidelines, VA expects this analysis to be complete by June 30, 2011.’’ 

E. I recently received a breakdown of each of the 89 positions within the Office 

of the Secretary, which includes an ‘‘Ombudsman/Non-Governmental Affairs’’ at a 

General Schedule (GS)–15 pay level, a non-career Staff Assistant (GS–11); three 

Special Assistants/Staff Coordinators at GS–9, 11 and 12; three Executive Correspondence Analysts at GS–15; two Executive Writers at GS–13 and 14; two Correspondence Analysts at GS–12 and 13; and a Supervisory Correspondence Analyst 

at GS–13. 

i. For each of these positions, please describe their responsibilities. 

Response. The Ombudsman/Non-Governmental Affairs position includes: serving 

as a primary access point for Non-Governmental Organizations (NGO’s) to VA resources, departmental contacts, Veteran data, and VA needs; facilitating opportunities for collaborations with NGO’s that supplement VA’s services and supports for 

Veterans, their families, and survivors; promoting complimentary missions that reduce duplication; providing consultation to the Secretary and other Executive Leadership on key NGO matters; and maintaining an extensive network of NGO 

contacts. 

As examples of the activities of this position, during FY 2011 to date, the Ombudsman/NGO has: provided over 174 consultations on, or to, NGO’s about VA, 

NGO community awareness, public/private working relationships, Veterans and 

their families’ needs, and many other related topics; provided 85 NGO’s serving Veterans with 153 internal and external referrals to other key resources; worked with 

more than 10 NGO’s serving Veterans to create collaborations that benefit VA, Veterans and their families; represented VA at 17 external Veteran community events; 

vetted 11 NGO’s for senior leader meetings; conducted in-depth research on 43 

NGO’s; and developed and managed a 205 member NGO network distribution list. 

The non-career Staff Assistant position includes: strategic communication planning for announcements, roll-out events, and initiatives to include video releases 

and video production; and special events to include briefing and staffing especially 

to support special communications projects planning and execution. As examples of 

the activities of this position, during FY 2011 to date, the Staff Assistant has: supported Caregivers legislation implementation plan distribution to VA stakeholders; 

served as executive producer of at least 5 videos used in both internal and external 

communications; oversaw and advised on various major communications initiatives; 

planned and coordinated several events for VA leadership to reinforce VA’s homelessness program (e.g., DC VAMC Homelessness Stand Down, Homeless Point in 

Time Count) and a major Senior Leadership Conference. 

Three Special Assistants/Staff Coordinators: This pivotal support team serves as 

a direct staff coordinating element for senior leadership of the Department. They 

are responsible for a variety of duties relative to planning, executing and recording 

the day-to-day operational activities for the Secretary of Veterans Affairs, Deputy 

Secretary and Chief of Staff. This team serves as a direct link between the Department leaders, principal staff, and key leadership throughout the Department. During FY 2010, this team was responsible for scheduling coordination, documenting 

and executing related follow-on tasks for approximately 1,300 meetings. 

This team is also responsible for planning, staffing, and executing travel for the 

leaders in the Office of the Secretary. They develop complex schedules to meet the 

intent of senior leadership to achieve maximum efficiencies and ensure that the purpose and outcomes of the site visit is achieved. Coordination requires involvement 

of VA facility leadership throughout the Continental United States, and both national and local government officials, to include Members of Congress and their 

staff. Responsibilities include coordination and execution of travel to international 

locations. This team planned and executed more than 40 site visits in FY 2010 including two overseas. 

The Office of the Secretary of Veterans Affairs’ (OSVA) Executive Secretariat has 

a team of staff that is responsible for all business documents and correspondence 

that require action and signature by the Secretary, Deputy Secretary, and Chief of 

Staff. The Executive Secretariat positions described below fulfill many of these responsibilities for OSVA. 

Three Executive Correspondence Analysts; two Executive Writers: This is a team 

of writers/reviewers that are responsible for the daily processing and preparation of 

Executive correspondence for the Office of the Secretary. These analysts and writers 

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ten responses on average in each of the last 3 years. Correspondence includes responses to Members of Congress, Federal, state and local officials, private sector organizations, and internal VA memorandums. The team assured accuracy for content, grammar and consistency of Department positions as well as proper coordination and vetting across all VA elements. This staff also conducted individual and 

group training for correspondence officials across VA—training more than 300 employees in 2010. In addition to correspondence and decision documents, these employees reviewed and edited all testimony and questions for the record. 

Two Correspondence Analysts: These employees prepare, arrange and control correspondence packages for final presentation to Senior Officials. They assure the 

package contains the necessary information, in the correct order, and then process 

it after signature for dispatch. They also ensure the official record is complete and 

in each of the last 4 fiscal years averaged processing approximately1500 items. 

One Supervisory Correspondence Analyst: This employee supervises 3 persons to 

include those that process and assign all incoming mail (approximately 12,000 items 

per year) and those that answer Office of the Secretary telephones (average more 

than 70 calls a day). This employee also serves as the Records Management Officer 

and FOIA Officer for the Office of the Secretary. 

All of the employees in this section operate an electronic document management 

tracking system daily. 

ii. Please explain how the staff is of direct benefit to veterans. 

Response. Veterans directly benefit from the important work performed by each 

employee assigned to the Office of the Secretary of Veterans Affairs (OSVA). On a 

daily basis, the OSVA directly supports the Secretary’s mission to transform the Department into a 21st Century organization that is people-centric, results-driven, and 

forward-looking. OSVA staff is responsible for facilitating effective coordination and 

cooperation between the Secretary’s office and various organizations and stakeholders involved in Veterans’ affairs. They implement and oversee various programs, communicate priorities and issues, and prepare correspondence on behalf of 

the Department. 

The OSVA’s overall size includes the staff positions described above, as well as 

other positions and congressionally established offices. The OSVA is compromised 

of the following: 

• Center for Women Veterans Affairs (CWV)—this office was established by Congress in November 1994, and serves as the primary advisor to the Secretary on all 

matters related to policies, legislation, programs, issues, and initiatives affecting 

women Veterans. CWV’s mission is to monitor and coordinate VA’s administration 

of health care and benefits services and programs for women Veterans. 

• Center for Minority Veterans (CMV)—CMV was mandated by Congress in 1994, 

under Title 38 Public Law 103–446, Section 509. It serves as an advocate for minority Veterans by conducting outreach activities to promote the awareness and use of 

Veteran benefits and services by evaluating the overall effectiveness of the provisions of VA benefits and services. 

• Office of Survivors Assistance (OSA)—OSA was established by Public Law 110– 

389, Title II, Section 222, in October 2008. Its mission is to serve as the principal 

advisor to the Secretary on all policies, programs, legislative issues, and other initiatives affecting survivors and dependents of deceased Veterans and Servicemembers. 

• Office of Employment Discrimination Complaint Adjudication (OEDCA)— 

OEDCA is an independent Department of Veterans Affairs adjudicatory authority 

created by Congress and established in February 1998. Its mission is to objectively 

review the merits of employment discrimination claims filed by present and former 

VA employees and non-agency applicants for employment. 

• Center for Faith-based and Neighborhood Partnership (CFBNP)—This Center 

was established on June 1, 2004, by Executive Order 13342. Its mission is to develop 

partnerships and provide relevant information to faith-based and secular organizations and expand their participation in VA programs in order to better serve the 

needs of Veterans, their families, and survivors. 

• Executive Secretariat—this office is responsible for all administrative operations for the OSVA. The Executive Secretariat serves as the process owner for administrative procedures in the Department of Veterans Affairs Central Office. In addition, the Executive Secretariat is responsible for all business documents and correspondence that require action and signature by the Secretary and Deputy Secretary, such as policy development, personnel actions centralized to the Secretary, 

review of congressional testimony and responses to pre- and post-hearing questions, 

spending proposals, regulations, reorganizations, and legislation; the Executive Secretariat is the business owner for the Department’s electronic document management and tracking system. 

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• Office of the Secretary Special Staff—this special staff includes VA’s senior 

leadership’s special assistants and senior advisors. This special staff coordinates 

travel, meetings, and executive briefings; facilitates correspondence; conducts liaison 

with stakeholders, and assists in VA’s transformation through analysis and oversight activity. The special staff also includes non-career staff and advisors such as 

the Chief Technology Officer, VA Innovation Initiative Program Director, and White 

House liaison. 

Since Secretary Shinseki’s arrival in January 2009, the OSVA staff has been a 

significant contributor to this organization’s programs and accomplishments on behalf of Veterans, their families, and survivors. They have been instrumental in establishing a more accountable, transparent and enterprise-wise culture within VA. 

Accomplishments at VA—with the help of OSVA—are many, but much work remains. VA has helped deliver benefits for the Post-9/11 GI Bill under a compressed 

timeline and has dramatically improved collaboration with DOD in many areas. 

From the development of Electronic Health Records to a continuously improving 

eBenefits system that gives Servicemembers and Veterans direct access to their 

records, VA is delivering for Veterans. OSVA is an indispensible part of the VA 

team. 

Question 7. Last year, the President signed the Patient Protection and Affordable 

Care Act (PPACA) into law and that will affect all areas of health delivery in this 

country. 

A. How will the PPACA affect the workload of the Veterans Health Administration (VHA)? 

Response. VA has been carefully assessing the potential impact of the Affordable 

Care Act (ACA) since its enactment. VA’s partnership with its consulting health actuary, Milliman, has positioned VA well to assess the potential impact of health reform on VA. Preliminary analyses have looked at understanding how the ACA could 

impact VA’s health care system and to what extent various Model factors such as 

enrollment, reliance, and morbidity are expected to change. Based on our assessment of the Act, we believe that VA’s Medical Benefit Package meets the minimum 

essential coverage provisions of the ACA. There are also administrative requirements in the Act that could increase VA’s resource requirements such as those associated with data sharing with HHS. 

B. What steps did VA take to reflect any increase or decrease as a result of the 

PPACA in this year’s budget request? 

Response. The ACA establishes the Indian Health Services (IHS) as the payer of 

last resort for all health programs operated by the Indian Health Service, Indian 

tribes, tribal organizations, and Urban Indian organizations. Section 10221 authorizes IHS to establish Sharing Arrangements with Federal Agencies. The cost of 

health care to IHS will be reduced and transferred to VHA. The FY 2012 budget 

submission includes $52 million in 2012 and $57 million in 2013 for reimbursement 

to IHS. At this time, VA does not have a clear view of the expected financial impact 

of this law, but will continue to monitor developments as additional information and 

clarification is received. 

C. What will be the impact of the health care reform act on VA’s budget in long 

term projection models? 

Response. Beyond the funds requested in the 2012/2013 budget submission (response 7b above), VA does not have a clear view of the expected financial impact 

of this law, but will continue to monitor developments as additional information and 

clarification is received. 

Question 8. Recently, VA announced the creation of two new offices—the Office 

of Patient Centered Care and Cultural Transformation under VHA and the Office 

of Tribal Government Relations. 

A. In what way did VA take into consideration the current budgetary restraints 

the country finds itself in while creating these offices? 

Response. The Patient Centered Care (PCC) effort is one of many transformation 

initiatives in the Department’s Strategic Plan. These major initiatives are designed 

to improve the value of VA health care—safety, quality, efficiency, and the experience patients and their families have when they obtain VA health care services. A 

cost benefit analysis was attempted before undertaking our PCC initiative. A literature review suggested that many private sector organizations that have adopted 

similar patient care principles have realized economic returns on that investment. 

For example, patients tend to have shorter hospital stays and make different decisions about end of life care. 

After reviewing the evidence, we felt that there was not enough specific data to 

do a formal return on investment analysis. On the other hand, patient centered care 

approaches are rapidly becoming the norm in private health care. The Joint ComVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00273 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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mission has recently published proposed standards that will be incorporated into 

their accreditation requirements. Recognizing the evolving industry standards and 

the needs of Veterans, VA has undertaken this initiative to craft standards and programs that are best aligned with our unique mission and patient population. We 

do expect many of the necessary changes can easily be accomplished within existing 

resources and will improve patient satisfaction and quality outcomes. 

OPIA’s initiative to Enhance Partnerships with Tribal Governments is a cost effective way to build positive partnerships with tribal governments (i.e., partnerships 

equivalent to those VA engages in with state and local municipalities) with whom 

the Federal Government already has a unique political relationship. This effort will 

result in informed decisionmaking within VA when it comes to policy, program planning and priority setting as the agency serves this population of American Indian/ 

Alaska Native (AI/AN) Veterans. Consequently, informed decisionmaking results in 

smarter use of fiscal resources and better outcomes for AI/AN Veterans. Twelve percent (12%) of AIANs in the US are Veterans, one of the highest per capita populations of Veterans in any ethnic group. Simultaneously with their exceptionally 

high rates of military service, AIANs are also one of the most vulnerable populations. Approximately 25% of AIANs live in poverty and they have higher obesity 

(23.9%) that any other racial/ethnic group (CDC, 2003). Thirty-three percent (33%) 

of AI/ANs had no health insurance coverage in 2007; of those with coverage, 24% 

relied on Medicaid (DHHS). Currently VA has one quarter of a single employee (.25 

FTE) dedicated to Native American issues. VA has an opportunity to demonstrate 

its support of AI/AN populations with a relatively low cost through this OPIA office 

with five full time employees. 

More importantly, VA has an opportunity to reduce AINA Veterans’ reliance on 

Medicaid as well as to increase preventative care that reduces later VA medical 

costs. For example, one of OPIA’s current efforts is to jointly coordinate access for 

VA’s mobile clinics and mobile Vet Centers to tribal lands. This is key to fighting 

obesity among AI/AN populations. Obesity is associated with diseases such as diabetes, cardiovascular disease, hypertension, coronary heart disease and cancer (CDC). 

A 2003 study on diabetes estimates that it costs $13,243 per patient to treat diabetes compared to $2,560 for patients without diabetes 

If OPIA can increase access for VA preventative healthcare and keep just 1% AIAN vets from developing diabetes, VA will save well more than the $800,000 cost 

for this initiative in OPIA’s FY 2011 budget. 

B. How many additional full-time equivalents (FTEs) and how much increased 

funding did VA request for each new office in this request? Response. There are five FTEs. VA requested $800,000 to fund these offices. 

C. Under whose direction will the Office of Tribal Government Relations operate? 

Response. The Assistant Secretary for Public and Intergovernmental Affairs. 

D. How many people will the office of Tribal Government Relations serve? 

Response. According to the 2008 Census Bureau American Community Survey, 

there are 160,471 American Indian/Alaska Native Veterans. There are 565 federally 

recognized Tribes (tribal governments). The Office will be working with tribal governments as political entities on a Nation-to-nation (inter-governmental) basis to facilitate communication between the Department of Veterans Affairs and tribal governments. 

E. Are there any other new offices currently in the planning stages to be rolled 

out this year? If so, please explain. 

Response. There are no new offices in the planning stages to be rolled out this 

year in OPIA. 

F. Can these services be met through any office currently in existence within VA? 

If so, please detail which offices and why was it not considered to expand an existing office rather than creating a new one. 

Response. No, the Office of Tribal Government Relations (OTGR) office is located 

within the Office of Public and Inter-Governmental Affairs. The office serves the 

needs of the VA in relation to incorporating key stakeholder perspectives (in this 

instance tribal governments) as they apply to cross-cutting issues affecting all three 

Administrations in VA. Therefore, the best ‘‘home’’ for the OTGR is within an office 

located at the Departmental level. 

Question 9. The Office of Congressional and Legislative Affairs (OCLA) is requesting funding for an estimated 52 FTEs in fiscal year 2012, which is a 44% increase 

over fiscal year 2010. In addition, each programs office under VHA and VBA has 

Congressional liaison staff also tasked with working with the Hill. 

A. Please explain the functions performed by OCLA and the Congressional liaisons of VHA and VBA. In what areas do they overlap? 

Response. The Office of Congressional and Legislative Affairs (OCLA) is the lead 

office responsible for maintaining open communications with Congress through 

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briefings, meetings, calls, hearings, site visits, written communications, reports, and 

responses to requests for information. OCLA also maintains constituent casework offices on Capitol Hill to support Congressional offices’ Veterans, dependents, and survivors casework. Additionally, OCLA is responsible for liaison with the U.S. Government Accountability Office (GAO) and coordinates all meetings and correspondence 

with the agency. During FY 2010, OCLA supported 105 hearings, 322 information 

briefings, coordinated the responses to over 1,240 questions for the record, responded to over 7,100 written and over 15,000 telephonic requests for information, 

and countless e-mails, and supported approximately 100 oversight visits. In FY 

2010, OCLA also coordinated the VA response to 50 GAO reports that focused on 

VA issues. In the FY 2012 budget request, OCLA will assume the funding for the 

Office of Advisory Committee Management, which is responsible for supporting the 

VA’s advisory committees. The Office of Advisory Committee Management supported 23 advisories committees and 54 advisory committee meetings during FY 

2010. 

The Congressional liaisons assigned to VHA and VBA are the conduit for the flow 

of information between OCLA and the VA Administrations. Each liaison facilitates 

the accurate assignment within their respective Administration, manages their Administration’s responses to Congress, and tracks actions until they are completed 

and delivered to Congress. There is no overlap of duties between the Administration 

Congressional liaisons and OCLA personnel. 

Question 10. The deadline for full implementation of the caregivers program as 

mandated in the Caregivers and Veterans Omnibus Health Services Act of 2010 

(Public Law 111–163) has passed with only the plan for implementation presented 

to Congress a few weeks ago. 

A. When does VA intend to move to full implementation of the family caregiver 

program? 

Response. VA has identified below a general timeline with goals for implementing 

the family caregiver program required by title I of Public Law (PL) 111–163, the 

Caregivers and Veterans Omnibus Health Services Act of 2010. VA’s planning and 

work on regulations has been ongoing since before the Caregivers and Veterans Omnibus Health Services Act of 2010 was signed into law. This work has continued 

throughout the time the Implementation Plan was under development. VA is working as quickly and responsibly as possible to deliver these enhanced benefits to eligible Veterans and their caregivers and will keep the Committee closely apprised of 

its progress. 

Create Caregiver Support Line 

Hire All Caregiver Support Coordinators 

New State-of-the-Art Web Site 

February 1, 2011 (completed) 

April 2011 

May 2011 

On February 28, 2011, VA transmitted a draft Interim Final Rule to the Office 

of Management and Budget. We believe this measure will expedite the rulemaking 

process and set the path to begin delivering caregiver benefits as early as this summer. 

B. How is the implementation reflected in the FY 2012 budget? How much funding is allotted for this program and under which accounts? 

Response. VA will be updating the cost estimates for the implementation of the 

Caregiver Act. These costs cannot be finalized while the Interim Final Rule is pending. VA will continue to keep the Committee informed, including providing our final 

estimate, once the process is completed. 

Question 11. VA recently announced that it plans to reorganize the Veterans Benefits Administration. 

A. Will this reorganization result in the creation of additional positions or elimination of positions within VBA? If so, please specify the number of positions that 

will be created or eliminated and the nature of those positions. 

Response. Eight new positions are created as a result of the reorganization: 

• Director, Office of Strategic Planning 

• Director, Veterans Benefits Management System 

• Director, Veterans Relationship Management Program 

• Deputy Chief of Staff 

• Deputy Under Secretary for Economic Opportunity 

• Director, Pension and Fiduciary Service 

• Assistant Director for Pension 

• Assistant Director for Fiduciary 

No positions are eliminated as a result of the reorganization. 

The following positions are re-titled under the reorganization: 

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• Deputy Under Secretary for Benefits now titled Principal Deputy Under Secretary for Benefits • Associate Deputy Under Secretary for Policy and Program Management now titled Deputy Under Secretary for Disability Assistance • Associate Deputy Under Secretary for Field Operations now titled Deputy 

Under Secretary for Field Operations • Associate Deputy Under Secretary for Management now titled Director, Office 

of Management • Director, Compensation and Pension Service, now titled Director, Compensation 

Service 

B. What level of funding is needed for the reorganization effort? 

Response. No additional funding is need for this reorganization. It will be carried 

out within existing funding levels. 

C. Does the fiscal year 2012 budget request include any necessary funding to 

carry out this reorganization? 

Response. No additional funding is requested in the FY 2012 budget to carry out 

this reorganization. 

Question 12. In the General Administration budget request, Volume III page 5A– 

7, there is a chart entitled ‘‘Employment Summary—FTE by Grade,’’ which breaks 

down proposed General Administration hiring for fiscal year 2012. The current request is for 3,315 General Administration employees, which would be almost 6% 

more than the 2011 Continuing Resolution (CR) level and 20% over the fiscal year 

2010 actual level. Of the proposed 176 employee increase over last year, 148 of these 

jobs are at GS–12 or higher. This chart also breaks out Senior Executive Service 

(SES) employees. If VA’s request is met, there will be 105 SES employees, an increase of 32 over a two-year period and seven more than last year. 

A. How will these staffing increases be of direct benefit to our Nation’s veterans? 

Response. Half (88) of the 176 FTE increase between 2011 and 2012 is for resident engineers within the Office of Acquisition, Logistics & Construction, who will 

provide necessary oversight of construction projects at VA facilities nationwide. The 

remaining FTE increases fall primarily across four staff offices: the Office of Human 

Resources & Administration, Office of Policy & Planning, Office of Security & Preparedness, and the Office of Management. These FTE will support the Secretary’s 

Transformation initiatives including: the Human Capital Investment Plan, VA DOD 

collaboration activities, Homeland Security Presidential Directives implementation 

and compliance, and financial audits of Non-VA Care (Fee) programs. These investments are expected to significantly improve how VA delivers services to Veterans 

and their families in the near term. 

B. Please explain what specific functions these new SES employees will perform. 

Response. Of the 32 SES level positions above 2010, 27 were positions approved 

prior to FY 2012, The distribution of these 32 SES level positions is as follows: 

• 10 General Schedule positions within the Office of General Counsel converted 

to SES (Regional Counsels in the field) • 9 positions within the Office of Policy and Planning including those of the Deputy Assistant Secretary (DAS) for Policy (1), DAS for Data & Evaluation (1), Chief 

Actuary (1), and the Enterprise Project Management Office (ePMO) (5) • 6 positions within the Office of Management: Executive Director of Operations(1), Director, Office of Performance Management (1), Financial Operations (1), 

Office of Asset Enterprise Mgt.-Green Management (1), Office of Budget (2) • 3 positions within the Office of Acquisitions, Logistics, and Construction to lead 

Facilities Acquisition (1), Facilities Programs and Plans (1), and Engineering Operations Support (1). • 3 positions within the Office of the Secretary • 1 position within the Office of Security and Preparedness: Director of Personnel 

Security & Identity Management; lead for Secretary’s Preparedness Initiative 

C. What is the additional cost for these additional FTEs? 

Response. The average annual salary for General Administration FTE is about $93.7 thousand. However, for the 148 FTE (Grade 12 or higher) cited above the average annual salary is approximately $98 thousand. The additional cost for 148 FTE 

is: 

148 FTE × $98 thousand × 1.27% (fringe benefits %) = $18.4 million per year. 

Question 13. Another chart available in the budget, Volume III page 5-A8, has a 

breakout of fiscal year 2010 FTE in two categories, Field and Headquarters (HQ). 

According to this chart, in fiscal year 2010, 2,028 FTE within the General Administration worked at HQ and 725 in the Field. Please provide a similar breakdown for 

the requested FTE for fiscal year 2012. 

Response: 

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READJUSTMENT BENEFITS

Question 1. The fiscal year 2012 budget request appears to reflect (in Volume 3, 

page 2B–3) that the average cost of automobile grants during fiscal year 2012 will 

be $11,000. Does this estimate take into account Public Law 111–275, which increased the automotive assistance allowance? If not, please provide a revised estimate including the impact of Public Law 111–275. 

Response. The FY 2012 Budget Submission did not include the cost of the increased automobile grants provided by section 804 of Pub. L. 111–275. Including the 

impact of the increase from FY 2011 of $11,000 to FY 2012 of $18,900, the cost of 

the Automobile Grant Program will increase by $14.5M in FY 2012. These increased 

costs will be reflected in the Mid Session Review Readjustment Benefits model update. 

Question 2. The fiscal year 2012 budget request reflects that changes made by 

Public Law 111–377, the Post-9/11 Veterans Educational Assistance Improvements 

Act of 2010, were ‘‘not incorporated into this budget.’’ Please provide updated estimates of the workload, average cost, and total cost of readjustment benefits based 

on the changes made by that new law. 

Response. The impact of Public Law 111–377 is currently being assessed by VA 

staff and will be fully incorporated into the release of the 2012 Mid Session Review 

Budget. 

Question 3. The fiscal year 2012 budget request with respect to readjustment benefits includes this explanation: ‘‘The average cost per trainee is highest for chapter 

33, reaching $16,527 in 2012. Chapter 30 average costs per trainee ($8,061 by 2012) 

are less than chapter 33, causing the majority of eligible trainees to transfer programs.’’ To date, how many trainees have transferred to chapter 33 from chapter 

30 and how many additional trainees are expected to transfer to chapter 33 during 

fiscal year 2012? 

Response. We do not have data to identify the number of trainees that have transferred from chapter 30 to chapter 33. We do know that the number of chapter 30 

trainees decreased by nearly 95,000 from FY 2009 to FY 2010. Additionally, we 

know that approximately 36,400 individuals used both chapter 30 and chapter 33 

benefits during fiscal year 2010. At this time, we are unable to forecast the number 

of trainees expected to transfer to chapter 33 from chapter 30 during FY 2012. 

VOCATIONAL REHABILITATION AND EMPLOYMENT

Question 1. The fiscal year 2012 budget request reflects that the Vocational Rehabilitation and Employment (VR&E) program expects to spend $897,000 on equipVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00277 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN

32BurrGE13.eps
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ment during fiscal year 2011 and requests $2.4 million to spend on equipment during fiscal year 2012. What factors account for this over 168% increase? 

Response. Equipment costs increase to support the hiring of additional FTE for 

the IDES and VetSuccess on Campus initiatives and for VR&E’s share of infrastructure improvements for the co-location and relocation of VBA facilities. 

Question 2. The fiscal year 2012 budget request reflects that the Vocational Reha- bilitation and Employment program expects to spend $3 million on travel during fiscal year 2011 and requests $3.5 million to spend on travel during fiscal year 2012. 

A. What factors account for this 16% increase in travel expenses? 

Response. Increased travel costs support the training of new VR&E counselors 

hired for the IDES and VetSuccess on Campus initiatives and increased oversight 

to IDES and VetSuccess On Campus locations. 

B. How many employees are expected to travel during fiscal year 2012, what is 

the purpose of the travel, and what is the expected average cost for each trip? 

Response. Training requirements for new counselors hired for the IDES and 

VetSuccess on Campus initiatives will entail travel for approximately 119 new counselors. Approximately two or three oversight personnel will be required to travel to 

each of the 17 stations that are responsible for VetSuccess on Campus locations and 

comparably for the IDES locations. The cost of each trip will vary depending on the 

location of the new counselors and oversight staff and their destinations but the approximate average cost is $1,500 for one week. 

Question 3. For fiscal year 2012, the Vocational Rehabilitation and Employment 

program requests additional employees in order to provide services in connection 

with the Integrated Disability Evaluation System (IDES). The budget request provides this description: ‘‘With mandatory counseling services, we will assist Servicemembers in developing vocational goals and commencing vocational rehabilitation 

services to support their successful transition from the military to their home communities.’’ 

A. Have VA and the Department of Defense (DOD) finalized a plan for including 

services from the Vocational Rehabilitation and Employment program in the IDES 

process? If so, please explain when the plan was completed and provide the specifics 

of that plan. 

Response. VA and DOD are developing a plan for expansion of VR&E into the 

IDES process. The plan has not been finalized. 

B. At what point during the IDES process would mandatory counseling take 

place? 

Response. Servicemembers would participate in a mandatory counseling appointment when referred to the Physical Evaluation Board. Vocational Rehabilitation 

Counselors will receive referrals for appointment scheduling in collaboration with 

the Physical Evaluation Board Liaison Officers and Military Service Coordinators. 

C. Would those counseling services be expected to add to the length of the IDES 

process? 

Response. The counseling services are not expected to add to the length of the 

IDES process. 

D. Would counseling be mandatory for servicemembers in regular components of 

the military who have already secured civilian employment for after they are discharged from service? 

Response. The initial counseling appointment would be mandatory for every Servicemember referred to the Physical Evaluation Board through the IDES process. 

E. Would counseling be mandatory for members of the Guard or Reserves in the 

IDES process who have civilian jobs? 

Response. The initial counseling appointment would be mandatory for all Guard 

and Reserve members referred to the Physical Evaluation Board through the IDES 

process. 

Question 4. In the fiscal year 2012 budget request, there is an increase of 60 FTE 

due to the realignment of funds currently used to purchase contract counseling services to hire additional vocational rehabilitation and employment counselors. 

A. What metric was used determine it was more effective and efficient to hire the 

additional vocational rehabilitation and employment counselors? 

Response. VA compared total costs and quality of service of FTE against that of 

contract counselors. FTE total costs and performance metrics such as average rehabilitation rate and Veteran feedback were compared against FY 2010 contracting 

rates and contractor quality of service analysis from case mangers. The analysis indicated savings to the government and better service to Veterans when VR&E counselors were used. Contract counselors are still used to supplement services VA provides to Veterans, including serving Veterans in remote areas. 

B. What is the average caseload for FTE counselors versus contract counselors? 

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Response. Contractors in the last national contract were capped at a 125 Veterans 

per counselor. In FY 2010 VR&E counselors carried an average caseload of 136 

cases. 

C. Will the decrease in contract counseling services negatively impact veterans 

living in rural or underserved areas? Please explain. 

Response. VR&E estimates the increased staffing levels and funding in the FY 

2012 budget request for contract counseling services will help continue our high 

level of service to Veterans living in rural areas. Further, VR&E has successfully 

piloted remote counseling technology to enhance services provided to Veterans living 

in rural areas and/or who have difficulty with transportation due to disability. The 

success of remote counseling with both Veterans and counselors has prompted 

VR&E Service to begin national implementation in FY 2011. 

D. What performance measures does VA use to evaluate the effectiveness of contract counseling services? 

Response: 

Coverage of Jurisdiction—Contractor shall have an adequate number of trained 

counseling staff to ensure provision of services for Veteran clientele throughout the 

Regional Office jurisdiction. 

Responsiveness—Contractor shall submit accurate timely reports detailing services provided and additional service needs until rehabilitation or closure of the case. 

These reports must be in accordance with the M28 manual and the report format 

identified in the contract. 

Customer Satisfaction—Contractor shall provide a level of service that is responsive to Veteran or eligible dependents’ needs, as evidenced by positive feedback from 

clients, lack of complaints, and periodic contact of clients by VR&E to assess customer satisfaction. 

Question 5. The Vocational Rehabilitation Assistance Study identified the need to 

incorporate VR&E services into the IDES. In the fiscal year 2012 budget request, 

VA seeks $16.2 million to employ 110 FTE at the largest IDES locations. 

A. At what IDES locations will the FTE be employed? 

Response. The IDES installations where VR&E FTE will be assigned have not 

been finalized. VA is coordinating with DOD to identify locations. 

B. How does VA plan to monitor the effectiveness of this initiative? 

Response. VA will keep data on all participants in the IDES process. Participation 

rates will be assessed by the number of Servicemembers that begin the IDES process and receive a rating in addition to those that participate in a rehabilitation and/ 

or education benefit program. 

Question 6. For the fiscal year 2012 request, the VetSuccess on Campus seeks almost $1.1 million for the continuation of the eight pilot campuses and nine additional campuses. Please list the additional nine campuses and explain how the additional sites were determined? 

Response. The additional nine campuses for 2012 expansion of VetSuccess on 

Campus have not been identified. A list of schools that meet basic criteria such as 

number of Veterans on campus, proximity to VA resources, and availability of space 

on campus, will be used to select the nine campus locations. 

HOUSING

Question 1. The fiscal year 2012 budget request reflects that the Housing program 

expects to spend over $29.9 million on Other Services during fiscal year 2011, which 

is $790,000 more than VA originally planned to spend on Other Services during fiscal year 2011. For fiscal year 2012, VA is requesting $32.8 million for Other Services. That increase is explained as follows: ‘‘Other services increases $6.7 million 

as a result of increases to the Appraisal Management Service/Automated Valuation 

Model contract, Housing’s portion of contracts supporting the Veterans Relationship 

Management initiative, and must-fund contracts to internal and external 

customers.’’ 

A. What factors account for the increase in Other Services during fiscal year 

2011? 

Response. Payroll savings from elimination of the 2011 pay raise were realigned 

to Other Services to fund a job task analysis for loan production specialists. This 

supports VBA’s strategic plan objective of defining competencies and providing national training products for nationally standardized positions. 

B. Please provide a detailed itemized list of how these funds would be spent during fiscal year 2012. To the extent that these funds will be spent on contracts, 

please explain the nature of the contract and the expected outcomes. 

Response: 

274 

2012 Housing Other Services Increase over 2010 

Appraisal Management Service/Automated Valuation Model Contract ................................................ $4.2M 

Housing’s share of the Veterans Relationship Management Initiative ............................................... 0.1M 

Must-fund contracts to internal and external customers management support* .............................. 2.4M 

Total Increase .......................................................................................................................... $6.7M 

* VBA incurs obligations that are considered ‘‘must-fund,’’ such as contractual obligations to the Department of Homeland Security for 

guard services, the Department of the Treasury for mailing benefits payments, the National Archives and Records Administration for records 

storage, and several VA customers (Debt Management Center, Financial Services Center, etc.). This figure represents those obligations and 

other management support obligations, such as VBA infrastructure obligations for the collocation or relocation of facilities and equipment 

operating, maintenance, and repair service contracts, which are apportioned to the Housing program. 

INSURANCE

Question 1. The fiscal year 2012 budget request reflects that the Insurance Serv- ice is requesting $1.1 million for Other Services. Please provide a detailed itemized 

list of how these funds would be spent during fiscal year 2012. To the extent that 

these funds will be spent on contracts, please explain the nature of the contract and 

the expected outcomes. Response. The Insurance Service is requesting $1.1 million in Other Services in 

the fiscal year 2012 budget for the continuation of ongoing operations and to support 

the training needs of Insurance employees and stakeholders to assist in serving Veterans and Servicemembers more effectively. Of this $1.1 million, $750 thousand is budgeted for shared overhead expenses for 

the Regional Office and Insurance Center, which includes building maintenance, 

guard services, maintenance and repairs of equipment/furniture, shredding contract, 

and the building security access system. $344 thousand is budgeted for ongoing 

training of our human capital, which includes tuition reimbursement, the maintenance of our internal electronic reference guide for system practices and procedures, 

the development of web-based training modules, and outside training courses. 

COMPENSATION AND PENSION

Question 1. VA’s FY 2010 Performance and Accountability Report reflects that 

VBA plans to ‘‘contract with vendors to collect medical records from private physicians/offices instead of direct requests to physicians by VA.’’ Similarly, Secretary 

Shinseki’s testimony for the March 2, 2011, hearing before the Senate Committee 

on Veterans’ Affairs reflects that VA intends to use ‘‘a private contractor to retrieve 

the records from the provider, scan them into a digital format, and send them to 

VA through a secure transmission.’’ 

A. Has VA entered into any contracts for this purpose? If not, what is the expected timeline for entering into these contracts? 

Response. The Department of Veterans Affairs (VA) entered into a contract with 

DOMA Technologies, LLC, in September 2010. 

B. Through these contracts, how many contractors are expected to perform claims 

processing functions (i.e., evidence gathering)? 

Response. VA has entered into one contract for services provided to seven Regional Offices. Upon expiration of the current contract, VA may seek to enter into 

another contract with terms that would provide services for additional Regional Offices. 

C. Where will these contractors be located? 

Response. DOMA Technologies, LLC is headquartered in Virginia Beach, VA. 

D. When are contractors expected to be on board and how long is VA expecting 

to use contractors to gather evidence? 

Response. Performance of work pursuant to the contract began in December 2010. 

The contract is scheduled to expire six months after work began, in June 2011. VA’s 

evaluation of the performance is ongoing, and based upon the results, VA will determine whether a new contract is necessary at the end of the current contract. 

E. How much in total does VA expect to spend on these contractors? 

Response. VA has budgeted $384 thousand for this contract. 

F. Will VA use fiscal year 2011 funds to pay for these contractors? If so, how 

much? 

Response. If VA determines that the benefits of the contractor’s services outweigh 

the costs, VA will use FY 2011 funds to cover the cost of a new contract. VA estimates that the cost of a nationwide contract will be $3 million for 2011. 

G. How much is requested for this initiative for fiscal year 2012? 

Response. VA has requested $16.4 million for this initiative in FY 2012. 

H. What performance measures will be used to gauge the effectiveness of the contractors? 

275 

Response. In order to gauge the effectiveness of the current contract, VA is evaluating the timeliness of the seven regional offices using the contractor’s services as 

compared to the timeliness of regional offices requesting medical records directly 

from private physicians. 

I. What impact, in terms of increased productivity, does VA expect from using 

these contractors? 

Response. VA expects this contract to improve the timeliness of claims decisions 

by reducing the time in the claims processing cycle that VA is awaiting receipt of 

medical evidence needed to determine eligibility for benefits. The current contract 

supporting seven regional offices will help VA assess the improvements in the timeliness of service delivery, as well as whether there is any potential for increased productivity through this contract. 

Question 2. According to the fiscal year 2012 budget request, VA’s goal is to 

‘‘eliminate the disability claims backlog by 2015 such that no veteran has to wait 

more than*** 125 days for a high quality decision.’’ However, for fiscal year 

2011 and 2012, VA expects to receive more claims than it decides and, by the end 

of fiscal year 2012, the inventory of claims is expected to be over 934,000, which 

is more than double the year-end inventory two years ago. Also, VA expects it to 

take on average 230 days to complete a claim in fiscal year 2012, which is 65 days 

longer than it took in fiscal year 2010. 

A. Please provide specific details about VA’s plan to bring the backlog under control by 2015, such as what level of increase in productivity VA expects once the Veterans Benefits Management System is rolled out, how many claims VA expects to 

receive in each of the next four years, and how many claims VA would need to decide in each of the next four years. 

Response. VA’s multi-tiered approach for balancing the attack on workflow includes a number of innovations. Improved access for Veterans will come with advances in increased internet capabilities such as: online access both for claim status 

and self-service options such as ordering copies of discharge records; this will improve customer satisfaction for Veterans of all time periods while freeing VA staff 

to work on claims. A 21st Century electronic processing solution will virtually put 

an end to lost paperwork and infuse new efficiencies through the Veterans Benefits 

Management System (VBMS). New evidence-gathering tools such as Disability Benefits Questionnaires, three of which are currently in use for Ischemic Heart Diseases, Hairy cell Leukemia, and Parkinson’s Disease, will sharpen the focus in medical examinations to ensure all information needed to rate the claim is gathered the 

first time in the medical examination process and is presented during the development phase of adjudication. The Fully Developed Claims program puts Veterans in 

the driver’s seat for developing a claim that will be ready to rate when submitted, 

along with features that preserve the earliest possible effective date for back payments upon approval. 

In late 2012, VA estimates that production will begin to outpace receipts, the 

VBMS automated claims processing system simultaneously will be in a deployment 

phase, having completed a series of pilots currently under way. It will provide powerful new tools to claims examiners to boost efficiency and productivity. In addition 

to gains in accuracy which may reduce re-reviews and appeals, the rules-based processing and calculator tools also have a side benefit of speed in the rating process 

which will pay dividends in employee productivity and provide more staff hours to 

rate other claims. 

Beyond the estimates submitted in the 2012 President’s Budget, VA estimates receipts to be 1.39M, 1.46M, and 1.53M 2013 through 2015. Likewise, VA estimates 

production to be 1.40M, 1.61M and 1.85M in 2013–2015. Working under the assumption that the 2012 request for 14,320 C&P direct labor FTE remains constant, 

productivity due to the impact of the overall transformation plan (of which VBMS 

plays a part) will rise from 89 annual claims per C&P direct labor FTE in 2012 to 

129 in 2015. 

B. Please explain whether the fiscal year 2012 budget request would provide VA 

with the tools and resources needed to follow through with that plan. 

Response. VBA’s 2012 General Operating Expense budget request includes 14,320 

direct FTE for compensation and pension claims processing as well as $72.7 million 

and 66 FTE for program management and oversight of transformation initiatives, 

to include the Veterans Benefits Management System and Veterans Relationship 

Management initiatives. We believe these are the resources necessary to continue 

to deploy important initiatives associated with the transformation plan in 2012. 

Question 3. In discussing changes from the original fiscal year 2011 budget request, the fiscal year 2012 budget request for Compensation, Pensions, and Burial 

reflects that ‘‘[o]bligations increase $11.8 million for Other Services above the fundVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00281 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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ing reallocated from FTE from the original budget estimate.’’ The fiscal year 2012 

budget request also reflects that VA is requesting $337 million for Other Services 

for fiscal year 2012. 

A. During fiscal year 2011, how much was reallocated to Other Services from FTE 

and for what purpose? 

Response. In FY 2011, VBA will realign approximately $57 million from personal 

services for exploration of alternatives to FTE to assist in breaking the back of the 

backlog. 

B. What factors account for the $11.8 million increase in Other Services during 

fiscal year 2011? 

Response. The $11.8M increase is a result of the realignment of personal services 

funding to be used for exploration of alternatives to FTE to assist in breaking the 

back of the backlog. 

C. Please provide a detailed itemized list of how these funds would be spent during fiscal year 2012. To the extent that these funds will be spent on contracts, 

please explain the nature of the contract and the expected outcomes. 

Compensation & Pensions (C&P) Service 

2012 President’s Budget—Other Services Funding Request 

Medical Examinations ......................................................................................................................... $226.7M 

Veterans Benefits Management System ............................................................................................. 31.5M 

Claims Transformation Plan ............................................................................................................... 27.8M 

Instructional Systems Development and Training—includes Challenge training, leadership, and 

employee development programs ................................................................................................... 18.2M 

Pilots and Studies—includes work earnings loss study, pilot for sending checklists to Veterans 

for information needed from them to process their claims, Institute for Defense Analyses 

(IDA) contract to assess and implement changes to enhance the accuracy of the quality assurance program ............................................................................................................................ 4.0M 

C&P Operations and Support* ........................................................................................................... 28.5M 

Total Other Services Funding Request ............................................................................. $336.7M 

* This includes C&P Service’s routine operational expenses, such as contracts for shredding, equipment maintenance, and travel requirements. It also includes C&P Service’s portion of ‘‘must-fund’’ obligations, such as contractual obligations to the Department of Homeland 

Security for guard services, the Department of the Treasury for mailing benefits payments, the National Archives and Records Administra- tion for records storage, and several VA customers (Debt Management Center, Financial Services Center, etc.). The remaining funds consist of C&P Service’s portion of the Veterans Relationship Management initiative; VBA infrastructure investments, such as the co-location or relocation of facilities and associated equipment contract costs; and equipment operating, maintenance, and repair services contracts. 

Question 4. In connection with the Committee’s February 2010 hearing on VA’s 

fiscal year 2011 budget request, VA reported that ‘‘[i]n fiscal year 2010 the estimated output per Compensation and Pension direct labor FTE is 78 processed 

claims’’ and ‘‘[i]n fiscal year 2011 the estimated output per Compensation and Pension direct labor FTE is 79 processed claims.’’ 

A. For fiscal year 2012, what is the projected output per Compensation and Pension direct labor FTE (including in that FTE total any contractors that will perform 

claims processing functions, such as evidence gathering)? 

Response. VA estimates 14,320 Compensation and Pension direct labor FTE will 

produce ∼1,274,000 disability compensation and pension claims for an output of ∼89 

claims per direct labor FTE in fiscal year 2012. This estimate does not include any 

additional contractors that may perform claims processing functions, such as evidence gathering, due to the fact that the only services VA contracts for currently 

is a pilot to retrieve medical evidence from private physicians. The goal of this contract is not to supplement direct labor FTE, but to expedite the retrieval of evidence. 

B. As part of the plan to break the back of the backlog, will VA focus on increasing the average number of claims processed per employee? If so, please explain. 

Response. Yes, VA’s multi-tiered approach for eliminating the backlog includes a 

number of innovations. Improving online access for Veterans to obtain claim status 

information and perform self-service options, such as ordering copies of discharge 

records, improves customer satisfaction while freeing VA staff to work on claims. A 

21st Century electronic processing solution will virtually put an end to lost paperwork and infuse new efficiencies through the Veterans Benefits Management System (VBMS). New evidence-gathering tools such as Disability Benefits Questionnaires, now rolling out, sharpen the focus in medical examinations to ensure all information needed to rate the claim is gathered in the medical examination and presented succinctly. The Fully Developed Claims program puts Veterans in the driver’s seat for submitting a claim that will be ready to rate when received by VA. 

At the projected late–2012 peak of the bridge span when decisions production begins to outpace claims receipts, we will begin national deployment of the VBMS 

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automated claims processing system. VBMS will provide powerful new tools to 

claims examiners to boost efficiency and productivity. In addition to gains in accuracy and reductions in rework and appeals, the rules-based processing and calculator tools will also speed the rating process and increase productivity. 

Question 5. In connection with the Committee’s February 2010 hearing on VA’s 

fiscal year 2011 budget request, VA was asked to explain what would be a reasonable goal for rating-related claims processed per employee and VA provided this response: VA is currently undergoing a metric study associated with rating-related 

claims processed based upon employee experience levels. One key factor being analyzed is the average number of issues addressed for rating-related claims. We expect 

this study to provide us with baseline information that will enable us to establish 

appropriate measures and goals for claims processing employees. 

A. What is the status of that initiative and how much in total has VA expended 

on this initiative? 

Response. In 2009, the Institute for Defense Analyses (IDA) was contracted to 

conduct a study and provide an assessment of the current personnel requirements 

of the VBA. This study involved an analysis of rating-related claims processed based 

on employee experience levels and an assessment of the adequacy of the number of 

personnel assigned to each regional office for each type of claim adjudication position. VA paid $600,015 for this contract, which was mandated by section 104(b)(2) 

of Public Law 110–389, the Veterans Benefits Improvement Act of 2008. Results are 

being considered in the current revision of claims processors’ performance standards, as discussed in response to question 5C below. 

B. For fiscal year 2012, how much, if any, funding is requested for purposes of 

this initiative? 

Response: No funding is requested in FY 2012 for this initiative. 

C. For fiscal year 2012, will goals for claims processing employees be established 

based on this study? If so, please provide a list of the goals for claims processing 

employees with various levels of experience. 

Response. Goals for claims processors have not been revised based on this study. 

However, VBA is currently reviewing and revising the current performance standards for each category of claims processors, including Veterans Service Representative, Rating Veterans Service Representative, and Decision Review Officer. VBA is 

engaged with our Union partners to develop revised standards that allow VBA to 

achieve our overall strategic goals while meeting the needs of our stakeholders and 

employees. We anticipate these standards to be implemented in early FY 2012. 

Question 6. Since 2006, the level of claims processing staff has increased by more 

than 80%. In connection with the Committee’s February 2010 hearing on VA’s fiscal 

year 2011 budget request, VA was asked what metrics would be used to determine 

whether these hiring initiatives have been effective. VA responded that, ‘‘[w]hile 

VBA uses a combination of workload management indicators to gauge performance, 

we will closely monitor rating quality, inventory, and completed claims to determine 

the effectiveness of our recent hiring initiatives.’’ 

A. For fiscal year 2010, please explain whether those indicators (rating quality, 

inventory, completed claims) reflect that the large staffing increases have been effective. 

Response. VA’s recent staffing increases have been effective in decreasing the 

overall impact of external factors on performance. We increased our workforce in 

2010 by converting 2,400 American Recovery and Reinvestment Act employees to 

full-time and by hiring an additional 600 new employees; these employees are assisting VA in taking on the challenge of a dramatically increasing workload. 

VA’s pending claims inventory is rising due to the unprecedented volume of disability claims being filed. In 2010, we received approximately 1.2 million disability 

claims, a 17.6% increase over the previous year. While the volume and complexity 

of claims have increased, so too has the overall production effort of our claims processing workforce. In 2010, VBA processed an historic 1.08 million claims, an increase of 10.2% over 2009. 

VA continues to aggressively train claims processing staff across the Nation. Recognizing that it takes approximately two years for a new hire to become fully 

trained in claims processing, new employees are mentored and provided timely feedback from trainers, reviewers, and supervisors. Area offices are also providing increased oversight and support for those ROs whose national rating-related claims 

quality is below 85%. 

VA currently employs over 11,000 full-time claims processors. Hiring more employees is not a sufficient solution. The need to better serve our Veterans requires 

bold and comprehensive business process changes to transform VBA, and therefore 

VA, into a high-performing 21st century organization that provides the best services 

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available to our Nation’s Veterans, survivors, and their families; The Claims Transformation Initiative is VA’s effort to achieve these goals and break the back of the 

backlog by 2015. 

B. Please explain whether any measures of individual employee productivity currently are used to gauge the effectiveness of hiring initiatives and, if not, whether 

any such measures will be used during fiscal year 2012. 

Response. VA is actively revamping individual employee performance standards 

to ensure that individual goals tie directly to national initiatives to reduce the backlog and process claims with a 98% accuracy rate. In April 2010, VA implemented 

the revised performance plan for Veterans Service Representatives (VSRs) nationwide. This plan no longer allows work credit for interim claims actions; VSRs now 

receive credit only for performing a series of actions that will advance the claim to 

the next stage of the claims life cycle. The quality element has been increased to 

align the individual goal with the national quality goal, and local quality reviews 

are now based on the same review checklist as the national quality reviews. The 

revised performance plan is also designed to align local station performance targets 

to employee performance in both the quality and quantity of individual workload 

output. Similar reviews and revisions are currently underway for the Rating Veterans Service Representative and Decision Review Officer performance plans. 

Question 7. VA’s FY 2010 Performance and Accountability Report reflects that VA 

has developed ‘‘an overtime tracker to allow for nationwide reporting of claims processing during overtime hours at the local and national level.’’ 

A. For fiscal year 2010, how many overtime hours were worked for purposes of 

claims processing, how much in total was expended to pay for those overtime hours, 

and how many claims were completed as a result of those overtime hours? 

Response. In FY 2010, VBA expended $32 million for claims processing overtime. 

This is not broken down nationally by total overtime hours worked. Regional offices 

are allotted overtime funds based on local workload and support of national programs. VBA completed almost 250,000 actions related to rating claims in FY 2010 

on overtime. This included development actions and preparation and promulgation 

of rating decisions. Because all actions associated with processing individual claims 

are rarely all completed during overtime hours, a measure of ‘‘claims completed during overtime hours’’ is not easily defined. All claim’s steps processed on overtime are 

necessary and lead to the eventual completion of the rating claim. 

B. For fiscal year 2011, how many overtime hours are expected to be worked for 

purposes of claims processing, how much in total is expected to be expended to pay 

for those overtime hours, and how many claims are expected to be completed as a 

result of those overtime hours? 

Response. Because we are operating under a continuing resolution, our overtime 

spend level for FY 2011 is currently the same as FY 2010, $32 million for claims 

processing. We recently directed that overtime funds be specifically focused on completion of rating actions and promulgation of rating decisions, which will increase 

the number of rating claims completed on overtime. We continue to explore ways 

to integrate data across systems to better quantify work completed during overtime 

hours. 

C. For fiscal year 2012, what level of funding is requested to pay for overtime 

hours for claims processing? How many claims are projected to be completed as a 

result of those overtime hours? 

Response. In FY 2012, the VBA budget request includes the same level of funding 

for claims processing overtime, $32 million. For the reasons articulated in the previous responses, VBA does not have specific projections of overtime production. 

However, transformational initiatives such as Smart VA-Calculators and Disability 

Benefits Questionnaires (DBQs) will increase both efficiency and production of completed rating decisions. VBA expects to realize a resulting increase in production of 

rating claims completed on overtime. 

Question 8. In connection with the Committee’s February 2010 hearing on VA’s 

fiscal year 2011 budget request, VA reported that the overall attrition rate for VBA 

claims processing staff was approximately 10% per year from fiscal year 2005 to fiscal year 2009. VA also reported that ‘‘Regional offices that have difficulties in meeting performance targets are predominantly in high-cost metropolitan areas with 

high employee turnover.’’ 

A. What was the overall attrition rate for compensation and pension claims processing staff in during fiscal year 2010? 

Response. The attrition rate for VBA claims processors (permanent employees in 

GS–0996/0930 series positions) during FY 2010 was 6.05 percent. 

B. Please identify the five VA regional offices that experienced the highest attrition rates during fiscal year 2010 and the rates of attrition at those offices. 

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Response. In FY 2010, the following regional offices had the highest attrition rates 

for claims processing personnel (permanent employees in GS–0996/0930 series positions): 

Anchorage, AK: 25% 

White River Junction, VT: 17% 

Manchester, NH: 14% 

Little Rock, AR: 12% 

Albuquerque, NM: 12% 

C. For those offices, please identify the key performance outcomes for fiscal year 

2010, including timeliness and quality measures. 

Response. Key performance measures for fiscal year 10 were Average Days Pending (ADP), Average Days to Complete (ADC), and Rating Quality. 

ADP ADC Rating Quality 

National Average .............................................................................................. 116.9 165.5 83.8%

Anchorage ........................................................................................................ 110.1 186.1 87.6% 

White River Junction ........................................................................................ 156.2 208.0 82.4% 

Manchester ....................................................................................................... 116.3 168.6 84.4% 

Little Rock ........................................................................................................ 98.7 162.9 82.7% 

Albuquerque ..................................................................................................... 117.1 161.5 85.4% 

D. During fiscal years 2011 and 2012, what level of staffing and funding will be 

provided to those offices and what measures will VA take to ensure that Veterans 

in those areas will receive timely, accurate decisions? 

Response. The staffing levels for FY 2011 are as follows: 41 FTE in Anchorage, 

25 FTE in White River Junction, 64 FTE in Manchester, 198 FTE in Little Rock, 

and 98 FTE in Albuquerque. Funding for FY 2011 has been provided to support 

these staffing levels. The regional office (RO) staffing and funding levels for FY 2012 

will be determined after receipt of the FY 2012 appropriation and will be based on 

the latest workload and performance information available at that time. 

For the past several years, VBA has used a brokering strategy to assist ROs experiencing high turnover and to balance the inventory of pending claims across ROs. 

Pending claims are sent from ROs with high inventories to offices with capacity to 

process additional workload. This strategy is being used in all five of these ROs in 

fiscal year 2011. 

VBA monitors performance and develops specific action plans to improve performance. Oversight is provided through site visits conducted by both the Compensation 

Service and the Area Directors. RO directors are held accountable for performance 

though annual performance evaluations. 

Question 9. Under current law, a VA claimant and an attorney or agent who is 

representing him/her before VA may enter into an agreement providing that, if pastdue benefits are awarded to the claimant by VA, the attorney or agent’s fee will consist of a percentage of those past-due benefits and the attorney or agent will be paid 

directly by VA from those past-due benefits. In January 2011, VA announced that 

it is developing new procedures to govern cases where ‘‘VA mistakenly fails to make 

a direct payment of fees to an accredited attorney or agent out of VA funds.’’ VA 

provided this explanation: Current VA procedures note that, if VA fails to withhold 

a portion of past due benefits for direct payment of fees and the attorney or agent 

is eligible for fees, VA will pay the representative from VA funds. This procedure 

will remain the same. However, new procedures will provide that VA may recoup 

the amount of the fees by establishing an overpayment against the past due benefits 

paid to the claimant. 

A. To clarify, before these new procedures are implemented, if VA pays both the 

attorney or agent and the claimant for the amount that should have been paid directly to the attorney or agent, does VA try to recoup the duplicate payment? 

Response. No. Under the current procedures, if VA pays both the attorney or 

agent and the claimant the amount that should have been paid directly (and solely) 

to the attorney or agent, VA does not recoup the amount of the overpayment. The 

new procedures will provide that VA may recoup the amount of the fees from the 

claimant. 

B. In fiscal year 2010, in how many cases did VA fail to make direct payment 

of fees to an eligible attorney or agent and how much in total was paid to attorneys 

or agents ‘‘from VA funds’’ as a result? 

Response. The number of times VA fails to make direct payment of fees and the 

total amount paid to attorneys and agents from VA funds is not available, as this 

information is not electronically tracked. 

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C. To date, in fiscal year 2011, in how many cases did VA fail to make direct payment of fees to an eligible attorney or agent and how much in total has been paid 

to attorneys or agents ‘‘from VA funds’’ as a result? 

Response. See the response to 9B. 

D. What is the expected timeframe for developing the new procedures? 

Response. The Fast Letter outlining the new procedures is in the final concurrence stages of VBA. Once approved, the field will immediately implement the new 

procedures. 

Question 10. During 2010, VA was pursuing at least 40 pilots and initiatives in 

order to try to address the backlog of disability claims. As discussed at a July 2010 

hearing, over 12 years ago, former Under Secretary for Benefits Joe Thompson said 

this about VA’s efforts to improve claims processing: 

[The Veterans Benefits Administration] has undertaken a number of initiatives to bring about needed change * * *. The reasons for the lack of success * * * [include] inadequate planning, unclear goals and objectives, poor 

integration of interrelated efforts, a lack of coordination with other stakeholders, and insufficient implementation planning and follow-up. 

A. Please provide a list of any current initiatives/pilots. 

Response. See the attached document entitled ‘‘VA Claims Transformation— 

Claims Transformation Initiatives.’’ 

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B. When will determinations be made as to whether to continue, expand, or disband these initiatives/pilots? 

Response. We are accelerating to the extent possible the evaluation timelines, 

while also ensuring sufficient data are available to accurately assess the initiatives’ 

operational impact and success. For many initiatives, we use a 90-day cycle. However, given the length and complexity of the claims processing cycles, some initiatives must run longer. For example, the Indianapolis Integration Pilot will run 

longer to accommodate adjustments and tests. Some of the longer-term initiatives 

will run for a year or more: Disability Benefits Questionnaires, Integrated Communication Plan, and Disability Evaluation Narrative Text Tool. 

C. What efforts are being made to integrate the various initiatives/pilots? 

Response. We have selected the Indianapolis Regional Office as the site of the 

Veteran Benefits Administration’s Integration Lab (I-Lab). The purpose of I-Lab is 

to test multiple initiatives within a new end-to-end processing model. Our change 

initiatives are currently tested in separate regional offices. The I-Lab provides a 

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The I-Lab is currently testing the following initiatives: Intake Processing Center, 

Comprehensive Screening, Case Management, Lean Claims Processing, Express 

Lane, and Private Medical Records. 

D. What level of funding is requested during fiscal year 2012 to support the ongoing initiatives/pilots? 

Response. VBA’s 2012 General Operating Expense budget request includes $72.7 

million and 66 FTE for program management and oversight of transformation initiatives, to include the Veterans Benefits Management System and Veterans Relationship Management initiatives. 

Question 11. During 2010, VA expanded nationwide its fully developed claim initiative, through which VA expedites claims that arrive with necessary evidence. 

A. How many fully developed claims have been filed since this program was expanded and on average how long is it taking to provide a decision on fully-developed 

claims? 

Response. Between June 2010 (pilot start date) and March 9, 2011, the FDC program produced 5,193 completed claims. The average length of time to complete the 

FDC claims is 84.7 days. 

B. Please describe any outreach that has been conducted to alert veterans, their 

families, and their representatives about the fully developed claim process. 

Response. VA has attracted national publicity by issuing a news release about the 

FDC program, and has efforts in progress to develop additional media products to 

seek more national attention. A Web site was launched at http://benefits.va.gov/ 

fastclaims offering information and links to a detailed fact sheet and the forms for 

the program. The site has received more than 13,000 visits. The FDC program has 

been briefed to the major Veterans Service Organizations (VSOs), and VA recently 

had an intensive all-day meeting on FDC with a group of VSO representatives from 

around the country to discuss opportunities to expand Veterans’ understanding and 

use of the program. VA has taken FDC flyers to events for distribution to Veterans, 

such as VSO conventions, a NASCAR exhibition, and game four of the World Series 

last fall. 

C. What outreach activities will be undertaken with respect to this initiative in 

fiscal year 2012 and how much funding is requested for that purpose? 

Response. VA continues to seek the best approaches to provide outreach on this 

program and is currently developing a pilot in the Los Angeles and Waco regional 

offices’ catchments to gauge whether submission of FDC claims increases through 

a coordinated series of marketing efforts. In FY 2011, this is expected to involve online advertising, promotional events, and distribution of materials to local VSOs, as 

well as handouts, posters and banners for use at VA outreach events, VA medical 

centers, and other locations. Results from this pilot will guide VA outreach efforts 

for the FDC program in FY 2012. Funding for this initiative is not specifically identified as a line item in the FY 2012 budget request, but such resources would be 

included in the overall funds allocated for our transformational programs. 

Question 12. For many years, experts have stressed the need to update the VA 

disability rating schedule. In connection with the Committee’s February 2010 hearing on VA’s fiscal year 2011 budget request, VA indicated that ‘‘VBA plans to dedicate $2.2 million (includes FTE) in FY 2011 to update the rating schedule’’ and that 

VA anticipated spending $750,000 in fiscal year 2010 and $750,000 in fiscal year 

2011 on a contract for that purpose. Also, VA’s Project Management Plan for revision of the rating schedule reflects that ‘‘econometric earnings loss data will be obtained through future contracts with econometric companies if funding can be procured.’’ 

A. How much was expended during fiscal year 2010 on a contract or contracts related to the review of the rating schedule and how much is expected to be spent 

during fiscal year 2011 for that purpose? 

Response. In fiscal year 2010, VBA expended $196,000 for a contract physician 

to review and revise the current rating schedule. In the 2011 budget, VBA requested 

$750,000 for the work earnings loss study and has expended nearly $525,000. 

B. What level of funding would be required during fiscal year 2012 to obtain 

‘‘econometric earnings loss data*** through future contracts with econometric 

companies?’’ Is funding for that specific purpose included in the fiscal year 2012 

budget request? If so, how much is requested for that purpose? 

Response. VBA requested $1 million in the 2012 budget for a work earnings loss 

study. 

C. What is the current level of staffing dedicated to updating the rating schedule? 

What level of staffing will be dedicated to this effort during fiscal year 2012? 

Response. Seven FTE and one contractor are currently dedicated to updating the 

rating schedule, and that level of effort is estimated to continue into 2012. 

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D. How much in total was expended during fiscal year 2010 to update the rating 

schedule? Please provide an itemized list of how that funding was expended. 

Response. In 2010, VBA obligated $604,000 to update the rating schedule. 

2010 Funding Dedicated to Updating the Rating Schedule 

$000s 

Payroll and travel ..................................................................................... $327 

Contract physician .................................................................................... 196 

Musculoskeletal, mental health, endocrine & hemic/lymphatic forums .. 81 

Total Obligations ......................................................................... $604 

E. During fiscal year 2011, how much in total does VA currently plan to expend 

to revise the rating schedule? Please provide an itemized list of how that funding 

is expected to be expended. 

Response. VBA plans to spend $750,000 for a work earnings loss study, $387,000 

for a medical consultation contract, and payroll resources of approximately $1.1 million for seven FTE. 

F. How much funding in total from the fiscal year 2012 budget is requested for 

purposes of updating the disability rating schedule? Will that funding be specifically 

designated for the purpose of updating the rating schedule and under the control 

of the project manager who is leading that effort? 

Response. In the 2012 budget request, VBA requested $1 million for a work earnings loss study, $391 thousand for a medical consultation contract, and payroll resources of approximately $1.1 million for seven FTE. This funding is designated for 

the rating schedule update and will be monitored by the project manager. 

G. Does the fiscal year 2012 funding request include funding to reimburse experts 

for travel expenses or funding to plan and carry out any additional public forums? 

If so, what level of funding would be provided for those purposes? 

Response. The budget request does include funding to reimburse subject matter 

experts for travel expenses and for contractors to plan and execute public forums 

in the amount of $120,000. 

H. Does the fiscal year 2012 budget request contain sufficient funding for all employees, contracts, and other expenses necessary to update the rating schedule in 

accordance with the Project Management Plan? 

Response. In the FY 2012 budget request, funding is sufficient to carry out the 

approved Project Management Plan, which includes two studies as well as other 

work necessary to update the rating schedule. 

Question 13. At a Senate Committee on Veterans’ Affairs hearing in September 2009, the Committee discussed a report prepared by Economic Systems, Inc., 

entitled ‘‘A Study of Compensation Payments for Service-Connected Disabilities,’’ 

which in part included options for compensating veterans for loss of quality of life 

caused by their service-related injuries. The Under Secretary for Benefits at that 

time indicated that further study would be necessary before moving forward with 

most of the options in that report. After that, VA provided this information: 

The Advisory Committee on Disability Compensation is currently reviewing and 

analyzing potential models for compensating for Quality of Life (QOL) loss * * *. 

Due to the on-going work of the Advisory Committee on Disability Compensation, 

VA does not believe that additional studies to create a separate system to compensate for [quality of life] loss should be considered at this time. 

A. Has the Advisory Committee provided VA with any actionable recommendations regarding quality of life? If so, what actions does VA plan in response to those 

recommendations? 

Response. The Advisory Committee on Disability Compensation provided VA with 

12 recommendations. Two covered quality of life and non-economic (other than 

work) income loss. However, the term ‘‘quality of life’’ is absent from any and all 

VA regulations and statutes authorizing compensation, as is the term ‘‘non-economic’’ loss. VA’s compensation statute at title 38 U.S.C. 1155 only authorizes disability compensation to Veterans for reductions in earning capacity due to disability 

resulting from injury or disease incurred in or aggravated by active military service. 

A new compensation scheme based on quality of life or some other system would 

require legislation. 

B. Does VA plan to conduct any studies—separate from the Advisory Committee— 

on quality of life? If so, what level of funding is needed for that purpose during fiscal 

year 2011 and 2012? 

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Response. Completely separate from the Committee, the Compensation and Pension Service is contracting for an earnings loss study of the musculoskeletal section 

of the rating schedule. The purpose of this study is to evaluate the average earnings 

losses incurred by veterans due to service-connected musculoskeletal diseases or injuries as described within diagnostic codes within the schedule. Again, VA compensation statutes do not provide for compensation based on ‘‘quality of life’’ issues, 

but only average losses in earning capacities. Therefore, while this study will analyze compensation forms of earnings loss capacity outside the VA system (i.e. workers’ compensation and social security disability compensation), it will not address 

quality of life, because such a study would exceed VA’s compensation authority. 

C. How much in total has VA expended with regard to the Advisory Committee 

on Disability Compensation and what level of funding is requested for fiscal year 

2012? 

Response. Approximately $260,000 was spent in 2010. We plan for the Advisory 

Committee members to actively participate in the scheduled forums for updating the 

VASRD. The 2011 and 2012 budget requests include $300,000 in each year for the 

Advisory Committee. 

D. To date, what actions have been taken by VA in response to the Committee’s 

recommendations? 

Response. VA has acted upon most recommendations that fall within VA’s statutory authority. In response to the Committee’s recommendations, VA hired five additional personnel on the Compensation and Pension Service’s Policy Staff. These new 

hires include an experienced disability rating specialist with hands-on expertise as 

well as four new medical doctors to lead the effort to update the VASRD so that 

it incorporates econometric earnings loss data and current medial science. As recommended by the Committee in connection with updating the VASRD, VBA is receiving direct support from VHA medical subject matter experts (SMEs), who made 

formal presentations at four public forums and continue to provide medical science 

information as part of working groups set up after the forums. Also as recommended, VA initiated an Earnings Loss Study with the George Washington University, via an inter-agency agreement with the Department of Health and Human 

Services, to empirically study lost earnings by Veterans who are service-connected 

with musculoskeletal disabilities. The current medical science information that is 

captured from VHA SMEs and the earnings loss findings form the basis for updating the VASRD. 

Question 14. Last year, VA announced that claims based on exposure to contaminated water at Camp Lejeune would be consolidated at the VA regional office in 

Louisville. 

A. How many employees at Louisville will handle Camp Lejeune claims during 

fiscal year 2011 and during fiscal year 2012? 

Response. As of March 2011, the Camp Lejeune contaminated water (CLCW) caseload of 638 claims represents nearly 10 percent of the rating workload of the Louisville Regional Office (RO). At this time, the Veterans Service Center has 15 full-time 

employees devoted to processing these cases. The RO intends to maintain at the current level in FYs 11 and 12, provided CLCW receipts remain stable. The VSC will 

continue to monitor CLCW workload and make appropriate adjustment, as necessary. 

B. Does the fiscal year 2012 budget request include sufficient funding to provide 

any necessary training for these employees, so they will be kept informed of new 

studies or information regarding the contaminates at Camp Lejeune? If so, please 

explain. 

Response. The budget request for fiscal year 2012 contains sufficient funding to 

keep the Louisville Regional Office personnel fully trained and informed on the processing of Camp Lejeune-related claims. On January 11, 2011, VA Fast Letter 11– 

03, Consolidation and Processing of Disability Claims Based on Exposure to Contaminated Drinking Water at Camp Lejeune, North Carolina, was released to VBA 

field stations, explaining certain technical aspects of processing these claims. A 

training letter has also been developed to provide background information and explain the relationship between certain diseases and the volatile organic compounds 

known to have contaminated the Camp Lejeune water supply. This will assist adjudicators making rating decisions as well as VA medical examiners who may not be 

familiar with the specific science related to these contaminants. The training letter 

will be released in the near future. 

Following release of the Fast Letter, Compensation and Pension Service provided 

in-person training to Louisville staff. C&P will continue to communicate with that 

office on a weekly basis. In-person training sessions will be provided as needed to 

ensure that all aspects of the claims process are understood. Additionally, VA will 

continue to monitor the studies currently underway by the Department of Health 

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and Human Services’ Agency for Toxic Substances and Disease Registry (ATSDR) 

related to Camp Lejeune. This agency is developing computer modeling to recreate 

flow patterns of the contaminated water system as well as a survey questionnaire 

to assess long-term health effects among individuals who served at Camp Lejeune 

during the 1957 to 1987 period of water contamination. When results of these studies are received, VA will incorporate the findings into training sessions for the Louisville Regional Office to ensure that claims processing is up to date. These studies 

are projected to be completed in 2013. 

VBA’s budget request for 2012 provides sufficient funding to meet this training 

requirement. 

Question 15. Since 2003, certain cases remanded by the Board of Veterans’ Appeals have been handled at a centralized entity called the Appeals Management 

Center. 

A. How much was spent on the Appeals Management Center during fiscal year 

2010 and what level of staffing did that funding support? 

Response. During fiscal year 2010, $16.3 million was spent for the Appeals Management Center. $14.2 million comprised payroll and supported a staffing level of 

168 full-time employees. 

B. How much is projected to be spent during fiscal year 2011 and what level of 

staffing will that funding support? 

Response. At this time, Appeals Management Center on-board staffing level is 

projected to increase to 209 FTE, with 2011 funding at $18 million for both payroll 

and non-payroll expenditures. 

C. In total, how much funding is requested for fiscal year 2012, and what level 

of staffing will that funding support? 

Response. In 2012, the Appeals Management Center is expected to maintain the 

2011 staffing level and the funding request estimate is $18.3 million, including payroll and non-payroll expenditures. The anticipated $1.8 million increase in funding 

over 2011 is attributable to scheduled payroll increases (career-ladder and withingrade increases) and inflation associated with shipping, supplies and other non-payroll, general operating expenses. 

D. How many appeals are currently pending at the Appeals Management Center? 

Response. There are 20,899 appeals pending at the Appeals Management Center 

as of March 15, 2011. 

E. How many of those pending cases are ready-to-rate; how many employees are 

dedicated to handling ready-to-rate cases; and what steps are being taken to provide 

decisions on those cases before the evidence becomes outdated? 

Response. 11,715 cases are ready-to-rate as of March 15, 2011. 27 Decision Review 

Officers, 5 Rating Veterans Service Representatives (RVSRs), and 6 newly selected 

RVSR trainees are dedicated to handling ready-to-rate cases. Additional hiring is 

anticipated. Workload management tools have been implemented that focus on expediting the oldest pending remands. In January 2011, the Appeals Management Center began brokering approximately 500 ready-to-rate cases per month to a special 

processing team in Cleveland. 

F. What were the key performance outcomes for the Appeals Management Center 

in fiscal year 2010 (related to timeliness, accuracy, and inventory) and what are the 

expected performance outcomes for fiscal years 2011 and 2012? 

Response. Significant improvements were made in timeliness outcomes over FY 

2009. ‘‘Average days pending’’ improved from 383 days in FY 2009 to 233 days in 

FY 2010. ‘‘Average days to complete’’ improved from 477 days in FY 2009 to 428 

days in FY 2010. Accuracy was 74 percent for FY 2010. The pending remand inventory at the end of FY 2010 was 19,649, which was higher than the 18,500 target. 

Performance targets for fiscal year 2011 are 180 days for ‘‘average days pending,’’ 

and 380 days for ‘‘average days to complete.’’ The FY 2011 accuracy target is 90 percent. Additionally, the accuracy review for the Appeals Management Center has 

been adjusted to use a larger, statistically valid sample. For FY 2011, the end-ofyear inventory target remains 18,500 claims. 

The FY 2012 performance targets will be established near the end of FY 2011 

based on the actual performance of the Appeals Management Center during FY 

2011. 

Question 16. As one strategy to deal with VA’s backlog of disability claims, VA 

brokers claims between VA regional offices. 

A. How many cases did VA broker during fiscal year 2010 and how many cases 

does VA expect to broker during fiscal year 2011 and during fiscal year 2012? 

Response. In FY 2010, a total of 105,337 rating-related cases were brokered. 

Through February 2011, a total of 12,547 rating-related cases were brokered. The 

total expected FY 2011 brokering will be approximately 30,000 cases. The sharp deVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00298 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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cline in brokering is a result of utilizing the thirteen resource centers to process 

Agent Orange claims that are subject to the provisions of the Nehmer litigation. It 

is expected that beginning in early FY 2012, the resource centers will return to adjudicating brokered rating workload. VBA has not projected the volume of brokered 

cases for 2012. 

B. Has VA developed performance measures or collected data that would allow a 

comparison of the timeliness and quality of decisions rendered in brokered cases 

versus cases that are not brokered? If so, please explain. 

Response. Comparative quality data is collected for both regional offices that send 

brokered workload and resource centers that complete brokered work. VBA is currently engaged in refining existing data systems and workload tracking mechanisms 

to compare timeliness between sites that broker work and sites that complete brokered work. It is expected that these enhancements will be in place in fiscal year 

2012. 

C. Has VA developed performance measures or collected data that would allow VA 

to determine the cost-effectiveness of brokering? If so, please explain. 

Response. Measurements do not currently exist to determine the cost effectiveness 

of workload brokering. VBA is currently engaged in refining existing data systems 

and workload tracking mechanisms to allow appropriate data collection to support 

cost-effectiveness analyses. 

Question 17. According to VA’s fiscal year 2012 budget request, VA’s fiduciary program supervises over 110,000 incompetent beneficiaries. 

A. During fiscal year 2012, what level of funding would be used to support the 

fiduciary program and what level of staffing would that funding support? Response. In 2012, approximately $48 million will support approximately 600 fiduciary staff. 

B. What were the key performance outcomes for the fiduciary program during fiscal year (FY) 2010 and what are the expected performance outcomes for fiscal years 

2011 and 2012? 

Response. The key performance indicators for the fiduciary program are: 

1. Quality—Quality of the fiduciary program increased from 81.5% in FY 2009 to 

85.0% in FY 2010. The expected performance outcome for FY 2011 is 86.5% and 

90.0% in FY 2012. 

2. Timeliness of account audits—The timeliness of account audits increased from 

92.1% in FY 2009 to 92.3% in FY 2010. The expected performance outcome for FY 

2011 and FY 2012 is 93%. 

3. Timeliness of field examinations—The timeliness of field examinations completed in FY 2010 was 81.4%. The expected performance outcome for FY 2011 and 

FY 2012 is 92%. 

4. During FY 2011, VA initiated the performance outcome relating to the timeliness of accountings received—It is anticipated the performance outcome for FY 2011 

and FY 2012 will be more than 95% of all accountings are received prior to becoming seriously delinquent. 

C. Does VA’s fiscal year 2012 budget request include funding to develop an online training program for fiduciaries? If so, how much is included for that purpose? 

Response. The 2012 budget request does not include funds to develop an online 

training program for fiduciaries but we have conducted research to identify existing 

certification programs. We plan to develop a system in 2013. 

D. How many incompetent beneficiaries now live overseas and will the requested 

funding allow VA to appropriately protect the interests of those beneficiaries? If so, 

please explain. 

Response. The Fiduciary Program has 1,099 beneficiaries residing in 40 foreign 

countries. The funding requested in the 2012 budget will allow VA to appropriately 

protect the interests of those beneficiaries. Approximately 80 percent of these beneficiaries reside in the Republic of the Philippines and their welfare is monitored by 

a local VA fiduciary activity. VA leverages the support of our embassies to provide 

oversight of the remaining beneficiaries through periodic visits. 

Question 18. The FY 2010 Performance and Accountability Report reflects that VA 

has recognized the need to replace the Fiduciary Beneficiary System and to that end 

a Request for Information was released during fiscal year 2010. 

A. What level of funding is expected to be expended during fiscal year 2011 to 

replace the Fiduciary Beneficiary System? 

Response. VA estimates it will spend $50 thousand in General Operating Expense 

funds in its effort to replace the Fiduciary Beneficiary System in 2011. 

B. What level of funding is requested for fiscal year 2012 for this purpose? 

Response. VA estimates it will spend $38 thousand in General Operating Expense 

funds in its effort to replace the Fiduciary Beneficiary System in 2012. 

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C. What is the expected timeline for completion of the replacement of the Fiduciary Beneficiary System? 

Response. VA estimates the Fiduciary Beneficiary System will be replaced in 

2013. 

Question 19. A November 2010 Fast Letter (10–51) set forth procedures for VA regional offices to follow in handling requests for relief from the requirement that VA 

report to the National Instant Criminal Background Check System the names of 

beneficiaries who have been assigned a fiduciary. In part, that Fast Letter provides 

this guidance: ‘‘To grant relief, the record must show affirmatively, substantially, 

and specifically that the beneficiary is not likely to act in a manner dangerous to 

public safety, and that granting relief will not be contrary to the public interest.’’ 

A. How many of these requests for relief has VA received, how many have been 

decided, and how many remain pending? 

Response. As of March 9, 2011, VA has received 101 requests and decided 13. VA 

has 88 requests for relief pending. 

B. Of the requests for relief that have been decided, how many have been granted? 

Response. VA has granted one request for relief. 

C. What level of funding is requested for fiscal year 2012 to provide training for 

regional office employees on how to determine if a beneficiary is dangerous? 

Response. VA included criteria to consider in evaluating public safety in Fast Letter 10–15, dated November 22, 2010. Training will be incorporated in our annual 

training curricula. No additional funding in 2012 is needed for this purpose. 

Question 20. DOD and VA plan to roll out to 140 sites worldwide a joint disability 

evaluation system, called the Integrated Disability Evaluation System or IDES, 

through which an injured or ill servicemember, before being medically discharged 

from the military, completes both the DOD disability rating system and the VA disability rating process. While DOD and VA were piloting this concept, significant 

challenges came to light, including untimely medical examinations, logistical issues, 

and staffing shortages. 

A. At the 27 original (pilot) IDES sites, are there currently sufficient VA personnel to meet all relevant staffing goals? If not, please identify the specific sites 

where staffing goals are not being met and a timeline for when those goals will be 

met. 

Response. All 27 sites have sufficient staffing levels. 

B. At the 28 additional sites that have certified readiness to begin the IDES process, are there currently sufficient VA personnel to meet all relevant staffing goals? 

If not, please identify the specific sites where staffing goals are not being met and 

a timeline for when those goals will be met. 

Response. The 28 sites have sufficient staffing levels. 

C. During fiscal year 2011, how much in total does VA expect to expend with respect to the IDES (including both mandatory and discretionary funds) and how 

many VA employees will be dedicated to the IDES process? 

Response. The 2011 budget request includes approximately $23 million to support 

285 FTE and $13 million for contract examinations. 

D. During fiscal year 2012, how much in total does VA expect to expend with respect to the IDES (including both mandatory and discretionary funds) and how 

many VA employees will be dedicated to the IDES process? 

Response. The 2012 budget request includes approximately $24 million to support 

285 FTE and $20.4 million for contract examinations. 

E. For each site that will use the IDES process during fiscal year 2011 and 2012, 

please provide the level of funding that specific site has been or will be allocated 

(from any source) to carry out that process. 

Response. Expansion of the Integrated Disability Evaluation System is still in the 

planning phase with the Department of Defense. Therefore, no specific amount of 

money has been allocated for this population of servicemembers. 

F. For each site that will use the IDES process during fiscal year 2011 and 2012, 

please provide the number of servicemembers expected to enter the IDES process 

at that specific site per year. 

Response. Please see the attached spreadsheet, which contains a list of military 

treatment facilities and their anticipated annual caseload. 

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G. Is the requested level of funding for fiscal year 2012 sufficient for all necessary 

staff to meet staffing targets nationwide in general and specifically at the military 

bases in North Carolina? 

Response. The requested funding level would provide sufficient funding for the 

necessary staffing in fiscal year 2012. This includes all military bases in North 

Carolina. 

H. For fiscal year 2012, does the fiscal year 2012 budget request include sufficient 

funding for VA doctors or contractor services necessary to provide timely medical 

examinations for IDES participants nationwide in general and specifically at the 

military bases in North Carolina? 

Response. VBA’s fiscal year 2012 budget request included sufficient funds for the 

timely examination of IDES participants by contract examiners, where needed. 

I. For each branch of military service, please provide the most up-to-date performance statistics with respect to the IDES process, including the number of servicemembers referred to the IDES process, the number of servicemembers who remain 

in the process, the average length of time they have been pending in the IDES process, the average time it takes to complete the total process, the average time for 

claim development, the average time to complete medical evaluations, the average 

time to complete the Medical Evaluation Board, the average time to complete the 

Physical Evaluation Board, and the average time to complete a VA rating. 


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Response. Please see the attached spreadsheet. 

J. For each military base in North Carolina that is using the IDES process, please 

provide the most up-to-date performance statistics, including for each base the number of servicemembers referred to the IDES process, the number of servicemembers 

who remain in the process, the average length of time they have been pending in 

the IDES process, the average time it takes to complete the total process, the average time for claim development, the average time to complete medical evaluations, 

the average time to complete the Medical Evaluation Board, the average time to 

complete the Physical Evaluation Board, and the average time to complete a VA rating. 

Response. Please see the attached spreadsheet. 

K. In total, how many servicemembers currently have been pending in the IDES 

process for longer than 295 days, VA and DOD’s goal for completing the joint process? 

Response. As of March 6, 2011, 3,796 of the 12,824 Servicemembers currently enrolled in IDES have been pending for more than 295 days. 

Question 21. In a January 2011 report, the VA Inspector General OIG found that 

VA ‘‘is not correctly evaluating and monitoring 100 percent disability evaluations’’ 

and that, if corrective action is not taken, VA ‘‘will overpay veterans a projected $1.1 

billion over the next 5 years.’’ Please provide an update on any actions that have 

been taken in response to this report. 

Response. VBA remains committed to paying Veterans correctly and assigning appropriate disability evaluations at all levels. We are actively working to address the 

recommendations of the report, and resolving the system errors that have contributed to future examination controls being removed from records. 

VBA is currently testing a recent system modification to ensure that future diaries established through the rating process are not removed through other processing actions. Testing is scheduled through the end of March 2011, and VBA plans 

to implement this system modification by April 30, 2011; this will prevent the loss 

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porary 100-percent evaluations. VBA is also working to establish appropriate future 

diary controls within the system for the population of cases identified by OIG. 

In January 2011, VBA amended the training lesson for Veterans Service Representatives to address timely actions that must be taken on future examination notifications. Additionally, a new training lesson entitled Permanent & Total Ratings 

was made available for Rating Veterans Service Representatives in March 2011. 

VBA’s National Training Curriculum mandates completion of this lesson in FY 

2011. This lesson provides detailed information on evaluating permanent and total 

disability ratings, and allows participants to apply their knowledge in resolving actual case scenarios during training. 

Question 22. It is my understanding that, as one initiative to bring down the 

backlog of disability claims, VA plans to extend routine future disability examination requests to the maximum period of five years. 

A. Does VA track any data that would reflect how frequently those types of routine follow-up examinations reveal an improvement in the veteran’s disability, how 

often they reveal a worsening of the disability, and how often there is no change? 

If so, please explain. 

Response. This information is not currently captured in any VA systems. 

B. Has VA calculated an estimate of how many Veterans might be overpaid or 

underpaid as a result of this policy or how much in total will potentially be overpaid 

or underpaid? If so, please explain. 

Response. VA has not calculated the overpayments and underpayments per the 

explanation in 22a. 

Question 23. In addition to processing claims in a timely manner, it is essential 

that decisions are accurate in order to avoid delays and frustrations for veterans 

and their families. 

A. How many employees are currently dedicated to VBA’s national quality assurance program? 

Response. Compensation and Pension Service currently has 49 employees dedicated to VBA’s national quality assurance program. In addition, under Section 224 

under Public Law (PL) 110–389, Veterans’ Benefits Improvement Act of 2008, VBA 

contracted with the Institute for Defense Analyses (IDA) over a three-year period 

to conduct an independent assessment of the quality assurance program carried out 

in the VBA. The final report is due to VBA in August 2011. VBA is also implementing dedicated quality teams at each of the regional offices. The dedicated Quality Review teams will conduct quality reviews as well as provide feedback and training on error trends. 

B. For fiscal year 2012, how many employees would be dedicated to VBA’s national quality assurance program? 

Response. At this time there are no plans to increase the number of employees 

in the National Quality Assurance Program. However, VBA does plan to add dedicated quality reviewers within the regional offices, which will focus solely on the improvement of quality. 

C. How many cases were reviewed in fiscal year 2010, how many are expected 

to be reviewed during fiscal year 2011, and how many are projected to be reviewed 

during fiscal year 2012? 

Response. We reviewed 46,507 cases for quality in fiscal year 2010. We project 

that we will review over 47,000 cases in both FY 2011 and FY 2012. 

GENERAL ADMINISTRATION

Office of the Secretary 

Question 1. The fiscal year 2012 budget proposal reflects that the Office of the 

Secretary expended $3,000 on Other Services during fiscal year 2010, expects to 

spend $246,000 on Other Services during fiscal year 2011, and requests $122,000 

for Other Services for fiscal year 2012. 

Response. NOTE: The expended amount in ‘Other Services’ during fiscal year 

2010 consisted of $227,000 in actual obligations and a reimbursement of $224,000 

from Veterans Benefit Administration (VBA) to Office of Employment Discrimination Complaint Adjudication (OEDCA) for services rendered, which resulted in a net 

difference of $3,000. Because OEDCA is in the same account as OSVA, it is reflected 

as an expenditure adjustment and nets against the ‘Other Services’ line. The reimbursement from VBA was recorded against ‘Other Services.’ 

A. Please provide an explanation of how these funds have been used or are expected to be used. 

Response. The following are the more significant items covered under ‘Other Services’ in FY10: 

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• $85k—Office of the Secretary—Training (includes eight 4-day sessions with 

more than 80 employees from across VA participating) 

• $17k—Center for Women Veterans (CWV)—A Women’s Summit where more 

than 400 stakeholders attended 

• $18k—CWV—stipends to cover the costs of its Advisory Committee. 

• $16k—Center for Minority Veterans (CMV)—stipends to cover the costs of its 

Advisory Committee 

• $18k—CMV Employee Training—including an employee participating in the 

Federal Executive Institute program. 

The following are the more significant items covered under ‘Other Services’ in 

FY11: 

• CWV has planned $108k in other services (including a committee meeting, a 

major biennial summit, advisory committee site visits, equipment, printing, and 

supplies) 

• CMV has planned $38k in other services (including committee meetings and 

equipment, printing, and supplies) 

• Office of the Secretary has planned $97k in other services (including equipment, 

printing, and supplies) 

B. If these are contracted services, what metrics will be used to determine whether these services will be used effectively? 

Response. The services are for meetings or events necessary by both the CWV and 

CMV in fulfilling as Advisory Committee requirements. In addition, equipment like 

copiers are leased and not purchased. 

Question 2. Before the House Committee on Veterans’ Affairs, Secretary Shinseki 

testified that recent increases in staff for this office are due in part to transitioning 

away from the use of detailed employees in that office. 

A. Please provide a breakdown of how many detailed employees currently work 

in the Office of the Secretary, how many have worked in that office over each of 

the past five years, and how many are projected to work in that office during fiscal 

year 2012. 

Response. As of March 30, 2011, two persons are currently on short-term detail 

to the Office of the Secretary. Over the past 5 years, 12 persons were on detail to 

the Office of the Secretary in 9 distinct positions. Duration of these details varied. 

Three of these detail positions were converted to full time positions in the Office 

of the Secretary, and six of the detail positions were eliminated. The 4-person Center for Faith-Based and Neighborhood Partnerships was also transferred from the 

Office of Public and Intergovernmental Affairs to the Office of the Secretary during 

this 5 year period. This transfer also involved temporary detailing of Center employees until funding adjustments were coordinated. All Center employees now work in, 

and are funded by, the Office of the Secretary. 

B. How many positions have been converted in fiscal year 2010 and fiscal year 

2011 from a detailed position to full time employee working for the Office of the Secretary? How many of these positions will be new FTEs to the Secretary’s office in 

fiscal year 2012? 

Response. Two detail positions were transferred and reassigned to the OSVA in 

FY 2010 and one in FY 2011. These positions were included in the OSVA FTE total 

for that fiscal year. 

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C. Once these detailees are shifted back to their original hiring offices, how are 

they reflected in the total number of FTEs in this year’s budget? Are they reflected 


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as an increase to that office’s FTEs count or were they always reflected in that office’s FTE numbers in the past? 

Response. Employees on detail are and continue to be reflected in the FTE numbers of their original office. 

Board of Veterans’ Appeals 

Question 1. According to the fiscal year 2012 budget request, the Board of Veterans’ Appeals (Board or BVA) experienced a 22% increase in case receipts from 

2008 to 2010 and expects to receive 66,600 new appeals in 2012. 

A. For fiscal years 2009 and 2010, what percentage of case receipts involved cases 

that previously had been remanded by the Board? 

Response. In fiscal year 2009, 32.60% of case receipts (or 16,288 cases) involved 

cases previously remanded by the Board. 

In fiscal year 2010, 30.93% of case receipts (or 16,224 cases) involved cases previously remanded by the Board. 

B. With the requested level of funding for fiscal year 2012, how many decisions 

does the Board expect to issue during fiscal year 2012? 

Response. The Board expects to issue 49,500 cases during fiscal year 2012. 

C. Currently, what is the average case disposition time and what is the expected 

case disposition time during fiscal year 2012 if the requested level of funding is provided? 

Response. The Board’s current average case disposition time, referred to as ‘‘cycle 

time,’’ is 110 days (fiscal year 2011 to date). Cycle time measures the time an appeal 

is physically received at the Board until a decision reached, excluding the time that 

the case is with a Veterans Service Organization representative for the preparation 

of written argument. The expected cycle time for fiscal year 2012 is 140 days. 

Question 2. The December 2010 report from the National Commission on Fiscal 

Responsibility and Reform included this recommendation: 

Reduce Federal travel, printing, and vehicle budgets * * *. We propose 

prohibiting each agency from spending more than 80 percent of its FY 2010 

travel budget and requiring them to do more through teleconferencing and 

telecommuting * * *. 

A. Of the $1.3 million the Board is requesting for travel expenses for fiscal year 

2012, what portion is attributable to the costs of travel (or field) hearings? 

Response. Of the $1.3 million the Board is requesting for fiscal year 2012, the 

Board projects spending $1.1 million on travel associated with conducting in-person 

hearings at field offices. 

B. What accounts for the 37% increase in travel costs since fiscal year 2010 (from 

$948,000 to $1.3 million)? 

Response. The 37% increase in travel costs represents the rising costs of air and 

rail travel, as well as the rising costs of fuel, and other incidental travel expenses. 

C. In total, how much was spent on travel hearings during fiscal year 2010 and 

how much is expected to be expended during fiscal year 2011? 

Response. In fiscal year 2010, the Board spent $804,330 on travel for Veterans 

Law Judges (VLJs) to conduct in-person hearings with Veterans and Appellants in 

field offices. In fiscal year 2011, the Board anticipates spending $1,000,000 on travel 

for VLJs to conduct in-person hearings in the field, due to the rising costs of air 

and rail travel, as well as the rising costs of fuel, and other incidental travel expenses. 

D. Please provide a comparison of the costs to conduct hearings via videoconference versus conducting travel hearings. 

Response. The Board spends nearly $1,000,000 per year on travel costs for VLJs 

to conduct in-person hearings with Veterans and Appellants in the field. By comparison, there are no travel expenses associated with conducting hearings via videoconference. There are costs associated with the initial purchase of videoconference 

equipment, as well as minimal maintenance costs for the equipment, but those costs 

are not covered by the Board. 

The increased use of video conference technology also creates a time savings. VLJs 

would have greater flexibility over time management because video hearings would 

be conducted more efficiently from the Board’s offices in Washington, VLJs would 

not lose time in the field due to travel days or to appellants failing to attend scheduled hearings. 

Question 3. According to the fiscal year 2012 budget request, the Board now expects to spend over $2.5 million on Other Services during fiscal year 2011, which 

is 177% higher than originally anticipated in the fiscal year 2011 budget ($923,000). 

For fiscal year 2012, the Board requests over $2 million for Other Services. 

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A. Please provide a detailed itemized list of how these funds would be spent in 

fiscal year 2011. To the extent any of these funds will be spent on contracts, please 

explain the nature of the contract and the expected outcomes. 

Response: (Dollars in Thousands) 

Credit Card Purchases 

Training Credit Card Purchases ....................................................................................................... $29 

Miscellaneous (locksmith, rental furniture) ..................................................................................... $3 

Customer Service Survey ...................................................................................................................... $300 

Office of Resolution Management (BVA shares operational cost of discrimination complaints) ....... $67 

OGC Hein Online and CyberFed (Federal Register materials and Law Journal articles) .................... $5 

Government Movers (miscellaneous task service (assemble/disassemble/repair workstation)) ......... $70 

West Group (legal database) ................................................................................................................ $244 

OT Utilities (summer utilities for overtime on weekend) ..................................................................... $110 

All-Shred (sensitive documents destruction) ....................................................................................... $24 

FaxPlus (maintenance contract for office fax) ..................................................................................... $5 

Promisel & Korn (electronic research tool) .......................................................................................... $559 

Independent Medical Expert (expert medical opinions) ....................................................................... $60 

VA Franchise Funds (Financial Service Center) ................................................................................... $27 

Payroll support services, fiscal services 

Security and Investigation Centers .................................................................................................. $1 

Investigative services 

Transcription services 

York .............................................................................................................................................. $250 

Diaz .............................................................................................................................................. $250 

Bell ............................................................................................................................................... $250 

B. Please provide a detailed itemized list of how these funds would be spent in 

fiscal year 2012. To the extent any of these funds will be spent on contracts, please 

explain the nature of the contract and the expected outcomes. 

Response: (Dollars in Thousands) 

Credit Card Purchases 

Training Credit Card Purchases ....................................................................................................... $35 

Miscellaneous (services) .................................................................................................................. $4 

Office of Resolution Management (BVA shares operational cost of discrimination complaints) ....... $67 

OGC Hein Online and CyberFed (Federal Register materials and Law Journal articles) .................... $5 

Government Movers (miscellaneous task service (assemble/disassemble/repair workstation)) ......... $70 

West Group (legal database) ................................................................................................................ $254 

OT Utilities (summer utilities for overtime on weekend) ..................................................................... $110 

All-Shred (sensitive documents destruction) ....................................................................................... $24 

FaxPlus (maintenance contract for office fax) ..................................................................................... $7 

Promisel & Korn (electronic research tool) .......................................................................................... $450 

Independent Medical Expert (expert medical opinions) ....................................................................... $60 

VA Franchise Funds (Financial Service Center) ................................................................................... $28 

Payroll support services, fiscal services 

Security and Investigation Centers .................................................................................................. $1 

Investigative services 

Transcription services 

York .............................................................................................................................................. $300 

Diaz .............................................................................................................................................. $300 

Bell ............................................................................................................................................... $300 

Question 4. According to the fiscal year 2012 budget request, the Board now ex- pects to spend over $400,000 on Supplies and Materials during fiscal year 2011, 

which is 89% higher than originally anticipated in the fiscal year 2011 budget. For 

fiscal year 2012, the Board requests $570,000 for Supplies and Materials, which is 

169% higher than originally requested for fiscal year 2011 and 43% higher than the 

Board now expects to spend during fiscal year 2011. 

A. What accounts for these increased expenditures during fiscal year 2011? 

Response. In fiscal year 2010, the Board spent $650,000 on Supplies and Mate- rials. The Board’s original fiscal year 2011 request for only $212,000 for Supplies 

and Materials was in error, and was not enough to meet the Board’s actual Supplies 

and Materials needs. 

B. What accounts for the increase between fiscal year 2011 and 2012? 

Response. The Board requested $570,000 for fiscal year 2012 in the Supplies and 

Materials category, which represents a 22.8% increase from fiscal year 2011 to fiscal 

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year 2010. This request would correct the error made by the Board in the 2011 

budget request for Supplies and Materials. 

Question 5. In fiscal years 2009 and 2010, the BVA published a Veterans Law Review using appropriated funds. In connection with the Committee’s February 2010 

hearing on VA’s fiscal year 2011 budget request, the BVA stated that this law review ‘‘serves as a training function’’ and that the BVA expected to spend slightly 

more than $34,000 to publish the 2010 edition. 

A. How much was actually spent during fiscal year 2010 on the operation and 

publication of the Veterans Law Review? 

Response. In fiscal year 2010, the total expenditures on publication of the Veterans Law Review were $35,885, spent almost entirely on printing costs. 

B. How much is expected to be expended on the operation and publication of the 

Veterans Law Review during fiscal year 2011 and how much is requested for this 

purpose in the fiscal year 2012 budget? 

Response. In fiscal year 2011, the expected expenditure for the Veterans Law Review (again almost entirely for printing costs) is approximately $27,000. This decrease in funding reflects a more accurate view of the requisite supply of volumes 

to be printed. 

In fiscal year 2012, the Board requested $90,000, which was an over-projection, 

based on actual costs and demand. 

C. What specific goals does BVA expect to accomplish through this initiative and 

what metrics are in place to gauge whether this initiative is meeting those goals? 

Response. The goal of the Veterans Law Review is to provide a forum to address 

the legal issues and policy concerns faced by an expanding universe of Veterans’ 

benefits law. It also provides interested Board attorneys and Veterans Law Judges 

with additional experience in researching, editing, and writing legal articles, as well 

as experience with the management of a complex project. The training aspect of participation in the Veterans Law Review is of great value to the Board in accomplishing its mission. 

It is important to note that the Board sponsors the publication of the Veterans 

Law Review by providing printing costs and occasional meeting space. All employees 

who contribute do so largely on their own time, without detriment to serving the 

Veterans whose appeals are before the Board. The Board’s goal in sponsoring the 

Veterans Law Review is to increase scholarship in the area of Veterans law. It also 

provides an important and exciting learning opportunity for interested Board attorneys and Veterans Law Judges to explore areas of the law in a critical and in-depth 

manner that is not generally possible in the day-to-day operations of the Board. In 

an indirect way, this serves as an important supplement to the Board’s other training programs to support the professional growth and development of our staff. The 

Board does not have any metrics in place to measure whether these goals are being 

met because these are not the types of goals that are subject to clear measurement. 

From the experience gained in publishing the first three volumes of the Veterans 

Law Review, however, the Board feels strongly that the very small costs of publishing the document are more than outweighed by the personal growth and development of our staff. 

D. Does VA consider the publication of this law review to be a mission critical 

activity? 

Response. The Board considers the legal scholarship created in the Veterans Law 

Review to play a critical role in the development of a robust legal community practicing Veterans law. The insight gained increases awareness in the Veterans bar 

and will increase the quality of the arguments before the Board, the United States 

Court of Appeals for Veterans Claims, the United States Court of Appeals for the 

Federal Circuit, and the Supreme Court in this unique area of law which, even after 

three decades of judicial review, is still in its relative infancy compared to most 

other areas of Federal jurisprudence. 

E. Has BVA or VA approached any law schools, bar associations, or other entities 

to determine whether they would be willing to publish a Veterans Law Review? 

Response. By creating the Veterans Law Review, the Board sought to fill an educational void in the increasingly complex world of Veterans’ benefits appellate adjudication. To date, the Board has not approached any law schools, bar association, 

or other entities to determine if any of them would be willing to take over the publishing of this law journal. 

Question 6. The fiscal year 2012 budget request includes $73.3 million to support 

544 employees for the Board. 

A. Please provide a breakdown of the positions that would be filled in fiscal year 

2012 (such as members of the Board, professional staff, and administrative staff) 

and the number of staff for each type of position. 

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Response. The breakdown of the 544 positions in fiscal year 2012 is as follows: 

Attorney Adviser ...................................... 345 

Veterans Law Judge ............................... 64 

All Other ................................................. 135 

B. How many members of the Board (or Veterans Law Judges) currently are employed by the BVA? 

Response. The Board currently employs 59 Veterans Law Judges, with five appointments currently pending at the White House. 

C. Please provide a breakdown of the percentage of Board members who were existing Board employees when selected to become a Board member; the percentage 

who were selected from other VA offices; and the percentage who were selected from 

outside of VA. 

Response. With respect to the Board’s current 59 Veterans Law Judges, the percentage who were, or were not, already Board employees when selected is broken 

down as follows: 

• Percentage of Board members who were existing Board employees (95%) • Percentage who were selected from other VA offices (5%) • Percentage who were selected from outside of VA (0%) 

General Counsel 

Question 1. Within the Office of General Counsel, Professional Staff Group (PSG) 

VII represents VA before the U.S. Court of Appeals for Veterans Claims. 

A. How many employees currently are assigned to PSG VII? 

Response. As of March 15, 2011, there are 119 FTEE assigned to PSG VII (one 

is currently serving on active duty with the Navy). 

B. Currently, what is the average caseload handled by PSG VII attorneys? 

Response. There are approximately 40 active cases per attorney on average. An 

active case is one in which the Secretary’s dispositive pleading has yet to be filed. 

C. For fiscal year 2012, what level of funding would be dedicated to supporting 

PSG VII and how many employees would that level of funding support? Response. The FY 2012 budget request would allocate $17.1M in funding to PSG 

VII, which would support 131 FTEE. 

D. With the requested level of funding for fiscal year 2012, what would be the 

average caseload for attorneys in PSG VII? 

Response. Barring any unforeseen events, we anticipate that the caseload would 

average around 36 active cases per attorney at the projected FY 2012 funding level. 

E. How many motions for extension of time did PSG VII file during fiscal year 

2010? 

Response. PSG VII filed 3,411 extension motions on behalf of the Secretary during 

FY 2010, which represented approximately 284 extension motions per month on average. 

F. To date, how many motions for extension of time have been filed by PSG VII 

during fiscal year 2011? 

Response. During the period extending from October 1, 2010 to February 28, 2011, 

PSG VII filed 642 extension motions on behalf of the Secretary, which represented 

approximately 128 extension motions per month on average. 

Question 2. For many years, the Office of General Counsel has been involved in 

a project known as the VA Regulation Rewrite Project. 

A. What is the status of that project? 

Response. VA has published 20 Notices of Proposed Rulemaking (NPRMs), which 

encompass all of VA’s compensation and pension regulations in Part 3 of 38 CFR. 

Because the Compensation and Pension (C&P) Regulation Rewrite Project is a 

major, comprehensive reorganization, updating, as well as redrafting of these regulations, VA compiled its responses to public comments submitted on all 20 of the 

proposed rules into a single final rule document. Due to the enormity of the project 

and based upon requests from several Veterans Service Organizations (VSOs), VA 

is giving the public and VSOs an additional opportunity to review and comment on 

the entire new Part 5 in a second, consolidated NPRM. Once this large NPRM is 

published and the public has had an opportunity to comment, VA will make final 

revisions and publish the Final Rule. 

B. Please provide a timeline of the remaining milestones for this project. 

Response. The current C&P Regulation Rewrite Project schedule calls for publication of the consolidated NPRM by November 1, 2011, and publication of the Final 

Rule by January 1, 2013. VA’s Office of the General Counsel (OGC) will continue 

to oversee the transition to the new Part 5 CFR from the existing Part 3 provisions 

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for several years, until Part 3 provisions are no longer applicable to any Veterans’ 

claims. 

C. To date, how much has been expended in connection with this project and how 

much is requested for fiscal year 2012? 

Response. The C&P Regulation Rewrite Project is not a separate entity nor is it 

separately funded. OGC’s Office of Regulation Policy & Management (ORPM) is responsible for the project which consumes about 10% of its time. 

ORPM’s budget has ranged from $1.3M–1.4M a year. Therefore, the cost associated with the C&P Regulation Rewrite Project is approximately $130–140K per year 

and amounts to about $1M since 2004. 

Consistent with previous fiscal years, OGC anticipates devoting approximately 

$140K to the project in FY 2012. 

D. How many Office of General Counsel employees currently are dedicated to that 

project? 

Response. Currently, two ORPM FTEE in OGC are assigned responsibilities associated with the C&P Regulation Rewrite Project. The Deputy Director for ORPM supervises the project and spends approximately 75% of his time managing that process. One additional ORPM employee spends about 10% of her time on the project. 

In addition, two attorneys—one from C&P Service and one from the Board of Veterans Appeals (BVA)—remain detailed to ORPM for the Project. ORPM uses unpaid 

student interns for academic credit. Other attorneys in OGC perform legal reviews 

for the proposed regulations, as they do for all VA regulations, but their time spent 

on this project is not tracked separately from their other rulemaking work. 

E. With the funding requested for fiscal year 2012, how many Office of General 

Counsel employees would be dedicated to this project during fiscal year 2012? 

Response. There would be no change in the number of OGC employees dedicated 

to the C&P Regulation Rewrite Project during fiscal year 2012. 

Office of Management 

Question 1. The fiscal year 2012 budget request for the Office of Management includes the following information: 

As a result of the centralization of certified invoice payments at the [Financial Services Center], continued improvements have been made in reducing 

interest penalty payments and increasing discounts. Centralization resulted 

in a decrease of 24% in interest penalties per million dollars disbursed to 

commercial vendors from $47 per million in 2009 to $35 per million in 2010. 

A. In total, how much did VA spend on interest penalties during fiscal year 2010? 

Response. VA spends $854.3K on interest penalties during fiscal year 2010. 

B. In total, how much is expected to be spent during fiscal years 2011 and 2012 

on interest penalties? 

Response. During fiscal year 2011 $732.7K is expected to be spent and $696.0K 

in fiscal year 2012. 

Question 2. According to the fiscal year 2012 budget request, the Office of Management now plans to spend over $50 million on Other Services during fiscal year 

2011, which is 35% higher than the amount VA originally anticipated would be 

spent on Other Services during fiscal year 2011. For fiscal year 2012, the Office of 

Management is requesting over $42 million for Other Services. 

A. What accounts for that increase in spending during fiscal year 2011? 

Response. The 2011 current estimate for ‘‘Other Services’’ is $13.1 million above 

the amounts identified in the original 2011. This funding is for initiatives that were 

scheduled to be obligated at the end of 2010, but will now be obligated in 2011. 

These initiatives will help transform Department-level management by improving 

accountability, efficiency, and Veteran safety throughout the system. 

Also contributing to the higher 2011 estimate is an increase in billing of $3.2 million for payroll services from the Defense Finance & Accounting Service (DFAS). 

B. Please provide an itemized list of what expenditures would be made with these 

funds during fiscal year 2011 and fiscal year 2012. To the extent any of these funds 

will be spent on contracts, please explain the nature of the contract and the expected outcomes. 

Response: 

2011 ‘‘Other Services’’: 

• $31.3 million for the Defense Finance & Accounting Services (DFAS) contract. 

DFAS provides VA with all of its payroll services. 

• $3.9 million for Office of Business Oversight work in the areas of internal controls, contractual review, A–123 audits and Open Government. 

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• $4.3 million for contracts to support: Audit readiness contracts; Service Level 

Agreements (SLAs) for IT and H.R. support and services provided by the Financial 

Services Center (FSC); training; space, lease and moving expenses 

• $11.4 million for transformation and financial management initiatives that will 

improve Department-level management, accountability, and efficiency, including development of an integrated operating model and cost accounting enhancements. 

2012 ‘‘Other Services’’: 

• $32.7 million for the Defense Finance & Accounting Services (DFAS) contract. 

DFAS provides VA with all of its payroll services. 

• $3.6 million for Office of Business Oversight work in the areas of internal controls, contractual review, A–123 audits and Open Government. 

• $1.5 million for contracts to support: Audit readiness contracts; Service Level 

Agreements (SLAs) for IT and H.R. support and services provided by the Financial 

Services Center (FSC); training; space, lease and moving expenses. 

• $4.4 million for transformation and financial management initiatives that will 

improve Department-level management, accountability, and efficiency, including development of an integrated operating model and cost accounting enhancements. 

Question 3. According to the fiscal year 2012 budget request, the Office of Finance 

within the Office of Management manages the financial operations at VA’s Debt 

Management Center. 

A. For the completeness of the record, please describe the scope of responsibilities 

of the Debt Management Center. 

Response. The Debt Management Center (DMC) is responsible for collecting debts 

that arise from an individual’s participation in any VA benefit program. If DMC is 

unable to affect collection, they are responsible for referring the debt to the Department of the Treasury for offset under the Treasury Offset Program or further collection action by collection agencies under contract with the Department of the Treasury. 

B. How many telephone lines does the Debt Management Center currently operate and how many operators are dedicated to answering those telephones? 

Response. DMC is currently operating 28 toll-free telephone lines with 37 operators. To provide expanded service to Veterans, the DMC increased the telephone 

service hours from 7:30 AM to 6:00 PM effective September 2010. 

C. How many telephone operators are expected to be assigned to the Debt Management Center during fiscal year 2012? 

Response. DMC expects to increase staffing levels to 40 operators within the next 

three months and maintain that staffing level into fiscal year 2012. DMC will continue to monitor workload throughout fiscal year 2011 and into fiscal year 2012 and 

will adjust staffing levels as needed. 

D. During fiscal year 2010, how many debts were referred to the Debt Management Center, what was the total value of those debts, and how much did the Debt 

Management Center recoup? 

Response. DMC provided collection services for all VA benefit programs, which include education, compensation, pension, and loan guaranty. Debts are automatically 

created and referred to DMC when an adjustment is made to a beneficiary’s award 

that reduces his/her entitlement. During FY 2010, DMC received 595,354 new debts 

valued at $1,349,099,996. Collections/offsets for the fiscal year on all debts totaled 

$1,018,347,000. 

E. How many debts are expected to be referred to the Debt Management Center 

during fiscal year 2011 and during fiscal year 2012? 

Response. DMC experienced an increase of 37% in total number of new debts referred from fiscal year 2009 to fiscal year 2010. This is attributable, for the most 

part, to the implementation of the new Post-9/11 GI Bill Program, where an individual can have multiple debts on their record at any given time. For example, an 

individual could have an outstanding advance payment as well as tuition and fees 

overpayment and a housing allowance overpayment all at the same time. Based on 

the expected number of Post-9/11 GI Bill Program participants in receipt of benefits 

and the increase in related debts experienced in fiscal year 2010, the DMC expects 

the percentage of new debts will increase by similar amounts in fiscal years 2011 

and 2012. Based on that percentage, DMC expects to have 815,881 new debts referred in fiscal year 2011 and 1,117,763 new debts referred in fiscal year 2012. 

F. What performance measures are used to determine the effectiveness of the 

Debt Management Center? 

Response. DMC currently has six performance measures they use to determine effectiveness of operations. They are: 

(1) Timeliness of Deposits (Goal—Deposit within 2 business days) 

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(2) Timely Response to Congressional Inquiries (Goal—Respond within 5 business 

days) 

(3) Timely Response to General Correspondence (Goal—Respond within 12 business days) 

(4) Lost Call Rate (Goal—Maintain a lost call rate of less than 5%) 

(5) Timely Application of Unapplied Funds (Goal—Identify and apply funds within 

60 calendar days) 

(6) DMC Efficiency and Effectiveness (Goal—Meet or exceed expected rate of return) 

G. In terms of those metrics, please explain the performance of the Debt Management Center during fiscal year 2010 and to date during fiscal year 2011. 

Response. During FY 2010, DMC performed accordingly: 

Timeliness of Deposits—Averaged deposits within 1 day measured against a goal 

of 2 business days. 

Timely Response to Congressional Inquiries—Averaged responses within 4.21 days 

measured against a goal of 5 business days. 

Timely Response to General Correspondence—Averaged responses within 11.12 

business days measured against a goal of 12 business days. 

Lost Call Rate—Averaged a 2.28% lost call rate against a goal of less than 5%. 

Timely Application of Unapplied Funds—Averaged application within 49 calendar 

days measured against a goal of 60 calendar days. 

DMC Efficiency and Effectiveness—Achieved a rate of return of $114.25 for every 

dollar spent measured against a goal of $80.88. 

During FY 2011 to date, DMC performed accordingly: 

Timeliness of Deposits—Averaged deposits within 1.2 days measured against a 

goal of 2 business days. 

Timely Response to Congressional Inquiries—Averaged responses within 4.74 business days measured against a goal of 5 business days. 

Timely Response to General Correspondence—Averaged responses within 11.5 

business days measured against a goal of 12 business days. 

Lost Call Rate—Averaged a lost call rate of 2.22% measured against a goal of less 

than 5%. 

Timely Application of Unapplied Funds—Averaged application within 52 calendar 

days measured against a goal of 60 calendar days. 

DMC Efficiency and Effectiveness—For first quarter, achieved a rate of return of 

$136.24 for every dollar spent measured against a goal of $125.00. 

H. What would be the expected performance outcomes for the Debt Management 

Center during fiscal year 2012? 

Response. DMC plans to maintain current performance measures and expects to 

meet or exceed those performance measures during fiscal year 2012. 

Office of Human Resources and Administration 

Question 1. In connection with the Committee’s February 2010 hearing on VA’s 

Fiscal Year 2011 budget request, VA provided the following explanation for the $14 

million difference between what had been requested for travel for fiscal year 2010 

($2.4 million) for the Office of Human Resources and Administration and the 

amount then expected to be spent on travel by that office ($16.8 million): 

Under VA’s new corporate level training program, all travel and training 

are managed, obligated and reported by the [Human Capital Investment 

Plan (HCIP)] at the corporate level. Costs that previously may have been 

obligated and reported at the field level are now reported at the corporate 

level under HCIP. 

A. Please explain in more detail the change in the reporting methods for travel 

and training costs. 

Response. Last year, VA Learning University assumed responsibility for managing all Human Resources and Administration sponsored training related travel. 

This effectively centralized this function and created a level of efficiency in support 

of VA’s training goals. 

During the first quarter of FY 2011, VALU has provided over 54,000 training opportunities (Functional Specific Training, Leadership and Management, Project/Program Manager Training, Transformation Training, Customer Service, and Union 

Training for Managers/Leaders) utilizing various modalities. 

B. As a result of this corporate level reporting of travel training costs, were there 

decreases in the travel budgets for other offices during fiscal year 2010? If so, please 

identify any such decreases. 

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Response. VA believes that as we implement more VALU on-line training, travel 

budgets will decrease and VA has incorporated this trend in its estimates. VA estimates VA-wide travel of $252 million which is expected to decrease by $7 million 

or 2.7% from the 2011 estimated level. 

C. What metrics are used to determine which staff needs to travel? 

Response. Our travel cost is executed against VALU sponsored training programs 

derived from a requirements process that identifies critical training needs and fills 

training gaps identified by the VA Administration(s) and VA Staff Offices. VALU 

also provides training to the field in centralized locations where there are areas of 

high concentration of VA employees allowing for a reduction in expected travel that 

would have been incurred to support the training efforts. 

D. What options (such as video conference, webinars, or local options) were explored to reduce the costs to the taxpayer? 

Response. The vast majority of training conducted by VALU ( HRA) is conducted 

through its online Learning Management System (LMS) which is the most cost effective way to train thousands of VA employees. Training is also being conducted 

through various modalities, including non-LMS online training, video conferencing, 

training hubs/clusters in the field, and at various existing training facilities (such 

as the VA Acquisition Academy, IT Training Academy, Office of Personnel Management, etc.) This technical training supports our VA professional employees deployed 

in very small numbers in any specific facility, and needing very specific training targeted to their profession. The training venues offer highly interactive, case study 

and scenario-based training to large numbers of a specific professional group (i.e. 

financial management professionals). This training modality is an efficient and effective means of targeting our professional career fields. 

Question 2. In connection with the Committee’s February 2010 hearing on VA’s 

fiscal year 2011 budget request, VA projected that, during fiscal year 2011, 8,800 

employees would take trips and that each trip would cost on average $2,000, at a 

total cost of $17.6 million in travel expenses for the Office of Human Resources and 

Administration. According to the fiscal year 2012 budget request, the Office of 

Human Resources and Administration now expects to spend over $27 million on 

travel during fiscal year 2011, which is nearly $10 million more than this office requested for travel funds in VA’s fiscal year 2011 budget proposal. For fiscal year 

2012, this office is requesting over $28 million for travel expenses. 

A. To date, how many employees have traveled during fiscal year 2011 and what 

was the average cost per trip? 

Response. Through February 2011, VALU has expensed travel cost for 2,194 VA 

employees taking training and the average cost for fiscal year 2011 is $1,196.82 per 

trip. Some employees have travelled more than once. The total cost of VALU sponsored travel is $3.8 million through February 2011. 

B. Has this office made any changes in light of this recommendation of the National Commission on Fiscal Responsibility and Reform: ‘‘Reduce Federal travel.’’ If 

so, please explain. 

Response. Yes. We are addressing this by providing training conference venues 

where we are able to reach a larger number of VA employees in a centralized location and reduce the number and frequency of smaller scale technical training 

events. We are also providing the vast majority of our training courses via VA’s online LMS. 

C. During fiscal year 2011, how was the additional $10 million now allocated for 

travel originally expected to be spent? 

Response. The $10 million reflected in the current budget for travel was originally 

requested in FY 2011 to fund VA staff training. 

D. What factors account for the over $1 million increase in expected travel expenses between fiscal year 2011 and fiscal year 2012? 

Response. The 4.7 percent increase in travel cost from FY 2011 to FY 2012 is primarily due, in part, to anticipated inflation. 

E. For fiscal year 2012, how many trips is the $28 million expected to support? 

Response. We expect that $28 million would support the travel of over 13,000 

trips to training courses 

Question 3. For fiscal year 2012, the Office of Human Resources and Administration is requesting over $309 million for Other Services. 

A. Please provide a detailed itemized list of how these funds are expected to be 

spent. 

Response. The majority of the Other Services category of obligations is for contracts ($308.6 million) and is detailed in the response to 3B. The remaining $790 

thousand is for maintenance and repair services, including the repair of furniture 

and equipment. 

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B. To the extent any of these funds will be spent on contracts, please explain the 

expected nature of the contract and the expected outcomes. 

Response. The Other Services category of obligations includes the contracts detailed below. 

Training, Development and Management: 

Corporate Senior Executive Management Office ($9.5 million): The Corporate Senior Executive Management Office (CSEMO) centrally manages the recruitment actions for all 407 executive positions, has oversight of the VA-wide corporate Executive Resources Board, oversees and manages Executive Performance Management, 

leads the new VA SES Orientation Program and provides formalized SES On-Boarding. Initiatives under the Corporate Management Office include executive coaching 

and leadership development, the creation of a new performance management system 

that makes meaningful distinctions in performance, and the development of a collaborative Web site for VA executives. 

Leadership Assessment/Competency ($1 million): Targeting senior leaders, managers and supervisors, this contract is aimed at assessing and developing leaders 

across VA to foster and support a strong, capable leadership corps, and ensure that 

VA leaders have the skills and proficiency to effectively lead people and programs. 

Program evaluation elements will complement organizational leadership evaluation 

and assessments performed by the National Center for Organizational Development. 

Evaluation activities will include a review and acceptance of proposed certification 

and standards by VA and OPM general counsel. 

Leadership Infusion ($4.3 million): This initiative procures seats in pre-designed 

and custom leadership and management training programs through the U.S. Office 

of Personnel Management (OPM) Center for Leadership Capacity Services (CLCS). 

These pre-designed training programs are designed to increase proficiency in each 

leadership competency and improve performance at the supervisor, manager, and 

executive levels of across the Department. 

Basic/Advanced Supervisory Management Training ($30.5 million): To Reach 

nearly 22,000 managers and supervisors, VA has implemented an enterprise-wide, 

corporate university approach to supervisory and management training. This initiative includes development of all aspects of competency-based basic and advanced supervisory and management training programs, development and delivery of training 

using multiple modalities and production of documents and materials needed to conduct instructor-based training, and analysis, design, and development support to VA 

production staff to produce video, VA knowledge network satellite, graphics, and 

eLearning materials. In addition, the project will include the testing of training materials and implementation of training programs and evaluations. 

Transformational Leadership ($10 million): This contract will enable design, development, and delivery of training programs that result in increased proficiency in 

each competency and enable optimization of performance for leaders at the supervisor, manager, and executive levels of leadership. The proposal reflects five major 

facets of work: (a) development of a Transformational Leadership Competency 

Model, (b) a framework for senior leader training identified as the Senior Leadership Academy, (c) options for manager and supervisor training, (d) objectives for 

program related assessment and evaluation through engagement with the National 

Center for Organizational Development and (e) linkages with the VA Transformation Communication Strategy. 

National Center for Organizational Development (NCOD) ($3.6 million): NCOD 

will evaluate the effectiveness of the VA’s Human Capital Improvement Plan 

(HCIP) initiatives through the development of an HCIP performance tracking dashboard, 360 degree assessments of managers, supervisors and executives, and onsite 

Organizational Assessments for identified VA Organizations to assess specific areas 

of focus (e.g., Information Technology, Human Resources). NCOD will conduct assessments utilizing multiple measures (surveys, focus groups, interviews, etc.) to objectively evaluate organizations within VA, including employees and leadership. Results from the assessments will guide and support ongoing HCIP initiatives and 

training development to ensure that curriculum meets identified gaps. NCOD will 

also implement the Civility, Respect, and Engagement in the Workforce (CREW) initiative across all of VA. CREW was created to improve employee satisfaction and 

success in meeting performance measures while decreasing conflict in the workplace. Finally, NCOD will expand the VHA All Employee Survey (AES) to encompass all VA employees once per year and will provide the necessary coordinator 

training, organizational mapping, marketing activities, administration coordination, 

data analysis and presentation, and support for action plan development. 

Office of Information and Technology (OI&T) Workforce Training Program ($28.7 

million): Contractor support is needed to both maintain VA’s OI&T Supervisor comVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00316 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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petency model and implement it for CIOs and application software developers. The 

scope of the required role-specific professional development activities covers the following primary tasks: 

• Provide administrative support for the establishment of a program office to establish processes and provide administrative support for program review, development of program milestones, resource allocation, and monitor milestone progress; 

• Provide operations and maintenance support for the Information Security Officer (ISO) Competency Model and develop courseware to fill gaps in the supervisor 

curriculum; 

• Implement the CIO Professional Development Program; 

• Initiate and implement Application Software Developers Professional Development Program; 

• Provide operations and maintenance support for the OI&T Supervisory Program 

and develop courseware to fill gaps in the Supervisory Training Program curriculum; 

• Develop and implement an On-Boarding Program to orient and integrate new 

employees into the Office of Information and Technology; 

• Develop and implement an intern program to begin building bench strength and 

a labor pool in newer technologies; and 

• Develop and implement a vendor-supplied certification and voucher program 

that includes IT-related technical and professional development certification. 

HR Academy ($5.8 million): The H.R. Academy will support the more than 3,800 

VA H.R. professionals ranging from GS–7 to GS–15 in their career development, 

skills, and abilities. A gap analysis of 22 core competencies and specialized skills 

determined several areas in need of improvement. By closing the known gaps 

through a standardized, organized H.R. Academy and associated curricula, VA H.R. 

professionals will gain the ability to advance their proficiencies in order to provide 

improved service to clients and customers. Academy plans call for the implementation of certification programs as well the creation of a cadre of exemplary H.R. professionals who can provide consultation and operational service at the highest levels 

of industry standards. The H.R. Academy will be a virtual ‘‘Academy’’ that provides 

course curricula at three levels of practice: Practitioner, Expert Practitioner, and 

Advanced/Leader. The curricula will consist of online and classroom training programs that are easily available through a variety of vendors and modalities, costeffective, and demonstrably able to close proficiency gaps. 

VA Acquisition Academy ($19.9 million): Specifically mandated by the Office of 

Federal Procurement Policy, is the requirement to establish Federal Acquisition 

Certification-Program/Project Managers (FAC-P/PM) as a structured career development program for P/PMs throughout Federal civilian agencies. The Academy will be 

designed to address gaps in program and project management skills critical to the 

success of major departmental initiatives. In particular, it will train the Acquisition 

and Information Technology workforce and other employees requiring project and 

program management training and/or certification to meet the FAC-P/PM competencies. The project will acquire commercial or government training in support of 

Supply Chain Management (SCM) and other acquisitions and logistics management 

curricula, provide training for employees requiring Contracting Officer’s Technical 

Representative (COTR), and support the formation of the VA Facilities Management 

Academy program. The development of Project Management skills meets another 

goal: the shortage of project management skills among IT and other critical mission 

occupations have resulted in costly and poorly managed programs in the past. 

Program Based Training ($32.7 million): The purpose of this project is to design, 

develop, and implement program based training for approximately 40,000 employees 

in cross-cutting career fields not previously identified for action. Examples of career 

fields include all VA Staff Offices and new groups set up to implement the 13 major 

initiatives, which represent the Department’s highest priorities and include Management Analysts, Program Analysts, Budget Analysts, Accountants, Auditors, Executive and Staff Assistants, Human Resources Liaisons, Paralegals and Legal Assistants, Project Managers, and Contracting Officers Technical Representatives. 

These training programs shall be offered in a wide variety of training methodologies 

including e-Learning, facilitated and instructor-led group events, and independent 

study. 

Workforce Planning and Career Broadening ($26.2 million): Focused on ensuring 

that the VA is prepared for the future and on the development and retention of a 

skilled workforce, these initiatives will first target 44,000 VA employees in missioncritical positions. The VA will create a workforce planning program to centrally coordinate the development and retention of a critical staff throughout the entire Department. 

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VA Learning University ($7.7 million): VA Learning University (VALU) contracts 

will cover program expenses associated with providing educational programs to the 

Department’s employees through established learning technology infrastructure. 

While core programs rely heavily on remote and on-line training delivery through 

the Department’s Learning Management System to minimize costs, VALU will also 

utilize Leadership VA, Mentor Training to support the VA Central Office Leadership 

Development Mentoring Program, the Aspiring Leaders Program and other special 

emphasis training programs. Skillsoft License renewals ($1.6 million): This ongoing contract will continue to 

provide VA employee access to online courses and digital online books, job aids, educational reference materials and other courseware through OPM’s Government Online Learning Center. The content is available to VA employees through the VA 

Learning Management System. 

Improvements to Human Resources Processes and Systems: 

Hiring Reform: Improving VA Central Office H.R. Service (COHRS) and Knowl- edge Management ($5.5 million): One of the major goals of this initiative is to 

streamline the VA’s processes for recruiting and hiring qualified personnel. This 

contract will support H.R. business process reengineering, service level agreements, 

new standard operating procedures, employee competency assessments and the creation of individual development plans. It will include the development of libraries 

of up-to-date position descriptions and functional statement for core positions, the 

design and implementation of an on-boarding tool, workload tracking tool, redesign 

the COHRS Web site, and the development of universally applicable position descriptions/functional statements for identical work performed Department-wide, and 

the development of a Knowledge Management system. Human Resources Information System ($53.5 million): This project is the central 

component of an overall VA H.R. enterprise-level initiative that will upgrade the 

VA’s antiquated COBOL-based H.R. processing systems. The new Human Resources 

Information System (HRIS) will replace the existing paper driven Personnel and Accounting Integrated Data System (PAID) with an ‘‘off-the-shelf’’ solution that will 

be provided by an approved OPM Human Resources Line of Business Shared Service Center (SSC). The SSC provider will offer proven modern HRIS services to VA 

for a fee, based on the nature of the services provided and the number of employees 

serviced in a year. This service will eliminate the manually laden basic transactional and maintenance work by current H.R. staff associated with PAID, paper 

driven processes, and disconnected applications. Recruitment/Centralized Intern Hiring Projects ($8.2 million): To meet VA’s succession planning needs into the future, VA will need to strengthen its employment 

pipeline by consolidating its various internship programs. Focused recruitment will 

ensure new talent by increasing the number of Presidential Management Fellows 

and other student/graduate appointments. Other recruitment contracts will improve 

the process and tools for hiring, the on-boarding process, and retention of acquired 

talent. 

Veterans Employment Initiatives ($16.4 million): Contract funds will support the 

implementation of VA’s Veterans Employment Strategic Plan to support increased 

hiring of Veterans at VA and support the President’s Executive Order on Veterans 

employment. The recruiting, retention, and reintegration program is designed to recruit from a pool of 23 million Non-VA Veterans, retain the 90,000 VA Veteran employees currently working for the Department, increase the percentage of Veterans 

employed to VA established goals, and provide reintegration assistance for the 7,000 

VA Military Servicemembers who are eligible for deployment. The contract funds 

will be used to stand up a new Veteran recruiting, retention, and reintegration office 

and maintain a virtual career assessment center to assist in transitioning the military employee back to the workplace. 

Safety and Health: 

Worklife and Health and Wellness Initiatives ($5.3 million): Collectively, these initiatives address the quality of the work environment and are designed to improve 

employee performance, lower sick leave usage and increase productivity by promoting a positive life-style and a healthful working environment. Based on an 

agreement between VA and the Department of Health and Human Service, Federal 

Occupational Health (FOH), the objective of this program is to provide a range of 

options to help employees and their families balance personal and workplace responsibilities at every life stage. The FOH Wellness/Fitness Program includes access for 

all VA employees to an on-line health information program offering: a comprehensive lifestyle management center, on-line health risk assessment, tracking programs, personal improvement programs, and an online health encyclopedia. 

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Occupational Safety and Health ($4.1 million): Occupational Safety and Health 

(OSH) will implement initiatives contained in the Worker’s Compensation and Safety Strategic Plans, recommendations made by the Office of Inspector General in collaboration with Administration members of the VA Worker’s Compensation and 

Safety Steering Committees. Initiative contracts will be dedicated to improving safety and workers’ compensation program management (e.g., developing and implementing worker’s compensation case management), educational products, and safety 

surveys to provide improved program support and oversight. OSH expects to reduce 

program costs through the prevention of injuries and illnesses and by the reduction 

in employee injury costs, saving VA dollars and returning employees to work. 

Other Program Initiatives: 

Alternative Dispute Resolution ($1.5 million): Increased emphasis on the VA’s 

ADR program is expected to reduce conflict in the workplace and decrease the 

amount of time and money spent on EEO complaints and grievances. In order to 

promote leadership skills in the areas of effective communication, negotiation and 

problem solving, ORM has developed Department-wide curriculum for VA leaders 

on managing conflict. Ongoing Alternative Dispute Resolution (ADR) contract funds 

will enable ORM to continue implementation of a program that promotes leadership 

skills and conflict competency to include awareness of behaviors that escalate conflict, and skill in resolving disputes at the earliest stage possible. Contract funding 

will also support continued operation of the Resolution Support Center (RSC), a fullservice hotline established to serve as an additional resource to managers, employees and Veterans through which questions can be raised and consultative services 

and referrals provided by subject matter experts. In FY 2010, this program saved 

VA an estimated $80 million in costs associated with protracted EEO complaints. EEO and Diversity Programs ($10.8 million): The VA processes Equal Employment Opportunity (EEO) complaints for VA employees, applicants for employment, 

and former employees. Statutorily mandated complaint processing services include 

counseling, mediation, procedural determinations, and investigations. These services 

are provided through a nationwide network of ORM field operations offices. Contract 

funds are used for contract investigators, as well as, transcription services to capture the testimony of witnesses. VA will also continue to implement the Department-wide Diversity and Inclusion Strategic Plan for FY 2009—2013. This Plan represents a major transformation of the diversity management function in VA to a 

broader, more inclusive paradigm. Contract funds in the Office of Diversity and Inclusion (ODI) will support the implementation of the Plan’s strategies such as employee training, leadership development, and compliance oversight in the areas of 

diversity and disability program management to avoid costly liability associated 

with non-compliance with statutory obligations and EEOC requirements. ODI will 

expand its diversity-focused internship program, fully implement an EEOC-compliant Reasonable Accommodations Case Management System and expand the use of 

its centralized account to fund reasonable accommodations in support of the Americans with Disabilities Act Amendments Act of 2008 (ADAAA). 

Labor-Management Relations ($5.6 million): LMR promotes successful labor-management relationships that allow the Department to effectively manage its workforce while meeting its labor relations obligations. This contract effort will improve 

the relationship between labor unions and management by providing training to encourage and establish cooperative and productive labor-management partnerships. 

A range of training delivery strategies, including classroom and web-based training, 

may be utilized. Training may include establishment and maintenance of effective 

labor management forums. 

Emergency Employee Accountability ($2.8 million): This contract effort will develop an enterprise-wide personnel accountability system (PAS) to allow communications with and accounting for VA employees during a natural disaster, act of terrorism or other emergency. This initiative will improve VA ability to provide continuity of benefits and Veterans services as well as to serve the community in areas 

such as health care, in compliance with VA’s fourth mission to ‘‘Increase VA Capability to Support the Nation in Time of Need.’’ PAS will provide the capability for 

VA to alert andnotify employees and contractors by name and obtain responses as 

to their safety and ability to work during and immediately after declaration of the 

emergency. 

Office of Administration ($6.2 million): The Office of Administration (OA) serves 

as the VA’s hub for all building and facility related services for the VACO campus, 

comprised of eleven Washington area office buildings. On-going contract funds are 

required to support a clean, safe, attractive and accessible environment. Contract 

funding is requested to support the VACO Health Unit and Transit Benefits Program for employees. Funds will also be used to support the operations of OA’s leasVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00319 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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ing and space functions, simplified acquisitions, transportation and labor services, 

and audio/visual and media services needs. 

Strategic Operations ($7.4 million): The Strategic Management Group provides effective management and oversight over the Department’s Human Capital Improvement Plan initiatives. This contract funds administrative support for the establishment of a program review, development of program milestones, resource allocation, 

and for monitoring milestone progress. Contract activities include overall coordination and management of VA transformation and HCIP initiatives, assistance with 

the management of change and ongoing support of a project management office 

(PMO) support organization and staff. 

Question 4. The fiscal year 2012 budget request for the Office of Human Resources and Administration shows an increase of $288,000 or 136% over fiscal year 2010 for 

printing and reproduction. 

A. What accounts for that 136% increase in printing costs from fiscal year 2010? 

Response. The fiscal year 2012 budget request includes printing requirements 

that were not made during FY 2010 due to delays in employee relocation for the 

Lafayette Building renovation. HR&A is responsible for several administrative functions related to the VACO campus including printing and distributing customer 

service guides, Occupancy Emergency Response Guides, and Emergency Evacuation 

Procedures to all VACO campus employees. The FY 2012 printing costs will include 

publication of guides to employees in new VA spaces. The requested increase will 

also cover the printing of several new HR&A publications listed in response 4B. 

B. Please provide an itemized list of how these funds will be expended. 

Response. The increase request for FY 2012 printing funds is attributed to printing the following materials: 

• Customer Service Guide, Occupancy Emergency Response Guide, Emergency 

Evacuation Procedures. • Strategic Human Capital Plan. This Report is to be shared with VA senior leader and serves as a ‘‘roadmap’’ for the accomplishment of VA Strategic goals, objectives, and initiatives using our human capital resources. • Human Capital Management Report (jointly with the Office of Oversight & Effectiveness). This Report has a similar audience to the above. The Report indicates 

on an annual basis what VA was (or was not) able to accomplish using their human 

capital resources. • Knowledge Management (KM) User Guide and Overview. These two documents 

(the second being two-side laminated) will be used to educate our H.R. professional 

community and others on what Knowledge Management is and how to use the new 

KM program. • Workforce Planning Fact Sheet. This two-sided laminated document will serve 

a similar role, educating VA workforce planners on the Department’s new corporatewide Workforce Planning Program. 

Question 5. The fiscal year 2011 budget request included $3 million for a ‘‘Health 

and Wellness initiative,’’ which would fund a contract to an outside vendor. The 

‘‘Health and Wellness initiative’’ was again mentioned in the FY 2012 budget under 

the Human Capital Investment Plan. 

A. How much has been budgeted for FY 2012 for continuation of the ‘‘Health and 

Wellness initiative?’’ 

Response. In FY 2012, $3.04 million has been budgeted for the continuation of 

this initiative. 

B. How much of the $3 million was obligated to an outside vendor to support the 

initiative? Who was the outside vendor and how does VA evaluate their job performance? 

Response. In FY 2011, $2.7 million was obligated to Federal Occupational Health 

(FOH) via Inter-Agency Agreement with the Department of Health and Human 

Services. Performance is measured through: 

i. Employee Participation—The percentage of VA employees who sign up/register for the program and complete an online Health Risk Assessment (HRA). 

The Web site is designed and maintained by the vendor (FOH) and usage rates, 

drop off rates, etc. are monitored monthly through Executive Summary Reports. 

This measure provides quantitative data for the number and type of recognized 

health risk behaviors in VA. This data allows VA to focus on these behaviors 

and address them. The database also provides us with the demographic areas 

where high risk health behaviors exist and provides an overall ‘‘snapshot’’ of the 

state of wellness of VA employees. 

ii. Feedback Surveys—Volunteer feedback surveys will be available through 

the Web site. Surveys will contain questions on all program areas and results 

will be used to identify program strengths and weaknesses to improve upon. 

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The results of this data will be both qualitative and anecdotal, allowing for 

more detailed feedback on areas for program improvement. 

a. Using the performance metrics outlined by VA last year in response to Senator 

Burr’s questions for the record in connection with the February 2010 budget hearing, how effective has this program been in ‘‘promoting healthier employees?’’ 

Response. The program is still in its ‘‘Baseline Year.’’ Only quantitative data on 

levels of utilization and participation have been collected. Program effectiveness 

measures will be reviewed at six months and at the end of the fiscal year to assess 

for program modifications to better meet employee needs. The official VA-wide program launch took place September 23, 2010. As of March 3, 2011, 6.5 percent of VA 

employees had signed up and completed an HRA. Program effectiveness results will 

also be identified with the Employee Feedback Survey which is scheduled for dissemination at approximately the six-month point of the program (April 2011) and 

will be available continuously so employees may provide feedback at any time. 

b. Please outline the number of personal health coaches and active program coordinators, how they are chosen, and how their performance is measured. 

Response. There are 120 Lifestyle Coaches. Coaches were selected after completing the Healthy Lifestyle Coach requirements (Bachelors degree or higher in 

health promotion, health education background, counseling or other health related 

field and at least one year of experience in coaching). Coaches go through initial 

training and then will have ongoing evaluation and training. Measurement of FOH 

coach utilization and goals set by the employee will be ongoing. Employee health 

risk assessments will be reviewed by the coaches and then discussed with the employee to identify significant changes that merit tailoring of program elements to 

meet their needs. 

There are 330 Local Wellness Representatives who serve as program coordinators. 

This position is a voluntary and collateral position within the VA; representatives 

volunteer for this position in addition to their regular duties. They must have an 

overall interest in health and wellness promotion and be committed to serving as 

the liaison between the Health and Wellness Team, who oversee the VA-wide 

wellness program, and the on-site employee. The most direct measure for Wellness 

Representatives’ performance is the overall participation rate at their respective 

sites. 

Office of Policy and Planning 

Question 1. For fiscal year 2012, the Office of Policy and Planning is requesting over $20.7 million to support 125 employees. This would be an 87% increase in staffing since fiscal year 2010, a 21% increase over fiscal year 2011 staffing levels, and 

a 127% increase over fiscal year 2008 staffing levels. 

Response. For clarification, the Office of Policy and Planning (OPP) is requesting a total of 105 full time equivalent (FTE) ($17.6 million) in the fiscal year (FY) 2012 

budget authority, an increase of 2 FTE over the FY 2011 request and 12 FTE over 

the FY 2010 request. The additional 20 FTE ($3.1 million) would be assigned to the 

Enterprise Program Management Office (ePMO). The ePMO was attached to OPP 

in late 2010, after the FY 2011 budget submission, as a pilot program. It is responsible for developing Department-wide program management standards/doctrine; supporting the execution of the Department’s $2.5 billion portfolio of the 16 major initiatives, and assisting the Department’s 20 supporting initiatives. The ePMO brings 

program management capabilities to large scale programs; is helping VA develop a 

program management culture; and will facilitate the successful development of future programs throughout the Department. In the last month alone, the ePMO has 

led a concentrated effort that has resulted in the awarding of $63.3 million in contracts and the preparation of $104.5 million of actionable contract packages in support of 16 major initiatives (see list of initiatives following response to question 3D). 

Since the ePMO provides Department-wide services, the operating expenses of the 

ePMO will be paid via reimbursements from the Veterans Benefit Administration 

(VBA), the Veterans Health Administration (VHA), and the Office of Information 

and Technology (OIT) in FY 2011 and FY 2012. The ePMO currently consists of a 

small cadre of six FTE and contract support. As the ePMO is proving to be successful in helping the Department to develop more effective program management capabilities, it is anticipated that the ePMO will be incorporated into OPP’s budget authority request for FY 2013, subject to the approval of the Department’s leadership. 

A. What measurable performance outcomes would suggest whether the previous 

staffing increases have been effective? 

Response. Since 2009, staffing increases have allowed OPP to establish the Office 

of Corporate Analysis and Evaluation (CA&E) and the Transformation and Innovation Service (TIS). We have also dedicated additional resources to the National Center for Veterans Analysis and Statistics (NCVAS) and the VA/DOD Collaboration 

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Service. As a result of these additional resources, OPP has been able to improve outcomes to Veterans during FY 2010 and FY 2011 in support of the four key integrated strategies articulated in the VA Strategic Plan. 

Enhance our understanding of Veterans’ and their families’ expectations by collecting and analyzing client satisfaction data and other key inputs. 

• Completed the National Survey of Veterans, a comprehensive nationwide survey 

of Veterans, active duty servicemembers, activated National Guard and Reserve 

members and family members and survivors. Data collected through the National 

Survey enables VA to compare characteristics of Veterans who use VA benefits and 

services with those of Veterans who do not; and study VA’s role in the delivery of 

all benefits and services Veterans receive. • Established VA data governance policy and processes to ensure VA enterprise 

data and information are available, current, reliable, readily accessible, and useful. 

Developed and implemented business intelligence capabilities and tools to transform 

data into information to support data-driven planning, analysis, and decisionmaking 

activities. 

Anticipate and proactively prepare for the needs of Veterans, their families, and 

our employees. 

• Improved VA policy toward Gulf War Veterans by advocating for the implementation of recommendations made by the Advisory Committee on Gulf War Veterans. 

Produced a comprehensive annual report on the use of selected VA benefits and 

services by pre-9/11 Gulf War Era Veterans. The recommendations included presumptive criteria for a number of serious illnesses for which Veterans will now be 

eligible to receive treatment from VA. • Completed the Program Evaluation of VA’s Mental Health Program. This study 

provided VA with information about the services it provides, the impact on Veterans, how VA compares to the private sector, patient outcomes, and costs. Study 

findings and recommendations are used to refine and improve VA services by suggesting policy and operating changes. 

Create and maintain an effective, integrated Department-wide management capability to make data-driven decisions, allocate resources, and manage results. 

• Began the implementation of planning, programming, budgeting, and evaluation (PPBE) capabilities to implement multi-year strategic resource allocation system across the Department and independent analysis to inform senior level decisionmaking on resource options. CA&E is an independent body dedicated to aligning VA 

resource allocations with investments that best serve our Veterans, their families, 

dependents, and survivors. • Implemented the new strategic management process for VA. This process uses 

strategy to drive the budget and performance plans, and aligns the execution of VA 

strategy with performance management and organizational and individual accountability in an iterative way. This process centers on implementing the strategic goals, 

integrated objectives, and integrated strategies throughout VA. • Ensured the success of Departmental transformation initiatives via collabora- tion, oversight, and monitoring of the $2.5 billion portfolio of 16 major transformation initiatives and 20 supporting initiatives. This included assisting in the development of operating plans, intensive mid-year reviews, and problem solving sessions with the 16 major initiatives that provided independent assessment of 

progress, identified barriers to success, helped define solutions, and elevated issues 

to senior leadership, as required. 

Create a collaborative, knowledge-sharing culture across VA and with DOD and 

other partners to support our ability to be people-centric, results-driven, and forward-looking at all times. 

• Contributed to transforming VA/DOD Collaboration by coordinating the development and implementation of joint programs such as the expansion of the virtual 

lifetime electronic record (VLER) pilots; the expansion of the integrated disability 

evaluation system (IDES) pilot to worldwide deployment; the development of the integrated mental health strategy (IMHS) and its 28 joint strategic actions; the increased access of servicemembers to VA benefits and service information through eBenefits; the development of joint policy for the implementation of separation health 

assessments for all servicemembers; and significant improvements to the transition 

assistance program (TAP). 

Additionally, OPP continued to provide ongoing services and capabilities to the 

VA and to Veterans that included the following outcomes: 

• Provided statistical and geospatial analysis to support recurring and ad-hoc reporting. Examples of these statistical products include the Geographical Distribution 

of VA Expenditures Report, the Unemployment Rate of Veterans Report: 2000 to 

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2009, the Labor Force Participation Rates of Veterans Report: 2000 to 2009, The VA 

Information Pocket Guide; the Gulf War Era Veterans: pre-9/11 Report, and the VA/ 

DOD Disability Evaluation System Trend Analysis. 

• Provided actuarial services to the Department on an ongoing basis. FY 2010 efforts included development of the VA compensation and pension liability model. 

• Updated VA’s official estimates and projections of the Veteran population by 

State, county and congressional district from 2009 to 2039. Veteran population estimates are projected with characteristics such as: age, gender, period of service, race, 

ethnicity, rank (officer/enlisted), and branch of service. 

Conducted a nationwide management analysis/business process reengineering 

study of sanitation operations (8,831 FTE) and biomedical engineering (990 FTE) 

services across VHA and monitored the implementation of the recently reengineered 

plant operations and grounds maintenance (7,269 FTE) functions. 

B. What indicators would suggest whether additional staffing increases are 

warranted? 

Response. Despite the outcomes described above, additional capabilities are needed in FY 2012. The nine FTE within CA&E are not enough to implement a Departmental-wide programmatic alignment of the VA’s $132 billion budget, conduct independent assessments of resource requirements needed to meet planned Veteran outcomes, and fully integrate PPBE across a 300,000 person organization with three 

distinct administrations (VBA, VHA, and NCA). Additional resources are also required to fully engage with DOD and the military services in the growing number 

of activities required to ensure effective transition from active duty to Veteran status. Finally, there is a recognized gap in the strategic planning ability of the VA 

to conduct long-term policy analysis and consider alternative futures that will impact Veterans and the Department in the long-term. 

The additional 12 FTE to bring the budget authority FTE to 105 in FY 2012 are 

requested to meet the emerging requirements identified above. First, to fully integrate and establish the PPBE methodology in the Department, it is necessary to expand the CA&E office from nine to 13 personnel. CA&E is still an exceptionally 

lean, and efficient, operation in relation to comparable governmental agencies. The 

desired CA&E staffing of 13 would provide strategic resource management and independent analysis and oversight of a program budget in excess of $132 billion and 

a workforce in excess of 300,000. By comparison, the Office of Program Analysis and 

Evaluation (PA&E) at the Department of the Army is staffed with approximately 

100 personnel and supports a similar sized program/budget of $149 billion in FY 

2012. The VA/DOD Collaboration Service is expanding from 13 to 16 personnel to 

address the growing number of issues associated with VA/DOD collaboration including IDES, VLER, electronic health records, IMHS, TAP, etc. Finally, we are establishing a new capability within the Office of Policy to conduct long-term policy analysis and alternative futures development in coordination with DOD and other Federal agencies. 

C. Please list the specific positions that would be added to the Office of Policy and 

Planning during fiscal year 2012 with this level of funding and the expected paygrades for those positions. 

Response. Most of the additional 12 FTE requested for FY 2012 will be management analyst grades 12/13/14. We will also hire statisticians and operational research personnel at the 13/14 level. 

D. Please explain the outcomes or achievements that are expected to be attributable to these additional employees. 

Response. As noted, the additional FTE are requested for 2012 to enhance capabilities primarily in three areas: 

• The Office of Corporate Analysis and Evaluation will continue implementation 

of a Departmental-wide strategic resource management system to help inform VA 

leadership with analysis and options for future funding of Veterans needs. CA&E 

provides the Secretary, VA and senior leadership with independent and objective 

analysis of resource requirements and options for funding Veterans needs across the 

spectrum of health care, benefits, and memorial services. Through independent 

analysis and evaluation, CA&E provides an added level management insight on the 

effectiveness and efficiency of VA programs and budgets and measurable impact to 

the Veteran. 

• The Office of VA/DOD Collaboration will expand its development and monitoring of joint policies and programs such as the expansion of the VLER pilots; the 

expansion of the IDES pilot to worldwide deployment; the development of the IMHS 

and its 28 joint strategic actions; the increased access of servicemembers to VA benefits and service information through e-Benefits; the development of joint policy for 

the implementation of separation health assessments for all servicemembers; and 

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significant improvements to TAP. These activities will protect the equity of Veterans 

as they transition from servicemembers; producing better outcomes in health care 

delivery and benefit service for Veterans, servicemembers, military retirees, and eligible dependents. • Finally, we are establishing a new capability within the Office of Policy to conduct long-term policy analysis and alternative futures development in coordination 

with DOD and other Federal agencies. It will provide policy analysis capability to 

a evaluate range of future policy issues and requirements, i.e. policy challenges due 

to population trends, changing demographics and implications to VA infrastructure 

and capabilities such as the impact of health care reform on Veterans, and implementation of Caregivers Legislation. 

Question 2. The fiscal year 2012 budget request for the Office of Policy and Plan- ning shows an increase of $395,000 for travel over the amount ($112,000) expended 

in fiscal year 2010 for travel. Response. OPP is requesting $300,000 in travel budget authority for FY 2012. OPP only expended $110,000 in travel during FY 2010 because there was there 

were very few senior leaders assigned to the office during much of the year. The 

Assistant Secretary, for example, was not confirmed until March 2010 and the Principal Deputy Assistant Secretary was not appointed until September 2010. The Executive Director for CA&E and the Deputy Assistant Secretary for Policy were not 

appointed until the fall of 2010. The increased travel funding is also requested to 

support the additional functions and staff assigned to OPP, to include travel to support VA/DOD activities, PPBE functions, and operational oversight of the transformation initiatives. 

The remaining requests for $207,000 in travel funds for FY 2012 are from the ePMO ($120,000) and the VA Innovation Initiative (VAi2) ($87,000), both of which 

are paid via reimbursing agreements by VBA, VHA, and OI&T. The ePMO, which 

supports program management activities across the Department, is involved with 

Major Initiatives across the country. VAi2 is involved with working with the private 

sector entrepreneurs, academia, and internal VA employees to identify and prototype cutting edge solutions to assist in solving VA’s most challenging issues. 

A. What metrics are used to determine which staff needs to travel? 

Response. Travel is approved at the Deputy Assistant Secretary level for mission 

essential requirements. Senior executive service employees’ travel is approved by 

the Assistant Secretary. These decisionmakers approve travel when it supports: 

• Field operations • Technical training required for mission essential skills development • Planning and policy implementation • Management oversight to include on-going assessments of VLER pilot expansion, IDES pilot and deployment sites, IMHS development, and major initiatives development. 

B. What options (such as video conference, webinars, or local conferences) were 

explored to reduce the costs to the taxpayer? 

Response. Whenever possible, we will use technology (video conference, and 

webinars) to reduce the cost of our travel. For example, most recently, the ePMO 

used extensive video teleconferencing over a three week period to synchronize contracting activities between the VA acquisition centers in New Jersey, Texas, and 

Maryland with activities here in Washington. 

Question 3. According to the fiscal year 2012 budget request, the Office of Policy 

and Planning now expects to spend $4.5 million more on Other Services than is estimated in the fiscal year 2011 budget. For fiscal year 2012, the Office of Policy and 

Planning is requesting $21.4 million for Other Services, which would be a 27% increase over the amount that the office now plans to spend during fiscal year 2011 

and 94% more than this office originally requested for fiscal year 2011. 

A. Please provide a specific itemized list of how these funds would be spent during 

fiscal year 2011 and fiscal year 2012. To the extent any of these funds will be spent 

on contracts, please explain the nature of the contract and the expected outcomes. 

Response. The FY 2012 budget authority request for OPP is only $10.6 million 

for ‘‘Other Services,’’ which is actually a decrease of approximately $500,000 from 

our 2011 request. The remaining $10.8 million is being requested to support the 

ePMO ($10.1 million) and VAi2 ($0.7 million), which will be funded via reimbursements from VBA, VHA, and OI&T. 

B. What factors account for the nearly $6 million increase during fiscal year 2011? 

Response. Since OPP plans to actually spend less in FY 2011 than originally requested, the increase in spending is fully reflective of the additional responsibilities 

assigned to the ePMO and VAi2. 

C. How was that $6 million originally intended to be spent? 

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Response. VBA, VHA and OIT intended to spend the $6 million on transformation 

initiatives. 

D. What factors account for the over $4.5 million increase between fiscal year 

2011 and 2012? 

Response. This increase is due to the additional responsibilities assigned to the 

ePMO and VAi2. The ePMO will develop project management standards, methodologies and processes to govern the management of the major transformational initiatives in VA; share best practices; help major initiative teams to define requirements 

and get the resources (people, money, contracts, and space) they require to effectively execute; review operating plans to determine whether the proposed resources 

will achieve the intended outcomes; and identity opportunities for re-engineering VA 

process to institutionalize change and improve VA’s long term capacity to execute 

large cross cutting programs. This activities are all directed at improving the quality 

and accessibility of health care, benefits, and memorial services for Veterans while 

optimizing value. VAi2 is responsible for using joint public-private sector collaboration in order to improve health care, benefits and memorial services for Veterans. 

16 Major Initiatives 

1 Eliminate Veteran homelessness. 

2 Enable 21st century benefits delivery and services. 

3 Automate GI Bill benefits. 

4 Create Virtual Lifetime Electronic Records. 

5 Improve Veterans’ mental health. 

6 Build VRM capability to enable convenient, seamless interactions. 

7 Design a Veteran-centric health care model to help Veterans navigate the 

health care delivery system and receive coordinated care. 

8 Enhance the Veteran experience and access to health care. 

9 Ensure preparedness to meet emergent national needs. 

10 Develop capabilities and enabling systems to drive performance and out- comes. 11 Establish strong VA management infrastructure and integrated operating 

model. 

12 Transform human capital management. 

13 Perform research and development to enhance the long-term health and 

well-being of Veterans. 

14 Optimize the utilization of VA’s Capital Portfolio by implementing and executing the Strategic Capital Investment Planning (SCIP) process. 

15 Health Care Efficiency: Improve the quality of health care while reducing 

cost. 

16 Transform health care delivery through health informatics. 

Office of Operations, Security, and Preparedness 

Question 1. For fiscal year 2012, the Office of Operations, Security, and Preparedness requests $4.4 million for Other Services. Please provide an itemized list of how 

these funds would be spent. To the extent any of these funds will be spent on contracts, please explain the nature of the contract and the expected outcomes. 

Response. In fiscal year 2012, The Office of Operations, Security, and Preparedness is requesting $4.4 million for contract support for the Department of Homeland 

Security (DHS) Guards contract at VACO for the security of our employees in the 

work place ($2.8 million), Program Support for the Homeland Security Presidential 

Directive 12 (HSPD–12) Program Office ($1.0 million), Funding for the VA Continuity of Government (COG) site ($0.25 million), and Maintenance and Support 

Contracts (access control systems, security cameras etc.) ($35 million). 

The DHS Guards contract helps to ensure that VACO employees, veterans, and 

visitors have a safe and secure workspace. Additionally, in a crisis situation the 

Federal Protective Service uniformed officers provide emergency response force. The 

program support for the HSPD–12 Program Office is necessary to assist in the establishment and maintenance of the Agency-wide HSPD–12 Program. The COG site 

allows VA senior leadership to have a space to continue to function in the event of 

a crisis. 

Question 2. For fiscal year 2012, the Office of Operations, Security, and Preparedness requests $13.7 million for 107 employees. This would amount to an 84% increase in staffing since fiscal year 2008 and a 41% increase since fiscal year 2010. 

A. What measurable performance outcomes would suggest whether the previous 

staffing increases have been effective? 

Response. OSP’s mission has significantly increased in scope since fiscal year 

2008. During fiscal year 2010 the Office took on responsibility for the Department’s 

Personnel Security and Suitability Program as well as the operation of the VACO 

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Personal Identity Verification (PIV) badging office (11 FTE). The Office of Emergency Management (OEM) increased staffing in mandated programs in Exercise, 

Test and Evaluation and Planning and National Security (7 FTE). The Office of Security and Law Enforcement (OS&LE) increased staffing to provide more Oversight 

of field activity, VA police units, and critical infrastructure protection planning activities (6 FTE). The Office of the Assistant Secretary identified a requirement for 

a Human Resources official (1 FTE). 

Going from fiscal year 2010 to fiscal year 2012, OSP is requesting an increase of 

12 FTE. These are identified for the HSPD–12 Program Office (7 FTE), VA internally authorized in the fiscal year 2011 President’s Budget submission. The fiscal 

year 2012 President’s Budget identifies an additional 5 FTE for the following functions; 1 each for the Director Personnel Security and Identity Management 

(PS&IM), Director for PSS, Director of the Integrated Operations Center (IOC), a 

Special Security Representative (SSR) for a remote site, and one FTE in the Assistant Secretary’s office to support required functions such as a Privacy Officer, a 

FOIA support role, and Records Management functions. 

B. What indicators would suggest whether additional staffing increases are warranted? 

Response. OSP is the Executive Lead for the VA Major Initiative Preparedness. 

This required an SES incumbent to function as the Initiative Lead (position also is 

the Director of PS&IM). This initiative is in direct support of the Secretary’s transformation of the VA into a 21st century organization. 

The VA Integrated Operations Center has evolved into a fusion center with representatives from 15 organizations that gather information from all sources, not just 

VA, who then analyze; generate predictions and recommendations for senior leadership. This allows VA to fully participate in the interagency arena in response to real 

time events. 

The Director of National Intelligence signed the Intelligence Community Directive 

(ICD) 705 (Effective May 26, 2010), which requires a Special Security Representative (SSR) for each operational Sensitive Compartmented Information Facility 

(SCIF). In FY 2012, VA will operate a VA Reconstitution Planning Site that contains a SCIF, thus requiring an additional SSR staff member. 

The Personal Security and Suitability Service (PSS) was established to standardize the method in which VA processes security and suitability requirements for 

the Department. The increased staff is to support additional training, oversight and 

audit functions that have not been fully operational. 

The Resource Management Office was established to ensure compliance of Financial Management, Human Resource Management and Administrative and Logistics 

Management, to ensure procedures, laws, regulations, and policies in the Office of 

Operations, Security and Preparedness. 

Office of Public and Intergovernmental Affairs 

Question 1. For fiscal year 2012, the Office of Public and Intergovernmental Affairs requests $13.6 million for 93 employees. This would amount to a 35% increase 

in staffing since fiscal year 2010 and a 48% increase in staffing since fiscal year 

2008. 

A. What measurable performance outcomes would suggest whether the previous 

staffing increases have been effective? 

Response. New Media Team—VA’s main Facebook page now has over 100,000 

subscribers who we reach on a daily basis—more than any other cabinet-level agency and among the top 10 of all Federal organizations (to include the White House 

and military services). 

• Among Veterans who use Twitter, more get their information from VA than 

from any VSO or Veterans organization. With over 14,000 Twitter followers, VA has 

more followers than IAVA, the VFW, and the American Legion combined. 

• Nearly 34,000 people are now receiving information directly each day from one 

of 79 VA medical centers now on Facebook. 

• Over 7,000 people are now receiving information directly each day from one of 

43 VA medical centers now on Twitter. 

• VA’s 250 YouTube videos have been viewed over 463,000 times. 

• VA’s 5,300 photos on Flickr have been viewed over 395,000 times. 

OPIA established the Homeless Veterans Initiative Office to end homelessness in 

5 years. The initiative began in 2009 with 131,000 homeless Veterans. In 2011, that 

number has fallen to 75,000. One of the most innovative efforts has been to implement a new strategy to prevent and rapidly end homelessness for those at highest 

risk. We expected to award funding by July 2011 that will aid 10,000 Veteran families who have lost housing or those at serious risk to maintain housing. This effort 

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will, for the first time, effectively reduce those Veterans at low income with a nationwide community based intervention. 

B. What indicators would suggest whether additional staffing increases are warranted? 

Response. The new employees will be supporting the Office of Tribal Government 

Relations; Paralympic Program Office; Homeless Veterans Initiatives and Outreach 

Program offices. 

Question 2. For fiscal year 2012, the Office of Public and Intergovernmental Af- fairs requests $100,000 for a staff assistant to ‘‘coordinate schedules and write 

speeches/correspondence.’’ 

A. Please explain how adding a staff assistant to write speeches will help improve 

the lives of veterans or their families. 

Response. VA is charged with informing Veterans, dependents, and survivors of 

the benefits and services to which they may be eligible. The Office of Public and 

Intergovernmental Affairs (OPIA) builds confidence in VA and its readiness to serve 

America’s Veterans of all generations. OPIA accomplishes this by developing, maintaining and communicating the Department’s message through media relations and 

public, intergovernmental and Veteran engagement to empower Veterans and their 

families. 

The Staff Assistant to the Assistant Secretary will coordinate schedules and write 

speeches/correspondences for the Assistant Secretary and senior level principals. As 

a representative of the Secretary and of the President, the Assistant Secretary is 

responsible for conducting outreach and communications with Veterans, dependents, 

survivors, and stakeholders throughout the country. This results in a highly complex schedule with events, meetings and speaking engagements throughout the 

country with a diverse set of audiences. OPIA requires a staff member to manage 

the travel and scheduling logistics for the Assistant Secretary and, at times, travel 

with the Assistant Secretary as an aide and a representative of VA. Further, OPIA 

requires a staff member who can ensure that the messages from the Assistant Secretary, through speeches and presentations, are coordinated and in line with other 

key outreach and strategic communications efforts from the Department. It is imperative that OPIA be staffed appropriately to ensure that Veterans and their families receive consistent and regularly benefit information from the Department. 

The Staff Assistant will also be writing responses to inquiries from the White 

House, Congressional inquiries, Veterans and family members of veterans which we 

receive on a daily basis. This will also include all the telephone inquiries we receive. 

The Assistant Secretary receives on average 25–30 requests from Veterans daily. 

B. Please provide a list of the type of engagements for which speeches would be 

written. 

Response. The Staff Assistant coordinates messaging on speeches for VA principals which include all Assistant Secretaries. In 2010 alone, the Assistant Secretary for Public and Intergovernmental Affairs received at least 312 requests for 

speaking engagements (regretted 246, accepted 66). VA principals such as the Assistant Secretary for Public and Intergovernmental Affairs speak at events for 

women groups, military branches, veteran service organizations, VA offices and administrations, healthcare specialists, the legal community, Federal and state agencies, universities, private corporations, and non-profit assisting Veterans and servicemembers. 

Question 3. In the fiscal year 2012 budget request, the Office of Public and Intergovernmental Affairs requests $800,000 and 5 FTE to enhance VA’s partnership 

with Tribal Governments. The Office of Tribal Government Relations is in the process of being stood up at this time. In correspondence between the Committee on Veterans’ Affairs and the Office of Congressional and Legislative Affairs, VA justified 

the new office by stating that employees in the new office will do the following: 

The new employees will serve as the regional Office of Tribal Government 

Relations representatives responsible for developing ongoing positive collaborative relationships and partnerships with tribal officials, the Veterans 

Benefits Administration, the Veterans Health Administration and National 

Cemetery Administration and other key partners in assisting with facilitating policy and program consultation initiatives, communication plans, 

program promotion and access to health care services, benefits and funding 

or special project opportunities offered by the VA. The employees will be responsible for developing annual work plans and providing quarterly and annual accomplishment reports to both VA leadership and the tribes within 

their regional service area. The Director and employees will establish a five 

year strategic plan for the office that aligns with the Departmental strategic plan with meaningful input from the tribes from each region. 

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A. VA has had a long-standing relationship with the Indian Health Service (IHS), 

which required coordination with many Indian tribes throughout the United States. 

Who was previously in charge of forging those relationships between VA, IHS, and 

Indian tribes? 

Response. There was previously no lead office designated within VA to work with 

tribal governments on cross-cutting issues involving all three Administrations. Relationships were formed on an ad-hoc basis within the programs, with tribal governments, but nothing was formally dedicated to be the primary point of contact interfacing with tribal governments on behalf of the Secretary. 

B. Please explain the rationale used to determine whether or not to stand up a 

new administrative office within VA to strengthen tribal government relations 

versus increasing the ability of a standing office in VA to meet the same goals. 

Response. There are 565 federally recognized tribes located across the United 

States. The United States and Indian Tribes have a unique political relationship 

that is distinct from any other ethnic group or governmental entity. It was determined that if the office was housed within a VA Administration, it would not reach 

across all programs and services offered by VA that affect Indian Tribes. Therefore, 

it would be best suited to be housed at the Departmental level. Additionally, given 

the high rates of military service amongst American Indian/Alaska Native tribal 

members, given the large number of federally recognized tribes, the complexity of 

issues, and the predominantly rural and far reaching geographic locations where 

most tribal governments are situated, the importance of tribal the tribal consultation process in informed decisionmaking, it was determined that sufficient workload 

existed to dedicate the office specifically to focus on the needs and concerns tribal 

governments have in accessing services, benefits and funding opportunities to serve 

the needs of American Indian/Alaska Native Veterans. 

Question 4. According to the fiscal year 2012 budget request, the Office of Advisory Committee Management is tasked with the responsibility of serving as VA’s liaison with VA’s 25 advisory committees and setting uniform procedures for the 

Committees. In fiscal year 2011 the office charged with overseeing all of VA’s advisory committees had a budget of $249,000 and two associated FTE. There is apparently no budget request for funds or FTE in fiscal year 2012. 

A. Please provide the names and descriptions for all 25 official VA advisory committees and any other councils or committees under the auspices of VA. 

Response. Currently the VA has only 23 advisory committees. The following list 

of VA advisory committees includes 15 that have been established by statute (with 

an asterisk *) and 8 non-statutory panels designed to provide advice on selected VA 

programs and policies. The advisory committees listed below are arranged alphabetically according to key words [bold print] in their titles. Immediately following 

the list of committees are summaries of the Committees’ objectives. 

*1) Advisory Committee on Cemeteries and Memorials 

2) Clinical Science Research and Development Service Cooperative Studies 

Scientific Evaluation Committee 

*3) Advisory Committee on Disability Compensation 

*4) Veterans’ Advisory Committee on Education 

*5) Veterans’ Advisory Committee on Environmental Hazards 

*6) Advisory Committee on Former Prisoners of War 

7) Genomic Medicine Program Advisory Committee 

*8) Geriatrics and Gerontology Advisory Committee 

*9) Research Advisory Committee on Gulf War Veterans’ Illnesses 

10) Health Services Research and Development Service Merit Review 

Board 

*11) Advisory Committee on Homeless Veterans 

12) Joint Biomedical Laboratory Research and Development and Clinical 

Science Research and Development Services Scientific Merit Review Board 

*13) Advisory Committee on Minority Veterans 

14) National Research Advisory Council 

*15) Advisory Committee on Prosthetics and Special Disabilities Programs 

*16) Advisory Committee on the Readjustment of Veterans 

*17) Veterans’ Advisory Committee on Rehabilitation 

18) Rehabilitation Research and Development Service Scientific Merit Review Board 

19) Veterans’ Rural Health Advisory Committee 

*20) Special Medical Advisory Group 

*21) Advisory Committee on Structural Safety of Department of Veterans Affairs Facilities 

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22) Department of Veterans Affairs Voluntary Service National Advisory Committee 

*23) Advisory Committee on Women Veterans 

Advisory Committee on Cemeteries and Memorials (Statutory) 

To provide advice to the Secretary of Veterans Affairs on the administration of 

national cemeteries, the selection of cemetery sites, the erection of appropriate memorials, and the adequacy of Federal burial benefits. 

Clinical Science Research and Development Service Cooperative Studies Scientific 

Evaluation Committee 

To provide advice on VA cooperative studies, multi-site clinical research activities, 

and policies related to conducting and managing these efforts while ensuring that 

new and ongoing projects maintain high quality, are based upon scientific merit, 

and are efficiently and economically conducted. 

Advisory Committee on Disability Compensation (Statutory) 

To provide advice to the Secretary of Veterans Affairs on establishing and supervising a schedule to conduct periodic reviews of the VA Schedule for Rating Disabilities (VASRD). 

Veterans’ Advisory Committee on Education (Statutory) 

To provide advice to the Secretary of Veterans Affairs on the administration of 

education and training programs for Veterans and Servicepersons, Reservists, and 

dependents of Veterans under Chapters 30, 32, 35, and 36 of Title 38, and Chapter 

1606 of Title 10, United States Code. 

Veterans’ Advisory Committee on Environmental Hazards (Statutory) 

To provide advice to the Secretary of Veterans Affairs on adverse health effects 

that may be associated with exposure to ionizing radiation, and to make recommendations on proposed standards and guidelines regarding VA benefit claims based 

upon exposure to ionizing radiation. 

Advisory Committee on Former Prisoners of War (Statutory) 

To provide advice to the Secretary of Veterans Affairs on the administration of 

benefits for veterans who are former prisoners of war, and to assess the needs of 

such veterans in the areas of service-connected compensation, health care, and rehabilitation. 

Genomic Medicine Program Advisory Committee 

To provide advice on the scientific and ethical issues related to the establishment, 

development, and operation of a genomic medicine program within the Department 

of Veterans Affairs. 

Geriatrics and Gerontology Advisory Committee (Statutory) 

To provide advice to the Secretary of Veterans Affairs on all matters pertaining 

to geriatrics and gerontology by assessing the capability of VA health care facilities 

to meet the medical, psychological, and social needs of older veterans , and by evaluating VA facilities designated as Geriatric Research, Education, and Clinical Centers. 

Research Advisory Committee on Gulf War Veterans’ Illnesses (Statutory) 

To provide advice to the Secretary of Veterans Affairs on proposed research studies, research plans, or research strategies relating to the health effects of military 

service in Southwest Asia during the Gulf War. 

Health Services Research and Development Service Merit Review Board 

To provide advice on the fair and equitable selection of the most meritorious research projects for support by VA research funds. The ultimate objective of the 

Board is to ensure the high quality and mission relevance of VA’s legislatively mandated research and development program. Board members advise on the scientific 

and technical merit, originality, feasibility, and mission relevance of individual research proposals. They also advise on the adequacy of protection of human and animal subjects. 

Advisory Committee on Homeless Veterans (Statutory) 

To provide advice to the Secretary of Veterans Affairs on benefits and services 

provided to homeless veterans by the Department of Veterans Affairs. 

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Joint Biomedical Laboratory Research and Development and Clinical Science Research and Development Services Scientific Merit Review Board 

To provide advice on the scientific quality, budget, safety, and mission relevance 

of investigator-initiated research proposals submitted for VA merit review consideration. The proposals to be reviewed may address research questions within the general area of biomedical and behavioral research or clinical science research. The 

Board also advises VA research officials on program priorities and policies, as well 

as administration of VA’s intramural program. 

Advisory Committee on Minority Veterans (Statutory) 

To provide advice to the Secretary of Veterans Affairs on the administration of 

VA benefits for veterans who are minority group members in the areas of compensation, health care, rehabilitation, outreach, and other services. 

National Research Advisory Council 

To provide advice to the Secretary of Veterans Affairs on research and development sponsored and/or conducted by the Veterans Health Administration, to include 

policies and programs of the Office of Research and Development. 

Advisory Committee on Prosthetics and Special Disabilities Programs (Statutory) 

To provide advice to the Secretary of Veterans Affairs on VA prosthetics programs 

and the rehabilitation research, development, and evaluation of prosthetics technology. The Committee also assesses VA programs that serve veterans with spinal 

cord injury, blindness or vision impairment, loss of or loss of use of extremities, 

deafness or hearing impairment, or other serious incapacities. 

Advisory Committee on the Readjustment of Veterans (Statutory) 

To provide advice to the Secretary of Veterans Affairs on policies, organizational 

structures, and the provision and coordination of services to address veterans’ postwar readjustment to civilian life, with particular emphasis on Post Traumatic Stress 

Disorder, alcoholism, other substance abuse, post-war employment, and family adjustment. 

Veterans’ Advisory Committee on Rehabilitation (Statutory) 

To provide advice to the Secretary of Veterans Affairs on the rehabilitation needs 

of disabled veterans and the administration of VA’s rehabilitation programs. 

Rehabilitation Research and Development Service Scientific Merit Review 

Board 

To provide advice on the fair and equitable selection of the most meritorious research projects for support by VA research funds, and to provide advice for research 

program officials on program priorities and policies. The ultimate objectives of the 

Board are to ensure that the VA Rehabilitation Research and Development program 

promotes functional independence and improves the quality of life for impaired and 

disabled veterans. 

Veterans’ Rural Health Advisory Committee 

To provide advice to the Secretary of Veterans Affairs on health care issues affecting enrolled veterans residing in rural areas. 

Special Medical Advisory Group (Statutory) 

To provide advice to the Secretary of Veterans Affairs and the Under Secretary 

for Health on matters relating to the care and treatment of veterans and other matters pertinent to the operations of the Veterans Health Administration (i.e., research, education, training of health manpower, and VA/DOD contingency planning). 

Advisory Committee on Structural Safety of Department of Veterans Affairs Facilities (Statutory) 

To provide advice to the Secretary of Veterans Affairs on structural safety in the 

construction and remodeling of VA facilities, and to recommend standards for use 

by VA in the construction and alteration of facilities. 

Department of Veterans Affairs Voluntary Service National Advisory Committee 

To provide advice to the Secretary of Veterans Affairs and the Under Secretary 

for Health on how to coordinate and promote volunteer activities within VA health 

care facilities. 

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Advisory Committee on Women Veterans (Statutory) 

To provide advice to the Secretary of Veterans Affairs on the needs of women veterans regarding health care, rehabilitation benefits, compensation, outreach, and 

other programs administered. 

B. Please explain which office will be serving as liaison to the VA advisory committees in fiscal year 2012. 

Response. In FY 2012, the Office of Congressional and Legislative Affairs will support the Office of Advisory Committee Management. The funding for the Office of 

Advisory Committee Management has been incorporated into OCLA’s overall budget 

request. It was not specifically highlighted as a separate entity. 

C. In the last two years, how many recommendations or findings made by advisory committees have been implemented by the Secretary to change VA procedures 

or improve its delivery of care or benefits to veterans? 

Response. In the last two years VA advisory committees made 220 recommendations. VA has implemented, or is in the process of implementing, 87% of them. 

D. Of the 25 advisory committees noted in the fiscal year 2012 budget request, 

do any of them have a termination or sunset date other than those listed in the 

summary volume of the fiscal year 2012 budget request? If so, please list the end 

dates and whether the Committees have been dissolved. 

Response. VA Advisory Committees with termination or sunset dates are: 

Veterans’ Advisory Committee on Education—December 31, 2013 

Advisory Committee on Homeless Veterans—December 30, 2011 

Advisory Committee on Minority Veterans—December 21, 2014 

E. What is the operational cost of these committees for fiscal year 2012? 

Response. Estimated operational cost for VA’s advisory committees for fiscal year 2012 is $6 million which includes personnel payments to non-Federal members (stipend), Federal members, non-member consultants, and Federal staff (salary of Federal staff(s) who provides support to the Committee); travel and per diem; and other 

costs (court reporter, conference space, etc.). 

Costs for VA’s advisory committees have been controlled. Committees meet on an 

average of twice a year. Over the last two of years we have made several procedural 

and process changes designed to improve the management of VA’s advisory committees, to include, where statutorily permissible, limiting membership and stipends 

and requiring an annual operations plan and annual assessment to enhance operations planning. Actual costs for the last three fiscal years are: 

Actual Costs 

FY 08—$5,422,621 

FY 09—$5,870,115 

FY 10—$5,870,972 

FY 11—$5,925,000 (estimate) 

Office of Congressional and Legislative Affairs 

Question 1. For fiscal year 2012, the Office of Congressional and Legislative Affairs requests $6.1 million for 52 employees. This would amount to a 44% increase 

in staff since fiscal year 2010 and a 58% increase since fiscal year 2009. 

A. What measurable performance outcomes would suggest whether the previous 

staffing increases have been effective? 

Response. OCLA has a critical role in keeping Congress informed of VA’s work 

on behalf of Veterans as well as responding to Member and Committee inquiries on 

legislation, policy initiatives, on behalf of constituents, and many other areas. 

OCLA’s efforts in providing Members of Congress with the information they require 

is people-intensive, and for a number of years OCLA was not staffed sufficiently to 

keep pace with Congress’ increasing requests for information. OCLA’s budget request is intended to put additional personnel toward meeting the needs of Congress. 

In October 2010, OCLA produced its Operating Plan which defined performance 

measures and metrics for the office for FY 2011–2013. These measures and metrics 

were created to improve OCLA’s responsiveness to Congressional requests for information and set goals for the office that support VA’s Strategic Plan. These measures 

and metrics will be the standard to measure OCLA’s progress and are reviewed on 

a monthly, quarterly, and annual basis. OCLA also published a new Standing Operating Procedures (SOP) Manual following a comprehensive review of all of the office’s internal processes. Since the implementation of the Operating Plan, and publication of the SOP, OCLA has improved its responsiveness to Congressional requests 

for information. As an example, OCLA has revitalized the questions for the record 

(QFR) process. OCLA assigned new program analysts to assist with implementing 

the new collaborative processes outlined in the SOP that streamlined the overall 

QFR process and turned an underachieving performance throughout FY 2010 into 

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a process that is exceeding its targeted goal in FY 2011. In FY 2010, OCLA submitted 16% of the QFRs on time. Through the first five months of FY 2011 OCLA 

has submitted a 100% of the QFRs on time. OCLA supported 322 congressional 

briefings in FY 2010. Through the first five months of FY 2011, OCLA coordinated 

173 briefings, which is a 60 percent increase over the same period last FY. The 

added briefings were a result of the greater depth and breadth on issues staffed by 

the additional congressional relations officers and congressional liaison officers. 

These new personnel have also contributed to ensuring OCLA improved its performance in submitting VA witness written testimony on time. In FY 2010, OCLA submitted only 60% of testimony on time. Through the first five months of FY 2011, 

OCLA has submitted 100% of testimony on time. VA is committed to providing Congress accurate and timely information and the increase in personnel are necessary 

to achieve that goal. 

B. What indicators would suggest whether additional staffing increases are warranted? 

Response. There are two main indicators that suggest increased staffing is required. OCLA monitors the feedback Members of Congress and Congressional staff 

provide on the timeliness and accuracy of the information VA provides to Congress. 

While OCLA has made significant improvement, there are still additional improvements to be made to decrease the time it takes to respond to requests for information. The other main indicator is OCLA’s All Employee Survey results. These results 

indicate additional personnel are needed to balance workload within the office. The 

results of the survey indicated employees realize the importance of their jobs, but 

are impacted by the high volume of work and the very dynamic environment they 

operate in. These factors were considered in reorganizing OCLA’s structure to provide greater depth and breadth on issues, adding positions to support the most overworked areas, and rebalancing existing duties and responsibilities. OCLA requested 

additional funding and staff to accomplish these actions. However, in FY 2009 and 

FY 2010, OCLA was unable to achieve its authorized number of employees due to 

high employee turnover. In FY 2009, OCLA was authorized 38 FTEs, only 34 were 

obligated. In FY 2010, OCLA was authorized 42 FTEs, and only obligated 36. As 

of March 2011, OCLA has increased the number of personnel to 43 and should be 

able to achieve our authorized strength of 46 employees before the end of the fiscal 

year. In FY 2012, OCLA requests additional funding to support three additional personnel, which includes the Office of Advisory Committee Management. As a result 

of the office’s grade structure, FY 2012’s requested funding would increase the office’s overall FTE to 49 vice 52. 

C. Please provide a list of the specific positions that have been or will be added 

to the office since fiscal year 2009 and the pay-grades for those positions. 

Response. In FY 2010, OCLA added four positions to its organizational structure. 

Congressional Relations Officer—GS–14 

Congressional Relations Officer—GS–14 

Congressional Liaison Officer—GS–13 

Congressional Liaison Officer—GS–13 

In FY 2011, OCLA will add four positions to its organizational structure. 

Director, Benefits Legislative Affairs—GS–15 

Program Analyst—GS–9 

Program Analyst—GS–9 

Congressional Liaison Assistant—GS–8 

In FY 2012, OCLA is requesting to add three positions to its organizational structure. 

Director, Health Legislative Affairs—GS–15 

VA Advisory Committee Management Officer—GS–14 

VA Advisory Committee Program Analyst—GS–11 

Question 2. The Office of Congressional and Legislative Affairs requested an 80% 

increase in travel over the same period. 

A. What metrics are used to determine which staff needs to travel? 

Response. OCLA personnel travel in support of Members of Congress and Congressional Staff. Staffs are primarily assigned to support Congressional travel by 

their respective portfolios. Every OCLA request for travel is approved at the deputy 

assistant secretary level. Requests for travel in support of organizational meetings/ 

conferences or training are also approved at the deputy assistant secretary level to 

ensure a requirement exists for attendance and there is sufficient return to support 

the expenditure of travel funds. OCLA’s travel budget also pays for Members of 

Congress and Congressional staff oversight travel. 

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B. What options (such as video conference, webinars, or local conferences) were 

explored to reduce the costs to the taxpayer? 

Response. During October 2010, OCLA completed installation of video teleconferencing equipment that enables the office to participate in teleconferences vice traveling to the conference/meeting sites out of the Washington, DC area. OCLA will 

offer Congressional staff the option of conducting a video teleconference for meetings 

with out of town VA personnel versus having VA personnel travel to Washington, 

DC for the meeting. OCLA staff also participates in webinars when possible to reduce travel costs. OCLA has coordinated staff training with VA’s Learning University utilizing conference facilities adjacent to VA headquarters on Vermont Avenue. 

Office of Acquisition, Logistics, and Construction 

Question 1. For fiscal year 2012, the Office of Acquisition, Logistics, and Construction requests $36 million for Other Services, which includes funding for the President’s Acquisition Improvement Initiative. 

A. Please provide an itemized list of how these funds would be spent. To the extent any of these funds will be spent on contracts, please explain the nature of the 

contract and the expected outcomes. 

Response. The table below shows the major contracts and expenses the Office of 

Acquisition, Logistics, and Construction plans during FY 2012 in the Other Services 

account. 

General Operating Expense (GOE) Other Service Items 

Acquisition Improvement Initiative ............................................................................................. $23,854,000 

Service Level Contracts for Hoteling .......................................................................................... $2,700,000 

National Institute of Building Standards (NIBS) Contracts ....................................................... $2,931,000 

NIBS Membership and Design Guide ......................................................................................... $170,000 

Seismic Maintenance Interagency Agreement ............................................................................ $61,000 

Federal Facilities Council Contract ............................................................................................ $30,000 

National Park Service Portal Interagency Agreement ................................................................. $20,000 

Financial Service Center Service Level Agreement .................................................................... $500,000 

Historical Preservation Contracts and Interagency Agreements ................................................ $824,000 

Moving Cost Related to Regional Office Relocations ................................................................ $180,000 

Training ....................................................................................................................................... $132,000 

Permanent Change of Station Moves ......................................................................................... $479,000 

Repair of Furniture and Equipment ........................................................................................... $44,000 

Strategic Planning Support ........................................................................................................ $131,000 

Maintenance and Repair Services .............................................................................................. $38,000 

Subtotal for GOE ......................................................................................................................... $32,094,000 

Other Service Amounts Included Under Reimbursements 

Other Service Costs for 140 FTE Reimbursed from Major Construction 

Permanent Change of Station Moves ......................................................................................... $869,078 

Training ....................................................................................................................................... $70,000 

Contracts—reimbursement prorated portion NIBS, Historical, FFC, etc. .................................. $1,771,922 

Total for Major Construction Reimbursement ............................................................................ $2,711,000 

Others Service Costs for 51 FTE Reimbursed from Medical Facility 

Permanent Change of Station Moves ......................................................................................... $377,860 

Training ....................................................................................................................................... $25,500 

Contracts—reimbursement prorated portion NIBS, Historical, FFC, etc. .................................. $681,640 

Total for Medical Facility Reimbursement .................................................................................. $1,085,000 

Other Service Costs for 6 FTE Reimbursed from Supply 

Repair of Furniture & Equipment ............................................................................................... $1,000 

Maintenance & Repair Services ................................................................................................. $1,000 

Contracts—including prorated portion of FSC contract ............................................................ $131,000 

Training ....................................................................................................................................... $5,000 

Total for Supply Reimbursement ................................................................................................ $138,000 

Subtotal Reimbursements ........................................................................................................... $3,934,000 

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Grand Total ................................................................................................................................. $36,028,000 

The information below provides details on funds that will be spent on contracts. 

Acquisition Improvement Initiative: Part of the President’s Acquisition Improvement Initiative to increase the capacity and capability of the acquisition workforce. 

This funding will specifically support 1) improvements in the VA Acquisition Academy Training Model; 2) enhancement of VA’s program management culture; 3) the 

Warrior to Workforce (W2W) Program—which strives to develop and implement a 

formalized training program for wounded veterans to obtain the positive education 

requirement for entry into the GS–1102 Contracting Series and completion of the 

VAAA’s Acquisition Internship School program and curriculum; 4) the acquisition 

intern program—which continues to implement a formalized and holistic training 

program to provide additional entry level contract specialists for VA and other 

Agencies. Contract Specialist Tuition Reimbursement—which supports the VA in developing its existing contracting workforce by providing $2.5M in funding toward 

tuition reimbursement. 

Contracts will specifically support the development and implementation of the required curriculum and training programs associated with aforementioned programs. 

Service Level Contracts for Hoteling: Provides temporary locations for three new 

regional offices as part of the implementation of phase II of the VAFM Transformation Initiative until GSA long term leases are put in place. 

Federal Facilities Council: Support facilities engineering related studies and identify best-practices. 

Financial Service Center Service Level Agreement: The Financial Service Center 

contract is a Service Level Agreement between Department of Veterans Affairs (VA) 

Financial Services Center (FSC) and the Office of Acquisition, Logistics and Construction (OALC). OALC reimburses FSC for services provided to OALC including 

construction accounting, credit card processing, payment services, customer support 

help desk services, payroll services, permanent change of station travel processing 

services, etc. 

National Institute of Building Standards (NIBS) Contracts/NIBS Membership 

and Design Guide: NIBS was authorized by the U.S. Congress in the Housing and 

Community Development Act of 1974, Public Law 93–383 to address the need for 

an organization that could serve as an interface between government and the private sector. The Institute provides an authoritative source of advice for both the private and public sector of the economy with respect to the use of building science 

and technology. 

Seismic Maintenance Interagency Agreement: Seismic Maintenance Interagency 

Agreement (IAA): The agreement is between the U.S. Geological Survey (USGS) and 

VA, signed on April 20, 2009. It includes the installation of multi-channel systems 

for recording earthquake shaking at VA hospitals and to provide earthquake damage alerts. USGS will install multi-channel instruments in 27 buildings in a period 

of four (4) years. The final year of the IAA is 2012. To date, 13 hospital buildings 

were completed. Instrumentation of the remaining 14 hospitals will be completed in 

FY 2011 and FY 2012 The instruments and engineering support will provide specific 

information on potential damage to VA facilities within minutes. 

Historical Preservation Contracts and Interagency Agreements: Provide ‘‘on-call’’ 

historic preservation compliance assistance to medical centers and cemeteries. Work 

can include archaeological surveys, historic structure assessments, historic American building documentation, and consultation with consulting parties, drafting 

agreement documents, and assistance with curating artifacts. 

National Park Service Portal Interagency Agreement: VA supports the NPS Historic preservation portal which hosts the VA historic preservation checklist and provides key information on preservation laws and regulations to VA field personnel. 

Strategic Planning Support: OALC long range planning to align organizational 

goals to the Secretary’s long range vision for the Department. Strategic planning 

support will also implement a process to track development, implementation, and 

completion of initiatives. 

B. What metrics will be used to gauge the effectiveness of the Acquisition Improvement Initiative? 

Response. The following are the metrics used to measure VA’s acquisition processes. Execution of the acquisition improvement initiative is expected to have a positive impact on these measures. 

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Metrics for VA Acquisition Improvement Initiatives 

Balanced Scorecard Quadrant Measure 

Business Processes Procurement Customer Satisfaction 

Financial Federal Procurement Data System Accuracy 

Customer Satisfaction Procurement Savings 

Customer Satisfaction Unauthorized Commitments 

Business Processes FPDS Verification 

Business Processes Procurement Action Lead Time (PALT) 

Business Processes High Risk Contracting Reductions 

Learning and Growth Socio-Economic Program Goal Performance 

Customer Satisfaction Electronic Contract Management System (eCMS) Usage 

Business Processes Contracting Competition 

EDUCATION

Question 1. In 2009, VA provided $356 million in emergency payments of education benefits to approximately 122,000 individuals. In connection with the February 2010 budget hearing, VA acknowledged that ‘‘[a]pproximately $120 million 

was issued to advance payment recipients who had not established their benefits eligibility for the fall enrollment period.’’ According to a November 2010 report from 

the VA Office of Inspector General, ‘‘the emergency payments resulted in an estimated loss of about $87 million in unrecoverable debts.’’ 

A: To date, how much of the $356 million has been recouped by VA? 

Response. As of March 5, 2011, VA has collected $259,411,399. 

B: To date, how much of the $356 million has been determined to be uncollectable 

and why? 

Response. As of March 10, 2011, none of these debts have been determined to be 

uncollectable. Any emergency payment debts that do not have a current re-payment 

plan have been referred to Treasury for offset from other Federal payments. Treasury can also refer these debts to third party collection agencies. 

Question 2. VA’s fiscal year 2011 budget proposal requested funding for various 

contracts, including a contract with MITRE Corporation’s Center for Enterprise 

Modernization, a contract for an Outcome and Customer Satisfaction Survey, a contract for Training Performance Support Systems, a contract for National Student 

Clearinghouse Match, and a contract for Education State Approving Agency Contract Review. 

A: Please provide an update on those contracts, including the amount of funds 

that have been expended and the results achieved. 

Response. The following FY 2011 funds have been expended during the continuing 

resolution. 

1. MITRE Corporate Center for Enterprise Modernization 

Funds expended: $1.4 million. 

Results achieved: During FY 2011, MITRE has provided User Acceptance Testing 

(UAT) Support for four releases (3.0, 4.0, 4.1, and 4.2) of the Post-9/11 GI Bill LongTerm Solution (LTS). MITRE developed test scripts and test cases for each release, 

which were used by Veteran Claims Examiners to successfully test the LTS. In addition to UAT Support, MITRE has provided strategic management support to Education Service to include strategy development and planning; Integrated Master 

Schedule planning; and organizational strategic support, analysis and recommendations. 

2. Customer Satisfaction Survey 

Funds expended: $2.7 million. 

Results achieved: VBA’s Benefits Assistance Service (BAS) leads the customer satisfaction survey effort for all VBA programs including education programs. Under 

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this contract with J D Power and Associates (JDPA), the survey questionnaires have 

been finalized and are awaiting the selection files for the survey participants. BAS 

and JDPA are in the process of finalizing the data transfer agreement and developing the reporting site. JDPA is requesting the data files by the end of April for 

a May deployment of the surveys. The initial survey results are expected by September 2011. 

3. State Approving Agency Contract Review 

Funds expended: No funds have been expended for this contract in FY 2011. 

Results achieved: This contract generated recommendations for greater efficiency 

in the State Approving Agency (SAAs) contract and contract processes. A thorough 

review and analysis were completed to ensure compliance with all laws and regulations. A contract deliverable made recommendations for funds distribution that take 

into account the differences amongst SAAs and would allow VA to consider factors 

not addressed in the current funding allocation methodology. The deliverable provided recommended improvements to current contracting processes. As VA is focused on implementing SAA-related changes resulting from Public Law111–377, recommendations from this contract have not been implemented at this time, and will 

be revisited at a later date. 

4. National Student Clearinghouse Match 

Funds expended: VA anticipates expending $40,625 relating to this contract 

in FY 2011. 

Results achieved: Contractor is expected to provide student data reports that will 

show degree attainment characteristics for VA education beneficiaries and graduation rates compared to a randomly selected student population. 

5. Training Performance Support Systems—TPSS 

Funds expended: To date, no funds have been expended for this contract in 

FY 2011. However, a task order package has been submitted for Lifecycle 

Maintenance and additional task orders may be submitted subject to 

training needs and funds availability for FY 2011. 

Results achieved: VA anticipates that the contractor will provide Lifecycle Maintenance and fulfill any additional training module requirements subject to training 

needs. 

B: Does the fiscal year 2012 budget proposal include any funding to continue 

these contracts? If so, please provide the amounts and expected achievements. 

Response. VA requested the following FY 2012 funds to fulfill the listed contracts: 

1. MITRE Corporate Center for Enterprise Modernization 

Funds requested: $5.1 million. 

Expected achievements: VA anticipates that MITRE will continue to develop test 

scripts and test cases for each release as we look forward to the full automation and 

implementation of the LTS in 2012. MITRE will also continue to provide UAT support and strategic management support to Education Service. 

2. Customer Satisfaction Survey 

Funds requested: $5 million. 

Expected achievements: JDPA is expected to provide similar services to the BAS 

during fiscal year 2012 and produce a survey that will convey customer satisfaction 

results to the Education Service. 

3. State Approving Agency Contract Review 

Funds requested: No funds were requested for this contact for FY 2012. 

Expected achievements: VA does not anticipate extending this contract. 

4. National Student Clearinghouse Match 

Funds requested: $53,000 

Expected achievements: Contractor is expected to provide student data reports 

that will show degree attainment characteristics for VA education beneficiaries and 

graduation rates compared to a randomly selected student population. 

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5. Training Performance Support Systems—TPSS 

Funds requested: $586,000 

Expected achievements: The contractor is expected to begin work on training modules for the Education Liaison Representative (ELR), Education Compliance Survey 

Specialist (ECSS), Equal Opportunity Compliance Surveys and State Approving 

Agency Contract Management. The contractor will continue to work on existing 

training modules for Veterans Claims Examiners and Education Case Managers, 

TIMS Clerks, and ELR/ECSS compliance surveys. These modules will be updated 

as part of a routine maintenance to incorporate new legislation, policy, and procedures. 

C: Does the fiscal year 2012 budget proposal include any funding to secure contract services to help process education claims? 

Response. VA’s FY 2012 budget proposal does not include a request for funding 

to secure contract services to help process education claims. 

Question 3. VA’s fiscal year 2011 budget proposal for the Education Service included $3.1 million for Supplies and Materials. VA indicated that $1.2 million of 

that amount would be spent on printer cartridges in connection with an initiative 

to provide printers for individual employees. Since then, VA has indicated that the 

printer initiative was canceled. How is that $1.2 million now expected to be spent? 

Response. This funding requirement is no longer applicable. Funds for the printer 

cartridges initiative were eliminated from VBA’s budget. 

Question 4. According to VA’s Web site, individuals with questions about education benefits may call VA’s 1–888-GIBILL–1 phone number but they should ‘‘[b]e 

advised this line only accepts calls from 7:00 AM–7:00 PM central time Monday– 

Friday and you may experience long hold times.’’ 

A. Currently, how many employees are dedicated to answering calls to that telephone number? 

Response. There are currently 280 employees working in the Education Call Center (ECC) in Muskogee, Oklahoma. Of those 280 employees, 140 are call agents permanently assigned to the ECC. An additional 45 employees are term appointments 

(expiration date is Sept. 30, 2011) and 18 are temporary appointments (expiration 

date is Sept. 30, 2011). Currently, 34 agents are temporarily detailed from the 

Muskogee National Call Center (NCC) to the ECC to assist with the high volume 

of calls. The ECC also has 32 Education Case Managers (dedicated 5 hours/day to 

call handling) and 11 Senior Case Managers (handling call escalations) to assist 

with technical questions and call handling. 

B. Currently, what is the average ‘‘hold time’’ for an individual calling that telephone number? 

Response. The average ‘‘hold time’’ for fiscal year 2011 to date is four minutes and 

one second. 

C. For fiscal year 2012, what level of funding is requested for purposes of handling these telephone calls and how many employees will that level of funding support? 

Response. VA’s FY 2012 budget submission identifies the overall staffing level for 

administration of the education programs. Funding levels for specific functions supporting education claims processing, such as managing the Education Call Center, 

are allocated during the budget execution year. We therefore do not have this information available. 

D. With the requested level of fiscal year 2012 funding, what is the expected hold 

time for callers? 

Response. VBA’s current performance measures for call centers are based on 

abandoned and blocked call rates. To improve customer service, we are in the process of analyzing data and establishing goals to replace the abandoned call measures 

with measures for wait times. Analysis of the impact of workload and staffing fluctuations during peak enrollment periods on wait times is critical to establishing appropriate measures and improving customer service. At this time, we do not have 

sufficient data available to project expected hold time. 

Question 5. In connection with the February 2010 hearing on VA’s fiscal year 2011 

budget proposal, the Education Service indicated that it planned to expend $1.2 million during fiscal year 2011 on ‘‘[o]utreach pamphlets and letters.’’ 

A. How much has VA expended so far during fiscal year 2011 on outreach pamphlets and letters? 

Response. Approximately $55,000 has been expended in FY 2011 (Qtr 1). 

B. How much is requested for this purpose in the fiscal year 2012 budget proposal? 

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Response. VA has requested approximately $1.9 million to fulfill all outreach efforts in FY 2012, which include the mailing of letters and pamphlets. 

C. What metrics are used to determine if these pamphlets and letters are effective? 

Response. There are currently no metrics that gauge the effectiveness of outreach 

materials; however, VBA’s Benefits Assistance Service is conducting an outreach assessment. As part of this assessment, VBA intends to address metrics for this area. 

We do monitor usage of our Web site pages using Google Analytics to determine 

most visited Web sites. We also monitor usage of our Frequently Asked Questions 

and Facebook comments to evaluate what areas of information require clarification. 

In FY 2009, we enlisted MITRE assistance in conducting focus groups on communication to our stakeholders and made changes to our outreach strategy based on 

that information. MITRE will be conducting follow-up sessions with key stakeholders and Veterans to determine the effectiveness of our communications plan. 

D. In terms of those metrics, please explain the performance outcomes to date 

during fiscal year 2011. 

Response. See response to 5c. 

VETERANS HEALTH ADMINISTRATION

Question 1. The President’s Commission on Fiscal Responsibility and Reform’s December 2010 report recommended that Federal agencies ‘‘reduce Federal travel, 

printing and vehicle budgets.’’ (Recommendation 1.10.5) However, in the fiscal year 

2012 budget request Appendix for Medical Services there is listed an increase of 8% 

or $6 million for employee travel over the fiscal year 2010 actual level. Over the 

same period, there is listed an increase of 61% or $14 million for the ‘‘transportation 

of things.’’ 

A. How did VHA take into account the President’s commission’s recommendation 

to reduce travel when formulating this budget? 

Response. The eight percent increase in travel is over a 2 year period from FY 

2010 to FY 2012. While there is an increase in Employee Travel from FY 2010 

through FY 2014, VHA took the President’s commission’s recommendation to reduce 

travel and directly applied it to the preparation of the 2012 President’s Budget by 

limiting the amount of growth to only the inflationary rate per year from FY 2011 

to FY 2013 (see chart below). This is a reduction from the FY 2009 to FY 2010 increase of 19.75 percent. 

The 61 percent increase in Transportation of Things is over a 2 year period from 

FY 2010 to FY 2012. Estimates for Transportation of Things are made up of several 

components that are highly variable and are outside of the control of VA, such as 

Shipment of Bodies, Declared Emergency Shipment of Bodies, and Other Shipments 

which include shipment of personal effects of deceased beneficiaries. 

B. Please explain the assumptions used to formulate the budget for employee 

travel and transportation of things. 

Response. VHA used the Administration’s inflationary assumptions for the formulation of Employee Travel. VHA used an historical four year average to formulate 

the Transportation of Things because of the dramatic change in year-to-year actuals 

for this budget line. 

Question 2. The number of veterans who have served in the Armed Forces of the 

United States has been on a steady decline. The total veteran population has declined by 2.4 million since September 30, 2006, and VA estimates it will decline by 

427,793 veterans from 2011. However, VHA estimates their unique patients will increase by 85,567 in fiscal year 2012 over fiscal year 2011 and will increase further 

by another 116,607 in fiscal year 2013. 


32VAb1.eps 32VAb2.eps
333 

A. If the overall veteran population is decreasing, what accounts for the steady 

increase in unique patients? 

Response. While the Veteran population is decreasing, the Veteran enrollment 

rates are holding fairly steady. Thus, in spite of the declining Veteran population, 

the enrolled Veteran population is projected to increase by approximately 465,900 

from FY 2010 to FY 2013. This increase in Veteran enrollees results in a projected 

increase of approximately 274,000 Veteran patients from FY 2010 to FY 2013. However, the proportion of enrollees who are patients remains constant at 65 percent 

during this period. The likelihood of an enrollee becoming a patient is correlated 

with enrollee age, priority, gender, morbidity, special conflict status (OEF/OIF/OND 

status versus other), reliance on VA health care, and whether the enrollee used VA 

before or after Eligibility Reform. Also, new enrollees tend to have a higher likelihood of being a patient in the first year of enrollment. 

B. Of the unique patients, which period of veterans is expected to start utilizing 

the VHA system in greater numbers? 

Response. VA does not have the data on period of service for all enrollees that 

would allow a comparison of utilization of the VA health care system by period of 

service. 

Question 3. In the Budget Message of the President accompanying the fiscal year 

2012 budget request, he writes: 

America is emerging from the worst recession in generations. In 2010, an 

economy that had been shrinking began to grow again. After nearly 2 years 

of job losses, America’s businesses added more than one million jobs. (The 

Budget, page 1) 

With that in mind, the FY 2012 budget shows a contingency fund of close to $1 

billion to cover a potential increase in demand due to our current economic conditions. 

A. If the President believes that the economy is getting better, why does VA need 

a contingency fund? Response. The $953 million contingency fund, estimated in the VA’s Enrollee 

Health Care Projection Model, was created to address the potential demand increase 

for medical care services due to changes in economic conditions. Recent studies have 

shown that unemployment rates among Veterans are approximately double those of 

non-Veterans. As Veterans lose access to other health care options, such as employee health insurance, they increasingly seek VA care. These funds will only become available for obligation if the Administration determines that the estimated 

need due to economic conditions materializes in 2012. 

B. What is the threshold that needs to be reached for VA to use this additional 

funding? And what are the mechanics to releasing the fund? 

Response. Section 226 of the Administrative Provisions states that ‘‘* * * such 

funds shall only be available upon a determination by the Secretary of Veterans Affairs, with the concurrence of the Director of the Office of Management and Budget, 

that: 

(a) The most recent data available for: 

(1) National unemployment rates, 

(2) Enrollees’ utilization rates, and 

(3) Obligations for Medical Services, 

validates the economic conditions projected in the Enrollee Health Care Projection 

Model, and 

(b) Additional funding is required to offset the impact of such factors.’’ 

C. Should this increase in demand not materialize what is VA’s alternate plan for 

this funding? 

Response. If the increase in demand does not materialize, these funds would not 

become available for obligation and they would be used for deficit reduction. 

Question 4. In the VA budget justification books under Medical Services there is a category that shows a savings of just over $1 billion for ‘‘operational improvements.’’ The previous administration also sent to the Hill a budget request in fiscal 

year 2007 which included management efficiencies. In a Senate Committee on Veterans’ Affairs (SVAC) hearing on the fiscal year 2007 VA budget, then-Senator 

Obama stated: 

The VA had made management efficiency claims which make up over $1 billion 

in this year’s budget, but the [Government Accountability Office (GAO)], at least, 

says haven’t been and can’t be proven. So one of the concerns, and I am sure you 

will hopefully have a chance to respond directly to this is, if those savings prove 

illusory, what happens and how are you planning that possibility? (SVAC hearing, 

Feb. 16, 2006.) 

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A. Should these savings not materialize, how has VA planned for that risk? 

Response. These savings estimates are in six separate areas of operations and 

represent modest, achievable goals unlike the unspecified savings referenced above. 

Question 5. The Medical Care Collections Fund was established by the Balanced 

Budget Act of 1997 and has shown a steady increase in what has been collected 

from first party and third party payers over the years. Originally, VA estimated it 

would collect $3.2 billion in fiscal year 2012. According to a conversation my staff 

had with VA’s Chief Business Officer, that figure has been downgraded to $2.8 billion. 

A. How much of this down grade is due solely to a change in the actuarial model 

and has VA also assumed changes to the economy in this revision? 

Response. The down grade was not due to a change in the VHA Office of Policy 

& Planning’s Enrollee Health Care Projection actuarial model. The reduction is a 

result of VA revising several assumptions from CBO’s collections model to incorporate economic market conditions, in addition to a number of other factors, to 

project MCCF collections in FY 2012. These factors include: 

• Poor economic conditions—Growth in national unemployment (from 7.7 percent 

in the First Quarter of FY 2009 to 9.8 percent at the end of the First Quarter of 

FY 2011) will continue to impact both first party collections (Veteran out-of-pocket 

costs) and third party collections (unemployment and resultant loss of health insurance coverage). 

• Hardship waivers and exemptions from copayments are increasing—Veteran 

first party copayment economic hardship waivers and exemptions were at their 

highest levels in FY 2010 (the most recent completed year) than in any prior year, 

and this is expected to continue with the current economic conditions. 

• Third party ‘‘Collections to Billings’’ (CtB) ratios are down nationally—CtB ratios are expected to continue a downward trend, reducing third party collections. 

CtB decreased from 43.1 percent in January 2009 to 39.1 percent in January 2011, 

and was influenced by the continued shift by insurers of payment responsibility to 

the patient (i.e., higher deductibles, increased copayments, etc.). Section 1729 of title 

38 prevents VA from billing the Veteran if the insurance company does not pay. 

Each one percent decrease in CtB represents a $55 million loss in revenue. 

• Veterans aging to 65 years and older—FY 2012 begins to reflect the shift in 

workload for Vietnam Era Veterans aging to 65 years and older. Once a Veteran 

is Medicare-eligible, Medicare becomes the primary insurance coverage and VA can 

bill insurance companies only for the portions Medicare does not cover (typically 

their deductibles). This significantly reduces the amount VA can collect. 

• Priority Group migration from lower to higher status—National Priority Group 

migration over the past two years has shown a sharp decrease in collections for Veterans in Priority Group 8, which are the primary drivers of both first and third 

party collections. 

• Shift in Service Connected Workload vs. Non-Service Connected Workload As 

Veterans migrate from lower to higher status, there is also a shift in workload from 

Non-Service Connected (Non-SC) care (which could be billable if the Veteran has insurance) to Service Connected (SC) care (regardless of insurance coverage VA does 

not bill for SC care). From FY 2009 to FY 2011 the total number of outpatient encounters has seen an increase of two percent nationally in SC care, with an equal 

decrease of two percent in Non-SC care, which has impacted Third Party collections. 

Question 6. The fiscal year 2012 budget request calls for savings of $150 million 

through medical and administrative support savings. 

A. What will be the total loss of FTE? 

Response. There are no discrete reductions in FTE included in this cost savings 

estimate. Total FY 2012 FTE is estimated to actually increase by 524. The savings 

are achieved through clinically appropriate substitution of less costly staff for more 

expensive predecessors, for example the replacement of a physician with a nurse 

practitioner, or the replacement of a registered nurse with a licensed practical 

nurse, in positions where there will be no degradation in either the quality or quantity of health care services provided to Veterans. There may be other occupations 

where care extenders may be utilized and, in each case, VHA will do appropriate 

assessments to ensure care to Veterans is not compromised. 

B. Please explain what type of positions fall within this category? 

Response. Please see response to 6. A. 

C. Will these cuts be realized at individual VA facilities or at Veterans Integrated 

Service Network (VISN) headquarters and VA Central Office? 

Response. The cost savings of $150 million will be achieved by more efficiently 

employing the resources in various medical care, administrative, and support activiVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00340 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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ties at each medical center and will be achieved by targeting the following areas 

to improve overall operational efficiency: 

• High missed outpatient appointments/no show rates • Observed to Expected Length of Stay • Diagnostic colonoscopy (CPT code 45378) cost per procedure • Cardiac catheterization cost per procedure • Primary care cost per encounter 

Question 7. The FY 2012 budget request proposes a change in current law to remove the requirement for VA to reimburse certain employees appointed under title 

38, section 7401(1), for expenses incurred for continuing professional education. 

Under current law, the Secretary shall reimburse for up to $1000 per year for full 

time physicians and dentists for continuing education. The budget states that the 

change in law could have a potential cost savings annually of $325 million and $3.25 

billion over ten years. 

A. How will VA guarantee that doctors and dentists have the ability to receive 

all of the continuing education needed to maintain their requirements under their 

licenses, specifically at facilities in rural areas without access to major academic institutions? 

Response. VHA health care professionals, including physicians, are solely responsible as a condition of employment for maintaining their professional licensure and 

for completing the associated continuing medical education requirements. VHA’s 

Employee Education System (EES) provides training to support VHA’s mission and 

pursues opportunities for accrediting these training programs for professional continuing education credits wherever feasible and advisable. Some training, education, 

or conference events may not be professionally appropriate for continuing education 

accreditation. 

Question 8. The FY 2012 budget request asks for $451 million for reimbursement 

to eligible veterans of emergency services pursuant to the Veterans Millennium 

Health Care Act. This represents an increase of $87.5 million since FY 2010 or 24%. 

The FY 2013 advanced appropriation calls for an additional $52.5 million, which is 

an 11.6% increase over FY 2012. 

A. What accounts for the 24% increase in the amount for reimbursed emergency 

services? To what extent is this attributable to Public Law 111–137? 

Response. The 24 percent increase in the amount for reimbursed emergency services is not attributable to Public Law 111–137. Public Law 110–387, Section 402 is 

responsible for this increase. The change in the law, which allows for payment of 

emergency inpatient care beyond the point of stabilization if VA facilities are not 

available, is the primary reason for the significant increase in projected budget requirements. Other reasons contributing to this increase in projected costs include 

the increase in unique Veterans served, overall economic conditions impacting Veteran eligibility and utilization, and increased billing rates reflecting medical costs 

inflation. 

B. VA is currently rolling out the Patient Aligned Care Team (PACT) model with 

one of the goals of limiting the necessity of readmissions and hospitalization. If the 

PACT model will limit the growth of reimbursement for emergency services under 

the Millennium bill, what accounts for this increase in FY 2013? 

Response. The goal of limiting the necessity of readmissions and hospitalizations 

applies to those that occur in VA medical facilities. It will not reduce the cost of 

emergency admissions to civilian hospitals which are estimated to increase. The 

costs in FY 2013 are projected to increase when compared with FY 2012 but these 

costs will be less than what VA would have incurred without this initiative. Factors 

beyond VA’s control, such as the proximity of Veterans to facilities (VA or non-VA) 

and rising health care costs influence the need for and cost of emergency care. 

Question 9. The fiscal year 2012 budget request for the Energy/Green Management Program shows the program funding decreased 82% between FY 2010 and 

2012. According to the budget request, the program is to be increased 15.5% between FY 2012 and 2013. 

A. With the fluctuations in the budget for the Energy/Green Management Program, how will VA have the necessary funding to meet the performance benchmarks 

set forth in Executive Order 13514? 

Response. VA contracted to implement a large number of green building, renewable energy, and energy/water efficiency improvement projects in FY 2010, which 

are scheduled to come on-line as late as FY 2012. We also funded a number of feasibility studies for additional projects and are conducting energy assessments of 25% 

of our facilities annually. Performance improvements related to the FY 2010 investments are projected to be significant and to move VA successfully forward through 

FY 2013. In the meantime, we continue to incorporate renewable energy and other 

336 

sustainable features into our new construction projects and to select future projects 

at existing facilities based on results of feasibility studies and energy assessments. 

To continue progress toward EO 13514 goals in the face of fluctuating direct funding, VA will be making use of third-party financing mechanisms—energy savings 

performance contracts (ESPC) and utility energy savings contracts (UESC)—to procure some of these projects. Using these instruments will allow VA to implement 

projects without up-front investment, with costs paid for out of the stream of resulting operational savings. With a centralized contracting activity dedicated to the Energy/Green Management Program, VA is well-positioned to accelerate the use of 

ESPC/UESC to meet EO 13514 performance benchmarks. In addition, VA is pursuing a number of low cost/no cost initiatives as part of this program. For example, 

we are instituting a ‘‘stoplight’’ style reporting process to evaluate how facilities are 

addressing EO 13514 requirements. We created a ‘‘Green Routine’’ program that encourages and supports all employees in everyday practices such as turning off lights 

and double-sided copying. And, we established two new internal awards programs, 

one covering ‘‘green’’ professionals such as environmental managers and one covering all other employees who make innovative contributions to greening their 

facility. 

Question 10. The fiscal year 2012 budget request shows an increase of 2,589 between FY 2011 and 2012 for contract hospital (psychiatric) workload and an additional increase of 2,143 between FY 2012 and 2013. At the same time, the budget 

request shows a decrease of 2,990 for psychiatric residential rehabilitation within 

VA over the same timeframe. 

A. Please explain the justification for eliminating internal psychiatric residential 

rehabilitation capacity with contract hospitals outside VA? 

Response. Psychiatry Average Daily Census levels have trended upwards over the 

last several years and out year projections indicate continued increases but at a 

slower rate. The experience with Residential Rehabilitation is different. VA Mental 

Health Service views Psychiatric Residential Rehabilitation (PRRT) and Domiciliary 

care as equivalent care options, and are both Residential Rehabilitation care. In recent years there has been a decrease in PRRT with a commensurate increase in 

Domiciliary Residential Rehabilitation Treatment. The budget for FY 2012 and FY 

2013 forecasts an increase for the combined workload of PRRT and Domiciliary care, 

the two forms of Residential Rehabilitation care, as shown in the following table. 

Question 11. The fiscal year 2012 budget request estimates savings of $315 mil- lion in FY 2012 and $362 million in FY 2013 by moving the fee care program payments to be consistent with those of the Centers for Medicare and Medicaid Services 

(CMS) rates. 

A. What are the underlying assumptions for these estimated savings? 

Response. The underlining assumptions for these savings were based on use of the 

multiple pricing schedules covered under the regulation. VA has had authority to 

pay inpatient hospital claims and physician services utilizing the Centers for Medicare & Medicaid Services (CMS) payment methodologies for many years. Effective 

for non-VA treatment on or after February 15, 2011 VHA adopted CMS payment 

methodologies for outpatient services. This aligns VHA with standard Federal payment schedules and assures all payments from VA utilize the same structure. Prior 

to adopting CMS payment methodologies VHA processed payment for outpatient 

services for facility charges using a ‘‘VA Fee Schedule’’ which is based on billed 

charges and reimbursement was based on the 75 Percentile of those charges, significantly higher than standard CMS pricing. The estimated savings was developed 

using the difference between the 75 Percentile from the VA Fee Schedule and the 

CMS rates extrapolated from actual payment data from the first six months of calendar year 2008. VHA contracted with an outside vendor to complete a comparison 


32VAb3.eps
337 

to identify cost savings under this legislation. The analysis compared CMS rates 

with VA Fee Schedule rates to make this estimate. A sampling of lab, ESRD, and 

other Medicare methodologies to estimate an average savings based on these rates. 

B. VA is currently in the process of upgrading the IT infrastructure to process 

the new fee payments at the Medicare rate. What is VA’s timeline for completing 

these upgrades? Will VA be able to realize savings in FY 2012 if systems are not 

fully in place to handle the move to the CMS rate? 

Response. The current claims processing system, Fee Basis Claims System, is 

scheduled to be updated with CMS rates by mid-year FY 2012. To assure accurate 

pricing, VA developed an interim solution utilizing a contract service to price claims 

submitted to VHA for authorized services by non-VA providers. This service will initially be manual, with a move to a web-based solution by the end of April. The VA 

will continue to utilize this service until such time as the appropriate technology 

is in place to accurately price these claims. 

C. How do the savings in the FY 2012 budget request compare to the estimates 

that VA provided in the regulations moving the purchased dialysis program to CMS 

rates? Please explain any changes in assumptions that led VA to adjust the savings 

estimate. 

Response. The FY 2012 budget request utilizes the same cost savings estimates 

documented in the Final Rule. 

D. How are the anticipated savings in the FY 2012 budget request affected by contracts that VA currently has in place with private dialysis facilities or from replacing these contracts with payments at the Medicare rate? 

Response. VA is currently assessing the impact of continued use of contracts in 

relation to the new regulation. This assessment will include a specific market analysis and a determination on impact to access for health care, assuring access is not 

negatively impacted while also assuring a cost effective program. 

E. Please explain the estimated savings VA will accrue from dialysis contracts 

and Basic Ordering Agreements compared to the former regulation that required VA 

to pay at the 75th percentile of billed charges? 

Response. Cost savings in FY 2011 were estimated based on use of contracts and 

blanket ordering agreements (BOA). The contract and BOA rates and payments are 

compared with prior year payments. Prior to use of contracts/BOAS VA was required to pay at the 75th percentile of billed charges. 

Question 12. The FY 2012 budget request calls for clinical staff and resource realignment which will presumably save VA $150.8 million. To reach that projected 

savings, VA states it will cut 313 doctor and 1,133 registered nursing positions. The 

lost FTE will be replaced by non-physician providers and LPNs. Due to the economic 

down-turn, thousands of skilled registered nurses have reentered the workforce. It 

would seem that we should be trying to entice these skilled clinicians to work at 

VA; however, VA has decided to cut the number of RN positions for FY 2012. 

A. Registered nurses are the backbone of any well operated hospital or clinic. 

What will be the effect to both institutional knowledge and patient care if VA is 

successful in cutting the numbers of doctors and registered nurses and replacing 

them will less trained and skilled positions? 

Response. VA is replacing positions through attrition, not designated elimination 

of staff, so there will be no acceleration of loss of institutional knowledge. Only those 

positions identified as clinically appropriate will be used for substitution of more 

cost effective specialties, so there is no anticipated impact on patient care. 

B. Will these cuts in RN and physician FTE result in the loss of actual personnel 

at facilities or are these FTE not currently filled? If not, why does the budget include positions that are not filled? 

Response. These estimates are based on substitution of positions with less costly 

and more clinically appropriate specialties when they become vacant. There is no 

associated loss of total FTE. Positions that have not historically been filled are not 

included in the budget estimates. 

C. Please explain the decisionmaking process that led VA to make this cut in RN 

positions. 

Response. In response to anticipated resource constraints and to exercise good 

stewardship of VA resources, the executive leadership at each VA medical center or 

program office will determine if a physician or registered nurse position that becomes vacant requires a replacement with the same clinical skills or may appropriately be filled with a less costly alternative specialty without any degradation of 

quality or capacity of health care for Veterans. 

Question 13. VA has taken a number of steps over the last two years to try and 

limit the number of hospital or clinic visits which are needed for veterans. The 

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mary and specialty care, with the ultimate goal of allowing veterans to receive all 

of their needed treatment and consultations in one visit. In order to better understand how veterans are currently utilizing VA services, please provide the following 

information. 

A. VA has stated that by realigning the primary care model used at their facilities, scheduling of appointments will be focused on veterans’ wishes and will eliminate the need for multiple visits. Please define what VA believes constitutes 

unneeded multiple visits. 

Response. Unneeded multiple visits are those where patient concerns can be addressed by means other than face-to-face clinic visits e.g., telephone care, secure 

messaging, My HealtheVet, and/or mail. In addition, VA data suggests return visit 

intervals can be increased resulting in a reduction of clinic visits without a decrease 

in quality by using other means as well. 

B. Assuming there have been unneeded multiple visits, how many unneeded multiple visits took place in FY 2010, how many took place in FY 2011, and how many 

are forecasted for FY 2012? 

Response. Currently, this data is not available in the VA scheduling package. 

C. VA currently has performance metrics for both primary care and specialty care 

appointments completed within 14 days of the desired date. How does VA measure 

the interrelation between scheduling primary and specialty care appointments on 

the same date? 

Response. When making appointments, schedulers are instructed to coordinate 

appointments for patients as much as possible. However, VHA Directives do not require that appointments for primary and specialty care be scheduled to occur on the 

same date. For that reason, VHA does not monitor the number of primary and specialty care appointments scheduled to occur on the same date. The wait time for 

each appointment is purely the measurement of the number of dates from the desired date for that specific appointment and the date that appointment is completed. 

However, if a Veteran were to specify that his desired date for an appointment is 

on the same date another appointment is scheduled to occur, he scheduler would 

be expected to enter that date as the desired date for the appointment being scheduled, and if possible offer an appointment on that date. 

Question 14. In recent months, the Committee has been approached by senior 

former employees at VA medical centers from across the country claiming they were 

targeted by their superiors for raising concerns about improper facility practices. 

They raised concerns specifically with the use of what VA calls ‘‘Administrative Investigations Boards.’’ 

There is an obvious need for Medical Directors to investigate malfeasance and 

fraud in VA facilities. However, Medical and VISN directors do not always have the 

ability to terminate or punish those who have been found to put veterans’ lives at 

risk or who have become a liability to the organization. Yet some senior level former 

VA employees suggest that certain senior leaders have found ways to abuse the 

process and have used it as a tool to retaliate. 

A. VA has previously indicated there is no centralized oversight of AIBs by the 

VISNs or VA Central Office. In fact, VA has stated that the guidelines for AIBs are 

almost at the complete discretion of the senior leader who convenes an AIB. How 

does VA conduct oversight and provide guidance from the VISN and Central Office 

to ensure the AIB’s are used properly? 

Response. VA Directive 0700 establishes policy within the Department of Veterans Affairs (VA) regarding administrative investigations. It establishes uniform 

standards for the conduct, reporting, and review of administrative investigation 

boards, and clarifies the responsibilities of those involved. VA Handbook 0700 establishes operational requirements and procedures for convening, conducting, reporting, 

and reviewing administrative investigations. The General Counsel (GC) is responsible for the contents of both documents. However, GC does not typically oversee 

local administrative investigations. 

Determining the facts and the appropriate response to matters within their areas 

of responsibility is an inherent duty of VA executive leadership. Generally, the decision to order an investigation, and the appropriate scope of the investigation, is a 

matter within the discretion of the Convening Authority. These actions are expected 

to be consistent with VA Directive/Handbook 0700 and any other governing requirements. Retaliation by any VA employee against any person for cooperating with an 

investigation or providing truthful testimony is prohibited. In some cases, employees 

are entitled to specific protections against retaliation, such as those established 

under the Whistleblower Protection Act. Witnesses who believe they are being 

reprised against can report the matter to the Convening Authority and they may 

also report the matter to the Office of Special Counsel (OSC) or VA’s Office of Inspector General (OIG). Employees who believe the investigation was convened for 

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the purpose of harassment following their participation in protected activity may 

also report their concerns to OSC, the VA OIG, or other senior officials in the employee’s supervisory chain of command. 

The VA Secretary’s memorandum dated July 30, 2009 entitled ‘‘Senior Management Conduct Issues’’ requires specific procedures for investigation of allegations of 

serious misconduct involving senior managers. Senior managers include all members of the Senior Executive Service; Associate and Assistant Directors; Chiefs of 

Staff, Nurse Executives at VHA facilities, heads of other VA facilities; including National Cemeteries, Network Offices, and Regional Offices; any GS–15 position or 

Title 38 equivalent in VA Central Office; and all other positions centralized to the 

Secretary. All Administrative Investigative Boards that concern VHA senior managers are attended by or reviewed by the VHA Human Resource Management 

Group, which has a reporting alignment to the Under Secretary for Health through 

VHA’s Workforce Management and Consulting Office. To assure consistency 

throughout the Agency, any decisions involving occupants of these covered positions 

require the concurrence of the Office of General Counsel and VA Office of Human 

Resources Management. The reviews by these other offices also occur even when determinations are made that no action is necessary or counseling or training is recommended. 

The Office of Human Resources Management in VA Central Office provides regular training in the conduct of administrative investigations for potential board 

members. Additionally, VHA’s Senior Executive Orientation recently added a session addressing ‘‘When to convene an AI?’’ 

B. Which office in VA has direct responsibilities for ensuring fair procedures are 

being followed in the AIB process? 

Response. As indicated above, OGC is responsible for implementing the requirements found in VA Directive/Handbook 0700, but does not directly oversee each investigation. Employees who have concerns regarding unfair procedures during the 

conduct of an AI may report their concerns to the Convening Authority or other senior management officials. In addition, employees who believe an investigation is 

being used to harass them for engaging in protected activity may contact the OSC 

or the VA OIG. 

VHA Performance Plan 

Question 1. In the FY 2012 budget request there is a performance indicator listed 

with the stated major institutional goal to ‘‘design a veteran-centric health care 

model and infrastructure to help veterans navigate the health care delivery system 

and receive coordinated care.’’ The only associated performance measure for this is 

the non-institutional long term care average daily census, which has a limited scope 

dealing directly with long term care. With the roll out of the PACT model, what performance measures will VA utilize to measure both PACT and the major institutional goal of designing a veteran-centric health care model and infrastructure? 

Response. Currently, VA uses the Primary Care Staffing ratio to monitor and 

measure PACT infrastructure implementation and patient and employee satisfaction 

scores to measure satisfaction with implementation. In addition, VA also monitors 

access, coordination, and continuity as indicators of PACT implementation progress. 

Veterans Canteen Service Revolving Fund 

Question 1. In the FY 2012 budget request, the current estimate for FY 2011 shows personnel costs totaling $12.1 million while only estimating $11 million in fiscal year 2012. In addition, in the Summary of Employment section there is a projected increase of 25 employees from FY 2011 Current Estimate to FY 2012. 

A. What accounts for the increase in average employment while decreasing the 

amount of money obligated to the costs of personnel? 

Response. Projected personnel increases are the result of new or upgraded canteen 

operations in CBOCs and outpatient clinics. Most Canteen Service personnel are 

hourly rate workers, employed either full-time or part-time. Consequently, the estimated annual cost for these employees is considerably less than it would be for 25 

full-time employees. 

The original cost estimate for FY 2012 would have shown a slight increase from 

the FY 2011 estimate due to the new hires and an assumed increase in the costof-living allowance. However, the estimate was revised downward as a result of the 

pay freeze to a figure that is slightly less than the original estimate for FY 2011. 

Question 2. In the program description of the Veterans Canteen Service, the FY 

2012 budget request mentions that ‘‘provisions of the Veterans’ Benefits Act of 

1988 * * * eliminated the requirement that excess funds be paid to the Treasury 

and authorized such funds to be invested in interest bearing accounts.’’ 

A. What type of interest-bearing accounts have the excess funds been invested in? 

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Response. The Veterans Canteen Service (VCS) invests only in Treasury bills. 

B. Please detail the invested funds performance since the ability to do so was authorized. 

Response. Over the past 10 years, VCS investment income has varied due to market-based fluctuations in interest rates. Before September 11, 2001, VCS earned 

$1.5 to $2 million per year. Since September 11, 2001, rates were dramatically lower 

as interest income ranged from $381,000 to $800,000 per year through 2008. Since 

2008, interest rates have been zero and VCS proceeded with significant capital and 

technology investment thus reducing funds invested. In FY 2012 VCS expects capital and technology investments to slow and investment income begins to grow. 

Question 3. The fiscal year 2012 budget request shows a decrease in the Cost of Merchandise Sold from $24.5 million in FY 2011 to $15 million in FY 2012. 

A. Please outline the reasons for a projected decrease of $9.5 million in Cost of 

Merchandise Sold. 

Response. There has not been a decrease in Cost of Merchandise Sold from FY 

2011 to FY 2012 which is presented in the ‘‘Analysis of Increases and Decreases— 

Obligations’’ table in the President’s FY 2013 Budget Submission, Vol. 2, page 4A– 

3 (below). 

The table shows an overall estimated increase of $62,547, 000 in obligations for FY 2011, of which $24,500,000 is an increase in Cost of Merchandise Sold. For FY 

2012, the table shows an overall estimated increase of $41,000,000, of which 

$15,000,000 is an increase in Cost of Merchandise Sold. 

The question assumes that the total Cost of Merchandise Sold fell from $24,500,000 to $15,000,000 between FY 2011 and FY 2012 when in fact the amount 

increased each year by those amounts. 

HOMELESS VETERANS

Question 1. The President has made ending homelessness among veterans a top priority of his administration. The FY 2012 budget request includes $939 million, 

a 51% increase from FY 2010, for specific programs to prevent and reduce homelessness among veterans. 

A. Do the fiscal year 2012 request and the fiscal year 2013 advance funding request anticipate or require changes in the law to release funding for homeless veterans’ programs? 

Response. There are two specific programs for which changes in law are requested 

the Grant and Per Diem (GPD) Program and the Support Services for Veterans 

Family (SSVF) Program. VA’s FY 2012 budget submission includes increased funding for both the GPDSSVF programs for FY 2012 and FY 2013 

Section 2013 of title 38, United States Code, currently authorizes the appropriation of up to $150,000,000 per fiscal year for the GPD Transitional Housing program. The GPD Program FY 2012 and FY 2013 budget anticipates an increased 

level of spending in order to increase program capacity to serve approximately 

20,000 homeless Veterans. The budget request for FY 2012 and FY 2013 is 

$224,117,000 per fiscal year. To accommodate this anticipated increase, a legislative 

change in the authorized spending amount is requested. 

The SSVF Program currently is authorized to spend up to $60 million over three 

years ending in FY 2011. FY 2012 and FY 2013 budgets anticipate a $100 million 

annual appropriation. Such an appropriation contemplates modification of the SSVF 


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Program’s current funding authority. Approximately 19,000 Veterans and their families will receive services in 2012 and 2013. 

Question 2. Even though the administration has made ending homelessness 

among veterans a top priority, the Domiciliary Care for Homeless Veterans and the 

Compensated Work Therapy programs have a reduction in their budgets. The FY 

2012 request has a 10% decrease for Domiciliary Care for Homeless Veterans and 

an 11% decrease for the Compensated Work Therapy/Vocational training program 

from FY 2010. 

A. What is the justification for the reductions in these programs’ budgets? How 

do the reductions in these programs align with VA’s overall strategy to end homelessness? 

Response. The Domiciliary Care for Homeless Veterans (DCHV) and Compensated 

Work Therapy (CWT) budget projections are based on historical program costs plus 

additional program cost that are part of the initiative to end homelessness among 

Veterans. The FY 2010 President’s budget costs were estimated at $119 million and 

did not contain any new program costs related to the homeless initiative. The actual 

FY 2010 DCHV costs were $175 million. The increase in FY 2010 actual costs is 

related to program expansion and initiatives to improve workload capture and cost 

reporting. 

The FY 2011 and FY 2012 figures are estimates based on historical costs plus 

planned expansion related to the homeless initiative. The Veterans Health Administration (VHA) will continue to monitor budget estimate verses actual costs to further refine budget submissions. The FY 2012 CWT and DCHV budget requirements 

will be reevaluated and addressed within the total Homeless program budget as FY 

2011 Actuals become finalized and VA’s FY 2013 President’s budget costs are submitted. 

Question 3. The Housing and Urban Development-VA Supported Housing (HUDVASH) Program is one of the signature VA initiatives to provide permanent housing 

to homeless veterans with case management services. Since 2008, Congress has 

funded approximately 30,050 vouchers. As of December 31, 2010, only 21,078 formerly homeless veterans are currently living in permanent housing. The President’s 

request for FY 2011 and FY 2012 includes additional funding for 10,000 vouchers 

each year. 

A. Of the remaining 9,422 vouchers, only 7,419 have been issued to veterans. 

What is the status of vouchers that have not been issued to veterans? When does 

VA believe that all vouchers will be issued and leased? 

Response. HUD has received approximately 30,000 HUD-VASH vouchers since 

2008 (approximately 10,000 per year in 2008, 2009 and 2010). HUD is responsible 

for allocating these vouchers to local Public Housing Authorities (PHA) and VA’s 

role in the program is to screen, case manage, and refer eligible Veterans to PHAs 

for distribution of these vouchers. 

The data referenced above reflect cumulative numbers starting in 2008. 

As of February 28, 2011, 19,834 Veterans are currently under lease. Of the vouchers not leased up, approximately 6,667 are in the hands of Veterans who are in the 

housing search process. Approximately 3,936 Veterans have been referred to the 

PHA to undergo the process of background checks to ensure the referred Veterans 

are not on any sexual offender registry and that they qualify for income eligibility. 

It is important to note and understand that these numbers are dynamic and that 

Veterans leased up today could not be leased up tomorrow due to ‘‘graduation’’ or 

‘‘falling out’’ of the HUD-VASH program for a variety of reasons. This response provides a point-in-time snapshot of HUD-VASH voucher status as of February 2011. 

VA is working diligently with HUD and local PHAs to ensure that Veterans receive supportive services during this process. VA is working with the PHA to ensure 

that vouchers are assigned expeditiously and to ensure the maximum number and 

Veterans are placed into permanent housing. 

Additionally, vouchers can be re-issued and have been re-issued to other homeless 

Veterans. VA, through its case managers, is working diligently with the PHAs to 

issue these vouchers. It is important to note that the number of vouchers available 

for issue at any given time fluctuates as a result of Veterans who ‘‘graduate’’ or discontinue the program and no longer need their voucher. These vouchers are able 

to be redistributed. 

Once a Veteran is referred to the HUD-VASH program, it takes an average of 126 

days for the Veteran to get housed. During this time, Veterans are referred to the 

PHA to complete the application process, begin identifying and locating suitable and 

affordable housing, arranging for the inspection of the selected unit, signing the 

lease with the landlord, and making arrangements to move into their housing. AddiVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00347 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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tionally, Veterans are engaging in clinical services that assist them in enhancing 

their skills to live a full and productive life. 

Many VA facilities are working closely with their PHA partners, landlords and 

other community groups to streamline the process and improve the timeliness of distributing vouchers to Veterans and moving them into rental units. Significant improvements have already occurred. In the first year, the mean cumulative lease up 

rate was 548 Veterans housed each month. In 2010, the mean cumulative lease up 

rate increased to 929 Veterans per month, and thus far in FY 2011, the mean cumulative lease up rate is 992 Veterans per month. VA believes it can maintain this 

rate, and will have approximately 90% of the Veterans permanently housed by September 30, 2011. 

B. Of the remaining vouchers, what VA medical facilities were these vouchers allocated to? How is VA ensuring there is not a systematic problem resulting in 

issuing the remaining vouchers? 

Response. As of February 28, 2011, the attached list of the medical centers have 

vouchers that still need to be assigned. 

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To clarify, the local Public Housing Authority (PHA) receives the vouchers and 

awards them to eligible Veterans referred by HUD-VASH case managers at the local 

VA medical center. 

Note: This list is dynamic and will change based on the productivity and activity 

of the medical center. The number of vouchers available at any given time fluctuates as a result of Veterans leaving or discontinuing the program and no longer 

needing vouchers. These vouchers are able to be redistributed. 

VA is confident that delays are not systemic and is working with these Medical 

Centers to ensure they are assisting homeless Veterans as expeditiously as possible. 

VISNs and Medical Centers submit to the VA National Homeless Program Office 

at least monthly reports of voucher issuance and lease up rates. The National Program Office has been able to determine where sites are experiencing delays. As of 

the end February 2011, 20 of the 132 medical centers awarded vouchers account for 

90% of the underutilized vouchers. A total of 98 sites have fully implemented their 

vouchers. Reasons for delays vary and include clinical decisions to have Veterans 

treated in a more acute treatment setting to address mental health and medical concerns prior to referring them for permanent supportive housing with the Public 

Housing Authorities, hiring delays at the local Medical Center, the need for better 

collaboration with the community in identifying homeless Veterans and streamlining the application process, reconciling poor credit histories for Veterans and obtaining access to funding to help Veterans with move in expenses. Delays have also 

occurred due to difficulties in finding and approving suitable affordable housing in 

certain high cost areas. VA will continue to put emphasis on incorporating the 

Housing First model into its HUD-VASH program, allowing Veterans more timely 

access to housing, while providing them with needed supportive services to ensure 

that they are able to maintain housing. VA is also actively pursuing the use of 


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shared contracted community case management services in those communities with 

VA medical centers that have been slow to hire case managers. 

C. Of the veterans who have received a HUD-VASH voucher, how many are gainfully employed and have been able to return the voucher because they no longer 

need the program? 

Response. As of February 2011, homeless program evaluation data indicates that 

there are 752 Veterans whom have exited HUD-VASH because they met program 

goals, exceeded the income limits and no longer need the program to remain in permanent housing, or found and obtained alternative housing. 

Specific gainful employment data is not directly collected at this time. 

D. How is VA ensuring that homeless veterans living in rural and underserved 

areas are able to participate in the HUD-VASH program? 

Response. In the voucher selection processes for past years, HUD and VA were 

able to target approximately 11% of the allocated vouchers to rural and underserved 

areas in recognition of the fact that identifying and serving rural homeless is a priority. VA and HUD work closely to disseminate housing choice vouchers where they 

are most needed. Furthermore, when vouchers are not being appropriately utilized 

by a local Public Housing Authority (PHA), HUD has taken proactive measures to 

relocate those vouchers to another PHA that has Veterans with unmet housing 

needs. VA will continue to monitor this issue and coordinate with HUD to get 

vouchers to locations where there is unmet need. 

Question 4. HUD-VASH case managers play a vital role in the operation and success of the HUD-VASH program. Case managers are on the front lines working with 

veterans, landlords, and other community organizations to assist homeless veterans 

in obtaining and maintaining permanent housing. In the President’s request, the 

HUD-VASH case management account receives a 183% increase from FY 2010. 

As of December 31, 2010, VA has funded 1,230 HUD-VASH positions; however, 

only 897 have been filled. 

A. Is VA contracting with local organizations to ensure that homeless veterans are 

receiving case management services? If not, does VA need legislative authorization 

to contract these services? 

Response. VA is able to contract with local organizations to ensure that homeless 

Veterans receive case management services. In FY 2010, The DC VA Medical Center 

contracted with the District of Columbia to provide community case management 

services for 150 Veterans. All 150 Veterans were placed in housing within 6 months, 

and because of the success with this initiative, the contract was extended. Sites in 

California, Florida, New York City and Denver are currently exploring a targeted 

shared contracted case management model. 

B. How many additional case managers will be needed to ensure that the additional vouchers are effectively and efficiently received by homeless veterans? 

Response. VA is funded for 1,207 case managers rather than 1,230. VA expects 

to continue using a staff to Veteran funding ratio of 1 case manager for every 25 

Veterans whom are utilizing a voucher. Therefore, if HUD receives funding for an 

additional 10,000 vouchers, VA would anticipate hiring another 400 case managers. 

It is important to note that the number of case managers that will be needed is dependent upon the number of vouchers allocated. 

Question 5. On May 20, 2010, the Senate Appropriations Subcommittee on Transportation, Housing and Urban Development, and Related Agencies and the Subcommittee on Military Construction, Veterans Affairs and Related Agencies held a 

hearing regarding ending veterans’ homelessness.’’ 

Secretary Donovan testified as follows: ‘‘For FY 2011, HUD did not request funding for HUD-VASH. While the need for homeless veterans’ assistance is great, with 

the significant level of resources that we have been provided by Congress in recent 

years, we want to ensure that these resources are used as effectively and efficiently 

as possible.’’ 

A. Planned program expansions will provide an additional 10,000 new vouchers 

in 2011 and 2012. How is VA ensuring that these additional resources will be used 

effectively and efficiently? What is VA’s justification for the additional vouchers 

when HUD did not request additional vouchers in FY 2011? 

Response. VA has several processes in place to ensure resources are used effectively and efficiently. VA and HUD have a shared Office of Management and Budget 

high priority performance goal for which both agencies have committed to reducing 

the number of homeless Veterans on any given night to 59,000 by June 2012. A primary strategy for achievement of this goal involves utilizing the HUD-VASH program to provide homeless Veterans with vouchers so they can access permanent 

housing. This high performance goal provides an opportunity for both agencies to 

improve performance. 

348 

VA has established performance monitors that promote timely hiring of case managers and timely lease-up rates of awarded vouchers by medical centers. Medical 

Centers that are having implementation issues have been asked to provide action 

plans. In regards to hiring, all medical centers that have not filled these positions 

are required to submit action plans and progress toward hiring until all positions 

are filled. VA anticipates all positions will be filled by June 30, 2011. Medical Centers have been instructed to detail appropriate staff into any vacant case management positions to ensure Veterans have timely access to case management services. 

The National Homeless Program Office is providing oversight to medical centers 

that are encountering difficulty with hiring; and in some cases, VA is working with 

medical centers to contract case management services with known and proven community partners. 

In instances where there have been low leasing rates, site visits have been made 

and technical assistance has been provided. Medical Centers have been asked to 

provide corrective action plans which are being closely monitored by the VA National Homeless Program Office. As VA addresses the issues that have caused 

delays at these sites, they should be well positioned to more quickly process any additional vouchers that may be forthcoming. 

Both HUD and VA have also conducted consultative site visits with communities 

experiencing implementation delays. These visits have assisted in reducing barriers 

and promoting greater coordination between VA, Public Housing Authorities (PHA) 

and community partners. VA plans to continue this process through FY 2011. 

VA and HUD plan to continue the performance component, instituted in FY 2010, 

to the voucher award allocation process that incentivizes high performers and challenges low performers to increase their productivity as a pre-condition to receiving 

additional vouchers. VA and HUD will continue to conduct training for both VA case 

managers and for PHA staff. Additionally, VA and HUD will continue to conduct 

satellite broadcasts to inform and train staff. Finally, in response to extreme situations, HUD has reassigned vouchers to other PHAs. 

VA is promoting the utilization of a Housing First Model in several large cities. 

Housing First promotes rapid and direct placement of homeless individuals (in some 

cases with accompanying family members) into housing, and offers treatment and 

supportive services with variable intensity and frequency as an integrated component of the service. The Housing First approach represents a change from linear 

models that seek to prepare individuals for permanent housing by requiring completion of treatment in residential rehabilitation or transitional housing, and often require demonstrated sobriety before moving into permanent independent housing. 

VA requested additional funds to hire case managers that would support HUD 

VASH vouchers to ensure the Department was poised to implement programming 

should additional vouchers be awarded to HUD. 

In FY 2008 and in FY 2010, HUD did not request in the President’s budget additional vouchers but received 10,000 vouchers each of those years in the HUD-VASH 

Program. Based on this prior history, the Department requested additional case 

mangers to handle any additional vouchers. 

VA continues to review and refresh its plan to end Veteran homelessness as new 

information and data is obtained. The Veteran Supplemental Report to the 2009 Annual Homeless Assessment Report (AHAR) to Congress reports 75,609 homeless 

Veterans on any given night. The total annual count of sheltered and unsheltered 

homeless Veterans exceeded 160,000 of which 38% or 60,000 were chronically homeless. This estimate of Veteran homelessness and unmet need, demonstrates to VA 

that obtaining additional permanent housing resources would be valuable. 

B. With the rapid increase of vouchers in 2011 and 2012, how does VA plan to 

effectively allocate the vouchers to local VA medical centers and local public housing 

authorities to ensure that veterans receive the vouchers in a timely manner? 

Response. Housing and Urban Development is ultimately responsible for allocating vouchers to local public housing authorities. 

In past years, VA has conferred with HUD in determining relative need, using 

data provided by the Continuums of Care Point in Time data and VA homeless outreach data. Input from the respective Medical Centers is solicited and previous performance data is also considered. As plans for allocations approach finalization, facilities were notified to submit staffing plans for expedited approval so they could 

either commence hiring, or utilize contracted services which are already being set 

up in some locales. 

To ensure that Veterans receive vouchers in a timely manner, VA continues to 

transform its HUD-VASH program to the Housing First model. This allows Veterans quicker access to housing while providing them with needed supportive services to ensure that they are able to maintain housing. VA is also actively pursuing 

349 

the use of shared contracted community case management services in those communities with VA medical centers that have been slow to hire case managers. 

VA also instituted a performance measure regarding the number of vouchers 

issued to the medical center/facility that result in a homeless Veteran achieving 

resident status in PHA. As of February 28, 2011, the cumulative HUD-VASH 

achieving resident status rate was 77%. 

C. How is VA working to ensure the local partnerships between VA medical centers, public housing agencies, and community organizations in rural and underserved areas are effectively working together to end homelessness among veterans? 

Response. At the National Forum on Homelessness Among Veterans Conference 

held in December, 2010, each Medical Center was charged with holding a Homeless 

Veteran Summit to confer with key partners in VA’s efforts to end homelessness 

among Veterans. Key partners included local Public Housing Authorities, Continuums of Care, HUD, Department of Labor, State VA Departments other key Federal, state and local organizations. The goal of these meetings was to determine 

ways to more efficiently and effectively assist homeless Veterans in accessing needed supportive services and suitable permanent housing in order to achieve and 

maintain stabilization. There were over 170 Summits held locally. These summits 

have improved existing partnerships and assisted in building new partnerships. 

Also at this conference, each VA Medical Center was directed to participate in the 

2011 Point in Time Count of the homeless held in January, and in their local Continuums of Care. These directives have served to foster closer cooperation and collaboration between VA staff and community providers in rural areas. These meetings will continue and further strengthen the ability of VA and other housing and 

service provider partners to effectively work together to end homelessness among 

Veterans. 

In a further effort to expand partnerships in rural communities, the VA National 

Center on Homelessness among Veterans has developed a model of case management that combines homeless and mental health case management teams to improve access and engagement of homeless Veterans and Veterans with serious mental illness in rural communities. The model is currently being implemented in 16 

VISNs across the country with a primary objective of identifying and engaging Veterans in treatment while also increasing their access to homeless and other supportive services both within the VA and with other community partners. The combined homeless and mental health intensive case management teams are engaged 

in outreach and treatment helping to increase both mental health and homeless 

services for Veterans in rural America. Results from this project will be available 

by the end of this fiscal year. 

Question 6. Under the Operational Improvement section of the VA Real Property 

Cost Savings and Innovation Plan, the President proposes a $66 million cost savings 

through the VA Real Property Cost Savings and Innovation Plan. Under this plan, 

VA has identified 17 vacant or underutilized buildings to repurpose for homeless 

housing and other enhanced-use lease initiatives. 

A. VA must maximize the utilization of the buildings identified. Please list where 

the 17 buildings are located. Has VA engaged the local community in these areas 

to determine what types of homeless facilities are needed, such as transitional or 

permanent housing? 

Response. VA continues its efforts toward achieving the goals set forth in the 

President’s Memorandum on Real Property. VA has engaged local communities at 

key decision points in the process of repurposing its vacant and underutilized assets 

through enhanced-use leasing (EUL)—i.e., during a) the upfront planning phase to 

determine feasibility and need by conducting a market assessment for each campus 

to match supply (buildings and land) and demand among Veterans for the following 

housing types: Supportive Housing—housing with on-campus supportive services for 

homeless and at-risk Veterans and their families; Senior Independent Living—housing with limited on-campus supportive services for low-income Veterans who are 62 

and older and capable of living independently; and Non-Senior Assisted Living— 

housing with limited on-campus supportive services for disabled low-income Veterans—and b) the EUL project implementation phase through a public hearing to 

solicit stakeholder and local community input into each project. 

17 Vacant or Underutilized VA Buildings 

Network Station Name Building 

Number Total GSF 

1 Newington, CT ....................................................................................... 5 17,799 

1 Newington, CT ....................................................................................... 43 3,872 

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17 Vacant or Underutilized VA Buildings—Continued 

Network Station Name Building 

Number Total GSF 

7 Augusta, Uptown ................................................................................... 18 28,530 

7 Augusta, Uptown ................................................................................... 7 4,420 

7 Augusta, Uptown ................................................................................... 76 56,712 

10 Chillicothe ............................................................................................. 10 6,750 

12 North Chicago ....................................................................................... 48 26,496 

12 Hines ..................................................................................................... 48 39,546 

12 Hines ..................................................................................................... 51 58,000 

7 CAVHCS, Tuskegee ................................................................................ 62 72,203 

21 Menlo Park ............................................................................................ 301 15,200 

12 Milwaukee ............................................................................................. 2 133,730 

23 Minneapolis ........................................................................................... 229 9,000 

23 Minneapolis ........................................................................................... 211 19,160 

15 Topeka, KS ............................................................................................ 261 1,369 

15 Topeka, KS ............................................................................................ 263 1,376 

15 Topeka, KS ............................................................................................ 265 1,526 

Total ............................................................................................. ................ 495,689 

B. How does VA plan to proceed with this initiative to ensure that the maximum 

amount of homeless veterans can be reached? Has VA worked to strengthen community partnerships in these communities to provide the most beneficial and successful 

alliances for all stakeholders? 

Response. VA has included this initiative in the five-year plan to end homelessness among Veterans . Information has been disseminated to VA senior management at VA medical centers, VHA Network Homeless Coordinators’, VA national 

conferences and calls. VA’s Homeless Veterans Initiative Office and the Office of 

Asset Enterprise Management has meet with local community organizations interested in providing housing for homeless Veterans on VA property to assist with development issues. 

Strengthening partnerships with communities is a major pillar of VA’s plan to end 

homelessness among Veterans. The Homeless Veteran Initiative Office is the lead 

office and is developing and maintaining strategic external partnerships and socializing VA’s Plan to End Veteran Homelessness. 

Question 7. Within the Office of Public and Intergovernmental Affairs, VA has established the Homeless Veterans Initiative Office (HVIO), which ‘‘is responsible for 

policy development, inter and intra-agency coordination, developing/maintain strategic external partnerships and socializing VA’s plan to end Veteran homelessness.’’ 

In addition, VA has also created the National Center on Homelessness among Veterans, ‘‘whose mission is to develop, promote and enhance policy, clinical care, research and education to improve homeless services.’’ 

A. How do these offices align with VA’s five year plan to end homelessness? How 

do these offices function with other offices responsible for overseeing homeless programs? 

Response. The Office of the Assistant Secretary for Public and Intergovernmental 

Affairs (OPIA) is the Executive Sponsor for the Homeless Veteran Initiative. This 

office serves as the departmental lead for coordination, communications and monitoring of VA’s Plan to End Homelessness Among Veterans. The Homeless Veteran 

Initiative Office (HVIO) serves as the lead point of contact with the White House 

and other Federal agencies, including the U.S. Interagency Council on Homelessness, and with State and local government officials. 

Implementation and execution of the Plan is a responsibility shared by the Homeless Veterans Initiative Office (HVIO), Veterans Health Administration (VHA), and 

Veterans Benefits Administration (VBA). VHA is responsible for building and executing an operational budget, monitoring performance and oversight of regional and 

local health operations. Within the Veterans Health Administration, The National 

Center on Homeless Veterans was created to promote recovery-oriented care for Veterans who are homeless or at-risk for homelessness by developing, promoting, and 

enhancing policy, clinical care research, and education to improve homeless services. 

The Center’s goal is to establish a national forum to exchange new ideas; provide 

education and consultation to improve the delivery of services; and disseminate the 

knowledge gained through the efforts of the its Research and Model Development 

Cores to VA, other Federal agencies, and community provider programs that assist 

homeless populations. 

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B. With similar missions, how is VA ensuring that these offices are working cohesively together and do not become duplicative in nature? What oversight mechanism 

is in place to ensure funds are being spent in an effective and efficient manner? 

Response. The Homeless Veterans Initiative Office (HVIO) has lead responsibility 

to ensure the Plan to Eliminate Veteran Homelessness is continually reviewed and 

revised as needed to achieve the goal of ending Veteran homelessness. HVIO provides policy coordination and takes the lead in the monthly oversight of the plan 

by senior VA leadership. This oversight includes a monthly Operational Management Review meeting chaired by the Deputy Secretary. Topics addressed include a 

detailed review of expenditures in each of the programs that constitute the Plan. 

Both HVIO and VHA Homeless Program leads participate, and review specifics related to their program activities. Independently of these monthly reviews, the HVIO 

and VHA Homeless Program leads meet weekly both one on one and with a representative of the Secretary’s office to monitor ongoing program activities and address emerging issues. As of February 2011, the HVIO and VHA Homeless Programs’ physical offices are co-located, facilitating ongoing communication and coordination of efforts. 

Question 8. The Office of Research and Development plans to expand research on 

homelessness, focusing specifically on intervention, risk factors, health care usage 

patterns and other areas to assist with VA’s plan to end homelessness. 

A. How is the HVIO and the National Center for Homelessness among Veterans 

working with the Office of Research and Development to ensure that their efforts 

to end homelessness are not being duplicated? How are the HVIO, the National 

Center on Homelessness among Veterans, and the Office of Research and Development ensuring that VA’s efforts to end and prevent homelessness among veterans 

are effective? 

Response. The Homeless Veteran Initiative Office (HVIO), the VA National Center 

for Homelessness among Veterans (NCHV) and the Office of Research and Development (ORD) are in close collaboration. Efforts to address homeless among Veterans 

in each of these offices are discussed at regular meetings with senior leadership. 

The NCHV has worked very closely with ORD, most specifically the Health Services Research and Development Office (HSR&D), to create a homeless portfolio that 

would be coordinated with the Federal Strategic Plan to Prevent and End Homelessness and with the VA Plan to End Veteran Homelessness. 

The ORD recently funded four prominent researchers to study homelessness. 

These studies will inform leadership of the effectiveness of VA’s efforts to end and 

prevent homelessness. 

The projects include: 

Homeless Solutions in a VA Environment (H-SOLVE) 

The purpose of this study is to determine whether VA implementation of 

Housing First can serve the chronic homeless population with serious mental 

illness. 

Aligning Resources to Care for Homeless Veterans (ARCH) 

The purpose of this study is to evaluate ways to best organize and deliver primary care for homeless Veterans. ARCH will assess 4 different adaptations of 

the PACT primary care model in a mixed methods study that includes multicenter, randomized-controlled trials of embedded peer-mentoring within different iterations of the PACT model, focus groups of study participants assessing satisfaction, treatment engagement and self-efficacy within the different 

care models and a cost-utility analysis to determine the most cost-efficient approach to organizing care for this population. Findings from this study will help 

determine optimal care approaches for reducing emergency department visits 

and acute hospitalizations, increasing patient satisfaction, and improving chronic disease management. 

Population-based Outreach Services to Reduce Homelessness among Veterans 

with Serious Mental Illnesses (SMI). 

The purpose and aims of this study are to develop a Navigator outreach program to identify Veterans with SMI and a lifetime history of homelessness to 

determine whether contact by the Navigator is associated with increased health 

services use, housing or other social services as well as decreased mortality. 

Addiction Housing Case Management for Homeless Veterans Enrolled in Addiction Treatment 

This randomized, controlled trial will develop and test a model for homeless 

Veterans entering addiction treatment with aims of evaluating: (1) addiction 

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treatment with addiction/housing case manager (experimental); or (2) addiction 

treatment with weekly housing group (time and attention control) and assessed 

for two years to determine if addiction/housing case management results in earlier transition to and higher retention in stable housing among homeless Veterans entering addiction specialty care. 

In addition to the above-noted efforts the NCHV and HSRD have funded an evidence based treatment manual, Maintaining Independence and Sobriety through 

Systems Integration, Outreach and Networking (MISSION) that can assist VA case 

managers better meet the needs of homeless veterans with co-occurring mental 

health and substance use treatment needs. The ORD is also considering funding a 

trial to study how this evidence based treatment manual can be disseminated with 

the VA Homeless services. Additionally, the NCHV and HSRD are evaluating how 

they can collaborate to initiate research related to homeless Women Veterans. The 

close collaboration between the VA National Center and ORD will ensure VA is efficiently researching the issues that will be most effective in ending homelessness 

among Veterans. 

CONSTRUCTION

Question 1. According to a September 2010 GAO report entitled The FY 2009 Federal Real Property Report; the Federal Government had 10,327 excess buildings in 

FY 2009 with an operating cost of $133.7 million. This is an increase of 187 buildings and $600 million in operating costs from the fiscal year 2008 report. Across the 

country, VA has about 1,100 buildings that are vacant or underutilized. 

A. Exactly how many excess and underutilized buildings does VA have across the 

country? Please list their previous functions prior to abandonment. 

Response. The VA currently estimates we have 895 buildings that are vacant or 

underutilized. Of these approximately 296 are vacant, the remaining 599 are considered underutilized, but are still in use providing support to Veterans. The underutilized buildings are not used at capacity and may not be operating as efficiently as 

possible, but cannot be easily disposed of without consolidating operations to make 

them fully vacant. Below is a breakout of the GSA Usage code for the 895 vacant 

or underutilized buildings. 

Number of Vacant and Underutilized 

Buildings by GSA Usage Code 

All Other ................................................. 198 

Dormitories/Barracks .............................. 1 

Hospital .................................................. 34 

Housing ................................................... 126 

Industrial ................................................ 29 

Laboratories ............................................ 15 

Office ...................................................... 118 

Other Institutional Uses ......................... 68 

Post Office .............................................. 1 

Service .................................................... 154 

Storage ................................................... 3 

Warehouses ............................................. 148 

Grand Total ............................... 895 

The VA currently has plans for reuse or disposal of 350 of these buildings. After 

those actions, there will be approximately 96 vacant buildings and 451 underutilized 

buildings remaining in the inventory. Many of these buildings are very small (340 

of the 545 are <5,000 GSF) and have little reuse potential. VA continues to look for 

consolidation opportunities to make available for reuse a portion of the 451 underutilized buildings, but until consolidation occurs those building remain in use providing Veteran services. 

B. When a new construction project is proposed, does VA take into account the 

excess buildings owned by VA? 

Response. Yes. A primary gap used to evaluate the need for additional space 

under SCIP is space. A facilities space gap is calculated as the projected space needs 

to total currently existing building space, resulting in either additional space need 

or excess space. In cases of excess space, VISNs are required to reuse or dispose 

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of excess space before requesting new construction. This requirement ensures that 

there is a plan for excess space, either renovating to put back into service, reusing 

in other VA administrations, repurposing for homeless housing, or disposing of the 

asset. Each VA administration and office is part of the review of each SCIP action 

plan, providing a review for potential reuse opportunities as well. 

C. How many of these buildings can be re-utilized for other purposes within VA, 

and thereby save the taxpayers in construction costs? 

Response. Of the currently identified 895 vacant or underutilized buildings, 184 

are planned for internal reuse or repurposing via VA’s Enhanced-Use Leasing (EUL) 

Program. The Building Utilization Review and Repurposing (BURR) initiative is a 

strategic effort to identify and repurpose unused and underutilized VA land and 

buildings nationwide in support of the Secretary’s goal to end Veteran homelessness. 

The Department’s EUL authority allows VA to match supply (available buildings 

and land) and demand among Veterans for housing with third-party development, 

financing, and supportive services. Other potential reuse opportunities will continue 

to be explored. 

D. How many of these buildings can be sold to a private entity or transferred to 

another Federal agency? 

Response. There are currently 19 buildings planned for sale or transfer. The majority of the buildings with reuse value are being repurposed in support of ending 

Veteran homelessness. The remaining buildings are generally being planned for 

demolition or deconstruction due to their size (more than 1/3 less than 5,000 GSF), 

location, lack of reuse potential, or poor condition. For example, many buildings are 

located in the center of VA medical center campuses; such that they are not attractive business opportunities for private partners who rely on customer traffic that 

could disrupt patient care. 

Question 2. As stated in your budget justification for Construction, VA notes that 

‘‘VA has undergone a profound transformation in the delivery of health care over 

the past 20 years.’’ The VHA infrastructure was developed in a period of time when 

delivery of health care was more in-patient focused. What this left the VHA with 

were capital assets that ‘‘often do not fully align with current health care needs.’’ 

(Volume 4, page 2–3.) 

A. What is VA’s strategic plan to balance the vast needs in infrastructure while 

taking into consideration the tight budget restraints we are operating under? 

Response. VA’s strategic plan to balance during budget constraints is to focus capital investments on the most critical infrastructure needs. Through the Strategic 

Capital Investment Planning (SCIP) process, the most critical needs within the construction (major and minor) and non-recurring maintenance programs are funded in 

priority order. VA infrastructure needs are first prioritized against each other to develop one integrated list of capital requirements. 

Question 3. In the fiscal year 2012 budget Appendix for Construction, Minor 

Projects, there is a line item titled ‘‘other services from non-Federal sources,’’ which 

will be funded at $37 million in FY 2012. This would be an increase of 131% or $21 

million from FY 2010 actual and equal to the continuing resolution level. 

A. What accounts for a doubling of this account in one year? 

Response. While the 2012 estimate for this is $21 million higher than the 2010 actual, it is important to note that the 2012 request is actually $10 million less the 

2009 actual. 

2009 Actual: $47 million 

2010 Actual: $16 million 

2011 Estimate: $37 million 

2012 Estimate: $37 million 

Actual spending year to year can vary depending on the requirements, as well as 

the timing, of the actual construction schedules. The estimate for 2011 and 2012 is 

equal to the average of the last 4 years of actuals for this activity. 

B. Please explain what services are being provided to the Federal Government 

under this line item? 

Response. This line item largely consists of contracts for maintenance, certification, inspection, repair of equipment and land planning associated with construction contracts. 

Question 4. VA has an unfunded liability in medical construction which seems to 

grow larger every year. Currently, this backlog stands at roughly $6 to 8 billion in 

projects waiting for funding. Simultaneously, the costs of individual projects are also 

increasing, with the current estimate of the VA hospital in New Orleans at just 

under $1 billion. 

A. What is VA’s strategic plan to secure funding for individual projects in order 

to get this list to a more manageable size? 

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Response. VA is comprised of over 5,000 buildings and 30,000 acres. VA infrastructure needs are prioritized against each other to develop one integrated list of 

capital requirements and construction requests are also weighed against other VA 

priorities to determine the appropriate level of funding each fiscal year. In order to 

maximize resources, and fund additional projects, VA requests funding for larger, 

individual projects in phased sections. Each phase is a stand-alone project or phase 

that can be obligated within the fiscal year of request, without any extenuating circumstances. 

B. How has VA taken into account the long term patient demand projection and 

needs when considering what types of facilities to build and where? 

Response. VA relies on the Enrollee Health Care Projection Model (EHCPM) to 

project the demand for care by specific categories of care over a 20-year planning 

horizon. The EHCPM is an actuarial model that is updated each year that takes 

into account Veteran demographics and illness complexities to project long-term patient demand for inpatient and outpatient care. The EHCPM uses previous utilization and referral patterns to inform VA on health care demands based on where enrollees live and which VA facilities they will likely go to for care. In making longterm projections, the EHCPM takes into account Veteran reliance on VA vs. nonVA care, and incorporates the same assumptions as other Federal agencies regarding future discharges of Iraq and Afghanistan Veterans. 

The EHCPM projections serve as the foundation for VHA’s Health Care Planning 

Model (HCPM). Veterans Integrated Service Networks (VISN) use the HCPM’s 

standard methodology to systematically analyze gaps between current and projected 

demand for care in each market over the next five, ten, and twenty years to plan 

strategic initiatives to best address the anticipated gaps in services. This information is then used to inform what types of facilities VA will need in the future, as 

well as well as where they should be built. VA’s rigorous planning ensures that Veterans receive the highest quality care in the most appropriate locations for inpatient 

and outpatient environments. 

C. Has VA performed a business case study on the benefits of leasing or buying 

to consider the long term needs of VA to ascertain which would be more financially 

advantageous to VA? If so, what were the results? 

Response. Many factors are evaluated when considering leasing or buying. An example of some factors include, the need for additional space, the capacity to build 

on medical center campuses or renovate existing buildings, the requirement for 

quick implementation or flexibility to terminate a contract, budget constraints, the 

most cost effective alternative, all go into the buy versus lease determination. Each 

acquisition decision is considered and reviewed on an individual basis. 

VA Policy, the OMB A–11, Capital Programming Guide and OMB A–94 requires 

a detailed cost benefit analysis be completed for all Major initiatives. The VA Strategic Capital Investment Planning (SCIP) process expanded this requirement to all 

capital initiatives via a cost-effectiveness analysis (CEA). The CEA provides a life 

cycle cost comparison of alternatives including: build, renovate, lease, and contract 

out for services. A cost effectiveness analysis must be completed for each capital solution to compare costs and provided as part of a completed business case application. 

In addition, each business case is required to conduct an alternatives analysis, including a comparison of the net present value (NPV) of four options: status quo; construct new/renovate; lease space; and contract out services. Project business case applications are scored and ranked on several SCIP Criteria, one of the main criterion 

is called the ‘‘Best Value Solution,’’ which provides an analysis of which option has 

the best net present value (NPV). If the chosen option does not have the best NPV, 

an explanation of why it is the chosen option is required. 

INFORMATION AND TECHNOLOGY

Question 1. The Office of Information and Technology (OI&T) has asked for an 

increase of $25.8 million over fiscal year 2010 levels for Research and Development 

(R&D). The VA has 16 Major Transformational Initiatives to improve collaboration 

and integration among the various VA departments. The R&D initiative focuses on 

the genomic medicine, point of care research, medical informatics and Information 

Technology (IT) and VA Central Office field research. 

A. What accounts for a $25.8 million increase in two years? 

Response. The Research & Development transformational initiative receives funding from the Medical and Prosthetics research budget for business needs and the 

Office of Information and Technology (OI&T) for IT needs. Fiscal Year 2010 is the 

baseline for this question so it is important to state that in Fiscal Year 2010, Research & Development did not receive any transformational initiative funds from eiVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00360 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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ther the business or OI&T budgets. Hence, all subsequent transformational initiative funds appear as an increase in funding. In Fiscal year 2011, $17.1 million of 

OI&T funding is budgeted, pending congressional action, to fund the following: the 

Veterans Affairs Research and Development lead role in personalized medicine, including the Million Veteran Program and the Genomic Informatics System for Integrative Science [GenISIS]; comparative effectiveness research [Point of Care research]; new tools to mine VA electronic medical records to optimize strategies for 

Veteran care, including Veterans Affairs Informatics and Computing Infrastructure 

[VINCI] and Consortium for Healthcare Informatics Research [CHIR]; and new tools 

to improve research administrative oversight while decreasing costs in the future, 

including the Research Administrative Management System [RAMS]. The Fiscal 

Year 2012 funding level is forecast at $30 million from OI&T funding and $0 from 

business funding. 

B. How much in total will be expended on this initiative? 

Response. Outyear funding levels for this initiative will be developed as future 

needs are analyzed. 

Question 2. Assistant Secretary Baker recently informed the Hill of OI&T’s intention to hire 705 new employees. According to a spreadsheet provided to Committee 

staff on February 14, 2011 (copy attached), it appears that a substantial amount of 

these employees are to be located in the Washington, DC, area or VA Central Office. 

Please reconcile the staffing levels outlined in that document with the staffing levels 

requested in the fiscal year 2012 budget request. 


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Response. OI&T request for FY 2012 does not request an increase in FTE. OI&T 

is currently understaffed and faces employment turnover rates of about 10%. The 

effort to hire 705 new employees is intended to bring staffing levels to where they 

should be. This effort would get OI&T hiring on track, not increase FTE. 

Question 3. The Virtual Lifetime Electronic Record (VLER) is one of the President’s initiatives for VA/DOD. According to the fiscal year 2012 budget request: 

‘‘Both VA and DOD have agreed that the objective for VLER is to establish a coherent, lifetime electronic record that will capture Servicemember/Veteran information 

from accession into military service to interment and until the last benefit is administered. VLER will include all information necessary to provide medical care, services, benefits, and compensation to the Veteran, eligible family members, or eligible 

beneficiaries.’’ 

A. What steps will be or have been taken by VA to improve upon the program, 

as recommended in the February 2011 GAO Report on Electronic Health Records? 

Response. The Virtual Lifetime Electronic Record (VLER) program has often been 

so closely linked to the Electronic Health Record (EHR) modernization initiative as 

to become synonymous. It is important to understand that VLER is closely aligned 

with but unique from the EHR initiative. VLER is an interoperable and communication environment where by health, benefits and administrative information may be 

electronically accessed by every Servicemember, Veteran and/or their beneficiaries. 

The VLER environment is structured to support the secure exchange of health, benefits and administrative information between public and private partners. Health, 

benefits and administrative information resides in many DOD and VA systems. 

VLER ensures that regardless of the information source, policies, regulations, and 


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procedures are put into place to secure and protect the information accessed or exchanged, and the terminologies, definitions, and terms are clearly presented. 

NATIONAL CEMETERY ADMINISTRATION

Question 1. The budget request for fiscal year 2012 under Operations and Mainte- nance for Other Services is $86 million. Please provide a detailed itemized list of 

how these funds would be spent during fiscal year 2012. To the extent that these 

funds will be spent on contracts, please explain the nature of the contract and the 

expected outcomes. 

Response. The following chart provides a list of projects funded under Other Services: 

Category Cost 

($M) Description 

National Shrine Projects ......................... $32.9 Contracts to raise, realign, and clean headstones/markers and repair 

sunken graves. 

Road and Grounds Maintenance ............ 33.6 Contracts to maintain and repair roads, sidewalks, and other property. Contracts for mowing and trimming, snow removal from streets 

and sidewalks, and tree pruning. 

Non-Recurring and Recurring Maintenance and Projects.2.5 Contracts to maintain and repair buildings and other structures. 

Equipment Maintenance ......................... 0.5 Maintaining and repairing cemetery and office equipment. 

Operational and Other Services ............. 12.7 Contractual services for cemetery operations, including security services, trash removal, and pest control. Contractual services for customer satisfaction surveys. Also includes payments to other VA staff 

offices for centralized support activities and to the Defense Finance 

and Accounting Service for payroll processing costs. 

Janitorial Services .................................. 1.4 Contracts for janitorial and cleaning services. 

Compensated Work Therapy ................... 0.8 Payments made for participation in the Compensated Work Therapy 

program. 

Franchise Fund Payments ...................... 0.7 Payments based on service level agreements for centralized financial 

services and security services (background investigations, ID badges, 

etc.). 

Employee Relocations ............................. 0.5 Payments for storage of household goods and relocation services. 

Training .................................................. 0.4 Tuition for attendance at training courses. 

Total ............................................... $86.0 

Question 2. In Volume III page 1B–10, there is a chart entitled ‘‘Employment 

Summary-FTE by Grade.’’ The request for fiscal year 2012 for SES employees is 11, 

an increase of 4 SES employees over fiscal year 2011 and an increase of 7 over fiscal 

year 2010. 

A. Please explain why the National Cemetery Administration (NCA) needs 4 additional SES level employees. 

Response. The new SES positions reflect the growing scope and complexity of 

NCA operations. We are not requesting any additional funding or FTE for the positions. 

Five of the seven positions are for our regional office directors. Workload has increased considerably in the field. For example, in the last decade NCA has opened 

15 new national cemeteries, a national training center, and a national scheduling 

center. 

Another of the new positions is for the Memorial Program Service director. In FY 

2010, this office processed nearly 400,000 headstone/marker applications and over 

800,000 Presidential Memorial Certificates. Its responsibilities have expanded to include the First Notice of Death function and the new medallion benefit. 

The final position restores an SES management slot that was available to NCA 

prior to FY 2010. 

B. What functions will they perform? 

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Response. These new positions are necessary to reflect current management requirements and will ensure the recruitment and retention of top managers. 

Question 3. For fiscal year 2012, the amount requested for travel for NCA is the 

same as the current expected travel expenditures during fiscal year 2011, over $2.7 

million. How often do and how many people are eligible for travel? 

Response. NCA’s 2012 travel budget is straight-lined from the 2011 request, despite increased costs associated with all modes of transportation. NCA is a national 

organization with 131 cemeteries in 39 states and Puerto Rico; oversight of grants 

made to states for state Veterans cemeteries in 38 states, Guam and Saipan; a national training center; and a national scheduling center. Travel funding is critical 

to ensure appropriate operational oversight, training, and organizational communication. Employee travel is approved based on program and training requirements. 

Approximately 480 NCA employees travel in a year. Some employees travel once a 

year, while others travel several times a year. 

Question 4. In Volume III page 1B–15, the explanation for the budget line Transportation of Things reflects that ‘‘costs include the transportation of household goods 

as part of permanent change of station moves of transferring employees.’’ For fiscal 

year 2012, what percentage of the Transportation of Things budget would be used 

for employee relocation costs? 

Response. In FY 2012, an estimated 26 percent of the Transportation of Things 

budget line will be used for employee relocation costs. 

RESPONSE TO POSTHEARING FOLLOW-UP QUESTIONS SUBMITTED BY

HON. RICHARD BURR TO U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. Question 1 regarding VA’s Housing program asked VA to explain why 

the Housing program was projecting to spend $790,000 more on Other Services during fiscal year 2011 than VA had originally requested for Other Services for that 

fiscal year. In response, VA indicated that ‘‘Payroll savings from elimination of the 

2011 pay raise were realigned to Other Services to fund a job task analysis for loan 

production specialists.’’ 

a. Was the purpose of the pay freeze to reduce the deficit and, if so, is this use 

of funds consistent with that purpose? 

Response. The President’s memorandum of December 22, 2011, regarding the 

freezing of Federal employee pay schedules states its purpose, ‘‘as the first of a 

number of difficult actions required to put our Nation on a sound fiscal footing.’’ The 

2011 estimates included in the 2012 budget reflect the Department’s best estimates 

consistent with the guidance and funding levels appropriated to the Department by 

Congress in the Continuing Resolution in effect at that time. 

b. How much in total does VA expect to realize in payroll savings during fiscal 

year 2011? 

Response. The 2011 advance appropriation for VA medical care included $237 million for the employee pay raise, and $49 million of this amount was rescinded in 

Public Law 112–10. VBA reallocated $16 million in pay savings across all business 

lines. Those allocations were primarily for contract services to improve delivery of 

benefits and services to Veterans. All other payroll accounts were ultimately funded 

at the 2010 level by Public Law 112–10, which did not include funding for an employee pay raise and was at levels substantially lower than the 2011 President’s 

Budget request; thus, there are no other payroll savings in 2011. 

c. VA-wide, how much in total of the fiscal year 2011 payroll savings were realigned for other purposes? 

Response. Please see the response to 1.b., above. 

d. Please provide a detailed account of how any payroll savings expected to be realized in fiscal year 2011 have been or will be spent. 

Response. Please see the response to 1.b., above. 

Question 2. Under the category ‘‘General,’’ question 5(D) asked VA whether the 

fiscal year 2012 budget includes funding for benefits that are projected to be overpaid and not recouped. In part, VA responded: ‘‘In the calculation for the FY 2012 

President’s Budget request, the Readjustment Benefits account is projecting a net 

increase of $7.2 million in obligations associated with overpayments. This projection 

is based on historical trends and updated each budget cycle.’’ (Emphasis added.) 

a. What is the total amount included in the Readjustment Benefits account for 

fiscal year 2012 associated with overpayments? 

Response. The total cumulative overpayments for the Readjustment Benefits account are estimated to be $390.7 million at the end of fiscal year (FY) 2012. This 

cumulative amount includes overpayments from prior fiscal years. 

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b. Please explain the relevant historical trends over the past 5 years. 

Response. From FY 2006 to FY 2009, the cumulative overpayments ranged from $111 million to $121 million for the Readjustment Benefits account. Cumulative 

overpayments increased to $375 million FY 2010, primarily resulting from one-time 

advance education payments, most of which have already been recouped. The estimated FY 2012 overpayments of $390.7 million are also cumulative. Overpayments 

occur more frequently and in larger amounts under the Post-9/11 GI Bill program 

because of the way the program is designed. Tuition and fee payments are made 

at the beginning of the academic term, often before students have adjusted their 

courses. For example, if a student withdraws from a course after VA issued a payment, an overpayment is created. When changes like this occur, overpayments are 

unavoidable. While adjustments like this are inherent in the program, overpayments may be collected in the future and are not identified as funds that VA does 

not expect to recoup. 

Question 3. Under the category ‘‘General,’’ question 5(E) asked whether any performance measures for regional office personnel take into account the amount of unrecovered benefit overpayments attributable to their errors. VA responded that ‘‘VA 

systems do not track this information.’’ 

a. Will any planned technological improvements include the ability to track this 

type of information? If so, when will this type of information be available? 

Response. Almost all compensation and pension awards have been converted to 

VETSNET. Currently, no adjustment reasons exist in VETSNET to record administrative error awards or the adjustment period. Compensation Service is developing 

new business rules that will allow award adjustments due to administrative errors 

to be specifically identified. These changes will be part of future VETSNET Awards 

releases targeted for 2012. 

The goal of this VETSNET Awards design change is to add details regarding any 

amount of benefits incorrectly paid for a specific period. 

b. In the meantime, what steps will VA take to hold employees accountable for 

unrecoverable overpayments resulting from their errors? 

Response. Secretary Shinseki has set an aggressive goal to achieve 98 percent accuracy for all rating decisions by the end of FY 2015. Compensation Service is dedicated to meeting this aggressive goal for our Veterans. However, due to the complexity of the claims process, there will always be a certain number of human errors. Currently, errors are tracked through historical data collection in our computer 

applications and through claims quality assurance provided by Systematic Technical 

Accuracy Review (STAR). STAR reviews individual claims and identifies employee 

errors using established VA employee performance standards for Veterans Service 

Representatives, Rating Veterans Service Representatives, and Decision Review Officers. As part of these reviews, STAR identifies specific errors in claims processing 

so individual employees may receive additional training and guidance in those specific areas. STAR reviews also examine administrative decisions and the approval 

process for those decisions, which may include possible overpayments. Compensation Service is dedicated to meeting the Secretary’s goal for accuracy by providing 

the best possible training and guidance for our VA employees, both collectively and 

as individuals. 

Question 4. Under the category ‘‘Compensation and Pension,’’ questions 22(A) and 

(B) asked VA about an initiative to extend routine future disability examination requests to five years. In response to those questions, VA indicated that it does not 

have information about how often these types of examinations reveal a change in 

the veteran’s level of disability or about how many veterans would potentially be 

overpaid or underpaid as a result of this initiative. Please explain what factors were 

considered in determining to move forward with this initiative. 

Response. In 2010, Compensation Service issued Fast Letter (FL) 10–14, Procedural Change Regarding Routine Future Examinations, which modified Compensation Service claims-processing procedures for scheduling Veterans’ routine future examinations. Routine future examinations are now scheduled at five-year intervals 

instead of two-year intervals. Factors considered in determining to move forward 

with this initiative included: 

• Eliminating over 80,000 routine future examinations over the course of three 

years; and 

• Freeing resources to improve the timeliness of processing of other Veterans’ 

claims. 

Question 5. Under the category ‘‘Board of Veterans’ Appeals,’’ VA was asked in 

question 5 about VA’s publication of an annual Veterans Law Review. VA indicated 

that ‘‘employees who contribute [to the Law Review initiative] do so largely on their 

379 

own time’’ (emphasis added). In response to questions on VA’s fiscal year 2011 budget request, VA indicated that ‘‘[a]pproximately 70 attorneys and Veterans Law 

Judges volunteer their non-duty time to edit and publish the Veterans Law Review 

each year’’ (emphasis added). 

a. Please clarify whether employees of the Board of Veterans’ Appeals use dutytime to perform activities related to the law review. 

Response. Employees of the Board of Veterans’ Appeals do not use duty time to 

perform writing or editing for the Veterans Law Review (VLR); all writing and editing is voluntary and is conducted on non-duty time. 

With respect to other VLR activities, to include planning meetings and forms/citations training, the use of duty time is nominal to none, as these activities are largely scheduled during non-duty time. Approximately 5 times per year, the lead team 

of VLR editors, which consists of approximately 10 individuals, must meet to discuss 

scheduling, the selection of pieces for publication, and other issues that may arise, 

for which the Board provides meeting space. The three supporting teams of editors, 

consisting of the remaining 60 volunteers, must also meet approximately 2–3 times 

during the year. Finally, VLR provides a forms and citation training once annually. 

VLR is committed to scheduling these meetings and the training during non-duty 

time, e.g., during lunch breaks, although, at times, these activities may carry over 

to or fall within duty time for brief periods. 

b. If so, how much time on an individual and total basis do VA employees devote 

to this activity? 

Response. The approximately 70 employees involved with the VLR spend no hours 

of duty time on writing or editing for the VLR. With respect to the other VLR activities, the 10 lead editors devote no more than 5–6 hours annually to their meetings, 

and the three supporting teams of editors devote approximately 1–2 hours annually 

to their meetings. The forms and citations training is conducted over a 1 hour period 

annually. As noted above, nominal to no duty time is devoted to the VLR, as the 

activities are to be scheduled for non-duty time, although, on occasion, these activities may briefly carry over to or fall within duty time. 

Question 6. Under the category ‘‘General,’’ VA was asked in question 2 about the 

sentiment from the Commission on Fiscal Responsibility and Reform that 

‘‘[e]verything has to be on the table’’ with regard to fiscal reform. VA’s response indicated that, ‘‘[i]n the past two years, we have established and created management 

systems, disciplines, processes, and initiatives that help us eliminate waste.’’ 

a. How much has VA saved as a result of these ‘‘management systems, disciplines, 

processes, and initiatives?’’ 

Response. Please see the chart below for an accounting of the estimated savings 

included in VA’s budget submission. Descriptions that further detail each item are 

included in Volume 2 of VA’s congressional budget submission beginning on Page 

1A–14. 

b. Did the funds realized from these savings go to deficit reduction? If not, for 

what purposes were these funds realigned? 

Response. The estimated savings identified above are a vital component of VA’s 

multi-year budget planning, and contribute to deficit reduction efforts. 

Question 7. In the category ‘‘Office of Human Resources and Administration,’’ VA 

was asked in question 1(C): ‘‘What metrics are used to determine which staff needs 

to travel?’’ VA responded: 

Response. Our travel cost is executed against [VA Learning University (VALU)] 

sponsored training programs derived from a requirements process that identifies 

critical training needs and fills training gaps identified by the VA Administration(s) 

and VA Staff Offices. VALU also provides training to the field in centralized locaVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00385 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN

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tions where there are areas of high concentration of VA employees allowing for a 

reduction in expected travel that would have been incurred to support the training 

efforts. 

When it is necessary for staff to travel, what metrics are used to determine which 

staff needs to travel? 

Response. VALU provides training venues and travel resources to support the 

Veterans Affairs mission and business objectives through high quality, continuous 

learning, development that enhances leadership, occupational proficiencies, and personal growth. Individuals are designated for training based on individual development plans (IDP), specific functional training needs identified by department or administration and also may select cross cutting core competency training and leadership training which collectively address most of the VALU portfolio. The number of 

training events offered by VALU depends on several factors including courses identified through the requirements process, technical training conferences, transformational leadership and supervisor/manager training needs. Total course load is built 

based on resourcing and need. Individuals fill the available seats by registering thru 

Talent Management System and getting supervisor approval. The number of train 

ings an individual may attend is based on availability and approval. Total number 

of individuals training during a year is compared to targets set by leadership. Technical training conferences and leadership training typically require face to face 

training which dictates travel. Increasingly VALU is introducing virtual training 

and social media to reduce need for travel. 

Question 8. Also in the category ‘‘Office of Human Resources and Administration,’’ 

VA was asked in question 5(C) about the effectiveness of the Health and Wellness 

initiative in ‘‘promoting healthier employees.’’ VA stated that the program is still 

in the baseline year and the program’s effectiveness will be evaluated in six months 

and at the end of the fiscal year. What metrics will be used to determine if the program is ‘‘promoting healthier employees?’’ 

Response. While still in the baseline year, during the past six months VA 

Wellness Is Now (WIN) has implemented several aggressive promotional campaigns, 

organized a national event, and developed partnerships with the national unions, 

nursing services and the National Partnership Council. Metrics used to evaluate the 

program come from the online database which tracks many key elements such as 

health risks (smoking, obesity, hypertension and others). There has been a steady 

rise in completion of the online Health Risk Assessment (HRA) with 30,000 employees completing them (11% of the VA population, up from 5% in the last quarter). 

VA WIN’s first national ‘‘2K Walk & Roll’’ event, which was led by the VA’s Deputy 

Secretary, had 155 sites and over 16,847 employees participating in the event. VA 

WIN has developed useful ‘‘tools’’ for employees such as guidebooks to help motivate, get employees exercising and moving and to support their emotional wellbeing. A new satisfaction survey is being added to the database so we can better 

evaluate if the program is meeting our goals for employee satisfaction and promoting healthy employees. A complete update on the program will occur at the end 

of the fiscal year incorporating all elements of VA WIN. 

Question 9. Under the category ‘‘Office of Public and Intergovernmental Affairs,’’ 

VA was asked in question 1(B): ‘‘What indicators would suggest whether additional 

staffing increases are warranted?’’ VA responded: 

The new employees will be supporting the Office of Tribal Government Relations; Paralympic Program Office; Homeless Veterans Initiatives and Outreach Program offices. 

Please clarify what indicators VA uses to determine whether additional staffing increases are warranted for this office. 

Response. The National Veterans Outreach Office (NVO) was established within 

the Office of Public and Intergovernmental Affairs in 2010. NVO’s mission is to assess, standardize and coordinate outreach activities for the entire Department of 

Veterans Affairs. The office is developing outreach plans, web resources and training to assist VA administrations and program offices in unifying outreach communications through clear, accurate, consistent and targeted messaging. The Office is 

also providing project management of significant marketing and advertising contracts to ensure Veterans and their families are aware of benefits and services, and 

is working to develop a system to track department-wide performance measures for 

VA’s outreach programs. In addition, the office is responsible for coordinating an annual Outreach summit; the report on the outcomes of VA outreach programs to the 

Secretary of Veterans Affairs, Congress, Veterans Service Organizations, and other 

interested stakeholders, and the American people. 

381 

When NVO was initially set up, the Office was authorized a total of three FTE 

which include a GS–15 director; a GS 13/14 Program Specialist, serving as deputy 

director; and a GS 12/13 program specialist. It has quickly become apparent that 

the size and complexity of the office’s workload is greater than initially anticipated. 

Departments and offices throughout VA are relying on NVO for support, approvals 

and advice for their advertising and marketing initiatives, and Members of Congress, the news media and others are expecting considerable information about VA’s 

outreach efforts—frequently with short turnaround times. Because much of this information is both time-sensitive and proprietary to the enterprise, it should not be 

provided by contractors, but only by VA staff. In addition many of the decisions and 

recommendations NVO has been required to make cannot be delegated to contractors. The two existing staff members are working tirelessly to ensure all deadlines 

and expectations are met, however, once many of these plans are implemented, the 

workload will grow exponentially. 

The VA Parlaympic Office is responsible for the monthly allowance to Veterans 

who are eligible and meet the qualifications. To process these applications the VA 

must work closely with the United States Olympic Committee (USOC) and Veterans 

Benefit Administration. This requires checks and balances to ensure that claims are 

processed in a timely manner and meet the intent of the law. This not only requires 

working with VBA but also the Veteran athlete and the coaches at the USOC. The 

VA Paralympics Program Office needs to verify that the Veteran is training on a 

daily/weekly basis and meets the standards set forth by USOC and its governing 

bodies to be a Paralympic athlete. The VA Paralympic Program office also manages 

the grant program that was established by Pub. L. 110–389. This requires that the 

office ensures that the grants are administrated in accordance with VA and other 

Federal regulations. 

The Office of Tribal Government Relations (OTGR) engages in intergovernmental 

efforts focused on increasing American Indian and Alaskan Veterans’ access to 

health care and benefits (enrollment, interagency collaboration for health care service delivery), promoting economic sustainability through outreach focused on awareness of Veteran-owned small business opportunities, the Native American Direct 

Home Loan program, the Post-9/11 GI Bill, and facilitating increased access to compensation and benefits. OTGR has a geographically, culturally and politically diverse mandate to work with 565 distinct political entities. American Indians and 

Alaska Natives serve in the United States military at a rate higher than any other 

ethnic group. Estimates are that of 1% of the US population are Veterans while approximately 15% of American Indians and Alaska Natives are Veterans. There are 

565 federally recognized Tribes located in 38 states. The increase in FTEs would enable VA to expand its responsiveness in developing intergovernmental relations with 

tribal governments and improve efforts to extend VA’s reach to Veterans living in 

Indian Country, much of which is located in rural or remote areas. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. MARK BEGICH TO

U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. As you continue to focus more on rural veterans and their unique 

needs. I wanted to stress to you the Alaska Native Health Care system. They have 

hospitals and clinics in very remote areas in my state and are very willing to provide health care and provide space for VA. I know your Department is working on 

the MOU with tribes. What is the status of the MOU and is it ready to be negotiated with the Alaska Native health entities? 

Response. The VA-IHS Memorandum of Understanding (MOU) was signed by Dr. 

Robert Petzel, Under Secretary for Health, and Dr. Yvette Roubideaux, Director, Indian Health Service, on October 2, 2010. A number of areas are addressed in the 

MOU, including improving the delivery of care by sharing programs, increasing access to services and benefits, improving coordination of care, and increasing efficiency through sharing contracts and purchasing agreements. The MOU also focuses 

on the joint development of applications and technologies, as well as the implementation of new technologies such as tele-health. Additionally, this agreement focuses 

on increasing the quality of care through training and workforce development, attention to cultural competency, joint credentialing of staff, and sharing of contingency planning and preparedness efforts for emergencies and disasters. In order to 

accomplish the main goals of the MOU, 12 work groups have been established that 

have representation from both the VA and IHS. All of the work groups have met 

and most have developed action items and timelines for accomplishing their items. 

An implementation work group, led by Dr. Mary Beth Skupien, Director, Office of 

Rural Health, and a yet to be determined designee from IHS, will meet soon to disVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00387 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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cuss the submitted action items and procedures for administering the work groups. 

At this time, the MOU can be used in negotiations with Alaska Native health entities. 

Question 2. Last February, I conducted Veterans’ Affairs Committee hearing in 

Alaska, we heard from the VSO’s about the time it was taking to get a response. 

Are you continuing to Broker the ratings to other states? I am hearing that this 

is still causing delay and hardship for veterans waiting for their benefits. 

Response. The Anchorage Regional Office is currently brokering out claims for 

service-connected compensation benefits to the Salt Lake City, UT, and Ft. Harrison, MT, VA Regional Offices. Between the two offices, cases are brokered at a 

rate of approximately 145 per month. Anchorage has experienced a 32 percent increase in its pending workload since the beginning of FY 2011. Comparatively, the 

nationwide inventory has increased by 49 percent. These increases are due in significant part to the Secretary’s decision to add three additional disabilities to the 

list of conditions presumed to be related to Agent Orange exposure for Veterans who 

served in the Republic of Vietnam. VA anticipates that as the Agent Orange-related 

claims are completed, both in Anchorage and nationwide, VA will reduce the pending inventory. 

Question 3. As you are aware, VISN 20, more specifically Alaska has had a rural 

demonstration pilot project for outreach to rural veterans. Object of pilot was to 

reach veterans and inform them about veteran’s benefits. The pilot was pulled to 

reaccess, focus groups were conducted, I have asked for the report and what the follow up will be on getting these vets information. Will you please tell me the status 

of the pilot in Alaska? 

Response. The pilot was not pulled, but concluded at the end of FY 2010. The Veteran Focus Groups were completed in August 2010, and the report was received in 

September 2010. As a result of the August Congressional Delegation visit, it was determined that focus groups should also be conducted with the vendors. These were 

completed in December 2010, and the final report was received in late January 2011 

evaluating both Veteran and provider results. Alaska leadership has met with the 

Director of the Alaska Area Native Health Service, IHS, DHHS and the CEO of the 

Alaska Native Tribal Health Consortium to begin a consultative process for the next 

steps to provide services to Alaska Native rural Veterans. In addition, a meeting 

is scheduled with the President/CEO of the Alaska Native Health Board which has 

experience with conducting tribal consultation between Federal and tribal entities. 

The report that you requested was forwarded to your staff via e-mail on March 10, 

2011. 

Question 4. VISN 20 is one of the fastest growing VISNs, our facilities in Alaska 

are seeing an increase in use, does the budget take into account the growing population of veterans and does the VISN believe that they have the adequate resources 

to serve Veterans? 

Response. As the table indicates, both VISN 20 and Anchorage have higher 

growth than the VHA average when comparing unique patient growth from January 2010 to January 2011. 

January 2010 to January 2011 

Access Point % Change in Unique Veterans Served 

VHA ........................................ 2.20% 

VISN 20 .................................. 4.80% 

Anchorage .............................. 3.90% 

The VHA budget takes into account the growing population of both Alaska and 

VISN 20. The FY 2011 Alaska operating budget was supplemented over $18M ($10 

million from VHA; $8 million transferred internally from VISN 20) due to Alaska’s 

purchased care cost structure. With this additional support, VISN 20 leadership believes it has adequate resources to serve Alaska’s Veterans for FY 2011. However, 

with increased referral to the local community in the provision of oncology and other 

specialty care in the last few months, VISN 20 is currently evaluating what additional resources will be necessary to sustain this care in future years. 

Question 5. My question is regarding the HUD VASH vouchers and the need to 

look at increasing them. In our newest CBOC in Juneau, there is a need for VASH 

vouchers; I am told they do not have a case manager to manage the vouchers. I recently cosponsored a Bill that will give the Secretary authority to contract with nonprofits to conduct the case management. The pilot in DC seems to be a good examVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00388 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
383 

ple. Can you tell me what the obstacles are in utilizing legitimate non-profits and 

tribal agencies in supplying the needed case management? 

Response. VA is able to contract with local organizations to ensure that homeless 

Veterans receive case management services. There are a few obstacles in utilizing 

outside agencies to provide case management services: 

• In some geographic areas, particularly rural areas, VA medical centers are having difficulty finding viable partners to contract with for case management services. 

• Ensuring that contract agencies have the same qualifications and meet the 

same performance standards as VA employees, that the services they provide are 

comparable to VA’s, and that prospective community partners are knowledgeable 

about VA treatment and benefit services. 

Question 6. What can Congress do to help you eliminate the benefits backlog? 

Response. Congressional support of VA’s FY 2012 budget request is essential to 

achieving our goal of eliminating the claims backlog. Funding is requested to support critical Claims Transformation initiatives designed to streamline our business 

processes and develop and deploy powerful 21st century IT solutions to simplify and 

improve claims processing for timely and accurate decisions. The cornerstone of VA’s 

Claims Transformation Strategy is the Veterans Benefits Management System 

(VBMS). VBMS integrates a business transformation strategy to address process 

and people with a paperless claims processing system. Combining a paperless claims 

processing system with improved business processes is the key to eliminating the 

backlog and providing Veterans with timely and quality decisions. 

VA’s 2012 budget request also includes funding for the Veterans Relationship 

Management (VRM) initiative, another of VA’s major transformation initiatives. 

VRM will provide Veterans, their families, and survivors with direct, easy, and secure access to the full range of VA programs through an efficient and responsive 

multi-channel program, including phone and Web services. VRM will provide VA 

employees with up-to-date tools to better serve VA clients, and empower clients 

through enhanced self-service capabilities. 

As the incoming volume of claims continues to rise, it is also vitally important 

that Congress appropriate funds to support VBA’s requested FTE level of 20,321. 

The disability claims workload from returning war Veterans, as well as from Veterans of earlier periods, is increasing each year. Annual claims receipts increased 

51 percent when comparing receipts from 2005 to 2010 (788,298 to 1,192,346). We 

anticipate claims receipts of nearly 1.5 million in 2011 (including new Agent Orange 

presumptive claims) and more than 1.3 million in 2012. 

Funding to support the requested FTE level and these innovative systems and initiatives will put VA on a path to achieving our ultimate goal of no Veteran waiting 

more than 125 days for a quality decision on his/her claim. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. MIKE JOHANNS TO

U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. My state staff often deals with veterans who have been waiting in the 

appeals process for over five years. These veterans are typically pre-9/11 veterans, 

with many from the Vietnam era. It appears that regional offices have specific goals 

for processing initial claims, but no such metric seems to exist for claims in the appeals process. Does the Department of Veterans Affairs establish singular management responsibility for a claim once it enters the appeal process? 

Response. Regional Offices have nationally established goals for different stages 

of the appeals process. Goals are set in the following areas: 

• Notice of disagreement (NOD) inventory: The total number of NODs pending at 

the end of the month. 

• NOD average days pending: The average number of days from receipt of the 

NOD to current end of month. 

• Form 9 timeliness: The average number of days from receipt of a substantive 

appeal until certification to the Board of Veterans’ Appeals (BVA). 

Achievements under these goals are measured and included in the regional office 

directors’ yearly performance evaluations. 

To ensure direct management responsibility for the appeals process, each regional 

office has a team of employees dedicated to processing the appeals workload. The 

composition of the local appeals team may vary, but typically includes Decision Review Officers (DRO), Rating Veterans Service Representatives (RVSRs), and Veterans Service Representatives (VSRs). 

The DRO is a senior technical expert who is responsible for processing appeals. 

DROs hold many responsibilities including: 

384 

• Holding informal conferences and formal hearings with Veterans • Evaluating the evidence of record including the need for additional evidence as 

a result of information obtained during the hearing • Making direct contact with the appellants and their representatives • Providing feedback to RVSRs on their initial decisions • Playing a central role in employee development, including mentoring new rating 

specialists, participating in the training of RVSRs, and coordinating training opportunities with BVA and local medical centers • Certifying appeals to the BVA and coordinating their transfer to BVA. 

VBA’s Appeals Management Center (AMC) has jurisdiction over most appeals remanded to VBA for additional action by BVA and the Court of Appeals for Veterans 

Claims. The AMC has approximately 180 employees whose sole focus is to process 

appellate remands. 

Question 2. Additionally, how will new technology and a paperless system help resolve these longstanding claims that are stuck in the appeals process? 

Response. The Veterans Benefits Management System (VBMS) is utilizing smartscanning technology, which provides searchable PDFs and electronic data. Enhanced 

search capability allows for easy identification of key words to aid in the quicker 

review of evidence. Future functionality will support the linking of evidence to specific disabilities/key words, providing the reviewer with the capability to better organize documents/images for subsequent reviews. Utilizing business rules, VBMS will 

have tools to assist the reviewer with identifying gaps in the claim development 

process, consequently reducing premature advancement of a claim to the next step 

in the claims process. More significantly, the planned advanced rules-engine technology will assist decisionmakers with assigning disability evaluations based on 

predefined embedded evaluation criteria for disabilities in the current 38 CFR, Part 

4, Schedule for Rating Disabilities. Incorporating these rating tools will support consistent and accurate disability decisions, which may reduce the number of cases entering the appeals process. These tools and capabilities will also directly support Decision Review Officers in carrying out their decisionmaking responsibilities on appealed claims decisions. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. SCOTT BROWN TO

U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. I met with members of Massachusetts Chapter of Disabled American 

Veterans in my Boston office recently and listened to their concerns about the inadequate facilities at the VA Hospital in West Roxbury. It serves veterans from the 

entire North East Region, and is the highest level of care within its regional Veterans Integrated Service Network. 

West Roxbury VA Hospital serves veterans from all over New England, but its 

operating room is too small for modern surgical equipment. As a result, the facility 

is in need for significant upgrades. 

I am concerned that with a proposed 40% cut in VA construction in FY 2012 that 

the facility that has needed these improvements for many years will be one of the 

projects pushed to the side. Please provide me with an indication of where the West 

Roxbury VA Hospital stands on the list of modernization/recapitalization priorities 

for the VA and why. 

Response. VA Boston HCS submitted, and Veterans Integrated Service Network 

1 endorsed, a major construction project for consideration in fiscal year (FY) 2012 

to modernize and enhance the West Roxbury campus, a tertiary care VA facility 

serving Veterans throughout New England. 

The multi-story project would co-locate such critical as: operating rooms; intensive 

care units; emergency department; radiology (including a magnetic resonance imaging unit and computed tomography); instrument sterilization (supply, processing 

and distribution); and other ancillary services. The proposed addition would renovate existing building space to increase capacity to accommodate workload increases and improve clinical access. At present, the West Roxbury facility provides 

and will continue to provide safe, appropriate, and skilled care to our Veterans. Additionally, investments have been made to further enhance the facility’s services. In 

the past three years, more than $20 million has been spent in improvements and 

repairs to the infrastructure and $36 million in equipment. 

The proposed project was evaluated during the FY 2012 Strategic Capital Investment Planning (SCIP) review, along with other capital investment proposals submitted for consideration. The project was ranked seventh of the major construction. 

The four highest ranking major construction projects are included in the FY 2012 

budget request. The West Roxbury project and the other projects not selected during 

385 

the FY 2012 SCIP process must be resubmitted in FY 2013 for funding consideration. 

Chairman MURRAY. Thank you very much, Mr. Secretary. As you 

know, we have been called to vote. We have a few minutes to get 

to the Floor. I am going to call a short recess, approximately 10 

minutes, and when I return we will begin with questions. 

[Recess.] 

Chairman MURRAY. We will reconvene this hearing. A number of 

Members are still on the Floor voting, and they will be returning 

shortly. We will now move to the question period with the 

Secretary. 

Mr. Secretary, I have a great deal of respect for the work that 

you have done on homeless and women’s issues, and I know you 

are working diligently in a number of ways, but I wanted to bring 

up an issue that I am very concerned about. 

I have already discussed the caregiver issue with you. I have 

talked about it with Jack Lew. I have talked with senior staff at 

the White House, and I have spoken directly with the President of 

the United States. VA’s plan on the caregivers’ issue was overdue, 

and once submitted, it hardly resembled the bill that unanimously 

cleared this Congress. Three weeks ago, my Committee staff requested information on how that plan was developed, and to date, 

no information has been provided. 

Rather than following the law, the Administration set forth some 

overly stringent rules, bureaucratic hurdles that would essentially 

deny help to caregivers. 

Sarah and Ted Wade, who were staunch advocates and worked 

hard with us to get this passed, were invited by the President to 

attend the bill signing at the White House. Ironically, they will not 

be eligible for the new program under the plan that the Department submitted. 

We are also hearing from a lot of other veterans and caregivers 

from across the country who fall outside of this new line in the 

sand the VA has drawn or who have been left in limbo and now 

do not know if this benefit that they advocated and worked so hard 

for will support them. 

Mr. Secretary, it appears that your Department is not complying 

with the law as written. Can you please tell this Committee why? 

Secretary SHINSEKI. Chairman Murray, let me begin by expressing my regret that the implementation plan was late getting to 

you. We did our best. We are looking forward at this point on how 

to accelerate the process. 

I would also add that the importance of family in caring for our 

Nation’s injured veterans has been a long-standing concern and 

issue for the VA; and, as you know, we have about eight decades 

of history of caring for the caregivers. 

We have demonstrated this dedication to them in a wide range 

of ways over the years. Benefits that are already offered include 

education, training, homemaker, home health services, respite care, 

and family support services. But more than programs, we see it in 

the thousands of acts of compassionate care provided by VA employees on the front lines. 

Through the caregivers bill enacted last year, thanks to the leadership—your leadership specifically but the leadership of Congress 

386 

as well—Congress and the President built on this foundation by establishing landmark new benefits for post-9/11 veterans that for 

the first time provide direct financial and broad health care support directly to the caregiver. We have not done this before, and we 

are working through the complexity of what this means. 

Implementation of the more unprecedented features of the law 

has taken longer than I anticipated or would have liked. We understand the frustration that has been expressed on the part of some. 

We have responded by greatly expediting the required regulatory 

process through the use of what I described as the interim final 

regulation, transmitted to the Office of Management and Budget on 

Monday. 

I assure veterans and the Congress that the Administration will 

move quickly and, we plan to have direct-to-caregiver benefits in 

place this summer, early this summer. 

We also understand the concerns that have been expressed with 

the scope of the benefit, as we have proposed, in our implementation plan. We have an obligation to get this right, to get this benefit right, and that means meeting the requirements of the law and 

also making sure that those VA employees on the front lines of caring for our veterans have a clear and consistent set of guidelines 

to apply. 

It has been a challenging exercise. I will state that. It is my personal obligation to be able to explain to an injured veteran why he 

or she would not be eligible for this benefit while someone else in 

his or her company with similar injuries would be, and that is the 

standard we are trying to establish here. 

That standard has guided our efforts to this point, and I hope remains in whatever standard we finally establish. 

That said, I want to be clear we are absolutely open to suggestions for different places to draw that line than what we have put 

forward. What we put forward was a starting place, but the standard must work in the real world on the clinical front lines where 

differences exist; and combinations of injuries, mental and physical, 

are as unique as the veterans themselves. 

To that end, Madam Chairman, VA is willing and I am willing 

to work with you and Members of this Committee and your staff 

and all the veterans and families who are represented and have a 

stake in this. I welcome the input both from you, Ranking Member 

Burr, and others in trying to develop clear, clinical guidelines for 

this program. 

OMB is now reviewing the regulation. I will take this opportunity to encourage all with a stake in this important new program 

to provide us the benefit of their insights and their comments, and 

I will provide feedback to you at the appropriate time. 

Chairman MURRAY. Thank you very much, Mr. Secretary. I know 

this is a new law. We considered that as we prepared it and wrote 

it and worked with many, many people to get it done. But I think 

it is absolutely imperative that in this time of war with OIF and 

OEF soldiers coming home seriously disabled, a generation of soldiers that are facing very long-term care with spouses, siblings or 

parents caring for them, that we make this right and make it right 

soon. 

387 

I am deeply concerned, first of all, in the lack of communication 

and the lateness in getting this to us. We are past that now, but 

we are at a very unfortunate stage. The rules have gone to OMB 

and may be out in a few months. Then implementation takes a 

while, and you are only now offering to let us look at different ways 

of writing the law. 

So, we have a real challenge in front of us to be able to write 

it in the way Congress intended. If the rules come out as we saw 

the draft with the narrow definition, it will not be in keeping with 

the intent of Congress. 

We are happy to work with you now to tell you what we feel 

should be implemented, but we are facing a seriously difficult challenge because of where it is today. 

So I am very concerned about that and will have more to say 

about it. I think it is important to remember why we wrote this. 

We know that in every war soldiers come home and need care; but 

in this war, in particular, where we have saved the lives of many, 

many soldiers, they have come home with very seriously challenging issues to deal with, and their spouses or their parents are 

now required to quit their job, lose their income, and care for them. 

That was the reality behind the intent of Congress. 

The narrowness we saw in your rules excludes many people who 

we believe Congress wrote the law to cover. So we are going to 

have to work on this. 

But I wanted to ask you today, of $180 million that the budget 

submission specifies for the Caregivers and Veterans Act, how 

much is going to be actually allocated for the implementation of the 

family caregiver program? 

Secretary SHINSEKI. In the 2012 budget, it is $66 million. 

Chairman MURRAY. $66 million for the implementation. 

The legislation authorized an average of $308.4 million for this 

program each year. Can you tell us why the VA is only planning 

to use about 21 percent of that? 

Secretary SHINSEKI. Madam Chairman, I would just say that 

that again is where we established the start point. We expect this 

program will grow. 

Chairman MURRAY. Pardon me. 

Secretary SHINSEKI. We expect that this program will grow. The $66 million was based on our estimate of going through the veterans who are in various categories of serious and severe injuries, 

and the numbers on which $66 million are based was that initial 

eligibility start point, roughly about 1,000. 

Chairman MURRAY. Very narrowly redefined though; not defined 

as the law was. 

Secretary SHINSEKI. That is correct. 

Chairman MURRAY. It was the intent of Congress that the law 

not be narrowly defined. So we have an issue between us on that 

one. 

Secretary SHINSEKI. OK. 

Chairman MURRAY. Let me ask one other question, and I will 

then turn to the Ranking Member, but we will have a lot more discussion about this caregiver bill. 

I recently saw a newsletter written by the director of the Indianapolis VA medical center, talking about a variety of cost savings 

388 

initiatives that the VAMC will undertake. He indicated that he intended to seriously reduce bonuses but he also would be slowing 

the hiring of additional and replacement staff. 

Will those types of cost savings actually result in the degradation 

of quality? 

Secretary SHINSEKI. Madam Chairman, I am going to call on Dr. 

Petzel to address the specific issue there at Indianapolis. But what 

I would offer up front is that we now have a year-long budgeting 

dialog—the beginning of the year, midyear, and end of year—and 

there are adjustments made. 

No VISN director of the 21 VISNs has come in and said they are 

unable to execute their program for the year, and we hold them responsible for balancing resources and requirements. 

Dr. PETZEL. Thank you, Mr. Secretary. 

Madam Chairman, the estimate, the letter that you read, which 

I also read, was an early estimate of what their budget might look 

like. Those estimates are refined almost weekly as medical centers 

begin to spend their money. If you were to look, in fact—we have 

asked what the estimate is now; it is substantially reduced. 

As the Secretary has said, we review—here in Washington, he 

personally reviews with each one of the networks, their budgets, 

and how well their medical centers are doing. 

We have no evidence that any medical center is not going to be 

able to meet their obligations and not going to be able to provide 

the kind of care that you and I expect. 

Chairman MURRAY. Well, the Indianapolis director said that they were facing an $18 million budget gap this fiscal year. 

Dr. PETZEL. That was the difference between what they wanted 

and what they got. It does not represent the difference between 

what they need and what they got. 

So if you were to look, if we were to ask what is that gap now, we would find that is not $18 million. It has been substantially reduced, if not actually disappeared. In addition to that, if that were true, if there were an $18 million 

shortfall between what they got and what they needed, the networks are able to make up those differences. They have reserve 

funds. The Secretary has a reserve fund. We have, as I said, reviews at least three times a year here in Washington of the financial state of each one of the medical centers. There would be money 

to take care of that. 

Chairman MURRAY. How many VISNs currently are facing a 

budget shortfall? 

Dr. PETZEL. None. 

Chairman MURRAY. Quickly, on the issue of bonuses, I was surprised at the number of bonuses that were awarded last year. 

Among them, actually, was the director of the medical center in 

Dayton, OH, where there have been serious problems we have been 

hearing about: with respect to a dentist failing to practice basic hygiene and overall poor management of human resources in the dental clinic and other areas. 

Apparently, he received more than $11,000 this year and $64,000 

since 2006, with problems going on the entire time. Executives 

from other troubled medical centers received significant bonuses as 

well. 

389 

Mr. Secretary, I wanted to ask you. Are you going to be seriously 

reducing the number of bonuses paid the same way that the director of Indianapolis was forced to do? 

Secretary SHINSEKI. Madam Chairman, let me start and then 

call on Dr. Petzel for any details. 

I would offer that for the past 2 years, we have paid specific attention to the way bonuses are paid. Without making any statements about how it was run prior, I just did not find as close a connection between performance and bonuses. 

I do believe bonuses have a real role to play in the compensation 

programs designed to encourage best behaviors, superior performance; and where that happens, I think there is justification for 

that. 

For the past 2 years we have looked very closely at it and I am 

happy to provide you the details. You will see the ‘‘outstandings’’ 

and the number of bonus payments actually adjusted quite significantly. 

To your direct question about Dayton, I cannot justify the performance of what happened at Dayton. I think there is a failure of 

leadership, and therefore, I am not going to try to describe why a 

bonus was sensible. 

But suffice it to say, this issue came up because VA workers 

thought we had a problem. This went on for an extended period of 

time where it was not brought to the attention of leadership and, 

again, I attribute that to a failure in the leadership, that the climate was not conducive for the workforce to believe they could 

raise the issue and get a satisfactory response. I own that, and my 

responsibility is to correct that, and that is what we are doing. 

Chairman MURRAY. OK. I appreciate that. Thank you. 

Senator Burr. 

Senator BURR. Thank you, Madam Chairman. 

I have got a number of questions, Madam Chairman, and I am 

going to ask unanimous consent that I have the opportunity to 

send them all to the VA and have them respond for the record. 

Mr. Secretary, I am going to spend my time now talking about 

the caregivers bill. I did not intend to do this, and there will not 

be questions. 

I would like to tell you a story this morning. On an evening when 

the U.S. Senate alarms for some type of bio- or chemical-detection 

went off, all the doors were shut down, and Members and staff 

were hustled into the Russell garage for hours until we got the allclear, that night I had an opportunity to meet a young man. He 

could hardly function. 

He was a warrior back from Iraq, a kid that when they made the 

decision at Landstuhl to put him on a plane and fly him to the 

United States, there was not a health care professional in the room 

that believed he would live through that trip; and for that reason, 

he was discharged before he left because it was perceived that it 

would be advantageous to the family to have him discharged 

before. 

There was only one problem; they never told Ted Wade. Ted 

lived. Ted got back because of an unbelievable spouse and family 

support. Ted continues to make progress every day. He will never 

get back to the kid he was. 

390 

It was Ted Wade and Sarah Wade that I think played the biggest 

part in the creation of the Caregiver Act. When we talked about 

passing the caregiver bill, I do not think that there was a Republican or Democrat on this Committee who did not look around and 

see Sarah and Ted Wade. 

Sarah was tireless in her contributions to crafting the legislation 

to get it right so that at the end of the day we could look at the 

product we had produced and be proud, not just today but for the 

future, that this was going to affect families in ways that provided 

them the opportunity to invest in their family members who had 

committed so much. 

Until this morning, it really was not raised to this level on my 

radar and when we wrote the legislation, we wrote it in a way that 

was pretty clear. 

I have got to tell you, if I were you, I would pull it back from 

OMB; I would ask them not to comment. If I were you, I would go 

back and rewrite this rule. I say to you and your staff of great professionals, if you insist on moving this as currently written, it will 

be one hell of a fight because the way I read this, unless somebody 

otherwise is institutionalized, a caregiver gets no benefits. That 

was not the intent of the Committee Members. 

If there is something that we are missing from a standpoint of 

the ability to administer or the funding needed, then it is a conversation we need to have, and I am ready to have it. 

But to suggest that only the veterans that otherwise would be institutionalized qualify for this is to take a kid whose medical assessment was that he would never live to make the trip back to the 

United States and then say, you know, ‘‘You’ve got a loving, caring 

wife, who is going to take care of you. She will change her entire 

life to be able to be there to take care of you. But because she does 

that and you continue to improve, your only other option would not 

be to be institutionalized.’’ 

We were trying to make sure that was not the only option that 

was left for kids, to institutionalize them, and now all of a sudden 

it has become the threshold for participation in the program. 

Let me suggest that the effort is misguided right now, and I 

would implore all of you go back to the table. Read the bill again. 

What is not clear might be influenced by our intent, and we will 

help you move from where we are today to where we need to be 

for these veterans in the future. 

I thank you for your commitment. 

Thank you, Madam Chairman. 

Chairman MURRAY. Thank you very much, Senator Burr, and I 

look forward to working with you on that. 

Senator Rockefeller. 

STATEMENT OF HON. JOHN D. ROCKEFELLER IV, 

U.S. SENATOR FROM WEST VIRGINIA 

Senator ROCKEFELLER. Thank you, Madam Chair. 

One of the reasons I am here, not the most important reason, but 

one of the reasons I am here is that this is your first day chairing, 

and I think that is extraordinarily good news for the Veterans’ 

Committee, very good news for General Shinseki, and very good 

news for veterans as a whole. So I wanted to say that. 

391 

Chairman MURRAY. Thank you. 

Senator ROCKEFELLER. That is on the record, is it not? 

Chairman MURRAY. It is. 

Senator ROCKEFELLER. OK. The other reason I am here is parochial, which is very untypical of me, actually. But I have a point 

that bothers me. 

I had a conversation with the head of the National Science Foundation recently. They had a very important program that affected 

a lot of the research that we were doing at West Virginia University. 

It emanated actually from EPSCoR. It was a philosophy matter 

because it used to be that science research was given to the Harvards, the Stanfords, the Yales, you know, all of those. But the 

smaller universities, or you could say smaller States, that do not 

have the high ranking, that are not as prestigious, just never got 

a grant from the National Science Foundation. 

They were peer-reviewed so that you could say that we did bad 

grants but I do not think we did because I helped invent that program, EPSCoR. 

I got the head of the National Science Foundation to agree that 

rather than accumulate all of the secondary programs in his office, 

as opposed to committing them to a general sciences fund which 

would then mean that money would go to other institutions such 

as West Virginia University, such as—I do not know in Washington 

you do not have a small university, do you? 

Chairman MURRAY. We have great universities. 

Senator ROCKEFELLER. You just have great universities, and we 

are aspiring to that, too. 

What comes into play is the fairness doctrine on the Beckley 

nursing home situation. 

West Virginia is not a big State. The Beckley nursing home—the 

case that I could make to you for that is lengthy and goes back a 

number of years. Senator Byrd and I worked on that very, very 

hard. Senator Murray remembers this herself I know. Anyway, 

WVU is on a sort of secondary list. 

Now, you are overwhelmed with all kinds of things. You are 

going to be facing budget cuts, I mean, all kinds of things that you 

are overwhelmed with, and I know that. I have enormous respect 

for you, as you know. 

But when I see that we are lumped in with all other construction 

projects in one massive category from which some will emerge and 

some will not—being from Appalachia and having that degree of fatalism which is necessary to have if you are from Appalachia and 

also necessary to overcome if you are from Appalachia—I have this 

feeling that we are not going to get funded. 

Now, we would have the funding had the omnibus appropriations 

bill passed last year, but that was stopped at the last moment. 

So my question to you is what can we do? I am just in the wilderness on this. It is so important to our State, to our veterans, and 

yet we are not high enough on the list, and we have been ranked 

in another category. I do not know what it is that we can hope to 

expect. I also want to know what it is that I do about trying to improve our circumstance, because if you are from Appalachia you 

have to be skeptical. You have to assume that you are going to be 

392 

left behind, that others will be picked because they have more people, they have, you know, more criteria. 

So, I admit that is a fairly self-serving project but it serves veterans with dementia and all kinds of other problems. This is something that you and I have actually talked about and I have written 

to you about it. 

But I just wondered what can I look forward to doing or what 

should I be doing? I mean this hearing is a darn good first step. 

But what should I be doing to improve the opportunity for that 

project to succeed? 

Secretary SHINSEKI. Senator, you and I have discussed this. I am 

going to call on Dr. Petzel here to give us an update of where we 

think we are. We thought we had this issue addressed. 

Senator ROCKEFELLER. Right. 

Secretary SHINSEKI. We are now adjusting to the current situation. 

Senator ROCKEFELLER. I understand that. 

Secretary SHINSEKI. But let us give you the state of play here 

from our side. 

Dr. PETZEL. Thank you, Mr. Secretary. 

Senator Rockefeller, I do not know specifically where this sits 

right now on the construction list, so what I would like to do is 

have the time to go back and look to see what the order of priority 

is with nursing-home construction. As I am sure the Secretary 

could tell you and Mr. Grams could tell you, we have a huge need 

in terms of construction. 

Senator ROCKEFELLER. Of course. 

Dr. PETZEL. This is special from a number of different perspectives. One, it talks about an Alzheimer/dementia unit which is 

something that we desperately need within the VA. 

So what I would like to do is beg your indulgence, go back and 

take a look at the list, and we will communicate after I have had 

a chance to look at it. 

Senator ROCKEFELLER. Completely satisfactory. 

Secretary SHINSEKI. I would just add, Senator, that in my opening comments, I talked about something called SCIP, which is our 

Strategic Capital Infrastructure Program where we look at all of 

our assets: medical centers and outpatient clinics, both leased and 

ones we run, to make sure that we have, looking forward, a good 

plan for what we expect out of each of those. 

I would offer that constructing a nursing home care unit at Beckley was submitted as part of that 2012 SCIP process for consideration as a future budget request. It is not in the 2012 budget, but 

we anticipated we were not going to have this issue to deal with 

in 2012. 

We are now adjusting. In our 2012 study, this nursing home is 

addressed as a requirement for a future budget request. That is 

sort of the current state of play. The project is about an 80,000- 

square-foot facility which I think we have costed, so we have a 

pretty good idea of what that is going to be. It will give us a way 

to make sure that it gets addressed here in the future. 

Senator ROCKEFELLER. I thank you. 

Thank you, Madam Chairman. 

Chairman MURRAY. Thank you, Senator Rockefeller. 

393 

I want to welcome to our Committee Senator Boozman. We are 

delighted to have you. Do you want to give an opening statement 

and ask questions? Either one. 

STATEMENT OF HON. JOHN BOOZMAN, 

U.S. SENATOR FROM ARKANSAS 

Senator BOOZMAN. Thank you, Madam Chair. I want to congratulate you on being Chairman. I look forward to working with you 

and Senator Burr as we all push forward and work really hard to 

get a lot of stuff accomplished for veterans. 

I guess really the only questions I would have—I appreciate having the opportunity to work with you, Secretary Shinseki, on the 

House side on the Veterans’ Affairs Committee—I know that you 

really are working hard for our veterans. We just have a lot of 

issues out there that we have to deal with. 

One of the things that I was really involved with was a GI Bill 

implementation. I really feel kind of bad in the sense, you know, 

there for a while I literally—as being Chair and then Ranking 

Member on the Veterans’ Employment Subcommittee, Economic 

Opportunity—it seemed like, you know, we were meeting every 

month, getting updated. So I would really like a bit of an update 

there; making sure that we have got the resources. Then, the other 

thing that I was really concerned about was putting veterans to 

work. In this difficult time of employment, it is hard on everyone 

and yet, with these multiple deployments, I am very concerned that 

perhaps employers are starting—maybe psychologically or whatever, sometimes willfully, it is difficult. Many of these individuals 

are from small towns. They get called up and it is hard sometimes 

to go back to work. 

So if you could comment on those things, I would appreciate it. 

Secretary SHINSEKI. Senator, let me begin with GI Bill processing. I think a lot has transpired since we went through that first 

initial fall where everything was done pretty much by hand. 

We have automation tools that are now in place and there have 

been successive drops. One more drop to go—a program to be inserted to give us a long-term automated solution to the GI Bill 

processing. 

I will call on Secretary Baker to describe for you what that is, 

and then I will address the other pieces of your question. 

Senator BOOZMAN. The other thing, Mr. Secretary, is in the 

course of that, and here today again we have limited time, but I 

would be interested if you have a process in place that would make 

it more efficient for us to legislatively adjust it somewhat. That 

would be very helpful also. 

Mr. BAKER. Thank you, Senator. On the efficiencies I am going 

to defer to Mr. Walcoff to talk potentially about those. 

We are working hard right now on the technology to implement 

the upgrade to the law. This weekend we will install the IT 

changes for the 60-day requirements from that law. 

On June, I believe it is about the 14th, we will install all the IT 

changes necessary to support the August 1st requirements of law. 

So we are processing well there. 

We have many optimizations we can do in the processing of those 

claims that are scheduled for the release after the new law is put 

394 

in place. So that is actually deferred while we implement the new 

law. But we are on track with the program and very pleased with 

the new technology that is in place, with the long-term solution 

and its flexibility for us. 

Let me ask Mr. Walcoff to talk about efficiencies from a legislative standpoint. 

Mr. WALCOFF. Thank you, Secretary Baker. 

Senator Boozman, it is good to work with you again. I am really 

pleased to be able to say that we have come a long way since those 

days that you were referring to, the first semester that we had the 

new GI Bill. 

A lot of that progress is due to the technology that has been developed by Secretary Baker and his people. I just want to give you 

an example of how effective this technology is. 

In the processing of a supplemental claim—say it is not the first 

time a veteran has come in but once he has been enrolled, he 

comes in semester after semester; they are called supplemental 

claims. 

Under the manual system, the one that caused us to have such 

a big backlog 2 years ago, it took about 40 minutes to work a supplemental claim. With the new technology that has been delivered 

by our IT people, we now do a supplemental claim in about 7 minutes. They are the largest number of the claims that we receive. 

So with that type of efficiency gain from the technology, it has 

enabled us to be in much better shape in terms of the delivery of 

benefits. 

Senator BOOZMAN. Thank you. 

Secretary SHINSEKI. To the issue of jobs, it is something we work 

on. I am part of an interagency effort to increase the number of 

veterans hired into the Federal Government departments. 

We just had the latest meeting yesterday and the vast majority 

of a number of departments have increased veteran hiring inside 

their own organizations. The VA is probably just around 30 percent. We were several points less 2 years ago. So we have begun 

to make the move in the right direction. 

Other things we have underway, small businesses that are 

owned by veterans, disabled veterans, are a high priority with us. 

We look for the opportunity to give them a veteran’s first competition opportunity for contracts that VA controls. We encourage other 

departments to do the same. 

We invite in small business owners once a year, take them 

through a training program where we encourage them to start 

businesses primarily because veterans tend to hire other veterans 

and that creates the churn we are looking for. 

Senator BOOZMAN. Thank you, Madam Chairman. 

Chairman MURRAY. Thank you very much. 

Mr. Secretary, last week I had a number of listening sessions 

with veterans in my homestate, and I heard a lot of concern about 

the elimination of interval pay during breaks in schools. 

I know the President’s Fiscal Year 2012 Budget does not completely reflect the implementation of the recently enacted improvements legislation. But I wanted to ask you today if you have any 

more information on the number of students we have that might 

be affected by the elimination of interval pay: how many are vetVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00400 Fmt 6633 Sfmt 6601 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
395 

erans; how many are active duty; how many are transferees; and 

what is the average amount of living allowance that they are going 

to be losing? 

Secretary SHINSEKI. Madam Chairman, I am going to call on Mr. 

Walcoff to provide some of that detail. Some of that data I think 

we will have to provide for the record, and I am happy to coordinate that with you. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. PATTY MURRAY TO

HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Response. The Department of Veterans Affairs (VA) provided education benefits 

to more than 800,000 students in fiscal year (FY) 2010. Of these, approximately 

366,000 students trained under the Post-9/11 GI Bill. During this period, approximately 278,000 Post-9/11 GI Bill students qualified for interval payments—235,000 

Veterans and 43,000 transferees. While there were 18,000 servicemembers, these individuals are not entitled to interval pay under the Post-9/11 GI Bill. Based on the 

recently enacted legislation, 278,000 individuals would no longer qualify for an interval payment, which currently provides an average housing allowance of 

$1,348.84. 

For the other VA education programs, such as the Montgomery GI Bill—Active 

Duty, Montgomery GI Bill—Selected Reserve, Reserve Educational Assistance Program, and the Dependents’ Educational Assistance Program, there were approximately 311,000 individuals who would no longer qualify for interval payment based 

on FY 2010 data. 

Chairman MURRAY. That would be fine. 

Secretary SHINSEKI. I would say we have enrolled in the GI Bill 

program right now about 427,000 veterans and family members, 

and the elimination of interval pay applies to all of them. 

Chairman MURRAY. Right. 

Secretary SHINSEKI. So, if we add to the GI Bill program, the 

Montgomery GI Bill voc rehab students, that number is 800,000; 

and the elimination of interval pay applies to all of those students. 

Mr. WALCOFF. I do not have anything more specific in terms of 

numbers. The Secretary gave the numbers that I have with me. 

But I will tell you that one of the things that we are very concerned about is that veterans are in the know about all the 

changes, including that change, because a lot of plans were made 

based on the fact that they expected that they would get paid for 

the intervals. 

So, we basically have an outreach plan to veterans to make sure 

that they know about all the changes. As a matter of fact, there 

is a letter that is going out—— 

Chairman MURRAY. They not only know, they are panicked. 

Mr. WALCOFF. I know. It is a serious situation for some who had, 

in their planning, had it down to the point where they need every 

payment that they were expecting. But we are sending a letter out 

to every veteran who is receiving the GI Bill to make sure that if 

they had not known, that they are at least now aware of it; and 

we acknowledge that it is going to have a negative effect on some 

veterans. 

Chairman MURRAY. Mr. Secretary, would the Department consider using any authority for emergency payments, like it did during the period of time when difficulties were first encountered with 

this program, to use some kind of help for financial hardship for 

some of these students? 

396 

Secretary SHINSEKI. Madam Chairman, I think the answer is 

yes. I mean, there are opportunities for the Secretary to exercise 

a judgment in specific cases. We tend not to write a blanket policy 

that applies to everyone but deal on a case-by-case basis. 

Yes, the emergency route is available. I do know the other side 

of that is the requirement to also later collect and that presents a 

challenge for some. So we want to be judicious here and provide it 

to the most strenuous cases where we know there is no other alternative, and then after that waive whatever difficulty there might 

be. Manage the problem, not create another one. 

Chairman MURRAY. OK. I completely respect the complexity of it, 

but I do think there are some very significant financial hardships 

for some of these folks that would be very much helped by that, so 

I would like to work with you on that. 

Secretary SHINSEKI. OK. 

Chairman MURRAY. Let me ask about claims processing. It is a 

perennial question but it is as serious today as when I first started 

working on this Committee a long time ago. 

It is one of the most common issues and heartfelt issues I hear 

from veterans. It will be one of the top priorities I have as chair 

of this Committee and I know that you are willing to work on that 

too, and I want us to both work from our respective positions because our veterans deserve no less. 

So, I want to ask a few questions about VBA. Can you account 

for the decrease from last year’s level in discretionary spending for 

VBA? 

Secretary SHINSEKI. Mr. Walcoff. 

Mr. WALCOFF. Yes. When you look at the 2011 budget—as you 

know, there was a big increase in the 2011 budget and that included the hiring of a lot of people. To support that hiring, there 

was a lot of money put in there for the training of all those people: 

the travel involved with that; all the support mechanisms that are 

needed to support the hiring of a large number of people. 

We are not planning on doing that kind of hiring in 2012 for a 

lot of reasons that we can get into. But to answer your question 

directly, a lot of that money that was in the 2011 budget to support 

the hiring of new people and the training of those people is taken 

out because we are not going to have that influx in 2012. That is 

the primary reason; and there is no pay raise. There are a few 

other reasons but that is the primary reason. 

Chairman MURRAY. OK. What specifically is included in the VA’s 

budget that is intended to ensure more timely and accurate resolution of claims? 

Secretary SHINSEKI. We have a number of pilots underway that 

deal in three areas: people, process, and technology; and it takes 

all three to attack this claims backlog issue that has built up over 

years. 

Just a little history. When I arrived to 2009, VBA produced 

977,000 claims decisions that year, a high watermark for them. Everyone was very excited about it, and then realized that they got 

a million claims in return. 

In 2010, they produced a million claim decisions, and got 1.2 million claims in the door. We expect this year that the number of 

claims we receive are going to be 1.4–1.5 million claims. 

397 

It is a large number issue, and merely hiring more people will 

not get us out ahead of it. So we must automate. As I say over in 

VA, IT is the elephant in the house. We must do this, and we must 

do it quickly. 

In the meantime there is a crossover point. We have been investing heavily in IT, and we are looking for that crossover point at 

which we can begin to stop the investments in personnel and have 

what we have invested in automation take over. 

That crossover point we intend to be in 2012. Counting on IT 

drops that are going to produce what we have invested, spent monies for, that is to be determined. We are going to see that happen 

over the next year. 

I have a high degree of confidence that this will go with Secretary Baker leading the way on this and creating a structure for 

doing these things—a high degree of confidence. But again, we will 

know it when we see it. But 2012 is our target, and this budget 

for 2012 is an important crossover point. 

Chairman MURRAY. Thank you very much. 

Senator Sanders. 

Senator SANDERS. Senator Murray asked the question that I 

wondered about, the processing of claims. Let us go to another 

area. How are we doing on homelessness? It appears to me we are 

making some progress. Can you give us some background on that? 

Secretary SHINSEKI. I would say from the Secretary’s seat I have 

reached out and pinned a rose on an individual who is seated to 

my right. Dr. Petzel is the lead on our homeless program primarily 

because 85 percent of the homeless issue is a health-related issue. 

It is health care in general. It is depression. It is other mental 

health issues. Substance-abuse. 

The individual we have resourced with the capabilities to do 

something about that is our VA health care system. So Dr. Petzel 

has the lead for that, and through him every VISN director and 

every medical center director also has a responsibility to treat 

homelessness as a priority, not when someone walks in the door 

who happens to be homeless but reaching out to the communities 

they live in, touching base with folks from across the Nation that 

do this day-in and day-out: Catholic Charities, Salvation Army, 

Volunteers of America, Swords-to-Plow Shares, etc. 

As I have described them in the previous testimony, they are 

really the creative geniuses here who, with very little, have done 

so much. It is time for us to link in with them. We have, and advantaged what they know to help us build a registry of the names 

of homeless veterans, at the same time looking at building a registry of at-risk veterans because whatever we see of the homeless 

situation—today the estimate is about 76,000, down from 107,000 

previously. 

It is still an estimate. So, building a registry here is important 

to get us out of rescue mode, getting people off the streets, into prevention as well, and that is what we intend here, heavy effort in 

rescue today. 

We know that they are out there. We need a registry so we can 

focus on them, but at the same time, we need to develop some appreciation for the protection requirements. 

398 

Senator SANDERS. So what I am hearing, General, is that we are 

working with other organizations, we are making some significant 

progress. 

Secretary SHINSEKI. Absolutely. 

Senator SANDERS. That is my impression. 

Let me ask you a more general question, and if Dr. Petzel wants 

to jump in, that is fine. As I understand it, you run the largest 

medical system in the United States? 

Secretary SHINSEKI. That is correct. 

Senator SANDERS. Let me ask you a general question. We talk 

about health care a whole lot, with many debates. In fact, I just 

was talking to some young people from the United Kingdom and 

asked them about their system. 

In your judgment, compared to other systems in the United 

States of America, how does the VA rank? Is it a good system? 

Does it compare well to other systems? What would you say? 

Secretary SHINSEKI. Senator, I am going to answer that with 2 

years of hindsight. As I have testified before, I did not grow up in 

VA. Did not know much about it when I arrived to this position, 

and I am not a clinician. So, much of what I know today has been 

learned here by going and visiting our various facilities, and relying on the great expert guidance here by Dr. Petzel among others. 

I would categorize the VA health care system as excellent, and 

I compare that to a 38-year history of being in another very large 

health care system which took very good care of me day-to-day and 

also in the more serious moments, and I always thought it was an 

excellent system. 

Senator SANDERS. You are referring to the military. 

Secretary SHINSEKI. The military health care system. I would put 

VA very much in that category, and in a number of ways superior 

to that. 

Dr. Petzel. 

Dr. PETZEL. Thank you, Mr. Secretary. 

Senator Sanders, just a couple of comments to elaborate on what 

the Secretary said. We are actually the largest integrated health 

care delivery system in the country, and that is where the physicians, the hospitals, et cetera, all work under the same kind of organization. I think it is an important distinction to make. 

When you look at our performance, we have a very deep array 

of performance measures, particularly around quality, about 170 of 

them. When you look at those measures that we can compare with 

the private sector, which is quite limited because there are not as 

many things being measured there and published right now, we 

rank very well. 

When you look at our performance on HEDIS and the ORYX 

measures—one, HEDIS looks at outpatient; ORYX looks at inpatient, which are nationally collected on every single medical center 

in the country—and compare the Medicare population performance 

of these medical centers with us, we rank way above. 

Senator SANDERS. It’s my understanding—somebody was telling 

me in terms of information technology, you guys are pretty close 

to the top. Are you not? 

Dr. PETZEL. Our medical records, certainly at this point in time 

rank one of the best, if not the best, in the country. Of course, the 

399 

private sector is playing catch-up right now and they are breathing 

down our neck. But, yes, we do have an excellent medical records 

ranking. 

Senator SANDERS. If my memory serves, and please correct me 

if I am wrong, but there is obviously a lot of concern about infections in hospitals. You guys were doing pretty well in that, are you 

not? 

Dr. PETZEL. A little background, Senator. The overall infection 

rate is a hard thing to measure across the country, not just within 

the VA. There has been disagreement as to what constitutes an infection, et cetera. The one place that there is a standard way of 

looking at this is with methicillin-resistant staph aureus or MRSA. 

VA has done a remarkable job over the last four and one-half years 

of reducing its hospital-acquired MRSA infection rate. I would say 

we are doing as well as any hospital system in the country right 

now. 

Senator SANDERS. These are my last questions, Madam Chair. 

Everybody is concerned about the high costs of health care in the 

United States. We spend almost twice as much as any other country on health care. How cost-effective is the VA health care system? 

Secretary SHINSEKI. I would just point out that the effectiveness 

of the VA health care system is excellent, and one of the ways we 

look at this is comparing what it costs to take care of a patient during the course of a year and compare it to what our known costs 

are for taking care of a homeless veteran who comes to us on those 

occasions when they need help. The cost of taking care of the homeless veteran is three and one-half times the cost of other health 

care we deliver. 

Therefore, it is in our interest to get our homeless population in, 

cared for, and off the streets. So, it is both a health care issue for 

them and a cost factor for us to give them the excellence that VA 

provides. 

Senator SANDERS. But you would argue that at a time of great 

concern about health care costs, you are running a cost-effective operation? 

Secretary SHINSEKI. We are. 

Senator SANDERS. Madam Chair, thank you. 

Chairman MURRAY. Thank you. 

Let me follow up on the issue of homelessness. It is one near and 

dear to my heart. I notice that the House continuing resolution 

would end the expansion of the HUD-VASH program, and I wanted 

to ask you today how many eligible veterans do you have on the 

waiting list to participate in that program? 

Secretary SHINSEKI. Dr. Petzel. 

Dr. PETZEL. Just to review the HUD-VASH situation right now, 

in 2008 we received 10,000 vouchers. We received 10,000 vouchers 

in 2009 and 10,000 vouchers in 2010. To date, we have assigned 

29,000 of those vouchers. They have actually been acted on by 

HUD in 22,000 cases. 

I am not aware at the present time of a waiting list for HUDVASH vouchers. That does not mean there is not one. I just am not 

aware of it. 

Chairman MURRAY. If you could check for me and find out. 

Dr. PETZEL. We will. 

400 

Chairman MURRAY. I would really appreciate that. 

Dr. PETZEL. Yes, Madam Chairman. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. PATTY MURRAY TO

HON. ROBERT A. PETZEL, M.D., UNDER SECRETARY FOR HEALTH, U.S. DEPARTMENT OF VETERANS AFFAIRS

According to VA officials, there is no master HUD-VASH List. Facilities are allowed to locally keep a list of veterans who might be eligible, but not all facilities 

keep these lists, and an overall list or count is not tracked nationally. 

Chairman MURRAY. And the budgetary implications if the government does not continue running. I just heard the Secretary say 

that caring for a homeless veteran costs three and one-half times 

that of one that we have in the system, and the budgetary implications of that too. If you could get that back to me, I would appreciate it. 

Chairman MURRAY. I want to ask about women veterans. We 

have talked about it a number of times. I wanted to ask what 

funds in this budget are directed toward expanding operating hours 

in women’s clinics to make sure that women get the care they need. 

Secretary SHINSEKI. Let me comment, Madam Chairman, and I 

will turn to Dr. Petzel for specifics. 

In the 2012 budget, we intend to spend $270 million on gender 

specific care. It is more than a 25 percent increase over previous 

budgets. 

We have also dedicated $12 million to specific women’s issues research. To this point in 2011, we have invested $29 million in clinical enhancements and another $21 million in facility improvements. Those are things that will occur this year in preparation for 

these other budget data for 2012 that I have provided to you. 

Dr. PETZEL. Thank you, Mr. Secretary. 

Senator Murray, I cannot specifically identify money that is in 

the budget directed at enhancing the hours for women veterans. 

We do have a program in a general sense of enhancing the available hours for clinics, primary care, specialty clinics, et cetera, including the women’s clinics. But I will go back and look to see if 

we can break this out, but I could not do that for you now. 

Secretary SHINSEKI. Let me just add, we do not have a specific 

answer here. This is trying to build for the 2012 numbers, but we 

have initiatives under way in which we are studying how to extend 

operating hours to include evenings and Saturdays for female veterans, especially if they bring children with them. 

Chairman MURRAY. To that point, what is the status of the 

childcare project—the pilot program that we put in? 

Secretary SHINSEKI. Dr. Petzel. 

Dr. PETZEL. That was part of the caregiver legislation. We are 

creating a request for proposals and hopefully are going to have pilots out there by the summer so that we can quickly see what the 

implications might be for the entire system. 

Chairman MURRAY. That is really a huge barrier for women veterans today. 

Dr. PETZEL. We absolutely agree with you. It is a barrier for 

male veterans in many cases as well. 

Chairman MURRAY. That is true. 

401 

Senator Burr, do you have any additional questions? 

Senator BURR. No additional questions. 

Chairman MURRAY. OK. I have a number of other questions I 

will submit for the record. But before I let you go, Mr. Secretary, 

I did want to ask you, on January 5th, President Obama nominated Allison Hickey to be Under Secretary of Benefits and Steve 

Muro to be Under Secretary of Memorial Affairs. 

We, in this Committee, do not yet have the questionnaire from 

Mr. Muro or the other documents we need from these nominees in 

order to proceed. 

When can this Committee expect those documents? 

Secretary SHINSEKI. Madam Chairman, it is a priority with me. 

I have been working on this for over year. I will get you the documents. I was not aware there was a hold up. I will get the documents you need. 

Chairman MURRAY. OK. I appreciate that very much. 

I thank you very much for your testimony. I look forward to 

working with you on this budget, and as Senator Burr and I both 

have talked to you specifically about, the caregivers’ issue, which 

is not going to go away. This is something we feel very strongly 

about. Thank you. 

If the second panel could move forward to the table. While they 

are coming up, I am going to go ahead and introduce them in order 

to expedite the time. 

We have a number of witnesses who are here to speak on behalf 

of The Independent Budget. 

It will be Carl Blake, National Legislative Director of the Paralyzed Veterans of America; Joe Violante, the National Legislative 

Director for the Disabled American Veterans; Christina Roof, National Acting Legislative Director of AMVETS; and Ray Kelley, National Legislative Director for Veterans of Foreign Wars. 

I also want to welcome to our table Tim Tetz, Director for the 

National Legislative Commission of The American Legion, and Dr. 

Maryann Hooker, Lead Neurologist at the Wilmington, Delaware, 

VA Medical Center, representing the American Federation of Government Employees. 

Beginning with Mr. Blake, we will move down the table in order. 

The Independent Budget witnesses will have 20 minutes total to 

make their presentation. The American Legion and AFGE will each 

be recognized for 5 minutes. 

I want to remind all of you that your prepared remarks will be 

made part of the record, and thank you all for joining us today. 

Mr. Blake, we will begin with you. 

STATEMENT OF CARL BLAKE, NATIONAL LEGISLATIVE 

DIRECTOR, PARALYZED VETERANS OF AMERICA 

Mr. BLAKE. Madam Chairman, Ranking Member Burr, and Members of the Committee, on behalf of the co-authors of The Independent Budget, the Paralyzed Veterans of America is pleased to 

be here today to present the views of The Independent Budget for 

the Department of Veterans Affairs on the fiscal year 2012 health 

care budget. 

Before I begin, I would just like to take the opportunity to thank 

the majority and minority staffs of the Committee for allowing the 

402 

IB to sit down with them in advance of the President’s Budget actually being released to discuss the budget recommendations that 

The Independent Budget ultimately provided on February 14 and 

15. 

As you know, last year the Administration recommended an ad- vance appropriation for fiscal year 2012 of approximately $50.6 billion in discretionary funding for VA medical care. The House supported this recommendation in H.R. 1 as well. When combined with the $3.7 billion for medical care collections 

previously projected by the Administration, the total available operating budget recommended for 2012 is approximately $54.3 billion. 

However, included in the President’s budget request for fiscal 

year 2012, the Administration revised the estimates for medical 

care down by $713 million due to the proposed Federal pay freeze, 

a factor that was not included in H.R. 1. 

However, The Independent Budget did choose to mirror the zero 

pay raises for fiscal year 2012 in our recommendations across all 

of the accounts of the VA. 

I would like to say the IB appreciates the increases that the Administration has recommended for fiscal year 2012 in its medical 

care budget request. However, we do have some real concerns with 

the methods that the Administration uses to get to those projected 

increases. 

Of particular concern to The Independent Budget is an ill-defined 

contingency fund that would provide $953 million more for medical 

services for fiscal year 2012. Moreover, we are especially concerned 

that the VA presumes ‘‘management improvements’’, a gimmick 

that was commonly used by previous administrations under the 

term ‘‘management efficiencies’’ of approximately $1.1 billion to be 

directed toward fiscal year 2012 and fiscal year 2013. 

The VA has explained that these management improvements provide $1.1 billion that the VA would like to carryover, and yet 

if the VA is not authorized to carryover this additional money, its 

Fiscal Year 2012 Budget request and 2013 advance appropriations 

request will be insufficient to meet the health care demand of veterans it serves. 

Finally, we have real concerns about the revised estimates in 

medical care collections from the originally projected amount as 

also mirrored in the advance appropriations language, $3.7 billion. 

So now what is projected is only $3.1 billion for fiscal year 2012. 

Given this revision in estimates, the VA budget request may arguably be short $600 million in additional budget authority for next 

year. 

For fiscal year 2012, the Administration recommends $53.9 billion for total medical care spending. The Independent Budget recommends approximately $55 billion for total medical care. This includes approximately $43.8 billion for medical services. 

Our medical services recommendation includes $41.3 billion for 

current services, $1.5 billion for the increase in patient workload, 

and $1 billion for additional medical care program costs. 

Each of these areas is explained in more detail in my full written 

statement and even greater detail in The Independent Budget for 

Fiscal Year 2012. 

403 

For medical support and compliance, The Independent Budget 

recommends approximately $5.4 billion, and finally, for medical facilities the IB recommends approximately $5.9 billion. While our 

recommendation does not include an additional increase for non-recurring maintenance above current services levels, it does reflect a 

fiscal year 2012 baseline of approximately $1.1 billion, and I would 

point out that the Administration’s non-recurring maintenance request is approximately $850 million, up from fiscal year 2012. 

We are also concerned about the steep reduction in spending for 

medical and prosthetic research. The Independent Budget recommends $620 million, approximately $111 million more than the 

Administration’s request. As you know, research is a vital part of 

veterans’ health care and an essential mission of the national 

health care system. 

The Independent Budget is pleased to see that the Administration has proposed an increase in the medical care accounts for fiscal year 2013. However, we urge Congress, and this Committee in 

particular, to remain vigilant to ensure that the proposed funding 

levels for fiscal year 2013 are, in fact, sufficient to meet the continued growth in demand on the VA health care system. 

Madam Chairman, that concludes my statement. I will be happy 

to answer any questions. 

[The prepared statement of Mr. Blake follows:] 

PREPARED STATEMENT OF CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR, 

PARALYZED VETERANS OF AMERICA, CONCERNING THE INDEPENDENT BUDGET

Chairman Murray, Ranking Member Burr, and Members of the Committee: As 

one of the four co-authors of The Independent Budget (IB), Paralyzed Veterans of 

America (PVA) is pleased to present the views of The Independent Budget regarding 

the funding requirements for the Department of Veterans Affairs (VA) health care 

system for FY 2012. 

With the newly elected 112th Congress just beginning to conduct business, it is 

important to once again review and assess the efforts of the 111th Congress to provide sufficient, timely, and predictable funding for the Department of Veterans Affairs (VA), particularly the VA health-care system. The first session of the 111th 

Congress laid the groundwork for a historic year in 2010. In 2009 the President 

signed Public Law 111–81, the ‘‘Veterans Health Care Budget Reform and Transparency Act,’’ which required the President’s budget submission to include estimates 

of appropriations for the Medical Care accounts for fiscal year (FY) 2012 and thereafter (advance appropriations) and the VA Secretary to provide detailed estimates 

of the funds necessary for these accounts in budget documents submitted to Congress. Consistent with advocacy by The Independent Budget, the law also required 

a thorough analysis and public report by the Government Accountability Office 

(GAO) of the Administration’s advance appropriations projections to determine 

whether that information is sound and accurately reflects expected demand and 

costs to be incurred in FY 2012 and subsequent years. 

The Independent Budget veterans service organizations (IBVSOs) were pleased to 

see that in February 2010 the Administration released a detailed estimation of its 

FY 2011 funding needs as well as a blueprint for the advance funding needed for 

the Medical Care accounts of VA for FY 2012. It is important to note that last year 

was the first year that the budget documents included advance appropriations estimates. Unfortunately, due to differences in interpretation of the language of Public 

Law 111–81, the GAO did not provide an examination of the budget submission to 

analyze its consistency with VA’s Enrollee Health Care Projection Model. The Independent Budget was informed that the GAO was not obligated to report on the advance appropriations projections of VA until at least 2011. The IBVSOs look forward 

to working with Congress to ensure that the GAO fulfills its responsibility this year. 

For FY 2011, Congress provided historic funding levels for VA in the House and 

Senate versions of the Military Construction and Veterans Affairs appropriations 

bill that matched, and in some cases exceeded, the recommendations of The Independent Budget. Unfortunately, as has become the disappointing and recurring procVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00409 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
404 

ess, the Military Construction and Veterans Affairs appropriations bill was not completed even as the new fiscal year began October 1, 2010. Although the House 

passed the bill in the summer, the Senate failed to enact the bill in a timely manner. This fact serves as a continuing reminder that, despite excellent funding levels 

provided over the past few years, the larger appropriations process continues to 

break down over matters unrelated to VA’s budget due to partisan political gridlock. 

Fortunately, this year, the enactment of advance appropriations has temporarily 

shielded the VA health-care system from this political wrangling and legislative 

deadlock. However, the larger VA system is still negatively affected by the incomplete appropriations work. VA still faces the daunting task of meeting ever-increasing health-care demand as well as demand for benefits and other services. 

In February 2010, the President released a preliminary budget submission for VA 

for FY 2011. The Administration recommended an overall funding authority of $60.3 

billion for VA, approximately $4.3 billion above the FY 2010 appropriated level but 

approximately $1.2 billion less than The Independent Budget recommended. The Administration’s recommendation included approximately $51.5 billion in total medical 

care funding for FY 2011. This amount included $48.1 billion in appropriated funding and nearly $3.4 billion in medical care collections. The budget also included 

$590 million in funding for Medical and Prosthetic Research, an increase of $9 million over the FY 2010 appropriated level. 

For FY 2011, The Independent Budget recommended that the Administration and 

Congress provide $61.5 billion to VA, an increase of $5.5 billion above the FY 2010 

operating budget level, to adequately meet veterans’ health-care and benefits needs. 

Our recommendations included $52 billion for health care and $700 million for medical and prosthetic research. 

The Administration also included an initial estimate for the VA health-care accounts for FY 2012. Specifically, the budget request calls for $54.3 billion in total 

budget authority, with $50.6 billion in discretionary funding and approximately $3.7 

billion for medical care collections. Unfortunately, because work on the FY 2011 appropriations bill was not completed, advance appropriations funding for FY 2012 remains in limbo. 

Moreover, recent actions by VA suggest that the FY 2011 advance appropriations 

funding levels (which were affirmed in the President’s budget request) may not be 

sufficient to support the health-care programs managed by VA. In a letter sent to 

Congress on July 30, 2010, VA Secretary Eric Shinseki explained that he believes 

the advance appropriations levels provided for FY 2011—that virtually match the 

Administration’s request for FY 2011—will be insufficient to meet the health-care 

demand that VA will face this year. He also emphasized that the passage of Public 

Law 111–163, the ‘‘Caregivers and Veterans Omnibus Health Services Act,’’ and 

Public Law 111–148, the ‘‘Patient Protection and Affordable Care Act,’’ will increase 

workloads for VA. Unfortunately, the House version of the FY 2011 Military Construction and Veterans Affairs appropriations bill did not fully address this projected current year demand. Likewise, the Senate version of the appropriations bill 

is apparently insufficient to meet the new demand the Secretary projects. 

While we appreciate the funding levels that are provided by the appropriations 

bills, we believe that the Secretary’s letter sends a clear message that, absent some 

unclear ‘‘management action’’ by VA, more funding will be needed for FY 2011 for 

VA Medical Care accounts. We hope that as the House and Senate finally complete 

work on the FY 2011 Military Construction and Veterans’ Affairs appropriations 

bill, proper consideration must be given to this concern. 

FUNDING FOR FY 2012

Last year the Administration recommended an advance appropriation for FY 2012 

of approximately $50.6 billion in discretionary funding for VA medical care. The 

House Committee on Appropriations supported this recommendation in H.R. 1 as 

well. When combined with the $3.7 billion Administration projection for medical 

care collections, the total available operating budget recommended for FY 2012 is 

approximately $54.3 billion. However, included in the President’s Budget Request 

for FY 2012, the Administration revised the estimates for Medical Care down by 

$713 million due to the proposed Federal pay freeze (a factor not included in 

H.R. 1). 

The Independent Budget appreciates the increases that the Administration has 

recommended for FY 2012 in its Medical Care budget request. However, we have 

some real concerns with the methods that the Administration uses to get to those 

projected increases. Of particular concern to The Independent Budget is an ill-defined contingency fund that would provide $953 million more for Medical Services 

for FY 2012. Moreover, we are especially concerned that the VA presumes ‘‘manageVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00410 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
405 

ment improvements’’ of approximately $1.1 billion to be directed toward FY 2012 

and FY 2013. The use of management improvements or efficiencies was a gimmick 

commonly used in the past to reduce the requested level of discretionary funding; 

and yet, rarely did the VA realize any actual savings from those gimmicks. Additionally, we are concerned that the VA does not clearly define the relationship between the contingency fund and the ‘‘management improvements’’ that it proposes. 

Finally, we are concerned about the revised estimate in Medical Care Collections 

from the originally projected $3.7 billion (included in last year’s advance appropriations recommendation and supported by Congress) to now only $3.1 billion. Given 

this revision in estimates, the VA budget request may arguably be short at least 

$600 million in budget authority for next year simply based on the revised collection 

estimate. 

For FY 2012, the Administration recommends $53.9 billion for total Medical Care 

spending. The Independent Budget recommends approximately $55.0 billion for total 

medical care, an increase of $3.4 billion over the FY 2011 operating budget level 

currently proposed in H.R. 1, the ‘‘Continuing Resolution for FY 2011.’’ The medical 

care appropriation includes three separate accounts—Medical Services, Medical 

Support and Compliance, and Medical Facilities—that comprise the total VA health 

care funding level. For FY 2012, The Independent Budget recommends approximately $43.8 billion for Medical Services. Our Medical Services recommendation includes the following recommendations: 

Current Services Estimate ............................................................. $41,274,505,000 

Increase in Patient Workload ........................................................ 1,495,631,000 

Additional Medical Care Program Costs ...................................... 1,010,000,000 

Total FY 2012 Medical Services ............................................. $43,780,136,000 

Our growth in patient workload is based on a projected increase of approximately 

126,000 new unique patients—Priority Group 1–8 veterans and covered non-veterans. We estimate the cost of these new unique patients to be approximately $1.0 

billion. The increase in patient workload also includes a projected increase of 87,500 

new Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans 

at a cost of approximately $306 million. 

Finally, our increase in workload includes the projected enrollment of new Priority 

Group 8 veterans who will use the VA health care system as a result of the Administration’s continued efforts to incrementally increase the enrollment of Priority 

Group 8 veterans by 500,000 enrollments by FY 2013. We estimate that as a result 

of this policy decision, the number of new Priority Group 8 veterans who will enroll 

in the VA should increase by 125,000 between FY 2010 and FY 2013. Based on the 

Priority Group 8 empirical utilization rate of 25 percent, we estimate that approximately 31,250 of these new enrollees will become users of the system. This translates to a cost of approximately $148 million. 

Last, The Independent Budget believes that there are additional projected funding 

needs for the VA. Specifically, we believe there is real funding needed to restore the 

VA’s long-term care capacity (for which a reasonable cost estimate can be determined based on the actual capacity shortfall of the VA), to provide additional centralized prosthetics funding (based on actual expenditures and projections from the 

VA’s prosthetics service), and to meet the new projected demand associated with the 

provisions of Public Law 111–163, the ‘‘Caregivers and Veterans Omnibus Health 

Services Act.’’ In order to restore the VA’s long-term care average daily census 

(ADC) to the level mandated by Public Law 106–117, the ‘‘Veterans Millennium 

Health Care Act,’’ we recommend $375 million. In order to meet the increase in demand for prosthetics, the IB recommends an additional $250 million. This increase 

in prosthetics funding reflects the significant increase in expenditures from FY 2010 

to FY 2011 (explained in the section on Centralized Prosthetics Funding) and the 

expected continued growth in expenditures for FY 2012. 

Finally, we believe that there will be a significant funding need in order for the 

VA to address the provisions of Public Law 111–163, specifically as it relates to the 

caregiver provisions of the law. During consideration of the legislation, the costs 

were estimated to be approximately $1.6 billion between FY 2010 and FY 2015. This 

included approximately $60 million identified for FY 2010 and approximately $1.54 

billion between FY 2011 and FY 2015. However, no funding was provided in FY 

2011 to address this need. As a result, the VA will have an even greater need for 

funding to support Public Law 111–163 between FY 2012 and FY 2015 in order to 

fully implement these provisions. While the Administration claims to have provided 

an additional $208 million for implementation of Public Law 111–163, we remain 

concerned about the lack of action by the VA thus far to actually implement the 

406 

law. Moreover, it is not clear where that additional funding is included in the FY 

2012 Medical Care budget request. With this in mind, The Independent Budget recommends approximately $385 million to fund the provisions of Public Law 111–163 

in FY 2012. 

For Medical Support and Compliance, The Independent Budget recommends approximately $5.4 billion, approximately $50 million above the FY 2011 appropriated 

level. Finally, for Medical Facilities, The Independent Budget recommends approximately $5.9 billion, approximately $160 million above the FY 2011 appropriated 

level. While our recommendation does not include an additional increase for nonrecurring maintenance (NRM), it does reflect a FY 2012 baseline of approximately 

$1.1 billion. While we appreciate the significant increases in the NRM baseline over 

the last couple of years, total NRM funding still lags behind the recommended two 

to four percent of plant replacement value. In fact, the VA should actually be receiving at least $1.7 billion annually for NRM (Refer to Construction section article ‘‘Increase Spending on Nonrecurring Maintenance). 

For Medical and Prosthetic Research, The Independent Budget recommends $620 

million. This represents a $39 million increase over the FY 2011 appropriated level. 

We are particularly pleased that Congress has recognized the critical need for funding in the Medical and Prosthetic Research account in the last couple of years. Research is a vital part of veterans’ health care, and an essential mission for our national health care system. 

ADVANCE APPROPRIATIONS FOR FY 2013

As explained previously, Public Law 111–81 required the President’s budget submission to include estimates of appropriations for the medical care accounts for FY 

2012 and subsequent fiscal years. With this in mind, the VA Secretary is required 

to update the advance appropriations projections for the upcoming fiscal year (FY 

2012) and provide detailed estimates of the funds necessary for the medical care accounts for FY 2013. Moreover, the law also requires a thorough analysis and public 

report of the Administration’s advance appropriations projections by the Government Accountability Office (GAO) to determine if that information is sound and accurately reflects expected demand and costs. 

The Independent Budget is pleased to see that the Administration has proposed 

an increase in the Medical Care accounts for FY 2013. We simply urge Congress 

to remain vigilant to ensure that the proposed funding levels for FY 2013 are in 

fact sufficient to meet the continued growth in demand on the health care system. 

Moreover, it is important to note that this is the first year that the GAO will examine the budget submission to analyze its consistency with VA’s Enrollee Health Care 

Projection Model. The Independent Budget looks forward to examining all of this 

new information and incorporating it into future budget estimates. 

In the end, it is easy to forget, that the people who are ultimately affected by 

wrangling over the budget are the men and women who have served and sacrificed 

so much for this Nation. We hope that you will consider these men and women 

when you develop your budget views and estimates, and we ask that you join us 

in adopting the recommendations of The Independent Budget. 

This concludes my testimony. I will be happy to answer any questions you may 

have. 

Chairman MURRAY. Thank you very much. 

Mr. Violante. 

STATEMENT OF JOSEPH A. VIOLANTE, NATIONAL 

LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS 

Mr. VIOLANTE. Thank you, Madam Chairman. 

On behalf of the Disabled American Veterans, I am here today 

to present the recommendations of The Independent Budget for the 

Fiscal Year 2012 in the area of veterans’ benefits. 

First, however, I want to congratulate you, Chairman Murray, on 

your selection to lead this great Committee. I also want to welcome 

back Ranking Minority Member Burr. The DAV looks forward to 

working together with both of you and all Members of the Committee and your staff to improve the lives of our Nation’s veterans, 

particularly disabled veterans, their families, and survivors. 

407 

I also want to extend a special ‘‘Aloha’’ to former Chairman 

Akaka. His leadership over the past 4 years contributed to historic 

achievements for veterans. 

Madam Chairman, for fiscal year 2012, The Independent Budget 

recommends only modest increases in personnel levels for the Veterans Benefits Administration, and those increases are targeted 

primarily at Vocational Rehabilitation and Employment Service 

and the Board of Veterans Appeals. 

The voc rehab program is one of the most important benefits provided to disabled veterans. However, a 2009 study by the Government Accountability Office found that 54 percent of Veterans Affairs Regional Offices reported they had fewer voc rehab counselors 

than needed. The current caseload target is one counselor for every 

125 veterans, but that ratio is reported to be as high as 1 to 160. 

Therefore, the IB supports an increase of 100 new counselors and 

an additional 50 FTEE dedicated to management and oversight of 

the growing number of contract counselors and service providers. 

The Board of Veterans Appeals workload has consistently averaged about 5 percent of the total number of claims before VBA. So 

as claims rise, so too do the number of appeals. To meet that new 

demand and to avoid creating an even larger backlog of appeals, 

the IB recommends funding increases for the Board that are commensurate with the increased workload. 

Madam Chairman, the IB once again calls on Congress to completely end the ban on concurrent receipt for all disabled veterans 

and eliminates the SBP/DIC offset for veterans, widows, and dependents. 

Madam Chairman, VA is at a critical junction in its efforts to reform an outdated, inefficient, and overwhelmed claims processing 

system. Secretary Shinseki has made clear his intention to, ‘‘break 

the back of the backlog,’’ as a top priority; and while we welcome 

this goal, we would caution that eliminating that backlog is not 

necessarily the same as reforming the claims process system. 

To achieve real and lasting success, the VA must focus on creating a veteran’s benefits claims processing system designed to decide each claim right the first time. 

Undoubtedly, the most important new initiative underway is the 

Veteran’s Benefits Management System, VBMS, their new IT program being designed to provide a paperless and rules-based method 

of processing and awarding claims. 

We would urge Congress to carefully monitor and oversee this 

work and recommend considering an independent outside expert 

review of the VBMS. 

However, regardless of the IT solutions, VBA must ensure that 

they have a properly trained workforce and a comprehensive quality control system. 

That concludes my statement. I will be happy to answer any 

questions the Committee may have. 

[The prepared statement of Mr. Violante follows:] 

PREPARED STATEMENT OF JOSEPH A. VIOLANTE, NATIONAL LEGISLATIVE DIRECTOR, 

DISABLED AMERICAN VETERANS, ON BEHALF OF THE INDEPENDENT BUDGET

Chairman Murray, Ranking Member Burr and Members of the Committee: On behalf of the Disabled American Veterans and our 1.2 million members, all of whom 

are wartime disabled veterans, I am pleased to be here today to present the recomVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00413 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
408 

mendations of The Independent Budget for the fiscal year 2012 budget in the area 

of veterans’ benefits. As you know, The Independent Budget is a collaboration 

amongst the DAV, AMVETS, Paralyzed Veterans of America and Veterans of Foreign Wars. 

First, however, I want to congratulate you, Chairman Murray, on your selection 

to lead this great Committee. I also want to welcome back the Committee’s Ranking 

Minority Member, Richard Burr. The DAV looks forward to working together with 

both of you, as well as all of the returning and new Members of the Committee, 

to improve the lives of our Nation’s veterans, particularly disabled veterans, their 

families and survivors. 

I also want to extend a special ‘‘Aloha’’ to former Chairman Akaka. Your leadership over the past four years contributed to historic achievements for veterans, including enactment of the Veterans Health Care Budget Reform and Transparency 

Act of 2009 and the Caregiver and Veterans Omnibus Health Services Act of 2010. 

For the past 25 years, The Independent Budget has provided Congress and the 

Administration with budget and policy recommendations to strengthen programs 

serving America’s veterans. I note with appreciation that Public Law 111–275, the 

Veterans Benefits Act of 2010, which was enacted in the last Congress, contained 

a number of provisions addressing recommendations made to this Committee by The 

Independent Budget. In particular, the new law includes an increase in the automobile grant from $11,000 to $18,900; an expansion of eligibility for Aid and Attendance benefits for veterans suffering from Traumatic Brain Injury; an increase in 

Supplemental Service-Disabled Veterans’ Insurance (SDVI or ‘‘RH’’) from $20,000 to 

$30,000; and an increase in Veterans Mortgage Life Insurance (VMLI) for disabled 

veterans from $90,000 to $150,000 effective October 1, 2011, with a 2012 increase 

to $200,000. Each of these and many other provisions in this new law will make 

a real difference in the lives of thousands of disabled veterans and their families 

and we thank this Committee for helping to enact this legislation. 

SUFFICIENT STAFFING FOR THE VETERANS BENEFITS ADMINISTRATION

Madame Chairman, for fiscal year 2012, The Independent Budget recommends 

only modest increases in personnel levels for the Veterans Benefits Administration 

(VBA), and those increases are targeted at Vocational Rehabilitation and Employment (VR&E) and the Board of Veterans Appeals (BVA). Over the past couple of 

years, with strong support from Congress, VBA’s Compensation and Pension (C&P) 

Service has seen a significant increase in personnel to address the rapidly rising 

workload they face. It is important to note that this large increase in claims processors could actually result in a short-term net decrease in productivity, due to experienced personnel being taken out of production to conduct training, and the 

length of time it takes for new employees to become fully productive. While we do 

not recommend additional staffing increases at this time, we do recommend that 

VBA conduct a study on how to determine the proper number of full-time employees 

necessary to manage its growing claims inventory so that claims are decided accurately and in a timely manner. 

The Independent Budget does, however, recommend that Congress authorize at 

least 160 additional full-time employees for the VR&E Service for fiscal year (FY) 

2012, primarily to reduce current case manager workload. A 2009 study by the Government Accountability Office (GAO) found that 54 percent of Department of Veterans Affairs Regional Offices (VAROs) reported they had fewer counselors than 

they needed and 40 percent said they had too few employment coordinators. VR&E 

officials indicated that the current caseload target is 1 counselor for every 125 veterans, but that ratio is reported to be as high as 1 to 160 in the field. An increase 

of 100 new counselors would address that gap. Given its increased reliance on contract services, VR&E also needs an additional 50 full-time employee equivalents 

(FTEE) dedicated to management and oversight of contract counselors and rehabilitation and employment service providers. In addition, VR&E has requested at least 

10 FTEE in FY 2012 to expand its college program—‘‘Veteran Success on Campus,’’ 

and we support that request. 

With the number of claims for benefits increasing over the past several years, so 

too is the number of appeals to the BVA. On average, BVA receives appeals on 5 

percent of all claims, a rate that has been consistent over the past decade. With the 

number of claims projected to rise significantly in the coming years, so too will the 

workload at BVA, and thus the need for additional personnel. Funding for the BVA 

must rise at a rate commensurate with its increasing workload so it is properly 

staffed to decide veterans’ appeals in an accurate and timely manner. 

409 

CLAIMS PROCESSING REFORM: GET IT RIGHT THE FIRST TIME

The VBA is at a critical juncture in its efforts to reform an outdated, inefficient, 

and overwhelmed claims-processing system. After struggling for decades to provide 

timely and accurate decisions on claims for veterans’ benefits, the VBA over the past 

year has started down a path that may finally lead to essential transformation and 

modernization, but only if it has the leadership necessary to undergo a cultural shift 

in how it approaches the work of adjudicating claims for veterans benefits. 

The number of new claims for disability compensation has risen to more than 1 

million per year and the complexity of claims have also increased as complicated 

new medical conditions, such as Traumatic Brain Injury, have become more prevalent. To meet rising workload demands, The Independent Budget has recommended, 

and Congress has provided, significant new resources to the VBA over the past several years in order to increase their personnel levels. Yet despite the hiring of thousands of new employees, the number of pending claims for benefits, often referred 

to as the backlog, continues to grow. 

As of January 31, 2011, there were 775,552 pending claims for disability compensation and pensions awaiting rating decisions by the VBA, an increase of 

289,081 from one year ago. About 41 percent of that increase is the result of the 

Secretary’s decision to add three new presumptive conditions for Agent Orange (AO) 

exposure: ischemic heart disease, B-cell leukemia, and Parkinson’s disease. Even 

discounting those new AO-related claims, the number of claims pending rose by 

171,522, a 37 percent increase of pending claims over just the past year. Overall, 

there are 331,299 claims that have been pending greater than VA’s target of 125 

days, which is an increase of 147,930, up more than 80 percent in the past year. 

Not counting the new AO-related, over 50 percent of all pending claims for compensation or pension are now past the 125-day target set by the VBA. 

Worse, by the VBA’s own measurement, the accuracy of disability compensation 

rating decisions continues to trend downward, with their quality assurance program, known as the Systematic Technical Accuracy Review (STAR) reporting only 

an 83 percent accuracy rate for the 12-month period ending May 31, 2010. Moreover, 

VA’s Office of Inspector General found additional undetected or unreported errors 

that increased the error rate to 22 percent. Complicating the Department’s problems 

is its reliance on an outdated, paper-centric processing system, which now includes 

more than 4.2 million claims folders. 

Faced with all of these problems, VA Secretary Shinseki last year set an extremely ambitious long-term goal of zero claims pending more than 125 days and 

all claims completed to a 98 percent accuracy standard. Throughout the year he repeatedly made clear his intention to ‘‘break the back of the backlog’’ as his top priority. While we welcome his intention and applaud his ambition, we would caution 

that eliminating the backlog is not necessarily the same goal as reforming the 

claims-processing system, nor does it guarantee that veterans are better served. 

The backlog is not the problem, nor even the cause of the problem; rather, it is 

only one symptom, albeit a very severe one, of a much larger problem: too many 

veterans waiting too long to get decisions on claims for benefits that are too often 

wrong. If the VBA focuses simply on getting the backlog number down, it can certainly achieve numeric success in the near term, but it will not necessarily have addressed the underlying problems nor taken steps to prevent the backlog from eventually returning. To achieve real success, the VBA must focus on creating a veterans’ benefits claims-processing system designed to ‘‘get each claim done right the 

first time.’’ Such a system would be based upon a modern, paperless information 

technology and workflow system focused on quality, accuracy, efficiency, and 

accountability. 

Recognizing all of the problems and challenges discussed above, we have seen 

some positive and hopeful signs of change. VBA leadership has been refreshingly 

open and candid in recent statements on the problems and need for reform. Over 

the past year, dozens of new pilots and initiatives have been launched, including 

a major new IT system that is now being field-tested. The VBA has shared information with the veterans service organizations (VSOs) about its ongoing initiatives and 

sought feedback on these initiatives. These are all positive developments. 

Yet despite the new openness and outreach to the VSO community, we remain 

concerned about VBA’s failure to fully integrate service organizations in reforming 

the claims process. VSOs not only bring vast experience and expertise about claims 

processing, but our local and national service officers hold power of attorney for 

hundreds of thousands of veterans and their families. In this capacity, VSOs are an 

integral component of the claims process. We make the VBA’s job easier by helping 

veterans prepare and submit better claims, thereby requiring less time and resources to develop and adjudicate them. VBA leadership must commit to a true 

410 

partnership with service organizations, and infuse this new attitude throughout the 

VBA from central office down to each of the 57 regional offices. 

Madame Chairman, the VBA must also change how it measures success and rewards performance in a manner designed to achieve the goal of ‘‘getting it right the 

first time.’’ Unfortunately, most of the measures that the VBA employs today, 

whether for the organization as a whole, or for regional offices or employees, are 

based primarily on measures of production, which reinforces the goal of ending the 

backlog. VBA must change how it measures and reports progress and success so 

that there are more and better indicators of quality and accuracy. VBA must also 

continue to review employee performance standards to ensure that it creates incentives and accountability to achieve quality and accuracy, not just increased speed 

or production. 

PILOT PROGRAMS

As the VBA moves forward with dozens of pilots and initiatives designed to modernize and streamline the claims-processing system, it is imperative that the VBA 

have a systematic method for analyzing and integrating ‘‘best practices’’ that improve quality and accuracy, rather than just those that may increase production. 

One of the most important new initiatives is the use of templates for medical evidence, which VBA calls Disability Benefits Questionnaires (DBQs). There are currently three DBQs that have been approved for use in claims for the three new presumptive conditions associated with Agent Orange exposure: ischemic heart disease, 

Parkinson’s disease, and B-cell leukemia. An additional 76 DBQs are in various 

stages of the development and approval process. We support the use of DBQs as a 

method to streamline and improve the quality and timeliness of decisions; however, 

it is crucial that DBQs are properly completed, either by VA or private medical examiners. VBA employees must be properly trained so they understand that DBQs 

are but one piece of evidence that must be considered in the development and 

decisionmaking process. VBA’s rating specialists must properly consider the evidentiary weight and value of all evidence related to the claim and address it adequately in the reason and bases of the subsequent decision. 

One of the major new claims process reform initiatives is the Fully Developed 

Claims (FDC) program, which began as a pilot program mandated by Public Law 

110–389, and was rolled out to all VAROs last year. We were pleased that VBA 

modified the FDC application process at our request so that a veteran could make 

an informal notification to the VBA of his or her intention to file a FDC claim, 

thereby protecting the earliest effective date for receipt of benefits. However, we 

have been hearing numerous reports from the field that local ROs are not allowing 

such informal claims to be made. We have also been told that the participation level 

of veterans in the FDC program remains low. We continue to believe in the FDC 

program and urge this Committee to work with us and VBA to address the obstacles 

to its success. 

In order to synthesize the ‘‘best practices’’ from all of the ongoing pilots, VBA recently started a new Integration Laboratory at their Indianapolis Regional Office. 

Given all of the pressure to ‘‘break the backlog’’ by increasing production, we have 

concerns about whether the VBA will successfully extract and then integrate the 

best practices from so many ongoing initiatives. Given the enormous pressure to reduce the backlog, we are concerned that there could be a tendency to focus on process improvements that result in greater production rather than those that lead to 

greater quality and accuracy. 

Congress must continue to provide aggressive oversight of the VBA’s myriad ongoing pilots and initiatives to ensure that practices adopted and integrated into a cohesive new claims process are judged first and foremost on their ability to help VA 

get claims ‘‘done right the first time.’’ 

TRAINING AND QUALITY CONTROL

Madame Chairman, two longstanding weaknesses of VBA’s claims adjudication 

process are training and quality control, which should be linked to create a single 

continuous improvement program, both for employees and for the claims process 

itself. Quality control programs can identify areas and subjects that require new or 

additional training for VBA employees and better training programs for employees 

and managers should improve the overall quality of the VBA’s work. 

VBA’s primary quality assurance program is the STAR program. The STAR program was last evaluated by the VA Office of Inspector General (OIG) in March 2009, 

with the OIG finding that STAR does not provide a complete assessment of rating 

accuracy. Although the STAR reviewers found that the national accuracy rate was 

about 87 percent, the OIG found additional errors and projected an overall accuracy 

411 

rate of only 78 percent. In addition to rectifying errors found by the OIG, we recommend that the VBA establish a true quality control program that looks at claims 

‘‘in-process’’ in order to determine not just whether a proper decision was made, but 

how it was arrived at in order to identify ways to improve the system. The data 

from all such reviews should be incorporated into the VBA’s new information technology systems being developed so that analysis can provide management and employees important insights into processes and decisions. This in turn would lead to 

quicker and more accurate decisions on benefits claims, and most important, the delivery of all earned benefits to veterans, particularly disabled veterans, in a timely 

manner. 

Training is essential to the professional development of an individual and tied directly to the quality of work they produce, as well as the quantity they can accurately produce. Veterans service organization officers have been told by many VBA 

employees that meeting production goals is the primary focus of management, 

whereas fulfilling training requirements and increasing quality is perceived as being 

secondary. An overemphasis on productivity must not interfere with the training of 

new employees who are still learning their job. 

The Government Accountability Office (GAO) recently conducted a study to determine the appropriateness of training for experienced claims processors and the adequacy of VBA’s monitoring and assessment of such training. Of particular interest 

are GAO findings that experienced claims processors’ had concerns with the training 

received—specifically the hours, amount, helpfulness, methods, and timing of training. Likewise, as the GAO report pointed out, there is very little done by the VBA 

to ensure the required training is completed or to assess the adequacy and consistency of the training, nor to properly ascertain the total number of employees who 

have met the annual training requirement. In fact, only one VARO met the annual 

training requirement and nine VAROs had less than half their employees meet the 

annual training requirement. It is simply unacceptable to have only one VARO 

meeting the most basic requirement of ensuring that all its employees complete 80 

hours of training. VBA must place greater emphasis on training by implementing 

stricter monitoring mechanisms for all VAROs and ensuring that they are held accountable for failure to meet this minimal standard. 

Madame Chairman, Public Law 110–389, the ‘‘Veterans’ Benefits Improvement 

Act of 2008,’’ required the VBA to develop and implement a certification examination for claims processors and managers; however, today there are still gaps in the 

implementation of these provisions. While tests have been developed and piloted for 

Veterans Service Representatives (VSRs) and Rating Veterans Service Representatives (RVSRs), additional tests need to be developed and deployed for Decision Review Officers and supervisory personnel. None of these certification tests are mandatory for all employees, nor are they done on a continuing basis. 

The VBA cannot accurately assess its training or measure an individual’s knowledge, understanding, or retention of the training material without regular testing. 

It is important, however, that all testing and certification be applied equally to employees and to the people who supervise and manage them. All VBA employees, 

coaches, and managers should undergo regular testing to measure job skills and 

knowledge, as well as the effectiveness of the training. 

Equally important, testing must properly assess the skills and knowledge required to perform the work of processing claims. Many employees report that the 

testing does not accurately measure how well they perform their jobs, and there 

have been reports that significant numbers of otherwise qualified employees are not 

able to pass the tests. VBA must ensure that certification tests are developed that 

accurately measure the skills and knowledge needed to perform the work of VSRs, 

RVSRs, decision review officers, coaches and other managers. 

Successful completion of training by all employees and managers must be an absolute requirement for every VARO and must be a shared responsibility of both employees and management. Managers must be held responsible for ensuring that 

training is offered and completed by all of their employees. However it is also the 

responsibility, as well as part of the performance standard, for employees to complete their training requirements. Managers must provide employees with the time 

to take training and employees must fully and faithfully complete their training as 

offered. Neither should be able or pressured to just ‘‘check the box’’ when it comes 

to training. 

NEW VBA INFORMATION TECHNOLOGY SYSTEMS

Madame Chairman, undoubtedly the most important new initiative underway at 

the VBA is the Veterans Benefits Management System (VBMS), which is designed 

to provide the VBA with a comprehensive, paperless, and ultimately rules-based 

412 

method of processing and awarding claims for VA benefits, particularly disability 

compensation and pension. Following initial design work, the VBMS had its first 

phase of development in Baltimore last year where a prototype system was tested 

in a virtual regional office environment. The first actual pilot of the VBMS was 

begun in November 2010 at the Providence, Rhode Island Regional Office. The sixmonth pilot program began with simulated claims and was scheduled to begin working on actual ‘‘live’’ claims early this year. A second six-month pilot is expected to 

begin in May 2011 at the Salt Lake City Regional Office, which will build on the 

work begun at Providence. A third pilot is scheduled to begin in November 2011 at 

an undesignated location, and the final national rollout of the VBMS is schedule to 

take place in 2012. 

Although the development and deployment of a modern information technology 

(IT) system to process claims in a paperless environment is long overdue, we have 

concerns about whether the VBMS is being rushed to meet self-imposed deadlines 

in order to show progress toward ‘‘breaking the back of the backlog.’’ While we have 

long believed that the VBA’s IT infrastructure was insufficient, outdated, and constantly falling further behind modern software, Web, and cloud-based technology 

standards, we would be equally concerned about a rushed solution that ultimately 

produces an insufficiently robust IT system. 

Given the highly technical nature of modern IT development, we would urge Congress to fully explore these issues with the VBA and suggest that it could be helpful 

to have an independent, outside, expert review of the VBMS while it is still early 

enough in the development phase to make course corrections, should they be necessary. 

To be successful, the VBMS must include the maximum level of rules-based decision support feasible at the earliest stages of development in order to build a system 

capable of providing accurate and timely decisions, as well as include real-time, 

quality control as a core component of the system. VBA must also commit to incorporating all veterans’ legacy paper files into the paperless environment of the VBMS 

within the minimum amount of time technically and practically feasible. 

DISABILITY COMPENSATION AND QUALITY OF LIFE

The Institute of Medicine (IOM) Committee on Medical Evaluation of Veterans for 

Disability Compensation published a report in 2007, ‘‘A 21st Century System for 

Evaluating Veterans for Disability Benefits,’’ recommending that the current VA 

disability compensation system be expanded to include compensation for nonwork 

disability (also referred to as ‘‘noneconomic loss) and loss of quality of life. Nonwork 

disability refers to limitations on the ability to engage in usual life activities other 

than work. This includes ability to engage in activities of daily living, such as bending, kneeling, or stooping, resulting from the impairment, and to participate in 

usual life activities, such as reading, learning, socializing, engaging in recreation, 

and maintaining family relationships. Loss of quality of life refers to the loss of 

physical, psychological, social, and economic well-being in one’s life. 

The IOM report stated that, ‘‘* * * Congress and VA have implicitly recognized 

consequences in addition to work disability of impairments suffered by veterans in 

the Rating Schedule and other ways. Modern concepts of disability include work disability, nonwork disability, and quality of life (QOL) * * *’’ The congressionallymandated Veterans Disability Benefits Commission (VDBC), established by the National Defense Authorization Act of 2004 (Public Law 108–136), spent more than 

two years examining how the rating schedule might be modernized and updated. 

Reflecting the recommendations of the IOM study, the VDBC in its final report 

issued in 2007 recommended that the, ‘‘* * * veterans disability compensation program should compensate for three consequences of service-connected injuries and 

diseases: work disability, loss of ability to engage in usual life activities other than 

work, and loss of quality of life.’’ 

The IOM Report, the VDBC (and an associated Center for Naval Analysis study) 

and the Dole-Shalala Commission (President’s Commission on Care for America’s 

Returning Wounded Warriors) all agreed that the current benefits system should be 

reformed to include noneconomic loss and quality of life as a factor in compensation. 

The Independent Budget recommends that Congress finally address this deficiency 

by amending title 38, United States Code, to clarify that disability compensation, 

in addition to providing compensation to service-connected disabled veterans for 

their average loss of earnings capacity, must also include compensation for their 

noneconomic loss and for loss of their quality of life. Congress and VA should then 

determine the most practical and equitable manner in which to provide compensation for noneconomic loss and loss of quality of life and then move expeditiously to 

implement this updated disability compensation program. 

413 

ELIMINATION OF CONCURRENT RECEIPT FOR ALL DISABLED VETERANS

Madame Chairman, many veterans retired from the Armed Forces based on longevity of service must forfeit a portion of their retired pay, earned through faithful 

performance of military service, before they receive VA compensation for serviceconnected disabilities. This is inequitable—military retired pay is earned by virtue 

of a veteran’s career of service on behalf of the Nation, careers of usually more than 

20 years. Entitlement to compensation, on the other hand, is paid solely because of 

disability resulting from military service, regardless of the length of service. 

A disabled veteran who does not retire from military service but elects instead 

to pursue a civilian career after completing a service obligation can receive full VA 

compensation and full civilian retired pay—including retirement from any Federal 

civil service. A veteran who honorably served and retired for 20 or more years and 

suffers from service-connected disabilities due to disability should have that same 

right. 

Congress should enact legislation to repeal the inequitable requirement that veterans’ military longevity retired pay be offset by an amount equal to their rightfully 

earned VA disability compensation if rated less than 50 percent. 

REPEAL OF OFFSET AGAINST SURVIVOR BENEFIT PLAN

When a disabled veteran dies of service-connected causes, or following a substantial period of total disability from service-connected causes, eligible survivors or dependents receive Dependency and Indemnity Compensation (DIC) from VA. This 

benefit indemnifies survivors, in part, for the losses associated with the veteran’s 

death from service-connected causes or after a period of time when the veteran was 

unable, because of total disability, to accumulate an estate for inheritance by survivors. 

Career members of the Armed Forces earn entitlement to retired pay after 20 or 

more years’ service. Unlike many retirement plans in the private sector, survivors 

have no entitlement to any portion of the member’s retired pay after his or her 

death. Under the Survivor Benefit Program (SBP), deductions are made from the 

member’s retired pay to purchase a survivors’ annuity. Upon the veteran’s death, 

the annuity is paid monthly to eligible beneficiaries under the plan. If the veteran 

died of other than service-connected causes or was not totally disabled by serviceconnected disability for the required time preceding death, beneficiaries receive full 

SBP payments. However, if the veteran’s death was a result of his or her military 

service or followed from the requisite period of total service-connected disability, the 

SBP annuity is reduced by an amount equal to the DIC payment. Where the monthly DIC rate is equal to or greater than the monthly SBP annuity, beneficiaries lose 

all entitlement to the SBP annuity. 

We strongly believe this offset is inequitable because no duplication of benefits is 

involved. Payments under the SBP and DIC programs are made for different purposes. Under the SBP, a dependent purchases coverage that would be paid in the 

event of the death of the servicemember. On the other hand, DIC is a special indemnity compensation paid to the survivor of a servicemember who dies while serving 

or a veteran who dies from service-connected disabilities. In such cases, VA indemnity compensation should be added to the SBP, not substituted for it. 

We note that surviving spouses of Federal civilian retirees who are veterans are 

eligible for dependency and indemnity compensation without losing any of their purchased Federal civilian survivor benefits. The offset penalizes survivors of military 

retired veterans whose deaths are under circumstances warranting indemnification 

from the government separate from the annuity funded by premiums paid by the 

veteran from his or her retired pay. Congress should repeal the offset between DIC 

and the SBP. 

In addition, Congress should lower the age required for survivors of veterans who 

died from service-connected disabilities who remarry to be eligible for restoration of 

dependency and indemnity compensation to conform with the requirements of other 

Federal programs. Current law permits the VA to reinstate DIC benefits to remarried survivors of veterans if the remarriage occurs at age 57 or older or if survivors 

who have already remarried apply for reinstatement of DIC at age 57. Although we 

appreciate the action Congress took to allow this restoration of rightful benefits, the 

current age threshold of 57 years is arbitrary. Remarried survivors of retirees of the 

Civil Service Retirement System, for example, obtain a similar benefit at age 55. 

We believe the survivors of veterans who died from service-connected disabilities 

should not be further penalized for remarriage and that equity with beneficiaries 

of other Federal programs should govern Congressional action for this deserving 

group. 

414 

VA SCHEDULE FOR RATING DISABILITIES

The amount of disability compensation paid to a service-connected disabled veteran is determined according to the VA Schedule for Rating Disabilities (VASRD), 

which is divided into 15 body systems with more than 700 diagnostic codes. In 2007, 

both the VDBC, as well as the IOM Committee on Medical Evaluation of Veterans 

for Disability Compensation in its report ‘‘A 21st Century System for Evaluating 

Veterans for Disability Benefits,’’ recommended that VA regularly update the 

VASRD to reflect the most up-to-date understanding of disabilities and how disabilities affect veterans’ earnings capacity. 

In line with these recommendations, the VBA is currently engaged in the process 

of updating the 15 body systems, beginning with mental disorders and the musculoskeletal system. Additionally, it has committed to regularly updating the entire VA 

Schedule for Rating Disabilities every five years. 

In January 2010, the VBA held a Mental Health Forum jointly with the Veterans 

Health Administration (VHA), which included a VSO panel. In August 2010, the 

VBA and VHA held a Musculoskeletal Forum, which also included a VSO panel. 

Just a few weeks ago, a series of four public forums were held in Scottsdale, Arizona 

over the course of two weeks on four additional body systems. The Arizona sessions 

in particular, were far removed from the public and offered little opportunity for 

most VSOs to observe, much less offer any input. 

While we are appreciative of such efforts, we are concerned that except for these 

initial public forums, VBA is not making any substantial efforts to include VSO 

input during the actual development of draft regulations for the updated rating 

schedule. Since the initial public meetings, the VBA has not indicated it has any 

plans to involve VSOs at any other stage of the rating schedule update process other 

than what is required once a draft rule is published, at which time they are required by law to open the proposed rule to all public comment. We strongly believe 

that the VBA would benefit from the collective and individual experience and expertise of VSOs and our service officers throughout the process of revising the rating 

schedule. In addition, since the VBA is committed to a continuing review and revision of the rating schedule, we believe it would be beneficial to conduct reviews of 

the revision process so that future body system rating schedule updates can benefit 

from ‘‘lessons learned’’ during prior body system updates. 

Madame Chairman and Members of the Committee, this concludes my statement 

and I would be happy to answer any questions you may have. 

Chairman MURRAY. Thank you very much. 

Ms. Roof. 

STATEMENT OF CHRISTINA M. ROOF, NATIONAL ACTING 

DEPUTY LEGISLATIVE DIRECTOR, AMVETS 

Ms. ROOF. Chairman Murray, Ranking Member Burr, and distinguished Members of the Committee, on behalf of AMVETS, I would 

like to thank you for inviting me and the other Independent Budget 

organization representatives to share with you our recommendations on the Department of Veterans’ Affairs Fiscal Year 2012 

Budget. We believe our recommendations will prove to be the most 

fiscally responsible way of ensuring the quality and integrity of the 

care and benefits our veterans community depend on and receive 

today. 

As a partner of The Independent Budget, AMVETS devotes a majority of our time to the concerns and matters of VA’s National 

Cemetery Administration, or NCA, and to VA entrepreneurship, as 

well as Federal procurement. Today I will briefly be speaking to 

these issues. 

The most important obligation of NCA is to honor the memory 

of America’s brave men and women who have served in the Armed 

Forces. 

As of late 2010, NCA maintained more than three million graves 

at 131 national cemeteries in 39 States and in Puerto Rico. 

415 

With the anticipated opening of several new national cemeteries, 

annual internments are projected to increase to approximately 

116,000 in 2013 and maintain at that level through 2015. 

The IB recommends a total operating budget of $275 million for 

NCA for fiscal year 2012. This is so that NCA may meet the increasing demands of interments, gravesite maintenance, and related essential elements of cemetery operations. 

Furthermore, due to the challenges that the State Cemetery 

Grants Program is experiencing in meeting the growing demand for 

their services, the IB recommends Congress appropriate $51 million to the State Cemetery Grants Program for fiscal year 2012. 

This funding level will allow SCGP to establish new State cemeteries at their current rate of need and will provide burial options 

for veterans that otherwise would have no reasonably access to a 

State or national cemetery. 

In 1973, NCA established a burial allowance that provided partial reimbursements for the costs of funerals. However, while the 

cost of funerals has risen over 700 percent since 1973, the VA benefit has only been raised 250 percent. 

We call on the Administration and Congress to provide the resources required to meet the critical nature of NCA’s mission and 

to fulfill this Nation’s commitment to all veterans who have served 

their country so honorably and faithfully. 

AMVETS’ second focus in the fiscal year 2012 IB is on veteran 

entrepreneurship and Federal procurement, as it relates to servicedisabled veteran-owned small businesses and veterans-owned small 

businesses. While I do note that a majority of the proceeding information is focused on policy rather than hard fiscal numbers, we believe that identifying broken policies, duplication of efforts, and 

lack of oversight are key factors in determining a fiscally responsible budget. 

Supporting service-disabled veteran-owned small businesses and 

veteran-owned small businesses contributes significantly in sustaining a veteran’s quality of life, while also contributing to the 

success of transitioning from military life to civilian life. 

Given the current state of our economy, now more than ever, 

Federal agencies must be held accountable to meeting the 3 percent Federal procurement goal as outlined by Executive Order 

13360 and Section 36 of the Small Business Act. 

Furthermore, Congress must ensure adequate resources are 

available to effectively monitor and recognize those agencies not 

meeting the 3-percent goal, and hold them accountable to their 

failure. 

Another critical part of protecting our veterans in the Federal 

procurement system is through a centralized vendor verification 

system. 

Thus far VA has been awarded $1.4 billion in Recovery Act funds 

to aid our veterans in their entrepreneurial endeavors. According 

to VA, of the Recovery Act funds they have received, $538 million 

have been awarded to veteran-owned small businesses. 

However, we have really serious concerns due to the lack of 

verification processes at VA on how many of those awarded contracts were to legitimate veteran-owned businesses. Even though 

changes were made to the CFR regarding the verification process 

416 

last year, we believe the minor updates still leave the veteranowned business verification system and VA open to fraud. 

A continued lack of clarity and inconsistent status verification 

processes will continue to cause the same unwanted results of 

many service-disabled veteran-owned small businesses and veteran-owned small businesses not receiving the protections they are 

entitled to under the law. 

In closing, I want to encourage each of the Committee Members 

to review my full written testimony which will outline all of the 

IB’s concerns and recommendations regarding NCA, veteran entrepreneurial and Federal procurement. 

Again, Chairman Murray, Ranking Member Burr, and Members 

of the Committee, we thank you for inviting us to share with you 

our recommendations, and I am ready to answer any questions 

that you may have. 

[The prepared statement of Ms. Roof follows:] 

PREPARED STATEMENT OF CHRISTINA M. ROOF, NATIONAL DEPUTY LEGISLATIVE

DIRECTOR, AMVETS 

Chairman Murray, Ranking Member Burr and Distinguished Members of the 

Committee: On behalf of AMVETS I would like to thank you for allowing myself and 

representatives of the other member organization authors of the Independent Budget to share with you our recommendations on the Department of Veterans Affairs 

Fiscal Year 2012 budget, in what we believe to be the most fiscally responsible way 

of ensuring the quality and integrity of the care and benefits our veterans community receive. 

AMVETS is honored to join our fellow Veterans’ Service Organizations in presenting the Independent Budget’s recommendations on the Fiscal Year 2012 Department of Veterans Affairs Budget Request. AMVETS testifies before you as a co-author of The FY 2012 Independent Budget. This is the 25th year AMVETS, the Disabled American Veterans, the Paralyzed Veterans of America and the Veterans of 

Foreign Wars have combined our expertise, experiences and resources to produce 

this unique and in-depth document; one that has stood the test of time. 

In developing the Independent Budget we are always guided by the same set of 

principles. These principles include, first, our belief that veterans should not have 

to wait for the benefits to which they are entitled through their service to our country. Second, every veteran must be ensured access to the highest quality medical 

care available. Third, specialized care must remain a top priority and focus of the 

Department of Veterans Affairs (VA). Furthermore, we believe veterans must be 

guaranteed timely access to the full continuum of health care services, including, 

but not limited to, long-term care. Finally, veterans must be assured accessible burial in a state or national cemetery regardless of their location. 

As a partner of the Independent Budget, AMVETS devotes a majority of our time 

to the concerns and matters of the Department of Veterans Affairs National Cemetery Administration (NCA) and to all of the aspects of veteran entrepreneurship and 

Federal procurement. Today I will be speaking directly to these two issues. 

By way of background, the stated mission of The National Cemetery Administration (NCA) is to honor veterans with final resting places in national shrines and 

with lasting tributes that commemorate their service to our Nation. Their vision is 

to serve all veterans and their families with the utmost dignity, respect, and compassion and ensure that every national cemetery will be a place that inspires visitors to understand and appreciate the service and sacrifice of our Nation’s veterans. 

Furthermore, many states have established state veterans cemeteries. Eligibility is 

similar to that of the Department of Veterans Affairs (VA) national cemeteries, but 

may include residency requirements. Even though they may have been established 

or improved with government funds through VA’s State Cemetery Grants Program, 

state veterans cemeteries are run solely by the states. 

As of late 2010 the Department of Veterans Affairs National Cemetery Administration (NCA) maintained more than 3 million graves at 131 national cemeteries in 

39 states and Puerto Rico. Of these cemeteries, 71 are open to all interment; 19 will 

accept only cremated remains and family members of those already interred; and 

417 

1http://www.cem.va.gov/cem/cems/listcem.asp 

41 will only perform interments of family members in the same gravesite as a previously deceased family member.1

VA estimates nearly 23 million veterans are living today. They include veterans 

from World Wars I and II, the Korean War, the Vietnam War, the Gulf War, the 

conflicts in Afghanistan and Iraq, the Global War on Terrorism, as well as peacetime veterans. With the anticipated opening of the newly planned national cemeteries, annual interments are projected to increase to approximately 116,000 in 

2013, and are projected to maintain that level through 2015. Historically, only 12 

percent of veterans opt for burial in a state or national cemetery, although these 

numbers are rising. 

The most important obligation of the NCA is to honor the memory of America’s 

brave men and women who served in the Armed Forces. Therefore, the purpose of 

these cemeteries as national shrines is one of NCA’s top priorities. Many of the individual cemeteries within the system are steeped in history and the monuments, 

markers, grounds and related memorial tributes represent the very foundation of 

the United States. With this understanding, the grounds, including monuments and 

individual sites of interment, represent a national treasure that must be protected, 

respected and cherished. 

The Independent Budget Veterans Service Organizations (IBVSOs) would like to 

acknowledge the dedication and commitment of the NCA staff who continue to provide the highest quality of service to veterans and their families. We call on the Administration and Congress to provide the resources needed to meet the changing 

and critical nature of NCA’s mission and fulfill the Nation’s commitment to all veterans who have served their country honorably and faithfully. In FY 2010, $250 million was appropriated for the operations and maintenance of NCA, with approximately $2 million in carryover. NCA awarded 47 of its 50 

minor construction projects that were in the operating plan. Additionally, the State 

Cemetery Grants Service (SCGS) awarded $48.5 million in grants for 12 projects. 

NCA has done an exceptional job of providing burial options for the nearly 91 percent, about 170,000, of veterans who fall within a 75-mile radius threshold model. 

However, the NCA realized that, without adjusting this model, only one area, St. 

Louis, would qualify for a cemetery within the next five years and that the five 

highest veteran population concentrated areas of the country would never qualify 

if the threshold remained unchanged. 

In 2010, the IBVSOs recommended several new threshold models for NCA to consider in an effort to best serve a veterans population declining in number. The 

IBVSOs are pleased to see that NCA has adjusted its model and will begin factoring 

in 80,000 veterans within a 75-mile radius for future cemetery placement. This 

modification will allow NCA to continue to provide burial options for veterans who 

would otherwise be limited geographically for this benefit. 

NATIONAL CEMETERY ADMINISTRATION (NCA) ACCOUNTS

The Independent Budget recommends an operations budget of $275 million for 

NCA for fiscal year 2012 so it can meet the increasing demands of interments, 

gravesite maintenance and related essential elements of cemetery operations. 

NCA is responsible for five primary missions: (1) to inter, upon request, the remains of eligible veterans and family members and to permanently maintain gravesites; (2) to mark graves of eligible persons in national, state, or private cemeteries 

upon appropriate application; (3) to administer the state grant program in the establishment, expansion, or improvement of state veterans cemeteries; (4) to award 

a Presidential certificate and furnish a United States flag to deceased veterans; and 

(5) to maintain national cemeteries as national shrines sacred to the honor and 

memory of those interred or memorialized. 

However, the national cemetery system continues to face serious challenges. 

Though there has been significant progress made over recent years, NCA is still 

struggling to remove decades of blemishes and scars from military burial grounds 

across the country. Visitors to national cemeteries are still likely to encounter sunken graves, misaligned and dirty grave markers, deteriorating roads, spotty turf and 

other patches of decay that have been accumulating for decades. If NCA is to continue its commitment to ensure national cemeteries remain dignified and respectful 

settings that honor deceased veterans and give evidence of the Nation’s gratitude 

for their military service, there must be a comprehensive effort to greatly improve 

the condition, function, and appearance of all our national cemeteries. 

NCA has worked tirelessly to improve the appearance of our national cemeteries, 

investing $45 million in the National Shrine Initiative in FY 2010 and approxiVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00423 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
418 

mately $25 million per year for the three previous years. NCA has done an outstanding job thus far in improving the appearance of our national cemeteries, but 

we have a long way to go to get us where we need to be. In 2006 only 67 percent 

of headstones and markers in national cemeteries were at the proper height and 

alignment. By 2009 proper height and alignment increased to 76 percent. NCA is 

on target to reach 82 percent this fiscal year. To ensure that NCA has the resources 

to reach its strategic goal of 90 percent, the IBVSOs recommend that NCA’s operations and maintenance budget be increased by $20 million per year until the operational standards and measures goals are reached. 

In addition to the management of national cemeteries, NCA is responsible for the 

Memorial Program Service. The Memorial Program Service provides lasting memorials for the graves of eligible veterans and honors their service through Presidential 

Memorial Certificates. Public Laws 107–103 and 107–330 allow for a headstone or 

marker for the graves of veterans buried in private cemeteries who died on or after 

September 11, 2001. Prior to this change, NCA could provide this service only to 

those buried in national or state cemeteries or to unmarked graves in private cemeteries. Public Law 110–157 gives VA authority to provide a medallion to be attached 

to the headstone or marker of veterans who are buried in a private cemetery. This 

benefit is available to veterans in lieu of a government-furnished headstone or 

marker. 

THE STATE CEMETERY GRANTS PROGRAM

The State Cemeteries Grant Program (SCGP) faces the challenge of meeting a 

growing interest from states to provide burial services in areas that are not currently served. The intent of the SCGP is to develop a true compliment to, not a replacement for, our Federal system of national cemeteries. With the enactment of the 

Veterans Benefits Improvements Act of 1998, the NCA has been able to strengthen 

its partnership with states and increase burial service to veterans, especially those 

living in less densely populated areas not currently served by a national cemetery. 

Currently there are 48 state and tribal government matching grants for cemetery 

projects. 

The Independent Budget recommends Congress appropriate $51 million for SCGP 

for FY 2012. This funding level would allow SCGP to establish new state cemeteries 

at their current rate that will provide burial options for veterans who live in regions 

that currently has no reasonably accessible state or national cemeteries. 

BURIAL BENEFITS

Burial allowance was first introduced in 1917 to prevent veterans from being buried in potter’s fields. In 1923 the allowance was modified. The benefit was determined by a means test, and then in 1936 the means test was removed. In its early 

history the burial allowance was paid to all veterans, regardless of their service 

connectivity of death. In 1973 the allowance was modified to reflect the status of 

service connection. The plot allowance was introduced in 1973 as an attempt to provide a plot benefit for veterans who did not have reasonable access to a national 

cemetery. 

In 1973, NCA established a burial allowance that provided partial reimbursements for eligible funeral and burial costs. The current payment is $2,000 for burial 

expenses for service-connected (SC) death, $300 for non-service-connected (NSC) 

deaths, and $300 for plot allowance. At its inception, the payout covered 72 percent 

of the funeral cost for a service-connected death, 22 percent for a non-service-connected death, and 54 percent of the burial plot cost. In 2007 these benefits eroded 

to 23 percent, 4 percent, and 14 percent respectively. It is time to restore the original value of the benefit. 

The IBVSOs are pleased that the last Congress acted to improve the benefits, 

raising the plot allowance to $700 as of October 1, 2011. However, there is still a 

serious deficit in original value of the benefit when compared to the current value. 

While the cost of a funeral has increased by nearly 700 percent, the burial benefit 

has only increased by 250 percent. To restore both the burial allowance and plot 

allowance back to their 1973 values, the SC benefit payment should be $6,160, the 

NSC benefit value payment should be $1,918, and the plot allowance should increase to $1,150. 

Based on accessibility and the need to provide quality burial benefits, The Independent Budget recommends that VA separate burial benefits into two categories: 

veterans who live inside the VA accessibility threshold model, and those who live 

outside the threshold. For those veterans who live outside the threshold, the SC 

burial benefit should be increased to $6,160, NSC veteran’s burial benefit should be 

increased to $1,918, and plot allowance should increase to $1,150 to match the origiVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00424 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
419 

nal value of the benefit. For veterans who live within reasonable accessibility to a 

state or national cemetery that is able to accommodate burial needs, but the veteran 

would rather be buried in a private cemetery, the burial benefit should be adjusted. 

These veterans’ burial benefits will be based on the average cost for VA to conduct 

a funeral. The benefit for a SC burial should be $2,793, the amount provided for 

a NSC burial should be $854, and the plot allowance should be $1,150. This will 

provide a burial benefit at equal percentages, but based on the average cost for a 

VA funeral and not on the private funeral cost that will be provided for those veterans who do not have access to a state or national cemetery. 

In addition to the recommendations we have mentioned, the IBVSOs also believe 

that Congress should enact legislation to adjust these burial benefits for inflation 

annually. 

The IBVSOs call on the Administration and Congress to provide the resources required to meet the critical nature of the NCA mission and fulfill the Nation’s commitment to all veterans who have served their country so honorably and faithfully. 

NCA honors veterans with a final resting place that commemorates their service 

to this Nation. More than 3 million servicemembers who died in every war and conflict are honored through internment in a VA national cemetery. Each Memorial 

Day and Veterans Day we honor the last full measure of devotion they gave for this 

country. Our national cemeteries are more than the final resting place of honor for 

our veterans; they are hallowed ground to those who died in our defense, and a memorial to those who survived. 

AMVETS’ second focus in the FY 2012 IB is on veteran entrepreneurship and 

Federal procurement as it relates to Service Disabled Veteran Owned Small Businesses (SDVOSB) and Veterans Owned Small Businesses (VOSB). We believe that 

both of these issues play a vital rule in the success of transitioning servicemembers 

and the quality of life for veterans. And while I do note that a majority of the proceeding information is focused on policy rather than hard fiscal numbers, we believe 

that broken policy, duplication of efforts and lack of oversight are key factors in determining fiscally responsible budgets. 

VETERAN PREFERENCE IN FEDERAL HIRING AND PROCUREMENT

Supporting Service-disabled Veteran-owned Small Businesses (SDVOSBs) and 

Veteran-owned Small Businesses (VOSB) contributes significantly in sustaining a 

veteran’s quality of life, while also contributing to the success and ease of transitioning from active duty to civilian life. Often in these tough economic times, self employment and entrepreneurship are the only ways many veterans are able to earn 

a living wage. Given the circumstances, now more than ever, Federal agencies must 

be held accountable to meet the Federal procurement goals outlined by Executive 

Order 13360, Sections 15 (g) and 36 of the Small Business Act and the numerous 

other published Federal regulations outlining veterans’ preference and SDVOSB setaside laws. 

The Government Accountability Office’s (GAO) most recent review of interagency 

agreements found that VA is still lacking an effective process to ensure that interagency agreements include the required language instructing all Federal agencies 

comply with VA’s contracting goals and preferences for SDVOSBs and VOSBs. 

While it is noted that VA issued guidance to all contracting officers on managing 

interagency acquisitions in March 2009, the numerous interagency agreements still 

did not even include the required language addressing VA’s contracting goals and 

preferences until it was amended on March 19, 2010. This serves as an example of 

how VA is clearly lacking an established hierarchy or clear delegation of duties in 

oversight activities. This lack of oversight is continuing to contribute to VA having 

no assurance or metrics in place to conduct proper oversight that agencies have 

made maximum feasible efforts to contract with SDVOSBs or VOSBs. This lack of 

oversight only stands to hurt those in which the laws were established to protect, 

the veterans. 

We recommend stronger oversight, outreach and enforcement by all Federal agencies tasked with ensuring the success of our veteran entrepreneur community. This 

includes, but is not limited to, the U.S. Department of Labor (DOL), Office of Small 

Business Programs (OSBP), Small Business Administration (SBA), Office of Federal 

Contract Compliance and Procurement (OFCCP) and all other Federal agencies committing to reaching their 3 percent goal. All Federal agencies must make a high priority of assisting in the development and implementation of stronger strategies and 

accountability in reaching the three-percent goal of veteran employment and 

contracting. 

Congress must ensure adequate resources are available to effectively monitor and 

recognize those agencies that are not meeting the three-percent goal and hold them 

420 

accountable for failure. The annual reports filed by all Federal agencies, reporting 

the prior fiscal years’ actual percentage of goal achieved, should serve as guidance 

as to which agencies need the most assistance in the development and implementation of stronger contracting plans and oversight. 

CENTER FOR VETERAN ENTERPRISE

Another critical aspect in ensuring the success of our veteran entrepreneur community is promoting and assisting veterans in their entrepreneurial endeavors 

through programs such as the Center for Veteran Enterprise (CVE). CVE was established to assist all veterans with the numerous aspects of establishing and maintaining a small business. CVE is a subdivision of the Office of Small and Disadvantaged Business Utilization that extends entrepreneur services to veterans whom 

own or who want to start a small business. CVE is also tasked with aiding other 

Federal contracting offices in identifying VOSBs in response to Executive Order 

133600. In the past, VA has faced many obstacles, from lack of leadership to best 

practices with their entrepreneurship programs, which have directly resulted in and 

prevented the success of veteran owned businesses. For this reason, VA established 

the program entitled the Center for Veterans Enterprise (CVE) with the passage of 

the Veterans Entrepreneurship and Small Business Development Act of 1999. Furthermore, on Dec. 22, 2006, President Bush signed Public Law 109–461, the Veterans Benefits, Health Care, and Information Technology Act of 2006 in an effort 

to successfully identify and grant status to SDVOSBs. Effective June 20, 2007, 

this legislation authorized a unique ‘‘Veterans First’’ approach, specific to VA 

contracting. 

As we move through the 21st century, during a time of war on multiple fronts, 

the VOSB and SDVOSB population continues to rise at a rate not seen since the 

end of World War II. As America’s war-fighters transition back into civilian life, 

many are choosing to pursue lives as entrepreneurs. Given the almost 35 percent 

influx of VOSB and SDVOSB, it is vital that the Center for Veterans Enterprise be 

ready and able to meet the growing demand for their services. However, the IBVSOs 

do not believe that CVE is serving the needs of those veterans it was originally designed to help. Due to a lack of leadership over the past year, we have seen CVE 

slowly move from the role of assisting VOSB and SDVOSBs to that of an information and referral agency for other Federal and state agencies. We believe the Center 

for Veteran Enterprise must be brought back up to par with what it was originally 

tasked to do: assisting our veteran population in all aspects for their entrepreneurship endeavors. In order to effectively accomplish this Congress must provide dedicated funding and strong oversight in ensuring CVE is properly staffed, trained and 

funded. 

VENDOR VERIFICATION SYSTEMS

Another key part of protecting our veterans in a successful Federal procurement 

system is through a centralized vendor verification system. We believe it to be vital 

for all Federal agencies to utilize a continually updated, single centralized source 

database in the verification of all businesses claiming preferred status as a VOSB 

or SDVOSB. 

At present, vendors desiring to do business with the Federal Government must 

register in the Central Contractor Registration (CCR) database, and those who indicate they are veterans or service-disabled veterans, self-certify their status without 

verification. Public Law 109–461 required VA to establish a Vendor Information 

Page (VIP) database to accurately identify businesses that are 51 percent or more 

owned by veterans or service-disabled veterans. This database was originally designed to act as a reliable, centralized database enabling all Federal agencies a single source in the identification of possible SDVOSB and VOSB for consideration during their procurement processes. Furthermore, both contractors and subcontractors 

involved in the procurement process of any government award is then required to 

provide the Secretary of Labor a specific breakdown of all information required by 

the VETS 100 and VETS 100-A filed on an annual basis, demonstrating their continued compliance with the contracts terms regarding veterans preference and status. As of April 15, 2009, approximately 18,000 SDVOSBs were registered in the 

Central Contractor Registration, however, due to lack of oversight and an inconsistent, self-reported status verification processes, many non-veteran-owned businesses are not receiving the protections they are entitled to under the law. 

On February 8, 2010, the final CFR rules regarding ‘‘VA Veteran-Owned Small 

Business Verification Guidelines’’ were published. The document affirms as final, 

with changes, an interim final rule that implements portions of the Veterans Benefits, Health Care, and Information Technology Act of 2006. This law requires the 

421 

Department of Veterans Affairs (VA) to verify ownership and control of veteranowned small businesses, including service-disabled veteran-owned small businesses. 

This final rule declares to define the eligibility requirements for businesses to obtain 

verified status, explains examination procedures and establishes records retention 

and review processes. However, the newly published rule fails to outline any solid 

changes or improvements to the SDVOSB verification process. We further believe 

the newly published rules on the verification process focused on control and ownership definitions, yet provided no clarification on the specifics of the verification process. The IBVSOs believe these updates to 38 CFR, Part 74 regarding Public Law 

109–461 still leave the integrity of the SDVOSB and VOSB verification system open 

to fraud. This continued lack of clarity and non-uniformed inconsistent status 

verification processes will cause the same unwanted results of many veteran owned 

businesses not receiving the protections they are entitled to under the law. 

VA has thus far been awarded $1.4 billion in recovery act funds to aide in the 

employment and contracting opportunities available to SDVOSB and VOSB. To date 

$538 million has been used on awards to SDVOSB and VOSB, according to VA. 

However, we have very serious concerns on how much of these appropriated funds 

were actually awarded to legitimate SDVOSB and VOSBs, due to the lack of 

verification processes in place at VA. 

In an effort to resolve this issue we recommend that all Federal agencies should 

be required to certify veteran status and ownership through the VA’s VIP program 

before awarding contracts to companies claiming veteran status. We also recommend the database be maintained and updated on a regular basis to avoid backlogs of vendors waiting to be certified or re-certified. 

Furthermore, Congress must take the necessary actions in requiring all Federal 

agencies to use a single source database in all verifications of veteran ownership 

statuses before unknowingly awarding contracts to companies on the basis of claiming SDVOSB or VOSB preference. Finally, internal promotion and education on 

proper usage of the database should coincide with implementation of databases use. 

VETERAN SET-ASIDES

Protecting veteran set-asides within the Federal procurement system is a matter 

that must be addressed more rigorously within VA’s training and personnel programs. Public Law 109–461, the ‘‘Veterans Benefits, Health Care and Information 

Technology Act of 2006,’’ was signed Dec. 22, 2006, and went into effect on June 20, 

2007. The law allows VA special authority to provide set-aside and sole-source contracts to small businesses owned and operated by veterans and service-disabled veterans. This legislation is codified in Title 38, United States Code, sections 8127 and 

8128. After more than three years since its enactment, no significant change has 

been implemented with regard to how Federal contracting officers are trained. VA 

personnel involved in the acquisition process need to be trained and familiarized 

with all current and new authorizations and responsibilities under P. L. 109–461, 

as well as all other procurement directives regarding VOSBs and SDVOSBs. Our 

service-disabled veterans who own small businesses cannot afford to wait any longer 

for VA to enforce compliance with the law. 

Under current policy, no proof of compliance is required, nor do random labor audits occur. OIG has issued more than 10 reports illustrating these deficiencies in 

recent years. Most recently, in October 2009 the U.S. Government Accountability Office (GAO) issued their report on ‘‘Service-Disabled Veteran-Owned Small Business 

Program: Case Studies Show Fraud and Abuse Allowed Ineligible Firms to Obtain 

Millions of Dollars in Contracts’’ to the Committee on Small Business. This report 

outlines how millions of dollars in set-aside contracts were awarded to non-SDVOSB 

businesses due to the gross lack of program controls in place to detect and prevent 

fraud. The report identified 10 case-study examples of firms that did not meet the 

basic SDVOSB program eligibility requirements, but yet received over $100 million 

in SDVOSB set-aside contracts. VA, DOL, SBA and the OFCCP must exercise better 

oversight and stronger enforcement with consequences for any government agency 

or nongovernment business claiming to be awarding set-asides to veteran-owned 

businesses when, indeed, they are not. There needs to be an immediate focus on 

proactive measures to eliminate untruths, such as ‘‘rent a vet,’’ and cease only exercising ‘‘reactive’’ strategies. VA, the DOL, SBA, and OFCCP should pool all their resources and successful strategies to ensure swift action and to avoid duplication of 

efforts. 

Furthermore, we believe VA must develop and implement uniformed training 

processes for all staff involved with the Federal procurement process, especially contracting officers. VA must also provide systems and metrics to identify the strengths 

and weaknesses in its procurement processes, as well as continued training and 

422 

evaluations of contracting staff in efforts of successfully identifying weaknesses and 

strengths within the program as a whole. 

Last, VA, DOL, SBA, OFCCP and the Employment and Training Administration 

must collaborate in developing and implementing a single-source database for employer outreach programs for the promotion of veterans’ entrepreneurship at local 

and national levels. This system must allow all employers to locate veterans for employment as well as provide an updated listing of employment opportunities. 

Again, Chairman Murray, ranking Member Burr and Members of the Committee, 

we thank you for inviting us to share with you our recommendations and stand 

ready to answer any questions you may have. 

Chairman MURRAY. Thank you very much. 

Mr. Kelley. 

STATEMENT OF RAYMOND C. KELLEY, DIRECTOR, NATIONAL 

LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF 

THE UNITED STATES 

Mr. KELLEY. Madam Chairman, on behalf of the 2.1 million 

members of the Veterans of Foreign Wars and its auxiliary, congratulations on your appointment to the chairmanship and thank 

you for the opportunity to testify today. 

As a partner of The Independent Budget, the VFW is responsible 

for the construction budget. So I am going to limit my remarks to 

that subject today. 

A vast, growing, and aging infrastructure continues to create a 

burden on VA’s overall construction and maintenance requirements. These facilities are the instruments that are used to deliver 

the care to our injured male veterans. 

Every effort must be made to ensure that these facilities are safe 

and sufficient environments to deliver that care. A VA budget that 

does not adequately fund facility maintenance and construction will 

reduce the timeliness and quality of care to our veterans. 

This is why the IB partners are recommending an overall construction budget of $2.8 billion, $2.2 billion for the major construction accounts, and $585 million for the minor construction accounts. 

Last fall, the VA provided the IB partners with an overview of 

the new strategic capital investment plan, or SCIP. After the briefing and upon reviewing VA’s Fiscal Year 2012 Budget submission, 

the IB partners were pleased with the improved transparency of 

the capital planning. 

VA has advised the IB partners that SCIP is intended to identify 

capital acquisition needs ranging from nonrecurring maintenance 

and leasing to major and minor construction projects, and to close 

the currently identified performance gaps. 

All told, these gaps will require between $53 and $65 billion in 

funding over the next 10 year. However, at the Administration’s requested level, it will take between 18 and 22 years to achieve this 

10-year Plan. 

Underfunding VA’s capital plan in its infancy will only exacerbate the ongoing construction and maintenance needs. We are 

happy to see that the VA’s Fiscal Year 2012 Budget request for 

medical facilities in New Orleans, Denver, and along with three 

other major construction sites will be fully funded. However, only 

seven of the 23 partially-funded major construction projects will 

continue to be funded in fiscal year 2012, leaving well over $4 bilVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00428 Fmt 6633 Sfmt 6601 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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lion remaining in partially-funded projects dating back to fiscal 

year 2007. 

These projects include: improving seismic deficiencies; providing 

spinal cord injury centers; completing a polytrauma blind rehab 

and research facility; as well as expanding mental health facilities. 

These projects have a purpose and should be funded as quickly as 

possible to fulfill the promise of care to our wounded and ill 

veterans. 

The VA is requesting approximately $545 million to continue 

construction on seven existing projects and to begin work on four 

new projects. At this pace, VA will not reach its strategic capital 

investment 10-year plan. 

Therefore, the IB partners request Congress provide funding of $1.85 billion for VHA major construction accounts. This will allow 

VA to complete all current partially-funded major construction 

projects within 5 years, begin providing funding for 15 new projects 

and fund the four currently partially-funded seismic correction 

projects at a level that will have them completed in 3 years. 

The IB partners are pleased with VA’s funding requests for VHA 

minor construction accounts. This level of funding will allow VA to 

fully fund more than 75 projects. 

The Administration’s requests for NCA construction projects to- tals nearly $80 million. The IB is requesting $161 million. This will 

allow NCA to complete nearly all of its minor construction projects 

and begin three major projects, expanding veterans’ access to cemeteries in Hawaii, Florida, and Colorado. 

The IB partners are also requesting an increase in funding for research facilities, funding at the level of $150 million will allow 

work to begin on the five highest priority research projects. 

Again, it is critical to the care of our veterans that we fully fund 

VA construction. 

Madam Chairwoman, I thank you again for this opportunity and 

look forward to any questions you or the Committee may have. 

[The prepared statement of Mr. Kelley follows:] 

PREPARED STATEMENT OF RAYMOND C. KELLEY, DIRECTOR, NATIONAL LEGISLATIVE

SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES

Madam Chairwoman and Members of the Committee: On behalf of the 2.1 million 

men and women of the Veterans of Foreign Wars of the U.S. (VFW) and our Auxiliaries, I would like to thank you for the opportunity to testify today. The VFW 

works alongside the other members of the Independent Budget (IB)—AMVETS, Disabled American Veterans and Paralyzed Veterans of America—to produce a set of 

policy and budget recommendations that reflect what we believe would meet the 

needs of America’s veterans. The VFW is responsible for the construction portion of 

the IB, so I will limit my remarks to that portion of the budget. 

The Department of Veterans Affairs (VA) manages a wide portfolio of capital assets throughout the nationwide system of health-care facilities. According to the latest VA Capital Asset Plan, VA owns 5,405 buildings and almost 33,000 acres of 

land. It is a vast network of facilities that requires much time and attention from 

VA’s capital asset managers. Unfortunately, VA’s infrastructure is aging rapidly. Although Congress has funded a significant number of new facilities in recent years, 

the vast majority of existing VA medical centers and other associated buildings are 

on average more than 60 years old. 

Aging facilities create an increased burden on VA’s overall maintenance requirements. They must be maintained aggressively so that their building systems—electrical, plumbing, capital equipment, etc.—are up to date and that these facilities are 

able to continue to deliver health care in a clean and safe environment. Older, outof-date facilities do not just present patient safety issues: from VA’s perspective, 

older buildings often have inefficient layouts and inefficient use of space and energy. 

424 

This means that even with modification or renovation, VA’s operational costs can 

be higher than they would be in a more modern structure. 

VA has begun a patient-centered reformation and transformation of the way it delivers care and new ways of managing its infrastructure plan based on the needs 

of sick and disabled veterans in the 21st century. Regardless of what the VA healthcare system of the future may look like, our focus must remain on ensuring a lasting, accessible, modernized system that is dedicated to the unique needs of veterans 

while also providing unparalleled and timely care when and where veterans need 

it. 

The Capital Asset Realignment for Enhanced Services (CARES) process, VA’s 

data-driven assessment of current and future construction needs, gave VA a longterm roadmap and has helped guide its capital planning process over the past 10 

years. The CARES process developed a large number of significant construction objectives that would be necessary for VA to fulfill its obligation to sick and disabled 

veterans. Over the past several years, the Administration and Congress have made 

significant inroads in funding these priorities. Since fiscal year (FY) 2004, $5.9 billion has been allocated for these projects. 

The Independent Budget veterans service organizations believe that CARES was 

a necessary undertaking and that VA has made slow but steady progress on many 

of these critical projects. In the post-CARES era, many essential construction 

projects are still awaiting authorization and funding, and the IBVSOs firmly believe 

that Congress cannot allow the construction needs that led to the CARES blueprint 

to be disregarded. Both strong oversight and sufficient funding are critical in this 

ongoing task of maintaining the best care for veterans. 

Given the challenges presented by the CARES blueprint, including a backlog of 

partially funded construction projects, high costs of individual projects, and our concern about the timeliness of these projects—noting that it can take the better part 

of a decade from the time VA initially proposes a project until the doors actually 

open for veterans’ care—VA has proposed a new program, named ‘‘Strategic Capital 

Investment Planning’’ (SCIP). This initiative will address some of the infrastructure 

issues that have been noted in The Independent Budget. SCIP is VA’s newest approach to reevaluating its aging and underutilized infrastructure, as well as examining the lack of infrastructure in various locations 

around the country. The intent of SCIP, according to VA, is to scrutinize all property so that VA can best address gaps in delivery of care and services to veterans. 

Unlike CARES, SCIP will cover all of VA, not only Veterans Health Administration 

facilities; however, similar to CARES, SCIP is designed to evaluate the condition of 

VA infrastructure, in order to build a 10-year integrated capital plan. The goal is 

to improve quality of and access to VA services by modernizing facilities based on 

current and future needs. If SCIP is approved as VA’s capital planning method, the 

Department plans to begin this process with the FY 2012 budget cycle. 

VA has also advised the IBVSOs that SCIP is intended to address the funding 

shortfall of $24.3 billion to deal with major construction and facility condition assessment backlogs, inefficient use of resources, and high maintenance costs, as well 

as an existing commitment of about $4.4 billion to complete ongoing major construction projects. If approved, the goal of this new initiative must be a comprehensive 

plan that will improve quality by providing equitable access to services for all veterans across the VA system of care and services. As the age of VA structures increase, costs go up, often dramatically so. Accordingly, more funding is spent on 

older projects, leaving less for other maintenance and construction needs and increasing the overall budget for both major and minor construction. VA must adopt 

a plan for the future that will review and assess all current and future needs while 

providing priorities and transparency at the forefront. 

A draft of the SCIP proposal was most recently provided to the IBVSOs in October 2010. The overview included a future-oriented view of VA capital needs beginning with the 2012 budget. According to VA, SCIP would adapt to changes in environment, provide a comprehensive planning process for all projects, and result in 

one prioritized listing of capital projects VA wide. The list intends to ensure equitable access to services for veterans across the country and includes major and 

minor construction, nonrecurring maintenance, and leasing. 

Because SCIP is a new initiative, The Independent Budget veterans service organizations encourage VA to be transparent during the process and would advise that 

challenges must be met when reviewing all current and future needs of its aging 

infrastructure. The goal must be a comprehensive plan that will improve quality by 

maintaining equitable access to services across the VA system. The changing healthcare delivery needs of veterans, including reduced demand for inpatient beds and 

increasing demand for outpatient care and medical specialty services, along with 

limited funding available for construction of new facilities, has created a growing 

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backlog of projects that are becoming more expensive to complete. VA has advised 

that SCIP is intended to address the funding shortfalls of its current capital backlog 

needs. 

MAJOR AND MINOR CONSTRUCTION ACCOUNTS

The Department of Veterans Affairs continues to be faced with challenges with 

respect to the maintenance backlog. VA regularly surveys each facility as part of 

the Facilities Condition Assessment (FCA) process. VA estimates the cost of repair 

and uses this cost estimate as a component of its Federal Real Property Report requirements. According to its latest Five-Year Capital Plan, VA has estimated the 

total cost of repairing all ‘‘D-rated’’ and ‘‘F-rated’’ FCA deficiencies at a cost of $8 

billion, even as it and Congress have greatly increased the amount of funding and 

resources devoted to this critical aspect of capital asset management. Although Congress has increased recent funding for nonrecurring maintenance (NRM), these 

funding levels only touch the surface of the backlog. 

For years, NRM and other maintenance needs were significantly underfunded, 

and massive backlogs ensued (see ‘‘Increased Spending on Nonrecurring Maintenance’’ in this Independent Budget). Maintenance is only a small fraction of the 

major infrastructure issues confronting the system. The Independent Budget veterans service organizations (IBVSOs) are also concerned about the huge backlog of 

major medical construction projects and the political and economic reality that fully 

funding each of these projects and constructing them in a timely manner may not 

be feasible. 

One of the reasons for such a large backlog of construction projects is because 

Congress allocated so little funding during the Capital Asset Realignment for Enhanced Services (CARES) process. The Appropriations Committees provided few resources during the initial review phase, and against our advice, preferred to wait 

for the result of CARES. Because of our convictions that a number of these projects 

needed to go forward and that they would be fully justified through any plans developed by CARES, the IBVSOs argued that a de facto moratorium on construction was 

unnecessary and would be harmful. The House agreed with our views as evidenced 

by its passage of the Veterans Hospital Emergency Repair Act, March 27, 2001; 

however, Congress never appropriated funding to carry out the purposes of that act, 

and the construction and maintenance backlogs continued to grow. 

Upon completion of the CARES decision document in 2004, former VA Secretary 

Anthony Principi testified before the Health Subcommittee of the House Committee 

on Veterans’ Affairs. He noted that CARES ‘‘reflects a need for additional investment of approximately $1 billion per year for the next five years to modernize VA’s 

medical infrastructure and enhance veterans’ access to care.’’ In a November 17, 

2008, letter to the Senate Committee on Veterans’ Affairs, then-Secretary James 

Peake reported that VA would need at least $6.5 billion over the following five years 

to meet its funding requirements for major medical facility construction projects. 

As noted previously, VA has proposed a new program, Strategic Capital Investment Planning (SCIP), to address some of the construction and infrastructure issues 

presented in The Independent Budget. Given the President’s pledge to create a VA 

for the 21st century, the IBVSOs expect the Department to proceed with its SCIP 

plan in a transparent way, coordinate the plan through our community and other 

interested parties, and provide its plan to Congress for review and approval if required. However, until SCIP is fully implemented, we fear that VA’s capital programs and the significant effects on the system as a whole and veterans individually 

will go unchanged; ultimately risking a diminution of care and services provided by 

VA to sick and disabled veterans in substandard facilities. 

Until the SCIP plan is approved and in place across the VA network of care, the 

IBVSOs will continue to argue for sufficient funding needs to maintain VA’s capital 

infrastructure and to ensure a safe and useful system for all veterans who need VA 

health care. With this in mind, the IBVSOs would like to outline the components 

of our Major and Minor Construction account requests of this Independent Budget. 

Major Construction 

Category Recommendation 

($ in thousands) 

Major Medical Facility Construction ........................................................................................... $1,850,000 

NCA Construction ........................................................................................................................ $ 61,000 

Advance Planning ....................................................................................................................... $45,000 

Master Planning .......................................................................................................................... $15,000 

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Major Construction—Continued 

Category Recommendation 

($ in thousands) 

Historic Preservation ................................................................................................................... $20,000 

Medical Research Infrastructure ................................................................................................ $150,000 

Miscellaneous Accounts .............................................................................................................. $ 60,000 

TOTAL ................................................................................................................................. $2,201,000 

Minor Construction 

Category Funding 

($ in thousands) 

Veterans Health Administration .................................................................................................. $450,000 

National Cemetery Administration .............................................................................................. $100,000 

Veterans Benefits Administration ............................................................................................... $20,000 

Staff Offices ................................................................................................................................ $15,000 

TOTAL ................................................................................................................................. $585,000 

Major Medical Facility Construction—This amount would allow VA to continue to 

address the backlog of partially funded construction projects which includes any ongoing major construction projects already approved. Depending on the stage in the 

process and VA’s ability to complete portions of the projects within the fiscal year, 

remaining funds could be used for projects identified by VA as part of SCIP. 

National Cemetery Administration—This amount would fund a number of national cemeteries from VA’s priority list as well as potential projects identified by 

SCIP. 

Advanced Planning—This amount helps develop the scope of the Major Medical 

Facility construction project as well as to identify proper requirements for their construction. It allows VA to conduct necessary studies and research similar to the 

planning process in the private sector. 

Master Planning—A description of The Independent Budget request follows later 

in the text. 

Historic Preservation—A description of The Independent Budget request follows 

later in the text. 

Miscellaneous Accounts—These included the individual line items for such accounts as asbestos abatement, the judgment fund, and hazardous waste disposal. 

Minor Construction Account—SCIP has already identified minor construction 

projects that update and modernize VA’s aging physical plant, ensuring the health 

and safety of veterans and VA employees. 

Medical Research Infrastructure—Funding needs to be allocated by Congress to 

allow for needed renovations to VA research facilities. 

Medical Research Infrastructure—A description of The Independent Budget request follows later in the text. 

National Cemetery Administration—This includes minor construction projects 

identified by SCIP to include the construction of several columbaria, installation of 

crypts, and landscaping and maintenance improvements. 

Veterans Benefits Administration—This includes several minor construction 

projects identified by SCIP in addition to the leasing requirements the Veterans 

Benefits Administration needs. It also includes $2 million transferred yearly for the 

security requirements of its Manila office. 

Staff Offices—This includes minor construction projects related to staff offices, including increased space and numerous renovations for the VA Office of Inspector 

General. 

We view these issues as the critical areas that must be addressed when developing our funding recommendations. We would also like to note that within many 

of these categories lies ongoing and unfunded projects as well as backlogged facility 

repairs and maintenance. 

427 

INADEQUATE FUNDING AND DECLINING CAPITAL ASSET VALUE: 

The Department of Veterans Affairs must protect against deterioration of its infrastructure and a declining capital asset value. 

Good stewardship demands that VA facility assets be protected against deterioration and that an appropriate level of building services be maintained. Given VA’s 

construction needs, such as seismic correction, compliance with the Americans with 

Disabilities Act (ADA) and Joint Commission on Accreditation of Healthcare Organization (JCAHO) standards, replacing aging physical plant equipment, and projects 

that were identified by the Capital Asset Realignment for Enhanced Services 

(CARES) initiative, the VA construction budget continues to be inadequate. During 

the past decade of underfunded construction budgets, VA has not adequately recapitalized its facilities. 

Recapitalization is necessary to protect the value of VA’s capital assets through 

the renewal of the physical infrastructure. This ensures safe and fully functional facilities long into the future. 

VA facilities have an average age of more than 60 years, and it is essential that 

funding be increased to renovate, repair, and replace these aging structures and 

physical systems. In the past, The Independent Budget veterans service organizations (IBVSOs) have cited the recommendations of the final Report of the President’s Task Force to Improve Health Care Delivery for Our Nations Veterans (PTF). 

To underscore the importance of this issue, we again cite the recommendations of 

the PTF. It was noted that VA health-care facility major and minor construction 

over the 1996 to 2001 period averaged only $246 million annually, a recapitalization 

rate of 0.64 percent of the $38.3 billion total plant replacement value. At this rate 

of investment, VA would be recapitalizing its infrastructure every 155 years. 

If maintenance and restoration were considered along with major construction, VA 

invests less than 2 percent of plant replacement value for its entire facility infrastructure nationwide. A minimum of 5 percent to 8 percent investment of plant replacement value is necessary to maintain health-care infrastructure. If this rate is 

not improved, veterans could be receiving care in potentially more unsafe and dysfunctional settings as time goes along. Improvements in the delivery of health care 

to veterans require that VA adequately create, sustain, and renew physical infrastructure to ensure safe and functional facilities. The FY 2008 VA Asset Management Plan provided the most recent estimate of plant replacement value (PRV). 

Using the guidance of the Federal Government’s Federal Real Property Council, 

VA’s PRV is more than $85 billion. The IBVSOs appreciate the Administration’s efforts to increase the total capital budget, and we hope future requests will be more 

in line with the system’s needs. 

Recommendations: 

Congress and the Administration must ensure that adequate funds are appropriated for VA’s capital needs so that it can properly invest in its physical assets 

to protect their value and to ensure that it can continue to provide health care in 

safe and functional facilities long into the future. 

INCREASED SPENDING ON NONRECURRING MAINTENANCE: 

The deterioration of many VA properties requires increased spending on nonrecurring 

maintenance. 

For years The Independent Budget veterans service organizations (IBVSOs) have 

stressed the importance of providing necessary funding for nonrecurring maintenance (NRM) accounts to ensure that longstanding and continual upkeep requirements at VA facilities are met. NRM embodies the many small projects that together provide for the long-term sustainability and usability of VA facilities. NRM 

projects are onetime repairs, such as modernizing mechanical or electrical systems, 

replacing windows and equipment, and preserving roofs and floors, among other 

routine maintenance needs. Nonrecurring maintenance is a necessary component of 

the care and stewardship of a facility. When managed responsibly, these relatively 

small, periodic investments ensure that the more substantial investments of major 

and minor construction provide real value to taxpayers and to veterans as well. 

When NRM projects are ignored, the results can be detrimental to the value of 

a VA property and the quality of care they facilitate for veterans. Nonrecurring 

maintenance projects that are left undone inevitably require more costly and timeconsuming repairs when they are eventually addressed. Furthermore, this lack of 

attention to basic structural maintenance issues jeopardizes the safety of staff and 

patients. Because delayed maintenance projects always require a more invasive response as opposed to situations in which NRM is responsibly managed, the IBVSOs 

428 

believe neglecting such projects is tantamount to denying veterans timely and professional care and even placing them in danger. 

Accordingly, to fully maintain its facilities, VA needs an NRM annual budget of 

at least $1.7 billion. Teams of professional engineers and cost estimators survey 

each medical facility at least once every three years as part of VA’s Facilities Condition Assessment (FCA) process. These surveys assess all components of a given facility to include internal issues, such as plumbing, and external issues, such as parking and mobility barriers. Each component of a facility is given a letter grade, A 

through F. Areas given a grade of F no longer function or are in danger of imminent 

structural or system failure. VA estimates the cost of repair for each item that is 

rated D or F and then uses this cost estimate as a component of its Federal Real 

Property Report requirements. VA’s latest Five-Year Capital Plan estimated the 

total cost of repairing all D-rated and F-rated FCA deficiencies at a staggering $8 

billion, even as VA and Congress have greatly increased the amount of funding and 

resources devoted to this critical aspect of capital asset management. Since that 

time, NRM received a one-time allocation of $1 billion through Public Law 111–5, 

the ‘‘American Recovery and Reinvestment Act.’’ 

VA uses the FCA reports as part of its Federal Real Property Council metrics. 

The department calculates a Facility Condition Index (FCI), which is the ratio of 

the cost of FCA repairs compared to the cost of replacement. According to the FY 

2008 Asset Management Plan, this metric has declined from 82 percent in 2006 to 

68 percent in 2008. VA’s strategic goal is 87 percent, and for the Department to 

meet that goal, it would require a sizable investment in NRM and minor construction. Given the low level of funding NRM accounts have historically received, the 

IBVSOs are not surprised that basic facility maintenance remains a challenge for 

VA. 

In addition, the IBVSOs have long-standing concerns with how this funding is apportioned once received by VA. Because NRM accounts are organized under the 

Medical Facilities appropriation, it has traditionally been apportioned using the Veterans Equitable Resource Allocation (VERA) formula. This formula was intended to 

allocate health-care dollars to those areas with the greatest demand for health care, 

and is not an ideal method to allocate NRM funds. When dealing with maintenance 

needs, this formula may prove counterproductive by moving funds away from older 

medical centers and reallocating the funds to newer facilities where patient demand 

is greater, even if the maintenance needs are not as intense. We are encouraged by 

actions the House and Senate Veterans’ Affairs Committees have taken in recent 

years requiring NRM funding to be allocated outside the VERA formula, and we 

hope this practice will continue. 

Another issue related to apportionment of funding and the budget cycle has been 

well documented. Prior to the passage of advance appropriations, the Government 

Accountability Office (GAO) had found that the bulk of NRM funding was not apportioned until September, the final month of the fiscal year. For example, the GAO 

reported that 60 percent of total NRM funding for FY 2006 was allocated in September of that year. 

In other words, during the first 11 month of FY 2006, only 40 percent of NRM 

funding had been allocated even as VA knew any unobligated funds would be remitted to the Department of the Treasury by statute. This is a shortsighted policy that 

impairs VA’s ability to properly address its maintenance needs, and with NRM 

funding year to year, those conditions, which lead to a functional mishandling of essential funds, have been changed by advance appropriations. Medical accounts are 

now appropriated by Congress a year in advance to allow VA the ability to plan farther in advance and reduce the impact of delayed appropriations. 

Not receiving timely appropriations from Congress has curtailed the positive impacts of medical spending over the years, and Congress must now provide oversight 

of this process to ensure that these upfront dollars for NRM and all medical spending realize their potential benefits. Congress and VA should provide oversight to ensure this change will not result in medical center managers continuing to sit on 

unspent funds for longer periods of time, but that it will produce more efficient 

spending and better planning, thereby eliminating the previous situation in which 

these managers sometimes spent a large portion of their maintenance funding very 

late in the fiscal year. 

Recommendations: 

VA must dramatically increase funding for nonrecurring maintenance (NRM) in 

line with the industry standard of 2 percent to 4 percent of plant replacement value 

in order to maintain modern, safe, and efficient facilities. Congress should provide 

VA with additional maintenance funding in the Medical Facilities appropriation to 

429 

enable the Department to begin addressing the substantial maintenance backlog of 

Facilities Condition Assessment—identified projects. 

Congress should provide NRM funding to support maintenance and upgrades to 

VA’s research infrastructure. Portions of the NRM account should continue to be 

funded outside of the Veterans Equitable Resource Allocation formula so that funding is allocated to the facilities that have the greatest maintenance needs, rather 

than based on other criteria unrelated to the condition of facilities. Congress must 

provide oversight of the NRM funding allocated through the advance appropriations 

process to ensure NRM funds are being spent in such a way to meet their full 

potential. 

MAINTAIN CRITICAL VA HEALTH INFRASTRUCTURE: 

The Department of Veterans Affairs must execute a comprehensive, strategic health 

infrastructure plan that is focused on the unique needs of its veteran population. 

In order to reduce the growing backlog and maintenance needs of its medical facilities, Congress and the Administration must work together to secure the Department’s future by designing the ‘‘VA of the 21st century.’’ 

Today we find ourselves at a critical juncture with respect to how VA health care 

will be delivered and what the VA of the future will be like in terms of its 

healthcare facility infrastructure. One fact is certain—our Nation’s sick and disabled 

veterans deserve and have earned a stable, accessible VA health-care system that 

is dedicated to their unique needs and can provide high-quality, timely care where 

and when they need it. Given these significant challenges and the shift in care in 

many areas, in 2008 VA developed a new approach to dealing with infrastructure, 

the Health Care Center Facility (HCCF) leasing program. Under the HCCF leasing 

program, in lieu of the traditional approach to major medical facility construction, 

VA would obtain by long term lease a number of large outpatient clinics built privately to VA specifications. These large clinics could provide a broad range of outpatient services, including primary and specialty care as well as outpatient mental 

health services and ambulatory surgery. 

According to VA, inpatient needs at such sites would be managed through contracts with affiliates or local private medical centers. The Independent Budget veterans service organizations (IBVSOs) believe that the adoption of Strategic Capital 

Investment Planning (SCIP) and more HCCF leasing proposals illustrate a shift toward reliance on healthcare leasing or a build-to-suit strategy with reliance on community providers or academic affiliates for inpatient services, rather than VA constructing its own comprehensive medical centers. We remain watchful as to how 

such arrangements will be managed and what unintended consequences may await 

sick and disabled veterans and those who represent them. 

Further, SCIP must be clearly explained and integrated with all stakeholders involved in the process—specifically, how will it be developed and prioritized, and will 

the implementation of the HCCF model impact VA’s specialized medical care programs, continuity of high-quality care, delivery of comprehensive services, protection 

of VA biomedical research and development programs, and particularly the 

sustainment of VA’s renowned graduate medical education and health profession 

training programs? VA noted that, in addition to any new HCCF facilities, it would 

maintain its VA medical centers, larger independent outpatient clinics, communitybased outpatient clinics (CBOCs), and rural outreach clinics. 

VA has argued that adopting the HCCF model would allow it to quickly establish 

new facilities that would provide 95 percent of the care and services veterans need 

in their catchment areas, specifically primary care, a variety of specialty care services, mental health, diagnostic testing, and same-day ambulatory surgery. Initially, 

the IBVSOs have been supportive of the goals of this program. The HCCF model 

seems to offer a number of benefits in addressing VA capital infrastructure problems, including more modern facilities that meet current life-safety codes, better geographic placements, increased patient safety, reductions in veterans’ travel costs, 

and increased personal convenience. 

This process could also offer the advantage of quick completion as compared to 

the existing major construction design-authorization-appropriation process, thus allowing more flexibility to respond to changes in patient loads and technologies and 

making possible net savings in operating costs and in facility maintenance. 

While it offers these obvious advantages, the HCCF model raises concerns about 

VA’s plan for providing inpatient services. VA suggests it will contract for these essential services with affiliates or community hospitals. The IBVSOs believe this program would privatize many services that we believe VA should continue to provide 

directly to veterans. We are also deeply concerned about the overall impact of this 

new model on the future of VA’s system of care, including the potential unintended 

430 

consequences on continuity of high quality care; maintenance of VA’s specialized 

medical programs for spinal cord injury, blindness, amputation care, and other 

health challenges of seriously disabled veterans; delivery of comprehensive services; 

its recognized biomedical research and development programs; and, in particular, 

the impact on its renowned graduate medical education and health profession training programs, in conjunction with long-standing affiliations with nearly every health 

professions university in the Nation. 

Moreover, we believe the HCCF model could well challenge VA’s ability to provide 

alternatives to maintaining directly its existing 130 nursing home care units now 

called ‘‘community living centers’’), homelessness programs, domiciliary facilities, 

compensated work therapy programs, hospice and respite, adult day health-care 

units, the Health Services Research and Development Program, and a number of 

other highly specialized services, including 24 spinal cord injury/dysfunction centers, 

10 blind rehabilitation centers, a variety of unique ‘‘centers of excellence’’ (in geriatrics, gerontology, mental illness, Parkinson’s, and multiple sclerosis), and various 

critical care programs for veterans with serious and chronic mental illnesses. 

In general, the IBVSOs believe the HCCF proposal could be a positive development, with good potential. But the process must be transparent to all those involved—veterans, stakeholders, community leaders, VA employees—and there must 

be a well-thought-out and well-communicated plan to carry out the HCCF policy. It 

has been proven that leasing can help to diminish long and costly in-house construction delays and can be adaptable, especially when compared to costs for renovating 

existing VA major medical facilities. Leasing options have been particularly valuable 

for VA as evidenced by the success of the leased-space arrangements for many VA 

community-based outpatient clinics, Vet Centers, and leased VA regional office staff 

expansions. However, the IBVSOs remain concerned with VA’s plan for obtaining 

inpatient services under the HCCF model, and have many unanswered questions. 

There are major concerns with the pervasive contracting that would be mandated 

by this type of proposal. 

Acknowledging all the changes taking place in health care, VA needs to look very 

closely at all its infrastructure plans, and needs to do a better job explaining to veterans, their representatives, and Congress what its plans are for every location, 

with a full exposition based on facts. 

Responding to a Congressional request, VA addressed a number of specific questions related to its plan for the HCCF leasing initiative, including whether studies 

had been carried out to determine the effectiveness of the current approach; the full 

extent of the current construction backlog of projects; its projected cost over the next 

five years to complete; the extent to which national veterans organizations were involved in the development of the HCCF proposal; the engagement of community 

health-care providers related to capacity and willingness to meet veterans’ needs; 

the ramifications on the delivery of long-term care and specialized services; and 

whether it would be able to ensure that needed inpatient capacity would remain 

available indefinitely. 

Based on its response, the IBVSOs believe VA has a reasonable foundation for assessing capital needs and has been forthright with the estimated total costs for ongoing major medical facility projects, and that the HCCF model can be a basis for 

meeting some of these needs at lower cost. We agree with VA’s assertion that it 

needs a balanced capital assets program, of both owned and leased buildings, to ensure that demands are met under current projections. Likewise, we agree with VA 

that the HCCF concept could provide modern health-care facilities relatively quickly 

that might not otherwise be available because of the predictable constraints of VA’s 

major construction program. 

However, what is not clear to us is the extent to which VA plans to deploy the 

HCCF model. In areas where existing CBOCs need to be replaced or expanded with 

additional services due to the need to increase capacity, the HCCF model would 

seem appropriate and beneficial. 

On the other hand, if VA plans to replace the majority or even a large fraction 

of all VA medical centers with Health Care Center Facilities, such a radical shift 

would pose a number of concerns for us. Nevertheless, the IBVSOs see this challenge as only a small part of the overall picture related to VA health infrastructure 

needs. The emerging HCCF plan does not address the fate of VA’s 153 medical centers located throughout the Nation that are on average 60 years of age or older. It 

does not address long-term-care needs of the aging veteran population, inpatient 

treatment of the chronically and seriously mentally ill, the unresolved rural health 

access issues, the lingering questions on improving VA’s research infrastructure, or 

the fate of VA’s academic training programs. Fully addressing these and related 

questions is extremely important and will have an impact on generations of sick and 

disabled veterans far into the future. 

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We would like to reiterate: Creating a VA of the 21st century must include all 

stakeholders’ interests. The IBVSOs expect VA to establish any new infrastructure 

plan in a transparent way; vet that plan through our community and other interested parties; and provide its plan to Congress for review, oversight, and approval 

if required by law. Congress and the Administration must work together to secure 

VA’s future to design a VA of the 21st century. It will take the joint cooperation 

of Congress, veterans’ advocates, and the Administration to support this reform, 

while setting aside resistance to change, even dramatic change, when change is demanded and supported by valid data. 

Finally, one of our community’s frustrations with respect to VA’s infrastructure 

plans is lack of consistent and periodic updates, specific information about project 

plans, and even elementary communications. The IBVSOs ask that VA improve the 

quality and quantity of communications with us, our larger community, enrolled veterans, concerned labor organizations, and VA’s own employees, affiliates, and other 

stakeholders as the VA capital planning process moves forward. We believe that all 

of these groups must be made to understand VA’s strategic plan and how it may 

affect them, positively and negatively. 

Talking openly and discussing potential changes will help resolve the understandable angst about these complex and important questions of VA health-care infrastructure. While we agree that VA is not the sum of its buildings, and that a veteran patient’s welfare must remain at the center of the Department’s concern, VA 

must be able to maintain an adequate infrastructure around which to build and sustain ‘‘the best care anywhere.’’ 

If VA keeps faith with these principles, the IBVSOs are prepared to aid and support VA in accomplishing this important goal. 

Recommendations: 

VA must develop a well-thought-out health-care infrastructure and strategic plan 

that becomes the means for it to establish a veterans health-care system for the 

21st century. Congress, the Administration, and internal and external stakeholders 

must work together to secure VA’s future, while maintaining the integrity of the VA 

health-care system and all the benefits VA brings to its unique patient population. 

VA’s new proposal, the Strategic Capital Investment Planning (SCIP) and VA’s 

health Care Center facility leasing proposal must be clearly explained and integrated with all stakeholders involved in the process, including how will it be developed, prioritized, and implemented, and how it will impact VA’s specialized medical 

care programs, continuity of high-quality care, delivery of comprehensive services, 

protection of VA biomedical research and development programs, and particularly 

the sustainment of VA’s renowned graduate medical education and health profession 

training programs. 

VA must improve the quality and quantity of communications with internal and 

external communities of interests, including the authors of this Independent Budget, 

concerning its plans for future infrastructure improvements through the HCCF leasing and other approaches. 

VA must improve the quality and quantity of communications with internal and 

external communities of interests, including the authors of this Independent Budget, 

concerning its plans for future infrastructure improvements through the HCCF leasing and other approaches. 

EMPTY OR UNDERUTILIZED SPACE AT MEDICAL CENTERS: 

The Department of Veterans Affairs must use empty and underutilized space appropriately. 

The Department of Veterans Affairs maintains approximately 1,100 buildings that 

are either vacant or underutilized. An underutilized building is defined as one 

where less than 25 percent of space is used. It costs VA from $1 to $3 per square 

foot per year to maintain a vacant building. Studies have shown that the VA medical system has extensive amounts of empty space that can be reused for medical 

services. It has also been shown that unused space at one medical center may help 

address a deficiency that exists at another location. Although the space inventories 

are accurate, the assumption regarding the feasibility of using this space is not. 

Medical facility planning is complex. It requires intricate design relationships for 

function, as well as the demanding requirements of certain types of medical equipment. Because of this, medical facility space is rarely interchangeable, and if it is, 

it is usually at a prohibitive cost. Unoccupied rooms on the eighth floor used as a 

medical surgical unit, for example, cannot be used to offset a deficiency of space in 

the second floor surgery ward. Medical space has a very critical need for inter- and 

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intradepartmental adjacencies that must be maintained for efficient and hygienic 

patient care. 

When a department expands or moves, these demands create a domino effect on 

everything around it. These secondary impacts greatly increase construction expense 

and can disrupt patient care. Some features of a medical facility are permanent. 

Floor-to-floor heights, column spacing, light, and structural floor loading cannot necessarily be altered. Different aspects of medical care have various requirements 

based upon these permanent characteristics. Laboratory or clinical spacing cannot 

be interchanged with ward space because of the different column spacing and perimeter configuration. Patient wards require access to natural light and column grids 

that are compatible with room-style layouts. Laboratories should have long structural bays and function best without windows. When renovating empty space, if an 

area is not suited to its planned purpose, it will create unnecessary expenses and 

be much less efficient if simply renovated. Renovating old space, rather than constructing new space, often provides only marginal cost savings. Renovations of a 

specific space typically cost 85 percent of what a similar, new space would cost. Factoring in domino or secondary costs, the renovation can end up costing more while 

producing a less satisfactory result. 

Renovations are sometimes appropriate to achieve those critical functional 

adjacencies, but are rarely economical. As stated earlier in this analysis, the average 

age of VA facilities is 60 years. Many older VA medical centers that were rapidly 

built in the 1940s and 1950s to treat a growing war veteran population are simply 

unable to be renovated for modern needs. Most of these so called ‘‘Bradley-style’’ 

buildings were designed before the widespread use of air conditioning and the floorto-floor heights are very low. Accordingly, it is impossible to retrofit them for modern mechanical systems. Many of them also have long, narrow wings radiating from 

small central cores, an inefficient way of laying out rooms for modern use. This central core, too, has only a few small elevator shafts, complicating the vertical distribution of modern services. Another important problem with this existing unused 

space is its location. Much of it is not in a prime location; otherwise, it would have 

been previously renovated or demolished for new construction. This space is typically located in outlying buildings or on upper floor levels and is unsuitable for modern use. 

Public Law 108–422 incentivized VA’s efforts to properly dispose of excess space 

by allowing VA to retain the proceeds from the sale, transfer, or exchange of certain 

properties in a Capital Asset Fund (CAF). Further, that law required VA to develop 

short- and long-term plans for the disposal of these facilities in an annual report 

to Congress. VA must continue to develop these plans, working in concert with architectural master plans and the long-range vision for all such sites. 

Recommendations: 

VA must develop a plan for addressing its excess space in non historic properties 

that is not suitable for medical or support functions because of its permanent characteristics or locations. 

PROGRAM FOR ARCHITECTURAL MASTER PLANS: 

Each VA medical facility must develop a detailed master plan and delivery models 

for quality health care that are in a constant state of change as a result of factors 

that include advances in research, changing patient demographics, and new 

technology. 

The Department of Veterans Affairs must design facilities with a high level of 

flexibility in order to accommodate new methods of patient care and new standards 

of care. VA must be able to plan for change to accommodate new patient care strategies in a logical manner with as little effect as possible on other existing patient 

care programs. VA must also provide for growth in existing programs based on projected needs through capital planning strategy. 

A facility master plan is a comprehensive tool to examine and project potential 

new patient care programs and how they might affect the existing health-care facility design. It also provides insight with respect to growth needs, current space deficiencies, and other facility needs for existing programs and how they might be accommodated in the future with redesign, expansion, or contraction. 

In many past cases VA has planned construction in a reactive manner. Projects 

are first funded and then placed in the facility in the most expedient manner, often 

not considering other future projects and facility needs. This often results in shortsighted construction that restricts rather than expands options for the future. The 

Independent Budget veterans service organizations believe that each VA medical 

center should develop a comprehensive facility master plan to serve as a blueprint 

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for development, construction, and future growth of the facility; $15 million should 

be budgeted for this purpose. 

We believe that each VA medical center should develop a comprehensive facility 

master plan to serve as a blueprint for development, construction, and future 

growth of the facility. VA has undertaken master planning for several VA facilities, 

and we applaud this effort. But VA must ensure that all VA facilities develop master plan strategies to validate strategic planning decisions, prepare accurate budgets, and implement efficient construction that minimizes wasted expenses and disruption to patient care. 

Recommendations: 

Congress must appropriate $15 million to provide funding for each medical facility 

to develop a 10-year comprehensive facility master plan. The master plan should include all services currently offered at the facility and should also include any projected future programs and services as they might relate to the particular facility. 

Each facility master plan is to be reviewed every five years and modified accordingly 

based on changing needs, technologies, new programs, and new patient care delivery 

models. 

ARCHITECT-LED DESIGN-BUILD PROJECT DELIVERY: 

The Department of Veterans Affairs must evaluate use of architect-led design-build 

project delivery. 

VA currently employs two project delivery methods: design-bid-build and designbuild. Design-bid build project delivery is appropriate for all project types. Designbuild is generally more effective when the project is of a low complexity level. It is 

critical to evaluate the complexity of the project prior to selection of a method of 

project delivery. 

Design-bid-build is the most common method of project design and construction. 

In this method, an architect is engaged to design the project. At the end of the design phase, that same architect prepares a complete set of construction documents. 

Based on these documents, contractors are invited to submit a bid for construction 

of the project. A contractor is selected based on this bid and the project is constructed. With the design-bid-build process, the architect is involved in all phases 

of the project to insure that the design intent and quality of the project is reflected 

in the delivered facility. In this project delivery model, the architect is an advocate 

for the owner. 

The design-build project delivery method attempts to combine the design and construction schedules in order to streamline the traditional design-bid-build method 

of project delivery. The goal is to minimize the risk to VA and reduce the project 

delivery schedule. Design build, as used by VA, is broken into two phases. During 

the first phase, an architect is contracted by VA to provide the initial design phases 

of the project, usually through the schematic design phase. After the schematic design is completed, VA contracts with a contractor to complete the remaining phases 

of the project. 

This places the contractor as the design builder. One particular method of project 

delivery under the design-build model is called contractor-led design build. Under 

the contractor-led design-build process, the contractor is given a great deal of control 

over how the project is designed and completed. In this method, as used by VA, a 

second architect and design professionals are hired by the contractor to complete the 

remaining design phases and the construction documents for the project. With the 

architect as a subordinate to the contractor rather than an advocate for VA, the contractor may sacrifice the quality of material and systems in order to add to his own 

profits at the expense of VA. In addition, much of the research and user interface 

may be omitted, resulting in a facility that does not best suit the needs of the patients and staff. 

Use of contractor-led design-build has several inherent problems. A short-cut design process reduces the time available to provide a complete design. This provides 

those responsible for project oversight inadequate time to review completed plans 

and specifications. In addition, the construction documents often do not provide adequate scope for the project, leaving out important details regarding the workmanship and/or other desired attributes of the project. This makes it difficult to hold 

the builder accountable for the desired level of quality. As a result, a project is often 

designed as it is being built, compromising VA’s design standards. 

Contractor-led design-build forces VA to rely on the contractor to properly design 

a facility that meets its needs. In the event that the finished project is not satisfactory, VA may have no means to insist on correction of work done improperly unless 

the contractor agrees with VA’s assessment. This may force VA to go to some form 

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of formal dispute resolution, such as litigation or arbitration. An alternative method 

of design-build project delivery is architect-led design-build. This model places the 

architect as the project lead rather than the builder. This has many benefits to VA. 

These include ensuring the quality of the project, since the architect reports directly 

to VA. 

A second benefit to VA is the ability to provide tight control over the project budget throughout all stages of the project by a single entity. As a result, the architect 

is able to access pricing options during the design process and develop the design 

accordingly. Another advantage of architect-led design-build is in the procurement 

process. Since the design and construction team is determined before the design of 

the project commences, the request-for-proposal process is streamlined. As a result, 

the project can be delivered faster than the traditional design-bid-build process. Finally, the architect-led design-build model reduces the number of project claims and 

disputes. It prevents the contractor from ‘‘low-balling,’’ a process in which a contractor submits a very low bid in order to win a project and then attempts to make 

up the deficit by negotiating VA change orders along the way. 

In addition to selecting the proper method of project delivery, there is much to 

learn from the design and construction process for each individual project. It is important for VA to apply these ‘‘lessons learned’’ to future projects. 

Recommendations: 

VA must establish a category system ranking design/construction project types by 

complexity. This system should be used to determine if the project is a candidate 

for the design-build method of project management. The design-build method of 

project delivery should only be used on projects that have a low complexity, such 

as parking structures and warehouses. For health-care projects, VA must evaluate 

the use of architect-led design build as the preferred method of project delivery in 

place of contractor-led design-build project delivery. VA must institute a program of 

‘‘lessons learned.’’ This would involve revisiting past projects and determining what 

worked, what could be improved, and what did not work. This information should 

be compiled and used as a guide to future projects. This document should be updated regularly to include projects as they are completed. 

INCREASE NEED FOR VA RESEARCH SPACE AND INFRASTRUCTURE MPROVEMENTS: 

The Department of Veterans Affairs needs research space renovations and improved 

infrastructure. 

A state-of-the-art physical environment for VA research promotes excellence in 

science as well as teaching and patient care. Research opportunities help VA recruit 

and retain the best and brightest clinician scientists to care for veterans. However, 

many VA facilities effectively have run out of usable research space. Also, research 

‘‘wet’’ laboratory ventilation, electrical supply, plumbing, and other projects appear 

frequently on internal VA lists of needed upgrades along with research space renovations and new construction, but these projects languish due to the weight VA 

places on direct medical care projects as opposed to research space and facility 

needs. 

Five years ago, the House Appropriations Committee expressed concern (House 

Report 109–95) that ‘‘equipment and facilities to support the research program may 

be lacking and that some mechanism is necessary to ensure the Department’s research facilities remain competitive.’’ The Committee directed VA to conduct a comprehensive review of its research facilities and report to the Congress on the deficiencies found and suggestions for correction of the identified deficiencies. 

To comply, VA initiated a comprehensive assessment of VA research infrastructure. To prompt VA to complete its long overdue assessment, House Report 111– 

564 accompanying the FY 2011 VA appropriations bill directed the Department to 

provide its final report to Congress by September 1, 2010, with details of any recent 

renovations or new construction. 

As of publication of this Independent Budget, VA had not released the results of 

its review. According to an October 26, 2009, VA report to the VA National Research 

Advisory Committee, however, preliminary results of the review indicated, ‘‘there is 

a clear need for research infrastructure improvements throughout the system, including many that impact on life safety.’’ 

The Independent Budget veterans service organizations (IBVSOs) are concerned 

that a significant cause of VA’s research infrastructure neglect is that neither VA 

nor Congress provides direct funding for research facilities. The VA Medical and 

Prosthetic Research appropriation excludes funding for construction, renovation, or 

maintenance of VA research facilities. VA researchers must rely on their local facility management to repair, upgrade, and replace research facilities and capital equipVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00440 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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ment associated with VA’s research laboratories. As a result, VA research competes 

with other medical facility direct patient care needs (such as medical services infrastructure, capital equipment upgrades and replacements, and other medical maintenance needs) for funds provided under either the Major Medical Facility, Minor Construction, or Medical Facilities appropriations accounts. 

The IBVSOs believe that correction of VA’s known infrastructure deficiencies 

should become a higher VA and Congressional priority. Therefore, we recommend 

VA promptly submit to Congress the report it requested in 2006, provide construction funding sufficient to address VA’s five highest priority research facility construction needs as identified in its facilities assessment report, and approve a pool 

of funding targeted at renovating existing research facilities to address the current 

and well-documented shortcomings in research infrastructure. For these funding 

needs we recommend $150 million and $50 million, respectively. Additionally, an 

emerging problem is that VA research facilities often are not an integral component 

of planning for new VA medical centers (including new medical centers in Las 

Vegas, Denver, and Orlando). 

Modern-day biomedical research needs customized power, safety, privacy, and configuration requirements that should be fundamental to the new construction planning processes, not an expensive afterthought. The IBVSOs urge the Administration 

to require that research space be made an integral component of planning for every 

new medical center and that such space be designed by architects and engineers experienced in contemporary research facility requirements. 

Recommendations: 

Congress should require VA to report its findings from its research infrastructure 

review, now pending more than five years. Congress should authorize construction 

of, and appropriate $150 million in FY 2012 to advance, the five highest priority 

research construction projects identified by VA in its research infrastructure review, 

and provide VA an additional $50 million in maintenance funding (in the Non Recurring Maintenance account) in FY 2012 to address current shortfalls in VA’s research laboratories and other research space. 

PRESERVATION OF VA’S HISTORIC STRUCTURES: 

The Department of Veterans Affairs must further develop a comprehensive program 

to preserve and protect its inventory of historic properties. 

The Department of Veterans Affairs has an extensive inventory of historic structures that highlight America’s long tradition of providing care to veterans. These 

buildings and facilities enhance our understanding of the lives of those who have 

worn the uniform, of those who cared for their wounds, and of those who helped 

to build this great Nation. Of the approximately 2,000 historic structures in the VA 

historic building inventory, many are neglected and deteriorate year after year because of a lack of any funding for their upkeep. These structures should be stabilized, protected, and preserved because they are an integral part our Nation’s 

history. 

Most of these historic facilities are not suitable for modern patient care but may 

be used for other purposes. For the past seven years, The Independent Budget veterans service organizations (IBVSOs) have recommended that VA conduct an inventory of these properties to classify their physical condition and study their potential 

for adaptive reuse. VA has moved in that direction; historic properties have been 

identified. Many of these buildings have been placed in an ‘‘Oldest and Most Historic’’ list and require immediate attention. 

The cost for saving some of these buildings is not very high considering that they 

represent a part of American history. Once gone, they cannot be recaptured. For example, the Greek Revival Mansion at the VA Medical Center in Perry Point, Maryland, built in the 1750s can be restored and used as a facility or network training 

space for about $1.2 million. The Milwaukee Ward Memorial Theater, built in 1881, 

could be restored as a multipurpose facility at a cost of $6 million. These expenditures would be much less than the cost of new facilities and would preserve history 

simultaneously. The preservation of VA’s historic buildings also fits into the VA’s 

commitment to ‘‘green’’ architecture. Materials would be reused, reducing the 

amount of resources needed to manufacture and transport new materials to building 

sites. 

As part of its adaptive reuse program, VA must ensure that facilities that are 

leased or sold are maintained properly. VA’s legal responsibilities could, for example, be addressed through easements on property elements, such as building exteriors or grounds. The IBVSOs encourage VA to use the tenants of Public Law 108– 

422, the ‘‘Veterans Health Programs Improvement Act,’’ in improving the plight of 

436 

VA’s historic properties. This act authorizes historic preservation as one of the uses 

of the proceeds of the capital assets fund resulting from the sale or leases of other 

unneeded VA properties. 

Recommendations: 

VA must continue to develop a comprehensive program to preserve and protect 

its inventory of historic properties. VA must allocate funding for adaptive reuse of 

historic structures and empty or underutilized space at medical centers. 

Madam Chairwoman, this concludes my statement. I would be happy to answer 

any questions that you or the Members of the Committee may have. 

Chairman MURRAY. Thank you very much. 

Mr. Tetz. 

STATEMENT OF TIM TETZ, DIRECTOR, NATIONAL 

LEGISLATIVE COMMISSION, THE AMERICAN LEGION 

Mr. TETZ. Madam Chair, Ranking Member Burr, thank you for 

opportunity to come before you and testify on behalf of the American Legion. 

As a parent of an 8- and 10-year-old, I am continually presented 

with tears and crying. As every parent knows, all crying is not the 

same. All tears do not have the same weight. There is a reason for 

the water works, the crying. Your task as a parent is to find it, find 

the base reason, then you have a much better chance of having a 

peaceful evening; but if you are successful in finding only one of 

the reasons, your evening is bound to be less than enjoyable. 

Crying might have been what brought her pain to your attention 

but the underlining symptom might be a fever of 104. Your first 

response has to be to get that fever down; but ultimately, if you 

want to have a lasting success, you need to understand the underlying causes of the fever. Crying is one symptom. The fever is another. The true problem is an infection. 

Congress, the VA, and the veterans’ service organizations have 

presented with or demonstrated on a number of occasions some of 

this crying, some of these symptoms. We have all had our moments 

of crying. Our task must now focus on treating those symptoms of 

that underlying infection. This infection manifests itself in many 

ways. 

We have all spoken to the backlog of claims. VA processes over 

a million claims a year. Over the past years we have thrown money 

at IT solutions in the form of VBMS, personnel, and wave after 

wave of new hires, and a multitude of new pilot programs. Yet 

have we treated the symptom or the root infection? 

The VA claim system is broken because VA places an undue 

stress on the numbers of claims processed and a minimal stress on 

accuracy. New IT tools that are used to implement the old system 

will just allow us to make these mistakes faster. It will not unclog 

the system because the cycle of improper denials and appeals will 

not go away. 

This budget gives VA quite a bit of money to implement the IT 

programs and initiatives. But does it fix it all the way? Does it establish a system that incorporates rules-based processing to enhance accuracy? VA must build a system that tracks individual 

error and holds stations accountable for not only the volume of 

work they accomplish but also the accuracy of that work. 

437 

Treat the root of the problem, not the symptom. Spending money 

to prevent symptoms and infection from rising is just as important 

as treating them once they arise. 

Investment in infrastructure and facilities ensures that today’s 

cough does not turn into tomorrow’s infection. Infrastructure, modernization, and facilities adequate to meet the needs of our Nation’s 

veteran population—these are foundational expenditures. 

Construction money is money you have to spend now or you will 

surely spend it later. When you spend it later, you always spend 

more. 

The American Legion is troubled to see the proposed major con- struction has dropped from $1.1 billion in 2010 to less than half 

that figure in 2012 with minor construction also seeing a nearly 

$200 million decrease. 

We have seen firsthand in our annual System Worth Saving 

(SWS) visits, the need for such expansion and infrastructure to 

meet the needs of the growing veterans community, and we strongly urge Congress to at least meet the previous level of funding. 

This cannot be an area to cut corners when so many rural veterans are hungry for access to the VA health care, when urban facilities lack the adequate needs, and when cities like Denver, New 

Orleans, and Las Vegas await new medical centers to serve the veterans in a manner they deserve. 

The American Legion remains cautiously optimistic that the Fiscal Year 2012 Budget proposal will meet the needs of our Nation’s 

veterans. 

We appreciate the effort the VA has made toward addressing the 

symptoms and issues that currently face our Nation’s veterans. We 

challenge their reduction of funding in programs and budgets that 

have long-term consequences. 

Full funding of the VA to meet the needs of veterans is essential. 

Regardless of politics, if there is a cost to be met to care for veterans who have borne the battle of this Nation, we must bear that 

cost. To do so requires sacrifice, but the American Legion understands the importance of insuring there is no waste in that sacrifice. 

Be vigilant and keep oversight over the VA to ensure that the 

money ‘‘we the people’’ give is spent as wisely as possible without 

waste and with efficiency and consistency. 

I thank you again for the opportunity to provide this testimony 

and will gladly answer any questions. 

[The prepared statement of Mr. Tetz follows:] 

PREPARED STATEMENT OF TIM TETZ, DIRECTOR, NATIONAL LEGISLATIVE COMMISSION, THE AMERICAN LEGION

Madam Chairman and Members of the Committee: The American Legion welcomes this opportunity to comment on the President’s Department of Veterans Affairs (VA) budget request for fiscal year (FY) 2012 and 2013. 

The American Legion is pleased to see the budget, at a proposed 10.6 percent increase over 2010 levels, recognizes many of the needs faced by veterans and that 

this continues to be an area where we must ensure proper funding. The nation is 

facing many difficult challenges, and the veterans of America face many of their 

own challenges. Not only do we see the return of large numbers from two overseas 

wars, we also face the challenges of an aging veterans’ population from previous 

wars. Unemployment strikes veterans at a rate two thirds higher than the general 

population and medical challenges are only now beginning to be understood in the 

form of Traumatic Brain Injury (TBI) and long term issues such as the effects of 

438 

environmental exposures in Vietnam and the Gulf War Theater and the psychological effects of war from Posttraumatic Disorder (PTSD). 

Not only do external challenges such as these affect veterans, but internal obstacles within VA also represent significant challenges to be met by a budget. VA is 

transforming to 21st century ‘‘paperless’’ technology through the Veterans Benefits 

Management System (VBMS.) Will it be enough to turn the tide against a rising 

backlog when VA is awash in a sea of claims that has topped one million each of 

the past two years? This is a major concern. VA facilities, be they medical, administrative or for the purposes of our national cemeteries are much in need of upgrades 

and expansion to properly serve the veterans’ community. 

These all point to the importance of a fully funded VA to meet the needs of the 

growing numbers of veterans. It is vital to ensure that the mission set forth by 

President Lincoln, ‘‘To care for him who shall have borne the battle, and for his 

widow and his orphan,’’ must not be given short shrift despite the economic woes. 

This debt must be honored. 

However, this is also a time of fiscal responsibility. The American Legion believes 

there should never be a wasted dollar spent in the service of veterans and that a 

maximum amount of the money spent must find its way down to the veteran on 

the street level. If there is a cost to be paid to care for the veterans of this country 

we must pay it, but the money must be used efficiently and prudently. This is a 

time for smart money. 

Smart money is investing in infrastructure. Infrastructure is construction money 

wisely spent and research to stay ahead of medical conditions before the most devastating lasting effects can be felt. Smart money is avoiding duplicative spending 

and making sure the money saved goes to places where even a small shortfall can 

be a major setback. Smart money is ensuring the Information Technology (IT) transformation of VA does more to transform the operational mindset and less to give 

electronic tools that repeat the errors of the past—but with greater speed. 

It is also important to recognize investment in veterans is not investment in a 

vacuum or isolated community that has little impact on the rest of America. It was 

once noted that if you wanted to ‘‘reach the veterans of America’’ you should simply 

speak to the whole of America, for they have integrated into near every community. 

Urban or rural, from Washington state to Puerto Rico and Maine to Hawaii veterans are an integral part of the community and money invested in veterans shores 

up these communities. 

A simple example is VA’s Home Loan program, which provides low interest loans 

to veterans with no down payment and minimal closing costs. In a time where foreclosures have crippled the American housing markets, VA Home Loans have performed better than any other class of loans. In fact, according to the Mortgage 

Bankers Association, in 2010, the VA’s percentage of loans that are seriously delinquent or in foreclosure is the lowest of all measured loan types—lower even than 

prime loans. In this way it is clear to see that investing in veterans can provide 

stability to communities that help all citizens in the difficult economy. It is all the 

more important that vital, community stabilizing programs such as the VA Home 

Loan program, receive full funding and are not curtailed in a short sighted aim of 

trimming a budget that only creates greater costs in the future. 

There are, however, two issues the American Legion urges Congress to address 

that will make this program fully functional and as effective as it deserves to be: 

first—the extension of the VA’s maximum guaranty amount which is currently set 

to snap back at the end of this fiscal year; and second—providing a fee structure 

that is not over-burdensome but ensures that the program is self-sustaining. Surely 

a self sustaining program that provides stability to America’s housing market while 

returning the investment that veterans have made to their country is about as 

smart money as Congress can provide. 

This is not a line-by-line excoriation and examination of a budget. This is an attempt to recognize the important areas The American Legion believes Congress 

must consider while determining the overall budget. Washington DC has a reverence for the new. Part and parcel of this reverence is often to roll out sexy new 

programs to solve the errors of the past, while letting the old programs languish 

in the background, still on the books and draining money, yet broken and creating 

drag on operations like a jammed chain on a bicycle. Sometimes the smarter choice 

is to ensure what you already have is working. It can be better to make fundamental repairs that bolster the existing system rather than throw the baby out with 

the bath water and reinvent the wheel. 

The VA has a unique medical system that is tailor-made to push cutting edge research, but it must be bolstered and funded to do so. The VA is expanding medical 

facilities and programs to provide outreach to rural veterans who are a more difficult community to serve. As more veterans move to rural areas, this must be conVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00444 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
439 

tinued to help meet their needs. VA has dedicated doctors and health care professionals who work hard to treat the veterans of this country; they must have the best 

facilities we can provide them. Veterans must have basic amenities at their health 

care facilities like parking and child care, or they cannot make use of the excellent 

system that serves their health care needs. There is an extensive network of state 

veterans’ homes, yet duplicative evaluation of these homes by both VA and SMS 

leads to millions of dollars of waste that could be better applied elsewhere, and this 

is only one example of overlap. VA has spent millions of dollars on dozens and dozens of pilot programs to fix the model of operations that has led to a multiyear backlog for veterans’ disability claims. It’s time to make the most of the lessons gleaned 

from these pilots and Congressional studies; it’s time to stop studying and start 

implementing. 

MEDICAL AND PROSTHETIC RESEARCH

While the President’s proposed budget points to $6.2 billion in funds to care for TBI 

and PTSD, the vast majority of this money is directed solely at care and not at 

funding the research that will improve care and reduce the future costs incurred 

in treating these conditions. 

The American Legion believes VA’s focus in research must remain on understanding and improving treatment for medical conditions that are unique to veterans. Servicemembers are surviving catastrophically disabling blast injuries due to 

the superior armor they are wearing in the combat theater and the timely access 

to quality combat medical care. The unique injuries sustained by the new generation 

of veterans clearly demand particular attention. It has been reported that VA does 

not have state-of-the-art prostheses like DOD and that the fitting of prostheses for 

women has presented problems due to their smaller stature. 

There is no reason that VA should not be the preeminent source of research in the 

world in the treatment of PTSD, TBI and prosthetic and amputee medicine. 

There is a need for adequate funding of other VA research activities, including 

basic biomedical research and bench-to-bedside projects. Congress and the Administration should continue to encourage acceleration in the development and initiation 

of needed research on conditions that significantly affect veterans, such as prostate 

cancer, addictive disorders, trauma and wound healing, Post Traumatic Stress Disorder, rehabilitation, and other research that is conducted jointly with DOD, the National Institutes of Health (NIH), other Federal agencies, and academic institutions. 

As challenging health concerns such as the long term effects of TBI, exposures 

to environmental hazards in domestic and overseas deployment, and the mental 

health impact of exposure to combat conditions as well as sexual trauma and assault develop, it is essential that VA lead the way in research and development to 

combat and treat these conditions. Servicemembers affected by these conditions will 

have a deep and lasting effect on the economy through their ability to contribute 

if these conditions are not treated and mitigated. Learning to attack these conditions early can very often be the difference between manageable symptomatology 

and more devastating and less treatable levels in the future. Quite simply, the more 

that can be learned about diagnosing and treating these conditions, the more likely 

this Nation can avert catastrophic impact in the future. 

Yet this proposed budget cuts funding from this vital area. The FY 2010 Final 

Budget saw an allocation of $581 million in this area, slashed by $72 million to $509 

million in the proposed FY 2012 Budget. In a budget seeing increases in many other 

areas, a reduction to this critical area cannot be overlooked. 

Truly, investing in research at the onset is investing in the future. While The 

American Legion applauds the VA budget’s stated research priorities of Mental 

Health, Gulf War Illness and Environmental Exposures, Prosthetics, and Traumatic 

Brain Injury and Spinal Cord Injuries, the allocated $509 million should be made 

more robust. As the lesson learned from Agent Orange exposure in Vietnam should 

have taught us, research delayed into developing residuals of war can have devastating economic impact down the road. Money invested now in this research has 

the potential to not only save this Nation money in the long run, but also ameliorate 

and alleviate the suffering of veterans at a time when the long-term impact can be 

minimized. 

CONSTRUCTION—MAJOR AND MINOR

As a part of the preparation for the annual System Worth Saving (SWS) reports, 

The American Legion has seen firsthand the structural deficiencies and challenges 

faced with the infrastructure of the VA health care system. During those site visits, 

many VA Medical Center staff have informed Legion personnel that they are unable 

440 

to dedicate needed funds toward construction projects due to the funding needs of 

actual medical care. Furthermore, many VA construction projects were only made 

possible through the use of funding from the America Reinvestment and Recovery 

Act. Such money is no longer available to meet the construction needs to shore up 

VA infrastructure in areas such as seismic criteria, aging electrical systems, insufficient parking and space utilization, and other needed areas. Therefore, the need to 

fully fund this area of the budget is even more apparent. 

Recent reports of the VA Regional Office in Roanoke, VA noted that the floors of 

the building were in danger of collapsing due to the aggregate weight of the files. 

While this highlights yet another major implication of the claims backlog, it further 

underlines that this is not an area where VA can afford to scrimp and save. Substandard facilities do not serve the veterans of this country. 

Construction is money that must be spent, either now or later. When the choice is 

made to spend later, the cost is always much higher. 

If we are to truly invest in the future of this country, there are few more sound 

decisions to be made than investing in infrastructure. Just as the roads and bridges 

of America must be shored up to support the crumbling infrastructure and prevent 

even greater costs down the road, so too must the infrastructure of VA be solidified 

to meet the needs of the growing veterans’ community. 

Whether it is much needed medical facilities to the rural regions of the country, 

repairs to aging urban hospitals, proper laboratory facilities, adequate parking, or 

other needs, it is short sighted to see opportunities to cut here, for cuts to this area 

now will only bring greater costs down the road. The wise fiscal decision is to invest 

carefully now to head off ballooning costs in the future. 

IT SYSTEMS

Since the data theft occurrence in May 2006, VA has implemented a complete 

overhaul of its Information Technology (IT) division nationwide. The American Legion hopes VA continues to take the appropriate steps to strengthen its IT security 

to regain the confidence and trust of veterans who depend on VA for the benefits 

they have earned. 

As acknowledged by the GAO Report 11–265, ‘‘Electronic Health Records: DOD 

and VA Should Remove Barriers and Improve Efforts to Meet Their Common System Needs’’ there are still major hurdles to be overcome to achieve the goals set 

forth of a Virtual Lifetime Electronic Record for servicemembers from induction 

through the rest of their lives as active duty and veteran. The President’s budget 

sets aside monies for this purpose, but it is vitally important to ensure that this 

component is not left behind, nor allowed to falter. Achieving this goal should remain a major priority of both DOD and VA in cooperation with one another. 

The American Legion supports the centralization of VA’s IT. The amount of work 

required to secure information managed by VA is immense. The American Legion 

urges Congress to maintain close oversight of VA’s IT restructuring efforts and fund 

VA’s IT to ensure the most rapid implementation of all proposed security measures. 

Obviously, with VA’s transformation of the Veterans Benefits Administration 

(VBA) to a ‘‘paperless’’ processing system through the Veterans Benefits Management System (VBMS) this can be an area of great savings overall for VA as VBA 

moves out of the research and piloting stage of this system and into regular operations. Startup costs can now be eliminated and hopefully VA will be vigilant in ensuring that this new system offers the speed and accuracy promised. 

FISCAL RESPONSIBILITY

Fiscal responsibility is, of course, a vital concern in the difficult times we are facing as a Nation. The American Legion believes strongly money spent must be utilized wisely. To this end, all aspects of operation must be scrutinized, and where 

waste and mismanagement needlessly contribute to an inflated budget, these must 

be eliminated. Rather than wholesale cutting of necessary infrastructure, areas of 

redundancy must be sought, and targeted cuts to those areas serve a far better purpose in managing the budget of VA. 

Better coordination with outside evaluations can help reduce internal costs of 

evaluation. State veterans’ homes are evaluated not only by VA internal evaluation, 

but also by outside CMS evaluation. Better coordination and standardization of 

evaluation could result in reduced costs of VA evaluations of millions of dollars by 

reducing this level of redundancy. The American Legion has similarly called for 

some time for VA to accept outside, third party evaluation of accuracy and quality 

rates in the benefits management and claims system. Such outside evaluation could 

441 

further reduce costs where areas of redundancy with VA’s own evaluative process 

can be found. 

To be sure, such savings may seem small in comparison to the entirety of the 

budget. Elimination of the above redundancy could provide savings on the level of 

around $10 million. However, when considered against the balance of small areas 

where a little money goes a long way, the impact of such savings and the proper 

redistribution of this money could be great. 

VA’s funding of State Cemetery Grants contributes in many ways to a vital task, 

providing for the respectful repose of our Nation’s veterans in conjunction with the 

National Cemetery Administration (NCA.) The grants cover everything from major 

construction to basic irrigation and bringing these state cemeteries to National 

Shrine Standards. As the horrifying situation played out over the last few years 

across the river in Arlington National Cemetery has proven, or tales of missing 

headstones or grounds gone to seed and disrepair in other locations attest, there are 

few more unconscionable acts than to give substandard service to the families of veterans in their interment. NCA takes such failings seriously, and works tirelessly to 

preserve their status as one of the top two organizations in service and satisfaction 

in the entire Nation. We cannot fall short in meeting these National Shrine Standards. A mere $5 million dollars has been estimated to be the difference between 

fully funding the available projects and letting some projects slide to backlog status. 

Some projects may cost as little as a few hundred thousand dollars or even less. 

VA has already let our living veterans down by allowing claims service to fall into 

backlog status, they cannot afford to allow a similar lapse in our veterans’ 

cemeteries. 

Better Central Office oversight is further needed at the local level to ensure that 

money directed to the VISNs and Regional Offices are being spent in accordance 

with the direction of the administration. All too often in The American Legion’s visits to local areas as a part of the System Worth Saving (SWS) Reports and Regional 

Office Action Review (ROAR) sees wide variances in execution from region to region. 

To truly manage the budget of VA most effectively, developing uniform consistency 

is vital across the country. 

The President’s budget includes vastly rising costs in administrative areas, such 

as increases ranging from 41% in the Office of the Secretary to nearly 100% in the 

Office of Policy Planning and well over even that for the Office of Public and Intergovernmental Affairs. Certainly VA has struggled to meet demands, and has been 

woefully late in compliance with implementation of Public Laws enacted. A HVAC 

DAMA Subcommittee meeting last year regarding Public Law 110–389 that found 

nearly half of the provisions short of implementation well over a year and a half 

past the passage of the law. Delays in implementation and publication of new Agent 

Orange regulations are well documented. Certainly we must not overlook the recent 

tardiness in an implementation plan for the Caregivers’ Act. If VA is short staffed 

and unable to comply with basic regulations for operations, they should be given 

adequate staffing. Congress has generously provided VA with additional staffing for 

their claims processors that Acting Undersecretary for Benefits Michael Walcoff has 

recently stated in testimony is now sufficient for VA to reduce the backlog and meet 

the Secretary’s stated goal of no claims languishing longer than 125 days at a 98 

percent accuracy rate. If the Central Office truly needs this plus up of numbers to 

adequately manage the ability of VA to complete their daily tasks, then this funding 

is welcomed. 

The American Legion does underline the need to ensure that this staffing is essential. As belts are tightened in budget season, not only in Washington but in 

every household across the country, we cannot afford wasteful spending. Every 

penny spent must be to the good cause of helping the veteran at ground level. 

CONCLUSION

Madame Chairwoman and Members of the Committee, The American Legion believes it is absolutely critical that the entire military and veterans’ community (active-duty, Reserve Component, and veterans) continue to remain supportive of honorable military service. No servicemember should ever doubt: 

• the quality of health care he or she will receive if injured; 

• the availability of earned benefits for honorable military service upon discharge; 

or 

• the quality of survivors’ benefits should he or she pay the ultimate sacrifice. 

A true investment in the future means investing in key areas of infrastructure 

now and not making short sighted cuts to vital areas that will only bring greater 

costs down the road. 

442 

Full funding of essential projects such as research in emerging health risks and 

disabilities, as well as the physical infrastructure of VA facilities will be the prudent 

choice now to stave off even greater financial burdens down the road. VA must meet 

these challenges with an adequate budget to fund these necessary aims. 

VA MEDICAL DISCRETIONARY PROGRAMS 

P.L. 111–117 

FY 2010 VA 

Final Funding 

P.L. 111–322 

FY 2011 VA 

Funding 

President’s 

FY 2012 VA 

Budget 

Proposal 

FY 2013 

Proposed 

Advance 

Appropriations 

American 

Legion’s 

FY 2013 

Request 

Medical Services ....................................... $34.7 billion $37.1 billion $39.5 billion $41.3 billion $38.1 billion 

Medical Support & Compliance ................ $4.9 billion $5.3 billion $5.4 billion $5.7 billion $5.3 billion 

Medical Facilities ...................................... $4.8 billion $5.7 billion $5.4 billion $5.4 billion $6.2 billion 

Medical/Prosthetic Research .................... $581 million $581 million $509 million $600 million 

Medical Care Collections Fund ................. [$2.9 billion] [$2.9 billion] [$3.1 billion] 

Total Medical Care ................. $47.9 billion $51.6 billion $53.9 billion $52.4 billion $50.2 billion 

VA NON-MEDICAL DISCRETIONARY PROGRAMS 

P.L. 111–117 

FY 2010 VA 

Final Funding 

P.L. 111–322 

FY 2011 VA 

Funding 

President’s 

FY 2012 VA 

Budget 

Proposal 

American 

Legion’s 

FY 2012 

Request 

Major Construction .............................................................. $1.2 billion $1.2 billion $590 million $1.2 billion 

Minor Construction .............................................................. $703 million $703 million $550 million $800 million 

State Veterans’ Homes Construction Grants ....................... $100 million $100 million $85 million $100 million 

State Veterans’ Cemeteries Construction Grants ................ $46 million $46 million $46 million $60 million 

General Operating Expenses ................................................ $2.1 billion $2.5 billion $2.5 billion $2.6 billion 

Information Technology ........................................................ $3.3 billion $3.3 billion $3.2 billion $3.5 billion 

National Cemetery System ................................................... $250 million $250 million $251 million $260 million 

Chairman MURRAY. Thank you very much. 

Ms. Hooker. 

STATEMENT OF MARYANN D. HOOKER, M.D., LEAD NEUROLOGIST, WILMINGTON, DELAWARE, VA MEDICAL CENTER, REPRESENTING AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES 

Dr. HOOKER. Thank you very much, Madam Chairman, Ranking 

Member Burr, and other Members of the Committee in absentia. 

Thank you for the opportunity to testify on behalf of AFGE regarding clinical staff and resource realignments mentioned in the VA’s 

budget request. 

I joined VA in 1991. Prior to that, I rotated through several VA 

hospitals during medical school, internship, and residency. I greatly appreciate the education I received during my training years. 

I wonder how the proposed realignment will impact medical education and academic affiliations if physicians are shifted away from 

patients. 

As a neurologist, I work with a number of special patient populations: patients with spinal cord injury; multiple sclerosis; Traumatic Brain Injury; amyotrophic lateral sclerosis; dementia; and 

Parkinson’s disease to mention a few. 

The veterans I see for second level Traumatic Brain Injury 

screens are sent to be evaluated for those subtle changes that cannot be picked up on routine examinations. Those changes that lead 

443 

to many years of lost work, lost relationships, and lost lives due to 

missing the diagnosis. 

Parkinson’s disease is another entity where specialty expertise is 

invaluable both in making the correct diagnosis and in developing 

the proper treatment in concert with the patient. 

I see a lot of women veterans who suffer from migraine and other 

pain syndromes where specialty care also lessons the burden of suffering and allows patients to lead more productive lives. 

Without knowing the specifics of VA’s proposed changes, I can 

only speak from direct experience in saying that the substitution 

of other providers for physicians or LPNs for RNs may, in some 

cases, have very negative effects to the health care team—patient 

and provider alike. 

Each member serves a unique role. Indeed, the patient care center initiative of which Patient Aligned Care Teams or PACT is, but 

one aspect, if properly implemented, perfectly illustrates the symbiotic relationships inherent in providing good medical care. 

I have to tell you, though, because some of these initiatives have 

already begun, that I am seeing patients who have not seen their 

primary care provider in over 2 years. 

They are already lost to the VA system either through frustration with having to repeatedly call for appointments because there 

are no real openings or through the lack of adequate support staff 

to notify them of the need to make appointments, either by sending 

out the letters or making the telephone calls or even printing the 

reports to show who is missing from the system. 

Gaming strategies such as these to show the achievement of 30- 

day access to providers will be even more egregious as VA implements 14-day access performance measures. 

Realignment leading to less care providers will only exacerbate 

these problems. Primary care providers already are overburdened 

by the constant need to document completion of ever increasing 

numbers of clinical reminders. 

They frequently are shifted among teams or clinical locations to 

cover staff shortages. They no longer know which patients are on 

their panels and patients no longer know their primary care provider. 

Rather than addressing failures in the current system, we are 

moving on to the next great thing that will not be fully funded at 

the facility level. 

All this constant shuffling of patients and care providers leads to 

high levels of staff turnover which is very costly. Nurses forced to 

work at the top of their scope, such as in the emergency department or intensive care unit, frequently are asked to work outside 

their scope. This leads to more stress, more burn out, more staff 

turnover, and more medical misadventures. 

Patients feel this stress too as they identify very strongly with 

their VA care providers. 

In our behavioral health service, 12 providers have left in less 

than 2 years. Only four have been replaced. For patients receiving 

behavioral health care services—our most fragile population, they 

are expected to cope, manage, and navigate themselves through a 

fractured system of care that is not integrated with primary care 

that itself is also fractured. 

444 

Care Coordination Home Telehealth, is another program under 

the Patient Centered Care initiative, though this one with the goal 

of keeping patients out of the hospital and away from the clinics, 

also is not well-integrated with primary care. 

The nurses in this program work from templates and standardized order sets to manage the care of patients with complex problems such as diabetes, hypertension, and PTSD, all without the direct input of the patient’s primary care provider. 

I view my work at VA as an avocation more than a vocation. I 

have a deep respect for the men and women who served and have 

served in the Armed Forces. My father was in the Army and was 

awarded the Bronze Star. It is in his honor that I serve; and it is 

in the honor of the servicemembers past and present, with them in 

mind on behalf of AFGE that I express concern over these proposed 

changes. 

Thank you. 

[The prepared statement Dr. Hooker follows:] 

PREPARED STATEMENT OF MARYANN D. HOOKER, M.D., LEAD NEUROLOGIST, WILMINGTON, DELAWARE, VA MEDICAL CENTER, SECRETARY, AFGE LOCAL 342 

Chairman Murray, Ranking Member Burr and Members of the Committee: The 

American Federation of Government Employees (AFGE) and the AFGE National VA 

Council (NVAC) (hereinafter ‘‘AFGE’’) appreciate the opportunity to testify today on 

the Fiscal Year (FY) 2012 budget for the Department of Veterans’ Affairs (VA). 

AFGE represents more than 200,000 VA employees, including nearly 120,000 Veterans Health Administration (VHA) employees providing direct medical services to 

veterans. 

AFGE’s testimony focuses primarily on the portion of the VA’s FY 2012 budget 

request that relates to ‘‘Clinical Staff and Resource Realignment’’. The budget request assumes yearly savings of $151 million (in FY 2012 and FY 2013) based on 

three realignments: 

• Conversion of selected physician to non-physician providers; 

• Conversion of selected registered nurses (RN) to licensed practical nurses 

(LPN); and 

• More appropriate alignment of required clinical skills with patient needs. 

The lack of details in this proposal leaves many questions unanswered: which 

physician duties will be assigned to an RN? Will LPNs replace RNs in both inpatient and outpatient settings? Will staff be realigned in behavioral health and specialized medical services? 

Without more specifics, it is difficult to assess whether these proposed conversions 

to lower skilled positions will result in a more efficient use of scarce VA medical 

dollars, or a harmful deskilling of the care we provide to veterans, many of whom 

are chronically ill or severely disabled. We urge the Committee to consider the following: 

• How will the proposed staff realignment impact the quality of care that our veterans receive? 

• How will it impact veterans’ access to care? 

• Will this realignment actually produce anticipated savings for taxpayers over 

the short run or the long run? 

• Perhaps most important: Is the pursuit of these modest savings worth the risk 

of unintended consequences to veterans? 

Fortunately, AFGE’s assessment need not be purely theoretical; the VA is already 

attempting to achieve efficiencies through staff realignment, telehealth, team-based 

care, group appointments and shorter appointments, among other cost containment 

strategies. Unfortunately, what AFGE has learned so far from our gives us cause 

for concern. Too often, these realignments and cost containment strategies are implemented without proper oversight or advance planning, resulting in reduced access and quality of care. Also, rather than saving money, they sometimes cost the 

taxpayer more, in the form of costly contract care, less continuity of care and higher 

staff turnover. We also note that every time patients are reassigned, care coordination may suffer, clinicians have to spend additional time to learn the needs of a new 

patient, and veterans have to build relationships with new providers. 

445 

The impact of staff and resource realignment also will depend in part on whether 

it was planned or merely the unintended byproduct of budget shortfalls and hiring 

freezes. Yes, shortfalls and hiring freezes have not disappeared from the VHA landscape despite advance appropriations for FY 2011. AFGE recently received reports 

of shortfalls and hiring freezes from several VISNs. At the Wilmington VA, the Director just announced that no one can be hired on a permanent basis and the medical center budget is frozen. 

This news is both puzzling and troubling. AFGE joins the Independent Budget veterans service organizations (IBVSOs) in urging Congress, the Administration and 

GAO to ensure that this critical funding reform law is fully and properly implemented. 

Staff and resource realignment can and should be used in certain instances. For 

example, in some facilities, RN tasks such as administration of flu vaccines and B12 

injections, are being reassigned to LPNs. In addition, many VA clinicians are unnecessarily burdened by administrative duties, due to new initiatives and reporting requirements. These clinicians already have extremely limited face time with patients; 

many primary care providers cannot spend a lot more than 30 minutes with new 

patients, and rumors of 15 minute new patient appointments have resurfaced. 

Therefore, AFGE urges the Committee to take a close look at the growing administrative burdens placed on VA clinicians that divert scare appointment time away 

from patient interaction. We also hope the VA will reconsider its current efforts to 

downgrade the Patient Support Assistant positions that provide critical backup to 

clinicians. 

Clearly, the impact of staff realignments will also vary greatly depending on 

which medical services are targeted. At the Wilmington VA, the Pain Clinic Nurse 

Practitioner (NP) has had to run the clinic without the backup of an anesthesiologist. Like so many other VA initiatives, inadequate funding is provided for proper 

implementation of the VA’s National Pain Initiative. As a result, the Wilmington 

has to send veterans out to non-VA facilities for their pain injections, resulting in 

delays and fractionated care. If RN positions such as these were converted to LPNs, 

the adverse impact on care could be significant. 

A report from a VISN 1 facility reveals similar realignment problems: That facility’s Pain Team has a physician who mostly does back injections and an NP is in 

charge of medication management. For the more difficult and complex pain patients, 

it may be better and safer to have a physician perform medication management, especially when narcotics are involved. 

Realigning that increases the portion of specialty care delivered by a non-physician can also lead to delayed and fractionated care. When orthopedic patients see 

an NP or physician assistant for their first visit, they often have to return for a second appointment or go elsewhere in order to be examined by an orthopedist. 

At the Wilmington VA, realignment has adversely impacted veterans seeking 

emergency care for behavioral health problems. At the Wilmington VA, the first oncall for emergency behavioral health patients is a licensed clinical social worker. In 

this type of setting, physician extenders are placed under enormous pressures to 

carry out the duties and schedules designed for a physician, resulting in further 

burnout and higher attrition. They may also be forced to perform duties outside 

their scope of practice. More generally, AFGE urges the Committee to look at the 

attrition rate among social workers and psychologists who are expected to carry out 

many of the duties of a psychiatrist. 

Realignment-related problems may be especially difficult to detect and monitor in 

certain settings. For example, the Patient Aligned Care Team (PACT) is a laudable 

initiative that was recently described by Secretary Shinseki as an ‘‘historic step in 

redefining medical care’’. Unfortunately, implementation of PACT has been hindered 

by short staffing and poor coordination. Physicians and nurses already handling 

enormous workloads are required to take on new PACT duties. In some facilities, 

the only way to staff a PACT team is to transfer clinicians away from departments 

that are severely short-staffed. 

Our members report that some PACT teams operate without the regular participation of a physician. Then, the remaining team members are forced to ‘‘realign’’ 

themselves to cover the gap. AFGE has received several reports of RNs having to 

work outside their scope of practice as a result of these hard-to-detect realignment 

problems. 

We also share the concern of the IBVSOs that PACT could adversely impact specialty care if not implemented properly; staffing and coordination problems are likely to worsen the impact. 

Again, AFGE believes that PACT has great potential to improve VA care. We urge 

this Committee to investigate implementation problems and ensure that front line 

446 

practitioners and their representatives have the opportunity to provide regular 

input into the evaluation process. 

We also urge greater oversight of VA’s Telehealth program. Here too, staffing 

problems that may be difficult to detect are hindering implementation of a valuable 

VA initiative. We are troubled by reports from several facilities that physicians are 

pressured to refer and keep veterans in telehealth programs, even when, in their 

professional judgment, another form of care would better serve the patient. (Some 

physicians have been offered cash incentives to divert patients to telehealth.) 

In VISN 4, rural health care dollars were used to hire an NP at the Philadelphia 

VAMC. Then the VISN notified Wilmington’s CBOC primary care providers that 

consults for cardiology, endocrinology and hematology/oncology could be placed 

through the coordinator at Philadelphia. If, after reviewing the consult, the specialist wants to see the patient, the patient would be required to bypass the Wilmington VA to go to the Philadelphia VA, even though Wilmington has the very cardiology, endocrinology and hematology/oncology specialty services the patient needs. 

(It is also troubling that the Philadelphia VA can only run an orthopedic surgery 

clinic one-half morning every other week, even though back and neck pain are 

among the top complaints causing veterans to seek care.) 

Diagnostics is another area where conversion to lower skilled positions could be 

problematic. For example, depending on the medical need, an NP substituting for 

an internist may be required to work outside of his or her scope of practice. 

As mentioned above, emergency care has suffered tremendously because of inadequate staffing. The goal is no longer to provide care to the veteran in the emergency department, but to refer the patient outside the VA system for care. At Wilmington, VA, we recently learned that the emergency department is slated to increase its maximum capacity from six to fourteen patients, yet administration wants 

to provide zero increase in nursing or physician staff. Recently, five patients each 

spent over 48 hours in the emergency department, including one who received two 

blood transfusions while he lay on a stretcher for two days. Meanwhile a 25-bed 

ward has sat idle for the past three years because of too few floor nurses. 

Other concerns: 

AFGE is disappointed to see the return of VA’s proposal to eliminate all continuing medical education (CME) reimbursement for physicians and dentists. The 

VA recruits prospective clinicians with the promise of professional growth, but is reluctant to comply with the 1991 law that entitles clinicians to a modest sum for 

courses required to maintain certification and professional licenses. 

The justification provided (without any supporting data) in the FY 2012 budget 

request is that physicians and dentists no longer need this recruitment/retention 

benefit because the pay system enacted in 2004 has made the VA competitive with 

other employers. If VA is sufficiently competitive, why do so many facilities have 

trouble recruiting these clinicians, and why does the VA continue rely so heavily on 

more costly fee basis care to fill the gaps? Furthermore, the 2004 pay law (P.L. 108– 

445) made no linkage to lower CME costs, but it did link better pay with less fee 

basis care—a desired outcome the VA has still not documented. 

Rather than arbitrarily cut this modest CME benefit, AFGE urges this Committee 

to first conduct comprehensive oversight of VA physician and dentist issues, including: ongoing problems with the base, market and performance pay provisions in the 

2004 law, its impact on VA’s use of fee basis care, whether AFGE’s CME program 

(again, still at 1991 levels) is competitive with other health care employers, the 

CME needs of other VA clinicians, and the impact of the physician/dentist ‘‘24/7’’ 

scheduling rule on recruitment and retention. 

In addition, it would be valuable to finally understand why medical centers that 

run out of money to hire more front line practitioners usually find other funds to 

contract for more expensive non-VA care to fill the gap. 

Perhaps, instead of looking for modest savings through realignment and the use 

of fewer physicians and RNs, the VA may want to examine the enormous growth 

of staff and resources at the VISNs, and the percentage of VISN staff that do not 

provide or support direct patient care. 

Thank you. 

447 

POSTHEARING ADDITIONAL INFORMATION FROM MARYANN D. HOOKER, M.D., LEAD

NEUROLOGIST, WILMINGTON, DELAWARE, VA MEDICAL CENTER, SECRETARY, AFGE 

LOCAL 342 

Chairman MURRAY. Thank you very much. Thank you all for the 

work you put into providing this information for all of us, and excellent testimony from everybody. 

I do have follow-up questions for all of you. We are running out 

of time here today at the hearing. Everybody has been very patient. 

So I am just going to ask one or two questions and then turn to 

Senator Burr. I’ll submit the rest to you and to ask you to respond. 

Mr. Violante, I do want to ask you—because claims backlog is a 

top issue everywhere we go, and you spoke a little bit about it in 

your testimony. I saw that the amount of funding in the President’s 

Budget request for VBA in the GOE account is significantly less 

than the funding recommended by the IB. 

Can you elaborate on the IB’s request and comment on the Administration’s? 


32ps2AFG.eps
448 

Mr. VIOLANTE. Sure. First of all, if you look at the level that is 

being considered for 2011, the IB is roughly just a little less than $200 million more from 2011, roughly about $246 million above 

what the President is requesting. 

Most of that increase is for what we believe to be increased costs 

in supplies, and there is a modest increase for vocational rehabilitation counselors, which account for about 150 individuals, and increases in the Board of Veterans’ Appeals, roughly about 30 employees there. 

We believe that what we are asking for is just a very modest increase above 2011. 

Chairman MURRAY. Any comment on the Administration’s request? 

Mr. VIOLANTE. We think it is a little low. 

Chairman MURRAY. That is sufficient. OK. 

Mr. VIOLANTE. I do not agree with Mr. Walcoff on the training 

part of it. We believe there needs to be much more training involved, especially when we are looking at the problems that the VA 

is facing. 

Chairman MURRAY. His testimony was that they would not be 

hiring as many so they did not need the training dollars. Tell me 

why you disagree with that. 

Mr. VIOLANTE. We do not believe that they are adequately 

trained at this point, that there needs to be additional training provided to the employees that they do have, and we believe that more 

funds should be expended on training those individuals. 

Chairman MURRAY. OK. Let me ask if anybody wants to comment on this. I think we all recognize these are very tough economic times and discretionary funding is going to be really hard to 

come by this year. 

I want to ask if anybody wants to comment, if you believe that 

the VA’s proposed operational improvements are appropriate and 

will help VA to spend taxpayer dollars in a more efficient and costeffective manner. 

If you all want to comment back for the record, you can do that. 

I see you are willing to jump in. 

Dr. HOOKER. It is always dangerous to give me a microphone and 

a platform from which to speak. 

My concern would be losing the veterans that we have now that 

we have already lost and providing the care that they so desperately need; the efficiencies and the resources, I think, can be 

better utilized in fixing what it is we have now rather than promoting new initiatives that we have not tested at this point, as far 

as clinical care. 

Chairman MURRAY. Others? Go ahead, Carl, jump in. 

Mr. BLAKE. Joe and I are sitting here thinking, I think you 

would have to better define operational improvements. I mean, I 

know that they have a number of different areas where they identified projected savings. I think that is what you are referring to. 

Chairman MURRAY. Right. 

Mr. BLAKE. We could probably better answer that with a statement. 

Chairman MURRAY. If you could get back to me with some comments on that I would really appreciate it. Great. 

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Chairman MURRAY. Senator Burr. 

Senator BURR. Once again, I want to thank all of you for your 

commitment to participate in The Independent Budget, more importantly, your willingness to come in here and share thoughts with 

us. 

The Chairman has pretty well spoken in what I think will be a 

protracted period of very difficult discretionary spending, not to 

just be encompassed in the next fiscal year but several to come. 

It is going to be vitally important that the decisions that are 

made at the VA do not lose focus on what the VA mission is and 

that is to provide the care that our veterans were promised. 

I have listened to some of additional requests that deal with 

training, that deal with expediting disability claims, that deal with 

construction needs. All of these are important. 

I guess my question to anybody that would like to take it is: you 

are seeing a massive expansion of FTEs within the central office 

of the VA. Is anybody asking why, and more importantly, how that 

affects the mission and the things that are of most concern to each 

and every one of you? 

My staff earlier in the week had just thrown down some things 

for me that we wanted to share with you to sort of set the stage 

for this. 

In the Fiscal Year 2012 Budget request for general administration, it breaks down the proposed number of FTEs. It calls for an 

increase of 562 employees over fiscal year 2010, most of whom are 

at a GS–12 or higher level. 

Now, I do not have to tell the veteran service organizations what 

they should be outraged about. But when you bring up the issues 

of construction, training, claims, the way I have broken it down I 

do not think that any of your issues are being addressed in the increase of 560 FTEs over fiscal year 2010. 

It has got to be a particularly skilled person at a GS–12 or higher, and before any of you have the opportunity to weigh in, I hope 

you understand that these people come with a long-term obligation 

to the VA. There is a benefit package that extends far past their 

employment. It is not like you can bring them in without something that, for a foreseeable future, does not take away from our 

ability to provide the funding to deliver the care. 

So, would anybody like to tackle that one? 

Mr. BLAKE. Senator Burr, I would start by pointing out for basis 

of comparison that The Independent Budget for general administration was significantly less than what the Administration recommended. 

From the broader perspective of the IB, we sort of took the perspective that we would apply the basics for inflation, which still exists out there, and not a lot else in our recommendations, health 

care side notwithstanding, because growth in demand is continuing. So it has its own little unique perspective. 

But your concerns are not lost on us, and I think our recommendations reflect that on some level. 

Senator BURR. Let me add one thing, if anybody else would like 

to chime in on this, in the 2012 budget request VA’s Office of Information and Technology, which I say up front needs some more inVerDate Nov 24 2008 21:08 Oct 18, 2011 Jkt 000000 PO 00000 Frm 00455 Fmt 6633 Sfmt 6601 H:\112TH HEARINGS\65905.TXT SVETS PsN: PAULIN
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vestment, needs some more personnel, has a request for an additional 128 FTEs. 

The VA also indicates that they have plans to hire 705 new employees in the coming months, many of these are at levels of GS– 

12 and higher. 

I think you could make the case out of information and technology that we are getting into the claims processing. Right there 

you have got 850 new FTEs. These are not claims processors. These 

are looking at the software, the hardware needs to try to facilitate 

the claims. 

I might add to that if anybody would like to comment, I just introduced a bill yesterday that I think, Joe, you are aware of, maybe 

all of you are aware of, that provides for any veteran that sends 

in an application, a claim that has all the documentation they 

need, that they get an additional year’s worth of benefits. 

In other words, an attempt to try to create an incentive so that 

we get claims that are accurate when they come in the door so that 

they go forward with all the information. 

If we screw it up then, we know we have something that we can 

look at that we can try to fix. But from the standpoint of the 

delays, waiting for all of the information that they have got to have 

to give the veterans the benefits. 

Fully develop these claims. Do not bring them in until they are 

fully developed and we will give you the benefit of an extra year’s 

benefits. 

Tell me what you think of that. Joe, I will put you on the spot. 

Mr. VIOLANTE. I have not read the language of the bill. I saw the 

information that you introduced a bill. I mean, it has been something that DAV and I think the other organizations here have 

talked about. 

Veterans are put at a disadvantage to begin a fully-developed 

claim if they are not allowed to protect that earlier effective date. 

From the sounds of the language of your bill, I mean, it would 

make that an incentive to wait that extra time to gather all your 

information, which then makes it easier for the VA. 

Senator BURR. Anybody got any other comments on any of this? 

Mr. VIOLANTE. I do. I agree with you also. As Carl said, we do 

not have the ability to peek behind the curtain as much as we 

would like to at VA. Yesterday, DAV’s national commander testified before the Joint Committees and basically called on these Committees to do some more oversight of VA. 

In talking to Secretary Shinseki, I know that he would like to 

know—it is a big bureaucratic agency—what is going on. He said 

before that he cannot fix the problem until he knows about it. 

So I would like to encourage the Committee to do more oversight, 

to look at some of the situations where they are adding personnel 

that are not really helping the hands-on services, either on the 

health care side or on the benefits side, to ensure that these claims 

and services are provided as quickly as possible. 

Senator BURR. Joe, I have said this to the Secretary, from the 

stand point of me personally, so this is not a shot at the Secretary 

or any of his professional staff. I believe that they are all multitalented and passionate about the job that they do. I think there 

451 

is tremendous pressure from you, and from the Congress to fix 

things that are not always easy to fix. 

I would hate to be in Dr. Petzel’s position where he is the most 

liked guy if you’ve got something on his list. But it is not always 

something he can bump up to number 1 or this year or next year 

from the standpoint of funding. 

Quite frankly, it has got to be frustrating for all of them to walk 

in and have the task of building an IT system, of having the task 

of fixing somebody else’s problem that they left where some of the 

opportunities were not fully developed. 

But that realization is why we are all here, to hold each other 

accountable to make the best decisions that we can. So, I think it 

is important that we call into question increases like this if, in fact, 

they do not pass the smell test; what is the outcome, and will it 

benefits us? I hope VA will take that back. 

Anybody else? 

Ms. ROOF. The longer I sit here the more I think about it; and 

you brought up the FTEs. Something you had said earlier is you 

asked the VA what money was appropriated for women’s programs 

and then again someone asked why is so much of what we appropriated for the caregivers bill, why is that not all being used. 

So those are the questions that pop into my mind. If there is 

money for things like speech writers and some of the positions you 

are talking about, something seems off there. 

I do not have all the facts. That would be a conversation I would 

have, to sit and talk to VA directly, but those are the kind of things 

that bother us as a veterans’ service organizations. 

Dr. HOOKER. I can tell you from the clinical perspective that all 

those increases in positions come out of our hides. They do not 

come down to the facility level; we are shorted and then it is a 

question of robbing Peter to pay Paul. 

So then the initiative is, say, polytrauma. Staff goes in, and then 

the next new initiative is women’s health. So, staff comes out of 

polytrauma and goes into women’s health. It is a constant shifting 

to meet what the latest performance measure is with no real addition to staff at the lower levels. 

Mr. TETZ. Senator, I would say that the American Legion agrees 

with many of the counterparts here in the fact that, one, we do not 

have the open veil that we would like to have and be able to say 

truly what is there. 

So we cannot get in the trenches and fight that and say absolutely 100 percent we agree with it. But, ultimately, at the end of 

the day what we should ask ourselves, whether we are a VA employee or a VSO, is this: has that employee, that team member who 

is at a hospital, a VBA center processing claims, what did they do 

for a veteran today? 

If they did not have direction action, direct help with a veteran, 

then truly we need that person to join the team; and that is the 

question we must ask ourselves. 

Senator BURR. I thank all of you. The Chairman has been awfully kind for letting me go over. I think this is a vital area; and 

we have the discretionary spending side even tighter next year. 

The question is, where does it come from? 

452 

My fear is that it would address even further the concern that 

Dr. Hooker has on the clinical side and eventually we find ourselves not talking about disability claims, we find ourselves talking 

about things we discussed two decades ago. 

I thank you, Madam Chairman. 

Chairman MURRAY. Thank you very much, Senator. 

I want to thank all of our witnesses for appearing before the 

Committee today, especially the VA folks who stayed for our second 

panel. I appreciate your sitting here so long. 

The President’s Budget is a good place for us to start our work 

this year. We have got work to do on research, construction, the IG 

office, and a number of areas that we have talked about today. 

This hearing will really help the Committee form its opinion of 

the Administration’s request as we offer our views and estimates 

to the Budget Committee later this month. 

I appreciate everybody’s participation. 

Thank you very much. This hearing is now adjourned. 

[Whereupon, at 1:14 p.m., the Committee was adjourned.] 

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