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57–025 2010

LEGISLATIVE HEARING ON H.R. 4062, H.R. 4465, 

H.R. 4505, AND DRAFT LEGISLATION 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

MAY 27, 2010 

Serial No. 111–81 

Printed for the use of the Committee on Veterans’ Affairs 

( 


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COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

DEBORAH L. HALVORSON, Illinois 

THOMAS S.P. PERRIELLO, Virginia 

HARRY TEAGUE, New Mexico 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

JOHN H. ADLER, New Jersey 

ANN KIRKPATRICK, Arizona 

GLENN C. NYE, Virginia 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

DAVID P. ROE, Tennessee 

MALCOM A. SHORTER, Staff Director 

SUBCOMMITTEE ON HEALTH 

MICHAEL H. MICHAUD, Maine, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

HARRY TEAGUE, New Mexico 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

GLENN C. NYE, Virginia 

DEBORAH L. HALVORSON, Illinois 

THOMAS S.P. PERRIELLO, Virginia 

HENRY E. BROWN, JR., South Carolina, 

Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

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

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

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

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

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

is further refined. 


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C O N T E N T S 

May 27, 2010 

Page 

Legislative Hearing on H.R. 4062, H.R. 4465, H.R. 4505, and Draft Legislation ........................................................................................................................ 1 

OPENING STATEMENTS 

Chairman Michael Michaud ................................................................................... 1 

Prepared statement of Chairman Michaud .................................................... 23 

Hon. Henry E. Brown, Jr., Ranking Republican Member .................................... 5 

Prepared statement of Congressman Brown .................................................. 23 

Hon. Harry E. Teague ............................................................................................. 5 

WITNESSES 

U.S. Department of Veterans Affairs, Robert Jesse, M.D., Ph.D., Acting Principal Deputy Under Secretary for Health, Veterans Health Administration .. 15 

Prepared statement of Dr. Jesse ..................................................................... 38 

Adler, Hon. John, a Representative in Congress from the State of New Jersey 3 

Prepared statement of Congressman Adler .................................................... 28 

American Legion, Barry A. Searle, Director, Veterans Affairs and Rehabilitation Commission ................................................................................................... 6 

Prepared statement of Mr. Searle ................................................................... 29 

Iraq and Afghanistan Veterans of America, Tim Embree, Legislative Associate ....................................................................................................................... 11 

Prepared statement of Mr. Embree ................................................................ 36 

Kissell, Hon. Larry, a Representative in Congress from the State of North 

Carolina ................................................................................................................ 2 

Prepared statement of Congressman Kissell ................................................. 23 

Thornberry, Hon. Mac, a Representative in Congress from the State of Texas . 3 

Prepared statement of Congressman Thornberry .......................................... 24 

Veterans of Foreign Wars of the United States, Eric A. Hilleman, Director, 

National Legislative Service ................................................................................ 8 

Prepared statement of Mr. Hilleman .............................................................. 32 

Vietnam Veterans of America, Richard F. Weidman, Executive Director for 

Policy and Government Affairs ........................................................................... 10 

Prepared statement of Mr. Weidman ............................................................. 33 

SUBMISSIONS FOR THE RECORD 

Disabled American Veterans, Adrian Atizado, Assistant National Legislative 

Director, statement .............................................................................................. 42 

Paralyzed Veterans of America, statement ........................................................... 45 

Gold Star Wives of America, Inc., Vivianne Cisneros Wersel, Au.D., Chair, 

Government Relations Committee, statement ................................................... 47 

MATERIAL SUBMITTED FOR THE RECORD 

Post-Hearing Questions and Responses for the Record: 

Hon. Michael Michaud, Chairman, Subcommittee on Health, Committee on 

Veterans’ Affairs to Hon. Eric K. Shinseki, Secretary, U.S. Department 

of Veterans Affairs, letter dated June 14, 2010, and VA responses ................ 49 


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LEGISLATIVE HEARING ON H.R. 4062, H.R. 4465, 

H.R. 4505, AND DRAFT LEGISLATION 

THURSDAY, MAY 27, 2010 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON HEALTH, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 10:02 a.m., in 

Room 334, Cannon House Office Building, Hon. Michael Michaud 

[Chairman of the Subcommittee] presiding. 

Present: Representatives Michaud, Teague, Rodriguez, Brown of 

South Carolina, and Boozman. 

OPENING STATEMENT OF CHAIRMAN MICHAUD 

Mr. MICHAUD. I would like to call the Subcommittee to order. It 

is my understanding we have votes as early as 11:00 or 11:30, so 

we will get started, and Mr. Brown is on his way down. I would 

ask unanimous consent that my full statement be submitted for the 

record. Without objection, so ordered. 

I would like to thank everyone for coming today. Today’s legislative hearing is an opportunity for Members of Congress, veterans, 

the U.S. Department of Veterans Affairs (VA), and other interested 

parties to provide their views and discuss the legislation that has 

been introduced within this Subcommittee’s jurisdiction in a clear 

and orderly fashion. This is an important part of the legislative 

process that will encourage frank and open discussion of new ideas. 

We have five bills before us, which address a number of important issues. First, we have a radiation safety bill that requires 

proper training of all employees at VA hospitals. Second, we have 

a bill that will require the VA to consider children under legal 

guardianship of veterans when determining the veterans’ copayment amount for medical treatment. And we also have a bill that 

would allow Gold Star Parents access to a State Veterans Home if 

they have had any children who died while serving in the armed 

forces. Then finally we have two draft pieces of legislation on improving VA’s outreach to veterans and another bill that would 

allow VA to provide hearing aids to World War II veterans. 

I want to thank our first panel for coming here today to discuss 

this legislation, as well as the draft legislation that we will hear 

afterwards. On the first panel we have Representative Adler from 

New Jersey, Representative Thornberry from Texas, and Representative Kissell from North Carolina. And we will start with Mr. 

Kissell and his legislation.


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[The prepared statement of Chairman Michaud appears on 

p. 23.] 

STATEMENTS OF HON. LARRY KISSELL, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF NORTH CAROLINA; HON. 

MAC THORNBERRY, A REPRESENTATIVE IN CONGRESS 

FROM THE STATE OF TEXAS; AND HON. JOHN ADLER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

STATEMENT OF HON. LARRY KISSELL 

Mr. KISSELL. Thank you, Mr. Chairman, and to my friends and 

colleagues on this Subcommittee. I thank you for the opportunity 

to come to you today to talk about H.R. 4465. And in light of time 

and recognizing that we need to move on, and in talking to the 

Chairman earlier that maybe the language of our bill might be a 

little bit confusing. But the intent is not, I am going to stick, Mr. 

Chairman, with the intent. 

In today’s society, if we ever did have a nuclear family and structured a certain way, certainly today that has changed. We know 

that for many reasons grandparents and great-grandparents are involved, and oftentimes in their late stages of life, in raising their 

grandchildren or great-grandchildren. We have a particular case in 

our district where a couple aged in their seventies, on low income, 

fixed income, had a situation within their family where they took 

legal guardianship of their great-grandchildren 5 years ago. They 

still have that legal guardianship. The children are now 5 and 10 

years old, and once again these are their great-grandchildren. 

In all ways, by the Internal Revenue Service (IRS), the schools, 

in all ways within society they are recognized as the legal guardians of these children. But however, with the VA rules when it 

comes to figuring copays and the income versus dependents, they 

are not given consideration for these being dependents and, therefore, they do have to pay a copay. Very clearly, if these children 

were recognized as being the dependents that they are, once again 

in all other aspects of society but with this, then they would not 

have to pay the copayment. With such fixed income we are asking 

within H.R. 4465 that this legal guardianship with grandparents 

and great-grandparents or other relationships be recognized for our 

veterans. If they have legal guardianship for more than 1 year, we 

ask that it be recognized that this is a dependency and it should 

be taken into account. 

We recognize this will not affect many people. The Congressional 

Budget Office has said that this will not affect many people. But 

the ones it will affect, we feel that we need to make this change 

in recognition for their status, and in trying to take care of some 

of our children in whatever way it came to them. And I thank you, 

Mr. Chairman, and the Committee for the opportunity to discuss 

this with you. 

[The prepared statement of Congressman Kissell appears on 

p. 23.] 

Mr. MICHAUD. Thank you very much, Mr. Kissell. Mr. Thornberry. 


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STATEMENT OF HON. MAC THORNBERRY 

Mr. THORNBERRY. Thank you, Mr. Chairman. And I do appreciate you having this hearing. I appreciate Dr. Snyder, who introduced this legislation, H.R. 4505, with me, and I appreciate your 

cosponsorship of it as well. 

With your permission I would like to make my full statement 

with some attachments part of the record. 

Mr. MICHAUD. Without objection, so ordered. 

Mr. THORNBERRY. And then I would just summarize. Mr. Chairman, as you know there are 137 State Veterans Homes in all 50 

States around the country, and they serve something over 28,000 

veterans and dependents. 

We all know of Gold Star Parents and think of Gold Star Parents 

as someone who has lost a child in the military. But for the purposes of being admitted to one of these State Veterans Homes the 

definition of a Gold Star Parent is you have to have lost all your 

children. So theoretically, you could have had three of your children die in the military, if you have one still surviving you are not 

eligible. And so what this bill does, it just changes that definition 

and says a Gold Star Parent is someone who has lost a child in the 

military, and would then be eligible for one of these State Veterans 

Homes. That is the basis of what this legislation does. 

Now, these State Veterans Homes have an occupancy rate that 

is about 86 percent, 87 percent, so there is room for additional people. The admissions criteria is still run by the States. So the States 

will decide if you have a veteran who wants to get in, and a Gold 

Star Parent, they still make that decision. But it just, this bill 

would just eliminate that Federal regulation that makes it very difficult for any parent to get into one of these State Homes. 

I might mention that the Consolidated Appropriations Act of 

2010 asked the VA to study this issue and figure out how much it 

would cost to allow a Gold Star Parent who has lost a child to get 

in one of these homes. VA came back and said, ‘‘It is not going to 

cost us anything so there is no use for us to do a study on it.’’ But 

they did say in their response that legislation is required to change 

this, indicating they cannot do it with a regulatory change, the burden is on our shoulders to make a change. And so this bill is supported by the American Legion, the National Association of State 

Veterans Homes, and other who I think you will hear from. I know 

of no opposition to it, Mr. Chairman. I think it is a basic issue of 

fairness. When you have capacity, you have some folks who would 

like to be admitted to these homes, to just remove this really Federal restriction that makes no sense, I think, to any of us. And I 

would appreciate the Committee’s consideration of it. 

[The prepared statement and attachments of Congressman 

Thornberry appear on p. 24.] 

Mr. MICHAUD. Thank you very much. Mr. Adler. 

STATEMENT OF HON. JOHN ADLER 

Mr. ADLER. I thank you, Chairman Michaud, and Ranking Member Brown, and Members of the Subcommittee for the opportunity 

to testify on behalf of H.R. 4062. The need for H.R. 4062 came from 

a very serious matter that occurred at the Philadelphia Veterans 

Affairs Medical Center. Starting in 2003, the brachytherapy proVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 I:\VA\57025.XXX GPO1 PsN: 57025

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gram at the Philadelphia VA was operated by a rogue doctor who 

botched approximately 86 percent of the prostate cancer treatment 

procedures he was contracted to perform on our veterans. These 

multiple failures, which went undetected year after year, highlighted significant problems in the VA’s oversight system. The VA 

failed until 2008 to catch this pattern of failure. 

H.R. 4062, the ‘‘Veterans’ Health and Radiation Safety Act,’’ is a 

comprehensive piece of legislation that seeks to remedy many of 

the mistakes that led to the problems surrounding the 

brachytherapy program at the Philadelphia VA Medical Center. 

This bill has three major components. First, the bill mandates that 

the VA conduct an evaluation of all of the low volume programs 

that are currently operating in its medical facilities to ensure that 

they are meeting their safety standards. The brachytherapy program at the Philadelphia VA was not subjected to independent 

peer review due to the fact that it was such a low volume program, 

serving only 116 patients over a 6-year period. Because of this lack 

of oversight errors that should have been caught and rectified, 

were allowed to continue for 6 years unnoticed. 

Second, H.R. 4062 requires that every VA employee and independent contractor working in a VA medical facility be trained in 

what constitutes a medical event, as that term is defined by the 

Nuclear Regulatory Commission (NRC), as well as when such an 

event should be reported, and to whom. Over the course of the 6- 

year period in which the brachytherapy program at the Philly VA 

was in operation, 86 percent of the patients were subjected to reportable medical events. However, because many of the medical 

personnel in the program, including the independent contractors, 

were not trained in what constitutes a medical event as that term 

is defined by the NRC, or to whom such an event should be reported, these errors were allowed to continue, and our veterans remained susceptible to substandard medical care for far too long. 

Lastly, this bill requires the Secretary to evaluate all medical 

services provided pursuant to a contract with a nongovernment entity. Such evaluations shall include independent peer reviews of 

such medical services, and written evaluations of a independent 

contractor’s performance by that contractor’s supervisors. The bill 

also states that before a contract for medical services can be renewed, the above evaluations must be conducted. In Philly one of 

the problems was that year after year that contracts were renewed 

every 6 months without any review by anybody, and this doctor 

continued to hurt good veterans. 

The veterans who sought treatment for prostate cancer at the 

Philadelphia VA did not receive the quality of care they deserve. 

Such mistreatment of our veterans is not only unacceptable, it violates the bond our country made with them when they agreed to 

fight for our safety and security. It is my hope that H.R. 4062 will 

ensure that the failures that occurred at the Philadelphia VA will 

never happen again. 

I thank the Chairman, and the Ranking Member, for letting me 

speak on this bill. 

[The prepared statement of Congressman Adler appears on 

p. 28.] 


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Mr. MICHAUD. Thank you very much. And once again I would 

like to thank all three of you for bringing forward these very important pieces of legislation. Having reviewed them, and pending 

the next couple of panels, I think we can actually work on all three 

of them, because I think all three are very important, I look forward to working with my Ranking Member Mr. Brown to see how 

we can move forward these pieces of legislation. I have no questions. Mr. Brown. 

OPENING STATEMENT OF HON. HENRY E. BROWN, JR. 

Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Michaud. I 

apologize for being late. We had about 35 businessmen from Canada come by my office at 10:00 for a tour. And, you know, Canada 

is a big trading partner with us. And so, I am sorry I am late. 

But let me just make a brief statement. Thank you all for coming 

today. When we honor the bravery and service of our military 

members and veterans, we must also honor the sacrifice and selflessness of their families. I do not think the loss of a child, whether 

one or many, can be differentiated, and I thank Mac for introducing his legislation. We look forward to further proceedings on 

these bills. Thank you. 

[The prepared statement of Congressman Brown appears on 

p. 23.] 

Mr. MICHAUD. Thank you. Mr. Teague, do you have any questions or opening statement? 

OPENING STATEMENT OF HON. HARRY TEAGUE 

Mr. TEAGUE. Yes. Chairman Michaud, thank you. Ranking Member Brown, thank you for allowing me a few moments to speak on 

my draft legislation, the ‘‘World War II Hearing Aid Treatment 

Act’’ and its importance to the veterans of our country. 

While many look back at World War II as one of the most significant events that the Unites States and humanity was ever involved 

in, it has only been recently as many of yesterday’s soldiers are 

passing away that we as a country have really reflected on its importance and what it meant to us as a Nation. I do not know why 

that is. I do not know why it has taken so long to recognize the 

sacrifices that were made in North Africa, Europe, and the Pacific 

Theater. Maybe it is because those individuals never wanted to 

make a big fuss over what they had done. They were just doing 

their job. 

As the son of a World War II veteran, my father talked about the 

War occasionally. It was not something he bragged on. Instead, it 

was something that he would mention as part of his story. It was 

just a part of what he was supposed to do. He felt it was his duty 

to go when called. Maybe that is why we have taken so long to recognize the many sacrifices of this War, because those that fought 

it were humble and did not want to make a big deal about it. 

What I do know is that, as was said by President Clinton, ‘‘when 

these men and women were young they saved the world.’’ That is 

no exaggeration. That is not just us saying something to be nice. 

That is the truth. Now we are losing World War II veterans at a 

faster rate than any other veteran group. It is important that we 


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make sure that we are doing all that we can to honor these men 

and women now while they are still with us. 

I believe that the ‘‘World War II Hearing Aid Treatment Act’’ is 

one of the ways we can do that. It will authorize the Secretary to 

furnish a hearing aid device to any veteran who served in the active military, naval, or air service during World War II, and who 

is being diagnosed with a hearing impairment. It is a simple act 

that can ensure that we are taking care of these historic veterans 

that did so much for us. Thank you, Mr. Chairman. That concludes 

my statement. 

Mr. MICHAUD. Thank you, Mr. Teague. Mr. Rodriguez, do you 

have any questions, or a statement? If not, once again I want to 

thank all three of you for coming today and I look forward to working with you as we markup these pieces of legislation. So once 

again, thank you very much. 

I would like to call the second panel forward, and while they are 

coming forward I will introduce them. It is Barry Searle, who is the 

Director of the Veterans Affairs and Rehabilitation Commission for 

the American Legion; Eric Hilleman from the Veterans of Foreign 

Wars (VFW); Rick Weidman, who is with the Vietnam Veterans of 

America (VVA); and Tim Embree, who is with the Iraq and Afghanistan Veterans of America (IAVA). I want to thank all four of you 

for coming this morning, and look forward to your testimony. We 

will start with Mr. Searle. 

STATEMENTS OF BARRY A. SEARLE, DIRECTOR, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; ERIC A. HILLEMAN, DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE 

UNITED STATES; RICHARD F. WEIDMAN, EXECUTIVE DIRECTOR FOR POLICY AND GOVERNMENT AFFAIRS, VIETNAM 

VETERANS OF AMERICA; AND TIM EMBREE, LEGISLATIVE 

ASSOCIATE, IRAQ AND AFGHANISTAN VETERANS OF AMERICA 

STATEMENT OF BARRY A. SEARLE 

Mr. SEARLE. Mr. Chairman and Members of the Subcommittee, 

thank you for the opportunity to present the views of the American 

Legion on legislation and proposed legislation important to veterans. 

H.R. 4062, the ‘‘Veterans’ Health and Radiation Safety Act,’’ this 

legislation would require the Secretary of Veterans Affairs to ensure that all employees at a VA hospital where radioactive isotopes 

are used in the administration of medical services receive appropriate training on what constitutes a medical event and when to 

whom a medical event should be reported. It would require specific 

evaluations and peer review of all medical services provided under 

contract with a nongovernment entity. The American Legion’s System Worth Saving Task Force annually conducts site visits at the 

VA medical centers nationwide to assess quality and timeliness of 

VA health care. During task force visits, we have found that turnover of personnel and shortage of personnel require renewed emphasis on standardized procedures, quality review, and individual 

training as well as documentation of that training. As technologies 


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continue to change and treatments and procedures continue to develop, it is critical that the VA staff delivering care be properly 

trained and are accountable. The American Legion supports not 

only the specified training and accountability highlighted in H.R. 

4062 but also the standardization of all patient care delivered 

across the VA system. 

H.R. 4505, expansion of State Home care for parents of veterans 

who died while serving in the armed forces. The legislation permits 

a State Home to provide VA nursing home care to parents who suffered the loss of a child who died during service in the armed 

forces. The American Legion believes that a commitment is made 

not only by servicemembers who commit to the service of their 

country but also family members who must say goodbye to their 

loved ones. The American Legion believes that when a servicemember is killed in the line of duty and a dependent parent is 

deemed medically eligible for nursing home admission, that parent 

should be entitled to VA Nursing Home Care. We believe the current regulation imposes too high a threshold of suffering on surviving parents when it requires that all children must have died 

in the service while on active duty. We understand that currently 

the occupancy rate of the nursing homes remains at approximately 

85 percent nationally. It is felt that the number of parents who 

would utilize the opportunity is small enough to not significantly 

impact occupancy. The American Legion supports H.R. 4505. 

H.R. 4465, the determination of attributable income for veterans 

with children. This legislation would direct the VA Secretary, when 

examining a veteran’s attributable income, to treat as a dependent 

child of such a veteran any other person who is placed in the legal 

custody of the veteran and has not attained 21, or has not attained 

age 23 and is enrolled in a full-time course of study, or is incapable 

of self-support due to mental or physical incapacity. The American 

Legion supports H.R. 4465. 

Proposed legislation, the ‘‘World War II Hearing Aid Treatment 

Act.’’ The American Legion recently adopted a resolution acknowledging current advances in scientific research, which require review of prior and potential environmental threats to servicemembers. It is understood that past acceptable norms in environmental exposure for noise have been found to be unacceptable in 

today’s environment. Especially in the case of World War II veterans the state of the art for working environment protection of 

servicemembers had not evolved to the current levels. The fact of 

service and exposure to these environmental exposures would 

imply the potential for hearing loss. The American Legion supports 

this proposed legislation to furnish World War II veterans with 

hearing aids. 

We would further submit, for the Subcommittee’s consideration, 

the fact that environmental issues for hearing loss were in existence through the Vietnam War. It was not until recently that significant efforts have been made to protect the hearing of servicemembers. The American Legion suggests expanding this bill to 

cover veterans for the Korean and Vietnam War eras also. 

Improved ‘‘VA Outreach Act of 2010,’’ the American Legion has 

testified concerning improvements VA could make to further outreach to veterans. VA continues to make progress to improve its 


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outreach to program veterans. Currently the VA in many cases informs veterans service organizations (VSOs) on system improvements accomplished. VSOs in turn advise veterans on these efforts. 

This partnership between VA and the VSOs in informing veterans 

is critical to the success in the VA’s outreach program. 

However, issues remain with the VA’s outreach to veterans. Earlier this month the American Legion testified that the VA continues to struggle with informing veterans of entitlements such as 

efforts to assist transitioning servicemembers through the Benefits 

Delivery at Discharge Program, and the Transition Assistance Programs. In particular, Reserve component members released from 

active duty mobilizations at times are rubber stamped and returned home with little or no understanding of what entitlements 

they have earned due to their honorable service. The American Legion also understands that policies developed at Central Office with 

the best of intentions are for the most part executed at the discretion of the director at the local level, and therefore, vary in local 

implementation. For example, VA has a veteran employment hiring 

program policy to recruit veterans as outlined in Secretary 

Shinseki’s Memorandum dated 21 October, 2009. However, the 

American Legion has seen a variation of hiring from about 25 percent to 79 percent. We feel this variation is due to the Director’s 

emphasis on outreaching to veterans. 

Many veterans are moving to rural and extremely rural areas. 

Nevertheless, these veterans have earned the right to receive information and updates on changes that impact their earned benefits. 

While the VA has made efforts to become more user friendly we 

continue to hear, especially from older veterans, that the system 

requires documentation that is still too complicated. 

We are concerned that the VA does not consistently utilize this 

proven partnership between veterans service organizations and the 

VA to optimize outreach to veterans. The establishment of a VA 

Advisory Committee on Outreach as proposed in draft legislation 

requiring representation from members of the VSO community and 

reporting to the VA Secretary will enhance VA’s outreach program 

and ultimately better serve America’s veterans. The American Legion supports the outreach to veterans, and in particular Improved 

VA Outreach Act of 2010. Thank you. 

[The prepared statement of Mr. Searle appears on p. 29.] 

Mr. MICHAUD. Thank you, Mr. Searle. Mr. Hilleman. 

STATEMENT OF ERIC A. HILLEMAN 

Mr. HILLEMAN. Thank you, Mr. Chairman, Ranking Member 

Brown, Members of the Subcommittee. On behalf of the 2.1 million 

men and women of the VFW and our auxiliaries, it is my pleasure 

to be here representing them before you today. Due to the number 

of bills before this Committee today, I would like to limit the bulk 

of my remarks to two bills and briefly comment on the remaining 

bills. 

H.R. 4505, a bill to enable State Veterans Homes to furnish nursing home care to parents whose children died while serving in the 

armed forces. The VFW is proud to support this legislation, which 

would authorize State-run nursing homes to accept surviving parents of a child who died while serving in the armed forces. Current 


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law requires that a parent must have lost all of their children to 

military service to qualify for nursing home care. The VFW believes 

the care of a Gold Star Parent is a sacred trust, and this bill would 

provide a critical benefit at a time when they may need the longterm care State Homes offer. We ask Congress to act quickly to 

enact this legislation. 

The next bill is the draft bill, ‘‘World War II Hearing Aid Treatment Act.’’ The VFW admires the goal of this legislation, but cannot support it as written. Millions of Americans participated in 

combat in World War II, where over 416,000 were killed, and hundreds of thousands were wounded. Almost everything about modern warfare involves loud and often incredibly loud noise. Acoustic 

trauma is a major cause of hearing loss. Those who fought in the 

island campaigns of the Pacific, North Africa, Normandy, and the 

Battle of the Bulge, or flew through the flak and fighter filled skies 

over Germany and France were exposed to incredibly loud noises 

that left damage throughout their lives. 

However, training for and fighting a war in terms of noise exposure is virtually identical in younger veterans, who trained and 

fought in every other war from Korea, Vietnam, to the current conflicts in Iraq and Afghanistan. The Institute of Medicine (IOM) 

studied hearing loss in the military. Essentially they said servicemembers are exposed to a wide range of noise, from occupational, 

i.e. trucks, generators, planes, to acoustic trauma, machine gun 

fire, artillery, and improvised explosive devices. Their recommendations focused on prevention in the military. But they suggested, 

‘‘given the likely occurrence of maximum noise included hearing 

loss at 6,000 hertz, include the measurement of hearing thresholds 

at 8,000 hertz in all audiograms to allow for detection of the noise 

notch pattern of hearing loss associated with noise exposure.’’ 

The military widely recognizes that servicemembers are exposed 

to potential hearing damage throughout their training and average 

duties. In addition to exchange of gunfire, mortars, and explosions, 

and those associated with combat, the Army has rated and recognizes the basic acoustic trauma that is caused by machinery, equipment, and weapons as well. For example, a basic Humvee produces 

between 75 to 100 decibels of noise, while a mortar operator endures 180 decibels of noise with every mortar fired. The VFW cannot support this legislation between the only factual difference 

World War II veterans’ exposure to noise and that of every other 

generation are the age of the veterans. 

H.R. 4062, Veterans’ Health and Radiation Safety Act, the VFW 

supports the legislation that would amend title 38 of the U.S. Code 

to make certain improvements in the administration of medical facilities within the Department of Veterans Affairs. 

H.R. 4465, to amend title 38 of the U.S. Code to direct the Secretary of the VA to take into account dependent children when determining a veteran’s financial status when receiving hospital care 

or medical services. The VFW supports this legislation to allow certain dependents to be counted in determining earnings threshold 

for the purposes of seeking services with VA. 

Finally, draft bill Improved VA Outreach Act of 2010, the VFW 

supports this Act which would improve outreach within the Department of Veterans Affairs by coordinating the efforts among the SecVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 I:\VA\57025.XXX GPO1 PsN: 57025

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retary of Public Affairs, the Veterans Health Administration, the 

Veterans Benefits Administration, and the National Cemetery Administration. 

Thank you, Mr. Chairman. This concludes my testimony, and I 

am happy to answer any questions this Committee may have. 

[The prepared statement of Mr. Hilleman appears on p. 32.] 

Mr. MICHAUD. Thank you. Mr. Weidman. 

STATEMENT OF RICHARD F. WEIDMAN 

Mr. WEIDMAN. Mr. Chairman, thank you for the opportunity for 

Vietnam Veterans of America to present our views here today. 

In regard to H.R. 4062, ‘‘Veterans’ Health and Radiation Safety 

Act,’’ one would think that this piece of legislation would not be 

needed but clearly demonstrated by the situation at Philadelphia 

VA Medical Center, it is. VVA is generally in favor of anything that 

promotes greater reporting and is accompanied by greater accountability for quality assurance by the VA health care system. And in 

this particular instance you can code the metrics into VistA, and 

do so without additional burdens on the clinician, which takes 

away from patient-centric care. And so we favor this legislation at 

this point. And to add to the analysis of the annual report would 

also add something that we do not talk about very often. 

The size of the staff at the VA has swollen enormously since 

1994. But the staff, numbers of staff working for the Congress and 

for the Committees on both sides of the Hill is less today than it 

was in 1994. And you need the organization capacity here to be 

able to go through all of the reporting mechanisms that you put in 

place, to be able to absorb that information and assimilate it, and 

work with the Members of the Committee to help them understand 

what situations need more close monitoring and oversight hearings. 

And so we would just put in a pitch for, and we will reiterate that 

to the Speaker and to the Republican Leader as well. 

H.R. 4505, which authorizes the VA Secretary to authorize VA 

State Nursing Homes to take in Gold Star Parents is something we 

are very much in favor of. Of all weeks in the year, this is the most 

appropriate week that we all should be thinking about Gold Star 

Families. Not just the moms and dads, but also the spouses and 

the children who are left behind, as well as siblings. We very much 

favor this. The Gold Star Manor in California cannot possibly handle most of the folks whose sons, primarily, and daughters are not 

around to care for them in their later years. And so this is a needed step. It is not a heavy lift. And we very much favor early passage. 

The draft to Improve VA Outreach Act of 2010, we do favor this. 

VA’s testimony this morning, written statement says it is redundant. But gosh, we cannot see it. There is so little outreach and 

education of the veterans’ community as to what are the benefits 

and services available to them, and what are the long-term health 

care risks that result from military service depending on what 

branch did you serve in, when did you serve, where did you serve, 

that we at VVA started Veterans Health Council. VVA, it is 

www.veteranshealth.org. And we are partnered with a number of 

other organizations, more than 50 organizations, primarily medical 

societies, like the American Academy of Ophthalmology, American 


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Psychiatric Association, disease advocacy groups, like American Diabetes Association, Men’s Healthcare Network, and other veterans 

service organizations like National Association of Black Veterans, 

the United Spinal Cord Association, Veterans First Project, and 

National Association of Uniformed Services, in order to do outreach 

directly to those folks. We have given out over 100,000 brochures 

and are getting about 5,000 hits a month on our Web site because 

people are not getting that information in a succinct form from VA, 

one. Two, is to do the outreach through the U.S. Department of 

Health and Human Services (HHS). The reason why that is so important is we have to reach out to civilian medicine. Less than 20 

percent of the VA population eligible, potentially eligible, uses the 

VA medical system as their primary health care system. We have 

to reach that 80 percent outside in order that they understand 

what is available to them. So we are very much in favor of this. 

Last but not least, I see I am out of time, the WWHAT bill, 

which is, love the name. But we would like to commend you. The 

IOM study that was cited before that was September 2005 that 

looked in depth basically said there was no recordkeeping, there 

was no longitudinal study of any human beings, much less military 

veterans of World War II. Therefore, trying to prove that you were 

exposed to those kinds of noises in World War II, they are all octogenarians now, and nonagenarians. It is time to give them a hearing aid to improve the quality of their lives in the time that they 

have left. In regard to other comments about including the Korean 

War, we would concur with that, as well as other military service. 

But the bill as it is, we favor. 

Thank you very much, Mr. Chairman, for the opportunity. 

[The prepared statement of Mr. Weidman appears on p. 33.] 

Mr. MICHAUD. Thank you very much, Mr. Weidman. And Mr. 

Embree. 

STATEMENT OF TIM EMBREE 

Mr. EMBREE. Thank you, sir. Mr. Chairman, Ranking Member, 

and Members of the Subcommittee, on behalf of Iraq and Afghanistan Veterans of America’s 180,000 members and supporters, I 

would like to thank you for inviting us to testify before your Subcommittee today. 

My name is Tim Embree. I am from St. Louis, Missouri. I served 

two combat tours in Iraq with the United States Marine Corps Reserve. This legislation being considered today will profoundly affect 

veterans of all generations and their families. We appreciate this 

opportunity offer our feedback. 

IAVA proudly supports the Improved VA Outreach Act of 2010. 

Too many men and women discharging from the military are not 

enrolling in the Department of Veterans Affairs for their well 

earned benefits. Currently, the burden is on the veteran to seek out 

their benefits within a passive VA. This is unacceptable. The VA 

must develop a relationship with the servicemembers while they 

are still in the military, not after the servicemember has traded in 

his uniform for a t-shirt and blue jeans. The VA should learn from 

successful college alumni associations. Those folks did not wait 

until graduation day to find their newest members. They greeted 

on the 1st day of freshman year, and repeatedly engaged them 


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throughout their education with planned activities and social 

events. The VA should do the same. 

They should greet servicemembers once they complete basic 

training and build on that relationship throughout the servicemember’s time in uniform. When a person leaves the service the 

VA should create a regular means of communicating with them 

about events, new programs, and opportunities. The VA must aggressively promote VA programs to veterans who have not yet 

accessed their Department of Veterans Affairs benefits. If I have 

half as many letters and emails from the VA as I do from my college alumni association that would be a good start. 

To transfer the VA from reactive to proactive, IAVA believes the 

Department of Veterans Affairs must invest in aggressive, modern, 

and innovative outreach. This is not happening now and veterans 

are clearly suffering as a result. IAVA was disappointed when 

there were only a few brief mentions of outreach activities in the 

President’s VA budget submission, none of which were for a dedicated outreach campaign. We believe the VA must include a distinct line item for outreach within each VA appropriation account. 

This line item should fund outreach programs such as the Operating Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) outreach coordinators, mobile Vet Centers, and the VA’s new social 

media presence on Facebook and Twitter. 

The VA’s current outreach campaign is disappointing. When the 

VA announced it had placed ads on more than 21,000 buses nationally in order to spread the word about the suicide prevention lifeline, we were initially enthusiastic. But then we saw the ad. We 

saw another missed opportunity. The VA bus ad had over 30 small 

print words. The average bus ad is limited to five to 10 words. In 

the short time when a bus passes, a veteran would have to go by 

the bus repeatedly to even read the hotline number. 

IAVA has run one of the largest nongovernmental outreach campaigns in history. We have partnered with the Ad Council and 

some of the world’s best advertising firms. We have learned a lot 

about the best ways to communicate complex and series issues 

through television and print, and we are ready to work with the 

VA to share our expertise. 

The Improved VA Outreach Act will help the VA take their current outreach efforts to a whole new level. This bill requires the VA 

to effectively coordinate outreach efforts among the different parts 

of the Department, as well as other agencies offering services to returning servicemembers. To work closely with HHS in order to promote community health centers. These community health centers 

may be the only medical facility a rural vet can reasonably access 

without spending a full day riding in a car or bus. To set up an 

outreach committee tasked with coordinating efforts, which currently are being done on an ad hoc basis among many of the VA’s 

separate departments, and to submit a 2-year plan fully explaining 

their outreach activities. 

To bring America’s next generation of veterans into the VA to receive the benefits they have earned will require an unprecedented 

VA outreach program. The Improved VA Outreach Act of 2010 is 

the first step in getting us there. 


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Stories about veterans leaving VA facilities sicker than when 

they entered cast a cloud over the confidence veterans place in the 

system charged with their care. Therefore, IAVA endorses H.R. 

4062, the ‘‘Veterans’ Health and Radiation Safety Act.’’ Improper 

use of medical equipment, especially radioactive isotopes, can lead 

to unexplained illness, cancer, and even death. The VA was recently issued the largest fine by the Nuclear Regulatory Commission for misuse of radioactive isotopes in the treatment of nearly 

100 veterans in Philadelphia. H.R. 4062 mandates the proper oversight of these treatments so veterans can be confident in the safety 

of the care they receive. 

It is common sense to support of Gold Star Parents, who have 

given so much to our Nation. That is why IAVA supports H.R. 

4505. This bill expands access for Gold Star Parents to State Nursing Homes. H.R. 4505 changes the requirements to include Gold 

Star family members who have no remaining sons or daughters, 

but have lost one of their children in service to their country. 

IAVA is proud to continue working with this Committee on the 

many issues facing today’s veterans. Thank you very much for your 

time today and I look forward to answering any questions you may 

have. 

[The prepared statement of Mr. Embree appears on p. 36.] 

Mr. MICHAUD. Thank you very much, Mr. Embree. Mr. Brown, 

do you have any questions for the panel? 

Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Chairman, no 

I do not. I appreciate the input on these bills. I know we are pretty 

much in agreement, except maybe on the hearing aid issue. And we 

will certainly look forward to further discussion on that. Thank you 

all for being here. 

Mr. MICHAUD. Mr. Teague. 

Mr. TEAGUE. No, I do not have any questions at this time. And 

for the sake of speed, we will save them for later. Thank you. 

Mr. MICHAUD. Mr. Boozman. 

Mr. BOOZMAN. No, I also do not have any questions. Again, we 

appreciate your guys’ hard work, and all that you represent, and 

giving us your opinion regarding this. So thank you very much. 

Mr. MICHAUD. Mr. Rodriguez. 

Mr. RODRIGUEZ. Yes, let me also just take this opportunity to 

thank you and maybe inquire about one comment. The 84 percent 

vacancies in the nursing home, is this nationwide? Because I know 

in Texas we only have about six or seven of them, and we do not 

have too many nursing homes for veterans. I am not sure if we 

even have any vacancies. Does anybody want to make any comments on that? I know we usually have a waiting list. 

Mr. SEARLE. Yes, sir. Those come from VA’s numbers themselves 

that they reported on average that that is where their numbers 

are. There are some homes that are less. But on a national average 

it is about an 84 percent occupancy rate in the nursing homes. 

Mr. RODRIGUEZ. Yes, because I know in Texas we never had 

them until just in the last decade or so, perhaps the last two decades. I do not have any in my district, and in my previous district, 

I only had one. Okay, thank you. 

Mr. MICHAUD. Thank you. I have a question for everyone on the 

panel, and which some of you touched upon in your testimony. VA 


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states in their written testimony that they do not support H.R. 

4062, the ‘‘Veterans’ Health and Radiation Safety Act,’’ because 

they either met or are working to meet the recommendations provided in the May 2010 Inspector General (IG) report. What is your 

response to VA’s rationale for not supporting this legislation? And 

can you explain whether you believe the VA has made sufficient 

progress in improving the handling of radioactive isotopes at the 

VA medical facilities? I know some of you have touched upon this 

question in your opening remarks. Mr. Searle, do you want to 

start? 

Mr. SEARLE. Again, through our System Worth Saving Task 

Force we have gone to the various medical centers. We have found 

that there are, and we can forward to you in detail some of the results, but we have found that there is a turnover of personnel, and 

that the training of the personnel needs to be standardized and it 

needs to be reinforced. Because new personnel with the activities 

that are going on need to be reinforced. 

Mr. HILLEMAN. Mr. Chairman, thank you for this question. In 

the mind of the VFW it is a confidence issue. Here we had an incident where a number of veterans were harmed by medical procedures that they trusted, doctors that they had faith in. And that 

faith has been undermined. So Congress taking action to ensure 

that an event like this never happens again is something we 

strongly support. Not only that, but the reporting mechanisms in 

the bill will help to ensure that the steps VA is already taking are 

followed through on. Thank you, sir. 

Mr. WEIDMAN. Much of what happens in this room and with the 

distinguished Members of this Committee that you focus on are 

things that all you have to do is have common sense and VA would 

already be doing. And in some instances they do not have the authority to move forward, but in many others they do. And this is 

one of those instances. Clearly, there has not been put in place the 

metrics to measure this systemwide and to report on it. And once 

again, as I said in both our written statement and in the oral statement, it can be designed to have metrics that are not onerous on 

the service providers that will allow VA to know what is going on 

at X, Y, and Z service delivery point. 

The biggest problem within the VA systemwide, and certainly 

with in the medical health care system, is what you measure and 

how do you measure it, and how well do you measure it? It is the 

quality assurance that is the primary failure of this system. To 

know where there are deficiencies, one, and two, holding people accountable at the supervisory and management level has been lacking, in our view, for a very long time and that is where we need 

to go with this system. To ensure that we are getting the bang for 

the buck, we have had over a third increase in the health care 

budget in the last 4 years. And the question is whether or not we 

are getting the bang for the buck. We are not convinced that we 

are yet, but it is certainly possible. But it is going to take a lot of 

oversight on a bipartisan basis but this Committee and we encourage you to do that. And this is one more step in that road. 

Mr. EMBREE. Mr. Chair, thank you for the question. Actually, 

this kind of ties into the VA outreach. Right now from the OIF and 

OEF era veterans, it is tough enough to get these folks into the VA 


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system, for them to learn about the VA system. And to learn about 

the quality of VA health care. VA health care is very, very good. 

Unfortunately, when situations like this arise where it breaks 

down the trust, and it hurts the appearance of the VA health, then 

we need to fix that right away. And there needs to be strong oversight. And we need to restore confidence in this system. And that 

helps with the outreach to these young veterans that are now coming from the battlefields of Afghanistan and Iraq. 

So it is so important for programs like this to have strong oversight to instill confidence in the new veterans that are now trying 

to come into the system. Because we want to bring these new veterans into the system, but we want them to have confidence in the 

system that we are trying to convince them to enter. 

Mr. MICHAUD. Great. Once again, I want to thank each of you 

for your testimony this morning. I look forward to working with 

you as we move forward with the legislation that we heard this 

morning. And I am sure there will probably be additional questions 

that staff will submit to you in writing. So once again, thank you 

very much. 

I would like to ask the third panel to come forward. And while 

they are coming forward, the third panel includes Dr. Jesse, who 

is the Acting Principal Deputy Under Secretary for Health with the 

VHA. He is accompanied by Walter Hall, who is the Assistant General Counsel to the VA. I want to thank you both for coming this 

morning. And we will turn it over to Dr. Jesse. 

STATEMENT OF ROBERT JESSE, M.D., PH.D., ACTING PRINCIPAL DEPUTY UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF 

VETERANS AFFAIRS; ACCOMPANIED BY WALTER A. HALL, 

ASSISTANT GENERAL COUNSEL, OFFICE OF GENERAL COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Dr. JESSE. Yes, good morning Mr. Chairman and Members of the 

Subcommittee. It is a pleasure to appear before you for the first 

time today as Acting Principal Deputy Under Secretary for Health. 

I am accompanied by Mr. Walter Hall, the Assistant General Counsel. We appreciate the opportunity to testify on five pending bills 

and offer VA’s views. 

H.R. 4062, the ‘‘Veterans’ Health and Radiation Safety Act,’’ 

would require VA to submit an annual report to Congress on low 

volume programs, require employees working at VA hospitals 

where radioactive isotopes are used to receive training in recognizing medical events, and require VA to provide frequent evaluations of nongovernment medical service contractors. While we appreciate the intent of H.R. 4062, there are a number of reasons 

why VA does not support it at this time. 

Mr. Chairman, we all acknowledge the lapses that occurred at a 

brachytherapy program at one of our facilities and as a result the 

Office of the Inspector General has issued a report with five recommendations. VA has taken specific actions to comply with all of 

these recommendations, which are detailed in my written statement. Consequently, we believe we have addressed most of Congress’ concerns that are reflected in H.R. 4062. We have other 

issues with the legislation that are specifically related to termiVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00019 Fmt 6633 Sfmt 6633 I:\VA\57025.XXX GPO1 PsN: 57025

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nology, the scope of the legislation, and reporting requirements, 

and these are also expanded in my written testimony. 

VA would like to work with the Committee to better understand 

the intent of H.R. 4465, which would change the attributable income for the purposes of determining eligibility. On its face the bill 

benefits only a small population, namely those persons placed in 

the legal custody of a veteran as a result of a court order. Such persons would be considered children under more generous criteria 

than the veteran’s natural children. If this differentiation was not 

Congress’ intent, and it does not appear that it is, VA is ready to 

work with the Committee to develop a proposal that would achieve 

its objective. 

VA supports H.R. 4505, which would permit a State Home constructed with VA’s resources to provide services to the parents of 

veterans if any of the parents’ children died while serving in the 

armed forces. The legislation provides for fair and more equitable 

treatment of all parents whose son or daughter died while on active 

military duty. There are not additional costs to the VA for this. 

The first draft bill under consideration is the Improved VA Outreach Act of 2010. I am pleased to report that VA is already meeting the intent of the legislation. VA recently created a National 

Outreach Office in the Office of Public and Intergovernmental Affairs, which is responsible for ensuring the effective coordination of 

outreach activities across all VA sectors. In addition, VA has five 

advisory committees on homeless veterans, minority veterans, 

women veterans, readjustment, and rural health that provide outreach direction in their annual reports to the Secretary and to Congress. VA has already established a work group to better coordinate services between Indian Health Service and VA, and is working on a memorandum of agreement to improve that coordination. 

The final bill on the docket today is a draft bill that would expand eligibility for hearing aids to all veterans of active duty service in World War II, even if those veterans are not otherwise entitled to compensation under title 38 of the United States Code. We 

currently have authority to provide hearing aids to veterans with 

service-connected hearing loss as well as to veterans whose hearing 

loss is not service-connected but is so severe that it impedes their 

communication and participation in their medical care. 

While hearing loss can be frustrating and dangerous, especially 

for older adults, VA does not support the legislation as it would result in inequitable treatment of non-World War II veterans with 

hearing loss. The legislation would also create special benefits for 

veterans needing hearing aids in relation to veterans needing other 

prosthetic appliances that are equally crucial to the veterans, well 

being and quality of life. The discretionary cost of this legislation 

would be approximately $14.8 million in the 1st year, $350 million 

over 5 years, and $509.7 million over 10 years. 

This concludes my statement, Mr. Chairman. I would be pleased 

at this time to answer any questions you or other Members of the 

Subcommittee may have. 

[The prepared statement of Dr. Jesse appears on p. 38.] 

Mr. MICHAUD. Thank you very much, doctor. I have a question 

concerning the facts that you just stated, about all the veterans 

who are eligible for hearing aids. There are approximately 2.4 milVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 I:\VA\57025.XXX GPO1 PsN: 57025

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lion World War II veterans who are service-connected. You mentioned even those that might not be service-connected still access 

hearing aids? 

Dr. JESSE. Yes, sir. 

Mr. MICHAUD. How did you come up with that outrageous number? The cost? 

Dr. JESSE. I would have to go back through the math of all that. 

But we can certainly get that to you for the record. 

Mr. MICHAUD. I would hope so, and I would hope that it is very 

explicit, because that math does not seem to add up. Once you exclude those veterans who are not service-connected, it just does not 

add up. There are currently, as I mentioned, I think 2.4 million 

World War II veterans. How many are non-service-connected out of 

that amount? Do you know that number off the top of your head? 

Dr. JESSE. I do not know that number, no sir. 

[The VA subsequently provided the following information:] 

According to VA’s latest official estimate of the veteran population, 

VetPop2007, approximately 2.0 million World War II Veterans were alive 

in September 2010. In FY 2010, 11 percent (217,449) of World War II Veterans received disability compensation benefits. 

Mr. MICHAUD. Because I think once we exclude those veterans 

who are non-service-connected, I think we can have a better idea. 

I believe a hearing aid costs approximately, $6,000? Or less? I am 

not sure of the exact number. But I question very much the fiscal 

note on this legislation. 

As another issue, one of the frustrations that I know a lot of us 

have, including the VSOs at both the national level and the State 

level, is the difficulty of trying to get veterans to sign up for VA 

health care. Part of it is due to some mistrust about the quality of 

service that veterans might receive when they go to the VA. I think 

the other part is, quite frankly, they do not know what they are 

eligible for. And it is confusing. To give you a good example from 

my neck of the woods; when Great Northern Paper Company filed 

bankruptcy and closed their doors, the drugs companies actually offered some programs within their respective companies on how the 

members or individuals could access prescription drugs at low or 

no cost. The problem was there were over 300-some odd programs 

between all of the drug companies. There were 11 or 12 pages of 

applications you would have to fill out. And if you are unemployed, 

you are not going to do that. However, with the efforts of Senator 

Snowe and myself, we were able to get the drug companies to narrow the applicaton down to four questions, and the computer system figured out which programs they were eligible for. That is 

manageable. 

There must be a way where VA can help educate or encourage 

veterans to participate in the VA. For instance, working with the 

IRS to simplify something that the IRS or social security can send 

out to taxpayers to see whether they qualify for VA benefits. I 

think between the IRS and social security you are going to be able 

to hit the bulk of the American population. And there has to be a 

way for VA to do more of that type of outreach. Have you thought 

about anything in that regard? 

Dr. JESSE. A couple of things. One of the major roles of the Office 

of Public and Intergovernmental Affairs was to really begin at the 


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VA level to not just address this but to actually coordinate all of 

the other activities that are going on. I actually take to heart the 

comment about college alumni, and how they try and engage people 

earlier on. And I think that the real key to outreach is to start before they get discharged from the military, even to the point that 

they are enlisting, to understand that there are clear benefits that 

come along with this commitment to serve their country. And, at 

the time of separation from the service, to be much more robust in 

ensuring that the veterans understand their benefits. A lot of effort 

is going on now in coordinating this with the U.S. Department of 

Defense, including coordinating some of the discharge exams with 

the eligibility exams for VA, and the attempt to make sure that 

these are coordinated. This is the first impression many of these 

veterans will get of VA. And then those delays, any issues there, 

may actually turn people off. And we are spending a tremendous 

amount of energy to work in that regard as well. 

Mr. MICHAUD. Those are good efforts. I appreciate Secretary 

Shinseki’s and Secretary Gates’ efforts to work for those who are 

newly sworn in to the military. I think that those efforts are going 

to work. But we also have a huge amount who have already gone 

through the process. And we have to look at trying to get those individuals into the VA system. I think one area where we can have 

the biggest outreach impact on the American people is either 

through the IRS, social security, or through HHS for those who are 

on Medicare or Medicaid. I think there definitely has to be a real 

concerted effort to get individuals into the system. I can understand that there is some reluctance in doing that because ultimately that would mean that there would be more cost to the VA, 

and Congress would probably have to appropriate more funding to 

take care of those individuals. But that is what we are here for, 

to take care of the veterans. 

Dr. JESSE. Well, absolutely, sir. And it is really our explicitly 

stated goal that we want to be the health care system that they 

want to belong to, and we feel this is very important. 

Mr. MICHAUD. Thank you. Mr. Boozman. 

Mr. BOOZMAN. Thank you, Mr. Chairman. In regard to H.R. 

4062, the IG came out I think with five things that they feel like 

needed to be implemented. I guess the question I would have, do 

you agree with those five? Do you have some concerns about them? 

If so, what? If not, how are we doing in regard to implementing the 

five things that they suggest? 

Dr. JESSE. Well actually, we agree with all five of those recommendations. We have been working diligently to get all those 

components in place and, you know, very much appreciate their 

input in identifying the problems and moving those forward. Most 

of these, I think, are well along the way. It will take some time to 

get all of these components in place. But we, you know, we agreed 

on the, Dr. Petzel, the Under Secretary, had agreed to their recommendations, and we are moving forward. 

Mr. BOOZMAN. And so we do have a timeline that we are moving 

towards to get implementation? 

Dr. JESSE. Yes, in the sense that we have, you know, we do have 

a meeting with the NRC. 

Mr. BOOZMAN. Kind of yes and no? 


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Dr. JESSE. Well, have we set an exact date for this piece and this 

piece and this piece? The answer is no. But we—— 

Mr. BOOZMAN. This is something I think, Mr. Chair that we 

might ask you all to maybe come up with a timeline so that we 

can—— 

Dr. JESSE. Certainly. 

Mr. BOOZMAN [continuing]. Check in periodically as to what is 

happening in that regard. 

Dr. JESSE. We would be glad to do that. 

[The VA subsequently provided the following information:] 

The Department of Veterans Affairs (VA) Office of Inspector General (OIG), 

in VA OIG Report 09–02815–143, published May 3, 2010, identified five 

recommendations to improve brachytherapy treatment of prostate cancer at 

the Philadelphia VA Medical Center and other VA Medical Centers. 

Recommendation 1: 

‘‘VHA’s National Director of Radiation Oncology Programs should have 

sufficient resources, to ensure that VHA provides one high quality 

standard of care for the prostate brachytherapy population. To achieve 

this end, VHA should standardize, to a practical extent, the privileging, 

delivery of care, and quality controls for the procedures required to provide this treatment.’’ 

VA issued standard procedures for training, written directives and clinical 

requirements in January 2009 and implemented them in May 2009. All 

service chiefs, medical physicists, and Radiation Safety Officers (RSO) in 

prostate brachytherapy program completed mandatory training in January 

2009. The Veterans Health Administration (VHA) finished adapting Radiation Oncology (RO) guidelines from the American College of Radiology 

(ACR) in September 2009. On September 27, 2010, VA’s Radiologic Physics 

Center awarded a contract for medical physics quality assurance. VA’s National Health Physics Program (NHPP) completed its annual inspections of 

seed implant programs in August 2009, January 2010, and September 2010. 

The inspections for all active programs in this annual cycle should be complete by February 2011. VA continues to track and monitor progress to ensure all RO programs are ACR inspected and accredited; as of September 

2010, 22 facilities have received ACR site surveys, 10 of these facilities have 

received accreditation, 8 facilities submitted ACR applications, and 6 of 22 

facilities deferred pending corrective action plan approval. By December 

2010, VA will expand National Cancer Institute Radiation Policy Council 

medical physics quality assurance coverage to all RO programs, including 

an inspection of linear accelerators every year and on-site peer review of 

physics practice every 3 years. 

Recommendation 2: 

‘‘VHA should take the steps required to ensure that patients who received low radiation doses in the course of brachytherapy be evaluated 

to ensure that their cancer treatment plan is appropriate.’’ 

VA reviewed all 114 brachytherapy cases and notified and reevaluated 

under-dosed Veterans for possible additional treatment by the Philadelphia 

VA Medical Center (VAMC). VA referred 18 patients to the VA Puget 

Sound Health Care System for the placement of additional seeds. VA referred patients to Puget Sound if the patients had completed their 

brachytherapy treatment within the past year of discovery and had been 

considered to have been under-dosed. Eight Veterans were identified as 

needing additional treatment, and these Veterans received treatment consisting of a second procedure to boost areas of low dose implantation at the 

Puget Sound facility. Seven of the eight Veterans are being followed by the 

Philadelphia VAMC, and the eighth is being followed by the Erie VAMC. 

The remaining 10 Veterans did not have a second prostate brachytherapy 

procedure as VA determined it was not necessary or the Veteran refused 

this treatment. VA continues to provide health care to these Veterans. 

Each Veteran is seen every 6 months for followup cancer care. The Philadelphia VAMC’s RO Service performs these evaluations, and continues to 


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provide ongoing evaluations for 5 years of cancer-free survival, after which 

the primary care clinic follows the Veteran at least annually for the lifetime 

of the Veteran. 

Recommendation 3: 

‘‘VHA should review the controls that are in place to ensure that VA 

contracts for health care comply with applicable laws and regulations, 

and where necessary, make the required changes in organization and/ 

or process to bring this contracting effort into compliance.’’ 

All VA facilities are required to ensure contractors comply with applicable 

regulations and standard procedures. VA established this requirement in 

standard procedures and implemented it in May 2009. VA is revising VA 

Directive 1663, ‘‘Health Care Resources Contracting—Buying,’’ based on 

section 8153 of title 38, United States Code, to clarify some areas of the 

previous directive. The goal is to define the requirements so that contracting officers will be able to comply in a timely manner. Service Area 

Training Officers will be working with the Contracting Officer’s Technical 

Representatives (COTR) to establish a more formal program and to develop 

specialized COTR training by types of contracts. While the rewrite of VA 

Directive 1663 is ongoing, all new contracts are consistently being reviewed 

and all areas of concern are being addressed prior to the solicitation to ensure the contracts are technically sufficient. The National RO Program Office reviews all solicitations for RO contracts before the contract begins. Beginning in December 2010, standard language for RO contracts, including 

quality assurance programs, will be posted on VHA’s Procurement and Logistics Office intranet Web site. 

VHA supports the Veterans Affairs Acquisition Academy (VAAA) in implementing the newly developed Medical Sharing (1663) course. This Academy 

will begin holding a Medical Sharing Training Class in fiscal year (FY) 

2011. 

Recommendation 4: 

‘‘Senior VA leadership should meet with Senior NRC leadership to determine if there is a way forward that will ensure the goals of both organizations are achieved.’’ 

VA’s Under Secretary for Health and National Director for Radiation Oncology met with the Nuclear Regulatory Commission (NRC) Chairman and officials on June 8, 2010. VA’s National Director for Radiation Oncology presented VHA’s position on the proposed medical events rules at the NRC 

Commission Meeting on Part 35, Proposed Rule on Medical Events Definitions, on July 8, 2010. The Commissioners disapproved the proposed rule 

and have requested VHA and other stakeholders to assist in this process. 

VA is working with a group of experts representing the relevant professional societies to help NRC staff draft new rules concerning medical 

events. 

Recommendation 5: 

‘‘VHA should work with the OIG to develop a list of documents that 

should routinely be provided to the OIG when an outside agency is notified of a (possible) untoward medical event.’’ 

VHA has surveyed its program offices to compile a list of events that are 

possibly reported to other agencies, and discussions are ongoing in regard 

to coordinating the reporting of incidents to OIG. 

Mr. BOOZMAN. Are there provisions in the bill that go beyond the 

actions that you are currently taking? 

Dr. JESSE. The provision in the bill that goes beyond the actions 

we are currently taking, and the one that I think has the greatest 

concern to us, is one that is, I think maybe is a little bit lost in 

the definition. But there is a requirement that we review all medical services contracts weekly. We have looked, and that does not 

specifically refer just to nuclear medicine related contracts. So as 

we look at that, and not including contracts related to the Community-Based Outpatient Clinics, and other things along those lines, 


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we currently have just under 1,000, I think 971 medical services 

contracts. If we review them weekly, that is 50,000 reports a year. 

Which I think would basically pull our people away from doing 

clinical work and we would be a reporting agency. 

Mr. BOOZMAN. Okay. 

Dr. JESSE. So I think, you know, that piece is probably one of the 

greatest concerns. The other is the terminology related to training 

of all personnel in nuclear related, what are called reportable medical events. Currently, all personnel who work in nuclear medicine 

receive that training. And that is where that training needs to be. 

To say that we would have to train all medical center employees 

would be a huge burden, a huge cost, and probably not productive. 

Those are the main concerns we have. 

Mr. BOOZMAN. And that would be different from the typical hospital setting? Or the typical setting in, out there in the private sector versus the—— 

Dr. JESSE. Oh, the private sector? I think what we do is in line 

with what happens in the private sector, yes. It is the people who 

work in nuclear medicine and with these patients that are trained 

and recognize that. 

Mr. BOOZMAN. Right. Very good. One more thing, H.R. 4505 is 

seeking to modify a regulation. Is that something that VA could 

look and do without—— 

Dr. JESSE. Yes, sir. We have actually discussed that. We could 

change that through regulation—— 

Mr. BOOZMAN. And I guess my comment is would you be willing 

to look at it, and kind of come back and—— 

Dr. JESSE. No, absolutely, we would be very glad to do that. The 

one, as I understand it, if we do it through regulation it will take 

about a year. If it is done through legislation it could be facilitated. 

But either way, we fully support this. We think this is a gap in current regulations. 

Mr. BOOZMAN. Right. 

Dr. JESSE. We think it needs to be corrected, and our preference 

would be to correct it as expediently as possible. 

Mr. BOOZMAN. Good. Well maybe you and us working with Mr. 

Thornberry can figure out what is the best way to pursue it. 

Dr. JESSE. We would be happy to. 

Mr. BOOZMAN. Okay. Thank you, Mr. Chair. 

Mr. MICHAUD. Thank you very much, and I appreciate that. And 

having dealt with the VA, particularly on the nursing home issues, 

the length of time that it takes them to go through the regulatory 

process would be a concern. And I agree with Representative 

Thornberry that we should look to work with VA on this. But I 

think we ought to try to deal with that as soon as possible, and 

I know the regulatory process sometimes does not work that swiftly. And sometimes that outcome might not be what we want, either. 

Mr. BOOZMAN. Will the gentleman yield? No, I agree. If we can 

get a statement from VA and a strong statement from the Committee, then perhaps we can go ahead and get that done. 

Mr. MICHAUD. Great. Thank you. I have no further questions. I 

want to thank you both for coming. I want to thank you both for 

your testimony. I look forward to working with you, and I am sure 


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there will be some additional questions as we move forward with 

the two draft pieces of legislation and the three bills that we have 

before us today. Thank you for your continued service working with 

our veterans and your employees. We still have a ways to go. As 

you heard from the previous panel, there are some concerns with 

the perception of what VA is doing and not doing, and I look forward to working with you to make sure that we do have and improve on the system we currently have today. So once again, I want 

to thank both of you for coming today. If there are no further questions, I will close this hearing. Thank you. 

Dr. JESSE. Thank you, sir. 

[Whereupon, at 11:05 a.m., the Subcommittee was adjourned.] 


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A P P E N D I X 

Prepared Statement of Hon. Michael H. Michaud, Chairman, 

Subcommittee on Health 

I would like to thank everyone for coming today. 

Today’s legislative hearing is an opportunity for Members of Congress, veterans, 

the VA and other interested parties to provide their views on and discuss introduced 

legislation within the Subcommittee’s jurisdiction in a clear and orderly process. 

This is an important part of the legislative process that will encourage frank discussions and new ideas. 

We have five bills before us today which address a number of important issues. 

First, we have a radiation safety bill that requires proper training of all employees 

at VA hospitals where radioisotopes are used to provide medical care. Next, we have 

a bill which requires the VA to consider children under the legal guardianship of 

a veteran when determining the veteran’s co-payment amount for medical treatment. We also have a bill which would allow gold star parents access to the state 

veterans homes if they had any child who died while serving in the Armed Forces. 

Finally, we have draft legislations on improving the VA’s outreach to veterans and 

the provision of hearing aids to World War II veterans. 

I look forward to hearing the views of our witnesses on the bills before us today. 

f 

Prepared Statement of Hon. Henry E. Brown, Jr., Ranking Republican 

Member, Subcommittee on Health 

Thank you, Mr. Chairman, and thank you for holding this legislative hearing. 

I am pleased to be here and eagerly anticipate consideration of the five bills before us that cover a variety of issues regarding our veterans. 

I want to thank all of the Members who have sponsored these bills and taken the 

time to participate in our hearing today. 

I am particularly interested in hearing about H.R. 4505, which was introduced by 

my friend and colleague from Texas, Mac Thornberry. 

In order to receive VA per diem payments, a State Veterans Home must maintain 

an occupancy rate of 75 percent veterans. However, veteran spouses or parents who 

have lost all of their children due to military service are also eligible for admission, 

if allowed by State policy. H.R. 4505 would permit a State Home to also provide 

services to a parent if one of their children died while serving in the Armed Forces. 

When we honor the bravery and service of our military members and veterans, 

we must also honor the sacrifice and selflessness of their families. And, I do not 

think the loss of a child—whether one or many—can be differentiated. I thank Mac 

for introducing this legislation. 

As we continually attempt to improve services and increase the well-being of our 

veterans, it is vital that we continue to work together and have candid discussions 

about the best ways to improve services and move forward with legislation to benefit 

our veterans. And, I look forward to hearing more about all of the bills on our calendar this morning. 

I want to thank our witnesses for being here and in the interest of moving forward with our discussion, I yield back the balance of my time. 

f 

Prepared Statement of Hon. Larry Kissell, a Representative in 

Congress from the State of North Carolina 

Chairman Michaud and Ranking Member Brown, thank you for your invitation 

to this hearing and allowing me to share with you the importance of H.R. 4465. As 

I am sure all Congressional members experience in their various states and disVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00027 Fmt 6604 Sfmt 6621 I:\VA\57025.XXX GPO1 PsN: 57025

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tricts, our constituents’ concerns come in a wide range of shapes and sizes. Some 

of these concerns require major legislation to address the issues, while others may 

require incremental changes to bring relief to those hurting the most. 

As our Nation’s socio-economic dynamic changes, we as a Congress must ensure 

we address the emerging needs of our veterans. This Committee does an outstanding job of identifying needs and providing legislation to honor those who 

served our Nation. Today I present to you H.R. 4465. This bill provides assistance 

to the growing number of veterans who are accepting custody of additional dependents. 

H.R. 4465 acknowledges the efforts of veterans who accept legal custody of a child 

that is not their own. This bill amends the current law so that the VA considers 

children placed in the legal custody of a veteran as dependents when determining 

if a veteran must pay a co-payment for medical treatment. Although not all veterans 

are required to pay co-payments, those that do receive additional consideration 

based on their household income and number of dependents. Dependent children are 

defined as biological, adopted, and step-children. The current law does not address 

veterans who voluntarily assume the parenting role for a child and receive full custody from the courts. 

I am not sure of the number of veterans that are accepting these roles. When 

CBO scored the bill they reported only a few veterans would be affected and the 

bill would have an insignificant effect on spending pending appropriations. I became 

aware of the problem after Robert and Miriam Preiser approached me. The Preisers 

have been married for 13 years. Robert is 70 and Miriam is 79 years old. Between 

the two of them they have 10 children, 24 grandchildren, and 17 great-grandchildren. They are on a fixed income. Because of his 2 year tour in the Army about 

60 years ago, Robert receives a great deal of his care through the Veterans Administration. 

About 5 years ago a number of unfortunate events resulted in Child Protective 

Services assuming custody of two of the Preiser’s great grandchildren, a 5 year old 

boy and a 2.5 month old girl. I will not go into the details of the case, but ultimately 

CPS determined the parents were not fit to raise the children. The Preisers immediately stepped in and volunteered to become the children’s guardian. After about 

a year of court proceedings, the courts granted the Preisers full custody. 

The Internal Revenue Services, the courts, the local school district, Child Protective Services, and other state and federal entities consider the children as dependents. The IRS allows the Preisers to claim the children as dependents due to the 

court documents they possess. If you choose to proceed with this bill and it eventually passes, it will ensure that the VA considers children in the legal custody of a 

veteran are considered as dependents when determining if the veteran must pay a 

co-payment for medical treatment. 

f 

Prepared Statement of Hon. Mac Thornberry, a Representative in 

Congress from the State of Texas 

I appreciate the opportunity to testify before the Subcommittee today on H.R. 

4505. 

There are 137 State Veterans Homes located in all 50 States and in Puerto Rico 

that provide hospital and skilled nursing care to approximately 28,500 veterans and 

dependents. State Veterans Homes are institutions that many of our veterans and 

their dependents have relied upon for nearly 150 years. 

Gold Star Parents are parents who have lost a son or daughter who died while 

serving our country in the military. However, to be eligible for admission to a State 

Veterans’ Home, a Gold Star Parent must have lost all of his or her children while 

in military service. State Veterans’ Homes must deny admission to a Gold Star Parent if they have any surviving children. 

H.R. 4505 would allow State Veterans Homes to admit the parents of servicemembers who died while serving our Nation to VA Nursing Homes. My legislation 

would permit admission into a State Veterans’ Home to any parent who lost at least 

one son or daughter while serving our Nation to protect our freedoms and way of 

life. 

Those we ask to fight and die in our wars should have the assurance that their 

families will be cared for by their country. 

Losing a child to war is a stunning and life altering event, which is why I am 

pushing for this bipartisan legislation to become law in the coming weeks. 

Additionally, the financial impact to the Federal Government will be minimal, 

since the VA does not pay a per diem to state homes for Gold Star Parents. In our 


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conversations with state officials, they expect that the impact to state budgets would 

be minimal as well. 

The Consolidated Appropriations Act of 2010 required the VA to conduct a feasibility study to identify the potential impact of providing State Veterans’ Home care 

to Gold Star Parents. The VA determined that such feasibility study would be useless because there would be no additional cost to the VA by providing this service. 

The bill is supported by the American Legion and the National Association of 

State Veterans Homes, and I know of no opposition. 

In closing, I appreciate your consideration of this bill and ask for your support 

to ensure that Gold Star Parents are able to receive the support they need. I look 

forward to answering any questions you might have about my bill. 

Again, thank you for holding this hearing and allowing me to testify. 

Department of Veterans Affairs (VA) 

Report to Congress on State Home Care 

Issue: The Joint Explanatory Statement accompanying Public Law 111–117, 

Transportation, Housing and Urban Development and Related Agencies Appropriation Act, 2010, urges the Department to undertake a feasibility study to identify any 

potential impacts of permitting State Home Care facilities to provide services to 

non-Veterans who have had a child die while serving in the Armed Forces, as long 

as such services are not denied to a qualified Veteran seeking those services. The 

Department is directed to report back to the Committees on Appropriations of both 

Houses of Congress within 90 days of enactment of this Act on what steps, if any, 

have been taken to undertake the feasibility study and any findings, should the 

study be completed. 

Background Information: 

General eligibility requirements for admission to a State Veterans Home: Veterans in need of skilled nursing care and who have a general honorable military 

discharge are given admission priority. Spouses, surviving spouses, and Gold Star 

parents in need of skilled nursing care are also eligible for admission, if allowed by 

state policy. VA is prohibited by law from exercising any supervision or control over 

the operation of a State Veterans Home, including setting admission criteria. Admission requirements are determined exclusively by the state. The states also establish and manage operating procedures, personnel practices, and other operational 

matters. 

Discussion: 

• VA Medical Centers of jurisdiction and State Veteran Homes must comply with 

the 75 percent Veteran residency rule (title 38 U.S.C. 8131–8137), i.e., State 

Homes are required to maintain an occupancy rate of 75 percent Veterans to 

be eligible for VA per diem payments. 

• Admission requirements for State Veterans Homes are determined exclusively 

by the state. 

• Current authority does not allow VA per diem payments for services provided 

in a State Veterans Home to Gold Star parents or any other non-Veteran residents. 

• The Veterans Health Administration believes it is feasible to permit State 

Home Care facilities to provide services to non-Veterans who have had a child 

die while serving in the Armed Forces, as long as such services are not denied 

to qualified Veterans seeking those services. Legislative authority would need 

to be enacted. 

• There would likely be some financial impact on the states to support non-Veterans in State Veterans Homes. 

Recommendation: 

A feasibility study is not required because there would be no additional cost to 

VA by permitting State Home Care facilities to provide services to non-Veterans 

who have had a child die while serving in the Armed Forces. 

Veterans Health Administration 

April 2010 


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The American Legion 

Washington, DC. 

January 26, 2010 

Honorable Mac Thornberry 

U.S. House of Representatives 

2209 Rayburn House Office Building 

Washington, DC 20515–4313 

The American Legion fully supports your proposed legislation to enable State Veterans’ Homes to furnish nursing home care to parents any of whose children died 

while serving in the Armed Forces of the United States. Such parents are respectfully referred to as Gold Star parents. 

Currently, Gold Star parents may receive care in a State Veterans’ Home only 

if they have lost all of their children in service to the country. The loss of a single 

servicemember brings much grief and sadness to a grateful nation. The American 

Legion believes this benefit was granted with good intention, but unrealistic expectations of personal sacrifice. As a nation at war, to maintain such a standard for 

an earned benefit is unacceptable. The pain of loss for parents of an only child is 

just as unbearable as the loss for parents with more than one child. 

Thank you Representative Thornberry for offering legislation that would extend 

the heartfelt gratitude of a grieving nation to parents of a fallen hero. The American 

Legion fully supports your proposed legislation to address this injustice. The American Legion appreciates your continued leadership in addressing the issues that are 

important to veterans, members of the Armed Forces, and their families. 

Sincerely, 

Steve Robertson 

Director, National Legislative Commission 

Texas General Land Office 

Austin, TX. 

January 26, 2010 

Honorable Mac Thornberry 

U.S. House of Representatives, District 13 

2209 Rayburn House Office Building 

Washington, D.C. 20515–4313 

Dear Congressman Thornberry: 

I am writing you to express my complete support of S.1450, a bill to allow the 

parents of service-members who died while serving the Nation access to VA Nursing 

Homes. Currently, an individual is allowed admission into a State Veterans Home 

if the individual is an eligible veteran, the spouse of an eligible veteran, or a Gold 

Star parent. The problem that arises is the way the term ‘‘Gold Star parent’’ is currently defined in the Code of Federal Regulations (CFR) administered by the VA. 

According to the CFR, Gold Star parents are eligible for admission to State VA 

Nursing Homes if they have lost all of their children who were serving our country 

on active duty military service. This legislation would rectify this and permit admission into a State VA Nursing Home to any parent that lost at least one son or 

daughter, while fighting to protect our freedoms and way of life. 

As chairman of the Texas Veterans Land Board, I oversee our Texas State Veteran Nursing Home program where we provide skilled nursing care to over 1,000 

Texas veterans and their family members in one of our seven facilities. As most people are aware, State Veterans Homes were founded for wounded and homeless veterans following the American Civil War and have become institutions that many of 

our veterans and their dependents have come to rely on for nearly 150 years. Currently there are 137 State Veterans Homes located in all 50 States and in Puerto 

Rico that on a daily basis provide hospital, skilled nursing, rehabilitation, long-term, 

dementia and Alzheimer’s, domiciliary, respite, end of life, and adult day health 

care, to approximately 28,500 veterans and dependents. 

I believe that it is only fair that the parents who lost a son or daughter in military service have access to these first class facilities. This legislation is strongly supported by the National Association of State Veterans Homes. 

Please join me in supporting our parents who have given more than we as a nation could ever ask of them by changing the definition of a Gold Star Parent. 


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If you have any additional questions, please contact my federal liaison Jim Darwin at 512–463–2623 or email at jim.darwin@glo.state.tx.us. 

Sincerely, 

JERRY PATTERSON, Commissioner 

Texas General Land Office 

National Association of State Veterans Homes 

RESOLUTION 2010–2 

SUPPORT FOR ADMISSION TO STATE VETERANS HOMES OF ANY 

PARENT WHOSE CHILD PERISHED WHILE SERVING ON ACTIVE DUTY 

IN THE ARMED FORCES OF THE UNITED STATES 

WHEREAS, State Veterans Homes were founded for soldiers and sailors following the American Civil War, and have ably served veterans and some of their 

immediate dependents and survivors for nearly 150 years; and 

WHEREAS, currently there are 140 State Veterans Homes in all States and in 

Puerto Rico, on a daily basis providing hospital, skilled nursing, skilled rehabilitation, long-term care, dementia and Alzheimer’s care, domiciliary care, respite care, 

end of life care, and Adult Day Health Care to 28,500 veterans and dependents; and 

WHEREAS, Title 38, United States Code, authorizes State Veterans Homes to 

care for non-veteran residents, but only to the extent that non-veteran residents 

constitute no more than twenty-five percent of bed capacity at Such State Veterans 

Homes; and 

WHEREAS, Title 38, Code of Federal Regulations, defines eligible non-veteran 

residents of State Veterans Homes as immediate dependents and survivors of veterans with antecedent residence in State Veterans Homes, and parents, all of whose 

children died while serving in active military service to the United States; and 

WHEREAS, recognizing the contemporary trend of the all-volunteer military 

force, the wide array of career paths available to American citizens, and modern 

asymmetrical wars and military conflicts that require both periodic and episodic deployments to combat engagements throughout the world, a post-World War II policy 

that requires all of a parent’s children to have perished in war as a precondition 

of eligible residence of a parent in a State Veterans Home under Title 38, United 

States Code, as interpreted in its Code of Federal Regulations, is unwarranted and 

exhibits an exclusionary intent toward parents who have suffered irreparable loss 

of a child, or children, who served their Nation in uniform. 

NOW, THEREFORE, BE IT RESOLVED, that the National Association of 

State Veterans Homes (NASVH) supports an amendment to Title 38, Code of Federal Regulations, or in absence of such revision, amendment to Title 38, United 

States Code, to authorize admission to State Veterans Homes of any parent whose 

child perished in active military service to the United States; and fully supports the 

legislative objectives of the National Association of State Veterans Homes (NASVH) 

to receive from VA a per diem payment that equals 50 percent of the national average cost of providing care in a State Veterans Home. 

Adopted 

With Change 

Rejected 

COLLEEN RUNDELL, M.S., LNHA 

President 

National Association of State Veterans Homes 

f 

Dated this ll day of lllll, 2010 


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Prepared Statement of Hon. John Adler, a Representative in 

Congress from the State of New Jersey 

I would like to thank Chairman Michaud, Ranking Member Brown, and Members 

of the Subcommittee for the opportunity to testify on behalf of H.R. 4062, the Veterans’ Health and Radiation Safety Act. This Subcommittee has been integral in ensuring that the health care needs of our veterans are being met. I commend you 

on your leadership. 

The need for H.R. 4062 came from a very serious matter that occurred at the 

Philadelphia Veterans Affairs Medical Center. Starting in 2003, the brachytherapy 

program at the Philadelphia VA Medical Center was operated by a rogue doctor who 

botched approximately 86 percent of the prostate cancer treatment procedures he 

was contracted to perform on our veterans. These multiple failures, which went undetected year after year, highlighted significant problems in the VA’s oversight system. The VA failed until 2008 to catch this pattern of failure. 

Upon learning of these glaring oversights, I became outraged that the brave men 

who so selflessly served our country had been subjected to such poor treatment and 

were neglected by a hospital and system created to protect them. 

H.R. 4062, the Veterans’ Health and Radiation Safety Act is a comprehensive 

piece of legislation that seeks to remedy many of the mistakes that led to the problems surrounding the brachytherapy program at the Philadelphia VA Medical Center. 

This bill has three major components centered on increasing oversight and ensuring reform throughout the VA Health Care System. 

First, my bill mandates that the VA conduct an evaluation of all of the low-volume programs that are currently operating in its medical facilities to ensure that 

they are meeting their safety standards. The brachytherapy program at the Philadelphia VA Medical Center was not subjected to independent peer review due to the 

fact that it was such a low volume program, serving only 116 patients over a 6-year 

period. Because of this lack of oversight, errors that should have been caught and 

rectified were allowed to continue for 6 years unnoticed. 

Second, H.R. 4062 requires that every VA employee and independent contractor 

working in a VA medical facility be trained in what constitutes a ‘‘medical event,’’ 

as that term is defined by the Nuclear Regulatory Commission, as well as when 

such an event should be reported and to whom. The bill also provides that if a VA 

hospital has failed to administer such training, the use of radioactive isotopes at 

that VA medical facility may be suspended by the Secretary. 

Over the course of the 6-year period in which the brachytherapy program at the 

Philadelphia VA was in operation, 86 percent of the patients were subjected to ‘‘reportable medical events.’’ However, because many of the medical personnel in the 

program, including the independent contractors, were not trained in what constitutes a ‘‘medical event,’’ as that term is defined by the NRC, or to whom such 

an event should be reported, these errors were allowed to continue and our veterans 

remained susceptible to substandard medical care for far too long. 

Lastly, my bill requires the Secretary to evaluate all medical services provided 

pursuant to a contract with a non-government entity. Such evaluations shall include 

independent peer reviews of such medical services and written evaluations of an 

independent contractor’s performance by that contractor’s supervisor. The bill also 

states that before a contract for medical services can be renewed, the above evaluations must be conducted. 

One of the biggest problems that occurred at the Philadelphia VA was the lack 

of oversight and supervision VA officials had over the independent contractors they 

contracted with to provide medical services in their brachytherapy department. 

What is particularly troubling is that these contracts were re-upped every 3 to 6 

months with little to no scrutiny as to the performance of the independent contractors. It is my hope that this provision in the bill will increase oversight throughout 

the VA Health care system. 

The veterans who sought treatment for prostate cancer at the Philadelphia VA 

Hospital did not receive the quality health care their selfless service to our country 

earned them. Such mistreatment of our veterans is not only unacceptable; it violates 

the bond our country made with them when they agreed to fight for the safety and 

security of this Nation. It is my hope that H.R. 4062 will help ensure that the failures that occurred at the Philadelphia VA Medical Center will never happen again 

within the VA. 

I would again like to thank Chairman Michaud, Ranking Member Brown, and 

Members of the Subcommittee for allowing me the time to testify on this important 

matter. I would be happy to answer any questions you might have. 

f 


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Prepared Statement of Barry A. Searle, Director, Veterans Affairs and 

Rehabilitation Commission, American Legion 

Mr. Chairman, Ranking Member and Members of the Subcommittee: 

Thank you for the opportunity to present the views of The American Legion on 

H.R. 4062: The Veterans’ Health and Radiation Safety Act; H.R. 4505: Expansion 

of State Home Care for Parents of Veterans Who Died While Serving in the Armed 

Forces; H.R. 4465: Determination of Attributable Income for Veterans with Children; and two pieces of proposed legislation: ‘‘Improve VA Outreach Act of 2010’’ and 

‘‘The World War II Hearing Aid Treatment Act’’. 

H.R. 4062—Veterans’ Health and Radiation Safety Act 

This legislation would require the Secretary of Veterans Affairs to report annually 

to Congress on the low-volume (treating 100 patients or less) programs at each VA 

medical facility. It would further direct the Secretary to ensure that all employees 

at a VA hospital where radioactive isotopes are used in the administration of medical services receive appropriate training on what constitutes a medical event and 

when and to whom a medical event should be reported. It would prohibit such isotopes from being used at a VA hospital where such training is not provided. Finally, 

H.R. 4062 would require the Secretary to carry out specified evaluations and peer 

reviews of all medical services provided under contract with a non-government entity. 

The American Legion’s ‘‘System Worth Saving’’ Task Force annually conducts site 

visits at VA Medical Centers nationwide to assess the quality and timeliness of VA 

health care. In preparing for these visits, The American Legion team researches 

Government Accountability Office (GAO) reports, VA’s Office of Inspector General 

(VAOIG) reports, and news articles relating to potential breakdowns in a system 

that we consider, ‘‘The Best Care Anywhere.’’ 

During The American Legion ‘‘System Worth Saving’’ Task Force visits, and in 

our research, we have found that turnover of personnel and the shortage of personnel at most facilities require renewed emphasis on standardized procedures, 

quality review and individual training, as well as documentation of that training. 

Further, The American Legion believes that VA must maintain proper oversight of 

medical care, utilization of facilities and resources in order to ensure veterans receive the highest quality of care. 

In a May 2010, VAOIG report concerning the review of Brachytherapy Treatment 

of Prostate Cancer at Philadelphia, PA and other VA Medical Centers, a recommendation was made for VHA to ‘‘standardize to a practical extent, the privileging, delivery of care, and quality controls for the procedures required to provide 

treatment.’’ As technologies continue to change and treatments and procedures continue to develop, it is critical that VA staff delivering care be properly trained and 

are accountable. H.R. 4062, ‘‘Veterans’ Health and Radiation Safety Act,’’ continues 

and enhances protections for veterans through required reporting, training, and 

evaluation of services provided by Veterans’ Health Administration (VHA). The 

American Legion supports not only the specified training and the accountability 

highlighted in H.R. 4062, but also the standardization of all patient care delivered 

across the VHA system. 

The American Legion supports H.R. 4062. 

H.R. 4505—Expansion of State Home Care for Parents of Veterans Who 

Died While Serving in the Armed Forces 

This legislation would authorize the Secretary of Veterans Affairs to permit a 

state home to provide VA nursing home care to parents who suffered the loss of a 

child who died while serving in the Armed Forces. 

The American Legion is well known for its long history of advocating on behalf 

of veterans and their families. We believe firmly that a commitment is made not 

only by the servicemembers who raise their hand in service to this country, but also 

their family members who must say good bye to their loved ones who head into combat to protect the freedoms of this Nation. President Lincoln, during his Second Inaugural Address made the statement that would later become the mission of VA, 

‘‘To care for him who shall have borne the battle and for his widow, and his orphan.’’ The American Legion strongly believes that when a servicemember is killed 

in the line of duty and a dependent parent is deemed medically eligible for nursing 

home admission, that parent be entitled to VA nursing home care. Currently, Title 

38 Code of Federal Regulations (CFR) imposes too high a threshold of suffering on 

surviving parents when it requires that all children must have died while serving 

on active duty. H.R. 4505 amends section 51.210(d) of Title 38, CFR, to provide servVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00033 Fmt 6604 Sfmt 6621 I:\VA\57025.XXX GPO1 PsN: 57025

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ices to ‘‘a non-veteran any of whose children died while serving in the Armed 

Forces.’’ 

The American Legion at its 2009 Convention approved a resolution which recommends amending section 51.210(d) Title 38, CFR, ‘‘To authorize admission to 

State Veterans Homes the parents of any servicemember who perished while on active military service to the United States.’’ 

Additionally, in January 2010, The American Legion sent letters to Members of 

Congress to express full support of this legislation. The American Legion believes 

the original intent and wording of section 51.210(d) of Title 38, CFR, was granted 

with good intention. But unrealistic expectations of personal sacrifice exist when requiring that all children of a parent must die in the service to this Nation in order 

to qualify for admission to a nursing home. 

The American Legion supports H.R. 4505. 

H.R. 4465—Determination of Attributable Income for Veterans with Children 

This legislation would direct the VA Secretary, when examining a veteran’s attributable income for purposes of determining whether a veteran is unable to defray the 

necessary expenses of hospital, nursing home, and domiciliary care, to treat as a dependent child of such veteran any unmarried person who: 

1. Is placed in the legal custody of the veteran for at least 12 consecutive months; 

2. Either has not attained age 21, has not attained age 23 and is enrolled in a 

full-time course of study at an institution of higher learning, or is incapable 

of self-support due to mental or physical incapacity; 

3. Is dependent on the veteran for over one-half of the person’s support; or 

4. Resides with the veteran, unless separated to receive institutional care. 

The American Legion believes a pension is an earned and defined benefit for a 

veteran through their honorable service to the Nation. We do not believe that pension should be reduced or offset based upon other income earned by the dependent 

children of a veteran. 

The American Legion supports H.R. 4465. 

Proposed Draft Legislation—‘‘World War II Hearing Aid Treatment Act’’ 

The American Legion recently adopted a resolution acknowledging current advancements in scientific research to review prior and new potential environmental 

threats to servicemembers. It was resolved that, ‘‘The American Legion’s comprehensive policy on environmental exposures be an all inclusive policy and vigorously support the liberalization of the rules relating to the evaluation of studies involving exposure to any environmental hazard.’’ 

It is understood that past acceptable norms of environmental exposure for noise, 

for example weapon’s qualification in basic training conducted without proper hearing protection, have been found to be unacceptable in today’s environment. These 

instances could lead to the possibility of a service connection for hearing loss if 

claimed. Also, especially in the case of WWII veterans the ‘‘state of the art’’ for 

working environmental protection of servicemembers had not evolved to the current 

levels. The fact of service and exposure to these environmental exposures would 

imply the potential for hearing loss. 

Furthermore, the only measure of assessing hearing loss on separation from service in this era was the so-called ‘‘Whisper Test,’’ which has been found insufficient 

to measure actual hearing loss by both medical experts and the courts. As VA’s procedures for adjudication of benefits claims rely heavily on the status of hearing at 

separation, these inadequate exams unfairly prejudice the system against the veterans who clearly suffered traumatic noise exposure during their service. The fact 

that hearing loss can have a gradual onset and is not always immediately detectable 

after traumatic noise further contributes to the difficulties that veterans of earlier 

eras face in becoming service connected for their loss. 

The bill could potentially save VA development time related to determining the 

etiology of hearing loss conditions and could alleviate some of the workload contributing to the claims backlog. 

The American Legion supports this proposed legislation to furnish WWII 

veterans with hearing devices. 

We would further submit for this Subcommittee’s consideration the fact that environmental noise exposure issues that this proposed legislation is attempting to address were in existence through the Vietnam War and that it was not until relatively recently that significant efforts were made to protect the hearing of serviceVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00034 Fmt 6604 Sfmt 6621 I:\VA\57025.XXX GPO1 PsN: 57025

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members. Therefore, The American Legion recommends this Subcommittee consider 

expanding the bill to cover veterans from the Korean and Vietnam War eras also. 

‘‘Improve VA Outreach Act of 2010’’ 

In May 2008, The American Legion testified concerning improvements VA could 

make to improve outreach to veterans. VA had made progress at that time and continues to make progress to improve its outreach program to veterans. Currently, in 

the case of the Veterans’ Benefits Administration (VBA), efforts have been made to 

inform and involve Veterans’ Service Organizations (VSOs) in finding solutions to 

improve the claims process. VSOs, in turn, advise veterans on efforts made by VA 

to assist them. This partnership between VA and VSO’s in informing veterans is 

critical to the success of VA’s outreach program. 

However, while VA has made improvements in outreach significant issues remain 

and there is much work to be done. Earlier this month, The American Legion testified that VA continues to struggle with informing veterans of entitlements. The joint 

efforts of the Department of Defense (DoD) and VA to assist transitioning servicemembers through the Benefits Delivery at Discharge (BDD) program and the Transition Assistance Program (TAP) briefings are laudable. Progress is being made, but 

outreach efforts vary both in quality and effectiveness. In particular, Reserve component members released from active duty mobilizations are often rubber stamped and 

returned to their home station with little or no understanding of what entitlements 

they have earned due to their honorable service. 

The American Legion understands that policies developed at VA Central Office, 

with the best of intentions, are for the most part executed at the discretion of the 

Regional Office Director or the Veterans Integrated Service Network (VISN) Director; and therefore, vary in local implementation. For example, VA has a veteran employment hiring program policy to recruit veterans, as outlined in Secretary 

Shinseki’s Memorandum dated 21, October 2009. However, The American Legion 

has seen a wide variation in hiring of veterans at the Regional Office level. The variation ranges from about 25 percent to 79 percent depending on the Regional Office. 

We feel that this is due to the discretion given to the Regional Office Director in 

interpreting the policy. It further depends on that individual’s emphasis on hiring 

veterans. We do not believe that there is a substantial difference in qualified veterans in one area as compared to another. The American Legion feels that a greater 

amount of accountability for success in outreach to veterans to identify opportunities 

for employment should be required for the subordinate offices in VA. 

Many veterans are moving to rural and extremely rural areas. Nevertheless, these 

veterans have earned the right to receive information and updates on changes that 

impact their earned benefits. While VA has made efforts to become more ‘‘user 

friendly’’ we continue to hear, especially from older veterans and those in rural 

areas, that the system and required documentation is still too complicated. 

The American Legion urges strong improvements to outreach. In addition to upgrading our Web site www.legion.org to make it more user friendly, The American 

Legion Magazine and the Web site have regular updates on such issues as the 

new Post-9/11 GI Bill and recent changes to veterans’ entitlements. Additionally, 

The American Legion’s Veterans’ Affairs and Rehabilitation Commission publishes 

periodic ‘‘Bulletins’’ based on VA information, which are utilized by the Department 

(State) Service Officers to further assist with VA’s outreach to veterans. As a recent 

example, a ‘‘Bulletin’’ was distributed after receiving a request for information from 

VA concerning ‘‘brown water Navy veterans’’ concerning vessels that were in inland 

waters of Vietnam and whose crews may be impacted by Agent Orange. 

The American Legion is also assisting VA to improve its outreach to Priority 

Group 8 veterans. This endeavor is focused on advising veterans of new regulations 

that allow VA to enroll certain Priority Group 8 veterans who have been previously 

denied enrollment in the VA health care system because their income exceeded VA’s 

income thresholds. 

These successful partnerships between VA and VSOs continue to benefit the veteran population. This demonstrates that extended VA outreach has an immediate 

impact on the lives of veterans, and VA must not lag behind in the modernization 

and scope of their own outreach to veterans. 

The establishment of a VA Advisory Committee on Outreach as proposed in the 

draft legislation, with representation from members of the VSO community reporting to the VA Secretary, will enhance VA’s outreach program and ultimately better 

serve America’s veterans. Requiring an analysis of the recommendations of the Advisory Committee, as part of the strategic plan submitted to Congress, will enhance 

the value of these recommendations. 


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The American Legion supports all reasonable efforts toward improving 

outreach to veterans and The Improved VA Outreach Act of 2010, in particular. 

As always, The American Legion thanks this Subcommittee for the opportunity 

to testify and represent the position of the over 2.5 million veteran members of this 

organization and their families. This concludes my testimony. 

f 

Prepared Statement of Eric A. Hilleman, Director, National Legislative 

Service, Veterans of Foreign Wars of the United States 

MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE: 

On behalf of the 2.1 million men and women of the Veterans of Foreign Wars of 

the U.S. and our Auxiliaries, I want to thank you for the opportunity to testify at 

today’s legislative hearing. 

H.R. 4062, Veterans’ Health and Radiation Safety Act 

VFW supports legislation that would amend Title 38, United States Code, to make 

certain improvements in the administration of medical facilities within the Department of Veterans Affairs. 

Section II mandates that VA conduct annual reporting to Congress on low volume 

programs, treating less than 100 patients a year. Section III demands adequate 

training for employees and contractors on appropriate reporting of medical services 

and programs where the use of radioactive isotopes is present. Section IV requires 

all contractors and contracting offices to adhere to rigorous guidelines when using 

this method of health care treatment. 

The use of radioisotopes at VA hospitals has increased the levels of risk to patients who undergo these potentially life-saving treatments and tests. Diagnostic 

techniques in nuclear medicine allow a non-invasive method of detecting and evaluating most cancers. Further, some cancerous growths can be controlled or eliminated by irradiating the detected growth. 

VFW asks Congress and VA to strongly demonstrate that safety and training are 

provided to all employees, contractors, and non-government entities who are employed at VA where radioactive isotopes are used. We believe this bill is the correct 

step toward this goal. 

H.R. 4465, to amend Title 38, United States Code, to direct the Secretary of 

VA to take into account dependent children when determining the veteran’s financial status when receiving hospital care or medical services 

The VFW supports this legislation to allow certain dependents to be counted in 

determining earnings thresholds for the purpose of seeking benefits and services at 

VA. 

This legislation requires VA to recognize children placed in the legal custody of 

the veteran as a result of a court order. Under the bill, in order for the child to 

be counted as eligible, they must be in the custody of the veteran for at least 12 

consecutive months, require support at least 50 percent of the time, and/or be under 

the age of 21 (or 23 if enrolled as a full-time student). Currently, children placed 

in the legal custody of a veteran are not counted for the purposes of health care 

categories or qualification for pension or benefits. VFW believes H.R. 4465 will correct that inequity and passing it is the right thing to do. 

H.R. 4505, to enable State homes to furnish nursing home care to parents, 

whose children died while serving in the Armed Forces 

VFW supports this legislation, which would authorize state-run nursing homes to 

accept the surviving parents of a child who died while serving in the armed services. 

The VFW believes the care of all Gold Star parents is a sacred trust and this bill 

would provide a critical benefit at a time when they may need long-term care. We 

ask Congress to enact this legislation quickly. 

Draft Bill, World War II Hearing Aid Treatment Act 

VFW admires the goal of this legislation but cannot support it as written. Millions 

of Americans participated in combat where nearly 300,000 were killed and 671,000 

were wounded. Almost everything about modern warfare involves loud, often incredibly loud, noise. Acoustic trauma is a major cause of hearing loss. Those who fought 

in the island campaigns of the Pacific, North Africa, Normandy, the Battle of the 

Bulge to the River Elbe, or flew through the flak and fighter filled skies of France 

and Germany were exposed to incredible amounts of hearing damaging noise. HowVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00036 Fmt 6604 Sfmt 6621 I:\VA\57025.XXX GPO1 PsN: 57025

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ever, their experiences in training for and fighting a war are, in terms of noise exposure, virtually identical to their younger brothers and sisters who trained and 

fought in every other war from Korea to Vietnam to the current conflicts in the Middle East. 

We cannot support this legislation because the only factual difference between 

their exposure to noise and that of all veterans is that they are older. We believe 

the bill is inequitable as it discriminates against other veterans based on age. We 

would be happy to work with the Committee on clarifying hearing aid benefits for 

all veterans. 

Draft Bill, Improved VA Outreach Act of 2010 

The VFW supports the Improved VA Outreach Act of 2010. This bill aims to improve outreach activities within the Department of Veterans Affairs by coordinating 

the efforts among the offices of the Secretary, Public Affairs, Veterans Health Administration, Veterans Benefits Administration and the National Cemetery Administration. 

In order to increase the effectiveness of VA outreach, it also directs the Secretary 

to annually review activities performed by VHA, VBA, state veterans agencies, 

county veterans agencies, VSOs and other federal departments (referred to in section 6306), to include the National Guard and Reserve component bureaus under 

Section 561 of Title 38, CFR 

The VFW has always encouraged and supported increased awareness of benefits 

and services provided by VA to veterans. We believe that all veterans and their survivors should have access to up-to-date information about services and benefits for 

which they may be eligible. However, a key component missing in the language of 

this bill is training. We believe that effective outreach can only be achieved through 

the proper training of individuals performing outreach activities. We also note that 

since any successful initiative will result in increased claim submissions to VA, 

funding for VBA adjudication must keep pace with increases in the number of 

claims filed as a result of greater outreach. 

We applaud sections 4 and 5, which establish an advisory committee to provide 

a biennial report on outreach activities. The Committee will bring together various 

experts in veterans’ issues to make recommendations on how to improve VA benefits, services and programs. Reaching out to Federal, state and local stakeholders 

encourages the sharing of best practices and helps VA in identifying the needs of 

eligible veterans and their families. This is especially critical now with many injured servicemembers returning from the current conflicts unaware of their benefits. 

Mr. Chairman, Members of the Committee, this concludes my testimony. I would 

be happy to address any questions you may have. Thank you. 

f 

Prepared Statement of Richard F. Weidman, Executive Director for Policy 

and Government Affairs, Vietnam Veterans of America 

Mr. Chairman, Ranking Member Miller, Distinguished Members of the House 

Veterans’ Affairs Subcommittee on Health and honored guests, Vietnam Veterans 

of America (VVA) thanks you for the opportunity to present our views regarding 

H.R. 4062, H.R. 4505, the draft legislation on Outreach, and the draft legislation 

entitled the WHAT Act. With your permission, I shall keep my remarks brief and 

to the point. 

H.R. 4062 Veterans’ Health and Radiation Safety Act 

Requires the Secretary of Veterans Affairs to report annually to Congress on the 

low-volume (treating 100 patients or less) programs at each medical facility of the 

Department of Veterans Affairs (VA); and, Directs the Secretary to ensure that all 

employees at a VA hospital where radioactive isotopes are used in the administration 

of medical services receive appropriate training on what constitutes a medical event 

and when and to whom a medical event should be reported. Prohibits such isotopes 

from being used at a VA hospital where such training is not provided; and, requires 

the Secretary to carry out specified evaluations and peer reviews of all medical services provided under contract with a non-government entity. 

The recent events at the Philadelphia VA Medical Center where veterans were 

harmed over an extended period by clinicians and technicians who were not properly 

trained have quite naturally caused great concern in the veterans’ community about 

both efficacy and safety. 

The provisions of H.R. 4062 will take sensible and prudent steps to require the 

VHA to ensure that quality assurance mechanisms are in place so that those who 


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are engaged in nuclear medicine activities anywhere within the Veterans Health 

Care system are properly trained, understand proper reporting of untoward incidents and record keeping with a view toward quality assurance in general, have 

proper supervision, have in place written procedures for quality assurance, and require periodic peer reviews to ensure that the treatments provided are at the proper 

dosing to actually work, but not so high as to cause the individual being treated 

harm. 

VVA always favors sensible reporting that does not place undue burdens on the 

practicing clinician at the service delivery level. If the VHA sets up proper metrics 

all of the reporting that is necessary to accomplish the objective in this case (and 

most others) can be programmed to pick up the salient data on the VistA electronic 

health care records system. Therefore, requiring that a synopsis of activity over the 

course of a year, as well as an analysis of the program, be included in the VA’s Annual Report is a potentially useful step. VVA does not generally favor more staff 

for the sake of more staff in any branch of government, but it is key that the Committees on Veterans Affairs on both sides of the Hill have the organizational capacity to dig into the Annual Report, the Strategic plan for VA, and other key reporting 

mechanisms to be able to assist the distinguished Members of this Committee to 

hold the VA much more accountable than it has been in the past. 

VVA favors passage of H.R. 4062. 

H.R. 4505, Authorizes the Secretary of Veterans Affairs (VA) to permit a state home 

to provide VA nursing home care to parents who had any children who died 

while serving in the Armed Forces. 

It is fitting that this proposed legislation should come for a hearing this week proceeding Memorial Day. Of all weeks in the year, this is when we should all be thinking about the terrible price of freedom in lives lost early, cut down in the early 

prime of life by virtue of service to country. 

Each of the young people lost early left a web of bother and sister war fighters, 

as well as family and friends for whom the loss is particularly harsh. This is especially true for the Gold Star parents, the mothers and fathers who have lost their 

son or daughter in military service to country. What this proposed bill would do is 

give the Secretary of Veterans Affairs the authority to permit states who wish to 

do so to provide any needed care to these Gold Star Mothers and Gold Star fathers. 

VVA certainly hopes that most states, if not all, would choose to provide such care 

as needed to these fine Americans who have suffered a loss so great that most of 

us cannot even imagine how great the pain must be. When they age their son or 

daughter is not there to care for them as the years take their toll. It is incumbent 

on the rest of us in our society to then step up and fill the void left by the early 

death of our comrade in arms. Insofar as possible those of us in veterans service 

organizations should and do step up to assist Gold Star families, and particularly 

gold star mothers. Supporting this move to cover nursing care as needed is the minimum we can and should do, as this is something that is beyond the span of control 

of the things we already do for and with the families. 

VVA strongly supports early passage of this legislation. 

Draft to Improve VA Outreach Act of 2010 Legislation 

The fact is, only 20 percent of veterans actively use the VA for their health care, 

and even many of these are not familiar with the health care and other benefits 

to which they are entitled by virtue of their service. What of the other eighty percent who never go to a VA regional office or medical center? Most of them are, quite 

simply, ignorant of these benefits—ignorant because they are uninformed. And they 

are uninformed because the VA has not in the past even tried to do a concerted, 

coordinated, comprehensive job of reaching out to them. 

VVA believes the VA has both a legal responsibility and an ethical obligation to 

reach out to all veterans and their families to inform them of the benefits to which 

they are entitled, and of the possible long-term health risks and problems they may 

experience due to where and when they served. Populating kiosks in VA medical 

centers with booklets and pamphlets is fine for those who make it to a VA medical 

facility. However, these do not get into the hands of either the very poor who do 

not use the system or the better off who do not need to use the system. 

What is needed is a real strategic plan, one that will employ TV and radio ads, 

billboards, and public service announcements, as well as cooperative efforts with civilian organizations and entities in a coordinated effort, yet one that adapts to regional and local realities. The proposed legislation would mandate such a comprehensive plan. What VVA suggests is requiring the Secretary of Veterans Affairs 

to establish a separate account for the funding of the outreach activities of the DeVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00038 Fmt 6604 Sfmt 6621 I:\VA\57025.XXX GPO1 PsN: 57025

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partment. This would establish a separate subaccount for the funding of the outreach activities of each element of the Department of Veterans Affairs. 

The way to make things happen at the VA is to make sure that they plan for 

it, and then require that they specifically provide the line item budget for it, and 

then to monitor the dickens out them to ensure that it is done, and done correctly. 

VVA has specifically started a project called the Veterans Health Council 

(www.veteranshealth.org) because the VA does such a poor job of informing veterans 

and their families as to the wounds, maladies, injuries, diseases, and other adverse 

health risks they may be subject to depending on what branch of the military they 

served, when and where they served, their military occupational specialty, and what 

actually happened to them while in military service. The primary mission of the 

VHC is to partner with medical societies, professional medical organizations, disease 

advocacy groups, other veterans organizations, and interested parties to inform civilian medicine about these special health risks of veterans, so they can provide better care to the their patients, and so we can educate the veteran and their families 

through their civilian provider. 

While we are making some progress with the work of the Veterans Health 

Council, we are under no illusion that we have or are likely to ever have the resources or the reach to get this job done correctly. But at least we have started, 

whereas the VA has not done so. This bill would require them to start doing what 

they should have been doing all along. 

VVA strongly favors early passage of this much needed legislation. 

Draft World War II Hearing Aid Treatment WHAT Act Legislation 

The dangers and risks of military service to hearing, because of the loud noises 

that are so prevalent in every branch of the military, have been so well known for 

so long that we have tended to either ignore this important subject or to joke about 

aspects of it with wry military humor. Until recently we have not seriously looked 

at the very serious medical conditions of irreversible damage to one of the five basic 

human senses that is so often resulting from military service. 

Earlier in this decade the Congress, led by the Members on this distinguished 

Subcommittee, mandated that VA contract with the Institute of Medicine of the National Academy of Sciences to take a comprehensive look at the damage to hearing 

as well as the generally thought of as being closely associated with hearing loss, but 

equally debilitating condition of tinnitus. That mandate led to a project of the little 

known but quite extraordinary Medical Follow Up Agency (MFUA) convening a 

panel of experts and conducting a consensus study that resulted in a report being 

issued in September of 2005. 

Noise-Induced Hearing Loss and Tinnitus Associated with Military Service 

from World War II to the Present 

Type: Consensus Study 

Topics: Veterans Health (http://www.iom.edu/Global/Topics/VeteransHealth.aspx) 

Boards: Medical Follow-Up Agency http://www.iom.edu/About-IOM/ 

Leadership-Staff/Boards/Medical-Follow-Up-Agency.aspx 

Activity Description 

A congressionally mandated study by the Institute of Medicine assessed noise-induced hearing loss and tinnitus associated with military service from World War II 

to the present, the effects of noise on hearing, and the availability of audiometric 

testing data for active duty personnel. 

The expert committee was charged with providing recommendations to the Department of Veterans Affairs (VA) on the assessment of noise-induced hearing loss 

and tinnitus associated with service in the Armed Forces. The Committee was asked 

to 

• review staff-generated data on compliance with regulations regarding 

audiometric testing in the services at specific periods of time since World War 

II, 

• review and assess available data on hearing loss, 

• identify sources of potentially damaging noise during active duty, 

• determine levels of noise exposure necessary to cause hearing loss or tinnitus, 

• determine if the effects of noise exposure can be of delayed onset, 

• identify risk factors for noise-induced hearing loss, and 

• identify when hearing conservation measures were adequate to protect the 

hearing of servicemembers. 


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Staff of the Medical Follow-up Agency identified populations of veterans from each 

of the armed services (Army, Navy, Air Force, Marine Corps, and Coast Guard) and 

from each of the time periods from WWII to the present. The service medical records 

of a sample of these individuals were obtained and reviewed for records of 

audiometric surveillance (including reference and termination audiograms). 

The Committee’s final report, Noise and Military Service: Implications for Hearing 

Loss and Tinnitus, was released in September 2005. That report can be accessed 

at the link below: 

http://www.iom.edu/Reports/2005/Noise-and-Military-Service-Implications-forHearing-Loss-and-Tinnitus.aspx 

Essentially what this report detailed is what we already knew and what was not 

known, because there were no significant longitudinal studies of humans and 

audionomic hearing loss, much less such studies of military personnel. Moreover, 

the study confirmed that there was little if any attention made to protecting the 

hearing of military personnel until the 1970s, and even then the efforts were minimal and usually restricted to highly controlled training situations (e.g., the rifle 

ranges used in basic training). For obvious reasons, soldiers in combat situations 

were (and are today) unlikely to wear hearing protective gear because it does not 

allow them to be at the highest state of situational awareness of the enemy or potential enemies (i.e., what you can’t hear can and will hurt/kill you). 

World War II veterans are now in their eighties and nineties. It is clear that there 

are no good records to research to prove service connection for hearing loss for these 

men and women who still survive today. It is as likely as not that many, if indeed 

not most, of them first suffered damage that led to greater hearing loss than they 

would have otherwise experienced started in military service. For most who experience hearing loss today being able to have access to use of decent hearing aids and 

devices is perhaps the one single thing that would improve the quality of life for 

the most of these veterans. It is long past the time when these folks should be subjected to the adversarial system of proving service connection to the satisfaction of 

VBA personnel (and it is adversarial, despite the assertions of VBA officials). We 

urge you to pass this legislation to provide the hearing devices to these men and 

women who need and want them without cost on a no fault basis, without making 

them have to prove a nexus in military service more than sixty 5 years ago. 

VVA commends the Chairman, Ranking Member, and the other distinguished 

Members of this Committee for moving to assist these men and women with early 

passage of the WHAT act. 

I shall be glad to answer any questions you might have. Again, I thank you on 

behalf of the Officers, Board, and members of VVA for the opportunity to speak to 

this vital issue on behalf of America’s veterans. 

f 

Prepared Statement of Tim Embree, Legislative Associate, Iraq and 

Afghanistan Veterans of America 

Mr. Chairman, Ranking Member, and Members of the Subcommittee, on behalf 

of Iraq and Afghanistan Veterans of America’s one hundred and eighty thousand 

members and supporters, I would like to thank you for inviting us to testify before 

your Subcommittee. My name is Tim Embree. I am from St Louis, MO and I served 

two tours in Iraq with the United States Marine Corps Reserves. The legislation 

being considered today will profoundly affect veterans of all generations and their 

families. We appreciate this opportunity to offer our feedback. 

Executive Summary: 

Three bills being considered today will positively affect our members and their 

families so IAVA supports them. The ‘‘Improve VA Outreach Act’’ addresses the 

need for a concerted VA effort to reach out to veterans and their families to promote 

the services and benefits available to them. H.R. 4062, the ‘‘Veterans’ Health and 

Radiation Safety Act,’’ insures the safety of veterans receiving specialized treatments involving radioactive isotopes. H.R. 4505 expands access for gold star parents 

to state nursing homes. 

Full Testimony: 

H.R. XXXX, Improve VA Outreach Act of 2010 

IAVA proudly supports the ‘‘Improve VA Outreach Act of 2010.’’ Too many men 

and women, discharging from the military, are not enrolling in the Department of 

Veterans Affairs (VA) for their well earned benefits. Currently, the burden is on 

them to seek out their benefits, within a passive VA. This is unacceptable. It is long 


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1http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1707. 

overdue for the VA to aggressively recruit veterans and their families into VA programs. 

‘‘The VA could be more aggressive in contacting OIF/OEF veterans and at 

least talking to them before the veteran has a mental health crisis. They 

need to be proactive instead of reactive.’’—IAVA Member 

The VA must develop a relationship with the servicemember while they are still 

in the military, not after the servicemember has traded their uniform for a t-shirt 

and jeans. The VA should learn from successful college alumni associations, which 

do not wait until graduation day to find their newest members. Instead, they greet 

them on the first day of freshman year and stay with them throughout school with 

engagement activities and social events. The VA should do the same: greet servicemembers as they complete basic training and build on that relationship throughout 

the servicemember’s time in uniform. 

When a person leaves the service, the VA should create a regular means of communicating with them about events, new programs and opportunities. And the VA 

must reach out to aggressively promote VA programs to veterans who have not yet 

accessed their VA benefits. If I got half as many letters and emails from the VA, 

as I do from my college alumni association, that would be a great start. 

To transform the VA from ‘‘reactive’’ to ‘‘proactive,’’ IAVA believes the VA must 

invest in aggressive, modern, innovative outreach. This is not happening now—and 

veterans are clearly suffering as a result. IAVA was disappointed that there were 

only a few brief mentions of outreach activities in the President’s VA budget submission; none of which were for a dedicated outreach campaign. We believe the VA 

budget must include a distinct line item for outreach within each VA appropriation 

account. This line item should fund successful outreach programs such as the OEF/ 

OIF Outreach Coordinators, Mobile Vet Centers and the VA’s new social media 

presence on Facebook and Twitter. 

The VA’s current outreach campaign is disappointing. When the VA announced 

that it had placed ads on more than 21,000 buses nationally,1 to spread the word 

about the suicide prevention lifeline, we were initially enthusiastic; an image of the 

ad is below. When we saw the ad, it was clearly a failure. The ad has over 30 small 

print words; the average bus ad is limited to 5–10 words. In the short time in which 

a bus passes, a veteran would have to go by the bus repeatedly to even read the 

hotline number. 

IAVA has run one of the largest non-governmental outreach campaigns in history, 

through a partnership with the Ad Council and some of the world’s best advertizing 

firms. We have learned a lot about the best ways to communicate complex and serious issues through television and print. We are ready to work with the VA and 

share our expertise. 

The ‘‘Improve VA Outreach Act’’ will help the VA take their current outreach efforts to a whole new level. It requires the VA to: 

1. Effectively coordinate outreach efforts among the different parts of the department as well as other agencies offering services to returning servicemembers; 


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2. Work closely with the Department of Health and Human Services to promote 

community health centers. These community health centers may be the only 

medical facility a rural veteran can reasonably access without spending a full 

day riding in a car or bus; 

3. Set up an outreach committee tasked with coordinating efforts which currently 

are being done on an ad hoc basis among many of the VA’s separate departments; and 

4. Submit a 2-year plan fully explaining their outreach activities. 

To bring America’s next generation of veterans into the VA, to receive the benefits 

they have earned, will require an unprecedented VA outreach program. The ‘‘Improve VA Outreach Act of 2010’’ is the first step in getting us there. 

H.R. 4062, Veterans’ Health and Radiation Safety Act (Adler) 

IAVA endorses H.R. 4062, the Veterans’ Health and Radiation Safety Act. Improper use of medical equipment, especially radioactive isotopes, can lead to unexplained illness, cancer and even death. The VA was recently issued the second largest fine by the Nuclear Regulatory Commission for misuse of radioactive isotopes 

in the treatment of nearly 100 veterans in Philadelphia. Stories about veterans leaving VA facilities sicker than when they entered casts a cloud over the confidence 

veterans place in the system charged with their care. H.R. 4062 mandates the proper oversight of these treatments so veterans will be confident in the safety of the 

care they receive. 

H.R. 4465, Adjusting veterans financial status based on the number of their 

dependents (Kissell) 

IAVA does not take a position on H.R. 4465 because it appears to be duplicative 

of current law. This bill requires the VA to take into consideration that veterans 

seeking care in a state nursing home may have children and therefore the veteran’s 

‘‘attributable income’’ should be adjusted accordingly, when deciding whether a veteran can pay for nursing home care. Section 1722 of title 38 establishes this eligibility and already accounts for each dependent a veteran might have by increasing 

the ‘‘attributable income’’ threshold for free care for each dependent the veteran has. 

If H.R. 4465 somehow expands or clarifies the definition of dependent, IAVA would 

gladly support it. 

H.R. 4505, Authorizing state homes to provide services to gold star parents 

(Thornberry) 

IAVA supports H.R. 4505, and stands with Gold Star mothers (or whoever carries 

weight from that community) which expands access for gold star parents to state 

nursing homes. Previously, a gold star family member would only be eligible for 

these services only if all their sons and daughters died in combat. This bill changes 

that requirement to include a gold star family member, who has no remaining sons 

and daughters, but has lost one of their children in the service of their country. It 

is a common-sense way to support our Gold Star parents—who have given so much 

for our Nation. 

H.R. XXXX, World War II Hearing Aid Treatment Act (Teague) 

IAVA supports the draft legislation known as the ‘‘WHAT Act–WWII Hearing Aid 

Treatment Act.’’ We believe that any veteran with a diagnosed hearing impairment, 

whether they served in Baghdad or Normandy, should have access to free hearing 

aid devices from the VA. Again, this seems like common sense. 

f 

Prepared Statement of Robert Jesse, M.D., Ph.D., Acting Principal Deputy 

Under Secretary for Health, Veterans Health Administration, 

U.S. Department of Veterans Affairs 

Mr. Chairman, thank you for inviting me here today to present the Department 

of Veterans Affairs’ (VA) views on pending legislation. Accompanying me this morning is Assistant General Counsel Walter A. Hall. We appreciate the Committee’s 

support of Veterans and VA, and we appreciate being able to comment on these bills 

as we both work to improve the benefits provided to those who served. 

H.R. 4062 

H.R. 4062, the ‘‘Veterans’ Health and Radiation Safety Act,’’ would require VA to 

submit an annual report to Congress on low-volume programs (defined as programs 

that treat 100 patients or fewer annually) at VA medical facilities. The report would 

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grams. Additionally, H.R. 4062 would require that employees working at VA hospitals where radioactive isotopes are used receive training on recognizing and reporting medical events. Hospitals failing to provide this training would be prohibited from using radioactive isotopes for a period of time determined by the Secretary. Lastly, VA would be required to evaluate non-government medical services 

contractors through weekly independent peer reviews, written evaluations, and 

other evaluations VA determines are appropriate. A contracting officer must review 

and consider the results of these evaluations before VA renews any contracts with 

non-government medical service contractors. 

Mr. Chairman, we all are aware of a very unfortunate lapse that occurred at a 

brachytherapy program at one of our facilities. We testified about this incident before this Committee on July 22, 2009. On May 3, 2010, the Office of the Inspector 

General (OIG) issued a report on this incident with five recommendations. Specifically, OIG recommended that the Veterans Health Administration (VHA) standardize, to a practical extent, the privileging, delivery of care, and quality controls 

for the procedures required to provide this treatment. This has been accomplished. 

Standardized procedures have been developed and site visits have verified they are 

uniformly in place at all facilities and steps have been taken to ensure that patients 

who received low radiation doses in the course of brachytherapy be evaluated to ensure that their cancer treatment plan is appropriate. We have contacted all Veterans that were potentially impacted for follow-up testing and monitoring at other 

VA and private facilities and are reviewing the controls that are in place to ensure 

that VA contracts for health care comply with applicable laws and regulations, and 

where necessary, will make the required changes in organization and/or process to 

bring this contracting effort into compliance. A template that outlines basics requirements for all contracts is currently in development. 

The report also recommended that senior VA leadership meet with senior Nuclear 

Regulatory Commission (NRC) leadership to determine if there is a way forward 

that will ensure the goals of both organizations are achieved. VA is currently working to arrange this meeting. Finally, the report recommended that VHA should work 

with the OIG to develop a list of documents that should routinely be provided to 

the OIG when an outside agency is notified of a possible untoward medical event. 

VHA will work closely with OIG to meet this recommendation. 

We appreciate the intent of H.R. 4062 but for a number of reasons we do not support it. First we note that section 2 requires the Secretary to submit annual reports 

to Congress on low volume programs. However, the definition of a ‘‘program’’ is not 

clear. Any treatment ‘‘program’’ could be defined so narrowly that no facility treats 

100 patients or more a year in a particular program, or so broadly that almost every 

program includes more than 100 patients annually. Moreover, treatment quality is 

not always related to patient volume or patient volume just within a given VA facility. Many VA facilities have on staff specialist providers who also work elsewhere 

in the community. When you combine all care provided by a specialist, the volume 

can be, and many times is, significantly more than can be accounted for just within 

VA workload. In addition, standard credentialing, privileging, and review of quality 

of care are required at every facility regardless of the size of a program. 

All procedures that are performed and all medical care provided at all VA facilities involve quality assessment (QA) and oversight. The first procedure each year 

has precisely the same QA requirements as the last, whether the annual procedure 

total is 5, 50 or 500. Further, each procedure is performed by a fully credentialed 

and privileged physician. Instead of the requirement to provide an annual report on 

‘‘low volume’’ programs, we would like to work with Congress to identify what information would be useful for Congress to receive on an annual basis.The mandatory 

training that would be required by section 3 would apply to all VHA staff and would 

not be limited to staff directly involved in the use of radioactive materials. The NRC 

regulations already require all staff involved in the use of radioactive materials to 

have training and further require that facilities provide evidence of that training. 

Competency and training requirements for staff are based upon their defined duties 

and risks associated with those duties. In VHA, radiation safety training and education are provided annually, through the VA Learning Management System, to all 

staff involved in the use or handling of radioactive material. This includes all contract staff or physicians working in VA Nuclear Medicine services as a condition of 

their authorization to practice at a VA medical center. The definition of a medical 

event and reporting requirements are taught to and reviewed annually with all Nuclear Medicine technologists and physicians. VA’s National Health Physics Program 

provides a mechanism to ensure that the training provided is completed as required 

by VA policy. In addition, VA currently supports and trains all staff in reporting 

any untoward events or potential events consistent with guidance provided by the 


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National Center for Patient Safety and the facility safety programs. As a result, 

many of the requirements of section 3 are duplicative of current VA policy. 

The requirement in section 4 to obtain weekly independent peer review of all medical services provided pursuant to a contract, and written evaluations of the services 

carried out by the supervisor or manager of the employee providing the services, are 

excessive and would add unwarranted cost in staff time spent procuring and developing the reports. The requirement to undertake peer reviews each week may be 

ineffective if there are an insufficient number of procedures to carry out a statistically valid review. The requirement for additional reporting and oversight of all 

medical services provided by contract, most of which have not reported adverse 

events, would be a waste of resources. Given current VA procedures related to peer 

review and reporting, some of the provisions in this bill are not necessary. We are 

available to meet with Committee staff to discuss these issues in more detail. 

While VA appreciates the Committee’s focus on this issue, we believe with the 

above regulatory requirements, safeguards, and training, these additional measures 

are not necessary. We are still developing costs for this bill and will provide them 

for the record. 

H.R. 4465 

This bill would amend 38 U.S.C. 1722, which describes how VA determines that 

Veterans are considered unable to defray the expenses of necessary care for purposes of determining eligibility for health care under 38 U.S.C. 1705 and 1710. Section 1722 states that the term ‘‘attributable income’’ is determined in the same manner that eligibility for pension is determined under 38 U.S.C. 1521. H.R. 4465 would 

amend section 1722 to provide that the term ‘‘attributable income’’ is determined in 

the same manner that eligibility for pension is determined under section 1521 except 

that the Secretary shall treat as a child an unmarried person who is placed in the 

legal custody of the Veteran for a period of at least 12 consecutive months; either 

has not attained the age of 21, has not attained the age of 23 and is enrolled in 

a full time course of study at an institution of higher learning approved by the Secretary, or is incapable of self support because of a mental or physical incapacity that 

occurred while the person was considered a child of the Veteran; is dependent on 

the Veteran for over one-half of the person’s support; and resides with the Veteran 

unless separated to receive institutional care as a result of disability or incapacitation or under such other circumstances as the Secretary may prescribe by regulation. 

VA would like to work with the Committee to better understand the intent of this 

legislation. On its face it would affect only a person placed in the legal custody of 

a Veteran as a result of an order of a court and would count the person as a child 

of a Veteran until age of 21 unless he or she is a full-time student or incapacitated. 

Currently all other persons (other than full-time students or those who are incapacitated) are not considered children once they reach 18 years of age. Thus, the effect 

of the bill would be that persons placed in the legal custody of a Veteran by a court 

would be considered children under more generous criteria than the Veteran’s natural children. The purpose of this differentiation is unclear. 

If the intention is to extend the broader criteria (the age 21 cut-off) to all children 

of Veterans, the language should be clarified. Moreover, all conditions in the bill as 

it is drafted are conjunctive so that it may also be read to provide that only persons 

placed in the custody of a Veteran by a court shall be treated as a child. 

VA currently neither tracks nor has access to databases that would provide numbers of individuals, or Veterans (either currently enrolled or potential users of VA 

health care) with a child (or children) as defined in the proposed legislation. Thus, 

we are unable to determine the potential financial impact the passage of this legislation would have upon VA health care enrollment, expenditures, and first and third 

party collections. 

H.R. 4505 

Pursuant to VA regulations (38 CFR 51.210), state homes constructed with VA 

grants are required to maintain an occupancy rate of 75 percent Veterans to be eligible to receive VA per diem payments. The only non-Veterans who are authorized 

to reside at state homes are either spouses of Veterans or parents of Veterans if 

all of their children have died while serving in the armed forces of the United 

States. H.R. 4505 would require that in administering section 51.210, VA permit a 

State home to provide services to the parents of Veterans if any of the parents’ children died while serving in the armed forces. 

VA supports this bill. There should be no additional costs to VA. 


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Draft Legislation—Improve VA Outreach Act of 2010 

Section 2 of the draft outreach bill would require VA to establish and maintain 

procedures to effectively coordinate outreach activities of VA between internal departments, Federal, state and local agencies, and Veterans Service Organizations 

(VSOs). This bill would require VA to annually review the procedures in place to 

conduct these activities and modify them as needed. Section 3 would require VA to 

consult with the Department of Health and Human Services (HHS) regarding outreach to Veterans who receive medical care through HHS community health centers 

or facilities of the Indian Health Service (IHS). Section 4 would establish an advisory committee on outreach comprised of representatives from VSOs, individuals 

with expertise in Veterans’ issues, marketing, branding, advertising, and communication, and representatives from State and county Veterans agencies. The Committee would also include representatives from the Center for Minority Veterans, 

Center for Women Veterans, VHA, Veterans Benefits Administration (VBA) and National Cemetery Administration (NCA) to serve as ex-officio members. Terms of 

service and pay for the Committee members would be decided by the Secretary. The 

Committee’s responsibilities would include providing advice to the Secretary on outreach matters, reviewing the strategic plan for outreach, preparing biennial reports 

for the Secretary, and providing the Secretary with any other reports that the Committee considers appropriate. The Federal Advisory Committee Act would apply to 

this committee. 

Section 5 would require the Secretary to submit to Congress a biennial strategic 

plan for outreach activities, including plans to identify and inform Veterans and dependents of available benefits and services; plans to enroll or register eligible Veterans; and goals, objectives, tasks, and performance measures for the above-mentioned plans. The strategic plan would be sent to the Advisory Committee on Outreach for recommendations prior to being submitted to Congress. 

Because the bill would require duplication of existing programs, VA does not support it. We note that the requirements set forth in section 2 are already being met. 

VA recently created the National Outreach Office in the Office of Intergovernmental 

Affairs, Office of Public and Intergovernmental Affairs. This new office is responsible for ensuring the effective coordination of the outreach activities of the Department between and among the Office of the Secretary, the Office of Public and Intergovernmental Affairs, VHA, VBA, NCA, staff offices, and external stakeholders. Further, VA already has a workgroup established to better coordinate services between 

IHS and VA and is working on a memorandum of agreement to improve collaboration. 

We believe Section 4, while well-intended, would be redundant. There are currently five advisory committees that provide outreach direction in their annual reports to the Secretary and Congress. These committees include the Advisory Committee on Homeless Veterans, the Advisory Committee on Minority Veterans, the 

Advisory Committee on the Readjustment of Veterans, the Veterans’ Rural Health 

Advisory Committee, and the Advisory Committee on Women Veterans. Finally, 

pursuant to 38 U.S.C. 6302, VA is already required to develop a biennial plan on 

outreach activities. 

The annual discretionary cost of this bill would be approximately $400,000. 

Draft Legislation—World War II Hearing Aid Treatment Act 

VA currently has authority to provide hearing aids to certain Veterans receiving 

VA health care. Specifically, 38 U.S.C section 1717(c) authorizes VA to provide them 

to any Veteran who is profoundly deaf and is entitled to compensation on account 

of hearing impairment. This draft bill would extend eligibility for hearing aids to 

all Veterans of active-duty service in World War II, even if those Veterans are not 

otherwise entitled to compensation under title 38, United States Code. 

Hearing loss can be frustrating and dangerous, especially for older adults. Further, the added effects of hearing loss and aging can combine to create a significant 

communication handicap and negatively impact the ability to communicate effectively. The negative effect of stress and communication difficulties can contribute to 

poor quality of life. In addition, untreated hearing loss among the older adult population is linked to emotional and social consequences such as depression and social 

isolation. Use of hearing aids has been shown to be effective for hearing loss remediation and is an important element of life quality for all of our Veterans with hearing 

loss. 

VA does not support the draft legislation because we currently have authority to 

provide hearing aids to Veterans with service-connected hearing loss. In addition to 

the statutory authority found section 1717(c), 38 USC 1707(b) authorizes the Secretary to provide sensori-neural aids in accordance with guidelines prescribed by the 

Secretary. These guidelines are found in 38 CFR 17.149 and list a number of difVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00045 Fmt 6604 Sfmt 6621 I:\VA\57025.XXX GPO1 PsN: 57025

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ferent categories of Veterans who are eligible for hearing aids, including Veterans 

with significant functional or cognitive impairment evidenced by deficiencies in activities of daily living and Veterans with hearing impairments resulting from the 

existence of another medical condition for which the Veteran is receiving VA care. 

VA also believes the legislation would cause inequitable treatments of non-World 

War II Veterans with hearing loss. Furthermore, the legislation would create unequal benefits for hearing aids in relation to other prosthetic appliances that are 

also crucial to Veterans’ well-being and quality of life. 

The discretionary cost of this legislation would be approximately $14.8 million in 

the first year, $350 million over 5-years and $509.7 million over 10 years. This concludes my statement, Mr. Chairman. I would be happy to entertain any questions 

you or the other Members of the Committee may have. 

f 

Statement of Adrian Atizado, Assistant National Legislative Director, 

Disabled American Veterans 

Mr. Chairman and Members of the Committee: 

Thank you for inviting the Disabled American Veterans (DAV) to submit our 

views for the record of this important hearing of the Subcommittee on Health. DAV 

is an organization of 1.2 million service-disabled veterans, and devotes its energies 

to rebuilding the lives of disabled veterans and their families. 

Mr. Chairman, the DAV appreciates your leadership in enhancing Department of 

Veterans Affairs (VA) health care programs that many service-connected disabled 

veterans rely upon. At the Committee’s request, the DAV is pleased to present our 

views on the bills pending before the Committee today. 

H.R. 4062, the Veterans Health and Radiation Safety Act 

Section 2 of this measure would require an annual report on low volume patient 

programs—specifically, programs with fewer than 100 participants in a calendar 

year—at all VA medical facilities. 

Section 3 of the bill would require the VA to ensure that all health care employees, including contract employees, receive appropriate training related to the use of 

radioactive isotopes and on what constitutes a medical event and to whom it should 

be reported should such an event occur. Failure to provide such training would require the VA to stop the use of radioactive isotopes at a VA facility until such time 

the Department deems appropriate. 

Section 4 mandates VA to establish specific requirements such as independent 

peer review of such services, written evaluations by the manager of the employee 

providing such services and evaluation review prior to extension of any existing contracts with non-government entities. 

The genesis of this bill appears to be the recent finding by the VA Office of the 

Inspector General (OIG) related to application of prostate brachytherapy in the 

treatment of prostate cancer patients at the Philadelphia, Pennsylvania VA Medical 

Center, when the wrong strength of implanted radioactive seeds was discovered. 

The OIG made five recommendations, with all of which the Veteran Health Administration (VHA) Under Secretary for Health concurred: 

1. VHA’s National Director of Radiation Oncology Programs should have sufficient resources, to ensure that VHA provides one high quality standard of care 

for the prostate brachytherapy population. To achieve this end, VHA should 

standardize, to a practical extent, the privileging, delivery of care, and quality 

controls for the procedures required to provide this treatment. 

2. VHA should take the steps required to ensure that patients who received low 

radiation doses in the course of brachytherapy be evaluated to ensure that 

their cancer treatment plan is appropriate. 

3. VHA should review the controls that are in place to ensure that VA contracts 

for health care comply with applicable laws and regulations, and where necessary, make the required changes in organization and/or process to bring this 

contracting effort into compliance. 

4. Senior VA leadership should meet with Senior U.S. Nuclear Regulatory Commission leadership to determine if there is a way forward that will ensure the 

goals of both organizations are achieved. 

5. VHA should work with the OIG to develop a list of documents that should routinely be provided to the OIG when an outside agency is notified of a (possible) 

untoward medical event. 


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DAV has no specific resolution with respect to H.R. 4062, the Veterans Health 

and Radiation Safety Act; however, we concur with the OIG that proper training, 

oversight and following all mandates and established procedures for radiation therapies are necessary for VA and non-VA contracted health personnel to ensure patient 

safety. We ask the Committee to provide oversight to ensure VA carries out all of 

the recommendations made by the OIG in this case and we have no objection to passage of H.R. 4062 to ensure Congress is properly informed about smaller, ‘‘low volume’’ VA treatment programs and that proper training of health personnel administering radioactive isotope treatment is mandated along with appropriate training 

for identifying and reporting a medical event that could be harmful to veteran patients. 

H.R. 4505—To enable State homes to furnish nursing home care to parents 

any of whose children died while serving in the Armed Forces 

Mr. Chairman, H.R. 4505 would empower State Veterans homes to furnish nursing home care to parents, any of whose children died while serving in the armed 

forces. Parents who lose a child to a military death are normally and generally referred to as ‘‘Gold Star Parents.’’ In this instance, nevertheless, their losing fewer 

than ‘‘all’’ of their children to military deaths serves as a bar to their admissions 

to State Veterans homes under the non-veteran eligibility standards both in the law 

and in the regulations. 

This bill would require the Secretary of Veterans Affairs to amend existing regulations (title 38, Code of Federal Regulations, Chapter 1, Part 51, Paragraph 

51.210(c), with the following policy: 

‘‘In administering section 51.210(d) of title 38, Code of Federal Regulations, the 

Secretary of Veterans Affairs shall permit a State home to provide services to, in 

addition to non-veterans described in such subsection, a non-veteran any of whose 

children died while serving in the Armed Forces.’’ 

Mr. Chairman, DAV does not have a national resolution from our membership on 

the specific matter entertained by this bill; however, we believe the current statutory eligibility limitation on non-veteran admissions to State Veterans homes (not 

to exceed 25 percent of operating bed capacity, or 50 percent of that capacity in the 

case of a home that was constructed by a State without federal matching funds) is 

a sufficient guard to ensure that veterans receive proper priority for admission to 

State home residence. Therefore, while DAV would offer no objection to the passage 

of this bill in its current form, we ask the Committee to consider amending the bill 

further to subject this non-veteran population to the same limitation that applies 

to other non-veterans who are eligible for admission to State Veterans homes. 

Draft Bill—Improve VA Outreach Act of 2010 

Section 2 of this bill would require VA to establish, maintain, and annually review 

procedures for ensuring the effective coordination of the outreach activities within 

VA, state and county veterans agencies, veterans service organizations, Department 

of Labor, National Guard Bureau, and each of the reserve components of the Armed 

Forces. 

Section 3 would amend title 38, United States Code, § 6306 to require VA to consult with the Department of Health and Human Services to seek to better serve veterans who receive medical care through community health centers or through facilities of the Indian Health Service. 

Section 4 would establish an 11-member VA Advisory Committee on Outreach 

with ex officio members from the Department’s Centers for Minority Veterans and 

Women Veterans, VHA, the Veterans Benefits Administration and the National 

Cemeteries Administration. The Committee would be required to provide a report 

to Congress with an analysis of and recommendations to improve VA’s strategic 

plan for outreach. 

Section 5 of this measure would amend title 38, United States Code, § 6302 by 

changing the required biennial plan to a strategic plan for outreach activities and 

for such plan to be reported to Congress. Rather than a summary of outreach plans 

VA is undertaking, the strategic plan would be a single outreach plan that includes 

the goals, objectives, tasks and performance measures for implementation. In addition, the strategic plan is to identify and inform eligible veterans and dependents 

not enrolled for benefits and services provided by the Department, and to enroll or 

register veterans eligible for VA benefits and services. Consultation by VA with outside entities for the purposes of developing the biennial plan would be substituted 

with the Department’s consideration of the Advisory Committee on Outreach’s analysis and recommendations of the strategic plan required under Section 4 of this 

draft bill. 


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As this Subcommittee is aware, VA has a statutory mandate to perform outreach 

activities to certain categories of veterans. For example, title 38, United States 

Code, § 2022 requires VA’s Mental Health and Readjustment Counseling Service to 

conduct joint outreach efforts to veterans at risk of homelessness. Title 38, United 

States Code, §§ 7722 and 7727 require the Veterans Benefits Administration to conduct outreach activities, which include sending letters to separating servicemembers, distributing full information about veterans’ benefits to veterans and their 

dependents, and outreach to assist claimants with the preparation and presentation 

of claims for benefits. 

Public Law 108–454, the Veterans Benefits Improvement Act of 2004, requires VA 

to prepare and submit to Congress a report containing a detailed description of the 

Department’s outreach efforts to inform members of the uniformed services and veterans (and their family members and survivors) of the benefits and services to 

which they are entitled and the current level of awareness of those benefits and 

services. The report is also to include the results of a national survey to ascertain 

servicemembers’ and veterans’ level of awareness of VA benefits and services and 

whether they know how to access those benefits and services. 

While this law did not address the lack of an annual strategic plan from VA to 

conduct its outreach activities, Public Law 109–233 added Chapter 63 to Part IV 

of title 38 to ensure all veterans, especially those who have been recently discharged 

or released from active military service, are provided timely and appropriate assistance to aid and encourage them in applying for and obtaining such benefits and 

services in order that they may achieve a rapid social and economic readjustment 

to civilian life and obtain a higher standard of living for themselves and their dependents. In addition, the outreach services program authorized in Chapter 63 is 

for the purpose of charging the Department with the affirmative duty of seeking out 

eligible veterans and eligible dependents and providing them with such services. 

This law requires a biennial plan for outreach activities by VA to identify and notify eligible veterans and dependents not enrolled for benefits and services provided 

by the Department. In addition, a biennial report to Congress is required that includes implementation of the biennial plan, recommendations for the improvement 

of VA outreach activities, and incorporation of the recommendations of the report 

mandated by Public Law 108–454. 

DAV has had the opportunity to review the December 1, 2008, VA biennial outreach activities report to Congress. Clearly VA is conducting numerous outreach activities to veterans of all eras and has a special emphasis on veterans of Operations 

Enduring and Iraqi Freedom. However, we note the report lacks an overarching 

plan as well as any parameters or statistical evidence to determine whether outreach efforts, individually or collectively, are achieving the desired results. Strategic 

planning is essential for successful business operations and a full understanding of 

the veteran population is an important element in providing education and outreach. 

The mission of VA would be incomplete and its programs would be ineffective if 

it only passively received applications from those who may by chance learn of benefits available to them. When veterans and their programs are brought together, utilization is optimized, economies of scale are attained, program goals are achieved, 

and program outcomes are improved. An essential part of VA’s mission is therefore 

to seek out and educate veterans about the special programs created for their benefit, and incidentally, the ultimate benefit of society. Thus, VA must maintain, and 

adjust based on experience, an active, ongoing, and systematic project to create 

awareness among potentially eligible veterans of the special benefits and services 

provided for them. This bill would reinforce the authority and congressional mandate for VA outreach and would benefit veterans suffering from service-related disabilities who may be unaware of the range of benefits and services available to 

them. DAV has no resolution from our membership to support this draft bill; however, its purpose appears beneficial, and we have no objection to the Committee’s 

favorable consideration. 

Draft Bill—To provide hearing aid devices to veterans of World War II 

Section 2 of this draft bill would allow the VA to provide a hearing aid device to 

any World War II era veteran diagnosed with a hearing impairment regardless of 

whether the veteran is entitled to VA compensation benefits. 

Prior to enactment of the Veterans’ Health Care Eligibility Reform Act of 1996, 

Public Law 104–262, VA’s authority to furnish prosthetic devices and appliances to 

veterans on an outpatient basis was very limited. The law significantly changed the 

eligibility of veterans to receive hospital care and outpatient medical services, including prosthetics, medical equipment, and supplies to any veteran otherwise reVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00048 Fmt 6604 Sfmt 6621 I:\VA\57025.XXX GPO1 PsN: 57025

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1 38 U.S.C. 1707(b). 

ceiving health care services from VA. Unfortunately, sensori-neural aids, which are 

a type of prosthetic device including eye glasses and hearing aids, were not included 

when providing prosthetic devices and appliances by VA was expanded. 

Section 103(a) of Public Law 104–262 provides that VA could furnish needed 

sensori-neural aids only in accordance with guidelines promulgated by the Secretary.1 Subsequently, the Department published regulations (38 CFR § 17.149) in 

the Federal Register establishing such guidelines. In 2002, the VHA issued Directive 2002–039 to establish uniform policy for the provision of hearing aids and eyeglasses. This directive was revised on October 28, 2008 as VHA Directive 2008–070. 

Current VHA policy on the prescription and provision of hearing aids (and eyeglasses) is to furnish such sensori-neural aids to the following veterans: 

1. Those with a compensable service-connected disability; 

2. Those who are former prisoners of war; 

3. Those awarded a Purple Heart; 

4. Those in receipt of benefits under title 38, United States Code 1151; 

5. Those in receipt of increased pension based on the need for regular aid and 

attendance or by reason of being permanently housebound; 

6. Those who have a visual or hearing impairment that resulted from the existence of another medical condition for which the veteran is receiving VA care, 

or which resulted from treatment of that medical condition; 

7. Those with a significant functional or cognitive impairment evidenced by deficiencies in activities of daily living, but not including normally occurring visual 

or hearing impairments; and 

8. Those visually or hearing impaired so severely that the provision of sensorineural aids is necessary to permit active participation in their own medical 

treatment. 

Moreover, VA will furnish needed hearing aids to those veterans who have service-connected hearing disabilities rated 0 percent if there is organic conductive, 

mixed, or sensory hearing impairment, and loss of pure tone hearing sensitivity in 

the low, mid, or high-frequency range or a combination of frequency ranges which 

contribute to a loss of communication ability; however, hearing aids are to be provided only as needed for the service-connected hearing disability. 

Clearly, veterans in Priority Groups 1–5 are eligible for hearing aids. Nonserviceconnected veterans (Priority Groups 6, 7, and 8) must receive a hearing aid evaluation prior to determining eligibility for hearing aids to establish medical justification 

for provision of these devices. These veterans must be enrolled or exempt from enrollment for VA health care and the device must be determined to be necessary to 

permit the veteran’s active participation in their own medical treatment 

Hearing impairment is the most common body system disability in veterans. It 

is apparent that section 103(a) of Public Law 104–262 is aimed at reducing the cost 

of providing sensori-neural aids. Top-of-the-line hearing aids are costly, but that is 

always true of the newest technology. Conversely, the cost of hearing aids employing 

older technology has actually decreased over the years. For example, in 1996 when 

Public Law 104–262 was enacted, a top of the line two-channel digital aid cost 

$2,500. The equivalent two-channel behind the ear hearing aid today can be purchased for $495. For VA in 2008 (using six companies on contract for different technology), the average cost for hearing aid devices it has furnished was $355, whereas 

in the private sector, the cost per aid was $1,500 to $2,500. 

In 2008, there were nearly 520,000 veterans that had a VA disability for hearing 

loss. While changes in eligibility for hearing aid services, along with the aging population, contributed to a greater than 300 percent increase in the number of hearing 

aids dispensed from 1996 to 2006, the cost of hearing aid devices has decreased. 

DAV has no resolution from our membership to support this draft bill; however, its 

purpose appears beneficial. 

Mr. Chairman, this concludes my statement. Thank you for allowing the DAV to 

present its views before the Subcommittee today. 

f 

Statement of Paralyzed Veterans of America 

Chairman Michaud and Members of the Subcommittee, Paralyzed Veterans of 

America (PVA) would like to thank you for the opportunity to present our views concerning pending legislation. PVA appreciates the effort and cooperation this SubVerDate Nov 24 2008 14:19 Dec 17, 2010 Jkt 057025 PO 00000 Frm 00049 Fmt 6604 Sfmt 6621 I:\VA\57025.XXX GPO1 PsN: 57025

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committee demonstrates as they address the problems of today’s veterans and the 

veterans of tomorrow. 

H.R. 4062, the ‘‘Veterans’ Health and Radiation Safety Act’’ 

PVA supports H.R. 4062, the ‘‘Veterans’ Health and Radiation Safety Act,’’ which 

would require an annual report on low volume programs at the Department of Veterans Affairs (VA) medical facilities and establish a requirement for training of employees and contractors wherever radioactive isotopes are used. 

Under the provisions of this legislation, the Department of Veterans Affairs (VA) 

will be required to ensure training is provided in the proper handling and use of 

radioactive isotopes in VA facilities. While PVA does not believe Congress should 

be in the business of legislating good medical practice, the incidents at VA facilities 

demonstrate that there sometimes is a need for directed guidance. Radioactive materials can never be taken for granted and ensuring VA employees, and more specifically their contractors, are required to have adequate and appropriate training is 

clearly necessary. PVA also thinks it is wise to have contracting officers review contracts prior to extension or renewal to ensure these requirements are met. The dangerous nature of radioactive materials makes this critical for both the safety and 

health of the employees and the veterans they serve. 

H.R. 4465, a bill to properly determine a veteran’s financial status 

PVA supports H.R. 4465 to properly account for a veteran’s children when determining financial status. While this may seem like a minor issue, it can have a tremendous impact on those that this legislation will affect. 

In today’s society, more and more extended families are taking responsibility for 

children. Grandparents and sometimes great grandparents are taking care of the 

children of their children. Invariably these ‘‘new’’ parents are older, often with much 

lower income, and are gaining custody of these children and providing for a family. 

While the Internal Revenue Service (IRS) recognizes the financial challenge custody of these children can create when determining financial status, VA does not. 

The IRS considers someone a dependent when a person has custody of the child. 

Social Security includes grandchildren in its definition of a child, making them eligible for dependent benefits. But for VA, a dependent is identified as the biological, 

adopted, or step-child of a veteran only. If a veteran has sole custody of a child and 

is enrolled in the VA, PVA believes that the child should be considered when calculating the financial status of the veteran. While the veteran could go through the 

burdensome adoption process, this expense will create only greater challenges for 

the custodial parents and it should not be necessary. The challenge of a grandparent 

or great grandparent taking on the care of a child is significantly difficult already 

and VA should not add to that burden. Additionally, PVA supports consistency 

across Federal Agencies when considering similar benefit calculations. 

H.R. 4505, a bill to furnish nursing home care to parents of children who 

died serving in the armed forces 

PVA supports H.R. 4505 to furnish nursing home care to parents of children who 

died serving in the armed forces. This legislation corrects an injustice that requires 

parents to lose all their children before being eligible for State Veterans Home residency. While this may have made sense in the past when children often remained 

home with their parents to tend the farm or family business, it does not make sense 

in today’s mobile economy. 

The ‘‘Improve VA Outreach Act of 2010’’ 

PVA welcomes legislation to improve outreach to our Nation’s veterans. There are 

still many veterans who may not realize they are eligible for VA benefits. This particularly includes women veterans who are traditionally underserved, and those veterans that may erroneously believe that because they did not serve in combat that 

they are not eligible for VA benefits. The Secretary should make every effort to 

reach out to these veterans, especially homeless veterans and those suffering in poverty who may be significantly helped by VA services. However, this outreach cannot 

simply be an empty slogan or program that allows VA to proclaim how much they 

are doing to reach veterans. 

PVA is concerned that this legislation may be headed in that direction. It is unfortunate that Congress must direct VA to ‘‘establish and maintain procedures for ensuring the effective coordination of outreach activities of the Department between 

and among’’ Federal agencies. This is a basic task that VA should be doing and 


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1 Although widowers are more than welcome in GSW, GSW’s membership is primarily widows. 

Use of the word widows or other gender specific language is meant to include widowers. 

should have been doing since its inception, and while PVA welcomes the creation 

of the Advisory Committee on Outreach, establishing a committee is often a way to 

demonstrate action when no actual action is taking place. This committee is meant 

to advise the Secretary on outreach matters, but this advisory process is already 

available through meetings the Secretary has with various congressionally chartered 

Veterans Service Organizations (VSO). We are not sure that a formal committee will 

improve this function. 

Formalizing this process may provide a stronger voice to the Advisory Committee 

and its membership. The requirement that the Advisory Committee conduct ‘‘an 

analysis of the strategic plan’’ and make recommendations ‘‘for improving the plan’’ 

is welcome, but if the Secretary chooses to ignore these recommendations, he can. 

The Secretary is only required to submit a ‘‘summary of all reports and recommendations of the Committee’’ to Congress and this summary can be slanted in 

any way the Secretary sees fit. If Congress truly wishes the Secretary to consider 

recommendations of the Advisory Committee, this committee should request testimony from the Advisory Committee itself or the members represented on the Committee, at the time of the Secretary’s report. It can be expected that Congressional 

Committees may request testimony in the event of significant disagreements with 

the Secretary, but by compelling testimony in the legislation it sends the message 

that the Advisory Committee should be heeded and not simply serve as a sounding 

board or one more empty gesture. 

PVA supports all efforts of VA to reach out to its constituents. With the ever increasing number of veterans from the wars in Afghanistan and Iraq, and the increasing age of veterans from previous conflicts, greater needs are being created. It 

is the hope of PVA that this outreach program can be an effort that will truly reach 

those who are in need. But this will not happen if sufficient resources are not committed to the effort. Simply establishing an Advisory Committee will not do it and 

PVA implores the Secretary to do more. 

Draft Legislation to ‘‘authorize the Secretary to provide hearing aid 

devices to veterans of World War II’’ 

PVA does not support the legislation to authorize the Secretary to provide hearing 

aid devices to veterans of World War II as currently written. PVA believes that if 

a veteran is enrolled in the VA health system that they should be eligible for a hearing aid. This would simply be another service provided to enrollees. However, PVA 

does not believe that a World War II veteran should be able to bring in a hearing 

aid prescription from their private doctor and have VA supply the device. PVA expressed similar objections in the past to non-VA prescriptions being filled by a VA 

pharmacist. PVA would support the legislation if it were clarified to clearly state 

its intent to provide for those who are enrolled in the VA health care system. In 

addition, PVA is concerned that the costs associated with this new benefit be supported with newly appropriated funds. The VA should not be expected to supply this 

new service with current appropriations which could have detrimental effects on 

care provided to other veterans. 

f 

Statement of Vivianne Cisneros Wersel, Au.D. Chair, Government Relations 

Committee, Gold Star Wives of America, Inc. 

The members of Gold Star Wives of America are the widows1 of military servicemembers who served during World War II, the Korean War, the Vietnam War, the 

Gulf War, the wars in Iraq and Afghanistan and in the periods between these wars. 

Our husbands died on active duty and/or as the result of a service connected cause. 

We are those to whom Abraham Lincoln referred when he made the government’s 

commitment ‘‘. . . to care for him who shall have borne the battle, and for 

his widow, and his orphan.’’ 

H.R. 4505 

H.R. 4505 would grant nursing home care in state veterans’ homes to the parents 

of those who died while serving the Armed Forces of the United States. 

Gold Star Wives of America (GSW) believes that this legislation needs to 

be amended to include: 


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• The widows of those who died while serving in the Armed Forces 

• The parents and widows of those who died of a service connected cause 

Many of these parents, wives and widows have spent or will spend much of their 

lives as the caregivers of severely disabled veterans. If anyone deserves nursing 

home care in a Department of Veterans Affairs (VA) or VA subsidized nursing home, 

it is the parents, wives and widows who have provided care to severely disabled 

servicemembers and veterans. 

The recent bill which provides for benefits to caregivers included only the caregivers of those who were injured in Iraq and Afghanistan. The caregivers of veterans from previous war eras were not included in these benefits. 

Survivor benefits during earlier war eras were less than adequate. Many of the 

widows from the World War II and Korean War eras receive Dependency and Indemnity Compensation (DIC) and $200–$300 in Social Security. Many of these widows live on $1500 a month or less and are financially challenged. 

Some of the widows of the Vietnam era receive only DIC and are not entitled to 

Social Security Widows’ Pension because their husbands died very young and had 

not accumulated enough quarterly work credits for them to receive a Social Security 

Widows’ Pension. (This oversight also needs to be fixed.) 

Congress has not been able to fund H.R. 2243, the bill to increase DIC or H.R. 

775, the bill to repeal the DIC offset to SBP for widows who have not remarried. 

As a result of this lack of funding many of our widows are in significant financial 

need now and they would have no means to pay for nursing home care should the 

need arise. 

As an alternative to providing care for parents, wives, and widows in a VA or VA 

subsidized nursing home, Congress should consider providing subsidized long term 

care insurance. Long term care insurance would be far less expensive and would 

allow these proposed beneficiaries to obtain nursing home care while remaining in 

their own communities close to friends and family. An exception might be made so 

that if a veteran is already in a nursing home, his family members would be eligible 

for care in the same VA or VA subsidized nursing home. 

Subsidized long term care insurance would also relieve the burden to the VA of 

providing care to additional family members when the VA is already staggering 

under the current burden of caring for veterans. 

‘‘Taking care of survivors is as essential as taking care of our Veterans 

and military personnel. By taking care of survivors, we are honoring a commitment made to our Veterans and military members.’’—Secretary of Veterans 

Affairs Eric Shinseki 


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MATERIAL SUBMITTED FOR THE RECORD 

Committee on Veterans’ Affairs 

Subcommittee on Health 

Washington, DC. 

June 14, 2010 

Hon. Eric K. Shinseki 

Secretary 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20240 

Dear Secretary Shinseki: 

Thank you for the testimony of Dr. Robert Jesse, Acting Principal Deputy Under 

Secretary for Health and Walter A. Hall, Assistant General Counsel, at the U.S. 

House of Representatives Committee on Veterans’ Affairs Subcommittee on Health 

Legislative Hearing on H.R. 4062, H.R. 4505, H.R. 4465, and Draft Legislation entitled, the ‘‘Improve VA Outreach Act of 2010,’’ and the ‘‘World War II Hearing Aid 

Treatment Act,’’ which took place on June 9, 2010. 

Please provide answers to the following questions by Monday, July 26, 2010, to 

Jeff Burdette, Legislative Assistant to the Subcommittee on Health. 

1. Dr. Jesse testified that the definition of a low volume ‘‘program’’ in H.R. 4062 

is unclear so that it can be narrowly defined to include all facilities or no facility. Please explain further by providing some specific examples of how VA can 

potentially define a ‘‘program’’. 

2. VA’s testimony requested clarification on H.R. 4465. It is my understanding 

that the goal of H.R. 4465 is to help veterans who receive pension for non-service connected disability and are in priority group 5. For this sub-group of veterans, their medical co-payments are reduced by the number of dependents 

they have. The current law narrowly defines dependents to include biological, 

step, and adopted children. This bill would newly include children who are 

under the guardianship of the veteran. This means that the veteran can have 

a higher income level and not exceed the VA national income threshold, which 

means free VA prescriptions and travel benefits, as well as free VA health care 

for the veteran. In light of this information, are you able to share VA’s position 

on this bill? 

3. The Gold Star Wives of America submitted a statement for the record recommending that H.R. 4505 be amended to make eligible for state nursing home 

care widows of individuals who died while serving in the Armed Forces, as well 

as parents and widows of those who died of a service-connected cause. Would 

VA continue to support this bill if it were amended to include the Gold Star 

Wives’ recommendations? Please explain. 

4. VA states that the draft legislation on outreach is largely duplicative of existing efforts. We’ve also heard our VSO panel testify about the need to greatly 

improve VA’s current outreach efforts. Given this clear need and if the draft 

legislation is duplicative, what other legislative authorities can help VA be 

more successful in outreaching to our veterans? 

5. VA estimates the cost of the draft hearing aid bill as $350 million over 5 years 

and $510 million over 10 years. Please explain the underlying assumptions 

that you used to develop this cost estimate. In other words, how many beneficiaries and cost per hearing aid did VA assume in this estimate? 

Thank you again for taking the time to answer these questions. The Committee 

looks forward to receiving your answers by Monday, July 26, 2010. 

Sincerely, 

MICHAEL H. MICHAUD 

Chairman 


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Committee on Veterans’ Affairs 

U.S. House of Representatives 

Post-Hearing Questions for the Honorable Robert A. Petzel, M.D., Ph.D. 

Under Secretary for Health, U.S. Department of Veterans Affairs 

From the Honorable Michael H. Michaud 

H.R. 4062, H.R. 4505, H.R. 4465, and Draft Legislation entitled, 

the ‘‘Improve VA Outreach Act of 2010’’ and the ‘‘World War II 

Hearing Aid Treatment Act’’ 

May 27, 2010 

Question 1: Dr. Jesse testified that the definition of a low volume ‘‘program’’ in 

H.R. 4062 is unclear so that it can be narrowly defined to include all facilities or 

no facility. Please explain further by providing some specific examples of how VA 

can potentially define a ‘‘program.’’ 

Response: H.R. 4062 defined a low volume program as a program that treats 100 

patients or fewer during a calendar year. Clinical programs within the Veterans 

Health Administration (VHA) provide a wide range of services comprised of clinical 

assessments, treatments, and procedures. In most cases this is aligned around a 

medical specialty or a subspecialty provider that has received training to provide a 

variety of assessments, treatments or procedures based upon his or her training and 

education. As Dr. Jesse stated, this can be a clinical offering that is within a single 

VA Medical Center, a Veterans Integrated Service Network (VISN), or at the national level. VA believes a better approach is to use a definition to be ‘‘a group of 

practitioners who collaborate closely to perform a procedure or collection of procedures that require the same skill sets.’’ 

VA does however, believe it best to address the concern presented in H.R. 4062 

through VA’s existing credentialing and privileging process. After initial 

credentialing, which focuses on the identified clinician’s training and experience, 

each individual medical center is required to complete privileging of the provider. 

The privileging process includes both experience in performing an identified procedure and a review of the clinical outcomes. This process requires a review every 2 

years for cause. The overall number of procedures performed within VA may not be 

the best predictor of competency, as many VA providers also perform procedures 

within community and academic settings, which may be included in the re-privileging process. The overall number of procedures performed may be extended to the 

person’s overall performance at various clinical sites. 

The overall review of the quality of care provided by an individual clinician requires both evidence of continued experience and the overall results of his or her 

clinical outcomes. Defining the overall competency of the individual and outcomes 

of a system-wide performance of procedures or treatments requires much more than 

volume triggers; VA must and does take into consideration quality outcomes and 

risk-adjusted factors. 

The following are examples: 

An Imaging Program consists of general and specialty procedures, including 

neuroradiology, interventional procedures, and nuclear medicine. At the facility 

level, each individual clinical service may be a separate program (nuclear medicine and radiology, for example). 

Radiation Oncology Program may include a variety of treatment and services 

such as external beam treatments, prostate brachytherapy seed implant services, and other brachytherapy treatments. 

Cardiology Program may include outpatient evaluations, procedures clinics, cardiac invasive procedures (catherization), and open heart surgery. 

Question 2: VA’s testimony requested clarification on H.R. 4465. It is my understanding that the goal of H.R. 4465 is to help Veterans who receive pension for nonservice connected disability and are in priority group 5. For this sub-group of Veterans, their medical co-payments are reduced by the number of dependents they 

have. The current law narrowly defines dependents to include biological and adopted children, and stepchildren. This bill would newly include children who are under 

the guardianship of the Veteran. This means that the Veteran can have a higher 

income level and not exceed the VA national income threshold, which means free 

VA prescriptions and travel benefits, as well as free VA health care for the Veteran. 

In light of this information, are you able to share VA’s position on this bill? 

Response: The effect of the bill would be that persons placed in the legal custody 

of a Veteran by a court would be considered children under more generous criteria 

than the Veteran’s natural children; the purpose of this differentiation is unclear. 


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If the intention is to extend the broader criteria (the age 21 cut-off) to all children 

of Veterans, we suggest clarifying the language. In addition, all conditions in the 

bill as drafted are conjunctive and could be interpreted to read that only persons 

placed in the custody of a Veteran by a court shall be treated as a child. VA is available to work with Committee Staff to provide clarity and technical assistance. 

Question 3: The Gold Star Wives of America submitted a statement for the 

record recommending that H.R. 4505 be amended to make eligible for state nursing 

home care widows of individuals who died while serving in the Armed Forces, as 

well as parents and widows of those who died of a service-connected cause. Would 

VA continue to support this bill if it were amended to include the Gold Star Wives’ 

recommendation? Please explain. 

Response: Current law limits state home beds to spouses and parents if all of 

their children have died while serving in the Armed Forces of the United States. 

Historically, the reason for permitting spouses was to make it possible for the Veteran to continue to live with the spouse if both required nursing home care. Spouses 

living in a state home at the time of death of a Veteran may continue to live in 

the home. The proposal by the Gold Star Wives to make widows of individuals who 

died while serving in the Armed Forces eligible for admission to State Veterans 

Homes would treat those spouses more equitably. Since VA does not pay a per diem 

to the state for any non-Veteran residents of State Veterans Homes, this proposal 

would not have any effect on VA’s costs. Accordingly, VA has no objection to the 

proposal. 

Question 4: VA states that the draft legislation on outreach is largely duplicative 

of existing efforts. We’ve also heard our VSO panel testify about the need to greatly 

improve VA’s current outreach efforts. Given this clear need and if the draft legislation is duplicative, what other legislative authorities can help VA be more successful 

in outreaching to our Veterans? 

Response: VA already has adequate legislative authority to conduct outreach to 

all Veterans and is aggressively working towards that end. VA is taking steps to 

align and synchronize its outreach efforts across VA business lines to ensure outreach activities employ clear, accurate, consistent, and targeted messages to inform 

Veterans and their families of the benefits and services available to them. 

VA has established an outreach office within the Office of Public and Intergovernmental Affairs (OPIA) and is in the process of hiring staff. The office will promote 

uniform messaging across the Department, reduce cost, and share the fiscal responsibility of researching, analyzing, and measuring our efforts. The three Administrations and Staff Offices will continue to execute outreach activities, but the overall 

Department outreach strategy will be coordinated across all organizations by OPIA. 

As a result, OPIA will ensure necessary and valuable information is delivered 

timely to Veterans and their families; will leverage technology and partnerships 

with our stakeholders; will unify outreach messages and measure tangible outcomes 

nationwide. VA will report the success of these activities to Veterans, Congress, 

stakeholders, and the American public. The outreach office is expected to be fully 

functional by the end of the year. 

Question 5: VA estimates the cost of the draft hearing aid bill as $350 million 

over 5 years and $510 million over 10 years. Please explain the underlying assumptions that you used to develop this cost estimate. In other words, how many beneficiaries and cost per hearing aid did VA assume in the estimate? 

Response: VA’s earlier estimate of the draft bill included baseline costs for the 

WWII veterans who are already eligible under current law. Excluding these baseline 

costs, the draft bill would cost $40 million over 5 years and $56 million over 10 

years. Under the draft bill, VA estimates that 13,260 additional World War II 

(WWII) Veterans will utilize hearing aids at the end of 5 years, and 2,508 additional 

WWII Veterans will utilize hearing aids at the end of 10 years. The cost assumed 

for hearing aids was $729 (per pair) at the end of 5 years, and $757 (per pair) at 

the end of 10 years. 

These projections are based on historical facts that VA has provided hearing aids 

to more than 700,000 WWII Veterans who were eligible for hearing aids in accordance with VA policy. This Veteran population will decrease over time, and more 

than half will have hearing loss based on published epidemiological studies. Not all 

WWII Veterans with hearing loss will seek VA hearing aid services. 

The following assumptions are based on VA data and Veteran health utilization 

information: 


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• Average Veteran receives 2 hearing aids at a time (current average contract 

cost is $349 each = $700 rounded); 

• Hearing aids are replaced on average every 4 years; 

• First 2 years hearing aids are under warranty with no repair or replacement 

cost; 

• One repair per 4 year life span of hearing aids; average repair cost is $102 in 

2010 (per VA Remote Order Entry System data); 

• Consumer Price Index inflation factors for repairs and hearing aid cost; 

• 710,000 WWII Veterans currently are in receipt of hearing aids; 

• Half of WWII Veterans have sufficient hearing loss requiring hearing aids; 

• 20 percent of eligible WWII Veterans meeting hearing aid loss criteria and not 

in receipt of VA hearing aids will request VA hearing aids at some time; 

• Half of the 20 percent of eligible WWII Veterans who request hearing aids will 

do so within the first year; and 

• New requests in outlying years will be 50 percent of the new requests for the 

previous year. 

Table 1. 10-year cost projections based on current VA data and WWII Veteran population 

FY 

WWII 

Veteran 

Population 

Hearing 

Aid 

Users 

New 

Hearing 

Aid 

Users 

Hearing 

Aid 

Cost/ 

Pair 

Hearing Aid 

Total Cost 

Average 

# of 

Repairs 

Repair 

Cost 

Repair 

Cost Total Total Cost 

2011 1,517,404 567,900 21,200 $700 $14,840,000 0 $102 $0 $14,840,000 

2012 1,294,133 493,315 10,600 $700 $7,420,000 0 $102 $0 $7,420,000 

2013 1,091,800 419,685 5,300 $700 $3,710,000 0 $102 0 $3,710,000 

2014 1,034,727 401,351 2,650 $729 $1,931,850 14,380 $106 $1,524,280 $3,456,130 

2015 855,070 334,446 13,260 $729 $9,666,540 7,021 $106 $744,226 $10,410,766 

5–YR $37,568,390 $2,268,506 $39,836,896 

2016 697,806 274,909 6,420 $729 $4,680,180 3,427 $106 $363,262 $5,043,442 

2017 562,022 223,007 3,107 $729 $2,265,003 1,461 $106 $154,866 $2,419,869 

2018 446,469 176,342 1,320 $757 $999,240 6,958 $110 $765,380 $1,764,620 

2019 349,623 137,630 5,510 $757 $4,171,070 3,204 $110 $352,440 $4,523,510 

2020 269,721 106,016 2,508 $757 $1,898,556 1,474 $110 $162,140 $2,060,696 

10–YR $51,582,439 $4,066,594 $55,649,033 

Æ 


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