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HEARING ON HEALTH AND BENEFITS 

LEGISLATION 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

JUNE 27, 2012 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

PATTY MURRAY, Washington, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

DANIEL K. AKAKA, Hawaii 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

RICHARD BURR, North Carolina, Ranking 

Member 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

SCOTT P. BROWN, Massachusetts 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

KIM LIPSKY, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

JUNE 27, 2012 

SENATORS 

Page 

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

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 3 

Brown, Hon. Scott P., U.S. Senator from Massachusetts ..................................... 4 

Boozman, Hon. John, U.S. Senator from Arkansas .............................................. 5 

WITNESSES 

Heller, Hon. Dean, U.S. Senator from Nevada ..................................................... 7 

Ayotte, Hon. Kelly, U.S. Senator from New Hampshire ...................................... 9 

Franken, Hon. Al, U.S. Senator from Minnesota .................................................. 11 

Wyden, Hon. Ron, U.S. Senator from Oregon ....................................................... 13 

Prepared statement .......................................................................................... 15 

Boxer, Hon. Barbara, U.S. Senator from California ............................................. 16 

Portman, Hon. Rob, U.S. Senator from Ohio ........................................................ 17 

Agarwal, Madhulika, M.D., M.P.H., Deputy Under Secretary for Health for 

Policy and Services, Veterans Health Administration ...................................... 20 

and 

Murphy, Thomas, Director, Compensation Service, Veterans Benefits Administration, U.S. Department of Veterans’ Affairs; accompanied by William 

Schoenhard, Deputy Under Secretary for Health for Operations and Management, Veterans Health Administration; Jane Claire Joyner, Office of 

General Counsel; and Richard Hipolit, Office of General Counsel .................. 21 

Joint prepared statement ................................................................................. 22 

Additional views ............................................................................................... 36 

Response to posthearing questions submitted by: 

Hon. Patty Murray ........................................................................................ 56 

Hon. Scott P. Brown ..................................................................................... 60 

Fast Letters ....................................................................................................... 69 

Keil, Tracy, Caregiver and Spouse of OIF Veteran .............................................. 79 

Prepared statement .......................................................................................... 82 

Edney, Mark Thomas, MD, OIF Veteran, Member, Legislative Affairs Committee of the American Urological Association .................................................. 84 

Prepared statement .......................................................................................... 87 

Ansley, Heather, M.S.W., Vice President of Veterans Policy, VetsFirst ............. 90 

Prepared statement .......................................................................................... 92 

Ilem, Joy J., Deputy National Legislative Director, Disabled American Veterans ...................................................................................................................... 97 

Prepared statement .......................................................................................... 98 

APPENDIX 

Cleland, Max, Secretary, American Battle Monuments Commission; prepared 

statement .............................................................................................................. 113 

American Society for Reproductive Medicine (ASMR); prepared statement ...... 114 

Beeler, Nathaniel, Avon, IN; letter ........................................................................ 115 

Zampieri, Thomas, Ph.D., Director of Government Relations, Blinded Veterans Association (BVA); prepared statement ................................................... 117 

Kasold, Hon. Bruce E., Chief Judge, U.S. Court of Appeals for Veterans 

Claims; prepared statement ................................................................................ 118 

Wright, Dennis L., Captain, U.S. Navy (ret.), Chairman, Clark Veterans 

Cemetery Restoration Association; letter ........................................................... 120 

Page

IV 

National Coalition for Homeless Veterans; letter ................................................. 122 

Paralyzed Veterans of America (PVA); prepared statement ................................ 125 

Collura, Barbara, President, Resolve; letter .......................................................... 132 

Sims, Ron, Seattle, WA; prepared statement ........................................................ 134 

Klein, Morris, Esq., Attorney at Law, Bethesda, Maryland, and Lois Zerrer, 

Zerrer Elder Law Office, LLC, Springfield, Missouri, on Behalf of the Special Needs Alliance; prepared statement ............................................................ 137 

Bhagwati, Anu, Executive Director, Service Women’s Action Network; prepared statement ................................................................................................... 139 

Huebner, Charles, United States Olympic Committee; prepared statement ...... 141 

Ansley, Heather L., Esq., M.S.W., Vice President of Veterans Policy, 

VetsFirst; letter .................................................................................................... 144 

Wright, Dennis L., Captain, U.S. Navy (ret.), Chairman, Clark Veterans 

Cemetery Restoration Association (CVCRA); letter .......................................... 145 

Wounded Warrior Project (WWP); prepared statement ....................................... 147 

SUBMITTED BY SENATOR BARBARA BOXER OF CALIFORNIA

AMVETS Department of California Service Foundation; letter .......................... 150 

Hampton, Brian A., Maj. USAR (ret.), President, Center for American Homeless Veterans, Inc.; prepared statement ............................................................. 152 

California Association of Veteran Service Agencies; letter .................................. 153 

The National Coalition for Homeless Veterans; letter ......................................... 154 

Blecker, Michael, Executive Director, Swords to Plowshares; letter ................... 155 

Kelley, Raymond C., Director, National Legislative Service, VFW; letter .......... 156 

SUBMITTED BY SENATOR DEAN HELLER OF NEVADA

Wong, Fang A., National Commander, The American Legion; letter .................. 157 

Gornick, Matt, Policy Assistant Director, National Coalition for Homeless 

Veterans; letter ..................................................................................................... 158 

(1) 

HEARING ON HEALTH AND BENEFITS 

LEGISLATION 

WEDNESDAY, JUNE 27, 2012 

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

The Committee met, pursuant to notice, at 10:04 a.m., in room 

124, Dirksen Senate Office Building, Hon. Patty Murray, Chairman 

of the Committee, presiding. 

Present: Senators Murray, Burr, Isakson, Brown of Massachusetts and Boozman. 

Also present: Senators Heller, Ayotte, Franken, Wyden, Boxer, 

and Portman. 

STATEMENT OF HON. PATTY MURRAY, 

U.S. SENATOR FROM WASHINGTON 

Chairman MURRAY. Good morning. Thank you, and welcome all 

of you to this hearing of the Veteran Affairs’ Committee this morning as we examine health and benefits legislation that is before our 

Committee. 

We have a number of Senators who are here who want to testify 

about their legislation. I will make an opening statement, then 

Senator Burr, and if we have any other Committee Members we 

will allow them to give theirs, then turn to other Senators. So, 

thank you all for being here. 

Like our hearing 2 weeks ago on economic opportunity and transition legislation, today’s agenda is ambitious and reflects important work by the Members on both sides of the aisle. I wanted to 

briefly highlight two of my bills that are on the agenda. 

The Mental Health ACCESS Act of 2012 is sweeping legislation 

that improves how VA provides mental health care. I think it is fitting actually that we are here considering this legislation on National PTSD Awareness Day. 

Over the past year, this Committee has repeatedly examined the 

alarming rate of suicide and the mental health crisis in our military and veterans’ populations. We know our servicemembers and 

veterans have faced unprecedented challenges, multiple deployments, difficulty finding a job when they come home, and isolation 

in their communities. Some have faced tough times reintegrating 

into family life, with loved ones trying to relate but not knowing 

how. 

These are the challenges our servicemembers and veterans know 

all too well. But even as they turn to us for help, we are losing the 

battle. Time and time again, we have lost servicemembers and vetVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 H:\112TH HEARINGS\76283.TXT PAULIN
2 

erans to suicide. We are losing more servicemembers to suicide 

than we are to combat, and every 80 minutes a veteran takes his 

or her own life. On average this year, we have lost a servicemember to suicide once every day. 

But while the Departments of Defense and Veterans’ Affairs 

have taken important steps toward addressing this crisis, we know 

there is a lot more that needs be done. We know that any solution 

depends upon reducing the wait times and improving access to 

mental health care, ensuring proper diagnosis, and achieving true 

coordination of care and information between the Departments. 

The Mental Health ACCESS Act would expand eligibility for VA 

mental health services to family members of veterans. It would require VA to offer peer support services at all medical centers and 

create opportunities to train more veterans to provide peer services, and this bill will require VA to establish accurate and reliable 

measures for mental health services. 

This Committee has held multiple hearings on VA mental health 

care, and we heard repeatedly about the incredibly long wait times 

to get into care. It is often only on the brink of crisis that a veteran 

seeks care. If they are told ‘‘sorry, we are too busy to help you,’’ 

we have lost the opportunity to help, and that is not acceptable. 

Without accurate measures, VA does not know the unmet needs. 

Without a credible staffing model, VA cannot deploy its personnel 

and resources effectively. 

The other bill I want to mention today is S. 3313. It is the 

Women Veterans and Other Health Care Improvement Act of 2012, 

which builds upon previous law to improve VA services for women 

veterans and veterans with families. 

This bill will create a child-care pilot program for veterans seeking readjustment counseling at Vet Centers and increase outreach 

to women veterans. We know that as more of our men and women 

return from Afghanistan, the VA will be called upon to provide care 

for our most severely wounded veterans. After suffering life-changing injuries on the battlefield, these veterans now face a future forever changed. 

Between 2003 and 2011, we know that more than 600 servicemembers experienced blast injuries that caused trauma to their reproductive or urinary tracts in Iraq and Afghanistan. Even more 

have experienced other injuries, like spinal cord injuries. 

Many of these veterans dream of 1 day starting a family. But 

with the injuries they have sustained on the battlefield that may 

not be possible without some extra help. While the Department of 

Defense and TRICARE are now able to provide advanced fertility 

treatment to injured servicemembers, today the VA can only provide limited treatment. VA’s services do not even begin to meet the 

needs of our most seriously injured veterans and their families. 

So, my bill will help make real the dream of starting a family 

by authorizing the VA to provide advanced fertility treatment to severely wounded veterans. By authorizing these treatments, we will 

bring VA services in line with what DOD and TRICARE already 

provide. It is the right thing to do, and it is what our veterans 

deserve. 

3 

I look forward to our second panel today where we have some 

very compelling testimony from families that have been impacted 

by these injuries. 

So, I look forward to hearing from our VA witnesses and all of 

our Committee Members and those Senators that are here today to 

talk about their legislation. 

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

Burr. 

Senator BURR. Thank you, Chairman Murray; and I also welcome 

our witnesses today. I would also like to welcome Senator Wyden, 

who just introduced a bill in the last couple of weeks together, 

which he will testify on today. And I welcome the rest of my colleagues who are here that I expect to do a similar thing. 

Before turning to today’s agenda, I want to say a few words 

about the Caring for Camp Lejeune Veterans Act, which would provide health care for veterans and their families who were stationed 

at Camp Lejeune when the water was contaminated with known or 

probable known carcinogens. 

I am very pleased that we have made progress on this bill in recent weeks, and I hope it will soon pass so that we can finally provide these veterans and their families with the care they need and 

deserve. 

As we consider other bills today—particularly any that create or 

expand programs—we should start by looking at how well existing 

programs are working and identify any gaps and inefficiencies. 

That should help us focus on changes that are truly needed and 

avoid creating any more duplicative and overlapping programs that 

can end up frustrating veterans and their families. 

Also, with the fiscal challenges facing our Nation, we need to 

know the cost of these bills; and for any that will move forward, 

we must find ways to pay for them. 

With all that in mind, I look forward to a productive discussion 

about the bills on today’s agenda. To start with, I would like to 

mention several of those bills that I have cosponsored. 

One is S. 1707, which would end the unfair process that strips 

veterans and their families of the rights to own firearms if VA believes they need help with their finances. 

Under this bill, the Second Amendment rights of a VA beneficiary could not be taken away unless a judicial authority finds 

that the individual is dangerous. This would put the decision about 

Constitutional rights in an appropriate forum and base it on relevant questions. 

Another bill, S. 2045, would require judges of the Court of Appeals for Veterans’ Claims to live within 50 miles of the Court’s office, a requirement that already applies to other Federal judges. 

This should increase the efficiency and effectiveness of the Court 

by encouraging the judges to be present and personally engaged on 

a daily basis. It would also emphasize that the judges must be totally committed to the Court’s important work. 

Then, S. 3084 would reform VA’s Veterans’ Integrated Service 

Networks or the acronym we all know, VISNs. In 1995, the veterans’ health care system was divided into 22 geographic areas. It 

now is divided into 21 VISNs. Each VISN has its own headquarters 

with a limited management structure to support the medical faciliVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 H:\112TH HEARINGS\76283.TXT PAULIN
4 

ties in that region. Since then, there has been a huge growth in 

staff at the VISN headquarters and increasing duplication in the 

duties they carry out. 

So, this bill would consolidate the boundaries of nine VISNs, 

move some oversight functions away from VISN management, and 

limit the number of employees at each VISN headquarters. All of 

this should make these networks more efficient and should allow 

resources to be reallocated to direct patient care. 

One other, S. 3202, is a bill Chairman Murray and I introduced 

to give VA the tools to help ensure that veterans and servicemembers are laid to rest with dignity and respect. By granting VA the 

authority to purchase caskets or urns when they otherwise would 

not be provided, veterans buried in national cemeteries can be laid 

to rest in a manner befitting their service. 

Finally, S. 3270 would create a ‘‘look-back’’ period so VA could 

consider whether someone applying for need-based pensions has recently transferred away assets. As the Government Accountability 

Office highlighted, there is an entire industry aimed at convincing 

veterans to move assets around in order to qualify for need-based 

pension benefits. 

That practice not only undermines the integrity of the pension 

program but can leave elderly veterans without any adequate resources in their greatest time of need. So, this bill aims to 

strengthen VA’s pension program, while discouraging companies 

from preying on elderly veterans. 

Madam Chairman, all of these bills would provide commonsense 

solutions to real issues affecting our Nation’s veterans, their families, and their survivors. I look forward to working with you and 

with our colleagues to see that these and other worthwhile bills 

that are on today’s agenda soon become law. 

Again, I want to stress how important this hearing is, and I want 

to thank you for your help with Camp Lejeune legislation. 

Chairman MURRAY. Of course, thank you very much, Senator 

Burr. We have three Committee Members present. If any of you 

would like to offer an opening statement before we turn to our visiting Senators; Senator Isakson, Senator Brown, do you have an 

opening statements? 

STATEMENT OF HON. SCOTT P. BROWN, 

U.S. SENATOR FROM MASSACHUSETTS 

Senator BROWN OF MASSACHUSETTS. Yes, I do. 

Thank you, Madam Chair. I am bouncing back and forth between 

HSGAC and this. I appreciate the opportunity. 

I want to say thank you, Senator Burr, for working on Camp 

Lejeune. It is something I am a cosponsor of. I have many Massachusetts families affected by that too. So, I appreciate your efforts 

and, Madam Chair, your willingness to move forward on that in a 

positive manner. 

As we know, we introduced a bill last week with Senator Burr, 

Housing for Families of Ill and Injured Veterans. It is pretty simple. It gives the VA the authority to award grants to the Fisher 

House Foundation for the construction of additional temporary 

lodging facilities similar to the ones which currently exist and that 

many people are aware are. 

5 

There is even a Fisher House in Washington State, Madam 

Chair, as you are probably aware of, and today there are 21 States 

and additional projects are already planned in nine other States. 

If you have been to Walter Reed or visited a VA medical center 

back home, you know the critical role that that facility plays in 

helping troops and their families navigate the difficult and often 

painful road to recovery. 

Our Fisher Houses in Massachusetts are an incredible asset for 

the family seeking care in our State and thankfully these homes 

create, as you all know, an instant community of support for our 

families. 

Unfortunately, the reality is that private and corporate charitable contributions are declining. There is a real concern about 

what is going to happen with a lot of the so-called deduction opportunities if charitable deductions is going to be one of those on the 

chopping block, and this has prevented Fisher House from producing the amount of homes required by VA for the foreseeable future even as demand continues to rise. 

In fact, Secretary Shinseki identified 19 medical centers that desperately need a Fisher House. On the other hand, the DOD budget 

is about $4 million annually to the Fisher House Foundation to 

cover the cost, and my point is I do think it is reasonable for the 

VA like DOD to put some skin in the game. Our bill gives the authority to do just that. 

I would also like to just make a quick reference to the Women’s 

Homeless Veterans Act that Senators Heller and Burr recently introduced, and I was proud to cosponsor as well. 

This Committee held a hearing back in March to learn more 

about what the VA was doing on this epidemic, and we heard from 

Ms. Sandra Strickland and learned firsthand about her personal 

experiences. She testified that she was hung up on by folks at the 

VA and felt bad that VA did not go above and beyond to address 

their current needs. What is worse it is not an isolated case. We 

reference that from the GAO report. 

So, I want to obviously thank those Senators Heller and Burr, 

and I am hopeful that we will be able to move these matters 

forward. 

As I mentioned, I am back and forth between hearings, and I am 

going to hopefully come back and testify. If not, I will offer questions for the record. 

Thank you, Madam Chair. 

Chairman MURRAY. Thank you very much. 

Senator Boozman. 

STATEMENT OF HON. JOHN BOOZMAN, 

U.S. SENATOR FROM ARKANSAS 

Senator BOOZMAN. Thank you, Madam Chair, and thank you, 

Ranking Member Burr, for holding this important hearing regarding legislation to improve the health care and benefits that each individual of our all volunteer force has earned through their 

sacrifice. 

I also appreciate that you have included several bipartisan bills 

in which we have been working to improve our veterans benefits 

6 

and quality-of-life. I would really like to just take a few minutes 

to say a few words about some of this. 

First off, I want to thank Senator Franken for his hard work, 

and I want to say that I echo the sentiments that he is going to 

be expressing in a little bit. 

With so many of our veterans living in rural areas, our Nation 

has seen fit to invest significant amount of money to improve the 

accessibility and quality of the health care that they receive. While 

the research of VA Office of Rural Health Strategic Plan is a little 

step in the right direction, I think it is so important for us to have 

a clear path forward to improve health care for our rural veterans. 

So, I would associate again myself with Mr. Franken’s sentiments and thank him for his continued partnership and hard work 

in addressing the issue. 

Another important bill that we have been working on is S. 3206 

to extend Paralympic Integrated Adaptive Sports Program. I would 

also like to take this opportunity to thank Senator Begich for his 

assistance and hard work with the bill and so many others, many 

of which we will hear today, that he has been such a great partner 

on the Committee and together we have been able to raise awareness about the several key issues to help our veterans and advance 

legislation through Congress. So again, thanks to him and his staff. 

S. 3206 would reauthorize this program that despite only being 

operational for about 18 months is already serving wounded warriors in more than under 50 communities in 42 States and has collaborated with 53 VA medical centers to provide adaptive sports 

programs for our disabled veterans right in their communities. 

More than 500 partner organizations have come together to help 

provide this important service to thousands of our disabled veterans that have leveraged these Federal dollars with their own 

funds and expertise. This type of activity is so important to our 

wounded warriors in improving quality-of-life, health, self-esteem, 

socialization. 

Now with our recent overseas engagements winding down, it is 

more important than ever that this valued program remain in 

place with no interruption in its authorization which would lapse 

at the end of the next fiscal year under current law. 

Another bill that is important that I have been working with 

Senator Baucus on, to whom I am grateful for his efforts on this 

issue, is S. 1838. This is simple legislation, a nearly identical companion of which has already passed the full House is part of 

H.R. 2074. 

It would create a pilot program in which the VA would examine 

the feasibility of the service-dog training activities as therapies in 

mental health rehab programs. 

Too often many of our veterans must rely on pharmacological 

therapies for seen and unseen injuries. This is not all bad, but I 

think we need to examine alternatives to this, which is why I am 

being very supportive of programs like Rivers of Recovery, which 

recently expanded into Arkansas and that teaches recreational 

therapy through fly fishing. 

This dog-training program could be a four-way win by providing 

therapy, teaching potential vocational skills as dog trainers, providing highly-trained service dogs for veterans in need, and proVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 H:\112TH HEARINGS\76283.TXT PAULIN
7 

viding a pathway for the rescue of shelter dogs that meet the criteria for the service. 

For all of these reasons, I think that this modest pilot program 

is worthy of examination. 

I have also been working with Senator Begich on S. 3094, which 

is a commonsense adjustment to the definition of homeless veterans so that it includes veterans who are fleeing domestic violence 

situations. 

With such an increasing percentage of our veterans population 

being women, this Committee has been hard at work to improve 

programs and benefits to meet their needs; and while it is not only 

women who could fall under this adjustment, it is important that 

we get our veterans the benefits and assistance they need when 

they need them and this simple adjustment would help ensure that 

that happens. 

Finally, I would like to express my strong support for S. 1707, 

the Veteran Second Amendment Protection Act. I have been strongly advocating for this legislation for the past few Congresses, and 

it is high time that we have got this done. 

This bill would protect the Second Amendment rights of our veterans who served in uniform. Right now if a veteran is assigned 

a fiduciary to administer their benefits, they can be automatically 

deemed adjudicated as mentally defective by a nameless and faceless bureaucrat and be denied their Second Amendment rights. 

There is nothing just about this. So this legislation would require 

that a judge or a magistrate make this determination. I think it 

is commonsense and Congress should move this bill forward. 

So, again, thank you all very much for bringing all of these 

things forward. We appreciate your hard work. 

Chairman MURRAY. Thank you very much. We do have a number 

of Senators who are here to testify about the legislation. We welcome all of them. I will call on them in order of their appearance 

beginning with Senator Heller. 

STATEMENT OF HON. DEAN HELLER, 

U.S. SENATOR FROM NEVADA 

Senator HELLER. Good morning. Thank you, Madam Chairwoman and Ranking Member Burr, for the opportunity for me to 

introduce this legislation, Senate bill 3308, the Homeless Women’s 

Veterans Act, before the Committee today; and I appreciate your 

hard work and effort on behalf of the Nation’s veterans. 

I know everybody here shares the same concerns about homeless 

veterans as I do. A couple of weeks ago I met with a constituent 

of mine, Dan Lyons, who walked from Reno, Nevada, to Washington, DC, to raise support for homeless veterans. A 6-month, 

2800-mile journey. 

He began walking on January 3, recording about 25 miles each 

day. This former Marine Corps veteran who served in Vietnam battled treacherous weather. He battled snakes and long, lonely miles 

just for the chance to sit down and ask that we do more to help 

struggling veterans. 

All too often we see clearly what is wrong with this society, and 

I think Dan reminds us of all that is right, and I am proud to tell 

his story as we discuss legislation helping homeless veterans. I 

8 

commend his steadfast determination in raising awareness for 

those who keep us safe, and I share his commitment in helping veterans in need. 

Too many of our Nation’s heroes are coming home from overseas 

to their homes underwater and high unemployment in their communities. This economy has left far too many veterans without 

work and in too many instances without a place to live; and while 

a number of veterans have fallen on tough times financially, some 

have also had difficulty adjusting to civilian life. 

Today there are over 100,000 veterans on America’s streets, 

roughly 16 percent of the homeless adult population. Congress has 

established numerous programs to provide services to homeless veterans facing economic hardship. 

One program, the Grant and Per Diem Program has provided 

construction costs, transportation costs, and counseling to thousands of veterans and has been successful in combating homelessness among veterans. 

While these programs provide significant assistance to our Nation’s veterans, there are still too many without a place to call 

home. Of particular concern is the growing number of homeless female veterans. 

In 1990, women made up 4 percent of all veterans. Today that 

number has doubled to 8 percent, amounting to almost 1.8 million 

women. As the demographics of our Armed Services have changed 

throughout the years so too have the needs of homeless veterans. 

Many homeless shelters today were never designed to serve the 

needs of female veterans or homeless veterans with children. The 

funding provided by Congress specifically dedicated to this growing 

population is simply not enough to ensure they have a safe and secure place to stay, nor do existing programs allow the VA to be reimbursed for services provided to children of homeless veterans. 

Shelters should not have to make the untenable decision to either lose money or deny services to children. For these reasons, I 

join with Ranking Member Burr to introduce the Women’s Homeless Veterans Act. I do appreciate the support of my friend, Senator 

Brown from Massachusetts, for his support on this legislation also. 

This commonsense legislation increases the percentage of funding allocated for homeless women veterans as well as providing the 

VA with the ability to reimburse shelters for services provided to 

children. 

Under this bill, at least 15 percent of funds allocated to the 

Grand Per Diem account must be directed to the special-needs program to greater meet the needs of homeless women veterans. The 

current program does not provide an amount that is reflective of 

this growing population. 

The increased resources could be used to construct wings at 

homeless shelters that are designed specifically for the security and 

safety needs of women and children or provide more counseling or 

other rehabilitative services for female veterans. 

The bill also clarifies that the VA can reimburse the cost of dependents of veterans, ensuring that shelters providing services will 

not have to turn children of veterans away. Ensuring that all of our 

veterans and their children have a safe and secure place to stay is 

the least that we can do. 

9 

I urge my colleagues to support this legislation to improve the 

lives of our Nation’s bravest. When they have sacrificed so much 

for our country to preserve and protect our freedoms, we should at 

least ensure that their needs are met when they fall on hard times. 

I am proud that both The American Legion and the National Coalition of Homeless Veterans have joined in support of this legislation 

and ask that their letters of support be entered to into the record. 

[The letters are included in the Appendix.] 

I thank Chairman Murray and Ranking Member Burr for holding this important hearing. I am deeply appreciative of the Committee’s time and look forward to continuing this important 

discussion. 

And as a finishing point, Dan Lyons, who walked for 6 months, 

did take the train home. [Laughter.] 

Thank you. 

Chairman MURRAY. Thank you very much, Senator Heller. 

Senator Ayotte. 

STATEMENT OF HON. KELLY AYOTTE, 

U.S. SENATOR FROM NEW HAMPSHIRE 

Senator AYOTTE. Thank you Madam Chair and Ranking Member 

Burr for convening this hearing today. 

I appreciate the opportunity to testify before this distinguished 

Committee regarding the Remembering America’s Forgotten Veterans Cemetery Act of 2012, which is S. 2320, which Senator 

Begich and I introduced earlier this year and which several Members of this Committee are cosponsoring. I would like to personally 

recognize and thank the Members of this Committee that are cosponsoring my bill who are Senators Akaka, Brown, Isakson and 

Wicker. 

From Normandy to Panama, America’s veterans’ cemeteries 

serve as a reminder of the extraordinary sacrifice thousands of 

brave American men and women have made on distant battlefields 

to protect our country. 

Maintaining America’s veterans’ cemeteries is a well-recognized 

responsibility of the Federal Government, and we have a moral obligation to make sure that these cemeteries are properly cared for. 

One of those cemeteries is the Clark Veterans Cemetery in the 

Philippines which contains the remains of more than 8,300 United 

States servicemembers and their dependents. 

In 1991, the United States abandoned Clark Air Force Base in 

the wake of a volcanic eruption; after 90 years of maintaining custodianship, the United States also unfortunately abandoned the 

graves of these brave Americans, leaving them unattended under 

a thick layer of ash. 

Over the next few years, the condition of the cemetery worsened, 

leaving the graves of our courageous veterans in an unacceptable 

state. Before you and also on the Committee Members’ iPads are 

pictures of what happened to the Clark Veterans Cemetery, and 

you can see from these pictures that no men or women or their dependents who have served our country admirably should they be 

left, their remains, in a cemetery that is in this condition and not 

cared for by our government. 

10 

Private volunteers became so concerned about the state of this 

cemetery that they volunteered and attempted to honor our servicemembers and their families buried there by maintaining the cemetery at their own expense, and I want to thank the Clark Veterans 

Cemetery Restoration Association and its president, Denis Wright, 

for volunteering their own time and resources to attempt to right 

this wrong and to give the servicemembers buried at Clark the dignity that they deserve. 

While these private citizens deserve our gratitude, the United 

States government has a moral responsibility to care for our veterans’ cemeteries that honor the remains of those who have bravely 

served our country. 

For almost a century, the United States government cared for 

those buried at the Clark Veterans Cemetery in the Philippines. 

Now, it is time for the United States to resume its responsibilities. 

Our legislation would accomplish this by requiring the American 

Battle Monuments Commission to restore, operate, and maintain 

Clark Veterans Cemetery to honor the courageous Americans that 

are buried there. 

In fact, Senate Resolution 481, which passed the Senate by voice 

vote on June 5, concluded that the United States government 

should designate an appropriate United States entity to be responsible for the ongoing maintenance of Clark Veterans Cemetery. 

Military cemeteries are managed by three Federal agencies, the 

American Battle Monuments Commission and the Department of 

Veterans Affairs National Cemetery Administration, and those in 

the United States and Puerto Rico that is the agency that maintains our cemeteries; and military departments also manage cemeteries that are located on military installations. 

Of these three Federal agencies, the American Battle Monuments 

Commission, which is responsible for designing, constructing, operating, and maintaining permanent American cemeteries in foreign 

countries, is the most appropriate agency to assume responsibility 

for the Clark Veterans Cemetery because the Cemetery is a permanent American cemetery in a foreign country. 

Although the American Battle Monuments Commission focuses 

much of its efforts on historical cemeteries and monuments in Europe, the Commission also maintains a Corozal American Cemetery 

in Panama, which is very, very similar to the Clark Veterans 

Cemetery. 

I am very pleased that the military coalition, which represents 

34 military veterans and uniformed services organizations totaling 

nearly 5.5 million members, and the National Military Veterans Alliance, which represents 3.5 million members in our country, as 

well as The American Legion, the Military Officers Association, and 

others have written endorsement letters or passed resolutions supporting this legislation. Millions of current and former servicemembers and dozens of service organizations have spoken. 

They all agree. We must do the right thing for Clark Veterans 

Cemetery. Madam Chair, I would ask that these letters be submitted for the record. 

Chairman MURRAY. The information will be included in the 

record. 

11 

Senator AYOTTE. The American veterans buried in Clark Veterans Cemetery deserve a dignified and well-maintained final resting place. There is no reason that the brave servicemembers buried 

at Clark should be deprived of the honor that they have earned and 

that veterans at other cemeteries are afforded. It is time for the 

United States government to fulfill its responsibility to care for this 

sacred ground. 

Again, I would like to thank you, Madam Chair, and Ranking 

Member Burr, for agreeing to hold this hearing. I am optimistic 

that we can move forward on this legislation and ensure that the 

United States government fulfills its responsibility to honor the 

final resting ground of those who have sacrificed and made the alternate sacrifice many of them for our country. 

Chairman MURRAY. Thank you very much for your statement. 

[The letters are included in the Appendix.] 

Chairman MURRAY. We will turn to Senator Franken. 

STATEMENT OF HON. AL FRANKEN, 

U.S. SENATOR FROM MINNESOTA 

Senator FRANKEN. Thank you, Madam Chairwoman. 

Chairwoman Murray and Ranking Member Burr, Members of the 

Committee, thank you for the opportunity to testify on behalf of the 

Rural Veterans’ Health Care Improvement Act. 

I apologize. I am going to have to leave immediately following my 

testimony today. 

I am very pleased to be working together with Senator Boozman 

on this legislation. His commitment to our Nation’s veterans, like 

his unflappable disposition, is well known and undisputed. I am 

honored that he is the lead sponsor of this legislation which was 

considerably improved through his work on it. 

The purpose of our legislation is very straightforward and very 

important: to improve access to quality health care for our Nation’s 

veterans living in rural areas. 

Like many States, Minnesota has a great many veterans who 

live in rural areas. Nationwide over 40 percent of all veterans enrolled in the VA system live in rural areas. That presents a challenge to accessing quality health care through the VA. 

To address this challenge, the VA created the Office of Rural Health or ORH in 2007. Congress has provided over $1 billion in 

support of ORH through fiscal year 2012. That is a significant 

investment. 

But the reality and the results are not yet where they need to 

be. The funds that Congress has provided have enabled the Office 

of Rural Health to undertake hundreds of initiatives throughout 

the country. 

Unfortunately, there has been no coherent strategic plan for 

those hundreds of initiatives, and I think this speaks to the Ranking Member’s opening statement about making sure that we are 

not wasting money and that we are not having duplicative plans 

but we are having well-thought-out, strategically-thought-out responses to these needs. 

As a result, improvements in veterans’ access to health care in 

rural areas has been piecemeal and uneven. Last year, a VA Inspector General found that ORH lacked reasonable assurance that 

12 

a majority of its funds, this is amounting to $273 million in fiscal 

years 2009 and 2010, actually no assurance that they actually improved access to and quality of care for rural veterans. That is a 

failure. It fails our veterans and it fails the public that funds VA’s 

programs. 

When we are talking about that much money and such an important mission, we are not going to let VA muddle through. We are 

going to demand that they get it right, and they get it right now. 

The ORH has an essential goal, to bring quality health care to 

veterans in rural areas. To achieve that, the VA needs to undertake careful, strategic planning, including the careful stewardship 

of taxpayer resources. That is the purpose of our legislation, which 

requires the VA to produce a strong and comprehensive strategic 

plan for ORH. 

Now, I appreciate that VA has taken some steps to address problems identified by the Inspector General’s report, but these steps 

are simply not enough. 

First, the strategic plan that the VA put out, which was already 

out when the IG made its findings does not move beyond the piecemeal approach ORH has been taking and does not develop a comprehensive strategy. 

The research of the ORH plan, as Senator Boozman said in his 

opening, the research of the ORH plan that VA issued late last 

year was an improvement over the initial plan, but not yet enough 

of an improvement. 

Second, while some of the features required by our legislation are 

included in the plan that VA put out others are not. If ORH is to 

be successful, it needs to address all of the important goals and objectives we have identified in the legislation. 

The Disabled American Veterans in their testimony note a couple 

of these areas. The full and effective use of mobile outpatient clinics and the provision and coordination of care for women veterans 

in rural areas. 

I will add another just by way of example. I believe you will not 

find the word emergency or emergencies in the VA’s current plan. 

Yet, the VA Inspector General has again and again reported the 

difficulties that many veterans in rural areas face trying to get 

care in an emergency. 

Understandably, many rural clinics are not equipped to handle 

many types of emergencies including heart attacks, strokes, and 

mental health emergencies. They simply go beyond the capacity of 

these relatively small clinics. But we know that emergencies will 

happen, and we need to be prepared. 

To address this, our legislation will require VA to ensure that all 

rural health care providers are actually identifying their clinical capacity and have a contingency plan for how they handle emergencies that exceed that capacity. 

That way, if a veteran shows up with a mental health emergency, for example, he or she will really get the best care possible 

in addressing that emergencies. We cannot have veterans committing suicide or suffering intense psychological anguish because they 

could not get care. 

I have also heard some Minnesota County veterans’ services officers about veterans who get taken to a hospital for a heart attack 

13 

because the VA clinic does not have an emergency room and then 

have real trouble getting reimbursed, getting it covered. They have 

to pay for it themselves. The coordination of care that our bill promotes will also make that situation far less likely. 

Finally, finally, our bill brings much-needed accountability to the 

VA’s Office of Rural Health. I appreciate that VA wants ORH to 

achieve its mission. This legislation will make that happen and 

happen faster. I would also note that the Appropriations Committee in its report accompanying the military construction/VA appropriations express its belief, quote, that ‘‘the VA must do more 

to plan for and provide quality health care to veterans living in 

rural and highly rural areas.’’ 

ORH is dedicated to the provision of health care to rural veterans, and the Congress has provided substantial funds for that 

very important purpose. But thus far the results have not been 

good enough and this speaks so clearly, I think, to what the Ranking Member said in his opening. 

Our legislation will ensure that the VA improves access to care 

for rural veterans so they can get the excellent health care that 

they deserve. We owe them nothing less. Thank you. 

Chairman MURRAY. Thank you, Senator Franken. 

With that, we will turn now to Senator Wyden. 

STATEMENT OF HON. RON WYDEN, 

U.S. SENATOR FROM OREGON 

Senator WYDEN. Thank you, Madam Chair. 

Madam Chair, I would ask first that my statement, my statement’s entirety could be put in the record and perhaps I could just 

summarize. I know you have additional colleagues who are waiting 

to testify. 

Chairman MURRAY. Absolutely. Every Senator’s statement will 

be printed in the record. 

Senator WYDEN. Thank you, Madam Chair, and first of all, 

Madam Chair, as your Pacific Northwest neighbor, let me just 

thank you for the extraordinary advocacy that you have brought to 

the cause of veterans. I get to see it, and most recently the work 

that you are doing now to up the ante in the fight against PTSD 

is extraordinarily important. I want you to know I appreciate it 

and want to help. 

And to Senator Burr, my friend, we have worked together for a 

lot of years on these kinds of issues, and you have just been tireless 

and a terrific partner, and I thank you for it. 

Madam Chair, what Senator Burr and I are sponsoring is 

S. 3270. This is a piece of legislation that comes about as a result 

of a lengthy undercover investigation done by the Government Accountability Office. It was done on behalf of Senator Burr, yourself, 

and several of us from the Senate Aging Committee. 

So, lots of times around here you cannot get one Committee to 

agree. We have now been able to get two committees to work together in a bipartisan way. 

The heart of the problem and what the GAO found, and I started 

looking at some of these senior abuses, you know, years ago when 

I was codirector of the Oregon Gray Panthers and the Senior Citizens Law Program, is they really uncovered some of the sleaziest 

14 

practices in terms of older veterans that I have seen in the years 

that I have spent working in this field. 

What it essentially involves is a program called Aid and Attendance. This program is essentially a lifeline for the poorest and most 

vulnerable who have served our country. It is for very sick veterans, folks who are no longer able to care for themselves and do 

not have the resources to pay for their care. 

What you have is essentially several hundred financial firms. 

They are called pension poachers, and we see them around the 

country basically trying to find ways to either talk these vulnerable 

veterans out all their resources or tie up their assets in a way that 

is good for the financial firm. 

These case, just to highlight, that we saw in our hearings was 

one from Montana. A veteran there was referred by the management of the retirement home to one of these pension poaching companies from Mississippi for assistance with the Aid and Attendance 

benefit. 

So, what the poachers did was charge the veteran a very substantial sum, $2,500, to fill out the application paperwork that they 

essentially can get for free, and it was eventually filed with the VA 

but it was denied because the paperwork was never actually signed 

by the veteran. 

What the poachers did, however, and this is a very common kind 

of practice, is to get the veteran’s signature on a power of attorney 

and that way they can tie up their assets in one of these corporations that are located out of State. 

That has been a special magnet for these pension poachers. They 

try to sell these inappropriate financial instruments, deferred annuity, certain types of trusts. That way they can, in effect, benefit 

while the veteran’s money, in effect, becomes unusable during the 

veteran’s lifetime. 

So, what the Government Accountability Office recommended, 

you know, Madam Chair, was the establishment of a look-back approach similar to what has been used for years with Medicaid or 

Social Security. 

This would take away the incentive for the pension poacher to 

target older veterans. Senator Burr and I have joined in sponsoring 

this bill. It is legislation that would, in effect, implement the recommendations from the Government Accountability Office that 

come from this undercover investigation. 

For colleagues who would like to see the tapes of this undercover 

inquiry, Senator Burr and I can make it available to you. But I will 

tell you that having worked in this field now for many years and 

going back to the days with Gray Panthers and always watching 

how unfortunately there are some people out there who try to rip 

off older people and here they are ripping off older veterans. 

This is some of the sleaziest stuff I have ever seen. We ought to 

take away the incentive to rip off the people who desperately need 

this benefit. 

My sense is in this kind of financial climate, and the Chair of 

the Committee did important work on the Super Committee, if people keep ripping off this program, people are going to say, well, 

maybe this is something we should not have any longer. 

15 

Senator Burr and I want to make sure that this program remains for the most needy and most vulnerable and that is why I 

very much appreciate the chance to come here. 

I know Senator Boxer and Senator Portman are waiting. If the 

rest of my remarks could be put into the record, I would very much 

appreciate it. 

Chairman MURRAY. We will do that. Thank you very much, Senator Wyden. 

Senator WYDEN. Thank you, Madam Chair, Senator Burr. 

[The prepared statement of Senator Wyden follows:] 

PREPARED STATEMENT OF HON. RON WYDEN, U.S. SENATOR FROM OREGON

Chairman Murray and Senator Burr, I want to thank you for allowing me the 

time to appear before the Committee on Veterans’ Affairs today. 

The legislation that I’m here today to discuss is the result of the great bipartisan 

efforts of the two of you and well as this Committee and the Senate Committee on 

Aging. I think this demonstrates the importance of this issue. 

Senator Burr, you especially have been a relentless driving force behind this bill, 

and I’m honored to have introduced it with you. 

As you’ll recall, a few weeks ago the Senate Special Committee on Aging held an 

investigative hearing on scams targeting elderly veterans using a specific VA pension as a lure. 

The Aging Committee found that some financial planners, lawyers and others are 

using the VA’s ‘‘enhanced pension with aid and attendance,’’ or simply, Aid and Attendance, to enrich themselves at our veterans’ and taxpayers’ expense. 

What makes this even worse is the fact that Aid and Attendance was specifically 

designed to help infirm and impoverished elderly veterans, so many of the victims 

of these pension poachers are the ones who can afford it least. 

At the hearing, the Government Accountability Office testified about the undercover investigation they conducted at the request of Senators Murray, Burr, Kohl 

and I. They found versions of this scam nationwide, with over two hundred pension 

poaching companies in operation. 

GAO’s recommendation to Congress was the establishment of a look-back period, 

similar to Medicaid or Social Security, to take away the incentive for the Pension 

Poachers to target elderly veterans, and preserve this benefit for the veterans it is 

intended to help. 

This recommendation has been echoed by veterans’ advocacy groups and the VA 

itself. 

Senator Burr and I authored S. 3270, which would provide this look-back. We 

worked closely with the VA and other experts to ensure our bill fixes the problem, 

but does not create collateral damage like an increased backlog of claims. 

We knew we had to drain the swamp and get rid of these pension poachers, but 

we also had to ensure the benefits our veterans need would be accessible quickly 

and without excessive red tape. 

We also didn’t want to inadvertently punish veterans who were misled by the 

false or inaccurate promises, so we’ve included specific waiver authority to address 

this. 

‘‘Aid and Attendance’’ is an invaluable lifeline for many veterans. This program 

is for the very sick—veterans who are no longer able to care for themselves and who 

do not have the resources to pay for care. It is a benefit intended to ensure that 

those who served their nation with honor can live out their final days in dignity. 

I believe the bill that Senator Burr and I have introduced, which already has 

strong bipartisan support, will preserve the Aid and Attendance benefit, while protecting our veterans from pension poachers who are driven only by greed. 

I’m pleased to announce we’ve received formal support from AMVETS, recognizing 

the importance of this legislation in protecting our veterans. 

We’ve also received a letter from the Assisted Living Federation of America, supporting this bill and pledging to help in the development of industry best practices 

to further ensure veterans are treated with the integrity they deserve. 

I hope that this Committee will support this legislation, and help put an end to 

the malicious practices of these pension poachers. 

Chairman Murray, Thank you again for the time to speak this morning. I truly 

appreciate your consideration of such an important matter. 

Chairman MURRAY. Senator Boxer. 

16 

STATEMENT OF HON. BARBARA BOXER, 

U.S. SENATOR FROM CALIFORNIA 

Senator BOXER. Madam Chairman, Ranking Member Burr, and 

Members of the Committee, my friends, you know, I am in the middle of some very interesting negotiations right now that are looking 

good; but even though that is the case, I want you to know how 

honored I am to be sitting here listening to my colleagues come forward with such good ideas, and to have this forum is such an 

honor. 

I just want to say, I am in awe of the Chairman for the work 

she is doing and the Ranking Member beside her, and to serve with 

the Ranking Member as the Chair of the Military Families Caucus 

is a great honor. 

So, I come here and I will stick within the time limit because I 

know how much work you have to do, and that you have to hear 

from a lot of people. I came here to talk to you about the epidemic 

of veteran homelessness and to offer an idea that does not cost any 

money that I think would be terrific involving the American people 

in fighting this epidemic. 

You know, I would say probably all of those in this room—I certainly hope all of us in this room—have safe, comfortable, permanent homes to live in, and we take it for granted. Yet every night 

67,500 of our Nation’s veterans are homeless. Again, 67,500 of our 

veterans are homeless. This is inexcusable because no veteran 

should ever have to spend the night on the streets, and I know we 

all agree with that. 

Ensuring that our veterans have safe, stable housing is also a 

smart thing to do because research has shown that a home is the 

very foundation on which a veteran can build and sustain a successful life. 

In my homestate of California I met a veteran, Holbert Lee. 

When Mr. Lee returned home from Vietnam, he ended up addicted 

to drugs and homeless on the streets of San Francisco. 

We have an organization there called Swords to Plowshares, and 

they helped him turn his life around, Madam Chairman. With the 

help of a housing voucher and VA support services, Mr. Lee now 

has a home to call his own; and today as a vocational specialist at 

the San Francisco VA. He is working to assist other veterans. 

Holbert Lee is a success story and proof of what can happen 

when we end a cycle of homelessness. But there are too many more 

men and women who we have not reached. 

Now, our government announced a goal to end veterans’ homelessness by 2015, and I would like to think when we announce a 

goal like that we mean it. This is not just something we throw out 

but yet Secretary Shinseki admitted, quote, while we are not where 

we need to be just yet, we have movement, but it is too early to 

begin high-fiving one another. 

It is clear from those words that we have a long way to go. So, 

I introduced S. 1806, the Check the Box for Homeless Veterans’ Act 

of 2011. Very straightforward. It creates a check-off box on the annual Federal tax return. Taxpayers can decide to make a voluntary 

contribution of one dollar or more to support programs that prevent 

and combat veterans’ homelessness. 

17 

The donations are deposited in a new homeless veterans’ assistance fund established at the Treasury that can only be used to supplement Congressionally appropriated funds for these various programs to help veterans. 

Now, let me be very clear. These funds in the check-off box will 

not be allowed by law to replace any budgeted dollars. There needs 

to be a maintenance of effort but they would be used to supplement 

those dollars. 

So, colleagues, I want to say, well, before I do my real close, I 

want to place in my record with your permission, Madam Chair, 

letters of support from the Veterans Foreign Wars, from the National Coalition for Homeless Veterans, from Team AMVETS, from 

the Center for American Homeless Veterans, Inc., and from the 

California Association of Veterans Services, and Swords to Plowshares. Might I put those in the record? 

Chairman MURRAY. We will do that. 

[The letters are included in the Appendix.] 

Senator BOXER. And I think if you read these letters, they 

strongly support this approach. 

So, in conclusion, I would say that our veterans have given so 

much. You are dealing with this every day and a lot of them suffer 

and they suffer mightily and having a home is the least we can do, 

and I think that all Americans want a chance to help. They feel 

sometimes helpless but with a dollar and a check off if every American paying, you know, their taxes did that we could do something 

special. 

I hope you will consider this. I will work with you to make it 

happen. I thank you for your dedication. 

Chairman MURRAY. Thank you very much. 

We will turn to Senator Portman. 

STATEMENT OF THE HON. ROB PORTMAN, 

U.S. SENATOR FROM OHIO 

Senator PORTMAN. Thank you, Madam Chair, I appreciate it. I 

got used to calling you Madam Chair in another little Committee 

we served on. 

Chairman MURRAY. I remember it. 

Senator PORTMAN. This one is more super than that one was. 

[Laughter.] 

Chairman MURRAY. And I agree. 

Senator PORTMAN. Thank you what you do every day for our veterans, and Ranking Member Burr, I was just with him in North 

Carolina recently, another champion for our veterans. Senator 

Isakson and Senator Boozman who testified on the floor last night 

about veterans. 

I am here to ask you to support this bill, S. 2244, the Veterans 

Missing America Act. It has been a privilege to work with my colleague, Senator Begich, on this, and it helps bring light to a critical 

issue that many of us are becoming aware of. 

At funeral homes and mortuaries all across this great country, 

thousands of veterans ashes and remains go abandoned, unclaimed; and in response to these unfortunate circumstances, a 

handful of veterans service volunteers began this project called 

Missing in America Project. It is a terrific group of volunteers who 

18 

have been very active in my homestate of Ohio, and I am sure in 

many of your States. 

Regrettably, when individuals pass away, and there is no next of 

kin identified, the remains sometimes stay at funeral homes or 

mortuaries, without anyone laying them to rest, indefinitely. 

Of the hundreds of thousands of unclaimed remains in this country, it is estimated that over 10,000 are remains of our veterans. 

The Missing America Project tries to identify anyone who is a veteran among those unclaimed remains and then provide a proper 

burial and funeral. 

Sometimes these dedicated volunteers have run into bureaucracy 

and complications because they tried to do that. It is a noble cause 

but, due to limitations on third-party involvement, it has become 

difficult for them. 

So, this legislation attempts to address these complications, recognizing their tireless work and dedication and in cooperation with 

numerous veterans service organizations have put together a legislative approach here that we think will help identify unclaimed remains and ensure that the Department of Veterans Affairs will 

work with these volunteers to see every veteran receives the respect that they deserve. 

As I mentioned, in Ohio we have taken a leadership role on this. 

Despite some of these roadblocks we are talking about we are trying to fix today, the Department of Veterans Affairs in Ohio, along 

with these volunteers from the Missing America Project, have had 

an initial burial of 10 veterans at the Dayton National Cemetery 

in May of this year. 

These were veterans of World War I, World War II, and Korea; 

and in this case, the remains had been at funeral homes for between 15 and 25 years. 

It was a very moving ceremony. There were a few hundred people who showed up to pay their respects, none of whom knew the 

veterans but they were there to pay their respects for their service 

to our country. 

Although we have had some successes like those, the work of 

these volunteers is encumbered by the Department of Veterans Affairs next-of-kin requirements. The bill, therefore, directs the Secretary of Veterans Affairs to work with veterans service organizations to assist entities in identifying veterans eligible for burial in 

a national cemetery. 

If the remains are of an eligible veteran, the Secretary of the Department of Veterans Affairs is then required to provide the burial 

benefits already authorized to that veteran. 

It is important to note to this Committee that since we introduced the legislation with Senator Begich in March and along with 

our counterparts in the House, there is companion legislation in 

the House, we have worked closely with the Department of Veterans’ Affairs to ensure the measure is appropriately worded to 

meet the sheer intent that we have; and through those discussions 

and their technical suggestions, we have amended the language including refining the burial eligibility criteria to ensure that benefits 

are provided to qualifying veterans. 

We stand ready to submit these technical amendments and refinements to the Committee during your markup of the bill. Our 

19 

intent is to add no new spending through this provision and we 

will work with the Committee very closely and, of course, with the 

Department to achieve that goal. 

I am proud to say that the National Association of State Directors of Veterans Affairs has expressed support for the Missing 

America Project and has urged our Nation’s leaders to take action. 

Additionally, this effort has the support of the National Funeral Directors Association and The American Legion. 

Those who gave their life in service to our country deserve an 

honorable burial, and this bill is a step toward ensuring that eligible veterans do receive that burial in a national cemetery given the 

respect that they rightly deserve. 

Thank you very much for the opportunity to testify on that this 

morning, and I look forward to working with the Committee on this 

going forward along with all of the other good work that you are 

doing. 

While I am here, Madam Chair, I would also like to thank you 

for having S. 3238 on the docket this morning. This measure would 

designate the Department of Veterans Affairs Community Based 

Outpatient Clinic in Mansfield, Ohio, in the name of Private First 

Class David F. Winder. I am pleased to cosponsor this measure 

along with Senator Sherrod Brown as we seek to honor this Metal 

of Honor recipient from Vietnam who provided medical aid to his 

soldiers in Vietnam and died in doing so. 

So again, thank you for your help on both of these important 

pieces of legislation, and I look forward to working with the Committee further. 

Chairman MURRAY. OK. Thank you very much. 

I will just let all the Senators know who have been testifying 

today that we are going to be working with them and their staff 

and the Administration on all of these bills. 

As Senator Burr mentioned, we do have to pay for all of the legislation that comes before this Committee. So, we have a lot of 

work to do, but we will be scheduling a markup on all of these 

pieces of legislation toward the middle of July, and I will be working with Senator Burr on that. So, thank you very much. 

At this time then, I would like to welcome and introduce our first 

panel. From the Department of Veterans Affairs, we have Dr. 

Madhulika Agarwal, the Deputy Under Secretary for Health Policy 

and Services at the Veterans Health Administration. 

Also joining us today from the VA is Thomas Murphy, Director 

of the Compensation Service at the Veterans Benefits Administration. Accompanying Dr. Agarwal and Mr. Murphy is Deputy Under 

Secretary for Health for Operations and Management at the Veterans Health Administration William Schoenhard, as well as Jane 

Claire Joyner and Richard Hipolit from the Office of General 

Counsel. 

We appreciate all of you being here today. 

The Department’s full statement will be entered into the record 

and, Dr. Agarwal, please begin. 

20 

STATEMENT OF MADHULIKA AGARWAL, DEPUTY UNDER SECRETARY FOR HEALTH POLICY AND SERVICES, VETERANS 

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS 

AFFAIRS 

Dr. AGARWAL. Chairman Murray, Ranking Member Burr, and 

other Members of the Committee, thank you for the opportunity to 

address the health care bills on today’s docket. 

My colleague, Mr. Murphy, will address the VBA bills under consideration. I will highlight some of the critical issues that are 

themes of many of the bills on the agenda and a detailed discussion 

of these bills can be found in my written statement. 

First, Chairman Murray, thank you for your continued efforts to 

emphasize the health care needs of women veterans. I am proud 

of VA’s efforts in improving women’s health, and I know we can 

make further enhancements working with the Committee. 

Your bill, S. 3313, the Women’s Veterans Health and Other Care 

Improvement Act, among other features includes reproductive 

health issues. The VA’s goal is to restore the capabilities of veterans with disabilities to the greatest extent possible. VA does not 

yet have a position on S. 3313 but we have had productive discussions with your staff which we look forward to continuing. 

Second, several bills address programs for rural veterans. VA is 

committed to improving access and quality of health care for this 

population. My written testimony outlines what VA is doing to 

meet this challenge, including greater use of telehealth technologies and collaboration with other Federal and State agencies 

and community providers to provide more points of care. 

This work is especially important to increase access to mental 

health services for veterans in rural areas. We note in our testimony that some features of the bills would overlap with our current efforts. We will be glad to discuss how we can best advance 

the goals of the legislation before us. 

Third, while we do not have views today on S. 3340 regarding 

the Mental Health ACCESS Act of 2012, we will follow-up with the 

Committee as soon as possible. 

We fully recognize there is no more critical need than effective 

and timely mental health care. We strive to improve all facets of 

mental health services. To increase our capacity to meet current 

and future demand, we have launched a new hiring initiative to increase staff, and we will continue our efforts to increase access to 

quality mental health care. 

Fourth, we regret we do not have a position this morning on 

S. 3049 which expands the definition of homelessness. We will provide information on that to the Committee as soon as possible. 

Let me assure the Committee that whatever the technical considerations may be on a statutory definition, VA never would and 

never will turn away a homeless veteran who finds themselves on 

the street because they are fleeing domestic violence. 

Finally, turning to Ranking Member Burr’s legislation on VISN 

reorganization, we have been working for the past year to review 

VISN operations. 

My written testimony describes these ongoing efforts, and we 

would like to brief the Committee in greater detail on these plans. 

We believe S. 3804 is too prescriptive in legislating particular 

21 

boundaries and structures and Mr. Schoenhard will be glad to discuss this issue. 

Madam Chairman, this concludes my statement. Mr. Murphy 

will now address the pending VBA legislation and we will then be 

ready to answer your questions. 

Chairman MURRAY. Mr. Murphy. 

STATEMENT OF THOMAS MURPHY, DIRECTOR, COMPENSATION SERVICE, VETERANS BENEFITS ADMINISTRATION, U.S. 

DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY 

WILLIAM SCHOENHARD, DEPUTY UNDER SECRETARY FOR 

HEALTH FOR OPERATIONS AND MANAGEMENT, VETERANS 

HEALTH ADMINISTRATION; JANE CLAIRE JOYNER, OFFICE 

OF GENERAL COUNSEL; AND RICHARD HIPOLIT, OFFICE OF 

GENERAL COUNSEL 

Mr. MURPHY. Chairman Murray, Ranking Member Burr, and 

other Members of the Committee, thank you for the additional time 

to comment on the extensive agenda before us today. As Dr. 

Agarwal did, I will only touch on a few highlights, as you have our 

detailed testimony for the record. 

VA wholeheartedly supports Senate Bill 2259, the Veterans Cost 

of Living Adjustment Act. It would express in a tangible way this 

Nation’s gratitude for the sacrifices made by our service-disabled 

veterans and their surviving spouses and children and would ensure that the value of their well-deserved benefits will keep pace 

with the increased cost of living. 

Two bills on the agenda concern the burial needs of the indigent 

veterans whose remains are unclaimed. Senate Bill 2244, the Veterans Missing in America Act and Senate Bill 3202, the Dignified 

Burial of Veterans Act. 

VA appreciates the Committee’s continued attention to ensure 

that these veterans, including, no doubt, homeless veterans, are 

honored and are not forgotten. We look forward to continuing to 

work with you to ensure that all veterans receive dignified and respectful burials, which they earned through our service to our 

Nation. 

We are supportive of these efforts and welcome discussions with 

the Committee on those few points in the testimony where he recommend improvements in the bill. 

For Senate Bill 1707, the Veterans Second Amendment Protection Act, we appreciate the objectives of this legislation to protect 

the firearms rights of veterans determined by VA to be unable to 

manage their own financial affairs. 

VA determinations of mental incompetency are based generally 

on whether a person lacks the mental capacity to manage his or 

her own financial affairs due to injury or disease. We believe that 

there are adequate protections in the law now such that a veteran 

with a determination of incompetency has two procedures available 

to make a showing to restore his or her ability to purchase a 

firearm. 

In the interest of time, I will then herein refer the Committee to 

my written statement. I would be happy to answer any questions 

you or the Members of the Committee may have. 

22 

[The prepared joint statement of Dr. Agarwal and Mr. Murphy 

follows:] 

PREPARED STATEMENT OF DR. MADHULIKA AGARWAL, DEPUTY UNDER SECRETARY

FOR HEALTH FOR POLICY AND SERVICES, VETERANS HEALTH ADMINISTRATION, U.S. 

DEPARTMENT OF VETERANS AFFAIRS

Chairman Murray, Ranking Member Burr, and other Members of the Committee, 

I am pleased to provide the views of the Department of Veterans Affairs (VA) on 

pending legislation. Joining me today are Tom Murphy, Director, Compensation 

Service, Veterans Benefits Administration; William Schoenhard, Deputy Under Secretary for Health for Operations and Management, Veterans Health Administration; 

Jane Clare Joyner, Deputy Assistant General Counsel; and Richard Hipolit, Assistant General Counsel. 

VA regrets not having sufficient time to formulate views for S. 1391; S. 3049; 

S. 3206; S. 3270; S. 3238; S. 3282; S. 3308; S. 3309; S. 3313; S. 3316; S. 3324; 

S. 3336; a draft bill to amend title 38, United States Code, to improve the multifamily transitional housing loan program of the Department of Veterans Affairs; 

and a draft bill entitled the ‘‘Mental Health Access to Continued Care and Enhancement of Support Services Act of 2012’’ or ‘‘Mental Health ACCESS Act of 2012.’’ VA 

will provide views for these bills at a later date. 

S. 1264—VETERAN VOTING SUPPORT ACT OF 2011

VA has a tradition of successfully supporting and facilitating Veteran voting, 

without disrupting the delivery of health care and services to Veterans. Facilities 

use posters and flyers to emphasize the issue of voting to patients and visitors, and 

VA volunteers assist Veterans in registering to vote. VA facilitates transportation 

to the polls for Veterans to vote, using VA resources and volunteers. VA tracks these 

voter registration and facilitation activities. 

The Department’s voter assistance policy (VHA Directive 2008–053) focuses on 

Veterans who are inpatients at VHA facilities. Under this directive, Veterans staying at VA facilities are currently provided the same type and level of assistance and 

support that would be required under the bill. During the 2008 election cycle more 

than 9,000 posters were placed at VA facilities, more than 225,000 flyers were provided to new inpatients through their welcome packets and comfort kits, and 1,100 

volunteers were recruited specifically to provide voter information and assistance to 

Veterans. VA also partnered with non-partisan groups to conduct more than 80 informational ‘‘voter drives.’’ As a result, close to more than 5,900 inpatients received 

assistance in registering to vote. While not a principal focus, voter assistance does 

reach Veterans using outpatient services as well. 

Section 3 of this bill would require VA to provide a ‘‘mail voter registration application’’ to each Veteran seeking enrollment in VA health care and to all enrolled 

Veterans any time there is a change in enrollment status or address. It would also 

require VA to provide assistance with voter registration to Veterans unless they 

refuse such assistance, and would require VA to accept completed voter registration 

forms and transmit them to the appropriate state election official within 10 days 

of receipt (unless they are received within 5 days of the registration deadline, in 

which case they must be sent within 5 days). Section 3 also would prohibit VA from 

influencing Veterans or displaying any political preference and would prohibit VA’s 

use of this information for any purpose other than voter registration. The bill would 

allow anyone aggrieved to provide notice of the violation to the facility director or 

the Secretary and would require the director or the Secretary to respond within 20 

days. If a violation is not corrected within 90 days, the aggrieved person may provide written notice to the Attorney General and Election Assistance Commission. 

Section 3 also authorizes the Attorney General to bring a civil action for violations. 

Section 4 would require VA, consistent with state and local laws, to assist Veterans residing in VA facilities with absentee balloting. Section 5 would require the 

Secretary to permit nonpartisan organizations to provide voter registration information and assistance at Department health care facilities, subject to reasonable limitations. 

Section 6 would similarly prevent VA from prohibiting any election-administration 

official from providing voter information to Veterans at any VA facility. Moreover, 

it would require VA to provide reasonable access to VA health care facilities to state 

and local election officials for providing nonpartisan voter registration services. Section 7 would require VA to submit an annual report to Congress on the agency’s 

compliance with this Act as well as the number of Veterans served by VA’s health 

care system, the number of Veterans who requested information or assistance with 

23 

voter registration, the number who received information or assistance, and information regarding notices of violations. 

As noted previously, VA is committed to helping Veterans exercise their right to 

vote, and, especially in recent years, has increased the non-partisan assistance provided to Veterans. While VA applauds the bill’s goals, it opposes S. 1264 as it is 

overly burdensome and, in some respects, duplicates the agency’s existing voter assistance efforts. 

As described above, Section 3 of the bill would require VA to provide a voter registration application form to each Veteran who seeks to enroll, and to enrolled Veterans any time there is a change in the enrollment status of that Veteran, or a 

change in the address of the Veteran. As VA facilities treat patients from multiple 

jurisdictions under a national system, implementing these requirements would be 

extraordinarily complicated. Under this national system, Veterans have the ability 

to use VA facilities not necessarily in their home jurisdiction. It would require VA 

to keep and apply authoritative information on elections, voter registration deadlines, and voter registration requirements in all 50 states. 

The multi-jurisdictional nature of VA also creates complications for providing the 

assistance with absentee ballots outlined in Section 4 of S. 1264; however, Section 

4 is limited to Veteran inpatients, those residing in Community Living Centers, and 

domiciliaries. 

This bill would also require the Secretary to permit nonpartisan organizations to 

provide voter assistance at facilities of the VA health care system. In addition, 

S. 1264 provides that the Secretary shall not prohibit any election official from providing voting information to Veterans at any facility of the Department of Veterans 

Affairs. Though the legislation allows VA to set reasonable time, place and manner 

restrictions on visits by election officials and nonpartisan groups, it is not clear that 

VA could entirely exclude election officials from certain facilities. There are some 

places within VA, such as National Cemeteries, psychiatric facilities, and Vet Centers, which are not appropriate locations for voter information and assistance activities from outside entities. Moreover, the definition of election official is overly broad 

as it could be interpreted to include volunteer ‘‘election judges’’ or ‘‘election monitors’’ who are assigned by campaigns or political parties to watch polling locations 

for irregularities on the day of an election. Directive 2008–053 currently provides 

nonpartisan organizations and election officials access to VA health care facilities 

for the purpose of providing voter information and assistance. 

The costs for the requirements of this bill are significant. They include an initial 

mail-out to approximately 8.2 million enrollees at a cost of $5.3 million and estimated recurring costs of $1.2 million annually. VHA would have to create a Voter 

Assistance Program in VA Central Office and in the field to support the proposed 

legislation. VA estimates the entire cost of implementing S. 1264 would be $26.0 

million in FY 2013, $6.1 million in FY 2014, $113.3 million over 5 years, and $242.4 

million over 10 years. 

S. 1631—A BILL TO AUTHORIZE THE ESTABLISHMENT OF A CENTER FOR TECHNICAL ASSISTANCE FOR NON-DEPARTMENT HEALTH CARE PROVIDERS FURNISHING CARE TO

VETERANS IN RURAL AREAS

Section 1(a) of S. 1631 would authorize the Secretary of Veterans Affairs to establish a center responsible for providing technical assistance to non-VA health providers who furnish care to Veterans in rural areas. Were the Secretary to exercise 

this authority, section 1(b) of the bill would permit VA to refer to the center as the 

‘‘Rural Veterans Health Care Technical Assistance Center’’ (the ‘‘Center’’). It would 

also require the Secretary to appoint a Director for the Center from candidates who 

are qualified to carry out the duties of the position and who possess significant 

knowledge and experience working for, or with, a non-VA health care provider that 

furnishes care to Veterans in rural areas. 

Section 1(c) of S. 1631 would require the Secretary of Veterans Affairs to select 

the location of the Center and, in doing so, to give preference to a location that 

meets a set of detailed criteria relating to available infrastructure and a high number of Veterans in rural and highly rural areas, among other factors. 

Section 1(d) of S. 1631 would require the Center to carry out the following tasks: 

• Develop and disseminate information, educational materials, training programs, 

technical assistance and materials, and other tools (1) to improve access to health 

care services for Veterans in rural areas and (2) to otherwise improve health care 

provided to Veterans by non-VA health care providers; 

• Improve collaboration on health care matters, including the exchange of health 

information, for Veterans receiving health care from both VA and non-VA providers 

serving rural populations; 

24 

• Establish and maintain Internet-based information on mechanisms to improve 

health care for Veterans in rural areas (including practical models, best practices, 

research results, and other appropriate information); • Work with existing Government offices and agencies, including those specified 

in the bill, on programs, activities, and other mechanisms to improve health care 

for rural Veterans; • Track and monitor fee expenditures incurred by VA in using non-VA health 

care providers to serve rural populations; and • Evaluate the Center through the use of an independent entity that is experienced and knowledgeable about rural health care matters, non-VA providers serving 

rural populations, and VA programs and services. 

Finally, section 1(e) of S. 1631 would authorize the Center, in discharging its functions, to enter into partnerships with: (1) persons and entities that have demonstrated expertise in the provision of education and technical assistance to Veterans in rural areas; (2) health care providers serving rural populations; and (3) persons and entities seeking to enter into contracts with the Federal Government in 

matters relating to functions of the Center (including the provision of education and 

technical assistance relating to telehealth, reimbursement for health care, improvement of quality of care, and contracting with the Federal Government). 

VA appreciates the aims of this legislation, but does not support S. 1631. VA’s Office of Rural Health (ORH) currently supports a number of programs and initiatives 

that are accomplishing many of the activities proposed for the Center for Technical 

Assistance. Specifically, ORH currently funds ‘‘The Health and Resource Initiative 

for Veterans Everywhere (THRIVE) On-Line,’’ a collaboration with Stanford University School of Medicine, eCampus Rural Health, and VA Palo Alto Health Care Systems. THRIVE also partners with multiple VA services and community agencies. 

Participating VA staff are from a number of complementary Department programs, 

such as mobile medical, homeless outreach, Operation Enduring Freedom/Operation 

Iraqi Freedom/Operation New Dawn (OEF/OIF/OND), women’s outreach, and incarcerated Veterans re-entry teams. Successful partnerships have been established 

with local homeless shelters, employment agencies, and county health clinics. 

THRIVE On-Line also provides technical assistance, materials, and other tools to 

VA and non-VA providers alike, to improve the health care of our Veterans in rural 

areas. In addition, ORH currently funds three Veterans Rural Health Resource Centers 

(VRHRCs). These centers function as field-based clinical laboratories for demonstration projects. A number of these projects are focused on developing models of care 

as well as innovative clinical practices and systems of care for rural Veterans. The 

VRHRC—Western Region is located in Salt Lake City, Utah. Much of the work of 

this center focuses on outreach, access issues, and the special needs of Native American Veterans and aging Veterans. One of its major efforts has been to establish an 

outreach program to build partnerships with community agencies and organizations 

that serve rural communities. Through these partnerships, rural Veterans receive 

information about, and assistance in identifying, VA benefits for which they may be 

eligible. The VRHRC—Central Region is located in Iowa City, Iowa. This center focuses on evaluating rural health programs and piloting new strategies to help Veterans overcome identified barriers to access to (quality) care. The VRHRC—Eastern 

Region has three locations: Gainesville, Florida; Togus, Maine; and White River 

Junction, Vermont. Their collective focus is on developing models to deliver specialty 

care and services to rural areas and on educating and training VA’s next generation 

of rural health care providers. VRHRC staff members also serve as rural health experts for VA providers Nation-wide, and they provide training and education services to both VA and non-VA providers caring for rural Veterans. 

ORH also funds and oversees Veterans Integrated Service Network (VISN) Rural 

Consultants (VRCs). There is a VRC in each VISN that serves as the primary interface for ORH, the VISN, and the community regarding rural activities. The VRCs 

work closely with internal and external stakeholders to introduce, implement, and 

evaluate ORH-funded projects. The VRCs are also instrumental in conducting outreach to develop strong partnerships with community members, state agencies, 

rural health providers, and special interest groups. Since being established, ORH 

has funded well over 500 projects across the VA health care system. These projects 

cover a myriad of areas, such as education, home-based primary care, long-term 

care, mental health, case management, telehealth, primary care, and specialty care. 

ORH also funds ‘‘Project Access Received Closer to Home (ARCH),’’ which is a 3- 

year pilot program to provide health care services to rural Veterans through contractual arrangements with non-VA care providers. 

VA has also recently drafted a memorandum of understanding (MOU) between 

the Department of Veterans Affairs (VA’s Office of Rural Health) and the DepartVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00028 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
25 

ment of Health and Human Services (Offices of the National Coordinator for Health 

IT and Rural Health Policy) to ensure interoperability between VA and rural health 

care providers to allow and promote the effective exchange of health information. 

Information on practical models, best practices, research results, and other appropriate information on mechanisms to improve health care for Veterans in rural 

areas, is already available on the ORH Web site at http://www.ruralhealth.va.gov/ 

, at THRIVE On-Line, http://ruralhealth.stanford.edu/, and on the VA Internet at 

http://www.va.gov/. 

As to the bill’s requirement to monitor and track fee expenditures in this area, 

the VHA Support Service Center (VSSC) already tracks all fee expenditures down 

to the Veterans’ Zip Code in the ‘‘Non-VA Care Cube.’’ 

In sum, S. 1631 is duplicative of VA’s on-going efforts to improve access to quality 

health care for Veterans residing in rural areas. VA has committed considerable resources not only to ORH and other affected VA program offices but also to our collaborative projects with other Government Departments and Agencies. To date, 

these and related efforts have proven, and continue to prove, successful in developing models of care, providing education to VA and non-VA providers through the 

Internet, establishing an MOU for health information exchange, and developing innovative clinical activities and systems of care. As we continue to monitor, expand, 

and improve our efforts in this area, we will be glad to keep the Committee advised 

of our activities and progress. 

VA estimates the costs associated with enactment of S. 1631 to be $2.1 million 

for FY 2013, $11.7 million over a 5-year period, and $25.8 million over a 10-year 

period. 

S. 1705—TO DESIGNATE THE DEPARTMENT OF VETERANS AFFAIRS

MEDICAL CENTER IN SPOKANE, WA

S. 1705 would designate the Veterans Affairs Medical Center in Spokane, Washington as the ‘‘Mann-Grandstaff Department of Veterans Affairs Medical Center.’’ 

VA defers to Congress in the naming of this facility. 

S. 1707—VETERANS SECOND AMENDMENT PROTECTION ACT

S. 1707, the ‘‘Veterans Second Amendment Protection Act,’’ would provide that a 

person who is mentally incapacitated, deemed mentally incompetent, or unconscious 

for an extended period will not be considered adjudicated as a ‘‘mental defective’’ 

for purposes of the Brady Handgun Violence Prevention Act in the absence of an 

order or finding by a judge, magistrate, or other judicial authority that such person 

is a danger to himself, herself, or others. The bill would have the effect of excluding 

VA determinations of incompetency from the coverage of the Brady Handgun Violence Prevention Act. 

We understand and appreciate the objective of this legislation to protect the firearms rights of veterans determined by VA to be unable manage their own financial 

affairs. VA determinations of mental incompetency are based generally on whether 

a person because of injury or disease lacks the mental capacity to manage his or 

her own financial affairs. We believe adequate protections can be provided to these 

veterans under current statutory authority. Under the NICS Improvement Amendments Act of 2007 (NIAA), there are two ways that individuals subject to an incompetency determination by VA can have their firearms rights restored: First, a person 

who has been adjudicated by VA as unable to manage his or her own affairs can 

reopen the issue based on new evidence and have the determination reversed. When 

this occurs, VA is obligated to notify the Department of Justice to remove the individual’s name from the roster of those barred from possessing and purchasing firearms. Second, even if a person remains adjudicated incompetent by VA for purposes 

of handling his or her own finances, he or she is entitled to petition VA to have 

firearms rights restored on the basis that the individual poses no threat to public 

safety. Although VA has admittedly been slow in implementing this relief program, 

we now have relief procedures in place, and we are fully committed going forward 

to implement this program in a timely and effective manner in order to fully protect 

the rights of our beneficiaries. 

We also note that the reliance on an administrative incompetency determination 

as a basis for prohibiting an individual from possessing or obtaining firearms under 

Federal law is not unique to VA or veterans. Under the applicable Federal regulations implementing the Brady Handgun Violence Prevention Act, any person determined by a lawful authority to lack the mental capacity to manage his or her own 

affairs is subject to the same prohibition. By exempting certain VA mental health 

determinations that would otherwise prohibit a person from possessing or obtaining 

firearms under Federal law, the legislation would create a different standard for 

26 

veterans and their survivors than that applicable to the rest of the population and 

could raise public safety issues. 

The enactment of S. 1707 would not impose any costs on VA. 

S. 1755—COVERAGE UNDER DEPARTMENT OF VETERANS AFFAIRS BENEFICIARY TRAVEL

PROGRAM OF CERTAIN DISABLED VETERANS FOR TRAVEL FOR CERTAIN SPECIAL DISABILITIES REHABILITATION. 

S. 1755 would amend VA’s beneficiary travel statute to ensure beneficiary travel 

eligibility for Veterans with vision impairment, Veterans with spinal cord injury or 

disorder, and Veterans with double or multiple amputations whose travel is in connection with inpatient care in a VA special disabilities rehabilitation program. 

This legislation could be construed to apply for travel of specified Veterans only 

in connection with their inpatient care in special rehabilitation program centers, 

and would apply only to Veterans with the specified medical conditions who are not 

otherwise eligible for beneficiary travel under 38 U.S.C. § 111. VA provides rehabilitation for many injuries and diseases at numerous specialized centers, including 

programs for Closed and Traumatic Brain Injury (CBI+TBI), Post Traumatic Stress 

Disorder (PTSD), other mental health issues, Parkinson’s Disease, Multiple Sclerosis, Epilepsy, War Related Injury (WRIIC), Pain Management, and various addictions. In addition, many of VA’s specialized treatment centers, including blind, SCI, 

and amputee centers, provide rehabilitation—both initial and ongoing—on an outpatient basis using on and off-station lodging. This legislation clearly would not 

apply to travel for those specified Veterans receiving care on an outpatient basis 

and thus would provide disparate travel eligibility to a limited group of Veterans. 

Therefore, VA does not support S. 1755 as written. 

VA does support expansion of travel benefits to a larger group of Veterans (including blind, SCI, and amputees) and those with other special needs who may not be 

otherwise eligible for VA travel benefits. VA welcomes the opportunity to work with 

the Committee to craft appropriate language as well as ensure that resources are 

available to support any travel eligibility increase that might impact upon provision 

of VA health care. 

VA estimates that the total cost for S. 1755 would be $3 million during FY 2013, 

$17.6 million over 5 years and $43.1 million over 10 years. This estimate is based 

on workload projections for inpatient services at specialized SCI, Blind, and Amputee centers. 

S. 1799—ACCESS TO APPROPRIATE IMMUNIZATIONS FOR VETERANS ACT OF 2011

S. 1799 would amend the definition of ‘‘preventive health services’’ in 38 U.S.C. 

1701 to include the term ‘‘recommended adult immunization schedule’’ and define 

it to mean the schedule established by the Advisory Committee on Immunization 

Practices (ACIP). S. 1799 would also amend section 1706 of title 38, to require the 

Secretary to develop quality measures and metrics to ensure that Veterans receive 

immunizations on schedule. These metrics would be required to include targets for 

compliance and, to the extent possible, should be consistent and implemented concurrently with the metrics for influenza and pneumococcal vaccinations. The bill 

would require that these quality standards be established via notice and comment 

rulemaking. S. 1799 would also require that details regarding immunization schedules and quality metrics be included in the annual preventative services report required by 38 U.S.C. 1704. VA notes that the effective dates under this proposal 

would be retroactive to July 1, 2011 for the publication of the proposed measures 

and metrics and January 1, 2012 for the implementation of the measures and 

metrics. 

VA does not support this legislation, as VA now provides prevention immunizations at no cost to the Veteran. In addition, VHA is represented as an ex-officio 

member of the ACIP and follows its recommendations. VHA is also an ex-officio 

member of the Department of Health and Human Services (HHS) National Vaccine 

Advisory Committee. 

VA develops clinical preventive services guidance statements on immunizations in 

accordance with ACIP recommendations (VHA Handbook 1120.05). All ACIP-recommended vaccines are available to Veterans at VA medical facilities. These vaccines currently include: hepatitis A, hepatitis B, human papillomavirus, influenza, 

measles/mumps/rubella, meningococcal, pneumococcal, tetanus/diphtheria/pertussis, 

tetanus/diphtheria, varicella, and zoster. As the recommendations change, VHA policy reflects those changes. The delivery of preventive care that includes vaccinations 

has been well established in the VHA Performance Measurement system for more 

than 10 years with targets that are appropriate for the type of preventive service 

27 

or vaccine. VA updates the performance measures to reflect changes in medical 

practice over time. 

Adding the statutory requirement for regulations to the development of targets 

would be burdensome and lengthy. Moreover, the process does not allow for nimble 

and quick changes as new research or medical findings surrounding a vaccine come 

to light. Because the clinical indications and population size for vaccines vary by 

vaccine, blanket monitoring performance of all vaccines can be cost prohibitive and 

may not have a substantial positive clinical impact at the population level. 

VA estimates the costs associated with enactment of S. 1799 to be as follows: 

$654,000 for FY 2013; $3.5 million over a 5-year period; and $7.7 million over a 10- 

year period. 

S. 1806—DESIGNATION OF CONTRIBUTIONS TO THE HOMELESS VETERANS

ASSISTANCE FUND

S. 1806 would amend the Internal Revenue Code of 1986 to establish in the 

Treasury a trust fund known as the ‘‘Homeless Veterans Assistance Fund,’’ and 

would allow taxpayers to designate a specified portion (not less than $1) of any overpayment of tax to be paid over to the Homeless Veterans Assistance Fund. Amounts 

in the Fund would ‘‘be available, as provided in appropriations Acts, to supplement 

funds appropriated to the Department of Veterans Affairs [(VA)], the Department 

of Labor [(Labor)] Veterans Employment and Training Service, and the Department 

of Housing and Urban Development [(HUD)] for the purpose of providing services 

to homeless veterans.’’ S. 1806 would require that in the President’s annual budget 

submission for fiscal year 2013 and each year thereafter, VA, Labor, and HUD include a description of the use of the funds from the Homeless Veterans Assistance 

Fund from the previous fiscal year and proposed use of such funds for the next fiscal 

year. 

While S. 1806 is well-intended, VA is opposed to its enactment. VA views its services to homeless Veterans as an obligation of the Nation, earned by those Veterans 

by their service. That is also reflected in Congress’ enactment of laws to allow VA 

to provide these services. The Secretary has made clear that this is in fact one of 

VA’s most important obligations. While we appreciate sincerely the motive of bringing this issue before the taxpayers, we believe the presence of a check-off could lead 

some to see these obligations as a discretionary charity. VA does involve charities 

and community organizations in its work, and they are vital. But VA prefers that 

all Federal funding come from affirmative appropriations taken by the Congress, 

rather than voluntary apportionments through the tax code. 

S. 1838—DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM

ON SERVICE DOG TRAINING

S. 1838 would require the Secretary, within 120 days of enactment, to commence 

a pilot program for a 3-year period to assess the feasibility and advisability of using 

service-dog training activities to positively affect Veterans with post-deployment 

mental health and Post Traumatic Stress Disorder (PTSD) symptoms and produce 

specially trained service dogs for Veterans. The bill would require the Secretary to 

conduct the pilot program at one Department of Veterans Affairs (VA) medical center other than in the Department of Veterans Affairs Palo Alto health care system. 

The bill requires that the VA medical center selected as the program site have 

an established mental health rehabilitation program that includes a clinical focus 

on rehabilitation treatment of post-deployment mental health disorders and PTSD 

and a demonstrated capability and capacity to incorporate service dog training activities into the rehabilitation program. In addition, the Secretary would be required 

to review and consider using recommendations published by experienced service dog 

trainers with regard to space, equipment and methodologies. In selecting the program site, the Secretary must give special consideration to Department of Veterans 

Affairs’ medical centers located in States that the Secretary considers rural or highly rural. The pilot program must be administered through VA’s Patient Care Services Office as a collaborative effort between the Rehabilitation Office and the Office 

of Mental Health Services. The national pilot program lead must be from Patient 

Care Services and have sufficient administrative experience to oversee the pilot program site. 

The bill also includes provisions concerning the service dogs themselves. The bill 

requires VA to ensure that each service dog in training is purpose-bred for this work 

with an adequate temperament, has a health clearance, and is age appropriate. 

Dogs in animal shelters or foster homes are not to be overlooked as candidates, but 

only if such dogs meet the service-dog candidate selection criteria under the bill. 

The Secretary must also ensure that each service dog in training is taught all basic 

28 

commands and behaviors required of service dogs, that the service dog undergo public access training and receives additional training specifically tailored to address 

the mental health conditions or disabilities of the Veteran with whom the dog will 

be paired. In other words, that VA independently and internally train or produce 

service dogs for Veterans with mental health conditions or disabilities. 

Other provisions of the bill concern participation in the pilot and the actual instruction of the service dogs. Veterans diagnosed with PTSD or other post-deployment mental health conditions would be eligible to volunteer to participate. The Secretary would be required to give a hiring preference for service-dog training instructor positions to Veterans who have PTSD or some other mental health condition. 

The bill would also require the Secretary to provide or refer participants to business 

courses for managing a service-dog training business. In addition, the bill contemplates the Secretary providing ‘‘professional support for all training under the 

pilot program.’’ 

VA would be required to collect data on the pilot program and determine the effectiveness of the program in positively affecting Veterans with PTSD or other postdeployment mental health condition symptoms. The data must also indicate the feasibility and advisability of expanding the pilot program to additional VA medical 

centers. VA would be required to submit an annual report to Congress following the 

end of the first year of the pilot program and each year thereafter to inform Congress about the details of the program and its effectiveness in specific areas. At the 

conclusion of the pilot program, the Secretary must submit to Congress a final report that includes recommendations with respect to the extension or expansion of 

the program. 

VA is not opposed to Veterans diagnosed with PTSD, or other post-deployment 

mental health conditions, training service-dog candidates for persons with disabilities as a component of a treatment plan, so long as the determination of placement 

with a particular Veteran is made by the service-dog training program that acquires 

the VA service-dog-in-training candidate and completes the final service-dog 

training. 

However, VA cannot support S. 1838 because as written the bill focuses on training of the dog as opposed to the therapeutic activities that such Animal Assisted 

Therapy or Animal Facilitated Therapy may provide the Veteran if appropriately 

administered as a component of a comprehensive mental health treatment program. 

It is also VA’s opinion that a pilot is unnecessary as current efforts at the Palo Alto 

program focus on the training activity as part of the comprehensive treatment program which incorporates the training of dogs in basic obedience and preparing the 

dogs to complete the Canine Good Citizen (CGC) test. Establishing another pilot in 

addition to the existing Palo Alto program would be duplicative, unnecessary and 

fiscally inefficient. 

While excepted from consideration as the pilot program site in S. 1838, the Service Dog Training Program initiated in July 2008 at the Palo Alto Veterans 

Healthcare System (Menlo Park Division), in collaboration with Bergin University, 

is an example of a program where Veterans diagnosed with PTSD participate in the 

training of dogs as one activity in their comprehensive recovery program. The training of these dogs by Veterans participating in the PTSD Treatment Program includes basic obedience training, and the participation is designed to provide the Veterans with opportunities in skills development and community reintegration. The 

program provides a bridge to community involvement as a component of the dogtraining activities. After completion of the basic obedience training program, the 

dogs that complete training are transitioned to an external Assistance Dogs International (ADI)-accredited organization where they complete a rigorous training regimen to become service dogs and are paired with disabled Veterans. 

The Palo Alto program is not an example of VA independently training or producing service dogs for Veterans through all phases of training. The dogs involved 

in the Palo Alto program were actually trained to become service dogs by an external ADI-accredited organization, over an extended period of time and subject to ADI 

standards as adopted and applied by that organization. The Palo Alto program 

training focuses on basic obedience (e.g., commands such as ‘‘sit,’’ ‘‘stay,’’ and ‘‘heel’’) 

and public access skills (sensitizing dogs to different environments) to prepare the 

dogs to become service dogs for disabled persons. That is because VA does not have 

the expertise, experience, or resources to develop independent training criteria or 

otherwise train or produce safe, high quality service dogs for Veterans. Such training is highly specialized and includes the training of the Veteran who is to receive 

the service dog. VA requires that a service dog candidate that is found to have the 

requisite ability to behave and learn skills at the service dog level, be ‘‘given’’ to a 

service dog training organization that has the personnel, skills, and specialized 

abilities to pair the dog with a disabled person (in this case a disabled Veteran) and 

29 

train the dog and Veteran on the specific tasks that the dog will perform for that 

individual Veteran. VA believes its reliance on the recognized expertise of a public 

or private organization is well-reasoned. 

It is unclear in S. 1838 whether subsection 1(d)(5)(C) is concerned with the volunteer Veteran participants who are training the dogs or the Veteran recipients of the 

dogs. Either interpretation is problematic. If subsection 1(d)(5)(C) is interpreted to 

refer to the Veterans with whom the dogs are paired to provide actual service dog 

services, rather than targeting the act of training as therapy and a component of 

a treatment plan for a particular Veteran, it would require VA to focus on determining what the dog’s specialty will be or which category of disabled Veteran it will 

serve. In other words, the specialized training requirement shifts the goal to the 

successful training of the service dogs instead of the therapeutic benefit to the Veteran derived from the act of training the dog. Veterans would only be qualified to 

provide basic training. The advanced stages of specialized training must be turned 

over to accredited service dog training experts. The dogs’ eventual roles or skills will 

depend on the outcome of this specialized training. If subsection 1(d)(5)(C) is intended to refer to the volunteer Veteran participants with whom the dogs are 

paired, it is equally inappropriate, as the dogs are not paired with a specific Veteran 

in the training process, but will almost certainly be trained by several Veterans who 

are participating in the residential program and who will work with the dogs as a 

team. Patients come and go based upon their individual clinical indications, and it 

is unlikely that all volunteer Veteran participants in the treatment/rehabilitation 

program will be there for the length of time it takes to train a dog to enter a service-dog training program. 

Subsection 1(d)(6) states that in designing the program, the Secretary must provide professional support for all training under the pilot program. It is not clear 

whether this is a mandate that third party organizations actually conduct the training and that Veterans assist or that the bill allows for Veterans to in fact act as 

‘‘owner-trainers’’ with assistance of third parties. 

The requirement to give a hiring preference to Veterans who have PTSD or other 

mental health conditions may be counterproductive to the goals and objectives of the 

pilot program. VA understands the pilot is aimed at creating a therapeutic treatment modality that will help patients currently suffering from and in treatment for 

PTSD and post-deployment mental health conditions. VA interprets the primary 

goal of the pilot to be finding better ways to improve the health of this Veteran population by exploring treatments, specifically Animal Assisted Therapy or Animal Facilitated Therapy that will prepare dogs to become service dogs for Veterans. For 

these reasons, it is critically important that the trainers selected be experts at their 

job, which is to train Veterans to train dogs as a component of treatment and as 

a member of the treatment team. It would be beneficial if they also appreciated the 

importance of serving Veterans and possessed a working knowledge of the needs of 

this Veteran population, but it is necessary not to confuse the role of the clinical 

staff with the role of the trainer which is that of training the Veteran to train the 

dog. The bill also envisions VA hiring trainers as employees. Allowing VA to contract for these services would afford VA more flexibility and access to already available training experts, particularly as there is no Government Service (GS) occupation training service dogs for disabled individuals. Although on the surface this 

sounds reasonable, should the program prove to be inappropriate for expansion/ 

spread there would be no position available for a dog trainer in the system. 

VA is highly doubtful that the requirements of the bill can be accomplished within 

120 days of the enactment. VA would have to establish selection criteria, advertise 

for sites (through a Request for Proposal), evaluate candidates and make selections. 

We are available to work with the Committee to provide advice on the components 

of what could be a workable program, and an appropriate mechanism to evaluate 

the current programs as to whether training service dogs is a clinically appropriate 

form of treatment based on information gleaned from the Palo Alto program and 

other related animal therapy programs currently in place within the VA. 

VA estimates the cost for the 3-year period of the pilot as follows: $635,281 in 

FY 2013; $658,151 in FY 2014; and $682,502 in FY 2015 for a total of $1,975,934. 

S. 1849—RURAL VETERANS HEALTH CARE IMPROVEMENT ACT

Section 2(a) of S. 1849 would require VA’s Director of the Office of Rural Health 

(ORH) to develop a 5-year strategic plan for improving access to, and the quality 

of, health care services for Veterans in rural areas. In developing this plan, the Director would be required to consult with the Director of VA’s Health Care Retention 

and Recruitment Office, VA’s Office of Quality and Performance, and VA’s Office of 

Care Coordination Services. It would also require the Director to develop this plan 

30 

not later than 180 days after the date of enactment, with the 5-year period beginning on the date of the plan’s issuance. 

Section 2(b) of the bill would require the strategic plan to include the following 

elements: 

• Goals and objectives for the recruitment and retention of VA health care personnel in rural areas; 

• Goals and objectives for ensuring timeliness and improving quality in the delivery of VA health care services furnished to Veterans in rural areas through the use 

of contract providers and fee-basis providers; 

• Goals and objectives for the implementation, expansion, and enhanced use of 

VA telemedicine in rural areas (through coordination with other appropriate VA offices); 

• Goals and objectives for ensuring the full and effective use of mobile outpatient 

clinics to provide health care services in rural areas; 

• Procedures for soliciting from each VA facility that serves a rural area a statement of the facility’s clinical capacity; its procedures in the event of a medical, surgical, or mental health emergency outside the scope of the facility’s clinical capacity; 

and its procedures and mechanisms to provide (and coordinate) health care for 

women Veterans (including procedures and mechanisms for coordination with local 

hospitals and facilities, oversight of primary care and fee-basis care, and management of specialty care); 

• Goals and objectives for modifying funding allocation mechanisms of the ORH 

to ensure that it distributes funds to Departmental components, to best achieve its 

goals and objectives in a timely manner; 

• Goals and objectives for the coordination and sharing of resources between VA 

and the Department of Defense, Department of Health and Human Services, Indian 

Health Service, and other Federal agencies, as appropriate and prudent, to provide 

health care services to Veterans in rural areas; 

• Specific milestones for the achievement of the goals and objectives developed for 

the plan; and 

• Procedures for ensuring the effective implementation of the plan. 

Section 2(c) of the bill would require, not later than 90 days after the date of the 

plan’s issuance, that the Secretary transmit the strategic plan to Congress (along 

with any comments or recommendations that the Secretary considers appropriate). 

VA does not believe that S. 1849 is necessary. VA’s past and continuing efforts 

already provide a comprehensive approach to ensuring access to quality health care 

for Veterans in rural areas. Specifically, in 2010, VHA’s ORH produced a 5-year 

strategic plan for fiscal years (FY) 2010–2014 to ensure that ORH programs and initiatives meet the health care needs of rural Veterans. That plan was refreshed in 

FY 2011, for FY 2012–2014, to better align ORH’s resources with identified health 

care needs, especially in light of new technologies and delivery systems for rural 

Veterans. 

The plan was updated by a committee of stakeholders comprised of the following 

members: Veterans Rural Health Advisory Committee; Veterans Integrated Service 

Network (VISN) rural consultants; Veterans Rural Health Resource Centers; ORH; 

VA Medical Center Directors; VA’s Office of Telehealth Services; VA’s Office of Mental Health Services; VA’s Office of Geriatrics and Extended Care, State VA Offices; 

VA’s Office of Health Informatics; VA’s Office of Academic Affiliations; VA Employee 

Education System; and VA’s Healthcare Retention and Recruitment Office. 

The Committee updated each of the six ORH strategic goals in line with broadly 

agreed-upon initiatives (and associated action items) that respond to the specific 

findings of ORH’s Nation-wide assessment to identify gaps in care at rural VA facilities and unmet clinical needs of rural Veterans. Input obtained at numerous town 

hall meetings and listening sessions also helped the Committee to better understand 

the perspective of rural Veterans and in particular the barriers that prevent them 

from accessing VA health care. 

The new initiatives included in the revised strategic plan include: an action plan 

to improve communications and outreach to rural areas; continued support of community-based outpatient clinics and outreach clinics; developing, implementing, and 

evaluating new models of specialty care; implementing and evaluating rural women’s health care initiatives, increased collaboration and partnership with non VA 

community networks and providers, increasing student training opportunities in 

rural health; enhancing telehealth capabilities in rural areas; and increasing training for rural providers. We will continue to monitor implementation of these initiatives under the plan and revise them as necessary. ORH will also continue to evaluate its on-going programs, especially the host of pilot and demonstration projects 

that ORH currently funds across the VA health care system, to assess their effecVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00034 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
31 

tiveness in delivering quality care to rural Veterans and improving those individuals’ access to care. 

One ORH initiative is the ‘‘Rural Health and Education Training Initiative.’’ It 

will provide infrastructure support for up to five VA sites of care to establish rural 

health training and education programs for medical residents, dental, nursing, and 

allied health professions students from affiliated institutions. Under the program, 

these trainees will receive particular instruction on providing care to Veterans residing in rural areas. This will include instruction on the special challenges associated 

with providing health care in rural areas and how VA is working to overcome these 

challenges. Once they complete their training, VA hopes to recruit and retain them 

in rural VA health care positions throughout the country. 

ORH is also supporting an initiative to provide rural clergy with both information 

on VA benefits and services and local VA contact information. This initiative will 

also educate clergy-participants about post-deployment readjustment challenges, the 

spiritual and psychological effects of war-trauma on survivors, and the important 

role that religious institutions can play in helping to reduce the societal stigma associated with mental illness and to assist Veterans in their parishes and communities 

to obtain care and services for their mental health issues. It will also address other 

ways in which they, as vital community partners, can help support Veterans and 

their families. 

Finally, as discussed in connection with S. 1631, VA and the Department of 

Health and Human Services (HHS) are working on a memorandum of understanding (MOU) to address shortages in the rural Health IT workforce and the need 

for the effective exchange of health care information between VA providers and 

rural providers furnishing care to Veterans. The MOU will serve to: 

• Increase the number of trained health IT and health information management 

professionals; • Diversify training programs to meet a wider range of training needs; • Reach out to potential workers and employers to inform them about career 

pathways in health information management and technology; • Support employers in staffing health IT positions; and • Examine ways to leverage existing resources to develop potential pilot sites for 

Health Information Exchange between rural providers and VHA. 

As indicated above, the 2010–2014 ORH strategic plan refresh will be re-evaluated periodically but at least on an annual basis to determine if additional initiatives or actions are needed. At the end of FY 2014, ORH will draft a new strategic 

plan based on its evaluations of the success of projects undertaken to date and updated assessments of the health care needs of Veterans residing in rural areas. 

VA estimates the costs associated with enactment of S. 1849 to be as follows: 

$215,000 for FY 2013; $368,000 over a 5-year period; and $768,000 over a 10-year 

period. 

S. 2045—TO REQUIRE JUDGES ON THE UNITED STATES COURT OF APPEALS FOR

VETERANS CLAIMS TO RESIDE WITHIN 50 MILES OF THE DISTRICT OF COLUMBIA

S. 2045 would amend 38 U.S.C. 7255, to require that active judges of the U.S. 

Court of Appeals for Veterans Claims reside within 50 miles of the District of Columbia. This bill also would amend section 7253(f)(1) to provide that violation of this 

residency requirement may be grounds for removal of a judge from the court. The 

absence of such a residency requirement in current law has not created difficulties 

for VA. Thus, VA perceives no need for this legislation. 

If enacted, S. 2045 would result in no costs or savings for VA. 

S. 2244—VETERANS MISSING IN AMERICA ACT OF 2012

S. 2244, the ‘‘Veterans Missing in America Act of 2012,’’ would direct the Secretary to cooperate with Veterans Service Organizations to assist entities in possession of unclaimed or abandoned human remains in determining whether such remains are those of Veterans or other persons eligible for burial in a national cemetery. If unclaimed remains are identified as those of Veterans or other eligible persons, VA would provide for burial of the remains in a national cemetery and would 

cover the cost of preparation, transportation, and burial of the remains. The bill 

would further direct VA to establish a publicly accessible national database of such 

identified individuals. 

VA strongly supports the goal of ensuring that those who have earned the right 

to burial in a national cemetery are accorded that honor. VA commends organizations and volunteers who work to ensure that unclaimed and abandoned remains 

of our Nation’s Veterans are identified and if eligible, receive a proper burial in a 

national cemetery. To ensure eligible Veterans receive burial in a national cemetery, 

32 

VA currently works with States, counties, municipalities and private organizations 

to determine the eligibility of unclaimed and abandoned remains that are held at 

funeral homes or coroner’s offices. In this regard, VA’s National Cemetery Scheduling Office (NCSO) located in St. Louis, Missouri coordinates with Federal, State 

and local agencies to verify a deceased individual’s military service and identity. 

NCSO also provides eligibility review assistance to entities such as the Missing In 

America Project (MIAP), to identify unclaimed remains and inter all eligible individuals. In FY 2011, NCSO processed 663 requests for burial eligibility determinations 

that were submitted by the MIAP, which works on behalf of entities, such as city 

and county coroners’ offices, to ensure eligible Veterans receive proper burial. Currently, NCSO is working with the State of Oregon to identify unclaimed remains 

recently found in that state and determine eligibility for burial in a national 

cemetery. 

VA does not, however, support this bill in extending existing funeral and transportation benefits to certain non-Veterans and placing no cap on the amount of such 

payments. Section 3(b) would require VA to pay the cost of the burial, preparation, 

and transportation of the unclaimed or abandoned remains of any individual who 

is eligible for national cemetery burial when there are insufficient alternative resources to cover such expenses. Under current law, VA provides reimbursement benefits, up to maximum amounts specified by statute, for funeral and transportation 

costs associated with the burial of certain Veterans. However, not all Veterans who 

are eligible for burial in a national cemetery qualify for these benefits; for example, 

Veterans who were not in receipt of disability compensation at the time of death 

generally do not qualify for reimbursement of funeral or transportation costs. VA 

would support extending current funeral and transportation benefits under sections 

2302(a)(2) and 2308 of title 38, United States Code, to all unclaimed remains of Veterans, subject to the same monetary caps generally applicable to such payments. 

However, VA does not support the current bill insofar as it would provide benefits 

for non-Veterans that are unavailable for many Veterans eligible for burial in a national cemetery and would lift the generally applicable monetary caps for this 

benefit. 

Section 3(c) of S. 2244 would direct VA to establish a database of the names of 

any Veterans or other individuals who are determined, under the identification process described in this bill, to be eligible for burial in a national cemetery. We believe 

this provision is unnecessary. Currently, VA maintains a publicly-accessible database, commonly known as the National Gravesite Locator (NGL), which already performs the functions proposed in the bill. The public can use the NGL to search for 

burial locations of Veterans and other individuals interred in VA National Cemeteries, State Veterans cemeteries, and various other military and Department of the 

Interior cemeteries. The NGL also provides information about Veterans buried in 

private cemeteries when the grave is marked with a Government-furnished headstone or marker. Names of Veterans or other individuals who are eligible for burial 

and whose remains are unclaimed or abandoned would be made available to the 

public through the NGL once they are interred. NCA continues to work to make this 

database even more accessible by implementation of a mobile application. 

S. 2244 would impose recurring costs on VA by extending entitlement to burial 

and transportation reimbursement benefits for a new category of individuals, without a monetary limit on the amount of such reimbursement. At this time, VA is unable to estimate the likely extent of those costs. 

S. 2259—VETERANS’ COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 2012

S. 2259, the ‘‘Veterans’ Compensation Cost-of-Living Adjustment Act of 2012,’’ 

would require VA to increase, effective December 1, 2012, the rates of disability 

compensation for service-disabled Veterans and the rates of dependency and indemnity compensation for survivors of Veterans. Current estimates suggest that the consumer price index will increase by 1.9 percent. This bill would increase these rates 

by the same percentage as the percentage by which Social Security benefits are increased effective December 1, 2012. 

VA wholeheartedly supports this bill, which is consistent with the President’s FY 

2013 budget request. It would express, in a tangible way, this Nation’s gratitude for 

the sacrifices made by our service-disabled Veterans and their surviving spouses 

and children and would ensure that the value of their well-deserved benefits will 

keep pace with the increased cost of living. 

VA estimates that this bill would result in first-year benefit costs of $772 million 

in FY 2013, 5-year benefit costs of $4.9 billion, and 10-year benefit costs of $10.9 

billion. However, as annual cost-of-living adjustments are assumed in the baseline 

33 

for the Disability Compensation program, no PAYGO costs are associated with this 

proposal. 

S. 2320—REMEMBERING AMERICA’S FORGOTTEN VETERANS CEMETERY ACT OF 2012

S. 2320, the ‘‘Remembering America’s Forgotten Veterans Cemetery Act of 2012,’’ 

would direct the American Battle Monuments Commission to restore, operate, and 

maintain Clark Veterans Cemetery in the Republic of the Philippines, subject to the 

availability of appropriations. This bill would make Clark Veterans Cemetery a permanent cemetery under the auspices of the American Battle Monuments Commission, pursuant to section 2104 of title 36, United States Code. 

Because S. 2320 pertains to the American Battle Monuments Commission’s authority under current chapter 21 of title 36 to allocate resources for the care and 

maintenance of military cemeteries and monuments in foreign countries, VA defers 

to the views of that Commission on this bill. 

S. 3052—NOTICE TO VETERANS OF AVAILABILITY OF SERVICES FROM VSOS

S. 3052 would amend title 38 to require the Secretary of Veterans Affairs to provide Veterans who electronically file claims for VA benefits with notice that relevant 

services are available from Veterans’ Service Organizations (VSOs). The bill would 

require the Veterans Benefits Administration (VBA) to notify each claimant who 

files a claim for benefits electronically that VSOs are available to provide services, 

and to provide a list of VSOs, and their Web site and contact information. 

S. 3052 is unnecessary, as VBA already provides notice to Veterans who file 

claims electronically that VSO representation is available. In addition, links to 

VSOs and private attorneys who offer representation on claims for VA benefits are 

currently available on VA’s eBenefits Web site, which also contains a directory of 

all recognized VSOs with their contact information. 

S. 3052 would not impose any costs on VA. 

S. 3084—VISN REORGANIZATION ACT OF 2012

Section 2 of S. 3084 would require VHA to consolidate its 21 Veterans Integrated 

Service Networks (VISN) into 12 geographically defined VISNs, would require that 

each of the 12 VISN headquarters be co-located with a VA medical center, and 

would limit the number of employees at each VISN headquarters to 65 FTE. VA 

does not support section 2 for a number of reasons. By increasing the scope of responsibility and span of control of each VISN headquarters while reducing the number of employees at each, the legislation would impede VA’s ability to implement 

the national goals of the Department. Currently, VISN headquarters are capable of 

providing assistance to supplement resource needs at facilities and are able to support transitions in staff within local facilities when there are personnel changes; 

with a responsibility for oversight of more facilities and fewer staff, the VISN headquarters would lose the opportunity to provide this sometimes essential service. 

VHA has already reviewed each VISN headquarters and is in the process of working with each to streamline operations, create efficiencies internal to each VISN, 

and to realign resources to facilities. This will achieve savings while not creating 

the negative outcomes of the restructuring and new organizations proposed in 

S. 3084. Current VHA plans are to reduce VISN staffing levels. 

VA currently maintains close relationships with other health care organizations, 

including those from other governmental, public, and private health care entities, 

when appropriate. The language appears to require VA to create new alliances with 

entities which may not be available or appropriate. VA’s health care system has 

benefited from developing an expertise in the clinical and cultural needs and demands of Veterans. Requirements to further partner with other organizations could 

lead to distractions and unintended outcomes. 

This section’s requirement that VISN budgets be balanced at the end of each fiscal year may have other unintended consequences. Currently, at the end of each fiscal year, each VISN’s accounts must be balanced, and this is sometimes achieved 

by providing additional resources from VHA Central Office. Additional resources 

may be needed for a number of reasons, including greater than anticipated demand, 

a national disaster or emergency, new legal requirements enacted during the year, 

and other factors. By codifying a requirement that the VISN budget be balanced at 

the end of each fiscal year, VA may lose this flexibility to supplement VISNs with 

additional resources, and Veteran patient care would suffer as a result. 

Section 2 also requires the Department to identify and reduce duplication of functions in clinical, administrative, and operational processes and practices in VHA. We 

are already doing this by identifying best practices and consolidating functions 

where appropriate. Furthermore, while section 2 describes how the VISNs should 

34 

be consolidated, it fails to clearly articulate the flow of leadership authority. In fact, 

by moving certain oversight responsibilities to regional centers, S. 3084 would create 

no clear lines of authority from VHA Central Office, regions, VISNs, to medical centers, actually producing less oversight and more confusion. 

Additionally, the proposed combination of VISNs simply combines VISNs to arrive 

at a reduction in the total number of Networks and employees without considering 

the underlying referral patterns within each VISN. The original VISN boundaries 

were drawn based upon local population health needs. Each VISN is charged with 

managing quality and access of health care while increasing the efficient delivery 

of population health. S. 3084 fails to take this into account in aligning VISN boundaries. For example, it is unclear why VISNs 19 and 20 should be consolidated, which 

would produce a single Network responsible for overseeing 12 states, 15 VA health 

care systems or medical centers, and a considerable land mass, while VISN 6, which 

oversees three states and eight health care systems or medical centers, remains its 

own entity. VA would appreciate the opportunity to review the Committee’s criteria 

for determining these boundaries. 

Last, Section 2 of S. 3084 seems to assume that locating the management function 

off campus from a medical center represents an inefficient organizational approach. 

We believe that assumption is not valid for all cases. Currently, six VISNs (1, 2, 

3, 20, 21, and 23) are co-located with a VA medical center; the legislation’s requirement for co-location with a VA medical center would require either construction to 

expand existing medical centers, using resources that would otherwise be devoted 

to patient care to cover administrative costs, or would require the removal of certain 

clinical functions to create space for VISN staff in at least nine VISNs given the 

bill’s proposed realignment of VISNs 1, 2, and 3, as well as 20 and 21. 

As a result of this legislation, Veterans may be forced to travel to different locations for services that were previously available at the new host facility, or may be 

unable to access new services that would have been available had construction resources not been required to modify existing facilities to accommodate VISN staff. 

While section 4 of the bill states that nothing in the bill shall be construed to require any change in the location or type of medical care or service provided by a 

VA medical center, the logistical reality of required co-location with medical centers 

would necessitate this result. 

VA also does not support section 3 of S. 3084. Section 3 would require VA to create up to four regional support centers to ‘‘assess the effectiveness and efficiency’’ 

of the VISNs. Section 3 identifies a number of functions to be organized within the 

four regional centers including: 

• financial quality assurance; 

• OEF/OIF/OND outreach; 

• homelessness effectiveness assessments; 

• women’s Veterans programs assessments; 

• energy assessments; and 

• such other functions as the Secretary deems appropriate. 

This would present several challenges, as certain services are more appropriately 

organized as fully consolidated national functions instead of regional ones. The functions identified for homelessness and women Veterans would create capabilities that 

duplicate existing national services. The current structure (VISN accountability and 

national oversight) is directly linked with ensuring accountable leadership oversight 

that is much more proximate to health care services provided to Veterans in facilities. The proposed structure creates two national-level entities competing for 

oversight analysis relationships with facilities. Furthermore, the proposed functions 

may not be the most appropriate ones to offer for consolidation into four centers. 

VHA has created seven Consolidated Patient Account Centers to achieve superior 

levels of sustained revenue cycle management, established national call centers to 

respond to questions from Veterans and their families, and is assessing consolidation of claims payment functions to achieve greater efficiencies and accuracy. These 

types of functions are more appropriate to move off-station without damaging the 

necessary management/accountability relationship between leadership, line management, and staff. The rationale behind the selected functions does not appear to have 

been based on a thorough analysis of the types of functions best suited to consolidation. 

S. 3084 appears to propose a reduction in the FTE associated with regional management, but the proposed regional service centers are likely to increase the overall 

staffing requirement. We believe this actually will result in a diversion of resources 

away from critical patient care. The proposed legislation would result in VISN management staff of roughly 780 persons. If each of the four regional centers is just 110 

FTEE, a not unrealistic assumption given the scope of responsibilities identified in 

35 

the legislation, then the proposed model would result in overall growth of regional 

staff compared with VHA’s current plans. 

It is not possible currently to identify costs for the proposed legislation but it is 

expected that the requirement to co-locate functions with medical centers would result in costlier clinical leases or additional construction. Additionally, the proposed 

VHA Central Office, Regional Center, and VISN structure would require increased 

staff. 

S. 3202—DIGNIFIED BURIAL OF VETERANS ACT OF 2012

S. 3202, the ‘‘Dignified Burial of Veterans Act of 2012,’’ would amend section 2306 

of title 38, United States Code, to authorize VA to furnish a casket or urn, of such 

quality as the Secretary considers appropriate for dignified burial in a national cemetery, of the remains of a Veteran for whom the Secretary is unable to identify next 

of kin, if there are not otherwise sufficient resources available to furnish a casket 

or urn. The bill would also require VA to submit a report to the Senate and House 

Committees on Veterans’ Affairs within 180 days of enactment, to describe industry 

standards for caskets and urns, and assess compliance with such standards at VA 

national cemeteries. 

VA does not object to enactment of the main feature of S. 3202, provided Congress 

identifies appropriate cost offsets, but believes its reporting requirement is unnecessary. Section 2 of the bill, would assist in ensuring that a suitable casket or urn 

is provided for interment in a national cemetery of the remains of any Veteran without family and necessary resources. This legislation is consistent with VA’s continued efforts to address the needs of homeless Veterans—many of whom die as unclaimed and indigent individuals. Section 3 of the bill, requiring a report on industry standards for caskets and urns and VA’s compliance with such standards at national cemeteries, is unnecessary. Currently, NCA relies upon licensed funeral directors who prepare remains to comply with relevant Federal, State, and local laws regarding the preparation of Veterans’ remains. When caskets or urns are presented 

for burial, NCA cemetery directors assess containers to determine any possible 

health or safety risks and whether the caskets or urns are sufficiently constructed 

to allow for necessary handling for burial. On rare occasions when caskets or urns 

do not meet these standards, NCA instructs the funeral director to return to the 

cemetery with remains in a proper container to facilitate burial. For the remains 

of Veterans with next of kin, NCA respects the wishes of families regarding their 

choice of containers so long as there are no public health or safety concerns. 

VA recognizes that S. 3202 complements other bills recently introduced in Congress that seek to address issues relating to the unclaimed remains of Veterans. 

S. 2244 and H.R. 2551, both titled the ‘‘Veterans Missing in America Act,’’ generally propose to expand VA’s authority to provide an allowance to those who assist 

with the transportation and interment of unclaimed remains of Veterans. VA will 

continue to provide technical assistance to the Committees on these bills. 

At this time, VA is unable to estimate the extent of costs that would result from 

enactment of S. 3202 because it is difficult to project the number of unclaimed Veteran remains that may be affected by this legislation. In 2009, the National Funeral 

Directors Association projected that the average cost for a metal casket was $2,295. 

Chairman Murray, this concludes my statement. I would be happy to answer any 

questions you or the other Members of the Committee may have. 

36 

ENCLOSURE

VA VIEWS

S. 1391—IMPROVING THE DISABILITY COMPENSATION EVALUATION PROCEDURE FOR VET- ERANS WITH POST TRAUMATIC STRESS DISORDER OR MENTAL HEALTH CONDITIONS

RELATED TO MILITARY SEXUAL TRAUMA, AND FOR OTHER PURPOSES

S. 1391 would amend 38 U.S.C. § 1154, Consideration to be accorded time, place, 

and circumstances of service, by adding a new subsection (c) that would liberalize 

the standard of proof for service connection of Post Traumatic Stress Disorder 

(PTSD) and a new subsection (d) that would lower the standard of proof for service 

connection of ‘‘covered mental health conditions’’ related to military sexual trauma. 

Proposed new section 1154(c) would require the Department of Veterans Affairs 

(VA) to accept as sufficient proof of service connection for PTSD alleged to have been 

incurred or aggravated by military service: (1) a diagnosis of PTSD by a ‘‘mental 

health professional;’’ (2) written testimony by the Veteran that the PTSD was incurred or aggravated during service; and (3) a written statement by the mental 

health professional relating the PTSD to the claimant’s service, if the claimed incurrence or aggravation of PTSD is consistent with the circumstances, conditions, or 

hardships of the Veteran’s service. 

Proposed new section 1154(d) would similarly require VA to accept as sufficient 

proof of service connection for covered mental health conditions-defined as PTSD, 


627psVA2ltr.eps
37 

anxiety, depression, or ‘‘other mental health conditions the Secretary determines to 

be related to military sexual trauma’’-when the condition is claimed to result from 

military sexual trauma during active service: (1) a diagnosis of the covered mental 

health condition by a ‘‘mental health professional;’’ (2) written testimony by the Veteran of the alleged trauma; and (3) a written statement by the mental health professional relating the mental health condition to the claimed trauma, if the claimed 

trauma is consistent with the circumstances, conditions, or hardships of the Veteran’s service. 

Proposed sections 1154(c) and (d) would require departure from current practice 

for adjudicating both PTSD claims and claims based on other covered mental health 

conditions. In the case of PTSD claims, current procedures under 38 CFR § 3.304(f) 

require credible supporting evidence that an in-service stressor occurred in order to 

establish that current PTSD symptoms are related to an event in service. This generally means objective and verifiable documentation that the stressor actually 

occurred. 

Section 3.304(f) currently provides particularized rules for establishing stressors 

related to combat, former prisoner-of-war (POW) status, fear of hostile military or 

terrorist activity, and personal assault. These particularized rules are based on an 

acknowledgement that certain circumstances of service may make the claimed 

stressor more difficult to corroborate. At the same time, they require threshold evidentiary showings designed to ensure accuracy and fairness in determinations as to 

whether the claimed stressor occurred. Evidence of a Veteran’s service in combat or 

as a prisoner of war generally provide an objective basis for concluding that claimed 

stressors related to such service occurred. Evidence that a Veteran served in an area 

of potential military or terrorist activity may provide a basis for concluding that 

stressors related to fears of such activity occurred. In such cases, VA also requires 

the opinion of a VA or VA-contracted mental health professional, which enables VA 

to ensure that such opinions are properly based on consideration of relevant facts, 

including service records, as needed. For PTSD claims based on a personal assault, 

lay evidence from sources outside the Veteran’s service records may corroborate the 

Veteran’s account of the inservice stressor, such as statements from law enforcement authorities, mental health counseling centers, family members or former servicemembers, as well as other evidence of behavioral changes following the claimed 

assault. 

S. 1391 would require VA to accept as proven the occurrence of military sexual 

trauma or a PTSD stressor without even the minimal threshold evidence currently 

required in most compensation claims to support a Veteran’s account of events in 

service. The claimant would be required merely to state that PTSD was incurred 

or aggravated in service or that a military-sexual-trauma stressor or event occurred 

in service. As long as there was a current diagnosis of PTSD, or other covered mental health condition, and a mental health professional offered a medical opinion that 

the symptoms were related to military service, service connection would be granted. 

This would occur whether the mental health professional had access to the Veteran’s service records or not or was otherwise able to evaluate the veracity of the 

claimant’s statements regarding the occurrence of the claimed in-service stressor or 

event. 

The regulatory provisions at 38 CFR §§ 3.303 and 3.304(f) have established equitable standards of proof and the evidence for corroboration of an in-service injury, 

disease, or event, for purposes of service connection. Further, 38 U.S.C. § 1154 properly requires consideration of the time, place, and circumstances of service when 

evaluating disability claims and provides for acceptance of lay statements concerning combat-related injuries, provided evidence establishes that the Veteran engaged in combat. S. 1391 would expand section 1154 to require VA to accept lay 

statements as sufficient proof of in-service events in all PTSD claims and military 

sexual trauma claims involving covered mental health conditions, based solely on 

the nature of the claim and without requiring the objective markers, such as combat 

service, that are essential to the effective operation of section 1154. Without the requirement of any evidentiary threshold for the mandatory acceptance of a lay statement as sufficient proof of an occurrence in service, this legislation would eliminate, 

for discrete groups of Veterans, generally applicable requirements that ensure the 

fairness and accuracy of claim adjudications. 

VA is committed to serving our Nation’s Veterans by accurately adjudicating MST 

claims in a thoughtful and caring manner, while fully recognizing the unique evidentiary considerations involved in such an event. The Under Secretary for Benefits 

has spearheaded the efforts of the Veterans Benefits Administration (VBA) to ensure that these claims are adjudicated compassionately and fairly, with sensitivity 

to the unique circumstances presented by each individual claim. 

38 

VA is aware that, because of the personal and sensitive nature of the MST 

stressors in these cases, it is often difficult for the victim to report or document the 

event when it occurs. To remedy this, VA developed regulations and procedures specific to MST claims that appropriately assist the claimant in developing evidence 

necessary to support the claim. As with other PTSD claims, VA initially reviews the 

Veteran’s military service records for evidence of MST. VA’s regulation also provides 

that evidence from sources other than a Veteran’s service records may corroborate 

the Veteran’s account of the stressor incident, such as evidence from mental health 

counseling centers or statements from family members and fellow Servicemembers. 

Evidence of behavior changes is another type of relevant evidence that may establish occurrence of an assault, such as a request for transfer to another military duty 

assignment. Veterans are provided notification regarding the types of evidence that 

may establish occurrence of an in-service personal assault and are requested to submit or identify any such evidence. 

VBA has also placed a primary emphasis on informing VA regional office personnel of the issues related to MST and providing training in proper claims development and adjudication. VBA developed and issued Training Letter 11–05, Adjudicating Posttraumatic Stress Disorder Claims Based on Military Sexual Trauma, in 

December 2011. This was followed by a nationwide Microsoft Live Meeting broadcast on MST claims adjudication. The broadcast focused on describing the range of 

potential markers that could indicate occurrence of an MST stressor and the importance of a thorough and open-minded approach to seeking such markers in the evidentiary record. In addition, the VBA Challenge Training Program, which all newly 

hired claims processors are required to attend, now includes a module on MST within the course on PTSD claims processing. VBA also provided its designated Women 

Veterans Coordinators with updated specialized training. These employees are located in every VA regional office and are available to assist both female and male 

Veterans with their claims resulting from MST. 

VA believes these actions ensure that MST claimants are given a full and fair opportunity to have their claim considered, with a practical and sensitive approach 

based on the nature of MST. VA believes that processes and training in place now 

provide MST claimants a full and fair opportunity to present their claim. VA has 

recognized the sensitive nature of MST-related PTSD claims and claims based on 

other covered mental health conditions, as well as the difficulty inherent in obtaining evidence of an in-service MST event. Current regulations provide multiple 

means to establish an occurrence, and VA has initiated additional training efforts 

and specialized handling procedures to ensure thorough, accurate, and timely processing of these claims. 

In summary, VA opposes S. 1391 because we believe it would go too far in relaxing standards requiring service connection for a current disability to be based on 

credible supporting evidence of an injury, disease, or event in service. 

Benefit costs are estimated to be $137.1 million during the first year, $2.0 billion 

for 5 years, and $7.1 billion over 10 years. Costs for general operating expenses are 

estimated to be $5.0 million during the first year, $24.1 million for 5 years, and 

$52.5 million over 10 years. IT costs are estimated to be $196 thousand during the 

first year, $531 thousand for 5 years, and $967 thousand over 10 years. 

S. 3049—EXPANDING THE DEFINITION OF HOMELESS VETERAN

S. 3049 would broaden the definition of ‘‘homeless veteran’’ found in 38 U.S.C. 

§ 2002(1) to include ‘‘any individual or family who is fleeing, or is attempting to flee, 

domestic violence, dating violence, sexual assault, stalking, or other dangerous or 

life-threatening conditions in the individual’s or family’s current housing situation, 

including where the health and safety of children are jeopardized, and who have no 

other residence and lack the resources or support networks to obtain other permanent housing.’’ It would do this by adding to the Title 38 definition a reference to 

an additional subsection of the general definition of homeless individual found in 

the McKinney-Vento Homeless Assistance Act, at 42 U.S.C. § 11302. 

VA supports the intent of S. 3049. VA understands that the Department of Housing and Urban Development (HUD) uses the definition found in 38 U.S.C. § 2002(1) 

in the application of some of its programs. Therefore, we suggest the Committee 

consult with HUD regarding any changes to that definition. 

VA has taken steps to address the critical issue of domestic violence. In recognition of the unique and emerging health challenges posed by victims of domestic violence, the Deputy Under Secretary for Health for Policy and Services recently chartered a Domestic Violence Task Force to ‘‘develop a national plan/policy on domestic 

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logical safety and well being; and define the scope of domestic violence to be addressed.’’ As evidenced by this task force, VA intends to study this population and 

VA’s options for serving this population; however, at this time, VA lacks subject 

matter experts to implement programming directly targeted at victims of domestic 

violence. Furthermore, in the event VA would be expected to reach and target this 

population, VA needs time and resources to implement systems, protocol, and policies to ensure timely interventions and meet the needs of this vulnerable population. Domestic violence is a complex health issue and addressing it involves collaboration between many programs and external local, State and Federal agencies 

to address identification, prevention, provision of safety supports, treatment, and 

legal consequences. 

VA is not able to provide an accurate cost estimate for S. 3049 since we currently 

lack information regarding the size and characteristics of the potential population. 

For example, VA’s estimates of the homeless population do not include individuals 

fleeing domestic violence. Many VA providers have only minimal training on domestic violence. S. 3049 would likely require additional training for VA employees and 

providers, which may have some costs, depending upon the scope of the training. 

S. 3206—MONTHLY ASSISTANCE ALLOWANCE TO DISABLED VETERANS TRAINING OR COM- PETING FOR THE PARALYMPIC TEAM AND ASSISTANCE TO UNITED STATES

PARALYMPICS, INC. 

Section 1 of S. 3206 would extend the authority for appropriations to fund the 

payment of the monthly monetary allowance under 38 U.S.C. § 322(d) (to Veterans 

training for or selected to compete on the U.S. Paralympic team) for a period of 5 

years (through FY 2018). VA supports such an extension. 

By its own terms, the cost of enactment of this section would be $2 million in FY 

2014, with a total 5-year cost (FY 2014 through FY 2018) of $10 million. 

Section 2 of S. 3206 would extend (through FY 2018) VA’s authority to award 

grants to United States Olympic Committee (USOC) for its U.S. Paralympics Integrated Adaptive Sports Program. Under current law, VA has provided grants totaling $7.5 million to the USOC in each FY 2010 and FY 2011. Due to identified need, 

VA currently is processing an $8.0 million USOC grant request in FY 2012. VA supports extending the authority for this program, which has positively impacted the 

lives of thousands of Veterans. 

S. 3270—PENSION AMENDMENTS

Section 1(a) of S. 3270 would amend the net worth limitations applicable to Veteran’s pension in 38 U.S.C. § 1522 to provide that when a Veteran (or Veteran’s 

spouse) disposes of ‘‘covered resources’’ for less than fair market value (including 

transfers to annuities or trusts) on or after the beginning date of a 36-month lookback period, the disposal may result in a period of ineligibility for pension. In addition, section 1(a) would provide a method for calculating the period of ineligibility 

for pension resulting from a disposal of covered resources at less than fair market 

value. The period of ineligibility, expressed in months, would be determined by dividing the total value of all applicable covered resources disposed of by the Veteran 

(or the Veteran’s spouse) by the amount of pension that would have been payable 

to the Veteran under 38 U.S.C. §§ 1513 or 1521 without consideration of the transferred resources. 

Section 1(b) of S. 3270 would amend 38 U.S.C. § 1543 to apply to a surviving 

spouse’s or surviving child’s pension the same restrictions pertaining to disposal of 

covered resources at less than fair market value as would apply to Veterans under 

subsection (a). 

Section 1(c) of S. 3270 would specify the effective date and applicability of the 

amendments made by section 1(a) and (b). Section 1(d) of S. 3270 would require VA 

to provide annual reports to Congress regarding: (1) the number of individuals who 

applied for pension during the period covered by the report; (2) the number of individuals who received pension during that period; and (3) the number of individuals 

whose pension payments were denied or discontinued during that period because 

covered resources were disposed of for less than fair market value. 

Currently, if a pension claimant (or the spouse of a Veteran pension claimant) disposes of assets before the date of the pension claim, VA does not consider those assets as part of the claimant’s net worth, so long as the transfer was not a gift to 

a relative living in the same household as the claimant. S. 3270 would provide that 

such disposals of ‘‘covered resources’’ for less than fair market value during a 36- 

month look-back period may result in a period of ineligibility for pension. 

VA supports the objectives of S. 3270 to provide for consideration of recent asset 

transfers for less than fair market value in evaluating a pension claimant’s net 

40 

worth and to impose a period of ineligibility for pension where such transfers occur. 

The bill would clarify current law by prescribing that pension applicants cannot create a financial need, qualifying them for VA pension, by disposing of assets that the 

applicant could use for the applicant’s own maintenance. It would also clarify that 

an applicant cannot create pension eligibility by restructuring assets during the 36- 

month period preceding a pension application through transfers to certain financial 

products or legal instruments, such as annuities and trusts. A recent Government 

Accountability Office study found that there is a growing industry that markets 

these products and instruments to vulnerable Veterans and survivors and potentially causes them harm. The amendments contemplated by S. 3270 would enable 

VA to implement necessary program integrity measures. 

However, VA is concerned that the provisions of S. 3270 specifying how the period 

of ineligibility will be calculated would be unnecessarily complex and burdensome 

to administer. The provisions of section 1(a) of S. 3270 to be codified at 38 U.S.C. 

§ 1522(a)(2)(E)(ii) would require VA to divide the total value of all applicable covered 

resources disposed of by the Veteran (or Veteran’s spouse) by ‘‘the amount of the 

monthly pension that would be payable to the veteran under section 1513 or section 

1521 of this title without consideration of such resources under paragraph (1).’’ Sections 1(a) and 1(b) of S. 3270 would provide for similar calculations under 38 U.S.C. 

§§ 1522(b)(2)(E)(ii), 1543(a)(4)(E)(ii), and 1543(b)(2)(E)(ii). It appears that the divisor 

used to calculate the ineligibility period under these provisions would require VA 

to develop for and adjudicate up to 3 years’ worth of countable income. Such a complex calculation would significantly increase VA’s adjudicative burden and, as a result, delay the payment of pension claims to eligible Veterans. 

VA suggests modifying this calculation method. The goals of S. 3270 could be 

achieved more efficiently by revising the language describing the divisor to refer to 

‘‘the monthly amount a claimant would have received based on the maximum annual pension rate including any amount of increased pension payable on account of 

family members, but not including any amount of pension payable because a person 

is in need of regular aid and attendance or is permanently housebound.’’ It would 

be burdensome and inefficient to require VA to develop income and expense information to determine up to 3 years’ worth of countable income in a decision that 

would deny pension in any event. By using less claim-specific criteria tied to the 

maximum annual pension rate, VA would be able to quickly determine the length 

of the penalty period and conserve adjudication resources for expeditious processing 

of claims. 

The use of such less-specific criteria is not without precedent. Congress used similar language in 38 U.S.C. § 1503(a)(8) in establishing the rule for calculating the 5- 

percent threshold for medical expense deductions in VA pension, which is based on 

the maximum annual pension rate including increased pension payable on account 

of family members, but without regard to special monthly pension. 

At this time, VA has no objection to this section but is unable to estimate the 

costs or savings associated with this proposal because sufficient data is not available. 

S. 3238—A BILL TO DESIGNATE THE DEPARTMENT OF VETERANS AFFAIRS COMMUNITY

BASED OUTPATIENT CLINIC IN MANSFIELD, OHIO, AS THE DAVID F. WINDER DEPARTMENT OF VETERANS AFFAIRS COMMUNITY BASED OUTPATIENT CLINIC, AND FOR

OTHER PURPOSES

S. 3238 would designate the Department of Veterans Affairs community based 

outpatient clinic located in Mansfield, Ohio, as the ‘‘David F. Winder Department 

of Veterans Affairs Community Based Outpatient Clinic.’’ VA defers to Congress in 

the naming of this facility. 

S. 3282—A BILL TO AMEND TITLE 38, UNITED STATES CODE, TO REAUTHORIZE THE

VETERANS’ ADVISORY COMMITTEE ON EDUCATION, AND FOR OTHER PURPOSES

S. 3282 would amend 38 U.S.C. § 3692 to extend the expiration date of the Veterans Advisory Committee on Education (Committee) to December 31, 2014. It 

would also change the composition of the Committee to include representatives of 

institutions and establishments furnishing education or vocational training to eligible Veterans or persons enrolled under chapter 31 of Title 38 (Training and Rehabilitation for Veterans with Service-Connected Disabilities) while removing those 

providing training to Veterans or persons enrolled under chapter 32 of that title 

(Post-Vietnam Era Veterans’ Educational Assistance). 

Further, S. 3282 would require the composition of the Committee, to the maximum extent practicable, to include: 

41 

• Veterans who served on active duty and were deployed in connection with a 

contingency operation, • at least one Veteran who is a student currently enrolled in a program of education and receiving assistance for the pursuit of such program of education under 

chapters 30, 31, 33, or 35 of Title 38, • at least one representative from the American Council on Education or an affiliated organization, • at least one representative from an organization that represents Veterans, • a representative of a State Approving agency, and • at least two school certifying officials from different regions of the country. 

The Committee would be required to seek feedback on the policies of VA relating 

to the administration of chapters 30, 31, 33, 35, and 36 of Title 38 and chapter 1606 

of Title 10 from students who are currently training under such chapters or Veterans seeking to enroll for training under such chapters. 

At least twice each year, the Committee would be required to submit to VA and 

Congress a report on the administration of chapters 30, 31, 33, 35, and 36 of Title 

38 and chapter 1606 of Title 10, including recommendations for legislative and administrative action to improve educational assistance under such chapters. 

VA supports this legislation. If reauthorized, VA would be able to continue to receive recommendations and seek advice from the Members of the Committee with 

regard to the administration and proposals to enhance VA education benefit programs. VA estimates that S. 3282 would have insignificant costs associated with its 

enactment. 

S. 3308—A BILL TO AMEND TITLE 38, UNITED STATES CODE, TO IMPROVE THE FUR- NISHING OF BENEFITS FOR HOMELESS VETERANS WHO ARE WOMEN OR WHO HAVE DEPENDENTS, AND FOR OTHER PURPOSES

Section 1(a) of S. 3308 would amend 38 U.S.C. § 2012(a) to permit a grantee receiving per diem payments under VA’s Homeless Providers Grant and Per Diem 

Program (GPD Program) to use part of those payments for the care of a dependent 

of a homeless Veteran who is receiving services covered by the GPD Program grant. 

This authority would be limited to the time period during which the Veteran is receiving services under the grant. 

Section 1(b)(1) of the bill would amend 38 U.S.C. § 2061(c) to require the Secretary 

to ensure that the total amount of grants awarded in any year under VA’s Grant 

Program for Homeless Veterans with Special Needs is not less than 15 percent of 

the total amount of grants awarded under the GPD Program under 38 U.S.C. 

§ 2011. This would ensure a level of minimum funding for grants targeted to assist 

homeless populations with special needs, such as women, including those with 

minor dependents, frail elderly, etc. Section 1(b)(2) would amend 38 U.S.C. § 2061 

to authorize for appropriation such sums as may be necessary for the purposes of 

this program for FY 2013 and each fiscal year thereafter. The law currently authorizes for appropriation $5 million to conduct the program through FY 2012. 

VA supports the intent of section 1(a) of S. 3308. We feel that this authority is 

needed to fully reach the entire homeless population. However, full implementation 

of the legislation would require additional funding to avoid diminished services for 

homeless Veterans. At the current level of funding VA would be unable to provide 

grants to current grant recipients as well as Veterans with dependants. 

VA does not support Section 1(b) for two reasons. First, it fails to take into account that entities receiving grants under 38 U.S.C. § 2011 become eligible, subject 

to the availability of appropriations, to receive per diem payments subsequently 

under 38 U.S.C. § 2012. This means that VA may award per diem payments to current grant recipients in lieu of awarding new grants under section 2011. Indeed, VA 

conducted its last capital grant Notice of Funding Availability in FY 2010. Since 

then, VA has offered a Special Needs grant round pursuant to 38 U.S.C. § 2061 and 

a GPD ‘‘Per Diem Only’’ grant round pursuant to 38 U.S.C. § 2012 (see also 38 CFR 

part 61.33). 

Second, funding for Special Needs Grant Program is not a separate, line-item 

budget item. Funds designated for this program are included in the general allocation for the entire GPD program and come out of VA’s Medical Services account. 

With competing priorities for Medical Service dollars, VHA currently funds the GPD 

Programs at the levels that are authorized to be appropriated to for these programs. 

Were the mandate in section 1(b) enacted, it would dramatically disrupt GPD Program operations and force the closure of current GPD projects. To illustrate, within 

the GPD Program’s current budget of approximately $224 million for FY 2012, VA 

expects to support approximately 15,000 operational GPD beds with per diem payments in the amount of approximately $164 million (80 percent bed occupancy rate), 

42 

and support GPD Liaison positions in the amount of approximately $29 million. Additionally, there are approximately 1,900 capital beds in development from past capital grant rounds. VA estimates these capital beds could require an additional $21 

million in per diem grant support. Were the requirements of section 1(b)(1) in place, 

VA would be required to spend at least $33 million on GPD Special Needs grants. 

This would be a dramatic increase in Special Needs funding—far above the current 

mandated spending level of $5 million. Such an increase would have to be absorbed 

from the GPD Program budget, and, to do that, the GPD Program would be forced 

to close existing and proven GPD projects. 

This concern is heightened by the fact that under existing law the total amount 

authorized for appropriation for the GPD program will drop from $250 million in 

FY 2013 to $150 million in FY 2014 and every fiscal year thereafter. For FY 2012, 

approximately $164 million is slated to cover per diem payments to approximately 

15,000 Veteran beds. In FY 2014, the required funding for per diem payments will 

exceed the amounts authorized to be appropriated for the GPD’s programs. VA will 

then be forced to close GPD projects or reduce per diem rates for all beds to remain 

within those authorization limits. In other words, without a corresponding provision 

in 38 U.S.C. § 2013 to authorize appropriations in such sums as are needed to carry 

out the purposes of the GPD for FY 2014 and thereafter, the effect of the mandate 

in section 1(b)(2) will be meaningless. 

VA estimates the costs associated with enactment of S. 3308 to be $25.5 million 

for FY 2013, $137.3 million over 5 years, and $302.5 million over 10 years. 

S. 3309—HOMELESS VETERANS IMPROVEMENT ACT OF 2012

S. 3309 is a comprehensive bill to continue and improve VA’s provision of benefits 

to homeless Veterans and their families. Key provisions of the bill are targeted at 

addressing specific problems identified in recent reports by VA’s Office of Inspector 

General and the Government Accountability Office, e.g., current barriers to access 

to care and services faced by both homeless women Veterans and homeless Veterans 

with children, the need for infrastructure improvements to ensure the privacy and 

security of women Veterans receiving services under VA or VA-sponsored programs, 

etc. 

Section 2 of S. 3309 would amend current law to prohibit the Secretary from making a grant for a project under VA’s Homeless Providers GPD Program unless the 

applicant also agrees in its grant application to meet the physical privacy, safety, 

and security needs of homeless Veterans receiving services through the project. 

VA supports Section 2. This new requirement would help reinforce the GPD Program’s inspection efforts and also ensure that GPD grantees comply with VA’s ongoing efforts to ensure the privacy, safety, and security needs of Veterans participating in the GPD Program. We note as a practical matter that current GPD grantees would be required to absorb the costs of making these improvements as VA 

lacks authority to offer grants to existing GPD providers to renovate or remodel existing GPD facilities. (38 CFR part 61.10.3) To help current grantees recover these 

unanticipated costs, VA would need authority similar to that specified in 38 U.S.C. 

§ 2012(c), wherein all GPD grantees were required to comply with the Life Safety 

Code. In section 2012(c), Congress authorized a five-year period during which VA 

offered grants to GPD grantees to assist the grantees in meeting the new requirements of the Life Safety Code. Regardless, future grant rounds for new grantees 

would incorporate this requirement as part of the application process. 

VA does not support Section 3 of S. 3309, which would amend current law to require the Secretary, when awarding grants under the GPD Program, to assist eligible entities not only in establishing, but also in maintaining programs to furnish 

services for homeless Veterans (i.e., outreach services; rehabilitative services; vocational counseling and training; and transitional housing assistance). VA does not 

support this legislative measure because it would likely result in substantial costs 

that are not contemplated in the GPD Program’s budget or in long-term financial 

planning for the GPD Program. VA believes that most, if not all, GPD projects 

would request grant funding for repairs and/or remodeling, but for the reasons previously explained, it is unlikely there would be sufficient funds available to cover 

repairs and/or remodeling of grantees’ facilities. 

The GPD Program was, in part, conceived to help save the Federal Government 

such costs, especially given the fact that such services can generally be obtained at 

lower cost in the community. Were VA to provide grants to cover the costs of maintaining grantees’ infrastructures, the overall cost-effectiveness of the GPD Program 

would be reduced, and, more importantly, fewer funds would be available for the 

provision of direct services to homeless Veterans. As an administrative matter, VA 

43 

would have to amend its GPD regulations before such maintenance grants could be 

awarded. 

VA estimates the cost of Section 3 of S. 3309 to be $29.0 million in FY 2013; $68.4 million over 5 years; and $115.5 million over 10 years. 

Section 4 of the bill would amend 38 U.S.C. § 2044(e) to require that, of the 

amounts required to be made available for conduct of VA’s Financial Assistance Program for Supportive Services for Very Low-Income Veteran Families in Permanent 

Housing (referred to below as the ‘‘SSVF’’ Grant Program), at least 1 percent of such 

funding must be made available for the furnishing of legal services to assist Veteran 

families with issues that interfere with their ability to obtain or retain housing or 

supportive services. 

VA does not support Section 4 because it duplicates existing authority. Grants 

awarded under the SSVF Program already require grantees to assist participants 

with obtaining legal services for issues that interfere with their ability to obtain or 

retain permanent housing or supportive services. See 38 CFR § 62.33(g), implementing 38 U.S.C. § 2044(b)(1)(D)(vii). Some grantees have identified creative nocost options for providing such legal services, relying on area law school clinics and 

local bar associations’ pro bono initiatives. Such a spending-minimum for legal services would likely discourage grantees from cultivating local networks of legal service 

providers who will provide participants services at no cost. Beyond discouraging or 

providing a disincentive for the development of no-cost options for providing legal 

services, VA is also concerned that this provision would not be an efficient use of 

resources inasmuch as the mandated level of funding could well exceed the grantee’s 

actual costs of obtaining legal services for participants. Yet, even in such cases, 

grantees would still have to slate the mandated-minimum amount for this purpose, 

using funds that could otherwise be expended to furnish other needed supportive 

services to participants. 

Our non-support for section 4 is not meant to discount the central role that legal 

services play in preventing and ending homelessness among Veterans. Garnering 

adequate resources or partnerships for the provision of legal services to homeless 

Veterans and those who are at risk of becoming homeless is absolutely key to this 

effort. Veterans accessing services in our homeless health care programs often have 

multiple unmet legal needs ranging from criminal matters (e.g., unresolved warrants) to civil matters (e.g., child support arrears and landlord-tenant disputes). 

While SSVF grants can be targeted at helping address their participants’ legal 

needs, those participants constitute only part of the homeless Veteran population in 

need of such services. We are heartened by the growing level of interest among lawyers and law students in serving homeless Veterans, as evidenced by an increasing 

number of Veteran-focused law school clinics and pro bono initiatives. Still, far more 

legal resources are needed to build a national practice community of attorneys who 

have the expertise and dedication needed to effectively serve this population. Outside of awarding grants under section 2044, VA’s ability to help non-profits provide 

or coordinate the provision of legal services to homeless Veterans is hamstrung by 

limits on our legal authority. We are currently exploring ways to leverage other existing Federal resources to deliver legal services to both homeless and at-risk Veterans, and we would be happy to discuss these efforts with the Committee. 

VA estimates the cost of Section 4 of S. 3309 to be $3 million in FY 2013; $15 

million over 5 years; and $30 million over 10 years. 

Section 5(a) of S. 3309 would amend 38 U.S.C. § 2012(a) to permit per diem payments made by the Secretary to grantees under VA’s GPD Program to include payments for furnishing care for a dependent of a homeless Veteran, but only while the 

Veteran is receiving services from the grantee under such grant. 

Section 5(a) of S. 3309 is identical to section 1(a) of S. 3308, discussed above. VA 

supports this section, but we refer you to our earlier comments, which identify some 

concerns we have with its enactment. VA estimates the cost of $25.5 million for FY 

2013; $137.3 million over 5 years; and $302.5 million over 10 years. 

Section 5(b)(1) of S. 3309 would require the Secretary to make funds available for 

per diem payments under VA’s GPD Program to grant recipients or eligible entities 

that are considered to be ‘‘non-conforming.’’ Non-conforming recipients or entities 

fall into three categories: (1) those that meet each of the transitional and supportive 

services criteria prescribed by the Secretary and furnish services to homeless individuals of which not less than 75 percent are Veterans; (2) those that meet at least 

one but not all of criteria prescribed by the Secretary and furnish services to homeless individuals of which not less than 75 percent are Veterans; and (3) those that 

meet at least one but not all of the criteria prescribed by the Secretary and furnish 

services to homeless individuals of which less than 75 percent are Veterans. Currently, the Secretary’s authority to make per diem payments to these non-conforming recipients and entities is discretionary. Section 5(b)(2) of the bill would reVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00047 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
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quire the Secretary to prescribe such regulations as may be necessary to implement 

this change. 

VA does not support Section 5(b). The number of eligible conforming entities seeking to receive GPD funds already far exceeds the resources of the GPD Program. 

For example, from 1994 through 2010, VA received 3,252 applications from conforming eligible entities for grant funding under the GPD Program. These applications included capital grant funding, per diem only funding, and GPD special needs 

funding. Out of the 3,252 applications from conforming eligible entities, VA could 

only fund 1,115 of these applications. Similarly, from 1994 through 2010, VA received applications requesting almost $1.4 billion in capital grant funding, but VA 

could only fund approximately $197 million in GPD capital grants. It is highly unlikely that funding will ever be available for nonconforming entities, rendering this 

mandate ineffectual and generating false expectations on the part of non-conforming 

entities who would seek such assistance. We are more concerned that changing the 

discretionary language in 38 U.S.C. § 2012(d)(1) to mandatory language would remove needed discretion and produce the undesired result of non-conforming entities 

receiving grants over conforming entities solely because of this requirement. 

There are no additional costs associated with section 5 because costs would come 

from those funds already slated to be awarded under the GPD. 

Section 6(a) would authorize the Secretary, subject to the availability of appropriations, to award grants to cover the operational expenses of grant recipients’ comprehensive service centers that are not otherwise covered by per diem payments 

made under the GPD Program. Section 6(b) would limit the aggregate amount of 

all such grants awarded in any Fiscal Year to $500,000. Section 6(c) would require 

the Secretary to promulgate regulations not later than one year after the date of 

the Act’s enactment to carry out this new authority. 

VA does not support Section 6 of S. 3309. VA does not believe this measure would 

be an effective use of VA’s resources and the GPD Program’s budget. VA funds 

would likely be put to better use funding traditional outreach in the community or 

Community Resource and Referral Centers (CRRCs). Historically, it has been difficult for service centers to remain viable for several reasons. VA’s statutory authority is limited to paying ‘‘per diem’’ to service center providers, and the service centers have difficulty in providing the federally-required information under Office of 

Management and Budget (OMB) Circulars and other Federal standards needed to 

accurately reflect the services they provide, to determine in a timely manner the eligibility of the individuals receiving those services, and to determine the amount of 

time actually spent with the individuals served. Given GPD grantees’ difficulties in 

accounting for services provided in service centers, VA does not believe service centers are an effective outreach model for VA homeless programs and services, especially given VA has more effective and proven methods of reaching the homeless 

Veteran population. For instance, VA excels at traditional outreach in the community and is introducing CRRCs throughout the country. VA estimates the cost associated with enactment of section 6 could be $500,000 per any fiscal year these operational grants are awarded. VA is unable, however, to estimate costs with greater 

specificity given the disparate operational needs of each GPD service center. 

Section 7 of S. 3309 would extend dental benefits under 38 U.S.C. § 2062 to a Veteran enrolled in VA’s health care system who is also receiving for a period of 60 

consecutive days assistance under section 8(o) of the United States Housing Act of 

1937 (commonly referred to as ‘‘Section 8 vouchers.’’). It would also amend current 

law to permit the Secretary to disregard breaks in the continuity of assistance or 

care for which the Veteran is not responsible. VA supports the intent of section 7 

of S. 3309, but must condition this support on assurance of the additional resources 

that would be required were this provision enacted. 

VA recognizes the need for dental care and supports the improvement of oral 

health and well-being for Veterans experiencing homelessness. Indeed, increasing 

access to dental care for Department of Housing and Urban Development VA Supportive Housing (HUD-VASH) Veterans is an important step in VA’s Plan to End 

Veteran Homelessness. Severe dental disease plagues the majority of Veterans experiencing homelessness, particularly the chronically homeless Veterans participating 

in HUD-VASH. Severe dental disease seriously impacts physical health as well as 

self esteem and mental health. 

Under Directive 2007–039, homeless Veterans participating in the GPD Program, 

Domiciliary Residential Rehabilitation Program, Health Care for Homeless Veterans 

(HCHV) contract residential treatment program, Community Residential Care Program, and Compensated Work Therapy-Transitional Residence (CWT-TR) program 

are eligible for a one-time course of focused dental care. (38 U.S.C. § 1712(a)(1)(H); 

38 U.S.C. § 2062). Section 7 would expand dental eligibility to Veterans participating in the HUD-VASH Program Veterans. 

45 

While VA is committed to ensuring eligible Veterans receive patient-centered, 

cost-effective, evidence-based care, we acknowledge that current resources are inadequate to provide these dental benefits to a new cohort of Veterans and to accommodate the related increase in workload. An expansion of the eligible dental population 

without a corresponding expansion of resources would severely limit VA’s ability to 

deliver dental care to Veterans already receiving VA dental care benefits. 

Finally, as a technical matter, the language proposed for section 2062 refers in 

error to subsection ’’(a)’’ when it should instead reference subsection ’’(b).’’ That is, 

it should be amended in relevant part to read: ’’(b) ELIGIBLE VETERANS.’’ VA further 

notes that while Section 7 of S. 3309 would amend the current structure of 38 

U.S.C. § 2062, the only substantive change would be the inclusion of HUD-VASH 

Veterans. 

VA estimates that there would be significant costs in the first years of operation 

as thousands of HUD-VASH Veterans become eligible for dental care. However, 

after the first few years of operation, the cost of providing dental care to Veterans 

in HUD-VASH would drop dramatically because the dental needs of this population 

would be satisfied or stabilized. VA would avoid new costs because VA expects a 10 

percent turnover in HUD-VASH vouchers in each fiscal year. Specifically, VA estimates the total cost associated with enactment of section 7 for FY 2013 to be $75.9 

million; $123.0 million over a five-year period, and $182.3 million over a 10-year period. (These estimates are comprised of the separate amounts estimated for direct 

patient care as well as projected increases in administrative costs.) VA’s cost estimate for this provision only focused on HUD-VASH vouchers and Veterans participating in the HUD-VASH program. It is possible that Veterans eligible for VA 

health care reside in Section 8 housing that is unaffiliated with the HUD-VASH 

program. As presently drafted, Section 7 could further increase the cost of this bill. 

Section 8 of S. 3309 includes a series of extensions to reauthorize VA’s benefits 

programs for homeless Veterans. VA supports Section 8 and notes that, if enacted, 

these extensions would not result in any additional costs beyond those contemplated 

in VA’s FY 2013 budget request. Each provision of Section 8 is discussed below in 

greater detail. 

Section 8(a) would authorize to be appropriated $250,000,000 for FY 2013 and 

$150,000,000 for FY 2014 and each fiscal year thereafter for the conduct of VA’s 

GPD Program. 

VA supports Section 8(a). Under current law, the amount authorized to be appropriated for the GPD Program for FY 2013 will be reduced from $250,000,000 to 

$150,000,000 and it remains the same for each subsequent fiscal year. We support 

section 8(a) to the extent that it would retain the program’s current level of authorization for FY 2013. We have concerns, however, about the terms that would drop 

the authorization level to $150,000,000 for FY 2014 and each fiscal year thereafter. 

Such a decrease would be highly problematic. GPD expenditures will far exceed 

the amount authorized to be appropriated for the program for FY 2014 and in following fiscal years. VA would require additional funding to support the existing 

projects at anticipated per diem and occupancy rates in FY 2014 and beyond. Otherwise, VA would be forced to either cut per diem payments to GPD community providers or summarily terminate operational GPD projects presently serving homeless 

Veterans. 

Section 8(b) would authorize to be appropriated $50,000,000 for FY 2013, for the 

conduct of the U.S. Department of Labor’s (DOL) Homeless Veterans Reintegration 

Programs. We defer to the views of the Secretary of Labor on this provision. 

Section 8(c) would extend VA’s general treatment and rehabilitation authority 

(codified at 38 U.S.C. § 2031(a)) for seriously and mentally ill Veterans from December 31, 2012 to December 31, 2014. VA supports this legislative measure, which 

would reauthorize the VA’s Health Care for Homeless Veterans Program (consisting 

of VA’s premier outreach program and a program offering contract therapeutic 

housing). 

Section 8(d) would extend VA’s operation of comprehensive service centers for 

homeless Veterans (under 38 U.S.C. § 2033) from December 31, 2012 to December 31, 2014. VA supports section 8(d), which would re-authorize VA’s Community 

Resource and Referral Centers. 

Section 8(e) would extend, through December 31, 2013, the Secretary’s authority 

under 38 U.S.C. § 2041 to sell, lease, or donate properties to nonprofit organizations 

that provide shelter to homeless Veterans. Under current law, the authority will expire on December 31, 2012. VA supports the extension, as it will help VA meet its 

goal of ending Veteran homelessness by 2015. We note, however, that the five-year 

extension that the Administration proposed would better enable VA to achieve our 

goal. While any extension of authority under 38 U.S.C. § 2041 would result in a reVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00049 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
46 

duction in property sales proceeds, neither a one-year, nor a five-year extension 

would result any significant loan subsidy costs. 

Section 8(f) would require VA to make available (from amounts approPriated for 

Medical Services) $300,000,000 for FY 2013 to carry out the Department’s Financial 

Assistance Program (required by 38 U.S.C. § 2044). VA supports section 8(f), which 

would re-authorize appropriations for the SSVF Program, VA’s premier prevention 

and rapid re-housing program. VA has already budgeted $300 million for the SSVF 

Program in FY 2014. 

Section 8(g) would extend VA’s Grant Program for Homeless Veterans with Special Needs through 2015. VA supports this measure. 

Section 8(h) would extend VA’s Advisory Committee on Homeless Veterans from 

December 31, 2012, to December 31, 2014. VA supports this provision. 

S. 3313—WOMEN VETERANS AND OTHER HEALTH CARE IMPROVEMENTS ACT OF 2012

Section 2 of the bill would add a new section 7330B to Title 38, entitled ‘‘Facilitation of reproduction and infertility research.’’ This new section would require the 

Secretary of VA to ‘‘facilitate research conducted collaboratively by the Secretary of 

Defense and the Director of the National Institutes of Health’’ to improve VA’s ability to meet the long-term reproductive health care needs of Veterans with serviceconnected genitourinary disabilities or conditions incurred or aggravated in line of 

duty that affect the Veterans’ ability to reproduce, such as spinal cord injury. The 

Secretary of VA would be required to ensure that information produced by research 

facilitated under section 73308 that may be useful for other activities of the Veterans Health Administration (VHA) is disseminated throughout VHA. No later than 

three years after enactment, VA would be required to report to Congress on the research activities conducted under section 7330B. 

VA supports section 2 of S. 3313. Generally, VA supports implementing research 

findings for the benefit of Veterans. VA’s goal is to restore the capabilities of Veterans with disabilities to the greatest extent possible. We utilize new research into 

various conditions to improve the quality of care we provide. Of note, rather than 

requiring VA to conduct research, this section would require VA to facilitate research that is conducted collaboratively by the Secretary of Defense and the Director 

of the National Institutes of Health. It is not clear how the term ‘‘facilitate’’ would 

be defined, which could raise privacy and security issues with respect to identifiable 

Veteran information. Given the ambiguity over the meaning of this term, VA is unable to provide a cost estimate at this time. If facilitation requires fairly minor involvement (coordination, distribution, etc.), VA expects the costs of this provision 

would be nominal; however, if facilitation is intended to mean direct funding, proposal reviews, and additional staff, costs would be greater. 

Section 3 of S. 3313 would include fertility counseling and treatment, including 

assisted reproductive technology, among those things that are considered to be 

‘‘medical services’’ under chapter 17 of title 38, U.S.C., as provided in 38 U.S.C. 

§ 1701(6). 

VA supports the intent of section 3 of S. 3313, but must condition this support 

on assurance of the additional resources that would be required were this provision 

enacted. The provision of Assisted Reproductive Technologies (including any existing 

or future reproductive technology that involves the handling of eggs or sperm) is in 

keeping with VA’s goal to restore the capabilities of Veterans with disabilities to the 

greatest extent possible and to improve the quality of Veterans’ lives. For many Veterans, having children is an important and essential aspect of life, and those who 

desire but are unable to have children of their own commonly experience feelings 

of depression, grief, inadequacy, poor adjustment, and poor quality of life. 

VA estimates the cost of providing these new benefits to all Veterans would be 

$59 million in FY 2013, $37 million in FY 2014, $232 million over 5 years, and $529 

million over 10 years. The cost estimate is higher in the first year than in subsequent years because VA assumes that existing demand would result in immediate 

utilization of this benefit, but that demand would decline after these services were 

provided. 

Section 4 would add a new section 1787 to Title 38 that would require VA to furnish fertility counseling and treatment, including assisted reproductive technology, 

to a spouse or surrogate of a severely wounded enrolled Veteran who has an infertility condition incurred or aggravated in line of duty, if the spouse and the Veteran 

apply jointly for such counseling and treatment through a process prescribed by VA. 

This section would authorize VA to ‘‘coordinate fertility counseling and treatment’’ 

for other spouses and surrogates of other Veterans. Section 4 would require VA to 

prescribe regulations to carry out section 1787 no later than 1 year after enactment. 

47 

VA supports section 4 in part, but must condition this support on assurance of 

the additional resources that would be required were this provision enacted. While 

VA supports providing infertility services including Assisted Reproductive Technology (ART) to severely wounded Veterans described in section 4 and their spouses 

or partners, VA does not support coverage of surrogates. The additional coverage of 

surrogates is inconsistent with coverage provided by the Department of Defense 

(DOD), Medicaid, Medicare, and several private insurers and health systems. Current DOD policy addressing assisted reproductive services for severely injured Servicemembers specifically excludes coverage of surrogates. Moreover, the complex 

legal, medical and policy arrangements of surrogacy vary from state to state due to 

inconsistent local regulations. VA acknowledges that surrogacy may offer the only 

opportunity for Veterans and their partners to have a biological child. However, 

there may be other options to consider when exploring how best to compensate these 

Veterans for their loss and to facilitate procreation. 

VA recommends clarification of the phrase, ‘‘a severely wounded veteran who has 

an infertility condition incurred or aggravated in line of duty in the active military, 

naval, or air service’’ in subsection (a) of proposed section 1787 in section 4. The 

current language is unclear as to whether this benefit would be available to the 

spouses and surrogates of enrolled Veterans that have suffered loss or loss or use 

of creative organs, or if the eligible population would be more limited based on certain conditions of such Veterans (e.g. those with SCI, polytrauma, genitourinary injuries). VA also recommends clarification of the terms ‘‘fertility counseling and treatment’’ and ‘‘assisted reproductive technology.’’ In addition, the meaning and scope 

of the coordination contemplated under proposed section 1787(b) (which would authorize VA to ‘‘coordinate fertility counseling and treatment’’ for the spouses and 

surrogates of other Veterans not described in section 1787(a)) is unclear, and could 

potentially account for spouses and surrogates of all other Veterans. VA recommends that this be clarified as well. 

VA recommends that this legislation be consistent with DOD’s 2012, ‘‘Policy for 

Assisted Reproductive Services for the Benefit of Seriously or Severely Ill/Injured 

(Category II or Ill) Active Duty Servicemembers.’’ As such we recommend this legislation account for both severe injury and illness. VA cannot separate the costs of 

illness and injury. In the context of reproductive health, the distinction between illness and injury often is not a clearly defined boundary. 

VA also recommends the language of the bill be modified to account for different 

types of family arrangements, so that benefits are not limited to only spouses of Veterans described in proposed section 1787 (e.g. to include both spouses and partners 

of Veterans). 

The bill does not state whether maternity services would be covered for a female 

spouse of a Veteran once infertility treatment is provided and pregnancy is established. These benefits typically would be provided in the private sector following 

successful fertility treatment. If the Committee intends that these benefits be included, we recommend that be made clear in the bill language. 

VA also notes that the timeline to implement regulations for this program within 

one year of enactment is unrealistic given the complexity of issues involved. 

VA’s cost estimates for care provided under this section do not account for maternity services for a female partner or spouse of a Veteran with infertility because the 

bill does not state that maternity services would be covered for a female partner 

or spouse of a Veteran once infertility treatment is provided and pregnancy is established. Potential costs for surrogates are also not reflected in this analysis because 

VA has no reliable way to predict how many surrogates would be utilized and cannot project the costs to cover the full range of legal and medical issues arising from 

surrogacy. This analysis accounts for the following infertility services, and includes 

the costs of providing in vitro fertilization to the proposed eligible population: advice/office visits, testing, drug therapy, surgery or treatment for blocked tubes, 

tubotubal anastomosis (reversal of tubal ligation), vasovasotomy (reversal of vasectomy), varicocele repair (repair of varicose veins around scrotum), artificial insemination (AI)/intrauterine insemination (lUI), assisted reproductive technologies 

(ART), and ART with donated egg/sperm, ART with frozen embryo, and ART with 

host uterus. VA’s cost estimates also assume there is pent-up demand for these 

services, so first year costs are expected to be significantly higher as Veterans and 

their families would immediately utilize these treatment options. The estimates reflect only the cost of services and do not reflect any potential costs associated with 

additional enrollment or additional utilization. VA’s cost estimate is based on the 

assumption that the benefits under section 4 would be extended to the spouses of 

Veterans with SCI, polytrauma, or genitourinary injuries, or other creative organ 

loss. VA is unable to differentiate between creative organ loss that is a result of injury and that which is a result of illness. Therefore, this analysis includes spouses 

48 

and partners of Veterans with creative organ loss which could be a result of illness 

or injury. 

VA estimates the total cost to provide care under section 4 for spouses and partners of severely injured Veterans (those with polytrauma, genitourinary injuries, 

and spinal cord injuries, as well as creative organ loss, which could result from both 

injury or illness) to be approximately $77 million in FY 2013, $36 million in FY 

2014, $252 million over 5 years, and $590 million over 10 years. As with section 

3, VA anticipates a greater cost in FY 2013 as existing demand for these services 

is addressed. 

Section 5 would require VA to enhance the capabilities of the VA Women Veterans Call Center (WVCC) in responding to requests by women Veterans for assistance with accessing VA health care and benefits, as well as in referring such Veterans to community resources to obtain assistance with services not furnished by 

VA. 

VA supports section 5 of S. 3313, and VA believes the most effective means of implementing this section would be to establish an inbound calling system specifically 

for women Veterans. By building on capabilities within the WVCC, an incoming call 

center would allow women Veterans to call the WVCC, and VA to connect them to 

resources, assist with specific concerns, and provide information on services and 

benefits. Many Veterans call VA daily requesting more details on how to enroll, how 

to find their DD–214, and what benefits they have earned. WVCC can directly connect women Veterans to Health Eligibility Center employees for enrollment information and discussion of benefits available to them. Calls could also be transferred to 

the appropriate medical center to assist eligible Veterans with obtaining a health 

care appointment. Once a woman Veteran is connected to VA health care services, 

the Women Veterans Program Manager could also assist her in finding community 

resources that may not be provided by VA. VA estimates section 5 would cost $1.2 million in FY 2013, $6.4 million over 5 

years, and $14.1 million over 10 years. 

Section 6 of S. 3313 would expand the locations and duration of the pilot program 

required by section 203 of Public Law 111–163. Section 203 required VA to carry 

out a pilot program to evaluate the feasibility and advisability of providing reintegration and readjustment services in group retreat settings to women Veterans 

recently separated from service after a prolonged deployment. Section 6(a) would increase the number of locations at which VA is required to carry out the pilot program from three to fourteen locations. Section 6(b) would extend the duration of the 

pilot from 2 years to 4 years. 

VA supports section 6 of S. 3313. VA is currently in the final year of the original 

2-year pilot program, authorized by section 203 of Public Law 111–163. These retreats under the pilot program focus on building trust and developing peer support 

for the participants in a therapeutic environment. In FY 2011, VA provided three 

retreats to women Veterans with three more retreats scheduled for FY 2012. VA 

could benefit from additional retreats as a greater number of women Veterans will 

be able to participate. These additional participants will also provide more data for 

VA to make a determination as the appropriateness of these retreats during the 

final reporting phase. Initial reports provided after the completed retreats show favorable results with supplying participants with tools needed to make a successful 

reintegration into civilian life. 

While VA supports section 6, we note that there may not actually be fourteen distinct geographic locations that offer the level of service the program requires. Therefore, we recommend that section 6(a) be amended to require VA to carry out the 

pilot program in up to fourteen locations. VA would continue to look for new locations to hold these retreats if section 6 were enacted, but previously used facilities 

may need to be reused due to the shortage of potentially qualifying locations based 

on the retreat requirements, specifically the need for specialized locations to complete outdoor team building exercises and other conditions. 

Because VA will have completed retreats at six locations by the end of FY 2012, 

section 6 would require VA to schedule retreats at an additional eight locations before entering the final reporting phase. VA estimates that the cost of implementing 

this pilot program at an additional eight locations for an additional 2 years of the 

pilot program would cost $335,640 in FY 2013 and $348,000 in FY 2014, for a total 

of $683,640. 

Section 7(a) would modify the duration of the pilot program required by section 

205 of Public Law 111–163. Section 205 required VA to carry out a 2-year pilot program at no fewer than three VISNs to furnish child care services to eligible Veterans as a means of improving access to mental health care and other health care 

services. Section 7(a) would extend the duration of the pilot such that ’’[a] child care 

center that is established as part of the pilot program may operate until the date 

49 

that is 2 years after the date on which the pilot program is established in the third 

Veterans Integrated Service Network.’’ 

VA supports section (7)(a). Currently, VA has two operational sites for the pilot 

program required by section 205 of Public Law 111–163: the first site established 

in Buffalo in October 2011, and the second site established in Northport in 

April 2012. The third identified site, in American Lake, WA, began offering services 

in the community in August 2012, and is expected to open its program on its VA 

campus in late 2012. This amendment would extend the authorization to execute 

currently planned programs and consequently would result in no additional cost to 

VA. 

Section 7(b) would require VA to carry out a pilot program to assess the feasibility 

and advisability of providing assistance to qualified Veterans to obtain child care 

during the period such Veterans are receiving readjustment counseling and related 

mental health services at a Vet Center. The pilot program would be carried out in 

at least three Readjustment Counseling Service Regions selected by VA, for a 2-year 

period beginning when the last pilot location established under this section is initiated. VA would be required to report to Congress on the pilot program not later 

than 180 days after completion of the pilot program, which would include findings 

and conclusions, as well as recommendations for continuation or expansion of the 

pilot program. Paragraph (8) of section 7(b) would authorize the appropriation of 

$1,000,000 for each FY 2014 and FY 2015 to carry out the pilot program. This section would define ‘‘Vet Center’’ as ‘‘a center for readjustment counseling and related 

mental health services for veterans under section 1712A of title 38, United States 

Code.’’ 

VA supports section 7(b). Some Veterans who use Vet Center services, especially 

those who have served in either Iraq or Afghanistan, have voiced concerns that the 

lack of available child care has impacted their ability to consistently use Vet Center 

services. Vet Center staff members are constantly searching for new initiatives that 

have the potential to increase Veteran access to services. This pilot program could 

help to identify the scope of these concerns within the Vet Center program and determine the effectiveness of potential interventions. However, we have identified 

some concerns about confidentiality under the proposed pilot program, as VA’s Vet 

Centers currently maintain a separate set of records to preserve Veteran information. There is a possibility that Veterans participating in the program would need 

to consent to a verification process that could lead to a child care provider knowing 

that the Veteran is using Vet Center services. The pilot program could allow us to 

determine whether this has an impact on utilization of Readjustment Counseling 

Services. 

VA is not able to provide an accurate cost estimate for section 7(b), as VA has 

no experience in predicting the potential use of such child care programs by Veterans who use Vet Center services. It is not viable to use cost estimates from the 

VA Child Care Pilot Program required by section 205 of Public Law 111–163, as this 

pilot is providing additional services through onsite child care and Vet Centers do 

not have space to accommodate such additional services. Further, usage comparisons with this pilot are not viable, as Vet Centers provide services during non-traditional hours, including after normal business hours and on weekends when requested by the Veteran. Depending upon how the program is executed, the $1 million that would be authorized to be appropriated under paragraph (8) of section 7(b) 

may not be adequate to support a pilot program offering child care services at three 

Vet Center locations. 

S. 3316—A BILL TO REQUIRE THE SECRETARY OF LABOR TO CARRY OUT A PILOT PROGRAM ON PROVIDING VETERANS WITH ACCESS AT ONE-STOP CENTERS TO INTERNET

WEB SITES TO FACILITATE ONLINE JOB SEARCHES, AND FOR OTHER PURPOSES. 

Section 1 of S. 3316 would require the Secretary of Labor to commence a pilot program to assess the feasibility and advisability of providing Veterans seeking employment with access to computing facilities to facilitate the access of such Veterans to 

Internet Web sites. The bill requires commencement of the pilot program not later 

than 90 days after the date of the enactment of this Act. VA defers to the DOL on 

section 1 of the bill. 

Section 2 of this bill would repeal 38 U.S.C. § 7324, which requires the Secretary 

of VA to submit to Congress an annual report on the use of authorities to enhance 

retention of experienced nurses. VA supports this proposal. This reporting requirement has been provided annually to Congress since 2002. The Veterans Health Administration (VHA) is very interested in retaining experienced nurses, and this report has demonstrated for 10 years how VHA utilizes its authorities to enhance retention. Given that VHA intends to continue its retention efforts, as the report has 

50 

demonstrated over the last 10 years, there is minimal value in resubmitting the 

same data, with slight variation, annually. There would be a cost savings associated 

with the bill. Annually, VA spends $4,082 to prepare this report. VA estimates cost 

savings of $20,400 over 5 years and $40,820 over 10 years. 

S. 3324—GRANTS TO NONPROFIT ORGANIZATIONS FOR THE CONSTRUCTION OF FACILITIES

FOR TEMPORARY LODGING

S. 3324 would authorize VA to award grants to the Fisher House Foundation, Inc. 

for the construction, furnishing, and decorating of Fisher Houses to be used by VA 

to provide temporary lodging under 38 U.S.C. § 1708(a). This bill would also authorize VA to accept, use, and dispose of gifts of services or property for purposes of 

awarding these grants or for operating and maintaining Fisher Houses. Finally, the 

bill would authorize the appropriation of $4,000,000 for FY 2013 and each fiscal 

year thereafter. 

VA Fisher Houses improve access to care for Veterans by providing a supportive 

environment for family members and caregivers to stay during the course of medical 

treatment. Veterans are more likely to travel long distances to receive care if their 

families and caregivers can accompany them without bearing the burden of costs associated with hotel lodging. VA supports the Fisher House and other similar foundations. We note that the bill would set a new precedent in allowing funding for Fisher 

House construction, where previously VA only provided operation and maintenance 

funding. Further, the bill limits these grants to only the Fisher House Foundation. 

Other community organizations have provided funding for the construction of temporary lodging at VA medical centers. For example, Lilly Endowment, Inc., in collaboration with other community organizations, funded a grant to construct the 

‘‘Veterans House,’’ which opened in 2011, and is located on the grounds of the Richard L. Roudebush VA Medical Center in Indianapolis, Indiana. VA estimates the cost of this bill to be $4.2 million in the first year, $20.9 million over 5 years and $41.9 million over 10 years. 

S. 3336—A BILL TO AUTHORIZE THE SECRETARY OF VETERANS AFFAIRS TO CARRY OUT

A MAJOR MEDICAL FACILITY PROJECT LEASE FOR A DEPARTMENT OF VETERANS AF- FAIRS OUTPATIENT CLINIC AT EWA PLAIN, OAHU, HAWAII, AND FOR OTHER PURPOSES

S. 3336 would authorize the Secretary of VA to carry out a major medical facility 

project lease for an outpatient clinic at Ewa Plain, Oahu, in an amount not to exceed $16,453,300. 

VA supports the bill, but as written it does not fully describe the project. Because 

the outpatient clinic will be co-located with the Department of Defense, VA suggests 

modifying the language as set forth below. 

‘‘The Secretary of Veterans Affairs may carry out a major medical facility 

lease for a Department of Veterans Affairs outpatient health care access 

center, to include a co-located clinic with the Department of Defense and 

the co-location of the Veterans Benefits Administration Honolulu Regional 

Office and the Kapolei VA Vet Center, in an amount not to exceed 

$16,453,300.’’ 

S. 3340—MENTAL HEALTH ACCESS TO CONTINUED CARE AND ENHANCEMENT OF

SUPPORT SERVICES ACT OF 2012

Title I 

With regard to sections 101 through 103 and sections 107 through 113 of S. 3340, 

VA defers to the views of the Department of Defense (DOD), as these sections primarily affect DOD programs. 

Section 104 of S. 3340 would limit disclosure by DOD medical and mental health 

care providers of a mental health condition of a member of the Armed Forces, treatment of a member for a mental health condition, or a member’s request for treatment of a mental health condition. Under this section, a DOD medical or mental 

health care provider could only make such a disclosure if: 

(1) The disclosure is to another covered entity (as defined for purposes of the 

Health Insurance Portability and Accountability Act of 1996 (HIPAA)) and is necessary; 

(2) The member concerned requests the disclosure; 

(3) The member concerned does not meet the minimum standards for deployment 

prescribed under section 1 074f(f) of Title 10, United States Code, at the time of the 

disclosure, regardless of the deployment status or plans of the member; or 

(4) The disclosure is necessary in an emergency to protect the life or safety of the 

member concerned or others. 

51 

While VA supports the goal of limiting unnecessary disclosures of Servicemembers’ mental health records, we do not support section 104 because its provisions would complicate and delay the delivery of benefits to which Veterans are entitled. Currently, the Veterans Benefits Administration (VBA) is authorized to request and receive mental health treatment records from DOD without requiring the 

Veteran to sign a medical release for such disclosure. However, because VBA is not 

a ‘‘covered entity’’ under HIPAA, section 104 would require that a Servicemember 

or Veteran specifically request that VBA obtain the protected records. Thus, the provisions of section 104 would add an additional administrative burden for VBA in adjudicating claims for mental disorders that would potentially operate to the detriment of Veterans in need of compensation benefits by delaying the adjudication 

of their claims. 

There are no mandatory or significant discretionary costs associated with section 

104. However, the proposed provision would likely delay claims processing for Veterans seeking compensation for mental health conditions by imposing the additional 

requirement that VA obtain from every Veteran claiming compensation for a mental 

health condition a specific release of information to forward to DOD. This additional 

step could ultimately delay the delivery of benefits, or possibly result in a denial 

of benefits otherwise warranted if the Veteran failed to provide the necessary authorization. 

Section 105 would require DOD and VA to enter into an MOU governing the sharing of examination results and other records retained under DOD’s medical tracking 

system for members of the Armed Forces deployed overseas. 

VA does not support the proposed provision. Current agreements between DOD 

and VA already permit the sharing of information contained within medical tracking 

systems for members deployed overseas. The current agreements enable VA to procure such records for purposes of VA health care and benefits claims. For example, 

DOD and VHA share information from DOD’s Pre-and Post-Deployment Health Assessment surveys and the Post-Deployment Health Reassessments surveys by utilizing the Federal Health Information Exchange (FHIE) and Bidirectional Health 

Information Exchange systems. DOD sends data on separated Servicemembers to 

VA on a monthly basis, and weekly for individuals referred to VA for care or evaluation. Because VA and DOD already share this information pursuant to an MOU governing health information sharing, this provision is unnecessary. It is unclear 

whether this provision would require an additional MOU to replace or supplement 

the existing memorandum covering the same subject. There would be no costs associated with enactment of this provision. 

Section 106 would require DOD and VA to enter into an MOU providing for participation of members of the Armed Forces in VA peer support counseling programs 

and would require VA to provide training to Servicemembers who will perform peer 

support counseling duties under those programs. VA has no objection to this section 

of S. 3340. VA already is undertaking actions consistent with the objective of section 

106 without the use of a memorandum of understanding. VA currently has a peer 

support specialist position in development for which active duty Servicemembers 

would be eligible to apply. All VA peer support counselors receive training. In addition to the formal peer support training program, a volunteer position description 

has also been developed expressly to provide volunteer support to those Veterans 

in the suicide prevention program. While VA does not consider these volunteers to 

be ‘‘peer specialists’’ and would not expect or want these volunteers to provide counseling services, there are a variety of ways that they can provide support to fellow 

Veterans, such as companionship. VA encourages and supports this engagement 

through the suicide prevention volunteer program. VA estimates the cost of this provision would be $32.4 million for FY 2013; $167.5 million over 5 years; and $349.8 

million over 10 years. 

Title II 

Section 201(a) would require that VA, no later than December 31, 2013, develop 

and implement a comprehensive set of measures to assess mental health care services furnished by VA. These measures must provide an accurate and comprehensive 

assessment of the timeliness of the furnishing of VA mental health care, the satisfaction of patients who receive VA mental health care services, the capacity of VA 

to furnish mental health care, the availability and furnishing of evidence-based 

therapies by VA. Section 201(b) would require VA, not later than December 31, 

2013, to develop and implement guidelines for the staffing of general and specialty 

mental health care services, including at community-based outpatient clinics. Such 

guidelines must include productivity standards for providers of mental health care. 

VA has no objections to Section 201(a), although it is partially duplicative of current processes in place by the VHA Office of Mental Health Operations (OMHO) and 

52 

Office of Mental Health Services (OMHS). OMHO and OMHS have partnered to 

develope four separate work groups to address access measurement in response to 

the recent review by the Office of the Inspector General. VHA leadership has put 

forth both temporary and long-term proposals addressing access measurement. VHA 

is currently reviewing patient satisfaction using the Survey of Healthcare Experiences of Patients survey tool, and conducting meetings with Veterans at every 

OMHO site visit scheduled this year and on a recurring 3-year basis to provide feedback from Veterans on mental health services. VHA has also developed a specific 

survey to obtain Veteran feedback about mental health care and will be implementing the survey in FY 2013. Capacity to furnish mental health care is measured 

by the Comprehensive Mental Health Information System (MHIS), which allows 

VHA to review the amount of mental health services provided per unique Veteran 

at a facility and compare results across facilities. Likewise, VHA is able to partially 

monitor the availability and furnishing of evidence-based psychotherapies (EBP) 

using the Comprehensive MHIS, which provides an overall measure for psychotherapy implementation as well as specific metrics related to the provision of such 

services for Veterans with PTSD, Depression, Substance Use Disorders , and Serious Mental Illness (SMI). VHA anticipates the implementation of the templates for 

the EBP notes in FY 2013 will provide more specific information for analysis. 

VA has no objections to section 201(b), OMHO is partnering with OMHS to further develop the mental health staffing model. A pilot is currently underway in 

(Veterans Integrated Service Networks (VISN) 1, 4, and 22, the results of which will 

help further guide implementation to all VISNs in FY 2013. Productivity standards 

for mental health providers have been drafted and are being reviewed internally by 

VHA before final approval. There are no additional costs involved for these subsections if efforts are covered by current VHA staff. 

Section 201(c) would require VA seek to enter into a contract with the National 

Academy of Sciences to create a study committee to consult with VA on VA’s development and implementation of the measures and guidelines required by subsections 

(a) and (b); and to conduct an assessment and provide an analysis and recommendations on the state of VA’s mental health services. The contract must require the 

study committee to assess certain issues, conduct surveys, and make recommendations to the Secretary on certain issues. Any subcommittee that assists the study 

committee must include at least one former VHA official and two former VHA employees who were providers of mental health care. The study committee would be 

required to submit periodic reports to VA and provide other consultation to VA. Not 

later than 30 days after receiving a report from the Committee, VA would be required to submit to the Congressional Veterans’ Affairs Committees a report on VA’s 

plans to implement each recommendation in the report. 

Section 201(c) appears to be duplicative of processes already in place within 

OMHO. However, VA does not object to the provision because a contract might be 

beneficial for consultative purposes to augment current internal efforts. 

VA has no objection to this subsection.VHA has already reviewed barriers to mental health services using focus groups with mental health provider staff as well as 

through OMHO site visits at every facility this fiscal year. Comprehensive site visits 

have been conducted during which OMHO reviewed the implementation of the Uniform Mental Health Services Handbook at each facility. VHA could further modify 

these ongoing site visits to review implementation of early interventions services for 

hazardous drinking and relationship problems for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans, as proposed 

in section 201(c). A survey of Veterans and clinical providers is also currently being 

finalized for distribution to the field and will include Veterans from OEF/OIF/OND. 

Follow-up analyses of both the surveys and the site visits will be submitted to upper 

management detailing overall concerns. Individual facilities are submitting action 

plans based on each site visit report. These actions plans are monitored by OMHO 

and a follow-up action plan will be developed based on the survey summary. It 

should be noted that site visit teams are also comprised of facility mental health 

providers and leaders. A compiled report can be made regularly to the Secretary for 

distribution to Congress as desired. 

Section 201(d) would require VA to make available to the public on a VA Internet 

Web site the measures and guidelines developed and implemented under this section and an assessment of the VA’s performance using such measures and guidelines. VA would be required to update the measures, guidelines, and assessment 

made available to the public not less frequently than quarterly. 

VA has no objection to this provision. VHA could publish its measures and guidelines along with an assessment of VA’s performance that is based on these metrics. 

This would be placed on an Internet Web site for public awareness. However, it 

53 

should be noted that such assessments cannot always be updated quarterly, as some 

metrics may be updated at various points of the year. 

Section 201(e) would require VA to submit to the Congressional Committees on 

Veterans’ Affairs a report on the Secretary’s progress in developing and implementing the measures and guidelines required by section 201 no later than June 30, 

2013, and no less frequently than twice each year thereafter. This subsection specifies what the report must include. 

VA has no objection to providing reports to the Senate Veterans’ Affairs Committee (SVAC) and House Veterans’ Affairs Committee (HVAC) to report on 

progress on the implementation of the measures and guidelines from above. However, to reduce the burden of report preparation, we recommend this provision be 

modified to require reports annually or as needed. 

Section 201(f) would require VA to submit to the Congressional Committees on 

Veterans’ Affairs a report on the Secretary’s planned implementation of such measures and guidelines not later than 30 days before the date on which the Secretary 

begins implementing the measures and guidelines required by this section. This 

subsection sets forth the required elements of this report. 

VA has no objection to this provision. While VHA already has measures in place, 

OMHO could submit a report to the Secretary that outlines descriptions of each 

measure and current vacancies. Prior to submitting an assessment of how many additional positions may be needed to meet demand for services, VHA would need to 

complete the staffing model pilot and incorporate revisions to the staffing model 

based on the outcome of the pilot. 

For those subsections of section 201 with costs, VA estimates the cost of Section 

201 provisions to be $2.3 million in FY 2013; $7.7 million over 5 years; and $9.1 

million over 10 years. 

Section 202 would limit the individuals who can receive readjustment counseling 

from VA, including at Vet Centers, to the following: 

(1) Individuals (Veterans and members of the Armed Forces) who served on active 

duty in a theater of combat operations or an area at a time during which hostilities 

occurred in that area. 

(2) Individuals (Veterans and members of the Armed Forces) who provided direct 

emergency medical or mental health care, or mortuary services to the causalities of 

combat operations or hostilities, but who at the time were located outside the theater of combat operations or area of hostilities. 

(3) Individuals (Veterans and member of the Armed Forces) who engaged in combat with an enemy of the United States or against an opposing military force in a 

theater of combat operations or an area at a time during which hostilities occurred 

in that area by remotely controlling an unmanned aerial vehicle, notwithstanding 

whether the physical location of such Veteran or member during such combat was 

within such theater of combat operations or area. 

(4) Individuals who previously received readjustment counseling. 

(5) Individuals who are family members of a member of the Armed Forces who 

is serving on active duty in a theater of combat operations or in an area at a time 

during which hostilities are occurring in that area. 

(6) Individuals who are family members of a Veteran or member of the Armed 

Forces described above. 

With respect to individuals described in (1) through (4) above, VA would be authorized to provide counseling to assist in readjusting to civilian life. For individuals 

described in (5) and (6) who are family members of a member who is deployed in 

a theater of combat operations or an area at a time during which hostilities are occurring in that area, VA may provide counseling during such deployment to assist 

them in coping with the deployment. For individuals who are family members of a 

member or Veteran who is readjusting to civilian life, VA may provide counseling 

to them to the degree that counseling furnished to them is found to aid in the readjustment of the Veteran or member to civilian life. 

Section 202 also would permit licensed and certified mental health care providers 

to determine that mental health services are needed to facilitate a Veteran’s successful readjustment to civilian life. Currently, the law only permits physicians or 

psychologists to do this. 

Section 202 would define the term ‘‘Vet Center’’ as a facility which is operated 

by VA for the provision of services under this section and which is situated apart 

from VA general health care facilities. 

Section 202 would define the term ‘‘family member’’ to mean an individual who 

is a member of the family of the Veteran or member of the Armed Forces, including 

a parent, a spouse, a child, a step-family member, or an extended family member; 

54 

or an individual who lives with the Veteran or member of the Armed Forces, but 

is not a member of the family of the Veteran or member of the Armed Forces. 

Finally, section 202 would authorize VA to provide for and facilitate the participation of VA employees who provide services under this section in recreational programs that are designed to encourage the readjustment of Veterans eligible for 

counseling under this section; and operated by organizations named in or approved 

by VA to prepare, present, and prosecute claims for Veterans’ benefits. 

VA supports this section, which would expand readjustment counseling services 

to two new cohorts: (1) Medical, Mental Health, and Mortuary Professionals who 

deal with the casualties of war; and (2) Servicemembers and Veterans who served 

in positions within unmanned aerial vehicle crews. Both of these groups represent 

individuals that may not have necessarily deployed to combat theaters or areas of 

hostilities though still experience firsthand the reality of war and have their own 

unique readjustment to civilian life. 

There would be no cost associated with this section. These two cohorts represent 

a relatively small number of Veterans and Servicemembers. Furthermore, VA will 

be augmenting Vet Center staff around Active Duty military bases, where many of 

these individuals are stationed, as a part of the implementation of Section 401, Public Law 111–163 which expands Vet Center eligibility to active duty Servicemembers 

who served in OEF/OIF/OND. 

Section 203 would authorize VA, subject to the availability of appropriations, to 

furnish mental health care to immediate family members of members of the Armed 

Forces who are deployed in connection with a contingency operation through VA 

medical facilities, !elemental health modalities, and such community, nonprofit, private, and other third parties as the Secretary considers appropriate. Family members would not be eligible for VA payments for beneficiary travel as part of this 

care. VA does not support this provision. These services are currently provided to family members of deployed Servicemembers by TRICARE or at a DOD medical facility. 

It is unclear what additional services would be offered by VA that are not already 

provided by TRICARE or DOD. VA estimates the cost of the provision to be $1.1 billion in FY 2013; $7.6 billion over 5 years; and $19 billion over 10 years. 

Section 204 would amend Subchapter 1 of Chapter 73 of title 38 of the United 

States Code, to add a new section 7309, which would restructure the Readjustment 

Counseling Service (RCS) as a distinct organization within VHA, and add a new position of Chief Officer with direct authority over RCS staff and assets, including Vet 

Centers, who would report directly to the Under Secretary for Health. It would establish qualifications standards for Chief Officer, including, in part, combat Veteran 

status, psychological doctorates and internships approved by the American Psychological Association (APA), and minimum amount of required experience in administering and providing direct counseling or outreach services. This new section 

would fund the activities of RCS, including Vet Centers, through VHA’s Medical 

Care appropriations, but prohibit allocation of the funds through the Veterans Equitable Resource Allocation system. Section 7309 also would require an annual report 

to Congress on the activities of RCS, including each Vet Center’s workload, additional treatment capacity, and ratio between FTE employees and individuals served, 

and detailed analysis of demand and unmet need for readjustment counseling services and the plan for meeting such need. 

VA does not support this section, which would reorganize RCS within VHA. RCS 

is an independent organizational unit within VHA that provides unique services in 

a safe and confidential environment not provided at VA medical center facilities. Its 

current organizational placement under the Deputy Under Secretary for Policy and 

Services allows RCS to interact with all other clinical programs at the national 

level, while maintaining independence at the operational level. This alignment provides a conduit for coordination and collaboration where services are similar (e.g. 

policy development for mental health services that are common to both RCS and 

other facilities); it also supports the alignment of patient needs when primary care 

or specialty services are identified. 

Section 204 would also establish the statutory qualifications in the new section 

7309 for the Chief Officer position. These include combat Veteran status, psychological doctorates and internships approved by the APA, and minimum years of experience in administrating or providing direct counseling and outreach services. 

Qualification requirements for VA’s organizational Chief Officers are generally not 

set forth in statute. For example, Title 38 does not recognize specific professional 

associations for other health care professionals. In addition, the APA would have the 

sole authority to determine satisfactory doctorates and internships. This would conflict with the Secretary’s authority under 38 U.S.C. § 7402(b)(8) to determine, by polVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00058 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
55 

icy, whether a particular psychological doctorate or internship is ‘‘satisfactory,’’ and 

would require a statutory amendment before VA could accept doctorates or internships from other psychological professional associations. Finally, new section 7309 

would establish the minimum amount of experience required to qualify for the Chief 

Officer position. There is no evidence to support that any set time makes a person 

more or less qualified to apply for the position. These provisions could limit VA’s 

ability to recruit and appoint qualified candidates and result in an unintentional 

limitation on the sources of qualified individuals. 

There are no costs associated with this section. 

Section 205 would require the Secretary to establish a national program of outreach to societies, community organizations and government entities in order to recruit qualified mental health providers on a part-time, without compensation basis 

under 38 U.S.C. § 7405. Section 205 would enable VA to partner with or assist in 

developing a community entity, including through use of a sharing agreement under 

38 U.S.C. § 8153 that provides strategic coordination to the societies, community organizations, and government entities in order to maximize the availability and effective delivery of their mental health services to Veterans. In carrying out the national outreach program, VA would train mental health professionals on military 

and service specific culture, combat experience, and other factors unique to Veterans 

who served in OEF/OIF/OND. 

This section would require VA to participate in outreach to recruit Without Compensation (WOC) Mental Health providers to provide mental health services on VA’s 

behalf. VA currently has provisions for woe Employees that require mandatory credentialing and privileging procedures to assure competency and safety. VHA wants 

to ensure it has the ability to set recruitment targets and approve only those individuals who are qualified to provide mental health services. This summer VHA will 

release an accredited Military Culture Training program that will be available to 

all community providers, including those who provide care in the community for 

Veterans and Servicemembers. 

We do not believe that this legislation is needed and we do not support the widespread recruitment of WOC mental health providers who are not credentialed and 

privileged to provide services under our guidelines. However, VA supports the goal 

of conducting outreach to mental health providers who are appropriately qualified 

to treat our Nation’s Veterans. VA is well positioned to set the appropriate recruitment and training guidelines that will maintain the integrity and safety of VA mental health care. 

VA estimates costs of $32.4 million for FY 2013; $167.5 million over 5 years; and 

$349.8 million over 10 years. Other costs may be needed, e.g., to run EES training 

programs for such WOC employees, but those cannot be estimated at this time. 

Section 206 would amend 38 U.S.C. § 7411 to authorize reimbursement to fulltime board-certified physicians and dentists for certification, recertification, or continuing professional education (CME) expenses up to $1,000 per year or, in the case 

of full-time psychiatrists, up to $4,000 per year. 

VA does not support this section, which would create an inequity among other 

professionals subject to similar continuing education and certification obligations. 

VA estimates costs for the provision at $24.6 million in FY 2013; $132 million 

over 5 years; and $292 million over 10 years. 

Section 207 of S. 3340 would require (as opposed to merely authorize) the Secretary to establish and carry out the peer support counseling program as provided 

for in 38 U.S.C. § 1720F(j). Section 207 would also require that the training provided 

to peer counselors include the training carried out under a contract with a national 

not-for-profit mental health organization for Veterans of OEF and OIF to provide 

peer outreach and peer support services. This program would need to commence at 

each VA medical center no later than 270 days after enactment of the Act. 

VA does not support this provision. Currently, peer services are being provided 

at VA medical centers. In addition, the President recently signed an Executive 

Order to improve access to mental health services for Veterans, Servicemembers 

and military families. The Order requires VA to hire and train 800 peer-to-peer 

counselors to empower Veterans to support other Veterans and help to meet mental 

health care needs by December 31, 2013. Toward this end, new peers will be hired 

this fiscal year and throughout the coming fiscal year to enable VHA to provide 

these services at all VA medical centers and very large community-based outpatient 

clinics (CBOC). VA has developed the national training program and is currently 

soliciting bids for implementation. It is expected that an award will be made this 

summer and training will begin this fall. 

VA estimates that this provision will cost $27.8 million in FY 2013; $249.4 million 

over 5 years; and $567.3 million over 10 years. 

56 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY TO

MADHULIKA AGARWAL, M.D., M.P.H., DEPUTY UNDER SECRETARY FOR HEALTH FOR

POLICY AND SERVICES, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. Last Congress, we created a pilot program to provide child care at several VA medical centers for veterans who were coming in for health care services. 

I understand that the first site opened in October 2011, but that the third site is 

not open for business yet. Please provide any preliminary assessment of the program, or lessons learned from the implementation to date. 

Response. In October 2011, the Department of Veterans Affairs (VA) began carrying out a 2-year pilot program to provide child care services to eligible Veterans 

at the Buffalo VA Medical Center (VAMC), and expanded this program to the 

Northport VAMC in April 2012. The third selected site, at American Lake, WA, a 

Division of the VA Puget Sound Health Care System, is scheduled to open in early 

fiscal YEAR (FY) 13. Preliminary information from this program reveals that Veterans are overwhelmingly supportive of the program and report that it has made 

health care more accessible for them. In FY 2012, VA projects it will spend a little 

more than $1 million to support the program. Data from the Buffalo program covers 

10 months (October 2011-July 2012), and Veteran utilization has steadily increased. 

Buffalo cared for 108 children in the month of July. The overall monthly average 

for the number of children cared for is 61. The program operates 5 days a week at 

both the Buffalo and Northport VAMCs. The Northport VAMC has 3 full months 

of data available (May 2012-July 2012), and has experienced high utilization since 

opening, providing care to 130 children in the month of July. The overall monthly 

average for the number of children cared for is 92. 

We have identified contracting and construction issues as challenges to timely implementation. For example, the Buffalo VAMC operated under a monthly purchase 

order until VA awarded a contract on June 22, 2012. Other delays with construction 

and contracting have pushed back the opening of the American Lake site until early 

FY 2013. 

VA officials have learned several valuable lessons from this pilot. Perhaps most 

important is that an implementation team comprised of individuals from General 

Counsel, Contracting, Public Affairs, and other offices is essential to timely implementation. The requirement for an integrated implementation team will be added 

as experience has indicated significant delays occurred as each office dealt with 

issues such as outreach and contracting sequentially rather than concurrently. 

We also receive valuable feedback from Veterans concerning hours of operation, 

logistics, implementation, and other elements of the program via our approved satisfaction survey. Suggestions for improvement are carefully considered and implemented as appropriate. As the pilot progresses, we anticipate other lessons learned 

will be more readily identified, and we will include this information in our report 

to Congress after the completion of the pilot program. 

VA has determined that its authority to execute the pilot program will expire on 

October 2, 2013, 2 years after the first pilot site opened in Buffalo. Because not all 

facilities began providing these services at the same time, under the current authority, Northport and American Lake will not be able to operate for a full 2 years. Section 7(a) of S. 3313, the Women Veterans and Other Health Care Improvements Act 

of 2012 which currently resides in the Committee, would provide a technical amendment authorizing the program to run for a period of 2 years beginning on the date 

the third site is activated. If such an amendment were made, VA would expand the 

pilot to additional locations in FY 2013 to obtain more, valuable information on the 

costs and benefits. These sites would be selected based upon interest by facility leadership, availability of resources, need for child care services among the Veteran population, and other relevant factors. These additional locations would provide VA 

with more data, thereby allowing VA to provide a better recommendation to Congress on whether the pilot should be continued or expanded. 

Question 2. The Mental Health ACCESS Act of 2012 would make a range of improvements to mental health services for our servicemembers and veterans. Among 

its other provisions, this bill would expand the availability of mental health services 

for family members of veterans and deployed servicemembers. Please discuss the 

importance of veterans having good, stable family support when they return home 

from deployments, and the extent to which VA can help accomplish this goal. 

Response. Family members of Veterans with emotional symptoms and problems 

that arise during their military service or post-deployment face many challenges as 

they strive to be a significant source of strength and support for their Servicemember or Veteran family member. A recent study found that 86 percent of Veterans with Post Traumatic Stress Disorder (PTSD) view their symptoms as a source 

of family stress (Batten et al., 2009). In the case of PTSD, symptoms of emotional 

57 

numbing, including difficulties experiencing and expressing positive and negative 

feelings, can hinder the ability of the Veteran with PTSD to feel close or connected 

to family members (Riggs et al, 1998). Also, symptoms such as irritability, being 

easily startled, and having trouble concentrating or sleeping can contribute to conflict within the family (Taft et al., 2007). Other issues that can contribute to relationship and family issues include difficulty with trusting others, lowering of selfesteem, and problems with power and control. 

Family members are an extremely important source of support for Veterans as 

they heal. The ability to reconnect and reestablish strong bonds with loved ones is 

a critical part of the post-deployment adjustment and the recovery process. The ultimate goal of family support is creating and sustaining mutually-satisfying relationships that bolster the Veteran’s successful community adjustment. Research shows 

that more than three-fourths of Veterans with PTSD are interested in more family 

involvement in treatment (Batten et al., 2009). Furthermore, the success of treatment for PTSD can be increased if family members provide the Veteran with social 

and emotional support. 

VA has the ability to provide a number of services, including several couple- and 

family-based programs to help families develop the skills and attitudes to support 

recovery. VA offers a telephone hotline, Coaching into Care, for family members to 

learn effective strategies to encourage the Veteran to begin or reinitiate VA Services. Many VA facilities sponsor ‘‘The Support and Family Education (SAFE) Program,’’ which is an 18-session educational workshop for families of Veterans living 

with PTSD or serious mental illness. Families may attend as many sessions as 

needed. SAFE topics include Communication Tips for Family Members, ProblemSolving Skills for Families, and Skills for Managing Stress Effectively as a Family 

Member. VA also offers Veteran-Centered Brief Family Consultation (VCBFC), in 

which the family meets with a mental health professional as needed to resolve specific issues related to the Veteran’s treatment and recovery. This intervention is designed to be brief; it usually consists of between one and five sessions for each consultation. Finally, VA offers more intensive couples counseling to help Veterans and 

their loved ones have more satisfying relationships. 

Recently, VA was authorized through section 304 of Public Law 111–163 to provide services to family members up to 3 years after deployment to receive readjustment counseling and mental health services to assist the family member in readjusting after deployment. These services are available through Vet Centers, as well 

as at an increasing number of VA medical centers as new peer support specialists 

are hired. Mental health services for family members can be arranged with community organizations as needed. 

References 

Batten, S. V., Drapalski, A. L., Decker, M. L., DeViva, J. C., Morris, L. J., Mann, 

M. A., & Dixon, L. B. (2009). Veteran interest in family involvement in PTSD 

treatment. Psychological Services, 6(3), 184–189. 

Riggs, D. S., Byrne, C. A., Weathers, F. W., & Litz, B. T. (1998). The quality of the 

intimate relationships of male Vietnam veterans: problems associated with 

Post Traumatic Stress Disorder. Journal of Traumatic Stress, 11(1), 87–101. 

doi: 10.1023/A:1024409200155. 

Taft, C. T., Street, A. E., Marshall, A. D., Dowdall, D. J., & Riggs, D. S. (2007). 

Posttraumatic stress disorder, anger, and partner abuse among Vietnam combat veterans. [Research Support, U.S. Gov’t, Non-P.H.S.]. J Fam Psychol, 

21(2), 270–277. doi: 10.1037/0893–3200.21.2.270 

Question 3. A veteran is lost to suicide every 80 minutes, and so far this year, 

one servicemember commits suicide per day. One of the keys to effective suicide prevention is ensuring there is timely access to care. Often veterans only seek care 

when they are on the verge of crisis. If VA turns them away because they are too 

busy, we have lost the opportunity to help that individual. Concerns remain whether there are enough providers in the system. 

How can VA use authorities like those provided in the Mental Health ACCESS 

Act, along with existing hiring and retention authorities, to recruit and retain top 

mental health providers? 

Response. In direct support of the Mental Health Hiring Initiative (MHHI), the 

Veterans Health Administration (VHA) Workforce Management and Consulting 

(WMC) Office, in partnership with the VHA Human Resources (HR) and Office of 

Mental Health (OMH), has developed and implemented a systematic process to recruit, hire, and retain top mental health providers. 

WMC created multiple task forces that target the recruitment and staffing efforts 

to bring these new employees into VA as effectively and efficiently as possible. The 

58 

Recruitment and Marketing Task Force provides oversight of the national recruitment and marketing strategies for MHHI. 

Recruitment & Marketing Task Force 

Key processes include use of a skilled national team of professional health recruiters, targeted advertising and outreach, aggressive recruitment from a pipeline of 

qualified candidates to leverage against mission critical mental health vacancies, 

and provision of consultative services to Veterans Integrated Service Networks 

(VISN) and VA stakeholders. 

The National Recruitment Program (NRP) provides VHA with an in-house team 

of highly skilled professional recruiters employing private sector best practices to fill 

VA’s most mission critical clinical occupations. As of July 16, 2012, the NRP has 

provided dedicated recruitment support to 251 mental health positions at the specific request of VISN/VAMC leadership (primarily psychiatry and psychology). This 

team of recruiters has helped hiring managers identify and select over 100 psychiatrists. One example of their efforts was recruitment at the American Psychiatric Association (APA) event held May 5–8, 2012, in Philadelphia, PA, which resulted in 

identifying 7 psychiatrists who have received offers, and all are projected to be on 

board by September 30, 2012. 

The Marketing and Advertising task group has implemented an aggressive, multifaceted, sustained national marketing and outreach campaign to include maximum 

visibility to rural and highly rural markets. Completed milestones include: 

• Spotlight advertisement renewed on USAJobs Web site as of June 18, 2012. An 

earlier run resulted in over 8,000 ‘‘click-throughs’’ to www.VAcareers.va.gov. • Online banner advertisement currently being run on seven professional mental 

health association homepages. • Eleven Web banners currently running through the Joining Forces partnership 

and its APA-affiliated networks. 

VA has taken these efforts over the past several months and in previous years 

to partner with professional associations, societies, and other health care organizations for the purpose of recruiting additional mental health providers. 

Hiring and Tracking Task Force 

The Hiring and Tracking Task Force provides oversight for MHHI. This team 

moves the hiring process forward expeditiously in a focused manner and addresses 

any issues or concerns immediately while resolving road blocks to fill each position 

promptly. This task force provides daily oversight on the tracking status of each position and consultative services to VISN Human Resource officers (HRO), OMH, and 

VHA recruiters, as needed. This task force tracks the daily progress of the 1,900 

new hires as well as the 2,815 existing vacancies. The task force conducts daily conference calls with the field H.R. community to ensure engagement and accountability. Hiring Task Force members collaborate with VISN HROs to ensure efficiency and flexibility by implementing specific workflows to enhance timelines: 

Recruitment and Retention Incentives 

VHA promotes maximized flexibility with, and availability of, recruitment and retention incentives (relocation, home buy-out, signing bonuses, student loan repayment programs, etc.) to better attract the best qualified candidates. VHA collaborates with the Office of Human Resource Management to reassess current salary tables for psychiatrists to make these positions more competitive with private industry 

and DOD. 

Provider retention remains a top strategic priority for VHA in its commitment to 

maintaining quality services to Veterans. These incentives permit the staffing and 

retention of difficult-to-fill positions with high quality candidates who possess 

unique skills and competencies. VA clinical education programs are a crucial resource for VA’s employment pipeline. With over 100,000 trainees rotating through 

VA facilities annually, we have a vigorous developmental cohort from which to recruit new staff in 40 or more disciplines. We know, for example, that roughly 70 

percent of current VA optometrists, physicians, and psychologists participated in VA 

training programs prior to their employment in VA. VA is still reviewing the provisions of the Mental Health ACCESS Act to determine how those provisions might 

complement these efforts. 

Question 4. I understand the Department has reviewed each VISN office and is 

proposing to reduce the number of staff. 

a. How are you posing to change which functions will be performed by the network offices? 

Response. VA recognizes the need to improve the consistent and efficient use of 

staffing resources in each VISN office and to ensure that staffing is aligned with 

59 

mission and function. To this end, a workgroup comprised of a small group of VISN 

directors was chartered in the fall of 2011 to conduct a review of each VISN office 

to establish definitions of core and non-core staff functions, identify targeted staffing 

levels, develop an implementation timeline and plan to align VISN staffing levels, 

and develop a monitoring mechanism to assure achievement of target staffing levels. 

As part of the VISN staffing alignment process, each VISN was asked to review its 

organizational chart and staffing reports, and identify which functions are performed by whom, which functions are core to the mission of the VISN office, and 

describe the basis for consolidating certain functions. The input provided by the 

VISNs was evaluated by the workgroup. The workgroup identified a core set of staff 

for all VISNs and that plan has now been approved by the Under Secretary of 

Health. VHA staff briefed staffs on the House and Senate Committees on Veterans’ 

Affairs on July 17, 2012. 

b. What do you believe is an appropriate number of medical centers for a network 

office to oversee? 

Response. VISN boundaries were developed originally based on patient-referral 

patterns, including aggregations of patients and facilities that would be needed to 

support a continuum of primary, secondary, and tertiary care, and to a lesser extent, to be consistent with jurisdictional boundaries such as state lines. Every VISN 

composition is unique, and the complexity levels of the VA medical centers, size of 

patient populations, geographies and regional aspects vary widely. There is no prescribed number of appropriate medical centers for a Network Office to oversee. However, currently the maximum number of health care systems in any one VISN is 

11, and that number does represent the upper limit that would be advisable. 

c. When was the last time the Department reviewed the network boundaries to 

see if they are still the most appropriate way to organize the health care system? 

Response. The current VISN boundaries were first drawn in 1995 as part of 

VHA’s ‘‘Vision for Change’’ plan for reorganizing the Veterans Health Administration, which called for the dissolution of the hierarchical central office, regional office 

and network structure, in favor of 22 VISNs with 5–11 medical centers and various 

other VA assets. One of the sub-objectives of the VISN boundaries of 1995 was to 

achieve a basic budgetary and planning unit for delivery of Veterans health care, 

and a means of pooling resources. The last time VA reviewed the number of VISNs 

was in 2002, and merged VISNs 13 and 14 to form VISN 23. When the VISNs were 

originally formed, there were no medical foster homes, no ambulatory surgery centers, and hundreds fewer community-based outpatient clinics, community living centers (nursing homes), and domiciliaries. VA has subsequently gathered more data 

on long-term care and mental health services, as well as for some inpatient services, 

because sufficient information was not available at the time regarding demand for 

these services and other factors. 

Question 5. VA currently has discretionary authority to pay beneficiary travel for 

some individual who are not otherwise covered specifically by law. Given how difficult it can be for veterans who are blind or have the serious injuries outlined in 

S. 1755, it would seem these veterans could use this assistance. How many of these 

veterans received beneficiary travel benefits from VA under the existing authority? 

Response. VA does not track beneficiary travel payments by patient diagnosis. 

However, historical data indicates that approximately 33 percent of VHA users collect travel benefits. Assuming the same benefit use rate for the three groups identified in S. 1755, VA estimates the following beneficiary travel usage based upon 

workload for FY 2011. 

Condition VHA Users Beneficiary 

Travel Users 

Spinal Cord Injury (SCI) .......................................................................................................... 20,724 6,839 

Amputee .................................................................................................................................. 7,088 2,339 

Blind ........................................................................................................................................ 39,956 13,185 

Total ............................................................................................................................... 67,768 22,363 

Question 6. The Department recently set a goal to increase access to mental 

health care services through telehealth consultations, and is working to improve veterans’ access to services in rural areas. As you know, bandwidth capacity in rural 

areas can be severely limited. Some medical centers have to prioritize clinical services when networks are slow in order to protect critical hospital functions. One particularly vulnerable service is these remote mental health care services are interVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00063 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
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rupted. What is VA’s plan to ensure each medical center and clinic involved in the 

clinic-based telehealth program is properly equipped and will have enough bandwidth to conduct video consultations? 

Response. In anticipation of using telehealth to expand Veterans access to mental 

health services (telemental health) and other specialty care services, VA ensured the 

necessary support structures are in place as part of its FY 2011–2012 Expansion 

Initiative. The Telehealth Expansion Initiative began in June 2011, and resulted in 

the completion of major purchases in all VISNs of clinical videoconferencing equipment and associated telehealth peripherals and equipment; and the hiring of Telehealth Program Managers in each VISN and Telehealth Coordinators at every 

VAMC. In FY 2012, funding support continued for these positions and VISNs were 

provided additional funding to recruit 1,144 Telehealth Clinical Technicians (TCTs) 

to assist clinicians with delivery of telehealth based care, where the patient and the 

provider are separated geographically. 

As of 3rd quarter FY 2012, this VA initiative has: 

• Provided more than 3,200 clinical videoconferencing units for telehealth to all 

VAMCs and their associated sites of care. 

• Ensured these sites of care have the necessary telecommunications capability 

(‘‘bandwidth’’), namely being able to provide two concurrent clinical video telehealth 

(CVT) consultations at 384 kilobits/second, in place by September 2012. 

• Recruited and trained a 1,012 telehealth clinical technicians (TCT) to assist clinicians in VA medical centers and community-based outpatient clinics to provide 

care via telehealth, and to offer the first line of support in the event of technical 

problems with equipment as of June 2012. 

• Established a national telehealth help desk that provides immediate access to 

technical assistance for clinicians and TCTs at all VA sites of care with expertise 

to resolve technical problems that TCTs cannot address on-site. 

As a result of this preparatory work VA has the technology infrastructure and 

technical support to meet its goals for increased access to mental health care services through telehealth consultations. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. SCOTT BROWN TO

MADHULIKA AGARWAL, M.D., M.P.H., DEPUTY UNDER SECRETARY FOR HEALTH FOR

POLICY AND SERVICES, U.S. VETERANS HEALTH ADMINISTRATION

Question 1. Please describe the relationship that currently exists between VA and 

the Fisher House Foundation. 

Response. Fisher Houses are housing facilities located at, or in proximity to, a VA 

medical facility; are available for residential use on a temporary basis by patients 

of that facility and their family members; and are constructed by and donated to 

the Secretary by the Zachary and Elizabeth M. Fisher Armed Services Foundation. 

VA has 21 operational Fisher Houses with planned expansion to 38 VA Fisher 

Houses over the next several years. In 2011, over 11,797 families and caregivers utilized VA Fisher Houses in order to be close to a Veteran or Active Duty Servicemember during the course of medical treatment. 

VA Fisher Houses improve access to care for Veterans and Active Duty Servicemembers by providing a supportive environment for family members and caregivers 

to stay during their course of medical treatment. Veterans and Active Duty Servicemembers are more likely to travel long distances to receive care if their families and 

caregivers can accompany them without bearing the burden of costs associated with 

hotel lodging. Once donated to VA, it is the expectation of the Fisher House Foundation that VA Fisher Houses are maintained in pristine condition, and funding is 

available to support the costs of refurbishing, redecorating, and replacing major appliances in VA Fisher Houses. The corresponding VA medical center is also responsible for funding all Fisher House operations. 

Question 2. In the opinion of VA leadership, how many VA medical centers or 

campuses require a Fisher House, and which sites are the most critical? 

Response. VA has a formal process to identify and prioritize VA medical centers 

for Fisher House construction. First, VA initiates a formal call for Fisher House applications. 

Applications are evaluated and prioritized based upon the following criteria: 

• The availability of services in specialty areas such as Polytrauma, Spinal Cord 

Injury, Blind Rehabilitation, Transplant, Inpatient Palliative Care and Hospice Programs, and Oncology Programs; 

• VA medical centers serving a large post-9/11 Active Duty population; 

• VA medical centers serving large rural catchment areas; and 

61 

• The availability of land to construct a VA Fisher House on or within close proximity to a VA medical center. 

The following are locations with an identified need for a Fisher House: 

• Michael E. DeBakey VA Medical Center, (second house)—Houston, Texas 

• North Florida /South Georgia Veterans Healthcare System—Gainesville, Florida 

• Tennessee Valley Healthcare System Murfreesboro Campus—Murfreesboro, 

Tennessee 

• Clement J. Zablocki Veterans Affairs Medical Center—Milwaukee, Wisconsin 

• Louis Stokes VA Medical Center—Cleveland, Ohio 

• VA Long Beach Healthcare System—Long Beach, California 

• VA Connecticut Healthcare System—West Haven, Connecticut 

• VA Eastern Colorado Healthcare System—Denver, Colorado (new medical center) 

• Orlando VA Medical Center—Orlando, Florida 

• Omaha-VA Nebraska/Western Iowa Healthcare System—Omaha, Nebraska 

• VA Maine Healthcare System—Togus, Maine 

• VA Caribbean Healthcare System—San Juan, Puerto Rico 

• New Mexico VA Healthcare System—Albuquerque, New Mexico 

• Portland VA Medical Center—Portland, Oregon 

• Southern Arizona VA Healthcare System—Tucson, Arizona 

VA continues to assess on a regular basis the need for additional Fisher Houses, 

and many VA medical centers have expressed interest in future Fisher House construction. 

Question 3. For those existing VA medical centers and campuses without a Fisher 

house, what is the VA currently doing to provide families with comparable lodging? 

Response. VA medical centers provide alternative resources to accommodate families requiring temporary lodging assistance. These resources may include providing 

lodging at a temporary lodging facility located at a VA health care facility (generally 

referred to as a ‘‘Hoptel’’), or a temporary, non-VA lodging facility, such as a hotel 

or motel, funded by a VA health care facility. VA medical centers also have relationships with community Hospital Hospitality organizations, such as Ronald McDonald 

House, to assist with temporary lodging accommodations for family members as 

needed. 

Question 4. In the absence of legislation, what can VA do within existing authorities to fund the Fisher House construction on the grounds of medical centers and 

campuses? 

Response. The construction of VA Fisher Houses is a joint venture between the 

Department of Veterans Affairs and the Fisher House Foundation. Existing statutory authority (38 U.S.C. § 1708) defines the term ‘‘Fisher House’’ as a housing facility that is located at, or in proximity to, a Department medical facility; is available 

for residential use on a temporary basis by patients of that facility and others described in 38 U.S.C. § 1708(b)(2); and is constructed by, and donated to the Secretary by, the Zachary and Elizabeth M. Fisher Armed Services Foundation. Current statutory authority does not authorize VA to fund Fisher House construction. 

Question 5. In 2011 GAO released a report entitled, Homeless Women Veterans: 

Actions Needed to Ensure Safe and Appropriate Housing. In that report, GAO found 

that VA and HUD lacked information regarding the characteristic and needs of 

homeless women veterans at the national, state, and local levels. What is the VA 

currently doing to get a handle on this problem, especially as it relates to understanding the unique needs of homeless women veterans with children? 

Response. Established in 2009 by Department of Veteran Affairs Secretary, the 

National Center on Homelessness among Veterans (the Center), is a multi-site initiative within VISN 4 and 8, with leadership offices located at the Philadelphia 

VAMC. As a key component of VA’s National Homeless Programs Office, the Center 

and its academic affiliates play a critical role in piloting new innovations and developing the empirical knowledge needed to improve the care and quality of life for 

Veterans who are homeless or at-risk for homelessness. The Center’s goal is to improve services to homeless Veterans by developing, promoting, and enhancing policy, 

clinical care research, and education. The Center is also designed to be a national 

resource for both VA and community partners, improving the quality and timeliness 

of services delivered to homeless Veterans and their families. The Center is developing a comprehensive Homeless Registry, a data warehouse that tracks and monitors homeless program expansion, operation, and treatment outcomes. The Homeless Registry allows ‘‘real-time’’ access to data by VA providers, program administrators, VAMC staff, as well as VISN and VHA Central Office leadership to facilitate 

performance monitoring and decisionmaking. 

62 

The registry enhances VHA’s capacity to utilize longitudinal programmatic and 

Veteran-specific data to better evaluate how programs function and how the system 

as a whole is progressing to end Veteran homelessness. The registry has the capacity to provide individualized reports on Veteran characteristics by geographic regions. This new capacity facilitates VHA’s ability to target resources (program funding and grant funding) to where the need is greatest. Examples include gender specific, age, and service era data that inform decisions related to Supportive Services 

for Veteran Families (SSVF) and Department of Housing and Urban DevelopmentDepartment of Veterans Affairs Supportive Housing (HUD-VASH) programs as well 

as Grant and Per Diem (GPD). 

VHA has also realigned its data collection about homeless programs to be more 

consistent with those in HUD’s Homeless Management Information System (HMIS) 

standards. VA bed capacity is now entered into the HMIS bed inventory section to 

achieve coordinated and complete data collection of VA resources in HMIS. VA and 

HUD have collaborated on a single reporting mechanism of Veteran homelessness 

in the Veterans Annual Homelessness Assessment Report (Vet AHAR). These modifications promote greater consistency in reporting prevalence of Veteran homelessness both inside and outside of VA. 

In June 2012, the Homeless Data Cube became available through the VHA Support Service Center (VSSC). The Homeless Data Cube provides data on VA Homeless Services, data analysis, and reporting. The data in the cube goes back to 2006 

through the present and utilizes a variety of data sources. The Homeless Data Cube 

contains descriptive and demographic data on homeless Veterans, including gender, 

Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn 

(OEF/OIF/OND) status, etc. The Homeless Data Cube also contains utilization and 

outcome data on homeless and at-risk Veterans served within VA. Finally, the data 

can be analyzed by program, location (including national, facility, VISN and state), 

and fiscal year. 

Since 1993, VA has collaborated with local communities across the United States 

in Project Community Homelessness Assessment, Local Education, and Networking 

Groups (CHALENG) for Veterans. The mission of CHALENG is to bring together 

Veterans, representatives from VAMCs and Veterans Benefits Administration regional offices, community providers and advocates, local officials, and other concerned citizens to identify the needs of homeless Veterans and then work to meet 

those needs through planning and cooperative action. In 2011, the CHALENG Veterans survey provided gender specific information, and in 2012, the community partner survey will include gender specific questions to increase awareness of women 

and their families’ unique needs. 

VA is working with the US Interagency Council on Homelessness, national Veterans Service Organizations, and Federal, state, local and community partners that 

serve homeless and formerly homeless women Veterans and children to capture the 

needs of homeless women Veterans. 

Chairman MURRAY. Thank you very much. We really appreciate 

the VA’s testimony today. I just have a couple of questions I am 

going to ask and then I will submit the rest for the record because 

we want to make sure we have time to get to the second panel 

today, and I know there are a number of Committee Members here 

who want to ask you questions as well. 

Let me just begin. The witnesses on the next panel are going to 

talk about VA’s fertility treatment options for seriously injured veterans. Their testimony, when taken collectively, is resoundingly 

clear. VA’s fertility treatment options fall short for our veterans 

with very severe injuries. 

Unlike the Department of Defense, the VA is prohibited by regulation from offering IVF. I wanted to ask you today, is the VA considering lifting the ban? 

Dr. Agarwal. 

Dr. AGARWAL. Thank you for the question, Madam Chairman. 

Consistent with VA’s goals to improve health and quality-of-life 

for veterans, we do offer certain infertility treatments and diagnostic tests including genetic counseling. 

63 

However, regulation in 1999 did exclude IVF services from VA’s 

defined medical benefits package. DOD in April this year has defined and clarified implementation guidance on provision of IVF 

services for certain categories of servicemembers, and the VA is reviewing its regulatory options and your Women’s Health Bill, which 

was introduced on June 19, and we will work with you and your 

staff to bring about what needs to happen. 

Chairman MURRAY. Well, the VA cannot offer much in the way 

of care for spouses. What does that mean for couples who need 

extra assistance conceiving a child because of the war injury? 

Dr. AGARWAL. Thank you again for this question, Madam. Congress has generally restricted eligibility of health care services in 

VA to spouses. There are some rare exceptions such as in 

CHAMPVA. 

S. 3313 is aimed at expanding that authority to include infertility management for spouses under some circumstances when the 

veterans injury has precluded their ability to procreate naturally. 

We do not have our position on this yet but are reviewing it and 

again look forward to working with you and the Committee. 

Chairman MURRAY. I appreciate it. On our second panel we are 

going to have some compelling testimony. I hope that the Members 

of our Committee are able to hear what I have been hearing as 

well on this. 

I also wanted to just mention the Mental Health ACCESS Act of 

2012, which I have introduced. I want to stress we need comments 

back from the VA very urgently on this. This is going to expand 

the availability of mental health services for family members of 

veterans and deployed servicemembers. 

As we talked about, the VA currently has very limited authority 

to provide service to family members. So, I would appreciate your 

comments back on that as soon as you can as well. 

With that, let me turn it over to Senator Burr for any questions 

he has. 

Senator BURR. I thank the Chairman. 

Mr. Secretary Schoenhard, VA’s written testimony states that 

the VHA has, and I quote, already reviewed each VISN headquarters, is in the process of working with each to streamline operations, create efficiencies internal to each VISN and to realign 

resources. 

Has General Shinseki been briefed on what that realignment is 

going to look like? 

Mr. SCHOENHARD. Ranking Member Burr, yes, he had been 

briefed, and we are still in the process of discussion and evaluation. 

Senator BURR. When does the Secretary plan to approve those 

recommendations? 

Mr. SCHOENHARD. Sir, we should be having this accomplished 

here in the coming weeks. We look forward to briefing you and 

your staff. 

Senator BURR. Will we be briefed before the Secretary signs off 

on it or after the Secretary signs off on it? 

Mr. SCHOENHARD. Sir, I think we would brief you after the Secretary signs off. 

Senator BURR. Does the Committee play any part in this process? 

64 

Mr. SCHOENHARD. Sir, we would very much appreciate the opportunity to brief you and the members of your staff and any Members 

of the Committee regarding our work. 

Senator BURR. Before or after the Secretary signs off? 

Mr. SCHOENHARD. Sir, I think we would like to further evaluate 

and review our work and then sit with you, Sir. 

Senator BURR. In the 17 years since Dr. Kaiser created the 

VISNs, there has been a significant growth in the number of VISN 

headquarters staff. The original plan called for 220 full-time workers, full-time employees. Yet, the current staff is at 1,340. 

Do you anticipate the staff level in VISN reorganization to be 

cut? 

Mr. SCHOENHARD. Sir, we do. Let me just, if I can, just back up 

and say we have done a systemic review of the function of the 

VISN, and I think that you will be seeing reductions in our staff 

as a result of this effort. 

Senator BURR. Well, I just was taken a little bit aback by the 

Under Secretary’s comments that my legislation was too prescriptive. I am not sure how you can set up an administrative structure 

without it being prescriptive. 

Mr. SCHOENHARD. Yes, sir. 

Senator BURR. You have got to design what it is over, what its 

mission is, and hopefully what the staffing is; and that is, in fact, 

what I put in my legislation. 

Is that what your review is going to do? 

Mr. SCHOENHARD. Yes. We have looked at the core function of a 

VISN, the core staff required to accomplish that mission, and I 

think that our focus has been with the end in mind what is it that 

a VISN should do as the main operating vehicle for accountability 

and leadership to address all of the concerns we have heard this 

morning regarding care to rural veterans, care and mental health 

and the rest, to do that in a way that is population health based, 

is based on the veterans in that location with sufficient span of 

control to accomplish that mission and to serve veterans. 

Senator BURR. I look forward to the opportunity for you and I to 

get together. 

Mr. SCHOENHARD. Yes, sir. 

Senator BURR. Sooner rather than later. 

Mr. SCHOENHARD. Yes, sir. 

Senator BURR. Mr. Murphy, you addressed the Second Amendment issue. If individuals, let me ask you this. How many veterans’ 

names have been turned over to NICS? How many are currently 

on that list? 

Mr. MURPHY. I do not have the details on the number of names 

that are currently on their list. I can tell you the details around 

the number of requests for relief or removal from the list. 

Senator BURR. How many names have been requested to be 

relieved? 

Mr. MURPHY. 185, Senator. 

Senator BURR. How many have been granted? 

Mr. MURPHY. A total of 19. 

Senator BURR. That is out of 127,000 names that have been 

turned over on the NICS list? 

65 

Mr. MURPHY. Correct. I am assuming your numbers are correct. 

I do not have those in front of me. 

Senator BURR. Trust me, they are. 

Mr. MURPHY. OK. 

Senator BURR. If individuals seek relief from the NICS reporting 

requirements, does the VA assist them in coming up with the evidence needed to show whether they are dangerous? 

Mr. MURPHY. Yes, Senator, we do. 

Senator BURR. What do you do? 

Mr. MURPHY. The Duty to Assist Act requires us to fully develop 

the case. This is not a light matter in the Veterans Administration. 

This is a fully adjudicated, fully developed claim with a full decision letter, with an explanation of how the decision was arrived at 

with all supporting evidence and documentation provided to them. 

Senator BURR. Are there any veterans that are determined incapable to handle their own personal finances whose name is not 

put on the NICS list? 

Mr. MURPHY. Let me make sure I understand the question. Are 

there veterans who—— 

Senator BURR. You have somebody that has determined that a 

veteran cannot write a check. So, they cannot handle their finances. They have now assigned to a spouse to be in charge of the 

finances. 

Is there anybody that that has happened to that that veteran 

was not then listed on the NICS list? 

Mr. MURPHY. I can say that they are not supposed to be. I am 

not saying that through administrative process for errors that it 

had not occurred. 

Senator BURR. My understanding, and I will get you to go back 

and clarify this if I am wrong, every veteran who is relieved of 

their financial or deemed that they cannot handle their own finances is automatically put on the list. 

Mr. MURPHY. They are placed on the list by the Veterans Administration. Yes. 

Senator BURR. So, what are the qualifications of the VA employees who make the decisions about whether veterans and their families should be stripped of their Second Amendment? What training 

do these people go through? 

Mr. MURPHY. I do not believe we have an option in this, Senator. 

We are directed—— 

Senator BURR. You have VA employees that are making a decision on whether somebody is capable of doing their own personal 

finances. That determination that they are not capable of doing 

that strips them of their Second Amendment right. It is very simple. 

What training does that VA employee go through to be qualified 

to make a determination that would strip somebody of their constitutional rights? 

Mr. MURPHY. Our employees, our adjudicators are trained in determining whether or not that veteran is capable of making the financial determinations they have with the funds that the Veterans’ 

Administration provides to that individual. 

As a result of that decision, they are placed on the NICS list. It 

is not a determination whether the individual is capable of hanVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00069 Fmt 6633 Sfmt 6601 H:\112TH HEARINGS\76283.TXT PAULIN
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dling firearms or not. It is, can they manage their personal finances or not. 

Senator BURR. I know. But when they go on the NICS list, they 

are now deprived of firearm ownership. 

Mr. MURPHY. That is correct. 

Senator BURR. OK. So, a determination that they cannot handle 

their personal finances strips them of their Second Amendment 

right and also, the way that it is written, it forbids any firearm to 

be handled by anybody in the household. 

So, you, in essence, strip the spouse of the Second Amendment 

right. You strip children of the Second Amendment right because 

you have determined that a veteran cannot handle their own personal finances. 

Are we in agreement? 

Mr. MURPHY. We are. 

Senator BURR. OK. I do not want to make this too simplistic. But 

if a veteran cannot sign their name to a check and the VA determines that their spouse should be assigned the financial responsibilities because you are transferring money into an account, do 

we agree that that would trigger their listing on the NICS list and 

they would lose their Second Amendment right as well as everybody else in the household? 

Mr. MURPHY. That is one I need to ask Mr. Hipolit to verify for 

me because I am unaware of the requirement for other members 

of the household’s restriction to own firearms. 

Mr. HIPOLIT. Yes, that is correct as well. I was also personally 

not aware of the household restriction. I know that if VA determines that the person is incapable of handling their financial affairs, that does get them on the NICS list. 

Senator BURR. But you would agree, Mr. Hipolit, that a determination that they cannot handle their finances has a wide definition to it? 

Mr. HIPOLIT. I would say that if VA determines that they are unable to handle their finances, that does qualify them to get on the 

NICS list and their names are referred for the list. 

Senator BURR. That is not necessarily a mental determination. It 

could be a physical determination, correct? If they are not capable 

of handling their finances. 

Mr. HIPOLIT. If they had a physical disability that impaired their 

ability to handle their financial affairs. 

Senator BURR. So, they are automatically classified as 

dangerous? 

Mr. HIPOLIT. Our determination is just whether they can handle 

their financial affairs and then that automatically triggers the requirements to refer their names. 

Senator BURR. So, would you agree that the purpose of the NICS 

list which is to take guns away from dangerous people and the 

threshold that VA currently uses to determine who goes on the 

NICS list are potentially two very different things? 

Mr. HIPOLIT. I think that the law enforcement agencies determined who should be put on the NICS list, and they determined 

that person is found to be—— 

Senator BURR. But they do not in the case of veterans. In the 

case of veterans, the only person that determines whether they go 

67 

on the NICS list is the VA, and it is determined based upon are 

they capable of handling their own personal finances. 

Mr. HIPOLIT. Well, the law that requires us to make the referral 

is a regulation from the—— 

Senator BURR. And you are the only agency in the Federal Government that across-the-board sends every person that is not qualified to handle their personal finances to the NICS list? 

Are you aware of that? 

Mr. HIPOLIT. That is not my understanding. It is my understanding that other agencies refer people as well. 

Senator BURR. Other agencies refer people but they have a different threshold for the ones that they refer. I think they might use 

the definition of dangerous, and what I have heard you say is dangerous does not come into play. Mental capacity does not come into 

play. Capability of handling your own personal finances is the only 

threshold, and when they hit that, they are automatically put on 

the NICS list. 

Mr. HIPOLIT. From the VA standpoint, if they are determined not 

to be able to handle their financial affairs, we have to refer them 

for the NICS list. 

Senator BURR. I hate to dig in on this. I just want to point out 

to you that the threshold is very, very different at VA. There are 

many veterans, spouses, and family members who are deprived of 

their Second Amendment rights to own firearms based upon an arbitrary decision by somebody at VA that they cannot handle their 

own personal finances. 

These people are all of a sudden labeled as dangerous when, in 

fact, the decisions may have been a physical disability that did not 

permit them to handle their own finances. I hope this is something 

the Committee will look at. I am actually shocked that the Veterans’ Affairs Committee is not outraged at the way this is being 

implemented. 127,000 of our country’s veterans are stripped of a 

constitutional right. Some probably should. Many of those 127,000 

should have never had their right taken away. 

I thank the Chair. 

Chairman MURRAY. Senator Boozman. 

Senator BOOZMAN. Just really quickly to follow up. So, the process is that they are deemed where they need help in handling their 

finances. 

How do they become aware that they are on the list? Do you 

send him a letter, explaining again that all the guns in the house 

need to go out and all that? 

I guess what I am saying is do the people who are actually on 

the list know that they are on the list—— 

Mr. MURPHY. It is actually more extensive than that, Senator. 

Senator BOOZMAN [continuing]. And the ramifications of what 

has happened to them. 

Mr. MURPHY. There is a decision made and with the appointing 

of a fiduciary comes a VA employee actually visiting the veteran’s 

home, talking with the veteran, explaining to the veteran, and ensuring that they are in a safe environment for that veteran to be 

living. 

Mr. HIPOLIT. Under the NICS Improvements Act, there was a notification requirement put in. Before VA declares somebody incomVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00071 Fmt 6633 Sfmt 6601 H:\112TH HEARINGS\76283.TXT PAULIN
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petent, we have to make them aware that that would affect their 

ability to possess and buy a firearm. So, there is a notification 

requirement. 

Senator BOOZMAN. Of the 18 that were reversed, how long did it 

take to go through the process? 

Mr. MURPHY. The number of days to complete is 187. 

Senator BOOZMAN. 187 days? 

Mr. MURPHY. Yes, sir. 

In that, there are some requirements to allow veterans time notices with time to respond, multiple 60-day periods. So, in order to 

provide due process to the veteran to fully develop their rights 

under this in the appeals process 187 days. 

Senator BOOZMAN. Did you say 18 had been reversed? 

Mr. MURPHY. It is 19, Senator. 

Senator BOOZMAN. 19. 

Mr. MURPHY. Yes, sir. 

Senator BOOZMAN. So, the average of those was 187 days? 

Mr. MURPHY. Correct, to get reversed. 

Senator BOOZMAN. What was the longest? 

Mr. MURPHY. I do not have the details on the spread. If you 

would like, I would be more than happy to provide those for you. 

Senator BOOZMAN. What would you guess? 

Mr. MURPHY. The 187 days average includes some of the veterans for us just starting this process. So, what I would say that 

that number would be higher than what the average if I just looked 

over the last few cases that went through. 

So, the first few veterans that went through going through a new 

process took a little bit longer time and pushed it beyond that 187 

days. But I believe that the next time I appear before you, if you 

asked me this question, it is going to be some number below that 

187. 

Senator BOOZMAN. Thank you, Madam Chair. 

Chairman MURRAY. Thank you. Senator Burr, do you have a 

question? 

Senator BURR. Madam Chairman, just one follow-up question to 

Mr. Murphy because you said that you were under duty to assist. 

Mr. MURPHY. That is correct, Senator. 

Senator BURR. I have got this memo from the Department of Veterans Affairs, dated November 22, 2010, and it says that the duty 

to assist as demonstrated in an order and examinations for securing private medical records do not apply in this program. 

Mr. MURPHY. Well, Senator, then I was in error. 

Senator BURR. OK. I just wanted to make sure we were on the 

same sheet. Thank you. 

Mr. MURPHY. I did bring three documents today. I understand 

how important this is to you, so what it is is our Fast Letter, the 

specific instructions to the field for the relief process. In addition 

to that, I have two redacted decision letters: one that was granting 

the relief; and one that was denying the relief. If you would like 

to see those, Senator, I would make those available to you. 

Senator BURR. Let me just ask the Chair if she would make them 

available for the record? 

Chairman MURRAY. I will do that. 

[The letters referred to follows:] 

69 


627FASTltr1.eps

November 22,2010 

Director (00/21) 

DEPARTMENT OF VETERANS AFFAIRS 

Veterans Benefits Administration 

Washington, D.C. 20420 

Fast Letter 10- 51 

All VA Regional Offices and Centers 

SUB): Processing Requests for Relieffrom the Reporting Requirements of the National 

Instant Criminal Background Check System (NICS) 

This letter provides new information on the National Instant Criminal Background Check 

System (NICS) relief program and procedures for processing relief requests. 

Within 30 days of date of this letter, the Compensation and Pension (C&P) Service will 

return all pending requests for relief in its possession, with their associated claim folders 

and principle guardianship folders (PGFs), to regional offices (ROs) and centers for 

action in accordance with this letter. Please conclude all actions within 90 days of receipt 

of the claims folder. 

Background 

The Brady Handgun Violence Prevention Act of 1993, Public Law 103-159 (The Brady 

Act), prohibits the sale of firearms to certain people. The NICS Improvement 

Amendments Act (NIAA) of2007 sets new requirements for federal and state agencies, 

and contains an amendment to the Brady Act that obligates V A to allow beneficiaries the 

opportunity to request relief from the reporting requirements imposed by the Brady Act. 

V A is also obligated to provide beneficiaries both written and oral notification of the 

firearms prohibitions, penalties for violating them, and information regarding the 

availability of the relief program. 

NICS Relief Program 

The NIAA places the responsibility for administering the relief program on the agency 

that provided the information to NICS. The primary focus regarding relief provisions 

outlined in this letter is public safety. Further, relief from the reporting requirements is 

not a benefit under Title 38 and as such, principles common to the VA adjudication 

process, such as benefit of the doubt and duty to assist (as demonstrated in ordering 

examinations or securing private medical records) do not apply to this program. The 

burden of proof for these relief requests resides with the claimant, and failure to meet that 

burden is sufficient to deny the request. Decisions that deny relief are not subject to 
70 


627FASTltr2.eps

Page 2. 

Director (00/21) 

review by the Board of Veterans' Appeals, but VA denials of requests for relief under the 

NIAA are subject to review in Federal district court. Accordingly, it is important that all 

denials contain a detailed explanation of the basis for denial. 

Handling Requests for Relief 

Requests for relief from the Brady Act reporting requirements must be clear and explicit. 

Do not infer or interpret a request for relief as a claim for reconsideration of 

incompetence or a claim of competency as a request for relief. 

Development 

If the request for relief is received following the final rating of incompetency, establish 

end product (EP) 290 using the "NICS Relief Request" claim label. If the evidence of 

record is sufficient to grant relief according to the criteria outlined below, follow the 

procedures under Administrative Decision. If the evidence is insufficient to grant relief, 

send the attached development letter (Enclosure 1). Allow the beneficiary 30 days to 

respond to the letter. 

The beneficiary may submit a request for relief prior to the final incompetency rating. If 

the request for relief is received prior to the final rating of incompetency, send the 

development letter (Enclosure 1), but do not render a decision on the request for relief 

until the rating of incompetency is final and the 3D-day development response time has 

expired. Then follow the procedures under the Administrative Decision section below. 

If the beneficiary submits a claim for reconsideration of competency in conjunction with 

the request for relief, establish EP 020. After any appropriate development, refer the 

claim to the rating team. If the rating veterans service representative confirms and 

continues incompetency, do not address the issue of relief in the rating decision. Instead, 

follow the procedures under Administrative Decision outlined below. 

Note: We will program all NICS development and decision letters in PCGL as soon as 

possible. In the interim, copy and paste the text of the enclosures into a free text 

document. 

Deciding Relief 

In deciding requests for relief, decision makers must consider the beneficiary's record 

and reputation, as well as the beneficiary's mental and physical status. To grant relief, 

the record must show affinnatively, substantially, and specifically that the beneficiary is 

not likely to act in a manner dangerous to public safety, and that granting relief will not 

be contrary to the public interest. 
71 


627FASTltr3.eps

Page 3. 

Director (00/21) 

In making determinations, consider not just the beneficiary's desire to own firearms and/ 

or ammunition, but the safety of himself, his family, and the communi ty. As VA's 

determinations on requests for relief have the potential to affect public safety, grant relief 

on the basis of clear and convincing evidence. 

In determining whether to grant relief, relevant records may include: 

• A statement from the primary mental health physician assessing the beneficiary's 

mental health status over the last five years. 

• Medical infonnation addressing the extent of mental health symptoms and 

whether or not the beneficiary is likely to act in a manner dangerous to 

himself/herself or to the public. 

• Infonnation documenting that a court, board, or commission that originally 

determined incompetence has restored competency status or otherwise determined 

that the beneficiary has been rehabilitated through any procedure available under 

the law. 

• Statements or records from law enforcement officials, such as the Federal Bureau 

of Investigation (FBI), the Bureau of Alcohol, Tobacco, and Firearms (ATF), or 

the Attorney General, showing that the granting of relief would not be contrary to 

the public interest. 

When determining relief requests, consider if any of the following unfavorable factors are 

manifest over the past five years: 

• The presence of any mental disability that has been evaluated at more than 

lO-percent disabling. (If there is no rating of record, consider whether evidence 

indicates that any current mental disability causes no more than mild or transient 

symptoms observable only during periods of significant stress, or whether 

symptoms of mental disability are completely alleviated through the use of 

continuous medication (38 CFR 4.130). Also, consider the presence of any 

personality disorder when determining relief requests. 

• Evidence of recurring substance abuse or any substance abuse within the last year. 

• Local, state, or federal convictions for felonies and/or violent offenses (including, 

but not limited to, menacing, stalking, assault, battery, burglary, robbery, rape, 

murder, and attempts thereof). 

• Demonstration of overtly aggressive or hostile behavior and/or demeanor. 

• Presence of suicidal or homicidal ideations. 

Administrative Decision 

The RO or center will handle all requests for relief by preparing an administrative 

decision (seec~M21-1 MR, Part III, Subpart v, Chapter I, Section A, Topic 2). The RO 
72 


627FASTltr4.eps

Page 4. 

Director (00/21) 

Director must approve all administrative decisions after concurrence by the Veterans 

Service or Pension Management Center Manager, or designee. 

Inform the beneficiary of the determination by sending the NICS relief grant or denial 

letter (Enclosure 2 or 3). If relief is granted, notify the NICS Manager within three days 

at V A VBA W ASICOINICS under the subject "NICS relief grant." The notification must 

include the beneficiary's name, claim number, Social Security number (if different than 

claim number), date of birth, contact information (including address and telephone 

number), and the date of the grant of relief. Upon granting relief, the C&P Service will 

notify the FBI, which manages the NICS database for the Department of Justice, to 

remove the beneficiary from the NICS database. The FBI will remove the beneficiary's 

name from the database within approximately two months after notification by the NICS 

Manager. 

If a beneficiary who was formerly found incompetent is found competent, the request for 

relief becomes moot. In the final competency rating, include the following statement 

under Reasons for Decision for the competency issue: 

"We received your request for relief from the Department of Justice (DoJ) 

reporting requirements contained in the Brady Handgun Violence Prevention Act. 

We have determined you are competent for VA purposes, so it is not necessary to 

render a decision on that request. VA will inform DoJ of your changed status." 

File all documents exclusive to this relief decision on the right side of the claims folder. 

Questions 

Questions concerning information contained in this letter should be e-mailed to 

VA VBA W AS/COINICS. 

Recission: At the earliest opportunity, we will incorporate into the M21-1MR the 

provisions of oral and written notice from pages 4 and 5 of Fast Letter (FL) 09-08, 

National Instant Criminal Background Check System (NiCS) improvement Amendments 

Act of 2007, which is otherwise rescinded. 

Enclosures 

lSI 

Thomas J. Murphy 

Director 

Compensation and Pension Service 
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627FASTltr5.eps

Enclosure 1 - NICS Relief Development Letter 

xxxxxxxxxxx 

xxxxxxxxxxxxx 

xxxxxxxxxxxx 

Dear Mr.lMs.: 

IMPORTANT - reply needed 

In reply, refer to: 

File Number: XXXXXXX 

We received your request for relief from the Department of Justice reporting 

requirements contained in 18 U.S.c. § 922(d)(4) and (g)(4). VA must report to the 

National Instant Criminal Background Check System (NICS) individuals whom V A 

determines to be unable to contract or manage their own affairs. 

Pursuant to 18 U.S.c. § 925(c) and § 101(c) (2) (A) of the NICS Improvements 

Amendment Act of2007, Public Law 110-180, VA is obligated to decide whether you are 

eligible to receive relief from the reporting requirements of the Brady Handgun Violence 

Prevention Act. This letter contains information about what we will do with your request 

and what you can do to help us decide it. 

We may grant relief if clear and convincing evidence shows the circumstances regarding 

your disability, and your record and reputation are such, that you are not likely to act in a 

manner dangerous to yourself or others, and the granting of relief is not contrary to public 

safety and/or the public interest. 

What Can You Do? 

To support your claim for relief, you may submit such evidence as: 

• A statement from your primary mental health physician assessing your mental 

health status over the last five years. 

• Medical information addressing the extent of your mental health symptoms and 

whether or not you are likely to act in a manner dangerous to yourself or to 

public. 

• Information documenting that a court, board or commission that originally 

determined incompetence has restored your competency status or otherwise 

determined that you have been rehabilitated through any procedure available 

under the law. 
74 


627FASTltr6.eps

• Statements or records from law enforcement officials, such as the Federal Bureau 

of Investigation (FBI), the Bureau of Alcohol, Tobacco, and Firearms (ATF), or 

the Attorney General, which show that the granting of relief would not be 

contrary to the public interest. 

Please put your V A file number on the first page of every document you send us. 

Where Should You Send Your Evidence? 

Please send all documents to this address: (include RO address) 

How Soon Should You Send What We Need? 

We strongly encourage you to send any information or evidence as soon as you can. If 

we do not hear from you within 30 days, we will make a decision on your request based 

on the evidence of record. 

How Can You Contact Us? 

Please give us your VA file number, XXXXXXXXXX, when you do contact us. 

• Send written correspondence to the address above. 

• Send us an inquiry using the Internet at httPs:lliris.va.gov. 

• Call us at 1-800-827-1000. If you use a Telecommunications Device for the Deaf 

(TDD), the number is 1-800-829-4833. 

We look forward to resolving your request in a timely and fair manner. 

Sincerely yours, 

Veterans Service Center Manager 
75 


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Enclosure 2 - NICS Relief Grant Letter 

XXXX 

XXXXXXXX 

XXXXX, XX XXXXX 

Dear Mr.lMs. : 

In reply, refer to: 

File Number: xxx xx xxxx 

We received your request for relief under the National Instant Criminal Background 

Check System (NICS) Improvement Amendments Act (NIAA) 0(2007 (Public Law 110-

ISO). 

What We Decided 

We decided that you are eligible for relief from the Department of Justice reporting 

requirements imposed by the Brady Handgun Violence Protection Act. 

We reviewed the following evidence in considering your claim: 

• (enter evidence) 

Our review of this evidence reveals that your disability, record, and reputation are such 

that you are not likely to act in a manner dangerous to yourself or others. Further, the 

granting of relief is not contrary to public safety or the public interest. Please allow the 

Department of Justice up to eight weeks to update its records in accordance with our 

decision. 

If You Have Questions or Need Assistance 

You may find more information about the Relief from Disabilities program in 18 U.S.C. 

§ 925( c). If you have any questions regarding this decision, you may contact us by letter, 

Internet, or telephone. In all cases, be sure to refer to your V A file number, 

XXXXXXXX. 

To Contact V A by Here is what to do. 

Mail Send inquiries to the address at the top of this letter 

Internet Send an inquiry via VA's website at https://iris.va.gov. 

Telephone Call 1-800-827-1000. If you use a Telecommunications 

Device for the Deaf (TOO), the number is 1-800-829-4833. 
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Page 2. 

We sent a copy of this letter to your representative, XXXXXX, whom you can also 

contact if you have questions or need assistance. 

Sincerely yours, 

Veterans Service Center Manager 

cc: 
77 


627FASTltr9.eps

Enclosure 3 - NICS Relief Denial Letter 

xxxx 

xxxxxxxx 

xxxxx, xx xxxxx 

Dear Mr.lMs. : 

In reply, refer to: 

File Number: xxx xx xxxx 

We received your request for relief under the National Instant Criminal Background 

Check System (NICS) Improvement Amendments Act (NIAA) 0/2007 (Public Law 110-

ISO). 

What We Decided 

We detennined you are not eligible for relief from the Department of Justice reporting 

requirements imposed by the Brady Handgun Violence Protection Act. 

We considered the following evidence: 

• (enter evidence) 

Based on this review, we are unable to conclude through clear and convincing evidence 

regarding your disability, record, and reputation that 

• you will not likely act in a manner dangerous to yourself or others, and 

• the granting of relief would not be contrary to the public interest. 

Your Right for Review 

NIAA rcliefrequests are not matters which fall within the scope of title 38 of the United 

States Code and denial of such requests are not subject to review by the Board of 

Veterans' Appeals. However, denials of requests for relief under the NIAA are subject to 

review in Federal district court. See 18 U.S.C. § 925(c) for more information concerning 

appellate rights. 

If You Have Questions or Need Assistance 

You may find more information about the Relief from Disabilities program in 18 U.S.c. 

§ 925( c). If you have any questions regarding this decision, you may contact us by letter, 

Internet, or telephone. In all cases, be sure to refer to your V A file number, 

xxxxxxxx. 
78 

Senator BOOZMAN. Madam Chair, can I just ask one other thing 

quickly? 

Chairman MURRAY. Yes, Senator Boozman. 

Senator BOOZMAN. In regard to Senator Ayotte, you know, with 

her bill and the cemetery issue in the Philippines, can you all comment about that? 

I guess, you know, one of the things that we are so proud of 

when you go overseas and you see the—we are the only Nation in 

the world that really does that, you know, that takes such good 

care of our veterans. That really distinguishes us instead of the 

mass graves and this and that. We have done such a tremendous 

job. Tell me about, you know, rectifying that or if you feel like we 

need to rectify it, specifically what the problem is, how we got into 

this situation. 

Mr. MURPHY. That is a bill, well, the picture is shown there and 

VA’s understanding of exactly the condition of that specific cemetery, that is a bill that falls clearly under the American Battle 

Monuments Commission, and we have to defer to their input on 

that bill. 

Mr. HIPOLIT. I would add that the National Cemetery Administration maintains cemeteries within the United States and the 

Commonwealth of Puerto Rico. We do not have overseas cemeteries. The American Battle Monuments Commission traditionally 

maintain the overseas cemeteries. 

Senator BOOZMAN. So, is this particular cemetery in a Catch–22 

situation where it does not have anybody who has claimed it because I suspect if it fell under their—if they felt like it fell under 

their jurisdiction, they would be taking care of it. 

Mr. HIPOLIT. I cannot speak for them, but I think as of this time 

no Federal agency has responsibility for that cemetery. 


627FASTltr10.eps
79 

Senator BOOZMAN. Can we say that you all are committed to 

helping to work that out where there is a claiming of the cemetery 

so we can do the appropriate thing? 

Mr. HIPOLIT. Our position is that we need to defer to the American Battle Monuments Commission because that would be more 

within their jurisdiction then within VA’s. I can see that those pictures were quite moving of the current condition of the cemetery, 

and I can fully understand the concern over it. 

Senator BOOZMAN. Good. Thank you very much. 

Chairman MURRAY. Thank you very much. 

With that, I would like to thank this panel. I do have additional 

questions I will submit for the record because I want to leave time 

for our second panel today. So, thank you again very much. 

Dr. AGARWAL. Thank you. 

Chairman MURRAY. With that, I like to call up our second panel; 

and as we are changing out positions here, I am going to introduce 

them. 

We are going to be joined today by Tracy Keil. She is the wife 

of a paralyzed veteran, as well as Dr. Mark Thomas Edney, who 

is an Operation Iraqi Freedom veteran and a urologist who is representing the American Urological Association. 

Speaking on behalf of VetsFirst today is Vice President of Veterans Policy, Heather Ansley. Rounding out this panel is Joy Ilem. 

She is the Deputy National Legislative Director of the Disabled 

American Veterans. 

Before I turn to the testimony from this panel, I also want to 

take a moment to thank retired Staff Sergeant Andrew Robinson 

for joining us today. He is in the audience. 

Andrew was injured in 2006 when a roadside bomb threw him 

from the truck that he was in. Like Tracy, who we will be hearing 

from in just a moment and her husband Matt, Andrew and his wife 

Sarah also went through some very challenging times and had to 

use in-vitro fertilization to conceive there now 6-month-old twins I 

understand. 

Andrew, I want to thank you for your service to the country, and 

thank you for driving down to be here with us today for this important legislative hearing. 

All of your statements will be entered into the record, and I really do appreciate all of your testimony today. 

Ms. Keil, I am going to start with you and thank you so much 

for your courage in coming speaking to our Committee today. So we 

will begin with you. 

STATEMENT OF TRACY KEIL, CAREGIVER AND 

SPOUSE OF AN OIF VETERAN 

Ms. KEIL. Good afternoon, Chairman Murray, Ranking Member 

Burr, Members of the Committee. Thank you for inviting me to 

share my family’s experiences with you today. 

My husband, Staff Sergeant Matthew Keil, was shot in the neck 

while on patrol in Ramadi, Iraq, February 24, 2007, just 6 weeks 

after we were married. 

The bullet went through the right side of his neck, hit his 

vertebral artery, went to his spinal cord, and exited his left shoulder blade. Matt instantly became a quadriplegic. 

80 

When I first saw him 3 days after he was injured, I was in shock. 

They explained to me that he had a Christopher Reeves-type injury. He was on a ventilator for the rest of his life, and he would 

never move his arms or legs. 

Matt and I looked at each other in the hospital room at Walter 

Reed, and he asked me if I still loved him. I told him, baby, you 

are stuck with me. At that moment, we knew that we would be OK 

if we stayed in it together. 

I knew that we just needed to work really hard to get Matt off 

his ventilator and increase his life expectancy so that we could live 

out our dreams. 

Ultimately, we moved to Craig Hospital in Denver to be closer 

to our families. Four weeks to the day of arriving at Craig Hospital, Matt was officially off his ventilator, and we could truly concentrate on him doing physical rehabilitation. 

Matt was able to regain 10 percent function of his left arm but 

not his hand. He was feeling good and getting used to his new normal of being a wheelchair and asking for help for everything. It 

was while we were at Craig Hospital that we started talking about 

having a family. 

The Craig doctors talked to us about in-vitro fertilization, letting 

us know that that would be most likely the only way we could conceive. We started to get really excited that even though so much 

had been taken away from Matt physically that we could still have 

the future that we always dreamed up. 

We had our whole lives ahead of us. Matt was just 24 when he 

was injured, and I was 28. We were very fortunate that he survived his injuries that day, and we made a promise to each other 

on our wedding day, for better or for worse, in sickness and in 

health; and we meant every word and we still do today. 

It is a challenge for my husband and I every day, but we knew 

we still wanted a family. I remember back when he was in rehab 

at Craig and all we could talk about was when we were going to 

be adjusted to our new normal and when we will be ready to have 

children. We always knew since the day we met that we wanted 

to have kids. 

In 2008, we moved into a fully accessible home built for us by 

Homes For Our Troops, and we started filling like things were falling back into place in our lives. We felt like we were getting back 

on track to where we were before he was injured. 

However, his injury ultimately, unfortunately, prevents him from 

having children naturally. In mid-2008, I started asking the VA 

what services they could offer my husband and I to assist us with 

fertility. I remember hitting roadblocks at every turn, and I decided 

to take things into my own hands. 

At one point, I was leading 12 women whose husbands were injured, writing letters, and making phone calls, and trying to get 

anyone to listen to us that we really needed help. 

Fertility treatments are very expensive; and since I had left my 

full-time job, we were still trying to adjust living on one income. 

I felt helpless and hopeless that our dreams of having a family may 

never come true. 

The VA did finally say that they would cover the sperm withdrawal from my husband and that costs around $1,000 and that 

81 

they would store it for us at no charge. However, they could not 

offer me anything. 

It is very difficult to put into words the emotions that I felt when 

I found out there was no help available for us from the VA or 

TRICARE. I felt very defeated, sad, disappointed and, in some 

ways, I felt helpless. 

I researched everything I could about how to get TRICARE to 

cover some of the costs, but they could not because it was a direct 

result of my husband’s injuries and that fell under the VA. The VA 

said they had no programs in place for this sort of thing. I even 

started asking nonprofits to assist with the cost and they could not 

help due to the other immediate needs of injured servicemembers. 

In January 2010, my husband and I decided that we needed to 

move forward with our plans to start a family and we began our 

journey of fertility treatments. We selected a doctor in the private 

sector that has been a leader in IVF. We were fortunate that the 

best fertility doctor in the world is right in our town. 

Having a doctor located near our home was helpful because I had 

to go every other day and then daily near the time of the transfer. 

This made it very easy for my husband to be there with me every 

step of the way. 

I was on several medications that I took every day along with injections into my stomach three times a day. I would go to the doctor every other day for blood draws to check my hormone levels and 

make sure everything was progressing normally. 

Each time I would be at the fertility clinic I was charged any- where from $250 to $650. TRICARE did not cover any of these 

costs of anything related to the fertility treatments because I did 

not have any fertility issues myself. Everything was a direct result 

of my husband’s injuries. 

We are fortunate that Matt and I got pregnant on our first try 

with IVF. We welcomed our twins Matthew and Faith November 

9, 2010. As you can see from the attached photographs, they are 

happy, healthy, and they love riding around with their dad. 

As a couple who had already sacrificed so much for our country, 

I do not believe we should also have to give up on our dream of 

having a family. Fertility treatments are not a guarantee of having 

children, but it does give us hope. 

It gives us hope that we can have a normal life just like everyone 

else. Part of living the American dream for us was having a home 

to raise our children and, of course, having the children to fill our 

home. 

Now we have both, and while it is incredibly difficult to raise 

children while your husband is in a wheelchair, it is possible. We 

are living proof that anything is possible. 

This is exactly the way our family is supposed to be. I strongly 

believe that my husband is supposed to be in a wheelchair. I cannot tell you why but this is the life that we are supposed to be living, and it is what it is supposed to look like. We are happy. We 

are healthy, and we are living out our dreams. 

Now that my husband is retired, we are able to raise our children together as stay-at-home parents. We are a team and my only 

wish is that other families could find this happiness. One of the 

things I love the most about having children now is that their dad 

82 

is just their dad. They do not see the wheelchair. They make him 

feel like the man he was before he was injured, and they complete 

our life together and the kids have helped fulfill our dreams that 

we had when we got married and started our life together. 

I would like to emphasize this statement. Wartime changes a 

family. It should not take away the ability to have one. 

I hope that hearing our story today has helped you understand 

the importance of offering fertility treatments to injured veterans 

who have lost the ability to reproduce naturally. 

I have always wanted more than anything for my husband to feel 

whole again. There is no magical cure for spinal cord injury. There 

is nothing out there that will help him walk again or move his 

arms. 

However, Congress, the VA, and the American people have said 

countless times that they want to do everything they can to support him and other wounded warriors. This is your chance to honor 

his sacrifice and others like him. Having a family is exactly what 

he needed to feel whole again. 

Please help us make these changes so that other families can 

share in this experience, and I also ask that you turn to the last 

page of my written statement and look at the photos I have provided. This is the face of a truly recovered injured veteran. 

Thank you for your time and I look forward to your questions. 

[The prepared statement of Ms. Keil follows:] 

PREPARED STATEMENT OF TRACY KEIL, CAREGIVER AND SPOUSE OF OIF VETERAN

Good Afternoon. Chairman Murray, Ranking Member Burr, Members of the Committee, thank you for inviting me to share my family’s experience with you today. 

My husband, Matt, was shot in the neck while on patrol in Ramadi, Iraq, on February 24, 2007, just 6 weeks after we were married. The bullet went through the 

right side of his neck, hit his vertebral artery, went through his spinal cord and 

exited through his left shoulder blade. Matt instantly became a quadriplegic. When 

I first saw him 3 days after he was injured I was in shock, they explained to me 

that he had a ‘‘Christopher Reeve type injury.’’ He would be on a ventilator for the 

rest of his life, and would never move his arms or legs. 

Matt and I looked at each other in his hospital room at Walter Reed and he asked 

me if I still loved him? I said ‘‘baby you’re stuck with me!’’ at that moment we knew 

that we would be OK if we stayed in this together. I knew that we just needed to 

work really hard to get Matt off his ventilator to increase his life expectancy. Ultimately we moved to Craig Hospital in Denver to be closer to family support. 

Four weeks to the day of arriving at Craig Hospital in Denver, Matt was officially 

off of his ventilator and we could truly concentrate on him doing physical rehabilitation. Matt had regained about 10% function of his left arm but not his hand. He 

was feeling good and getting used to his new normal of being in a wheelchair and 

asking for help for everything. 

It was while we were at Craig hospital that we started talking about having a 

family. Craig doctors talked to us about invitro fertilization and recommended some 

doctors for us to speak to when we were ready to start a family. We started to get 

really excited that even though so much had been taken away from Matt physically 

that we could still have the future we always dreamed of. 

My husband is the most amazing man I have ever met. He is strong, honest and 

loyal, and he wanted us to both have everything we always wanted before his injury 

and we agreed that this injury wasn’t the end, it was the beginning of a new life, 

and we were in this together. 

We had our whole lives ahead of us. Matt was just 24 when he was injured and 

I was 28. We are very fortunate that he survived his injuries that day and we made 

a promise to each other on our wedding day ‘‘For better or worse, in sickness and 

in health.’’ I meant every word and still do today. It is a challenge for my husband 

and me every day, but we knew we still wanted to start a family. I remember back 

when he was in rehabilitation at Craig Hospital it’s all we could talk about was 

83 

when we were going to be adjusted to our new normal and when would we be ready 

to have children. We always knew we had wanted children. 

In 2008 we moved into a fully handicap accessible home built for us by Homes 

For Our Troops. We were starting to feel like things were falling into place in our 

lives. We felt like we were starting to get back on track to where we were before 

Matt was injured. 

His injury unfortunately prevents him from having children naturally. In mid 

2008 I started asking the VA what services they could offer my husband and I to 

assist us with fertility. I can remember hitting road blocks at every turn. I decided 

to take things into my own hands and write letters and make phone calls to try 

and get anyone to listen to us that we needed help. Fertility treatments are very 

expensive and since I had left my full time job we were still adjusting to living on 

one income. 

I felt helpless and hopeless and thought that our dreams of having a family may 

never come true. The VA finally said that they would cover the sperm withdrawal 

from my husband*** that costs $1,000 and that they would store the sperm for 

us at no charge. 

It was very difficult when I found out there was no help available for us from 

the VA or TRICARE. I felt very defeated, sad, disappointed and in some ways I felt 

helpless. I researched everything I could about how to get TRICARE to cover some 

of the costs but they couldn’t because it was a direct result of my husbands’ injury 

and that fell under the VA. The VA said that they had no programs in place for 

this sort of thing. I even started asking non profits to assist with the cost and they 

couldn’t help due to the other immediate needs of injured servicemembers. 

I am very pleased that this issue is being addressed because it is necessary for 

the success of the families. We shouldn’t have to struggle with how we are going 

to pay for costly fertility treatments when they are a direct result of a combat injury. We already have so many adjustments to make to all of our hopes and dreams 

and plans. We should never have to contemplate whether or not to even have children because of how expensive fertility treatments can be. I have always wanted 

more than anything for my husband to feel whole again. There is no magical cure 

for a spinal cord injury, there is nothing out there that will help him walk again 

or move his arms. What we do have though is a strong voice. We can help other 

families just like ours so they don’t have to go through what we went through. 

In January 2010 my husband and I decided that we needed to move forward with 

our plans to start a family and we began our journey of fertility treatments. We selected a doctor in the private sector that has been a leader in IVF. Having a doctor 

located near our home was very important for us because I had to go to the doctor 

every other day and then daily near the time of the transfer. This made it very easy 

for my husband to be there with me every step of the way. I was on several medications that I took 3 times a day along with giving myself hormone injections into my 

stomach three times a day for several weeks. I would go back to the doctor every 

other day for blood draws to check my hormone levels to make sure everything was 

progressing normally. TRICARE did not cover any of the costs of anything related 

to the fertility treatments because I did not have any fertility issues, everything was 

a direct result of my husbands’ injury. 

Matt and I were very fortunate that we got pregnant on our first try with IVF. 

We welcomed our twins Matthew and Faith on November 9, 2010. 

Fertility treatments are not a guarantee of having children, but it gives us hope. 

It gives us hope that we can have a normal life just like everyone else. Part of living 

the American Dream for us was having a home to raise our children*** and of 

course having the children to fill our home. Now we have both and while it is incredibly difficult to raise children while your husband is in a wheelchair it is possible. We are living proof of anything is possible. 

To be honest, not walking is the easy part. The hard part is that it affected every 

single aspect of our lives. Matt requires assistance with almost everything. As his 

caregiver, I feed him, bathe him, dress him, get him in and out of bed, I am the 

sole driver in our household, I even assist him with changing the channel on the 

TV. He has lost almost all independence. The day we had our children something 

changed in both of us. This is exactly what we had always wanted, our dreams had 

arrived. While it may be challenging to care for my husband and my children, this 

is exactly what our family is supposed to be. I strongly believe that my husband 

is supposed to be in a wheelchair, I can’t tell you why, but this is what our life is 

supposed to look like. We are happy, we are healthy and we are living out our 

dreams. Now that my husband is medically retired we have the ability to raise our 

children together as stay home parents. We are a team and my only wish is that 

other families could find this happiness. 

84 

Since having our children I see my husband light up again, I see him happy, fulfilled. He is truly living the American Dream. I cannot imagine where we would be 

if we didn’t save money knowing we would need to do IVF in the future. 

One of the things I love the most about having children now is that their dad is 

just their dad. They don’t see the wheelchair. They will be kind to people with disabilities and more understanding. All of the injured veterans who have children are 

helping share with others that people with disabilities are just like everyone else, 

they just do things a little differently. My husband is a shining example of a wonderful father who loves his children and we would have done anything possible to 

have them. 

They make him feel like the man he was before he was injured, they complete 

our life together and the kids have helped fulfill our American dream. The VA, Congress and the American People have said countless times that they want to do everything they can to support my husband or make him feel whole again and this 

is your chance. Having a family is exactly what we needed to feel whole again. 

Please help us make these changes so that other families can share in this experience. If the VA does decide to begin offering fertility treatments I think it’s important 

to note that this is a very personal issue. Selecting a doctor to perform these treatments was very personal for my family and we didn’t want to use ‘‘just anybody.’’ 

We wanted to go to the best. I think it would be wonderful to let the private sector 

help these men and women start their families and do their part to help injured 

servicemembers. This way if the families choose, they can go to a private sector doctor to have these services performed. I know that it is a challenge for my family 

to drive to the VA on a daily basis for treatments. Sometimes families can find 

something closer to their homes to make things easier. We have to remember that 

we are talking about the most severely injured veterans that encounter fertility 

issues due to their injuries, so doing whatever is easiest for the family is extremely 

important. 

Fertility is an area where we need experts in the field with extensive experience. 

Those doctors are already set up in private practices across the country. I think it 

would be very beneficial to the families to fee base the fertility specialist of their 

choice. There is also the option of capping the benefit at a certain amount of money 

or a certain amount of rounds of fertility treatments. As family of a severely injured 

veteran, I do not expect taxpayers to pay for every single thing we could ever wish 

for, so putting a limit on the fertility amounts is certainly understandable and expected. 

There are about 600 men and women who have returned home with damage to 

their reproductive ability. Today I ask you to please support these brave servicemembers in their dream to have families. I am here today to say that this injury 

took away so much of my husband physically that he cannot get back, but we could 

not let this injury take away our dream of a family. Having children meant that 

we were back to where we were before he was injured. It brought a sense of accomplishment and fulfilled our dreams of a family. In some ways it made my husband 

feel whole again. 

I hope that hearing our story today has helped you understand the importance 

of offering fertility treatments to injured veterans who have lost the ability to reproduce naturally. What happened to them is by no fault of their own. Wartime 

changes a family, it shouldn’t take away the ability to have one. 

Thank you for your time. 

Chairman MURRAY. Ms. Keil, thank you so very much for your 

courage in speaking out for so many others. I have been looking at 

the pictures. They are actually in front of me. I am sorry the audience cannot see them. They are absolutely adorable. 

And you are right. That is truly compelling. So, thank you very 

much for being here today. 

Dr. Edney, we will turn to you. 

STATEMENT OF MARK THOMAS EDNEY, M.D., OIF VETERAN, 

MEMBER, LEGISLATIVE AFFAIRS COMMITTEE OF THE AMERICAN UROLOGICAL ASSOCIATION 

Dr. EDNEY. Chairman Murray, Ranking Member Burr, Members 

of the Committee, honored guests, fellow servicemembers, I thank 

the Committee on Veterans’ Affairs for inviting me to testify. 

85 

My name is Mark Edney. I am a Urologist, a physician who 

treats genitourinary disease and injury. I am also an Army 

Reservist. 

It is an honor and privilege to be able to testify before the Senate 

Committee on Veterans’ Affairs in support of Senate 3313. My testimony has the support of many organizations dedicated to this 

issue, including the American Urological Association, The Men’s 

Reproductive Health Alliance, the American Fertility Association, 

and the Men’s Health Network, and others, many of whom are represented in the room today. 

I am a husband and the father of three children, ages 10, 7, and 

5 years. In my 10 years of reserve service, I have been called back 

to duty three times: first to Walter Reed Army Medical Center in 

2004, next a combat tour with the 399th Combat Support Hospital 

in Mosul, Iraq in 2006, and finally a tour at Tripler Army Medical 

Center in Hawaii in 2009. 

I have seen and treated genitourinary injury in the theater of operations, and I have also participated in its chronic management 

in our largest military medical centers. 

It is important to understand the breadth of the types of injuries 

that can occur that threaten fertility. The most common mechanism of injury to the genitourinary organs in theater right now is 

blast effect from improvised explosive devices and also from gunshot wounds. 

The most common types of male genitourinary injuries are testicular rupture, penile shaft, urethral and bladder injury. Blast injuries to the phallus often result in erectile dysfunction or render it 

otherwise incapable of intercourse. 

Urethral injuries often result in scar tissue, preventing the release of semen. Shrapnel often penetrates the perineum, the area 

that includes the sexual organs and the rectum. 

Even with proper current protective gear, the perineum is exposed. In these instances, the external sexual organs may be preserved, but injury can occur to the pelvic portion of the tissue cylinders responsible for normal function. 

Damage can also occur to the nerve and vascular supply responsible for normal function. Damage anywhere in the sperm delivery 

system may result in the absence of sperm in the semen. 

There are a range of female injuries that can result from fertility 

problems. Blast injury can occur to the perineum and the vaginal 

vault which precludes intercourse. Shrapnel or bullet penetration 

of the pelvis can injure the ovaries, inhibiting egg development and 

delivery. Damage to the fallopian tubes easily results in a lack of 

ability to transmit the egg to the uterus. 

Overall genitourinary injuries comprise five to 10 percent of 

wounds suffered in battle, but they can be some of the most psychologically debilitating. 

Spinal cord and Traumatic Brain Injury are two major classes of 

non-neurologic injury that can also impede utility through sexual 

dysfunction in men. 

There are also non-ballistic threats to women’s reproductive 

health in theater. A recent survey of female soldiers revealed that 

there can be a lack of confidence of the unit level health care providers with respect to competence in women’s health issues and 

86 

concerns around confidentiality leading to avoidance of care 

seeking. 

There are underappreciated psycho-social issues with female 

family separation that can have both psychological and physiological effects that lead to sexual dysfunction and fertility issues. 

The issue of military sexual trauma which can have a profound 

impact on sexual function and fertility continues to be addressed 

military-wide through the sexual harassment, assault response and 

prevention program. 

To support these issues, S. 3313 has critical provisions that improve female—the female veterans call center and expand the 

counseling of women upon separation from the military. 

Given the many ways that injured soldiers can return to their 

home units, their civilian life, and their families with fertilitythreatened injuries, the question becomes how are we willing to 

help them. 

Though genitourinary is not publicly visible, it is no less physically or psychologically debilitating than loss of limb or other 

overtly disfiguring injury. Professionals who specialize in fertility 

will attest to the intense psychological pain and suffering endured 

by infertile couples who will go to great financial and emotional extremes in order to conceive a child. 

S. 3313 contains powerful provisions that provide access to advanced reproductive technologies for fertility impaired soldiers, 

their spouses, and surrogates. 

Intrauterine insemination or IUI and in-vitro fertilization or IVF 

are the advanced reproductive techniques that S. 3313 makes 

available. 

IUI is the deposition to process sperm into the uterine canal to 

then finish the normal cycle of fertilization. It is used when female 

anatomy is intact at and above the cervix but when any number 

of the injuries I have mentioned preclude delivery of sperm to the 

uterine cavity. 

IVF is employed when the injury or combination of injuries precludes the normal meeting of sperm and egg. Fertilization is 

achieved in the laboratory. Then the fertilized eggs is then replanted back into the uterus for normal gestation. 

If the uterus has been rendered incapable of sustaining a pregnancy, a surrogate can be engaged for the pregnancy of the natural 

parents fertilized egg. 

It is noteworthy that the substantial cost of an IVF cycle in the 

private sector where battle injury infertile VA couples now must 

turn is on the order of $20-30,000 per cycle with success rates of 

20 to 40 percent per cycle. Multiple cycles are often necessary. 

The expertise and technology exists within the VA and the DOD 

for a fraction of the cost. We just need S. 3313 to unlock it for these 

most deserving Americans. 

There is a desperate need to establish a research database of soldiers with genitourinary injury to better study the continuum of 

care from prevention to initial management to reconstruction and 

to fertility treatment and outcomes. 

Senator Murray’s bill takes a critical step in calling for the Department of Defense and the NIH to conduct collaborative research 

87 

to address the long-term reproductive health care needs of veterans 

with service-connected reproductive injuries. 

Also to this end, I want to bring to the Committee’s attention 

H.R. 1612, which has been reintroduced this session with the sponsorship of Congressman Brett Guthrie and 25 cosponsors in the 

House. 

The bill, promulgated by the American Urological Association, 

sets up a national commission on uro-trauma. The 16-member commission, which is a collaboration of the Departments of Defense, 

Veterans Affairs, and Health and Human Services, will be a sunset 

commission with defined objectives. 

They are in summary, one, to study the current state of knowledge from prevention to initial management to chronic therapy. 

Two, to identify public and private resources that can be brought 

to bear for fertility-impaired soldiers. Three, to identify care enhancing programs of potential benefit to the genitourinary injured 

soldier. 

The bill is described in more detail in my written testimony, and 

I would be happy to discuss it further with any Members of the 

Committee who might be interested in supporting it. 

We as a Nation have done better recently at addressing the physical disability that results from war injury. Appropriately, hundreds of millions of dollars have been dedicated to the research and 

development of prosthetics to return soldiers with loss of limb to 

a higher degree of physical ability. We are getting better at detecting and addressing the psychological wounds of war from PTSD 

and dramatic brain injury. 

There is an important group who have been left behind. Those 

suffering the publicly invisible but intensely emotionally painful 

loss of fertility as the result of genitourinary injury. 

Let us together show these finest Americans that we are willing 

to go beyond our current efforts of physical and emotional support. 

Let us use the expertise and tools that we have in place today to 

restore their fertility so that they may 1 day look into the eyes of 

their own children and see the family history, the pride, and hope 

for the future that so many of the rest of us have been blessed to 

know. 

We owe these brave Americans no less for the sacrifices they 

have made for our great Nation. 

I thank the Committee again for the privilege and honor of being 

asked to testify. 

[The prepared statement of Dr. Edney follows:] 

PREPARED STATEMENT OF MARK T. EDNEY, M.D., F.A.C.S., ARMY RESERVIST, OPER- ATION IRAQI FREEDOM VETERAN AND MEMBER, LEGISLATIVE AFFAIRS COMMITTEE, AMERICAN UROLOGICAL ASSOCIATION

Chairman Murray, Ranking Member Burr, Members of the Committee, honored 

guests, fellow servicemembers, I thank the Committee on Veterans’ Affairs for inviting me to testify. 

It’s an honor and privilege to testify before the Senate Committee on Veterans Affairs in support of Senate Bill 3313. This Bill provides critically needed support for 

soldiers within the Department of Veterans Affairs who have suffered fertility-impairing trauma in battle. My comments have the support of many organizations that 

have tangibly dedicated themselves to the care, rehabilitation, and restoration of 

fertility to soldiers who have suffered urogenital and other forms of trauma that 

threaten fertility. These organizations include the American Urological Association, 

The Men’s Reproductive Health Alliance, the American Fertility Association, and 

88 

the Men’s Health Network. This is by no means an exhaustive list of the professional organizations and patient advocacy groups with a vested interest in this subject, many of whom are represented in the room today. 

I am a Urologist, a specialist who treats genitourinary disease and injury, in private practice in Salisbury, MD. I am a husband and the father of three children 

10, 7, and 5 years old. I am also an Army Reservist of 10 years. I have been called 

to active duty 3 times: first to Walter Reed Army Medical Center in 2004, one tour 

with the 399th Combat Support Hospital in Mosul, Iraq in the winter of 2006, and 

finally a tour at Tripler Army Medical Center in 2009. I have seen and treated genitourinary trauma in the theater of operations and have participated in its chronic 

management at our largest military medical centers stateside. 

To begin, a brief review of the mechanics of natural human fertilization may be 

helpful. The testicle produces two elements essential to fertility: sperm and testosterone. After going through the stages of maturation, sperm leave the testicle 

through a series of tubes (the epididymis and vas deferens) and wait temporarily 

in the section of vas deferens that enters the prostate gland (ejaculatory duct). 

When ejaculation occurs, the supporting fluid (semen), is released from the seminal 

vesicles, sperm is released from the ejaculatory ducts (emission), and the mixture 

is propelled forward to be deposited in the vagina. Sperm then begin their journey 

across the cervix, into the body of the uterus. Eventually a very small percentage 

of the original populations make it to the fallopian tube to meet the egg which upon 

penetration of a single spermatozoon, is then fertilized. The fertilized egg (zygote) 

then implants in the wall of the uterus for the remainder of gestation. 

Normal female physiology is as follows: Eggs mature in the ovaries and once per 

cycle, an egg (oocyte) is released into the fallopian tube and begins its migration toward the body of the uterus. If it encounters a sperm on the way and becomes fertilized, the resulting zygote (fertilized egg) implants into the wall of the uterus and 

gestation ensues. If not, the oocyte is expelled and the process repeats on a monthly 

basis. 

It’s important to understand the breadth of types of injuries that result in threats 

to fertility. The most common mechanism of injury to the genitourinary organs in 

Operation Iraqi Freedom and Operation Enduring Freedom is blast effect from improvised explosive devices (IEDs), followed by gunshot wounds. The most common 

types of male genitourinary injuries, sometimes seen in isolation, but commonly in 

combination are: testicular rupture (unilateral or bilateral), penile shaft/pendulous 

urethral injury, posterior urethral injury, and bladder injury. Spinal cord injury and 

Traumatic Brain Injury are two major classes of non-urological injury that can impede fertility through ejaculatory dysfunction. If testicular rupture injuries present 

within a few hours as most do with current evacuation systems, salvage is possible 

with rates of up to 74% reported recently. Bilateral testicular loss is a devastating 

injury that obviously precludes future fertility. 

Blast injuries to the phallus often result in either erectile dysfunction or otherwise render it mechanically incapable of intercourse to achieve a natural pregnancy. 

Urethral injuries of either the pendulous or posterior aspect often result in stricture 

(scar tissue) formation that renders ejaculation either impaired or impossible. 

Schrapnel often penetrates the perineum, the area that includes the sexual organs 

and rectum. The perineum, even with proper use of the current protective gear, is 

unprotected. In these instances, the external sexual organs may be preserved but 

injury can occur to the portion of the erectile bodies (the tissue cylinders in the 

penis responsible for erection) that attach to the pubic bones or to the nerve and 

vascular supply responsible for erectile function. Even if the testicles are uninvolved 

or salvaged after a schrapnel injury, damage to the ductal system anywhere from 

epididymis to ejaculatory duct may result in lack of sperm delivery to the ejaculate. 

There is a groin-protective garment that is issued to soldiers as they are deployed. 

It is a triangular shaped shield that attaches to the front of the Improved Outer 

Tactical Vest (IOTV). Its design and location, however, are felt by many soldiers to 

be cumbersome and to inhibit mobility and so it is not worn by many. There is a 

critical need to invest in the research and development of protective gear for the 

genital organs that is effective and practical for the tactical environment. 

Blast or gunshot wounds to the female pelvis can also result in a variety of fertility-impairing injuries. Trauma to the perineum and vagina can easily result in 

an altered vaginal vault that renders intercourse impossible. Additionally, penetrating schrapnel injury to the female pelvis can disrupt the ovaries, fallopian tubes, 

body of the uterus or the vaginal vault. Fallopian tube injuries can preclude the normal passage of the egg and therefore prevent fertilization. Uterine injury can result 

in a uterus incapable of sustaining a pregnancy which then opens the issue of 

surrogacy. 

89 

Women also experience non-ballistic risks to maintenance of reproductive health 

while in theater. A recent white paper developed by the Army’s Women’s Health Assessment Team identified several barriers to optimal genitourinary health for female soldiers in theater. These included lack of secure facilities for women to attend 

to personal hygiene. There is in some instances a lack of confidence in unit-level 

health care provides with respect to competence in women’s health issues and concerns around confidentiality leading to avoidance of care-seeking. There are underappreciated psycho-social issues with female family separation that can have both 

psychological and physiological effects that lead to sexual dysfunction and fertility 

issues. The issues of military sexual trauma, which can have profound impact on 

sexual function and fertility, continue to be addressed military-wide through the 

Sexual Harassment/Assault Response and Prevention (SHARP) program. S. 3313 

seeks to meet these needs in two critical ways. First, by increasing the number of 

retreat-style counseling opportunities for returning female soldiers, and second, by 

improving the functionality of the female veterans’ call center. 

Given the many ways that injured soldiers can return to their home units or civilian life and their families with fertility-threatening injuries, the question becomes 

how are we willing to help them? Though genitourinary trauma is not publicly visible it is no less physically or psychologically debilitating than loss of limb or other 

overtly disfiguring injury. Procreation is one of the most fundamental of human 

instincts. 

The range of male and female injuries described above can all result in the inability for couples to achieve a pregnancy in standard fashion. That’s where advanced 

reproductive technology is brought to bear and where S. 3313 will have an immediate and profound impact for fertility-impaired soldiers, and their spouses. The advanced techniques are specifically intrauterine insemination (IUI) and in-vitro fertilization (IVF). IUI involves processing sperm that have been obtained either from 

the ejaculate or harvested from the testicle or epididymis, and implanting them directly into the uterus to complete the remainder of the natural fertilization process. 

In-vitro fertilization (IVF) is the process by which sperm and egg are united in a 

controlled laboratory environment and post-fertilization the zygote is placed in the 

uterus for implantation. IUI is employed when female anatomy is intact and functional from the cervix up, but either a male or female injury precludes depositing 

a requisite number of sperm into the vagina. As IUI is less technology and labor 

intensive, it is also less expensive per cycle. IVF is employed when a male and or 

female injury precludes the natural union of sperm and egg in the fallopian tube 

for any number of the reasons mentioned above. In cases where the uterus has been 

rendered incapable of sustaining a pregnancy, a surrogate can be engaged to carry 

the fertilized egg for the natural parents. More labor intensive than IUI, IVF also 

costs more but it is important to note that the cost per cycle of IVF in government 

facilities is tens of thousands of dollars less than in the private world, where VA 

couples are now forced to seek care at $20–30,000 dollars per cycle. The per-cycle 

success rate depends on a variety of factors including age. Pregnancy rates range 

between 20 and 45% per cycle and live birth rates range between 10% and 30% per 

cycle. 

An important provision of S. 3313 provides treatment to the spouse of the injured 

soldier. It’s important to understand the concept of sub-fertility. It is possible that 

a soldier with a fertility impairing injury, given a normally functioning partner, 

could still conceive naturally. Should the partner, however, have a condition resulting in sub-fertility (low sperm count, low sperm volume for men or hormonal cycle 

variables or minor anatomic variation for women), the partner under S. 3313 would 

be eligible for treatment. 

Currently the Department of Defense as of April 2012 (DOD instruction 1300.24) 

provides for advanced fertility treatment for soldiers who have suffered genitourinary injury. This DOD policy is a start but as currently written only covers those 

soldiers with the most severe general injury status who may be infertile. There are 

soldiers in the DOD who may have suffered isolated genitourinary injury and despite their infertility may remain functional in their MOS and this class of soldiers 

is not covered for infertility care under current policy. It’s important that the Department of Veterans Affairs create policy based on ‘‘infertility injury’’ and not a 

more general injury scale so as to capture every soldier who has been rendered infertile from battle injury. Every soldier with battle injury infertility deserves access 

to advanced reproductive technology. 

There is a desperate need, not only within the Department of Veterans Affairs but 

including the Departments of Defense and Health and Human Services to fund a 

longitudinal, prospective database of soldiers with genitourinary injury to better 

study the continuum of care from prevention, to initial management in theater, to 

reconstruction at higher levels of care to fertility treatment and outcomes. S. 3313 

90 

takes a critical step in calling for the Dept of Defense and NIH to conduct collaborative research to address long-term reproductive health care needs of veterans with 

service-connected GU/reproductive injuries. Also to this end, I want to bring to the 

Committee’s attention H.R. 1612 which has been re-introduced this session with the 

sponsorship of Congressman Brett Guthrie along with 25 co-sponsors in the House. 

The Bill, promulgated by the American Urological Association, seeks to establish a 

National Commission on Urotrauma. The 16 member Commission, a collaboration 

of the Departments of Defense, Veterans Affairs, and Health and Human Services, 

will be a sunset Commission with defined objectives as follows: 1) To conduct a comprehensive study of the present state of knowledge of the incidence, duration, and 

morbidity of, and mortality rates resulting from urotrauma and of the social and 

economic impact of such conditions; 2) To evaluate the public and private facilities 

and resources (including trained personnel and research activities) for the prevention, diagnosis, and treatment of, and research in such conditions; and 3) To identify 

programs (including biological, behavioral, environmental, and social programs) in 

which, and the means by which, improvement in the management of urotrauma can 

be accomplished. The Bill has been scored at a nominal cost and the offset has been 

identified. I would be happy to discuss the Bill further with any Members of the 

Committee who would like to learn more and perhaps support it. 

There is a wealth of expertise and the infrastructure is in place within the Department of Veterans Affairs and Department of Defense to provide soldiers with 

fertility-impairing injuries comprehensive management so that they may have their 

own children. S. 3313 unlocks that capability for soldier in the VA system to protect 

them from the $20–30,000 per cycle fees in the private sector where they now by 

necessity seek treatment. This is a wrong that S. 3313 rights. We as a nation have 

done better recently at addressing the physical disability that results from war injury. Appropriately, hundreds of millions of dollars have been dedicated to the research and development of prosthetics to return soldiers with loss of limb to a higher degree of physical ability. We are getting better at detecting and addressing the 

psychological wounds of war from PTSD and Traumatic Brain Injury. There’s an important group who have been left behind: those suffering the publicly-invisible but 

intensely emotionally painful loss of fertility as a result of genitourinary injury. 

Let’s together show these finest of Americans that we are willing to go beyond our 

current efforts of physical and emotional support. Let us use the expertise and tools 

that we have in place today to restore their fertility so that they may one day look 

into the eyes of their own children and see the family history, pride, and hope for 

the future that so many of the rest of us have been blessed to know. We owe these 

brave Americans no less for the sacrifices they have made for our great Nation. 

Chairman MURRAY. Thank you very much, Dr. Edney. 

With that, let us now turn to Ms. Ansley please. 

STATEMENT OF HEATHER ANSLEY, M.S.W., VICE PRESIDENT 

OF VETERANS POLICY, VETSFIRST 

Ms. ANSLEY. Thank you. Chairman Murray, Ranking Member 

Burr, and distinguished Members of the Committee, thank you for 

inviting VetsFirst to share our views and recommendations regarding the legislation that is the subject of this morning’s hearing. 

My oral testimony will focus on our support for the Mental 

Health ACCESS Act of 2012. First, however, I would like to take 

a moment to highlight our support for some of the other bills included in today’s hearing that are of particular interest to our 

members. 

Specifically, we support S. 3313, which has been discussed already today. S. 1838, regarding service dog training, and S. 1755 

concerning coverage for rehabilitation services for certain veterans. 

Each of these bills is critically important to allowing disabled 

veterans to live in their communities full, healthy lives. Our comments on these and other bills before the Committee are included 

in our written testimony. 

The chair of the VetsFirst Committee who was on the Hill with 

me yesterday spent 16 months at the Bronx VA in the late 1960s 

91 

after acquiring a spinal cord injury and he recently told me that 

during those 16 months he had one visit with a psychologist. 

The visit ended rather abruptly when he told the psychologist 

that he was thinking about returning to grad school. The psychologist shut the folder and wished him well. Thirty-six years later, 

after becoming a quadriplegic, he finally sought the mental health 

counseling that he needed to deal with the emotional and mental 

consequences that any type of serious injury brings. 

Although the services of the Bronx VA have greatly improved 

since that time, we want to make sure that another generation of 

veterans do not have problems accessing VA mental health care. 

Through VetsFirst work with the Consortium for Citizens with 

Disabilities, CCD, which is a coalition of over 100 national consumer, service-provider, and professional organizations that advocate on behalf of people with disabilities, we are working to expand 

our efforts and working with members of the disability community, 

the veterans community, and mental health communities to engage 

in efforts to address these concerns. 

To expand our efforts, we are working with the Mental Health 

Liaison Group, MHLG, which is a coalition comprised of national 

behavioral health organization’s that represents consumers, family 

members, advocates, professionals, and providers and advocates on 

behalf of people with until health or substance use issues. 

We highlighted our concerns about wait times for appointments 

and asserted our belief that clinicians might need to be given the 

time and resources to provide patients with evidence-based therapy 

in a letter that we sent to VA earlier this year. 

We have also expressed that VA should leverage the full range 

of certified mental health professionals that are available. We are 

pleased that VA has reached out toward us regarding our concerns, 

and we welcome the opportunity to continue working with VA and 

appreciate the outreach to both CCD and MHLG including the 

Vietnam Veterans of America, the American Foundation for Suicide 

Prevention, Mental Health America, and VetsFirst, who are the 

members of the coalitions that are leading this outreach effort with 

VA. 

The remainder of my comments on the Mental Health ACCESS 

Act of 2012 reflect the views of VetsFirst and my comments addressed only Title II which directly concerns VA. 

Access to quality mental health care is critical in ensuring that 

veterans are able to successfully reintegrate into their communities. We appreciate the requirement in this legislation for a VA 

to develop a measure of access to health care that will evaluate the 

timeliness, satisfaction, capacity, and availability of furnishing evidence-based therapies. 

We also support the requirement that VA develop a comprehensive staffing model that will include productivity standards. Requiring the VA to work with the National Academy of Sciences to 

create a study committee to advise in the development of these 

guidelines and measures will provide a heightened level of expertise. The mandates for transparency that require posting this information online will increase accountability. 

92 

To increase access, we also support expanding eligibility for Vet 

Centers services which is a positive step for servicemembers, families, and veterans. 

As we all know, Vet Centers are vital links to care for many who 

might not otherwise seek services. The role that Vet Centers plays 

an important role in the delivery of this care. We support this legislation expansion of eligibility as long as Vet Centers are properly 

resourced to meet the needs that they are designed to address. 

Although VA must have sufficient resources to meet the mental 

health needs of our Nation’s veterans, we also believe that the 

scope of the need requires VA to link with community resources. 

We support the requirement for VA to carry out a national program of outreach to connect with community mental health resources which represents a good opportunity to mobilize qualified 

providers in a concerted effort to organize clinicians who meets VA 

requirements and that will help to expand service capacity. 

In addition to community resources, peer support counselors are 

also an important component of the mental health delivery system. 

The counselors serve as a useful vector for helping individuals to 

seek more formal types of care and that establishing one of these 

programs at each VA medical center will ensure the availability of 

these services to as many veterans as possible. 

Again, thank you for the opportunity to share VetsFirst’s views 

on this legislation. This concludes my testimony and I will be 

pleased to answer any questions that you may have. 

[The prepared statement of Ms. Ansley follows:] 

PREPARED STATEMENT OF HEATHER L. ANSLEY, ESQ., M.S.W., VICE PRESIDENT OF

VETERANS POLICY, VETSFIRST, A PROGRAM OF UNITED SPINAL ASSOCIATION

Chairman Murray, Ranking Member Burr, and other Distinguished Members of 

the Committee, Thank you for the opportunity to testify regarding VetsFirst’s views 

on the bills under consideration today. 

VetsFirst represents the culmination of 60 years of service to veterans and their 

families. United Spinal Association, through its veterans service program, VetsFirst, 

provides representation for veterans, their dependents and survivors in their pursuit 

of Department of Veterans Affairs (VA) benefits and health care before VA and in 

the Federal courts. Today, United Spinal Association is not only a VA-recognized national veterans service organization, but is also a leader in advocacy for all people 

with disabilities. 

WOMEN VETERANS AND OTHER HEALTH CARE IMPROVEMENTS ACT OF 2012 (S. 3313)

After a decade of war, many severely disabled veterans who have experienced 

trauma related to improvised explosive devices and other conditions of warfare may 

experience infertility. For many veterans, the ability to start or grow their families 

represents an important part of moving forward with their lives. Unfortunately, the 

current services available from VA in many cases do not reflect the needs of these 

veterans and their families. 

Presently, VA provides male veterans who have spinal cord injuries with fertility 

services for retrieving, storing, and preparing sperm for use for assisted reproductive technology. These services are available to male veterans who are service-connected and also for those who have access to VA health care but whose disabilities 

are not related to their military service. Although VA provides these services for 

male veterans who have spinal cord injuries, there is no provision to provide the 

assisted reproductive technologies needed for fertilization. 

The Women Veterans and Other Health Care Improvements Act takes important 

steps toward assisting veterans, their spouses, and surrogates in holistically addressing infertility. VetsFirst supports the addition of fertility counseling and treatment, including treatment using assisted reproductive technology to the definition 

of medical services. We are also pleased that this legislation not only expands the 

definition of medical services to include these treatments, but also provides them 

93 

to veterans’ spouses or surrogates. We are disappointed, however, that these services are not required for veterans who are not service-connected. 

We appreciate the requirement for the promulgation of regulations to implement 

these new statutory requirements. To provide a level of certainty to veterans and 

their spouses, it will be important for VA to develop a non-inclusive list of the types 

of technologies that will be provided (at a minimum) by VA. It must also be clear 

to veterans and their spouses or surrogates whether VA will provide services related 

to subsequent costs of pregnancy and post-partum care. 

This legislation also requires VA to facilitate collaborative research with the Department of Defense (DOD) and the National Institutes of Health which will help 

VA to address the long-term reproductive health needs of veterans. This research 

will be critical in addressing the unique infertility issues of veterans with combatrelated injuries. We are also pleased that the legislation requires that the research 

be disseminated within the Veterans Health Administration to guide treatment 

practices. 

VetsFirst also supports efforts in the legislation to improve access to VA services 

for women veterans. Women make up an increasing percentage of the veteran population. Consequently, VA must improve efforts to address the unique needs and concerns of women veterans. Otherwise, women may be hesitant to take advantage of 

their benefits. 

MENTAL HEALTH ACCESS TO CONTINUED CARE AND ENHANCEMENT OF SUPPORT

SERVICES (ACCESS) ACT OF 2012

The need to access high quality VA mental health services when needed is critically important for our Nation’s veterans and their families. After a decade of war, 

the number of veterans who need mental health services due to Post Traumatic 

Stress Disorder and other wounds related to their service has greatly increased. Veterans from previous wars also continue to need mental health care services which 

allow them to be vital contributors to their communities and families. 

The difficulty of some veterans in accessing VA mental health care services in a 

timely manner has been detailed in numerous hearings before this Committee over 

the last year. The report from VA’s Office of Inspector General regarding access to 

mental health care that was released on April 23, 2012, highlighted concerns about 

appointment times and the lack of accurate performance data. Aside from the statistics, we are acutely aware of the sheer human toll of war as reflected by the number 

of servicemembers and veterans who are committing suicide on a daily basis. 

As an organization that is both a veterans service organization and a disability 

organization, we are very concerned about the ability of veterans to have timely access to evidence-based therapies. Through our work with the Consortium for Citizens with Disabilities (CCD), VetsFirst is working with members of the disability, 

veterans, and mental health communities to engage in efforts to address these concerns. Specifically, representatives of the CCD Veterans and Military Families Task 

Force and the Mental Health Liaison Group (MHLG) have been meeting regularly 

to better determine how we might work with VA to improve access to mental health 

services for our Nation’s veterans. 

CCD is a coalition of over 100 national consumer, service provider, and professional organizations which advocates on behalf of people with disabilities and chronic conditions and their families. 

The MHLG is a coalition comprised of national behavioral health organizations 

representing consumers, family members, advocates, professionals, and providers 

which advocates on behalf of individuals with, or at risk of, a mental health or substance use condition, including servicemembers, veterans, and their families. 

On April 5, the CCD Veterans and Military Families Task Force and MHLG sent 

a letter signed by 41 member organizations to VA expressing our concerns about the 

delay in veterans receiving VA mental health services. In this letter, which is included with our testimony, member organizations highlighted our concerns about 

wait times for appointments. We also asserted our belief that clinicians must be 

given the time and resources to provide veterans with evidence-based therapies that 

represent the best practices for addressing veterans’ specific needs. Last, we asserted that VA should leverage the full range of certified mental health professionals, including psychiatric social workers and licensed professional counselors, to 

increase access to these best practice therapies. 

We are pleased to report that VA reached out to us regarding our concerns, and 

we look forward to growing our partnership to ensure that our Nation’s veterans 

have access to needed mental health services. We welcome the opportunity to continue working with VA and appreciate the outreach to CCD and MHLG, including 

Vietnam Veterans of America, the American Foundation for Suicide Prevention, 

94 

Mental Health America, and VetsFirst who are the member organizations leading 

the outreach effort. 

The remainder of VetsFirst’s comments on the Mental Health ACCESS Act of 

2012 reflect our individual views. For purposes of our testimony, we are limiting our 

comments to Title II—Department of Veterans Affair Matters. 

Access to quality mental health care is critical in ensuring that veterans are able 

to successfully reintegrate into their communities. To ensure that access standards 

are being met, VA must develop comprehensive measures that accurately determine 

whether proper access to services is being provided. We appreciate the requirement 

in this legislation for VA to develop a measure of access to health care that will 

evaluate timeliness, satisfaction, capacity, and availability and furnishing of evidence-based therapies by VA. We also support the requirement that VA develop a 

comprehensive staffing model that will include productivity standards. 

The development of access measures and staffing guidelines for mental health 

care is crucial to meeting the mental health care needs of veterans. Requiring VA 

to contract with the National Academy of Sciences to create a study committee to 

advise in the development of these guidelines and measures will provide a heightened level of expertise. We also support the requirement for the study committee 

to assess the mental health needs of our newest veterans. The mandates for transparency through reporting and posting the measures and guidelines online will help 

to facilitate accountability. 

Expanding access to Vet Centers is a positive step in efforts to address the mental 

health care for veterans, servicemembers, and their families. Vet Centers are a critical link to care for many veterans who might not otherwise seek services. The role 

that Vet Centers play in the delivery of this care is crucial. Thus, the services and 

supports provided by Vet Centers must be available when needed by these individuals. We support this legislation’s expansion of eligibility for services as long as Vet 

Centers are properly resourced because of the great need for readjustment services 

by servicemembers and their families. 

We also support the proposed organization of VA’s Readjustment Counseling Service. We appreciate the inclusion of language stating that, ‘‘The Readjustment Counseling Service is a distinct organizational element within Veterans Health Administration.’’ We are also pleased that the Chief Officer of the Service will have direct 

authority over staff and assets and that its budget request will be listed separately. 

The autonomy of the Service contributes to its successful outcomes and outreach to 

veterans. 

Although VA must have sufficient resources to meet the mental health needs of 

our Nation’s veterans, the scope of the need requires VA to fully utilize any available resources that will properly meet these needs. Requiring VA to carry out a national program of outreach to connect with community mental health resources represents a good opportunity to mobilize qualified providers. A concerted effort to organize clinicians who meet VA requirements will expand the capacity of VA services. We are also pleased that the legislation requires training in military culture 

to ensure that these providers are able to better meet the needs of veterans. 

In addition to community resources, peer support counselors are also an important component of the mental health delivery system. These counselors serve as useful vectors for helping individuals to seek more formal types of mental health care. 

Requiring that peer support counseling programs be established at each medical 

center will ensure the availability of these services to as many veterans as possible. 

We believe that the steps taken in Title II of this legislation will strengthen VA’s 

ability to serve veterans, servicemembers, and their families. 

To require VA to consider the resources of individuals applying for pension that were 

recently disposed of by the individuals for less than fair market value when determining the eligibility of such individuals for such pension (S. 3270) 

VA’s pension program provides benefits for veterans who are low-income and are 

either permanently and totally disabled, or age 65 and older, if they served during 

a period of war. These benefits are critical for veterans who have few other resources available to them. 

Because these benefits are very important to low-income disabled veterans, we believe that these benefits must be protected to ensure that they are fully available 

when needed. As a result, we do not condone fraudulent efforts to benefit from the 

VA’s pension program. We also believe, however, that people should not have to impoverish themselves just to receive the services that they need whether in VA’s program or any other government benefits program. 

The look-back proposed in this legislation seeks to preempt efforts to transfer assets to make veterans eligible for pension benefits. Without commenting further on 

the specific merits of this proposal, we are concerned that the legislation does not 

95 

1Kelly A. Thompson, ‘‘The Dilemma for Military Parents of Children with Disabilities.’’ EP 

Magazine. November 2011. 

exempt transfer of assets to special needs trusts. Special needs trusts are designed 

to supplement the services and supports received by people with disabilities through 

Social Security and Medicaid. The funds in a special needs trust may be used for 

expenses such as modifying a home for accessibility, paying for recreational activities, or purchasing tickets to visit family. If the funds were made directly available 

to the individual, then he or she may lose eligibility for Supplemental Security Income (SSI) benefits and Medicaid services and supports, which are income dependent. By placing the funds in a special needs trust, parents can ensure, for instance, 

that their disabled children retain eligibility for these crucial benefits and services. 

A good example illustrating the importance of special needs trusts is found in the 

current quandary with the DOD survivor benefit plan (SBP). An SBP annuity allows 

for retiring servicemembers to make a portion of their retired pay available to their 

survivors. However, Federal law requires that these benefits must be paid to a ‘‘natural person.’’ Thus, if a child with a disability is in receipt of income dependent 

services and supports, then the child may lose these benefits and services because 

SBP funds cannot be paid to a special needs trust. Unfortunately, the amount received from the annuity may not be sufficient to pay for the services lost. Thus, the 

child not only loses eligibility for the services but then is unable to pay for them 

privately. 

In the November 2011 edition of Exceptional Parent Magazine, Kelly A. Thompson, an attorney, relayed how this dilemma played out for one adult child with a 

disability. 

‘‘A recent example concerns a 52 year-old man with an intellectual disability who had lived in a group home for 18 years and attended a day program for individuals with disabilities. His only income was SSI of $674 per 

month. His SSI benefits and Medicaid paid for his programs and services. 

However, when his father, a retired Navy officer, died, his adult son began 

to receive military SBP in the amount of $2,030 per month. This SBP payment made him ineligible for Medicaid waiver services. The private pay cost 

of the programs and services he was receiving prior to his father’s death 

is $8,600 per month, more than four times his SBP payment. He lost his 

group home placement, as well as his day program, and was transferred to 

a state ‘‘training center’’—a large institutional setting isolated from the 

community.’’ 1

People with disabilities greatly benefit from access to special needs trusts. In the 

Omnibus Budget Reconciliation Act of 1993, Congress exempted the transfer of assets for the benefit of a person with a disability under the age of 65 from the lookback provisions of the Medicaid program. Thus, not only is a person with a disability able to benefit greatly from a special needs trust but the transfer of assets 

to the trust for the benefit of another does not count against the transferor in the 

event that he or she subsequently needs Medicaid assistance. In light of the importance of special needs trust, it is clear that these benefits should be available for 

the disabled children of veterans, without disadvantaging the veteran in receiving 

VA pension benefits if needed. 

It should also be noted that a person with a disability who is under the age of 

65 may have his or her own assets transferred into a special needs trust that directly benefits him or her. These types of trusts may only be established by a parent, grandparent, legal guardian, or a court and allow the individual to remain eligible for Medicaid services and supports. Any remaining funds available at death 

must be used to pay-back the Medicaid program for services provided. 

Any efforts to penalize transfer of assets under the VA’s pension program must 

provide for appropriate exemptions for transfers to special needs trusts similar to 

those available through other Federal programs also based on financial need. 

To require VA to carry out a pilot program on service dog training therapy (S. 1838) 

Service animals provide multi-faceted assistance to people with disabilities. Specifically, service animals promote community integration. In addition to performing 

specific tasks such as pulling a wheelchair or opening a door, these same service 

animals can also help to break down barriers between people with disabilities and 

society. In addition to increased social interaction, many people with disabilities also 

report experiencing a greater sense of independence. 

We support efforts to ensure that properly trained service animals are available 

to veterans who can benefit from their assistance. This legislation provides a unique 

opportunity to benefit not only veterans seeking the assistance of a service dog but 

96 

also provides veterans with post-deployment mental health concerns or Post Traumatic Stress Disorder the opportunity to benefit from training these dogs. The dual 

nature of this approach has the potential to assist a wide range of veterans. 

To provide coverage under the VA’s beneficiary travel program for the travel of certain disabled veterans for certain special disabilities rehabilitation (S. 1755) 

Veterans who have spinal cord injuries or disorders, vision impairments, or double 

or multiple amputations require access to rehabilitation services that allow them to 

live as independently as possible with their disabilities. For those veterans who 

need these services but who are not eligible for travel benefits, the ability to pay 

for travel to these rehabilitation programs is very difficult. In addition, few of these 

services are available locally, particularly in rural areas. 

We strongly support providing travel benefits for catastrophically disabled nonservice-connected veterans who need to travel to receive in-patient care at special 

disabilities rehabilitation programs. Every effort must be made to reduce barriers 

that limit access to these services. The long-term savings of ensuring that these veterans are able to maintain their health and function significantly outweighs the 

short-term costs associated with this legislation. 

Veteran Voting Support Act of 2011 (S. 1264) 

Exercising the right to vote is a fundamental aspect of American citizenship. For 

servicemembers and veterans who have served as the defenders of our Nation’s freedoms, the opportunity to register to vote and exercise that right is particularly 

meaningful. 

The Veteran Voting Support Act seeks to increase access to voter registration opportunities by requiring VA to provide voter registration applications and assistance 

to veterans during specified interactions with VA. Although we support the efforts 

of this legislation to ensure that veterans have increased opportunities to register 

to vote, we are concerned by the lack of a meaningful enforcement mechanism and 

protections for registrants that are available through the National Voter Registration Act (NVRA). 

The NVRA provides mechanisms, including state designation of Federal agencies 

as voter registration agencies, to ensure that citizens, including veterans, have more 

opportunities to register to vote or update a previous registration. Since 2008, at 

least seven states have requested that VA agree to designation as a voter registration agency. 

If VA were to be designated as a voter registration agency under the NVRA, in 

the event of a violation, either the Department of Justice (DOJ) or a third party 

may bring an action requesting enforcement. Under the Veteran Voting Support 

Act, however, the only initial remedy is for the veteran to provide written notice to 

the facility director or the Secretary of Veterans Affairs. If the violation is not remedied within 90 days, the individual may file a written notice of complaint with DOJ 

and the Election Assistance Commission. But, there is no opportunity for third party 

litigation, which has proven critical in ensuring that the NVRA is enforced by individual states. 

Although the Veteran Voting Support Act parallels the NVRA, other important aspects of the NVRA would not be available under this legislation. For example, if a 

veteran registers to vote through VA under the mechanism of the Veteran Voting 

Support Act, then the veteran’s registration will not be official until submitted by 

VA. Under the NVRA, the registration would be considered officially submitted once 

provided to VA. 

Last, we are concerned that the Veteran Voting Support Act does not require VA 

to report the number of voter registration applications submitted to VA. Thus, it 

will be difficult to determine whether VA is fully implementing the legislation as 

required. Ultimately, we believe that the NVRA provides a better system of voting 

rights that is more enforceable than those envisioned under the Veteran Voting 

Support Act. 

Unfortunately, VA has expressed concern that agreeing to state designation as a 

voter registration agency would be too costly and would expand VA’s mission at a 

time when resources are critically needed to assist veterans of the wars in Iraq and 

Afghanistan, as well as meet the needs of veterans of all eras. We believe, however, 

that serving as a voter registration agency enhances VA’s fulfillment of its mission 

to help veterans reintegrate into their communities. 

Thus, we would support legislation that is at least modeled on the requirements 

of the NVRA. 

Thank you for the opportunity to testify concerning VetsFirst’s views on these important pieces of legislation. We remain committed to working in partnership to enVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00100 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
97 

sure that all veterans are able to reintegrate in to their communities and remain 

valued, contributing members of society. 

Chairman MURRAY. Thank you very much. 

Ms. Ilem. 

STATEMENT OF JOY J. ILEM, DEPUTY NATIONAL LEGISLATIVE 

DIRECTOR, DISABLED AMERICAN VETERANS 

Ms. ILEM. Chairman Murray and the Members of the Committee, 

thank you for inviting DAV to present our views on the bills under 

consideration today. I will limit my remarks to five bills that are 

of particular interest to DAV and our members. 

In accordance with the long-standing resolutions, DAV is pleased 

to support S. 1391, a bill that would change the standard of proof 

required to establish service connection for veterans with Post 

Traumatic Stress Disorder resulting from military service and mental health conditions related including PTSD due to military sexual 

trauma. 

We believe the enactment of this bill would provide a commonsense standard of proof or veterans who have experienced serious 

mental and physical trauma but that is often difficult to verify because of a lack of documentation. 

S. 2259 would provide cost-of-living adjustment or COLA in the 

rates of compensation for veterans with service-connected disabilities and the rates of DIC. DAV supports this legislation. However, 

consistent with DAV resolution 172, we oppose rounding down adjusted rates to the lower whole dollar. 

We thank the Chairman for her continued efforts on improving 

VA services for women veterans and are pleased to support 

S. 3313. This bill is focused on improving the Department’s ability 

to meet the long-term reproductive health care needs of veterans 

who have a service-connected condition that affects the veteran’s 

ability to reproduce. 

While DAV has no specific resolution from our membership related to reproductive and infertility research and infertility counseling and treatment because it focuses on service-connected injuries and would be beneficial to many DAV members and veterans, 

we have no objection to the passage of these provisions. 

Regarding the remaining sections of the bill, DAV has heard 

positive feedback related to counseling services in retreat settings 

and the childcare pilot programs established in Public Law 111– 

163. We supported the original provisions for these pilots in according to DVA resolution 185 and are pleased to support the proposal 

to expand them in this measure to include veterans seeking readjustment counseling services at Vet Centers. 

The Mental Health ACCESS Act of 2012 focuses on improving 

and enhancing the programs and activities of DOD and VA related 

to suicide prevention, resilience, and behavioral health disorders of 

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

We appreciate the bill’s provisions related to implementing a 

comprehensive set of measures to assess timeliness, satisfaction, 

and barriers to mental health care, improving access to services, 

productivity standards for the providers, and establishing an IOM 

study committee with the inclusion of members that have VA clinical mental health experience. 

98 

Of particular interest to DAV is section 204 of the measure. As 

intended by Congress in establishing its original mandate in 1979, 

the RCS was to be an independent, non-medical, non-psychiatric 

model of care for veterans who were in need of combat related readjustment services but did not necessarily want to go to traditional mental health clinics in VA. 

Today’s new combat veterans have made it clear to DAV and others that date too desire a similar non-stigmatizing readjustment 

program to aid them and to have found Vet Centers to be a welcoming, non-judgmental places to receive that help. 

DAV is pleased to support this comprehensive measure in accordance with DAV resolution 189 and 200 and we appreciate the 

Chairman’s continued efforts on improving mental health programs 

for veterans, members of the Armed Forces, and their families. 

The final bill we would like to comment on is S. 3084, the VISN 

Reorganization Act of 2012. This measure would require the Secretary of the VA to restructure and realign VHAs 21 current Veterans Integrated Service Networks or VISNs and to set personnel 

limits for the VISNs. 

DVA has no specific resolution concerning the organizational 

alignment of the VISNs and no formal position on this bill. However, we have urged Congress to examine VISN staffing and functions by conducting an independent study of the VISN structure. 

In this regard, we appreciate Senator Burr’s intention to address 

this critical issue in his measure. It appears from VA’s testimony 

in the previous panel that it is working toward a VISN reorganization plan; and like this Committee, we look forward to hearing 

more about that plan and are hopeful that the best VISN model to 

serve our veteran population will be established. 

Madam Chair, that concludes my statement and I am happy to 

answer any questions you or Committee Members may have. 

Thank you. 

[The prepared statement of Ms. Ilem follows:] 

PREPARED STATEMENT OF JOY J. ILEM, DEPUTY, 

NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS

Chairman Murray, Ranking Member Burr and Members of the Committee: On behalf of the Disabled American Veterans (DAV) and our 1.2 million members, all of 

whom are wartime disabled veterans, I am pleased to present our views on the 23 

legislative bills and two draft measures under consideration today. 

S. 1264, VETERAN VOTING SUPPORT ACT OF 2011

The Veteran Voting Support Act of 2011 would require the Secretary of Veterans 

Affairs to permit facilities of the Department to be designated as voter registration 

agencies and expand assistance to veterans in registering to vote and voting. Section 

3 of the bill directs the Department of Veterans Affairs (VA) to provide mail voter 

registration application forms to each veteran who seeks to enroll in the VA health 

care system; and is already enrolled in such system when there is a change in the 

veteran’s enrollment status or when there is a change in the veteran’s address. 

It also requires the Secretary to accept completed voter application forms and 

transmit them to appropriate state election officials and requires forms accepted at 

VA medical centers, community living centers, community-based outpatient centers, 

and domiciliaries be transmitted within ten days of acceptance, unless a completed 

form is accepted within five days before the last day for registration to vote in an 

election, in which case it must be transmitted within five days of acceptance. 

Section 4 requires each director of a VA community living center, domiciliary, or 

medical center to provide assistance in voting by absentee ballot to resident veterans, and requires such assistance to include: 1) providing information relating to 

99 

the opportunity to request an absentee ballot; 2) making available absentee ballot 

applications upon request, as well as assisting in completing such applications and 

ballots; and 3) working with local election administration officials to ensure the 

proper transmission of the applications and ballots. 

Section 5 requires the Secretary to permit nonpartisan organizations to provide 

voter registration information and assistance at facilities of the VA health care 

system. 

Section 6 prohibits the Secretary from banning any election administration official, whether state or local, party-affiliated or non-party affiliated, or elected or appointed, from providing voting information to veterans at any VA facility. It also directs the Secretary to provide reasonable access to facilities of the VA health care 

system to state and local election officials for the purpose of providing nonpartisan 

voter registration services to individuals. 

Although DAV has a long-standing resolution encouraging disabled veterans to 

register to vote and to vote—and initially provided our support for S. 1556, the Veteran Voting Support Act of 2009—at this time we have reconsidered our position 

on the bill due to concerns about the overall negative impact this bill would have 

on the Veterans Health Administration (VHA) and the fact that VA is currently providing voter registration to veterans when requested. Currently, VHA Directive 

2008–053 defines VA’s policy for assisting patients who seek information on voter 

registration and voting. Based on the policy, VA does not solicit voter registration 

but provides assistance to veterans who are inpatients under VA’s care; residents 

of VA community living centers and domiciliaries who want to get registered to vote 

or vote in an election. Additionally, state and local election officials, as well as nonpartisan groups are invited into VA health care facilities and those visits are coordinated to ensure there are no disruptions in patient care services. Finally, flyers and 

information on the voting assistance program are posted throughout facilities and 

volunteers have been specifically recruited in the past to help with these efforts. 

Based on this policy, it appears that much of the bill would be duplicative of VA’s 

current efforts and therefore unnecessary. Likewise, we are confident that the policy 

and existing Federal Regulations under title 38, subsection 17.33, ensure veteran 

patients the opportunity to exercise their voting privilege. 

S. 1391

S. 1391 would change the standard of proof required to establish service connection for veterans with Post Traumatic Stress Disorder (PTSD) resulting from military service, and for veterans suffering from certain mental health conditions, including PTSD, resulting from military sexual trauma that occurred in service. 

Essentially, S. 1391 would eliminate the requirement of an in-service, verifiable 

stressor in conjunction with claims for PTSD. Under this change, VA would now be 

able to award entitlement to service connection for PTSD even when there is no official record of such incurrence or aggravation in service, provided there is a confirmed diagnosis of PTSD coupled with the veteran’s written testimony that the 

PTSD is the result of an incident that occurred during military service, and a medical opinion supporting a nexus between the two. 

In November 2010, VA modified its prior standard of proof for PTSD related to 

combat veterans by relaxing the evidentiary standards for establishing in-service 

stressors if it was related to a veteran’s ‘‘fear of hostile military or terroristic activity.’’ S. 1391 would buildupon that same concept and expands it to cover all environments in which a veteran experiences a stressor that can reasonably result in 

PTSD, regardless of whether it occurred in a combat zone, as long as it occurred 

when the veteran had been on active duty or active duty for training. The legislation 

would also remove the current requirement that the diagnosis and nexus opinion 

come only from VA or VA-contracted mental health professionals, but would instead 

allow any qualified mental health professional. 

S. 1391 would also allow VA to award entitlement to service connection for certain 

mental health conditions, including PTSD, anxiety and depression, which a veteran 

claims was incurred or aggravated by military sexual trauma experienced in service, 

even in the absence of any official record of the claimed trauma. Similar to the evidentiary standard above for PTSD, the veteran must have a diagnosis of the covered 

mental health condition together with a written testimony by the veteran that the 

claimed trauma was incurred during military service. Further, the veteran must 

have a medical opinion from a mental health professional indicating that the 

claimed mental health condition is reasonably related to military sexual trauma, 

which would include a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment while the veteran was serving on active duty or active 

duty for training. 

100 

DAV supports S. 1391, which is consistent with DAV Resolutions 59 and171. DAV 

Resolution 171 states that, ‘‘establishing a causal relationship between injury and 

later disability can be daunting due to lack of records or certain human factors that 

obscure or prevent documentation of even basic investigation of such incidents after 

they occur * * *’’ and that, ‘‘* * * an absence of documentation of military sexual 

trauma in the personnel or military unit records of injured individuals prevents or 

obstructs adjudication of claims for disabilities for this deserving group of veterans 

injured during their service, and may prevent their care by VA once they become 

veterans * * *.’’ Further, DAV Resolution 59 states that, ‘‘* * * proof of a causal 

relationship may often be difficult or impossible * * *’’ and that, ‘‘* * * current 

law equitably alleviates the onerous burden of establishing performance of duty or 

other causal connection as a prerequisite for service connection * * *.’’ Enactment 

of S. 1391 would provide a commonsense standard of proof for veterans who have 

experienced serious mental and physical traumas in environments that make it difficult to establish exact causal connections. 

S. 1631

S. 1631 would authorize the Secretary of Veterans Affairs to establish a center for 

technical assistance for non-Department health care providers who furnish care to 

veterans in rural areas. This bill makes the head of such center the Director of the 

Rural Veterans Health Care Technical Assistance Center. It also requires the Secretary, in selecting the center’s location, to give preference to a location that, among 

other things, has a high number of veterans in rural and highly rural areas, and 

is near one or more entities carrying out programs and activities relating to health 

care for rural populations. 

The purpose of the center would be to develop and disseminate information, educational materials, training programs, technical assistance and materials and other 

tools to improve access to health care for veterans living in rural areas. It would 

also help to establish and maintain Internet-based information such as best practice 

models, research results and other appropriate information. 

VHA’s Office of Rural Health’s (ORH) mission is to improve access and quality 

of care for enrolled rural and highly rural veterans by developing evidence-based 

policies and innovative practices to support their unique needs. ORH includes information on its Web site about the three Veterans Rural Health Resource Centers 

(VRHRC) that have been established. The Western Region center in Salt Lake City 

focuses on outreach, access issues and the special needs of Native Americans (American Indian, Alaska Native, Native Hawaiian, Pacific Islander) and aging veterans. 

The Central Region center in Iowa City, Iowa focuses on evaluating rural health 

programs and piloting new strategies to help veterans overcome barriers to access 

and quality. The Eastern Region center located in Gainesville, Florida focuses on 

developing models to deliver specialty care services to rural areas, training VA and 

non-VA service providers caring for rural veterans and bringing specialty care to 

community-based clinics via tele-health technology. 

DAV Resolution No. 203 supports the mission of the VA’s Office of Rural Health 

and improvements to VA coordinated health care services for veterans living in 

rural areas. DAV originally supported S. 1631 when it was introduced in September 2011. It is unclear from the information we have available to us if any of the 

VRHRCs are in fact devoting resources toward the intent of this bill, which is to 

aid non-VA providers who furnish care to veterans in rural areas with technical assistance. We urge the Committee to ask VA to provide specific details in this regard. 

In the event that VA is not working toward this goal, we continue to support this 

bill and taking other actions to help medical providers better deliver much-needed 

health care to veterans in rural areas. 

S. 1705

Introduced by Chairman Murray, this bill would designate the VA Medical Center 

in Spokane, Washington, as the ‘‘Mann-Grandstaff Department of Veterans Affairs 

Medical Center.’’ DAV has no resolution on this issue and has no national position 

on this bill. 

S. 1707, VETERANS SECOND AMENDMENT PROTECTION ACT

Introduced by Senator Burr, this bill would amend title 38, United States Code, 

to clarify the conditions under which certain persons may be treated as adjudicated 

mentally incompetent for certain purposes. DAV has no resolution on this issue and 

has no position on this bill. 

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S. 1755

S. 1755 would provide for coverage under VA’s beneficiary travel program disabled veterans with vision impairment, a spinal cord injury, or multiple amputations for travel related to in-patient care in a special disabilities rehabilitation program. Currently, VA is authorized to pay the actual necessary expense of travel (including lodging and subsistence), or in lieu thereof an allowance based upon mileage, to eligible veterans traveling to and from a VA medical facility for examination, 

treatment, or care. According to title 38, United States Code, Section 111(b)(1), eligible veterans include those with a service-connected rating of 30 percent or more; receiving treatment for a service-connected condition; in receipt of VA pension; whose 

income does not exceed the maximum annual VA pension rate, or; traveling for a 

scheduled compensation or pension examination. 

Notably, the VA Secretary has the discretionary authority under section 111(b)(2), 

to make payments for beneficiary travel to or for any person not currently eligible 

for travel by such person for examination, treatment, or care. 

DAV has no resolution on this issue and has no position on this bill. However, 

we would note that while the intended recipients of this expanded eligibility criteria 

would certainly benefit, we would urge the Committee to consider a more equitable 

approach rather than one based on the specific impairments of a disabled veteran. 

Further, we ask that if the Committee does favorably consider this measure, it also 

take appropriate actions to ensure that sufficient additional funding be provided to 

VA to cover the cost of the expanded program. 

S. 1799, ACCESS TO APPROPRIATE IMMUNIZATIONS FOR VETERANS ACT OF 2011

This measure would require the Secretary of Veterans Affairs to make available 

periodic immunizations against certain infectious diseases as adjudged necessary by 

the Secretary of Health and Human Services through the recommended adult immunization schedule established by the Advisory Committee on Immunization Practices. The bill would include such immunizations within the authorized preventative 

health services available for VA-enrolled veterans. The bill would establish publicly 

reported performance and quality measures consistent with the required program 

of immunizations authorized by the bill. The bill would require annual reports to 

Congress by the Secretary confirming the existence, compliance and performance of 

the immunization program authorized by the bill. 

Although DAV has no adopted resolution from our membership dealing specifically with this matter of immunizations for infectious diseases, DAV Resolution No. 

193 calls on VA to maintain a comprehensive, high quality, and fully funded health 

care system for the Nation’s sick and disabled veterans, specifically including preventative health services. Preventative health services are an important component 

of the maintenance of general health, especially in elderly and disabled populations 

with compromised immune systems. If carried out sufficiently, the intent of this bill 

could also contribute to significant cost avoidance in health care by reducing the 

spread of infectious diseases and obviating the need for health interventions in 

acute illnesses of those without such immunizations. For these reasons, DAV supports this bill and urges its enactment. 

S. 1806

S. 1806 would amend the Internal Revenue Code of 1986 to allow taxpayers to 

designate overpayments of tax as contributions to the homeless veterans assistance 

fund. DAV has no resolution on this issue and has no position on this bill. 

S. 1838

S. 1838 would require the Secretary of Veterans Affairs to carry out a pilot program on service dog training therapy. If enacted, this measure would require the 

Department to conduct a pilot program to assess the feasibility and advisability of 

using service dog training activities as part of an integrated post-deployment mental 

health program. The purpose of the pilot program is for VA to produce specially 

trained service dogs for veterans; to determine how effectively the program would 

assist veterans with Post Traumatic Stress Disorder (PTSD) and the feasibility of 

extending or expanding the pilot program. 

DAV has no resolution on this issue and has no position on this bill. However, 

we are looking forward to the receipt of findings from VA’s ongoing research project 

to determine the efficacy of service dog usage by veterans challenged by mental illness and post-deployment mental health conditions related to combat, including 

PTSD. We recognize that trained service animals can play an important role in 

maintaining functionality and promoting maximum independence and improved 

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quality of life for persons with disabilities—and that pilot programs such as the one 

proposed could be of benefit to certain veterans. However, we do have a concern 

about VA’s experience with advanced training methods for the many varieties of 

highly specialized service dogs. 

S. 1849, RURAL VETERANS HEALTH CARE IMPROVEMENT ACT

S. 1849, the Rural Veterans Health Care Improvement Act, would require VA to 

develop a five-year strategic plan for ORH for improving access to, and the quality 

of, health care services for veterans in rural areas. 

DAV supports the intention of S. 1849 in accordance with DAV Resolution No. 

203. However, we note that the VA’s ORH has made available its ‘‘Strategic Plan 

Refresh’’ for Fiscal Years 2012–2014 with six specific goals and a number of initiatives to achieve those goals. The VA’s Strategic Plan on rural health care is comprehensive and seems to cover many of the provisions listed in S. 1849; however, 

we would like to see additional information on the use of mobile clinics and coordination of care for women veterans living in rural areas. We ask VA to provide an 

update on the use of mobile clinics in rural areas and the provisions in the bill that 

would require a survey of each VA facility that serves rural and highly rural areas 

concerning the provision for and coordination of care for women veterans—including 

options for fee-basis care and specialty care. DAV is interested in hearing VA’s testimony on these topics, and in the event that their current two-year plan does not 

address those specific provisions outlined in S. 1849, we would support passage of 

an amended version of this bill related to those specific provisions or any others that 

are missing from VA’s plan. 

S. 2045

S. 2045 would require judges of the United States Court of Appeals for Veterans 

Claims to reside within 50 miles of the District of Columbia. DAV has no resolution 

on this issue and has no position on this bill. 

S. 2244, VETERANS MISSING IN AMERICA ACT OF 2012

This bill would direct the Secretary of Veterans Affairs to cooperate with veterans 

service organizations and other groups in assisting the identification of unclaimed 

and abandoned human remains. The VA would also be required to determine if any 

such remains are eligible for burial in a national cemetery. The VA would cover the 

burial cost if the remains are determined to be that of an eligible veteran who does 

not have a next of kin or other person claiming the remains, and there are no available resources to cover burial and funeral expenses. In addition, the bill calls on the 

VA to establish a public database of the veterans identified in this project. DAV has 

no resolution on this issue and has no position on this bill. 

S. 2259, VETERANS’ COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 2012

S. 2259 would provide for a cost-of-living adjustment (COLA), effective December 1, 2012, in the rates of compensation for veterans with service-connected disabilities and the rates of dependency and indemnity compensation for the survivors of 

certain disabled veterans based on the Social Security COLA. DAV generally supports this legislation; however, consistent with DAV Resolution 172, we oppose 

rounding down the adjusted rates to the next lower whole dollar. 

S. 2320, REMEMBERING AMERICA’S FORGOTTEN VETERANS CEMETERY ACT OF 2012

S. 2320 would direct the American Battle Monuments Commission to provide for 

the ongoing maintenance of Clark Veterans Cemetery in the Republic of the Philippines, and for other purposes. DAV has no resolution on this issue and has no position on this bill. 

S. 3049

S. 3049 would expand the definition of homeless veteran for purposes of benefits 

under the laws administered by the Secretary of Veterans Affairs. DAV has no resolution on this issue and has no position on this bill. 

S. 3052

S. 3052 would require the Secretary of Veterans Affairs to notify veterans who 

electronically file claims for benefits that they may be able to receive assistance 

from veterans service organizations (VSOs), and to provide contact information for 

such VSOs. DAV Resolution 001 states that, ‘‘* * * our first duty as an organizaVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00106 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
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tion is to assist the service-connected disabled, their surviving spouses and 

dependents * * *,’’ and the inclusion of information explaining the availability of 

VSO assistance and VSO contact information on electronic claims applications 

would likely increase our ability to do exactly that. In fact, DAV has made this exact 

request to the Veterans Benefits Administration as they have been developing a new 

electronic paperless claims system, and it is our understanding that just as VSO 

contact information is provided to veterans who file paper claims, it will similarly 

be provided to those who file electronic claims. As such, while enactment of statutory language may not be necessary, we are not opposed to the favorable consideration of this bill. 

S. 3084, VISN REORGANIZATION ACT OF 2012

S. 3084, the VISN Reorganization Act of 2012, would require the Secretary of Veterans Affairs to restructure and realign VHA’s 21 current Veterans Integrated Service Networks (VISNs) as well as set personnel limits for VISNs. 

Section 2 of the bill would place a limitation on the number of VISN management 

units at 12, down from the current 21, and would lay out the missions, policies, 

budgets, procedures and other responsibilities of these integrated regional VISNs, 

including alliances with other agencies, health care organizations and governments 

in conducting their work. It would also specify that each network’s VISN headquarters be restricted to not exceed employment of more than 65 full-time employee 

equivalents, including contractors, and would require VA to submit reports to Congress annually on VISN employment; budget and other benchmarks. This section 

would also prescribe a consolidation of the existing 21 VISNs in a specified pattern 

and direct the Secretary to choose one of the existing VISN offices consolidated as 

sites of the new combined VISN headquarters, including dealing with leased space 

in commercial buildings, relocation of employees and reemployment assistance for 

those displaced. 

Section 3 of the bill would establish four VISN regional support centers whose 

main purpose would be to evaluate the effectiveness and efficiency of the new 

VISNs, across a number of parameters, with a preference that these support centers 

be established in existing VA medical center locations. 

Section 4 of the bill would clarify that this reorganization of VISNs would not require any change to existing direct care at VA sites, including medical centers, 

CBOCs, or Vet Centers. 

DAV has no resolution concerning the organizational alignment of the VHA, or 

of the VISNs; thus, DAV has no position on this bill. However, last year, DAV, along 

with other national VSOs, put forward a set of nine recommendations to eliminate 

waste, duplication and inefficiency within VA, one of which dealt with the size of 

VISN bureaucracy versus its original mandate as outlined in VA’s ‘‘Vision for 

Change’’ report that led to the creation of the current VISN structure. 

We would also note that the VA Office of Inspector General recently completed 

two reports on VHA’s VISNs, with a particular concern about the size of their staffing. Results of these reviews were inconclusive, but strongly suggested that VISNs 

have expanded their permanent staffing allocations significantly compared to the 

levels in 1995, rather than relying on using ‘‘temporary’’ task forces and working 

groups pulled from medical centers and other facilities as envisioned in the original 

plan. In addition, a number of coordinator positions covering a variety of subjects 

(OEF/OIF; suicide; quality; credentialing of professionals; and FRC, etc.) have been 

imposed by Congress or VA Central Office over the years, further adding to their 

staffing totals. Also, pressures on acquisition, human resources and financial management have dictated establishment of consolidated functions for the activities at 

the VISN level leading to additional personnel. 

In our recommendations, DAV and the other VSOs urged Congress to examine 

VISN staffing and functions by contracting with the National Academy of Sciences, 

Institution of Medicine (IOM), to conduct an independent study of the VISNs, including their staffing levels, and to submit recommendations to Congress about 

whether and how these functions should be reorganized. We believe such a study 

is necessary before setting specific limitation on either the number of VISNs (12) 

or FTEE per VISN (65). Therefore, we recommend that the Committee ask IOM to 

conduct such a study, with appropriate protections for the many benefits the structure has brought to VA health care, before taking any legislative action to restructure or reorganize VHA’s VISN system. 

S. 3202, DIGNIFIED BURIAL OF VETERANS ACT OF 2012

S. 3202, the Dignified Burial of Veterans Act of 2012, would authorize VA to furnish a casket or urn to a deceased veteran when VA is unable to identify the vetVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00107 Fmt 6633 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
104 

1Meeting the Needs of Injured Veterans in the Military Paralympic Program: Hearing before 

the House Committee on Veterans’ Affairs, 111th Congress. 17 (2009) (testimony of Adrian 

Atizado) 2Legislative Hearing on H.R. 4255, H.R. 6221, H.R. 6224, H.R. 6225, and H.R. 6272: Hearing 

before the Subcommittee on Economic Opportunity of the House Committee on Veterans’ Affairs, 

111th Congress. 19 (2008) (testimony of Kerry Baker) 3Section 521A, paragraph (d) of the bill states, amongst other things, that a program under 

that section includes a program that ‘‘promotes*** competition.’’ The activities described in 

that same section are, among others, instruction, participation, and ‘‘competition in paralympic 

sports.’’ 

eran’s next-of-kin and determines that sufficient resources are not otherwise available to furnish a casket or urn for burial in a national cemetery. The bill would further require that VA report back to Congress on the industry standard for urns and 

caskets and whether burials at VA’s national cemeteries are meeting that standard. 

Under current law, VA is not authorized to purchase a casket or urn for veterans 

who do not have a next-of-kin to provide one, or the resources to be buried in an 

appropriate manner. DAV has no resolution on this issue and has no position on 

this bill. However, if it is to be favorably considered by the Committee, we urge additional resources be provided to VA to ensure that implementation of this discretionary authority does not result in a reduction of funding for other authorized 

programs. 

S. 3206

S. 3206 would extend from 2013 to 2018 the authorization of appropriations under 

title 38, United States Code, section 322, allowing VA pay a monthly assistance allowance to disabled veterans training or competing for the Paralympic Team. It 

would similarly extend the authorization of appropriation under section 521A for VA 

to provide assistance to United States Paralympics, Inc. 

The DAV has testified previously on sections 521A and 322 before and after enactment of Public Law 110–389.1,2 Specifically, while the intent of Public Law 110–389 

is laudable, our concern was and remains the impact it may have on the National 

Disabled Veterans Winter Sports Clinic, which is a rehabilitation event and not a 

training ground for future Olympians.3

In addition, the same paragraph allows for individuals with disabilities who are 

not veterans or members of the Armed Forces to participate in sports programs that 

receive funds originating from VA grants. As an organization devoted to improving 

the lives of our Nation’s wartime disabled veterans, we are concerned about any 

shift of VA’s mission, personnel, and resources away from disabled veterans, their 

families and survivors. 

Unfortunately, our concern was appropriate based on issues surrounding the implementation, oversight and accountability for the first year of the grant program 

authorized under section 521A. As you may be aware, VA and U.S. Paralympics, a 

division of the United States Olympic Committee (USOC), signed its Memorandum 

of Understanding at the beginning of fiscal year 2010, announced the Olympic Opportunity Fund and subsequently sought proposals. It was in this first year that it 

became apparent to DAV there was a lack of VA oversight and accountability on 

the implementation of the grant program and grant recipients, as well as a lack of 

accountability to ensure adherence by certain grant recipients to the intent of the 

law. 

We note, however, that a number of improvements have been and continue to be 

made since the consolidation of VA’s Office of National Programs and Special 

Events, which managed VA’s National Rehabilitation Special Events, with the Office 

of National Veterans Sports Programs and Special Events, and additional staff and 

resources were provided to this office. Furthermore, we look forward to the actions 

VA will take to address the findings and recommendations of the Government Accountability Office’s investigation of this grant program. 

In an effort to ensure limited VA resources are wisely spent directly, rather than 

incidentally, on disabled veterans and disabled members of the Armed Forces to 

participate in recreation and sport activities, we urge this Committee, if this measure is favorably considered, to include a future mandatory review of this grant program by the Government Accountability Office (GAO). We also urge this Committee 

to conduct oversight of this grant program subsequent to the release of GAO’s upcoming and future reports. 

S. 3238

S. 3238 would designate the VA community-based outpatient clinic in Mansfield, 

Ohio, as the David F. Winder Department of Veterans Affairs Community Based 

105 

Outpatient Clinic. DAV has no resolution on this issue and has no national position 

on this bill. 

S. 3270

S. 3270 would require the Secretary of Veterans Affairs to consider the resources 

of individuals applying for pension that were recently disposed of by the individuals 

for less than fair market value when determining the eligibility of such individuals 

for such pension. DAV has no resolution on this issue and has no position on this 

bill. 

S. 3309, HOMELESS VETERANS ASSISTANCE IMPROVEMENT ACT OF 2012

S. 3309, the Homeless Veterans Assistance Improvement Act of 2012, is a comprehensive bill that focuses on improving services for homeless veterans. 

Sections 2, 3 and 4 of the bill require that recipients of VA grants for comprehensive service programs for homeless veterans meet physical privacy, safety, and security needs of such veterans; modify the authority of the Department to provide capital improvement grants for comprehensive service programs that assist homeless 

veterans by not only establishing but maintaining such programs; and provide funding for furnishing legal services to very low-income veteran families in permanent 

housing. 

Section 5 modifies the requirements relating to per diem payments for services 

furnished to homeless veterans allowing such payments to include furnishing care 

for a dependent of a homeless veteran who is under the care of that veteran while 

he or she receives services from the grant recipient (or entity). 

Section 6 authorizes grants by VA to centers that provide services to homeless 

veterans to be used for operational expenses. The aggregate amount of all grants 

awarded in any fiscal year may not exceed $500,000. 

Section 7 expands the authority of VA to provide dental care to eligible homeless 

veterans who are enrolled for care for a period of 60 consecutive days, and who are 

receiving assistance under section 8(o) of the United States Housing Act of 1937 (42 

U.S.C. 17 1437f(o)); or receiving care (directly or by contract) in any of the following 

settings; a domiciliary; therapeutic residence; community residential care coordinated by the Secretary; or a setting for which the Secretary provides funds for a 

grant and per diem provider. 

Section 8 of this measure extends the dates, authorities and resources affecting 

homeless veterans for the following programs in title 38, United States Code: 

• Comprehensive programs 

• Homeless veterans reintegration programs 

• Outreach, care, treatment, rehabilitation and therapeutic transitional housing 

for veterans suffering from serious mental illness 

• Program to expand and improve provision of benefits and services by VA to 

homeless veterans 

• Housing assistance for homeless veterans 

• Financial assistance for supportive services for very low-income veteran families 

in permanent housing 

• Grant program for homeless veterans with special needs; and 

• The Advisory Committee on Homeless Veterans 

DAV is pleased to support S. 3309, the Homeless Veterans Assistance Improvement Act of 2012, as it is in line with DAV Resolution No. 205, which calls for us 

to support sustained and sufficient funding to improve services for homeless veterans. This resolution approved by our membership also urges Congress to strengthen the capacity of VA’s programs to end homelessness among veterans and to provide health care and other specialized services for mental health, including dental 

care. 

S. 3313, WOMEN VETERANS AND OTHER HEALTH CARE IMPROVEMENTS ACT OF 2012

S. 3313, the Women Veterans and Other Health Care Improvements Act of 2012, 

contains a number of important enhancements to women veterans health care 

programs. 

Section 2 of the bill instructs the Secretary of Veterans Affairs to facilitate reproductive and infertility research conducted collaboratively by the Secretary of Defense and the Director of the National Institutes of Health to find ways to meet the 

long-term reproductive health care needs of veterans who have a service-connected 

genitourinary disability or a condition that was incurred or aggravated while serving on active duty, such as spinal cord injury, that affects their ability to reproduce. 

106 

The Secretary of Veterans Affairs would ensure that any information produced by 

the research deemed useful for other activities of the VHA be disseminated throughout the VHA. Within three years after the date of enactment, the Secretary will report to Congress on the research activities conducted. 

Section 3 of the measure clarifies that fertility counseling and treatments, including treatment using assisted reproductive technology, are medical services the Secretary may furnish to veterans. 

Section 4 of this bill requires the Secretary to furnish reproductive treatment and 

care for spouses and surrogates of veterans by allowing the Secretary to furnish fertility counseling and treatment, including the use of assisted reproductive technology, to a spouse or surrogate of a severely wounded veteran who has an infertility condition incurred or aggravated while on active duty and who is enrolled in 

the health care system established under section 1705(a) 25 of title 38, United 

States Code, if the spouse and the veteran apply jointly for such counseling and 

treatment through a process prescribed by the Secretary. 

In the case of a spouse or surrogate of a veteran not described who is seeking 

fertility counseling and treatment, the Secretary may refer such spouse or surrogate 

to a qualified clinician and would be required to prescribe regulations to carry this 

out no later than one year after enactment. 

While DAV has no specific resolution from our membership related to reproductive and infertility research and fertility counseling and treatment, this section of 

the bill is focused on improving the Departments’ ability to meet the long-term reproductive health care needs of veterans who have a service-connected condition 

that affects the veteran’s ability to reproduce. For these reasons DAV has no objection to the passage of these sections of the bill, with the exception of subsection (b) 

of section 4 of the measure: DAV has no position on that particular subsection. 

Section 5 of this bill requires that the Secretary of Veterans Affairs enhance the 

capabilities of the VA women veterans call center by responding to requests by 

women veterans for assistance with accessing health care and benefits and by referring such veterans to community resources to obtain assistance with services not 

furnished by VA. 

Sections 6 and 7 of the bill seek to modify the pilot program of counseling women 

veterans newly separated from active duty in retreat settings by increasing the 

number of locations from three to fourteen and by extending the time of the pilot 

program from two years to four years; and to modify the duration of the established 

child care pilot programs for certain veterans receiving VA health care under Public 

Law 111–163 to note that the pilot program may operate until the date that is two 

years after the date on which the pilot program is established in the third VISN. 

Section 7 of the measure would also require a child care pilot program in at least 

three Readjustment Counseling Service Regions for certain veterans receiving readjustment counseling and related mental health services. It requests the Secretary 

of Veterans Affairs to carry out a pilot program to assess the feasibility and advisability of providing assistance to qualified veterans to obtain child care so that such 

veterans can receive readjustment counseling and related mental health services. 

Child care assistance under this subsection may include: stipends for the payment 

of child care offered by licensed child care centers either directly or through a voucher program; payments to private child care agencies; collaboration with facilities or 

programs of other Federal departments or agencies; or other forms of assistance as 

the Secretary considers appropriate. When the child care assistance under this subsection is provided as a stipend, it must cover the full cost of such child care. 

No later than 180 days after the completion of the pilot program, the Secretary 

shall submit to Congress a report on the pilot program. The report shall include the 

findings and conclusions of the Secretary as a result of the pilot program, and shall 

include such recommendations for the continuation or expansion of the pilot program as the Secretary considers appropriate. There is authorized to be appropriated 

to the Secretary of Veterans Affairs to carry out the pilot program $1,000,000 for 

each of fiscal years 2014 and 2015. 

We thank the Chairman for her continued efforts on improving VA’s women veterans heath programs and services and are pleased to support this draft measure. 

DAV has heard positive feedback related to the pilot program of counseling women 

veterans newly separated from active duty in retreat settings and the childcare pilots established in Public Law 111–163. We supported the original provisions for 

these program pilots and are pleased to support the proposal to expand them. Likewise, we are supportive of the provisions in section 5 of the bill that require VA 

to enhance the capabilities of the Department’s women veterans call center related 

to assistance with accessing health care and benefits and referrals to community resources to obtain assistance with services not furnished by VA. 

107 

DRAFT BILL TO ESTABLISH AND NAME OUTPATIENT CLINIC IN HAWAII

Introduced by Senator Inouye, this bill would authorize the Secretary of Veterans 

Affairs to carry out a major medical facility project lease for a VA outpatient clinic 

at Ewa Plain, Oahu, Hawaii and designate such clinic as the Daniel Kahikina 

Akaka Department of Veterans Affairs Clinic. DAV has no resolution on this issue 

and has no national position on this bill. 

DRAFT BILL ON MENTAL HEALTH ACCESS ACT OF 2012

This draft measure, the Mental Health Access to Continued Care and Enhancement of Support Services Act of 2012, or the Mental Health ACCESS Act of 2012, 

is a comprehensive bill focused on improving and enhancing the programs and activities of the Department of Defense (DOD) and VA related to suicide prevention 

and resilience and behavioral health disorders of members of the Armed Forces and 

veterans. 

All of the sections in Title I of this bill are related to DOD matters with the exception of sections 105, 106 and 109. These provisions require collaboration between 

the two agencies with respect to improving sharing of patient records and information under the medical tracking system/electronic health record shared between 

DOD and VA; participation of members of the Armed Forces in peer support counseling programs of VA; and compliance of DOD with requirements for use of VA’s 

Schedule for Rating Disabilities in determinations of disability of members of the 

Armed Forces. DAV recognizes the need for the both Departments to collaborate on 

certain mental health matters and we are supportive of these specific sections in 

accordance with DAV Resolution No. 200, approved by our membership. This resolution supports program improvements and enhanced resources to support readjustment services for the post-deployment mental health needs of war veterans. Further, DAV Resolution No. 177 calls for improved collaboration between VA and DOD 

in making disability determinations. As for the remaining sections in Title I of the 

measure, however, DAV takes no formal position on the issues that fall exclusively 

under the jurisdiction of DOD. 

Sections in Title II of the measure deal with VA mental health matters. Section 

201would instruct the Secretary of Veterans Affairs to develop and implement a 

comprehensive set of measures to assess mental health care services VA is providing. The provisions would require VA to specifically assess the timeliness of the 

furnishing of mental health care; the satisfaction of patients who receive it; VA’s 

current capacity to furnish mental health care; and the availability and furnishing 

of evidence-based therapies. 

The section also would require that the Secretary develop and implement guidelines and productivity standards for providers of mental health care for the staffing 

of general and specialty mental health care services, including those resident in 

community-based outpatient clinics. The bill would require the Secretary to enter 

into a contract with the National Academy of Sciences Institute of Medicine (IOM) 

to create a study committee to assess and provide an analysis and recommendations 

on the state of VA’s mental health services. The study committee would also be responsible for assessing barriers to accessing mental health care by Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn (OEF/OIF/OND) 

veterans as well as the quality of mental health care they are receiving. 

We are especially pleased that the bill would require VA to provide detailed recommendations for overcoming observed barriers, and to improve access to timely, effective mental health care at VA health care facilities and that the Secretary and 

IOM would be required to include at least one former VHA official and at least two 

former VA employees who were providers of mental health care as members of the 

study committee. Likewise, we are pleased the bill includes provisions to ensure 

transparency in the process—specifically that the measures and guidelines developed and implemented as well as an assessment of the performance of VA using 

such measures and guidelines are to be made available to the public on a VA Web 

site and must be updated quarterly at a minimum. 

Given the previous hearings held by this Committee on mental health matters 

and the findings from various informal surveys and official reports on timeliness of 

VA mental health care and ongoing staffing shortages, DAV fully supports the aforementioned provisions. These requirements are in line with a mandate from our 

membership contained in DAV Resolution No. 200. 

Section 202 would expand the Vet Center mandate established in Public Law 

111–163 to include Readjustment Counseling Service (RCS) furnishing counseling to 

certain members of the Armed Forces and their family members. This language 

would authorize limited eligibility for family members to receive counseling 

separately from a given servicemember when those family members are dealing 

108 

with combat-related deployment problems. Under this section, counseling furnished 

could include a comprehensive assessment of the veteran’s or family member’s psychological, social, and other characteristics to ascertain whether they are experiencing difficulties associated with coping with the deployment of a member, or readjustment of the family to civilian life of a veteran or servicemember following a 

deployment. 

The RCS provides an optimal model of psychological counseling for a veteran’s 

family to assist with recovery and post-deployment mental health challenges. Therefore, we believe this provision is fully consistent with the RCS’s mission and goals 

to help combat veterans recover from that unique experience. Public Law 111–163 

provided VA a new authority for active duty personnel to receive Vet Center services outside their military chains of command, as well as a number of other, novel 

authorities enabling family caregivers of severely injured veterans to receive direct 

VA services. Historically, Vet Centers have been counseling family members in certain circumstances when such counseling is helpful to keep families intact, to deal 

with survivors’ grieving of a lost servicemember or veteran, to deal with separation 

anxieties and depression, and to aid family members in coping with a number of 

deployment-related stresses. Therefore, we see these new provisions as consistent 

with the RCS mission to continue as a non-medical source of healing and recovery 

for this young population. We believe this is an important, but incremental improvement in the RCS mandate. Therefore, DAV fully endorses this provision in accordance with DAV Resolution No. 189 that supports a comprehensive Vet Center Program for combat veterans of all eras. 

Section 203 establishes authority for the Secretary of Veterans Affairs to furnish 

mental health care through facilities other than Vet Centers to immediate family 

members of Armed Forces personnel deployed in connection with a contingency operation; this authority would be subject to the availability of appropriations for this 

purpose. We support this provision, also on the strength of Resolution No. 189. 

Section 204 stipulates the organization of the RCS in the VA and notes that it 

is a distinct organizational element within the VHA that provides counseling and 

other important health and psychological services. This measure would require the 

Chief Officer of the Readjustment Counseling Service to report directly to the Under 

Secretary for Health with no intervening supervisory layers between them. The provision would also specify qualifications of an individual for holding this sensitive 

post. 

For the past 35 years, the RCS has served as a quasi-independent source of psychological counseling for combat veterans and family members. In fact, the Committee may recall that the original charter for the RCS was modeled on a novel readjustment counseling service initiated independently by DAV following the Vietnam War when it became apparent to our predecessors that VA was not addressing 

the urgent counseling and readjustment needs of a number of Vietnam veterans. As 

intended by Congress in establishing its original mandate in 1979, the RCS was to 

be an independent, non-medical, non-psychiatric source of care for certain veterans 

who did not want to be labeled ‘‘mentally ill’’ by VA, but who were in need of services to aid them in readjusting from the sacrifices they endured in military combat 

environments. The RCS succeeded all expectations in playing that role. Today’s combat veterans have made it clear to DAV and others that they desire a similar, nonstigmatizing service to aid them, and have found the Vet Centers to be welcoming, 

non-judgmental places to receive that help. 

Without notice to this community and without any consultation beforehand, the 

VHA journalized the RCS under its medical professional arm. The RCS office now 

reports through, and is thus restrained by, a gauntlet of bureaucracies led by VA 

physicians and those working for VA physicians in VA Central Office. Reporting to 

physicians is wholly inconsistent with the non-medical, psychological and pastoral 

mission of RCS, and detracts from its historic role as planner, budgeter, staffer and 

operator of all RCS programs in 300 Vet Centers in every State and most major cities. No other VA medical professional service in the current VHA configuration possesses this level of combined responsibility or accountability as does the RCS. We 

cannot see any advantage having been accrued to VHA as a consequence of this realignment (except perhaps to promote medical and psychiatric traditionalism), but 

many disadvantages have become apparent. 

With these views in mind, we strongly endorse this section that would return RCS 

to its traditional state of independence from medical and psychiatric supervision in 

a VA bureaucracy. 

The section also would require funding for the activities of the Readjustment 

Counseling Service, including the operations of Vet Centers, to be derived from 

amounts appropriated for the VHA for medical services and not through the Veterans Equitable Resource Allocation system that funds most other VA clinical care. 

109 

The section would also require the budget request for the RCS to be segregated from 

other funding needs for VHA. We fully support these provisions on the same basis 

that we support RCS being maintained as a separate entity in VHA’s organization, 

reporting only to the Under Secretary for Health. If funding for RCS is routed 

through VERA, it is subject to the overall needs of each VISN. This would give each 

VISN office the opportunity to parse RCS funding to other needs deemed more urgent or higher priority. We do not support this concept. RCS funding should be 

maintained and justified by RCS only, exclusive of interference by outside interests. 

The section also requires that, not later than March 15 of each year, the Secretary 

shall submit a report to the Committee on Veterans’ Affairs of the Senate and the 

House of Representatives on the activities of the RCS during the preceding calendar 

year. Each report would include for each period covered: 1) a summary of the activities of the RCS, including its Vet Centers; 2) a description of the workload and additional treatment capacity of the Vet Centers, including, for each Vet Center, the 

ratio of the number of full-time equivalent employees and the number of individuals 

who received services or assistance; 3) a detailed analysis of demand for and unmet 

need for readjustment counseling services; and 4) the Secretary’s plan for meeting 

any such unmet needs. We support this provision. 

Section 205 would instruct the Secretary of Veterans Affairs to carry out a national program of outreach to societies, community organizations, and government 

entities in order to recruit mental health providers, who meet the quality standards 

and requirements of the VA to provide mental health services for the Department 

on a part-time, without-compensation basis. In carrying out this program the Secretary could partner with a community entity or assist in the development of a community entity, including by entering into an agreement that would provide strategic 

coordination of the societies, community organizations, and government entities in 

order to maximize the availability and efficient delivery of mental health services 

to veterans. The Secretary would be required to provide training to mental health 

providers to ensure that clinicians who provided mental health services under this 

authority gain sufficient understanding of military and service specific culture, combat experience, and other factors that are unique to the experience of OEF/OIF/OND 

veterans. 

DAV is pleased to support this comprehensive draft measure and we appreciate 

the Chairman’s continued efforts on improving mental health programs and services 

for our Nation’s servicemembers, veterans and their families. We are especially appreciative of your recognition of the importance of the RCS’s role in restoring new 

veterans to society and family life following their strenuous deployments to Afghanistan and Iraq, over this decade-long war. We particularly appreciate those provisions in this bill. 

DAV would again like to thank the Committee for the opportunity to submit our 

views on the numerous legislative measures under consideration at this hearing. 

Much of the proposed legislation would significantly improve VA benefits and services for our Nation’s servicemembers, veterans and their families. 

This concludes my testimony. I am happy to answer any questions Committee 

Members may have related to my statement. 

Chairman MURRAY. Thank you. 

Thank you very much to all of our folks who have come today 

to testify. We really appreciate it. I just am going to do a couple 

of questions and then submit some for the record as our time is 

running out rapidly. 

But I did want to go back to Ms. Keil. The Department of Defense, as I mentioned earlier, provides access to advanced reproductive treatments and recently issued some guidance on offering 

these services at no cost to severely injured servicemembers and 

their spouses. 

The VA, on the other hand, cannot provide these services, and 

it is pretty clear they do not meet the reproductive health needs 

of veterans who have experienced severe trauma as you outlined to 

us in your testimony a few moments ago. 

When you and your husband, Matt, were trying to conceive, you 

faced some very substantial roadblocks from both the Department 

of Defense and VA; and since that time, DOD has changed their 

110 

policy. They now do offer fertility services for severely injured 

veterans. 

I believe that veterans like Matt have earned DOD and VA coverage and there should be no difference. I assume you agree with 

that. 

Ms. KEIL. I absolutely agree. My understanding is that you 

would need to travel to a military treatment facility in order to receive those services that the DOD is offering, whether that be Fort 

Bragg or Walter Reed. That is not an option for families of the 

most severely injured such as my husband. 

There is no way that I could travel to one of those treatment facilities and to care for my husband, and I want him there every 

step of the way. 

So, that for us would not be an option. I feel that he, with his 

service and sacrifice, I feel that he now falls under the VA guidelines of care. He is a medically retired servicemember, and he ultimately is the VA’s responsibility. 

So, I feel that we fall under their responsibility. 

Chairman MURRAY. Thank you very much. I really appreciate 

that. 

Ms. Ilem, I just wanted to ask you. One of the issues I hear a 

lot about especially for women veterans is the lack of childcare. It 

is a substantial barrier to families accessing health care, and Congress has begun to address that issue. 

The last Congress, as you know, we created a pilot program to 

provide childcare at several of our VA medical centers. This year 

the legislation I have introduced expands upon that success to include childcare at several Vet Centers. 

This is important because Vet Centers, as you know, provide 

mental health care and readjustment counseling services in a comfortable, non-clinical setting that some veterans prefer. 

So, I wanted to ask you. I was really pleased to hear your testimony today about the positive experiences that a number of your 

members have had. 

How do you think expanding access to child care services would 

improve the accessibility to care for our veterans? 

Ms. ILEM. And we definitely appreciate your leadership on that 

issue. It was a long time coming. It certainly has been identified 

as a barrier over the years in numerous studies and I think we 

heard from the recent event that you hosted with a number of 

women veterans who need psychological counseling that are using 

the Vet Center and even VA’s that child care, having access to 

child care was a big issue because for the children it is just not an 

appropriate place for them to bring their children, discussing some 

very private matters during those sessions. 

So, I think it absolutely opens the door one more step for those 

that Vet Centers should be included and we welcome those 

provisions. 

Chairman MURRAY. OK. Thank you very much and again we are 

out of time but I do want to thank all of our witnesses today, and 

I will just let everyone know that I am going to be working with 

all the Members of this Committee as we develop legislation based 

on today’s hearing on all of these bills as well as our last legislative 

hearing for our markup which is going to be held in July. 

111 

I am optimistic that by the time of the next markup, the President is going to be signing into law the Honoring America Veterans 

and Caring for Camp Lejeune Families Act of 2012, which includes 

legislation from our last markup. 

Veterans legislation continues to be bipartisan and that is as it 

should be. So, I want to thank all the members of our Committee. 

The Senators who are working on legislation I look forward to 

working with all of you in the coming weeks on this critical legislation affecting our Nation’s heroes. 

Thank you very much. 

With that, this Committee hearing is adjourned. 

[Whereupon, at 11:59a.m., the Committee was adjourned.] 

(113) 

A P P E N D I X 

PREPARED STATEMENT OF MAX CLELAND, SECRETARY, AMERICAN BATTLE

MONUMENTS COMMISSION

Mr. Chairman and Members of the Committee: Thank you for this opportunity to 

offer testimony on several bills before the Committee. As only one, S. 2320, the Remembering America’s Forgotten Veterans Cemetery Act of 2012, pertains to responsibilities of the American Battle Monuments Commission, I will limit my testimony 

to it. 

S. 2320 would direct the American Battle Monuments Commission to provide for 

the ongoing maintenance of the former Clark Air Base Cemetery in the Republic 

of the Philippines. 

We agree that Clark cemetery is a problem that warrants resolution. When the 

Air Force vacated Clark Air Base and the base rights agreement with the Philippines expired, the cemetery became the responsibility of the Philippine Government. Over time, this had the effect of leaving its care in the hands of a few dedicated VFW volunteers. They have done a wonderful job with limited resources, particularly considering that burials of U.S. veterans have continued since the Air 

Force departure, but the volunteers cannot be expected to continue that effort indefinitely. 

We do not know how many of the 8,000 dead at Clark cemetery are U.S. veterans—the Clark Veterans Cemetery Restoration Association Web site cites several 

thousand as confirmed veterans and others as presumed veterans. 

We are on record as stating that Clark cemetery does not fall within our Commission’s core commemorative mission. That remains true. However, given the Air 

Force’s history with the cemetery and the fact that veterans’ burials have continued, 

we initiated a meeting in ABMC’s Virginia Headquarters last December with representatives of the Air Force and the Department of Veterans Affairs National Cemetery Administration to explore possible solutions to this issue. A consensus could 

not be reached on what should or could be done. 

ABMC has serious concerns with S. 2320 as drafted. While this bill’s intention is 

laudable, we do not believe the bill addresses adequately issues that must be resolved before any corrective action is taken. 

If the Congress should decide to move legislation forward, the Administration believes such legislation should address three critical elements: access, authority, and 

funding. 

1. Access—To our knowledge, the United States has no legal standing to undertake any work at Clark cemetery. The Department of State would have to enter negotiations with the Philippine Government to provide long-term U.S. access to the 

cemetery. This would have to be accomplished before any agency of the Federal Government could maintain the cemetery. 

2. Authority—ABMC has no authority to spend its appropriations to maintain a 

cemetery controlled by a foreign government and the Administration does not support any change in this position. 

3. Funding—The requirement that the Commission restore, operate and maintain 

Clark cemetery ‘‘subject to the availability of appropriations for the restoration, operation, and maintenance of cemeteries by the American Battle Monuments Commission’’ is not supportable. We cannot successfully complete a project of this scale 

with existing appropriations without significant negative consequences on the rest 

of ABMC’s program. There is presently no government estimate of the cost to restore and maintain Clark cemetery. The Clark Veterans Cemetery Restoration Association estimated the restoration cost at $2.0 million and annual maintenance costs 

at $250,000. There are more than 8,000 graves to maintain at Clark cemetery-more 

than we maintain at 19 of our 24 overseas cemeteries. Most of the headstones at 

Clark are partially buried in volcanic ash. We believe the association’s estimates do 

114 

not come close to the amount required given the magnitude of the restoration work 

required. 

ABMC’s Fiscal Year 2013 budget request for Salaries and Expenses is $2.7 million, or five percent, below our Fiscal Year 2012 appropriation. Most of that reduction will be taken in maintenance and infrastructure programs. We cannot sustain 

such reductions indefinitely while maintaining the standards our war dead deserve 

and that our Nation demands. 

We recognize that the Budget Control Act limits all agencies, including ABMC, 

to a budgeted level in the out years, and that any increase to our budget would have 

to be offset from another agency’s out year allowances. Nonetheless, if the Congress 

directs our agency to take on a large-scale new program requirement such as the 

restoration and maintenance of Clark cemetery, even the association’s under-estimated cost would reduce our Fiscal Year 2013 funding request by an additional four 

percent—for a total reduction of $5.0 million. Taken further, this would result in 

a 14 percent cut in program funding for engineering and maintenance, horticulture, 

logistics and interpretation. 

This is not sustainable for an agency of our size and budget. An unfunded new 

mission of the scope of Clark cemetery cannot help but have a significant impact 

on our ability to execute our core mission. 

Before closing, I must comment on Finding 8 of the bill, which references the 

Commission’s fund raising authority. We caution the Committee from going down 

this road. Requiring private funding of new memorial projects authorized by the 

Congress has become common practice, but fund-raising results have not been universally successful. It is not common practice to require private funding of our Nation’s overseas cemeteries. S. 2320 implies that the care of ABMC cemeteries could 

become dependent on the uncertainties of public fund raising. This carries with it 

the implication that the Congress is prepared to back away from the commitment 

to provide perpetual care to the war dead buried within them. 

S. 2320 has serious issues that prevent us from supporting this legislation. 

PREPARED STATEMENT OF THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE

The American Society for Reproductive Medicine appreciates the opportunity to 

provide comment on S 3313, the ‘‘Women Veterans and Other Health Care Improvements Act of 2012,’’ and is pleased that the Senate Veterans’ Affairs Committee has 

considered this bill for a public hearing. 

ASRM is a multidisciplinary organization of nearly 8,000 medical professionals 

dedicated to the advancement of the art, science, and practice of reproductive medicine. ASRM members include obstetrician/gynecologists, urologists, reproductive 

endocrinologists, nurses, embryologists, mental health professionals and others. As 

the medical specialists who present treatment options for patients and perform procedures during what is often an emotional time for them, we recognize how important a means to addressing their medical condition can be for those hoping to build 

their families. 

The ‘‘Women Veterans and Other Health Care Improvements Act of 2012’’ would 

direct the Secretary of Veterans Affairs to collaborate with the Secretary of the Department of Defense and the Director of the National Institutes of Health to facilitate research to improve the long term reproductive health care needs of veterans 

who have a service-connected genitourinary disability or a condition that was incurred or aggravated in the line of duty that affects the veteran’s ability to reproduce. ASRM is very pleased that this bill recognizes the need for greater attention, 

dedication and investment of Federal resources to the disease of infertility. The National Institutes of Health and the Centers of Disease Control are two public agencies that devote resources to this disease, but due to the myriad of causes of infertility, and the numerous implications of the disease, it is vitally important that 

other Federal agencies work to make combating infertility a priority. The attention 

to infertility by the agencies governing our military service personnel and our separated from military service personnel is long overdue and welcomed. 

The bill allows that the Department of Veterans Affairs may furnish fertility 

counseling and treatment, included assisted reproductive technologies, to veterans 

and requires the Department of Veterans Affairs to furnish fertility counseling and 

treatment, including assisted reproductive technologies, to a spouse or surrogate of 

a severely wounded veteran who has an infertility condition incurred or aggravated 

in the line of duty as long as the spouse and veteran apply jointly for such counseling and treatment. 

ASRM solidly supports the provision of fertility services to severely wounded veterans. It is nothing but unjust to send our military personnel into harm’s way and 

115 

to not provide health care services to address health care needs that arise due to 

their service and dedication to our country. 

Of course, because infertility is a disease and one that affects 1 in 8 couples, we 

advocate for the provision of health benefits to address the disease for all those affected, no matter the cause. Insurance coverage of infertility is rare. And while we 

can debate as to what is essential and what is not essential when it comes to coverage of health care, there is a huge gap when it comes to the ability of individuals 

diagnosed with infertility to treat their disease. In fact, the Federal Employee 

Health Benefits Program, the largest employer-sponsored private health plan in the 

Nation, and a model for the health reform law in several key areas, does not provide 

coverage for most infertility services, and specifically for assisted reproductive technology. ASRM would recommend that the Federal Government can demonstrate its 

commitment to the importance of addressing infertility by requiring its own health 

program to provide coverage for infertility services for its own workforce. 

We would like to raise a couple of additional shortcomings in the bill. 

First, the bill is written is such a way to give the Department of Veterans Affairs 

the option (i.e. ‘‘may’’ furnish) to provide fertility counseling and treatment for veterans generally, but ‘‘shall’’ provide fertility counseling and treatment for spouses 

or surrogates when a severe injury occurs to the veteran during the line of duty. 

As written, the bill seems to leave out the required treatment of the veteran himself 

or herself when injured during the line of duty. Obviously this is not the intent of 

your bill, but the language should be clarified to require coverage of the injured veteran himself or herself. The source of the infertility can be male factor, female factor 

or both. 

The bill could go further to specifically include furnishing of services to those affected by infertility caused by exposure to toxins during their deployment as these 

exposures can also compromise one’s ability to reproduce. So too, fertility preservation is a common concern for military personnel with orders to deploy, and coverage 

by TRICARE for those who opt to attempt to preserve their fertility via sperm banking should be allowed. 

The bill limits required fertility counseling and treatments to a spouse or surrogate of the injured veteran. Until such time that every state legally recognizes the 

marriage of same sex partners, the effect of this bill will be that only those veterans 

whose marriage is deemed legal will be furnished those services outlined in the bill. 

This effectively denies coverage to injured veterans who are single or who are in 

same sex partnerships. It is no longer a stigma to reproduce outside of the context 

of marriage, or a male/female marriage, and ASRM would recommend that holding 

veterans to a standard that is not the norm any longer in today’s society is discriminatory. 

ASRM would also recommend that you clarify the term ‘‘surrogate’’ in the bill as 

this word can have different meanings. It would be appropriate to precede the word 

‘‘surrogate’’ with the word ‘‘gestational’’ in the bill language. ASRM would further 

recommend that the use of donor gamates be a covered treatment option. 

Thank you for the opportunity to comment on this bill and for your attention to 

this important public health issue. 

LETTER FROM NATHANIEL BEELER OF AVON, INDIANA

Chairman Murray, Members of the Senate Veterans’ Affairs Committee, My name 

is Nathaniel Beeler and I am 10 years old, almost 11. I live in Avon, Indiana. I am 

working to alert Senators about an important veteran’s issue that is addressed in 

Senate Bill S. 2320. Clark Veteran’s Cemetery in the Philippines urgently needs 

your support. Many of our soldiers who sacrificed their lives for our country lie in 

disgraceful conditions at the Clark Veteran’s Cemetery in the Philippines. I care 

deeply for the veterans who sacrificed their lives for my very freedom and I think 

they should have respectful conditions for the price they paid. 

I first read about the cemetery last summer and I wanted to do something to support our fallen heroes. I made a power point presentation and presented this issue 

to my class in April and we wrote letters to Senator Coats, Senator Lugar, and Congressman Todd Rokita. Since then, I have expanded my efforts to include six petition drives. I have collected a total of 764 signatures, ranging from kindergartners 

to a WWII Pearl Harbor survivor. After I got out of school in May, I decided to increase my efforts ten-fold. 

I know it must grieve you also to know that our veterans are lying in disgrace, 

buried in ash and weeds. Some have 8–12 inches of ash covering their headstones 

so that you cannot read their information. This is not how the United States treats 

their veterans. These brave men and women, who sacrificed for my freedom, kept 

116 

our freedom for many generations to come. Now they lay in disgrace and dishonor 

and that violates their sacrifice and ruins the vision of how the United States treats 

their fallen comrades. 

I know that I am only 10 years old, but I want to do something for the veterans 

because of how much they have done for me. I live in freedom and luxury in the 

greatest nation in the world, thanks to them. I get to go to school without being 

blown up on the way, good food is in our kitchen and available abundantly at the 

store even though we are at war, and I sleep in a warm, comfortable bed without 

fear of being attacked and killed in the night, all because of the sacrifice and efforts 

of our veterans. 

Here is the issue: When the Air Force left the Philippines due to volcanic eruption, they left in a hurry, and failed to place the cemetery under the proper agency 

to manage our cemeteries on foreign soil. S. 2320 would place Clark under the 

ABMC. All of it is explained in my PowerPoint presentation, which I will attach. 

[A paper version is held in Committee files.] We have veterans buried there who 

died in the Spanish American war all the way to an Iraqi veteran. I just read a 

great book called The Great Raid of Cabanatuan and I learned about how many Filipino people sacrificed and suffered and died alongside our troops. They were brave 

young men and women who helped turn the tide in WWII. Many suffered through 

or died on the Bataan Death March and were POWs. A lot of them were freed and 

then went into the jungles and mountains to lead or participate in the underground 

gorilla effort against the Japanese. We could never have rescued our POW’s without 

their help. This has made me even more dedicated and motivated to doubling up 

on my efforts to restore Clark Veteran’s Cemetery. 

Since you are all Members of the Senate Committee on Veterans Affairs, you are 

very important and Clark needs your support! All of my hope and trust is in you 

because only the U.S. Government can restore this forgotten cemetery which contains our brave war dead. If the US doesn’t do something now, it will be like they 

have been abandoned twice. I read a good book called Behind the Enemy Lines. It 

is about brave men and women that fought for our country from the Revolutionary 

War all the way to Iraq. The stories are so amazing, especially the soldiers bravery! 

The stories reminded me of the men and women who are buried at Clark. I am very 

devoted and motivated to bring them the honor and dignity they have earned and 

deserve. By supporting this bill, you could influence other Senators to support 

S. 2320, and have the domino effect. 

When I grow up, I hope to be a pilot in the Marines. I have read that the Marines 

main statement is: ‘‘Leave no man behind.’’ But at Clark, many Marines have been 

left behind, buried in ash and dishonor. I will never stop fighting for them and their 

honor, because they never stopped fighting for me and for you and for our Nation. 

I am only 10 years old but I have been taught that the United States is the most 

powerful and just nation in the world and we have this title because of the many 

veterans who fought under our flag because they believed that freedom was worth 

dying for. Even if they were fighting for other people’s freedom, they believed the 

ideas the United States stands for are worth dying for. So now they lay in disgrace 

when they are really heroes. We can’t allow this to go on! We have to act now. 

I can only go out and get signatures of support and every one I talked to agreed 

that we should be able to read the headstones of our war dead. But you can make 

a law and fix this predicament. 

A gold star mother signed my petition on Saturday, June 16th. I have thought 

many times about all the mothers of those who are buried at Clark, and how sad 

and exasperating it must be to have your child buried in disgrace and dishonor 

when they sacrificed and gave of themselves in order that we are a free country. 

I hope you will support S. 2320! I have another petition drive scheduled for July 4, 

2012. It will be my biggest event yet—15,000 people attended in the past. I think 

I will gain many signatures and much progress for the effort to restore Clark Veteran’s Cemetery! 

I am attaching my power point and my petitions to be admitted into public testimony, along with my statement. I hope this is read and admitted because I really 

want to help Clark Veteran’s Cemetery to be restored! 

Sincerely, 

NATHANIEL BEELER. 

117 

1Department of Veterans Affairs, Office of Rural Health, Demographic Characteristics of 

Rural Veterans Issue Brief (Summer 2009). 2 VSO IB 2013 Beneficiary Travel pg 119–120, 124–125. 3 Horowitz et al., 2005, Major and Subthreshold Depression Among Older Adults Seeking Vision Rehabilitation Services The Silver Book 2012, Volume II pg 9 www.silverbook@ 

agingresearch.org. 

PREPARED STATEMENT OF THOMAS ZAMPIERI, PH.D., DIRECTOR OF GOVERNMENT

RELATIONS, BLINDED VETERANS ASSOCIATION

INTRODUCTION

The Blinded Veterans Association (BVA) is the only congressionally chartered Veterans Service Organization exclusively dedicated to serving the needs of our Nation’s blinded veterans and their families. The organization has served blinded veterans for 67 years. On behalf of BVA, thank you for this opportunity to present 

statement for the record on the issue of the current Department of Veterans Affairs 

(VA) Beneficiary Travel Program. Chairwoman Patty Murray, Ranking Member 

Burr, and members of the Senate VA Committee, thank you for the changes you 

already have made to Beneficiary Travel in recent years, and today we appreciate 

the introduction of S. 1755 to improve the access for disabled blind and spinal cord 

injured veterans who require services at the VA specialized Blind Rehabilitation 

Centers (BRCs) and Spinal Cord Injury Centers (SCIs). 

BENEFICIARY TRAVEL FOR BLINDED VETERANS: S. 1755

BVA thanks Senator Tester for introducing S. 1755. We also express appreciation 

to Congressman Michaud for H.R. 3687, the companion House bill legislation for disabled SCI and blinded veterans who are currently ineligible for travel benefits. This 

bill would assist low-income and disabled veterans by removing the travel financial 

burdens to access vital care that improve independence and quality of life. Veterans 

who must currently shoulder this hardship, which often involves airfare, can be discouraged by these costs to travel to a BRC or SCI site. The average age of veterans 

attending a BRC is 67 because of the high prevalence of degenerative eye diseases 

in this age group. 

It makes little sense to have developed, over the past decade, outstanding blind 

rehabilitation programs with 13 Blind Centers and with high quality inpatient specialized services, only to tell low income, disabled blinded veterans that they must 

pay their own travel expenses to access the training they need. To put this dilemma 

in perspective, a large number of our constituents are living at or below the poverty 

line while the VA Means threshold for travel assistance sets $14,340 as the income 

mark for eligibility to receive the benefit. VA utilization data revealed that one in 

three veterans enrolled in VA health care was defined as either a rural resident or 

a highly rural resident. The data also indicate that blinded veterans in rural regions 

have significant financial barriers to traveling without utilization of public transportation. 

To elaborate on the challenges of travel without financial assistance, the data 

found that for most health characteristics examined, enrolled rural and highly rural 

veterans were similar to the general population of enrolled veterans. The analysis 

also confirmed that rural veterans are a slightly older and a more economically disadvantaged population than their urban counterparts. Twenty-seven percent of 

rural and highly rural veterans were between 55 and 64. Similarly, approximately 

25 percent of all enrolled veterans fell into this age group.1 In FY 2007, rural veterans had a median household income of $19,632, 4 percent lower than the household income of urban veterans ($20,400).2 The median income of highly rural veterans showed a larger gap at $18,528, adding significant barriers to paying for air 

travel or other public transportation to enter a BRC or SCI rehabilitation program. 

More than 70 percent of highly rural veterans must drive more than four hours to 

receive tertiary care from VA. Additionally, states and private agencies do not operate blind services in rural regions. In fact, almost all private blind outpatient agency 

services are located in large urban cities. With the current economic problems with 

state budgets clearly in view, we expect further cuts to these social services that 

will bring even more challenges to the disabled in rural regions. 

Consider the following facts: 

• In a study of new applications for recent vision loss rehabilitation services, 7 

percent had current major depression and 26.9 percent met the criteria for subthreshold depression.3

118 

4 Ramratten, et al., 2001 Arch Ophthalmology 119(12) 1788–94. Prevalence and Causes of Visual Field Loss in the Elderly, www.Silverbook.org/visionloss Silver Book, Volume II 2012 pg 9. 5 Rein, David B. et al., 2006 The Economic Burden of Major Adult Visual Disorders in the 

U.S. www.Silverbook.org/visionloss Silver Book, Volume II 2012 pg 9. 6 Rein, et al. The Economic Burden of Major Adult Vision Disorders in the U.S. 2006 

www.Silverbook.org/visionloss Volume II pg 10. 

• Vision loss is a leading cause of falls in the elderly. One study found that visual 

field loss was associated with a sixfold risk of falls.4

• While only 4.3 percent of the 65 and older population lives in nursing homes, 

that number rises to 6 percent of those who are visually impaired, and 40 percent 

of those who are blind.5

• Individuals who are visually impaired are less likely to be employed–44 percent 

are employed compared to 85 percent of adults with normal vision in working population age 19–64.6

If blinded veterans are not able to obtain the blind center training to learn to 

function at home independently because of travel cost barriers, the alternative—institutional care in nursing homes—may be far more expensive. The average private 

room charge for nursing home care was $212 daily ($77,380 annually), and for a 

semi-private room it was $191 ($69,715 annually), according to a MetLife 2008 Survey. Even assisted living center charges of $3,031 per month ($36,372) rose another 

2 percent in 2008. BVA would point to these more costly alternatives in describing 

the advantages of VA Beneficiary Care so that veterans can remain in their homes, 

functioning safely and independently, and with the rehabilitation training needed 

to re-enter the workforce. 

We caution that private agencies for the blind are almost always outpatient centers and located in large urban cities. Many rural states have no vision rehabilitation centers and they do not have the full specialized nursing, physical therapy, 

audiology, pharmacy, radiology or laboratory support services that are necessary for 

the clinical care that BRCs and SCIs provide. The lack of electronic health care 

records in private centers is also a problem when veterans return to VA for their 

other medical follow-up care. BVA requests that all private agencies be required to 

demonstrate peer reviewed quality outcome measurements that are a standard part 

of VHA Blind Rehabilitative Service. They must also be accredited by either the National Accreditation Council for Agencies Serving the Blind and Visually Handicapped (NAC) or the Commission on Accreditation of Rehabilitation Facilities 

(CARF). Blind Instructors should be certified by the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP). 

CONCLUSION

Chairwoman Murray and Ranking member Burr, BVA again expresses its thanks 

for the changes that the VA committee has made to these Beneficiary Travel programs in the past couple of years. BVA requests support for S. 1755, which will ensure that VHA cover travel costs by changing Title 38, Section 111 of the U.S. Code 

Eligibility. Veterans who would not otherwise be able to attend special rehabilitation programs to improve their quality of life will now have that opportunity. The 

end result will also be a previously unavailable means for blind or spinal cord injured veterans to live independently in their own homes. BVA appreciates the opportunity to provide this statement for the record today. 

PREPARED STATEMENT OF HON. BRUCE E. KASOLD, CHIEF JUDGE, 

U.S. COURT OF APPEALS FOR VETERANS CLAIMS

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

Committee: Thank you for the opportunity to present written testimony on a number of legislative proposals, in particular S. 2045, which would establish in statute 

a duty station for the judges of the United States Court of Appeals for Veterans 

Claims, consistent with other Federal courts, as well as a requirement for active 

service judges to reside within fifty miles of the District of Columbia. This past 

March, I provided testimony to the House of Representatives Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs, on a 

mirror proposal in the House—H.R. 4213—and my testimony today essentially is 

unchanged. 

In the haste of creating the Court of Appeals for Veterans Claims—the youngest 

Federal appellate court—the application of several policy issues written in statute 

and applicable to Federal judges in general appears to have been overlooked with 

regard to the judges of the Court of Appeals for Veterans Claims. A defined duty 

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station is one example. The duty station for Federal judges generally is prescribed 

by statute, see 28 U.S.C. § 456, but until your proposal and that of H.R. 4213, no 

similar legislation has applied to the Court of Appeals for Veterans Claims. In the 

absence of legislation, the Court’s Board of Judges has determined that the duty 

station for all Court personnel, including active judges other than recall-eligible retired judges, is the Court’s principal office. This mirrors your proposed bill. 

With regard to a residence requirement, we note that congressional mandate is 

mixed with regard to establishing such a requirement for an appellate court with 

national jurisdiction. Although the judges of the Court of Appeals for the Federal 

Circuit are required to reside within 50 miles of the District of Columbia, see 28 

U.S.C. § 456, the judges of the Court of Appeals for the Armed Forces have no residency requirement. 

To the extent the perceived need for a residency requirement arises from concerns 

over the efficient operation of the Court, we note that working from a remote area 

is becoming more practical. Our cases are now electronically filed and stored and 

are accessible anywhere a judge can locate a computer. Decisions are circulated for 

review electronically, and this is the preferred method to distribute cases for review 

even for those present and working at the Court (as opposed to working remotely). 

Conversations can and do take place by e-mail, phone, and video (although video 

is not widely available at the Court yet, but likely not far off). Indeed, recently, one 

of our judges was on travel and worked a case electronically with his iPad while 

his wife was driving the car. Moreover, the advent of e-filing and enhanced electronic communication capability, as well as recent changes in the administrative 

processing of appeals after they have been briefed—as discussed in my testimony 

before this Committee last month—have resulted in the Court’s most productive 

years. 

Should Congress proceed with a residency requirement for the Court, we suggest 

that it be tied to the Washington, DC, greater metropolitan area, and not just the 

confines of the District of Columbia, to be consistent with the statutorily required 

location of the Court’s principal office, which can be anywhere in the Washington, 

DC, greater metropolitan area. See 38 U.S.C. § 7255. 

With regard to the other legislative proposals before the Committee, I note that 

they concern operations unrelated to the Court or matters within the specific purview of the Department of Veterans Affairs. Accordingly, I have no special insight 

to offer the Committee. 

Thank you again for the opportunity to provide a written statement on the proposed legislation. 

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LETTER FROM DENNIS L. WRIGHT, CAPTAIN, U.S. NAVY (RETIRED), 

CHAIRMAN, CLARK VETERANS CEMETERY RESTORATION ASSOCIATION


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• Since the VFW assumed responsibility in 1994, they have buried 400 additional veterans, 

including one killed in action in Fallujah, Iraq in 2004. 

The annual out-of-pocket cost VFW Post 2485 expends is $25,000 per year for the six day 

laborers who maintain the landscaping and assist with burials of veterans. 

The solution is equally simple. Congress must do the right thing and direct the American Battle 

Monuments Commission to assume responsibility for the perpetual care and administration. 

There is no real budget impact unless one imagines $25,000 per year, today raised solely through 

donations, to be a budgetary impact. 

We know ABMC will object to this bill. Please do not be misled. ABMC docs maintain another 

active cemetery in Panama, which is virtually identical to the situation at Clark, except Clark is 

much more historic with SAW IP A W war dead. It also manages another non WWIIWWII site in 

Mexico. Further, ABMC presently manages two other existing sites in the Philippines, the 

Cabanatuan POW Memorial 90 minutes to the north, and the Manila WWII Memorial and 

Cemetery 90 minutes to the south. This "is" ABMC's mission and ABMC "is" authorized today 

in 36 USC 21 if they chose to do it or more importantly interpret it that way. Don't let ABMC 

throw up a smoke screen. Also, please do not get distracted by red herrings. There is no cost 

impact for ABMC to accept the cemetery today in its "AS IS" condition. Then over time, with 

their expertise and professional management team, ABMC can properly develop a plan to restore 

the CVC to its rightful place in history with dignity and respect for those who "Served With 

Honor", the motto of the cemetery. 

In summary, thanks to the VFW volunteers and the generosity of several small American 

companies, the cemetery has been restored to a modest level of decorum and dignity. It is not a 

difficult task then for the Senate to task AMBC to assume what volunteers have done for the past 

two decades - - immediately assume responsibility and then plan for an orderly restoration in the 

out-years. 

A bi-Iateral agreement will be required between the U.S. and Philippine Government, and the 

Philippine Government has already asserted, that while it will not cede control or ownership, it 

will honor a request by the U.S. Government to "care and administer" the cemetery and to take 

over from the VFW volunteers. Again, please to not be misled by smoke screens from ABMC or 

others. Senate Resolution 481 has set the framework for bi-Iateral cooperation. The solution is 

quite simple. It ranges from a simple Usufruct Agreement to a Diplomatic Note or other form of 

a Memorandum of Agreement. Also please keep in mind that the majority of ABMC sites, 

including both of those in the Philippines, are covered by similar Memorandums of Agreement 

or Diplomatic Notes. 

I urge the Committee to take note of the broad base and overwhelming level of support for the 

CVC from across the nation. Of note are written letters, resolutions and deeds to include: 
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[Attachments listed were not submitted to the Committee.] 

LETTER FROM THE NATIONAL COALITION FOR HOMELESS VETERANS

Chairman Patty Murray, Ranking Member Richard Burr, and Distinguished 

Members of the Senate Committee on Veterans’ Affairs: The National Coalition for 

Homeless Veterans (NCHV) is honored to submit this written testimony for the 


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123 

hearing on health and benefits legislation on June 27, 2012. NCHV represents more 

than 2,100 community- and faith-based organizations nationwide that serve veterans and their families in crisis. These organizations help our Nation’s most vulnerable heroes by providing health services, emergency and supportive housing, job 

training and placement assistance, legal aid, case management and other critical 

supports. 

A few of the bills addressed at today’s hearing would significantly impact the ability of service providers to deliver the needed care to help homeless and at-risk veterans achieve or maintain independent living: 

• S. 1806, Sen. Barbara Boxer’s bill to amend the Internal Revenue Code of 1986 

to allow taxpayers to designate overpayments of tax contributions to the homeless 

veterans assistance fund 

• S. 3049, Sen. Mark Begich’s bill to expand the definition of homeless veteran 

for purposes of benefits under the laws administered by the Secretary of Veterans 

Affairs 

• S. 3309, Sen. Patty Murray’s ‘‘Homeless Veterans Assistance Improvement Act 

of 2012’’ 

NCHV supports each of these measures. We offer a few targeted recommendations 

to improve upon S. 3309, however. 

S. 1806, A BILL TO AMEND THE INTERNAL REVENUE CODE OF 1986 TO ALLOW TAXPAYERS

TO DESIGNATE OVERPAYMENTS OF TAX CONTRIBUTIONS TO THE HOMELESS VETERANS

ASSISTANCE FUND

Limited Federal funds for homeless veteran assistance are often concentrated in 

heavily populated areas. A significant number of community- and faith-based service 

providers lie outside of major metropolitan areas, which makes it is more difficult 

to compete for Federal grants. However, the homeless and at-risk veterans served 

by these organizations require the same help to reintegrate into society as those in 

larger urban areas. 

This bill would establish the Homeless Veterans Assistance Fund, which would 

supplement proven Federal programs and could be authorized to target nontraditional, or ‘‘nonconforming entities,’’ and support high-demand activities such as: 

• Child care assistance for single veterans in employment assistance programs 

• Transportation assistance to medical and employment services 

• Security deposits and utility hook-up fees for housing placements 

• Clothing, uniforms and tools for employment 

The U.S. General Accounting Office has reported that American taxpayers may 

have overpaid as much as $945 million, based on data from tax year 1998. This 

amounts to an average overpayment of $438 per taxpayer (‘‘Tax Deductions,’’ 

March 2002). Tax overpayments may be inevitable, but they do not need to be meaningless. The simple act of checking a box, as authorized by this bill, would enable 

taxpayers to contribute all or part of their overpayments to help prevent and end 

homelessness for those who have served this country in a way increasingly few 

Americans ever will. 

S. 3049, A BILL TO AMEND TITLE 39, UNITED STATES CODE, TO EXPAND THE DEFINITION

OF HOMELESS VETERAN FOR PURPOSES OF BENEFITS UNDER THE LAWS ADMINISTERED BY THE SECRETARY OF VETERANS AFFAIRS

The Department of Veterans Affairs (VA) currently defines ‘‘homeless veteran’’ 

based on an incomplete citation of the McKinney-Vento Homeless Assistance Act (42 

U.S.C. 11302 (a)). The full definition of ‘‘homeless’’ under this act includes the following: 

‘‘Any individual or family who is fleeing, or is attempting to flee, domestic 

violence, dating violence, sexual assault, stalking, or other dangerous or 

life-threatening conditions in the individual’s or family’s current housing 

situation, including where the health and safety of children are jeopardized, 

and who have no other residence and lack the resources or support networks to obtain other permanent housing.’’ 

Sen. Begich’s bill serves a single purpose: to include this provision in VA’s definition of ‘‘homeless veteran.’’ Although some of these veterans may already qualify for 

VA homeless assistance due to the nature of their circumstances, we must make certain that we do not deny these vulnerable families the help that they need. 

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S. 3309, ‘‘HOMELESS VETERANS ASSISTANCE IMPROVEMENT ACT OF 2012’’ 

Sec. 2. Requirement that recipients of grants from Department of Veterans Affairs for 

comprehensive service programs for homeless veterans meet physical privacy, 

safety, and security needs of such veterans. 

Earlier this year, the VA Office of Inspector General reported ‘‘serious female veteran safety, security, and privacy issues’’ at certain Grant and Per Diem (GPD) Program sites (‘‘Audit of the Homeless Providers Grant and Per Diem Program,’’ 

March 2012). Sec. 2 of this bill would help to remove any ambiguity over the need 

for grantees to fully address these issues in the grant application process. 

Sec. 3. Modification of authority of Department of Veteran Affairs to provide capital 

improvement grants for comprehensive service programs that assist homeless veterans. 

Successful GPD providers who have previously received Capital Grants to establish their programs should have the opportunity to compete for funding to maintain 

those program facilities, including making the necessary renovations to serve homeless women veterans. Sec. 3 of this bill would give the VA Secretary the discretion 

to make these grants. 

Sec. 4. Funding for furnishing legal services to very low-income veteran families in 

permanent housing. 

Outstanding warrants can present a barrier to independent housing for veterans 

and their families. Dozens of communities around the country have responded to 

this issue by adopting veteran-specific court programs. One such example is the 

Homeless Court Program (HCP)—a collaboration between veteran service providers 

and local court systems in which a veteran’s participation in a rehabilitative program can be considered ‘‘payment’’ for various misdemeanor offenses. 

Sec. 4 of this bill would set aside at least 1.0 percent of SSVF Program funding 

for providers that will provide ‘‘legal services to assist the veteran family with issues 

that interfere with the family’s ability to obtain or retain housing or supportive 

services.’’ NCHV recommends that this funding be targeted to communities that 

have demonstrated both a commitment and an ability to resolve veterans’ legal 

issues. This could be accomplished by restricting these funds to communities with 

established Veterans Court programs. 

Sec. 5. Modifications to requirements relating to per diem payments for services furnished to homeless veterans. 

The Grant and Per Diem Program currently lacks authority to directly serve veterans’ dependent children. Under the current authorization, veteran families are either forced to split up or be denied entry into the program. 

With the introduction and rapid expansion of the SSVF Program, VA has recognized that homelessness cannot be effectively ended and prevented without caring 

for the veteran family as a whole. This same philosophy should apply to the GPD 

Program. 

Sec. 5 of this bill would allow veterans’ dependents to directly receive services 

through the program. Additionally, under this section the VA Secretary would be 

required to make per diem payments to ‘‘nonconforming entities,’’ such as those discussed earlier in this testimony (regarding S. 1806). The Secretary is already authorized to make these payments. A mandate would potentially benefit underserved 

communities, but it should not be applied if it will compromise the integrity of the 

highly competitive GPD Program. 

Sec. 6. Authorization of grants by Department of Veterans Affairs to centers that provide services to homeless veterans for operational expenses. 

Drop-in service centers are an important element of the GPD Program. They provide essential services and referrals to homeless and at-risk veterans who may not 

yet be ready or willing to enter into a residential therapy program, or are unable 

to because of capacity limitations. Yet with a reimbursement rate of no more than 

$4.86 per hour per veteran accessing the service center, few grantees can afford to 

maintain full-time staff for this purpose. 

The operational grants allowed by Sec. 6 of this bill would help support established service centers. NCHV recommends this provision clearly identify staffing expense as an allowable operational cost. 

Sec. 7. Expansion of Department of Veterans Affairs authority to provide dental care 

to homeless veterans. 

VA dental care for homeless veterans is a limited resource and does not reach 

enough of the homeless veteran community. For many of these men and women vetVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00128 Fmt 6601 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
125 

erans, their job prospects and self-esteem suffer until they are able to address such 

issues as severe oral pain and missing teeth. The department’s dental program 

helps them alleviate these barriers. 

Veterans who live in housing units supported by HUD-VASH vouchers, meanwhile, have an enormous advantage over the homeless veteran population at large: 

stable housing with regular case management and counseling supports. Given these 

considerations, NCHV does not endorse Sec. 7 of this bill, which would expand eligibility for VA’s homeless veteran dental care to a non-homeless population: HUDVASH voucher holders. 

Sec. 8. Extensions of authorities and programs affecting homeless veterans. 

This section would impact nearly every major homeless veteran program in the 

Federal Government. Among the critical FY 2013 reauthorizations included in this 

section are: 

• $250 million for the Grant and Per Diem Program • $300 million for the Supportive Services for Veteran Families Program • $50 million for the Homeless Veterans Reintegration Program (HVRP), the Nation’s only employment program wholly dedicated to serving homeless veterans 

The GPD Program represents one of six pillars in the VA Secretary’s Five-Year 

Plan to End Veteran Homelessness: community partnerships. Its role in ending veteran homelessness should not be diminished. Therefore, NCHV is concerned that 

Sec. 8 of this bill would scale back the program’s authorization to $150 million well 

before the maturity of the Five-Year Plan in 2015. We recommend that the program’s authorization be sustained at the $250 million level. 

Additionally, while this section would reauthorize the Special Needs Grant Pro- gram through 2015, NCHV maintains that the current authorization level of $5 million is insufficient to meet the needs of the program’s target populations—particularly veterans with dependent children. We recommend that the program’s authorization should be at least 15 percent of the total authorization for section 2011, title 

38, U.S. Code. This would help to ensure that the necessary capital funding is available to provide safe, private and secure facilities for homeless women veterans and 

single homeless veterans with dependent children. 

IN SUMMATION

NCHV has been at the center of the campaign to end veteran homelessness since 

1990, and knows better than most the role that the Senate Committee on Veterans’ 

Affairs has played in bringing our Nation to within reach of the goal of ending veteran homelessness. With passage of this legislation, this Committee will buildupon 

its rich bipartisan legacy of leadership in providing assistance that is responsive to 

the needs of an evolving veteran population. 

We greatly appreciate the opportunity to submit this written testimony on behalf 

of our Nation’s homeless veteran service providers, and look forward to working 

with this Committee to help advance S. 1806, S. 3049, and S. 3309—with the above 

recommendations—to the full Senate. 

Respectfully, 

JOHN DRISCOLL, 

President and CEO. 

MATT GORNICK, 

Policy Assistant Director. 

PREPARED STATEMENT OF PARALYZED VETERANS OF AMERICA

Chairman Murray, Ranking Member Burr, and Members of the Committee, Paralyzed Veterans of America (PVA) would like to thank you for the opportunity to 

present our views on the broad array of legislation impacting the Department of 

Veterans Affairs (VA) pending before the Committee. These important bills will help 

ensure that veterans receive the best health care and benefits services available to 

them. 

S. 3313, THE ‘‘WOMEN VETERANS AND OTHER HEALTH CARE IMPROVEMENTS ACT OF 2012’’ 

PVA strongly supports the ‘‘Women Veterans and Other Health Care Improvements Act of 2012.’’ If enacted, this bill would improve health care services for 

women veterans within the VA. 

PVA is particularly pleased to see the provisions related to reproductive services 

for catastrophically disabled service-connected veterans. One of the most devastating results of spinal cord injury or dysfunction for many individuals is the loss 

of the ability to have children and raise a family. PVA has long sought inclusion 

126 

of reproductive services in the spectrum of health care benefits provided by the VA. 

Sections 2, 3 and 4, of the proposed legislation are significant steps in securing 

these much needed and long overdue treatment modalities that are critical components of catastrophically disabled veterans’ maximization of independence and quality of life. 

Advancements in medical treatments have for some time made it possible to overcome infertility and reproductive disabilities. For some paralyzed veterans procreative services have been secured in the private sector at great cost to the veteran 

and family. In April 2010, a Memorandum promulgated by the Office of the Assistant Secretary of Defense (Health Affairs) extended reproductive services, including 

in-vitro fertilization, to servicemembers and retired servicemembers who had a loss 

of reproductive ability due to serious injury while on Active Duty. The Memorandum 

notes ‘‘Although many medical and other benefits are available to these members 

and their families, members with spinal and other injuries that make it impossible 

to conceive a child naturally are not provided TRICARE coverage, which can assist 

them in becoming a parent.’’ 

An implementing guidance memorandum described available reproductive services as sperm retrieval, oocyte retrieval, in-vitro fertilization, artificial insemination, 

and blastocyst implantation. Similar to the Department of Defense’s recognition that 

reproductive services are crucial elements in affording catastrophically disabled individuals and their spouses with life-affirming ability to have children and raise a 

family, so too will passage of the provisions of this bill that authorize the VA to offer 

similar services to veterans disabled in service to the Nation. 

This bill also proposes to improve access to VA care by making both health care 

and benefits information available through the VA Women Veterans Call Center, as 

well as referrals for community resources to obtain assistance with services not furnished by the VA. While we support improvements to the call center, PVA believes 

that VA must continue working toward developing a comprehensive model of care 

that provides woman veterans with a broader variety of quality services that they 

need. The FY 2013 Independent Budget reported that 51 percent of women veterans 

who utilize VA health care services also use non-VA providers. Given this high percentage of woman seeking health care services in the VA and with other providers, 

the VA must not only work to improve the variety of services available to meet 

women’s health care needs, but it must also work to ensure that there is adequate 

care coordination with the non-VA providers serving women veterans. Care coordination is the only way to monitor the quality of care provided to women veterans 

outside the VA health care system. 

PVA also supports the proposed extensions of the pilot program for counseling in 

retreat settings for women veterans newly separated from service, and the pilot programs on assistance for child care for certain veterans. Providing veterans with 

child care assistance eliminates a barrier to care that prevents many veterans from 

receiving appropriate health services. Women veterans are one of the fastest growing populations within the VA health care system and we must make certain that 

they have access to, and receive, quality health care services through the VA. 

S. 3238

PVA’s National office has no position on naming the VA community-based outpatient clinic in Mansfield, Ohio, as the David F. Winder VA Community-Based 

Outpatient Clinic. PVA believes naming issues should be considered by the local 

community with input from veterans organizations within that community. With 

that in mind, we would defer to the views of PVA’s Buckeye Chapter. 

S. 3206

PVA supports S. 3206, a bill that would extend the authorization for the VA to 

pay a monthly assistance allowance to disabled veterans training or competing for 

the Paralympic team. PVA continues to support the partnership between the 

Paralympics and the VA to expand sports and recreation opportunities to disabled 

veterans and injured servicemembers. We believe that this has certainly been a 

worthwhile program as the need for expansion of these activities is necessary. We 

appreciate the role that the Paralympics have played in this expansion. 

S. 3202, THE ‘‘DIGNIFIED BURIAL OF VETERANS ACT OF 2012’’ 

PVA fully supports the provisions of S. 3202, the ‘‘Dignified Burial of Veterans Act 

of 2012.’’ Under current law, VA is not authorized to purchase a casket or urn for 

veterans who have no designated next-of-kin or who lack the resources to provide 

and appropriate, dignified burial to properly memorialize the deceased veteran. The 

proposed legislation would ensure that VA furnishes a casket or urn to a deceased 

127 

veteran when VA is unable to identify the veteran’s next-of-kin and determines that 

sufficient resources are not otherwise available to furnish a casket or urn for burial 

in a national cemetery. This provision is consistent with the requirements that 

would be placed on the VA if the provisions of S. 2244, the ‘‘Veterans Missing in 

America Act,’’ were enacted. Additionally, this bill would require VA to issue a report to Congress on the industry standard for urns and caskets and whether burials 

at VA’s national cemeteries are meeting that standard. 

S. 3084, THE ‘‘VISN REORGANIZATION ACT OF 2012’’ 

PVA opposes S. 3084, a bill that would establish a new organizational structure 

for the alignment of the Veterans Integrated Service Networks (VISN) around the 

country. PVA has serious concerns about the precedent that this legislation would 

set. The VA currently uses the VISN structure as a management tool for the entire 

VA health care system. It makes no sense for the Congress to legislate how the VA 

should manage its system. Furthermore, this sets a dangerous precedent whereby 

any member could decide that the VA’s VISN alignment is not satisfactory (in their 

opinion), and that it should be redrawn in such a way to support his or her own 

state or district. 

However, we believe that the current network alignment could be reassessed and 

possibly realigned. There is certainly nothing that suggests that 21 service networks 

is the optimal structure. But where does the VA draw the line when establishing 

its health care system structure? With the current 21 VISN’s, the VA seems to do 

a good job of managing a massive health care system. This is not to suggest that 

the administration of these networks is not bloated, but the alignment itself seems 

satisfactory. 

Meanwhile, it is our understanding that the Veterans Health Administration is 

already considering a realignment of its VISN structure. If this is in fact the case, 

then we believe the VA should provide more information on this plan. 

S. 3052

PVA supports the provisions of S. 3052. This legislation affirms the important role 

that veterans’ service organizations (VSO) play in assisting veterans with their 

claims for benefits. It would ensure that veterans who choose to file a claim for benefits electronically are informed about their options for representation from a VSO 

national service program. We would offer one suggestion about the proposed language of the bill. We believe that the qualifier—‘‘to the degree practical’’—at the beginning of the new Section 5103B should be removed from the bill. We see no reason 

why it would not be practical to inform veterans of their representation options. 

However, this language gives the VA an excuse should it choose not to provide this 

information. 

S. 3049

PVA supports S. 3049, a bill that expands the legal definition of ‘‘homeless veterans’’ to align with the commonly accepted legal standard for homelessness that 

exists in this country. Due to an oversight in the law, the legal definition of ‘‘homeless veterans’’ differs significantly from the existing definition of homelessness. Specifically title 38 U.S.C. does not recognize as being homeless an ‘‘individual or family 

who is fleeing, or is attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions in the individual’s 

or family’s current housing situation’’ (42 U.S.C. § 11302b). The wording change proposed by S. 3049 would allow veterans who experience a domestic violence situation, 

and choose to leave that situation, to access the same benefits available to all other 

homeless veterans. Currently, in order to qualify for benefits offered to homeless 

veterans through the VA, an individual must only meet the definition of homeless 

in outlined by 42 U.S.C. § 11302a. It only makes sense that the VA’s definition for 

homelessness align with the larger Federal standard. 

S. 2320, the ‘‘Remembering America’s Forgotten Veterans Cemetery Act of 2012’’ 

Since 1991, the veterans’ cemetery at Clark Air Force Base in the Philippines has 

remained unattended and seriously deteriorated. Volunteers have over the years 

tried to do some minor maintenance, but those efforts have proven futile at best. 

No Federal assistance has been provided to upkeep the Clark Veterans Cemetery. 

Meanwhile, the remains of more than 8,300 servicemembers and their dependents 

remain interred there. 

The fact that the final resting place for those who have served and sacrificed is 

in such a state of decay is wholly unacceptable. The American public would not 

stand for any national cemetery in this county to be maintained in this manner, and 

similar hallowed grounds outside of the United States should not be treated in this 

128 

way as well. PVA supports S. 2320 which would give the American Battle Monuments Commission (ABMC) authority to care for Clark Veterans Cemetery. The 

ABMC is the best suited to assume this authority with their experience in care for 

cemeteries and monuments in foreign lands. We must however emphasize that adequate additional resources must be provided to the ABMC to ensure that the proper 

care is given to the cemetery. 

S. 2259, the ‘‘Veterans’ Compensation Cost-of-Living Adjustment Act of 2012’’ 

PVA supports S. 2259, the ‘‘Veterans’ Compensation Cost-of-Living (COLA) Adjustment Act of 2012,’’ that would increase, effective as of December 1, 2012, the 

rates of compensation for veterans with service-connected disabilities and the rates 

of dependency and indemnity compensation (DIC) for the survivors of certain disabled veterans. This would include increases in wartime disability compensation, 

additional compensation for dependents, clothing allowance, and dependency and indemnity compensation for children. PVA continues to oppose the provision of this 

legislation that would round down any benefit to the next lower whole dollar 

amount. 

Last year marked the first time in three years that veterans (and Social Security 

recipients) received a COLA increase. While our economy continues to struggle, veterans’ personal finances have been affected by rising costs of essential necessities 

to live from day to day and maintain a certain standard of living. 

S. 2045

PVA does not support the proposed legislation. We believe that imposing the locality residence requirement would lead to the negative impression across the country 

that the Court of Appeals for Veterans Claims is an ‘‘inside the beltway club,’’ a 

common concern often raised by people on many issues outside of the Washington 

metropolitan region. Perhaps more importantly, we are concerned that imposing this 

locality restriction could eliminate some of the most qualified judges from consideration for the Court. In fact, we understand that one of the currently sitting judges 

works remotely from his home in another state and continues to be one of the most 

productive judges on the Court. 

S. 2244, THE ‘‘VETERANS MISSING IN AMERICA ACT OF 2012’’ 

The purpose of the Missing in America (MIA) Project is to locate, identify and 

inter the unclaimed cremated remains of American veterans through the joint efforts of private, state and Federal organizations. The non-profit organization seeks 

to ‘‘provide honor and respect to those who have served this country by securing a 

final resting place for these forgotten heroes.’’ The proposed legislation would require the VA to assist entities in possession of unclaimed or abandoned human remains in determining if any such remains are the remains of veterans or other individuals eligible for burial in a national cemetery. Additionally, the legislation would 

require the VA to cover the cost of funeral expenses and burial in the event that 

no next-of-kin can be identified. PVA fully supports this legislation. We would only 

emphasize that Congress must provide any additional resources necessary to allow 

VA to provide burial services. 

S. 1849, THE ‘‘RURAL VETERANS HEALTH CARE IMPROVEMENT ACT’’ 

PVA supports S. 1849, a bill that requires a five year strategic plan for the VA 

Office of Rural Health (ORH) to improve access and the quality of health care services for veterans in rural areas. Approximately 40 percent of veterans who utilize 

VA health care services live in rural areas, with a significant proportion of this population residing in ‘‘highly rural’’ areas. If enacted, S. 1849 would require the VA 

to create a strategic plan for the ORH that includes identifying goals and objectives 

for recruitment and retention as well as for improving timeliness of care provided 

to veterans living in rural areas. 

PVA believes that attracting and retaining adequate staff within the Veterans 

Health Administration (VHA) is one of the most critical elements to providing quality health care in a timely manner. However, recruiting and retaining medical professionals in rural settings continues to be a challenge as the population of veterans 

residing in rural areas continues to grow. PVA believes that the requirements of 

S. 1849 to provide specific goals and objectives to improve rural health care for veterans has the potential to further develop and expand upon the improvements that 

VA has already made in the area of rural health care. Particularly, PVA is pleased 

that this bill requires VA leadership to define specific goals and objectives in the 

areas of recruitment and retention, and enhance the use of current programs using 

technology to increase veterans’ access to VA health care services. 

129 

While PVA supports S. 1849, it must be noted, that this bill requires the VA ORH 

to develop a strategic plan that includes goals and objectives for ensuring timeliness 

and improving the quality of health care services provided through contract and feebasis providers. PVA believes that non-VA providers serve a purpose in meeting the 

health care needs of veterans residing in rural areas and are an essential component of the VA providing timely care in remote settings. However, such options 

should not be used as a method or course to eliminate VA facilities. PVA believes 

that the greatest need is still for qualified VA health care providers to be located 

in rural settings. We believe that the VA is the best health care provider for veterans. Providing primary care and specialized health services is an integral component of VA’s core mission and responsibility to veterans. Over the years, VA has 

earned a reputation as a leader in the medical field for its quality of care and innovation in providing ‘‘veteran-specific’’ health care. 

Providing quality health care in rural settings is a continuous challenge for the 

VA, however, Congress, the VA, and stakeholders such as veteran service organizations must continue to develop innovative strategies to meet the health care needs 

of rural veterans. PVA believes that the strategic plan proposed in S. 1849 is a step 

in the right direction. 

S. 1838

While PVA has no specific position on this proposed legislation, we believe that 

it could be beneficial therapy for veterans dealing with Post-Traumatic Stress Disorder (PTSD) and other mental health issues. A model program for this service was 

created in 2008 at the Palo Alto VA Medical Center in conjunction with the Assistance Dog Program. This program, maintained by the Recreational Therapy Service 

at the Palo Alto VAMC, is designed to create a therapeutic environment for veterans 

with post-deployment mental health issues and symptoms of PTSD to address their 

mental health needs. Veterans participating in this program train service dogs for 

later placement with veterans with hearing and physical disabilities. As we understand it, in 2006, Walter Reed Army Medical Center conducted a similar, privatelyfunded, pilot program where service dogs were used in therapeutic settings. 

In these programs, training service dogs for fellow veterans is believed to be helping to address symptoms associated with post-deployment mental health issues and 

PTSD in a number of ways. Specifically, veterans participating in the programs 

demonstrated improved emotional regulation, sleep patterns, and sense of personal 

safety. They also experienced reduced levels of anxiety and social isolation. Further, 

veterans’ participation in these programs has enabled them to actively instill or reestablish a sense of purpose and meaning while providing an opportunity to help 

fellow veterans reintegrate back into the community. Given the apparent benefit to 

veterans who have participated in similar programs as the one proposed by S. 1838, 

we see no reason to oppose this legislation. 

S. 1799, the ‘‘Access to Appropriate Immunizations for Veterans Act of 2011’’ 

PVA supports S. 1799, which proposes to amend title 38, United States Code to 

provide for requirements related to the immunization of veterans. It is accepted fact 

that proper and timely administration of immunizations can prevent the onset of 

more significant medical issues. By requiring the Secretary to ensure these immunizations are administered in compliance with the recommended adult immunization 

schedule, and requiring quality measures to ensure this is done, it can be expected 

that veterans using the VA will be healthier and less likely to suffer potential medical ailments. The Department of Defense (DOD) follows these procedures to ensure 

a more ready military force. It only makes medical and economic sense that the 

health gains achieved by the DOD program for individuals prior to leaving service 

should be continued to maintain and benefit the health of veterans. Proper and 

timely immunizations are a guarantee of better medical health in the VA patient 

population. 

S. 1755

PVA strongly supports S. 1755, a bill to amend title 38, United States Code, to 

provide certain disabled veterans coverage under the beneficiary travel program of 

the VA when seeking services for special disabilities rehabilitation. Currently, the 

Department of Veterans Affairs (VA) does not provide travel reimbursement for 

catastrophically disabled non-service-connected veterans who are seeking inpatient 

medical care. PVA believes that expanding VA’s beneficiary travel benefit to this 

population of severely disabled veterans will lead to an increasing number of catastrophically disabled veterans receiving quality comprehensive care, and result in 

long-term cost savings for the VA. 

130 

Under S. 1755, Section 111 of title 38 U.S. Code would be amended to extend 

travel reimbursements benefits for inpatient care to catastrophically disabled nonservice-connected veterans who have incurred a spinal cord injury or disorder, visual impairment, or multiple amputations. For this particular population of veterans, 

their routine annual examinations often require inpatient stays, and as a result, significant travel costs are incurred by these veterans. Eliminating the burden of 

transportation costs as a barrier to receiving health care, will improve veterans’ 

overall health and well being, as well as decrease, if not prevent, future costs associated with both primary and long-term chronic, acute care. 

Too often, catastrophically disabled veterans choose not to travel to VA medical 

centers for care due to significant costs associated with their travel. When these veterans do not receive the necessary care, the result is often the development of far 

worse health conditions and higher medical costs for the VA. For veterans who have 

sustained a catastrophic injury like a spinal cord injury or disorder, timely and appropriate medical care is vital to their overall health and well-being. 

S. 1707, THE ‘‘VETERANS SECOND AMENDMENT PROTECTION ACT’’ 

Regarding S. 1707, the ‘‘Veterans Second Amendment Protection Act,’’ PVA has 

no formal position on this legislation. 

S. 1705

PVA’s National office has no position on naming the VA medical center in Spokane, Washington, as the ‘‘Mann-Grandstaff Department of Veterans Affairs Medical Center. PVA believes naming issues should be considered by the local community with input from veterans organizations within that community. With that in 

mind, we would defer to the views of PVA’s Northwest Chapter. 

S. 1631

PVA generally supports the intent of S. 1631, legislation that authorizes the VA 

to establish a center for technical assistance for non-VA health care providers who 

furnish care to veterans in rural areas. As previously stated, we believe that the 

VA is the best health care provider for veterans. However, when veterans reside in 

rural areas and do not have timely access to VA health care services, it is important 

that the care provided outside of the VA meet the proper standards of quality and 

can be properly coordinated with VA medical professionals. S. 1631 proposes to improve collaboration on veterans’ health care matters between VA and non-VA providers serving veterans in rural areas by encouraging exchange of health care information between providers, creating shared internet-based information databases to 

collect information on mechanisms to improve health care for veterans in rural 

areas, and creating systems to monitor fee expenditures of the VA relating to nonVA provider services. 

PVA recognizes that veterans frequently seek health care services from non-VA 

providers independently and through VA purchased care and contract care programs. Therefore the VA must continue its efforts to increase care coordination, as 

this bill proposes, with private providers to ensure that veterans receive the best 

possible health care services available. With this in mind, PVA is concerned that 

the creation of the Rural Veterans Health Care Technical Assistance Center will 

contribute to growing VA administrative costs and perhaps will result in a duplication of efforts, as it appears that the purpose of the center is in direct alignment 

with VA’s Office of Rural Health. It is unclear in the bill exactly where the supervisory authority of the center will come from; therefore, PVA recommends that the 

center be housed within the ORH to most efficiently utilize VA resources. 

S. 1391

PVA supports S. 1391. According to reports, sexual assault in the military continues to be a serious problem, despite several actions by the Department of Defense 

(DOD) to combat the issue, including required soldier and leader training. As the 

military works to reduce the threat and incident of military sexual trauma (MST), 

it is important that victims of MST, both women and men, have the ability to receive care from the VA and receive timely, fair consideration of their claims for benefits. This is particularly important given the number of MST occurrences that go 

unreported. While current policies allowing restricted reporting of sexual assaults 

should reduce the number of incidents which have ‘‘no official record,’’ it can still 

be anticipated that there are those who will not report the incident out of shame, 

fear of reprisals or stigma, or actual threats from their attacker. To then place a 

high burden of proof on the veteran who has experienced MST to prove service-conVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00134 Fmt 6601 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
131 

nection, particularly in the absence of an official record, would add further trauma 

to an already tragic event. 

One particular recommendation that PVA would like to make about the proposed 

language is a clarification on what constitutes a ‘‘mental health professional.’’ We 

would hope that the intent of this legislation is not to limit ‘‘mental health professionals’’ to only VA health care professionals. 

S. 1264, THE ‘‘VETERAN VOTING SUPPORT ACT OF 2011’’ 

PVA supports S. 1264, the ‘‘Veteran Voting Support Act of 2011.’’ PVA advocates 

for the rights of veterans, persons with disabilities, and all Americans, which enable 

them to participate in the election process. Making the voting process accessible and 

available for paralyzed veterans has been a priority for our organization. 

PVA supports the requirement of the VA to provide information relating to requesting an absentee ballot and making absentee ballots available upon request. 

PVA also supports the provision of the bill that would permit nonpartisan organizations to provide voter registration information at facilities of the VA. 

THE ‘‘HOMELESS VETERANS ASSISTANCE IMPROVEMENT ACT OF 2012’’ 

PVA generally supports the provisions of the draft legislation, the ‘‘Homeless Veterans Assistance Improvement Act.’’ Many of the grant programs outlined in the 

legislation will help veterans who are homeless or are facing the prospect of homelessness to overcome the hurdles that they may face. PVA is disappointed to see 

that the annual amount authorized the Secretary of Veterans Affairs to carry out 

homeless veterans programs is being decreased from $200 million to $150 million. 

This step reflects a concern that we raised in the past that changing authorization 

levels for funding homeless programs would likely be an empty gesture. 

PVA is particularly pleased to see the extension of the Homeless Veterans Reintegration Program (HVRP). However, we are concerned that this extension only 

provides for one additional year. The HVRP program is perhaps one of the most 

cost-effective and cost-efficient programs in the Federal Government. Despite being 

authorized $50 million per year, it generally is appropriated less than half of that 

authorized level every year. And yet, it continues to serve a large number of veterans who are taking the necessary steps to overcome homelessness. 

Ultimately, in order to ensure that the myriad of homeless programs are successful, fully sufficient resources must be provided to these programs. Otherwise, overcoming homelessness becomes a policy without the possibility of true success. 

THE ‘‘MENTAL HEALTH ACCESS ACT OF 2012’’ 

PVA supports the proposed legislation, the ‘‘Mental Health ACCESS Act of 2012.’’ 

The proposed bill would improve and enhance the programs and activities of the VA 

regarding suicide prevention and resilience, and behavioral health disorders for veterans and servicemembers. While the VA has made tremendous strides in the quality of care and variety of services provided to veterans in the area of mental health, 

PVA believes that issues involving access to mental health care continue to exist 

and more must be done to make certain that all veterans receive timely and effective services. It is for this reason that we thank the Committee for reviewing this 

important piece of legislation. 

Under the proposed bill, the VA is required to conduct a comprehensive assessment of VA mental health care services with particular attention to the areas of 

timeliness of care, mental health staffing, and the availability and furnishing of evidence-based therapies. The bill goes a step further and requires the VA to establish 

a ‘‘Study Committee’’ to assist in developing and implementing the aforementioned 

improvements in mental health care delivery. PVA believes that a comprehensive 

assessment of VA mental health services is much needed, and we also support the 

requirement to have the VA develop and implement guidelines for the staffing of 

general and specialty mental health care services, including community-based outpatient clinics. Such staffing guidance is especially important in light of VA’s recent 

announcement to hire additional mental health professionals. 

One of the most significant provisions of the bill is the proposal to amend title 

38, United States Code, Section 1712A to expand eligibility for readjustment counseling and related mental health services. If enacted, this bill will enable VA to provide certain members of the Armed Forces, and their family members, with counseling services through VA Vet Centers. PVA strongly supports these amendments 

as we understand that servicemember deployments and veteran readjustment to civilian life not only affects the individuals who served their country, but also their 

family members, loved ones, and others that serve as close support networks. Nonetheless, with such a significant expansion of services now becoming available to this 

132 

new population, PVA is concerned that the cost increases associated with this 

change have the potential to limit the quality and availability of services for the intended groups. PVA recommends that the VA and Congress conduct an assessment 

that evaluates the ability of Vet Centers to provide the services needed by veterans, 

servicemembers, and their family members to best determine if and when these 

services can be provided. 

Additionally, the draft legislation gives the VA Secretary the authority to furnish 

mental health care through facilities other than Vet Centers to immediate family 

members of servicemembers deployed in connection with a contingency operation. 

Again, PVA supports and understands the intended purpose of this provision, however, should the VA provide the prescribed services, both VA and Congress must 

work to ensure that adequate resources are made available to meet the new demand. 

PVA would once again like to thank the Committee for the opportunity to submit 

our views on the legislation considered today. Enactment of much of the proposed 

legislation will significantly enhance the health care and benefits services available 

to veterans, servicemembers, and their families. We look forward to working with 

the Committee to ensure quick enactment and implementation of these important 

changes. 

This concludes PVA’s statement. We would be happy to receive any questions that 

you may have. 

LETTER FROM BARBARA COLLURA, PRESIDENT, RESOLVE

THE NATIONAL INFERTILITY ASSOCIATION, 

McLean, VA, June 26, 2012. 

Hon. PATTY MURRAY, 

Chairman, 

Committee on Veterans’ Affairs 

U.S. Senate, Washington, DC. 

RE: TESTIMONY FOR HEARING ON S. 3313 

DEAR CHAIRMAN MURRAY: On behalf of the 7.3 million Americans who are diagnosed with infertility, I commend you for introducing S. 3313, the ‘‘Women Veterans 

and Other Health Care Improvements Act of 2012.’’ Infertility is a devastating diagnosis to receive and it is further complicated by lack of insurance coverage for most 

Americans. As you know, TRICARE, and other medical benefits for active duty military and veterans, does not include coverage for infertility treatments including assisted reproductive technologies, such as in vitro fertilization (IVF). This places an 

added hardship on our servicemen and women and veterans with infertility that is 

unnecessary. 

RESOLVE: The National Infertility Association applauds your efforts to provide 

fertility counseling and medical treatment to veterans wounded in the line of duty. 

These veterans have many necessary medical services available to them upon returning home, yet if their military service has rendered them infertile, they have 

no access to medical treatment to have a child. This is an injustice that your bill 

seeks to correct. By providing this coverage, veterans have a chance at the family 

they always dreamed of. For many wounded veterans, assisted reproductive technologies such as IVF may be their only hope of ever having a biological child with 

their spouse. IVF has been practiced for over 30 years and is a safe and effective 

treatment for many types of infertility that cannot be treated with medication or 

surgical procedures. In recent years, professional guidelines have made IVF even 

safer and more effective through reducing the incidence of multiple births, improving egg and embryo freezing technologies, and improving pregnancy rates through 

embryo quality. 

RESOLVE would like to suggest that infertility coverage be expanded to include 

all veterans and active duty military so that all those with infertility in our Armed 

Forces have access to the care they need. Infertility affects men and women equally, 

and some infertility is unexplained. It is important that men and women receive access to care at the same level. Many couples find that they need to utilize third 

party reproduction to have a child, such as using donated sperm, eggs (oocytes), or 

embryos. Others can have a biological child but need a gestational carrier surrogate 

to carry the pregnancy. The cost for these medical services should be included in 

this legislation. 

Our wounded veterans deserve access to the best medical care that is available 

for their medical condition, and this bill will do just that. So much has been taken 

133 

away from our wounded veterans; don’t take away their dream of having a child, 

especially when medical treatment exists to help them. RESOLVE stands ready to 

assist the Department of Veterans Affairs in providing the necessary support and 

information to our veterans who pursue care for their infertility. 

Thank you again for introducing this bill. 

Sincerely yours, 

BARBARA COLLURA, 

President. 

134 

LETTER FROM RON SIMS, SEATTLE, WASHINGTON

Enclosures 


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135 

ENCLOSURES FROM RON SIMS REGARDING CLARK VETERANS CEMETERY


627apSIMS2.eps

'The veterans' cemetery that America forgot' Bv JIM GOMEZ 

CLARK. Philippines - MSNBC.msn.com 

Walking along the rows of tombstones here offers a glimpse of the wars America has fought and the men and 

women who waged them. 

But most of the grave markers have been half-buried for 20 years, and there is little hope that the volcanic ash 

obscuring names, dates and epitaphs will be cleared any time soon. 

Clark Veterans Cemetery was consigned to oblivion in 1991, when Mount Pinatubo's gigantic eruption forced the 

U.S. to abandon the sprawling air base surrounding it. 

Retired U.S. soldiers, Marines and sailors volunteer to keep watch, relying on donations to try to maintain the 

grounds, but they lament that they're short on funds to fix things, and that Washington is unwilling to help. 

"It's the veterans' cemetery that America forgot," Vietnam War veteran and ex~Navy officer Robert Chesko said. 

Workers at the cemetery north of Manila recently dug to fully expose a gravestone for an Army sergeant who died in 

World War IT in the Philippines. 

They discovered his wife's name engraved under his and a long-hidden tribute: "Daughter, sister, wife and mother of 

veterans." 

It's impossible to say what else remains hidden at the 17 -acre (seven-hectare) cemetery. 

It holds the remains of 8,600 people, including 2,200 American veterans and nearly 700 allied Philippine Scouls who 

saw battle in conflicts from the early 1900s to the resistance against brutal Japanese occupation troops in WWlI. 

Clark's dead also include military dependents, civilians who worked for the U.S. wartime government and at least 

2,139 mostly unidentified soldiers whose marble tombstones are labeled "Unknown." 

As America marks Independence Day, the veterans caring for the cemetery renewed their calls for Washington to 

fund and take charge of the work. 

"People celebrate on the Fourth of July but they forgot the 8,600 who helped make that freedom happen," said 

fonner Navy Capt. Dennis Wright, who saw action in Vietnam and is now a business executive. 

'Nickels and dimes' 

"We're trying to get the U.S. government to assume responsibility for maintaining the cemetery so we can get it up to 

standards ... not on nickels and dimes and donations and gifts," said retired Air Force Chief Master Sgt. Larry 

Heilhecker, who served as cemetery caretaker for five years until last month. 

Clark was a U.S. base for nearly a century, and was once the largest American Air Force installation off the U.S. 

mainland. It served as a key staging area for U.S. forces during the Korean and Vietnam wars. 

The Clark cemetery, which can accommodate at least 12,000 remains, was developed between 1947 and 1950, when 

it was used to collect the remains and tombstones from four U.S. military cemeteries as American officials soned out 

their dead from WWII and previous wars. 

Pagclof3 

An American cemetery at the then Fort McKinley in 

Manila became the exclusive burial ground for all 

Americans and allied Philippine Scouts who were 

killed in WWII combat. The I 52-acre (61-hectare) 

n06']01220:43PM 
136 


627apSIMS3.eps

Manila cemetery collected 17,202 dead, the largest 

number of American casualties interred in one place 

from the last world war. 

Now closed to burials, the stunningly landscapcd 

Manila cemetery became one of24 American burial 

grounds outsidc the U.S. mainland. 

Nearly 125,000 Americans who pcrished in WWI and 

\\TWII and the Mexican War arc interred in those 

U.S.-funded overseas cemeteries, regarded as among 

the most beautiful war memorials in the world. The 

overseas burial sites are administered by the 

American Battle Monuments Commission, or 

ABMC. 

Gravcs date back to 1903 

The dead at Clark are not limited to World War II 

casualties - thcy date as far back as 1903. Also 

unlike the Manila cemetery, it continues to accept 

burials. One U.S. veteran who lives in the area had his son buried here after he was killed in Iraq in 2005. But Clark 

is not administered by the ABMC. 

The Air Force managed Clark cemetery from 1947 to 1991, when it abruptly left after nearby Pinatubo roared back 

to life from a SOO-year slumber. 

Even before the eruption, negotiations with the Philippine government for a new U.S. military lease on Clark had 

bogged down after nearly a \,.:enlury ufpresence in the Philippines, according to the veterans. 

Philippine authorities failed to look after the cemetery. In 1994, American veterans were shocked to find it had 

become an ash-covered jungle of weeds, overgrown grass and debris. Half of its old steel fence had been looted. 

Today, a pair of U.S. and Philippine Hags Hutter in the wind over the graves. A recently restored marble obelisk, 

pockmarked by World War II gun and artillery fire, venerates the unknov.rn dead. A small sign at a new steel gate 

ushers in visitors with a tribute to the war dead: "Served with honor." 

All the improvements came from donations. Wright's company spent $90,000 to construct a new concrete and steel 

fence and a parking lot and make other improvements. An old veteran, confined to a nursing home in Florida, sent 

one dollar in a touching act, Heilhecker said. 

Forlorn 

Still, the Clark gravesites look forlorn compared to the American cemetery in Manila. 

A U.S. government decision to take control of the Clark cemetery could shed light on the fate of still-missing 

Americans, Wright said, citing the case ofa U.S. Anny Staff Sgt. Hershel Lee Covey, whose name is on a Clark 

cemetery tombstone that declared him as having died on July 17, 1942 in the Philippines. 

A check by The Associated Press showed ABMC lists Covey as "missing in action or buried at sea." 

Dashing the hopes of the American veterans, the ABMC and the Department of Veterans Affairs, which manages 

131 U.S. mainland cemeteries through an agency, both said Clark was outside their mandatc. 

"Whether the U.S. government should take on responsibility for maintaining such a foreign, private cemetery is a 

veterans' benefits issue outside the scope of our authority," ABMC public affairs director Michael Conley told the 

AP in an e-mailed reply to questions. 

Page 200 23!06,201220:43I'M 
137 

PREPARED STATEMENT OF MORRIS KLEIN, ESQ., ATTORNEY AT LAW, BETHESDA, 

MARYLAND, AND LOIS ZERRER, ZERRER ELDER LAW OFFICE, LLC, SPRINGFIELD, 

MISSOURI, ON BEHALF OF THE SPECIAL NEEDS ALLIANCE

Chairwoman Murray, Senator Burr and Members of the Committee, Thank you 

for inviting the Special Needs Alliance (SNA) to submit testimony this morning. 

The SNA is a national, not-for-profit organization of attorneys dedicated to the 

practice of disability and public benefits law. Our mission is to maintain a professional organization of attorneys skilled in the complex areas of public entitlements, 

estate, trust and tax planning, and legal issues involving individuals with physical 

and cognitive disabilities, including veterans with disabilities. SNA membership is 

based on a combination of relevant legal experience in the disability and elder law 


627apSIMS4.eps
138 

fields, direct family experience with disability, active participation with national, 

state and local disability advocacy organizations, and professional reputation. 

It is our privilege to provide comments on S. 3270, legislation that will impose a 

‘‘look-back’’ period for veterans and their spouses who transferred countable assets 

and then seek a Non-Service-Connected Disability Pension for assistance to pay for 

their care needs. 

NEED TO SPECIFY RESOURCE STANDARD

We respectfully request that the bill ultimately include a provision requiring the 

VA to specify the maximum amount of resources an applicant may retain to be eligible for benefits. 

The VA does not have a clear, fixed standard as to what amount of resources an 

applicant may possess to be eligible for benefits. Other means-tested programs that 

consider resources, particularly SSI and Medicaid, have specified maximum 

amounts of resources (the amount for SSI is $2,000 and the amount for Medicaid 

is determined by the state, usually between $2,000 and $4,000). Administrators at 

the VA apparently have discretion in determining whether a particular applicant 

has sufficient resources to qualify for the program. This can result in unequal treatment between applicants. A veteran can only ‘‘guess’’ whether the resources he or 

she has is low enough to be eligible for benefits. Moreover, a veteran in one region 

may qualify for benefits while a veteran in another region would not be eligible. 

This lack of consistency makes it difficult for a veteran to determine whether or not 

to apply for benefits. The lack of consistency is particularly disquieting now that an 

applicant may face a ‘‘penalty’’ for transferring resources. Ironically, the smaller the 

benefit the veteran receives, the greater the penalty (up to the 36 month maximum). 

CONSIDERATION OF SPECIAL NEEDS TRUSTS

We respectfully request that the bill ultimately include a provision exempting special needs trusts from consideration as a countable resource. 

The GAO suggested an eligibility scheme that is similar to other means-tested 

programs. Other means-tested programs, such as SSI and Medicaid, do carve out 

an exception for special needs trusts. A special needs trust is different than the purchase of annuities that the GAO has criticized in a recent report, and is not the 

type of trust contemplated or discussed as abusive. Only a person who has suffered 

a disability can become a beneficiary of a special needs trust. Specifically, a special 

needs trust allows a person who has a physical or mental disability to have assets 

held in trust to help pay for care needs that would not be covered by public benefits. 

Special needs trusts had been used for many years. In 1993, Congress explicitly authorized the use of special needs trusts for the benefit of individuals who are under 

the age of 65 and disabled as defined by the Social Security Administration. The 

assets of an individual with a disability that are placed in a properly drafted special 

needs trust are not considered available for purposes of qualification for SSI and 

Medicaid. Such trusts are irrevocable and require funds to be used only for the sole 

benefit of the beneficiary, and any funds remaining in the trust after the beneficiary 

dies must be ‘‘paid back’’ to the state Medicaid agency to the extent the agency paid 

for the beneficiary’s care. See 42 U.S.C. Section 1396d4(A). 

Congress has heretofore not taken a position on special needs trusts as they apply 

to VA benefits. A VA General Counsel opinion (VAOPGCPREC 33–97, VA General 

Counsel Opinion dated August 2, 1997) concluded that funds in a special needs trust 

are counted as resources. Thus, unlike applicants for other government needs-based 

benefits, veterans who are applicants for the improved pension and Aid and Attendance benefits who are also beneficiaries of special needs trusts will have the funds 

in the trust counted as an available resource. This in effect discriminates against 

the veteran who is treated differently than non-veterans in their ability to set aside 

such funds. 

We believe that there is no meaningful distinction between the treatment of special needs benefits for other public benefit programs and the VA program, and we 

respectfully urge the Committee to extend the current treatment of special needs 

trusts to VA benefits. 

TRANSFERS TO CHILDREN WITH DISABILITIES

The legislation should ultimately carve out an exemption for transfers to blind 

and disabled children. 

Continuing with the GAO suggestion that the VA eligibility standards follow 

other public benefit programs, this legislation should also exempt transfers to the 

children of veterans who are blind or disabled. Federal law for Medicaid and SSI 

139 

1http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1922 

2Street et al. 2008. ‘‘Sexual harassment and assault experienced by reservists during military 

service: Prevalence and health correlates.’’ Journal of Rehabilitation Research and Development 

45: 409–420; Kang et al. 2005. ‘‘The role of sexual assault on the risk of PTSD among Gulf War 

veterans.’’ Annals of Epidemiology 15(3):191–195. 

eligibility have exempted such transfers to blind and disabled children. See 42 

U.S.C. Section 1396p(a)(2)(B) and 1396p(c)(2)(A) and (B). 

ELIGIBILITY DATE AS APPLIED TO REDETERMINATIONS

The law should only apply to transfers made after the law goes into effect. 

It appears clear from the language of the legislation that the imposition of a lookback period is to be applied prospectively, as the changes go into effect one year 

after the bill is signed into law. However, the law applies to annual redeterminations as well, and since there is a three-year look back, a beneficiary may lose benefits resulting from transfers made two years before the effective date of the law. We 

therefore suggest that the law be clarified to state that transfers made prior to the 

effective date of the law shall not be subject to the look-back period. 

Thank you again for the opportunity to share these thoughts on S. 3270. The Special Needs Alliance looks forward to working with the Committee to address these 

technical issues in the legislation. Please let us know if we can be of further assistance. 

PREPARED STATEMENT OF ANU BHAGWATI, EXECUTIVE DIRECTOR, 

SERVICE WOMEN’S ACTION NETWORK

Chairman Murray and Members of the Committee: Thank you for the opportunity 

to present the views of the Service Women’s Action Network (SWAN) concerning 

three bills included in this legislative hearing: S. 1391, S. 3049 and S. 3313. 

SWAN is a nonprofit service organization founded to improve the welfare of current U.S. servicewomen and to assist all women veterans. SWAN offers personal 

support and guidance to fellow women veterans, provides legal and counseling services from military law experts and caseworkers, recommends sound policy reform to 

government officials, and educates the public about servicewomen’s issues through 

various media outlets. Conceived as a support network by and for women veterans, 

SWAN serves all military women, regardless of era, experience, or time in service. 

SWAN has been working on improving benefits for women veterans, both within 

the VHA and VBA as an ongoing policy priority for many years and is extremely 

encouraged by the engagement and leadership shown by the Committee over the 

years on key issues that are critical to ensuring that women veterans receive the 

very best in care and benefits. It is with that goal in mind that SWAN provides 

hearing testimony on the following bills: 

S. 1391—TO AMEND TITLE 38, UNITED STATES CODE, TO IMPROVE THE DISABILITY COMPENSATION EVALUATION PROCEDURE OF THE SECRETARY OF VETERANS AFFAIRS FOR

VETERANS WITH POST TRAUMATIC STRESS DISORDER OR MENTAL HEALTH CONDITIONS RELATED TO MILITARY SEXUAL TRAUMA, AND FOR OTHER PURPOSES. 

SWAN fully supports S. 1391. In 2010, the VA adopted a new evidenciary standard for combat-related Post Traumatic Stress Disorder (PTSD) claims. Prior to this 

change, veterans filing a claim for combat-related PTSD had to demonstrate they 

were traumatized by a specific event by supplying incident reports, witness statements or other evidence. Since the policy change, the evidence required has been 

reduced to having the veteran’s trauma claim related to fear of hostile military or 

terrorist activity and that it is consistent with the veteran’s service record. The intent behind this change was to expedite and increase access to much needed disability benefits for servicemembers suffering from the invisible wounds of war.1

However, when making these changes. The VA did not include PTSD caused by 

Military Sexual Trauma (MST), even if that trauma was a result of sexual assault 

or sexual harassment in a combat zone. By excluding MST-based PTSD claims in 

this procedural reform, the VA has created a double-standard and an unfair burden 

on women veterans who must submit additional evidence to support a service connection. This has a particularly disparate impact on women since MST is the leading cause of PTSD among women veterans, while combat trauma is the leading 

cause of PTSD among men.2 SWAN has recently worked with a woman who had 

both an MST-based PTSD claim and a combat PTSD claim pending. She abandoned 

her MST PTSD claim and only pursued her combat PTSD claim after her MST 

140 

3 In conjunction with the ACLU, SWAN filed a Freedom of Information Act (FOIA) request 

to obtain data concerning gender differences in approval for MST-related PTSD claims. Based 

on data analyzed for fiscal years 2008–2010 SWAN discovered that only 32% of all PTSD claims 

related to sexual trauma are accepted. Conversely, 53% of PTSD claims overall are accepted. 

About half of PTSD claims filed by Iraq and Afghanistan veterans are accepted. 4Williamson, Vanessa and Erin Mulhall. 2009. ‘‘Invisible Wounds: Psychological and Neurological Injuries Confront a New Generation of Veterans.’’ New York: IAVA. ; Mulhall, Erin. 2009. 

‘‘Women Warriors: Supporting She ‘Who Has Borne the Battle.’’’ New York: IAVA. 5http://www.charleston.va.gov/features/Female_Veterans_at_Higher_Risk_for_Suicide.asp 

claim was repeatedly rejected even after she provided the additional evidence requested by the VA. 

Additionally, SWAN has discovered through data obtained from the VA through 

a Freedom of Information Act (FOIA) request that there is a disparity in the approval rates of MST-based PTSD claims as compared to all other PTSD Claims, to 

include combat PTSD claims. Between 2008 and 2010, only 32% of MST PTSD 

claims were approved whereas 53% of all other PTSD claims were approved, and 

nearly 50% of PTSD claims from Iraq and Afghanistan veterans were approved.3

The end state of the current policy is this: For 2 out of 3 veterans who are survivors of in-service sexual assault they receive no disability benefits related to their 

PTSD. This lack of benefit care results in tremendous hardship for MST survivors, 

leading to untold mental and physical suffering, destroyed families, homelessness 

and suicide. This is not conjecture, it is supported by the facts: 40% of homeless 

women veterans report they were victims of military sexual assault,4 and the VA 

reports that the increase risk for sexual assault in the military is a factor in increased suicide among veterans.5

In 2011 SWAN began working with Under Secretary for Benefits, Allison Hickey 

to correct this disparity and create a fair policy. Initially, General Hickey was amenable to changing the policy due to the clear difference in language found in 38 CFR 

§ 3.304(f)(3). She soon moved away from that position and instead issued a letter 

to the Regional Offices which did absolutely nothing to help. The RO letter simply 

reiterated the current policy with an added emphasis on giving the veteran’s application the benefit of the doubt. She also issued instructions to increase training for 

claims officers but in practice, this has done nothing to improve the process. The 

claims officer is free to disregard the new instructions and still be justified in rejecting a MST-based PTSD claim based on the policy. 

What is not understood by the VA is in many cases, it is exceedingly difficult for 

a veteran suffering from MST-related PTSD to produce evidence to satisfy the subjective standards of the reviewing officer. This is due in part to the nature of sexual 

trauma—it often takes years after the initial assault for survivors to begin to seek 

out help many months or years after that to begin the arduous claims process. This 

extended amount of time between the event and the claim is a leading cause of rejections. 

Additionally, there a lack of official paperwork generated in most MST investigations, and although new policy changes have been made, there has existed for years 

and years, poor DOD-wide document retention policies for those forms that are produced. A new claim has the advantage of the new document retention policies, but 

any claim prior to 2011 does not. Finally, according to the DOD, in 2011 only 15 

percent of sexual assaults are reported, which means in 85% of sexual assault cases 

no official paperwork even exists to support a claim. In spite of current VBA rules 

which allow for non-DOD evidence to aid in the determination of a service-connected 

disability, the VBA still routinely denies MST-related claims, even in cases where 

non-DOD evidence is in abundance. 

Due to these systemic shortcomings that lead to ever increasing issues for veterans, in lieu of requirements for victims of in-service sexual assault to submit the 

corroborating evidence under the current policy, Committee support of S. 1391 is 

critical. The VA must extend to these claimants the same evidentiary relief it has 

recently afforded to veterans who experienced trauma due to operational deployment-related stressors. 

S. 3049—TO AMEND TITLE 38, UNITED STATES CODE, TO EXPAND THE DEFINITION OF

HOMELESS VETERAN FOR PURPOSES OF BENEFITS UNDER THE LAWS ADMINISTERED

BY THE SECRETARY OF VETERANS AFFAIRS. 

The U.S. Department of Housing and Urban Development recently changed their 

definition of ‘‘homeless’’ to include persons who flee their home due to domestic violence or sexual violence. S. 3049 would align the VA’s definition of ‘‘homeless’’ with 

141 

6http://www.hudhre.info/hearth/ 

7http://www.nationalhomeless.org/factsheets/domestic.html 

8GAO, Homeless Women Veterans: Actions Needed to Ensure Safe and Appropriate Housing, 

GAO–12–182 (Washington, DC: Dec 2011). 9http://www.defense.gov/news/newsarticle.aspx?id=48827 

10http://www.ncbi.nlm.nih.gov/pubmed/360560 

HUD’s definition, pursuant to the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act.6

SWAN supports S. 3049 and feels that aligning these definitions among Federal 

agencies is critical for two reasons: 1) There are established partnerships between 

the VA and HUD at the state level, and having parity in the definition would ensure an increased efficiency when operating together; 2) More specifically, the way 

in which the VA defines a ‘‘homeless person’’ can preclude them from getting emergency shelter or other services if they are a victim of domestic violence. 

Domestic violence is a leading cause of homelessness, particularly among women 

and families. According to a 2008 report by the US Conference of Mayors, 28% of 

families were homeless due to domestic violence and 39% of cities cited domestic violence as the primary cause of family homelessness.7 In spite of a decrease in overall 

veteran homelessness, women veterans are accounting for an increasing number of 

homeless. According to the GAO, the number of homeless women veterans has doubled from 3.89% in 2006 to 6.32% in 2010.8 It is critical that the Committee support 

S. 3049 in order to ensure that all veterans, including those who flee unsafe and 

abusive situations have adequate access to emergency and transitional housing. 

S. 3313—WOMEN VETERANS AND OTHER HEALTH CARE IMPROVEMENTS ACT OF 2012

SWAN fully supports S. 3313, the Women Veterans and Other Health Care Improvement Act. The provisions in this bill that would establish VA reproductive and 

infertility research and treatments, improve the VA’s women call center, increase 

the number of women’s counseling retreat locations from three to 14 and extend the 

pilot programs for assistance for child care all address extremely important issues 

facing women veterans, and would markedly improve the veteran’s ability to receive 

and sustain much needed medical assistance and care. SWAN would like to comment further on the infertility provisions found in the bill. 

Two weeks prior to the introduction of this bill, SWAN received a letter from a 

supporter named Heidi who lives in Illinois. Heidi described in detail her difficult, 

painful and ultimately disfiguring journey through the VA system in an effort to 

correct a fertility issue. She eventually sought help out-of-pocket at a non-VA hospital. There, her doctors struggled to correct the damage that had already been 

done. ‘‘I’m sure he did all he could,’’ Heidi wrote, ‘‘but I was too damaged. I decided 

that I am not going to be able to have kids so I need to forget about it.’’ 

There is a critical need in the VA for proper research and treatment for infertility, 

particularly in light of the high rates of genitourinary issues including urinary tract 

infections (UTIs) experienced by military women. According to a study conducted in 

2008 by the Defense Advisory Committee on Women in the Services (DACOWITS), 

for deployed female servicemembers the most common health risk is urinary tract 

infection.9 This has the long-term effect of increasing infertility specifically among 

military women due to the operational nature of the military. The National Institute 

of Health has found a vast amount of evidence linking the presence of genitourinary 

infection with infertility.10 It is therefore incumbent upon the VA to provide proper 

research and treatment for infertility for these women, and critical for the Committee to support S. 3313. 

I thank the Chair and the Committee for their time and attention in reading this 

testimony. I am available to answer any further questions if needed. 

PREPARED STATEMENT OF CHARLES HUEBNER, UNITED STATES OLYMPIC COMMITTEE

S. 3206—TO EXTEND THE AUTHORIZATION OF THE U.S. PARALYMPIC INTEGRATED ADAPTIVE SPORTS PROGRAM AND TO PROVIDE A MONTHLY ASSISTANCE ALLOWANCE TO

DISABLED VETERANS TRAINING OR COMPETING FOR THE PARALYMPIC TEAM

Chairman Murray and Ranking Member Burr, and Members of the Committee, 

my name is Charlie Huebner and I am the Chief of Paralympics for the United 

States Olympic Committee (‘‘USOC’’). Thank you for the opportunity to submit a 

statement in support of S. 3206, which extends the authorization for the highly successful partnership between the USOC and the Department of Veteran Affairs to 

provide Paralympic sports activities for disabled veterans in their communities. 

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Paralympic programs are sports for physically disabled athletes. These adaptive 

sports activities have become an integral part of their recovery to a full and healthy 

life after completing their service to our country. 

In 2008 Congress passed the Veterans Benefits Improvement Act, which authorized the Department of Veterans Affairs to award grants to the United States 

Paralympics to ‘‘plan, develop, manage, and implement an integrated adaptive 

sports program for disabled veterans and disabled members of the Armed Forces.’’ 

The program did not commence until Fiscal Year 2010 and the authorization expires 

at the end of Fiscal Year 2013. It is imperative that Congress act this year to extend 

the authorization for this program to ensure there is no interruption in the services 

being provided to our disabled Veterans. 

The USOC, which itself was created by Congress, is one of only four National 

Olympic Committees that mange both Olympic and Paralympic sport. We are one 

of only a handful of National Olympic Committees that are 100% privately funded, 

with our major competitors outspending us often as much as 5-to–1. 

Beginning in 2003, the USOC, at the request of Congressional leaders, and the 

Military and Veteran community began providing technical assistance, training and 

leadership in providing programs to injured servicemembers and Veterans, with a 

focus on developing sustainable programming at the community and installation 

level. 

The USOC has a strong history and expertise in more than 47 sports (including 

non-Paralympic sports). We have expertise in serving persons with a variety of 

physical disabilities. The USOC has inspiring Olympic and Paralympic ambassadors 

that compel partners and competing organizations to collaborate for a common 

cause. With more than 50 member organizations like the National Recreation and 

Parks Association and USA Hockey, we have a membership infrastructure of community sport organizations that touch thousands of U.S. communities, and allow for 

financial and programmatic efficiencies and significant private sector investment. 

Because of the extraordinary increase in need, in 2008 the USOC began accepting 

Federal funding for these programs, while continuing to expend considerable private 

resources in support of these efforts. The majority of these funds are distributed via 

grants to community sport organizations to implement and develop local program. 

The Paralympic Movement began shortly after World War II utilizing sports as 

a form of rehabilitation for injured military personnel returning from combat. Injured military personnel and Veterans are the soul of the Paralympic movement. 

When discussing the Paralympic movement, we are not just talking about a small 

number of elite athletes that will make future Paralympic teams. Rather, we are 

referring to the thousands of disabled active duty military personnel and Veterans 

that have participated in the growing number of physical activity programs created 

throughout the United States under the leadership of the USOC and our community 

partners—like Paralyzed Veterans of America, Disabled Sports USA, USA Shooting, 

and Metro Tacoma Parks and Recreation—that allow Veterans with physical disabilities an opportunity to re-engage in life by simply skiing with their buddies or 

playing in the backyard with their kids. As programming expands daily, we see a 

population that has lower secondary medical conditions, higher self-esteem, lower 

stress levels and higher achievement levels in education and employment. Increasingly, empirical research specific to this population is beginning to bear this out. 

More importantly, we see a population that inspires all Americans to pursue excellence, in sports and in life. 

We cannot emphasize enough the importance of our more than 200 partner organizations located in more than 170 communities and 47 states, and the District of 

Columbia. The Federal funding that the Veterans Integrated Adaptive Sports program has provided has enabled these organizations to leverage many millions of dollars more to provide the full range of Paralympic sports programming to our Veterans. We are proud to have the support and partnership of groups including the 

American Legion, The Fisher House Foundation, the Blinded Veterans Association, 

and the USO in endorsing S. 3206. 

We are also proud that our leadership, and our partners, accepted the responsibility to serve those who have served us. Because of your leadership in developing 

and providing funding for this USOC and VA partnership, we are able today to report on the several accomplishments that have been reached since the launch of the 

program in June 2010. Our primary emphasis in the first two years was to meet 

the immediate need to develop programming for the thousands of disabled Veterans 

returning to their communities and hometowns. Since June 2010, the VA, USOC 

and our more than 200 partners have: 

• Distributed more than 300 grants to community sport organizations to develop 

sustainable activity programs for disabled Veterans returning to their hometowns. 

143 

• These community programs are investing millions of dollars in private resources, combined with grants from the VA-USOC grant pool, to reach thousands 

of veterans with a focus on sustainable and consistent physical activity at the local 

level. 

• The VA and USOC have emphasized and led an effort to promote collaboration 

between the DOD, VA, and community sport organizations to recognize and enhance 

programmatic and financial efficiencies. To date, grant recipients have collaborated 

and partnered with over 70 VA and DOD medical facilities across the country. 

• Created the Paralympic Resource Network, an online database of Paralympic 

programs nationally which is designed to link individuals with physical and visual 

disabilities to sports programs in their communities. 

• Launched successful regional Pilot programs to test approaches for veteran recruitment and programming strategies that can be replicated in other areas in five 

locations including: Chicago-land area; New England; Northern California; Georgia/ 

Southeast region; and Texas/Gulf State area. 

• Inaugurated the VA Rehabilitative Adaptive Sports Conference that provided 

VAMC personnel and leadership with the tools, resources, and training necessary 

to successfully develop and implement adaptive sport and recreation programs for 

disabled veterans at VA facilities by collaborating with external community partners. 

• Distributed training stipends to over 90 Veteran athletes; 40 of these athletes 

have met the national team standard in their respective sports. 

Again, we felt it was imperative in the first two years to focus the majority of 

our efforts on development and expansion of sustainable programs at the community 

due to the significant volume of Veterans returning home. Based on our experience 

in collaborating with the VA and feedback from the congressional committees of jurisdiction and our community partners, we recognized that program development 

should shift to a more regional focus and enhanced oversight and monitoring needed 

to be put in place with respect to program resources, generally, and the growing 

number of sub-recipients. While sustainable and consistent program development is 

a continued focus, we have already proactively made adjustments in collaboration 

with the VA to accomplish the following: 

• Increase resources devoted to program oversight and monitoring in light of the 

expanded number of grant participants. This includes increasing our oversight beyond a self-reporting system, with desktop and personal site visits to grantees. With 

pro-bono services provided by a leading consultant firm, the USOC and VA have developed and instituted a new grant monitoring process, initiated internal audits of 

grant sub-award recipients, and re-deployed three USOC staff members to focus 

100% on monitoring and oversight. In year one and two, staff that was also focused 

on developing programming, were also responsible for monitoring and oversight. We 

have determined that with more than 200 program partners and an estimated 150 

grant recipients, it was not feasible for the program staff to also be responsible for 

monitoring and oversight. Please find attached the updated monitoring plan that 

the re-deployed staff are aggressively implementing and will meet. 

• In 2011 and 2012, the USOC declined to accept the federally-allowed administrative fee of five percent (5%), allowing an estimated $700,000 to be re-invested 

into programming and grants. 

• Enhance awareness and educational materials of the impact and importance of 

consistent physical activity for Veterans at the national, regional and local level. For 

example, in a recent public and privately-funded initiative around the USOC-hosted 

Warrior Games, the USOC and VA reached more than 67.0M Americans with educational programming about the importance of sport in the rehabilitation process. 

• Recommend additional resources to support VA—USOC regional coordinators 

that can enhance collaboration and impact of programs in targeted regions throughout the United States. The emphasis on developing and sustaining collaboration 

among competing entities is a critical and time-consuming aspect to this cost efficient strategy. We believe a neutral entity must lead this effort. 

• Continue to increase the number of community partners that are providing 

much-needed sport and recreation programs, primarily at their cost, at the local 

level for the disabled Veteran population. 

In closing, I would like to highlight one program that embodies all of our strategies, collaboration, training, technical assistance, awareness and financial support, 

along with an emphasis on hiring Veterans. Joe Brown is originally from Arizona. 

His family has a strong military history. His grandfather died as a POW during the 

Korean War. His father was an Air Force fighter pilot. Joe played football at the 

Ohio State University and three years in the NFL. But the Army Rangers were conVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00147 Fmt 6601 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
144 

tinually calling, so he joined the Army, the Rangers, and deployed to Iraq in 2004 

and again in 2007. 

During his 2007 tour he was calling in air strikes atop a three-story building, trying to help a unit in trouble. As his unit was leaving the building, Brown fell down 

a 30-foot shaft, suffering a severe brain injury. Brown knew the importance of physical activity and sport in the rehabilitation process. He attended the USOC VA 

Paralympic Leadership Conference to gain valuable training and connect with other 

organizations and agencies in his region. He pursued a position in the parks and 

recreation industry near a military facility so he could serve injured servicemembers 

and Veterans. He was hired by Harker Heights Parks and Recreation outside of Ft. 

Hood, Texas. Harker Heights was awarded a $23,000 VA-USOC grant in 2010. Joe 

leveraged that initial grant and has built a sustainable, on-going program that 

serves more than 80 veterans who can now participate in an array of physical activity programs under Joe’s leadership. 

I would like to thank the Committee, the VA leadership, particularly Secretary 

Eric Shinseki; Mike Galloucis, Executive Director of the Department of Veterans Affairs’ Office of Public and Intergovernmental Affairs; Chris Nowak, the Director of 

the VA’s National Veterans Sports Programs and Special Events; our organizational 

partners in carrying out this program; of course, Senators Boozman and Begich, who 

introduced S. 3206, and other Members of the Committee who have joined them in 

cosponsoring this legislation that extends a program that is so critical to supporting 

our Nation’s finest. 

LETTER FROM HEATHER L. ANSLEY, ESQ., MSW, VICE PRESIDENT OF VETERANS

POLICY, VETSFIRST

VETSFIRST, A PROGRAM OF UNITED SPINAL ASSOCIATION, 

Washington, DC, July 5, 2012. 

Hon. BARBARA BOXER

112 Hart Senate Office Building 

U.S. Senate, Washington, DC. 

DEAR SENATOR BOXER: VetsFirst, a program of United Spinal Association, wishes 

to express our support for S. 1806, which would allow individuals to designate tax 

overpayments as contributions to a fund for homeless veterans. This legislation 

would supplement the efforts of the Department of Veterans Affairs (VA) and other 

agencies that assist homeless veterans and their families. 

Homelessness among veterans and their families is a critical problem that requires the attention of all Americans. Homeless veterans represent all eras of military service, including those who served in Iraq and Afghanistan. Our nation must 

provide the services and supports needed by homeless veterans to ensure that current and future generations of veterans will no longer endure homelessness. 

VetsFirst believes that this legislation will allow Americans the opportunity to 

personally invest in our nation’s homeless veterans. The creation of the Homeless 

Veterans Assistance Fund will provide a new source of revenue to help our homeless 

veterans and their families, not supplant current efforts by VA and other agencies. 

Ending homelessness among our nation’s veterans will require access to housing, 

health care, and employment. The additional funds provided through this legislation 

will give an important boost to already occurring assistance. 

We appreciate your leadership on this issue and urge swift passage of this critical 

legislation that will help to eliminate and prevent homelessness for our nation’s veterans and their families. If you have any questions, please contact Heather Ansley, 

Vice President of Veterans Policy, at (202) 556–2076, ext. 7702 or by e-mail at 

hansley@vetsfirst.org. 

Sincerely, 

HEATHER L. ANSLEY, ESQ., MSW, 

Vice President of Veterans Policy. 

145 

LETTER FROM DENNIS L. WRIGHT, CAPTAIN, U.S. NAVY (RETIRED), 

CHAIRMAN, CLARK VETERANS CEMETERY RESTORATION ASSOCIATION


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• Since the VFW assumed responsibility in 1994, they have buried 400 additional veterans, 

including one killed in action in Fallujah, Iraq in 2004. 

The annual out-of-pocket cost VFW Post 2485 expends is $25,000 per year for the six day 

laborers who maintain the landscaping and assist with burials of veterans. 

The solution is equally simple. Congress must do the right thing and direct the American Battle 

Monuments Commission to assume responsibility for the perpetual care and administration. 

There is no real budget impact unless one imagines $25,000 per year, today raised solely through 

donations, to be a budgetary impact. 

We know ABMC will object to this bill. Please do not be misled. ABMC docs maintain another 

active cemetery in Panama, which is virtually identical to the situation at Clark, except Clark is 

much more historic with SAW IP A W war dead. It also manages another non WWIIWWII site in 

Mexico. Further, ABMC presently manages two other existing sites in the Philippines, the 

Cabanatuan POW Memorial 90 minutes to the north, and the Manila WWII Memorial and 

Cemetery 90 minutes to the south. This "is" ABMC's mission and ABMC "is" authorized today 

in 36 USC 21 if they chose to do it or more importantly interpret it that way. Don't let ABMC 

throw up a smoke screen. Also, please do not get distracted by red herrings. There is no cost 

impact for ABMC to accept the cemetery today in its "AS IS" condition. Then over time, with 

their expertise and professional management team, ABMC can properly develop a plan to restore 

the CVC to its rightful place in history with dignity and respect for those who "Served With 

Honor", the motto of the cemetery. 

In summary, thanks to the VFW volunteers and the generosity of several small American 

companies, the cemetery has been restored to a modest level of decorum and dignity. It is not a 

difficult task then for the Senate to task AMBC to assume what volunteers have done for the past 

two decades - - immediately assume responsibility and then plan for an orderly restoration in the 

out-years. 

A bi-Iateral agreement will be required between the U.S. and Philippine Government, and the 

Philippine Government has already asserted, that while it will not cede control or ownership, it 

will honor a request by the U.S. Government to "care and administer" the cemetery and to take 

over from the VFW volunteers. Again, please to not be misled by smoke screens from ABMC or 

others. Senate Resolution 481 has set the framework for bi-Iateral cooperation. The solution is 

quite simple. It ranges from a simple Usufruct Agreement to a Diplomatic Note or other form of 

a Memorandum of Agreement. Also please keep in mind that the majority of ABMC sites, 

including both of those in the Philippines, are covered by similar Memorandums of Agreement 

or Diplomatic Notes. 

I urge the Committee to take note of the broad base and overwhelming level of support for the 

CVC from across the nation. Of note are written letters, resolutions and deeds to include: 
147 

[Attachments listed were not submitted to the Committee.] 

PREPARED STATEMENT OF WOUNDED WARRIOR PROJECT

Chairman Murray, Ranking Member Burr and Members of the Committee: 

Wounded Warrior Project (WWP) welcomes your consideration today of the Mental 

Health Access to Continued Care and Enhancement of Support Services (ACCESS) 


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1 Charles W. Hoge, M.D., ‘‘interventions for War-Related Postraumatic Stress Disorder: Meeting Veterans Where They Are,’’ JAMA, 306(5): (August 3, 2011) 548. 

Act of 2012, and is very pleased to offer our views on its important provisions to 

improve and enhance VA behavioral health programs. 

This Committee’s painstaking and patient conduct of a series of hearings regarding the performance of VA’s mental health care system has made clear that—despite 

the dedicated efforts of its mental health clinicians—the Department of Veterans Affairs (VA) is not meeting its fundamental obligation of providing timely, effective 

mental health care to veterans of Operations Enduring Freedom, Iraqi Freedom and 

New Dawn (OEF/OIF/OND) who are struggling with combat-related mental health 

conditions. 

We applaud the Committee’s oversight work and welcome VA’s recent plan to increase its mental health staffing. While an important initiative, it is only a partial, 

and still-untested step, in the context of addressing wide-spread challenges. 

For years, VA has reported to Congress on the health care utilization of OEF/OIF/ 

OND veterans. These data indicate that a relatively high percentage of these veterans have accessed VA medical facilities, and a significant percentage have been 

‘‘seen’’ and diagnosed (or provisionally diagnosed) with a mental disorder. But these 

often updated and somewhat misleading reports are silent as to whether, for example, veterans have continued in treatment or reported improved. In that regard, one 

of the leading researchers on the mental health toll of the conflicts in Iraq and Afghanistan, Dr. Charles W. Hoge, has provided a more disturbing snapshot, underscoring real gaps in the VA mental health system: 

‘‘* * * veterans remain reluctant to seek VA care, with half of those in 

need not utilizing mental health services. Among veterans who begin PTSD 

treatment with psychotherapy or medication, a high percentage drop 

out * * * With only 50 percent of veterans seeking care and a 40 percent 

recovery rate, current strategies will effectively reach no more than 20 percent of all veterans needing PTSD treatment.’’ 1

The Committee’s oversight has most effectively identified, documented, and 

sparked VA action on some of the most glaring problems of timeliness and access. 

But VA’s responses—initially denying staffing problems, and subsequently hurriedly 

reversing course—create the impression of reactionary work with little substantive 

strategic planning. VA does not provide confidence that effective systems are in 

place or will be put in place to assure that wider gaps in the system will be closed 

or even that warriors will not re-experience in a year or two the kind of timeliness 

and access problems the Committee identified over the course of three hearings. We 

concur, therefore, that strong legislation is needed, and welcome the Committee’s 

consideration of Title II the bill which offers promise of markedly improving veterans’ access to needed treatment. WWP strongly supports those provisions. 

This legislation addresses important issues, while also implicitly recognizing the 

need for further and perhaps deeper analysis. Given the complexity of VA’s mental 

health system, the variability of veterans’ experience from facility to facility, the 

unreliability or absence of key data (as discussed in your most recent hearing on 

VA mental health), it is critical that VA seek a comprehensive independent, expert 

assessment to help assure that warriors will have reliable access to timely, effective 

mental health care across the system. We, therefore, applaud the inclusion in this 

measure of a requirement that VA contract with the National Academy of Sciences 

(NAS) to conduct a comprehensive assessment of VA mental health care (to include 

assessing barriers to care for OEF/OIF/OND veterans, the quality of care, and the 

range of services provided) and to provide VA specific detailed recommendations. 

NAS has served VA well in the past. We believe it can provide very helpful recommendations on overcoming barriers and improving access to timely, effective mental 

health care as well as on improving the effectiveness and efficiency of VA mental 

health services. Recommendations from a prestigious body (which under the bill 

would rely on a panel including members with VA expertise and experience) should 

provide a strong foundation for closing critical gaps that result in warriors never 

seeking needed treatment, dropping out of treatment prematurely, or simply not 

thriving despite getting some care. We also see real benefit in the bill’s requiring 

VA to consult with NAS in developing and implementing staffing guidelines and 

other measures to assess timeliness, patient-satisfaction, capacity and provision of 

evidence-based therapies. 

Importantly, warriors consistently express high satisfaction with the experience of 

getting help from Vet Centers. They cite relatively unique aspects of that experience, including the opportunity to work with clinicians who are themselves are often 

combat veterans and understand the warrior-experience; Vet Centers’ outreach-foVerDate Nov 24 2008 15:13 Feb 07, 2013 Jkt 000000 PO 00000 Frm 00152 Fmt 6601 Sfmt 6621 H:\112TH HEARINGS\76283.TXT PAULIN
149 

cused approach; and access to family services. As such, we appreciate the bill’s focus 

on Vet Center services and the organizational status, funding and planning for the 

Readjustment Counseling Service. We also applaud the bill’s clarifying that Vet 

Center staff can play an important outreach role and foster warriors’ readjustment 

by participating in recreational, rehabilitative programs such as WWP’s Project 

Odyssey. 

This bill is also important in recognizing that communities can play an important 

role in providing veterans access to needed mental health services and fostering 

their reintegration, and that VA can be an invaluable partner in such community 

efforts. We welcome the encouragement the bill provides VA to partner with community groups in support of those efforts, as well as the important direction that VA 

provide training in military culture and combat experience to clinicians who would 

be providing mental health services through such community initiatives. 

Finally, we applaud the bill’s requirement that every VA medical center provide 

for peer outreach and peer support services. With too many veterans either still reluctant to seek mental health care or dropping out of care, the importance of peeroutreach and peer-support cannot be overemphasized. 

We look forward to working with the Committee to advance these important provisions in furtherance of ensuring that warriors are able to get timely, effective 

mental health care. 

150 

TESTIMONY SUBMITTED BY SENATOR BARBARA BOXER OF CALIFORNIA

LETTER FROM AMVETS DEPARTMENT OF CALIFORNIA SERVICE FOUNDATION


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We are pleased that your Check the Box for Homeless Veterans Act will provide an 

alternate stream of funding for current and future homeless veterans programs to ensure that they 

are unaffected by the unpredictable congressional appropriations process. Specifically, S. 1806 

would give taxpayers the option to check a box on their annual tax return (or at any other time 

allowed under federal regulations) and to voluntarily donate any amount above $1.00 to a new 

Homeless Veterans Assistance Fund. The donations to the fund would be used to provide 

assistance to homeless veterans through the programs administered by the Departments of 

Veterans Affairs, Housing and Urban Development, and Labor. To ensure accountability, these 

three departments will describe how they used the funds from the Homeless Veterans Assistance 

Fund during the previous fiscal year and will propose future use of such funds for the upcoming 

fiscal year in the President's annual budget submission. 

We appreciate your decision to take the initiative in introducing this important legislation 

with your colleagues, Senators Begich and Merkley. Your introduction of this bill serves to 

reaffirm the strong support you have shown for California's veterans over the years. Our 

leadership and our members look forward to working with you to promote the Check the Box for 

Homeless Veterans Act and to encourage your colleagues in the Senate to advance it through the 

legislative process. 

Thank you for your strong support for reducing homelessness among our fellow veterans. 

Y0J:~ 

Jim Pidgeon 

President 

AMVETS Department of California Service Foundation 

• ~ 

1213 S. Dale Avenue, Anaheim, CA 92804 • Tel: 714. 761.5811. Fax: 714.761.5812 • ,~.:ii\)f .. ""G".ld.UiveL',U,'!'i 
152 

PREPARED STATEMENT OF BRIAN A. HAMPTON, MAJ. USAR (RET.), PRESIDENT, 

CENTER FOR AMERICAN HOMELESS VETERANS, INC. 


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LETTER FROM THE CALIFORNIA ASSOCIATION OF VETERAN SERVICE AGENCIES


627BxCAHV.eps

210 E. Rroad St., Suite 202 

Falls Church, V A 22046 

Letter of Support 

Telephone: (703) 237-8980 

Fax: (703) 237-8976 

14 November 2011 

Nationwide Veterans' Advocacy Group Cheers the 

Check the Box for Homeless Veterans Act of2011 

The Center for American Homeless Veterans gives its enthusiastic and unequivocal support to Senate Bill 

S.1806, also known as the Check the Box/or Homeless Veterans Act 0/2011. The simple addition of this 

checkbox to IRS tax forms will create a lIomeless Veterans Assistance Fund that will specifically target the necds 

of our homeless veterans and go a long way toward alleviating their sufferings. Furthermore, the revenue neutral 

nature of the bill will ensure that veterans are provided with better services without adding to the Federal deficit. 

On any given night, there are over 100,000 homeless American veterans on our streets. An additional 1.5 

million are considered to be at risk of homeless ness. With tens of thousands of troops returning from combat 

zones in Iraq and Afghanistan, this number is only set to grow. 

Our veterans remain at high risk for homelessness for many of the same reasons as those who did not serve. 

However, several additional factors contribute to veteran homelessness. Many of Ollr veterans return from 

overseas to find that their jobs have been taken and that the military skills they developed do not transfer to the 

civilian workplace. Worse yet, employers often refuse to hire members of the National Guard and Anny Reserve 

on the grounds that they may be deployed overseas. Finally, the physical and psychological burdens of serving in 

combat zones have left many veterans unable to successfully transition to civilian life and unable to work. 

The flagship enterprise launched in 1993, the Center for American Homeless Veterans has since held 200 

forums/receptions and rallies nationwide featuring more than 100 leading members of Congress and over 30 top 

members ofthe U.S. Department of Defense to highlight the plight of our veterans. Along the way, the Center has 

highlighted dozens of transitional facilities that are at the forefront of a nationwide effort to provide better 

services to American veterans. The Center continues to work with leaders on Capitol Hill to ensure that our 

veterans are a top national priority and that their needs are met! 

The Center for American Homeless Veterans cannot emphasize enough its support for the Check the Box/or 

flomeless Veterans Act 0/2011. Check the Box will allow taxpayers to give back to the men and women who 

fought to defend the freedoms we Americans enjoy and will provide our veterans with additional services at no 

additional cost to the government. fl· cerey, 

i /~ YB an A, Ha':pton 

MA.J USAR (ret.) 

President 

Center for American Homeless Veterans 

www.americanhomelessvcts.org 
154 

LETTER FROM THE NATIONAL COALITION FOR HOMELESS VETERANS


627BxNCHV.eps

Nov. 11,2011 

The Honorable Barbara Boxer 

United States Senate 

112 Hart Senate Office Building 

Washington, DC 20510 

Dear Senator Boxer: 

-® 

~ 

The National Coalition for Homeless Veterans (NCHV) would like to fonnally indicate its 

support for S. 1806, the "Check the Box for Homeless Veterans Act of 2011." This bill would 

serve a critical function in the homeless veterans assistance community, which is ramping up to 

end veteran homclessness by 2015. 

Limited federal funds for homeless veterans assistance are often concentrated in heavily 

populated areas. A significant number of community- and faith-based service organizations that 

already serve veterans - particularly those outside of metropolitan areas - arc at a disadvantage 

when competing for federal funds. Yet the veterans served by these organizations require the 

same help to reintegrate into society. 

The Homeless Veterans Assistance Fund created through this act could be authorized to support 

several high-demand activities, such as: 

Short-term housing stability for homeless, extreme low-income veterans 

Child care assistance for single veterans in employment assistance programs 

Transportation assistance to medical and employment services 

Security deposits and utility hook-up fees for housing placements 

Clothing, uniforms and tools for employment 

The simple act of checking a box would enable taxpayers to prevent and end homelessness for 

those who have served this country in a way increasingly few Americans ever will. By 

supplementing proven federal programs, the "Check the Box for Homeless Veterans Act of 20 11" 

will have a strong and lasting impact in communities nationwide. 

Thank you for your commitment to serving our veterans in crisis. We are proud to stand as your 

ally. 

Sincerely, 

John Driscoll 

President & CEO 

Mission: The National Coalition for Homeless Veterans 11'il! end homelessness among veterans 

by shaping public po/fey, promoting collaboration, and building the capacity qlservice provider,s. 
155 

LETTER FROM MICHAEL BLECKER, EXECUTIVE DIRECTOR, SWORDS TO PLOWSHARES


627BxSWORDS.eps

~ Plowshares 

Boomi of Oll8ClOrs 

Advisory Boarc 

JUlle fl, 2012 

The Honorable Barbara Boxer 

United States Senate 

112 Hart Senate Office Building 

Washington, D.C. 20510 

RE: Support for 5.1806 

Swords to Plowshares is writing in support of 5,1806; Check the Box for 

Homeless Veterans Act of 2011, introduced by Senator Barbara Boxer. Swords 

to Plowshares has provided permanent/supportive housing, 

employment/training, and supportive services for homeless veterans since 

1974. Historically, veterans are disproportionately represented among the 

homeless population throughout the country. California is certainly no 

exception - veterans account for 11% of the states population, however nearly 

one out of three Californians suffering from homeless ness has served in the 

military. 

If enacted, the Check the Box for Homeless Veterans Act of 2011, will establish in 

the U,S. Treasury the Homeless Veterans Assistance Fund. Taxpayers will have 

the opportunity to voluntarily contribute to the fund by "checking the box" on 

their annual tax return. The donations collected in the Treasury will be used to 

supplement Congressional appropriations directed to the Department of 

Veterans Affairs, Department of Housing and Urban Development, and 

Department of Labor initiatives with the goal of eliminating veteran 

homeless ness in communities throughout the country. 

Not only is 5.1806 a simple yet effective way to raise funds to combat the 

epidemic of homelessness among veterans, but it also provides an opportunity 

for all Americans to show their support and appreciation for our troops who 

have sacrificed so dearly in service to our great nation. 

I thank you for your leadership in support of America's military veterans with 

the introduction of 5.1806, and J contribute our efforts to ensure its passage. 

Sincerely, 

Michael Blecker 

Executive Director 

Swords to Plowshares 

\\\\\\ 
156 

LETTER FROM RAYMOND C. KELLEY, DIRECTOR, 

NATIONAL LEGISLATIVE SERVICE, VFW 


627BxVFW.eps
157 

TESTIMONY SUBMITTED BY SENATOR DEAN HELLER OF NEVADA

LETTER FROM FANG A. WONG, NATIONAL COMMANDER, THE AMERICAN LEGION


627HeLEG.eps
158 

LETTER FROM MATT GORNICK, POLICY ASSISTANT DIRECTOR, 

NATIONAL COALITION FOR HOMELESS VETERANS

Æ 


627HeNCHV.eps