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PENDING HEALTH CARE AND BENEFITS 

LEGISLATION 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED FOURTEENTH CONGRESS 

FIRST SESSION 

OCTOBER 6, 2015 

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 

JOHNNY ISAKSON, Georgia, Chairman 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

DEAN HELLER, Nevada 

BILL CASSIDY, Louisiana 

MIKE ROUNDS, South Dakota 

THOM TILLIS, North Carolina 

DAN SULLIVAN, Alaska 

RICHARD BLUMENTHAL, Connecticut, Ranking 

Member 

PATTY MURRAY, Washington 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JON TESTER, Montana 

MAZIE K. HIRONO, Hawaii 

JOE MANCHIN III, West Virginia 

TOM BOWMAN, Staff Director 

JOHN KRUSE, Democratic Staff Director 

(III) 

C O N T E N T S 

OCTOBER 6, 2015 

SENATORS 

Page 

Isakson, Hon. Johnny, Chairman, U.S. Senator from Georgia ............................ 1 

Blumenthal, Hon. Richard, Ranking Member, U.S. Senator from Connecticut ... 1 

Rounds, Hon. Mike, U.S. Senator from South Dakota ......................................... 20 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 22 

Boozman, Hon. John, U.S. Senator from Arkansas .............................................. 24 

Moran, Hon. Jerry, U.S. Senator from Kansas ..................................................... 25 

Tillis, Hon. Thom, U.S. Senator from North Carolina .......................................... 27 

Sullivan, Hon. Dan, U.S. Senator from Alaska ..................................................... 27 

WITNESSES 

Feinstein, Hon. Dianne, U.S. Senator from California ......................................... 2 

Letters for the record are included in the Appendix ..................................... 81 

Donnelly, Hon. Joe, U.S. Senator from Indiana .................................................... 3 

Shaheen, Hon. Jeanne, U.S. Senator from New Hampshire ................................ 5 

Lynch, Thomas, M.D., Assistant Deputy Under Secretary for Health Clinical 

Operations, Veterans Health Administration, U.S. Department of Veterans 

Affairs; accompanied by Vincent Kane, Special Assistant to the Secretary; 

and Jennifer Gray, Staff Attorney, Office of General Counsel ......................... 7 

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

Additional views ............................................................................................... 12 

Response to posthearing questions submitted by Hon. Richard 

Blumenthal .................................................................................................... 19 

Augustine, Lauren, Legislative Associate, Iraq and Afghanistan Veterans of 

America ................................................................................................................. 30 

Prepared statement .......................................................................................... 32 

Celli, Louis, Jr., Director, National Veterans Affairs and Rehabilitation Division, The American Legion .................................................................................. 34 

Prepared statement .......................................................................................... 36 

Harig-Blaine, Elisha, Principal Housing Associate, (Veterans and Special 

Needs), National League of Cities ...................................................................... 39 

Prepared statement .......................................................................................... 41 

Appendix A–C ............................................................................................ 44 

Norris, David B., National Legislative Vice-Chairman, Department of California, Veterans of Foreign Wars of the United States .................................... 48 

Prepared statement .......................................................................................... 49 

APPENDIX 

Hagel, Hon. Lawrence B., Chief Judge, U.S. Court of Appeals for Veterans 

Claims; prepared statement ................................................................................ 57 

Kirch, Darrell G., M.D., President and Chief Executive Officer, The Association of American Medical Colleges (AAMC); letter ........................................... 58 

Atizado, Adrian M., Deputy National Legislative Director, Disabled American 

Veterans (DAV); prepared statement ................................................................. 60 

Scott, Gregory C., President & CEO, New Directions for Veterans; letter ......... 64 

Rauber, Diane Boyd, Esq., Director of Legislative and Regulatory Affairs, 

National Organization of Veterans’ Advocates, Inc. (NOVA); prepared statement ...................................................................................................................... 67 

Stichman, Barton F., Joint Executive Director, National Veterans Legal Services Program (NVLSP); prepared statement ...................................................... 68 

Page

IV 

Paralyzed Veterans of America (PVA); prepared statement ................................ 70 

Morosky, Aleks, Deputy Director, National Legislative Service, Veterans of 

Foreign Wars of the United States (VFW); prepared statement ...................... 72 

Lieu, Rep. Ted W., U.S. Member of Congress from California; letter ................. 75 

Peck, Stephen, MWS, President & CEO, United States Veterans Initiative 

(U.S.VETS); letter ................................................................................................ 77 

Ward, Orlando, Executive Director of Public Affairs, Volunteers of America— 

Greater Los Angeles; letter ................................................................................. 79 

LETTERS SUBMITTED BY SENATOR DIANE FEINSTEIN

Blumenfield, Bob, Councilmember, Third District, City of Los Angeles; letter . 81 

Cragg, Jim, Director, Green Vets LA; letter .......................................................... 82 

Napolitano, Janet, President, University of California; letter ............................. 83 

Toebben, Gary, President & CEO, Los Angeles Area Chamber of Commerce; 

letter ...................................................................................................................... 85

Koretz, Paul, Councilmember, Fifth District, City of Los Angeles; letter ........... 86 

Bonin, Mike, Councilmember, Eleventh District, City of Los Angeles; letter .... 87 

Garcetti, Eric, Mayor, City of Los Angeles; letter ................................................. 88 

Roman, Nan, President and CEO, The National Alliance to End Homelessness; letter ............................................................................................................ 89 

Block, Gene D., Chancellor, University of California, Los Angeles (UCLA); 

prepared statement .............................................................................................. 90 

Gideon, Melanie, MHSA, Director, UCLA Health—Operation Mend, Executive 

Advisor, UCLA Health Sound Body Sound Mind; letter .................................. 91 

Allen, Ben, Senator, 26th District, California State Senate; letter ..................... 93 

Blecker, Michael, Executive Director, Swords to Plowshares; letter ................... 94 

Guest, Joseph ‘‘Nick’’, Adjutant/Quartermaster, Veterans of Foreign Wars, 

Department of California; letter ......................................................................... 95 

Members of the Board of Supervisors, County of Los Angeles; letter ................. 96 

(1) 

PENDING HEALTH CARE AND BENEFITS 

LEGISLATION 

TUESDAY, OCTOBER 6, 2015 

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

The Committee met, pursuant to notice, at 2:30 p.m., in room 

418, Russell Senate Office Building, Hon. Johnny Isakson, Chairman of the Committee, presiding. 

Present: Senators Isakson, Moran, Boozman, Heller, Rounds, 

Tillis, Sullivan, Blumenthal, Brown, and Tester. 

OPENING STATEMENT OF HON. JOHNNY ISAKSON, 

CHAIRMAN, U.S. SENATOR FROM GEORGIA 

Chairman ISAKSON. I call this Senate Committee to order. I 

would like to give a little pre-announcement. In the interest of everybody on the panel, all three distinguished Senators, as well as 

our audience and our Committee, as soon as we have eight members present, we are going to go into executive session so we can 

act on the nomination of Michael Michaud. So, if you do not mind, 

I will interrupt you for a brief time once we get to eight—if we get 

to eight—during your testimony. 

We are pleased today to have three Members of the Senate to 

discuss legislation that they have proposed to the Senate. We also 

have two distinguished panels who will comment on their legislation as well as other legislation. We are delighted that you are 

here, and as I said, we are going to use this meeting also for a 

markup whenever we get to a quorum of eight, with at least one 

minority member part of the eight. We will have our vote on Mike 

Michaud and send that on to the floor. I appreciate the Ranking 

Member’s and all the members’ cooperation in moving as quickly 

as we can on Mike because it is important that we get his nomination sent to the entire Senate. 

The bills we have today are about: our land use in West Los Angeles, our veterans’ benefits in terms of mental health, access to 

mental health, and many other provisions that are important to 

our veterans. I look forward to the testimony of all our Senators. 

I look forward to the testimony of our Committee Members. 

I will now recognize Senator Blumenthal for any remarks he has. 

STATEMENT OF HON. RICHARD BLUMENTHAL, 

RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT 

Senator BLUMENTHAL. In the interest of our colleagues’ time, I 

just want to thank you for being here. These measures that you 

2 

have proposed are very worthwhile, and we look forward to your 

testimony. 

Thank you. 

Chairman ISAKSON. Each member will get 5 minutes. It is the 

Committee’s tradition not to ask questions, so as soon as you have 

made your testimony, if you would like to be excused, you are welcome to. 

Senator Feinstein, we are delighted to have you. You will be 

first. 

STATEMENT OF HON. DIANNE FEINSTEIN, 

U.S. SENATOR FROM CALIFORNIA 

Senator FEINSTEIN. Thank you very much, Mr. Chairman, Ranking Member Blumenthal, and Members on both sides of the aisle. 

I am going to speak today on the Los Angeles Homeless Veterans 

Leasing Act, a bill I introduced with Senator Boxer. I would like 

to thank David Norris from the California chapter of the Veterans 

of Foreign Wars for traveling to Washington to testify in support 

of our proposal. 

This bill would allow a facility, which is a very large facility— 

it is 388 acres on Wilshire and San Vicente. On the north side of 

Wilshire is a veterans’ cemetery, and on the south side of Wilshire 

is a very large complex, including a hospital, several buildings, a 

UCLA baseball diamond, and many other things. It is rundown. It 

needs help. 

Now, the majority of veterans, the largest number of veterans in 

America, actually live in Los Angeles. There are 300,000 of them, 

and more than 4,000 have no place to go. They are, in fact, homeless. Ten percent of the veterans in this country live in Southern 

California. Simply put, we need to get things right at the West L.A. 

VA. 

I would like to briefly recap the history. Every VA facility in the 

country has the leasing authority provided in my bill except for the 

West L.A. VA. In 2007, Congress took that authority away after it 

became clear that leases were being granted to commercial entities 

that were not serving veterans. This included everything from a 

movie lot to a laundry facility. The problem led to a 2011 lawsuit, 

which was settled earlier this year. 

Now, thanks to the leadership of VA Secretary Bob McDonald, 

we are back on the right track. Since he has taken over, we have 

spoken many times about the issues L.A. veterans face. He has put 

an excellent new team together. I met with them in Los Angeles 

last month and was thoroughly briefed. 

I believe we now have a path forward to make sure the campus 

fulfills its obligation to serve the veterans, and here is why: this 

land is a grant from a former Senator by the name of Jones and 

the Bandini family in 1888. The grant said it has to be used exclusively for veterans. So, at a certain time, facilities were rented out 

like a Fox studio back lot to: UCLA for a baseball stadium; a laundry; and a rental car business. Well, that is not for veterans. 

This enhanced lease would enable the VA to partner with and 

thereby access about $600 million of the State of California’s 

money, which has been specifically earmarked for veterans, on that 

facility. At present, that cannot be done. 

3 

So, it is an essential tool to implement the new Master Plan, and 

it will allow the Department to build housing more quickly and 

more affordably than it would be able to through the traditional VA 

construction process. 

I also want to thank this Committee. You authorized funds for 

the first building for homeless vets. They now have 55 units. We 

have $35 million for the second building, and the thrust here is to 

allow nonprofits to come in for the specific purpose of building veterans housing. 

So, I am hopeful that—let me just point a couple of things out. 

New leases must be consistent with the Master Plan. The Office of 

Inspector General will regularly report on any new leases and landuse agreements. If the VA is not in compliance, new leases will be 

prohibited. The VA must submit a report to Congress 45 days before entering into any new lease agreement. 

I truly believe—and I have worked on this for 10 years now— 

that this plan will help turn the page and ensure that we are doing 

everything we possibly can for veterans in Los Angeles going 

forward. 

Mr. Chairman, I would like to insert letters of support from local 

officials, homeless advocacies, and veterans groups into the hearing 

record. 

Chairman ISAKSON. Without objection. 

Senator FEINSTEIN. Thank you very much for this courtesy. 

[The letters are found in the Appendix.] 

Chairman ISAKSON. Well, thank you, Senator Feinstein. 

I want the Committee to know that Senator Feinstein has 

worked with me diligently to try to bring this to a conclusion. Today’s testimony is very helpful in that. The VA, I understand, will 

have the Master Plan completed by October 22. We intend to move 

forward as quickly and expeditiously as possible. We appreciate 

your input. 

For the benefit of the other Members, we are going to go into an 

executive session for just 2 minutes, if you do not mind, so if everybody will stay put. 

[Whereupon, at 2:37 p.m., the Committee proceeded to other 

business and reconvened at 2:38 p.m.] 

Chairman ISAKSON. Thank you for your patience. 

Next we will hear from Senator Donnelly. Welcome to the 

Committee. 

STATEMENT OF HON. JOE DONNELLY, 

U.S. SENATOR FROM INDIANA 

Senator DONNELLY. Thank you, Mr. Chairman. 

Chairman Isakson, Ranking Member Blumenthal, and Members 

of the Committee, thank you for holding this hearing today. I appreciate the opportunity to speak briefly with you about my legislation, S. 717, the Community Provider Readiness Recognition Act. 

Mr. Chairman, as you know, the suicide rate among our military 

servicemembers and veterans is not just a tragedy; it is a crisis. 

Last year, we lost 443 servicemembers to suicide. Last week, the 

Department of Defense reported we have seen more than 200 military suicides in the first half of this year. We are all painfully 

4 

aware of the statistic that 22 veterans every day take their own 

lives. 

In Indiana, we have lost too many Hoosier veterans to this 

scourge. I am sure each Member of this Committee can say the 

same about your homestate. 

Despite the time and effort we, DOD, and VA have put into combating military and veteran suicide, these numbers and the stories 

of each of these preventable deaths tell us how much more work 

we have to do. 

The key challenge we must overcome is tackling this problem 

with a clear-eyed understanding of how stigma, provider shortages, 

and budget constraints impact when and how veterans and servicemembers seek care. 

I have worked over the past 3 years to advance common-sense 

bipartisan legislation to meet that challenge. We took an important 

step forward last year with the Jacob Sexton Military Suicide Prevention Act, which was part of the National Defense Authorization 

last year. 

This year, I am working with several Republican colleagues to 

advance the Servicemember and Veteran Mental Health Care 

Package; three bills aimed at improving the accessibility and quality of mental health care for vets, servicemembers, and their 

families. 

I am here today to talk about one of those care package bills that 

is on the agenda, S. 717. I have been working with my colleague 

Senator Ernst whose experience and insight as a veteran and as 

an officer in the Iowa Army National Guard has been indispensable. This bill creates a special designation for private sector community mental health providers who demonstrate a strong knowledge of military culture and evidence-based therapies for mental 

health issues common to veterans and servicemembers. It creates 

a regularly updated online registry so vets and servicemembers can 

search for these special providers. 

Due to an increasing demand for mental health services, combined with DOD and VA provider shortages, use of community providers by servicemembers and veterans has increased dramatically. 

If we know veterans and servicemembers are accessing care 

through private community providers, we owe it to them to do our 

best to improve the quality of care they receive in those settings 

and to provide resources to help them select providers who understand their unique challenges and how best to treat them. 

That is the goal of S. 717. Multiple, internal, and independent 

reviews of DOD and VA purchase care networks have identified the 

need to improve military cultural competency, the use of DOD/VA 

clinical practice guidelines, and evidence-based therapies to enhance the quality of care servicemembers and vets receive from 

community providers. 

I have a few examples with me here today: DOD’s 2010 Suicide 

Prevention Task Force report; the Institute of Medicine’s 2014 Assessment of PTSD Treatment for Military and Veteran Populations; 

and RAND’s 2014 report entitled ‘‘Ready to Serve.’’ 

We know more and more veterans each year are going to be 

seeking care from non-VA providers. We need to be sure as many 

of those providers as possible are trained to provide high-quality 

5 

care, and we need to give vets tools to help them make decisions 

on where to seek care, whether or not they are using their VA benefits. Both DOD and VA are working to push out trainings in military culture and evidence-based therapies for providers. But it will 

come as no surprise to hear the uptake rates on those trainings 

needs to improve. We need to give providers better incentives to 

participate. Many of the trainings are already free. Many already 

grant continuing medical education credit. 

We could require the training. We could tell providers they cannot be in DOD and VA purchase care networks unless they complete it. But imposing those kinds of mandatory requirements can 

backfire. At a time when our vets and servicemembers desperately 

need more options, S. 717 gives providers an incentive to voluntarily access military and veteran-specific training and receive a 

military/veteran-friendly designation if they fulfill the 

requirements. 

The Star Program, which was begun in Indiana, has now expanded to seven States, including the homestates of a number of 

Members of this Committee. Mr. Chairman, as you know, Georgia 

is one of those States, and it is an extraordinary program. 

The DOD provisions of this legislation were included in the fiscal 

year 2016 NDAA conference report under section 717, with unanimous bipartisan support. 

Can I have an additional 30 seconds? [Chairman nods.] 

Senator DONNELLY. Thank you, sir. 

Assuming we keep intact our 53-year record of passing the 

NDAA, this legislation will become law by year’s end, but only for 

military personnel and their families, not for veterans. The NDAA 

deals only with this program as it would impact DOD, servicemembers, and military families. It does not address veterans or the Department of Veterans Affairs. That is why I am here today asking 

to work with all of you to ensure the services established through 

this legislation are available not only to current military personnel 

but also the veterans that we care so much for. 

Mr. Chairman, thank you for your time. 

Chairman ISAKSON. Thank you, Senator Donnelly. I appreciate 

your testimony. 

Senator Shaheen? 

STATEMENT OF HON. JEANNE SHAHEEN, 

U.S. SENATOR FROM NEW HAMPSHIRE 

Senator SHAHEEN. Thank you, Mr. Chairman, Ranking Member 

Blumenthal, and all of the Members of the Committee, for holding 

this hearing today and for giving me the opportunity to speak in 

support of my legislation to expand the number of judges on the 

U.S. Court of Appeals for Veterans Claims. 

As every Member of this Committee knows full well, one of the 

most complex challenges facing this Committee and Congress over 

the next several years will be the growing backlog of veterans disability claim appeals. Veterans denied benefits by the VA continue 

to face a complicated, frustrating, and unacceptably prolonged process to receive additional consideration of their disability claims. 

The growth in the number of claims awaiting appeal over the 

past several years is staggering. As you, the Board of Veteran ApVerDate Mar 15 2010 13:40 May 02, 2016 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 Z:\ACTIVE\100615.TXT PAULIN
6 

peals is the highest appellate level within the VA. Over the past 

4 years, the number of disability claims appeals received by the 

Board has increased 65 percent, from 49,611 in 2012 to 81,640 in 

2016. The Board is now receiving almost twice as many claims per 

year as it has the capacity to decide. In 2014, it began the year 

with 65,000 unresolved cases. Over the course of the year, it received an additional 56,600 cases. 

As a result of this growing workload, the average number of days 

to resolve a case increased from 289 to 335 between 2014 and 2015, 

and I have personally spoken with veterans in New Hampshire 

who have waited 3, 5, even one 9 years to resolve a claim. 

As a matter of basic fairness to our Nation’s veterans, we have 

got to do better. We have to take a serious look at every level of 

the appeals process. The bill I am here to talk about this afternoon 

is very simple. It would reauthorize the Court of Appeals for Veterans Claims to employ nine judges instead of seven. Since 2002, 

Congress has granted temporary authorizations for the Court to increase to nine judges. Before that, it was authorized at seven. That 

authority ended in 2013, and as a result, the Court has been reduced to eight active judges. It will return to seven if we do not 

act soon. 

The Court noted in its 2014 annual report that, ‘‘Given the anticipated increase in the number of decisions to be rendered by the 

Board, we perceive a need to reauthorize nine judges. As we see 

unprecedented and unrelenting growth in the backlog of appeals, 

now is not the time to reduce our capacity to pre-2002 levels.’’ 

I urge the Committee to support this simple measure which will 

provide some immediate help to relieve the crisis. I look forward 

to answering any questions or further discussion about how we 

streamline the appeals process in the future. 

Thank you very much, Mr. Chairman. 

Chairman ISAKSON. Thank you, Senator Shaheen. 

Senator Donnelly, thank you very much for your testimony. We 

appreciate your being here for the meeting. Thank you. 

We will go into our Committee hearing now. 

Senator DONNELLY. Thank you, Mr. Chair. 

Chairman ISAKSON. We have two distinguished panels. The first 

panel is Thomas Lynch, M.D., Assistant Deputy Under Secretary 

for Health Clinical Operations, Veterans Health Administration, 

U.S. Department of Veterans Affairs; accompanied by Vince Kane, 

Special Assistant to the Secretary; and Jennifer Gray, Staff Attorney, Office of the General Counsel, U.S. Department of Veterans 

Affairs. 

If our first panel would come forward? [Pause.] 

We welcome all of you to the Committee today. Dr. Lynch, you 

will be the one to testify. Is that correct? 

Dr. LYNCH. I am, sir. 

Chairman ISAKSON. Welcome; you have the floor. 

7 

STATEMENT OF THOMAS LYNCH, M.D., ASSISTANT DEPUTY 

UNDER SECRETARY FOR HEALTH CLINICAL OPERATIONS, 

VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF 

VETERANS AFFAIRS; ACCOMPANIED BY VINCENT KANE, SPECIAL ASSISTANT TO THE SECRETARY; AND JENNIFER GRAY, 

STAFF ATTORNEY, OFFICE OF GENERAL COUNSEL 

Dr. LYNCH. Thank you. Good afternoon, Mr. Chairman, Ranking 

Member, and Members of the Committee. Thank you for the invitation to present our views on several bills that would affect VA benefits, programs, and services. Seated beside me to my right is Vincent Kane and to my left is Jennifer Gray. 

I would like to begin by thanking Senator Feinstein for introducing S. 2013, the Los Angeles Homeless Veterans Leasing Act of 

2015, and for the support from other congressional members, including Senator Barbara Boxer and Congressman Ted Lieu. 

The bill would authorize VA to enter into enhanced use leases 

and other agreements for housing and services benefiting veterans 

and their families. VA firmly supports this bill as it will enhance 

our current efforts to revitalize the campus and help end veteran 

homelessness in greater Los Angeles. This legislation will help us 

in three ways: 

First, it will allow VA to enter into agreements with housing providers, local governments, community partners, and nonprofits to 

provide housing and services for those veterans and their families 

that are homeless or at risk for homelessness. 

Second, it will allow VA to revitalize the campus into a rich and 

vibrant community that puts the needs of veterans first in a manner consistent with VA’s ongoing efforts to complete a new Master 

Plan for the campus. 

And, third, it will ensure the campus honors the underlying deed 

that transferred the property to the Federal Government in 1888 

to be a safe, welcoming, and healing environment for veterans. 

We appreciate the Committee’s support for this needed legislation and look forward to working closely with each of you and other 

veteran stakeholders on its passage and implementation. 

VA also supports S. 2022, which would increase pensions for 

Medal of Honor recipients. VA recognizes the extraordinary bravery 

and unparalleled service that our Medal of Honor recipients have 

provided on behalf of our Nation. An increase in their pension is 

an important step in demonstrating our commitment and our 

gratitude. 

VA supports Sections 2, 6, and 7 of S. 1885, the Veteran Housing 

Stability Act of 2015, a bill that seeks to improve the benefits and 

services we provide to homeless veterans and their families. VA 

does not have cleared views on Sections 5 and 8 yet; however, we 

will be working with the Committee to provide views and costs at 

a later date. 

There are several other provisions of the bill that we believe are 

not needed or may benefit from some further discussion with the 

Committee. These have been highlighted in our written statement. 

S. 717, the Community Provider Readiness Recognition Act of 

2015, would establish a special designation through DOD and VA 

for non-Department mental health care providers who demonstrate 

a strong knowledge of military culture and evidence-based medical 

8 

treatments. The VA does not support the provisions of this bill. A 

few years ago, DOD and VA did recognize the need to ensure that 

our non-Department clinicians were equipped with the necessary 

education and training to properly care for and treat our Nation’s 

veterans. Through joint collaboration and investment of resources 

between DOD and VA, we created a military cultural competence 

course and community provider toolkit which accomplished the intent of this bill. 

In addition, this bill would also require VA to create a registry 

of non-Department providers. While we acknowledge this would be 

helpful in identifying those providers that possess military training 

and evidence-based treatment experience, we have concerns about 

the way such a certification would be developed and maintained 

given all the facets associated with judging the quality of a 

provider. 

With respect to S. 1754, the Veterans Court of Appeals Support 

Act of 2015, VA would defer to the Veterans Court on whether this 

bill should be enacted as it would primarily affect the Court and 

not VA operations. 

Last, S. 1676, the Delivering Opportunities for Care and Services 

for Veterans Act of 2015, addresses many important issues related 

to medical education and training as well as recruitment and retention of VA leadership. We do not currently have prepared views, 

but are eager to engage and work with the Committee to provide 

this at a later date. 

Mr. Chairman, thank you for the opportunity to provide VA’s 

views on several important bills before the Committee today. My 

colleagues and I would be pleased to answer any questions that you 

or other Members of the Committee may have at this time. 

[The prepared statement of Dr. Lynch follows:] 

PREPARED STATEMENT OF THOMAS LYNCH, M.D., ASSISTANT DEPUTY UNDER SECRETARY FOR HEALTH CLINICAL OPERATIONS, VETERANS HEALTH ADMINISTRATION, 

U.S. DEPARTMENT OF VETERANS AFFAIRS

Good afternoon Chairman Isakson, Ranking Member Blumenthal, and Members 

of the Committee. Thank you for inviting us here today to present our views on several bills that would affect VA benefits programs and services. Joining me today are 

Vince Kane, Special Assistant to the Secretary and Jennifer Gray, Staff Attorney 

in VA’s Office of General Counsel. 

We do not have cleared views on sections 5 and 8 of S. 1885. We also do not have 

cleared views on S. 1676, a bill to increase the number of graduate medical education positions treating veterans, to improve the compensation of health care providers, medical directors, and directors of Veterans Integrated Service Networks, 

and for other purposes. We will be glad to work with the Committee on prioritization of those views and cost estimates not included in our statement. 

S. 717—COMMUNITY PROVIDER READINESS RECOGNITION ACT OF 2015

VA does not support S. 717, which would require the Department of Defense 

(DOD) and VA to jointly develop a system to provide a mental health provider readiness designation to non-Department mental health care providers who demonstrate 

knowledge of military culture and of evidence-based medical treatments approved 

by DOD and VA for treating the mental health issues of members of the Armed 

Forces and Veterans. This bill would also require DOD and VA to jointly establish 

and update a public registry with this information. 

Requiring VA and DOD to give the mental health provider readiness designation 

to non-Department providers would confuse Veterans and Servicemembers; they 

might think that VA has certified or endorsed the providers’ competence and ability 

to provide quality care, which could lead Veterans to assume a level of specialized 

competence that may not be warranted. Moreover, VA and DOD would be required 

9 

to put providers on the list based only on their knowledge of military culture and 

medical treatments without consideration for other factors that Veterans and Servicemembers should be aware of before choosing a provider of mental health care. 

These factors may include Veteran and Servicemember preferences for provider 

type, location, and provider acceptance of VA or Third Party Administration payment as paid in full, or a host of many other factors that may create potential barriers or incentives to care. 

VA has invested in the development of multiple resources to assist non-Department mental health care providers who may work with Servicemembers and Veterans. Two key resources are the DOD/VA Military Cultural Competence course and 

VA’s Community Provider Toolkit. However, VA does not use these resources to 

evaluate or certify outside providers’ competence or skills. For providers who complete the DOD/VA Military Cultural Competence course, which is currently open to 

the community, awarding free continuing education units if the learner scores 80% 

on the post-test. However, there is no process in place to determine if the knowledge 

transfers reliably and consistently or if it leads to a demonstrable behavior change 

or improved competence in clinical care. Assessment of providers’ knowledge also 

would require significant additional resources. 

VA understands the appeal of such a registry and agrees that the availability of 

information about providers with evidence of training in military culture and knowledge of evidence-based treatment of mental health conditions would make it more 

likely that beneficiaries could identify more knowledgeable providers. However, VA’s 

ability to create and maintain such a registry would be constrained by the limitations described above. A registry of this sort would be difficult to manage, qualifications would be difficult to assess beyond course completion, and maintaining accuracy would be very challenging. 

The Veterans Health Administration extensively explored this idea in collaboration with DOD as part of the Integrated Mental Health Strategy. Specifically, a 

workgroup explored the possibility of VA/DOD ‘‘certifying’’ rural community mental 

health clinicians who VA and DOD believed were adequately trained. The 

workgroup ultimately concluded that the legal, credentialing, and privacy challenges 

would be too difficult. The workgroup suggested a self-report registry as opposed to 

VA and/or DOD developing a certification process. 

We estimate that implementation of this provision would cost around $1.7 million 

in FY 2016, $5.9 million over 5 years and $10.4 million over ten years. 

S. 1754—VETERANS COURT OF APPEALS SUPPORT ACT OF 2015

S. 1754 would amend section 7253(a) of title 38, United States Code, by permanently increasing the maximum number of judges presiding over the United States 

Court of Appeals for Veterans Claims (Veterans Court) from seven to nine. Because 

the bill would primarily affect the Veterans Court and would not affect the operation of VA, we defer to the Veterans Court as to whether S. 1754 should be 

enacted. 

S. 1885—VETERAN HOUSING STABILITY ACT OF 2015

Section 2 of S. 1885 would expand the definition of ‘‘homeless Veteran’’ to include 

those Veterans fleeing domestic violence and interpersonal violence (DV/IPV), aligning VA’s definition with that of the Department of Housing and Urban Development 

(HUD). VA supports section 2. Since Veterans fleeing from DV/IPV are considered 

at high risk for homelessness, they are already served in VA’s homeless programs 

when it is clinically appropriate. 

Section 3 would require VA to create a new program to provide intensive case 

management interventions to homeless Veterans in at least six locations selected by 

VA based on criteria which is described in the bill. VA would also be required to 

prepare a report for Congress on the outcomes of the program. VA does not believe 

section 3 is necessary, as VA is already authorized to provide intensive case management through the HUD-VASH program. HUD-VASH is similarly already authorized to provide flexible team-based care management and thus does not require the 

proposed program to provide such services. 

Section 4 would require VA to award grants for the provision of case management 

services for Veterans who are transitioning to permanent housing and those who are 

at risk for homelessness. This would help address a current gap in case management service delivery. The Homeless Providers Grant and Per Diem (GPD) program, 

for example, lacks the authority to provide funding for case management services 

once a Veteran exits a GPD-funded transitional housing program. However, such 

services may be currently provided by grantees in VA’s Supportive Services for Veteran Families (SSVF) program. 

10 

Section 4 would also require the Secretary to prioritize for grant funding those 

organizations that would voluntarily stop receiving per diem payments under the 

GPD program (38 U.S.C. Section 2012) or Special Need awards (38 U.S.C. Section 

2061), and be willing to use their transitional housing facility for permanent housing. VA supports this section of the bill. Currently there are nearly 9,000 transitional housing beds developed through VA investment of capital in partnership with 

community organizations. As the number of homeless Veterans decreases, the need 

for some of this transitional housing will diminish, but there will be a continued 

need for permanent housing interventions like rapid re-housing and permanent supportive housing. This grant funding could enable VA to help fill this need for permanent housing interventions, consistent with the VA’s Housing First approach to assisting homeless Veterans. 

VA supports section 6, which would require VA and HUD to collaboratively provide outreach to public housing authorities, tribally designated housing entities, realtors, landlords, property management companies, developers, and other relevant 

audiences to educate them about the housing needs of Veterans and encourage them 

to rent to Veterans. VA and HUD currently collaborate on such efforts. 

VA supports section 7, which would codify the role of the VA National Center on 

Homelessness Among Veterans as a center of research, evaluation, and dissemination of best practices regarding services for homeless Veterans. 

S. 2013—LOS ANGELES HOMELESS VETERANS LEASING ACT OF 2015

S. 2013 would authorize the Secretary of Veterans Affairs to enter into EnhancedUse Leases and other agreements for housing and services at VA’s West Los Angeles Campus in Los Angeles, California. The leases would principally benefit Veterans and their families, including severely disabled, aging, and women Veterans. 

VA strongly supports this legislation. It would enable VA to enter into agreements 

with housing providers, local governments, community partners, and non-profits to 

provide additional housing and services for homeless and disadvantaged Veterans. 

Such leases would be squarely Veteran focused, as the benefits resulting from them 

would be designed to principally benefit Veterans and their families. The legislation 

would also enable VA to work with state entities such as the University of California, Los Angeles, to obtain improved services for Veterans, over and above the 

range of benefits generated from the current VA-UCLA medical affiliation arrangement. This effort is in line with VA’s goal to foster and improve its medical affiliations nationwide, to help ensure that sufficient quality and quantity of doctors, 

nurses, and research are available, to help ensure that Veterans will receive improved care and services well into the 21st Century and beyond. 

The legislation is important to VA’s goal of revitalizing the campus into a rich and 

vibrant community, which Veterans will be proud to call home. It would dovetail 

with existing law contained in Section 224 of Public Law 110–161, and the Consolidated Appropriations Act of 2008, to prohibit VA from selling or disposing of any 

land interests in the West Los Angeles Campus, to third parties. Additionally, the 

legislation contains several significant protections, to ensure fulfillment of the bill’s 

objectives. The protections including the following: 

• All leases must be consistent with the new Master Plan under development, 

with community input, that will detail how the campus will be used to benefit all 

Veterans; 

• Office of Inspector General (OIG) audit reports on lease and land-use management of the West Los Angeles Campus will be required to be issued two years following enactment of this legislation, five years following enactment, and then as 

necessary; 

• VA will be prohibited from entering into new leases during any periods where 

it is found by the OIG to be out of compliance with Federal policy or law pertaining 

to leases and land-use on the campus, until the Department certifies it has corrected 

any non-compliance or mismanagement; and 

• VA will be required to notify the Senate and House Veterans’ Affairs Committees and the congressional delegation for the area encompassing the campus 45 days 

before entering into or renewing any lease, and submit an annual report evaluating 

all leases and land-sharing agreements on the campus. 

These restrictions will help to ensure the campus is Veteran focused going forward, in a manner consistent with the underlying 1888 deed of the property to the 

United States. 

Along with supporting this legislation, VA is working intensely to positively revitalize the West Los Angeles Campus, to make it more Veteran focused. Such efforts 

include pursuing a new master plan for the campus; providing additional funding 

to VA’s homeless-related programs; and working with several entities in the Greater 

11 

Los Angeles area, to help end Veteran homelessness in Greater Los Angeles. Such 

entities include the California congressional delegation; the former plaintiffs in the 

West Los Angeles litigation (Valentini v. McDonald) that was settled in January 2015; Veterans Service Organizations; Veterans; State and local authorities; 

non-profit entities; VA contractors; the local community; and charitable organizations. Through such efforts and hopeful enactment of this proposed legislation, VA 

is confident that all homeless Veterans of Greater Los Angeles will be able to obtain 

housing and wrap around supportive services, so that they can have restored dignity 

and improve their lives and well-being. 

The ongoing Master Planning process takes into account VA’s clear priority to prospectively operate the campus as a vibrant, welcoming, and sustainable community 

where all Veterans—including homeless, severely disabled, women, and elderly Veterans—will feel comfortable accessing care, living, and interacting with one another, 

their families, VA personnel, and visitors. 

Since March of this year, almost 1,400 Los Angeles area Veterans have been 

placed into permanent housing through the implementation of housing first principles. Housing first is the proven method where homeless Veterans are placed into 

housing with the needed supportive services to keep them in housing and more effectively help them reintegrate into their community. On average, almost 275 Veterans per month are being placed into housing, largely through VA outreach, coordination efforts, and funding commitments. VA has also increased resources to expand 

capacity to care for homeless and at-risk of homelessness Veterans. Specifically, in 

2015 an additional $30 million was provided for Supportive Services for Veteran 

Families homeless prevention, and rapid rehousing programs. Approximately 800 

HUD-VASH vouchers were awarded for Greater Los Angeles. This increased the 

total vouchers in Greater Los Angeles to nearly 6,000. An additional 325 new beds 

have also been added at the West Los Angeles Campus, for bridge or emergency 

housing for Veterans in need. 

Despite these enhancements, there is more to do to care for our Veterans. The 

legislation will address gaps in services and facilitate the revitalization of the 388 

acre campus to better serve Veterans. It will also ensure we care for disadvantaged 

Veteran populations to ensure they have needed healthcare and housing. 

VA estimates that S. 2013 will be cost-neutral because it provides for outleases 

of certain properties on the VA West Los Angeles Campus, without additional cost 

to VA. The bill does not create an obligation by VA to fund the housing or services 

contemplated by Section 2(b). There is also no obligation for VA to use future appropriations to fund capital or other costs related to the outleases authorized by this 

section. 

S. 2022—SPECIAL PENSION OF MEDAL OF HONOR RECIPIENTS

S. 2022 would amend section 1562(a) of title 38, United States Code, by increasing 

the monthly rate for the Medal of Honor Pension to $3,000. VA administers the 

Medal of Honor Pension, a special pension benefit that is not based on income level, 

need, or disability, to recipients of the Medal of Honor. For reference, the monthly 

Medal of Honor Pension rate established pursuant to 38 U.S.C. § 1562 is currently 

$1,299.61. 

The bill would be effective either (1) 180 days after the date of enactment, or (2) 

if the date 180 days after the date of enactment does not fall on the first day of 

a month, the first day of the first month beginning after the date that is 180 days 

after the date of enactment. If the increased rate for the Medal of Honor Pension 

is effective prior to December 1, 2016, the monthly rate would not be increased by 

a cost of living adjustment (COLA) for FY 2017. Annual COLA increases would resume beginning on December 1, 2017. 

VA supports S. 2022, subject to Congress identifying acceptable offsets for the additional benefit costs. This legislation would be consistent with Congress’ original 

intent for the Medal of Honor Pension, which was to serve as a ‘‘recognition of superior claims on the gratitude of the country’’ and to ‘‘reward * * * in a modest way 

startling deeds of individual daring and audacious heroism in the face of mortal 

danger when war is on.’’ 

VA estimates that benefit costs to the appropriation for compensation and pension 

would be $788,000 in FY 2016, $7.2 million over five years, and $16.1 million over 

ten years. 

12 

ADDITIONAL VA VIEWS

THE SECRETARY OF VETERANS AFFAIRS, 

Washington, DC, December 8, 2015. 

Hon. JOHNNY ISAKSON, 

Chairman, 

Committee on Veterans’ Affairs, 

U.S. Senate, Washington, DC. 

DEAR MR. CHAIRMAN: By this letter, we are providing the remaining views and 

cost estimates for the following bills from the Committee’s October 6, 2015, legislative hearing: S. 1676 and sections 5 and 8 of S. 1885. 

We appreciate this opportunity to comment on this legislation and look forward 

to working with you and the other Committee Members on these important legislative issues. 

Sincerely, 

ROBERT A. MCDONALD. 

Enclosure. 

S. 1676—DELIVERING OPPORTUNITIES FOR CARE AND SERVICES FOR VETERANS

ACT OF 2015

Section 101 of S. 1676 would amend the Social Security Act to direct the Secretary of Health and Human Services to not take into account any resident within 

the field of allopathic or osteopathic medicine who counts towards the obligation of 

the Secretary of Veterans Affairs under section 301 (b)(2) of the Veterans Access, 

Choice, and Accountability Act of 2014 (Public Law 113–146; 38 United States Code 

(U.S.C.) 7302 note) (VACAA) when applying the limitations regarding the total 

number of full-time equivalent residents in a hospital’s approved medical residency 

training program. The Secretary would disregard such residents for cost reporting 

periods beginning on or after July 1, 2016. 

VA appreciates this effort to increase V A’s ability to expand graduate medical 

education (GME), including expanding into underserved communities by allowing 

other community partners to assist in GME development. Since VA does not sponsor 

its own physician residency programs, it relies on its academic affiliates to select 

and sponsor residents who then receive a portion (typically around a quarter of their 

time) of their clinical training in a VA facility. This arrangement can help ensure 

that residents receive a well-rounded educational experience. The current cap on 

residency positions funded by the Centers for Medicare & Medicaid Services (CMS) 

limits the ability of potential partners to sponsor new VACAA residency positions 

in collaboration with VA. 

This provision, however, would have a budget impact on CMS and VA that could 

be significant, which makes support for this provision contingent on the availability 

of resources for both CMS and VA for its implementation. Still, however, VA believes that a partnership with CMS on the VA GME Expansion could assist with 

addressing known inequities in physician workforce, including the increasing specialization of physicians and the geographic maldistribution. VA’s GME Expansion 

specifically targets Primary Care and Mental Health, and focuses on GME development in smaller and rural communities. A partnership with CMS on this initiative 

could create significant and beneficial change in the physician workforce for the nation. 

Section 102 would amend section 301 (b) of the VACAA to extend from 5 years 

to 10 years the time period provided for the Secretary of Veterans Affairs to increase the number of GME residency positions to 1,500; and extend by 5 years the 

time period during which the Secretary must file annual reports to Congress on 

residency positions at VA medical facilities. VA supports section 102. This legislation would provide additional time for VA to build the infrastructure needed to successfully create the required new residency positions. VA estimates that enactment 

of section 102 would be cost neutral. 

Section 103(a) would require the Secretary of Veterans Affairs and the Secretary 

of Health and Human Services to jointly conduct a 6-year pilot program to establish 

not less than three GME residency programs in behavioral medicine in underserved 

areas in the United States. Section 103(b) would require each residency program to 

provide participating residents the opportunity to work with diverse patient populations through rotations between medical facilities of VA, the Indian Health Service, and facilities participating under the Medicare program; provide education in 

the field of behavioral medicine; be carried out in a manner consistent with other 

13 

residency programs supported and funded by VA and the Department of Health and 

Human Services; and be located in a community that is designated as a medically 

under-served area under 42 U.S.C. 254b(b)(3)(A), in a state with a per capita population of Veterans of more than 9 percent according to the National Center for Veterans Analysis and Statistics and the United States Census Bureau, and be within 

100 miles of a Reservation as defined in 25 U.S.C. 1452. 

Section 103(c) would require the Secretary of Veterans Affairs and Secretary of 

Human Health and Services to provide to Congress at least annually a joint report 

containing certain specified elements regarding implementation of the pilot program. 

VA appreciates the goals behind section 103 but does not support these provisions. 

The extremely narrow criteria for the location of the three pilot sites would make 

the pilot program difficult to implement. For example, large states such as California and New York would be disqualified from consideration because of the per 

capita Veteran population requirement. Also, the requirement that each pilot site 

be located within 100 miles of a reservation would exclude many VA facilities from 

participation. In addition, the extremely limited residency training opportunities 

within the Indian Health Service would create a challenge when seeking to provide 

residents rotations through the Indian Health Service. Finally, the requirement for 

detailed annual joint reports from the Secretary of Veterans Affairs and the Secretary of Health and Human Services would be unduly burdensome given the relatively small portion of the GME workload these pilot sites would represent. VA estimates that the reporting requirement in section 103(c) would cost $260,000 annually and $1.56 million over the course of the pilot program. 

Section 104(a) would require the Secretary of Veterans Affairs to include in the 

education and training program required under section 7302(a)(1) of title 38 U.S.C., 

education and training of marriage and family therapists (MFT) and licensed professional mental health counselors (LPMHC). VA supports the goal behind section 

104(a) but does not believe that section 104(a) is necessary as VA is presently providing this training and will continue to do so. 

Section 104(b) would require the Secretary to apportion funding equally among 

the professions included in the education and training program. VA does not support section 104 and has a technical concern. It is unclear to which professions the 

requirement for equal apportionment of funding would apply. If the intent is to require equal funding among all professions, VA does not support such a requirement. 

Presently, trainee funding is allocated in accordance with future hiring needs and 

capacity to support training programs at VA facilities. If the intent is to provide 

equal funding for LPMHC and MFT training programs, this would be problematic 

as well. VA has attempted to provide equal funding for these two professions. Nonetheless, internships are conducted in partnership with academic affiliate programs 

and under principles ensuring a quality educational experience and in the context 

of state licensing laws governing the credentials of supervisors. We have been able 

to rapidly expand LPMHC internships, but for the MFT internships, the supervisory 

requirements do not allow equally rapid expansion. A legislative requirement for 

equal funding might actually result in curtailing training for one profession, so that 

training for one profession does not exceed funding for another. 

Section 105 would amend section 7402(b)(11)(A) of title 38 to expand eligibility for 

appointment within VA as a LPMHC to specifically include persons who hold a doctoral degree. VA supports section 105. VA estimates that there would be no cost associated with implementation of section 105. 

Section 201 would amend section 7451(a)(2) of title 38 to include physician assistants as ‘‘covered positions’’ to which the competitive pay provisions of that section 

apply. Presently, only registered nurses and certain positions as the Secretary may 

determine upon recommendation of the Under Secretary for Health are covered positions under section 7451. 

While VA supports the intent of Section 201, VA’s support is conditioned on Congress providing the additional funding necessary to support these costs. VA also believes that the following health care professionals should also be added as ‘‘covered 

positions’’ to this section of the law to apply these same competitive pay provisions 

to physical therapists, occupational therapists, physical therapy assistants, and occupational therapy assistants. 

Recruitment and retention of physical and occupational therapy professionals has 

been a longstanding challenge for VA. A major recruitment and retention barrier 

for these disciplines is the significant pay disparity between private sector market 

pay and VA pay schedules for these therapies. Although special pay rate authority 

exists at the local medical center level to address these disparities, such authority 

is not consistently utilized and is ineffective in many cases because special salary 

rates are below the full performance level salary. 

14 

VA estimates that the cost of enactment of section 201 for PAs would be $33.2 

million in FY 2016, $129 million over 5 years, and $241 million over 10 years. In 

addition, VA estimates that expansion of the cost of applying the competitive pay 

provisions of section 7511 to physical therapists, occupational therapists, physical 

therapy assistants, and occupational therapy assistants would be $42.8 million in 

FY 2016, $220 million over 5 years, and $458 million over 10 years. 

Section 202 would amend section 7681 of title 38 to require that not less than 

30 percent of the amount of debt reduction payments paid under the Education Debt 

Reduction Program (EDRP) each year be paid to individuals who practice medicine 

in a rural area or highly rural area or demonstrate a commitment to practice medicine in such an area. Section 202 would define ‘‘highly rural area’’ to mean an area 

located in a county or similar community that has less than seven individuals residing in that county or community per square mile, ‘‘rural area’’ to mean an area that 

is not an urbanized area or a highly rural area, and ‘‘urbanized area’’ to have the 

meaning given that term by the Director of the Bureau of the Census. VA does not 

support section 202. VA recognizes the intent of the legislation is to ensure use of 

EDRP for recruitment and retention in rural and highly rural areas. However, the 

proposed legislation would negatively impact the ability of local facilities to effectively use EDRP by restricting the flexibility that exists in the current process and 

seriously misaligning funding with respect to relative representation of clinical staff 

and vacancies. 

EDRP is designed for recruitment and retention of health care providers who are 

in difficult to recruit/retain health care positions and who are providing direct patient care services or services incident to direct patient care. Local facilities 

prioritize hard-to-recruit-and-retain occupations based on facility needs. Each VA 

medical facility receives EDRP funding allocation to recruit and retain health care 

providers. Many VA facilities, including both urban and rural facilities, are in fierce 

competition with the private sector. In fact, some of the hardest to recruit/retain facilities are in urban areas where the cost of living is extremely high and where VA 

has a harder time competing with the salaries offered by the private sector. 

Currently, the percentage of EDRP funding is on par with the percentage of rural 

and highly rural facilities and providers at those facilities. Rural and highly rural 

facilities make up 12.6 percent of VA facilities, and employ only 6 percent of VA’s 

clinical providers and support staff. In FY 2015, 11 percent of facilities receiving 

EDRP were rural or highly rural, and employees at those facilities received 8 percent of the total EDRP funds distributed, commensurate with their representation 

in the workforce. Furthermore, a review of current recruitment activity rates indicates that only 5.4 percent of clinical vacancies are in rural and highly rural 

facilities. 

Requiring 30 percent of all EDRP funding be awarded to rural facilities would create a significant disparity in overall program funding for other sites, preventing facilities with critical provider shortages from filling EDRP-eligible positions. Restricting usage of nearly one-third of all EDRP funding for rural areas would negatively 

impact the flexibility afforded to local facilities to determine their specific health 

care provider needs. Finally, past efforts to set aside EDRP funds for various hiring 

initiatives have indicated that funds set aside for special uses, such as this, are frequently under-used because the employees hired at those sites or for those positions 

simply do not have eligible student loan debt. It is imperative that flexibility not 

be restricted for use of these funds in a way that has unintended consequences, and 

potentially limits the use of the funding all together. VA estimates that there would 

be no cost associated with implementation of section 202. 

Section 203(a) would require the Secretary of Veterans Affairs to submit to Congress a report on the medical workforce of the Department not later than 120 days 

after the date of enactment of the Act. Section 203(b) would require the report to 

include specific elements. Specifically, section 203(b)(1) would require the report to 

include how many LPMHCs and MFTs are enrolled in the mental health professionals trainee program of the Department; how many are expected to enroll in the 

mental health professionals trainee program of the Department during the 180-day 

period beginning on the date of submittal of the report; a description of the eligibility criteria for such counselors and therapists compared to other behavioral 

health professions in the Department; a description of the objectives, goals, and timing of the Department regarding increasing the representation of such counselors 

and therapists in the behavioral health workforce of the Department; and a description of the actions taken by the Secretary, in consultation with the Director of the 

Office of Personnel Management (OPM), to create an occupational series for such 

counselors and therapists and a timeline for the creation of such an occupational 

series. 

15 

Section 203(b)(2) would require the report to include a specific breakdown of 

spending by the Department in connection with EDRP, as well as descriptions of 

how the Department prioritizes such spending and the actions taken by the Secretary to increase the effectiveness of such spending for the purposes of recruitment 

of health care providers. Section 203(b)(3) would require the report to include a description of any impediments to the delivery of telemedicine services to Veterans 

and any actions taken by the Department to address such impediments, including 

with respect to certain specified issues. 

Section 203(b)(4) would require the report to include an update on the efforts of 

the Secretary to offer training opportunities in telemedicine to medical residents in 

medical facilities of the Department that use telemedicine, consistent with medical 

residency program requirements established by the Accreditation Council for Graduate Medical Education, as required by the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012 (Public Law 112–154; 38 U.S.C. 7406 

note). Section 203(b)(5) would require the report to include an assessment of the development and implementation by the Secretary of succession planning policies to 

address the prevalence of vacancies in the Veterans Health Administration (VHA) 

of more than 180 days, including development of an enterprise position management 

system to more effectively identify, track, and resolve such vacancies. 

Section 203(b)(6) would require the report to include a description of the actions 

taken by the Secretary, in consultation with the Director of OPM, to address any 

impediments to the timely appointment and determination of qualifications for Directors of Veterans Integrated Service Networks (VISN) and Medical Directors of 

the Department. 

VA does not believe that the reporting requirements in section 203 are necessary 

and the actions and initiatives addressed by section 203 are already deployed or 

being pursued within VHA. VA estimates that the costs associated with enactment 

of section 203 would not be significant. 

Section 301 would amend section 7306(a)(4) of title 38 to add VISN Directors to 

the list of personnel who comprise the VA Office of the Under Secretary for Health 

and remove the requirement that Medical Directors be doctors of medicine, dental 

surgery, or dental medicine. 

Section 302 would amend chapter 74 of title 38 to add a new subchapter VII and 

section 7481 regarding compensation for Medical Directors and VISN Directors. Section 302 would establish the elements of pay for Directors appointed under section 

7306(a)(4) of title 38 to include basic pay as determined under section 7404(a) of 

title 38 and market pay as determined under the new section 7481. Section 302 

would require the Secretary to evaluate the amount of market pay payable to a Director not less frequently than once every 2 years and may adjust market pay as 

a result of such evaluation. Section 302 require the Secretary not less than once 

every 2 years to set forth a Department-wide total annual pay minimum and maximum which must be published in the Federal Register. Section 302 would prohibit 

the Secretary from delegating the authority to determine the Department-wide minimum and maximum total annual pay. 

VA supports sections 301 and 302, and the latter provision matches a proposal 

put forward in February 2015 in VA ’s Fiscal Year 2016 budget submission. VA believes that there are three primary factors that warrant a separate compensation 

system for Medical Directors and VISN Directors. First, existing pay compression 

within the current Senior Executive Service (SES) pay system and the closely proximate rates of pay for direct reports to Medical Center Directors and VISN Directors 

have resulted in declining Director applicant pools. Second, a high number of existing (an estimated 84 percent by FY 2018) Directors are or will soon be eligible for 

retirement. Third, private sector pay for health care leadership positions is highly 

competitive. 

In addition, there are limited pay incentives for experienced Medical Center Directors and VISN Directors to voluntarily move to fill more demanding positions. Due 

to the SES pay compression between experienced Medical Center Directors and 

VISN Directors, the small pay raise, if any, that VHA is able to offer in a reassignment may cause the candidate to be disadvantaged financially. The most significant 

cost disparities occur due to housing costs and in some cases, higher tax rates (e.g., 

New York, California). With current executive pay authorities, a move for the good 

of the organization most of the time means a move to the financial detriment of the 

Director and their family. On average, it has taken over 6 months to fill Medical 

Center Director and VISN Director positions, with many being re-announced multiple times for positions in both rural and major metropolitan areas. The reluctance 

on the part of these senior leaders to relocate is understandable. It is imperative 

that VHA have the ability to implement pay to retain eligible leaders, reward mobility, and ensure knowledge transfer to the next generation of Medical Center DirecVerDate Mar 15 2010 13:40 May 02, 2016 Jkt 000000 PO 00000 Frm 00019 Fmt 6633 Sfmt 6621 Z:\ACTIVE\100615.TXT PAULIN
16 

tors and VISN Directors. VA estimates that enactment of section 301 would involve 

no cost and that enactment of section 302 would cost $8.8 million in FY 2016, $46 

million over 5 years, and $93.2 million over 10 years. 

Section 401(a) would require the Secretary, not later than 1 year after the date 

of enactment of the Act, to conduct a 2-year pilot program to assess the feasibility 

and advisability of implementing in rural areas and highly rural areas with a large 

percentage of Veterans a nurse advice line to furnish to Veterans medical advice, 

appointment and cancellation services, and information on the availability of benefits from VA. 

Section 401(b) would require the pilot program to establish a nurse advice line 

that operates free of charge, is based on and improves upon the Department of Defense TRICARE advice line, complies with call center requirements set forth by 

URAC, uses a process for determinations of caller eligibility, allows for information 

sharing between VA and the nurse advise line, and maintains quality controls to 

ensure calls are answered by a customer service representative within 30 seconds 

with an abandonment rate of less than 5 percent. 

Section 401(c) would require the nurse advice line to provide an array of services 

including: medical advice from licensed registered nurses who assess the caller’s 

symptoms using a proprietary clinical algorithm meeting specified criteria, information to address basic questions regarding eligibility for VA benefits, and use of an 

appointment clerk to facilitate scheduling of appointments for health care from the 

Department. 

Section 401(d) would require, not later than 120 days after the date of completion 

of the pilot program, the Secretary to submit to Congress a report providing specified information regarding the pilot program. 

VA does not support section 401 as VA already provides telephone services for 

clinical care. Specifically, VHA Directive 2007–033, Telephone Service for Clinical 

Care, requires telephone services for clinical care to be made available to all Veterans receiving care at VHA facilities to include 24/7 telephone access to clinical 

staff trained to provide health care advice and information. Each facility is responsible for providing access for Veteran clinical concerns consistent with VHA Directive 2007–033. Veteran telephone access to clinical care during business hours is facility based, managed, and resourced. Veterans are able to call their local facility 

and speak with clinical staff to address and manage their concerns. VA staff members working with Veterans are responsible for following evidence-based guidance 

including during in-person and telephone contact. VA estimates that enactment of 

section 401 would cost $75 million in FY 2016, $385 million over 5 years, and $770 

million over 10 years. 

S. 1885—VETERANS HOUSING STABILITY ACT OF 2015

Section 5 of S. 1885 would amend section 2041 of title 38 U.S.C. to expand eligibility for the services provided under that section as well as the scope of services 

provided. Under section 2041, VA may enter into agreements to sell, lease, or donate real property acquired by the Secretary as a result of a default on a loan made, 

insured, or guaranteed by VA to qualified nonprofit organizations or state or local 

governments that agree to use the properties to shelter homeless Veterans and their 

families. Section 5 would permit such entities to continue assisting homeless Veterans and their families, as under current section 2041, but would also expand section 2041 to include Veterans and their families who are at risk of becoming homeless and very low-income Veteran families (as defined in section 2044(f) of title 38). 

Rather than limiting the entities’ assistance to shelter, as is currently the case, the 

entities would also be able to assist such Veterans and their families in acquiring 

and transitioning to permanent housing, and in maintaining occupancy in permanent housing. Section 5 would also require the entity to expand the range of services 

it provides to the Veterans that it houses by ensuring that such Veterans receive 

referrals for the benefits and services to which the Veterans may be entitled or eligible under title 38. 

VA does not object to section 5 but has a technical concern. Section 5(a)(2)(C) 

would amend subsection (a)(3)(B) of section 2041 to strike ‘‘solely as a shelter primarily for homeless Veterans and their families’’ and insert ‘‘to provide permanent 

or transitional housing for Veterans and families described in paragraph (1).’’ By 

striking ‘‘shelter,’’ section 5(a)(2)(C) would require the entity to agree to use the 

property in a manner more narrow than the overall purpose of the bill as expressed 

in section 5(a)(2)(A), which includes assisting eligible individuals ‘‘in acquiring shelter.’’ Therefore, VA recommends that line 2 of page 12 of the draft bill be revised 

to include ‘‘shelter or’’ before ‘‘permanent or transitional housing.’’ VA estimates 

that enactment of section 5 would result in new benefit loan subsidy costs of $16.6 

17 

million for FY 2016. The provision would expire at the end of 2016. VA estimates 

that enactment would not increase general operating expenses costs. 

Section 8 would amend section 2012 of title 38 to require VA to annually review 

each Homeless Provider Grant and Per Diem (GPD) program grant recipient and 

eligible entity that received a per diem payment and evaluate each grantee’s success 

in assisting Veterans to obtain, transition into, and retain permanent housing and 

increasing Veteran income through obtaining employment or income-related benefits. VA would only be able to continue providing per diem to the grantee if VA determines that the grantee’s performance merits continuation of the per diem. Section 8 would also require VA to establish uniform performance targets for all GPD 

grantees in order to conduct its review and evaluation. 

VA supports section 8 and has a minor technical concern. Currently, the GPD program has in place an annual inspection protocol which includes an evaluation of certain performance metrics established by VA. When grantees fail to meet the annual 

inspection requirements the GPD program begins corrective action process that can 

lead to stopping per diem if corrections are not implemented. VA believes the current annual inspections process could be changed to incorporate the criteria specified in, and new uniform performance targets required by, section 8. These changes 

would further help VA to tie continued per diem payment to grantee performance. 

VA’s minor technical concern relates to lines 5 and 6 of page 16 of the bill, which 

state that VA would evaluate performance with respect to success ‘‘in assisting Veterans obtain, transition into, and retain permanent housing.’’ VA recommends inserting the word ‘‘to’’ before the word ‘‘obtain.’’ VA estimates that the enactment of 

section 8 would be cost neutral. 

Chairman ISAKSON. Thank you, Dr. Lynch. 

Let me begin the questioning. When do you expect the Committee to receive the Master Plan for the West L.A. property? 

Dr. LYNCH. My understanding, Senator, is that it should be received by the Committee in mid-October. 

Chairman ISAKSON. October 22 is the date I have been hearing. 

Mr. KANE. Actually, the Master Plan is due—the draft Master 

Plan is due to the Secretary on October 15th. We expect to put it 

out to public comment shortly thereafter. Around the 21st we 

should be able to get something advanced to the Committee. 

Chairman ISAKSON. How long is the comment period? Sixty days? 

Mr. KANE. We are proposing—that is still being debated. The 

talk is between 30 and 60 days for a public comment period. 

Chairman ISAKSON. Does the Feinstein bill incorporate the baseball stadium for UCLA and the school? 

Mr. KANE. The Feinstein bill does not directly incorporate the 

UCLA stadium. It notes the importance of a partnership between 

the university and the VA, noting that that is our academic affiliate. But it is very clear that the focus of this is on housing for the 

veterans and services that directly benefit the veterans. 

The Secretary is working directly with all of us through the Master Plan and other legal issues to address the stadium. But the bill 

does not give any special provisions for the continuation of that 

stadium. 

Chairman ISAKSON. Well, is it not true that the stadium and the 

school are the two controversial portions of this property? 

Mr. KANE. They are two of the most controversial aspects of the 

property, but our intent is to make the entire property veteran-focused that puts the veteran first. 

Chairman ISAKSON. Well, pardon me for putting you on the hot 

seat, but I have to ask you this question. If you are going to submit 

by the 22nd of October a Master Plan, do you intend to deal with 

whether or not the VA is going to recommend the baseball stadium 

or the school or whether they are not? 

18 

Mr. KANE. So, the Master Plan really looks at how the campus 

can be revitalized to be a community. It will talk about how different zones on that campus, the 388 acres, can be best utilized. 

Decisions related to the continuation of the stadium get addressed 

through that zone process but, more importantly, are being addressed in separate discussions that look at what UCLA has submitted in the Master Plan as well as the ongoing discussions we 

have had with them about how they can provide services that really truly are veteran-focused and how that stadium can be 

repurposed to have a focus on veterans. 

It will not be directly addressed in the Master Plan, but it will 

be addressed as an outcome and a byproduct of our discussions and 

the master planning process. 

Chairman ISAKSON. When the property was conveyed to the VA 

by Mr. Jones in 1888, I believe—is that the correct date? 

Mr. KANE. Yes. 

Chairman ISAKSON. Was that by covenant on the deed, or was 

that by an agreement of some type? 

Mr. KANE. It was the deed. 

Chairman ISAKSON. It was on the deed? 

Mr. KANE. Yes. 

Chairman ISAKSON. So, the definition of benefiting veterans is a 

broad one, not a narrow one. 

Mr. KANE. Correct, although we have been very clear through 

our process, through the master planning, and through the activities that we have undertaken since the settlement back in January 

that the intent is to revitalize that campus as the home for our veterans and to make sure that the health care is state-of-the-art, 21st 

century, as well as that all the services that are on that campus 

are focused and prioritizing the veterans. 

Chairman ISAKSON. The reason I am spending so much time on 

questions on the West L.A. property is because I am one that believes there is potential revenue to the Government and to the VA 

on surplus property around the country the Veterans Administration owns, and this particular Master Plan may be a template for 

what we might do in the future for other properties that are vacant 

that could otherwise be leased to generate revenue for the VA or 

for the benefit of veterans. I think the Master Plan that you come 

up with and the ultimate comments that we receive to that Master 

Plan are going to be critically important in terms of what we do. 

Mr. KANE. We agree. We think that this Master Plan can be a 

template for creating what we want the new VA to be and to be 

focused on, which is 21st century health care, with the other services that really dignify and respect the men and women that serve 

this country. 

Chairman ISAKSON. Senator Blumenthal. 

Senator BLUMENTHAL. Thanks, Mr. Chairman. 

I think this hearing is very important because it deals with mental health, with equality of justice, and with homelessness. I appreciate all my colleagues’ efforts to address a number of the issues 

that veterans and their families face, ranging from those issues to 

the recruitment of VA health care professionals and housing 

instability. 

19 

There is a real and pressing need to move forward on many of 

these issues, and I want to offer my strong support for the bills 

mentioned by my colleagues, as well as for Senator Tester’s DOCS 

for Veterans Act, which is the next step in enhancing the VA’s 

medical workforce. In particular, it seeks to tackle the problem of 

vacancies at the network and facility director level across the VA, 

and, of course, my own measure which I have offered, the Veterans 

Housing Stability Act. I want to ask you, Dr. Lynch, I notice that 

there are some provisions that you do not support in this measure. 

Would you tell me why? 

Dr. LYNCH. There is one provision that VA does not support, 

which is Section 3, that would require VA to create a new program 

to provide intensive case management interventions for homeless 

veterans in at least six locations. VA feels that we already have a 

very strong program tied to HUD-VASH, but we feel, in addition 

to that, that there are other opportunities for outreach to veterans 

and homeless veterans at this time. 

The VA has an extensive network that has outreach to the street, 

under bridges, soup kitchens, prisons, and courts. There are gap 

analyses that are being done to assure there is a focus on cities, 

the veterans population, and their needs. 

Senator BLUMENTHAL. Do you feel the outreach already is 

sufficient? 

Dr. LYNCH. We do. 

Senator BLUMENTHAL. Well, I would respectfully disagree. I 

think that there is a need for more outreach to the homeless, from 

what I have seen at least in Connecticut. Although we are on the 

verge of purportedly ending front-line homelessness in Connecticut, 

there is a need for outreach every day that apparently is lacking 

or inadequate. So, I would just urge that perhaps you consider 

working with me on that issue. 

Let me ask you about the Veterans Court, increasing the number 

of judges in the Board of Appeals. I understand you do not run the 

Veterans Court of Appeals, but wouldn’t you agree that the backlog 

and the increase in caseload warrant this step? 

Dr. LYNCH. The case sounds compelling. I just feel on behalf of 

VA we are not in a position to decide for the Court. I certainly acknowledge there is backlog, and there could be value in additional 

judges. 

Senator BLUMENTHAL. Perhaps you could consult with others at 

the VA and come back to us; submit in writing a further position 

on this issue. I think it is within the purview of your responsibility 

to make sure that disability claims for the benefit of veterans are 

processed as expeditiously as possible. 

Dr. LYNCH. Yes, sir. We will do that. 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. RICHARD

BLUMENTHAL TO DR. THOMAS LYNCH, ASSISTANT DEPUTY UNDER SECRETARY FOR

HEALTH CLINICAL OPERATIONS, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

VA of course would not substitute its judgment for that of the Court of Appeals 

for Veterans Claims (CAVC) regarding their needs. However, VA does share with 

them the common goal of reducing the appeals backlog and securing final disposition of appeals faster. In addition, the requested additional resources for the Board 

of Veterans’ Appeals (the Board) in the FY 2017 budget will almost certainly lead 

to a proportional increase in the Court’s workload as there has been a relatively staVerDate Mar 15 2010 13:40 May 02, 2016 Jkt 000000 PO 00000 Frm 00023 Fmt 6633 Sfmt 6621 Z:\ACTIVE\100615.TXT PAULIN
20 

ble relationship between the Board’s output and appeals to the CAVC. We note in 

CAVC’s testimony for the record for this hearing they expressed support for S. 1754, 

including making permanent the increase in the number of judges from seven to 

nine. We deferred to the CAVC’s views in our written statement, but believe it is 

safe to say we join in that judgment. 

Senator BLUMENTHAL. Finally, let me ask you about the Delivering Opportunities for Care and Services for Veterans Act of 2015, 

which has been sponsored by Senator Tester and others. I gather— 

maybe you could restate your position on this bill. 

Dr. LYNCH. VA has not developed formal positions, but I think 

I can safely say, looking particularly at Sections 101 and 102, 

which deal with residency slots, the use of provisions of VACA regulations, that we feel strongly that these would be a positive aspect 

to allow us to develop more residency programs in VA, to have the 

potential to recruit residents from those programs to provide care 

for veterans. 

I think also looking at Section 300, which deals with additional 

provisions that put network directors and medical center directors 

under Title 38 and allow us to be more competitive as we recruit 

in localities and address complexity challenges that are facing a 

number of our locations, these are all going to be very positive actions that will help us, I think, be competitive in the health care 

market today. 

Senator BLUMENTHAL. Well, I am going to join as a cosponsor of 

this measure. I think it is absolutely vital, and I want to thank 

Senator Tester for his leadership. Thank you. 

Thanks, Mr. Chairman. 

Chairman ISAKSON. Thank you, Senator Blumenthal. 

Senator Rounds, followed by Senator Tester. 

HON. MIKE ROUNDS, U.S. SENATOR FROM SOUTH DAKOTA 

Senator ROUNDS. Thank you, Mr. Chairman. I just wanted to follow up also on Senator Tester’s proposed legislation, S. 1676. It 

would appear that it does a lot to help deliver health care long 

term to the rural parts of the country, and I am just curious. Originally, you indicated that you did not have a position, and yet you 

just gave some reasons why you would support it. 

I would like to go a little bit more in-depth on it. Would you 

share with us the reasons why you were not interested in supporting it? 

Dr. LYNCH. We are not in a position to say we are not supporting 

this bill. We just have not developed our views yet in a formal fashion at this point. But, looking at the provisions and sections of the 

bill, I see that there are opportunities particularly for rural health. 

If you look back at the VACA legislation, it identified residency 

positions that would be focused in rural and highly rural areas. 

Over the last year, we were actually able to get 400 requests for 

residency positions; 204 of those met the VACA requirements; 163 

of those positions have been filled, and we expect to fill the rest the 

coming academic year. 

I think the value of this bill moving forward is to begin to work 

with smaller medical centers apart from our major academic medical centers and osteopathic schools. It is going to require time to 

develop those residencies, probably a couple of years to develop the 

residency, another couple of years to get it accredited, and then 

21 

probably 3 years to fill the residency. So, there is an advantage to 

extending the provisions of the VACA legislation from 5 years to 

10 years. 

Senator ROUNDS. It sounds like a bureaucratic mess to me. 

Let me just go on and try another one: S. 717, which is the Donnelly-Ernst proposal. You indicated it was not OK with the VA, and 

this is the one that would designate certain non-Department mental health care providers who treat members of the Armed Forces 

and veterans as providers who have particular knowledge relating 

to the provisions of mental health care to members of the Armed 

Forces and veterans and for other purposes. 

I am just curious. It looks like a lot of our veterans leaving DOD, 

stepping in, and now coming under of the care of the VA, I suspect 

that if they could go directly to a VA facility and receive the care, 

they probably would look at that. And yet what we are looking at 

with this particular proposal is for those individuals who could not 

access the VA facility, you have indicated that you have got some 

other alternatives out there that would be comparable to this particular one. 

It looks to me like if it is working right now, we would not have 

the requests for the bill. Are you thinking that right now the ability to provide for those services is already there within the framework that you have laid out versus the alternative that has been 

proposed by this legislation? 

Dr. LYNCH. VA’s position is that we feel there is a need to educate the community, and we think we have vehicles out there to 

provide that education. VA is also embarking on another provision 

of the Defense Authorization Act that requested that VA begin to 

reach out to the community providers and engage them in providing mental health services. 

Our real concern is that we do not feel that we can adequately 

develop a program that certifies or recognizes somebody because, 

while they have taken the training, it is very difficult to determine 

the competency for people who do not work for us, and also to determine long range whether they maintain that competency. 

Senator ROUNDS. You know, a lot of the folks that work for you 

right now, good, hardworking individuals that provide good professional services, they do not start out with a program in which you 

have trained them to begin with. They come from outside in the civilian world. You provide them with training courses right now 

that make them better at what they do. They get experiences working with veterans today. It seems to me that the same type of approach would be comparable in these other non-VA-employed 

facilities. 

I would hope that you might reconsider the position just in terms 

of being able to provide services in those parts of the country that 

do not have access to the VA expertise that we do in some of our 

larger communities. 

Dr. LYNCH. Yes, sir. 

Senator ROUNDS. Thank you. 

Thank you, Mr. Chairman. 

Chairman ISAKSON. Senator Tester. 

22 

HON. JON TESTER, U.S. SENATOR FROM MONTANA 

Senator TESTER. Thank you, Mr. Chairman and Ranking Member, for including S. 1676 on today’s agenda, and I appreciate your 

support, Senator Blumenthal, on this bill. You know, this legislation, simply put, was really to address the chronic shortage of VA 

medical professionals and really allow you to better compete for the 

skilled staffing that you need over the next many years as VA continues to get pressure for services. 

Just as background, it incorporates a number of great ideas from 

folks, veterans, and medical communities. It has been endorsed by 

17 organizations representing everyone from medical colleges to 

mental health counselors to physician assistants to disabled vets, 

and I want to particularly thank the American Association of Medical Colleges and the American Legion for their early engagement 

and support of this bill. 

In July, this Committee unanimously reported out four provisions of this legislation, and I am hopeful we can advance the remaining provisions. In particular, I want to highlight a section that 

you have highlighted, Dr. Lynch, Section 101 regarding medical 

residencies, which I believe are the surest way to get a pipeline of 

docs into rural America and into the areas where we need them to 

address our veterans’ needs. 

Congress included a critical provision in the Choice Act to increase the number of residents training—and you are familiar with 

this, Dr. Lynch. 

Dr. LYNCH. Yes, sir. 

Senator TESTER [continuing]. At VA facilities by over 1,500 over 

the next 5 years. But, to date, it is my understanding that the VA 

has only been able to fill about 163 of those positions. Is that 

correct? 

Dr. LYNCH. Yes, Senator. 

Senator TESTER. OK. After speaking with a number of folks in 

the VA, it is clear that filling all 1,500 authorized residency positions, as Congress intended, simply cannot happen. Is that a fair 

statement? 

Dr. LYNCH. That is a fair statement. 

Senator TESTER. Is that because the VA no longer runs its own 

stand-alone residency program and must partner with non-VA affiliates to establish—— 

Dr. LYNCH. In most cases, to my knowledge, we need to partner 

with academic affiliates or community hospitals, yes. 

Senator TESTER. The problem with that is that even though VA 

is willing, non-VA affiliates are hamstrung by the current cap on 

Medicare-funded residencies. Is that correct? 

Dr. LYNCH. Yes. 

Senator TESTER. OK. That cap was established in 1997, for the 

Committee’s information. It is woefully insufficient to meet the 

needs that are out there, and that is why the Section 101 of this 

bill would establish those 1,500 residency positions that were authorized by the Choice Act. Subsequently, Centers for Medicare and 

Medicaid Services would be allowed to make Medicare direct graduate medical education and direct medical education payments for 

Choice students who are in the teaching caps. I just think this is 

critically important if we are going to be able to address the medVerDate Mar 15 2010 13:40 May 02, 2016 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6601 Z:\ACTIVE\100615.TXT PAULIN
23 

ical needs we have on the ground. I think it applies not only to 

rural but also urban VA centers. It absolutely has benefits to rural 

America, make no mistake about it, and they are big ones. It would 

lead to more VA and non-VA affiliate partnerships and more doctors ultimately joining the VA workforce. 

Dr. Lynch, does the DOCS for Veterans Act give the VA the flexibility and the tools it needs to really fill those residency positions? 

Dr. LYNCH. I think it gives us the extended timeframe to work 

with organizations to develop residencies, particularly in rural 

areas with osteopathic facilities, that we may not have had relationships with before that will allow us to have outreach into rural 

and highly rural areas. 

Senator TESTER. Do you see this as a strategy that would work 

to help fill the doctors that you need? 

Dr. LYNCH. I think this is a good strategy, Senator. 

Senator TESTER. OK. I want to talk about the other section you 

talked about, Section 300. Very quickly, it has to do with filling positions, making sure folks are held accountable in leadership positions because I think leadership does matter, whether veterans integrated service network (VISN) directors or whether they are medical directors of medical facilities. 

Do you believe a major hindrance to filling these positions has 

been the VA’s inability to compete within the health care industry—— 

Dr. LYNCH. Yes, sir. 

Senator TESTER [continuing]. For executive leaders in the private 

sector? 

Dr. LYNCH. Yes. 

Senator TESTER. Do you think the gap is wide? 

Dr. LYNCH. Yes, I do. 

Senator TESTER. Can you give me an indication of what that gap 

might be on average? 

Dr. LYNCH. I do not have any average numbers, but I can tell 

you that the salary paid in the private sector is significantly greater than what we are paying our VA medical center directors and 

network directors. 

Senator TESTER. OK. What kind of vacancies do you have now, 

focusing on just the medical directors? 

Dr. LYNCH. Medical center directors I think is in the range of 25 

to 30 percent. 

Senator TESTER. OK. So, 25 to 30 percent less salary or 25 to 30 

percent of those medical facilities do not have directors? 

Dr. LYNCH. Do not have directors. 

Senator TESTER. That is what I thought. You guys know this is 

like having a hospital with no CEO, which is a huge, huge problem. 

I would hope that we could kick out both Sections 101 and 300 out 

of this Committee and would love to have your help getting that 

done as we move forward. I appreciate all of you for being on the 

panel. Thank you for your hard work. 

Dr. LYNCH. Thank you. 

Chairman ISAKSON. I want to underscore what Senator Tester 

has said. There are far too many vacancies, far too many acting directors, and far too many people who do not have permanent responsibility at the VA. I have talked about that before, and I apVerDate Mar 15 2010 13:40 May 02, 2016 Jkt 000000 PO 00000 Frm 00027 Fmt 6633 Sfmt 6601 Z:\ACTIVE\100615.TXT PAULIN
24 

preciate that you brought it up. Just an editorial comment to pass 

on to Secretary McDonald. 

Dr. LYNCH. Yes, sir. 

Chairman ISAKSON. Senator Boozman. 

HON. JOHN BOOZMAN, U.S. SENATOR FROM ARKANSAS 

Senator BOOZMAN. I would second that editorial comment; it is 

just something that we simply have to fix. It is common sense, and 

it is good business practices. Yet, I know it is difficult in the situation you are in. 

Dr. Lynch, in your testimony you noted that you are supportive 

of Senator Graham’s legislation, S. 2022, and the idea of that, I 

think in your testimony and that we all understand, was to provide 

our Medal of Honor winners with a small pension as they go 

forward. 

One of the real values of these are individuals that have done 

such heroic things and I have had the opportunity to be around 

them at different events. They are so good about coming out. You 

see young people, all ages, that learn about the military and 

things, which is just a very positive experience. 

One of the problems, and the reason I support this, is that many 

times they come at their own expense. They are very willing to do 

things, but there is an expense incurred by themselves, which, 

again, they are in situations where perhaps it is difficult. So, I 

think that is another reason that the legislation would be beneficial. Would you agree with that, with the—— 

Dr. LYNCH. Yes. 

Senator BOOZMAN [continuing]. Importance of them being—and 

them adding so much to whatever the event is, helping us highlight 

the sacrifice and the importance of our military. 

Dr. LYNCH. Senator, absolutely. 

Senator BOOZMAN. Very good. I understand that you all are not 

supportive of Senators Donnelly and Ernst’s legislation concerning 

designating non-Department mental health care providers who 

treat members of the armed services and veterans as providers 

with specialized knowledge of providing mental health care to veterans and servicemembers. Tell me a little bit about that. You 

know, it is not uncommon at all in the private sector for them to 

be credentialed through medical societies and things like that. Why 

is it so difficult for VA to be able to do that? 

Dr. LYNCH. I think, Senator, the VA and DOD looked at this several years ago with respect to another program related to mental 

health services in rural areas and found that there were significant, what felt to be legal obstacles to this. There was also a feeling 

that some potential conflicts exist with State licensing and professional review boards. So, one aspect is legal. 

The other aspect is developing a process that would allow us to 

assess their competency beyond a simple self-administered educational program and to follow the progress of their treatment over 

time. Right now we just do not feel we have the resources to do 

that properly. 

Senator BOOZMAN. I would encourage us to perhaps visit with 

the American Psychiatric Association and the American Psychological Association and really see if we could figure that out, the 

25 

reason being is mental health care issues have been a crisis in the 

past, but they really are reaching the breaking point now, not only 

in VA but throughout our society. So, we have to start thinking 

outside the box. 

It is something that I would appreciate, and I think the Committee would appreciate it if you would really look hard and see 

how we can expand the services that we are providing, and yet it 

is very difficult to provide the service without ancillary help. That 

is why I think we see the medical societies and things credentialing 

these type of people. 

Dr. LYNCH. Yes, sir. 

Senator BOOZMAN. Thank you very much. 

Thank you, Mr. Chairman. 

Chairman ISAKSON. Senator Moran. 

HON. JERRY MORAN, U.S. SENATOR FROM KANSAS 

Senator MORAN. Thank you, Mr. Chairman. Dr .Lynch, thank 

you very much for your presence today. I may be following up on 

what Senator Boozman was talking about. 

I want to explore the issue of the use of community mental 

health providers within the VA, and my understanding is, under 

the Choice Act, the VA is required to provide services to those who 

cannot receive the service they need within 30 days or who live 

more than 40 miles from a VA facility. The facility, I guess, has 

now been redefined. 

Dr. LYNCH. Yes. 

Senator MORAN. One of the only places in Kansas that you can 

access mental health services in rural parts of our State, but generally across our State, are what we call community mental health 

centers, and they provide the wide array of mental health services. 

My impression is—and we have been working on this long before 

Choice was ever enacted, but we have been trying to convince the 

VA to enter into agreements with those mental health centers to 

allow veterans to receive care through there. It really has not developed, and my question is: In today’s circumstance where the VA 

is required to provide those services, maybe the bottleneck—it still 

does not seem to be happening—is how the VA or TriWest decides 

which organizations to contract with to provide those services. Can 

you explain to me how that process works? 

Dr. LYNCH. To my understanding, TriWest on behalf of the VA 

reaches out to providers in the community to engage them in the 

Choice program. There are some requirements. They do have to be 

Medicare-eligible in order to participate. They do have to provide 

a copy of their records within 30 days of the provision of services. 

We can reimburse them at rates up to Medicare. So, a lot of the 

challenges are related to working with the providers and getting 

them to engage in Choice. 

We have been working with TriWest to improve those engagements. We have been working to try to make it easier through 

some recent legislation which would actually let us work within the 

30-day interval and avoid 60-day reauthorizations to make this 

process easier to implement. There are some recommendations 

going forward as of November 1 that will help us, I think, more 

26 

greatly integrate the VA care in the community beyond what we 

are doing right now. 

Senator MORAN. Would there be, Dr. Lynch, any circumstances 

in which the VA would decide we do not want to have an outside 

provider provide this kind of service and, therefore, TriWest would 

never enter into negotiations with the provider? 

Dr. LYNCH. Not to my knowledge, as long as they meet the provisions of the Choice Act. 

Senator MORAN. There would not be an attitude or approach 

within the VA that says we want to retain the ability, only the 

ability—and in a sense, ‘‘revenue’’ is not the right word, but the 

revenue that flows from that veteran, we want to maintain that 

within the VA and not allow an outside provider to provide that 

service? 

Dr. LYNCH. No, Senator. I think the Secretary has made it clear 

that we are coming into a new era in VA, that we need to collaborate with the community, that we need to partner with them to 

provide care to veterans, and that we cannot do it all ourselves. 

Senator MORAN. One of the community mental health centers in 

Kansas told me that they were allowed to contract but only to provide screening services but not the actual care of the veteran. Does 

that make any sense? They were interested in providing a wide 

array of services, but the VA says no, we are only going to contract—or TriWest says they are only going to allow you to do 

screening. 

Dr. LYNCH. I do not understand that, but I would be happy to 

get more information and explore it with you. 

Senator MORAN. Do you have the sense that this implementation 

of the Choice Act is pretty uniform across the country VISN-toVISN? Or is it different because Kansas happens to be in a certain 

VISN? 

Dr. LYNCH. It varies across the country, depending upon our ability to recruit community partners. We are working aggressively, I 

can assure you, with both of our third-party administrators to engage the community and to have Choice providers available. 

Senator MORAN. Under the Clay Hunt Act the VA is also instructed to provide additional mental health community services. 

Any development there, or does the Choice Act, if fully and appropriately implemented, take care of that mandate? 

Dr. LYNCH. I would have to look at the provisions of the Clay 

Hunt Act that you are referring to, but I think we have a number 

of resources that we need through Choice. I think the other thing 

that I mentioned earlier through the Defense Authorization Act, 

our mental health services are actually mandated to reach out to 

the community and involve community providers in mental health 

care. 

Senator MORAN. Are family and medical professionals and therapist, are they—does the law require you to hire them within the 

VA? 

Dr. LYNCH. I do not know if the law requires us. I know that we 

have been reaching out to involve them more in VA services. I have 

had that discussion with our mental health program office, and we 

are beginning to look for ways to engage these individuals further. 

27 

Senator MORAN. My final question, Mr. Chairman, is that I was 

told that a community mental health center could not be reimbursed for any services provided by a family and marriage therapist, and that I think makes no sense, in part based upon what you 

just said, but I know there is an effort to integrate that profession 

into the VA. Yet the community mental health center says they 

cannot use family and marriage therapists and be reimbursed. 

Dr. LYNCH. I would have to look more specifically at that. 

Senator MORAN. Thank you very much. 

Chairman ISAKSON. Senator Tillis. 

HON. THOM TILLIS, U.S. SENATOR FROM NORTH CAROLINA 

Senator TILLIS. Thank you, Mr. Chair. I am sorry I was running 

late. I am not going to talk long except to just lend words of support for two bills: Senator Shaheen’s bill, S. 1754. I do not think 

you all have taken a position on it, but I think it is a valuable resource in trying to draw down the claims backlog and give some 

certainty to the veterans who are going through an appeals process. Also, Senator Graham’s bill, S. 2022. I look forward to seeing 

them make their way through the Committee. 

The only thing I will not do, since I do not think any of you all 

have anything to do with the Camp Lejeune toxic waste issue, but 

I am looking forward to a future meeting where I can get some resolution to questions that I posed in the last meeting. 

Thank you, Mr. Chair. 

Chairman ISAKSON. Thank you, Senator Tillis. 

Senator Sullivan? 

HON. DAN SULLIVAN, U.S. SENATOR FROM ALASKA 

Senator SULLIVAN. Thank you, Mr. Chair. Dr. Lynch, it is good 

to see you again. 

Dr. LYNCH. Yes, sir. 

Senator SULLIVAN. I think you probably will not be surprised 

when I talk about a topic that you and I have been spending a lot 

of time on lately, and that is the issues in Alaska. Again, I appreciate the Chairman and the Ranking Member’s support for our 

hearings out in the State in August that I think were, hopefully, 

very helpful to you and your team and certainly are helpful to me 

and my team. 

At the latest hearing, we talked about Dr. Shulkin’s six points 

with regard to an Alaska plan, an Alaska pilot program to fix what 

I think everybody recognizes has been a real problem in terms of 

the implementation of the Choice Act. I appreciate you following 

up, you and your team just recently with my staff. 

My understanding is that most of what Dr. Shulkin is going to 

do—and I am sure you have those six points in front of you this 

time—do you? 

Dr. LYNCH. Absolutely. 

Senator SULLIVAN. Good, I do, too. I will not grill you on them, 

though. That is, for most of that, we are not going to need legislation. I do think that on the issue my understanding, particularly 

from the call yesterday, on the pilot project in the Matsu Valley in 

terms of the partnerships that you might need some legislative authority there, and I just want to get a commitment from you—I 

28 

know I am going to get it—that you will work with my team and 

the Committee here that we can make sure we know what that is. 

So, whatever bills are moving soon, that we can make sure we have 

that in hand working with you. Can I get that commitment from 

you on that? 

Dr. LYNCH. Yes, sir. 

Senator SULLIVAN. What I wanted to do, just because you saw 

how passionate our veterans were on the issue, I just wanted to 

work through first the timeline on the issues in Alaska. I think you 

saw how urgent the issues are. In the last hearing, I talked about 

the ability for you guys to move up a timeline. 

Again, can I get a commitment as soon as possible so we can 

work with you to announce what we are going to do there in terms 

of an Alaska pilot plan, particularly in the areas where you have 

authority, so we can get that out and start giving our veterans 

hope? 

Dr. LYNCH. Yes, sir. I think we talked yesterday about two 

phases. One, we have already implemented a virtual integration 

between TriWest and the integrated care service in Anchorage so 

that there is a direct connection between those individuals at VA 

Alaska who have worked for a long time with the community providers. TriWest is going out and recruiting seven additional individuals who will actually be physically present in the Integrated 

Care Service Center. 

I think what came across in the phone call yesterday is we want 

to make sure we do this right, and we want to make sure we get 

the right people. Right now we think they will be in place by midNovember, including recruitment. But—— 

Senator SULLIVAN. OK. You do not think there is a way to move 

that up at all? 

Dr. LYNCH. Sir, it is my understanding they are moving as quickly as possible. 

Senator SULLIVAN. OK. 

Dr. LYNCH. They want this almost as bad as you do, because 

I—— 

Senator SULLIVAN. I doubt it, but that is OK. 

Dr. LYNCH. Well, I can tell you—— 

Senator SULLIVAN. Or maybe they do, and that is great. We are 

all trying to work together. That is the key. 

Dr. LYNCH. Having walked through and talked with the people 

in that unit, they are very committed to the veterans. 

Senator SULLIVAN. Oh, they are. 

Dr. LYNCH. They are very committed to the vendors that are 

working with our veterans. Anything they can do to facilitate the 

communication between veteran and vendor and make that work 

is going to be something they are going to push as quickly as they 

can do that to put in place a good service. 

Remember, this is a pilot. It will probably be implemented in 

other places across VA. We want to make sure it is successful. 

Senator SULLIVAN. Good. I appreciate that constructive answer. 

We are still getting a ton of veterans weighing in with my office 

on this issue, and what I thought would be useful in the remaining 

time I have is to have them speak directly to you and see if you 

can answer a couple of their questions. 

29 

One, Ms. Cathy Blodgett of Anchorage, she wrote in to our office 

and said she is a veteran, she works at the VA, and she is an Air 

Force veteran. Alaska VA takes pride in service to our veterans, 

but are spending dozens of hours on the phone trying to fix the 

contractor shortcomings, and our employees cannot do the jobs they 

are hired to do because they are spending so much time on resolving the Choice Act issues. 

Dr. LYNCH. Can I just make—— 

Senator SULLIVAN. I will just throw one other out there, because 

I am trying to get in under the buzzer. A board-certified doctor in 

Anchorage, Saket Ambasht, he said that—and he is a disabled vet. 

He wrote in to my office. He said he has provided care to 1,036 patients out of 7,994 over the last several years, but in the last several weeks has been only able to see two VA patients out of close 

to 100, again, from Choice Act implementation. 

Will the Alaska plan kind of address some of these issues that 

are directly coming from our vets and people who have worked 

with the VA or in the VA? 

Dr. LYNCH. I think you illustrated the point I just made, that the 

people at the VA, the people in the Integrated Care Service Center, 

care as much as you do about serving the veteran and resolving 

those problems and working efficiently and reestablishing what is 

important in Alaska, which are relationships between the veteran 

and the VA, between the VA and its vendors. So, I think you have 

made my point as well as your point. 

Senator SULLIVAN. Will the plan allow these kind of things to be 

fixed? 

Dr. LYNCH. I think it will, sir. 

Senator SULLIVAN. Thank you. 

Thank you, Mr. Chairman. 

Chairman ISAKSON. Thank you, Senator Sullivan. 

I want to thank our panelists for their testimony. Thank you for 

being here today, and we will recognize the second panel to come 

forward at this time. 

[Pause.] 

Chairman ISAKSON. Let me bring the Committee back to order. 

Before I introduce our panelists, I want to say a thank you, if I can, 

to The American Legion, the VFW, Iraq and Afghanistan Veterans 

of America, and all the other VSOs. Over the past 7 or 8 months, 

we have had a difficult situation in Denver, Colorado, with the 

Denver hospital, and I want to thank the Ranking Member in this 

eulogy as well—not eulogy, but whatever it is, anyway—testimony. 

Because of the support of the VSOs and the cooperation of the 

Ranking Member in the waning hours of last week, we pulled off 

something nobody thought we could do by getting the VA hospital 

authorized in Denver, finding the money to finish the hospital 

without going outside the VA to find that money, and I think it 

showed what we can do when we work together. But the VSOs 

were extremely helpful to back the Senate position in the waning 

days of that debate, and I want to publicly thank them. We hope 

you will tell your commanders the same. I want to thank Senator 

Blumenthal for his last-minute—not last-minute support, but in 

the waning minutes when we were challenged, he stuck behind the 

30 

Committee and stuck behind what we did, and we appreciate it 

very much. 

Senator BLUMENTHAL. Thank you, Mr. Chairman. 

I want to thank the Chairman for his leadership on this issue 

and others, although I am not sure I am wholly in accord with his 

eulogy. 

Chairman ISAKSON. Trilogy. 

Senator BLUMENTHAL. Trilogy. 

Chairman ISAKSON. Testimony. 

Senator BLUMENTHAL. But I do want to thank him very seriously 

for his leadership and, second, emphasize how important the veterans service organizations have been. I think the most telling 

word in that title is ‘‘service.’’ You have truly been of service to the 

veterans of America as well as to all of us who have a responsibility to try to provide for them, and the partnership that we have 

with the VSOs is enormously beneficial to the work we do, trying 

as hard as we can, and working as hard as you do to serve our 

common goals. I want to join in thanking you and hope you will 

pass that message along not only to your leadership but to your 

membership, because they are the ones who truly deserve credit for 

helping us serve the veterans of America and for their service to 

our country in uniform. 

Thank you. 

Chairman ISAKSON. I would like to introduce our second panel. 

First, Lauren Augustine, legislative associate, Iraq and Afghanistan Veterans of America. 

Second is Lou Celli, director of Veterans Affairs and Rehabilitation Division of The American Legion. 

Great name here, Elisha Harig-Blaine—what a great name—who 

is a Principal Associate of Housing (Veterans and Special Needs), 

National League of Cities. 

And David Norris, national legislative committee, Vice-Chairman, Veterans of Foreign Wars. 

We appreciate your being here today. Please limit your testimony 

to 5 minutes each, if at all possible, and we will start with Ms. 

Augustine. 

STATEMENT OF LAUREN AUGUSTINE, LEGISLATIVE 

ASSOCIATE, IRAQ AND AFGHANISTAN VETERANS OF AMERICA 

Ms. AUGUSTINE. Chairman Isakson, Ranking Member Blumenthal, and distinguished Members of the Committee, on behalf of 

Iraq and Afghanistan Veterans of America and our more than 

425,000 members and supporters, we would like to thank you for 

your kind welcome and the opportunity to share our views on these 

pieces of legislation. 

IAVA supports each of the bills before the Committee today. 

Having established that, I would like to focus my testimony on two 

areas our members have expressed the greatest concern: one, increasing access to health care and mental health care; and, two, 

eliminating veteran homelessness. 

Combating suicide among troops and veterans remains a top priority for IAVA and its members. According to IAVA’s 2014 member 

survey, 40 percent of respondents knew at least one Iraq or Afghanistan veteran who had died by suicide and 47 percent of reVerDate Mar 15 2010 13:40 May 02, 2016 Jkt 000000 PO 00000 Frm 00034 Fmt 6633 Sfmt 6601 Z:\ACTIVE\100615.TXT PAULIN
31 

spondents knew at least one veteran who had attempted suicide. 

While the work conducted by this Committee on the Clay Hunt 

SAV Act is greatly appreciated, there is still much more work to 

be done. First and foremost is the need to ensure that the Clay 

Hunt SAV Act is being implemented appropriately, and IAVA 

strongly urges the Committee to hold an oversight hearing before 

the end of 2015 to this end. 

IAVA recognizes that the VA provides a needed service by staffing mental health care providers specifically trained to understand 

military experiences and by using evidence-based treatments proven most effective. There is no question that the VA should remain 

the leading experts on veteran-specific care and services. However, 

many veterans do choose to seek care outside of the VA system. According to the 2014 IAVA member survey, 58 percent of respondents used VA health care, which leaves a sizable percentage potentially seeking non-VA care. In light of that, IAVA supports the 

measures outlined in S. 717 to identify non-VA mental health care 

providers that have military-specific competencies. 

Fostering a greater awareness of military culture and best practices of care among non-VA providers will strengthen the overall 

community of care available to veterans. IAVA encourages the 

Members of this Committee to recognize the potential benefit of 

this program and work together to help connect veterans to a valuable network of providers. 

Tied to the mental health care needs of veterans, ensuring greater access to VA health care must remain a top priority in order to 

prevent a repeat of the egregious situation that came to light out 

of Phoenix in 2014. While the Choice Act created a foundation for 

change at the VA, there are additional areas of concern that still 

need to be resolved. In understanding that, IAVA supports the numerous provisions in the DOCS Act that will build on those initiatives to ensure the VA is adequately meeting the needs of veterans. 

The Choice Act included a provision to add 1,500 medical 

residencies at the VA, but these residences are currently included 

in the cap for Medicare-funded residencies, and it is impacting the 

VA’s ability to fully utilize this provision. Excluding those 

residencies from the Medicare-funded cap will give the VA and its 

local partners the ability to utilize the increase in the manner in 

which it was intended. 

IAVA also supports the 5-year extension to this residency program and, in fact, would like to see the program made permanent. 

Additionally, IAVA highly supports the provision to increase the 

number of behavioral health residencies through a pilot program in 

rural areas and encourages the Committee to use the pilot program 

as a model for increased behavioral health residencies across the 

entire country. 

Another area of concern highlighted by some of today’s legislation addresses the continued effort to end veteran homelessness. 

There has been considerable progress made at addressing this 

issue in recent years, but there is now a need to address some of 

the concerns that can arise when a veteran may no longer be homeless but is still in need of transitional assistance, and what communities should do moving forward with the housing and services creVerDate Mar 15 2010 13:40 May 02, 2016 Jkt 000000 PO 00000 Frm 00035 Fmt 6633 Sfmt 6601 Z:\ACTIVE\100615.TXT PAULIN
32 

ated to address homelessness. In light of this, IAVA supports the 

Veteran Housing Stability Act. 

After chronic homelessness is ended, or dramatically reduced, 

there is a new need in communities to ensure veterans can sustain 

permanent housing and to ensure providers responsibly use existing transitional housing. The provisions included in this legislation 

that aim to accomplish those goals will help the VA and its community partners establish support services that will help prevent veterans from falling back into homelessness. IAVA applauds the type 

of planning this legislation focuses on to continue ending veteran 

homelessness and to prevent future veterans facing similar issues. 

Focusing on a specific regional homelessness concern, the West 

L.A. Homeless Veterans Leasing Act will help reinforce the effort 

to end veteran homelessness in an area greatly affected by the 

issue. 

As a strong supporter of VA accountability and oversight, IAVA 

understands the original need to remove this authority but believes, under the leadership of Secretary McDonald and the oversight provided in this legislation, the West L.A. campus is poised 

to create a strong community for veterans. It is time the VA utilize 

this space and support from the community for its original purpose. 

That support being stated, we are in close contact with our members and many key activists on the ground in L.A. Listening to 

their concerns, we must express concern that there may be a special status granted to the UCLA baseball stadium. It is imperative 

that Congress and the VA work together to address this issue and 

ensure there are no competing directives, and a veteran-centric 

model of care and service remain the priority. 

At IAVA, we believe our members, and all veterans, deserve the 

very best our Nation can offer when it comes to fulfilling the promises made to them upon entry into the military. There is no doubt 

that every Member of this Committee has the best interests of our 

veterans in mind when drafting legislation. 

Thank you for your time and attention. I am happy to answer 

any questions you may have. 

[The prepared statement of Ms. Augustine follows:] 

PREPARED STATEMENT OF LAUREN AUGUSTINE, LEGISLATIVE ASSOCIATE, 

IRAQ AND AFGHANISTAN VETERANS OF AMERICA

Bill # Bill Name or Subject Sponsor IAVA Position 

S. 717 Community Provider Readiness Recognition Act of 2015 Sen. Donnelly/Ernst Support 

S. 1676 DOCs for Veterans Act of 2015 Sen. Tester Support 

S. 1754 Amend title 38 to make permanent the increase in number of 

judges presiding over the United States Court of Appeals for 

Veterans Claims Sen. Shaheen Support 

S. 1885 Veteran Housing Stability Act of 2015 Sen. Blumenthal Support 

S. 2013 Los Angeles Homeless Veterans Leasing Act of 2015 Sen. Feinstein/Boxer Support 

S. 2022 Amend title 38 to increase the amount of special pension for 

Medal of Honor recipients Sen. Graham Support 

33 

Chairman Isakson, Ranking Member Blumenthal and Distinguished Members of 

the Committee; On behalf of Iraq and Afghanistan Veterans of America (IAVA) and 

our more than 425,000 members and supporters, we would like to extend our gratitude for the opportunity to share our views and recommendations regarding these 

pieces of legislation. 

IAVA supports each of the bills before the Committee today. Having established 

that, I would like to focus my testimony on two areas that our members have expressed the greatest concern: (1) increasing access to health care and mental health 

care; and (2) eliminating veteran homelessness. 

Combating suicide among troops and veterans remains a top priority for IAVA 

and its members. According to IAVA’s 2014 member survey, 40% of respondents 

knew at least one Iraq or Afghanistan veteran who has died by suicide and 47% 

of respondents knew at least one Iraq or Afghanistan veteran who had attempted 

suicide. While the work conducted by this Committee on the Clay Hunt Suicide Prevention for America Act is greatly appreciated, there is still much more work to be 

done with regard to providing mental health care and support to veterans and their 

families. First and foremost is the need to ensure that the Clay Hunt Act is being 

implemented appropriately, and IAVA strongly urges the Committee to conduct an 

oversight hearing before the end of 2015 to this end. 

IAVA recognizes that the Department of Veterans Affairs (VA) provides a unique, 

and needed, service by staffing mental health care providers specifically trained to 

understand military culture and experiences, and by using evidence-based treatments proven most effective at treating the mental health concerns facing veterans. 

There is no question that the VA should remain the leading experts on veteran-specific care and services. However, many veterans do choose to seek care outside of 

the VA system. According to the 2014 IAVA member survey, 58% of respondents 

used VA health care, which leaves a sizable percentage seeking non-VA care. In 

light of that, IAVA supports the measures outlined in S. 717 to identify non-VA 

mental health care providers that have military-specific competencies. 

Fostering a greater awareness of military culture and best practices of care among 

non-VA providers will increase access to care and strengthen the overall community 

of care available to veterans, which are two key components in decreasing veteran 

suicide. Additionally, providing a mechanism for private providers to identify themselves as having military competencies will encourage more providers to gain that 

knowledge and provide evidence-based treatment to veterans in their communities. 

There are already several mechanisms in place to aid in a quick and efficient implementation of this program while not increasing the workload of the VA. IAVA encourages the Members of this Committee to recognize the potential benefit of this 

program and work together to help connect veterans to a valuable network of 

providers. 

Tied to the mental health care needs of veterans, ensuring greater access to VA 

health care must remain a priority for all in the veteran community in order to prevent a repeat of the egregious situation that came to light out of Phoenix in 2014. 

While the Choice Act created a foundation for change at the VA, there are additional areas of concern that still need to be resolved. In understanding that need, 

IAVA supports the numerous provisions in the Delivering Opportunities for Care 

and Services for Veterans (DOCS) Act that build on the initiatives of the Choice Act 

to ensure the VA is adequately meeting the needs of veterans seeking care. 

The Choice Act included a provision to add 1500 Graduate Medical Education 

slots, or medical residences, at the VA to help increase awareness of the opportunities available at the VA. These residences are currently included in the cap for 

Medicare-funded residences and it is impacting the VA’s ability to fully utilize the 

increase in residencies. This legislation excludes those 1500 residences from the 

Medicare-funded cap to give the VA and its local partners the capability of utilizing 

the residency increase in the manner in which it was intended. This legislation also 

extends the residency program created by the Choice Act by five years to allow for 

realistic maturation of the residency program. IAVA supports this extension and in 

fact, would like to see the program made permanent. Additionally, IAVA highly supports the provision to specifically increase the number of behavioral health 

residencies through a pilot program in rural areas and encourages the Committee 

to use the pilot program as a model for increased behavioral health residences 

across the entire country. 

Another area of concern highlighted by some of today’s legislation addresses the 

rate of veteran homelessness across the country. There has been considerable 

progress made at addressing this issue in recent years, but the fact that tens of 

thousands of veterans remain homeless on a given night is a harsh reminder that 

there is need for additional support and services. 

34 

Given the progress made to end chronic veteran homelessness, there is now a 

need to address some of the concerns that can arise when a veteran may no longer 

be homeless, but is still in need of transitional assistance; and what communities 

should do moving forward with the housing and services created to address homelessness. In light of this, IAVA supports the Veteran Housing Stability Act, which 

builds on the successes of existing homeless prevention programs while addressing 

some of the shortfalls that need to be filled. 

After chronic homelessness is ended, or dramatically reduced, there is a new need 

in communities to ensure veterans can sustain permanent housing and to ensure 

providers responsibly use existing transitional housing. The provisions included in 

this legislation that aim to accomplish those goals will help the VA and its community partners establish support services for veterans that will help prevent veterans 

from falling back into homelessness. IAVA applauds the progress the VA, community partners and state agencies have made at eradicating veteran homelessness, 

and encourages the type of long-term planning this legislation focuses on to continue 

ending veteran homelessness and to prevent future veterans facing the same problem. 

Focusing on a specific regional homelessness concern, the West Los Angeles (L.A.) 

Homeless Veterans Leasing Act of 2015 will restore the ability of the West L.A. VA 

Campus to enter into enhanced use leases with community and state partners, 

which will help reinforce and support the effort to end veteran homelessness in an 

area greatly affected by the issue. 

As a strong supporter of VA accountability and oversight, IAVA understands the 

original need to remove this authority, but believes under the leadership of Secretary McDonald and the oversight provided in this legislation, the West L.A. campus is poised to create a strong community for veterans in need of support. It is 

time the VA utilize this space and support from the community for its original 

purpose. 

That support being stated, IAVA does encourage the Members of this Committee 

to work closely with the VA to ensure this legislation is supportive of and in congruence with the upcoming VA Master Plan set to be released in the near future. It 

is imperative that Congress and the VA work together to address this issue and ensure there are no competing directives; a veteran-centric model of care and services 

must continue to be the priority. 

At IAVA, we believe our members, and all veterans, deserve the very best our Nation can offer when it comes to fulfilling the promises made to them upon entry into 

the military. There is no doubt every Member of this Committee has the best interests of our veterans in mind when drafting legislation. But we do hope you take into 

consideration and implement what we, and our fellow veteran service organizations, 

have had to say on these pieces of legislation today. 

Thank you for your time and attention. IAVA is happy to answer any questions 

you may have. 

Chairman ISAKSON. Thank you. 

Mr. Celli? 

STATEMENT OF LOUIS CELLI, JR., DIRECTOR, NATIONAL VETERANS AFFAIRS AND REHABILITATION DIVISION, THE 

AMERICAN LEGION 

Mr. CELLI. Chairman Isakson, Ranking Member Blumenthal, 

and distinguished Members of this Committee, on behalf of our National Commander, Dale Barnett, and the over 2 million members 

of The American Legion, we thank you for this opportunity to testify regarding The American Legion’s positions on legislation pending before this Committee, and we appreciate the Committee’s 

focus on these critical issues that will have a direct effect on veterans and their families. 

It is a rare and gratifying experience for The American Legion 

when we can testify that we stand behind and support every bill 

being offered for consideration during a hearing, and The American 

Legion would like to take this opportunity to thank and congratulate this Committee and especially the leadership here today for 

their excellent bipartisan efforts on behalf of the Nation’s veterans 

35 

who have been numbed by the constant and ongoing drone of negative press regarding their Department of Veterans Affairs. 

The most comprehensive bill being considered today is S. 1676, 

which broadens the ability of VA to fill its ranks with qualified 

medical staff while attempting to compensate for income disparities 

suffered by certain geographical areas. While The American Legion 

supports this proposed legislation, we take a moment to recognize 

some of the non-monetary benefits of serving our veteran community while employed by VA: set schedules, defined hours, protection 

from malpractice claims, a vast network of resources, cutting-edge 

research opportunities, and the personal fulfillment of noble service, just to name a few. 

No one at this witness table or sitting at that dais is here because we were offered maximum earning potential. So, while The 

American Legion certainly supports competitive pay for all VA employees, we are also mindful of the need to make VA employment 

a more attractive employment option through non-monetary incentives. While money is going to be helpful, the best people to serve 

veterans are the ones that are motivated by an internal code and 

ethos. We cannot ignore financial reward, but we should not make 

that our primary recruitment tool either. 

S. 1745 addresses a critical need at the Court of Veterans Appeals. The attempt to clear the claims backlog has grown to a fever 

pitch, and the backlog of claims appeals has grown to unprecedented levels. Ensuring that the Court remains fully staffed with 

law judges could not be more important than it is today, and with 

the transitioning administration set to coincide with several projected retirements at the Court, the time to ensure veterans are not 

suffering needlessly due to a crippled court is now. 

A little over a year from now, The American Legion, together 

with our sister VSOs, will host an inaugural ball honoring the 78 

living recipients and the 3,500 heroes who are no longer with us 

who have earned the Nation’s highest military award, the Medal 

of Honor. At that event, it will be an honor for us to let them know 

that this Committee supported adjusting their monthly compensation to a more realistic value, something that has not been done in 

over 10 years. And while a handful of them currently live in California, they will also be interested to hear an update about the 

West Los Angeles campus. 

I was particularly encouraged, Chairman, to hear your comments 

regarding the template that you look forward to hearing about to 

see if we can generate revenue in other VA facilities across the Nation. The American Legion has been protesting the misuse of the 

West Los Angeles Campus VA medical center land use since 1983, 

and we applaud VA’s efforts to work with litigants to come to an 

agreement that benefits veterans while honoring the original deed 

set forth by the Jones and Baker families in 1888. 

While we absolutely support moving forward on legislation that 

establishes limited future leasing that only benefits Los Angeles 

area veterans, we remain angered over the lack of accountability 

of revenue that was lost and remains unaccounted for over the last 

several years through the illegal leasing practices employed by VA. 

Millions of dollars remain unaccounted for, and the employees responsible continue to retire and move on before answering for the 

36 

missing money that was supposed to support veterans in Los Angeles. When The American Legion asked VA officials for an accounting of those funds, we were repeatedly told, ‘‘We will get back to 

you.’’ We need accountability, and we need it now. 

Finally, The American Legion notices that there is no advisory 

committee involved in this process that includes any veterans service organizations. We ask you, How will the veteran’s voice be 

heard if not so much is being asked? 

Thank you. 

[The prepared statement of Mr. Celli follows:] 

PREPARED STATEMENT OF LOUIS CELLI, JR., DIRECTOR, NATIONAL VETERANS AFFAIRS

& REHABILITATION DIVISION, THE AMERICAN LEGION

Chairman Isakson, Ranking Member Blumenthal, and distinguished Members of 

the Committee: On behalf of our National Commander, Dale Barnett, and the over 

2 million members of The American Legion, we thank you for this opportunity to 

testify regarding The American Legion’s positions on pending legislation before this 

Committee. We appreciate the Committee focusing on these critical issues that will 

affect veterans and their families. 

S. 717: COMMUNITY PROVIDER READINESS RECOGNITION ACT OF 2015

To designate certain non-Department mental health care providers who treat members of the Armed Forces and veterans as providers who have particular knowledge 

relating to the provision of mental health care to members of the Armed Forces and 

veterans, and for other purposes. 

This bill would designate certain non-Department mental health care providers 

who treat members of the Armed Forces and veterans as providers who have particular knowledge relating to the provision of mental health care to members of the 

Armed Forces and veterans. The American Legion believes by establishing a registry of Non-VA Mental Health Care providers who have been designated by the Department of Veterans Affairs (VA) or Department of Defense (DOD) to understand 

VA/DOD culture is beneficial to the veteran and their family. This bill would ensure 

there are designated non-VA/DOD mental health providers that are readily available to treat veterans and help to reduce mental health access wait times within 

the VA Healthcare system. 

The American Legion supports S. 717. 

S. 1676: DELIVERING OPPORTUNITIES FOR CARE AND SERVICES FOR VETERANS

ACT OF 2015

To increase the number of graduate medical education positions treating veterans, 

to improve the compensation of health care providers, medical directors, and directors of Veterans Integrated Service Networks of the Department of Veterans Affairs, 

and for other purposes. 

This bill would give the VA increased tools and the flexibility to effectively and 

efficiently recruit and retain qualified healthcare professionals to practice and provide health care services to veterans living in rural and highly rural areas across 

the country. 

Section 101: Disregard of resident slots that include VA training against the Medicare graduate medical education limitations 

This section would ensure that up to 24 Graduate Medical Education (GME) residency slots within VA would not count toward the current cap under Section 

301(b)(2) of the Veterans Access, Choice, and Accountability Act of 2014. 

Section 102: Extension of period for increase in graduate medical education residency positions at medical facilities of the Department of Veterans Affairs 

Section 301 of the Veterans Access, Choice, and Accountability Act of 2014 authorizes the VA to allocate 1,500 additional residency positions over the next five years. 

This section would increase the timeframe for residency positions within the VA 

healthcare system from 5 years to 10 years. 

Section 103: Pilot program on graduate medical education residency programs in 

behavioral medicine in underserved areas 

This section authorizes VA, Indian Health Services (IHS), and the Department of 

Health and Human Services (DHHS) to develop a six-year pilot program to create 

no less than three behavioral health graduate medical residency programs to be located in underserved, rural and/or highly rural areas of the country. 

37 

1 American Legion Resolution No. 283: Licensed Professional Mental Health Counselors and 

Marriage and Family Therapists: Aug 2014 2 American Legion Resolution No. 101: Department of Veterans Affairs Recruitment and Retention: Sept 2015 

Section 104: Inclusion of mental health professionals in education and training 

program for health personnel of the Department of Veterans Affairs 

This section in accordance with Title 38, United States Code (U.S.C.) section 

7302(a)(1) would include the education and training of marriage and family therapists (MFTs) and licensed professional mental health counselors (LPMHCs) as well 

as including these professions in the VA’s recruitment programs. 

The American Legion supports the inclusion of licensed professional mental 

health counselors (LPMHCs) and marriage and family therapists (MFTs) as funded 

associated health trainees through the Department of Veterans Affairs (VA) trainee 

support programs.1

Section 105: Expansion of qualifications for licensed mental health counselors of 

the Department of Veterans Affairs to include doctoral degrees 

Title 38 U.S.C. section 7402(b)(11)(A) states that if a Licensed Professional Mental 

Health Counselor is to eligible to be appointed to a licensed professional mental 

health counselor position the individual must have a masters degree in mental 

health counseling or a related field from a college or university that is approved by 

the Secretary. This section of the bill calls for individuals to have a doctoral degree 

in the related mental health fields. 

Section 201: Requirement that physician assistants employed by the Department 

of Veterans Affairs receive competitive pay 

This section would amend Title 38, U.S.C. section 7451(a) (2) by inserting the 

name ‘‘Physician Assistant’’ in sections (b) and (c) respectively. This part of the bill 

would allow Physicians Assistants to be included into the Nurse Locality Pay System so that the Veterans Health Administration (VHA) can stay competitive with 

the local markets. 

The American Legion supports legislation addressing the recruitment and retention challenges that the VA has regarding pay disparities among physicians and 

medical specialists who are providing direct health care to our Nation’s veterans.2

Section 202: Modification of education debt reduction program of Department of 

Veterans Affairs to require a certain amount to be spent in rural and highly rural 

areas. 

This section would amend Title 38, U.S.C. section 7681 by inserting a new subsection (c) to include that 30 percent of the debt reduction allocated under the Education Debt Reduction Program each year shall be paid to individuals who practice 

in a rural or highly area, where the VA struggles to effectively recruit qualified 

mental health professionals. 

Section 203: Report on medical workforce of the Department of Veterans Affairs 

This section requires the Secretary of Veterans Affairs to submit a medical workforce report to the Senate and House Veterans’ Affairs Committees. This report 

would provide the Committees an assessment of how the VA is addressing medical 

workforce shortages to include the following: 

• The recruitment and integration of licensed professional mental health counselors and marriage and family therapists; 

• To determine if VA is utilizing the education debt reduction program; 

• To understand how VA is addressing barriers in delivering telemedicine; and 

• For the Veterans Health Administration to provide an assessment of succession 

plans regarding vacancies across the Department. 

Section 301: Establishment of positions of Directors of Veterans Integrated Service 

Networks in Office of Under Secretary for Health of Department of Veterans Affairs and modification of qualifications for Medical Directors 

This section would amend Title 38, U.S.C. section 7306(a)(4), by inserting ‘‘and 

Directors of Veterans Integrated Service Networks’’ after ‘‘Such Medical Directors;’’ 

and by striking ‘‘, who shall be either a qualified doctor of dental surgery or dental 

medicine.’’ 

Section 302: Pay for Medical Directors and Directors of Veterans Integrated Service Networks 

This section would provide the Secretary of Veterans Affairs the flexibility within 

a new compensation system to provide VA Veterans Integrated Service Network and 

Medical Center Directors the ability to determine market pay and to address the 

pay disparities between VHA and the private sector. 

Section 401: Pilot program on providing nurse advice line for veterans in rural 

and highly rural areas. 

38 

3 American Legion Resolution No. 37: Department of Veterans Affairs Rural Healthcare Program: Aug 2014 

This section of the bill authorizes that the Secretary of Veterans Affairs conduct 

a two-year pilot program to assess the feasibility of implementing a nurse advice 

line to address questions veterans living in rural and/or highly rural areas of the 

country have regarding their health care, availability of benefits, and appointment 

and cancellation services through an appointment clerk. 

The American Legion urges the VA Office of Rural Health (ORH) to ensure Rural 

Health Resource Centers provide services to rural veterans from surveys, national 

hotlines and connecting veterans living in rural communities with providers.3

Summary: 

This legislation is broad in scope, with many helpful sections that have the potential to improve the health care veterans receive from the VHA. In particular, improvements to mental health counseling, competitive salaries for medical professionals, and improvements to rural health care options all address problem areas 

for VHA and will be improved by the passage of this legislation. 

The American Legion supports S. 1676 

S. 1754: VETERANS COURT OF APPEALS SUPPORT ACT OF 2015

To amend title 38, United States Code, to make permanent the temporary increase 

in number of judges presiding over the United States Court of Appeals for Veterans 

Claims, and for other purposes. 

The Court is authorized seven permanent, active Judges, and two additional 

Judges as part of a past temporary expansion provision. Over the next two years 

a sequence of retirements risks resulting in the Court falling to just five judges 

right when a new administration and Congress have a thousand other nominations 

to worry about. Past history tells us that it will take at least two years before anyone notices the Court is drowning. With the Board growing and its output going up 

to levels not seen since the Court was created, the CAVC will be in big trouble if 

allowed to fall to five judges for multiple years. Therefore, this needs to be addressed this year. 

The American Legion has a long history of supporting the Court and it would be 

a great disservice to veterans and the Court to not address this now. 

The American Legion supports S. 1754. 

S. 1885: VETERANS HOUSING STABILITY ACT OF 2015

To amend title 38, United States Code, to improve the provision of assistance and 

benefits to veterans who are homeless, at risk of becoming homeless, or occupying 

temporary housing, and for other purposes. 

This bill would modernize and strengthen existing Department of Veterans Affairs’ housing programs for homeless and at-risk veterans. Currently, VA reports 

there are approximately 50,000 homeless veterans, representing 12% of America’s 

adult homeless population. As these numbers have declined and as progress is being 

made to end veterans’ homelessness, it has become clear that insufficient availability of affordable permanent housing is an obstacle to fully achieving this goal. 

This legislation aims to increase veteran access to permanent housing options by encouraging landlords to rent to veterans, providing grants for organizations that support formerly homeless veterans, and modifying a VA program that sells homes 

from VA’s foreclosure inventory at a discount to nonprofit agencies. 

This bill would also expand the definition of ‘‘homeless veteran’’ to provide additional benefits to veterans in need by including a veteran or veteran’s family fleeing 

domestic or dating violence, sexual assault, stalking, or other dangerous or lifethreatening conditions in their current housing situation. Additionally, it would also 

codify the VA’s National Center on Homelessness to guarantee its continued role in 

researching the most cost-effective approaches to ending veteran homelessness and 

disseminating them to the field. 

In conclusion, The American Legion believes that S. 1885 would dramatically help 

end and prevent veteran homelessness. We strongly believe that all programs to assist homeless veterans must focus on helping them reach their highest level of selfmanagement and this bill helps in accomplishing that ultimate goal. 

The American Legion supports S. 1885. 

39 

4 HVAC O&I Hearing: An Examination of Waste and Abuse Associated with VA’s Management of Land-Use Agreements: Feb 2015 5 Resolution No. 154: Department of Veterans Affairs Enhanced-Used-Leasing: Aug 2014 

6http://www.cmohs.org/medal-statistics.php 

S. 2013: LOS ANGELES HOMELESS VETERANS LEASING ACT OF 2015

To authorize the Secretary of Veterans Affairs to enter into certain leases at the Department of Veterans Affairs West Los Angeles Campus in Los Angeles, California, 

and for other purposes. 

This bill would allow veterans who are currently living on the streets to relocate 

to a more secure space on the campus of the West Los Angeles Healthcare System 

for the purpose of receiving housing, health care, education, family support, vocational training, and other needed services. 

For nearly 80 years, the VA West Los Angeles Campus has been providing disabled veterans a place to live and receive needed services. For over 35 years, The 

American Legion has been actively protesting the Department of Veterans Affairs 

misuse of the property. Since that time the VA has been leasing the land to private 

businesses in the area directly contrary to the explicitly stated original intent when 

the land was donated by Senator John P. Jones and a prominent Los Angeles family 

intending to serve the homeless veteran community in Los Angeles.4

While The American Legion supports S. 2013, we want to ensure that the revenues generated by these leases are benefiting the veteran community, as well as enhancing the West Los Angeles VA facility itself. We also want those revenues well 

documented and tracked and continue to urge VA to report what had happened to 

the original funds as The American Legion asked earlier this year. VA has continued to fail to provide answers regarding accounting of funds collected from commercial tenants of the West Los Angeles VA facility when the organization violated 

land-use agreements. To date, the money collected in exchange for use of campus 

assets has not been accounted for. 

The American Legion opposes any Enhanced-Used-Lease that does not specifically 

provide any obvious and permanent benefits, resources or services to the veterans’ 

community.5 This legislation can provide tangible benefits to the veterans in the 

West Los Angeles area, but there must be a complete and transparent accounting 

of the activities on the property, past and present, to restore trust in the veterans’ 

community. 

The American Legion supports S. 2013. 

S. 2022

To amend title 38, United States Code, to increase the amount of special pension for 

Medal of Honor recipients, and for other purposes. 

The American Legion enthusiastically supports an increase in the special pension 

assigned to Medal of Honor recipients. For the 78 living recipients 6 of this Nation’s 

highest military honor, an increase in the monthly pension based upon heroic acts 

in the face of nearly insurmountable challenges is a small token of appreciation and 

gratitude for their sacrifices. As the Nation’s largest wartime veterans service organization, The American Legion fully appreciates the service of those awarded the 

Congressional Medal of Honor and supports increasing their monthly pension to 

$3,000. 

The American Legion supports S. 2022. 

CONCLUSION

As always, The American Legion thanks this Committee for the opportunity to explain the position of the over 2 million veteran members of this organization. For 

additional information regarding this testimony, please contact Mr. Warren J. Goldstein at The American Legion’s Legislative Division at (202) 861–2700 or 

wgoldstein@legion.org. 

Chairman ISAKSON. Thank you, Mr. Celli. 

Mr. Harig-Blaine? 

STATEMENT OF ELISHA HARIG-BLAINE, PRINCIPAL HOUSING 

ASSOCIATE, (VETERANS AND SPECIAL NEEDS), NATIONAL 

LEAGUE OF CITIES 

Mr. HARIG-BLAINE. Thank you, Mr. Chairman. On behalf of the 

more than 19,000 cities, villages, and towns represented by the NaVerDate Mar 15 2010 13:40 May 02, 2016 Jkt 000000 PO 00000 Frm 00043 Fmt 6633 Sfmt 6601 Z:\ACTIVE\100615.TXT PAULIN
40 

tional League of Cities (NLC), I thank you and the Committee for 

the opportunity to provide testimony this afternoon. 

As required by law, I would like to disclose that I am currently 

serving as a member of the VA’s Advisory Committee on Homeless 

Veterans. 

NLC is dedicated to helping city leaders build better communities. We serve as a resource for municipalities as well as 49 State 

municipal leagues on a range of issues. Our work on veterans’ 

issues has been grounded in the areas of housing and community 

development. 

We are the lead partner with the Administration for the Mayors 

Challenge to End Veteran Homelessness, and to date, more than 

800 leaders have accepted this challenge, including 628 mayors, 9 

Governors, and 165 county and city officials. In addition, our program work supports national technical assistance initiatives that 

are accelerating local efforts to end veteran homelessness. 

Given our organizational focus on veteran housing and homelessness, my testimony will remain concentrated on S. 1885 and 

S. 2013, but we welcome the opportunity to support the Committee 

and its staff regarding all legislation under review. 

S. 1885 makes many needed amendments that will improve how 

VA can and should serve homeless veterans and their families, but 

we believe there are several opportunities to further enhance these 

proposals. 

Sections 3 and 4 of the bill propose two new programs and require VA to issue reports analyzing their effectiveness. For the report analyzing the effectiveness of a program providing intensive 

case management services to veterans, we encourage the VA also 

to be required to include costs that are incurred beyond the Department alone. 

We encourage the collection of information regarding costs that 

are incurred by other entities including cities, counties, and States, 

as well as costs that are not related to the provision of health care 

and benefits. For example, costs associated by the interactions veterans have with the public safety, judicial, and penal systems, 

while not incurred by the VA, should be measured to allow for a 

more robust cost-benefit analysis of the intensive case management 

intervention services that the Department would provide as part of 

this program. 

By documenting the costs incurred by entities outside of VA, the 

report can support municipal leaders in their efforts to ensure that 

limited local resources are used in the most cost-effective manner 

to end veteran homelessness. 

For the report analyzing the success of awarding grants to transitional housing providers to incentivize the conversion of facilities 

into permanent housing, we encourage the review and analysis of 

this program to include the depersonalized information regarding 

mental health diagnoses and histories of substance abuse. The collection of this information can help develop and/or further our understanding about the impact that mental health and substance 

abuse plays in the retention of housing. 

In regards to the legislation’s direction that HUD and VA collaborate with outside partners to improve outreach to landlords, we 

recommend that VA and HUD be required to separately, but not 

41 

independently, provide a report to both the House Committee on 

Veterans’ Affairs and this Committee on how they would use this 

within their respective organizational structures and with key national partners. 

Finally, in regards to the establishment of the National Center 

on Homelessness among Veterans, NLC has seen the tremendous 

impact that the National Center has played in advancing local efforts to end veteran homelessness. As cities across the country 

begin to see what the end of veteran homelessness looks like, they 

must be able to work with Federal partners and ensure the proper 

resources are in place to keep veteran homelessness rare, brief, and 

non-recurring. The National Center’s work allows this to happen, 

and we support the bill’s efforts to formally establish the center. 

Furthermore, we urge that the center be permanently authorized 

as quickly as possible. 

In regards to S. 2013, NLC strongly urges the Committee to advance this bill and work closely with your colleagues in the House 

and senate to have the legislation passed as soon as possible. As 

the Committee is aware, the support for this bill has come from the 

L.A. County Board of Supervisors and Mayor Eric Garcetti. In addition, L.A. Councilmembers Mike Bonin and Bob Blumenfield 

have written letters of support, which we have attached to our 

written testimony. Councilmember Bonin has also filed a resolution 

in support of this bill for consideration and approval by the full city 

council. A copy of the resolution is attached with our testimony, 

and it is expected the resolution will pass when voted upon 

tomorrow. 

Mr. Chairman, I again express the National League’s appreciation for the opportunity to speak before the Committee today, and 

I welcome the opportunity to answer any questions. 

[The prepared statement of Mr. Harig-Blaine follows:] 

PREPARED STATEMENT OF MR. ELISHA HARIG-BLAINE, PRINCIPAL HOUSING ASSO- CIATE (VETERANS & SPECIAL NEEDS), CITY SOLUTIONS & APPLIED RESEARCH, NA- TIONAL LEAGUE OF CITIES

S. 1885, VETERAN HOUSING STABILITY ACT OF 2015

In December 2013, Phoenix, AZ became the first city in the United States to end 

chronic veteran homelessness. When announcing this milestone, Phoenix Mayor 

Greg Stanton said, ‘‘The strategies that we’re using to end chronic homelessness 

among veterans are the exact same strategies that we’re going to use to end chronic 

homelessness among the broader population. This model—doing right by our veterans—is exactly how we’re going to do right by the larger population.’’ 

Since then, cities such as New Orleans; Houston; Binghamton, NY; Pocatello, ID; 

Las Cruces, NM; Mobile, AL; and Troy, NY have illustrated what the end of veteran 

homelessness looks like. 

While the progress on veteran homelessness is unprecedented, improvements can 

still be made and S. 1885 is an acknowledgement of this reality. As discussed by 

Senator Blumenthal during his remarks while introducing this legislation, S. 1885 

seeks to modernize housing programs provided by the U.S. Department of Veterans 

Affairs (VA), to ensure they are appropriately meeting the needs of homeless veterans and their families. 

S. 1885 makes many needed amendments that will improve how VA can and 

should serve homeless veterans and their families, but we believe there are several 

opportunities to further enhance these proposals. 

In Section 3, ‘‘Program on Provisions of Intensive Case Management Interventions 

to Homeless Veterans Who Receive the Most Health Care From the Department of 

Veterans Affairs,’’ S. 1885 would require VA to pilot intensive case management 

services in no less than six locations. The proposed legislation requires VA to issue 

a report analyzing the effectiveness of this program no later than December 1, 2018. 

42 

In delineating the content of this proposed report, S. 1885 requires VA to provide 

‘‘An estimate of the costs the Department would have incurred for the provision of 

health care and associated services to covered veterans (as described in subsection 

(b) of section 2067 of such title, as added by subsection (a)(1)) but for the provision 

of intensive case management interventions under the program, disaggregated by 

provision of intensive case management interventions in locations described in subparagraphs (A) and (B) of subsection (c) of such section.’’ 

NLC encourages the authors and co-sponsors of this proposed legislation to expand the requirements of VA in this section of the report to include costs beyond 

those incurred by the VA alone but for the provision of intensive case management 

interventions. 

NLC encourages the collection of information regarding the costs of providing 

health care and associated services to veterans that are incurred by other entities 

including cities, counties and states, as well as costs that are not related to the provision of health care and benefits. 

For example, costs associated by the interactions covered veterans have with the 

public safety, judicial and penal systems, while not incurred by the VA, should be 

measured to allow for a more robust cost-benefit analysis of the intensive case management intervention services that VA would provide as part of this program. 

By documenting the costs incurred by entities outside of VA, the report required 

by S. 1885 can support municipal leaders in their efforts to ensure that limited local 

resources are used in the most cost-effective manner to end veteran homelessness. 

In Section 4, ‘‘Program to Improve Retention of Housing by Formerly Homeless 

Veterans and Veterans at Risk of Becoming Homeless,’’ S. 1885 would give grants 

to providers who have successfully housed veterans in transitional housing programs to incentivize these organizations to convert facilities into locations that provide permanent housing. 

To analyze the impact of this program, S. 1885 requires a report be submitted to 

the Committee’s on Veterans’ Affairs in both the House and Senate no later than 

June 1, 2019. 

S. 1885 requires this report to review the proposed program using four overall assessment areas. NLC encourages a broadening of the information sought within 

each of these areas. 

NLC encourages the review and analysis of this program to also capture de-personalized information regarding any mental health diagnoses of veterans, as well as 

any assessment regarding their histories of substance use and/or abuse. In collecting 

this information, it is hoped that a more accurate understanding can be developed 

about the impact mental health and substance abuse plays in the retention of 

housing. 

In Section 6, ‘‘Outreach Relating to Increasing the Amount of Housing Available 

to Veterans,’’ S. 1885 directs the Secretaries of VA and the U.S. Department of 

Housing and Urban Development (HUD) to collaborate with numerous entities in 

an effort to increase the number of housing units identified and committed for housing homeless veterans. 

The recruitment of landlords to join collaborative community efforts to end veteran homelessness is both vital and challenging. Thanks to the Mayors Challenge 

to End Veteran Homelessness, community stakeholders are increasingly partnering 

with committed local leaders to use their platforms in order to raise public awareness about the need for landlords to be more actively involved in ending veteran 

homelessness. Successful landlord recruitment events have occurred in cities such 

as Los Angeles, Seattle, Chicago and Dallas. NLC is currently working with elected 

officials and community partners in Tucson, Charleston and Omaha to recruit 

landlords. 

NLC recommends that S. 1885 require VA and HUD to separately, but not independently, provide a report to both the House Committee on Veterans’ Affairs and 

the Senate Veterans’ Affairs Committee on how they would execute this within their 

respective organizational structures and with key national partners. 

In Section 7, ‘‘Establishment of National Center on Homelessness Among Veterans,’’ S. 1885 directs the Secretary of VA to establish and operate a center which 

carries out multiple functions, including the integration of ‘‘evidence-based and best 

practices, policies, and programs into programs of the Department for homeless veterans and veterans at risk of homelessness and to ensure that the staff of the Department and community partners can implement such practices, policies, and 

programs.’’ 

NLC draws the Committee’s attention to the latter portion of this direction. 

As cities across the country begin to see what the end of veteran homelessness 

looks like, their ability to ensure this tragedy never returns becomes paramount. 

For veteran homelessness to be kept rare, brief and non-recurring, cities must be 

43 

able to work with Federal partners and ensure the proper resources are in place. 

The National Center on Homelessness Among Veterans’ work to aggregate data 

helps Federal and local officials make decisions about resource allocations allowing 

all stakeholders to know they can maintain their progress. 

To allow the National Center to do this critical work, among its other activities, 

NLC urges the Committee to work with Senate colleagues and provide permanent 

authorization for the center as quickly as possible. 

S. 2013, LOS ANGELES HOMELESS VETERANS LEASING ACT OF 2015

In January 2015, VA resolved a long-standing conflict with numerous community 

partners in the Los Angeles area regarding the use of the West Los Angeles 

Campus. 

To ensure and support the execution of the agreement VA entered into, Senators 

Feinstein and Boxer joined Representative Lieu in sponsoring S. 2013 and filed a 

letter with the Committee in August. 

Support for S. 2013 has come from the Los Angeles County Board of Supervisors, 

Mayor Eric Garcetti, and Los Angeles Councilmembers Mike Bonin and Bob 

Blumenfield have also written letters of support, which NLC attaches to this testimony (see NLC testimony appendix A and B). 

In addition, Councilmember Bonin has filed a resolution in support of S. 2013 for 

consideration and approval by the full city council. A copy of the resolution is attached with our testimony and it is expected the resolution will pass when voted 

upon on October 7 (see NLC testimony appendix C). 

Given the high concentration of homeless veterans in Los Angeles and the report 

from earlier this year that the number of homeless veterans in the city has increased 6% since last year, NLC strongly urges the Committee to advance this bill 

and work closely with colleagues in the House and Senate to have this legislation 

passed as soon as possible. 

44 

ATTACHMENTS: APPENDIX A 


106psNLC-aGarcetti.eps
45 

APPENDIX B 


106psNLC-b1.eps
46 


106psNLC-b2.eps
47 

APPENDIX C 


106psNLC-c.eps
48 

Chairman ISAKSON. Thank you very much. 

Mr. Norris? 

STATEMENT OF DAVID B. NORRIS, NATIONAL LEGISLATIVE 

VICE-CHAIRMAN, DEPARTMENT OF CALIFORNIA, VETERANS 

OF FOREIGN WARS OF THE UNITED STATES 

Mr. NORRIS. I would like to start off this afternoon by thanking 

Committee Chairman Johnny Isakson and Ranking Member Richard Blumenthal for allowing me the opportunity to testify on 

S. 2013. 

I would also like to thank Senator Diane Feinstein and Senator 

Barbara Boxer for sponsoring this bill. 

I am here today along with Nick Guest. He is our national chaplain and the Veterans of Foreign Wars (VFW) State of California 

adjutant/quartermaster. He was also a VSO in L.A., and he uses 

the L.A. VA facilities. We are here representing the over 88,000 

VFW members from the State of California who are all in complete 

support of S. 2013, which lays the groundwork to return the West 

L.A. campus to where it belongs—veterans. 

While this bill specifically addresses the property located in Los 

Angeles, the larger issue of VA doing the right thing is important 

to all veterans. 

I am also the Student Veterans of America Chairman for the 

Veterans of Foreign Wars in California, and as I travel to the different college campuses, I hear the same question from our young 

veterans as I have for years from our older veterans: What is VA 

doing to help those who really need help like our homeless or our 

veterans with PTSD? I do not have the answer, but I think this is 

a start. 

California has one of the largest homeless veterans populations 

in the country. A lot of these veterans are also female veterans. 

Some have problems with drug and alcohol addiction, while others 

are contemplating suicide. 

If housing could be approved under the Master Plan or be able 

to increase housing for these veterans and their families, we may 

be able to bring some of our veterans back into becoming productive citizens of our great country. They served for us. Now let us 

help serve them. 

We now have a new VA Director in Southern California, and now 

is the perfect time to put this property back on track. I am not here 

to throw anyone under the bus for things that happened in the 

past. We cannot change the past or the things that have happened 

in the past, and it is a waste of your time to sit and listen to the 

old stories. 

The West L.A. campus was deeded through a will to the Federal 

Government with the explicit intent for the property to be used to 

assist veterans. Over time, VA lost sight of that intent and leased 

out parts of this property—which is over 300 acres—to private entities and has made little to no repairs or improvements for the veterans it was intended for. This bill returns this property to its veterans, and Congress should work quickly to pass this into law now. 

Along with us, the VFW, we are currently working with The 

American Legion, Purple Heart Association, Disabled American 

49 

Veterans, and many other veterans service organizations to make 

sure things are done correctly as we move forward. 

Again, thank you for allowing me to testify for all the veterans 

in California and around the world. Stand with us today and help 

us move this important bill forward. 

Thank you. 

[The prepared statement of Mr. Norris follows:] 

PREPARED STATEMENT OF DAVID B. NORRIS, VFW NATIONAL LEGISLATIVE VICE- CHAIRMAN, DEPARTMENT OF CALIFORNIA, VETERANS OF FOREIGN WARS OF THE

UNITED STATES

I would like to start off this afternoon by thanking Committee Chairman Johnny 

Isakson and Ranking Member Richard Blumenthal for allowing me the opportunity 

to testify on S. 2013. 

I would also like to take this time to thank Senator Diane Feinstein and Senator 

Barbara Boxer for sponsoring this bill. 

I am here today along with Nick Guest our National Chaplain and the Veterans 

of Foreign Wars California State Adjutant/Quartermaster. We are here representing 

the over 88,000 VFW members from the state of California who are in complete support of S. 2013, which lays the ground work to return the West LA campus to where 

it belongs—veterans. 

While this bill specifically addresses the property located in Los Angeles, the larger issue of VA doing the right thing is important to all veterans. 

I am also the Student Veterans of America Chairman for the VFW in California 

and as I travel to the different college campuses I hear the same question from our 

young veterans as I have for years from our older veterans—What is VA doing to 

help those who really need help like our homeless or our veterans with PTSD? 

California has one of the largest homeless veterans’ populations in the country. 

A lot of these veterans are also female veterans. Some have problems with drug and 

alcohol addiction, while others are contemplating suicide. 

If housing could be approved under the Master Plan or be able to increase housing 

for these veterans and their families, we may be able to bring some of our veterans 

back into becoming productive citizens of our great country. They served for us, now 

let’s help serve them. 

We now have a new VA Director in Southern California and now is the perfect 

time to put this property back on track. I am not here to throw anyone under the 

bus for things that have happened in the past. We cannot change those things and 

it is a waste of your time to sit and listen to old stories. 

The West LA campus was deeded through a will to the Federal Government with 

the explicit intent for the property to be used to assist veterans. Over time, VA lost 

sight of that intent and leased out parts of this property (which is over 300 acres) 

to private entities and has made little to no repairs or improvements for the veterans it was intended for. This bill returns this property to its veterans and Congress should work quickly to pass it into law. 

Along with us, the VFW, we are currently working with the American Legion, 

Purple Heart Association, DAV and many other veteran service organizations to 

make sure things are done correctly as we move forward. 

Again, thank you for allowing me to testify for all the veterans in California and 

around the world. Stand with us today and help us move this important bill forward. 

Chairman ISAKSON. Thank you, Mr. Norris. I want to commend 

all of you and your comments regarding West L.A. In particular, 

Mr. Celli, I think you made a great comment when you talked 

about being angry about how the funds and the proceeds of those 

leases have been handled. We really do not know how they have 

been handled, to tell you the truth. There has been a lack of coordination. As a guy who did real estate development for 33 years, if 

you do not have a plan to execute or a goal to execute, you do not 

have an understanding of what assets that you have, you never can 

maximize your return. This is a very valuable piece of real estate 

that has kind of been used here and used there with no direct 

tracking of the money, so I commend you for your testimony. 

50 

You, too, Mr. Norris. This is the time for us to get it right. I hope 

when the VA puts out their Master Plan, a proposed Master Plan, 

that both your organizations will comment, all of you will comment 

on that use, because we do need to get it right. It kind of reminds 

me of the Denver hospital. The Denver hospital got kicked down 

the road for 13 years, the cost overruns, nobody ever had a plan. 

We finally got a plan together. Now we are going to finish it, but 

it is costing us a lot of money. I think it has cost and deprived veterans of a lot of benefits over the years by not having a Master 

Plan that we could follow. 

I also agree on the question on homelessness. I think it is an unbelievable opportunity to have some land that can be used to help 

veterans’ homelessness in West Los Angeles and Los Angeles County, California, and I support that entirely. I think Senator Feinstein has done a good job of raising to the attention of the Senate 

this piece of legislation, and we will move forward. But we want 

your input and support, so when the VA publishes their recommended Master Plan, I hope each and every one of you will get 

your organizations to quickly and efficiently give us your feedback 

on those plans. 

I am hoping as Chairman of this Committee that this will be a 

template for how we deal with other surplus land the VA owns 

around the country today. We are sitting on a ham sandwich starving to death, in my opinion, by having a lot of vacant property that 

could be benefiting us that is not because we do not have a plan. 

It is time we had a plan to see that that revenue went to the benefit of our veterans. 

On the Court, going to nine judges, I understand we have eight 

judges now? The ninth one would be a Presidential appointee? 

The legislation proposes the authority to take it to nine. My 

question, I guess I will start with Ms. Augustine. I happen to understand the backlog, and I think it is an important need, but at 

some point in time in the future, if that is not the necessary number of judges that we need, should that be a floating cap or should 

that be a permanent cap in terms of the number of judges? 

Ms. AUGUSTINE. Mr. Chairman, there is currently a great need 

to address the significant backlog, and until that is addressed and 

focused, I think it is smart to make that a permanent increase and 

then reevaluate that need as it is no longer needed down the road. 

There will be a significant backlog for the foreseeable future, and 

that should be our focus. 

Chairman ISAKSON. I want to thank all of you for your testimony 

regarding Senator Graham’s proposal on the Medal of Honor recipients. I happen to associate myself with the comments that each 

and every one of you made. 

One of the rules I have put in as Chairman of the Committee is 

that we do not do anything that we cannot pay for. We talk about 

billions of dollars and millions of dollars often. This is, as I understand it, a $16 million price tag to see to it that the Medal of Honor 

winners get enhanced compensation, which I happen to support as 

well. But if each and every one of you would give us any input on 

where you think we might take that money to pay it and offset the 

cost of that benefit, we would appreciate that very much. 

51 

With that said, we will go to the Ranking Member, Senator 

Blumenthal. 

Senator BLUMENTHAL. Thanks, Mr. Chairman. 

I think all this testimony has been enormously valuable, and I 

appreciate particularly, Mr. Norris, your mention of both homelessness and Post Traumatic Stress, PTS. In fact, the two are linked; 

are they not? 

Mr. NORRIS. Correct. 

Senator BLUMENTHAL. Because somebody who is suffering from 

PTS is more likely to also suffer from addiction, homelessness, lack 

of employment, or a combination of factors that in effect result 

from the medical condition, often invisible, obviously, that is the 

source of it. I appreciate your comments on that issue. 

Ms. Augustine, I also thank you for your support of all those 

measures, the five—or six, I should say, that you mention. On the 

numbers of veterans—well, the number of judges on the U.S. Court 

of Appeals for Veterans Claims, you rightly mention the likelihood 

of a continuing large caseload there. In fact, the caseload has been 

rising, has it not? 

Ms. AUGUSTINE. To my knowledge, yes, it has been rising. 

Senator BLUMENTHAL. That is in part the result of the VA doing 

better on disability claims at the first level because the more cases 

that are processed, the more likely there are to be appeals in higher numbers. Is that correct? 

Ms. AUGUSTINE. Yes, that is also what IAVA has supported in 

the past. 

Senator BLUMENTHAL. The increase, in my view, really ought to 

be a permanent one. It is always possible to contract the Court, but 

that number should not be a temporary one, in my view. 

Let me ask you about the Community Provider Readiness Recognition Act, which would recognize providers in the community for 

mental health care services. There is such a desperate shortage. I 

support this measure. I have some questions about possibly endorsing the use of certain community mental health providers who may 

not have the same training as VA providers. Do you have a suggestion as to how we can possibly address that shortcoming? 

Ms. AUGUSTINE. Yes, sir. I think the best case to do here is to 

utilize the success of the Star Behavioral Health Program in DOD 

and replicate those same successes in the VA. It has been a successful program for veterans in rural areas and the National 

Guard, and I think it is time that we open up those same successes 

to veterans. 

Senator BLUMENTHAL. Great. Great answer. With respect to the 

Veteran Housing Stability Act of 2015, I can see some people saying, well, we have already done so much on homelessness and 

housing. Do you have a response to them? 

Ms. AUGUSTINE. Yes, sir. Having spoken with your staff extensively about this bill, as I understand it, this bill is actually looking 

at the next stage of addressing veteran homelessness, not necessarily chronic homelessness or the immediate need for stable 

housing, but what is the next step. We applaud the long-term planning that this legislation focuses on and think that it is the correct 

thinking in looking at what needs to come next to prevent this 

same sort of epidemic from happening in the future. 

52 

Senator BLUMENTHAL. In fact, the goal here is to go beyond 

meeting the immediate, as you say, the urgent apparent need that 

may be on the streets right now, but to provide a more permanent 

solution, and that is the goal here, an equally difficult goal, but one 

that I think we have an obligation to solve. 

I thank every one of you for your testimony today. It has been, 

as I mentioned earlier, enormously valuable, and, again, thank you 

for your service to our country. 

Thank you, Mr. Chairman. 

Chairman ISAKSON. Senator Boozman. 

Senator BOOZMAN. Thank you, Mr. Chairman. 

Mr. Celli, Ms. Augustine, the VA voiced opposition to S. 717 with 

concerns of legal, credentialing, and privacy issues. Tell me a little 

bit, have your organizations looked into this as far as what it 

would take as far as credentialing and this and that. Can you comment a little bit further about that particular bill? 

Mr. CELLI. We have not specifically looked into the credentialing 

issue because we understand that VA does have a good 

credentialing program in place. However—and this bill is very comprehensive, as we discussed earlier on in the testimony. The American Legion knows that the current need is not being met. 

Senator BOOZMAN. Right. 

Mr. CELLI. We support any legislation that seeks to increase that 

need. We supported the Choice Act. We did support the Choice Act 

as a template to see where the VA needed some additional resources, and these are the types of pieces of legislation that are 

starting to address that and what was ferreted out by the Choice 

Act. 

Senator BOOZMAN. Ms. Augustine. 

Ms. AUGUSTINE. I would reiterate that and include once again 

utilizing the success of the Star Behavioral Health Program as a 

model to implement this for veterans. It has been proven to be effective, and I think that we can replicate those successes easily for 

veterans. 

Senator BOOZMAN. Very good. Ms. Augustine, tell me about—in 

your testimony, you mention the progress that we have made in 

homelessness in the VA and that they have been working hard to 

do that and that we are moving in the right direction. The West 

L.A. plan of having a strong community for veterans’ needs, which 

seems to be something that is very beneficial. 

Are there other areas of the country where you feel like the same 

plan would be effective? 

Ms. AUGUSTINE. I would be happy to provide your office with specific locations that our members have expressed concern. I do not 

have any in front of me today, but I would be happy to take it up 

with your office about things that our members are telling us. 

Senator BOOZMAN. Thank you. 

The rest of you guys? 

Mr. CELLI. If I may, Senator. Specifically in South Dakota, we 

are looking at some really great land out there. South Dakota is 

being downsized, and we think that there is an opportunity to have 

a Center of Excellence out there specifically for PTSD. I think that 

the VA needs to take a serious look at that. 

53 

Senator BOOZMAN. Very good. Well, thank you all so much for 

being here. We really do appreciate your advocacy and your hard 

work and all that you represent. 

Thank you, Mr. Chairman. 

Chairman ISAKSON. Thank you, Senator Boozman. 

Senator Tillis? 

Senator TILLIS. Thank you, Mr. Chair. Thank you all for what 

you do. 

I want to go back—well, first off, I should have mentioned when 

I was talking about bills, I thank Ranking Member Blumenthal for 

1885. I think it is a great idea, a great opportunity, the work on 

making sure that we have the partnerships with the right NGO’s 

to provide the service is something I look forward to working with 

you on, and I appreciate your efforts. 

I wanted to go back to the judges and the backlog. Again, I may 

have found a way to actually weave the Camp Lejeune toxic substance subject into this hearing after all. 

Chairman ISAKSON. Surprise, surprise. 

[Laughter.] 

Senator TILLIS. I promised you. Part of what I think we need to 

do, as long as we have the backlog that we do, then we need the 

judicial capacity to clear the backlog. It does raise a question about, 

to your knowledge, what kind of work has been done to try to reduce—get to the root causes of some of these appeals? 

For example, in the Lejeune instance right now, they have about 

an 87-percent decline rate. We are guessing it should probably be 

somewhere north of 50. I do not know the root causes of all the appeals, but do you all know of any particular areas where the experience rate that causes an appeal may raise questions about the 

criteria to begin with? I will go down the line and start with Ms. 

Augustine, if you have a comment. 

Ms. AUGUSTINE. As was mentioned earlier, as there has been an 

increase in the number of benefit claims submitted to the VA, there 

is naturally going to be an increase in the number of appeals submitted to the VA as well. I think Secretary McDonald has done a 

considerable amount of work in the past year to address some of 

the training, some of the dissemination of information issues that 

were seen earlier. I think that continuing on those education-minded fronts and continuing to train VA employees well, we will begin 

to see a decrease in the number of appeals. But until that time, the 

increase in appeals is going—or increase in benefit claims is going 

to have an increase in appeals. 

Mr. CELLI. As we all know, claims are a complicated business 

and so are appeals. When the appeal—if the claim is remanded to 

the Appeals Management Center (AMC) and the work is not done 

that the law judge says needs to be done, it just goes back to the 

Board, and it gets into this hamster wheel. There has to be a much 

healthier relationship between the Board and the AMC, and I know 

there is some legislation right now that seeks to address that. 

With regard to making those positions permanent, I guess on the 

day where we see that there are nine law judges that do not have 

enough to do, then maybe we can consider reducing it then. 

Mr. HARIG-BLAINE. That has not been an issue area that we have 

focused on. 

54 

Mr. NORRIS. I would like to refer this back to our Washington office to work with you on that. We have a representative here from 

our Washington office. Alex is back there, and maybe he can get 

with your staff and—— 

Senator TILLIS. Yes, I think—and this is not trying to find fault. 

I think I have developed a reputation for doing everything I can to 

work with the Department, so it is not necessarily faulting—I 

mean, they are doing what they are doing within the parameters 

that they have been given, but it is a question about do you go 

back and rethink it and either come up with an acceptable disposition that the veteran may accept and not seek an appeal, or find 

other circumstances where maybe they should have been granted 

their request for disability to begin with. It is more a matter of just 

looking at the processes and seeing if we are doing the best job we 

can. 

I also wanted to talk briefly—a couple of Committee hearings 

ago, we had the discussion about homelessness and the VA’s goal 

to end veterans’ homelessness or at least provide the capacity that 

we do not currently have. 

In your opinion, though, there is a very aggressive goal out there 

to end homelessness. Do you think current course and speed with 

the programs already in place, that we actually have the ability to 

meet the goal that the VA has set forth for ending homelessness 

or providing the capacity to support any homeless veteran in the 

United States? 

I may have to just go off script here for a minute. I cannot remember—Dr. Lynch, you may be able to help me remember the 

date—there is a specific date out there with the goal for being able 

to provide that capacity. Do you recall what that date was? 

Mr. HARIG-BLAINE. Senator, I could help you with that. 

Senator TILLIS. Thank you. 

Mr. HARIG-BLAINE. The U.S. Interagency Council on Homelessness, which is the lead entity, they have set out the Opening Doors: 

Federal Strategic Plan for Ending Homelessness, and they have 

identified the end of this year as the—— 

Senator TILLIS. I find that unimaginable given the discussion we 

are having about West L.A. I worked—and we were fortunate to secure another homeless vets facility just north of Raleigh. I think it 

is great to set stretch goals, but in this particular case, when you 

look back at the population that is not served today into the calendar, it does not seem to make sense. It makes me wonder whether or not we are using our resources wisely to attain that goal, and 

that could be a subject of maybe a future Committee meeting. 

The last thing I will say is just on crisis intervention. It relates 

somewhat to Senator Blumenthal’s bill. Over the weekend I am 

working on a situation that is actually not in my State. It just happened to stem out of a conversation I had with a special operator 

100-percent disabled vet who himself—he has his own issues, but 

he spends most of his days helping other vets, and he literally has 

someone living with him today because he called the crisis line, 

was explaining that he was in a very dangerous situation with his 

wife, he wanted to remove himself from that situation, and the person on the crisis line said that they could get back to him in 4 

days. Anybody who knows anything about domestic violence knows 

55 

it is in that moment, and we have to have the processes in place 

to deal with it in that moment. I am spending time this week with 

my staff to get to the bottom of it, but these sorts of situations are 

critically important for the veteran’s safety, for the spouse’s safety. 

It may just be an outlier, but I think it is something that we have 

to really look at. We are responding in a very timely basis, whether 

it is a suicide threat, whether it is a domestic violence threat. I do 

not know if we are using the wonderful resources we have at the 

VA in these sort of crisis situations to the fullest extent of their 

capabilities. 

Thank you, Mr. Chair. 

Mr. CELLI. Mr. Chairman, I recognize that we are out of time. 

Could I add one thing? 

Chairman ISAKSON. Absolutely. 

Mr. CELLI. One of the things that The American Legion is extremely concerned with is not only what is being called now ‘‘functional homelessness,’’ but also there is a category of homeless veteran that is not being recognized at all, and that is the veterans 

that do not qualify for VA services, those with ‘‘bad paper.’’ And the 

percentage of veterans that do not qualify for VA services is increasing as we lower the backlog or as we lower the homeless rate. 

So, we are looking at better than 10 percent of veterans that fall 

through a crack that will never be recognized until we step up and 

do something about that. 

Chairman ISAKSON. On the subject of veterans’ homelessness, I 

want to commend the Committee, because in 7 days we took Nominee Michaud and took him from a markup to approval today to be 

Under Secretary of Labor for Veterans’ Employment. Other than 

opioids, drugs, and pharmaceutical problems that our veterans 

have and PTSD and TBI, unemployment is a huge contributor to 

homelessness. I am going to talk to Secretary Perez, and Mr. 

Michaud has already assured both the Ranking Member and myself that his focus is going to be like a laser beam and immediate 

to see to it we get the employment programs together so our veterans have more and more opportunities for employment and jobs 

and less and less homelessness. 

We appreciate all your comments today. I appreciate all the 

members’ comments today. We will leave the record open—— 

Senator BLUMENTHAL. Mr. Chairman, may I just make one comment in response to—— 

Chairman ISAKSON. Senator Blumenthal. 

Senator BLUMENTHAL. I am sorry to interrupt. I apologize. 

I want to just follow up on the comment you made, Mr. Celli, 

about veterans with ‘‘bad paper.’’ You may know that there was a 

lawsuit brought by the Yale Law School legal clinic on behalf of a 

Connecticut veteran who suffered from PTS, received a less than 

honorable discharge, and for two decades suffered that black mark. 

He became addicted, unemployed, and homeless. His name is 

Conley Monk. 

He brought a lawsuit against the Department of Defense. I 

joined in the lawsuit. I supported it. And then I reached out to 

then-Secretary of Defense Hagel, who, after some consideration, responded positively and revised the internal procedures to enable 

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able discharges, in other words, ‘‘bad paper,’’—to seek review by 

the Boards of Appeals within the Department of Defense. The procedure is complicated. It is needlessly fraught with red tape. It is 

part of that cycle that often afflicts veterans. We are talking about 

veterans of past wars—Vietnam. Conley Monk was a veteran of 

Vietnam. When he was in Vietnam and for more than a decade 

later, ‘‘Post Traumatic Stress’’ was not a term in our vocabulary, 

not a diagnosis in medical circles. Only in the 1980s did it become 

really recognized, long after Conley Monk was denied the very 

medical services that he needed to overcome the PTS. He was doubly a victim in the discharge that resulted from PTS, acting up, 

and then from the denial of health care services that would have 

helped him overcome that PTS. 

I want to thank you for recognizing this very, very important 

topic. Ms. Augustine has very correctly recognized the need for us 

to conduct some oversight on the Clay Hunt bill. I think there is 

a need for us to conduct some oversight on the change in policy 

that I believe with the best of intents Secretary Hagel implemented 

and his successors have committed to follow. I would respectfully 

suggest to the Chairman—and we will have a chance to talk about 

it—that both of these oversight hearings and inquiries are very 

much appropriate. I just want to commend the VSOs for their help 

and support in recognizing this issue and problem. 

Thank you. 

Chairman ISAKSON. We will leave the record open for 7 days for 

any revision, extension of remarks, or any additional comments 

anybody wants to submit to the Committee. 

There being no further business to come before the Committee, 

we stand adjourned. 

[Whereupon, at 4:14 p.m., the Committee was adjourned.] 

(57) 

A P P E N D I X 

PREPARED STATEMENT OF HON. LAWRENCE B. HAGEL, CHIEF JUDGE, U.S. COURT OF

APPEALS FOR VETERANS CLAIMS

Mr. Chairman and Distinguished Members of the Committee: Thank you for the 

opportunity to comment on S. 1754, a bill that would amend 38 U.S.C. § 7253(a), 

to make permanent the authorization for an increase in the number of judges on 

the U.S. Court of Appeals for Veterans Claims (Court), from seven to nine. Succinctly stated, the Court supports this legislation and urges its passage. 

The decision by Congress several years ago to expand the Court temporarily to 

nine judges came in response to a significant increase in the Court’s caseload, and 

a perception that the rise was not simply a spike but in fact a trend. Effective December 31, 2009, authorization permitted the Court to grow to nine active judges, 

and we reached that full complement in December 2012. We were fortunate to operate with nine judges for almost three years until the retirement of one of our colleagues one month ago. With full staffing the Court has been able to conduct effective, efficient, and expeditious judicial review. Your support in providing the resources to handle our heavy caseload is very much appreciated. 

Under current law we will operate with eight judges until the next retirement, 

and then we revert to seven judges, our current permanent authorization. The reality is that two judges’ terms expire within days of each other in December 2016, 

so absent legislation the Court will dip to six judges at that time. With the unpredictability of the judicial nomination and appointment process, and another retirement likely in 2017, there is a very real possibility that the Court will shrink to 

five judges just two years from now. Passage of S. 1754 would permit a judicial appointment now to bring us back up to nine judges, and would prevent the Court 

from dropping to a critically low number of judges in the near future. 

Since its creation in 1988, the Court has become one of the Nation’s busiest Federal courts based on the numbers of appeals filed and decided per judge. Up until 

about ten years ago the Court received roughly 2,200 appeals annually. That number began to rise significantly starting in FY 2005, reaching over 4,700 appeals filed 

in FY 2009. Since that time, annual appeals filed have not fallen below 3,500 and 

although we are still tabulating FY 2015 numbers, we estimate that over 4,400 appeals were filed. This is double the number of appeals filed annually during the 

Court’s first 15 years from 1989 to 2004. 

For cases decided, the Court terminated in the neighborhood of 4,400 appeals in 

FY 2015. That is in addition to acting on nearly 3,000 applications for attorney fees, 

hundreds of petitions for extraordinary relief, and thousands of procedural motions. 

We continue to be one of the busiest national courts, but we are efficiently handling 

this formidable caseload. Generally speaking, appeals filed at the Court come from 

veterans who are dissatisfied with a decision of the Board of Veterans’ Appeals 

(Board). Much emphasis and financial support has been placed toward increasing 

the numbers of personnel at the Department of Veterans Affairs, and toward improving claims processing times. Up from 41,910 decisions in FY 2013, the Board 

issued 55,532 decisions in FY 2014, and the Board estimates that it will decide at 

least the same number in FY 2015. Although it is difficult to predict with certainty 

what our caseload will be in the future, it seems likely, considering the number of 

claims filed annually with VA and the increased productivity by the Board, that the 

number of appeals filed at the Court will also rise further and stay high. 

Over the past several years the Court has striven to create efficiencies in how we 

conduct judicial review of veterans’ appeals. We have adopted an electronic case filing and management system. We are constantly improving our pre-briefing mediation program to resolve cases earlier in the process, to hone the issues on appeal, 

and to stretch our judicial resources to the greatest extent possible. We have an active bar, and we engage frequently with our practitioners to discuss ways to further 

58 

improve our process. Everyone involved in judicial review of veterans’ appeals 

shares a common goal of wanting to honor our veterans and provide full, fair, and 

prompt decisions on their appeals. Authorization for nine active judges would be a 

significant factor in furthering that goal. 

In closing, on behalf of the Court, I express my appreciation for your past and 

continued support, and for the opportunity to provide this statement. 

LETTER FROM DARRELL G. KIRCH, M.D., PRESIDENT AND CHIEF EXECUTIVE OFFICER, 

THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES


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PREPARED STATEMENT OF ADRIAN M. ATIZADO, DEPUTY NATIONAL LEGISLATIVE

DIRECTOR, DAV 

Chairman Isakson, Ranking Member Blumenthal, and Members of the Committee: Thank you for inviting DAV (Disabled American Veterans) to submit testimony for the record of this legislative hearing, and to present our views on the bills 

under consideration. As you know, DAV is a non-profit veterans service organization 

comprised of nearly 1.3 million wartime service-disabled veterans. DAV is dedicated 

to a single purpose: empowering veterans to lead high-quality lives with respect and 

dignity. 

S. 717—THE COMMUNITY PROVIDER READINESS RECOGNITION ACT OF 2015

If enacted this bill would require the Department of Defense (DOD) and Department of Veterans Affairs (VA) to designate certain non-department mental health 

care providers, presumably in the community—but who are familiar with the needs 

of active duty servicemembers and veterans—as providers who have particular 

knowledge relating to mental health care of such individuals. 


106apAMC3.eps
61 

The bill would require the two departments to work together to establish criteria 

to determine eligibility of private practitioners to participate in treating these beneficiaries. The bill would specify the necessary eligibility criteria in broad, general 

terms, including familiarity with, and knowledge about, the military and veteran 

culture and experience, and of evidence-based treatments for mental health conditions prevalent in the active duty and veteran populations. Qualified candidates 

would receive a mental health provider ‘‘readiness’’ designation from DOD and VA 

under the terms of this bill. 

The bill would require both DOD and VA to establish and maintain a registry 

available to the public of all providers who would be so designated. The bill would 

specify certain mental health professions, but would permit the two departments to 

broaden the groups of professions that would be eligible to participate. 

The bill is silent on whether either DOD or VA would engage these readiness-designated practitioners in any out-referral of authorized contract care, or whether designation of such providers would imply these individuals would gain some level of 

government preference in treating servicemembers and veterans in private facilities 

at DOD or VA expense. 

The prospect of a private network of mental health providers operating outside 

either system and providing mental health services to active duty servicemembers 

as well as to veterans presents the potential for fragmenting these individuals’ DOD 

and VA direct care. Thus, the bill might be more effective if a new provision were 

added to require the departments to consider out-referrals to members of this designated group on a preferential basis in circumstances in which servicemembers and 

veterans are being referred by the two departments to outside mental health care. 

The sponsor may wish to consider the potential implications for servicemembers and 

veterans who receive direct, integrated care and services in DOD and VA facilities 

and make adjustments to the bill accordingly. 

DAV believes the best and latest expertise to provide military and veteran mental 

health services resides in DOD and VA, respectively. However, on the assumption 

that not every servicemember or veteran has ready access to DOD and VA direct 

care services for mental health, that some might be aided by the information the 

bill would require to be made public, and on the assumption that some individuals 

may not want to receive mental health services from direct DOD or VA sources, 

DAV would offer no objection to enactment of this bill. Nevertheless, we ask that 

our concerns be taken into consideration if the Committee intends to advance this 

bill. 

S. 1676—THE DELIVERING OPPORTUNITIES FOR CARE AND SERVICES FOR

VETERANS ACT OF 2015

This bill, in four titles, would increase the number of graduate medical education 

positions treating veterans, improve the compensation of health care providers, medical directors, and directors of Veterans Integrated Service Networks of the Department of Veterans Affairs, and establish new requirements to aid the care and services delivered to veterans in rural and remote areas. 

Section 101 of the bill would exempt VA from limiting additional appointments 

of medical and osteopathic residents when fulfilling the requirements of section 

302(b) of Public Law 113–146. Existing law, in title 42, United States Code, imposes 

a ceiling on hospital residency positions for cost-reporting purposes in the Federal 

graduate medical education program (which reimburses residency costs from Federal funds). This bill would authorize hospitals to disregard and not take into account these limitations when additional residency positions are established in VA 

to fulfill the requirements of Public Law 113–146. The section would make technical 

changes to effect this policy exemption. 

Section 102 of this bill would extend for an additional five years a mandate from 

Public Law 113–146 for VA to add 1,500 new medical residency positions to its existing graduate medical education program, and also would extend for the same period VA’s requirement to report periodic progress to Congress in increasing VA residency positions. 

Section 103 would establish a six-year pilot program of not less than three graduate medical education residency programs in behavioral medicine in underserved 

areas in the United States. Participating agencies would be VA, the Indian Health 

Service, and private and public hospital facilities that participate in the Medicare 

program. The bill would establish criteria for locating such residency programs, and 

would require an annual report to Congress to measure the progress of the pilot program, and any impediments encountered. 

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sonnel education programs. In including these two new categories of personnel, the 

bill would also require VA to apportion funds equally for each of the health occupations included in the existing program. 

DAV has not received a resolution from our membership on the specific purposes 

of this section; thus, DAV takes no formal position on the bill. Nevertheless, we are 

concerned that the bill would parse VA resources and require each occupation concerned in the personnel training program to receive an equal share of the resources 

to be spent overall. DAV believes the level of expenditures for each profession or 

technical field concerned should be determined by VA, not through an edict of law. 

A number of variables could come into play and potentially waste valuable resources 

if they were required to be obligated to one professional or technical field despite 

the requirements of the others. We recommend VA be afforded the flexibility to 

make these decisions to ensure resources are spent most effectively. 

We would also remind the Committee of DAV’s and VA’s prior testimonies dealing 

with the topic of marriage and family counselors and licensed mental health counselors, and their potential employment in VA. DAV has long agreed with VA’s position that these individuals from these professions could be employed in the Department’s mental health programs without further acts of Congress. 

Section 105 of this bill would also expand VA’s hiring authority to include hiring 

mental health counselors who are educated at the doctoral level. 

Title III of this bill would increase compensation levels of certain health care executives in the Veterans Health Administration. DAV takes no formal position on 

these provisions. 

Title IV of the bill (section 401) would require VA to establish a two-year pilot 

program to determine the feasibility and advisability of implementing a ‘‘nurse advice line’’ in rural and highly rural areas with significant veteran populations. The 

functions of the advice line would include providing medical advice, appointment 

and cancellation services, and information on the availability of benefits. This bill 

would require a VA report on the results of the pilot program, with specific parameters. 

DAV has received Resolution No. 226 from our members at the most recent DAV 

National Convention, calling on Congress to improve VA health care services to 

rural and remote veterans. Therefore, we support Title IV of the bill. 

S. 1754—THE VETERANS COURT OF APPEALS SUPPORT ACT OF 2015

This bill would permanently expand the number of judges authorized to preside 

over the United States Court of Appeals for Veterans Claims (CAVC) from seven 

judges to nine. 

The CAVC’s caseload averages roughly 4,600 cases per year. As a result, the 

CAVC has had one of the highest, if not the highest, caseloads per active judge of 

any Federal appellate court in the country. In response, the CAVC was authorized 

in 2008, as part of the Veterans Benefits Improvement Act, to expand temporarily 

from seven to nine judges as of January 2010. 

The authorization to increase the number of CAVC judges was set to expire at 

the end of 2012 if the positions were not filled within that timeframe. Fortunately 

for the CAVC, the two available vacancies were filled prior to the authority’s expiration date. Due to this temporary authorization the CAVC now stands at nine judges, 

an increase justified due the growing number of appeals. 

If these two temporarily authorized appointments become vacant, the CAVC is not 

authorized to replace them as restricted under title 38, United Stated Code, § 7253 

(i) (2), which sets the limit of judges to not more than seven. Allowing the number 

of judges to drop below nine would adversely impact the CAVC’s ability to make 

timely decisions because the remaining judges would be left to absorb the ongoing 

workload. 

DAV has no resolution to support this bill; however, because permanently expanding the number of judges would be in the best interest of veterans who rely on the 

Court to resolve their claims, we would not object to its favorable consideration. 

S. 1885—THE VETERAN HOUSING STABILITY ACT OF 2015

This bill would amend title 38, United States Code, by expanding service and assistance to include veterans who are homeless, at risk of becoming homeless, and 

veterans with very low income. This expansion would also include veterans transitioning to occupancy, and maintaining permanent residential occupancy. In addition, this bill would also expand the current definition of ‘‘covered veteran’’ to include a veteran who is enrolled in the VA homeless registry. 

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ing under the homeless veteran category, and those associated with it. It would establish reporting requirements to Congress. The bill would also designate intense 

case management sites in three locations with the highest homeless veteran populations across the United States, and three in suburban or rural areas totaling no 

fewer than six sites. 

This bill also would require the Secretary to utilize resources from within the 

community. It would require the Secretary to conduct outreach, educating those 

with resources relative to housing about the needs of veterans, and the benefits of 

having veterans as tenants, and build upon community relationships. The Secretary 

would be required to collaborate with other community service providers, particularly housing and urban development, public housing, tribally designated housing, 

realtors, landlords, property management companies, and developers. This bill 

would establish criteria to use in determining success or failure of the services 

provided. 

This bill would establish a VA National Center of Homelessness Among Veterans. 

The center would function as a clearinghouse and resource center, wherein all factors affecting veterans’ homelessness can be researched. The center would also provide oversight on the effectiveness of related programs, and provide a foundation for 

best practices in reducing homelessness. The center would open no later than September 1, 2016, with a report due to Congress no later than December 1, 2018. 

DAV is pleased to offer support of this bill. It is consistent with DAV Resolution 

No. 118, which calls for sustained and sufficient funding to improve services for 

homeless veterans. 

S. 2013—THE LOS ANGELES HOMELESS VETERANS LEASING ACT OF 2015

This bill would authorize the Department of Veterans Affairs (VA) to carry out 

certain leases at the VA’s West Los Angeles Campus in Los Angeles, California, for 

establishment of supportive housing; health, education, and family support; vocational training, and other services that principally benefit veterans and their families. The bill would also authorize a lease of real property to a California institution 

that has had a long-term medical affiliation with the VA at the Los Angeles campus. 

DAV has received no resolution from our membership; however, we would not be 

opposed to enactment of this bill. 

S. 2022—TO INCREASE THE AMOUNT OF SPECIAL PENSION FOR

MEDAL OF HONOR RECIPIENTS

The appropriate Secretary of the Army, Navy, Air Force, or Coast Guard is required to pay a special pension on a monthly basis to each living person whose 

name has been entered on the Medal of Honor (MOH) Roll. The base rate for this 

special pension is currently $1,000 per month. This payment increases based on 

changes in cost of living. 

This bill would increase the base rate of this special pension from $1,000 to 

$3,000. The bill also includes provisions that would govern the annual periodic increase of this benefit. 

The MOH pension is paid as a sole benefit or added to VA pension or compensation rates for veterans who were awarded the MOH for their distinguished military 

service. While DAV has no resolution to endorse this particular legislation, we 

would not object to its enactment, which would provide this increased benefit to 

these deserving members of our Armed Forces who have gone above and beyond the 

call of duty for our country. 

Mr. Chairman and Members of the Committee, this concludes DAV’s testimony. 

We thank the Committee for inviting DAV to submit this testimony for the record 

of this hearing. DAV is prepared to respond to any further questions by Committee 

Members on the positions we have taken with respect to the bills under consideration. 

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LETTER FROM GREGORY C. SCOTT, PRESIDENT & CEO, NEW DIRECTIONS

FOR VETERANS


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PREPARED STATEMENT OF DIANE BOYD RAUBER, ESQ., DIRECTOR OF LEGISLATIVE AND

REGULATORY AFFAIRS, NATIONAL ORGANIZATION OF VETERANS’ ADVOCATES, INC. 

On behalf of the National Organization of Veterans’ Advocates, Inc. (NOVA), I 

would like to thank Chairman Isakson and Ranking Member Blumenthal for the opportunity to provide written testimony for the record during a legislative hearing 

of the Senate Committee on Veterans’ Affairs on October 6, 2015. 

Our written testimony will address Senate Bill 1754, the ‘‘Veterans Court of Appeals Support Act of 2015.’’ 

VETERANS COURT OF APPEALS SUPPORT ACT OF 2015

NOVA supports S. 1754, the ‘‘Veterans Court of Appeals Support Act of 2015,’’ 

which makes permanent the temporary increase in the number of judges presiding 

over the U.S. Court of Appeals for Veterans Claims (‘‘Veterans Court’’). 

In 1988, Congress enacted the Veterans Judicial Review Act of 1988 (VJRA). The 

VJRA created an Article I court to provide judicial oversight to a veterans’ benefits 

adjudication process that had existed in ‘‘splendid isolation’’ from our legal system. 

Brown v. Gardner, 513 U.S. 115, 122 (1994) (quoting H.R. REP. NO. 100–963, pt. 

1, at 10 (1988), as reprinted in 1988 U.S.C.C.A.N. 5782). Veterans and their dependents have exercised their right to judicial appeal in growing numbers since the inception of the Veterans Court. 

To assist the Veterans Court, Congress provided for the recall of retired judges 

in 1999. The chief judge is authorized to recall a retired judge when ‘‘substantial 

service is expected to be performed.’’ 38 U.S.C. § 7257(b)(1). As one commentator 

noted, by 2007, the Veterans Court was frequently recalling retired judges. Michael 

P. Allen, The United States Court of Appeals for Veterans Claims at Twenty: A Proposal for a Legislative Commission to Consider Its Future, 58 CATH.U.L.REV. 361, 

371 n.54 (2009). Review of Miscellaneous Orders issued by the Veterans Court since 

2007 indicates it often continues to exercise this authority to meet its needs. See 

Miscellaneous Orders 2008–2015, United States Court of Appeals for Veterans 

Claims (available at https://www.uscourts.cavc.gov/miscellaneous—orders.php). 

In 2009, Congress further provided for assistance with a temporary increase in 

the complement of judges serving on the Veterans Court from seven to nine. Veterans Benefits Improvements Act of 2008, Pub. L. No. 110–389, § 601, 122 Stat. 

4145, 4176–77 (amending 38 U.S.C. § 7253). This authority expired on January 1, 

2013, and without further action, there will be no ability to appoint additional 

judges when the next two terms expire. 

There is ample support for making the temporary increase permanent. In an effort to reduce the much-publicized claims backlog, the VA has processed record 

numbers of claims in the past few years. According to the VA, their overall claims 

inventory was reduced from 883,930 to 366,648 during the period between July 13, 

2012 and September 26, 2015. In addition, the VA reports their ‘‘claims backlog,’’ 

i.e., the subset of the claims inventory representing claims ‘‘awaiting a rating decision for more than 125 days since receipt,’’ was reduced from 611,073 to 75,444 between March 25, 2013 and September 26, 2015. See Veterans Benefits Administration Status Reports (available at http://benefits.va.gov/REPORTS/detailed—claims— 

data.asp; last reviewed October 2, 2015). This action is resulting in an increasing 


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numbers of appeals to the Board of Veterans’ Appeals (Board) and, in turn, to the 

Veterans Court. 

Specifically, from FY 2010 through FY 2013, the Board dispatched an average of 

45,981 decisions per year. U.S. Department of Veterans Affairs, Board of Veterans’ 

Appeals Annual Report (Fiscal Year 2014) 28 (July 2015) (available at http:// 

www.bva.va.gov/docs/Chairmans_Annual_Rpts/BVA2014AR.pdf); Board of Veterans’ 

Appeals Annual Report (Fiscal Year 2013) 25 (available at http://www.bva.va.gov/ 

docs/Chairmans_Annual_Rpts/BVA2013AR.pdf). In FY 2014, the number of decisions dispatched jumped to 55,532. Board of Veterans’ Appeals Annual Report (Fiscal Year 2014) at 28. In its most recent Annual Report, the Board estimated it 

would physically receive 74,072 cases for consideration and potentially issue 57,600 

decisions in FY 2015. Id. at 21; 28. The number of decisions dispatched is expected 

to keep rising, particularly as the Board has significantly increased the number of 

staff attorneys in its employ and is authorized to expand the number of Board members from 64 to 78. 

In turn, the Veterans Court received an average of 3,988 appeals and petitions 

between FY 2010 and FY 2013. United States Court of Appeals for Veterans Claims, 

Annual Reports (Fiscal Year 2010–2013) (available at http://www.uscourts.cavc.gov/ 

report.php). In FY 2014, the number of appeals and petitions rose to 4,057. United 

States Court of Appeals for Veterans Claims, Annual Report (Fiscal Year 2014) 

(available at http://www.uscourts.cavc.gov/documents/FY2014AnnualReport06MAR 

15FINAL.pdf). If the Board’s projections are any indication, the demand on the Veterans Court is likely to grow at an accelerated rate. 

Veterans who seek redress before the Veterans Court have endured many years 

of agency processing and review while waiting for the compensation earned through 

their service and sacrifice. These long delays should not be increased due to judicial 

backlogs related to an understaffed Veterans Court. The Veterans Court should be 

equipped to handle the anticipated influx of cases with a suitable number of qualified judges. Passage of the Veterans Court of Appeals Support Act of 2015 is one 

essential way to tackle the avalanche of appeals just on the horizon. Anything less 

would be an injustice. 

For more information: NOVA staff would be happy to assist you with any further 

inquiries you may have regarding our views on this important legislation. For questions regarding this testimony or if you would like to request additional information, 

please feel free to contact NOVA Executive Director David Hobson by calling our 

D.C. office at (202) 587–5708 or by emailing David directly at dhobson@ 

vetadvocates.org. 

PREPARED STATEMENT OF BARTON F. STICHMAN, JOINT EXECUTIVE DIRECTOR, 

NATIONAL VETERANS LEGAL SERVICES PROGRAM

Mr. Chairman and Members of the Committee: Thank you for the opportunity to 

present the views of the National Veterans Legal Services Program (NVLSP) on 

pending legislation. This testimony focuses on S. 1754, which would make permanent the temporary increase in the number of judges presiding over the U.S. Court 

of Appeals for Veterans Claims. The temporary increase was to nine full-time judges 

and this bill would make that number of judges a permanent fixture at the Court. 

NVLSP is a nonprofit veterans service organization founded in 1980. Since its 

founding, NVLSP has represented over 2,000 appellants before the Court of Appeals 

for Veterans Claims. NVLSP is one of the four veterans service organizations that 

comprise the Veterans Consortium Pro Bono Program. In conjunction with the Consortium, NVLSP has, since 1992, recruited, trained, and mentored thousands of volunteer lawyers to represent on a pro bono basis veterans who have appealed a 

Board of Veterans’ Appeals decision to the CAVC without a representative. In addition, NVLSP publishes through Lexis Law Publishing the leading treatise on veterans law—the 1900-page Veterans Benefits Manual—that is regularly used by 

those who represent appellants before the CAVC. 

NVLSP supports passage of S. 1754. In the past several years, the caseload of the 

Court has increased significantly. In fiscal year 2013, the Court received 3,724 case 

initiations (3,531 appeals and 193 petitions for a writ of mandamus). In calendar 

year 2014, the Court received 4,438 case initiations. In the first nine months of calendar year 2015, the rate of case initiations further increased to an annual rate of 

4,988. Over the last several years, the Court has had nine full-time judges. Although the caseload has increased, the nine full-time judges have been able to continue to issue decisions within a reasonably short period of time after the briefs arrive in chambers for a decision. Given the rising caseload and the fact that it is likely to continue, allowing the number of full-time judges to fall below nine would 

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1See STATISTICS DIV., ADMIN. OFF. U.S. CTS., JUDICIAL BUSINESS OF THE UNITED STATES

COURTS: 2014 ANNUAL REPORT OF THE DIRECTOR, [hereinafter, U.S. COURTS 2014 REPORT] tbl. B– 

12, available at http://www.uscourts.gov/statistics-reports/judicial-business–2014. 2See id. 

threaten the progress the Court has made in issuing decisions within a short period 

of time. 

An additional reason for NVLSP’s support of S. 1754 involves the Court’s overuse 

of a shortcut in disposing of appeals—use of its statutory authority under 38 U.S.C. 

§ 7254(b) to decide cases by a single judge. Single-judge decisions are issued by the 

Court in the form of a ‘‘memorandum decision’’ and are not precedential. Only published opinions issued by a panel of three judges or more carry precedential value. 

See Bethea v. Derwinski, 2 Vet. App. 252 (1992). No other Federal court of appeals 

has authority to decide cases by single judge; all of these other courts of appeal decide cases in panels of three judges or more. Some of these three-judge decisions in 

the other Federal court of appeals are designated as precedential, while others are 

designated as non-precedential. 

In recent years, single-judge dispositions by the CAVC have come to dominate to 

a degree far greater than non-precedential decisions are used in the other Federal 

courts of appeals. In fiscal years 2013 and 2014, the CAVC issued a precedential 

decision (i.e., an appeal decided by a panel of three judges or more) in only 1.8% 

of the cases decided by chambers (75 of 4,221). By comparison, in fiscal year 2014, 

the Federal geographic courts of appeals handled 12% of judgments by a precedential opinion.1 Although there was some variance, no Federal court of appeals issued 

a precedential decision in less than 6% of its decisions.2

The relative lack of precedential decisionmaking by the CAVC is inconsistent with 

its role as a national judicial interpreter of the law. The Court’s aversion to precedential decisionmaking has an adverse impact on the claims adjudication process. 

The lack of precedential decisions that interpret the meaning of statutes and regulations leaves veterans, the VA regional offices, and the Board of Veterans’ Appeals 

without binding guidance on how these authorities should be interpreted. When the 

VA decides claims in situations where the law is not clear, it encourages veterans 

whose claims are denied to appeal to a higher authority. Thus, the lack of binding 

precedent on the proper construction of a statute or regulation exacerbates the existing backlog of pending appeals within VA and leads to inconsistent outcomes for 

similarly situated veterans. 

Shortly after the Court was created by Congress, the CAVC took reasonable steps 

to cabin its authority to dispose of an appeal by a single judge. It announced in 

Frankel v. Derwinski, 1 Vet. App. 20, 25–26 (1990) that a single-judge disposition 

was only appropriate if ‘‘the case on appeal is of relative simplicity’’ and 

1. does not establish a new rule of law; 

2. does not alter, modify, criticize, or clarify an existing rule of law; 

3. does not apply an established rule of law to a novel fact situation; 

4. does not constitute the only recent, binding precedent on a particular point of 

law within the power of the Court to decide; 

5. does not involve a legal issue of continuing public interest; and 

6. the outcome is not reasonably debatable. 

The CAVC continues to publicly embrace the Frankel criteria to this day. 

But a survey of the single-judge decisions issued by the Court in 2013 and 2014 

demonstrates that the Court is not faithful to these reasonable criteria. As the 

Court’s annual reports reflect, there are three possible outcomes to an appeal over 

which the Court has jurisdiction: the Board of Veterans’ Appeal decision denying 

benefits is either (1) affirmed, (2) reversed, or (3) vacated and remanded for further 

administrative proceedings. In calendar year 2013, the variance in the affirmance 

rates among the nine judges in a single-judge decision was between a low of 26% 

for one judge to a high of 65% for another judge. In other words, in 2013, the first 

judge was 2.5 times more likely to affirm a challenge to a BVA decision denying 

a claim for benefits than the second judge. In 2013, three of the nine full-time 

judges were each over twice as likely to affirm a challenge to a BVA decision denying a benefits claim as either of two other judges. 

The variance in the results of single-judge memorandum decisions in 2014 was 

just as great as it was in 2013. The judge with the highest affirmance rate (60%) 

in 2014 was the same judge who had the highest affirmance rate in 2013. The judge 

with the lowest affirmance rate (22%) in 2014 was the same judge who had the lowest affirmance rate in 2013. In 2014, as in 2013, the judge with the highest affirmance rate was over 2.5 times more likely to affirm a challenge to a BVA decision 

denying a claim for benefits than the judge with the lowest affirmance rate. In 2014, 

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four of the nine full-time judges as an aggregate were over twice as likely to affirm 

a challenge to a BVA decision denying a benefits claim as three of the other judges 

as an aggregate. 

A statistical analysis of the large variance in 2013 and 2014 in the affirmance 

rates among the nine CAVC judges is that the magnitude of the variance cannot 

be explained by chance. That is, the large variance shows that single judges in 2013 

and 2014 reached outcomes in some individual appeals that would result in a different outcome had the appeal been adjudicated instead by one or more of the other 

judges. This is compelling evidence that single judges issued a significant number 

of memorandum decisions in 2013 and 2014 that were ‘‘reasonably debatable,’’ in 

violation of the last Frankel criterion. 

Members of the Court’s Bar have communicated with the Court about the problems with the Court’s overuse of nonprecedential single-judge decisionmaking. 

NVLSP is hopeful that the Court will respond to this constructive criticism by adjusting its decisionmaking process so that, at minimum, the percentage of cases decided by a panel of three CAVC judges in a precedential opinion approximates the 

percentage of precedential cases decided by the other Federal courts of appeal. 

NVLSP believes that by providing the Court with a permanent roster of nine fulltime judges, S. 1754 will serve as a catalyst to encourage the Court to make this 

adjustment. The Committee should, however, consider amending S. 1754 by adding 

a requirement that the Court periodically report to the Senate and House Committees of Veterans Affairs about the steps it is taking to adjust its decisionmaking 

process so that the percentage of cases decided by a panel of three CAVC judges 

in a precedential opinion is equal to or exceeds the percentage of precedential cases 

decided by the other Federal courts of appeal. 

PREPARED STATEMENT OF PARALYZED VETERANS OF AMERICA

Chairman Isakson, Ranking Member Blumenthal, and Members of the Committee, Paralyzed Veterans of America (PVA) would like to thank you for the opportunity to submit our views on legislation pending before the Committee. We appreciate the Committee focusing on these issues that will affect veterans and their families. 

S. 717, THE ‘‘COMMUNITY PROVIDER READINESS RECOGNITION ACT OF 2015’’ 

PVA supports S. 717, the ‘‘Community Provider Readiness Recognition Act of 

2015.’’ This legislation would allow the Department of Defense (DOD) and the Department of Veterans Affairs (VA) to designate certain non-department mental 

health care providers as knowledgeable, comfortable, and understanding of the culture of members of the armed services. It would make available a registry of those 

mental health providers for servicemembers and veterans to use. Given the critical 

shortage of mental health providers within the VA, community providers are often 

the only option. Many may be ill-equipped to provide care specific to one’s military 

experience. By designating those culturally competent providers, VA can lessen the 

likelihood servicemembers and veterans will receive poorer quality care. 

S. 1676, THE ‘‘DELIVERING OPPORTUNITIES FOR CARE AND SERVICES FOR

VETERANS ACT OF 2015’’ 

PVA supports S. 1676, the ‘‘Delivering Opportunities for Care and Services for 

Veterans Act of 2015.’’ This legislation seeks to address workforce issues inhibiting 

the Department of Veterans Affairs from meeting the needs of veterans in rural 

areas. This bill would allow for the training and hiring of desperately needed medical and behavioral health providers at VA medical facilities. It would ensure that 

the additional 1,500 medical residency slots authorized by the Veterans Access, 

Choice, and Accountability Act of 2014 would not count toward the current cap put 

in place by the Balanced Budget Act of 1997 on Medicare-funded graduate medical 

education (GME) positions. Further, it would establish mental health residency programs between VA and Indian Health Services (IHS) and clarify that doctoral degrees be recognized when determining eligibility for mental health counselor positions. The veterans of Iraq and Afghanistan are the most rural veteran cohort since 

World War I. These men and women will continue to rely on the VA system for decades to come. This legislation will help to resource VA with critically needed providers and leadership. 

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S. 1754, THE ‘‘VETERANS COURT OF APPEALS SUPPORT ACT OF 2015’’ 

PVA in accordance with past recommendations of The Independent Budget supports S. 1754, the ‘‘Veterans Court of Appeals Support Act of 2015.’’ As pointed out 

in the current version of The Independent Budget, the Court of Appeals for Veterans 

Claim’s (CAVA) caseload averages roughly 4,600 cases per year making it have one 

of the highest, if not the highest, caseloads per active judge of any Federal appellate 

court in the country. Recognizing this challenge, in 2008 the CAVC was authorized 

to temporarily expand to nine judges. 

We ask the Committee and Congress to enact S. 1754 to permit a permanent increase in judge appointments to keep pace with an increasing caseload that PVA 

believes will continue to grow as the VA backlog is reduced. 

S. 1885, THE ‘‘VETERAN HOUSING STABILITY ACT OF 2015’’ 

PVA fully supports S. 1885, the ‘‘Veteran Housing Stability Act of 2015.’’ PVA has 

continuously supported improving the housing options for homeless veterans. Veterans have made this country strong and protected our way of life. It is unfortunate 

that many veterans, often faced with the challenges of mental illness and substance 

abuse, become trapped in the ravages of homelessness. 

The VA has had several successes in reducing homelessness among veterans, but 

there is still more that can be done. The proposed legislation will continue to improve on previous programs and also provide for some of the most at risk veterans 

through the provisions of Section 3’s program of intensive management interventions for veterans covered by the legislation. PVA’s greatest concern is that as has 

happened in the past, Congress dictates VA programs without an adequate increase 

in funding. While funding provisions are not included in the legislation, PVA welcomes the reporting requirements that would identify both the cost of carrying out 

the program, as well as an estimate of costs VA would have incurred for services 

had the program not existed. 

In addition, PVA welcomes efforts to improve the retention of housing by veterans 

that were formally homeless. Preventing veterans from becoming homeless in the 

first place should be the overarching goal of homeless programs. In the event a veteran becomes homeless and is able to acquire new housing, it is even more critical 

to break the cycle of homelessness to prevent them from becoming homeless again. 

PVA applauds these efforts as well as the expansion of housing assistance programs 

outlined in Section 5. 

America’s veterans are some of the most deserving citizens and it is critical that 

the Nation demonstrate their continuing care for those who have borne the battle, 

especially when they suffer from homelessness. 

S. 2013, THE ‘‘LOS ANGELES HOMELESS VETERANS LEASING ACT OF 2015’’ 

PVA supports S. 2013, the ‘‘Los Angeles Homeless Veterans Leasing Act of 2015.’’ 

This legislation would authorize the Department of Veterans Affairs (VA) to work 

with local governments and non-profits to enter into long-term lease agreements for 

the sole purpose of providing supportive housing to veterans. The services that must 

be furnished by the lease-holders include nutrition, health care, vocational training, 

child care and transportation. Similar leases have been used to develop housing at 

VA properties across the country. Los Angeles County has around 4,400 chronically 

homeless veterans, according to the Los Angeles Homeless Services Authority. This 

is the largest population of homeless veterans in the country. Given budget shortfalls for construction, this bill will allow VA to create new housing faster than the 

agency could on its own by partnering with local governments and non-profits. 

S. 2022

PVA supports the increase in the special pension for Medal of Honor recipients. 

As our most honored heroes, those who have earned this prestigious honor, deserve 

our greatest respect and support. 

Once again, we thank you for the opportunity to submit for the record. We look 

forward to working with the Committee to see these proposals through to final passage. We would be happy to take any questions you have for the record. 

PVA would like to thank you again for the opportunity to testify on the proposed 

legislation. We hope that the Committee will give these bills swift consideration and 

move them forward for consideration in the full Senate. We would be happy to answer any questions that you may have. 

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PREPARED STATEMENT OF ALEKS MOROSKY, DEPUTY DIRECTOR, NATIONAL

LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES

Chairman Isakson, Ranking Member Blumenthal and Members of the Committee, 

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

States (VFW) and our Auxiliaries, I would like to thank you for the opportunity to 

testify on today’s pending legislation. 

S. 717, THE COMMUNITY PROVIDER READINESS RECOGNITION ACT OF 2015

This legislation seeks to improve the private sector’s ability to provide culturally 

competent and evidence-based mental health care to servicemembers and veterans 

by establishing a Department of Veterans Affairs/Department of Defense (VA/DOD) 

mental health readiness program for private sector providers. The VFW agrees with 

the intent of this legislation, but cannot support the bill as written. 

In a recent study entitled ‘‘Ready to Serve’’ the RAND Corporation found that only 

13 percent of private sector mental health providers deliver culturally competent 

and evidence-based mental health care. The VFW is also concerned by RANDs findings that less than 18 percent of TRICARE affiliates and less than 50 percent of 

private sector providers who work in a military or VA setting met RAND’s readiness 

criteria. The VFW acknowledges that VA and the military health care systems may 

never have the resources or capacity to directly deliver timely mental health care 

to all the servicemembers and veterans they serve. Thus, the two systems have a 

vested interest to ensure the private sector is ready and able to provide high quality 

mental health care when such care is not readily available at military treatment 

facilities or VA medical facilities. 

The VFW supports the intent of the readiness program, however, we are concerned that a readiness designation would be interpreted by servicemembers and 

veterans as VA and DOD deeming providers who are listed in the readiness registry 

as participants in their respective private sector provider networks. This may result 

in servicemembers and veterans receiving care from providers on the registry, but 

not being covered for such services by VA or DOD. 

To ensure this does not occur, the VFW recommends that the Committee amend 

the legislation to limited program eligibility to private sector providers who have 

been approved to participate in the VA Choice network or the TRICARE network. 

This would incentivize providers to join VA and DOD networks and would increase 

readiness among private sector mental health care providers who treat servicemembers and veterans. 

However, the VFW would oppose making the readiness program a requirement 

for acceptance into VA’s or DOD’s private sector provider networks. Approval to participate in VA’s and DOD’s networks must continue to be based on a provider’s accreditation and license to practice medicine. 

S. 1676, THE DOCS FOR VETERANS ACT OF 2015

The VFW supports ten of the eleven sections included in this legislation which 

would improve the quality of health care for rural veterans. The VFW does not support section 202 as written, but would like to offer a suggestion to improve it. 

VA is the largest single provider of health professions education in the United 

States and is second only to Medicare and Medicaid in funding graduate medical 

education (GME). According to VA, more than 120,000 health professionals train in 

VA medical facilities annually and almost all VA medical facilities have some health 

professions trainees. To further increase VA’s role in training America’s health care 

workforce, the Veterans Access, Choice and Accountability Act of 2014 authorized 

VA to add 1,500 additional GME residency slots over five years. However, a Medicare imposed cap on GME slots has limited VA’s academic affiliates from accepting 

additional slots. We support removing that barrier to ensure VA continues to train 

America’s health care providers. This legislation also includes other provisions that 

would increase access to VA health care for rural veterans. With the growing number of veterans living in rural areas, the VFW supports efforts to ensure rural veterans have timely access to the health care they need. 

This legislation would also require that at least 30 percent of VA’s Education Debt 

Reduction Program beneficiaries practice medicine in rural or highly rural areas. 

While the VFW supports expanding health care access for rural veterans, we cannot 

support establishing a quota for this important program. The Education Debt Reduction Program enables VA to recruit and retain the best and brightest health care 

professionals throughout the country. Requiring VA to have 30 percent of program 

beneficiaries practice in rural areas may limit VA’s ability to recruit and retain 

health care professionals in areas or occupations with the greatest need. The VFW 

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recommends the Committee amend section 202 to ensure the Education Debt Reduction Program is appropriately dispersed among health care providers in urban, rural 

and highly rural areas without establishing quotas. 

S. 1754, THE VETERANS COURT OF APPEALS SUPPORT ACT OF 2015

The VFW supports this legislation, which would permanently increase the number 

of judges at the Court of Appeals for Veterans Claims (CAVC) from seven to nine. 

Under current law, the CAVC is authorized up to seven active judges, but temporary expansions of two additional judges were authorized in 2001 and again in 

2008. These expansions came in an effort to stagger the terms of the judges. The 

original members of the CAVC all had terms that ended at the same time. The temporary expansion allowed more judges to be appointed within a certain timeframe, 

with the thought that there would then be some judges on the court who had at 

least a few years of experience when the majority of the judges retired. Unfortunately, since the current cohort also have terms that end around the same time, the 

Court will soon be in a similar predicament. 

The current situation is as follows: Judge Moorman recently retired, bringing the 

Court down to eight members. The terms of Judge Hagel, Kasold, Schoelen, Davis, 

and Lance all expire in 2018 and 2019. Judges Greenberg, Pietsch and Bartley were 

all appointed in 2012 under the last expansion. 

While it is possible for judges to be reappointed, it is unlikely that more than two 

of the five whose terms expire in the next few years will seek or accept reappointment. The VFW believes that expanding the Court is necessary to avoid a circumstance where judicial nomination, which can be an intensive and politically 

fraught process, would reduce the number of members of the court. If the Court is 

temporarily reduced to five of the seven judges authorized while they wait for the 

nomination and installation process, the backlog of cases at the Court would almost 

certainly grow, along with veterans’ wait times. 

With over 318,000 total appeals pending at VA, the appeals to the Board and the 

Court will only continue to grow in the foreseeable future. The VFW believes that 

the CAVC must remain fully staffed in order to handle the coming workload. With 

this in mind, we believe it is both justified and prudent to permanently expand the 

number of judges at the CAVC. 

S. 1885, THE VETERANS HOUSING STABILITY ACT OF 2015

The VFW firmly believes that no veteran should ever be homeless. We praise the 

great progress that has been made in reducing veterans’ homelessness in recent 

years as a direct result of coordinated efforts across multiple government agencies 

to provide transitional housing, rapid rehousing, and employment programs for veterans in need. This legislation seeks to build on that progress by improving the benefits afforded to homeless veterans. The VFW supports this legislation and has a 

suggestion to improve it. 

This legislation would clarify the definition of homeless, thereby aligning it with 

the McKinney-Vento Act to include those displaced by domestic violence. Expanding 

the definition of homeless to include veterans who are fleeing situations of domestic 

abuse is the right thing to do. This change would ensure veterans who have the 

courage to leave their abusive and sometimes life-threatening situations receive access to the benefits VA already provides thousands of homeless veterans. The VFW 

believes this legislation will significantly improve the lives of those who become 

homeless as a result of difficult circumstances outside of their control, and help 

them begin a new chapter in their lives. 

This legislation would also provide case management services to veterans who are 

at risk of becoming homeless to ensure they are able to retain their housing. This 

legislation would expand other homeless programs to at risk veterans. The VFW believes that the best way to eliminate homelessness among veterans is through prevention. We fully support such expansion and believe it will enable the Administration to significantly reduce the number of homeless veterans. 

The VFW generally supports section 7, which would require the Secretary to establish a national center for homelessness among veterans. While the VFW recognizes the need for a center of excellence to collect and disseminate best practices, 

we are concerned the center may not have the ability to ensure VA medical facilities 

and regional offices utilize such best practices. For this reason, we suggest that this 

section include an operations and compliance mechanism to ensure the Department 

fully benefits from having a center of excellence that improves the benefits VA provides homeless veterans. 

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S. 2013, THE LOS ANGELES HOMELESS VETERANS LEASING ACT OF 2015

The national VFW supports the position of the Department of California VFW to 

quickly enact S. 2013. This legislation sets the course to return the Veterans Affairs 

West Los Angeles Campus to a campus that meets the intent of the land grant by 

providing services directly to veterans in the community. We look forward to its 

quick passage. 

S. 2022, TO AMEND TITLE 38, UNITED STATES CODE, TO INCREASE THE AMOUNT OF

SPECIAL PENSION FOR MEDAL OF HONOR RECIPIENTS, AND FOR OTHER PURPOSES. 

This legislation would increase the amount of special pension granted to Medal 

of Honor recipients from $1,000 to $3,000 per month, adjusted annually for inflation. Medal of Honor recipients are held in the highest esteem by the veterans and 

military community. These men have turned the tide of battle against overwhelming 

enemy forces, and saved the lives of their comrades at great risk to themselves. 

With only 78 Medal of Honor recipients alive today, increasing their pension would 

not create a significant cost, but would represent a small but meaningful token of 

our appreciation for their heroic actions. Accordingly, the VFW supports this legislation. 

Mr. Chairman, this concludes my testimony and I will be happy to answer any 

questions you or the Committee Members may have. 

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LETTER FROM REP. TED W. LIEU, U.S. MEMBER OF CONGRESS

FROM CALIFORNIA


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LETTER FROM STEPHEN PECK, MWS, PRESIDENT & CEO, UNITED STATES

VETERANS INITIATIVE


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LETTER FROM ORLANDO WARD, EXECUTIVE DIRECTOR OF PUBLIC AFFAIRS, 

VOLUNTEERS OF AMERICA—GREATER LOS ANGELES


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LETTERS SUBMITTED BY SENATOR DIANNE FEINSTEIN

LETTER FROM BOB BLUMENFIELD, COUNCILMEMBER, THIRD DISTRICT, 

CITY OF LOS ANGELES


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LETTER FROM JIM CRAGG, DIRECTOR, GREEN VETS LA 


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LETTER FROM JANET NAPOLITANO, PRESIDENT, UNIVERSITY OF CALIFORNIA


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LETTER FROM GARY TOEBBEN, PRESIDENT & CEO, LOS ANGELES AREA

CHAMBER OF COMMERCE


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LETTER FROM PAUL KORETZ, COUNCILMEMBER, FIFTH DISTRICT, 

CITY OF LOS ANGELES


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LETTER FROM MIKE BONIN, COUNCILMEMBER, ELEVENTH DISTRICT, 

CITY OF LOS ANGELES


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LETTER FROM ERIC GARCETTI, MAYOR, CITY OF LOS ANGELES


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LETTER FROM NAN ROMAN, PRESIDENT AND CEO, THE NATIONAL ALLIANCE TO

END HOMELESSNESS


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LETTER FROM GENE D. BLOCK, CHANCELLOR, UNIVERSITY OF CALIFORNIA, 

LOS ANGELES


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LETTER FROM MELANIE GIDEON, MHSA, DIRECTOR, UCLA HEALTH—OPERATION

MEND, EXECUTIVE ADVISOR, UCLA HEALTH SOUND BODY SOUND MIND


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LETTER FROM BEN ALLEN, SENATOR, 26TH DISTRICT, CALIFORNIA STATE SENATE


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94 

LETTER FROM MICHAEL BLECKER, EXECUTIVE DIRECTOR, SWORDS TO PLOWSHARES


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LETTER FROM JOSEPH ‘‘NICK’’ GUEST, ADJUTANT/QUARTERMASTER, VETERANS OF

FOREIGN WARS, DEPARTMENT OF CALIFORNIA


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LETTER FROM MEMBERS OF THE BOARD OF SUPERVISORS, COUNTY OF LOS ANGELES


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Æ 


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