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S. HRG. 111–123 

VETERANS ORGANIZATIONS’ PRIORITIES FOR 

THE 111TH CONGRESS 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

JANUARY 28, 2009 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

ROLAND W. BURRIS, Illinois 

ARLEN SPECTER, Pennsylvania 2

RICHARD BURR, North Carolina, Ranking 

Member 

LINDSEY O. GRAHAM, South Carolina 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

WILLIAM E. BREW, Staff Director 

LUPE WISSEL, Republican Staff Director 

2 Hon. Arlen Specter was recognized on May 5, 2009, as a majority Member. 

(III) 

C O N T E N T S 

JANUARY 28, 2009 

SENATORS 

Page 

Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 1 

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 2 

Sanders, Hon. Bernard, U.S. Senator from Vermont ........................................... 4 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 6 

Begich, Hon. Mark, U.S. Senator from Alaska ..................................................... 7 

Burris, Hon. Roland W., U.S. Senator from Illinois ............................................. 7 

Johanns, Hon. Mike, U.S. Senator from Nebraska ............................................... 5 

WITNESSES 

Dean Stoline, Assistant Director, National Legislative Commission, The 

American Legion .................................................................................................. 8 

Prepared statement .......................................................................................... 11 

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka ............................................................................... 26 

Hon. Bernard Sanders .............................................................................. 30 

Adrian M. Atizado, Assistant National Legislative Director, Disabled American Veterans ........................................................................................................ 30 

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

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka ............................................................................... 37 

Hon. Bernard Sanders .............................................................................. 43 

Todd Bowers, Director of Government Affairs, Iraq and Afghanistan Veterans 

of America ............................................................................................................. 44 

Prepared statement .......................................................................................... 46 

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka ............................................................................... 54 

Hon. Bernard Sanders .............................................................................. 58 

Carl Blake, National Legislative Director, Paralyzed Veterans of America ....... 59 

Prepared statement .......................................................................................... 61 

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka ............................................................................... 65 

Hon. Bernard Sanders .............................................................................. 69 

Dennis Cullinan, Director, National Legislative Service, Veterans of Foreign 

Wars ...................................................................................................................... 70 

Prepared statement .......................................................................................... 71 

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka ............................................................................... 73 

Hon. Bernard Sanders .............................................................................. 73 

John Rowan, President, Vietnam Veterans of America ....................................... 73 

Prepared statement .......................................................................................... 75 

Response to post-hearing questions submitted by: 

Hon. Daniel K. Akaka ............................................................................... 76 

Hon. Bernard Sanders .............................................................................. 76 

APPENDIX 

Stroup, Theodore G., Jr., LTG USA (Ret.), Vice President, Association of 

the United States Army; prepared statement ................................................... 87 

(1) 

VETERANS ORGANIZATIONS’ PRIORITIES FOR 

THE 111TH CONGRESS 

WEDNESDAY, JANUARY 28, 2009 

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

The Committee met, pursuant to notice, at 9:33 a.m., in room 

418, Russell Senate Office Building, Hon. Daniel K. Akaka, Chairman of the Committee, presiding. 

Present: Senators Akaka, Tester, Begich, Burris, Sanders, Burr, 

and Johanns. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, 

U.S. SENATOR FROM HAWAII 

Chairman AKAKA. Good morning. This hearing will come to 

order. 

Before we begin today’s hearing, I extend my warmest welcome 

and aloha to the three new Members of the Committee: Senator 

Mark Begich of Alaska, Senator Roland Burris of Illinois, and Senator Mike Johanns of Nebraska. I want to welcome you to this 

Committee and to tell you that we have a great year ahead of us. 

We have much to do and we will do it together. 

The addition of these new members has caused a temporary shift 

on the dais, as you can see. Until we can work out some space 

issues, I regret any inconvenience this causes to all Members, but 

you will see the adjustments as we move here to accommodate all 

the Members that we have now. 

Another housekeeping item, given additional Membership, is the 

revision of both the Committee rules and the Committee budget. 

The Committee’s Ranking Member, Senator Burr, and I intend to 

seek additional space and funds to bolster the ongoing oversight 

work which is so critical. Members will receive these documents 

shortly, and afterwards I will be polling regarding your support. 

For the information of all, the Committee will promptly hold 

nomination hearings on advice and consent position, so Secretary 

Shinseki can have his team in place as quickly as possible. It is my 

hope that the nomination for Deputy Secretary will be made very 

soon, and, immediately following that, I will schedule a hearing in 

consultation with Senator Burr. Other nominations will be bundled 

to make maximum use of the Committee’s time. 

Now to the immediate business at hand, today’s hearing offers a 

valuable opportunity for us to collect the priorities of the veterans 

groups and craft our legislative and oversight agenda for this session, which is why we have you all here this early. In the coming 

2 

months, all of the veterans service organizations will have more 

formal legislative presentations, but I believe we should hear key 

priorities now. I am also looking for interplay between the organizations to focus on what can and should be done in the short term, 

and what can wait for later in the session. 

We must, in this time of war, equip VA with the resources to 

carry its missions now and into the future. I have said this time 

and time again: veterans’ benefits and services are a cost of war 

and must be understood and funded as such. 

Many of our views are in agreement, and I believe that together 

we have established a good track record relating to VA. VA health 

care is, in many respects, the best in the Nation. I am proud that 

our collective work has contributed to the improvements in quality 

and access. 

Now, we must keep the momentum going. We must work to 

achieve President Obama’s goal of integrating more Priority 8 veterans back into the VA health care system while ensuring that 

enough resources are available to maintain the quality of care. 

As someone who knows firsthand the impact on education funded 

through the GI Bill can have, we must make certain that the recent improvements to this vitally important benefit are being effectively implemented. 

Timely and accurate adjudication of disability claims remains an 

issue. 

I expect that benefits reform, including a hard look at the current appellate process, the role of IT and reaching consensus on 

elements of compensation, will claim much of this Committee’s attention this Congress. 

There are some major legislative initiatives remaining from the 

previous session that I hope will be enacted this session. The Committee’s bipartisan health and personnel improvements bill, which 

I just reintroduced as S. 252, is important to this Nation’s veterans 

and to the thousands who work in VA hospitals and clinics 

throughout this Country. Some of you worked to include vital provisions in that bill such as enhancements to women’s health care 

and, for that, I am very grateful. 

In the near future, I will also introduce a modified version of 

S. 1315, an omnibus benefits bill, which passed the Senate last 

Congress. S. 1315 included benefits for both young and old veterans, including numerous modifications to VA’s insurance programs and benefits for Filipinos who served under U.S. command 

during World War II. 

I look forward to the statements of the witnesses and to working 

with each of the organizations in the 111th Congress. 

And I am glad, again, to be serving with my Ranking Member, 

and I now call on him for his statement. 

Senator Burr. 

STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA 

Senator BURR. Thank you, Mr. Chairman. Aloha. 

Chairman AKAKA. Aloha. 

Senator BURR. Let me thank you for calling this hearing and assembling these witnesses who I look forward to hearing from. 

3 

Let me congratulate the new faces, two on your side, one on our 

side. 

One thing that I think you will find very quickly is that this 

Committee is unlike others in the U.S. Senate. Care for our veterans and their loved ones is not a partisan issue. If I could borrow 

a sentiment from our former colleague who is now our Commanderin-Chief, the men and women who wear the uniform, the Nation’s 

uniform, do not come from a collection of red and blue States but 

from the United States. 

And I think that is 100 percent accurate. They expect us to leave 

politics aside when we act on their behalf, and I am committed to 

work with the Chairman and all the Committee Members toward 

that end. 

Again, I welcome those new members. 

This morning, we will listen to the views of some of the leading 

veterans service organizations on what their top priorities are for 

the 111th Congress. I often hear from VSOs from North Carolina 

who provide me with a local perspective of some of the challenges 

confronting our Nation’s veterans. The organizations with us this 

morning provide a voice to millions of veterans nationwide. Collectively, they are a valuable resource upon which we may draw as 

we develop any legislative and oversight agenda. 

I am anxious to hear your testimony, to work with you and other 

important organizations like AMVETS and Gold Star Wives on behalf of veterans and their survivors. 

Looking through the testimony this morning, I found there are 

some common themes from all of you: 

First, funding of the VA health care system is a top priority on 

everyone’s list. Let me say from the onset that I am in full agreement with the goals of providing VA a timely, predictable, and sufficient budget. I look forward to exploring ways we can accomplish 

these goals with our witnesses here today. In my view, funding for 

the VA health care system should never be a political issue. 

Second, fixing the disability system and the disability claims system is another common theme. Mr. Atizado of the DAV calls the 

system ‘‘complex and burdensome.’’ Mr. Blake with PVA states that 

the process is done in ‘‘an expensive and antiquated manner.’’ Complex, burdensome, expensive, antiquated—these are not flattering 

adjectives to describe a system that is designed to help veterans 

with injuries resulting from service. This is nothing new, and I 

hope all of us here today can get behind innovative approaches to 

fixing the system. 

Finally, Mr. Chairman, another theme is ensuring adequate 

mental health treatment for veterans who need help with PTSD 

and TBI. Clearly, building capacity is part of the effort, and the VA 

is in the midst of hiring additional mental health professionals, but 

we need to make sure we focus on getting veterans into VA for effective treatment early. 

Secretary Shinseki stated he believes PTSD is treatable and that 

early treatment is key. I agree, and I think every person here understands that. It is time we develop a strategy to implement the 

Veterans’ Disability Commission’s recommendations of ensuring 

that veterans with mental health problems receive that necessary 

treatment soon after that veteran is diagnosed. 

4 

Mr. Chairman, I stand ready with you and this Committee to address these priorities on behalf of Nation’s veterans and their loved 

ones. Our approaches to solving some of these problems may differ, 

but our goal is in fact the same. 

I thank the Chair. 

Chairman AKAKA. Thank you very much for your statement, Senator Burr, our Ranking Member. 

Now let me call on Senator Sanders for his statement. 

STATEMENT OF HON. BERNARD SANDERS, 

U.S. SENATOR FROM VERMONT 

Senator SANDERS. Thank you very much, Mr. Chairman. I will 

be brief. 

I believe that over the years we have made some substantial 

progress in the VA in general—VA health care in particular. 

I believe that in the last 2 years, under Chairman Akaka’s leadership, we have made some very, very significant changes. We just 

passed last year, as you know, the most significant changes in GI 

education that we have had since World War II, which will impact 

hundreds of thousands of soldiers who have served in Iraq and Afghanistan and their families. We have provided record-breaking VA 

health care budgets. We have increased mileage reimbursement 

rates. We have begun the effort to bring back the Priority 8s who 

were thrown out of the health care system some years ago. 

So we are making some progress, Mr. Chairman. I think we 

should be proud of what we have accomplished. 

And one of the reasons—one of the reasons—I believe that we 

have made progress is that there is now a very positive relationship between the VSOs—the veterans services organizations—who 

are on the ground, who bring to us the concerns that they are hearing from veterans, and us. And I think we have worked very closely 

with the veterans organizations, and it is absolutely imperative 

that we continue to do so. 

Just a few weeks ago, I had a meeting with about 25 veterans 

of my Veterans Advisory Committee in Vermont; and the goal of 

that is to hear from the ground what people are experiencing when 

they go into the clinics, when they go into the hospitals, what 

about the claims. 

So, we are making progress, but obviously we have a long way 

to go. And I think there is a general consensus—you mentioned it; 

Senator Burr mentioned it. There is a general consensus on some 

of the problems that remain and where we have to go. 

Advanced appropriations. It is hard to run one of the largest 

health care systems in the country, where you have tens of thousands of employees, if you do not have a sense of what you are anticipating next year. It’s very difficult to do. 

We need to continue, in my view, to bring Priority 8s back on a 

gradual basis into the system. 

We need to clearly, as you have heard, reform the claims system. 

In this day and age, with all of the computer technology that we 

have, it is not clear to me why it would take so long for veterans 

to get their claims processed. 

I think we have to move forward to an automatic enrollment in 

VA for members of the Guard and Reserve. 

5 

Here is an issue that we raised in Vermont, Mr. Chairman. I 

hope we can discuss it here, and I hope some of our friends will 

comment on it. In my State, there is not a whole lot of flexibility 

in terms of the hours in which veterans can get into clinics and get 

into the hospital. You know, many people work 9 to 5. Should there 

be evening hours? Should we be more flexible in making sure that 

our clinics and CBOCs are available to veterans? 

I think we want to move forward in making our VA facilities a 

leader in green buildings and energy efficiency. 

We want to make sure we can have the best services available 

in the world in the VA, but unless veterans know about those services they are not going to be able to access them. So we have to 

do a better job in performing outreach. 

We do not want to forget—while we focus on PTSD and TBI from 

Iraq—we do not want to forget about Gulf War Syndrome from the 

war in 1991. We have still have tens of thousands of soldiers who 

are suffering from that. 

So, the bottom line is: we are making progress. We have a long 

way to go. We will not be successful unless we work with the veterans organizations and unless they are giving us the best information possible about what is happening on the ground. 

We get stuck here in Washington a little bit. Your job is to tell 

us what you are hearing from people who are experiencing the VA 

in all of its dimensions. 

Mr. Chairman, thank you very much. 

Chairman AKAKA. Thank you very much, Senator Sanders, for 

your statement. 

And now I call on Senator Johanns for his opening statement. 

Senator Johanns. 

STATEMENT OF HON. MIKE JOHANNS, 

U.S. SENATOR FROM NEBRASKA 

Senator JOHANNS. Chairman Akaka and Ranking Member Burr, 

thank you very much for the opportunity to say a few words. My 

opening statement will be very brief because this is my first meeting, and it is the first opportunity I have had to be in a hearing 

setting with this Committee assignment. 

I want to say first of all, though, that it is an honor to be on this 

Committee. It is an honor to serve with this group and think about 

the needs of our veterans and how we meet those needs. 

I also want to say thank you for calling this hearing together. As 

I looked through the list of witnesses and the statements, it gives 

me an opportunity as a new member to learn from you as to what 

the needs are out there and what I need to be paying attention to 

in order to be a valuable Committee member. 

It reminds me a bit of something I did when I was Governor of 

Nebraska. I would bring veterans groups into the Governor’s Office 

on a regular basis, and we would just go around the table, and I 

would listen to them as to what their veterans needed, what they 

were facing out there. It just helped me in terms of developing an 

agenda as Governor. 

I see this hearing as that same sort of opportunity: an opportunity for me to listen; to think about the priorities as you identify 

6 

them; and then to work with you, Mr. Chairman and Ranking 

Member, to meet those needs. 

Thank you very much. 

Chairman AKAKA. Thank you very much for your statement, Senator Johanns. 

Let me call on Senator Tester for his opening statement. 

STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

Senator TESTER. Thank you, Mr. Chairman. I too want to thank 

you and the Ranking Member for calling this hearing, and I look 

forward to working with both of you as we move forward on veterans’ issues in this Committee. 

I also want to welcome the new Members to the Committee. This 

is a good Committee. It should be very interesting. It has been a 

very rewarding one for me in the last Congress, and hopefully it 

will be equally rewarding in this 111th. 

I also want to thank the members that are here to testify. Your 

opinions are very much appreciated. We appreciate your commitment to the veterans through your individual organizations and appreciate your guidance and your sacrifice in doing that. So, thank 

you very, very, much. 

We have over 100,000 vets in the State of Montana. That is quite 

high a percentage for a State of 950,000. The only State that probably has more is my fellow Senator here to my left, Senator Begich 

from Alaska. Veterans make up a high percentage of our population. Quite honestly, when I started this job, we went around and 

had hearings around the State of Montana, and I found out things 

that were absolutely unbelievable, and we were able to address 

many of them. 

As Senator Sanders said earlier, we have much more work to do. 

We just confirmed General Shinseki to the head of the VA. I supported that confirmation. I think he is a good man, and I think he 

is somebody that we all can work with. 

But, we have made a lot of promises which we have to continue 

to work on to make sure that we live up to. State-of-the-art medical 

facilities throughout this country are critically important for our 

veterans. Making sure that we address PTSD and TBI issues that 

are out there, that are real, and that are not going to go away— 

we have to be proactive in that. 

This is the first time in a decade that the VA appropriations was 

in place before the beginning of the fiscal year. I think that is a 

step in the right direction. We need to continue to work on that 

and make sure that the veterans of this country do not have to 

come back every year, hat in hand, begging for money. We need to 

make that budget firm and continuous. 

We need to continue innovation. The Ranking Member talked 

about innovation in the VA. It is critically important, particularly 

in rural America and in Indian country. We need to upgrade the 

VA’s IT infrastructure, so that there is better, easier access for our 

veterans in this country. 

And we need to deal with the backlogs in disability claims. It is 

a big issue, and hopefully we can do something about that in this 

Committee this year, Mr. Chairman. 

7 

It is not going to be easy. There are many challenges still out 

there for our veterans. I have talked to many of you about them. 

But I know one thing: If we work together—both sides of the aisle 

come together and you folks are at the table—we will do some good 

work. 

Thank you very much for being here. 

Chairman AKAKA. Thank you very much, Senator Tester. 

Again, I welcome our new member, Senator Begich from Alaska, 

for his opening statement. 

STATEMENT OF HON. MARK BEGICH, 

U.S. SENATOR FROM ALASKA 

Senator BEGICH. Thank you very much. Mr. Chairman and to the 

Ranking Member, thank you for the opportunity to be on the Committee. 

I am going to actually be very brief because I am very interested 

in each one of your presentations today. I have read some of the 

testimony that you will be presenting. I am excited to hear some 

of the ideas that you will have on how to improve our system. 

Again, I am going to be as brief as this and say thank you very 

much, Mr. Chairman. 

I am looking forward to your conversations, and I agree with 

many of the conversations that have already occurred in regards to 

the needs that we have within the system. It is one reason why I 

wanted to be on this Committee. As Senator Tester said, 11 percent 

of our population are veterans in my State, and that is a significant 

amount of our population. 

I look forward to your ideas. And I will tell you that my fatherin-law is a retired colonel. He has already sent me many articles 

out of the DAV Magazine to inform me of all the priorities you have 

and that I need to follow. So, already, you have an ally within the 

family. 

Thank you very much, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Begich. 

Now let me call on the Senator from the State of Illinois, Senator 

Burris, for his opening statement. 

STATEMENT OF HON. ROLAND W. BURRIS, 

U.S. SENATOR FROM ILLINOIS 

Senator BURRIS. Thank you very much, Mr. Chairman and Mr. 

Ranking Member. I hope we will not get our names mixed up with 

the ‘‘I-S’’ and no ‘‘I-S,’’ Senator Burr. 

Like my colleagues, I am very pleased to be able to be on this 

Committee. I am not a veteran, but I know so many in my community of Chicago. I am deeply concerned about how we have so many 

homeless veterans in our urban areas and what is happening with 

their health care. We must look at that and determine how we can 

assist these individuals. 

I hear horror stories about what is happening to the hospitals 

there in Chicago (the closed-up one), and how difficult it is for veterans to get services, and how far they have to travel to get to and 

from those veterans hospitals. 

These men and women have paid in blood and injury for our 

safety and our security in this great country, and we cannot neglect 

8 

them. We cannot not assist them as they try to carry out their lives 

and carry out their family lives. So you have an ally here too. 

Unfortunately, Mr. Chairman, I am going to have to duck out because I have another committee. I have their testimony. I will certainly read it and look forward to working with you and this great 

Committee. Thank you. 

Chairman AKAKA. Thank you very much, Senator Burris. 

And now I welcome our panel of witnesses representing veterans 

organizations. I appreciate your being here today and look forward 

to your testimony. 

First, I welcome Dean Stoline, Assistant Director of the National 

Legislative Commission for The American Legion. 

I also welcome Adrian Atizado, Assistant National Legislative Director for Disabled American Veterans. 

Additionally, I welcome Todd Bowers, Director of Government Affairs for Iraq and Afghanistan Veterans of America. 

I welcome also Carl Blake, National Legislative Director for Paralyzed Veterans of America. 

I welcome Dennis Cullinan, Director of the National Legislative 

Service for Veterans of Foreign Wars. 

And finally, I welcome John Rowan, President of the Vietnam 

Veterans of America. 

Thank you all for joining us today. Your full statements will be 

included and will appear in the record of the Committee. 

Mr. Stoline, will you please begin with your statement? 

STATEMENT OF DEAN STOLINE, ASSISTANT DIRECTOR, NATIONAL LEGISLATIVE COMMISSION, THE AMERICAN LEGION 

Mr. STOLINE. Thank you and aloha, Mr. Chairman, Senator Burr 

and Members of the Committee. 

Chairman AKAKA. Aloha. 

Mr. STOLINE. On behalf of The American Legion, I thank you for 

inviting us today to this hearing. 

To the new Members of the Committee, I welcome you. The 

American Legion stands ready to assist you and your staff with any 

questions you may have, and I am here to be the spearhead for the 

Legion to help you. 

The American Legion’s current legislative portfolio is over 200 

legislative items. We stand ready at any time to present oral and 

written testimony before the Committee on these issues. I would 

like to highlight from our written testimony several issues today. 

The first is the new GI Bill. We would like the Committee to ensure oversight over the implementation of this for the August 1st 

deadline. We are concerned both that the VA probably has not 

hired enough employees to implement it by that date, and we also 

have concerns about the development of the information technology 

that will support that in the out years. 

One item we would like to add for your consideration on GI Bill 

benefits is to add vocational and educational benefits equal to the 

GI Bill benefits for those who go to college. We think servicemembers who wish a career in other areas such as apprenticeships 

to plumbing and electricity or become law enforcement officers 

should have the same stipends and benefits that accrue to those 

who are going to a 4-year institution. 

9 

With regard to funding of the health care portion of the budget, 

The American Legion still remains desirous of mandatory funding. 

However, in partnership with other VSOs, we are now recommending the idea of advance appropriations. This would be a policy 

in which the budget would be provided to the VA 1 year in advance 

of the current fiscal year. 

We see this as positive because the VA would be able to plan for 

that budget for a year, and the Congress would be able to oversee 

the expenditures, because the VA would have knowledge of the 

amount of money they have for equipment and personnel a year 

ahead of time. 

With regard to disability compensation claims and adjudication, 

that is the one great challenge I think the Congress has this year. 

The backlog is ever growing and is outrageous, in our belief, and 

we do not see relief in sight at this time. 

We have testified in the past on the inadequate staffing levels of 

the VA, the inadequate training of the VA for its adjudicators and 

the management pressure on the employees to make decisions that 

are based on quantity rather than the quality of the review of the 

merits of the claim. 

We think that is a disservice to the veterans, and we would like 

you to take a look to improving both the staffing levels and the 

training for those employees and to have management be more concerned about a quality review at the first level of the claim rather 

than pass it on to the appeals level and put the veterans in the 

‘‘hamster wheel’’ of appeals and remands and 4 or 5 years before 

they finally get resolution of their claim. 

As for the current budget, we think it needs to be increased. We 

appreciate the last 2 years’ increase to the budget, but part of that 

budget was at the expense of over a million and one-half Priority 

8 veterans who could not enroll in the system. And we think that 

is an egregious error. 

We appreciate the fact that you did give funding this last year 

to start re-enrollment, but the job is not done. We would like to see 

the job for re-enrollment of all Priority 8s completed in this fiscal 

year. 

With regard to Traumatic Brain Injury, the GAO has acknowledged that there are clinical challenges to the VA. We support additional TBI research and funding so that they can have the diagnostic tests to properly screen these veterans. 

We are concerned about access to care for our rural veterans. As 

the Nation becomes more urbanized, the military forces are actually having more of their members come from the rural areas of the 

Nation. Right now, the nationwide figures are: one-in-five veterans 

who receive VA health care come from the rural areas; and this 

ratio is going to grow, particularly because the Reserve components 

come mainly from the rural areas. 

Consequently, The American Legion would like to see an increase 

in the Community-Based Outpatient Clinics, or CBOCs, particularly for veterans living in States like Nebraska, Nevada, Utah, 

South Dakota, Wyoming and Montana, because the veterans living 

in those areas face extremely long drives, a shortage of health care 

providers and bad weather conditions. 

10 

VA has an Office of Seamless Transition for veterans coming off 

the Iraq and Afghanistan wars. But we are concerned, particularly 

with Reserve components, that those servicemembers, as they come 

back from their duty, are not getting the proper training and information from VA on their rights and benefits. Consequently, we 

would like to see more emphasis in the VA to ensure a successful 

transition from military duty to civilian life. 

We would like an increase in medical research and prosthetics 

research because the VA has a unique understanding of the 

wounds that occur to veterans, but VA should be paying particular 

attention to the issues that are already at hand for veterans in the 

past. That includes prostate cancer, addictive disorders, wound 

healing, Post Traumatic Stress Disorder and other medical problems. We also believe they should cooperate more with other agencies like DOD in their research. 

With regard to the different environmental exposures that veterans have from different wars, The American Legion would like 

the Congress to be forcing the DOD to release more and more information about Agent Orange that was used outside of Vietnam. It 

is almost impossible to settle some of these Agent Orange claims 

and the diseases that arise from it without that information. 

With regard to the Gulf War illness veterans, we would like the 

VA to continue research with the recommendation of the Research 

Advisory Committee on Gulf War Veterans. We would like VA to 

focus not only on the treatment but also help alleviate the suffering 

of those veterans. 

With regard to the Atomic Veterans, The American Legion would 

like the dosage program rescinded because that program is not 

working. A lot of the results come back that say the veterans were 

exposed to low doses of radiation, and again it is very hard to complete a claim and adjudicate properly for the veteran. 

With regard to information technology policy, while we support 

additional funding, we want to make sure the privacy rights of the 

veterans are maintained and that the information is secure. 

With regards to the Filipino veterans, The American Legion has 

supported the Filipino Veterans Act for about 60 years. However, 

our issue with that is how they are paid. In our written testimony, 

we have given the Congress several ideas on how to properly fund 

the Filipino veterans without taking funds away from other 

veterans. 

With regard to the National Cemetery Administration, we support keeping the current 75-mile service area and 170,000 veteran 

population, but we ask the Congress to be advised of the increased 

driving times in urban areas that makes it harder for some families to get to the cemeteries. That should be taken into consideration as you site future cemeteries. 

The American Legion regards the number of veterans being hired 

in the Federal Government as too low. We think Congressional 

oversight over the hiring of veterans should be increased, particularly with VA and DOD, and at all levels of the government. For 

example, in the VA’s October magazine, of the latest three veterans 

law judges that were appointed, none of them were veterans, and 

we think that is egregious since they are the ones who make the 

final determination within VA on our claims. 

11 

Chairman AKAKA. Will you wrap up your statement, please? 

Mr. STOLINE. Yes, sir. 

The last thing I would like to say is we are concerned about 

homeless veterans, and we would like the grants increased. We 

would also like some provisions made for homeless female veterans 

and their families. 

Thank you for allowing us here today. 

[The prepared statement of Mr. Stoline follows:] 

PREPARED STATEMENT OF DEAN STOLINE, ASSISTANT DIRECTOR, NATIONAL

LEGISLATIVE COMMISSION, THE AMERICAN LEGION

Mr. Chairman and Members of the Committee: On behalf of The American Legion, I thank you for this opportunity to present today the legislative priorities of 

our 2.6 million members on issues under the jurisdiction of this Committee. 

Those mandates with legislative intent create the legislative portfolio of The 

American Legion for the 111th Congress. National Commander David K. Rehbein 

presented The American Legion’s proposals before the Joint Session of the Committees on Veterans’ Affairs held on September 11, 2008. 

Please note The American Legion’s current legislative portfolio contains more 

than 200 legislative resolutions and we stand ready to present oral and written testimony before your Committee on these issues. I will, however, take a moment to 

highlight those issues we see as the most significant matters to focus upon this Congressional session taken from the Commander’s testimony. 

The war on terrorism—Operations Iraqi Freedom (OIF) and Enduring Freedom 

(OEF)—has generated nearly one million discharged veterans, all of whom are guaranteed access to health care through the Department of Veterans Affairs (VA) for 

the first five years after their return home. Hundreds of thousands of OIF and OEF 

veterans are using their VA healthcare benefits, thus increasing the workload of a 

healthcare system that was overburdened before the war began. 

It is a sacred and time honored obligation of The American Legion to ensure these 

veterans have the services they need and timely access to the care they have 

earned. The American Legion, working with Congress, has made considerable 

progress in recent years to meet that obligation. We especially thank the Congress 

for the increased funding for the VA healthcare system, the greater attention being 

paid to mental health concerns, including Post Traumatic Stress Disorder (PTSD) 

and Traumatic Brain Injury (TBI) care which have become known as the ‘‘signature 

wounds’’ of the war we fight today, and the new GI BILL which recognizes the significant sacrifices today’s veterans make to ensure our Nation’s safety. To all those 

programs, Congress responded with needed funding. 

The American Legion applauds the 110th Congress for the FY 2009 funding allocations for many VA accounts that met or exceeded funding targets proposed by The 

American Legion. The process of providing adequate and compassionate services to 

our veterans is, as we all know, continuous. We must stay on top of the changes 

in health care, in technology, and foremost, among the veterans we serve. 

We continue to work with Congress to ensure that government agencies, particularly VA, have the resources to provide quality health care, disability compensation, 

rehabilitation services and transitional programs to all eligible veterans. We are 

making progress, but we are not there yet. 

For example, the outrageous backlog of VA benefits claims and appeals remains 

a source of continuous frustration nationwide. And while new attention has been 

given to mental health care for returning veterans, VA providers themselves say 

they cannot keep up with it all. In some communities, it is truly a crisis. 

Funds have been budgeted for new VA medical facilities that have only been in 

blueprints far too long. VA must move into the 21st Century, addressing the needs 

of a new generation of war veterans with unique needs now entering the system, 

but at the same time honor the service of—and provide caring for—those veterans 

of past wars and conflicts. 

With that in mind and on behalf of The American Legion, I offer the following 

recommendations to the Committee today. 

VETERANS HEALTH CARE

The American Legion continues to have concerns about the effects of current 

budgets on VA’s ability to deliver quality care in a timely manner. America’s veterans are turning to VA for their health care needs and, as we welcome home injured veterans from the current War on Terrorism, it is forever our responsibility 

12 

as advocates to work together to ensure VA is capable of treating all eligible prior 

war veterans as well. We especially want the Committee to take note of the impending retirement of the Vietnam War cohort of veterans. 

BUDGET REFORM

The annual discretionary appropriations in Fiscal Year (FY) 2008 and FY 2009 

represented a dramatic improvement over years of consistent budgetary shortfalls, 

but these funding levels were achieved only through dynamic leadership in both 

chambers. However, even these two outstanding appropriations did not follow the 

normal appropriations process—one was achieved through a year-long continuing 

resolution with significant markups for VA medical care and the second required the 

President to declare a need for emergency appropriations for VA medical care. 

With the influx of returning veterans from Iraq and Afghanistan, the demands 

for various clinical providers, nurses, medical care facilities and equipment are 

mounting. Assured funding is essential to proactively meet the challenges faced at 

VA medical facilities. The American Legion believes reform of the budget process 

for veterans’ health care would provide timely, predictable, and sufficient appropriations for VA medical care. 

For several years, The American Legion lobbied for the meaningful reform of the 

Federal appropriations process as recommended by the President’s Task Force to 

Improve Health Care Delivery for our Nation’s Veterans (in 2003). This Task Force 

clearly identified the consistent mismatch between VA health care funding and the 

growing demand for health care services. 

The American Legion and eight other major veterans’ and military service organizations joined forces to urge Congress to provide annual appropriations that are 

timely, predictable, and sufficient. These three components are critical for effective 

long- and short-range decisionmaking by VA management. The Partnership for Veterans Health Care Budget Reform supported legislation that would make VA health 

care funding mandatory rather than discretionary. Under this concept, VA health 

care funding would be formula-based, much like other mandatory programs like 

Medicare, Social Security, and VA disability compensation and pension benefits. 

This concept was met with great resistance by lawmakers on Capitol Hill; so The 

American Legion and its colleagues now recommend an alternative to mandatory 

funding—advance appropriations. The American Legion believes this change would 

assure timeliness and predictability. Under advance appropriations, VA medical 

care discretionary appropriations would be approved prior to the start of the next 

fiscal year. Should The American Legion have concerns about the sufficiency of the 

advance appropriations, it would have an opportunity to address any shortfalls 

while testifying for the remainder of the VA appropriations for that fiscal year. 

MEDICARE REIMBURSEMENTS TO VA

As do most American workers, veterans pay into the Medicare system, without 

choice, throughout their working lives, including when they are serving on active 

duty or serving in the reserve components of the Armed Forces. However, although 

veterans must pay into the Medicare system, VA is prohibited from collecting any 

Medicare reimbursements for the treatment of allowable, nonservice-connected medical conditions. Since over half of VA’s enrolled patient population is Medicare-eligible, this prohibition constitutes a multi-billion dollar annual subsidy to the Medicare 

Trust Fund. The American Legion opposes the current policy on Medicare reimbursement and asks Congress to allow Medicare reimbursement for VA for the 

treatment of allowable, nonservice-connected medical conditions by enrolled Medicare-eligible veterans. 

TRAUMATIC BRAIN INJURY (TBI)

A recent General Accountability Office (GAO) report acknowledged VA’s clinical 

challenges in its efforts to screen OEF/OIF veterans for mild TBI and evaluating 

those who screen positive on the TBI screening tool. The challenges include the lack 

of objective diagnostic tests, such as laboratory tests or neuroimaging tests like MRI 

and computer tomography (CT) scans that can definitively and reliably identify mild 

TBI. Other challenges include the similarity of many symptoms of mild TBI to 

symptoms associated with other conditions, making a definitive diagnosis of mild 

TBI more difficult to diagnose. Many OEF/OIF veterans with mild TBI might not 

even realize that they have an injury and should seek health care. 

Soldiers with mild Traumatic Brain Injury were more likely to report poor health, 

missed workdays, medical visits, and a high number of somatic and post concussive 

symptoms than were soldiers with other injuries. On the other hand, after adjustment for PTSD and depression, mild Traumatic Brain Injury was no longer signifiVerDate Nov 24 2008 20:32 Nov 04, 2009 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6621 H:\ACTIVE\012809.TXT SVETS PsN: PAULIN
13 

cantly associated with these physical health outcomes or symptoms, except for 

headache. 

Clearly additional funding for TBI research and treatment is warranted and 

should be appropriately funded. 

ACCESS TO CARE FOR RURAL VETERANS

Research conducted by VA indicated veterans residing in rural areas are in poorer 

health than their urban counterparts. It was further reported that nationwide, one 

in five veterans who enrolled to receive VA health care lives in rural areas. Providing quality health care in a rural setting has proven to be very challenging to 

VA, given factors such as limited availability of skilled care providers and inadequate access to care. Even more challenging will be VA’s ability to provide treatment and rehabilitation to rural veterans who suffer from the signature ailments 

of the on-going Global War on Terrorism—traumatic blast injuries and combat-related mental health conditions. VA’s efforts need to be especially focused on these 

issues. 

A vital element of VA’s transformation in the 1990s was the creation of Community Based Outpatient Clinics (CBOCs) that proximate access to VA primary care 

within veterans’ communities. Recently, VA scheduled the opening of 44 additional 

CBOCs in 21 states. The new clinics will be fully activated in 2009, increasing VA’s 

network of independent and community-based clinics to 782. The American Legion 

believes the clinics are warranted due to the growing population of veterans within 

rural areas of the Nation. More veterans are also migrating to less populated areas 

with an abundance of automobiles, which are the primary catalysts that transport 

Improvised Explosive Devices (IEDs) in Iraq. 

While VA has taken the right step with the addition of more CBOCs, The American Legion believes more are warranted. There continues to be great difficulty serving veterans in rural areas, such as Nebraska, Nevada, Utah, South Dakota, Wyoming, and Montana where veterans face extremely long drives, a shortage of health 

care providers, and bad weather. VISNs rely heavily upon CBOCs to close the gap. 

SEAMLESS TRANSITION

VA has an Office of Seamless Transition that is available to participate in Department of Defense (DOD), National Guard and Reserves Transition Assistance Programs (TAP) and Disabled Transition Assistance Programs (DTAP). However, The 

American Legion remains concerned that many servicemembers returning home 

from OEF/OIF duty are not being properly advised of the benefits and services 

available to them from VA and other Federal and State agencies. This is especially 

true of Reserve and National Guard units that are demobilized at hometown Reserve Centers and National Guard armories, rather than at active duty demobilization centers. 

The American Legion recommends this Committee continue its oversight of VA to 

ensure that all recently separated veterans, to include Reserve components servicemembers are provided appropriate current and future plans and policies for a successful transition of the Nation’s heroes from active duty to civilian life. 

MEDICAL AND PROSTHETICS RESEARCH

The American Legion believes VA’s focus in research should remain on understanding and improving treatment for conditions that are unique to veterans. Servicemembers are surviving catastrophically disabling blast injuries due to the superior armor they are wearing in the combat theater and the timely access to quality 

triage. The unique injuries sustained by the new generation of veterans clearly demand particular attention. VA must be funded to provide and maintain state-of-theart prostheses. 

The American Legion also supports adequate funding of other VA research activities, including basic biomedical research and bench-to-bedside projects. This Committee should continue to encourage acceleration in the development and initiation 

of needed research on conditions that significantly affect veterans—such as prostate 

cancer, addictive disorders, trauma and wound healing, Post Traumatic Stress Disorder, rehabilitation, and other medical problems jointly with DOD, the National Institutes of Health (NIH), other Federal agencies, and academic institutions. 

14 

ENVIRONMENTAL EXPOSURES

Agent Orange 

One of the top priorities of The American Legion has been to ensure that long 

overdue major epidemiological studies of Vietnam veterans who were exposed to the 

herbicide Agent Orange are carried out. 

The Institute of Medicine (IOM) report, Characterizing Exposure of Veterans to 

Agent Orange and Other Herbicides Used in Vietnam, is based on the research conducted by a Columbia University team. Headed by principal investigator Dr. Jeanne 

Mager Stellman, the team has developed a powerful method for characterizing exposure to herbicides in Vietnam. The American Legion is proud to have collaborated 

in this research effort. In its final report on the study, the IOM urgently recommends that epidemiological studies be undertaken now that an accepted exposure 

methodology is available. The American Legion strongly endorses this IOM report. 

The IOM’s most recent report on veterans’ herbicide exposure in Vietnam, Veterans and Agent Orange: Update 2006, released July 27, 2007, added two new illnesses to the category of ‘‘limited or suggestive evidence of association,’’ AL amyloidosis and hypertension. This is a profound finding since many Vietnam War veterans suffer from hypertension. 

The ‘‘limited or suggestive’’ evidence finding meets the threshold of a positive association between the exposure of humans to a herbicide agent and the occurrence 

of a disease in humans, as set forth in title 38, United States Code § 1116, and has 

been used by VA to add other conditions, including type 2 diabetes, to the list of 

herbicide presumptive disabilities. Although the Secretary of Veterans Affairs, in 

violation of specific reporting requirements set forth in § 1116, has yet to publish 

his official determination regarding this latest IOM report in the Federal Register, 

The American Legion received a letter from the Secretary on June 26, 2008, informing our organization that AL amyloidosis is the only condition, based on the July 

2007 IOM report, that would be added to the list of disabilities presumed to be service-connected due to herbicide exposure. The Secretary specifically stated that he 

has ‘‘determined that the evidence available at this time does not warrant the establishment of a new presumption of service connection based on service in Vietnam 

for any additional diseases reviewed in the NAS report.’’ 

Since, at of the time of this writing, the Secretary has not published a notice of 

his determination in the Federal Register, which will include an explanation of the 

scientific basis for that determination; The American Legion is unable to comment 

on the reasoning behind VA’s decision not to recognize hypertension as presumptively service-connected to herbicide exposure among Vietnam veterans. Rest assured we will carefully review the Secretary’s determination once it is published in 

the Federal Register and will take appropriate action, including, but not limited to, 

seeking a legislative remedy to correct this injustice. 

The American Legion is extremely concerned about the timely disclosure and release of all information by DOD on the use and testing of herbicides in locations 

other than Vietnam during the war. Over the years, The American Legion has represented veterans who claim to have been exposed to herbicides in places other than 

Vietnam. Without official acknowledgement by the Federal Government of the use 

of herbicides, proving such exposure is virtually impossible. Information has come 

to light in the last few years leaving no doubt that Agent Orange, and other herbicides contaminated with dioxin, were released in locations other than Vietnam. This 

information is slowly being disclosed by DOD and provided to VA. 

Obtaining the most accurate information available concerning possible exposure 

is extremely important for the adjudication of herbicide-related disability claims of 

veterans claiming exposure outside of Vietnam. For herbicide-related disability 

claims, veterans who served in Vietnam during the period of January 9, 1962 to 

May 7, 1975 are presumed by law to have been exposed to Agent Orange. Veterans 

claiming exposure to herbicides outside of Vietnam are required to submit proof of 

exposure. This is why it is crucial that all information pertaining to herbicide use, 

testing, and disposal in locations other than Vietnam be released to VA in a timely 

manner. Congressional oversight is needed to ensure that additional information 

identifying involved personnel or units for the locations already known by VA is released by DOD, as well as all relevant information pertaining to other locations that 

have yet to be identified. Locating this information and providing it to VA must be 

a national priority. 

Gulf War Illness 

Gulf War research is moving away from the previous stress theories and is beginning to narrow down possible causes. However, research regarding viable treatment 

options is still lacking. The American Legion applauds Congress for having the foreVerDate Nov 24 2008 20:32 Nov 04, 2009 Jkt 000000 PO 00000 Frm 00018 Fmt 6633 Sfmt 6621 H:\ACTIVE\012809.TXT SVETS PsN: PAULIN
15 

sight to provide funding to the Southwestern Medical Center’s Gulf War Illness research program. The Center was awarded $15 million, renewable for five years, to 

further the scientific knowledge on Gulf War Veterans Illnesses research. This research will not only impact veterans of the 1991 Gulf War, but may prove beneficial 

for those currently serving in the Southwest Asia Theater and the Middle East. 

VA must continue to fund research projects consistent with the recommendations 

of the Research Advisory Committee on Gulf War Veterans’ Illness (RACGWI). It 

is important that VA continues to focus its research on finding medical treatments 

that will alleviate veterans’ suffering as well as on figuring out the causes of that 

suffering. 

Public Law 103–210, which authorized the Secretary of Veterans Affairs to provide priority health care to the veterans of the Persian Gulf War who have been 

exposed to toxic substances and environmental hazards, allowed Gulf War Veterans—and veterans of the Vietnam War—to enroll into Priority Group 6. The last 

sunset date for this authority was December 31, 2002. Since this date, information 

provided to veterans and VA hospitals has been conflicting. Some hospitals continue 

to honor Priority Group 6 enrollment for ill Gulf War veterans seeking care for their 

ailments. Other hospitals, well aware of the sunset date, deny Priority Group 6 enrollment for these veterans and notify them that they qualify for Priority Group 8. 

To these veterans’ dismay, they are completely denied enrollment because of VA’s 

restricted enrollment for Priority Group 8 since January 2003. Even more confounding is the fact that eligibility information disseminated via internet and printed materials does not consistently reflect this change in enrollment eligibility for 

Priority Group 6. VA has assured The American Legion that this issue will be 

rectified. 

Although these veterans can file claims for these ailments and possibly gain access to the health care system once a disability percentage rate is granted, those 

whose claims are denied cannot enroll. According to the May 2007 version of VA’s 

Gulf War Veterans Information System (GWVIS), there were 14,874 claims processed for undiagnosed illnesses. Of those undiagnosed illness claims processed, 

11,136 claims were denied. Due to their nature, these illnesses are difficult to understand and information about individual exposures may not be available, many 

ill veterans are not able to present strong claims. They are then forced to seek care 

from private physicians who may not have enough information about Gulf War Veterans’ illnesses to provide appropriate care. 

VA notes that veterans may still be granted service connection, if evidence indicates an association between their diseases and their exposures. This places the burden of proof on Gulf War veterans to prove their exposures and that the level of 

exposure is sufficient enough to warrant service connection. IOM and VA have acknowledged that there is insufficient information on the use of the identified solvents and pesticides during the Gulf War. 

VA states that Public Law 105–277 does not explain the meaning of the phrase, 

‘‘known or presumed to be associated with service in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War’’ and that there is no 

legislative history explaining the meaning of the phrase. VA has had adequate time 

to get Congress to clarify the statute’s intent and should have clarified the intent 

prior to delivering a charge to the IOM for the report. VA’s interpretation is that 

Congress did not intend VA to establish presumptions for known health effects of 

all substances common to military and civilian life, but that it should focus on the 

unique exposure environment in the Persian Gulf during the war. The IOM was 

commissioned to ascertain long-term health effects of service in the Persian Gulf 

during the war, based on exposures associated with service in theater during the 

war as identified by Congress, not exposures unique to the Southwest Asia Theater. 

The determination to not grant presumption for the ailments identified should be 

based solely on the research findings, not on the legitimacy of the exposures identified by Congress. 

The IOM has a similar charge to address veterans who served in Vietnam during 

the war. Herbicides were not unique to the operations in the Southeast Asia theater 

of conflict and there had not been, until recently, a definitive notion of the amounts 

of herbicides to which servicemembers had been exposed. Peer-reviewed, occupational studies are evaluated to make recommendations on which illnesses are associated with exposure the herbicides—and their components known to be used in theater. For ailments that demonstrate sufficient evidence of a causal relationship, sufficient evidence of an association, and limited evidence of an association, the Secretary may consider presumption. Gulf War and Health Volume 2 identifies several 

illnesses in these categories. However the Secretary determined that presumption 

is not warranted 

16 

VA needs to clearly define what type of information is required to determine possible health effects, for instance clarification of any guidance or mandate for the research. VA also needs to ensure that its charge to the IOM is specific enough to 

help it make determinations about presumptive illnesses. VA noted that neither the 

report, nor the studies considered for the report identified increased risk of disease 

based on episodic exposures to insecticides or solvents and that the report states no 

conclusion whether any of the diseases are associated with ‘‘less than chronic exposure,’’ possibly indicating a lack of data to make a determination. If this was necessary, it should have been clearly identified. 

Finally, Section 1118, title 38, U.S.C., mandates how the Secretary should respond to the recommendations made in the IOM reports. The Secretary is required 

to make a determination of whether or not a presumption for service connection is 

warranted for each illness covered in the report no later than 60 days after the date 

the report is received. If the Secretary determines that presumption is not warranted for any of the illnesses or conditions considered in the report, a notice explaining scientific basis for the determination has to be published in the Federal 

Register within 60 days after the determination has been made. Gulf War and 

Health, Volume 2 was released in 2003, four years ago. Since then, IOM has released several other reports and VA has yet to publish its determination on those 

reports as well. 

The American Legion urges VA to provide clarity in the charge for the IOM reports concerning what type of information is needed to make determinations of presumption of service connection for illnesses that may be associated with service in 

the Gulf during the war. 

The American Legion urges VA to get clarification from Congress on the intent 

of the phrase ‘‘known or presumed to be associated with service in the Armed Forces 

in the Southwest Asia theater of operations during the Persian Gulf War,’’ get clarification from the IOM committee to fill in as many gaps of information as possible, 

and re-evaluate the findings of the IOM report with the clarification provided. 

The American Legion also urges Congress to provide oversight to ensure VA provides timely responses to the recommendations made in the IOM reports. 

Atomic Veterans 

Since the 1980s, claims by Atomic Veterans exposed to ionizing radiation for a 

radiogenic disease, for conditions not among those listed in Section 1112(c)(2), title 

38, U.S.C., have required an assessment to be made by the Defense Threat Reduction Agency (DTRA) as to nature and amount of the veteran’s radiation dosing. 

Under this guideline, when dose estimates provided are reported as a range of doses 

to which a veteran may have been exposed, exposure at the highest level of the dose 

range is presumed. From a practical standpoint, VA routinely denied the claims by 

many atomic veterans on the basis of dose estimates indicating minimal or very lowlevel radiation exposure. 

As a result of the court decision in National Association of Radiation Survivors 

v. VA and studies by GAO and others of the U.S.’s nuclear weapons test program, 

the accuracy and reliability of the assumptions underlying DTRA’s dose estimate 

procedures have come into question. On May 8, 2003, the National Research Council’s Committee to Review the DTRA Dose Reconstruction Program released its report. It confirmed the complaints of thousands of Atomic Veterans that DTRA’s dose 

estimates have often been based on arbitrary assumptions resulting in underestimation of the actual radiation exposures. Based on a sampling of DTRA cases, it 

was found that existing documentation of the individual’s dose reconstruction, in a 

large number of cases, was unsatisfactory and evidence of any quality control was 

absent. The Committee concluded their report with a number of recommendations 

that would improve the dose reconstruction process of DTRA and VA’s adjudication 

of radiation claims. 

The American Legion was encouraged by the mandate for a study of the dose reconstruction program; nonetheless, we are concerned that the dose reconstruction 

program may still not be able to provide the type of information that is needed for 

Atomic Veterans to receive fair and proper decisions from VA. Congress should not 

ignore the National Research Council’s findings and other reports that dose estimates furnished VA by DTRA over the past 50 years have been flawed and have 

prejudiced the adjudication of the claims of tens of thousands of Atomic Veterans. 

It remains practically impossible for Atomic Veterans or their survivors to effectively challenge a DTRA dose estimate. 

It is not possible to accurately reconstruct the radiation dosages to which these 

veterans were exposed. The process prolongs claims decisions on ionizing radiation 

cases, ultimately delaying treatment and compensation for veterans with fatal diseases. Therefore, The American Legion believes the dose reconstruction program 

17 

should not continue. We urge the enactment of legislation to eliminate this provision 

in the claim of veterans with a recognized radiogenic disease who were exposed to 

ionizing radiation during military service. 

Mustard Gas Exposure 

In March 2005, VA initiated a national outreach effort to locate veterans exposed 

to mustard gas and Lewisite as participants in chemical warfare testing programs 

while in the military. For this recent initiative, VA is targeting veterans who have 

been newly identified by DOD for their participation in the testing, most of which 

had participated in programs conducted during WWII. DOD estimated 4,500 servicemembers had been exposed. 

The American Legion has been contacted by veterans who contend that the number of participants identified was understated by tens of thousands and that participation in these clandestine chemical programs extended decades beyond the World 

War II era. Investigators have not always maintained thorough records of the 

events; adverse health effects were not always annotated in the servicemember’s 

medical records; and participants were warned not to speak of the program. Without 

adequate documentation of their participation, participants may not be able to prove 

their current ailments are related to the testing. 

It is important DOD commits to investigating these claims as they arise to determine if they have merit. It is also important VA commit to locating those identified 

by DOD in a timely manner, as many of them are WWII era veterans. Congressional oversight may be necessary to ensure these veterans are granted the consideration they deserve. 

BLINDED VETERANS

There are approximately 38,000 blind veterans enrolled in the VA health care system. Additionally, demographic data suggests that in the United States, there are 

over 160,000 veterans with low-vision problems and eligible for Blind Rehabilitative 

services. Due to staffing shortages, over 1,500 blind veterans will wait months to 

get into one of the 10 blind rehabilitative centers. 

VA currently employs approximately 164 Visual Impairment Service Team (VIST) 

Coordinators to provide lifetime case management to all legally blind veterans and 

all OEF/OIF patients and 38 Blind Rehabilitative Outpatient Specialists (BROS) to 

provide services to patients who are unable to travel to a blind center. The training 

provided by BROS is critical to the continuum of care for blind veterans. The DOD 

medical system is dependent on VA to provide blind rehabilitative services. 

The American Legion urges VA to increase funding for more Blind Rehabilitative 

Outpatient Specialists. 

MEDICAL CONSTRUCTION AND INFRASTRUCTURE SUPPORT

Major Construction 

The CARES process identified approximately 100 major construction projects in 

the VA Medical Center System, the District of Columbia, and Puerto Rico. Construction projects are categorized as major if the estimated cost is over $10 million. Now 

that VA has disclosed the plan to deliver health care through 2022, Congress has 

the responsibility to provide adequate funds. VA has not had this type of progressive 

construction agenda in decades. Major construction money can be significant and 

proper utilization of funds must be well planned. However, if timely completion is 

truly a national priority, The American Legion continues to have concerns due to 

inadequate funding. 

In addition to the cost of the proposed new facilities are many construction issues 

that have been ‘‘placed on hold’’ for the past several years due to inadequate funding, and the moratorium placed on construction spending by the CARES process. 

One of the most glaring shortfalls is the neglect of the buildings sorely in need of 

seismic correction. This is an issue of safety. The delivery of health care in unsafe 

buildings cannot be tolerated and funds must be allocated to not only construct the 

new facilities, but also to pay for much needed upgrades at existing facilities. Gambling with the lives of veterans, their families and VA employees is absolutely 

unacceptable. 

The American Legion believes VA has effectively shepherded the CARES process 

to its current state by developing the blueprint for the future delivery of VA health 

care—we urge Congress adequately fund the implementation of this comprehensive 

and crucial undertaking. 

18 

Minor Construction 

VA’s minor construction program has also suffered significant neglect over the 

past several years. Maintaining the infrastructure of VA’s buildings is no small task 

due to the age of these buildings, continuous renovations, relocations and expansions. A slight hesitation in provision of funding leaves a profound impact. 

The American Legion recommends Congress adequately fund the implementation 

of this program. 

Information Technology Funding 

Since the data theft occurrence in May 2006, the VA has implemented a complete 

overhaul of its Information Technology (IT) division nationwide. Although not quite 

from its beginning stages, The American Legion is hopeful VA takes the appropriate 

steps to strengthen its IT security to renew the confidence and trust of veterans who 

depend on VA for the benefits they have earned. 

Within VA Medical Center Nursing Home Care Units, it was discovered there was 

conflict with IT and each respective VAMC regarding provision of Internet access 

to veteran residents. VA has acknowledged the Internet would represent a positive 

tool in the veteran’s rehabilitation. The American Legion believes Internet access 

should be provided to these veterans without delay, for time is of the essence in the 

journey to recovery. In addition, veterans should not have to suffer due to VA’s gross 

negligence in the matter. 

The American Legion believes there should be a complete review of IT security 

government wide. VA isn’t the only agency within the government requiring an 

overhaul of its IT security protocol. The American Legion urges Congress to exercise 

its oversight authority and review each Federal agency to ensure that the personal 

information of all Americans is secure. 

The American Legion supports the centralization of VA’s IT. The quantity of work 

required to secure information managed by VA is immense. The American Legion 

urges Congress to maintain close oversight of VA’s IT restructuring efforts and fund 

VA’s IT to ensure the most rapid implementation of all proposed security measures. 

COMPENSATION AND PENSION

Veterans Benefits Administration 

VA has a statutory responsibility to ensure the welfare of the Nation’s veterans, 

their families, and survivors. Providing quality decisions in a timely manner has 

been, and will continue to be one of VA’s most difficult challenges. 

Claims Backlog & Staffing 

In FY 2007, more than 2.8 million veterans received disability compensation benefits. Providing quality decisions in a timely manner has been, and will continue to 

be, one of the VA’s most difficult challenges. A majority of the claims processed by 

the Veterans Benefits Administration’s (VBA) 57 regional offices involve multiple 

issues that are legally and medically complex and time consuming to adjudicate. 

As of August 9, 2008, there were 618,314 claims pending in VBA, 394,201 of 

which are rating cases. There has been a steady increase in VA’s pending claim 

backlog since the end of FY 2004 when there were 321,458 rating cases pending. 

At the end of FY 2007, there were more than 391,000 rating cases pending in the 

VBA system, up approximately 14,000 from FY 2006. Of these, more than 100,000 

(25.7 percent) were pending for more than 180 days. Including non-rating claims 

pending, the total compensation and pension claims backlog was more than 627,000, 

with 26.5 percent of these claims pending more that 180 days. 

There were also more than 164,000 appeals pending at VA regional offices, with 

more than 142,000 requiring some type of further adjudicative action. At the end 

of FY 2007, the average number of days to complete a claim from date of receipt 

(182.5 days) was up 5.4 days from FY 2006. 

Inadequate staffing levels, inadequate continuing education, and pressure to make 

quick decisions, resulting in an overall decrease in quality of work, has been a consistent complaint among regional office employees interviewed by The American Legion staff during regional office quality checks. It is an extreme disservice to veterans, not to mention unrealistic, to expect VA to continue to process an ever increasing workload, while maintaining quality and timeliness, with the current staff 

levels. The current wartime situation provides an excellent opportunity for VA to 

actively seek out returning veterans from OEF and OIF, especially those with service-connected disabilities, as well as veterans from prior wars, for employment opportunities within VBA. Despite the recent hiring initiatives, regional offices will 

clearly need more personnel given current and projected future workload demands. 

VBA must be required to provide better justification for the resources it says are 

19 

needed to carry out its mission and, in particular, how it intends to improve the 

level of adjudicator training, job competency, and quality assurance. 

The American Legion recommends Congress increase VBA staffing levels, provide 

appropriate training support for these employees and increase the number of veterans of all wars hired in the VA. 

Production vs. Quality 

Since 1996, The American Legion, in conjunction with the National Veterans 

Legal Services Program (NVLSP), has conducted quality review site visits at more 

than 40 regional offices for the purpose of assessing overall operation. This Quality 

Review Team visits a regional office for a week and conducts informal interviews 

with both VA and veterans service organization (VSO) staff. The Quality Review 

Team then reviews a random sample of approximately 30–40 recently adjudicated 

American Legion-represented claims. The Team finds errors in approximately 20– 

30 percent of cases reviewed. 

The most common errors include the following: 

• Inadequate claim development leading to premature adjudication of claim; 

• Failure to consider reasonably inferred claims based on evidence of record; 

• Rating based on inadequate VA examination; and/or 

• Under evaluation of disability (especially mental conditions). 

These errors are a direct reflection of VA’s emphasis of quantity over quality of 

work. This seems to validate The American Legion’s concerns that emphasis on production continues to be a driving force in most VA regional offices, often taking priority over such things as training and quality assurance. Clearly, this frequently results in premature adjudications, improper denials of benefits and inconsistent 

decisions. 

VETERANS’ DISABILITY BENEFITS COMMISSION

In October 2007, after almost 21⁄2 years of study, the Veterans’ Disability Benefits 

Commission (VDBC or Commission), released its extensive report, Honoring the Call 

to Duty: Veterans’ Disability Benefits in the 21st Century, to the President and Congress. Due to the history surrounding the establishment of the Commission, The 

American Legion and others in the VSO community feared that it would be used 

as a tool to restrict veterans’ benefits. In fact, key Members of Congress and other 

Federal Government officials publicly expressed their desire to use the VDBC as a 

vehicle to institute radical changes in the VA disability system that would negatively impact and restrict entitlement to benefits for a large number of veterans. 

The American Legion closely monitored the Commission’s activities and provided 

written and oral testimony, as well as other input. 

The American Legion appreciates the Commission’s hard work and commitment 

and we are generally pleased with its recommendations. As the final report contains 

113 recommendations, this statement will focus, for the most part, on recommendations that will directly impact the disability compensation system as well as those 

addressed as high priority in the Executive Summary. 

The American Legion looks forward to working with Congress and VA to implement many of these recommendations. 

Filipino Veterans 

The American Legion fully supports the Filipino Veterans Equity Act and has testified in support of this legislation on a number of occasions for several years. The 

American Legion’s objection rests with how Congress plans to pay for larger bill that 

contains the Filipino Equity Act provision. In order to meet its PAY GO obligations, 

Congress plans to repeal the Hartness v. Nicholson decision. In fact, some Filipino 

veterans may very well benefit from the Hartness v. Nicholson decision; especially 

should the Filipino Veterans Equity Act become law. By repealing this decision, 

Congress would be denying one group of veterans (elderly, disabled homebound) 

an earned benefit to give another group of veterans (the Filipino veterans and others) benefits. The American Legion believes it is wrong and sets an unacceptable 

precedence. 

There is nothing that would prevent Congress from next year, repealing the Filipino Equity Act to use that money to pay for some other group of veterans. Such 

a ‘‘rob Peter to pay Paul’’ scheme clearly dishonors and disrespects all veterans involved. Even worse, it pits veterans against veterans. Thus, while The American Legion strongly supports the Filipino Veterans Equity Act, it cannot support this proposed PAYGO funding stream. Congress must not make a grave mistake in the 

name of fairness, equality or eve fiscal responsibility. 

20 

We urge Congress to do what is right. It has other funding options—not just the 

repeal of Hartness v. Nicholson but can waive the budget rules, which Congress has 

already done to fund other bills; or pass the Filipino Veterans Equity Act as part 

of an emergency supplemental appropriations. 

National Cemetery Administration 

The mission of the National Cemetery Administration (NCA) is to honor veterans 

with final resting places in national shrines and with lasting tributes that commemorate their service to this Nation. The American Legion recognizes NCA’s excellent record in providing timely and dignified burials to all veterans who opt to be 

buried in a National Cemetery. We also recognize the hard work that is required 

to restore and maintain National Cemeteries as national shrines and applaud NCA 

for its commitment and success toward that endeavor. 

The American Legion supports the ‘‘75-mile service area/170,000 veteran population’’ threshold that currently serves as the benchmark for establishing a new national cemetery. However, driving (commuting) times should be considered as innercity traffic can significantly increase travel times to distant cemeteries and driving 

time needs to be factored in when trying to determine if the veteran population is 

being served effectively. 

National Cemetery Expansion 

According to NCA’s estimates in the President’s budget request for FY 2009, annual interments will increase to 111,000, a 10 percent rise from FY 2007. Interments in FY 2013 are expected to be about 109,000, a 9 percent increase from FY 

2007. The total number of graves maintained is expected to increase from almost 

2.8 million in FY 2007 to over 3.3 million in FY 2013. The American Legion recommends that monies for additional employees be included in the budget. 

VOCATIONAL REHABILITATION AND EMPLOYMENT SERVICE (VR&E)

The mission of the VR&E program is to help qualified, service-disabled veterans 

achieve independence in daily living and, to the maximum extent feasible, obtain 

and maintain suitable employment. The American Legion fully supports these goals. 

VA leadership must focus on marked improvements in case management, vocational 

counseling, and—most importantly—job placement. 

Interagency Cooperation between DOL-VETS and VA 

It is our experience that the interagency collaboration and communication between the VR&E program, and the Department of Labor (DOL) Veterans Employment and Training Service (VETS) is lacking. The American Legion recommends exploring possible training programs geared specifically for VR&E Counselors through 

the National Veterans Training Institute (NVTI). Contracting for standardized or 

specialized training for VR&E employees could very well strengthen and improve 

overall program performance. 

Veterans’ Preference in Job Placement 

The Federal Government has scores of employment opportunities that educated, 

well-trained, and motivated veterans can fill given a fair and equitable chance to 

compete. Working together, all Federal agencies should identify those vocational 

fields, especially those with high turnover rates, suitable for VR&E applicants. 

There are three ways veterans can be appointed to jobs in the competitive civil service: by competitive appointment through an OPM list of eligibles (or agency equivalent); by noncompetitive appointment under special authorities that provide for conversion to the competitive service; or, by Merit Promotion selection under the Veterans Employment Opportunities Act (VEOA). The American Legion recommends 

the number of veterans in the Federal Government be increased. 

Provide military occupational skills and experience translation for civilian employment counseling 

The American Legion notes that due to the current demands of the military, 

greater emphasis on the Reserve component of the Armed Forces created employment hardships for many Reservists. The American Legion supports amending Section 4101(5), title 38, U.S.C., to add Subsection (D) to the list of ‘‘Eligible Persons’’ 

for Job Counseling, Training, and Placement Service for Veterans, to include members in good standing of Active Guard and Reserve Units of the Armed Forces of 

the United States who have completed basic and advanced Duty for Training 

(ACDUTRA) and have been awarded a Military Occupation Specialty. 

DOD provides some of the best vocational training in the Nation for its military 

personnel and establishes measures and evaluates performance standards for every 

occupation with the Armed Forces. There are many occupational career fields in the 

21 

Armed Forces that can easily translate to a civilian counterpart. Many occupations 

in the civilian workforce require a license or certification. In the Armed Forces, 

these unique occupations are performed to approved military standards that may 

meet or exceed the civilian license or certification criteria. Upon separation, many 

former military personnel, certified as proficient in their military occupational career, are not licensed or certified to perform the comparable job in the civilian workforce, thus hindering chances for immediate civilian employment and delaying career advancement. This situation creates an artificial barrier to employment upon 

separation from military service. 

A study by the Presidential Commission on Servicemembers’ and Veterans’ Transition Assistance identified a total of 105 military professions where civilian 

credentialing is required. The most easily identifiable job is that of a Commercial 

Truck Driver in which there is a drastic shortage of qualified drivers. Thousands 

of veterans must venture through each state’s laws instead of a single national test 

or transfer of credentials from the military. We have testified alongside members 

of the trucking industry to Congress for the need for accelerated MGIB payments 

for these courses and other matters. 

The American Legion supports efforts to eliminate employment barriers that impede the transfer of military job skills to the civilian labor market, and supports 

efforts to DOD take appropriate steps to ensure that servicemembers be trained, 

tested, evaluated and issued any licensure or certification that may be required in 

the civilian workforce. The American Legion supports efforts to increase the civilian 

labor market’s acceptance of the occupational training provided by the military. 

Department of Labor Veterans Employment and Training Service (DOL-VETS) 

The mission of VETS is to promote the economic security of America’s veterans. 

This stated mission is executed by assisting veterans in finding meaningful employment. The American Legion believes that by strengthening American veterans, we 

in turn strengthen America. Annually, DOD discharges approximately 300,000 servicemembers. Recently separated service personnel will seek immediate employment 

or increasingly have chosen some form of self-employment. In order for the VETS 

program to assist these veterans to achieve their goals, it needs to: 

• Improve by expanding its outreach efforts with creative initiatives designed to 

improve employment and training services for veterans; • Provide employers with a labor pool of quality applicants with marketable and 

transferable job skills; • Provide information on identifying military occupations that require licenses, 

certificates or other credentials at the local, state, or national levels; • Eliminate barriers to recently separated service personnel and assist in the 

transition from military service to the civilian labor market; • Strive to be a proactive agent between the business and veterans’ communities 

in order to provide greater employment opportunities for veterans; and • Increase training opportunities, support and options for veterans who seek selfemployment and entrepreneurial careers. 

The American Legion believes staffing levels for DVOPs and LVERs should match 

the needs of the veterans’ community in each state and not be based solely on the 

fiscal needs of the state government. Such services will continue to be crucial as today’s active duty servicemembers, especially those returning from combat in Iraq 

and Afghanistan, transition into the civilian world. Education, vocational and entrepreneurial training and employment opportunities will enable these veterans to succeed in their future endeavors. Adequate funding will allow the programs to increase staffing to provide comprehensive case management job assistance to disabled and other eligible veterans. 

The American Legion believes that military experience is essential to understanding the unique needs of the veteran and that all LVERs, as well as all DVOPs, 

should be veterans and should be additionally educated to be able to address the 

needs of veterans who desire entrepreneurial support. 

The American Legion also supports legislation that will restore language to Chapter 41, title 38, U.S.C., that require that half time DVOP/LVER positions be assigned only after approval of the DVET and that the Secretary of Labor would be 

required to monitor all career centers that have veterans on staff assigned. Public 

Law 107–288 has eliminated the requirement that DOL-VETS review all workforce 

centers annually and this has minimized Federal oversight of the programs since 

the ASVET has drastically cut funds allocated for this activity and established a 

policy that only 10 percent of the centers operated under title 38, U.S.C., will be 

reviewed, and Public Law 107–288 has removed the job descriptions of the DVOPs 

and LVERs from title 38, U.S.C., and given the States the ability to establish the 

duties and responsibilities, thus weakening the VETS program across the country 

22 

by eliminating the language that required these staff positions provide services only 

to veterans. 

Make Transitional Assistance Program (TAP)/Disabled Transitional Assistance Program (DTAP) a Mandatory Program 

The American Legion is deeply concerned with the timely manner that veterans, 

especially returning wartime veterans, transition into the civilian sector. Annually, 

for the past 6 years, approximately 300,000 servicemembers, 90,000 of them belonging to the National Guard and Reserve, enter the civilian sector each year. 

In numerous cases brought to the attention of The American Legion by veterans 

and other sources, many of these returning servicemembers have lost jobs, promotions, businesses, homes, and cars and, in a few cases, become homeless. The 

American Legion strongly endorses the belief that servicemembers would greatly 

benefit by having access to the resources and knowledge that the Transitional Assistance Program (TAP) and Disabled Transitional Assistance Program (DTAP) can 

provide and the TAP/DTAP program needs to update their program to recognize the 

large number of Guard and Reserve business owners who now require training, information and assistance while they attempt to salvage or recover from a business 

which they abandoned to serve their country. 

The American Legion strongly supports the Transition Assistance Program and 

Disabled Transition Assistance Program. Additionally, The American Legion supports that DOD require all separating, active-duty servicemembers, including those 

from Reserve and National Guard units, be given an opportunity to participate in 

Transition Assistance Program and Disabled Transition Assistance Program training not more than 180 days prior to their separation or retirement from the Armed 

Forces. 

To ensure that all veterans, both transitioning and those looking for employment 

assistance well past their discharge, receive the best care; the DOL-VETS program 

must be adequately funded. However, we feel that the current funding levels are 

inadequate. Funding increases for VETS since 9/11 do not reflect the large increase 

in servicemembers requiring these services due to the Global War on Terrorism. 

Military Occupational Specialty Transition (MOST) Program 

The American Legion supports legislation that will authorize $60 million for the 

next ten years to fund the Service Members’ Occupational Conversion and Training 

Act (SMOCTA). SMOCTA is a training program developed in the early 1990’s for 

those leaving military service with few or no job skills transferable to the civilian 

market place. SMOCTA has been changed to the Military Occupational Specialty 

Transition (MOST) program, but the language and intent of the program still applies. If enacted, MOST would be the only Federal job training program available 

strictly for veterans and the only Federal job training program specifically designed 

and available for use by state veterans’ employment personnel to assist veterans 

with barriers to employment. 

Veterans eligible for assistance under MOST are those with a primary or secondary military occupational specialty that DOD has determined is not readily 

transferable to the civilian workforce or those veterans with a service-connected disability rating of 30 percent or higher. MOST is a unique job training program because there is a job waiting for the newly trained veteran upon completion of training so that they can continue to contribute to the economic well being of the Nation. 

The American Legion recommends reauthorization of SMOCTA (now MOST) and 

adequate funding for the program. 

Employment 

DVOPs provide outreach services and intensive employment services to meet the 

employment needs of eligible veterans, with priority to disabled veterans and special 

emphasis placed on those veterans most in need. LVERs conduct outreach to local 

employers to develop employment opportunities for veterans, and facilitate employment, training and placement services to veterans. In particular, many LVERs are 

the facilitators for the Transition Assistance Program employment workshops. There 

are inadequate appropriations to several states because of policies and practices 

that cause these states to receive fewer positions and/or less funding. This procedure 

caused a deterioration of the available services provided to veterans in those states, 

and adversely impacts the level of services provided. The American Legion, therefore, recommends increased funding for this program. 

Homelessness (DOL-VETS) 

The American Legion notes that there are approximately 154,000 homeless veterans on the street each night. This number, compounded with 300,000 servicemembers entering the private sector each year since 2001 with at least a third of 

23 

them potentially suffering from mental illness, requires that intensive and numerous programs to prevent and assist homeless veterans are available. 

The Homeless Veterans Reintegration Program (HVRP) is a competitive grant 

program. Grants are awarded to states or other public entities and non-profits, including faith-based organizations, to operate employment programs that reach out 

to homeless veterans and help them become gainfully employed. The purpose of the 

HVRP is to provide services to assist in reintegrating homeless veterans into meaningful employment within the labor force and to stimulate the development of effective service delivery systems that will address the complex problems facing veterans. HVRP is the only nationwide program focused on assisting homeless veterans 

to reintegrate into the workforce. The American Legion strongly supports this highly 

successful grant program. 

Veterans Workforce Investment Program (VWIP) 

VWIP grants support efforts to ensure veterans’ lifelong learning and skills development in programs designed to serve the most-at-risk veterans, especially those 

with service-connected disabilities, those with significant barriers to employment, 

and recently separated veterans. The goal is to provide an effective mix of interventions, including training, retraining, and support services, that lead to long term, 

higher wages and career potential jobs. The American Legion recommends fully 

funding VWIP. 

Employment Rights and Veterans’ Preference 

The Uniformed Services Employment and Reemployment Rights Act (USERRA) 

protects the civilian job rights and benefits of veterans and members of the Armed 

Forces, including National Guard and Reserve members. USERRA also prohibits 

employer discrimination due to military obligations and provides reemployment 

rights to returning servicemembers. VETS administers this law, conducts investigations for USERRA and Veterans’ Preference cases, as well as conducts outreach and 

education, and investigates complaints by servicemembers. 

Since September 11, 2001, nearly 600,000 National Guard and Reserve members 

have been activated for military duty. During this same period, DOL-VETS provided 

USERRA assistance to over 410,000 employers and servicemembers. 

Veterans’ Preference is authorized by the Veterans’ Preference Act of 1944. The 

Veterans’ Employment Opportunity Act (VEOA) of 1998 extended certain rights and 

remedies to recently separated veterans. VETS was given the responsibility to investigate complaints filed by veterans who believe their Veterans’ Preference rights 

have been violated and to conduct an extensive compliance assistance program. 

Veterans’ Preference is being unlawfully ignored by numerous agencies. Whereas 

figures show a decline in claims by veterans of this conflict compared to Gulf War 

I, the reality is that employment opportunities are not being broadcast. Federal 

agencies as well as Federal contractors and subcontractors are required by law to 

notify OPM of job opportunities but more often than not these vacancies are never 

made available to the public. The VETS program investigates these claims and corrects unlawful practices. The American Legion recommends fully funding for Program Management that encompasses USERRA and VEOA. 

Veteran- and Service Disabled Veteran-Owned Businesses 

The American Legion views small businesses as the backbone of the American 

economy. The impact of deployment on self-employed National Guard and Reserve 

servicemembers is tragic with a reported 40 percent of all businesses owned by veterans suffering financial losses and, in some cases, bankruptcies. Many small businesses have discovered they are unable to operate and suffer some form of financial 

loss when key employees (who are members of the Reserve component) are activated. The Congressional Budget Office in a report, ‘‘The Effects of Reserve CallUps on Civilian Employers,’’ stated that it ‘‘expects that as many as 30,000 small 

businesses and 55,000 self-employed individuals may be more severely affected if 

their Reservist employee or owner is activated.’’ The American Legion is a strong 

supporter of the ‘‘Hope at Home Act of 2007,’’ which is bipartisan legislation that 

would not only require the Federal Government to close the pay gap between their 

Reserve and National Guard servicemember’s civilian and military pay but it would 

also provide tax credits up to $30,000 for small businesses with servicemembers who 

are activated. 

Additionally, the Office of Veterans’ Business Development within the Small Business Administration (SBA) remains crippled and ineffective due to a token funding 

of $750,000 per year. This amount, which is less than the office supply budget for 

the SBA, is expected to support an entire nation of veterans who are entrepreneurs. 

The American Legion feels that this pittance is an insult to American veterans who 

24 

are small business owners; consequently, this undermines the spirit and intent of 

Public Law 106–50 and continues to be a source of embarrassment for this country. 

The American Legion strongly supports increased funding of the efforts of the 

SBA’s Office of Veterans’ Business Development in its initiatives to provide enhanced outreach and specific community based assistance to veterans and self employed members of the Reserves and National Guard. The American Legion also 

supports legislation that would permit the Office of Veterans Business Development 

to enter into contracts, grants, and cooperative agreements to further its outreach 

goals and develop a nationwide community-based service delivery system specifically 

for veterans and members of Reserve components of the United States military. 

The American Legion recommends funding to enable the implementation of a nationwide community-based assistance program to veterans and self employed members of the Reserves and National Guard. 

The National Veterans Business Development Corporation 

Congress enacted the Veterans Entrepreneurship (TVC) and Small Business Development Act of 1999 (Public Law 106–50) to assist veterans and service-connected 

disabled veterans who own small businesses by creating the National Veterans 

Business Development Corporation. Presently, the objectives of P.L. 106–50 (as 

originally envisioned) are not being met. The American Legion supports a close review of the organization. 

The American Legion encourages Congress to require reasonable ‘‘set-asides’’ of 

Federal procurements and contract for businesses owned and operated by veterans. 

The American Legion also supported legislation that sought to add service-connected 

disabled veterans to the list of specified small business categories receiving 3 percent set-asides. Public Law 106–50 included veteran small businesses within Federal contracting and subcontracting goals for small business owners and within 

goals for the participation of small businesses in Federal procurement contracts. It 

requires the head of each Federal agency to establish agency goals for the participation by small businesses owned and controlled by service-connected disabled veterans, within that agency’s procurement contracts. 

Agency compliance with P.L. 106–50 has been minimal with only two agencies 

self-reporting that they have met their goals (the Department of Veterans Affairs 

and the Small Business Administration). In 2004, President Bush issued Executive 

Order 13360 to strengthen opportunities in Federal contracting for service-disabled 

veteran-owned businesses. 

The American Legion recommends: 

• Incorporate Executive Order 13360 into SBA Regulations and Standard Operating Procedures 

The American Legion endorses these recommendations from the ‘‘SBA Advisory 

Committee on Veterans Business Affairs’’ FY 2006 SBA report: 

• Change to Sole Source Contracting Methods 

• Develop a User Friendly Veteran Procurement Data base 

HOME LOAN GUARANTY PROGRAM

VA’s Home Loan Guaranty program has been in effect since 1944 and has afforded approximately 18 million veterans the opportunity to purchase homes. The 

Home Loan program offers veterans a centralized, affordable and accessible method 

of purchasing homes in return for their service to this Nation. The program has 

been so successful over past years that not only has the program paid for itself, but 

has also shown a profit in recent years. Administrative costs constitute a relatively 

small portion—less than 10 percent—of the total capital and operating costs. The 

predominant costs are claims costs and other costs associated with foreclosure and 

alternatives taken to avoid foreclosure. Each claim costs the Federal Government 

about $20,000. However, revenues that VA collects from different sources, including 

the funding fee that borrowers pay, property sales, and proceeds from acquired 

loans and vendee loans, offset this cost. 

The VA funding fee is required by law and is designed to sustain the VA Home 

Loan Program by eliminating the need for appropriations from Congress. Congress 

is not required to appropriate funding for this program; however, because veterans 

must now ‘buy’ in to the program, it no longer serves the intent of helping veterans 

afford a home. 

The fee, currently 2.15 percent on no-down payment loans for a first-time use, is 

intended to enable the veteran who obtains a VA home loan to contribute toward 

the cost of this benefit and thereby reduce the cost to taxpayers. The funding fee 

for second time users who do not make a down payment is 3.3 percent. The idea 

of a higher fee for second time use is based on the fact that these veterans have 

25 

already had a chance to use the benefit once, and also that prior users have had 

time to accumulate equity or save money toward a down payment. 

The following persons are exempt from paying the funding fee: 

• Veterans receiving VA compensation for service-connected disabilities. • Veterans who would be entitled to receive compensation for service-connected 

disabilities if they did not receive retirement pay. • Surviving spouses of veterans who died in service or from service-connected disabilities (whether or not such surviving spouses are veterans with their own entitlement and whether or not they are using their own entitlement on the loan). 

The funding fee makes the VA Home Loan program less beneficial compared to 

a standard, private loan in some aspects. The funding fee mandates the participant 

to buy in to the program; however that goes directly against the intention of the 

law, to provide veterans a resource for obtaining a home. The American Legion believes that it is unfair for veterans to pay high funding fees of 2 to 3 percent, which 

can add approximately $3,000 to $11,000 for a first time buyer. The VA funding fee 

was initially enacted to defray the costs of the VA guaranteed home loan program. 

The current funding fee paid to VA to defray the cost of the home loan has had a 

negative effect on many veterans who choose not to participate in this highly beneficial program. Therefore, The American Legion strongly recommends that the VA 

funding fee on home loans be reduced or eliminated for all veterans whether active 

duty, Reserve, or National Guard. 

HOMELESS VETERANS

The American Legion supports the efforts of public and private sector agencies 

and organizations with the resources necessary to aid homeless veterans and their 

families. The American Legion supports proposals that will provide medical, rehabilitative and employment assistance to homeless veterans and their families. 

Homeless veteran programs should be granted full appropriations to provide supportive services such as, but not limited to outreach, health care, habilitation and 

rehabilitation, case management, daily living, personal financial planning, transportation, vocational counseling, employment and training, and education. 

The American Legion applauds the Department of Housing and Urban Development (HUD)—Veterans Affairs Supported Housing (VASH) program. This program 

allowed HUD and VA to make up to 10,000 supportive incremental housing vouchers available to homeless veterans. The American Legion urges continued support 

of this program. 

Homeless Providers Grant and Per Diem Program Reauthorization 

In 1992, VA was given authority to establish the Homeless Providers Grant and 

Per Diem Program under the Homeless Veterans Comprehensive Service Programs 

Act of 1992, P.L. 102–590. The Grant and Per Diem Program is offered annually 

(as funding permits) by the VA to fund community agencies providing service to 

homeless veterans. VA can provide grants and per diem payments to help public 

and nonprofit organizations establish and operate supportive housing and/or service 

centers for homeless veterans. Funds are available for assistance in the form of 

grants to provide transitional housing (up to 24 months) with supportive services, 

supportive services in a service center facility for homeless veterans not in conjunction with supportive housing, or to purchase vans. The American Legion strongly 

supports increasing the funding level for the Grant and Per Diem Program. 

Domiciliary Care for Homeless Veterans Program 

DCHV operates 34 sites, with 1,833 dedicated domiciliary beds, providing time 

limited residential treatment with long-term physical, psychological, and rehabilitative counseling and services including aftercare. This program annually provides 

residential treatment to nearly 5,200 homeless veterans. The American Legion supports the program. 

Veterans Industries/Compensated Work Therapy Program 

VI/CWT offers vocational and rehabilitative services, ranging from evaluation and 

counseling to participation in compensated work and vocational training. Since 1994 

over 32,000 veterans have been successfully reintegrated into society as responsible 

members of the community through this program. The American Legion supports 

the program. 

Homeless Women Veterans and Children 

Homeless veterans’ service providers’ clients have historically been almost exclusively male. That is changing as more women veterans and women veterans with 

young children have sought help. Additionally, the approximately 200,000 female 

26 

Iraq veterans are isolated during and after deployment making it difficult to find 

gender-specific peer-based support. Access to gender-appropriate care for these veterans is essential. 

Homeless veteran service providers recognize that they will have to accommodate 

the needs of the changing homeless veteran population, including increasing numbers of women and veterans with dependents. Access to family housing through the 

distribution of the thousands of new Section 8 vouchers that will be made available 

through the HUD-VASH program will offer an important new resource allowing VA 

staff to assist the veteran and her family. 

The American Legion supports adequate funding for all domiciliary programs for 

qualified veterans. This includes funding for gender-specific, peer-based support and 

access to gender-appropriate care. 

SUMMARY

The American Legion appreciates the strong relationship we have developed with 

the Committee. With increasing military commitments worldwide, it is important 

we work together to ensure that the services and programs offered through VA and 

other government agencies are available to the new generation of American servicemembers who are returning home as well as for the veterans of prior conflicts. 

The American Legion is fully committed to working with each of you to ensure 

that America’s veterans receive the benefits they have earned. Whether it is improved accessibility to health care, timely adjudication of disability compensation 

claims, improved educational benefits or employment services, each and every aspect of these programs touches veterans from every generation. Together we can ensure that these programs remain productive, viable options for the men and women 

who have chosen to answer the Nation’s call to arms. 

RESPONSE TO POST-HEARING QUESTIONS FROM HON. DANIEL K. AKAKA TO DEAN

STOLINE, ASSISTANT DIRECTOR, NATIONAL LEGISLATIVE COMMISSION, THE AMERICAN LEGION

PTSD

Just this morning, the VA Inspector General issued a report on the Temple, Texas 

situation. Many will recall that a psychologist at that facility wrote a strangely 

worded email which set off a firestorm of concern for those who are suffering from 

PTSD. In a word, the IG found no systemic effort on the part of VA to reduce the 

number of PTSD claims via inappropriate diagnosis. 

Question 1. Is it your view that mental health issues, and particularly PTSD, are 

receiving appropriate attention, in terms of both compensation and care? 

Response. With regard to compensation, there are still problems with VA’s processing of mental disorder claims. The American Legion ‘‘Quality Review Team’’ has 

visited approximately 40 of VA’s 57 regional offices. During these visits we have discovered the following adjudication problems with both the establishment of service 

connection and the assignment of evaluation for mental disorders, including PTSD: 

Inadequate examinations—In some cases VA doctors do not assign global assessment of functioning (GAF) scores that are consistent with the symptomatology noted 

in the examination report. 

Premature negative decisions by VA adjudicators—for example, they rate on inadequate evidence, they fail to obtain potentially positive evidence, and in their efforts 

to take work credit they fail to return inadequate VA examinations for clarification 

or amendment. 

Inconsistent application of the General Rating Formula for Mental Disorders (38 

CFR 4.130)—for example, veterans with similar symptoms and GAF scores often receive drastically different ratings. 

PTSD Claims—Unnecessary development (really development to deny) when there 

is sufficient evidence to support the existence of a stressor in service. 

With regard to PTSD care, there is a possibility that mental health services could 

be lacking due to lack of mental health professionals, such as psychiatrists. If a certain amount of psychiatrists are warranted, there are implications that adequacy of 

care isn’t met when those personnel aren’t in place. To date, such are the findings 

during The American Legion’s 2009 site visits. As site visits progress, The American 

Legion can determine the extent of appropriateness of care. 

27 

COLLABORATION ON THE ISSUES

Question 2. How can your organizations collaborate to address the concerns of 

those who veterans who are returning after service in Iraq and Afghanistan? 

Response. Please look at our responses to the question regarding ‘‘Outreach.’’ 

VBA STAFFING

In light of the increased funding for VBA staffing, there are high expectations 

that VBA will improve the quality of claims decisions, and to do so in a timely 

manner. 

Question 3. What more do you believe Congress could do to assist in decreasing 

the backlog, and at the same time, improving timeliness and accuracy? 

Response. Congress should continue to conduct aggressive oversight of VA’s claims 

processing system. Specifically, VBA must be required to provide better justification 

for the resources it says are needed to carry out its mission and, in particular, how 

it intends to improve the level of adjudicator training, job competency, and quality 

assurance. 

OIF/OEF ILLNESSES

The Committee and, indeed, the full Congress, has focused a great deal of attention on mental health and TBI matters. Yet, the most common health condition of 

returning OEF/OIF veterans is not TBI or mental illness, but instead muscle and 

joint pain. 

Question 4. Do you have proposals on how to focus on this number one health concern from those who have served in Iraq and Afghanistan? 

Response. It is important the muscle and joint pain issue receive the same attention as Traumatic Brain Injury and mental illness. Just as the latter, the former 

must be implemented when conducting the Post-Deployment Health Assessment 

(PDRHA). It must also be implemented during the servicemember’s transition from 

active duty to civilian status. The American Legion believes that during the continuum of care process, the Department of Defense (DOD) and the Department of 

Veterans Affairs (VA) must educate servicemembers and veterans on mode of treatment of the aforementioned illnesses respectively. 

OUTREACH

Question 5. How are your organizations, individually or in some cooperative fashion, working to outreach to veterans and encourage them to take advantage of VA 

care and services? 

Response. American Legion Outreach Programs: 

Department (State) Service Officers 

American Legion Department Service Officers conduct direct outreach to veterans 

and their families regarding benefits available from VA. They also have specialized 

training and experience with VA regulations and are familiar with the many VA 

programs and services. They provide an invaluable service to veterans by representing them in the VA claims process or providing other assistance as needed. 

This service is free and the veteran does not have to be member to take advantage 

of it. When a veteran contacts The American Legion National Headquarters, views 

our Web site, or speaks to a Legion member, they are referred to that state’s Department Service Officer. A Post Service Officer’s Guide is distributed to 14,000 

posts nationwide to help answer benefit questions which also serves as a referral 

source for veterans wishing to file claims. 

Heroes to Hometowns 

In an effort to increase transparency and cooperation between DOD and the 

American people, The American Legion entered into an understanding with the Office of the Secretary of Defense’s (OSD) Office of Military Community and Family 

Policy (MCFP) under the authority of the Deputy Under Secretary of Defense for 

Military Community and Family Policy, Leslye A. Arsht, to assist in outreach and 

assistance efforts to transitioning severely injured servicemembers. The American 

Legion agreed to provide outreach support to the military community’s severely injured as they transitioned home through a program known as Heroes to Hometowns. This program embodies The American Legion’s long standing history of caring for those ‘‘* * * who have borne the battle * * *’’ and their families. 

Heroes to Hometowns is designed to welcome home servicemembers who no longer 

serve in the military. The American public’s strong support for our troops is especially evident in their willingness to help servicemembers who are severely injured 

28 

in the war, and their ever-supportive families, as they transition from the hospital 

environment and return to civilian life. Heroes to Hometowns is a program that focuses on reintegration back into the community, with networks established at the 

national and state levels to better identify the extraordinary needs of returning families before they return home and with the local community to coordinate government and non-government resources as necessary for as long as needed. 

There are three charter members in each State’s Heroes to Hometowns Executive 

Committee, each uniquely able to contribute to overall support with the ability to 

tap into their national, state, and local support systems to provide essential links 

to government, corporate, and non-profit resources at all levels and to garner the 

all important hometown support. 

State Heroes to Hometowns Committees are the link between the Military Treatment Facilities and the community. The charter members consist of the State Office 

of Veterans Affairs, the State Transition Assistance Office and the State’s veterans 

community represented by The American Legion. Heroes to Hometowns is a collaborative effort and The American Legion leads communities in preparation to support 

returning servicemember in areas such as: 

Financial assistance; 

Finding suitable homes and adapting as needed; 

Home and vehicle repairs; 

Transportation for veterans to medical appointments; 

Employment and educational assistance; 

Child care support; 

Arrange ‘‘welcome home’’ celebrations; and, 

Sports and recreation opportunities. 

When a transitioning veteran requests assistance via a web-form or brochure 

available through The American Legion, the veteran’s contact information is shared 

with the State Executive Committee. The American Legion State offices refer the 

veteran’s request to the local Post, which connects with the veteran to provide assistance. The American Legion focuses on those needs not provided by Federal and 

state agencies. 

To assist in the coordination of community resources, The American Legion 

supports OSD’s Military Homefront Online Support Network for military personnel 

and community organizations to connect and collaborate. Located at 

www.homefrontconnections.mhf.dod.mil, this online network is dedicated to citizens 

and organizations that support America’s service men and women. Through the support network, veterans can easily identify and quickly connect with national, state 

and community support programs. 

In 2007, the Heroes to Hometowns program expanded its vision to include all 

transitioning servicemembers, to include the underserved National Guard and Reserve components. Currently, the National Guard and Reserve do not have mandated TAP briefings when demobilizing. This hard-to-reach population primarily 

lives in rural America, disconnected from the traditional services provided by DOD 

or VA. The American Legion, with its 2.7 million members and 14,000 posts, reaches 

into these rural communities conveying a consistent message of strong support for 

America’s military personnel; the veteran who return home; care for the veteran’s 

family; and a patriotic pride in America. With the Heroes to Hometowns program, 

The American Legion reaches out to provide support long after the deployment is 

over. 

Department of Veterans Affairs Voluntary Service (VAVS) Program 

The American Legion is a staunch supporter of VA’s Voluntary Service (VAVS) 

program. In Fiscal Year 2007, some 7,527 regularly scheduled Legionnaires volunteered 909,137 hours at 167 VA facilities. Legionnaires volunteer at VA medical centers (VAMCs), Community-Based Outpatient Clinics, Vet Centers, and many other 

locations in support of hospitalized veterans. 

The American Legion recently entered into a pilot program with VA in creating 

Heroes to Hometowns VA Volunteer Coordinators at 10 VAMCs. These coordinators 

will work with the VAMC Social Work offices and identify transitioning servicemembers’ needs with community resources. Currently, The American Legion is 

working with the VAVS program to increase the level of community support at 

VAMCs. By providing volunteer outreach training and resources to support a sustained outreach program, The American Legion is working to prepare the American 

Homefront for the return of our fighting men and women. 

Department of Veterans Affairs OEF/OIF Welcome Home Celebration 

The American Legion is an active participant in the annual OIF/OEF ‘‘Welcome 

Home’’ Celebration Event held at VAMCs nationwide. This event is designed to proVerDate Nov 24 2008 20:32 Nov 04, 2009 Jkt 000000 PO 00000 Frm 00032 Fmt 6633 Sfmt 6621 H:\ACTIVE\012809.TXT SVETS PsN: PAULIN
29 

vide outreach services and offer valuable information, education and support to 

transitioning servicemembers and their families. Legionnaires answer questions 

about veterans’ benefits, filing claims and military discharge review requests. Here 

in Washington, DC, during the Welcome Home event held at the DC VAMC, medical 

staff enrolled transitioning Marines into the VA medical system for their five years 

of free medical services, while community volunteers provided an environment of 

support with live music, food and valuable information about veterans’ benefits and 

local community resources. 

The American Legion Magazine 

The American Legion uses a multimedia approach to its outreach. The American 

Legion Magazine has historically provided valuable and timely information on the 

issues facing America’s veterans. This tradition is carried on into the 21st Century 

via The American Legion Web site, www.legion.org, a hub for information, resources 

and specific points of contact for local assistance. A full library of informative brochures outline the leading issues facing America’s veterans today to the furthest 

reaches of the American landscape. At any point, a transitioning veteran may receive assistance from The American Legion via informational brochures, printed 

media, web-based request forms, a 1–800 call center, state veterans’ service officers 

and most importantly, the local American Legion post. 

The American Legion Local Post 

The American Legion Post is important in providing direct outreach as it provides 

a common meeting place for veterans and their families. The local Post may be the 

first place a veteran stops when returning home. It may be the first place where 

the community as a whole thanks a returning veteran for their service and sacrifice. 

Department of Virginia American Legion Post 270 is a leading example of the 

support provided by The American Legion family. Each year the food manufacturer 

‘‘Newman’s Own’’ awards financial grants to organizations that support the military. 

In 2004, Post 270 was awarded the Newman’s Own ‘‘Best Volunteer Program in the 

Country Supporting Our Active Duty Military and their Families’’ for the post’s outreach to Walter Reed Army Medical Center (WRAMC). All across America, American Legion Posts have partnered with businesses to assist returning veterans find 

gainful employment. Most notably, The American Legion has partnered with Military.com and Recruit Military on veteran-targeted job fairs. 

Within the past month, The American Legion worked with WRAMC to host a career and benefits fair for the injured servicemembers in outpatient care. Employers, 

many veterans themselves, meet with injured servicemembers and their supporting 

family member in a relaxed atmosphere. Servicemembers and family members were 

able to have dinner and meet with employers from all across the Nation. 

The American Legion works closely with DOD, VA and the Department of Labor 

(DOL) to assist transitioning veterans in accessing their benefits and resources in 

order to reach their fullest potential, regardless of location or disabilities. The American Legion believes that more emphasis should be placed on Heroes to Hometowns 

and programs that allow transparency within the government and utilizes the established resources with communities to fulfill the unmet needs of transitioning servicemembers. The American Legion has a proud history of securing and protecting 

the earned benefits of America’s veterans. The American Legion stands ready to 

continue this legacy today by caring for those veterans returning from the current 

conflicts. 

The American Legion’s departments and posts are in constant communication 

with their respective National Guard and Reserve units, nearest deployment posts, 

TAPs programs, and Standown hosts to ensure veterans have received or are receiving information and guidance on various issues that affects their concerns. In addition, The American Legion also informs these veterans of PDRHA times and locations to ensure these veterans and servicemembers aren’t falling through the cracks. 

WOMEN VETERANS

Question 6. VA has said that sufficient programs and funding already exist to care 

for women veterans. What would you point to as specific problems or shortfalls with 

respect to women veterans and what do you recommend that the Committee do to 

address these concerns? 

Response. The issue of continuum of care remains a major issue among this Nation’s women veterans. In addition, for those women veterans who suffer from Military Sexual Trauma (MST) and are apprehensive about going to their local VA medical centers, they (mainly by word of mouth) resort to the comfort of the Vet Center 

only to find that the Vet Center doesn’t have a qualified MST counselor to accommodate the veteran. Consequently, there is a problem providing MST counselors to 

30 

those suffering from MST. Although there is the challenge of providing adequate 

counseling to men suffering from MST, the additional challenge for women veterans 

is their adamant desire for anonymity. One remedy would be to have clinics with 

separate entrances for men and women veterans and more female counselors. 

PAPERWORK

Question 7. What is your organization’s opinion of VA’s expanded paperwork protection policy that came about as a result of the Inspector General’s audit which 

found that VA regional office personnel had mishandled some claims documents— 

is VA’s new policy on shredding appropriate? 

Response. The American Legion is pleased that VA took quick and decisive action 

to address this situation. However, there are concerns that the measures put in 

place are ‘‘overkill’’ and actually hinder the regional office employee’s efficiency and 

productivity. The American Legion’s Quality Review Team will be closely monitoring 

the impact of this new policy during our regional office site visits and will be in a 

better position to answer this question in more detail later this year. Furthermore, 

VA should not be destroying a veteran’s evidence. VA currently has regulations that 

allow VA to return duplicate information to the veteran and it should do so, rather 

than spend the staff time and money to shred evidence than at some future point 

in time might be relevant to the veteran’s claim. 

STIMULUS

Question 8. The Senate stimulus package includes appropriations for VA, espe- cially $3.7 billion included for VA infrastructure projects. What are your views? 

Response. We believe that VA should strive to award contracts to veteran-owned 

and service-disabled veteran-owned small businesses and that veterans should be 

employed to perform this work to the maximum extent possible and the Congress 

should oversee the expenditures of these funds to ensure these goals. 

RESPONSE TO POST-HEARING QUESTIONS FROM HON. BERNARD SANDERS TO DEAN

STOLINE, ASSISTANT DIRECTOR, NATIONAL LEGISLATIVE COMMISSION, THE AMER- ICAN LEGION

EXTENDED AND DIFFERENT HOURS FOR VA SERVICES

As I mentioned in my opening remarks, I have heard from many veterans who 

want to get to the VA for care but they can’t make it because of work. I believe 

we need to increase accessibility of the VA to all types of veterans, including those 

with full-time jobs, by providing evening and weekend hours so that people won’t 

have to choose between going to work and keeping a VA appointment. This could 

also help reduce missed appointments which waste time and resources of VA staff. 

My office is currently exploring what kind of authority VA needs to begin providing 

extended hours on a one night a week and one weekend day a week basis, possibly 

in the form of a pilot program. 

Question. What do members of the panel think about this idea? 

Response. The VA implemented the Advanced Clinic Access (ACA) to prevent long 

delays in providing care throughout the Medical Center; alleviating the wait list was 

accomplished by conducting evening and weekend clinics. It is The American Legion’s contention that the same could be done to accommodate those who work hours 

not conducive to VA’s regular hours. 

Chairman AKAKA. Thank you very much, Mr. Stoline. 

Now we will hear from Mr. Atizado. 

STATEMENT OF ADRIAN M. ATIZADO, ASSISTANT NATIONAL 

LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS 

Mr. ATIZADO. Mr. Chairman, Ranking Burr and other Members 

of the Committee, thank you for inviting the DAV to testify at this 

important hearing and to listen to our priorities for the 111th Congress. We do appreciate your consideration as you prepare your legislative agenda. 

Our priorities include VA health care funding reform, disability 

compensation improvements, family caregiver support services, 

women veterans’ health care, Traumatic Brain Injury, and mental 

31 

health care and substance use disorders. For the sake of brevity, 

I will highlight only our recommendations and refer you to my 

written testimony for further details. 

On VA health care funding reform, the DAV thanks Chairman 

Akaka and the eight co-sponsors for introducing in the 110th Congress the Veterans’ Health Care Budget Reform Act which received 

bipartisan support to achieve sufficient, timely and predictable veterans’ health care funding. This bill would allow Congress to fund 

VA health care 1 year in advance and address transparency in VA’s 

internal budget process. Advanced appropriation retains full Congressional discretion to set funding levels and Congress’ ability to 

provide strong oversight over VA programs, services and policies. 

We look forward to its reintroduction and passage in the 111th 

Congress. 

To improve VA’s disability claims process, the cumbersome and 

lengthy administrative claims and appeals process can be streamlined by eliminating redundancies and creating an integrated electronic claims process. Training, quality assurance and accountability changes must be approached in that order while resisting 

hasty broad-brush approaches. Sir, our broad view is that VA 

should empower personnel with expertise to manage and reduce 

the claims backlog without eroding decades of progress. 

In the same vein, disabled servicemembers should have a seamless transition primarily by restructuring the substandard military 

disability evaluation system. 

For family caregivers and support services: Just as severely disabled veterans face daunting and lifelong challenges, so do their 

family caregivers who help maintain a veteran’s quality-of-life and 

independence as they live in the community. While this role can 

exact a high cost on family caregivers, they seldom receive sufficient support services or financial assistance. In addition to psychosocial support services, VA should conduct individual needs assessment on family caregivers of severely disabled veterans as well as 

conduct a periodic national survey for planning and policy purposes. 

Women veterans’ health care: To address existing health disparities, legislation is needed to ensure women veterans’ health programs are properly assessed and enhanced so that access, quality, 

safety, and satisfaction with care is equal for women and men. VA 

should improve its ability to assess and treat women who have experienced combat or military sexual trauma and increase the use 

of gender-specific evidence-based treatments. Also, we believe VA 

should receive the resources to have at least one provider with 

women’s health expertise in each VA medical center. 

Traumatic Brain Injury or TBI is the signature injury to Iraq 

and Afghanistan war veterans, which can cause devastating and 

often debilitating and permanent damage. An increase in DOD and 

VA specialists with TBI expertise is needed, just as more research 

is needed to sustain the emerging evidence base for TBI. And while 

mild to moderate TBI can be much harder to diagnose, which often 

leads to lasting physical and psychological problems, proper screening and personalized recovery plans are essential to detect and 

treat TBI. 

32 

Mental health care and substance abuse disorder: Although VA 

has improved its programs in recent years, the scope of care provided and its distribution across VA does not meet the needs of veterans. Studies looking at the trends of mental health and substance use disorders in Iraq and Afghanistan war veterans drive 

the need to ensure access to and make available robust services. 

Programs that integrate the best research evidence, clinical expertise and patient needs are critical to avoid long-term health consequences. 

The DAV thanks this Committee for its efforts last Congress in 

passing the Veterans Mental Health and Other Care Improvements 

Act of 2008, now Public Law 110–387. 

In conclusion, Mr. Chairman, we would like to thank you as well 

as Senators Durbin and Murray for introducing S. 252, the Veterans’ Health Care Authorization Act of 2009. This bill, drawn in 

large part from a staff conference package based on S. 2969, the 

Senate bill in the 110th, contains many provisions that address our 

concerns I outlined herein. 

Mr. Chairman, this concludes my testimony. I would be happy to 

answer any questions you or this Committee may have. 

[The prepared statement of Mr. Atizado follows:] 

PREPARED STATEMENT OF ADRIAN ATIZADO, ASSISTANT NATIONAL LEGISLATIVE

DIRECTOR, DISABLED AMERICAN VETERANS

Mr. Chairman, Ranking Member Burr and other Members of the Committee: 

Thank you for inviting the Disabled American Veterans (DAV) to testify at this important hearing of the Committee on Veterans’ Affairs. DAV is an organization of 

1.3 million service-disabled veterans, and devotes its energies to rebuilding the lives 

of disabled veterans and their families. 

As you may be aware, our DAV advocacy campaign, Stand Up For Veterans, is 

well underway. Its purpose is to generate greater public understanding and build 

support for changes in veterans’ health care programs, benefits, and services for all 

the men and women injured or disabled in service to the Nation, including those 

from the wars in Iraq and Afghanistan, as well as those from prior eras and conflicts. In this effort, our campaign focuses our organization’s priorities which we 

hope this Committee will consider as it prepares its legislative agenda for the 111th 

Congress: 

• VA Health Care Funding Reform 

• Disability Compensation Improvements 

• Family Caregiver Support and Services 

• Women Veterans Health Care 

• Traumatic Brain Injury 

• Mental Health Care and Substance-use Disorder 

VA HEALTH CARE FUNDING REFORM

While great strides have been made in Congress to increase the level of Department of Veterans Affairs (VA) health care funding during the past several years, 

there is a long history of significant delays in receiving those funds. Notwithstanding notable improvements in the past two years, VA has received its annual 

funding for veterans’ health care late in 19 of the past 22 years. Unlike Medicare 

or Medicaid, the VA must rely on Congress and the President to pass a new appropriations law each year to provide VA hospitals and clinics with the funding they 

need to treat sick and disabled veterans. 

Due to the late and unpredictable budget process, VA is increasingly challenged 

to properly treat the physical and mental scars of war for all veterans needing care. 

Further, not knowing when or at what level VA will receive funding from year to 

year—or whether Congress will approve or oppose the Administration’s proposals— 

hinders the ability of VA officials to efficiently plan and responsibly manage VA 

health care. 

Broken financing causes unnecessary delays and backlogs in the system: hiring 

key staff is put off, or just not done, while injuries like PTSD or TBI are too often 

33 

not diagnosed or treated in a timely manner. Since 2001, the number of VA patients 

has grown by two million—a 50 percent increase—and our newest generation of veterans has increasingly complex mental and physical health care needs that will require a lifetime of care. Moreover, a 2007 report by the VA’s Office of Inspector General concluded that 27% of the injured veterans seeking treatment at VA facilities 

had to wait more than 30 days for their appointments. 

For the past decade, the DAV and its allies in the Partnership for Veterans 

Health Care Budget Reform—a coalition of nine veterans service organizations with 

a combined membership of eight million veterans—have sought to fundamentally 

change the way veterans health care is funded. While mandatory funding has been 

the focus over the past several years, the Partnership helped develop and fully endorsed S. 3527, the Veterans Health Care Budget Reform Act, introduced in the 

110th Congress. This legislation has also been endorsed by The Military Coalition, 

comprised of 35 organizations representing more than 5.5 million members of the 

uniformed services—active, reserve, retired, survivors, veterans—and their families. 

The DAV thanks the Chairman of this Committee and his eight co-sponsors for introducing this measure which received bipartisan support and has been endorsed by 

then President-elect Obama and [the recently confirmed] VA Secretary Eric 

Shinseki. 

We believe this legislation proposes a reasonable alternative to achieve the same 

goals as mandatory funding, by authorizing Congress to appropriate funding for veterans’ health care one year in advance and adding transparency to VA’s internal 

budget process. With the goal of ensuring sufficient, timely, and predictable veterans health care funding through advance appropriations, Congress retains full discretion to set funding levels for each fiscal year, and the legislation does not eliminate, reduce or diminish Congress’ ability to provide strong oversight over VA programs, services and policies. 

Introduction and passage of the Veterans Health Care Budget Reform Act in the 

111th Congress would address DAV’s highest priority in VA health care. 

IMPROVING VA DISABILITY CLAIMS PROCESS

The Department of Veterans Affairs (VA) disability claims process is a complex 

and burdensome system whose timeliness has declined in recent years to unacceptable levels, resulting in more than 800,000 backlogged claims. The complexity of 

this challenge ensures that there is no ‘‘magic bullet’’ solution capable of quickly resolving the claims backlog. Our broad view is that it is imperative that VA empower 

personnel with exceptional knowledge of current processes to manage and reduce 

the claims backlog without eroding decades of progress. The DAV believes the cumbersome and lengthy administrative claims and appeals process can be streamlined 

(1) by merging and eliminating redundancies within the benefits delivery system, 

and (2) integrating its electronic framework into a single, state-of-the-art information system to create, as much as practical, a new electronic claims process. 

Another reality intertwined with the foregoing is that the quality assurance and 

training programs in use by the Veterans Benefits Administration are inadequate 

as tools to sample the validity of decisions on claims. The VA must fundamentally 

change its quality assurance/accountability systems and training programs in order 

to successfully reform the compensation system. However, the underlying challenge 

here is that it must do so without significant infrastructure changes. 

Similar to the claims process itself, the Veterans Benefits Administration’s (VBA) 

training programs are plagued by a lack of accountability that perpetuates VA’s inability to produce accurate and equitable decisions on claims. Training, quality assurance, and accountability changes must be approached in that order, while VBA 

resists hasty broad-brush approaches. Subject matter experts from all corners of the 

veterans’ benefits arena should collaborate toward one goal—improve training in 

order to improve rating quality, and hold employees accountable in order to assure 

a quality product. 

Military personnel injured on active duty have been hamstrung with a Department of Defense (DOD) disability evaluation system that discharges them from active duty with unacceptable variances in disability ratings. These outcomes are the 

result of the current system which is unmanageable and inconsistent. The problem 

has been a focus of veterans service organizations for a substantial period of time 

and our observations were validated by the Veterans’ Disability Benefits Commission which was chartered by the National Defense Authorization Act of 2004. In its 

review, the commission found for example that the Army is less likely than other 

military groups to assign a disability rating of 30% or more, the cutoff for a person 

to receive lifetime retirement payments and health care. The Pentagon has a strong 

34 

incentive to assign ratings of less than 30% so the Services can avoid paying higher 

disability benefits. 

The military announced on November 7, 2008 an expansion of the Disability Evaluation System Pilot with all military services now taking part in a follow-on of the 

National Capitol Region test program. Now wounded servicemembers leaving the 

military may have easier, quicker access to their veterans’ benefits under this expanded pilot program that will offer streamlined disability evaluations. That is, provided they are of the fortunate few assigned to one of the 19 military installations. 

The initial phase of the expansion started on October 1, at Fort Meade, Maryland 

and Fort Belvoir, Virginia. The remaining 17 installations will begin upon completion of site preparations and personnel orientation and training, during an eightmonth period from November 2008 to May 2009. 

Although the Disability Evaluation System Pilot is a notable improvement, its 

productivity pace was slow with only 700 servicemembers who participated in the 

pilot having their cases finalized over a ten-month period. The issues that hinder 

the timely resolution of disability claims by the VA for veterans are the same as 

those for active duty servicemembers transitioning to veteran status. 

FAMILY CAREGIVERS SUPPORT AND SERVICES

The nature, prevalence, and degree of injuries that veterans of Operations Enduring and Iraqi Freedom (OEF/OIF) are sometimes so severe that family members, 

whose lives and livelihoods have been interrupted to care for their loved ones, need 

increased Federal support and assistance. 

They face daunting and life-long challenges. Often, they must drop everything to 

be at the bedside and take care of the physical and mental injuries of their sons, 

daughters, spouses, or parents. They must deal with a complex system of overlapping and changing support programs which poses a great challenge for family caregivers to understand and navigate, too often resulting in a state of confusion for the 

caregiver. 

Once severely disabled veterans return home, their family caregivers provide the 

needed support to maintain the veteran’s quality of life and independence while living in their community. Even though it is widely recognized that informal 

caregiving can delay or avoid institutionalization of the veteran, caring for a severely disabled veteran exacts a high cost on family caregivers. They often shoulder 

physical burdens, mental strain, and psychosocial challenges as a result of their 

caregiving responsibilities. They face the disruption and change of their family’s life, 

withdrawal from school or loss of employment and employer-based benefits, often 

sacrificing their own health, well-being, and economic future in order to care for a 

loved one. 

Although close family members are often willing to bear the burden of being primary caregivers for severely disabled veterans—thus relieving VA of that obligation 

or the cost of institutionalization—they seldom receive sufficient support services or 

financial assistance from the government. 

The DAV believes these informal caregivers should receive a comprehensive array 

of support services, to include respite care, financial compensation, vocational counseling, basic health care, relationship, marriage and family counseling, and mental 

health care to address the multiple burdens they face. Among other things, a ‘‘Caregiver Toolkit’’ should be provided to family caregivers, to include a concise ‘‘recovery 

roadmap’’ to assist families in understanding and maneuvering through the complex 

systems of care and Federal, state, and local resources available to them. Moreover, 

policymaking and planning to better serve family caregivers of severely injured veterans should include statistically representative data from a periodic national survey and individual assessments of family caregivers of severely injured and disabled 

veterans. By supporting the caregiver, we support the disabled veteran. 

WOMEN VETERANS HEALTH CARE

Although women have historically been a very small percentage of patients in the 

VA health care system, VA estimates that the number of women using VA health 

care services will double in less than five years if the current enrollment rate continues. In addition, of the more than 102,000 women who have served and separated 

from military deployment in Iraq and Afghanistan, over 48,000 have already received health care from VA. With an unprecedented and increasing number of 

women in the military and serving in Iraq and Afghanistan, VA is challenged to 

provide consistent, comprehensive, quality health care services to women veterans 

today and in the future. 

Women returning from combat theaters have unique physical and mental health 

care needs. More women servicemembers are being exposed to combat situations, 

35 

have experienced sexual trauma during military service, and need specialized postdeployment and mental health care services. The increasing demand for services 

and changing demographics of this population, coupled with the need to have more 

clinicians with women’s health expertise, will challenge VA resources and service 

delivery systems. 

According to VA’s own data, women veterans receive lower quality health care 

than men and do not consistently receive the recommended health care services to 

meet current VA standards. Unfortunately, VA has moved away from comprehensive women’s health clinics in recent years, favoring a health services model that 

is fragmented and fails to adequately address the comprehensive needs of women 

veterans. It is critical that women veterans gain access to high quality primary and 

gender-specific care, as well as mental health services from qualified clinicians. 

Legislation is needed to ensure women veterans’ health programs are properly assessed and enhanced so that access, quality, safety, and satisfaction with care are 

equal for women and men. To improve quality and reduce disparities in health care 

services for women receiving VA care, the Department should conduct a comprehensive long-term, longitudinal study on the unique health challenges facing women 

veterans who have served in combat theatres. 

VA must also redesign its women veterans care delivery model and establish an 

integrated system of health care delivery that covers a comprehensive continuum of 

care and serves as a best practice in the field. To accomplish this, VA should: 

• Identify and implement the best clinical models of care to meet the comprehensive health care needs of women veterans using the VA health care system; • Improve its ability to assess and treat women who have experienced combat 

and/or military sexual trauma; and increase the use of gender specific, evidencebased treatments; and • Receive sufficient resources to have at least one provider with women’s health 

care expertise on duty at every VA medical facility. 

TRAUMATIC BRAIN INJURY

Traumatic Brain Injury (TBI), a common injury to OEF/OIF veterans, can cause 

devastating and often permanent damage. Even mild-to-moderate TBI, which can be 

much harder to diagnose, will often lead to lasting physical and psychological problems. In addition, many OEF/OIF veterans have suffered ‘‘mild’’—but pathologically 

significant—brain injuries that have gone undiagnosed and largely untreated. Behavioral problems, memory loss, disruptive acts, depression and substance-use disorder are common symptoms associated with TBI. 

According to a RAND study released in April 2008, 19 percent of returning OEF/ 

OIF servicemembers report possible TBI. The RAND study estimated that over 

300,000 servicemembers had experienced TBI, but only 44 percent of these had been 

evaluated by a physician. Veterans with TBI often have difficulty communicating 

their health status or seeking proper assistance. Complicating this situation, many 

rural veterans are unable or unwilling to overcome the barrier of distance to reach 

the nearest VA medical facility. 

In order to detect and treat TBI, proper screening and personalized recovery plans 

are essential, particularly for those cases that are mild-to-moderate in severity. 

There is also a need to increase DOD and VA specialists with TBI expertise to assist 

in identifying and managing the complex conditions prevalent in this population. To 

date, DOD lacks a system-wide approach for identification, management, and surveillance of individuals who sustain mild-to-moderate TBI in combat, and VA programs addressing the needs of servicemembers with mild-to-moderate TBI have not 

been fully developed or implemented. 

More research is necessary to understand the long-term consequences of TBI, as 

well as the development of best practices in treating these injuries. These studies 

should also focus on older veterans who may have suffered these injuries in earlier 

wars, detect mild-to-moderate cases of TBI, and study their consequences. With 

Congressional oversight, we are hopeful that these needs will be met by the Defense 

and Veterans Brain Injury Center, one of the Defense Centers of Excellence, whose 

mission is to serve active duty military, their dependents and veterans with TBI 

through state-of-the-art medical care, innovative clinical research initiatives, and 

educational programs. In addition, we believe that a VA Central Office-based TBI 

program should be established which would be an effective means of organizing and 

improving VA’s responsiveness to veterans with TBI. 

MENTAL HEALTH CARE

According to VA, as of August 2008, over 945,000 OEF/OIF servicemembers have 

separated from military service. Of those, over 400,000 OEF/OIF veterans have 

36 

sought VA health care since 2002, and over 178,483 have received a diagnosis of 

a possible mental health disorder. Within that group, 105,465 have been given a 

probable diagnosis of Post Traumatic Stress Disorder (PTSD). 

The above-mentioned 2008 RAND study estimated that approximately 300,000 

OEF/OIF veterans had symptoms of PTSD or major depression with the best predictor for these conditions being exposure to combat trauma during deployment. 

Further, the report stated 53 percent of servicemembers with PTSD or depression 

sought help from a provider, but that 50 percent of those who sought care received 

minimally adequate treatment. 

Current research strongly suggests that PTSD can be treated successfully with 

appropriate therapies and evidence-based treatments. Although VA has improved its 

mental health programs in recent years, the scope of care provided, and its distribution across the 1,400 existing VA sites of health care does not meet the needs of 

veterans with post-deployment PTSD, depression, and co-morbid substance use disorders. VA’s National Mental Health Strategic Plan also reveals systematic shortfalls in veterans’ access, and documents gaps in scope and quality of VA behavioral 

health programs nationwide. 

Congress should continue to oversee implementation of the VA’s National Mental 

Health Strategic Plan and its Uniform Mental Health Services initiative. Frequent 

reports to document progress should be made to Congressional committees, consumer councils, veterans’ service organizations including DAV, and to VA’s Committee on Care of Veterans with Serious Mental Illness. 

VA should reformulate its approach to mental health to focus on recovery consistent with the principles of the New Freedom Commission on Mental Health, and 

VA should fully implement the recommendation of the Institute of Medicine to embrace these recovery therapies, while furthering research in PTSD, including research in improved screening methodologies and stigma reduction techniques. 

SUBSTANCE-USE DISORDER

Substance-use disorders are occurring at high rates among OEF/OIF veterans, 

based on converging evidence from studies of active duty personnel and recently discharged veterans. Studies of returning reservists and active duty members indicate 

that approximately one quarter acknowledge an alcohol problem. Rates are higher 

for those with multiple deployments, a growing cohort as the war continues. This 

is consistent with national studies that find rates of substance use twice as high 

among those exposed to serious stress. 

Substance use occurs on a continuum ranging from non-problematic use to hazardous/harmful misuse to abuse to full dependence. For many of these OEF/OIF veterans their alcohol misuse or abuse is new. Binge drinking and citations for driving 

under the influence (DUI) are characteristic of misuse and abuse in this age population. Many of these veterans could benefit from short-term and early interventions, such as motivational counseling, which have proven their efficacy. 

Recent surveys of OEF/OIF veterans returning from deployment have found increasing incidence of alcohol and other substance misuse in this population. In an 

anonymous study of active duty personnel by the DOD, 23 percent of respondents 

acknowledged having a significant alcohol problem. Also, an Army study of soldiers 

serving in Iraq concluded that while about 12 percent of soldiers reported alcohol 

misuse, only 0.2 percent were referred for treatment. Of those referred, only a small 

number received care within 90 days of screening. 

Over the past decade, VA’s substance use disorder treatment and rehabilitation 

services have been in decline. Only recently has VA begun to re-evaluate, rebuild 

and expand these specialized programs and to coordinate these services to address 

post-deployment mental health co-morbidities. Currently VA substance abuse treatment programs are targeted to veterans with severe substance abuse or dependence. 

Short-term interventions specifically targeted to veterans with hazardous or harmful levels of use or early abuse are generally not available. 

VA should focus intensive efforts to improve and increase early intervention and 

prevention of substance-use disorder in the veteran population. Ready access to robust mental health and substance-use treatment programs are critical to avoiding 

long-term health consequences post-deployment. VA must also continue moving forward with a Uniform Mental Health Services policy initiative that includes proper 

screening and access to a full continuum of care for substance-use disorders at all 

VA facilities. While some progress has been made, the pace needs to increase. 

The DAV thanks this Committee for its efforts last Congress in passing S. 2162, 

the Veterans’ Mental Health and Other Care Improvements Act of 2008 (Public Law 

110–387). This act, supported by DAV, requires VA to provide a full continuum of 

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ing in all its health-care facilities and programs involving OEF/OIF combat veterans—especially those in primary care. Congress must provide strong oversight 

and VA should aggressively enforce and implement these specialized programs, and 

ensure that sufficient funding is made available to achieve these goals. 

DAV has been pleased by Congressional responsiveness to many of the proposals 

emanating from our Stand Up For Veterans campaign that we have shared and discussed with Members of this Committee, your staff, and others in Congress. We 

thank the Chairman for introducing S. 252, the Veterans Health Care Authorization 

Act of 2009. This bill, drawn in large part from a staff conference package based 

on S. 2969 of the 110th Congress, contains many provisions that would address our 

priorities and concerns. We urge its passage early in this Congress. 

Mr. Chairman, this concludes my statement and I would be happy to answer 

questions on these issues from you or other Members of the Committee. 

RESPONSE TO POST-HEARING QUESTIONS FROM HON. DANIEL K. AKAKA TO ADRIAN

M. ATIZADO, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN

VETERANS

PTSD

Just this morning, the VA Inspector General issued a report on the Temple, Texas 

situation. Many will recall that a psychologist at that facility wrote a strangely 

worded email which set off a firestorm of concern for those who are suffering from 

PTSD. In a word, the IG found no systemic effort on the part of VA to reduce the 

number of PTSD claims via inappropriate diagnosis. 

Question 1. Is it your view that mental health issues, and particularly PTSD, are 

receiving appropriate attention, in terms of both compensation and care? 

Response. 

Compensation: 

The VBA recently improved/updated the Rating Schedule criteria for Traumatic 

Brain Injury (TBI), which was long overdue. We mention this because of the interplay between TBI and mental health disability. It therefore follows that the next 

logical step is to update the actual mental health rating criteria for PTSD, which 

we understand VBA to be undertaking. These moves by the Administration indeed 

show a proactive, albeit slow, approach to implementing changes that are vital to 

ensuring this generation’s servicemembers receive compensation commensurate with 

their disabilities and their resulting limitations. 

With regards to obtaining service connection for PTSD, VBA still requires a veteran to show combat exposure via official military records, except in certain circumstances, such as diagnosis during service. For many veterans, this remains a 

virtual impossibility because of poor military record keeping, poor Department of 

Veterans Affairs (VA) claims’ development procedures, or both. As VBA updates its 

rating criteria to incorporate 21st century understanding of disabilities, it too must 

update its ability, whether through application or through presumption, to determine who is and is not considered a combat veteran. We raise this issue in part 

to bring attention to the demoralizing reality of, following combat with the enemy, 

VA denying compensation to a veteran suffering from the debilitating effects of 

PTSD because his/her government refuses to accept that he/she actually saw combat 

with the enemy. 

Care: 

Based on VA’s quarterly report on VA health care utilization by veterans from the 

wars in Iraq and Afghanistan, the number of VA’s possible diagnoses of PTSD has 

risen over the past seven years and at a greater rate of increase between each of 

the quarterly reports. Such trends allow VA to better determine the demand for 

health care services in the future. 

VA has undertaken a monumental transformation of its programs and services to 

focus on recovery from mental health conditions and post-deployment readjustment 

issues and is under tremendous pressure to ensure implementation of the VA Mental Health Strategic Plan (MHSP) and Uniformed Mental Health Services (UMHS) 

package. 

Although the DAV is pleased about VA’s UMHS initiative, we are extremely concerned about the estimated timeline, resources and staffing levels necessary to establish and freely implement the initiative. There are many features of the UMHS 

package that require transformations, such as recovery-oriented care that clinicians 

believe will take years to accomplish. With a national shortage of behavioral health 

38 

personnel, we continue to hear reports from mental health practitioners in the field 

that the difficulty of recruiting and retaining behavioral health staff is a major contributing factor to the delay in spending mental health funding. 

Furthermore, VA has been a leader in research on efficacious interventions for severe PTSD, but, as documented in a November 2007, Institute of Medicine (IOM) 

report titled Gulf War and Health: Volume 6 Physiologic, Psychologic, and Psychosocial Effects of Deployment Related Stress, these effective approaches are complex, 

expensive, and time consuming. Prolonged exposure therapy, an intensive specialized counseling treatment, was highlighted in the IOM report as being one of the 

few proven effective treatments supported by evidence-based research studies. The 

DAV is concerned that VA does not currently have the capacity to deliver intensive 

exposure therapy. 

We urge Congress to provide concentrated oversight of spending on mental health 

services and require VA to provide a full accounting and breakdown of resource allocation, distribution and outcomes of the initiative goals. Oversight of these programs 

will be critical to their success. 

The DAV believes we too must do our part of oversight as veterans’ advocates. 

We believe the current advisory committee (the Committee on Care of Veterans with 

Serious Mental Illness Liaison Council) should be re-designated as a Secretary-level 

committee on mental health, armed with independent reporting responsibility to 

Congress. With the critical new focus on recovery moving away from the paternalistic doctor patient relationship toward the patient being a partner in determining 

the goals and the interventions necessary to achieve recovery, the DAV believes it 

is critical to develop recovery partnerships between VA planners, managers, clinicians, and the veteran users themselves. The new committee should include experts 

from both inside and outside VA; veteran consumers and consumer advocates, such 

as veterans service organizations (including the IBVSOs); and mental health associations concerned about VA programs and the veterans they serve. 

COLLABORATION ON THE ISSUES

Question 2. How can your organizations collaborate to address the concerns of 

those who veterans who are returning after service in Iraq and Afghanistan? 

Response. As a coauthor of The Independent Budget (IB), the DAV contributed to 

several articles within the document addressing the specific needs and concerns of 

veterans returning from the wars in Iraq and Afghanistan. The DAV is also one of 

nine veterans service organizations that constitute the Partnership for Veterans 

Health Care Budget Reform. Recognizing that a change is necessary to ensure that 

all eligible veterans—including those injured in Iraq, Afghanistan and elsewhere— 

have timely access to the quality medical care they need and deserve. The Partnership supports legislation in Congress that guarantees sufficient, timely and predictable funding for veterans health care. 

VBA STAFFING

In light of the increased funding for VBA staffing, there are high expectations 

that VBA will improve the quality of claims decisions, and to do so in a timely manner. 

Question 3. What more do you believe Congress could do to assist in decreasing 

the backlog, and at the same time, improving timeliness and accuracy? 

Response. In the past couple of years, Congress has provided a level of VBA funding that has allowed the VA to finally hire what will hopefully prove to be a sufficient number of claims adjudicators. However, training and experience both take 

time. It would be unwise to remain idle during this interim. Congress must do its 

part to ensure that VBA now has the best tools possible to assist both new and seasoned employees in carrying out the mission of providing timely and accurate decisions on benefits claims. 

In order to meet this goal, the claims’ processing system must become more efficient, but not at the expense of current benefits or fundamental rights provided by 

a grateful Nation. The DAV does not believe such sacrifices are necessary. Congress 

should seek the expertise of those that understand the benefits delivery system, 

whether inside or outside the agency. Together with these chosen experts, Congress 

and the agency should formulate a plan that will maximize every opportunity for 

the efficient administration of the claims process while seeking to enhance training 

and accountability without disrupting that process. Simultaneously, the agency 

should begin phase-in of new information systems that will allow for partial electronic claims processing. 

39 

If Congress and the VBA can merge these goals into a comprehensive and cohesive plan, we believe the veterans’ community is ready to lend its support as well 

so that all may enjoy a claims process worthy of the sacrifices of those it serves. 

OIF/OEF ILLNESSES

The Committee and, indeed, the full Congress, has focused a great deal of attention on mental health and TBI matters. Yet, the most common health condition of 

returning OEF/OIF veterans is not TBI or mental illness, but instead muscle and 

joint pain. 

Question 4. Do you have proposals on how to focus on this number one health concern from those who have served in Iraq and Afghanistan? 

Response. To be battle-ready, soldiers deployed to Afghanistan and Iraq carry, on 

average, a combat load of about 92.6 lbs (13 lbs for electronics, 55 lbs for Uniform 

and Equipment, 24 lbs for the Weapon) but can often carry 120 pounds or more including body armor, helmets, canteens, weapons and other gear that soldiers strap 

in addition to the ‘‘monster rucksack.’’ 

For purposes of prevention against the natural rigors of military service, the DAV 

believes much work has been done and is currently underway to address the weight 

distribution and burden of the foot soldier to decrease the potential work-related 

musculoskeletal injuries. For example, weight reduction and function improvement 

in products include: Lightweight Helmets (Marines)/Modular Integrated Communication Helmet (Army). Both have about a 40 percent improvement in impact protection, increased durability and ergonomics, and a half-pound reduction. The Improved Load Bearing Equipment (Marines), or rucksack, weighs 8.43 pounds and 

can hold up to 120 pounds and like the Army’s Modular Lightweight Load-carrying 

Equipment, both systems are an improvement in load-carrying ability, with new 

suspension systems that are adjustable for varying torso lengths and better weight 

distribution at the shoulders and hips. The Modular Tactical Vest (Marines) weighs 

1–2 lbs more than the decade-old Interceptor body armor, but offers more protection 

with the side armor, and several other additions, and is designed to more effectively 

distribute its weight throughout the wearer’s torso. The Army’s Interceptor Outer 

Tactical Vest is more than 3 pounds lighter than its predecessor, but provides an 

equal level of protection over an increased area. Other improvements have been 

made to individual equipment such as the Modular Sleep System which weighed 

less than its predecessor and a replacement with an Improved Sleeping System is 

underway. 

Body armor, rapid transport, and other life saving inventions have exponentially 

improved survival and care for soldiers during the wars in Iraq and Afghanistan. 

However, the treatment of their pain during medical transit from battlefield to combat hospitals is still often treated only with morphine which can cause side effects 

such as nausea, vomiting and respiratory depression, which are not experienced 

with the use of regional anesthesia. We believe that the innovative work being conducted by Army Lt. Col. (Dr.) Chester C. Buckenmaier III, chief of the regional anesthesia section at Washington’s Walter Reed Army Medical Center (WRAMC) warrants the Committee’s attention. 

Regional anesthesia affects a specific part of the body and allows for a patient to 

remain mostly cognizant during an operation, whereas general anesthesia affects 

the entire body. Patients that undergo regional anesthesia are found to have a 

quicker recovery time after surgery than those that undergo general anesthesia because they are not completely sedated, and they do not suffer the negative side effects of general anesthesia. Using a type of regional anesthesia called continuous peripheral nerve block (CPNB) is considered by experts as an important therapeutic 

tool in the anaesthetic and analgesic management of combat casualties at WRAMC. 

Lt. Col. Buckenmaier moved CPNB closer to the battlefield (21st Combat Support 

Hospital in Balad, Iraq) where he performed the first successful application of 

CPNB for pain management on SPC Brian Wilhelm in theater through evacuation. 

Expanding this program would require more physicians and CRNAs in the Army 

with the necessary training in advanced regional anesthesia. 

It is clear that the use of regional anesthesia such as CPNB is not meant as a 

primary anesthetic for every situation and it is not meant as a total replacement 

for the use of general anesthesia. However, benefits to the patient in the immediate 

are apparent. Research shows early and effective pain management in acute pain 

care is important to prevent the development of chronic painful conditions. 

In the VA, a recent study of Operation Iraqi Freedom and Operation Enduring 

Freedom (OIF/OEF) servicemembers receiving treatment in VA Polytrauma Centers 

found that pain is highly prevalent. The study also noted in its clinical implications 

that pain should be consistently assessed, treated, and regularly documented. The 

40 

report concluded that poly-traumatically injured patients are at potential risk for 

development of chronic pain, and that aggressive and multidisciplinary pain management (including medical and behavioral specialists) is a necessity. The report 

suggested the phenomenon of pain is a new opportunity for VA research in evaluating long term outcomes; developing and evaluating education or policy initiatives 

designed to improve the consistency of assessment and treatment of pain across the 

VA continuum of care; and developing and evaluating valid pain assessment measures for the cognitively impaired. 

Regarding pain assessment and treatment for the cognitively impaired, OIF/OEF 

servicemembers and veterans, who suffer from Traumatic Brain Injury, or TBI, pose 

a unique problem with assessing pain. Poly-traumatic injury includes veterans suffering from TBI and amputation, auditory and visual impairments, spinal cord injury, mental health conditions and burns, not to mention a whole host of fractures 

and crushing and soft tissue trauma. 

According to the Defense and Veterans Brain Injury Center (DVBIC), some experts have estimated the incidence of TBI among wounded servicemembers to be as 

high as 22%. Between January 2003 and March 31, 2008, DVBIC military, VA and 

civilian sites combined have seen a total of 6,602 patients with TBI. According to 

the VA, 60% or more of polytrauma survivors have some degree of brain injury. 

Brain injury is the most frequent problem treated at Polytrauma Rehabilitation 

Centers. With impaired cognition and communication skills, servicemembers and 

veterans suffer from attention and concentration deficits; memory problems; Problems with learning new skills and higher order reasoning. Such things affect a patient’s ability to report pain, its severity and effectiveness of treatment. Moreover, 

an impaired patient is vulnerable to under-treatment and over-treatment. 

While there are consensus statements regarding assessing pain in cognitively impaired and non-verbal patients, these guidelines are based on studies in the elderly, 

children and persons who are intubated or unconscious. No tools have been validated for cognitively impaired polytrauma patients—younger adults with brain injuries—even though prevalence of pain after TBI has been estimated at 44% or more 

(Martelli et al, 2004; Sherman, et al, 2006). 

Given our concerns about implementation and standardization of pain assessment 

and treatment across the VA system, the DAV testified on June 5, 2008, before the 

House Committee on Veterans’ Affairs Subcommittee on Health and on October 23, 

2007, before the Senate Committee on Veterans’ Affairs on the Veterans Pain Care 

Act of 2008, H.R. 6122 and S. 2160, respectively. We thank the Committee for its 

work to include the provisions of this bill, which were included in the Veterans’ 

Mental Health and Other Care Improvements Act of 2008 (Public Law 110–387, Sec. 

501). We believe the goals of this provision are laudable and in accord with providing high quality, comprehensive health care services to sick and disabled veterans. Having been signed into law, we believe strong oversight of VA’s progress implementing these provisions is necessary. 

OUTREACH

Question 5. How are your organizations, individually or in some cooperative fashion, working to outreach to veterans and encourage them to take advantage of VA 

care and services? 

Response. The DAV has an outreach program that includes our National Service 

Program for Veterans and Military Servicemembers, Mobile Service Office (MSO) 

Program, Information Seminars, Homeless Veterans, and Disaster Relief. 

National Service Program for Veterans: 

Our largest endeavor in fulfilling our mission to serve our Nation’s service-connected disabled veterans, their dependents and survivors is our National Service 

Program. In 88 offices throughout the United States and in Puerto Rico, the DAV 

employs a corps of approximately 260 National Service Officers (NSOs) who represent veterans and their families with claims for benefits from the VA, the DOD 

and other government agencies. Veterans need not be DAV members to take advantage of this outstanding assistance, which is provided free of charge. 

NSOs function as attorneys-in-fact, assisting veterans and their families in filing 

claims for VA disability compensation and pension; vocational rehabilitation and 

employment; education; home loan guaranty; life insurance; death benefits; health 

care and much more. They provide free services, such as information seminars, 

counseling and community outreach. NSOs also represent veterans and active duty 

military personnel before Discharge Review Boards, Boards for Correction of Military Records, Physical Evaluation Boards and other official panels. 

41 

National Service Program for Military Servicemembers: 

Transition Service Officers (TSOs) conduct or participate in pre-discharge transition assistance briefings, the Disability Transition Assistance Program (DTAP), the 

Transition Assistance Program (TAP), review service treatment records, and confer 

with Department of Defense and Department of Labor facilitators and other participants in the discharge process. The TSO program also allows DAV to assist servicemembers in the development of evidence, completion of required applications and 

prosecution of claims for veterans benefits administered under Federal, state and 

local laws. 

Mobile Service Office Program: 

Part of their outreach activities involves DAV’s MSO Program designed to educate 

disabled veterans and their families on specific veterans’ benefits and services. 

This outreach program generates considerable claims work on behalf of veterans 

and their families. NSOs, often aided by Department and Chapter Service Officers, 

travel to communities across the country to counsel and assist veterans with development of evidence, completion of required applications and prosecution of claims 

for veterans benefits administered under Federal, state and local laws. 

This program was revitalized in March 2001 and is the most extensive outreach effort in the history of our organization. Thanks to the generosity of a $1 million 

pledge from the Harley-Davidson Foundation in 2007, the DAV expanded the sites 

visited by the MSO to include Harley-Davidson dealerships, where benefits assistance is offered to veterans of all generations in communities where they live. 

These distinctive-looking and well equipped ‘‘offices on wheels’’ eliminate long 

trips some veterans in smaller towns and rural communities must take to visit our 

National Service Offices. The MSO program enhances DAV service to more veterans 

and their families. 

Information Seminars: 

DAV’s Veterans Information Seminars program is designed to educate disabled 

veterans and their families on specific veterans’ benefits and services. 

This outreach program generates considerable claims work on behalf of veterans 

and their families. The job of the NSO is to seek out veterans, to discover if they 

have a claim, and to follow that claim through to a successful conclusion. 

DAV NSOs conduct these workshops and offer the best counseling and claim filing 

assistance to veterans and their dependents. This exceptional service is available 

free of charge and does not require DAV membership to take advantage of this 

service. 

Homeless Veterans: 

The DAV helps homeless veterans make the transition from life on the streets to 

one of productivity and normalcy. Our motto, ‘‘We Don’t Leave our Wounded Behind,’’ is a heartfelt principle, a rule, and a promise that we, as a grateful Nation, 

must keep. We must remain steadfast in our efforts to fulfill our promise to veterans by ensuring that no veteran who honorably served his or her country is ever 

left behind. 

The DAV Homeless Veterans Initiative, which is supported by DAV’s Charitable 

Service Trust and Columbia Trust, promotes the development of supportive housing 

and necessary services to assist homeless veterans become productive, self-sufficient 

members of society. Our goal is to establish a partnership between the DAV and 

Federal, state, county, and local governments to develop programs to assist homeless veterans in becoming self-sufficient. 

Without question, proper VA assistance—including health care, substance abuse 

treatment, mental health services, education, and job training, etc.—will enable 

homeless veterans to improve their situations and begin the transition to once again 

become productive members of the society they served and defended. 

Disaster Relief: 

The September 11, 2001 terrorist attacks were tragic and terrifying to say the 

least. Many veterans and their families who were adversely impacted by the tragic 

events visited our NSOs who provided these individuals with DAV Disaster Relief 

grants on the spot, without lengthy delays or red tape. 

The Gulf Coast hurricanes, the Iowa floods, tornados and fires are just some of 

the natural disasters that have adversely impacted veterans and their families. As 

many residents of stricken areas were evacuated to other communities, the DAV assisted qualified veterans at the various evacuation sites, and participated in outreach events coordinated by the VA. 

The DAV has provided millions of dollars in disaster relief grants in the aftermath of natural disasters and other emergencies in various areas around the NaVerDate Nov 24 2008 20:32 Nov 04, 2009 Jkt 000000 PO 00000 Frm 00045 Fmt 6633 Sfmt 6621 H:\ACTIVE\012809.TXT SVETS PsN: PAULIN
42 

tion. DAV disaster relief grants may be issued for the purpose of providing food, 

clothing, and temporary shelter, or to obtain relief from injury, illness, or personal 

loss resulting from natural/national disasters that are not covered by insurance or 

other disaster relief agencies. 

WOMEN VETERANS

Question 6. VA has said that sufficient programs and funding already exist to care 

for women veterans. What would you point to as specific problems or shortfalls with 

respect to women veterans and what do you recommend that the Committee do to 

address these concerns? 

Response. The numbers of women now serving in our military forces are unprecedented in U.S. history and today, women are playing extraordinary roles in the conflicts in Afghanistan and Iraq. They serve as combat pilots and crew, heavy equipment operators, convoy truck drivers, and military police officers and serve in many 

military occupational specialties that expose them to the risk of combat, serious injury and death. 

As the population of women veterans undergoes exponential growth over the next 

decade, VA must act now to prepare to meet the specialized needs of the women 

who served. Overall, the culture of VA needs to be transformed to be more inclusive 

of women veterans and must adapt to the changing demographics of its women 

veteran users, taking into account their unique characteristics as young working 

women with child care and elder care responsibilities. VA needs to ensure that 

women veterans’ health programs are enhanced so that access, quality, safety, and 

satisfaction with care are equal for women and men. We refer you to specific recommendations outlined in the ‘‘Women Veterans Health and Health Care Programs’’ 

article in the Fiscal Year 2010 IB document, which is accessible online at 

www.independentbudget.org. 

PAPERWORK

Question 7. What is your organization’s opinion of VA’s expanded paperwork protection policy that came about as a result of the Inspector General’s audit which 

found that VA regional office personnel had mishandled some claims documents— 

is VA’s new policy on shredding appropriate? 

Response. The DAV is glad to see that VA’s own internal controls discovered the 

issue of document shredding. We are also pleased with VBA’s actions downstream 

of their discovery. Government employees normally enjoy a presumption of law that 

they carried out their duties absent evidence they did not. It was therefore a near 

total requirement that such presumption be relaxed in the face of systematic record 

destruction. 

We are nonetheless concerned with the seemingly arbitrary dates VA chose to employ in the foregoing relaxed standards. That noted, we realize the difficulty in 

choosing any set of dates to relax evidentiary standards of proof regarding record 

submission. 

Moreover, the veteran community wants to see accountability. VA employees that 

destroy records that may otherwise prove beneficial to claimants perpetrate fraud 

upon VA beneficiaries. Title 38, United States Code, contains clear guidelines for 

punishment, such as fines and imprisonment, for claimants who defraud the government, but no equal guidelines for VA employees who commit similar acts. Such a 

legislative amendment would go far in healing wounds caused by these dishonorable 

acts. 

STIMULUS

Question 8. The Senate stimulus package includes appropriations for VA, espe- cially $3.7 billion included for VA infrastructure projects. What are your views? 

Response. The stimulus package recommends a total of $3.574 billion to address 

VA’s infrastructure needs, including support, oversight, implementing a new ‘‘energy 

efficiency initiative,’’ and an additional $195 million for development of paperless 

claims processing and development of systems required to implement the Post-9/11 

G.I. Bill. 

The DAV has a resolution from its membership urging VA to redouble its efforts 

to request adequate funding in future budgets to ensure at minimum that VA fulfills the intent of its Capital Asset Realignment for Enhanced Services (CARES) initiative while examining other needs beyond those identified within the five-year period of the CARES initiative. Moreover, the resolution also urges Congress to provide appropriated funding sufficient to fulfill the needs for infrastructure identified 

through the CARES process, plus any other infrastructure needs VA identifies and 

justifies in the post-CARES period. 

43 

As part of the IB, the DAV believes the ongoing implementation of VA’s CARES 

indicates a large number of significant construction priorities. While Congress has 

provided $4.9 billion since fiscal year 2004, the current backlog of partially funded 

CARES projects requires additional funding for completion. Furthermore, VA recently estimated major facility projects over the next five years would require over 

$6.5 billion. As the IB recommended a total of $2.252 billion for VA construction. 

The DAV also recognized the importance of State Veterans Homes that is providing more of VA’s long-term care services to our Nation’s aging and disabled veterans. Based on VA’s mandated priority list for pending State Home construction 

grant applications for fiscal year 2009, there exists $434 million in Priority Group 

1 applications for which the State has set aside matching funds. Applications in Priority Group 2–7 would require $531 million. We support the $258 million provision 

in the stimulus package for the construction grants of State Veterans Homes. 

Finally, in our testimony before the Committee, the DAV believes the cumbersome 

and lengthy administrative claims and appeals process can be streamlined (1) by 

merging and eliminating redundancies within the benefits delivery system, and (2) 

integrating its electronic framework into a single, state-of-the-art information system to create, as much as practical, a new electronic claims process. Accordingly, 

we support the $195 million provision for the development of a paperless claims 

processing system. 

QUESTIONS FOR THE RECORD FROM SENATOR BERNARD SANDERS TO ADRIAN M. 

ATIZADO, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS

EXTENDED AND DIFFERENT HOURS FOR VA SERVICES

As I mentioned in my opening remarks, I have heard from many veterans who 

want to get to the VA for care but they can’t make it because of work. I believe 

we need to increase accessibility of the VA to all types of veterans, including those 

with full-time jobs, by providing evening and weekend hours so that people won’t 

have to choose between going to work and keeping a VA appointment. This could 

also help reduce missed appointments which waste time and resources of VA staff. 

My office is currently exploring what kind of authority VA needs to begin providing 

extended hours on a one night a week and one weekend day a week basis, possibly 

in the form of a pilot program. 

Question. What do members of the panel think about this idea? 

Response. As then Secretary of Veterans Affairs Jim Nicholson stated, ‘‘Illness 

doesn’t follow a 9-to-5 schedule.’’ He directed VA medical centers to provide extended hours to ensure veterans are able to receive the medical care they earned. 

(June 15, 2007 VA Press Release). 

Moreover, in an attempt to better manage patient access to care, VA began a process several years ago of reengineering its clinic patient flow through the ‘‘Advanced 

Clinic Access Initiative’’ developed by the Institute for Health Improvement (IHI). 

The strategy emphasizes managing demand in order to improve patient flow and 

thus access to services, all within existing capacity constraints. 

In the VA New Jersey Health Care System, staff applied advanced access strategies first to primary care clinics and then specialty clinic. In reporting the results 

of this implementation, working down the backlog of appointments required adding 

appointments and clinic hours for a finite period of time—again, within existing resources. 

VHA contracted Booz Allen Hamilton to conduct an independent review of its 

scheduling process and metrics in response to VA Office of Inspector General (OIG) 

reports in 2005, 2007, and 2008, that found reported outpatient waiting times to be 

unreliable. In its final report, Booz Allen Hamilton made a number of recommendations including VA needing to take aggressive steps to use fixed infrastructure more 

efficiently. These strategies include providing services at off-peak hours, such as 

early mornings, evenings, and Saturdays, when fixed assets are, currently, largely 

unused. To do this effectively, facilities should conduct surveys to understand which 

veterans would use which services during alternate hours. 

We believe extending operating hours of VA clinics is a reasonable solution to increase capacity and access if there is corresponding increase in resources to mitigate 

any adverse effects of increased workload on participating health care providers and 

support personnel. 

Chairman AKAKA. Thank you very much, Mr. Atizado. And now 

we will hear from Mr. Bowers. 

44 

STATEMENT OF TODD BOWERS, DIRECTOR OF GOVERNMENT 

AFFAIRS, IRAQ AND AFGHANISTAN VETERANS OF AMERICA 

Mr. BOWERS. I would just like to point out he got that in at 5 

minutes exactly. Well done. 

Mr. Chairman, Ranking Member and Members of the Committee, thank you for inviting the Iraq and Afghanistan Veterans 

of America to testify here today and for giving us the opportunity 

to present our 2009 legislative agenda. 

On behalf of IAVA and our more than 125,000 members and supporters, I would also like to thank you for your unwavering commitment to our Nation’s veterans. 

And I would also like to thank you all for braving the ice this 

morning to make it to this hearing. Maybe next year, we can do 

it in Hawaii, though that is not a formal recommendation. 

After 7 years of war, it has never been more critical to care for 

our Nation’s veterans. I know because I am one of them. I still 

serve as a staff sergeant in the United States Marine Corps, and 

I should point out that my testimony today does not reflect the 

views or opinions of the Marine Corps. 

At IAVA, we are committed to making sure that no servicemember and no veteran is ever left behind. The mission of IAVA 

is to improve the lives of more than 1.7 million Iraq and Afghanistan veterans and their families. 

IAVA is proud to have worked with our fellow VSOs in local communities, with the media and in Washington to draw attention to 

the issues facing our troops and veterans, and to get those problems solved. Over the past 4 years, IAVA has grown into a driving 

force behind many legislative victories for veterans. 

In 2008, we saw unprecedented success. First and foremost was 

the passage of the new GI Bill which will ensure affordable college 

education for all veterans of Iraq and Afghanistan. IAVA also 

worked to increase health care funding by $4.5 billion, to improve 

benefits for disabled veterans, to expand suicide prevention and to 

improve treatment for Traumatic Brain Injury. We have effectively 

partnered with many other veteran and military service organizations and also the Department of Defense, the Department of Veterans Affairs and Members of Congress to make these successes a 

reality. 

In 2008, IAVA launched a historic public service advertising campaign in partnership with the Ad Council. The groundbreaking 

multiyear effort seeks to ease the readjustment for servicemembers 

coming home from Iraq and Afghanistan. Extensive research was 

conducted to develop the Veteran Support Campaign, including 

focus groups around the country, extensive consultation with Iraq 

and Afghanistan veterans and the involvement of a panel of top 

mental health experts. 

All PSAs direct viewers to the first and only online community 

exclusive to Iraq and Afghanistan veterans. This innovative Web 

site will help veterans connect with one another and link them 

with comprehensive services, benefits assistance and mental health 

resources. 

A companion PSA campaign will be launched in 2009 that will 

engage and support the families and loved ones of Iraq and Afghanistan veterans. This is the most extensive veterans’ public outVerDate Nov 24 2008 20:32 Nov 04, 2009 Jkt 000000 PO 00000 Frm 00048 Fmt 6633 Sfmt 6601 H:\ACTIVE\012809.TXT SVETS PsN: PAULIN
45 

reach by a non-profit in history, and we hope it will provide not 

only much-needed services but innovations and lessons learned to 

be shared and replicated by the VA and DOD. 

While we have accomplished landmark successes in 2008, thanks 

in large part to the work of this Committee, there is still more to 

do. We are hopeful the new administration and the new Congress 

will continue to focus on veterans’ issues. 

Our 2009 legislative agenda, based on extensive processes of polling and seeking feedback from our 125,000-strong membership, 

makes recommendations in four areas crucial to today’s veterans: 

mental health, homecoming, health care and government accountability. 

Attached you will find the complete legislative agenda and the 

IAVA legislative priorities. We have also provided hard copies for 

your convenience. 

At this time, I would like to highlight just a few of the most urgent issues facing Iraq and Afghanistan veterans. 

Ensuring thorough, professional and confidential screening for 

invisible injuries: IAVA supports mandatory, face-to-face and confidential mental health and TBI screenings by a licensed medical 

professional for all servicemembers before and after their combat 

tour. The goal of this is to remove the stigma and seal the crack 

that many veterans and servicemembers tend to fall through. 

Senator Burr, I could not agree with your comments more, that 

getting veterans in fast is the key to solving these problems. 

Of our membership that we were able to poll, those who sought 

treatment, 70 percent said it was useful. So the key is getting them 

in the door. 

Advance fund veterans’ health care. Advance fund veterans’ 

health care, emphasis. The best way to ensure timely funding of 

veterans’ health care is to fully fund the Department of Veterans 

Affairs health care budget 1 year in advance. In addition, IAVA endorses the annual Independent Budget produced by leading veterans service organizations, including IAVA, as a blueprint for VA 

funding levels. 

I also agree with many of my members at the table today that 

this is key to ensuring that servicemembers get the appropriate 

care they need. 

Ending the passive VA System: The VA has traditionally been a 

passive, inward-looking system. Veterans must overcome tremendous bureaucratic obstacles to get the funding and services that the 

VA provides. Many veterans do not even know the benefits they 

are eligible for. The VA must develop a national strategy to promote the use of its services including advertising VA benefits, expanding VA outreach and modernizing the VA’s online presence. 

Of our poll, we found that 72 percent of our members had visited 

the VA Web site, and their responses are, well, I just will not say 

any here today. 

We also had in our priorities veterans in the economic stimulus 

package. We have seen great successes already, and I thank the 

Committee for your work on this issue. 

Finally, to correctly implement the new GI bill: The historic Post9/11 GI Bill, passed last year, included a provision to allow servicemembers to transfer their GI Bill education funding to a spouse or 

46 

dependent. But the Congress and the Administration can and must 

keep the bureaucracy moving to keep this benefit a reality. Our office regularly receives phone calls where servicemembers are wondering when they are going to have this benefit and how will they 

understand it? And we do not have those answers yet. 

That concludes my testimony at this time. I thank the Committee. I will be happy to answer any questions. 

[The prepared statement of Mr. Bowers follows:] 

PREPARED STATEMENT OF TODD BOWERS, DIRECTOR OF GOVERNMENT AFFAIRS, IRAQ

AND AFGHANISTAN VETERANS OF AMERICA

Mr. Chairman, Ranking Member, and Members of the Committee, thank you for 

inviting Iraq and Afghanistan Veterans of America (IAVA) to testify today, and for 

giving us the opportunity to present our 2009 Legislative Agenda. On behalf of 

IAVA and our more than 125,000 members and supporters, I would also like to 

thank you for your unwavering commitment to our Nation’s veterans. 

After seven years of war, it has never been more critical to care for our Nation’s 

newest warriors. I know, because I am one of them. I still serve as Staff Sergeant 

in the United States Marine Corps. I have served two tours in Iraq, and just returned from an additional deployment last summer. At IAVA, we are committed to 

making sure that no servicemember, and no veteran, is ever left behind. The mission of IAVA is to improve the lives of the more than 1.7 million Iraq and Afghanistan veterans and their families. IAVA addresses critical issues facing our newest 

generation of heroes, including psychological and neurological injuries, a flawed disability benefits system, and the implementation of the historic new GI Bill. Founded 

in 2004 by a small group of Iraq veterans, IAVA is dedicated to educating the public 

about the wars in Iraq and Afghanistan, advocating on behalf of those who have 

served, and fostering a community for troops, veterans, and their families. 

IAVA is proud to have worked in local communities, with the media, and in Washington to draw attention to the issues facing our troops and veterans, and to get 

those problems solved. Over the past four years, IAVA has grown into a driving 

force behind many legislative victories for veterans. In 2008, we saw unprecedented 

success. First and foremost was the passage of the new GI Bill, which will ensure 

an affordable college education for all veterans of Iraq and Afghanistan. IAVA also 

worked to increase veterans’ health care funding by $4.5 billion, to improve benefits 

for disabled veterans, to expand suicide prevention, and to improve treatment for 

Traumatic Brain Injury. We have effectively partnered with many other Veteran 

and Military Service Organizations, the Department of Defense, the Department of 

Veterans Affairs and Members of Congress to make these successes a reality. We’re 

the new kids on the block, but we have made a substantial impact, in a very short 

time. All in all, IAVA saw progress on 20 of our 28 legislative recommendations in 

2008. 

In 2008, IAVA also launched a historic Public Service Advertising (PSA) campaign 

in partnership with the Ad Council. The groundbreaking, multiyear effort seeks to 

ease the readjustment for servicemembers returning home from Iraq and Afghanistan. Joining such iconic Ad Council PSA campaigns as ‘‘Only You Can Prevent Forest Fires’’ and ‘‘Friends Don’t Let Friends Drive Drunk,’’ the groundbreaking Veteran Support campaign will feature TV, radio, print and online PSAs, both in 

English and in Spanish. Extensive research was conducted to develop the Veteran 

Support Campaign, including focus groups around the country, extensive consultation with Iraq and Afghanistan veterans, and the involvement of a panel of top mental health experts. All PSAs direct viewers to the first and only online community 

exclusive to Iraq and Afghanistan veterans, www.CommunityofVeterans.org. This 

innovative Web site will help veterans connect with one another and link them with 

comprehensive services, benefits assistance, and mental health resources. A companion PSA campaign launching in 2009 will engage and support the families and 

loved ones of Iraq and Afghanistan veterans. This is the most extensive veterans 

public outreach by a non-profit in history, and we hope it will provide not only much 

needed services, but innovation and lessons learned to be shared and replicated by 

the VA, and DOD. 

While we have accomplished landmark successes in 2008, thanks in large part to 

the work of this Committee, there is still more to do. We are hopeful the new Administration, and the new Congress, will continue to focus on veterans issues. Our 

2009 IAVA Legislative Agenda, based on an extensive process of polling and seeking 

feedback from our 125,000-strong membership, makes recommendations in four 

47 

areas crucial to today’s veterans: Mental Health, Homecoming, Healthcare and Government Accountability. 

Attached you will find out complete Legislative Agenda, and the IAVA Legislative 

Priorities. At this time, I’d like to highlight just a few of the most urgent issues facing Iraq and Afghanistan veterans. 

Ensure Thorough, Professional, and Confidential Screening for Invisible Injuries. 

IAVA supports mandatory, face-to-face and confidential mental health and TBI 

screening by a licensed medical professional, for all servicemembers, before and 

after their combat tour. 

Advance-Fund Veterans’ Health Care. The best way to ensure timely funding of 

veterans’ health care is to fully fund the Department of Veterans Affairs (VA) health 

care budget one year in advance. In addition, IAVA endorses the annual Independent Budget, produced by leading veterans’ organizations (including IAVA), as a 

blueprint for the VA funding levels. 

End the Passive VA System. The VA has traditionally been a passive, inward-looking system. Veterans must overcome tremendous bureaucratic obstacles to get the 

benefits and services that the VA provides. Many veterans do not even know what 

benefits they are eligible for. The VA must develop a national strategy to promote 

the use of its services, including advertising VA benefits, expanding VA outreach, 

and modernizing the VA’s online presence. 

Prioritize Veterans in the Economic Stimulus Package. Caring for our veterans 

isn’t just the right thing to do—it a sound economic investment. IAVA calls for tax 

credits for patriotic employers that hire new veterans and reservists, support for 

veterans struggling with student loans, and investment in shovel-ready projects like 

repairing veterans’ hospitals and cemeteries. 

Correctly Implement the New GI Bill. The historic Post-9/11 GI Bill, passed last 

year, included a provision to allow servicemembers to transfer their GI Bill education funding to a spouse or dependent. But Congress and the Administration can 

and must keep the bureaucracy moving to make this benefit a reality. 

Thank you for your time. 

IRAQ AND AFGHANISTAN VETERANS OF AMERICA

2009 LEGISLATIVE AGENDA

LEGISLATIVE PRIORITIES

The IAVA Legislative Priorities are the most urgent actions Congress must take 

to ensure that veterans of Iraq and Afghanistan get the care and support they have 

earned. 

A. Ensure Thorough, Professional, and Confidential Screening for Invisible Injuries 

IAVA supports mandatory, face-to-face and confidential mental health and TBI 

screening by a licensed medical professional, for all servicemembers, before and 

after their combat tour. See recommendation 1.1. 

B. Advance-Fund Veterans’ Health Care 

The best way to ensure timely funding of veterans’ health care is to fully fund 

the Department of Veterans Affairs (VA) health care budget one year in advance. 

In addition, IAVA endorses the annual Independent Budget, produced by leading 

veterans’ organizations (including IAVA), as a blueprint for the VA funding levels. 

See recommendation 3.1. 

C. End the Passive VA System 

The VA has traditionally been a passive, inward-looking system. Veterans must 

overcome tremendous bureaucratic obstacles to get the benefits and services that 

the VA provides. Many veterans do not even know what benefits they are eligible 

for. The VA must develop a national strategy to promote the use of its services, including advertising VA benefits, expanding VA outreach, and modernizing the VA’s 

online presence. See recommendations 1.2, 2.4, and 3.2. 

D. Combat Veterans’ Unemployment 

IAVA supports the expansion of employment training for troops leaving the military, tax credits for employers who hire troops and veterans, and a new ‘‘Green-toGreen’’ program to retrain veterans for high-paying jobs in the clean energy economy. See recommendation 2.3. 

E. Cut the Claims Backlog in Half 

Hundreds of thousands of disabled veterans are awaiting an answer on their VA 

benefits claims. Errors in claims decisions are a primary source of the backlog. 

48 

IAVA recommends a new evaluation system that holds claims processors accountable for the accuracy of their work. See recommendation 3.2. 

F. Improve Health Care for Female Veterans 

11 percent of Iraq and Afghanistan veterans are women. They deserve the same 

access to health care as any other American veteran. IAVA supports prioritized hiring of female practitioners and outreach specialists, increased funding for specialized in-patient women-only PTSD clinics, and significant expansion of the resources 

available to women coping with Military Sexual Trauma. See recommendations 1.2, 

3.3 and 3.5. 

G. Eradicate Homelessness Among Veterans 

About 150,000 veterans are homeless on any given night, and foreclosure rates 

in military towns are increasing at four times the national average. IAVA calls for 

20,000 new HUD-VA Supportive Housing vouchers, an increase in the Grant and 

Per Diem allowances for community organizations to help homeless veterans, and 

an extensive outreach campaign to promote VA home loan and financial counseling 

services. See recommendation 2.4. 

I. MENTAL HEALTH

Rates of psychological and neurological injuries among troops and new veterans 

are high and rising. But many troops and veterans are not getting the treatment 

they need. 

In a landmark 2008 RAND study, ‘‘Invisible Wounds of War,’’ almost 20 percent 

of Iraq and Afghanistan veterans screened positive for Post Traumatic Stress Disorder (PTSD) or major depression. But less than half of those suffering from mental 

health injuries are receiving sufficient treatment. Multiple tours and inadequate 

time at home between deployments increase rates of combat stress. 

Troops in Iraq and Afghanistan are also facing neurological damage. When troops 

are near an exploding mortar or roadside bomb, the blast can damage their brains, 

often without leaving a visible injury. The vast majority of Traumatic Brain Injuries 

(TBIs) are mild or moderate. But the injury is widespread: 19 percent of troops report a probable TBI during deployment. Tens of thousands of troops are suffering 

from both psychological and neurological injuries. 

Untreated mental health problems can and do lead to family issues, substance 

abuse, homelessness and suicide. For female servicemembers in particular, divorce 

rates are very high; female soldiers faced an 8.8 percent annual divorce rate, more 

than 2.5 times the national average. As of December 2008, there have been at least 

196 military suicides in Iraq and Afghanistan. These numbers do not include the 

many veterans who commit suicide after their service is complete, whose fatalities 

are not tracked or reported. 

Troops and veterans face significant barriers to mental health care. The Department of Defense (DOD) relies on an ineffective, antiquated system of paperwork to 

conduct mental health evaluations, and access to mental health care is difficult. According to the Pentagon’s Task Force on Mental Health, the military’s ‘‘current complement of mental health professionals is woefully inadequate.’’ The National Defense Authorization Act for 2009 singled out mental health professionals as a critically short wartime specialty, and authorized new recruitment and multi-year retention bonuses for psychologists. But as of December 2008, the bonuses had yet to be 

implemented. 

Effective treatment is also scarce for veterans who have left the military. The VA 

has given mental health diagnoses to more than 178,000 Iraq and Afghanistan veterans, or 45 percent of new veterans who visit the VA. But VA care is not always 

convenient. Veterans in rural communities are especially hard hit, and the availability and quality of health care for female veterans ranges widely. 

Exacerbating the problem of inadequate screening and treatment is the heavy 

stigma associated with receiving mental health treatment. More than half of soldiers and Marines in Iraq who test positive for a psychological injury report concern 

that they will be seen as weak by their fellow servicemembers. One in three of these 

troops worry about the effect of a mental health diagnosis on their career. As a result, many troops who need care do not seek it out. 

To learn more about troops’ and veterans’ psychological injuries, please see the 

2009 IAVA Issue Report, ‘‘Invisible Wounds: Psychological and Neurological Injuries 

Confront a New Generation of Veterans.’’ All IAVA reports are available at 

www.iava.org/reports. 

Mental Health Recommendations 

1.1 Ensure Thorough, Professional, and Confidential Screening for Invisible Injuries 

49 

• The Defense Department must supply mandatory, face-to-face and confidential 

mental health and TBI screening by a licensed medical professional, for all servicemembers, before and between 90 and 180 days after return from combat. • To maximize the effectiveness of the TBI Veterans Health Registry, the DOD 

and the VA should establish a joint protocol to share existing and future operational 

situation reports (SITREPS) of all servicemembers exposed to blasts and other 

causes of head and neck injury. 

1.2 Advertise VA Mental Health Services • The VA must receive specially-allocated funds to research, test and implement 

an effective national and local media strategy, that includes use of new and traditional media, to combat stigma and to promote the use of VA services such as Vet 

Centers and the Suicide Prevention hotline. The VA’s campaign strategy should include a comprehensive plan to involve Veterans Service Organizations, and should 

promote behavioral and mental health services to underserved groups, including 

homeless veterans, rural veterans and female veterans. 

1.3 Increase Mental Health Support for Military Families 

• Vet Centers should be authorized and funded to provide services to active-duty 

military servicemembers and their families. IAVA supports the expansion of VA 

mental health services to veterans’ families, including children, parents, siblings 

and significant others, if the veteran is receiving VA treatment for mental health 

or behavioral health problems. 

• Adequate funding must be provided to implement fully the National Guard and 

Reserve Yellow Ribbon Reintegration Program, which provides reintegration training to reserve component troops and their families. 

• IAVA calls for a study to better identify the causes of marital strain and high 

divorce rates among active and reserve component servicemembers, including multiple deployments, mental health injuries, and gaps in family support programs, 

particularly for the families of female servicemembers. 

• IAVA supports funding for an independent review of the scope of family violence 

in the military, and an analysis of the effectiveness of the Department of Defense’s 

response to the problem. 

1.4 Combat the Shortage of Mental Health Professionals 

• DOD must implement a full range of special pays, including accession and 

multi-year retention bonuses, as well as incentive and bonus pays, at a sufficient 

level to effectively recruit and retain critically needed behavioral and mental health 

professionals. Congress should require a biannual report on the implementation and 

effectiveness of the current recruitment and retention bonuses for mental health 

professionals. 

• IAVA supports providing suicide prevention training within combat life-saver 

training, the emergency medical training troops receive from combat medics. 

1.5 Address the Mental Health Needs of Female Troops and Veterans 

• IAVA supports increased funding for specialized in-patient women-only PTSD 

clinics. 

• To improve the quality of health care for female veterans, Vet Centers and VA 

medical facilities must be encouraged to hire female practitioners and outreach specialists, and especially female veterans. 

• The veterans’ suicide hotline operators should receive additional training to respond to sexual assault-related calls. 

• IAVA supports increased funding for the Department of Defense’s Sexual Assault Prevention and Response Office in order for it to expand its oversight role. 

1.6 End Discrimination against Psychologically Wounded Troops 

• To ensure that servicemembers suffering from service-connected psychological 

or neurological injuries have not been improperly discharged, IAVA recommends imposing an immediate moratorium on personality disorder discharges for combat veterans until an audit of past personality discharges is completed. 

• When troops seek voluntary alcohol and substance-abuse counseling and treatment, command notification should be at the discretion of the treating mental 

health professional. 

II. HOMECOMING

Even in the best of times, troops coming home from war face serious challenges 

reintegrating into civilian life. But as the economy falters, our newest veterans are 

being hit especially hard. 

Troops are facing serious challenges returning to the civilian workforce. Among 

Iraq and Afghanistan-era veterans of the active-duty military, the unemployment 

rate was over 8 percent in 2007, about 2 percent higher than their civilian peers. 

50 

In addition, National Guardsmen and Reservists, ‘‘citizen soldiers’’ who leave behind 

their civilian lives to serve alongside active-duty troops, are inadequately protected 

against job discrimination. 

In the most severe cases, economic hardship can push veterans into homelessness. 

Foreclosure rates in military towns are increasing at four times the national average, and almost 2,000 Iraq and Afghanistan veterans have already been seen in the 

Department of Veterans Affairs’ homeless outreach program. Given the state of the 

economy, the problem is likely to worsen in the coming years. 

One major step forward for improving veterans’ economic opportunities is almost 

complete. IAVA led the fight to provide today’s veterans with the same kind of education benefits America provided to veterans of World War II. In June 2008, we 

won. The new ‘‘Post-9/11’’ GI Bill makes college affordable to 1.7 million veterans 

of Iraq and Afghanistan, but a number of technical fixes are necessary in 2009 to 

maximize the GI Bill’s effectiveness. 

For more information about the transition challenges of new veterans, please see 

the 2009 IAVA Issue Reports, ‘‘Careers After Combat: Employment and Education 

Challenges for Iraq and Afghanistan Veterans’’ and ‘‘Coming Home: The Housing 

Crisis and Homelessness Threaten New Veterans.’’ All IAVA reports are available 

at www.iava.org/reports. 

Homecoming Recommendations 

2.1 Streamline and Simplify the Post-9/11 GI Bill 

• IAVA calls on Congress to oversee the accurate and timely implementation of 

all portions of the ‘‘Post-9/11 GI Bill,’’ including the tuition benefit, housing allowance, book stipend, and transferability provisions. 

• Eliminate the confusion of multiple education benefits by ensuring that the 

Post-9/11 GI Bill covers all types of education programs. 

• Veterans pursuing vocational and distance learning programs should be entitled 

to the same tuition benefits as veterans attending traditional colleges. 

• Rather than an unwieldy state-by-state benefit system, the Post-9/11 GI Bill 

benefit should have a national tuition cap tied to the price of the most expensive 

public school (currently about $13,000/yr). Partial tuition payments should be based 

on a percentage of this cap, not individual tuition costs. 

• The Yellow Ribbon Program, which provides matching Federal funds for private 

school scholarships given to GI Bill recipients, should be universally available to 

those in reserve component. 

• Veterans with remaining educational entitlement should be able to use their 

benefit to pay back student loans. 

• Veterans attending school part time should receive a pro-rated housing benefit. 

• Active Guard Reserve (AGR) service should be counted toward benefits calculations. 

2.2 Defend Troops Against Job Discrimination 

• USERRA, the Uniformed Services Employment and Reemployment Rights Act, 

protects National Guardsmen and Reservists from discrimination based on their 

military service. IAVA supports the extension of USERRA protections to servicemembers working in domestic response operations, such as hurricane or wildfire 

missions. 

• Processing of USERRA claims should be consolidated within the jurisdiction of 

a single agency. 

• Federal and state governments should be held to the same standard of 

USERRA compliance as private sector employers. 

• Employers who knowingly violate USERRA job protections should face civil and 

criminal prosecution. Congress must direct tough enforcement of USERRA by the 

Departments of Justice and Labor, and give these agencies specific resources for this 

function. Violation of USERRA should be explicitly added to the list of offenses for 

which suspension or debarment from eligibility for Federal Government contracts is 

authorized. 

• Servicemembers who face employment discrimination based on their military 

service must be afforded their day in court, as intended by the original USERRA 

statute. USERRA complaints should be exempt from pre-dispute binding arbitration 

agreements. 

• To prevent employers from firing an employee while a USERRA claim is being 

processed, courts hearing USERRA complaints should be required to use their full 

range of legal powers, including injunctions. 

• The DOD should implement a notification program for servicemembers’ employers specifically informing employees of their USERRA obligations. 

2.3 Combat Veterans’ Unemployment 

51 

• The employment training in the Transition Assistance Program for separating 

servicemembers should be modernized and made mandatory for all active-duty 

troops leaving the military. • IAVA recommends tax credits for employers who, when their reserve component 

employees are called to active-duty for over 90 days, continue to support their employees by paying the difference between the servicemembers’ civilian salary and 

their military wages. • IAVA supports a tax credit to promote the hiring of homeless veterans by reimbursing the employer for a percentage of the salary of the hired veteran. • Any economic stimulus proposals that promote ‘‘green collar’’ jobs should include a ‘‘Green-to-Green’’ program to retrain veterans for the new clean energy economy, and to encourage green employers to hire veterans. • The DOD should conduct a study of the differences between DOD and civilian 

vocational certifications in order to ease the transition of certifications into the civilian world. • To help mitigate the effect of frequent and lengthy deployments, IAVA supports 

new programs to provide small businesses owners in the National Guard and Reserves with additional access to capital, insurance, and bonding. 

2.4 Eradicate Homelessness Among Veterans • IAVA calls for a one-year moratorium on mortgage foreclosure for any servicemember returning from a combat tour. This provision should not sunset before 2012, 

at the earliest. Lenders who fail to abide by the moratorium should face stiff civil 

and criminal penalties. • Congress should appropriate funding for a VA outreach and advertising campaign in regions hard-hit by the mortgage crisis that have high veteran and servicemember populations. The campaign should promote VA home loan and financial 

counseling services. Adequate funding should also be provided to ensure that the VA 

has enough loan counselors to cope with call volume. • IAVA calls for a dramatic expansion of the HUD-VA Supportive Housing voucher program, to include the funding of an additional 20,000 housing vouchers. To ensure that vouchers are reaching eligible homeless veterans, a study must be conducted to examine voucher utilization rates, barriers to finding housing, service delivery and coordination, and housing retention among veterans participating in the 

program. • The Grant and Per Diem (GPD) program payment rate should better match the 

actual cost to help a homeless veteran. The VA should be given the discretion to 

increase GPD payment rates up to 150% of the daily rate for programs that are 

high-cost due to their location or range of services. • IAVA supports a pilot program to test preventative strategies against homelessness at VA facilities. Potential strategies should include emergency cash assistance, 

help with utilities, and short-term rental subsidies. • IAVA endorses a VA ‘‘GreenHomes’’ program that would convert underutilized 

VA properties into energy-efficient permanent housing for homeless veterans. 

2.5 Protect Servicemembers from Unfair Contracts • Students who are deployed overseas should be reimbursed by their college or 

university for tuition paid toward interrupted coursework. • Servicemembers should be protected from early termination fees if a servicemember terminates a lease due to a deployment. • Protections allowing servicemembers to suspend or cancel cell phone contracts 

should be extended to servicemembers whose service contract is a part of a shared 

family account. 

• Active-duty and recently separated servicemembers and their families should 

not be denied in-state tuition rates at local public universities due to a failure to 

meet state residency requirements. 

2.6 Steer Veterans to Alternative Sentencing 

• A pilot program should be funded to test the effects of alternative sentencing 

for veterans suffering from combat related stress injuries who are arrested for nonviolent crimes. The pilot should build on the work of the Veterans Court in Buffalo, 

NY. The results of this pilot should be used to create guidelines for other states on 

effective alternative sentencing programs. 

• The VA should repeal the standing prohibition on treatment for incarcerated 

veterans, and should coordinate with local municipalities to develop counseling, recovery, and peer-support services for veterans in the criminal justice system. 

III. HEALTH CARE AND BENEFITS

Far too many military families and veterans are struggling with the bureaucratic 

barriers to health care and benefits. Accessing medical care requires long waits for 

52 

appointments, and is often too far away. Even when a wounded veteran is too disabled to work, the disability compensation process can take years. 

Millions of veterans rely on the health care and benefits provided by the Department of Veterans Affairs (VA), and about 42 percent of eligible Iraq and Afghanistan veterans have already gone to the VA for health care. But accessing the system 

is often a problem. Wait times for appointments can be months long, and hospitals 

and clinics are frequently inconveniently located. As of 2003, more than 25% of veterans enrolled in VA health care live over an hour from any VA hospital. The VA 

has already taken steps to expand access to health care but much more must be 

done. 

A fundamental problem with VA health care is unreliable funding from Congress. 

Unlike the allocations for Medicaid and Medicare, funding for the Veterans Health 

Administration is not mandatory. As a result, veterans’ groups must fight each year 

to ensure that Congress provides adequate funding. In the past two years, however, 

Congress finally made veterans a priority, providing the VA with record budget increases. But when the VA budget is passed late, as it has been 17 of the past 20 

years, hospitals are forced to ration care and scrape by with temporary funding 

bills. Appropriating funding for the VA one year in advance would allow veterans’ 

hospitals to better plan their budgets, cut wait times, and ensure veterans have access to the care they need—and it would cost no additional money. 

The VA also provides benefits to promote veterans’ education, to help veterans 

buy a home, to compensate for combat-related disabilities, to provide for veterans’ 

funerals, and to support troops and veterans’ survivors. Almost 4 million veterans 

receive VA benefits, but for many, accessing the benefits they have earned is a difficult process. The DOD and the VA each have their own complicated and confusing 

disability benefits systems. As troops transition from the DOD to the VA, medical 

records and military service records regularly get lost in the shuffle, leading to long 

waits for benefits processing. Even within the VA system, veterans face inexcusable 

delays. With over 800,000 claims filed annually, the current average wait time of 

6 months is unacceptable. According to the VA’s own numbers, about 12% of ratings 

decisions are inaccurate. These wrongly-decided claims can take two years to complete the appeal process, and are the primary source of the claims backlog. 

Since the scandal at Walter Reed Army Medical Center in 2007 drew attention 

to the bureaucratic red tape that wounded troops face, the VA has added more 

claims processors. However, the current VA system rewards the quantity of claims 

processed, not the quality of processors’ decisions. The VA must refocus its efforts 

to effectively train the new workforce and to link performance reviews to both quantity and quality of claims processed. With these systems in place, stories of VA backdating claims or shredding paperwork could finally become a distant memory. 

For more on troops and veterans’ health care and compensation issues, consult 

the 2008 IAVA Issue Report: ‘‘Battling Red Tape: Veterans Struggle for Care and 

Benefits.’’ All IAVA reports are available at www.iava.org/reports. 

Health Care and Benefits Recommendations 

3.1 Reform Veterans’ Health Care Funding 

• To ensure timely and predictable funding, the VA budget should be appropriated at least one year in advance. 

• IAVA endorses the annual Independent Budget, produced by leading veterans’ 

organizations (including IAVA) as the blueprint for VA funding levels. 

• The Government Accountability Office should audit the VA’s internal budget 

model. The VA must be prepared to accurately project the number of veterans who 

will use VA health care, taking into account increases in demand due to an influx 

of Iraq and Afghanistan veterans and the downturn in the economy. 

3.2 Cut the Claims Backlog in Half 

• IAVA supports the Veterans’ Disability Benefits Commission’s call to mandate 

a 50% decrease in the claims backlog in 2 years. To make this possible, IAVA recommends a new evaluation system that rewards claims processors based on the accuracy of their work, not just the quantity of claims processed. 

• To make claims more consistent between regional offices, the VBA must reassess training requirements. Claims processors at the VA regional offices should receive annual standardized training specific to the errors found in each office’s processing during the previous fiscal year. The VBA should hold claims processors and 

their managers accountable for meeting the annual training requirement, and 

should provide opportunities for knowledge-sharing, in the model of 

CompanyCommand.army.mil and PlatoonLeader.army.mil. 

• IAVA believes it is the VA’s responsibility to clearly inform veterans about the 

requirements to substantiate a claim. The VA should publicize the criteria for 

claims establishment, and the VA’s ‘‘Duty to Notify’’ should include providing the 

53 

claimant with a thorough explanation of the elements needed to substantiate a 

claim. • Veterans should be able to waive the waiting period for evidence submission if 

the claim is fully developed. • Appeals forms should be sent out with Notice of Decision letters, to expedite the 

process if the veteran chooses to appeal. 

3.3 Improve Access to Care • Military families face significant barriers to receiving mental health care under 

TRICARE, including inaccurate lists of local providers, low provider reimbursement 

rates, and high levels of paperwork. IAVA recommends a study to determine the extent of these barriers and how they can be minimized. • IAVA recommends that the VA mandate uniform services at women’s clinics. 

Currently, women’s clinics vary in the services they deliver, from gender-specific 

care to general primary care. Women veterans should have access to female primary 

care providers when requested, and if necessary, the VA should contract with local 

health care providers to offer this service. • The Secretary of the VA should design and implement national guidelines to instruct VA facilities when it is appropriate to contract with local community health 

care providers in areas where rural veterans do not have reasonable access to care. • VA funding should be provided to promote, oversee, and evaluate a pilot program that creates a network of drivers for veterans struggling to find transportation 

to the nearest VA hospital. 

3.4 Smooth the Transition from the Military to the VA • Enrollment in VA health care should be required for all troops leaving activeduty service, whether from the active or reserve component, with the opportunity 

to opt out, rather than opt in. Participation in the Benefits Delivery at Discharge 

program must be mandatory. • The disability process should be streamlined, so that the DOD determines fitness for duty, and the VA determines disability compensation. The DOD should perform a thorough medical examination for all troops prior to their separation, and 

DOD records, including the DD–214, should be electronic and interoperable with a 

state-of-the-art VA system. The DD–214 should be updated to include email addresses. • Benefit Resource Counselors should be available for all National Guard and Reserve units. An incentivized training program should be established in coordination 

with the DOD and VA that would train at least one member of every National 

Guard and Reserve unit on available Federal and state benefits for servicemembers 

and their families. 

3.5 Ensure Benefits are Fair • The VA disability benefits schedule should be revised to provide adequate compensation for both loss of earning capacity and quality of life, and to accommodate 

new kinds of disability, including Post Traumatic Stress Disorder. While the Rating 

Schedule is revised, all compensation rates should be increased as recommended by 

the Veterans’ Disability Benefits Commission. • As recommended by the VA’s Advisory Committee on Women Veterans, the Veterans Benefits Administration should put in place a procedure to identify, track and 

report to Congress the outcomes of disability claims that involve Military Sexual 

Trauma (MST), in order to better understand the number of MST-related claims 

submitted annually, length of processing times, denial rates, and the types of disabilities that are associated with MST. • IAVA supports concurrent receipt of veterans’ disability and military separation 

or retirement benefits. • IAVA urges the complete repeal of the Widow and Widower’s Tax. • All National Guardsmen and Reservists who are veterans of the wars in Iraq 

and Afghanistan should qualify for early retirement based on the length of their active-duty service. 

3.6 Expand Health Tracking for Iraq and Afghanistan Veterans • Congress should fund a pre- and post-deployment longitudinal study that 

bridges the gap from Department of Defense and the Department of Veterans Affairs to track veterans’ mental health problems, diseases and mortality. • Troops returning from a tour in Iraq or Afghanistan should be required to enroll 

in the Gulf War Registry Program, with the opportunity to opt out, rather than opt 

in. 

3.7 Care for the Caregivers 

• IAVA recommends the creation and expansion of pilot programs to certify and 

train family caregivers of veterans as personal care attendants, so that they can receive compensation from the Department of Veterans Affairs. 

54 

• The VA should build on its current partnership with local universities to provide respite care to family caregivers. Graduate students should be trained to provide respite care for families caring for wounded warriors. 

IV. GOVERNMENT ACCOUNTABILITY

American troops and military families have responded to the demands of a prolonged two-front war with tremendous courage and dedication. But the government 

has not consistently shown the same commitment to supporting those called to 

serve. The wars in Iraq and Afghanistan have been a heavy burden for our Armed 

Forces, who represent less than one half of one percent of the American people. The 

military now regularly requires troops to serve multiple, extended combat tours. As 

General Peter Schoomaker, the former Chief of Staff of the United States Army, 

warns: ‘‘While our Soldiers are responding with extraordinary commitment, particularly in the face of adversity and personal hardships, we cannot allow this condition 

to persist.’’ 

At the same time, funding for the Iraq and Afghanistan wars has become a political football, used by politicians on both sides of the aisle to disguise the wars’ cost 

and fund unrelated pet projects. 

Finally, although our troops and military families prove their dedication to our 

country every day, they are all too often stripped of their rights as citizens. Military 

voters regularly receive their absentee ballots too late to allow them to vote. In addition, over 40,000 non-citizens serve in the U.S. military today, but they receive little 

protection for themselves or their families against unfair application of immigration 

laws. The last thing troops in the American military should be worrying about while 

deployed is the possibility that their spouses at home may be deported. 

Government Accountability Recommendations 

4.1 Issue a National Call to Service • IAVA supports Congressional efforts to expand nonmilitary service opportunities. The President must call on all Americans to show their support for our Nation’s troops and veterans by joining them in serving the Nation in the military or 

on the homefront. 

4.2 Prevent Military Voter Disenfranchisement • All too often, military personnel receive their ballots too late to be counted. 

States should provide uniform, simple access procedures for military and military 

dependent absentee voting that is valid in all 50 states. These procedures should 

include a re-examination of the dates limiting how early one can apply for an absentee ballot, to ensure troops can feasibly apply for and receive a ballot in time to cast 

their ballots. Election mail must be protected and prioritized, so that troops overseas receive their ballots on time. 

4.3 Provide a Road to Citizenship for Military Families • IAVA believes that the deportation of spouses of troops deployed to a combat 

zone should be deferred until at least two years after the deployed servicemember 

returns from combat. In addition, surviving widows and widowers of those killed in 

action should be eligible for expedited citizenship and/or ‘‘bereavement visas’’ to 

allow them to visit family in their country of origin in the years after their spouse’s 

death. 

4.4 End Abuse of the Emergency Supplemental Process • IAVA recommends that the DOD be obligated to report detailed equipment 

reset expenditures within the procurement accounts in a way that confirms that 

funds appropriated for reset are expended for the correct purposes. • Emergency supplemental funding undercuts Congressional oversight of spending. While supplemental funding is crucial for real emergencies, IAVA opposes the 

use of emergency supplemental to fund predictable military needs. 

RESPONSE TO POST-HEARING QUESTIONS FROM HON. DANIEL K. AKAKA TO TODD

BOWERS, DIRECTOR OF GOVERNMENT AFFAIRS, IRAQ AND AFGHANISTAN VETERANS

OF AMERICA

PTSD

Just this morning, the VA Inspector General issued a report on the Temple, Texas 

situation. Many will recall that a psychologist at that facility wrote a strangely 

worded email which set off a firestorm of concern for those who are suffering from 

PTSD. In a word, the IG found no systemic effort on the part of VA to reduce the 

number of PTSD claims via inappropriate diagnosis. 

55 

Question 1. For each of you, is it your view that mental health issues, and particularly PTSD, are receiving appropriate attention, in terms of both compensation and 

care? 

Response. It is IAVA’s belief that there needs to be full review of all previous congressionally mandated and chartered commission and their recommendations that 

pertain to PTSD compensation. Commissions’ such as the Presidents Commission on 

Returning Wounded Warriors and the Veterans Disability Benefits Commission 

have made multiple recommendations that IAVA fully supports but have yet to be 

implemented. Congress must review these recommendations and prioritize the implementation based on veteran needs and gaps based on the VA FY2008 Performance and Accountability Report. 

The VA disability benefits schedule should be revised to provide adequate compensation for both loss of earning capacity and quality of life, and to accommodate 

new kinds of disability, including Post Traumatic Stress Disorder. While the Rating 

Schedule is revised, all compensation rates should be increased as recommended by 

the Veterans’ Disability Benefits Commission. 

COLLABORATION ON THE ISSUES

Question 2. How can your organizations collaborate to address the concerns of 

those who veterans who are returning after service in Iraq and Afghanistan? 

Response. To draft IAVA 2009 Legislative Agenda, IAVA conducted direct polling 

of our membership to establish a solid foundation of the priorities that OIF and 

OEF veterans seek to have addressed this year. These priorities have been identified as: 

• Ensure thorough, Professional, and Confidential screening for invisible injuries. 

IAVA supports mandatory, face-to-face and confidential mental health and TBI 

screening by a licensed medical professional, for all servicemembers, before and 

after their combat tour. 

• Advance-Fund veterans’ Health Care. The best way to ensure timely funding of 

veterans’ health care is to fully fund the Department of Veterans Affairs (VA) health 

care budget one year in advance. In addition, IAVA endorses the annual Independent Budget, produced by leading veterans’ organizations (including IAVA), as a 

blueprint for the VA funding levels. 

• End the Passive VA system. The VA has traditionally been a passive, inwardlooking system. Veterans must overcome tremendous bureaucratic obstacles to get 

the benefits and services that the VA provides. Many veterans do not even know 

what benefits they are eligible for. The VA must develop a national strategy to promote the use of its services, including advertising VA benefits, expanding VA outreach, and modernizing the VA’s online presence. 

• Combat veterans’ Unemployment. IAVA supports the expansion of employment 

training for troops leaving the military, tax credits for employers who hire troops 

and veterans, and a new ‘‘Green-to-Green’’ program to retrain veterans for high-paying jobs in the clean energy economy. 

• Cut the Claims Backlog in Half. Hundreds of thousands of disabled veterans 

are awaiting an answer on their VA benefits claims. Errors in claims decisions are 

a primary source of the back-log. IAVA recommends a new evaluation system that 

holds claims processors accountable for the accuracy of their work. 

• Improve Health Care for Female veterans. 11 percent of Iraq and Afghanistan 

veterans are women. They deserve the same access to health care as any other 

American veteran. IAVA supports prioritized hiring of female practitioners and outreach specialists, increased funding for specialized in-patient women-only PTSD 

clinics, and significant expansion of the resources available to women coping with 

Military Sexual Trauma. 

• Eradicate Homelessness among veterans. About 150,000 veterans are homeless 

on any given night, and foreclosure rates in military towns are increasing at four 

times the national average. IAVA calls for 20,000 new HUD-VA Supportive Housing 

vouchers, an increase in the Grant and Per Diem allowances for community organizations to help homeless veterans, and an extensive outreach campaign to promote 

VA home loan and financial counseling services. 

All of these priorities have been shared with every Veteran Service Organization 

as registered with the Department of Veterans Affairs. It is IAVA’s goal to serve 

as a conduit between our newest generations of veterans. 

For the past three years, IAVA has been in full support of the Independent Budget 

as established by the leading veteran Service Organizations. In addition, IAVA supports many of the recommendations and resolutions established by The Military Coalition. IAVA has been a member of The Military Coalition as of June, 2008. IAVA 

56 

will continue to pursue effective VSO partnerships to ensure veterans are appropriately represented from all generations. 

VBA STAFFING

In light of the increased funding for VBA staffing, there are high expectations 

that VBA will improve the quality of claims decisions, and to do so in a timely manner. 

Question 3. What more do you believe Congress could do to assist in decreasing 

the backlog, and at the same time, improving timeliness and accuracy? 

Response. IAVA supports the Veterans’ Disability Benefits Commission’s call to 

mandate a 50% decrease in the claims backlog in 2 years. To make this possible, 

IAVA recommends a new evaluation system that rewards claims processors based 

on the accuracy of their work, not just the quantity of claims processed. 

To make claims more consistent between regional offices, the VBA must 

reassess training requirements. Claims processors at the VA regional offices should 

receive annual standardized training specific to the errors found in each office’s 

processing during the previous fiscal year. The VBA should hold claims processors and their managers accountable for meeting the annual training requirement, and should provide opportunities for knowledge-sharing, in the model of 

CompanyCommand.army.mil and PlatoonLeader.army.mil. 

IAVA believes it is the VA’s responsibility to clearly inform veterans about the 

requirements to substantiate a claim. The VA should publicize the criteria for 

claims establishment, and the VA’s ‘‘Duty to Notify’’ should include providing the 

claimant with a thorough explanation of the elements needed to substantiate a 

claim. 

OIF/OEF ILLNESSES

The Committee and, indeed, the full Congress, has focused a great deal of attention on mental health and TBI matters. Yet, the most common health condition of 

returning OEF/OIF veterans is not TBI or mental illness, but instead muscle and 

joint pain. 

Question 4. Do any of you have proposals on how to focus on this number one 

health concern from those who have served in Iraq and Afghanistan? 

Response. A recent report from the Washington Post highlighted that current 

combat loads carried by servicemembers in Iraq and Afghanistan are resulting in 

large amounts of orthopedic injuries. During their combat tours in Iraq and Afghanistan, it is common for servicemembers to carry loads as heavy as half their body 

weight. Depending on the length of their deployment, this constant strain can last 

up to 15 months and recovery time is shortened due to inadequate dwell time between multiple deployments. The numbers of non-deployable Army personnel is increasing at a staggering rate and other branches are also feeling the strain. Never 

before have servicemembers been subjected to such heavy loads for such extended 

periods of time and at a constant rate. 

IAVA recommends that a joint review be conducted by DOD and VA into the long 

term effects of carry large combat loads has on acute orthopedic injuries and musculoskeletal system of OIE and OEF veterans. 

OUTREACH

Question 5. How are your organizations, individually or in some cooperative fashion, working to outreach to veterans and encourage them to take advantage of VA 

care and services? 

Response. IAVA has recently launched a multi-tiered veteran’s outreach campaign 

in partnership with the Ad Council. The goal of this national media effort is to drive 

veterans to the Nation’s first online social networking Web site exclusive for OIF 

and OEF veterans. This Web site communityofveterans.org has established a secure 

online community for veterans to voice their concerns about issues ranging from 

PTSD disability compensation to difficulty accessing VA care. Below are highlights 

from the campaign. 

Campaign Overview: 

• IAVA has partnered with the Ad Council to launch a groundbreaking Public 

Service Advertising (PSA) campaign on Veterans Day 2008. This multiyear, national 

effort addresses readjustment issues and seeks to ease the transition for veterans 

returning home from Iraq and Afghanistan. 

• The campaign will feature two distinct series of PSAs (including TV, radio, 

print, outdoor, Web and rich media); one focused on Iraq and Afghanistan veterans 

57 

and a second on the families and loved ones of veterans who are also impacted by 

transitional issues. 

• The new campaign was developed in partnership with the Ad Council, a nonprofit organization that has created some of the country’s most iconic PSA campaigns including ‘‘Friends Don’t Let Friends Drive Drunk’’ and Smokey Bear. 

Strategy: 

• The Ad Council, IAVA and ad agency BBDO conducted extensive research to 

develop this campaign. We held several rounds of focus groups in three cities across 

the country with veterans, their families, and members of the general public. We 

also regularly consulted with a panel of distinguished mental health experts about 

the direction of the campaign. We will continue to hold briefings with a range of 

experts to solicit feedback and input going forward. 

Online Component: 

• The works aimed at veterans directs them to the first and only online community exclusive to Iraq and Afghanistan veterans through a new social networking 

Web site, communityofveterans.org 

• The innovative Web site will offer a platform for veterans to connect with one 

another and act as a portal for comprehensive mental health resources, with the 

goal of increasing the number of veterans who seek treatment for issues including 

PTSD and depression. 

• The campaign takes advantage of web 2.0 by reaching the modern veterans online—where they are already. It will act as a MySpace or Facebook plus exclusively 

for veterans, transforming the way that veterans interact with one another and talk 

about transitional issues. 

About the Ad: 

• Created pro bono by ad agency BBDO in New York, the compelling TV PSA, 

Alone, follows a young servicemember when he returns from Iraq. He is filmed in 

a completely empty airport terminal, alone on a subway and walking through desolate New York City streets. Eventually, he is approached by another Iraq veteran 

who extends his hand and welcomes him home. When the two men shake hands, 

the deserted city comes alive, illustrating the power of connecting with another veteran. 

• The magnitude of this shoot was incredible and required extraordinary help 

from the city of New York. With the City’s aid, we shut down an entire terminal 

at JFK International Airport, a subway car on the 7 line, and multiple New York 

City blocks, including in front of the Flat Iron Building and in the financial district. 

Issue Background: 

• IAVA and Ad Council developed this campaign to address the urgent challenges 

facing America’s newest generation of veterans. There are 1.7 million men and 

women who have served, or are currently serving, in Iraq and Afghanistan. 

• 1 in 5 Iraq and Afghanistan veterans will suffer from a mental health problem, 

ranging from depression to Post Traumatic Stress Disorder (PTSD), and over time, 

as many as 30–40% of new veterans could face serious psychological injuries. 

• Untreated mental health conditions can cause or aggravate other debilitating 

problems in the Veterans’ community including high rates of unemployment, homelessness, substance abuse, divorce, child abuse, and suicide. Many avoid seeking 

help because of the stigmas around seeking treatment or being diagnosed with a 

mental illness. 

Campaign Long-term Objective: 

• The challenges facing returning veterans are broad and multi-faceted and will 

not be solved overnight. There is no quick fix or cookie cutter solution. This campaign’s long-term objective is to gradually decrease the depression and PTSD-related 

outcomes among returning veterans and encourage them to take that safe, first step 

in getting help. Through this campaign we can begin to change the way that both 

private citizens and the government talk about and address these issues. 

Family Campaign: 

• A complementary PSA effort that will launch in the coming months will seek 

to engage the families and loved ones of these veterans. That body of work will empower veterans’ loved ones to start a conversion and encourage the veteran to seek 

help if necessary. A Web site dedicated to providing resources and information for 

families, supportyourvet.org, will also launch in the coming months. 

58 

WOMEN VETERANS

VA has said that sufficient programs and funding already exist to care for women 

veterans. 

Question 6. What would you point to as specific problems or shortfalls with respect to women veterans and what do you recommend that the Committee do to address these concerns? 

Response. 11 percent of Iraq and Afghanistan veterans are women. They deserve 

the same access to health care as any other American veteran. 

IAVA supports increased funding for specialized inpatient women-only PTSD clinics. 

To improve the quality of health care for female veterans, Vet Centers and VA 

medical facilities must be encouraged to hire female practitioners and outreach specialists, and especially female veterans. 

The veterans’ suicide hotline operators should receive additional training to respond to sexual assault-related calls. 

IAVA supports increased funding for the Department of Defense’s Sexual Assault 

Prevention and Response Office in order for it to expand its oversight role. 

IAVA recommends that the VA mandate uniform services at women’s clinics. 

Currently, women’s clinics vary in the services they deliver, from gender-specific 

care to general primary care. Women veterans should have access to female primary 

care providers when requested, and if necessary, the VA should contract with local 

health care providers to offer this service. 

As recommended by the VA’s Advisory Committee on Women Veterans, the Veterans Benefits Administration should put in place a procedure to identify, track and 

report to Congress the outcomes of disability claims that involve Military Sexual 

Trauma (MST), in order to better understand the number of MST-related claims 

submitted annually, length of processing times, denial rates, and the types of disabilities that are associated with MST. 

PAPERWORK

Question 7. What is your organization’s opinion of VA’s expanded paperwork protection policy that came about as a result of the Inspector General’s audit which 

found that VA regional office personnel had mishandled some claims documents— 

is VA’s new policy on shredding appropriate? 

Response. IAVA agrees with the chairman’s statement that the current freeze of 

document shredding as established by former Secretary Peake is not a long term 

solution. We look forward to finding out the status of the current policy changes 

that will take effect when the Committee receives testimony next month regarding 

this issue. It is paramount, that veterans are not shortchanged by destruction of 

their supporting documents when filing Disability Claims. The VA must also 

prioritize the importance of destruction of documentation containing personal information to ensure the privacy of veterans is protected. 

STIMULUS

Question 8. The Senate stimulus package includes appropriations for VA, especially $3.7 billion included for VA infrastructure projects. What are your views? 

Response. IAVA is grateful for what Congress has provided in the stimulus package. IAVA fully supported the Senate version. 

RESPONSE TO POST-HEARING QUESTIONS FROM HON. BERNARD SANDERS TO TODD

BOWERS, DIRECTOR OF GOVERNMENT AFFAIRS, IRAQ AND AFGHANISTAN VETERANS

OF AMERICA

EXTENDED AND DIFFERENT HOURS FOR VA SERVICES

As I mentioned in my opening remarks, I have heard from many veterans who 

want to get to the VA for care but they can’t make it because of work. I believe 

we need to increase accessibility of the VA to all types of veterans, including those 

with full-time jobs, by providing evening and weekend hours so that people won’t 

have to choose between going to work and keeping a VA appointment. This could 

also help reduce missed appointments which waste time and resources of VA staff. 

My office is currently exploring what kind of authority VA needs to begin providing 

extended hours on a one night a week and one weekend day a week basis, possibly 

in the form of a pilot program. 

59 

Question 1. Mr. Bowers, the IAVA has also discussed the important of changing 

the VA from a passive to an active institution when it comes to helping veterans. 

Is this a proposal that the IAVA would support? 

Response. Yes. IAVA fully supports any initiative that effectively increases outreach of services and benefits to OIF and OEF servicemembers and veterans. This 

legislation matches our 2009 Legislative Agenda recommendation #1.2. 

1.2 Advertise VA Mental Health Services • The VA must receive specially-allocated funds to research, test and implement 

an effective national and local media strategy, that includes use of new and traditional media, to combat stigma and to promote the use of VA services such as Vet 

Centers and the Suicide Prevention hotline. The VA’s campaign strategy should include a comprehensive plan to involve Veterans Service Organizations, and should 

promote behavioral and mental health services to underserved groups, including 

homeless veterans, rural veterans and female veterans. 

AUTOMATIC ENROLLMENT IN VA FOR MEMBERS OF THE GUARD AND RESERVE

Mr. Cullinan and Mr. Bowers, in both of your prepared testimonies you mentioned 

the importance of improving the hand off between the Department of Defense and 

the VA. I am working on legislation that would automatically enroll members of the 

National Guard and Reserve into VA health and dental care while they are going 

through discharge. This does not force these servicemembers to use the VA system 

but it does cut down on the process of applying for VA care later and allows VA 

care to be there if a veteran who doesn’t think they need the care realizes later in 

life that they want it. If the VA is meant to provide care of these veterans, we 

should not make it so hard for them to sign up for the care. 

Question 2. Mr. Bowers, is this a proposal that the VFW IAVA could support? 

Response. Yes. IAVA fully supports any initiative that will streamline the transition from Active Duty to Veteran status. When I returned from my second deployment, my unit leadership proactively encouraged all servicemembers returning from 

OIF to register with a VA representative from the Washington DC area Vet Center 

that was present during our demobilization process. By having all of our Marines 

register with the VA before demobilizing it removed any individual from falling 

through the cracks. This issue is addressed in our 2009 Legislative Agenda under 

item #3.4. 

3.4 Smooth the Transition from the Military to the VA • Enrollment in VA health care should be required for all troops leaving activeduty service, whether from the active or reserve component, with the opportunity 

to opt out, rather than opt in. Participation in the Benefits Delivery at Discharge 

program must be mandatory. 

Chairman AKAKA. Thank you very much, Mr. Bowers. 

Mr. Blake, your testimony. 

STATEMENT OF CARL BLAKE, NATIONAL LEGISLATIVE 

DIRECTOR, PARALYZED VETERANS OF AMERICA 

Mr. BLAKE. Chairman Akaka, Ranking Member Burr, Members 

of the Committee, on behalf of Paralyzed Veterans of America, I 

would like to thank you for the opportunity to testify today. 

As you know, PVA continues to work on issues that are important to our members, specifically those veterans with spinal cord 

injury or dysfunction, but also for all veterans. 

With this mind, I would like to outline our priorities for the 

111th Congress. They include, first and foremost, advanced appropriations for the VA health care system; elimination of health care 

copayments for catastrophically disabled Priority Group 4 veterans; 

proceeding with the construction of a freestanding tertiary care 

hospital in Denver, Colorado, that includes a spinal cord injury 

center in accordance with the recommendations of the CARES commission; improving recruitment and retention bonuses and incentives for nurses and allied health professionals; an increase in the 

adaptive automobile grant with an annual index to increase the 

value of the grant with the cost of inflation. 

60 

Senator Sanders, I would like to thank you for your leadership 

in trying to improve this benefit during the 110th Congress, and 

we look forward to working on this again this year. 

Finally, but certainly not the least important, improvements to 

the claims process, including through updated information systems 

technology, and, of course, as mentioned by my colleague from 

IAVA, smooth implementation of the GI Bill. 

I would like to focus my attention on only a couple of the issues 

that I mentioned. 

Chairman Akaka, we were pleased that during the 110th Congress you introduced legislation, the Veterans’ Health Care Budget 

Reform Act, S. 3527, that would reform the VA budget process by 

providing advanced appropriations for VA health care. The legislation was developed in consultation with the Partnership for Veterans’ Health Care Budget Reform, a group that includes nine 

major veterans service organizations including Paralyzed Veterans 

of America. 

The Veterans’ Health Care Budget Reform Act would ensure that 

the goals of the partnership—sufficient, timely and predictable 

funding—are met. Historically, advance appropriations have been 

used to make a program more efficient and effective, better aligned 

with funding cycles of the program recipients or provide insulation 

from annual political partisan maneuvering. By moving to advance 

appropriations, veterans’ health care programs would accrue all 

three of these benefits. 

Once again, we appreciate your support for this proposal during 

the 110th Congress, and we look forward to the introduction of 

similar legislation for the 111th, and we hope to build a broader 

base of bipartisan support for the legislation. 

In 1985, Congress approved legislation which opened the VA 

health system to all veterans. In 1996, Congress again revised that 

legislation with a system of rankings establishing priority ratings 

for enrollment. Within that context, PVA worked hard to ensure 

that those veterans with catastrophic disabilities would be placed 

in a higher enrollment category. 

To protect their enrollment status, veterans with catastrophic 

disabilities were allowed to enroll in Priority Group 4 even though 

their disabilities were non-service-connected and regardless of their 

incomes. However, unlike other Priority Group 4 veterans, if they 

would otherwise have been in Priority Group 7 or 8 due to their 

incomes, they would still be required to pay all fees and co-payments, just as others in those categories do now for every service 

they receive from VA. 

PVA believes this is unjust. VA recognizes their unique specialized status on the one hand by providing specialized service for 

them in accordance with its mission. The system then makes them 

pay for those very same services. Unfortunately, these veterans are 

not casual users of the VA health care system. Because of the nature of their disabilities they require a lot of care and a lifetime 

of services. 

We were pleased that the House Committee on Veterans’ Affairs 

approved and the House of Representatives eventually passed legislation, H.R. 6445, that would eliminate this financial burden placed 

on catastrophically disabled veterans during the 110th Congress. 

61 

In fact, the House bill had a rare triumvirate of bipartisan support 

of the House Democrats and Republicans and the VA. Unfortunately, the Senate never took action on the measure and the legislation was never enacted. 

We hope that with your leadership, and Senator Burr’s efforts as 

well, we will finally be able to resolve this issue during the 111th 

Congress. 

Finally, Mr. Chairman, I would like to thank you and Senator 

Burr for your efforts during the 110th. Veterans have certainly realized a lot of successes legislatively, and we look forward to working with you again. 

Just as sort of a housekeeping note, I would like to inform the 

Committee that The Independent Budget, which has already been 

mentioned, for fiscal year 2010 will be available for download on 

the Internet next Monday, February 2. The Web site for that document will be www.independentbudget.org. We hope to be able to 

deliver hard copies to the Committee staff and to the individual 

Committee offices shortly thereafter. Many of the issues discussed 

here by my colleagues today and that I also discussed will be discussed in further detail in that document. 

This concludes my testimony, Mr. Chairman. I would be happy 

to answer any questions. 

[The prepared statement of Mr. Blake follows:] 

PREPARED STATEMENT OF CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR, 

PARALYZED VETERANS OF AMERICA

Chairman Akaka, Ranking Member Burr, and Members of the Committee, on behalf of Paralyzed Veterans of America (PVA), I would like to thank you for the opportunity to present our priorities for the 111th Congress. We hope that the Senate 

Committee on Veterans’ Affairs will take our concerns under consideration as it prepares its legislative and policy agenda this year. We appreciate the legislative successes that veterans have realized under your leadership and we look forward to 

continued success in the future. 

PVA continues to work on issues important to our members, veterans with spinal 

cord injury or dysfunction, specifically, and to all veterans. With this in mind, I 

would like to outline our priorities for the 111th Congress. They are: 

• Advance appropriations for VA health care. 

• Elimination of health care co-payments for catastrophically disabled Priority 

Group 4 veterans. 

• Proceeding with the construction of a free-standing, tertiary care hospital in 

Denver, CO that includes a spinal cord injury center in accordance with the recommendations of the CARES commission. 

• Improving recruitment and retention bonuses and incentives for nurses and allied health professionals. 

• Increase in the adaptive automobile grant and an annual index to increase the 

value of the grant with the cost of inflation. 

• Improvements to the claims process, including through updated information 

systems technology, and smooth implementation of the 21st Century GI Bill. 

ADVANCE APPROPRIATIONS

Chairman Akaka, we were pleased that in September of last year you introduced 

legislation—S. 3527, the ‘‘Veterans’ Health Care Budget Reform Act’’—that would 

reform the VA budget process by providing advance appropriations for veterans’ 

health care. The legislation was developed in consultation with the Partnership for 

Veterans Health Care Budget Reform (Partnership)—a group that consists of nine 

major veterans service organizations, including Paralyzed Veterans of America. For 

more than a decade, the Partnership has worked to achieve a sensible and lasting 

reform of the funding process for veterans’ health care. While the Partnership has 

long advocated converting VA’s medical care funding from discretionary to mandatory funding, there has been virtually no movement in Congress in this direction. 

62 

The Veterans Health Care Budget Reform Act would ensure that the goals of the 

Partnership—sufficient, timely, and predictable funding—are met. Historically, advance appropriations have been used to make a program function more effectively, 

better align with funding cycles of program recipients, or provide insulation from 

annual partisan political maneuvering. By moving to advance appropriations, veterans’ health care programs would accrue all three of these benefits. 

To enhance the budget process even further, the proposed legislation includes provisions to add transparency and oversight to VA’s internal budget forecasting model. 

Due to the complex nature of VA’s actuarially-based Model, S. 3527 would require 

GAO to conduct an annual audit and assessment of the Model to determine its validity and accuracy, as well as assess the integrity of the process and the data upon 

which it is based. GAO would submit public reports to Congress each year that 

would assess the Model and include an estimate of the budget needs for VA’s medical care accounts for the next two fiscal years. Providing Congress with access to 

the Model and its estimates of VA health care’s resource needs, would provide greater confidence in the accuracy of advance appropriations for veterans’ medical care, 

as well as validate future requests for emergency supplemental appropriations. Once 

again, we appreciate your support for this proposal during the 110th Congress, and 

we look forward to the introduction of similar legislation and your continued support 

as we try to advance this legislation during the 111th Congress. 

ELIMINATION OF CO-PAYMENTS FOR CATEGORY 4 VETERANS

In 1985, Congress approved legislation which opened the VA health system to all 

veterans. In 1996, Congress again revised that legislation with a system of rankings 

establishing priority ratings for enrollment. Within that context, PVA worked hard 

to ensure that those veterans with catastrophic disabilities would be placed in a 

higher enrollment category. To protect their enrollment status, veterans with catastrophic disabilities were allowed to enroll in Priority Group Four even though their 

disabilities were non-service-connected and regardless of their incomes. However, 

unlike other Category Four veterans, if they would otherwise have been in Category 

Seven or Eight, due to their incomes, they would still be required to pay all fees 

and co-payments, just as others in those categories do now for every service they 

receive from VA. 

PVA believes this is unjust. VA recognizes their unique specialized status on the 

one hand by providing specialized service for them in accordance with its mission 

to provide for special needs. The system then makes them pay for those services. 

Unfortunately, these veterans are not casual users of VA health care services. Because of the nature of their disabilities they require a lot of care and a lifetime of 

services. In most instances, VA is the only and the best resource for a veteran with 

a spinal cord injury, and yet, these veterans, supposedly placed in a higher priority 

enrollment category, have to pay fees and co-payments for every service they receive 

as though they had no priority at all. 

We were pleased that the House Committee on Veterans’ Affairs approved and the 

House of Representatives eventually passed legislation—H.R. 6445—to eliminate 

this financial burden placed on catastrophically disabled veterans during the 110th 

Congress. In fact, the House bill received unanimous support from Republicans and 

Democrats as well as the VA. Unfortunately, the Senate never took action on the 

measure and the legislation was never enacted. We hope that with your leadership, 

we will finally be able to resolve this issue during the 111th Congress. 

DENVER/FITZSIMMONS VA MEDICAL CENTER

As you may be aware, there has been a great deal of controversy concerning the 

VA plan for providing health care in the Denver/Rocky Mountain region. The ongoing controversy surrounding the Department of Veterans Affairs’ decision to stop 

construction planning for a free-standing replacement hospital in Denver, Colorado 

and, instead, lease space from the University of Colorado Medical Center in a tower 

it plans to construct continues to generate opposition. The long awaited replacement 

facility which was to include a thirty bed spinal cord injury center was first approved by VA in 2002 and planning and design began in 2007 once Congress had 

appropriated funds. 

Unfortunately, in early 2008 the VA suddenly and without notice stopped all development on a free-standing medical facility and began planning to lease space in 

a new medical center to be built by the University of Colorado, with financing by 

the VA. Moreover, the VA jettisoned the plan for the recommended 30-bed spinal 

cord injury center in Denver as outlined by the Capital Asset Realignment for Enhanced Services (CARES) report. The VA has since made additional changes to the 

plan for SCI care simply as a means to ease the concerns of PVA. 

63 

However, we believe the VA will not be able to meet several important benchmarks for SCI care while leasing in the new University of Colorado tower. First, 

we believe the spinal cord injury unit will not be created to meet VA’s own design 

guidelines, including first floor location in the proposed new tower and dedicated 

SCI/D parking. Second, we do not believe that staffing requirements for the unit will 

be consistent with the guidelines agreed to by VA and Paralyzed Veterans of America. Third, we believe the new leasing arrangement will prevent PVA from the same 

access afforded us in other VA spinal cord injury centers to both counsel veterans 

and conduct site visits. Finally, VA’s guidelines call for the establishment of spinal 

cord injury centers at a tertiary care hospital to ensure that the center is supported 

by the full range of medical and ancillary health services. We do not believe this 

new leased facility will support all the necessary medical specialties and services 

with VA staff. 

Veterans’ organizations on the national level have joined with their local affiliates 

in opposing this action by VA. In a letter sent to the previous Secretary of Veterans 

Affairs, James Peake, national veterans’ organizations, including Paralyzed Veterans of America and the union representing VA employees, articulated our opposition and concerns and questioned whether this change in strategy was a first step 

in altering how VA has historically provided care. Veterans are rightly concerned 

that this may well be an approach that leads to greater privatization of services and 

ultimately lead to a diminution of VA and, specifically, its specialized services. 

It is time for the VA to return to the previous long-term plan to construct a freestanding, tertiary care hospital in Denver, CO that includes a spinal cord injury 

center in accordance with the recommendations of the CARES commission. In the 

meantime, we hope that the Committee will monitor this situation closely so as to 

ensure that the VA is not laying the groundwork in Denver for a long-term health 

care delivery plan that could ultimately lead to lower quality of care across the entire VA health care system. 

RECRUITMENT/RETENTION OF NURSES AND ALLIED HEALTH PROFESSIONALS

Given the VHA’s leadership position as a health system, it is imperative that VA 

aggressively recruit health-care professionals and work within established relationships with academic affiliates and community partners to recruit new employees. In 

order to make gains on these needs, VA must update and streamline its human resource processes and policies to adequately address the needs of new graduates in 

the health sciences, recruits, and current VA employees. Today’s health-care professionals and other staff who work alongside them need improved benefits, such as 

competitive salaries and incentives, child care, flexible scheduling, and generous 

educational benefits. VA must actively address the factors known to affect current 

recruitment and retention, such as fair compensation, professional development and 

career mobility, benevolent supervision and work environment, respect and recognition, technology, and sound, consistent leadership, to make VA an employer of 

choice for individuals who are offered many attractive alternatives in other employment settings. 

VA’s ability to sustain a full complement of highly skilled and motivated personnel will require aggressive and competitive employment hiring strategies that 

will enable it to successfully compete in the national labor market. VA’s employment 

success within the VHA will require constant attention by the very highest levels 

of VA leadership. Additionally, Members of Congress must understand the gravity 

of VA personnel issues and be ready to provide the necessary support and oversight 

required to ensure VA’s success. 

ADAPTIVE AUTOMOBILE BENEFITS

PVA believes that an increase in the adaptive automobile assistance grant to an 

amount commensurate with the original intent of this benefit is essential. VA provides certain severely disabled veterans and servicemembers with grants for the 

purchase of automobiles or other conveyances. This grant also provides for adaptive 

equipment necessary for safe operation of these vehicles. When the grant was created, Congress initially fixed the amount of the automobile grant to cover the full 

cost of the automobile. 

Because adjustments have not kept pace with increased costs, the value of the 

automobile allowance has been substantially eroded through the years. In 1946, the 

$1,600 allowance represented 85 percent of average retail cost of a new vehicle and 

was sufficient to pay the full cost of automobiles in the ‘‘low-price field.’’ For 2008, 

the National Automobile Dealers Association confirmed that the average price of a 

new car was $28,500. The current $11,000 automobile allowance represents only 

about 39 percent of the average cost of a new automobile. In accordance with the 

64 

recommendations of The Independent Budget, we recommend that the grant be increased to 80 percent of the value of a new car. In order to achieve this level, the 

allowance should be increased to $22,800. Furthermore, an automatic annual adjustment must be established, similar to what was provided for the Specially Adapted Housing grant in the Housing Recovery bill enacted during the 110th Congress, 

in order to maintain the automobile grant’s purchasing power as well. 

VA CLAIMS PROCESS AND THE 21ST CENTURY GI BILL

Finally, we believe that a number of issues within the claims process must be 

closely monitored as the VA seeks to update and modernize the process. We were 

particularly pleased with the fact that Congress appropriated significant increases 

in funding for VBA over the last couple of years. Likewise, we appreciate the emphasis placed on hiring many new claims adjudication personnel. We have long argued that the only way to give the VA a fighting chance at overcoming the rapidly 

growing claims backlog is to provide for adequate staffing. 

However, it is important to note that simply hiring additional staff is not enough. 

Equally important is to ensure proper training and accountability of claims adjudication staff at all levels of the process. While it is easy to blame first-line claims 

staff for improper ratings decisions, much of the blame also has to fall to the management within VBA. Performance measures for all levels of adjudication staff have 

wrongly focused too much on quantity of claims decided rather than quality. 

PVA is also concerned that VBA is not really spending the new funding Congress 

has provided in the last couple of years in the manner that Congress intended and 

the veterans service organizations (VSO) desired. Specifically, we believe that VA 

is spending too much of this new funding on pilot projects and special programs 

rather than on basic hiring and systemic needs. 

Moreover, we believe that VBA must accelerate the progress toward an electronic 

claims record system. As long as VA continues to use a paper file shipped around 

the country, the claims and appeals process will be done in an expensive and antiquated manner. Under the current system, VA staff need the actual claims file to 

act on claims. In a paperless, environment VA staff could act on claims without having to access a claimant’s actual claims file. Additionally, transition to a paperless 

system will permit claims work to be seamlessly transferred to any of VA’s regional 

offices, allowing for quicker decisionmaking on claims. As demonstrated by the Veterans Health Administration’s outstanding electronic medical record system, similar 

gains in access to records can be realized in the claims and appeals process. We urge 

Congress to accelerate funding of VA’s transition to an electronic claims record. 

Recent hearings have demonstrated how far behind the VBA is in using information technology in its claims adjudication process. While we believe that the entire 

claims process cannot be automated, there are many aspects and steps that certainly can. We have long complained to the VA that it makes no sense for severely 

disabled veterans to separately apply for the many ancillary benefits to which they 

are entitled. Their service-connected rating immediately establishes eligibility for 

such benefits as the Specially Adapted Housing grant, adaptive automobile equipment, and education benefits. However, they still must file separate application 

forms to receive these benefits. 

Furthermore, certain specific disabilities require an automatic rating under the 

disability ratings schedule. For example, it does not take a great deal of time and 

effort to adjudicate a below knee single-leg amputation. An advanced information 

technology system can determine a benefit award for just such an injury quickly. 

We believe that it is time for the VA to automate consideration of ancillary benefits 

and specific ratings disabilities that are generally automatic. 

Finally, we are very concerned about the implementation of the 21st Century GI 

Bill, set to become available to eligible veterans and servicemembers in August. 

Progress toward an effective implementation plan began with much difficulty. While 

we believe that the VA is being as proactive as possible to ensure that the benefit 

is available accurately and on time, we remain concerned about whether the VA will 

actually be ready to go when the effective date arrives. The VA has continued to 

offer monthly updates on its progress and we believe continued oversight by the veterans service organizations and Congress will be critical throughout the spring and 

summer. In the end, any problems that lead to inaccurate payment of benefits or 

delayed payments will be unacceptable. 

PVA appreciates the opportunity to provide our views on these important issues 

that the Senate Committee on Veterans’ Affairs will address in coming months. If 

you need additional information on each of the topics outlined here, they will be discussed in much greater detail in the 23rd edition of The Independent Budget, which 

65 

will be released within the next two weeks. In the meantime, we will be happy to 

provide you with any additional information that you request. 

Finally, we recognize that paying for many of these improvements will be difficult. 

However, we believe that this is a cost burden that this country must bear as veterans who have served this Nation with distinction and honor should be a top priority. 

This concludes my testimony. I will be happy to answer any questions you may 

have. 

RESPONSE TO POST-HEARING QUESTIONS FROM HON. DANIEL K. AKAKA TO CARL

BLAKE, NATIONAL LEGISLATIVE DIRECTOR, PARALYZED VETERANS OF AMERICA

PTSD

Just this morning, the VA Inspector General issued a report on the Temple, Texas 

situation. Many will recall that a psychologist at that facility wrote a strangely 

worded email which set off a firestorm of concern for those who are suffering from 

PTSD. In a word, the IG found no systemic effort on the part of VA to reduce the 

number of PTSD claims via inappropriate diagnosis. 

Question 1. Is it your view that mental health issues, and particularly PTSD, are 

receiving appropriate attention, in terms of both compensation and care? 

Response. It is apparent that the prevalence of mental health concerns in the current generations of veterans is more serious than ever before. While we believe that 

VA is making every effort to provide timely and effective treatment, we realize that 

it will take time to implement the level of care that is needed across the board. PVA 

does believe that VA is moving in the right direction. However, one hindrance to 

progress is the lack of training, compassion, and understanding that was evidenced 

by the particular clinician that created the need for the cited investigation. PVA has 

heard of cases where some treating physicians just did not believe that Post Traumatic Stress Disorder (PTSD) is a valid diagnosis, or that VA should be compensating veterans for it. Education and training of clinicians, VA disability evaluators, 

and other staff involved in working with veterans with mental health issues is paramount. Every VA employee should be held accountable for treating mentally ill veterans with the same compassion, understanding, and care that is expected for the 

physically disabled population. 

As to the question of compensation for PTSD, PVA generally believes that compensation does not go far enough for veterans being compensated for serious disability, such as 100% total and permanent and those veterans receiving Special 

Monthly Compensation. Our view holds for veterans being compensated for physical 

disabilities, mental disabilities, or both. 

COLLABORATION ON THE ISSUES

Question 2. How can your organizations collaborate to address the concerns of 

those who veterans who are returning after service in Iraq and Afghanistan? 

Response. As one of the four co-authors of The Independent Budget, we have already begun incorporating the concerns of this newest generation of veterans into 

the policy portion of our document. In fact, in order to enlighten our discussion in 

the best way possible, we have included representatives from the Iraq and Afghanistan Veterans of America (IAVA) into the debate about what we will include in our 

recommendations. Moreover, the Partnership for Veterans Health Care Budget Reform has included IAVA in many of the discussions as we have developed our main 

policy priority for the 111th Congress—advance appropriations for VA health care. 

Collaboration between groups such as IAVA, Student Veterans of America, and 

the larger veterans’ service organization community was also critical in the passage 

of the Post-9/11 GI Bill. Throughout the development of that legislation, these 

groups, and the current generation of veterans that they represent, were turned to 

as the subject matter experts for what the final legislation passed by Congress 

should look like. In fact, we are currently in discussions with these groups to make 

additional changes to the legislation that was enacted to ensure that the best education benefit is available on August 1, 2009. 

VBA STAFFING

In light of the increased funding for VBA staffing, there are high expectations 

that VBA will improve the quality of claims decisions, and to do so in a timely 

manner. 

66 

Question 3. What more do you believe Congress could do to assist in decreasing 

the backlog, and at the same time, improving timeliness and accuracy? 

Response. While we appreciate the emphasis placed on hiring many new claims 

adjudication personnel, it is important to note that simply hiring additional staff is 

not enough. Equally important is to ensure proper training and accountability of 

claims adjudication staff at all levels of the process. While it is easy to blame firstline claims staff for improper ratings decisions, much of the blame also has to fall 

to the management within VBA. Performance measures for all levels of adjudication 

staff have wrongly focused too much on quantity of claims decided rather than 

quality. 

Moreover, we believe that VBA must accelerate the progress toward an electronic 

claims record system. As long as VA continues to use a paper file shipped around 

the country, the claims and appeals process will be done in an expensive and antiquated manner. Under the current system, VA staff need the actual claims file to 

act on claims. In a paperless environment VA staff could act on claims without having to access a claimant’s actual claims file. Additionally, transition to a paperless 

system will permit claims work to be seamlessly transferred to any of VA’s regional 

offices, allowing for quicker decisionmaking on claims. As demonstrated by the Veterans Health Administration’s outstanding electronic medical record system, similar 

gains in access to records can be realized in the claims and appeals process, as well 

as significant cost savings as VBA and the BVA move toward a ‘‘Virtual VA.’’ We 

urge Congress to accelerate funding of VA’s transition to an electronic claims record. 

Recent hearings have demonstrated how far behind the VBA is in using information technology in its claims adjudication process. While we believe that the entire 

claims process cannot be automated, there are many aspects and steps that certainly can. We have long complained to the VA that it makes no sense for severely 

disabled veterans to separately apply for the many ancillary benefits to which they 

are entitled. Their service-connected rating immediately establishes eligibility for 

such benefits as the Specially Adapted Housing grant, adaptive automobile equipment, and education benefits. However, they still must file separate application 

forms to receive these benefits. That makes no sense whatsoever. 

Furthermore, certain specific disabilities require an automatic rating under the 

disability ratings schedule. For example, it does not take a great deal of time and 

effort to adjudicate a below knee single-leg amputation. An advanced information 

technology system can determine a benefit award for just such an injury quickly. 

We believe that it is time for the VA to automate consideration of ancillary benefits 

and specific ratings disabilities that are generally automatic. 

With this thought in mind, we believe that it is essential that VBA expeditiously 

adjudicate claims that can be adjudicated quickly. By tying into an advanced information technology system, the VA could identify and decide claims that can be 

granted quickly. We have observed through our national service officers in the field 

that oftentimes the VA continues to develop evidence in cases where the evidence 

already developed supports the grant of claimed benefits. 

PVA also believes that centralized training better prepares ratings specialists at 

all levels. Training of rating specialists was historically conducted at the local level 

by the more senior staff. The VA now provides centralized training at its Veterans 

Benefits Academy located in Baltimore, Maryland and via the VA intranet. The 

Compensation and Pension Service also issues Decision Assessment Documents 

(DAD) in response to Court precedent opinions to inform staff of these decisions. 

The VA should be lauded for these actions. Furthermore, as we have called for in 

The Independent Budget, co-authored by PVA, AMVETS, Disabled American Veterans, and the Veterans of Foreign Wars, Congress should fully fund VA’s training 

initiatives. Improved and continued centralized training should help reduce inconsistencies and disparities between Regional Offices and should improve consumer 

confidence. 

Meanwhile, we believe the VBA should use experienced adjudicators to decide initial claims and to prepare Veterans Claims Assistance Act (VCAA) notice letters. 

Rather that using its most inexperienced adjudication staff to perform initial review 

of claims, VA should employ more experienced adjudication personnel to review 

claims to determine what information or evidence each claimant should submit to 

VA in order to support their claims. After identifying the evidence or information 

that is needed to substantiate each claim these more experienced VA adjudication 

personnel should then have the responsibility to prepare and send VCAA notice letters to each claimant advising each claimant of the evidence or information they 

need to submit to VA in order to substantiate their claims. 

It also is important to realize that decisions made on appeal require greater expertise and often involve more complex questions of medicine and law. As such, it 

takes years to train a competent ratings specialist. Trainees and other adjudications 

67 

staff with little claims rating experience should simply not be conducting appellate 

review due to the complexity of these decisions. Increases in staffing today should 

be seen as an investment in the future. Unfortunately, in the end, staffing issues 

do not have a quick fix. 

With regards to the VCAA notice letters, we believe that there is much room for 

improvement in their quality and readability. The only individuals impacted by 

what we deem to be substandard VCAA notice letters are veterans. Current VCAA 

notice letters issued by the VA tend to be long and contain complicated legal language that most average veterans cannot comprehend. By simplifying VCAA notice 

letters, claimants will have less confusion and will have a better understanding of 

the information and evidence that the VA needs to grant their claims. 

We also believe that VA should not be reluctant to issue regulations overruling 

court opinions that have required the VA to provide unnecessary information in 

VCAA notice letters. VA often complains that much of the delays that it experiences 

in developing and adjudicating cases result from Court opinions ‘‘interpreting’’ the 

nature and content of an adequate VCAA notice letter. Congress should consider 

amending the law to direct VA to fill in the contours of an adequate VCAA notice 

letter by regulation. 

The VA and veterans’ service organizations can also explore opportunities to share 

resources for training. For example, PVA has prepared a Guide for Special Monthly 

Compensation (SMC) that has been adopted by the VA for use when training ratings specialists. This information has been included on the VA’s intranet. The PVA 

Guide has also been distributed via BVA Special Monthly Compensation training. 

PVA staff also interacts with other veterans’ service organizations at their training 

events. Moreover, Congress should require the VA to provide greater access for veterans’ service organizations to VA’s training modules. 

We remain concerned that VA does not readily accept medical statements and 

medical opinions prepared by private physicians. Congress should enact legislation 

that requires VA to accept a medical report or a medical opinion provided by a private physician unless VA is able to articulate sound reasons for declining to accept 

the private medical opinion. Experience seems to suggest that VA adjudicators are 

disinclined to accept private physician statements or medical opinions simply because the statements or medical opinions are prepared by private physicians and 

not VA doctors. These actions occur regardless of whether the private physicians’ 

findings are sound. By refusing to credit private medical statements or medical 

opinions, VA unnecessarily delays adjudication in many claims. 

The veterans’ service organizations play an active role in assisting veterans 

through their national service officer programs. As such, in recognition of the professionalism and expertise of the service officers who already work very close with VA 

staff, we believe certain opportunities to assist veterans filing claims should be expanded. First, Congress should authorize accredited veterans’ service organization 

representatives to file any type of claim for the veteran without obtaining the veteran’s signature. This will allow veterans to access benefits that they may not know 

are available in an expeditious manner. The VA should also authorize accredited 

service officers access to VA computer systems to input important data such as updates to personal information. This would relieve VA staff of some of the minutia 

that accompanies their own job responsibilities. It will also ensure that otherwise 

critical information impacting the claim filed by a veteran is updated in a timely 

manner. 

OIF/OEF ILLNESSES

The Committee and, indeed, the full Congress, has focused a great deal of attention on mental health and TBI matters. Yet, the most common health condition of 

returning OEF/OIF veterans is not TBI or mental illness, but instead muscle and 

joint pain. 

Question 4. Do you have proposals on how to focus on this number one health concern from those who have served in Iraq and Afghanistan? 

Response. During the 110th Congress, PVA testified in support of legislation— 

H.R. 6122 and S. 2160—introduced in the House and Senate that would establish 

a system-wide pain care initiative within the VA. PVA supported the suggestion 

that comprehensive pain care in not consistently provided across the entire VA 

health care system. With that in mind, we were pleased to see that Public Law 110– 

387, the ‘‘Veterans’ Mental Health and Other Care Improvements Act of 2008,’’ included provisions that would require the VA to establish a comprehensive national 

pain management policy. Now we would encourage to the Committee to conduct extensive oversight to ensure that the VA is following through on this requirement. 

With a comprehensive pain care policy, the VA will be better prepared to meet the 

68 

needs of those veterans from Operations Enduring Freedom and Iraqi Freedom who 

present with muscle and joint pain issues. 

We have seen firsthand the benefits of pain care programs as each VA facility 

that supports a spinal cord injury (SCI) unit also maintains a pain care program. 

Veterans with spinal cord injury know all too well the impact that pain, including 

phantom pain, can have on their daily life. The pain care programs that SCI veterans have access to have greatly enhanced their rehabilitation and improved their 

quality of life. 

OUTREACH

Question 5. How are your organizations, individually or in some cooperative fashion, working to outreach to veterans and encourage them to take advantage of VA 

care and services? 

Response. PVA is the only congressionally chartered veterans’ service organization 

that represents veterans with spinal cord injury or disorders (SCI/D). Through National Office programs, our Veterans’ Benefits Department’s Field Services Programs, and our Chapters located throughout the country, we reach out to all veterans with spinal cord injury or disorder, regardless of whether or not they are a 

veteran of the current conflicts or previous eras. 

PVA’s Field Services program serves as the first point of contact in our outreach 

efforts to veterans. Through one of our more than 60 National Service Offices 

throughout the Nation and Puerto Rico, we contact veterans with SCI/D to introduce 

them to PVA and begin providing them with all of the information and assistance 

they will need to navigate the VA health care and benefits processes. We assist veterans and their families through every stage of the VA’s claim process from initial 

filing of a claim for benefits to the Board of Veterans Appeals. At the same time, 

our PVA chapters located in many of the same locations provide peer support and 

counseling, particularly to newly injured veterans. 

PVA is also unique in that it maintains an active Sports and Recreation program 

that serves as a different outreach arm. Through this program SCI/D veterans learn 

about opportunities within the VA, such as the National Veterans’ Wheelchair 

Games and Winter Sports Clinic, as well as other sports and recreation opportunities that are available. 

WOMEN VETERANS

Question 6. VA has said that sufficient programs and funding already exist to care 

for women veterans. What would you point to as specific problems or shortfalls with 

respect to women veterans and what do you recommend that the Committee do to 

address these concerns? 

Response. Women have played a vital part in the military service throughout our 

history. In the last 50 years their roles, responsibilities, and numbers have significantly increased. Current estimates indicate that there are 1.8 million women veterans comprising nearly 8 percent of the United States veteran population. According to Department of Defense (DOD) statistics, women servicemembers represent 15 

percent of active duty forces, 10 percent of deployed forces, 20 percent of new recruits, and are a rapidly expanding segment of the veteran population. 

Historically, women have represented a small numerical minority of veterans who 

receive health care at Department of Veterans Affairs (VA) facilities. However, if 

women veterans from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/ 

OEF) continue to enroll at the current enrollment rate of 42.5 percent, it is estimated that the women using VA health care services will double in two to four 

years. Based on DOD rosters received through May 2, 2008, there are a total of 

868,717 military members who served in Iraq or Afghanistan and have since separated from active duty. Women have served 195,000 tours of duty in Iraq and Afghanistan; 89 percent were enlisted personnel who served in almost equal numbers 

on active duty and National Guard/Reserve components. 

As the population of women veterans undergoes exponential growth in the next 

decade, VA must act now to prepare to meet the specialized needs of the women 

who served. Overall the culture of VA needs to be transformed to be more inclusive 

of women veterans and must adapt to the changing demographics of its women veteran users—taking into account their unique characteristics as young working 

women with childcare and eldercare responsibilities. VA needs to ensure that 

women veterans’ health programs are enhanced so that access, quality, safety, and 

satisfaction with care are equal for women and men. We see the need for VA to reevaluate its programs and services for women veterans and to increase attention to 

a more comprehensive view of women’s health beyond reproductive health needs to 

include examining cardiac care, breast cancer, osteoporosis and colorectal cancer in 

69 

women. A plan should established that addresses the increased overall demands on 

ambulatory care, hospital and long-term care, gender-specific services, and mental 

health programs recognizing the unique and often complex health needs of women 

veterans. Mental health integration into primary care is also essential for provision 

of comprehensive women’s health. 

PVA would like to express our support for S. 252, the ‘‘Veterans Health Care Authorization Act of 2009,’’ which includes provisions to address women veterans’ 

health care needs. Finally, we would encourage you to review the extensive section 

on women veterans’ health care needs in the FY 2010 edition of The Independent 

Budget which outlines significant recommendations that we believe can best address 

the needs of women veterans. 

PAPERWORK

Question 7. What is your organization’s opinion of VA’s expanded paperwork protection policy that came about as a result of the Inspector General’s audit which 

found that VA regional office personnel had mishandled some claims documents— 

is VA’s new policy on shredding appropriate? 

Response. We believe that the VA’s rapid response to the ‘‘Shredding’’ issue has 

been more than adequate. Following disclosure of these incidences, PVA received 

timely briefings from the Undersecretary for Benefits and we were given an opportunity to provide suggestions and ideas as to how to address the problem. While it 

is atrocious and simply unacceptable that some claims adjudication staff would deliberately destroy claims or evidence, we have seen that VA did hold those individuals responsible and accountable for their actions. 

One suggestion we would like to make is that accountability should be made a 

standard for all operations in VA and that evidence that accountability must be 

more commonplace. Accountability measures should not be taken primarily as a reaction to a high visibility investigation, as has been the case too often in the VA. 

STIMULUS

Question 8. The Senate stimulus package includes appropriations for VA, espe- cially $3.7 billion included for VA infrastructure projects. What are your views? 

Response. PVA is pleased that the Senate chose to include a substantial amount 

of funding in the stimulus package. We were subsequently disappointed that funding for Major and Minor Construction was removed from the compromise Stimulus 

bill. The legislation identifies areas of significant need within the VA system, particularly as it relates to infrastructure needs. As explained in The Independent 

Budget, there is a significant backlog of major and minor construction projects 

awaiting action by the VA and funding from Congress. We have been disappointed 

that there has been inadequate follow-through on issues identified by the Capital 

Asset Realignment for Enhanced Services (CARES) process. In fact, we believe it 

may be time to revisit the CARES process all together. 

We are also pleased that the Stimulus bill identifies two areas of particularly critical need—non-recurring maintenance (included in the Medical Facilities account) 

and grants for state extended care facilities. In the last couple of years, Congress 

has provided substantial increases in funding for non-recurring maintenance. The 

VA has historically not invested adequate funding into its maintenance needs. In 

fact, the non-recurring maintenance accounts were often cannibalized during periods 

of budget shortfalls. The funding included in the stimulus bill should allow the VA 

to begin to break the logjam of maintenance needs. 

There is also a real demonstrated need for additional funding for state extended 

care facility construction. Considering the rapidly aging veterans’ population and 

the growing demand for long-term care services, it is imperative that state grant 

funding be increased to better position the VA and states for the future. 

RESPONSE TO POST-HEARING QUESTIONS FROM HON. BERNARD SANDERS TO CARL

BLAKE, NATIONAL LEGISLATIVE DIRECTOR, PARALYZED VETERANS OF AMERICA

EXTENDED AND DIFFERENT HOURS FOR VA SERVICES

As I mentioned in my opening remarks, I have heard from many veterans who 

want to get to the VA for care but they can’t make it because of work. I believe 

we need to increase accessibility of the VA to all types of veterans, including those 

with full-time jobs, by providing evening and weekend hours so that people won’t 

have to choose between going to work and keeping a VA appointment. This could 

also help reduce missed appointments which waste time and resources of VA staff. 

My office is currently exploring what kind of authority VA needs to begin providing 

70 

extended hours on a one night a week and one weekend day a week basis, possibly 

in the form of a pilot program. 

Question. What do members of the panel think about this idea? 

Response. In recent years, the VA has undertaken a process to improve the management of patient access to care. This has been done through the Advanced Clinic 

Access Initiative. Through this initiative, the VA focuses on improving patient flow 

and demand which has a significant impact on access. 

In a report released in 2008 by Booz Allen Hamilton which the Veterans Health 

Administration (VHA) contracted for, Booz Allen conducted an independent review 

of VHA’s scheduling process and metrics in response to several VA Office of Inspector General (OIG) reports. The OIG reports found outpatient waiting times reported 

by VHA to be unreliable. In its final report, Booz Allen made a number of recommendations including VA needing to take aggressive steps to use fixed infrastructure more efficiently. The recommendations also included providing services at offpeak hours, such as early mornings, evenings, and Saturdays, when fixed assets are, 

currently, largely unused. 

PVA believes that expanding VA clinic hours to evening and weekend schedules 

could certainly provide an excellent opportunity to address patient demands on the 

VA. However, it is imperative that VHA be given additional resources to account 

for this increase in workload. Expanding access hours will certainly increase the 

overall cost to the VA to provide health care. 

Chairman AKAKA. Thank you very much for your testimony. 

Now we will hear from Mr. Cullinan. 

STATEMENT OF DENNIS CULLINAN, DIRECTOR, NATIONAL 

LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS 

Mr. CULLINAN. Thank you very much. Chairman Akaka, Ranking 

Member Burr, distinguished Members of this Committee, on behalf 

of the men and women of the Veterans of Foreign Wars, I want to 

thank you for asking us to participate in today’s hearing. 

I also want to salute you for conducting it so early in the legislative season. I think it is something that will allow us to move forward together in a more cohesive and effective manner, and we 

really appreciate your having done that. 

I will just briefly touch upon some of our legislative priorities, all 

of which have already been addressed by my colleagues here at the 

time. 

A sufficient budget for VA is the first thing I will talk about. The 

necessity for that is something we all agree upon. 

With respect to advance funding, that is something that we now 

strongly support. With respect to that, this year’s budget is a highly sufficient budget and it arrived on time. That is remarkable, not 

only in its sufficiency but in its rarity. 

We do not think that VA funding is targeted for delay. It simply 

gets caught up in the annual budgetary wrangling that takes place, 

and that is why we continue to support advance funding for VA. 

It takes the VA funding out of that annual struggle and will allow 

the system to run more effectively and efficiently, and everyone 

benefits from that. 

Another issue with us is women veterans. We are very pleased 

to learn that legislation introduced last year providing women veterans’ health care is included in this year’s S. 2552. We salute you 

for having done that. 

Women veterans are still grossly under-represented in the system, and I am sure there are a variety of reasons for that. But this 

kind of legislation will provide not only better care, but we think 

increased utilization by women. 

71 

We would also mention to you another. Minority veterans need 

to be better cared for. 

Rural veterans is something Senator Burr touched upon. With 

urban veterans, they too seem to suffer their own form of isolation 

at times. So that is a group that needs to be better provided for. 

VA benefits and compensation: We salute the Congress for the 

additional resources and personnel that have put into the system. 

At this juncture, probably what is best needed is ongoing and stringent oversight by this Committee and the Congress with respect to 

the utilization of these resources. 

Another issue, of course, is retention. We and others have talked 

about this before. Someone who is bright enough to be an adjudicator and persistent enough—especially in a city such as Washington as a great example—if they are able to do that type of job, 

well, typically they can do something else for a lot more money and 

a lot less stress in their lives. So, something that has to be looked 

at is how we do we keep adjudicators on board, given the rigors of 

their profession and the obvious fiscal temptation to go elsewhere. 

Seamless transition: We strongly support that. It is an issue of 

medical records transferability between DOD and VA. It also touches on such things as training, job procurement and, of course, the 

implementation of the GI Bill. I think we all stand as one on that 

particular issue. 

Military quality-of-life is a key issue with us. We very much appreciate the fact that there is money—additional money. I think it 

was $3.75 billion in the stimulus package for VA facilities, an additional in the billions amount for military housing, facilities, that 

kind of thing. We salute the Congress for having done that. It is 

very much needed. 

And we would certainly maintain that it is shovel-ready in a 

sense, that both institutions—both agencies, departments—are in a 

state to spend the money right away. So it serves veterans, serves 

active duty military and serves the purpose of stimulating the 

economy. 

Veterans employment: Again, things such as USERRA need to be 

more stringently enforced. The provisions of USERRA need to be 

more stringently enforced. There are still stories that we hear of 

people not getting their jobs back. Veterans’ preference is another 

incident in hiring which needs to be monitored more closely. 

The last thing I would mention here today is the 3 percent 

governmentwide procurement goal. Again, the Department of Veterans Affairs meets this goal amply. However, I do not know where 

else in the Federal bureaucracy—perhaps DOD—where that actually takes place. 

And with that, Chairman Akaka, thank you very much. I appreciate your giving us this opportunity. 

[The prepared statement of Mr. Cullinan follows:] 

PREPARED STATEMENT OF DENNIS CULLINAN, DIRECTOR, NATIONAL LEGISLATIVE

SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES

Mr. Chairman and Members of the Committee: On behalf of the 2.4 million men 

and women of the Veterans of Foreign Wars of the U.S. (VFW) and our Auxiliaries, 

we appreciate the opportunity to present our views and concerns on this year’s legislative priority goals for veterans. 

72 

VA HEALTH CARE

The VFW calls on Congress to pass a sufficient budget for the Department of Veterans Affairs so that it can properly care for all of America’s sick and disabled veterans. 

The VFW urges funding for the Department of Veterans Affairs to be sufficient, 

predictable and timely, ending the trend of the last decade wherein VA’s budget has 

been delivered months late. 

Congress must ensure that the unique health care and benefits challenges of 

OEF/OIF veterans are met, to include increased funding for Traumatic Brain Injuries and other related disabilities, as well as improved access to care, especially for 

veterans suffering from mental illness and for the growing number of women veterans accessing the system 

The VFW calls on Congress and VA to increase priority given to women veterans 

by providing adequate services by hiring specialized health care providers and by 

providing training in gender-specific issues to help address shortfalls in gender-specific care and mental health care services for PTSD, Military Sexual Trauma and 

other needs. 

The VFW urges the Department to improve outreach so that all veterans are 

aware of the range of health care services and benefits available to them, especially 

with female, minority and rural veterans, who may be less aware of their rights 

than other groups of veterans. 

VA BENEFITS AND COMPENSATION

The VFW asks Congress to provide adequate resources to enable the Veterans 

Benefits Administration (VBA) to reduce the current backlog of claims. 

To protect the needs of current and future veterans, the VFW opposes any 

changes to the current definition of ‘‘line of duty,’’ structural changes to the programs for disability and survivors’ benefits, or curtailment of veterans’ or beneficiaries’ rights of entitlement or to appeal benefit decisions. 

SEAMLESS TRANSITION

The VFW demands a truly seamless transition for those men and women serving 

in uniform who are transferring from the Department of Defense to the Department 

of Veterans Affairs. We envision a system with a truly integrated electronic medical 

record that travels wherever the servicemember is stationed eventually to VA where 

it follows the veteran to wherever he or she receives health care. 

The VFW urges Congress and the Administration to improve the transition services and benefits provided to our veterans to ensure a steady and safe return to civilian life, including viable training, employment and education programs that address the realities of the current and future job markets to provide meaningful careers and not just temporary jobs. 

MILITARY QUALITY OF LIFE

The VFW calls on Congress to fully fund all programs that enable our troops to 

succeed in their mission. We must ensure our active duty, guard and reserve members are provided increased pay, affordable health care, and adequate housing and 

work facilities for themselves and their families. 

EMPLOYMENT

The VFW calls on Congress to ensure that the provisions of the Uniformed Service 

Employment and Re-Employment Rights Act (USERRA) are strictly enforced. 

Support the National Committee for Employer Support of the Guard and Reserve 

in its efforts to educate employers on the ever-increasing importance of hiring National Guard and Reserve members and the employer’s responsibilities as mandated 

by USERRA. 

Urge Congress to amend Public Law 106–50 to state that the three percent 

governmentwide procurement goal for Service Disabled Veteran-owned Small Businesses should be mandated and require agencies to report their procurement levels 

and held accountable if they fail to meet their three percent SDVOSB procurement 

requirement. We further urge Congress to exercise oversight to ensure adherence 

to existing laws related to SDVOSB and Executive Order 13360 with the goal of 

meeting and exceeding the three percent government procurement requirement for 

SDVOSBs. 

We thank this Committee for the opportunity to share our views, and we welcome 

any questions. 

73 

[The VFW failed to respond to post-hearing questions submitted 

by Senators Akaka and Sanders prior to printing.] 

Chairman AKAKA. Thank you very much for your testimony, Mr. 

Cullinan. 

Now we will hear from John Rowan. 

STATEMENT OF JOHN ROWAN, PRESIDENT, 

VIETNAM VETERANS OF AMERICA 

Mr. ROWAN. Aloha, Senator Akaka and Senator Burr and the 

other distinguished Members of this Committee. 

Chairman AKAKA. Aloha. 

Mr. ROWAN. And, especially to new Members, we welcome you to 

the veterans community, which is really what we all are. 

On behalf of the members of Vietnam Veterans of America and 

our families, I am pleased to present to you our legislative agenda 

for the 111th Congress and thank you for the work that was done 

in the 110th Congress because we have made significant strides; 

but still there is a lot of work left to be done. 

Obviously, we continue to support, along with our colleagues, the 

advance appropriations for the VA budget. As has been mentioned, 

a lot of us have the same agenda. We kind of get together on these 

things even though we have different backgrounds. 

We also obviously support the restoration of eligibility by 2012 

for all Priority 8 veterans who choose to use the VA system. 

We are concerned about transforming the VHA, the Veterans 

Health Administration, to an open evidence-based system that 

would include taking a complete military history for each veteran 

enrollee and using it in diagnosis and in treatment modalities. 

We are also concerned—and it is a little off the veterans field— 

but there is a big movement now to create an electronic medical 

health record for everybody in the United States, and it is part of 

President Obama’s new initiative and part of the stimulus package. 

When they roll that out, we want to ensure that the 80 percent of 

veterans in the United States who use the private medical sector 

find about issues as well, and that particular new electronic medical record system includes in the patient history section significant 

questions about military history. 

And so, when they ask the question—which they have never 

done before in my life, in my 30 years with my HMO—are you a 

veteran, and they get my answer. When they ask, are you a Vietnam veteran, and they get the answer, they should ask further 

questions to make sure I get my prostate checked and make sure 

I get my—I am a diabetic already. So I do not have to get that 

checked anymore. But I mean they do not ask that question, and 

it is very important. 

If we roll this important new phenomenon into the rest of the 

United States like we have in the VA, we need to make sure that 

the veterans who are out there and are not in the VA system get 

understood about what their health needs are. So, for the Vietnam 

veterans with Agent Orange, the Persian Gulf veterans with Gulf 

War Syndrome and the new veterans with God knows what is 

going to pop out. 

We also are concerned about finally getting the VA to do the National Vietnam Veterans Longitudinal Study. We think that there 

74 

were so many questions about what has happened to Vietnam veterans and why we are dying at such a fast rate, and, frankly, we 

think higher than our peers who did not serve in Vietnam. That 

study would have told us why, and we might find some things out 

without waiting for the scientists to answer all the questions. 

And, obviously, we are concerned about the pension system as 

well. I mean it is just ludicrous. I retired 8 years ago from the city 

of New York, and I was a manager. I walked out of there, working 

on a massive computer system, and I could read 1,500-page contracts online. Along with 10 other people reading the same contract 

at the same time. I do not understand why the VA cannot scan documents and set up a decent system. 

We have a new proposal that we want to put on the table. We 

believe that the VA should create a Veterans Economic Independence Administration to be headed by an under secretary. Such an 

entity would take responsibility for: the Center for Veterans Enterprise; vocational rehabilitation services; veterans preference (which 

is not done very well in the government); and would be given functional control over the Veterans Employment and Training Service, 

which currently resides in the Department of Labor. 

Frankly, as Dennis, I think, mentioned the 3 percent rule as 

well, nobody in this government lives up to the 3 percent rule, 

which says that service-disabled veterans and veteran-owned businesses are supposed to get preference in contracting. It does not 

happen, and we need to rectify that situation. 

We think that if we created this entity inside the VA to focus on 

the economic independence of the individual veteran—whatever he 

or she wants to do, whether go to work, start a business or a combination of both, whatever the case may be—to focus on that aspect 

of the reintegration of people into society. And so, we really urge 

you to take a look at that and to consider that possibility. 

We really do not even think it would cost very much. It might 

even save some money. We are just talking about moving people 

around and putting them under somebody. So you’d get a new 

Under Secretary of VA Economic Independence. That might cost a 

little bit, but we think it would be a worthwhile effort and certainly 

goes along with a lot of what our other colleagues have been talking about, particularly with the newer veterans coming back and 

getting into a new life in many cases. 

But I must tell you, even some of my old Vietnam veterans, when 

they retire, often go into business because, frankly, nobody can afford to live on what they retire on anymore and especially in this 

economy. And so, that is a big component of what we see happening in the future. 

And so, we urge you to take a look at this proposal, and we 

thank you for having this hearing, again, so early. I agree with 

Dennis. We like the idea of getting a running head start on this. 

We look forward to working with everybody on the Committee, 

and we look forward to answering any questions you may have. 

Thank you. 

[The prepared statement of Mr. Rowan follows:] 

75 

PREPARED STATEMENT OF JOHN ROWAN, NATIONAL PRESIDENT, VIETNAM VETERANS OF AMERICA

Good morning, Senator Akaka, Senator Burr, and other Members of this distinguished Committee. On behalf of the members of Vietnam Veterans of America and 

our families, I am pleased to present to you VVA’s main legislative priorities for the 

111th Congress. 

Too often, it seems to many that the government puts off dealing with the 

healthcare problems of entire generations of veterans. For instance, the Gulf War 

has been over almost twenty years and the government is finally confronted with 

evidence that is difficult to refute that there are real maladies associated with military service, illnesses that do not constitute as ‘‘syndrome’’ but are real and debilitating nevertheless. The government’s actions are unacceptable. Hence the need for 

legislative remedies. What follows are priorities that, if enacted and enforced, will, 

it is our belief and our hope, make the VA more efficient in caring for our Nation’s 

veterans. • Enact legislation to provide Advance Appropriations to fund veterans’ health 

care. On this issue, VVA is in lockstep with the other veterans service organizations 

that have come together in The Partnership for Veterans Health Care Budget Reform. This is our main priority. If legislation is enacted to make Advance Appropriations for the Veterans Health Administration the law of the land, it will enable VA 

managers, at VA medical centers and VISNs, to actually plan for the next fiscal 

year while Congress debates the budget. And, while Congress has been quite generous to veterans in the 110th Congress, as you are well aware, Congress has been 

late 19 out of the past 22 years in passing the budget. We believe that Advance Appropriations will solve many of the problems encountered by the VHA, and will enable veterans health care to realize a predictable, reliable, sufficient and, perhaps 

most important, timely funding stream. • Legislation also should ensure the restoration of eligibility by 2012 for all Priority 8 veterans who choose to use the VA health care system. To ensure that the 

system can accommodate them, we believe Congress should mandate that the VA 

increase the income ceiling by $5,000 every six months. We do not advocate the 

wholesale entry of Priority 8s into the system, as the system will be overrun. But 

you will be wise to note that Priority 8 veterans, along with Priority 7s, account 

for 40 percent of third-party reimbursements into the VA’s coffers. To a very great 

extent, they do pay for themselves. 

• Legislation may be needed to transform the VHA to an open, evidence-based 

system. This should include taking a complete military history for each veteran enrollee and using it in the diagnosis and in treatment modalities. It would also include verifying that all VA physicians and other clinicians complete each of the Veterans Health Initiative curricula in the wounds, maladies, illnesses, and other conditions that derive from military service, e.g., one’s branch of service; when one 

served; his/her M.O.S. (Military Occupational Specialty); where one served and 

when; and what one actually experienced. This should help transform the VHA into 

a wellness system that focuses on prevention, early and effective interventions, and 

innovative methods of motivating enrollees toward healthy lives as well as innovation that evolves into better and more effective treatments. 

• Legislation is needed, again, to mandate that the VA finally conduct the National Vietnam Veterans Readjustment Study (NVVRS), which would illuminate the 

health status, both physical and mental, of Vietnam veterans—men, women, minorities. The VA has consistently refused to do this study, citing what we believe are 

fallacious reasons. Congressional action, therefore, is very much needed. 

• And congressional action is needed to ensure that the VA, as well as the National Institutes of Health, ensure that research is done on the health effects of exposure to Agent Orange, to dioxin. We ask specifically for research into the potential 

intergenerational effects of a parent’s exposure on his/her children and grandchildren. We receive far too many calls from these folks telling tales of birth defects 

and learning disabilities that they were born with and that have been passed down 

to their children and they wonder: Could these health problems derive from a parent’s exposure in Vietnam to Agent Orange? We wonder this, too. 

• Additional legislation will be needed to revamp the VA’s compensation and pension system, stipulating the integration of state-of-the-art IT to include artificial intelligence, competency-based testing of all service representatives and adjudicators, 

and other necessary reforms. Legislation also should be enacted to automatically 

give veterans who file claims for benefits at least 30 percent if their initial claim 

is not adjudicated within 90 days, or if their appeal is not decided within 180 days 

from the time of filing. Additionally, legislation should provide for an across-theboard 25 percent increase in payments for all veterans receiving benefits, including 

76 

DIC and non-service pensions, to help them negotiate the economic realities in these 

hard times. 

• Legislation is needed that would mandate the creation within the VA of a Veterans Economic Independence Administration, to be headed by an Under Secretary. 

Such an entity would take responsibility for the Center for Veterans Enterprise, vocational rehabilitation services, veterans preference, and would be given functional 

control over the Veterans Employment and Training Service, which currently resides in the Department of Labor. 

• The VA health care system has evolved principally on the medical needs of the 

male veterans. However, according to figures supplied by the Department of Defense 

(DOD), 20 percent of new recruits are women, almost 15 percent of America’s active 

duty military are women, and nearly half of them have been deployed to Iraq and 

Afghanistan. This has particularly serious implications for the VA healthcare system because the VA itself projects that by 2010, over 14 percent of all veterans seeking VA health care services will be women, compared with two percent in 1997. VVA 

is requesting congressional legislation to bring into modern times, the delivery of 

the VA’s medical and mental health care for women veterans, which would also ensure that the VA would eliminate disparities in care based on gender. It would also 

ensure that the resources are appropriated to make steady progress toward the goal 

of virtually eliminating veterans who are homeless by 2012. Part of the need is for 

additional authorizing legislation, and part of what is needed is full funding of programs that have been proven to work, such as the DOL Homeless Veterans Reintegration Program (HVRP, which is currently authorized at $50 million). 

These represent our significant priorities. We have as well a wish list of legislative actions that we will present to you shortly, that focus on specific areas of concern. 

Now, I thank you for your interest and consideration of these issues, and I will 

be pleased to respond to any questions you may have. 

[VVA failed to respond to post-hearing questions submitted by 

Senators Akaka and Sanders prior to printing.] 

Chairman AKAKA. Thank you very much for your statements and 

your testimony. 

Before we begin our questions, I want to inform our Members 

and our witnesses that we expect an 11 a.m. vote, and our goal is 

to try to get to that vote at 11. So, let’s begin with the questions. 

My question is for the panel, and it has to do with health care 

financing. You have all listed VA health care finance reform and 

advance appropriations as a top legislative priority. Given that the 

budget for the current fiscal year was enacted on time and with a 

record-setting amount, what would you say to those who say that 

advance appropriations is therefore not needed? 

Mr. CULLINAN. Mr. Chairman, if I may, I will begin. 

As I mentioned earlier, we very much appreciate what the Congress accomplished with this particular budget package, but it is 

absolutely no guarantee it is going to happen in the near future. 

Undoubtedly, I think in our collective view, there will be entanglements in the future with respect to funding. So the need for advance appropriations is still there. 

Mr. BLAKE. Mr. Chairman, I shared a document that I put together with some other Appropriations Committee staff who had 

asked us the very same question. 

If you were to use the THOMAS Web site and go look at the appropriations bills that go back as far as THOMAS goes, which is 

20 years, you would find that in those 20 years only 3 years saw 

the appropriations actually passed prior to October 1. In fact, in 

many cases, you will find that it was passed in December, January 

and, in a couple of cases, February. 

77 

So, while we certainly appreciate everything that has been done 

in the last 2 years, and the fact that the appropriations bill was 

enacted prior to October 1 last year, I would say that that suggests 

an anomaly, not the norm. 

Chairman AKAKA. Thank you. 

Mr. ATIZADO. Mr. Chairman, if I may? 

Chairman AKAKA. Mr. Atizado. 

Mr. ATIZADO. There is another issue I think has not been addressed by my distinguished colleagues, and that is the other provisions in the bill—in the bill which you introduced—which includes 

a transparency of the budget process. I mean we just received a 

GAO report a couple weeks ago talking about VA’s long-term care 

budget projections, which they found to have some questionable 

data used to drive their budget proposal. 

We believe that having that provision in the bill which you introduced is another key feature that would help not only foster a 

meaningful debate between Congress and the Department as well 

as the veterans services organization, but to be able to do so on 

equal footing—talking about the same kind of data, apples-to-apples sort of things. I think that would go a long way. That does not, 

I believe, currently exist now with the current budget process. 

Chairman AKAKA. Thank you. 

Any other comments? 

Yes, Mr. Stoline. 

Mr. STOLINE. Yes, sir. Thank you. 

We are concerned. It is the delivery of the health care we are 

concerned about. From our field service representatives, they are 

getting information from the various facilities that they do not 

have the money soon enough to plan properly for the hiring of personnel and for the provision of equipment, and so that is our main 

concern. 

While we appreciate the timeliness up here in the Congress of 

the passage of the appropriation it has to be followed through to 

the veteran who needs the service. That is why we think with a 

budget known a year in advance the Congress can hold the VA accountable for not providing those services in a timely and efficient 

manner. 

Mr. BOWERS. Mr. Chairman, if I could just build off of that also. 

We are finding that a lot of our membership, as they return and 

get out of the military, are going to work for the VA; and they act 

as a very effective conduit to let us know what some of the issues 

are. Some of the problems that we have found is that they have 

difficulties in regards to increased hiring and also advancements of 

programs that provide direct outreach to servicemembers. Every 

year, they basically are put on pause for a few months until they 

find out what their budgets are going to be. 

So, it is the continuity of care that we are pursuing. By having 

the advance appropriations, it will really help that tremendously. 

Chairman AKAKA. Thank you. 

Mr. ROWAN. We concur. 

Chairman AKAKA. Thank you. Thank you very much, Mr. Rowan. 

This is just a quick comment, Mr. Stoline. I appreciate The 

American Legion’s support of providing benefits to the Filipino 

World War II veterans. It appears, though, that we have a difVerDate Nov 24 2008 20:32 Nov 04, 2009 Jkt 000000 PO 00000 Frm 00081 Fmt 6633 Sfmt 6601 H:\ACTIVE\012809.TXT SVETS PsN: PAULIN
78 

ference of opinion on the appropriateness of the offset that would 

pay for these benefits. The validity of the Harkness court decision 

will be revisited during a legislative hearing later this session, and 

we look forward to working with The Legion on the specifics of that 

decision. 

So, I just wanted to make that comment. You did mention that 

in your testimony. 

Mr. STOLINE. Thank you, sir. And we also provided in our written testimony some alternative views on how that could be paid for. 

Chairman AKAKA. Thank you. Thank you very much. 

Let me then call on Senator Burr for his questions. 

Senator BURR. Thank you, Mr. Chairman. 

I think it is evident that high on the list of everybody’s priorities 

is the budget issue. Let me share something with you. 

We contacted the Congressional Research Service. They were 

very specific. To go to an advance budget process does not require 

legislation. The Congress has it in its power to adjust the internal 

process to produce a budget that would pre-fund. So the fact that 

we are all calling for legislation, it is not required. 

Congress can, tomorrow, determine that we are going to do an 

advance budget for VA, and we have the power to do that. You just 

have to convince the Chairman of the Budget Committee and the 

Chairman of the Appropriations Committee. So it does not require 

a legislative remedy. 

I agree with all of you that timely, predictable, sufficient budgets 

are absolutely essential, and I think most of us at some time or another have complained about the fact that VA budgets and VA appropriations are held hostage to the overall appropriations process. 

Let me share one concern that I have. I have yet to find a piece 

of the Federal Government that can adequately predict what an appropriate amount is for next year of any agency. 

I would assume that if I asked all of you what gauge to use to 

determine that budget in advance, you would probably suggest the 

VA Enrollee Health Care Projection model. 

Well, GAO, for the VA’s 2005–2006 budget shortfalls, said that 

that resulted from unreliable data. We all agree that the data VA 

uses to process all their information is usually 2 to 3 years out of 

date. So, in essence, to do advance appropriations we would rely 

solely on what we know is outdated data. That is what I am hearing you ask for. 

Let me pose a question to all of you and get you to respond. If, 

in fact, we took a different approach and we said this: that if the 

VA appropriations are not completed by October 1, we would automatically put into place for that year—regardless of who they are— 

the President’s budget number for the VA. Would that suffice? 

Mr. STOLINE. The American Legion has talked about that issue, 

and we have concerns about it, that it would not suffice. We do not 

think that the Congress should give up its constitutional duties to 

appropriate funds to a Presidential budget that might be politically 

driven and might actually lower the amount of funds available, 

thus forcing us to accept that amount. 

I know you think it might be a form of mandatory appropriations, but we do not see it that way. 

79 

Mr. CULLINAN. Senator Burr, I would just add that what you just 

described, that kind of concurrence would have to occur annually, 

I assume, where the Congress would just go ahead and say, all 

right, we will fund the VA in advance, lacking legislation. 

So, at least to my mind, that would amount to almost the same 

thing as what we have. The Congress would have to say every 

year, OK, we will go forward with this funding on time. 

With respect to the President’s budget, I cannot think of an exception where we have not found the President’s budget submission—regardless of who it is, Democrat or Republican—having been 

lacking. So, we have had to go to the Congress, and the Senate especially has been terrific in answering the call, the veterans’ call 

for sufficient funding. 

So you have two things. That kind of process that you just described would be an annual process which is similar at least to 

what we have already got. And, second, in the past, the President’s 

budget just has not been up to snuff with our funding recommendation. 

Mr. BLAKE. Senator, might I ask you a question? 

Senator BURR. Sure. 

Mr. BLAKE. In your proposal, would that be sort of the short-term 

fix each year until the appropriations bill would then be completed? 

Is that what you are suggesting? 

Senator BURR. Clearly, we can pursue any avenue. What I have 

tried to address is timely, predictable, sufficient. 

I do not believe there is a President that is going to propose, regardless of what party they come from, something they perceive to 

be less than needed. It may not be everything everybody wants, but 

not less than needed. 

The Congress has the ability, as we have shown every year since 

I have been in the U.S. Senate and I think the U.S. House, that 

if there was a shortfall they stepped in with some type of supplemental funds. 

What I am trying to do is find some common ground where we 

do not lock ourselves into a budget that is computed based upon 

bad data which might have a bad outcome, meaning a shortfall, 

where continually we are relied upon to go back and have to do 

supplemental appropriations throughout the year. And I would 

imagine every time we find some way to pay for it, there is going 

to be an objection, possibly by somebody in the room if not somebody in the country, because we are going to take their money. 

In fact, here is a way to get on October 1 the surety that funding 

is in place, that planning can go on within the VA and, if in fact 

for some reason, the Presidential budget was insufficient the Congress has the ability to step in and do a supplemental at that time. 

If not, we have locked ourselves into a budget a year in advance, 

potentially, only to get to the October prior to and have everybody 

tell us that the amounts are insufficient. 

So, either way, the likelihood is somebody or all of us collectively 

will say they are insufficient. The remedy is the same. We can 

choose collectively now to go with a pre-funded budget by year or 

we could say let’s punt. And, if, in fact, Congress cannot do their 

business, if it is caught up in a process where the VA is held hosVerDate Nov 24 2008 20:32 Nov 04, 2009 Jkt 000000 PO 00000 Frm 00083 Fmt 6633 Sfmt 6601 H:\ACTIVE\012809.TXT SVETS PsN: PAULIN
80 

tage, then the President’s budget numbers trump and they take effect on October 1. 

I just ask you all to think about it. My time is expired. 

Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Burr. 

Senator Sanders. 

Senator SANDERS. Thank you very much, Mr. Chairman. 

I very much appreciated your testimony. What I find exciting is 

I think we are pretty much on the same page. I think we have 

made some progress in the last 2 years. I think under President 

Obama we are going to make more progress, and it is imperative 

that we continue to work together on many of the issues that you 

have raised and Members of the Committee have raised. 

Let me just start off with Carl Blake. 

Mr. Blake, can you tell the Committee why you think the Automobile Grant Program needs to be updated and why is it an important benefit; and would you support legislation to increase the existing benefit from $11,000 to $22,500 and include an index for annual adjustment of the benefit so that it always covers 80 percent 

of the cost of a new car? 

Why is this an important benefit and who utilizes it? 

Mr. BLAKE. Well, Senator, in answer to the second part of your 

question, we would absolutely support legislation as we have done 

in the past. It is also outlined in great detail in the Independent 

Budget as it has been in years past. 

Interestingly, this benefit is tied to some degree to the Specially 

Adapted Housing Grant. Both of these benefits are meant to increase independence and help individuals who incur a catastrophic 

disability to recognize things that they might not otherwise be able 

to achieve. Those are: owning a home; and independence through 

having their own automobile. 

Last year, the Congress did improve the Specially Adapted Housing Grant and I think achieved a level where it is not likely you 

will hear us talking about that much further because there was an 

index added to that. 

We were disappointed that the Adapted Automobile Assistance 

Grant did not include the same kind of an increase. Much like the 

Adapted Housing Grant had done over the years, the value of this 

particular grant has eroded significantly. 

Senator SANDERS. Very briefly, explain to everybody what the 

Adaptive Automobile Grant is. 

Mr. BLAKE. Well, it is basically a grant that allows an individual, 

once they purchase a car, to then pay for everything that is necessary to accommodate their disability—any type of adaptive equipment, whether it be for hand controls. In cases where an individual 

has a temperature control issue, it could pay for air conditioning 

or a different type of heating system or lifts. 

Senator SANDERS. In other words, what we have is veterans coming home who do not have the capability to drive a normal car, and 

what this does will upgrade or make the improvements in their car 

so that they can get the transportation that they need. We look forward to working with you on that. 

Let me throw out to all of the VSOs a very simple issue, and you 

tell me if I am missing something here. I have found in Vermont 

81 

that we have CBOCs—and I am a great fan of CBOCs. I want to 

see CBOCs expanded. But, unfortunately, not everybody gets sick 

or needs to go to a doctor, has the time to go to a doctor Monday 

through Friday, 8:30 to whatever it may be, 5. 

I have never understood why the clinics are not kept open at 

least some evenings a week and maybe on Saturdays to accommodate people who have time concerns, i.e., maybe they work or something. Is that sensible? 

Who wants to comment on that? 

Mr. ROWAN. Yes, I will jump in. 

I think that we have agreed and then talked about that idea in 

previous testimonies years ago, about the idea of expanding the 

hours of all the clinics in the VA system, period—not just the 

CBOCs, but also the clinics associated with the hospital systems. 

Senator SANDERS. Right. 

Mr. ROWAN. We are still seeing some problems with timeliness 

and the problems with the ability, even within the hours that we 

are constrained to, of getting appointments. 

Senator SANDERS. Right. 

Mr. ROWAN. And I can give you an example. I had to cancel an 

appointment I had yesterday because I had to come to D.C. for a 

meeting, and my next appointment—because the first available appointment from my primary care doctor, and this was just a visit 

to check on my test scores—will be in March; well over a month. 

Senator SANDERS. Right. 

Mr. ROWAN. And so, yes, I fully concur with the idea of getting 

more people into the system, more people and more hours, especially for those who are still working. 

Senator SANDERS. What about Saturday hours, maybe even Sunday and evening hours? Does that make sense to people? 

Mr. ROWAN. Use the facilities. 

Mr. ATIZADO. Senator Sanders? 

Senator SANDERS. Mr. Atizado. 

Mr. ATIZADO. Thank you, sir. 

I believe VA had, I am not sure if it was in testimony or as a 

press release, had mentioned extending clinic hours. The question 

at this point is how many and to what extent, because any increase 

in operation hours may not necessitate an increase in their manpower. And it is obviously a great idea. 

I mean, as my colleague here had mentioned, there is a capacity 

issue in VA. I think it is a reasonable tool to have. 

Senator SANDERS. Other thoughts? 

Mr. STOLINE. The American Legion would support more access 

for health care for veterans, and that would be one way to provide 

it. 

Senator SANDERS. Do we know? I am just raising this question 

to anybody. Is there any reason now why a CBOC or a medical facility in any State in the country could not have extended hours 

other than budgetary issues? 

I suspect there is not any. They could do it or they could not? 

Yes, they could. OK. So it is basically a budgetary issue. 

OK. My time is expired. Thank you very much, Mr. Chairman. 

Chairman AKAKA. Senator Johanns. 

Senator JOHANNS. Mr. Chairman, thank you. 

82 

And thanks for your testimony. I appreciate it. 

I have one question. I am not exactly certain who wants to respond to it, but let me put it out there. 

We have a rehabilitation hospital in Lincoln called Madonna. It 

is first class. I know people who have been serviced there or served 

there, and it just really is outstanding. 

As I understand it, there is a relationship with Madonna in the 

Western Iowa and Nebraska Regional VA System. They contracted 

for services out of this facility. 

I would like to hear your thoughts about this approach, kind of 

a public-private sort of approach, especially in areas like my State 

where you have a lot of rural area and somewhat limited services. 

Do you see more of this happening? 

Is it a good idea? Is it something we should be pursuing? 

Mr. CULLINAN. Senator, speaking for the VFW, we support providing care on a contract basis when it is necessary in situations 

where the care in rural remote areas where a VA provider simply 

isn’t available. In situations where certain types of specialty care 

isn’t available, that happens quite a bit. 

One concern of ours, and I believe of the rest of the group here, 

is that contract care not somehow supplant VA. That is something 

that goes back as long as I have been around, which is quite a 

while, that VA is a national treasure, that it be protected, that the 

resources that it offers veterans continue to be provided. In order 

to do that, the system has to stand as a piece, as a whole. 

But there are certainly instances where it is appropriate, and we 

recommend that. 

Mr. ROWAN. Senator, I would concur with that. I mean one of the 

things that is very clear, all the VA hospitals are associated with 

major medical facilities, and that is where they get most of their 

staffing from, frankly. 

So if there is a situation, even where there is not a distance 

issue, if there is just, if you got the better brain surgeon in the hospital next door, send that person to that doctor. I mean that happens on occasion. You see that, and we fully support that kind of 

program. 

We really think it is an issue with the mental health facilities 

where there is just not enough folks in the VA system to go around. 

I go back to the days in the Vietnam era when we had fee-basis 

provider stuff, particularly where some veterans really needed oneon-one counseling and not group therapy, which is the basis of the 

Vet Center program. And so, we fully concur with that idea. 

But, again, with my colleague, we have a VA system for a reason, 

and we want to continue to support that VA system. We have 

watched it change and become more accessible. We fully concur 

with that idea. 

Mr. BOWERS. One of the recommendations that we made was 

that the Secretary of the VA design and implement national guidelines to instruct VA facilities when it is appropriate to contract 

with local community health care providers. The reason being: that 

in working with a lot of our membership, we found that rural veterans—which the Iraq and Afghanistan conflicts have relied heavily on—fell into these gaps, fell into these problems. 

83 

We have not been able to identify sort of a nationwide ruling 

that really gives clarity to this process. By establishing that process, whether it be through a report or study, really could answer 

a lot of these questions right off the bat. 

Senator JOHANNS. That is all I have, Mr. Chairman, other than 

to say I really appreciate your approach to this because I agree 

with you. 

The VA is a treasure. We want to protect that, enhance it and 

do everything we can to improve it. But there are circumstances 

where that facility is there, and it provides the kind of service you 

need, and we should look at that. So I appreciate your thoughts on 

it. 

Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you, Senator Johanns. 

Senator Tester. 

Senator TESTER. Thank you, Mr. Chairman. 

I want to start by saying I appreciate what each one of your 

folks’ organizations do in helping fill in the gaps and addressing 

families and issues. I do not take that lightly. I really appreciate 

each and every one of you folks and what your organizations do for 

veterans in this country. 

The Chairman and Ranking Member both talked about advance 

funding with their first questions, and I think almost every one of 

you guys put it in the top three when you were talking. 

Just a clarification, Dennis, I am going to pick on you for a second. When you were all talking about advance funding, I interpreted that as mandatory funding. Can you tell me the difference? 

Mr. CULLINAN. Carl could actually do a better job. Let me take 

a stab at it. 

Senator TESTER. Well, he can as well. 

Mr. CULLINAN. Mandatory funding is basically funding VA in accordance with a formula. You establish a base line, say the current 

fiscal year. You adjust it by, say, 20 to 30 percent, and every year 

you adjust it on a percentile basis, basically. 

Advance funding is a situation where you say, OK, once it is set 

in motion, the funding, not for the immediately upcoming fiscal 

year but the one after that, gets adjudicated by the Congress. It is 

decided upon and, OK, it is ready to go. 

Senator TESTER. OK. 

Mr. CULLINAN. So that is the difference in a very simple way. 

Senator TESTER. That is all I needed. Thank you. 

I want to jump to a different area that probably was not addressed in any of your testimony, but its something that I have 

been hearing more and more about, mainly because of PTSD and 

TBI and other mental health conditions leading to lasting physical 

and psychological problems. We have veterans that suffer these injuries and go undiagnosed and, unfortunately, untreated. We end 

up with disruptive acts, depression, substance abuse. The list goes 

on and on and on. 

Several States have recognized this by setting up specialized 

courts and sentencing procedures to assist veterans of nonviolent 

crimes. Is there a need for veterans’ courts nationally? 

Go ahead. 

Mr. ROWAN. Yes, to be simple about it. 

84 

Actually, in Buffalo, New York, one of my national board of directors members is the County Commissioner for Veterans Affairs up 

there, and he was very heavily involved in establishing the veterans’ court in Buffalo. It has proved to be very useful in the short 

period of time that they have utilized it. 

And what they have been able to do is nip in the bud the problems of exactly what you talked about, that those of us that go 

back to the Vietnam era remember, which is the usual deterioration that starts off usually with drug abuse or simple assault nonsense, which then, of course, escalates into something much more 

horrible, which puts people in incarceration for the next 40 years. 

So, we fully support the idea of this. We have asked. We have 

watched a number of people. I have just talked to some, and Wisconsin apparently is going to try to do it Statewide. We have heard 

other States that are looking at it, and it has been particularly 

helpful when you find that the chief judge or the DA is a Vietnam 

vet. 

Senator TESTER. That is good. 

Do all the rest of you support that idea of a veterans’ court? And, 

if any of you have any negatives toward it, could you tell me? 

Mr. STOLINE. Well, The American Legion is a resolution-based 

organization, and I do not believe we have one on that particular 

issue. But on the standpoint of diverting a veteran from the criminal justice system and take care of his problem, we would be supportive of that issue. 

Senator TESTER. What role do you think the veterans organizations would play in a veterans’ court? 

Mr. ROWAN. I can actually talk about that. In Buffalo, again, my 

local VVA chapter there, we actually utilized their members as 

mentors for the folks who come into the court system, so that they 

not only have to go through the mandatory counseling and other 

programs, but they get assigned somebody to be able to sit and 

take them through the rest of the whole nonsense that everybody 

has to deal with coming back. 

Senator TESTER. OK. What role would the Veterans Administration itself play in veterans’ courts, if any? 

Mr. ROWAN. Well, again, we are really going to the VA as the primary care provider for both physical issues and mental health 

issues. 

Senator TESTER. All right. I just want to tell you that there is 

a wealth of information you folks have put in your testimony, both 

written and verbal, and I think there is some good stuff that we 

can take away from this hearing. 

Thank you very much for being here. 

Chairman AKAKA. Thank you very much, Senator Tester. 

Senator Begich. 

Senator BEGICH. Probably 1 or 2 minutes, I will be very quick. 

I actually would be interested, and I am going to say it to you 

but actually to Senator Tester. We have wellness courts in Alaska—mental health courts that have been very, very successful in 

dealing from the veterans’ end up. We try to guide them over 

there—especially returning veterans—when there is an early situation. So the idea has worked very successfully. 

85 

It is more expensive, but the end result is it is holistic. And it 

is not just about the veterans; it is about their family and other 

situations that occur. So, I think it is a very good idea. 

I want to ask a general question, well, two questions. First, do 

you all—and this is as a new Member to the Senate, as a new 

Member here on this Committee—do you have a regular process 

that you, as organizations working with members, work with the 

VA; not as individual organizations, but where you sit down as a 

working group and try to streamline or talk about their systematic 

problems? 

Because that is a lot of what I hear about the VA. I think there 

is a great service they provide, but they have major systematic 

problems, that delivery of service is pretty limited. 

Do you have a formal process or is it just whoever can get to 

them that week gets to them? 

Mr. ATIZADO. Senator, I do not believe there is an actual formal 

process. If I am hearing you correctly, something like a working 

group? 

Senator BEGICH. Yes. 

Mr. ATIZADO. To deal with the hot topic of the week or the month 

or whatever. 

Senator BEGICH. Because as we come and go, it is the systematic 

issues that we want to make sure happens—the long-term care. 

Mr. Chairman, I always forget how the bells work. So you have 

to guide me. I am sure staff will grab me any second here. 

Would that be of interest if there was a formal process that you 

as organizations collectively work? 

Mr. CULLINAN. Senator, I would just add that on the part of the 

VFW, we have our National Veterans Service, and they interact 

with VA on a regular basis. They attend meetings. They participate 

in these meetings. So, there is a regular interaction. 

Additionally, we have our Independent Budget for VA which represents a group of veterans organizations getting together, working 

together in a systematic way to address not only funding issues but 

policy issues as well. So all the organizations interact with VA, participate in these meetings, and additionally we have our Independent Budget. We have the partnership we refer to in support 

of funding. 

Mr. ROWAN. Senator, I was just checking with my staff. My understanding is that the Secretary of the VA meets on almost a 

monthly basis with a lot of the leaders of all major organizations— 

on a regular basis—to either bring up new issues or talk about 

problems. Like with the GI Bill: when they were moving forward 

with that and wanted to propose to contract it out, we nipped that 

in the bud. So, I mean those. 

We do have a continual interaction with them, I believe. It is not 

as formal perhaps as you may be discussing. 

Senator BEGICH. Right. OK. Mr. Chairman, because of time I will 

stop at that point. 

Again, your testimony has a lot of good detail into it. I will probably have some questions. Through my staff, I will get back to you 

based on some conversations that have occurred here. 

Chairman AKAKA. Thank you very much, Senator Begich. 

86 

I want to thank the panel very much for your testimony. You 

have given us a better understanding of your organization’s legislative priorities, and this is what the hearing was for today. 

I have additional questions, and I am sure that other Members 

of the Committee also have questions. I will submit, and they will 

submit their questions for the record. Perhaps we will do that as 

quickly as we can. 

We do have that 11 a.m. vote, as I said, which you have heard 

on the clocks. 

So, again, I want to thank you very much for your testimony, 

and we look forward to working with you this year. As you can tell, 

we have much to do and we have to take the time to do it as quickly as we can. Again, thank you very much. 

This hearing is adjourned. 

[Whereupon, at 11:03 a.m., the Committee was adjourned.] 

(87) 

A P P E N D I X 

PREPARED STATEMENT OF LTG THEODORE G. STROUP, JR., USA (RET.), 

VICE PRESIDENT, ASSOCIATION OF THE UNITED STATES ARMY

Mr. Chairman and Members of the Committee: Thank you for the opportunity to 

present the views of the Association of the United States Army (AUSA) concerning 

veterans’ issues. Both in personal testimony and through submissions for the record 

there exists a long-standing relationship between AUSA and the Senate Committee 

on Veterans’ Affairs. We are honored to express our views on behalf of our members 

and America’s veterans. 

The Association of the United States Army is a diverse organization of over 

105,000 members—active duty, Army Reserve, Army National Guard, Department 

of the Army civilians, retirees and family members. An overwhelming number of our 

members are entitled to veterans’ benefits of some type. Additionally, AUSA is 

unique in that it can claim to be the only organization whose membership reflects 

every facet of the Army family. Each October, at our Annual Meeting, our membership has the opportunity to express its views through the consideration and approval of resolutions for the following year. These resolutions provide the base upon 

which the Association’s leadership builds its legislative agenda. 

Each year, the AUSA statement before the Committee stresses that America’s veterans are not ungrateful. Much of the good done for veterans in the past would have 

been impossible without the commitment of many who serve on the Committee and 

the tireless efforts of its professional and personal staffs. 

The inherently difficult nature of military service has never been more self-evident than during the current conflict. While grateful for the good things done for 

veterans, AUSA reminds our elected representatives that we consider veterans benefits to have been duly earned by those who have answered the Nation’s call and 

placed themselves at risk. 

AUSA is heartened that Congress has expressed a commitment to support America’s veterans. Despite this, many are concerned that the declining number of veterans in Congress might in some way lessen the value this institution places on veterans and their service to the Nation. We, at AUSA, do not share this opinion. 

AUSA is confident that you—well-intentioned, patriotic men and women—will faithfully represent the interests of America’s veterans during fiscal deliberations. 

As elected representatives, you must be responsible stewards of the Federal purse 

because each dollar emanates from the American taxpayer. AUSA emphasizes that 

the Federal Government must remain true to the promises made to her veterans. 

We understand that veterans’ programs are not above review, but always remember 

that the Nation must be there for the country’s veterans who answered the Nation’s 

call. 

Veterans seldom vote in a block, despite their numbers. This is one reason AUSA 

seeks this forum to speak for its members about veterans’ issues. Our veterans have 

lived up to their part of the bargain; the Congress must live up to the government’s 

part. 

Those who have volunteered to serve their country in uniform deserve educational 

benefits that support their transition to civilian life. AUSA applauds Congress for 

enacting the Post-9/11 Veterans Educational Assistance Act of 2008. This landmark 

legislation will help educate a new generation of veterans by allowing them to enroll 

as a full-time students and to focus solely on education—as it funds tuition at an 

amount equal to the highest in-state tuition rate charged by a public college in a 

state, as well as providing stipends for housing and for books and other educational 

costs. 

In conjunction with the New GI Bill, AUSA urges the Congress to increase Survivors and Dependents Educational Assistance (DEA) a minimum of 20% to match 

the increases in Montgomery GI Bill benefits Congress passed in 2008 as well as 

88 

ensuring that the benefits in the DEA program be adjusted proportionally whenever 

Congress raises MGIB and New GI Bill benefits. 

Also, AUSA believes that the monthly stipend issued under the Vocational Rehabilitation and Employment (VR&E) program should be increased to reflect the basic 

allowance for housing (BAH) payments under the New GI Bill. VRE helps equip disabled veterans to transition back into the work force. 

AUSA strongly encourages Congress to raise education benefits for National 

Guard and Reserve servicemembers under Chapter 1606 of Title 10. For years, 

these benefits have only been adjusted for inflation. Currently, Reserve GI Bill benefits have fallen to less than 25 percent of the active duty benchmark giving them 

much less value as a recruiting and retention incentive. This also sends a signal 

to Reserve Component personnel that their service is undervalued. Further, a transfer of the Reserve MGIB-Select Reserve authority from Title 10 to Title 38 will permit proportional benefit adjustments in the future. 

AUSA also believes it is time to revisit the need to dock volunteer force recruits 

$1200 of their first year’s pay for the privilege of serving their country on active 

duty. Government college loan programs have no upfront payments; thus, it is difficult to accept any rationale for our Nation’s defenders to give up a substantial portion of their first year’s pay for MGIB eligibility. 

That said, perhaps a better solution would be to consolidate and deconflict the 

MGIB and New GI Bill into one educational benefits program for active and reserve 

components. The coexistence of the MGIB alongside the New GI Bill is causing considerable confusion. Benefits available in the MGIB such as pilot training, licensure/ 

certification tests and distance (online) course work are not available in the New 

GI Bill, while a tuition reimbursement indexing mechanism, housing benefits, and 

a book stipend are available in the New GI Bill but not the MGIB. 

Members of the National Guard called to active duty under Title 32 in support 

of the current crisis do not receive veteran’s status for their active duty military 

time. Those called to active duty under Title 10 do receive veteran’s status. This inequity must be addressed. Your support in allowing Guard members to earn veterans’ status on equal footing with their active duty and Reserve counterparts will 

send the message that National Guard personnel are part of the Total Force. 

Veterans’ medical facilities must remain expert in the specialties which most benefit our veterans. These specialties relate directly to the ravages of war and are 

without peer in the civilian community. Demand for VA health care still outpaces 

the capacity to deliver care in a timely manner. That said, a way must be found 

to build on the inclusion of more Category 7 and 8 veterans this year, so that ultimately all Category 7 and 8 veterans can receive care from the VA. AUSA believes 

that full funding should occur through modifications to the current budget and appropriations process that would authorize a two-year advance appropriation for the 

VA health care system, by using a mandatory funding mechanism or by some other 

changes in the process that achieve the desired goal. 

AUSA applauds the unprecedented and historic legislation which authorized the 

unconditional concurrent receipt of retired pay and veterans’ disability compensation for retirees with disabilities of at least 50 percent and the legislation that removed disabled retirees who are rated as 100 percent from the 10-year phase-in 

period. However, we cannot forget about the thousands of disabled retirees left out 

by this legislative compromise. The principle behind eliminating the disability offset 

for those with disabilities over 50 percent is just as valid for those 49 percent and 

below. AUSA urges that the thousands of disabled veterans left out of previous 

legislation be given equal treatment and that the disability offset be eliminated 

completely. 

Another critical area needs to be addressed. For chapter 61 (disability) retirees 

who have more than 20 years of service, the government recognizes that part of that 

retired pay is earned by service, and part of it is extra compensation for the serviceincurred disability. The added amount for disability is still subject to offset by any 

VA disability compensation, but the service-earned portion (at 2.5 percent of pay 

times years of service) is protected against such offset. 

AUSA believes that a member who is forced to retire short of 20 years of service 

because of a combat disability must be ‘‘vested’’ in the service-earned share of retired pay at the same 2.5 percent per year of service rate as members with 20+ 

years of service. This would avoid the ‘‘all or nothing’’ inequity of the current 20- 

year threshold, while recognizing that retired pay for those with few years of service 

is almost all for disability rather than for service and therefore still subject to the 

VA offset. 

Fortunately, legislation provided in previous defense bills extends Combat Related 

Special Compensation (CRSC) to retirees with less than 20 years of service with 

combat or operations-related disabilities. Unfortunately, retirees with non-combat 

89 

disabilities forced to retire short of 20 years of service still have to fund their VA 

compensation dollar-for-dollar from their disability retirement from DOD. 

AUSA supports legislation that establishes a presumption of service connection 

for veterans with Hepatitis C (HCV). 

The rules for interment in Arlington National Cemetery (ANC) have never been 

codified in public law. Twice the House has passed legislation to codify rules for burial in Arlington National Cemetery. However, the legislation has not passed in the 

Senate. AUSA supports a negotiated settlement of differences between the House 

and Senate concerning codification of rules for burial in Arlington National Cemetery. Further ‘‘gray area’’ reservists eligible for military retirement should be included among those eligible for interment at Arlington National Cemetery. 

AUSA remains opposed to the imposition of an annual deductible on veterans already enrolled in VA health care and any increase in the co-payment charged to 

many veterans for prescription drugs. AUSA urges Congress to continue to oppose 

such fees. 

AUSA supports continuing congressional efforts to help homeless veterans find 

housing and other necessities, which would allow them to re-enter the workforce 

and become productive citizens. 

Terminally ill veterans who hold National Service Life Insurance and U.S. Government Life Insurance should, upon application, be able to receive benefits before 

death, as can holders of Servicemembers Group Life Insurance and Veterans Group 

Life Insurance. AUSA supports legislation to amend the U.S. Code appropriately. 

Much more needs to be done to ensure that returning combat veterans, as well 

as all other service men and women who complete their term of service or retire 

from service receive timely access to VA benefits and services. This issue encompasses developing and deploying an interoperable, bidirectional and standards-based 

electronic medical record; a ‘‘one-stop’’ separation physical supported by an electronic separation document (DD–214); benefits determination before discharge; sharing of information on occupational exposures from military operations and related 

initiatives. AUSA strongly recommends accelerated efforts to realize the goal of 

‘‘seamless transition’’ plans and programs. 

We encourage the positive steps toward mutual cooperation taken recently by the 

Department of Defense (DOD) and the VA. The closer we can come to a seamless 

flow of a servicemember’s personnel and health files from service entry to burial, 

the more likely it will be that former servicemembers receive all the benefits to 

which they are entitled. AUSA supports closer DOD/VA collaboration and planning 

including billing, accounting, IT systems, patient records, but not total integration 

of facilities nor of VA/DOD healthcare systems. 

AUSA strongly supports preservation of dual eligibility of uniformed service retirees for VA and DOD healthcare systems. We applaud Congress’ opposition to ‘‘forced 

choice’’ in the past and encourage you to hold the line in the future. 

AUSA recognizes that significant progress has been made in reducing the unacceptably high numbers of backlogged disability claims. The key to sustained improvement in claims processing rests on adequate funding to attract and retain a 

quality workforce supported by investment in information management and 

technology. 

The Committee safeguards the treatment of America’s veterans on behalf of the 

Nation. AUSA knows that you take this responsibility seriously and treat this privilege with the gratitude and respect it deserves. Although your tenure is temporary, 

the impact of your actions lasts as long as this country survives and affects directly 

the lives of a precious American resource—her veterans. As you make your decisions, please do not forget the commitment made to America’s veterans when they 

accepted the challenges and answered the Nation’s call to serve. 

Thank you for the opportunity to submit testimony on behalf of the members of 

the Association of the United States Army, their families, and today’s soldiers who 

are tomorrow’s veterans. 

Æ