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35–636 2008

LEGISLATIVE HEARING ON 

H.R. 92, H.R. 315, H.R. 339, H.R. 463, H.R. 538 

H.R. 542, H.R. 1426, H.R. 1470, H.R. 1471, H.R. 1527 

H.R. 1944, AND DISCUSSION DRAFT OF THE 

‘‘RURAL VETERANS HEALTHCARE ACT OF 2007’’ 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

APRIL 26, 2007 

Serial No. 110–17 

Printed for the use of the Committee on Veterans’ Affairs 

( 


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COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

GINNY BROWN-WAITE, Florida 

MICHAEL R. TURNER, Ohio 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

Malcom A. Shorter, Staff Director 

SUBCOMMITTEE ON HEALTH 

MICHAEL H. MICHAUD, Maine, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

JEFF MILLER, Florida, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

HENRY E. BROWN, JR., South Carolina 

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

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

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

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

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

is further refined. 


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C O N T E N T S 

April 26, 2007 

Page 

Legislative Hearing on H.R. 92, H.R. 315, H.R. 339, H.R. 463, H.R. 538, 

H.R. 542, H.R. 1426, H.R. 1470, H.R. 1471, H.R. 1527, H.R. 1944, and 

Discussion Draft of the ‘‘Rural Veterans Healthcare Act of 2007’’ .................. 1 

OPENING STATEMENTS 

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

Prepared statement of Chairman Michaud .................................................... 45 

Hon. Jeff Miller, Ranking Republican Member ..................................................... 2 

Prepared statement of Congressman Miller ................................................... 45 

WITNESSES 

U.S. Department of Veterans Affairs, Gerald M. Cross, M.D., FAAFP, Acting 

Principal Deputy Under Secretary for Health, Veterans Health Administration ........................................................................................................................ 38

Prepared statement of Dr. Cross ..................................................................... 94 

Altmire, Hon. Jason, a Representative in Congress from the State of Pennsylvania ...................................................................................................................... 21 

Prepared statement of Congressman Altmire ................................................ 73 

American Legion, Shannon Middleton, Deputy Director for Health, Veterans 

Affairs and Rehabilitation Commission ............................................................. 26 

Prepared statement of Ms. Middleton ............................................................ 74 

American Veterans (AMVETS), Kimo S. Hollingsworth, National Legislative 

Director ................................................................................................................. 27 

Prepared statement of Mr. Hollingsworth ...................................................... 77 

Brown-Waite, Hon. Ginny, a Representative in Congress from the State of 

Florida ................................................................................................................... 6 

Prepared statement of Congresswoman Brown-Waite .................................. 47 

Disabled American Veterans, Adrian M. Atizado, Assistant National Legislative Director .......................................................................................................... 28 

Prepared statement of Mr. Atizado ................................................................. 79 

Filner, Hon. Bob, Chairman, Full Committee on Veterans’ Affairs, and a 

Representative in Congress from the State of California ................................. 24 

Prepared statement of Congressman Filner ................................................... 74 

Latham, Hon. Tom, a Representative in Congress from the State of Iowa ........ 19 

Prepared statement of Congressman Latham ................................................ 72 

Moran, Hon. Jerry, a Representative in Congress from the State of Kansas .... 22 

Ortiz, Hon. Solomon P., a Representative in Congress from the State of 

Texas ..................................................................................................................... 10 

Prepared statement of Congressman Ortiz .................................................... 48 

Paralyzed Veterans of America, Carl Blake, National Legislative Director ....... 30 

Prepared statement of Mr. Blake .................................................................... 84 

Pearce, Hon. Steve, a Representative in Congress from the State of New 

Mexico ................................................................................................................... 2 

Prepared statement of Congressman Pearce .................................................. 46 

Rothman, Hon. Steven R., a Representative in Congress from the State of 

New Jersey ........................................................................................................... 14 

Prepared statement of Congressman Rothman ............................................. 71 

Solis, Hon. Hilda L., a Representative in Congress from the State of California ..................................................................................................................... 18 

Veterans of Foreign Wars of the United States, Dennis M. Cullinan, Director, 

National Legislative Service ................................................................................ 32 

Prepared statement of Mr. Cullinan ............................................................... 89 


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iv 

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

Policy and Government Affairs ........................................................................... 33 

Prepared statement of Mr. Weidman ............................................................. 92 

SUBMISSIONS FOR THE RECORD 

American Academy of Neurology, statement ........................................................ 100 

Brown, Hon. Corrine, a Representative in Congress from the State of Florida, 

statement .............................................................................................................. 101 

Hinojosa, Hon. Rube ́n, a Representative in Congress from the State of Texas, 

statement .............................................................................................................. 101 


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LEGISLATIVE HEARING ON 

H.R. 92, H.R. 315, H.R. 339, H.R. 463, H.R. 538 

H.R. 542, H.R. 1426, H.R. 1470, H.R. 1471, H.R. 1527 

H.R. 1944, AND DISCUSSION DRAFT OF THE 

‘‘RURAL VETERANS HEALTHCARE ACT OF 2007’’

THURSDAY, APRIL 26, 2007 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON HEALTH, Washington, DC. 

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

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

[Chairman of the Subcommittee] presiding. 

Present: Representatives Michaud, Snyder, Hare, Miller, Stearns, 

Moran. 

OPENING STATEMENT OF CHAIRMAN MICHAUD 

Mr. MICHAUD. I would like to thank everyone for coming here 

today and I would ask unanimous consent that all written statements be made part of the record. Without objection, so ordered. 

I also ask unanimous consent that all Members be allowed five 

legislative days to revise and extend their remarks. Without objection, so ordered. 

Today’s legislative hearing will be the first of many this Subcommittee plans on holding to provide Members of Congress, veterans, the VA, and other interested parties with the opportunity to 

discuss legislation within the Subcommittee’s jurisdiction in a clear 

and orderly process. 

I do not necessarily agree or disagree with the bills before us 

today, but I believe that this is an important process that will encourage frank discussions and new ideas. We have 11 bills before 

us and one discussion draft. 

The discussion draft represents some of my ideas to improve the 

quality of care available to our rural veterans and the ability to access care, such as establishing mobile vet centers, improving information technology and technology sharing between the VA and 

non-VA providers, establishing a Rural Veterans Advisory Committee, creating Centers of Excellence to encourage research in innovative healthcare to address the needs of rural veterans, and encourage more healthcare professionals to work in rural areas. 

I look forward to hearing the views of our witnesses and to a discussion on this and the other bills before us. 


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I also look forward to working with everyone here to improve the 

quality of care available to our veterans. 

[The prepared statement of Chairman Michaud appears on p. 45.] 

Mr. MICHAUD. At this time, I would recognize Ranking Member 

Miller. 

OPENING STATEMENT OF HON. JEFF MILLER 

Mr. MILLER. Thank you, Mr. Chairman, for holding this legislative hearing. 

I also want to say thank you to the Members who brought these 

bills before us this morning and to all the witnesses that are going 

to be appearing here today. 

I look forward to engaging in a productive discussion about the 

legislation that will help us provide the best care for our veterans, 

whether it is through contract care or requiring more VA medical 

centers to provide chiropractic services, and I yield back. 

[The prepared statement of Congressman Miller appears on 

p. 45.] 

Mr. MICHAUD. Thank you, Mr. Ranking Member. 

Mr. Hare, do you have an opening statement? 

Mr. HARE. No, Mr. Chairman. I will have some questions later 

though. Thanks. 

Mr. MICHAUD. Okay. Thank you. 

At this time, I would like to welcome two of our Members who 

are here today to present testimony. I know, Mr. Pearce, you have 

another hearing you need to go to. So why don’t we start with you? 

STATEMENT OF HON. STEVE PEARCE, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF NEW MEXICO 

Mr. PEARCE. Thank you, Mr. Chairman. 

I would like to thank Chairman Filner, Ranking Member Buyer, 

Subcommittee on Health Chairman Michaud, and Ranking Member 

Miller for the opportunity to discuss this issue that is critical to the 

veterans of the State of New Mexico. 

Today I am asking for you and the Members of the Veterans’ Affairs Committee to consider my legislation, House Resolution 315, 

the ‘‘Help Establish Access To Local Timely Healthcare For Your 

Healthy Vets Act.’’

In New Mexico’s rural communities, many of our veterans are deprived of accessible medical facilities and face the high cost of gasoline to travel and to obtain care. My legislation would require the 

Secretary of Veterans’ Affairs to contract with local doctors and 

hospitals on a case-by-case basis to provide medical services including primary care for those veterans who live far away from the Veterans Affairs medical facilities. 

This would expand the capability of our local health providers in 

southern New Mexico to provide more convenient, efficient medical 

services for veterans who live in areas that are far away from established VA facilities. 

Currently veterans residing in southeast New Mexico must drive 

between four and six hundred miles round trip to receive care at 

New Mexico’s only VA hospital located in Albuquerque, New Mexico. 


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Just for example, it is 305 miles from my front door to Albuquerque. Now, you might think I live at the end of the Earth, but 

it is actually 40 miles further south to Jal, New Mexico. So those 

people have an even longer drive. 

I consistently hear stories from my constituents about the detrimental impact this long-distance drive has on their ability to access 

timely care and overall health. 

One Marine veteran amputee began having uncontrollable drainage from his good foot and was making two to three trips a week 

to the Albuquerque VA hospital. This equates to 18 hours of drive 

time a week. After 4 months, he finally lost his foot. 

Several local civilian healthcare experts feel the unfortunate 

travel marathon contributed to the failure to save his foot. 

Another 87-year-old Bataan veteran developed a serious bladder 

infection and was directed to make the 6-hour, round-trip drive 

along with his 85-year-old wife. Halfway through his treatments, 

prostate cancer was found and additional trips had to be made for 

chemotherapy. After 7 months of trips, he died and his wife’s 

health was seriously damaged after the strain of such long-distance 

care. 

My father is in his eighties. He is a veteran and I will guarantee 

you he is not able to make a 5-hour drive one way. 

Today I know that you will hear from several National Veteran 

Service Organizations who may not support my bill and others 

under consideration today. That is because many of these groups 

have committed themselves to the goal of keeping VA dollars inside 

the VA. I understand this concept and believe at first glance it 

sounds like a commonsense approach to VA budgeting. 

But following this logic, the only way to get more localized access 

to care for veterans in my district would be to build new facilities 

in areas closer to their homes. I believe there is a need for a fullservice veterans’ health center in south New Mexico and would love 

to see that come to fruition. 

However, I am realistic as are the veterans living in rural New 

Mexico. With the tight budgetary constraints that our Nation faces 

and the smaller population in States like New Mexico, that idea is 

much easier said than done. 

This is a reality veterans living in rural areas have been forced 

to accept. Since that solution is not realistic at this time, we must 

work to find other solutions to this problem that is hurting our veterans with every 6- to 8-hour, round-trip journey to the hospital. 

Unfortunately, the idea of expanded contracting authority raises 

flags with certain Veteran Service Organizations that see it as a 

step toward privatization. Yet, if they understand what is going on, 

we are spending dollars for gasoline and mileage and we are not 

paying it for the healthcare for our veterans. 

I will tell you that the Federal Government and the VA are not 

adequately living up to their commitment in serving my constituents in the rural parts of New Mexico. 

John Taylor, life member of the Military Order of the Purple 

Heart and life member of Disabled American Veterans, lives in 

Roswell, New Mexico, which is approximately 200 miles away from 

Albuquerque. In a letter John wrote to me, rural veterans in New 


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Mexico are dying and losing body parts because of a 6-hour, roundtrip drive to the nearest VA hospital in this State. 

Our VSO legislative representatives from the DAV have no experience or do not live in contact with this issue as they are from 

large urban areas with massive facilities and infrastructure for 

support. The classic response to invitations requesting visits to our 

rural areas has historically been we will try. But it takes time to 

get there and we have a very busy schedule. 

I submit the same time that is an inconvenience to executives is 

the same time that is killing my fellow veterans or at least causing 

serious exacerbation of their medical problems. 

U.S. Army retired Lieutenant Colonel Charlie Revie, a member 

of the Uniformed Services Disabled Retirees, noted that the drive 

from Las Cruces to our only major VA facilities is a 250-mile, oneway trip. 

The notion that providing contracted care to veterans through 

local doctors at non-VA hospitals is somehow a way to finagle them 

out of caring for them is absurd. Under my legislation, the VA will 

clearly still pay for the care of veterans obtained at non-VA hospitals. 

Veterans in my district and across rural America have been 

hearing politicians talk about increasing access for years. It is simply imperative that Congress take these issues seriously. 

Mr. Chairman, I will submit the rest of my statement, but I do 

appreciate the opportunity to come and testify before you today and 

yield back the balance of my time. 

[The prepared statement of Congressman Pearce appears on 

p. 46.] 

Mr. MICHAUD. Thank you, Mr. Pearce. Rural healthcare for our 

veterans is very important to me, coming from the great State of 

Maine. I appreciate your testimony. 

Mr. Miller. 

Mr. MILLER. I may have missed it in your comments, and it may 

be in the text of the legislation, but do you define geographically 

inaccessible? 

Mr. PEARCE. Would you state the question again, Mr. Miller? 

Mr. MILLER. Do you define geographically inaccessible? How do 

you define that in your legislation? 

Mr. PEARCE. The definition, I think, is over 120 or 150 miles. I 

will have to check on that. But, yes, we do have a definition. 

Mr. MILLER. Okay. Very good. 

Thank you, Mr. Chairman. 

Mr. MICHAUD. Mr. Hare, any questions? 

Mr. HARE. Congressman Pearce, just a quick question. In terms 

of the total number of veterans that are having a difficult time getting to—you mentioned the long drives and things of that nature. 

Is there an estimate of how many folks, how many veterans in your 

district, in your State are having this problem? 

Mr. PEARCE. Oh, Mr. Hare, I would guess that it is probably in 

the 20,000 range. In other words, most of the veterans in the 

southern district are a long way from a hospital. And the VA hospital in Albuquerque serves also Texas, so it reaches to the extremity. 


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Some of the places in the second district are within an hour or 

two, but most are at least 3 hours one way. The rest are 4 to 5 

hours one way. Again, my home is 5 hours one way from the time 

I leave the front door. So it is probably in the 20,000 range. And 

we are just simply requesting that the Secretary consider on a 

case-by-case basis that people be allowed to get some care. We have 

had veterans talk about driving to Albuquerque 5 hours away one 

way, 5 hours back to take a blood test. And when they got there, 

they were told I am sorry, that has been rescheduled. These are 

the sorts of problems that the people who come from large metropolitan areas just are not familiar with. 

I will tell you that we have had a significant improvement in the 

relationship with the veterans hospital administrator. He has actually not this past Saturday, but about two Saturdays ago came and 

met with me and local veterans in Roswell. That is still 120 miles 

north of my hometown and still 40 miles from the southern edge 

of our district. 

And keep in mind, I am on one side and there is another side. 

He was about 7 hours from the sites that are equivalent to us on 

the other side, New Mexico Square. Albuquerque is about twothirds through the middle. So when he was over here with us, he 

is 7 hours from those people over here. 

But at least he is coming down. We could never get the former 

administrator of the hospital to do that. So we are having some discussion, but he needs the flexibility to allow these people to go to 

local providers to do commonsense things. 

Mr. HARE. Well, my district is very rural too. And one of the 

things we have done, and I was just wondering if you have any of 

these, we have three veterans’ outpatient clinics because, for example, we have people who have to go from Quincy, Illinois, to St. 

Louis or drive to Iowa City which was, you know, a tremendous 

hardship on them and people getting in vans and taking them to 

get prescriptions or a blood test or something. 

Are there any VA outpatient clinics in your district? 

Mr. PEARCE. We do have clinics. And I will tell you that the clinic in Artesia, New Mexico, has a big sign that says we are not an 

emergency facility, meaning if you have an emergency go somewhere else. That is extraordinarily disruptive. 

So sometimes they do those things like the blood tests. Sometimes they do immunizations. Sometimes they say, no, we are too 

busy, you have got to go to Albuquerque. 

Mr. HARE. So you had a veteran drive 5 hours——

Mr. PEARCE. Yes. 

Mr. HARE [continuing]. For a scheduled blood test only to find 

out that——

Mr. PEARCE. Absolutely. 

Mr. HARE [continuing]. They canceled it and you had to drive—

so 10 hours for absolutely nothing? 

Mr. PEARCE. Yes. And that is one of the things that we had the 

VA hospital administrator, he said he would commit that if they 

are going to start cancelling people’s appointments, they would at 

least do it the day before or 2 days before. 

Some of these people have to go on their own money. There is 

no hotel compensation allowed and they have to go on their own 


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money. And they may leave a day and a half early because the 

drive is so hard. 

I will tell you that I suffer from varicose veins and they have recently gone in because I had this pooling of blood problem. And the 

worst thing you can do is drive with that situation. And to be describing this Marine veteran that was having to drive 5 hours with 

a foot that is leaking is to me the worst thing that you could do. 

And, sure enough, he ends up losing his foot. 

They tell me sitting on the airplane, though it is 9 hours for me 

to commute home from here to Washington, they tell me the worst 

thing I can do is sit in the airplane and, yet, that was the prescription for him. 

Mr. HARE. Thank you, Congressman. 

Mr. MICHAUD. Mr. Stearns, any questions? 

Mr. STEARNS. No. 

Mr. MICHAUD. Dr. Snyder. 

Mr. SNYDER. No. 

Mr. MICHAUD. Now I am pleased to recognize an honorable Member of this Committee, Mrs. Ginny Brown-Waite. 

Once again, Mr. Pearce, thank you very much. 

Mr. PEARCE. Thank you, Mr. Chairman. You have been very gracious. 

Mr. MICHAUD. Thank you. 

STATEMENT OF HON. GINNY BROWN-WAITE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA 

Ms. BROWN-WAITE. Thank you, Mr. Chairman, and thank you, 

Ranking Member and the Members who care enough to attend. I 

know that many people have simultaneous hearings going on that 

they also have to be to as I do, so I will be leaving after the testimony. 

I appreciate the opportunity to testify on House Resolution 92, 

the ‘‘Veterans Timely Access To Healthcare Act.’’ When I first came 

to Congress in 2003, I introduced this measure after hearing of the 

long wait times facing some veterans in need of healthcare. 

We recently checked with the VA and the VA is saying that 96 

percent of the patients seeking primary care can get an appointment within 30 days. I think that every Member of Congress, if 

they were polled, knows that they are hearing otherwise. I do not 

know where the VA is getting their figures from, but we hear otherwise. 

The stories that many of us have heard about these delays are 

unacceptable. The holdups can worsen the veteran’s health and 

pose a greater financial hardship on everyone involved. In some situations, these waits can be the difference between life and death. 

Events in Iraq and Afghanistan also remind us of the urgent 

matter at hand. With thousands of soldiers returning from the 

front lines, many will require immediate healthcare. VA medical facilities face a difficult task. Unless Congress takes action, wait 

times will only grow. 

My legislation would help ensure that our Nation’s veterans receive timely healthcare. For veterans seeking primary care from 

the VA, the bill would establish a 30-day timeframe as the standard for access to medical services. This standard would cover from 


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the time the individual schedules a visit until they actually see a 

medical provider. In the event this standard is unachievable, the 

VA would have authorization to contract for care from a private 

provider. 

At the same time, my bill also grants the VA some flexibility in 

meeting the standard. For those facilities in geographic areas that 

have a 90-percent or greater rate of complying with this requirement, the contracting provisions would not be necessary. 

Finally, Mr. Chairman, this legislation would establish comprehensive reporting requirements on wait times for individuals 

seeking care at VA medical facilities. 

As Members of Congress, we have an extraordinary responsibility to veterans. These brave men and women answered the call 

in our time of need and it is only fitting that we take care of them 

at their time of need. 

I look forward to working with my colleagues on the critical issue 

of wait times, and I would be happy to take any questions regarding the legislation. 

When I first got elected, I contacted all of the clinics in my area 

and asked what the wait times were. It did not jive with what I 

was being told by veterans. I then said I want you to tell me the 

real wait times that they have. 

Mr. Chairman, I am embarrassed to tell you that there was a big 

difference between their quick and dirty analysis and the true wait 

times that the veterans had to wait for the primary care. 

This is unacceptable, and because we have stayed on top of it, 

those numbers are somewhat within the acceptable range, but still 

not where they should be. Everybody in Congress wants to make 

sure that our veterans are taken care of and timely access to 

healthcare is very important. 

And with that, I yield back the balance of my time. 

[The prepared statement of Congresswoman Brown-Waite appears on p. 47.] 

Mr. MICHAUD. Thank you very much, Ms. Brown-Waite. 

Mr. Miller. 

Mr. MILLER. To my colleague from Florida, I think you have already answered the question, do you have any confidence in VA’s 

numbers in regards to wait times? 

Ms. BROWN-WAITE. No, sir, I do not. I honestly do not. I question 

it and every Member of Congress who hears from their veterans 

has to also question it. I know you have a large number of veterans 

and that you are very much on top of their needs as we all are. 

That is not what we hear. 

I am known as the nag in the 5th District. And I am fine with 

that because unless you nag the VA and let them know that you 

track those numbers, they do get out of control. And also they play 

games. They will schedule an appointment within ‘‘30 days’’ and on 

the 25th day perhaps cancel it. So it is not really an appointment 

within 30 days. So we need to constantly question their numbers. 

Mr. MILLER. You also talk in your legislation about requiring 

that veterans be referred to private physicians. What about the instance of the veteran that says he is willing to wait and go ahead 

and go through the system as normal? It does not preclude them 

from continuing on through VA? 


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Ms. BROWN-WAITE. If they are willing to wait, they certainly 

would have that flexibility. 

Mr. MILLER. That is all, Mr. Chairman. 

Mr. MICHAUD. Mr. Hare. 

Mr. HARE. I was just interested in where the VSOs are coming 

down on the legislation and if you could tell me why, from your 

perspective, there is opposition to the bill. 

Ms. BROWN-WAITE. Most of the VSOs that represent the veterans 

up here want to make sure that all the healthcare resides within 

the VA. And that certainly is their job. However, I think each of 

us when we go back home hear different from the veterans who 

want a much more timely access. 

Historically the VSOs have always wanted to contain the healthcare only within the VA system. And in a perfect world, that would 

be the ideal because of continuity of care. But we also do not want 

the veteran waiting inordinate amounts of time and the VA playing 

games with the wait times. 

Mr. HARE. Could you give me an example or two of what you 

have seen in terms of wait times. I know you mentioned a little bit 

about it, but maybe from in your district because, as you said, 

when we go back and we hear from the veterans, I just wondered 

if you had an instance or two that you could—— Ms. BROWN-WAITE. Certainly. Mr. Chairman, if I may respond. 

I have had veterans tell me exactly this situation that I just described of, yes, they had an appointment within 30 days, but on the 

21st or the 25th day, VA called to reschedule it 30 days later. That 

is not timely access and that is not serving the veterans. 

Certainly the VA clinics, and we are fortunate we have many in 

Florida, the VA clinics do all that they can, but they are also having trouble hiring for positions that are open. They do not have 

enough doctors. They do not have enough of the nurses and the 

medical technicians there. 

We are expanding clinics regularly, but people are still having 

trouble with the primary care access. 

Mr. HARE. Thank you very much. 

Mr. MICHAUD. Mr. Stearns. 

Mr. STEARNS. Yeah. Thank you, Mr. Chairman. 

My colleague from Florida has been a leader on this ever since 

she came to Congress and I commend her for it and for particularly 

in an informal basis to try and understand the facts. 

Ginny, you had indicated that it takes 30 days, that that is the 

question. But have you looked at once a person gets the appointment and then has to come back sometimes and it is not just the 

first appointment that takes a long time, it is coming back for the 

second and third? And I heard complaints that they can get within 

the 30 days, but then when they come to get the referral sometimes 

takes longer. And I just wonder if you had any experience on that. 

Ms. BROWN-WAITE. Mr. Stearns, it depends whether or not the 

second appointment is for specialty care. I know that there is a 

much longer wait for specialty care. I recently heard from a veteran seeking dermatology care and that was an inordinate amount 

of time that he had to wait. 

As you all know in Florida, dermatologists are, even in the private sector, there is a long wait for the dermatology appointment. 


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But very often they will get that first appointment and then there 

is a delay in the followup appointment. So, yes, I am hearing that 

as are other Members of Congress. 

Mr. STEARNS. Yes. That is what I hear that some complain, well, 

okay, I can get into the front door, but I cannot get any response 

beyond that. 

I do not know. I heard you talk about your informal investigation. What did you find was the real time when you talked to these 

veterans themselves? What have they been telling you? Like some 

of my veterans have told me well beyond 45, 50 days. 

Ms. BROWN-WAITE. Oh, absolutely. I hear well beyond that, as 

much as 2 months and longer that they are waiting. And that is 

just not acceptable and, yet, the VA tell us that overall 96 percent 

are being seen within that 30-day period. I guess it is in, you know, 

dog years that they are counting it because it is not 30 days in 

human days. 

Mr. STEARNS. Just your option you talked about, about the referral of veterans to private physicians if a network fails to meet the 

standards of access. I guess the question is, is your intention not 

to give an individual veteran the option of waiting to receive it or 

just, in other words, the veteran could decide, okay, I will wait 45, 

50 days or is it a mandate that he has to go to a private physician? 

Ms. BROWN-WAITE. No, sir. Obviously the veteran could wait for 

the VA care if that is their choice. 

Mr. STEARNS. Yeah. Mr. Chairman, I think it is important to 

point out that the legislation is not a mandate to go private, but 

giving the veteran the choice which is what I think ultimately the 

veteran wants to have. 

And I thank you. 

Mr. MICHAUD. Thank you. 

Dr. Snyder, any questions? 

Mr. SNYDER. Thank you, Mr. Chairman. 

I did not realize we had such Florida domination of the Veterans 

Committee until this very moment. 

Ms. Brown-Waite, I guess just two comments or questions, and 

I like what you said about nagging. I think that is what we all do 

sometimes on different issues. And I think it is really important 

that we all do that. 

The concern I have about this bill and some of the other bills is 

there is no new source of funds in this bill and if we pass any kind 

of language that requires the VA to hit this mark or we have to 

pull money out of our system, that money is going to be pulled from 

some place. And if you magnify that all over the country or at some 

point, then they say, well, we need to lay off a primary care doctor 

because we got to pay these bills down the road. 

And it seems like we dealt with this a few years ago and I think 

there was a decision made that trying to find healthcare in the private sector because we do not like what is going on in the VA system that we love so much, at some point, it leads into a spiral of 

funding problems for the underlying system. 

How do you respond to that? I mean, I applaud you. I mean, this 

is kind of a sophisticated form of nagging you are doing here this 

morning. I think it sends a message that we, I agree with you 100 

percent, we need to be working on these problems. But how do you 


smartinez on PROD1PC64 with HEARING
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respond to that criticism that we have heard through the years and 

which I have agreed with, by the way? 

Ms. BROWN-WAITE. Dr. Snyder, as you know, we have increased 

funding. This is my fifth year here and we have increased veterans’ funding for healthcare substantially during that time. It has been 

over 40 percent in those 5 years that the funding has been increased. 

We need to continue to increase that funding. No, this bill itself 

does not have a pricetag attached to it. That would be certainly 

part of the appropriations process. 

Mr. SNYDER. Yeah, which I think has some problems. 

Then the other, there is this other issue, too, which I think the 

VA system, as we all know, gets accolades for things that it does 

better than the private sector, but I was nagging one of my employees not long ago about I thought he had a dermatological thing he 

needed to have checked out and he finally succumbed to my verbal 

pressures. And it was like it was going to be almost, I think, like 

2 months before he could get in. I said that is not acceptable. So 

then he was calling around and he finally did find somebody. 

But the standard at a private community on some of these specialty things is not all that great either for getting in. But thank 

you. 

Thank you, Mr. Chairman. 

Mr. MICHAUD. Thank you, Dr. Snyder. 

And, once again, thank you, Ms. Brown-Waite for your testimony. 

Ms. BROWN-WAITE. Thank you, Mr. Chairman. 

Mr. MICHAUD. Next on is Mr. Ortiz. I want to thank you for coming here today as well and to present your legislation. 

STATEMENT OF HON. SOLOMON P. ORTIZ, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF TEXAS 

Mr. ORTIZ. Thank you, Mr. Chairman, Ranking Member, and 

Members of the Committee, for this opportunity to speak to you on 

behalf of south Texas veterans and help this Subcommittee understand the urgent need for a veterans’ hospital for the men and 

women who fought for us. 

We have this map before you because I will be addressing the 

Rio Grande Valley. The valley is way at the bottom with a population of close to 600,000 people, but the nearest hospital is about 

6 hours away. 

I would like to echo what my good friend, Mr. Pearce, testified 

to about the distance. Here with me today are the Veterans Alliance of the Rio Grande Valley so you can see the faces of the south 

Texans affected by the lack of a hospital. 

The Rio Grande Valley is the southern-most tip of my district. 

And these young men fought bravely for us in different wars, from 

the Korean War to the Vietnam War, and some of them still fighting the Iraqi and Afghanistan War. 

Here with me today is Jose Maria Vasquez, Ruben Cordova, Max 

Belmarez, Polo Uresti, Frank Albiar, and Mr. Felix Rodriguez. 

They wanted to be here today to put a face to the problem that we 

face in south Texas. 

My legislation gives the government flexibility in establishing a 

way to deal with hospital services in south Texas, but the only real 


smartinez on PROD1PC64 with HEARING
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solution, my friends, and I know you understand this problem, is 

a hospital. 

Most of the clinics that we have do not have any inpatient care. 

All they do is have outpatient care. We did try to contract out, but 

10 beds is not sufficient. The bottom line is veterans’ inpatient 

healthcare must be available where the veterans reside, not several 

hours away. 

Part of the healing process is for the family to be able to be close 

to their loved ones who are recuperating from wounds. Now we are 

beginning to see wounds that we did not see before because our 

young men and women are surviving this war because they have 

body armor and better equipment. 

These guys have fought, bled, sacrificed for this Nation. They 

need something that belongs to them, a hospital that gives them 

the care that they need where they reside. 

And we know that the VA plays the numbers game, but the numbers do not reflect the need, particularly in the Rio Grande Valley. 

When the VA commissioned the CARES study, they recognized 

the far south area of south Texas was in need of acute, inpatient 

care. They decided to meet this demand through contracting and 

leasing beds with the local hospitals, an approach that we tried but 

simply did not work. 

Veterans are still traveling in large numbers to San Antonio for 

care. And for many who are treated for emergencies at area hospitals, the bills go unpaid. 

Before, you can imagine this, these young men went and fought 

a war thinking that we as a government were going to take care 

of their problems. Now they have a five and a half hour drive, and 

do not even have vans. They do not have an ambulance. They have 

to get volunteers, my friends, to drive them for five and a half 

hours to the nearest VA hospital which is in San Antonio. 

Some of the Second World War veterans are bedridden and no 

ambulance to drive them and are dependent on volunteers to drive 

them. They have a van. How in the world can you see the Second 

World War veteran on a van when he is bedridden? Some of them 

just simply do not go to the hospital anymore or to the clinics that 

we have. 

Many of the veterans are so disgusted by the level of VA healthcare that they just simply do not sign up anymore. They have given 

up. 

You have heard me describe the conditions of south Texas veterans today, but they want to show you experience of veterans 

themselves, veterans who shed blood for our Nation. 

What I have done and what they wanted to do was give you testimonies, and it is a stack this high, of some of the sacrifices that 

they have gone through to go five and a half hours to get a 15- 

minute checkup because the locals do not have the equipment, because the locals just cannot do it. They go up there for 15 minutes. 

They drive five and a half hours. Then they come back another five 

and a half hours’ drive. 

Some of them, the older people are having prostate problems, in 

the eighties. They go there just to see that their appointment was 

canceled. Then they have to drive back again, and they say come 

back in 6 months. 


smartinez on PROD1PC64 with HEARING
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This is just something that I cannot understand. You know, we 

can find money to go fight a war, into the billions of dollars, but 

for some reason we cannot find enough money to take care of the 

promises that we made. 

I am a veteran. I served. We must give them what they fought 

for. And Vic and I, you know, we served, Congressman Snyder and 

Jeff Miller. This is something that we do every day. We talk about 

readiness, about military, about personnel, and about funding into 

the billions of dollars. 

I am afraid that what we are doing today is going to have a huge 

impact if we do not try to resolve some of these problems on retention and recruitment. 

I was at a fair that we had for veterans and I see this older man 

on crutches with his two young grandsons. And as I was talking 

to him, he says do you think I am going to recommend for my 

grandsons to go join the military when you look at my condition 

and they have not been able to take care of me? 

This is why we need something to address the needs of our soldiers, people who have fought, people who have bled, many have 

died, have never come back. 

We just had a recent young man come back from Iraq. He was 

shot in the back. His spinal cord is gone. He cannot walk anymore. 

He says I remember when I was in Iraq and I saw those young 

men lose their legs and I felt sorry for them, you know, and I still 

do. But you know what? Those young men who lost their legs can 

walk because of prostheses. There are a lot of us coming back with 

spinal injuries with our legs, but we cannot walk. 

When he was coming out of anesthesia, my friends, he was fighting. He thought they were taking him prisoner. We need competent 

people, trauma care, who understand what they are faced with. 

And this is something that we do not have. 

I have a large testimony, but I know that time is limited. Look 

at my legislation. I will leave with you some letters that you can 

read about the sacrifices that they go through. 

Thank you so much for listening to us. Hopefully you will take 

a look at my bill, and I will give you the testimony that the veterans and some petitions because this is something. I have been in 

Congress 25 years. I have been fighting for a hospital for the last 

24 years. 

What they have done in the past is to consolidate some of the 

clinics, shut down some hospitals, and now we are getting more 

and more soldiers coming back with different wounds from Iraq 

and we need to take care of that. 

Thank you so much. 

[The prepared statement of Congressman Ortiz appears on p. 48. 

The petition submitted by Congressman Ortiz is being retained in 

the Committee files.] 

Mr. MICHAUD. Thank you, Mr. Ortiz. And do you have a copy of 

that map, so we can have it for the record? 

Mr. ORTIZ. We do. We are going to pass you a copy of the map 

with the testimonials of several of the veterans. 

Mr. MICHAUD. Okay. Great. I appreciate it. 


smartinez on PROD1PC64 with HEARING
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And it is my understanding that under the Capital Asset Realignment for Enhanced Services (CARES) process there is no hospital, but we will check with VA to make sure. 

Mr. Miller. 

Mr. MILLER. Solomon, I assume that the closest DoD facility to 

south Texas is Corpus Christi. Is there a Navy hospital there at 

the Naval Air Station? 

Mr. ORTIZ. We had a Naval hospital. It was shut down. And 

sometime back, I testified before the VA Appropriations Subcommittee. They came down and they looked at the hospital. Again, 

the lack of funding. And then they came down and they said this 

hospital is obsolete, you know, does not conform to the American 

Association Guidelines. So we do not have a facility. 

Another problem that we have is the influx, you know, we have 

a lot of winter tourists, veterans that live in the area for 4 to 6 

months, they are vets who need treatment, about 20,000. We have 

about 140,000 people, soldiers who have served in the military. We 

do not have a facility. We tried contracting out with the local hospitals. 

One young man was having a cardiac arrest and he called his 

people at the VA, who say go to the hospital, go to the nearest hospital. He did. Then he got a bill for $10,000 that he still has not 

been able to pay. 

These are the problems that we face on an everyday basis. There 

is not a hospital. It is all outpatient care. 

Mr. MILLER. You said that the contracting side was not working. 

Is it not working in regards to them being able to get the care? Is 

the breakdown just in paying for the bills? Where is the breakdown? 

Mr. ORTIZ. It is both, because when you have 140,000 eligible 

people and you only have about 10 beds, you know, either they are 

full, they cannot take anybody, or if they take somebody else, they 

do not have room, then they charge the patient coming in. 

So this is why the system, we tried it before, it is not working. 

And when I meet with a veteran, they say, you know, when I enlisted, they told me that they were going to take care of my health 

and now I am back and I have to wait 6 months for an appointment. I cannot get inpatient care. It is all outpatient care. 

Mr. MICHAUD. Mr. Hare. 

Mr. HARE. Congressman, let me just say thank you for two 

things. One, first and foremost, for introducing this legislation. You 

know, you were absolutely right. I was listening to your testimony 

and the amounts of money that we spend, you know, $11 million 

an hour on this war and, yet, I sat at this Committee and I keep 

hearing people say how are we going to afford this. And my answer 

has always been the question is not can we afford, the question is 

how can we afford not to do this. 

So, Congressman, I would be honored to be a cosponsor of this 

bill. I think it is something that your veterans need and you have 

been a champion for veterans. And so I just want you to know that. 

And we will find the money. We have got it. You know, and I 

said before maybe we ought to take it out of Paris Hilton’s tax 

break. I do not know. But we will get it. 


smartinez on PROD1PC64 with HEARING
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But let me just suggest this to you, too, or thank you for this too. 

I thank you for taking the time to come in. Lane Evans is my predecessor as you know. And I want to thank you for coming in helping us complete the Hero Street Memorial with your help. 

And for those of you who do not know what that is, that is a Hispanic area in my district, one street where five young men gave 

their lives in World War II. 

And thanks to you, Congressman, that memorial is now finished. 

And I want to, on behalf of the people of Hero Street, I have not 

had a chance to thank you yet, but I want to thank you for doing 

that. 

And, again, thank you for introducing the legislation and I will 

do everything I can on my end to help you with it. And, you know, 

you are right. When you bring veterans in and you put a face on 

it, you know, I think it is a wonderful thing to do because sometimes we look at charts and numbers, but we are talking about 

people here. 

And from my perspective, I cannot think of anything more important to do than to support this bill. So thank you for taking the 

time. 

Mr. ORTIZ. Thank you so much for your comments. Thank you, 

sir. 

Mr. MICHAUD. Dr. Snyder. 

Mr. SNYDER. I have no questions. 

Mr. MICHAUD. Well, once again, thank you very much, Mr. Ortiz, 

for bringing the legislation forward. 

Mr. ORTIZ. Thank you so much. 

Mr. MICHAUD. The last panelist for this panel is Mr. Rothman. 

STATEMENT OF HON. STEVEN R. ROTHMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. ROTHMAN. Thank you, Mr. Chairman. 

Ranking Member, Members of the Committee, thank you for having me here today. 

I am here to testify today about the moral responsibility and national security obligation of the Federal Government to honor its 

commitment to all veterans, namely the commitment to provide 

them with quality, affordable healthcare. 

It is a moral responsibility because the American Government 

makes a promise to every veteran. We say that you volunteer to 

put your life on the line for freedom, because you are willing to sacrifice yourself for the good of all Americans, because of this courage, we will take care of you when you leave the service. 

We do not make that promise with our fingers crossed. We do not 

tack on fine print or attach a bunch of strings to the promise. We 

make that promise freely because our veterans gave freely of themselves in the service. 

It is a national security obligation because without question, the 

morale of a young soldier, I believe, is seriously hurt when he 

meets a 35-, 45-, 55-year-old veteran, combat veteran who is battling cancer or who had a heart attack but had no health insurance 

and was banned by his government from getting healthcare 

through the VA. It is outrageous. 


smartinez on PROD1PC64 with HEARING
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As a representative for more than 156,000 veterans, I have heard 

story after story from veterans in Bergen, Hudson, and Passaic 

counties of New Jersey who tell me that their government has broken its promise to them. That is because in January of 2003, the 

Bush Administration decided to cut costs by telling veterans designated as Priority 8 that they are banned from enrolling in the VA 

health system and will no longer have access to VA hospitals, clinics, or medications. 

The Administration defended its decision by saying that Priority 

8 veterans make too much money to be worth the added expense 

to the system. Just so you know, the amount of money they said 

was too much was anything over $26,902. I say that Priority 8 is 

wrong and that the Bush Administration has the wrong priorities. 

We made a promise to those men and women to take care of 

them and there is absolutely no justification for breaking our word. 

Those veterans often live in areas where the cost of living more 

than eats up the $26,902 of income that the Bush Administration 

seems to think is so great. 

In Bergen County, New Jersey, we have the second highest concentration of veterans in the State of New Jersey and the largest 

number of Priority 8 veterans. There are 73,000 Priority 8 veterans 

in New Jersey alone, 273,000 Priority 8 veterans throughout the 

country, 273,000 veterans who have been told they make too much 

money making $26,902. 

So an example, if you served in combat in Iraq or Afghanistan 

for a number of years, three, four deployments, five deployments 

and thank God you come home without any physical injuries, 5 

years later you get cancer, you cannot use the VA if you make more 

than 26,000 bucks. In my district, the number is a little bit higher, 

but it is certainly not enough to cover the costs of healthcare. 

Turned away, 273,000 veterans turned away from the VA. What 

is the message we are sending to our soldiers? We are saying that 

even though the government made this promise, even though all 

Americans believe that this is the case that if we serve, we are 

going to be taken care of, that is not the case. It is a lie. 

The President may promise to love veterans and love people in 

the Armed Forces, but that is not what he is doing. He had this 

Congress or he had his Administration come forth with a plan that 

has cut 273,000 veterans from healthcare through the VA. We need 

to keep our promises to our veterans. 

Mr. Chairman, Mr. Ranking Member, and Members of the Committee, again, we did not make those promises with our fingers 

crossed or our hands behind our back. They deserve this healthcare. 

And one of my colleagues was asking where we get the money. 

In my book, I think the way most Americans feel is this is an obligation, this is a promise we made. It is a moral imperative that we 

live up to our promise to those who put their lives on the line for 

us. It is a national disgrace, a national dishonor. 

Where should we get the money? Well, you know, if you have a 

lot of different needs, you take care of the most urgent need and 

the promise to those who did the most, that would fall into this category. And if, my goodness, because the health of the veterans’

healthcare system cannot take care of all of its veterans because 


smartinez on PROD1PC64 with HEARING
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this Administration will not provide the money, then maybe we 

ought to rethink our healthcare system. Oh, my goodness. 

The first thing we need to do, though, is live up to our promises 

to our veterans and take care of them if they get sick when they 

come home. 

Thank you, Mr. Chairman, Mr. Ranking Member, Members of 

the Committee. 

[The prepared statement of Congressman Rothman appears on 

p. 71.] 

Mr. MICHAUD. Thank you very much for your testimony. 

Mr. Miller. 

Mr. MILLER. Thank you very much for your testimony, and I 

think we all agree that there are many things that we can work 

on and do better. Certainly the VA system gets that from this Committee and Subcommittee all the time. 

Are you aware, Mr. Rothman, that an Operation Iraqi Freedom/ 

Operation Enduring Freedom (OIF/OEF) combat veteran can, when 

they come home, get 2 years of healthcare, so they do have that. 

I do not know if there is a lie being perpetrated on those veterans 

at all, and I do not think that is what you were trying to characterize, but——

Mr. ROTHMAN. Thank you for the clarification. But with regards 

to those veterans whose service preceded Iraq and Afghanistan, if 

they get a heart attack, if they get cancer and they do not qualify 

for Medicare because they are too young, they are under the age, 

they are in their thirties or forties or fifties, they are out of luck. 

They do not get any healthcare. And that is a lot of folks, 273,000 

in the United States. 

Mr. MILLER. I concur. Again there is an issue, but I think a lot 

of times while we are at war, we use current stories about veterans 

as they are returning home and there is a clear distinction in regards to their ability. 

Mr. ROTHMAN. I accept that distinction and I appreciate that. 

Mr. MILLER. Thank you for your testimony, Steve. 

Mr. MICHAUD. Mr. Hare. 

Mr. HARE. I would just concur with you. I mean, a promise made 

to veterans is a promise that we have to keep and for the life of 

me I continue to shake my head because even if we did not care 

about the health of the veteran, which should be first and foremost, 

I do not know how we are going to recruit other people to go in 

when they see the kind of treatment, or lack thereof, that we are 

giving to the current veterans. 

I really applaud you for doing this because I do not care what 

category you are, it just seems to me if you served this country, you 

are honorably discharged, this country makes a promise, and, as 

you said Congressman, we did not make it with fingers crossed or 

wink and a nod. We made the promise. So if we are going to make 

it to veterans we have to keep it. And for those two hundred and 

how much? I am sorry. 

Mr. ROTHMAN. Two seventy-three. 

Mr. HARE. Two hundred and seventy-three thousand veterans, I 

mean, what does that say for the service that they have given to 

this country? 

Mr. ROTHMAN. If I may, Mr. Chairman. 


smartinez on PROD1PC64 with HEARING
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Mr. MICHAUD. Absolutely. 

Mr. ROTHMAN. There are a lot of our service men and women 

who are not in combat as defined under the law that my friend 

from Florida referred to. Nonetheless they are in harm’s way. 

There are terrorists who would seek to blow up any servicemember 

in uniform or out of uniform. And so there is a justified distinction 

in those who served in combat, but I think every veteran deserves 

the right to, especially after 9/11, to, and before, to get this kind 

of care. 

And by the way, if you ask yourself is this not so sad and shocking for veterans, is it not sad and shocking for an industrialized nation, the richest in the world, if one of the people that served in 

the military gets a heart attack or cancer and they cannot afford 

health insurance, they are going to suffer in the United States of 

America? 

Mr. HARE. I just want to say, Congressman, you know, when people are sworn in to any branch of the service, they swear that they 

are going to protect this country and they do. And once they are 

discharged, I think we have a moral obligation to protect them. 

And for the life of me, I do not know why the Administration decided they were going to do this unless it was a cost-saving factor 

and even if that was the excuse, that is about as lame as it gets. 

So I think we have to restore this. I think your bill does that. 

And, again, I think, and I know one of the Members on the other 

side, what do you want to do, do you want to cover everybody? The 

answer is, yes, I do. And I think it is something that is terribly important. 

And, again, this Committee, and I love this Committee a great 

deal, we have been able to do some wonderful things. We have a 

great Chairman, great Subcommittee Chairman, great Members, 

and I think we finally decided that enough already. We have put 

the brakes on this. 

And I look forward to working with you on this because I think 

it is a moral obligation that we have as a country. 

I yield back. 

Mr. ROTHMAN. Thank you. I hope you will consider my bill, Mr. 

Chairman, Mr. Ranking Member. I appreciate your service for all 

of the veterans. We need to do more and to find the money to do 

it. 

Mr. MICHAUD. Thank you very much, Mr. Rothman, for your testimony. 

And since there are no further questions, I would ask that the 

next panel come up. 

We will be having votes shortly, so what we will do is have the 

next panel give their testimony before we ask questions. Keep in 

mind that we do have votes, and we have two more panels after 

this panel. 

I would ask unanimous consent that Chairman Filner be invited 

to sit at the dais for the Subcommittee hearing today. Hearing no 

objection, so ordered. 

I would like to welcome the second panel with us here this morning. And what we will do is start with Congresswoman Solis and 

move down the line. 

Congresswoman. 


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STATEMENT OF HON. HILDA L. SOLIS, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF CALIFORNIA 

Ms. SOLIS. Thank you very much, Mr. Chairman, Ranking Member Miller, for holding this very important hearing. 

I feel real privileged with this opportunity to present, I think, a 

case that has not been stated very clearly here in the Congress and 

it is with respect to a bill that I have introduced, Culturally Competent Veterans’ Care, House Resolution 542. 

The bill requires that the Department of Veterans Affairs conduct a thorough assessment identifying non-English languages that 

are likely to be encountered and ensure that such services are 

available in both English and a language in which a veteran is proficient. 

And as you will see by the posterboard here, these are servicemen that have actually come from the district, served in Afghanistan or Iraq. Unfortunately, they did not come home. There are 14, 

so some are missing. But if you can see their faces, you can tell 

that they are predominantly of Latino background. 

One of the cases that came to my attention when the war began 

was one of our fellow soldiers who had fallen. I went to visit the 

family. The mother was not proficient in English. The son was 

about 20 years old, passed away, was killed in Iraq. And the mother had no idea about the information that the military was relaying 

to her. We tried to get them an interpreter. 

What they ended up doing was actually getting another service 

officer, about 18, 19 years of age, to try to interpret what choices 

the family had in terms of burial services and life insurance and 

everything else, all the details that you would think somebody 

would be proficient and competent in. 

When I came to realize that, I saw a serious gap, but it kept repeating itself. And so different families that I would encounter in 

my district in LA, and this is typical of the southwest where you 

see a large concentration of Hispanic communities serving our military, you are finding these households, whether it is the family 

itself or the soldier, who is proficient in another language, which 

is in this case, I am arguing, Spanish, but it could be Asian, it 

could be Filipino, it could be Asian-Pacific Islander, because we 

have those individuals, too, serving in combat. 

And what I am finding is that upon calling the VA to ask them 

about services that could be provided in their language so that 

there is less resistance and more understanding and sensitivity in 

applying for services through the VA, that that should be a part 

of what the VA does. 

Well, apparently what they do is they receive grants and they decide what languages they want to provide information. And in 

many cases, I do not think a booklet or a piece of paper goes far 

enough. We need to have staff out there. And you cannot rely on 

another soldier who might be misinterpreting information, who is 

not trained properly to give that information to a family member, 

to a spouse, or to the soldier, him or her self. And we have encountered this situation multiple times. 

Upon inquiring with the VA, they said, well, we do not have 

enough staff available. We know that there are guidelines that we 

are supposed to be abiding by, they say, and, yet, in most of their 


smartinez on PROD1PC64 with HEARING
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facilities, I am told that only 43 percent of the entire VA services 

it is supposed to be providing the service is actually being applied. 

So I have a serious, serious concern and that is why I have introduced the bill. I think it goes a long way and I would just ask for 

your consideration and support. 

In addition, while you may see male members here, I have met 

several times with many of our recruits in our district and there 

is a large Latino population as well. And there are special circumstances there where women also need to be treated differently 

with respect to service-related benefits that they may have. 

So I think that that is something that we have to keep in mind 

as well, and I will gladly work with the Committee and hope that 

you may somehow incorporate our efforts here, if not possibly see 

the bill come through your Committee. 

But I thank you for the opportunity to be here this morning. 

Mr. MICHAUD. Thank you very much for your testimony. 

Mr. Latham. 

STATEMENT OF HON. TOM LATHAM, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF IOWA 

Mr. LATHAM. I thank the Chairman and the Ranking Members, 

Members of the Subcommittee. 

I am honored to have the opportunity to testify before you today 

regarding House Resolution 1426 which is the ‘‘Veterans’ Access to 

Local Healthcare Options and Resources Act,’’ also known as the ‘‘VALOR Act.’’ I introduced this legislation in response to a growing concern expressed by veterans in my district regarding access to VA healthcare. Veterans who live in rural parts of my district must travel 

long distances to VA medical facilities to receive the healthcare 

that was promised to them. 

Oftentimes they have to wait for months to get an appointment. 

They are frequently forced to give up a full day sometimes in fragile condition to travel for healthcare. 

Despite the remarkable improvement in the quality of VA healthcare during the past decade, the fact remains that not all America’s 

veterans have equal access to these services. 

One example of this inequity is the story of a Vietnam Army veteran from Fort Dodge, Iowa. He is a recipient of the Bronze Star 

and is service disabled. And he estimates that he has made the 4- 

hour round trip from Fort Dodge to the VA medical facility in Des 

Moines more than 100 times in the past 3 years. Because he cannot 

drive, he relies like most veterans on a shuttle graciously provided 

by one of the Veteran Service Organizations which takes up to 10 

or more veterans to Des Moines at a time. 

Since they have to wait for the last appointment to return, the 

trip takes an entire day, sometimes starting at 5 a.m. and returning late in the evening. 

Countless similar cases have been reported to me by veterans in 

my district. This situation leads me to ask the question, can we 

really say that we are providing top-quality care for our veterans 

when so many have limited access to it? 

Out of nearly 8 million veterans enrolled in the VA healthcare 

system last year, only 5 million veterans actually receive VA 


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healthcare. Recent reports show that the VA healthcare system 

continues to match or outrank private-sector healthcare in overall 

quality and consumer satisfaction. 

Out-of-pocket costs are extremely low, in particular for serviceconnected veterans, so why are less than two-thirds of the veterans 

enrolled in the system actually using it? I believe that access problems account for a great deal of this disparity. For millions of veterans, VA healthcare is simply not readily accessible, and again especially in rural areas. 

VA-funded research conducted by Dr. William Weeks and his colleagues from the VA Outcomes Group highlights the urgent need 

for action to increase healthcare access for our rural veterans. This 

research supports the conclusion that, compared to their urban 

counterparts, rural veterans have a higher prevalence of mental 

and physical problems and the least access to the VA healthcare 

system. 

I am concerned that this disparity will continue to grow over 

time unless we do something now about it. First, rural residents 

are over-represented among veterans. The VA Outcomes Group 

found that 22 percent of veterans are rural compared to 14 percent 

among the general population. 

Furthermore, rural veterans are over-represented among those 

serving in Iraq and Afghanistan due to the increased use of the National Guard and Reserve units. These units are often dispersed in 

rural areas far from large urban centers or concentrations of veterans where VA facilities tend to be located. 

As I previously mentioned, rural veterans are already likely to 

experience more health problems. While large numbers of these 

veterans return from combat, the need for VA healthcare in rural 

areas will increase dramatically in the coming years. 

The ‘‘VALOR Act’’ aims at meeting this need by providing veterans with an option, and I will emphasize it is an option, they are 

not mandated to do anything, to receive healthcare that they would 

otherwise be eligible to receive in a VA facility at the local hospital 

or a physician’s office. 

To provide this option, the legislation builds on the existing VA 

system for contracting with non-VA providers known as fee-basis 

care. The VA already has specific statutory authority to contract 

with non-VA facilities for medical care, but it is subject to way too 

many restrictions. 

The ‘‘VALOR Act’’ would require an expansion of fee-basis care 

to allow greater access to VA-funded healthcare in our local communities. 

Under the bill, covered services would include hospital care, medical services and rehabilitative services and preventative health 

services that a veteran would be eligible to receive at any VA facility. It also clarifies that VA drugs can be obtained with prescriptions written by contract physicians. 

Mr. Chairman, I see my time is up and I want to submit the rest 

of it for the record. But let me just say this is the number one veterans’ issue in my district. I hear about this all the time. So many 

of these people are World War II, Korean veterans and it is just 

virtually impossible for them to withstand a 5 o’clock in the morning to 8 o’clock, 9 o’clock at night situation just to get healthcare. 


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And I appreciate the opportunity to testify, and I look forward 

to answering any questions. 

[The prepared statement of Congressman Latham appears on 

p. 72.] 

Mr. MICHAUD. Thank you very much. I really appreciate it. 

The next is Mr. Altmire who is a freshman Member of Congress. 

I want to thank you for your willingness to become very active in 

veterans’ issues and look forward to your testimony as well. 

STATEMENT OF HON. JASON ALTMIRE, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF PENNSYLVANIA 

Mr. ALTMIRE. Thank you, Mr. Chairman, Ranking Member Miller, for the opportunity to testify before the Committee today. 

My bill, House Resolution 1944, the ‘‘Veterans Traumatic Brain 

Injury Act of 2007,’’ is bipartisan. And I introduced this legislation 

to increase the screening and treatment for traumatic brain injuries (TBI), for our Nation’s veterans. 

TBI is an impending crisis in this country. Our brave service 

men and women are returning from Iraq and Afghanistan with TBI 

at an alarming rate. Of those treated just at Walter Reed Army 

Medical Center, it is estimated that 65 percent have been diagnosed with TBI as a primary or co-morbid diagnosis. Many now 

consider TBI to be the signature injury for those returning from 

Iraq and Afghanistan. 

And I am concerned that the VA health system may not be properly identifying and treating TBI among our Nation’s veterans. It 

is estimated that more than half of all combat casualties have associated brain injuries. Most of them include mild TBI which is often 

missed in initial exams as physicians attend to other more visible 

injuries. 

My bill improves the coordination of TBI care for our Nation’s 

veterans by requiring the VA to screen veterans for symptoms, develop and operate a comprehensive program of long-term and postacute TBI rehabilitation, establish TBI transition offices at all polytrauma network sites, and create and maintain a veterans’ TBI 

health registry. 

And I do want to take the opportunity to commend the work of 

this Committee and the full Committee under Chairman Filner’s 

leadership for the work that has been done in just the first 4 

months on veterans’ healthcare. 

The 110th Congress is taking enormous strides in meeting its 

commitments to veterans. Here in the House, we voted for more 

than $11 billion in increased funding for veterans’ healthcare and 

we passed the ‘‘Wounded Warrior Assistance Act’’ to provide for the 

management of their medical care. 

And I know every Member of this Committee agrees that no 

group should stand ahead of our Nation’s veterans when it comes 

time to make Federal funding decisions. 

We owe no greater debt than to our veterans and while we have 

made some progress, more needs to be done. To this end, the bipartisan ‘‘Veterans Traumatic Brain Injury Treatment Act,’’ House 

Resolution 1944, will allow us to properly screen America’s returning heros for TBI and improve their treatment. 


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I would be happy to answer any questions that you have, and I 

do thank the Committee for allowing me to testify today. 

[The prepared statement of Congressman Altmire appears on 

p. 73.] 

Mr. MICHAUD. Thank you very much, Mr. Altmire. 

Next is Mr. Moran who is a distinguished Member of this Committee. 

STATEMENT OF HON. JERRY MORAN, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF KANSAS 

Mr. MORAN. Mr. Chairman, thank you very much. I am pleased 

to be on this side of the table this morning with you and Chairman 

Filner, Ranking Member Miller for the opportunity to testify. 

This is a topic that you have heard me speak about in the Committee before and it in many ways mirrors the comments of Mr. 

Latham, the gentleman from Iowa. We share the same kind of 

challenges when it comes to a rural district. 

I represent a congressional district that is about the size of the 

State of Illinois. It is almost 60,000 square miles and although 

there are 75 hospitals in my congressional district, there are no VA 

hospitals. 

And so the veterans, just as Mr. Latham described, have long 

distances to travel. We have been successful in bringing Community Based Outpatient Clinics (CBOCs) to the congressional district 

and I am very grateful for that, but I am convinced there will never 

be enough construction dollars to justify enough new clinics to 

serve the needs of veterans who live in the remote areas of Kansas 

and really across the country. 

I want to share just a couple of stories with you, again a World 

War II veteran. This letter comes from his wife. My husband has 

been a resident of a long-term care facility for 2 years and is unable to drive the 65 miles it takes to get a physical at the Hayes 

VA Clinic as is required by the VA to receive his prescription drug 

benefit. They stopped filling his prescription medicine. 

Veterans like Ralph gave several years of their lives for our 

country and I feel that he is being treated in a very ungrateful 

way. 

Another example, Hoxie, Kansas, in which the gentleman, the elderly veteran needed a new pair of eyeglasses. The veteran was 

told he must travel 4 hours to Wichita to the VA hospital to receive 

his new pair of glasses, a distance of about 260 miles, yet his hometown has an optometrist who is unable to meet his needs because 

he is not part of the VA. 

This does not make sense to me and I know that it does not 

make sense to many of my colleagues. It is long drives, bad weather, limited financial resources and ailments that make it very difficult for our veterans to make that trip and, therefore, many of 

them, I would say most forego getting treatment. 

It is no wonder that studies highlight the poor health of America’s rural veterans. It is not right that we penalize veterans because of their choices of where they live. 

This legislation, the ‘‘Rural Veterans Access To Care Act,’’ has 

the goal of stopping these disparities in access. The legislation 

would give our country’s most underserved veterans, those who live 


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the farthest from VA facilities the choice to receive care closer to 

home at a local hospital or physician’s office. 

This legislation requires the VA to coordinate care with the Department of Health and Human Services and to contract with 

qualified providers. These rural providers already supply healthcare, quality healthcare to America’s rural population. 

To further ensure quality standards for the veterans’ care, the 

VA should write quality criteria into contracts, monitor the service 

delivery, and put in place mechanisms to share healthcare information. 

The legislation would also require the VA to fill prescriptions 

written by outside physicians for eligible veterans. 

And I understand there are concerns. Mr. Michaud, I chaired 

this Subcommittee at one point in time and I promoted this legislation for a long time. It is not always supported by the Veteran 

Service Organization community. And I understand the concerns 

that are raised about the budgets and that there is a fear that if 

we enhance contracting that our VA hospitals will suffer. 

And I believe that it is important that we do both, fund the hospitals and CBOCs as well as provide contracting for our most rural 

veterans the outreach that they need. 

This legislation has not been scored, but I believe in order to 

lessen its budgetary impact, we can create criteria which the bill 

does. A veteran must live at least 60 miles from a VA primary care 

facility like a CBOC when seeking such outside care or 120 miles 

from the VA hospital or 240 miles from a VA tertiary care facility. 

So we have placed mileage restrictions in this legislation to minimize the budgetary impact. These requirements are based upon the 

VA’s own care system in which they establish the goals for service 

to veterans and using their criteria of distance and time for veterans that they desire to serve. 

Mr. Chairman, I believe that allowing highly rural veterans to 

take advantage of the convenience of an existing rural healthcare 

infrastructure is a commonsense solution to providing VA care 

when it is not otherwise available. 

I am not suggesting we abandon the VA healthcare system, a 

system that has served veterans well and continues to improve, but 

I do request that we put in place practical reforms to account for 

the reality of those who live on the fringes of the VA’s ability to 

care for them. 

I ask the Committee’s full consideration of this legislation and 

would work with others to supply other ideas and suggestions of 

how it can be improved or altered so that our veterans will finally 

have the access that we have promised them years ago. 

Thank you, Mr. Chairman. 

Mr. MICHAUD. Thank you very much, Mr. Moran, for your testimony. 

And the final panelist is our distinguished Chairman of the full 

Committee on Veterans’ Affairs, and I would like to thank you, Mr. 

Chairman, for assisting us in having this hearing on several pieces 

of legislation that are important to veterans and individual Members of Congress. So thank you, Mr. Chairman. 


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STATEMENT OF HON. BOB FILNER, CHAIRMAN, FULL COMMITTEE ON VETERANS’ AFFAIRS, AND A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mr. FILNER. Thank you. Mr. Chairman, thank you for your leadership. There are a lot of good bills here. 

Mr. Altmire, before you leave, I just want to thank you for your 

leadership on the traumatic brain injury situation. We are going to 

have a national symposium on brain injury and bring in a lot of 

creative and outside ideas about treatment to deal with it. And 

your bill will be there to be considered, so we thank you for that. 

And I thank also Mr. Latham and Mr. Moran. We are going to 

address a rural health agenda for our Nation’s veterans and we 

look forward to having your bills to look at as we proceed. So thank 

you for your leadership here. 

I have two bills on our agenda today, H.R. 1470 and H.R. 1471, 

and I appreciate the opportunity to speak on these bills. 

I think a special opportunity presents itself in that over 40 percent of the medical problems for returning servicemembers from 

Iraq and Afghanistan are what we call musculoskeletal and many 

can undoubtedly benefit from chiropractic care. As one American 

who has benefited from chiropractic care, I can promote it in absolutely good faith. 

H.R. 1470 which was introduced in the last Congress by former 

Congressman Jeb Bradley, who was a Member of this Committee 

from New Hampshire, is called the ‘‘Chiropractic Care Available to 

All Veterans Act.’’ It requires that chiropractors are phased into 

the VA with not fewer than 75 medical centers by the end of December 2009 and all of our centers by the end of 2011. 

House Resolution 1471 is the ‘‘Back Our Veterans Health Act,’’

which means better access to chiropractors to keep our veterans 

healthy. It requires that veterans have direct access to chiropractic 

care at the VA hospitals and clinics so that veterans do not have 

to go through a general practitioner, or gatekeeper, as this doctor 

is sometimes called. 

We must remember that since the creation of the VA healthcare 

system, the Nation’s doctors of chiropractic have been kept outside 

and all but prevented from providing proven, cost-effective, and 

much-needed care to our veterans. So, we are grateful that access 

is becoming greater. 

The support for VA chiropractic care is bipartisan and you may 

recall that the previous Secretary of the VA, Anthony Principi, released a policy directive before his departure regarding the true 

and full integration of chiropractic care in the VA. 

I hope that Secretary Nicholson will be equally open to this and, 

of course, both Republican and Democratic Members of this Committee have supported this bill. 

I have worked very closely with chiropractic patients, including 

our Nation’s veterans, on these bills as well as the American Chiropractic Association and the World Chiropractic Alliance. I see members of both groups here today. Thank you for your support and 

your energy in promoting these important concepts. 

Hopefully the VA will do some of this administratively, but I 

think we have to pass this legislation to make sure that there is 

direct access for our Nation’s veterans to this proven healthcare. 


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And I thank the Chairman. 

[The prepared statement of Congressman Filner appears on 

p. 74.] 

Mr. MICHAUD. Thank you very much, Mr. Chairman. 

Are there any questions of the panelists that are remaining? 

Mr. MORAN. Mr. Chairman, I would only suppose any Member of 

the Committee should compliment Chairman Filner. It is probably 

the political thing to do, but I appreciate his continued effort in regard to chiropractic care. 

I introduced legislation that ultimately became law 3 or 4 years 

ago, 5 years ago maybe, in requiring that the VA develop a chiropractic care protocol. And it is a slow process by which the VA has 

integrated chiropractic care. 

And I would join with Mr. Filner in trying to encourage that to 

occur and look forward to working with you to see that that is accomplished. 

Mr. FILNER. Thank you. 

We have passed three important bills in the last 5, 6 years and 

each time, we have gotten more direct because the VA just has not 

cooperated. So we continue to make sure, and we will have also 

oversight to make sure, that it does occur. 

Mr. MORAN. Thank you. 

Mr. MICHAUD. Dr. Snyder. 

Mr. SNYDER. Mr. Chairman, I want to ask questions of the Members that are not here because I will find that less stressful. 

Just a couple comments on Ms. Solis’ bill and I have not studied 

the bill, but I am sure my family doctor back down here, she is 

dealing with primarily counseling and mental health treatment 

issues with people who were raised in other countries or cultures 

and so their language skills are different than those of us who are 

native born. 

And I think at first blush, someone may say, well, they are veterans, they are in the service, what do we have to do that for. Well, 

just remember that the skills that are required to, you know, drive 

a striker or shoot or go on patrol are a whole lot different kind of 

language skill requirement than the kind of language that you 

need to talk about your relationship with your wife, your relationship with your children, what is going on with your feelings in 

terms of the rage that you may feel or fears that you may feel. 

There are just levels, different kinds of language skills and different cultural sensitivities. 

Like I said, I do not know if her bill is the answer to this and 

I do not know what the current VA policy is with regard to these 

issues, but I have, you know, worked in refugee camps where you 

try to provide mental health services to people that you do not have 

good language communication with and it is a challenge. 

And the second issue is with Mr. Altmire’s bill on TBI. We have 

talked about this issue before, but I hope in the mix, we will be 

sure that we are doing a good job of funding all the good research 

opportunities that are out there on traumatic brain injury because 

that is going to be a huge issue as Mr. Altmire pointed out. 

Thank you for your indulgence. 

Mr. MICHAUD. Thank you very much. 


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I would like to ask the third panel to please come up. On the 

third panel we have Shannon Middleton, Deputy Director of 

Healthcare for the American Legion; Kimo Hollingsworth, Legislative Director for American Veterans; Adrian Atizado, Assistant National Legislative Director for DAV; Carl Blake, Legislative Director for Paralyzed Veterans of America; Dennis Cullinan, Director of 

the National Legislative Service of VFW; and Rick Weidman who 

is the Executive Director of Vietnam Veterans of America. 

And I would like to thank all of you for coming here. I look forward to your testimony. Why don’t we start with Ms. Middleton 

and I would ask you to try to keep within the time limits because 

we do have to go vote here pretty quickly. 

Ms. Middleton. 

STATEMENTS OF SHANNON MIDDLETON, DEPUTY DIRECTOR 

FOR HEALTH, VETERANS AFFAIRS AND REHABILITATION 

COMMISSION, AMERICAN LEGION; KIMO S. HOLLINGSWORTH, 

NATIONAL LEGISLATIVE DIRECTOR, AMERICAN VETERANS 

(AMVETS); ADRIAN M. ATIZADO, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; CARL 

BLAKE, NATIONAL LEGISLATIVE DIRECTOR, PARALYZED 

VETERANS OF AMERICA; DENNIS M. CULLINAN, DIRECTOR, 

NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN 

WARS OF THE UNITED STATES; AND RICHARD F. WEIDMAN, 

EXECUTIVE DIRECTOR FOR POLICY AND GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA 

STATEMENT OF SHANNON MIDDLETON 

Ms. MIDDLETON. Mr. Chairman and Members of the Subcommittee, thank you for this opportunity to present The American 

Legion’s views on several pieces of legislation being considered by 

the Subcommittee. 

Providing quality healthcare in a rural setting has proven to be 

very challenging given the factors such as limited ability of skilled 

care professionals and inadequate access to care. 

The American Legion commends the Subcommittee for holding a 

hearing to discuss these very important and timely issues. My comments will address just a few of these bills. 

House Resolution 92, the ‘‘Veterans Timely Access to Healthcare 

Act,’’ seeks to establish standards of access to healthcare provided 

by the Department of Veterans Affairs. The American Legion believes that setting standards for timeliness in the delivery of 

healthcare and requiring VA to report on how these standards were 

executed will provide a realistic illustration of the ongoing challenges for rural veterans in gaining timely access to care. It will 

also allow VA and lawmakers to determine the best ways to improve timely access for rural veterans. 

House Resolution 315, the Help Establish Access to Local Timely 

Healthcare for Your Veterans bill would require that VA contract 

with community healthcare providers to improve access to healthcare for veterans in highly rural areas. 

The American Legion believes where there is limited access to 

VA healthcare, it is in the best interest of veterans residing in 

highly rural areas that local care be made available to them. This 


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would alleviate the unwarranted hardship rural veterans encounter 

with seeking care. 

House Resolution 463, the ‘‘Honor Our Commitment to Veterans 

Act,’’ discussed lifting the healthcare enrollment restriction on Priority 8 veterans. The American Legion supports removing the 

healthcare enrollment restriction to Priority 8 veterans. 

We believe that it is a more effective method to ensure that VA 

can continue to provide quality healthcare by assuring that there 

is sufficient funding to care for the veterans’ needs, not limiting access to those who have incomes that fall above the means tests 

thresholds. 

And, finally, House Resolution 1944, ‘‘Veterans Traumatic Brain 

Injury Treatment Act of 2007,’’ seeks to have certain veterans 

screened for traumatic brain injuries and discusses the creation of 

a comprehensive program for long-term care and rehabilitation 

that includes residential, community, and home-based components. 

The American Legion believes that the provisions in this bill are 

both necessary and timely. Symptoms of traumatic brain injury 

may not be obvious and may be dismissed or may occur over time. 

Screening those who were known to have been subjected to blast 

trauma in theater, even if they have no visible physical wounds, 

would aid in diagnosing injuries more quickly and improve the 

chances of a successful rehabilitation. 

Again, thank you, Mr. Chairman, for giving the American Legion 

this opportunity to present its views on such important issues. We 

look forward to working with the Subcommittee to bring an end to 

the disparities that exist in access to quality healthcare in rural 

areas. 

[The prepared statement of Ms. Middleton appears on p. 74.] 

Mr. MICHAUD. Thank you very much. 

Mr. Hollingsworth. 

STATEMENT OF KIMO S. HOLLINGSWORTH 

Mr. HOLLINGSWORTH. Mr. Chairman, Members of the Subcommittee, I am pleased to appear to offer testimony on behalf of 

American Veterans for the pending legislation. 

The central problem for veterans with regards to the VA healthcare system in a timely fashion has generally been access. Over the 

years, VA has become increasingly effective in providing timely access, although problems still do remain. 

Regarding the legislation before this Subcommittee, we would 

like to reaffirm our commitment that service-connected disabled 

veterans should have the highest priority healthcare and that these 

services should be of the highest quality. We believe VA does provide that service today. 

Many of today’s proposals do risk some unintended consequences 

to include quality control, safety, and potential adverse impacts on 

some mandated programs that VA is required to keep. 

Overall, the proposals seem to move VA toward higher cost. The 

escalating costs of healthcare in the private sector are well documented and, quite frankly, VA is doing a pretty good job at keeping 

healthcare costs down. 


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We believe the central question to all of these contract proposals 

is whether or not Members of Congress believe the VA healthcare 

system is a national asset worth preserving or abandoning. 

This in turn is reliant upon appropriate levels of funding to hire 

staff, operate facilities, and clinics, and provide unique and specialized services. Appropriate levels of funding would also allow VA to 

open outpatient clinics where needed and provide other contractual 

arrangements to provide VA-sanctioned healthcare. 

Many of these proposals have some triggering mechanism that 

would mandate the Secretary contract care. These triggering mechanisms appear to be a one-time event that authorizes veterans to 

essentially opt out of the system and have VA pick up the cost. 

VA was mandated to establish an office of rural healthcare within VHA and we would encourage Congress to fully fund the office 

and allow VA to conduct the mandated assessment. 

The issue of nonservice-connected veterans accessing VA care is 

not new and obviously we would support open enrollment to the VA 

healthcare system. If veterans want to use the system and they are 

willing to bring their dollars to receive healthcare, we believe they 

should have that opportunity. 

Very briefly on the capital asset realignment for enhancement of 

services, it was a systemwide process to do an assessment of VA 

infrastructure. In short, with regards to VA construction, AMVETS 

supported the CARES Commission process. 

Regarding legislation on the English language, we believe that 

veterans earn benefits and services and are granted access to the 

system by virtue of qualifying military service. This should continue to be the overriding principle when discussing veterans’

issues. 

And for Congress to pass a law and mandate the Secretary to 

provide these services when, in fact, they are starting to do this internally would create division and separation among veterans that 

took an oath to uphold and defend the Constitution of the United 

States in English. 

Mr. Chairman, with regards to chiropractor care, the program 

has been pretty successful at DoD. There was some resistance at 

VA initially getting the program started. We would like to see similar results within VA that appeared in DoD. 

This concludes my testimony. I will be happy to answer any 

questions. 

[The prepared statement of Mr. Hollingsworth appears on p. 77.] 

Mr. MICHAUD. Thank you very much. 

Mr. Atizado. 

STATEMENT OF ADRIAN M. ATIZADO 

Mr. ATIZADO. Mr. Chairman, Members of the Subcommittee, on 

behalf of the 1.3 million members of the DAV and its auxiliary, I 

wish to express my appreciation for the opportunity to present our 

views on healthcare legislation before us today. 

As a majority, the bills for consideration seek to address access 

to VA medical care whether it is time or distance that it takes a 

veteran to get to a facility or the time it takes a veteran to receive 

the care when needed. 


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The DAV is encouraged with this hearing and the number of bills 

introduced that Congress believes as we do that through their extraordinary sacrifices and contributions in military service, these 

veterans have earned the right to VA healthcare as a continuing 

cost of national defense. 

Operating on a limited resource environment, there is a cost to 

improving access to VA care. And in addressing this issue, it is incumbent upon us to ensure that VA receives on time sufficient 

funding to plan and meet the growing need of enrolled veterans’ healthcare including rural veterans’ care as well as for VA to be 

held accountable for meeting the need in a timely manner. 

Equally important that all of this be done without disrupting the 

delicate balance by the erosion of VA’s patient resource base and 

eventually what has been recognized as America’s best healthcare 

value. 

For the sake of brevity, I will highlight some measures in my 

oral testimony and refer you to my written statement for greater 

detail on our position and commentary on any of these measures. 

DAV opposes both House Resolution 92 and 339. Both contain, 

as my colleague mentioned, a trigger mechanism that would require VA to utilize its contracting care authority in the provision 

of medical care. This is in line with our organization’s opposition 

to any initiative that would turn VA into a primary insurer rather 

than provider of healthcare to veterans. 

In line with this, Mr. Chairman, our concern is this hard trigger, 

using limited resources, particularly without appropriate controls 

to protect from erosion the critical mass of VA patient over time 

as I had mentioned earlier. 

House Resolution 463 would overturn the policy to close enrollment and deny access to Priority 8 veterans. DAV believes that the 

manner by which this is accomplished in this bill would eliminate 

accountability over the Secretary’s responsibility to establish and 

operate a system of annual enrollment for VA healthcare. 

Similarly, DAV opposes ‘‘Rural Veterans Healthcare Act,’’ which 

would provide veterans access to VA care at the expense of worsening VA’s financial situation. We urge the confidence in the VA 

healthcare system displayed in this measure to remain and be used 

within the VA healthcare system, not outside, not without. 

Veterans’ geographic inaccessibility of VA care is a direct result 

of limited VA resources. This bill would not improve this financial 

situation nor does it address the higher cost of rural care and in 

the end would not serve veterans well. 

DAV members support the systemwide availability of chiropractic services within the VA as contemplated under House Resolution 1470. However, 1471 would establish chiropractic services’

practitioners on the same level as VA medical doctors in the direct 

provision of primary care services. 

DAV believes access to chiropractic services should be provided 

in consultation with VA primary care providers responsible for 

maintaining the overall health of patients assigned to them. Thus, 

we oppose House Resolution 1471. 

As this Committee is aware, the cost of providing care in rural 

and remote areas is higher than in urban areas. In much of our 

deliberation on this issue, we struggle to find a way to fill the indeVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00033 Fmt 6633 Sfmt 6633 E:\HR\OC\35636.XXX 35636

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terminate gap between limited resources and the demand for rural 

healthcare. 

Accordingly, we ask due consideration be given to the cost-effectiveness of the mobile vet center program in the draft bill titled 

‘‘Veterans Rural Healthcare Act.’’ This is a concern for such a program serving in rural areas and must be addressed accordingly. 

Much of the content of this bill is consistent with the recommendations on the Independent Budget. Further, we believe this 

measure is a good first step in addressing the healthcare needs of 

rural veterans and a good complementary step to the Public Law 

passed late last year. Therefore, DAV fully supports the purposes 

of this bill. 

Mr. Chairman, much of the content of the ‘‘Veterans Traumatic 

Brain Injury Act of 2007’’ is consistent with the recommendations 

of the IB. We have some recommendations in our testimony and 

refer you to them. 

This concludes my testimony, Mr. Chairman. I would be happy 

to answer any questions you may have. 

[The prepared statement of Mr. Atizado appears on p. 79.] 

Mr. MICHAUD. Thank you. 

We will have to recess at this time so we can get over and vote 

and we will recess until approximately 12:15 according to Mr. 

Tucker. 

[Recess] 

Mr. MICHAUD. I would like to reconvene the Committee. Sorry for 

the delay. The votes lasted longer than what Mr. Tucker originally 

thought they would last. 

We left off with Carl Blake from Paralyzed Veterans of America. 

Carl. 

STATEMENT OF CARL BLAKE 

Mr. BLAKE. Mr. Chairman, thank you for the opportunity to testify today. It seems ironic that in the face of some criticism about 

the care being provided in VA facilities that demand has never 

been higher. 

House Resolution 92 would establish standards of access to care 

within the VA healthcare system. Access is indeed a critical concern of PVA as with the other organizations. The number of veterans enrolled in the VA is approaching 8 million and the number 

of unique users is nearly 6 million. Unfortunately, funding for VA 

healthcare has not kept pace with the growing demand. Furthermore, Congress has failed to live up to its responsibility to provide 

adequate resources in a timely manner. As long as VA continues 

to receive funding months into its fiscal year, it will never be able 

to properly plan to meet this demand. To that end, access standards without sufficient funding provided by the start of the fiscal 

year are standards in name only. 

PVA is concerned that contracting healthcare services to private 

facilities when access standards are not met is not an appropriate 

enforcement mechanism for ensuring access to care. In fact, it may 

actually serve as a disincentive to achieve timely access for veterans seeking care. 

We do think that these access standards are important, but we 

believe that the answer to providing timely care is in providing sufVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00034 Fmt 6633 Sfmt 6633 E:\HR\OC\35636.XXX 35636

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ficient funding in the first place in order to negate the impetus 

driving healthcare rationing. 

Because House Resolution 315 and House Resolution 1527 principally address the same issue, I will outline our concerns with 

these proposed bills together. 

PVA is fully aware of the challenges the VA faces every day to 

provide timely access to quality care for veterans who live in rural 

areas. However, we are concerned that in addressing the problem 

of access for these veterans, the long-term viability of the VA 

healthcare system may be threatened. 

The services provided by VA, particularly specialized services 

like spinal cord injury care, are unmatched in the private sector. 

If a large pool of veterans is sent into the private sector for healthcare, the diversity of services and expertise in different fields is 

placed in jeopardy. 

Ultimately PVA has serious concern about the provisions of this 

legislation that would give VA additional leverage to broaden contracting out of healthcare services to veterans in geographically remote or rural areas thereby leading to privatization. 

Privatization is simply a means for the Federal Government to 

shift its responsibility of caring for the men and women who have 

served and sacrificed. 

Current law limits VA in contracting for private healthcare services to instances in which VA facilities are incapable of providing 

necessary care, when VA facilities are geographically inaccessible 

to a veteran for necessary care, when medical emergency prevents 

a veteran from receiving care in a VA facility, or to complete an 

episode of VA care, and for certain specialty examinations. 

The VA could better meet the demands of rural veterans through 

more judicious application of its fee-for-service program. Due to the 

concerns that I have outlined and included in my written statement, PVA cannot support House Resolution 315 or House Resolution 1527. 

PVA fully supports House Resolution 463. The provisions of this 

legislation are in accordance with the recommendations of the 

Independent Budget. However, we must emphasize that if this policy is overturned, additional adequate funding must be provided to 

meet this new demand. It would make no sense to make this 

change without providing that funding. 

PVA finds it difficult to comprehend the rationale for establishing a precedent for veterans in the VA healthcare system to 

leave the system and seek services elsewhere as House Resolution 

1426 would do. While this legislation may be well-intentioned, the 

potential unintended consequences far outweigh any benefit that 

this bill might provide. 

There would almost certainly be a diminution of established 

quality, safety, and continuity of VA care of veterans if they were 

to leave the system. 

While as a consequence of enactment of this bill some serviceconnected veterans might seek care in the private sector as a matter of personal convenience, they would lose the many safeguards 

built into the VA system through its patient safety program, evidence-based medicine, electronic medical records, and medication 

verification program. 


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These unique VA features culminate in the highest-quality care 

available public or private. Also these safeguards that are generally 

not available in private-sector systems would equate to diminished 

oversight and coordination of care and ultimately may result in 

lower quality care for those who deserve it most. 

Mr. Chairman, we recognize that the challenges the VA faces in 

the healthcare arena are difficult. However, we must reiterate that 

the VA will struggle to meet the ever-growing demand of veterans, 

particularly rural veterans, as long as it does not receive adequate 

resources in a timely manner. 

It is unreasonable and, frankly, unacceptable to place expectations on the VA to meet certain types of demand if it is not given 

the resources and tools necessary. 

I look forward to working with the Subcommittee to develop 

workable solutions that will allow veterans to get the best quality 

care available. 

Mr. Chairman, I would like to thank you again for the opportunity to testify, and I would be happy to answer any questions 

that you might have. 

[The prepared statement of Mr. Blake appears on p. 84.] 

Mr. MICHAUD. Thank you very much, Mr. Blake. 

Mr. Cullinan. 

STATEMENT OF DENNIS M. CULLINAN 

Mr. CULLINAN. Thank you very much, Mr. Chairman. On behalf 

of the men and women of the Veterans of Foreign Wars and auxiliaries, I want to thank you for including us in today’s most important discussion. 

First under discussion today was House Resolution 92, the ‘‘Veterans Timely Access to Healthcare Act.’’ The VFW strongly supports the intent of this legislation, but we do have concerns about 

the contracting aspect as well as the adverse impact on overall VA 

funding. 

Next under discussion is House Resolution 315, the ‘‘HEALTHY 

Vets Act.’’ Again, the VFW supports the intent of this bill. We 

would express our concern, however, with the potential for over-use 

of contracting care as we did with House Resolution 92. But there 

are certainly areas where its use is proper. 

We must be mindful, though, of a demonstration project VA is 

currently undergoing, Project HERO, Healthcare Effectiveness 

through Resources Optimization. We have been supportive of the 

Project HERO’s aims and think it would be wise to see how effective this demonstration project is and what lessons can be learned 

from it before making a sweeping legislative change. 

Next under discussion is House Resolution 339. Again the VFW 

supports the intent of this legislation, which is similar to House 

Resolution 92, in that it establishes standards of care for veterans 

waiting to receive care from VA. 

Next I will address House Resolution 463. The VFW strongly 

supports this legislation which would end the 4-year freeze on the 

enrollment of Category 8 veterans. We also urge that Congress 

keep in mind that this would have to be properly funded. 

Next the VFW will discuss House Resolution 542. The VFW supports this bill which would make mental health services available 


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for veterans with limited English proficiency. There can be no other 

area where clear communication is so important as with respect to 

the provision of mental health services. 

Next I will address House Resolution 538. This bill calls for a 

study to determine whether contract care, construction of a VA 

medical facility, or sharing agreement with defense facility would 

fill the needs of veterans residing in far south Texas. 

Current VFW Resolution 661 which was adopted by the voting 

delegates of our last national convention calls for a medical center 

in this region. 

Next I will address House Resolution 1426. The VFW opposed 

this legislation which would allow any veteran to elect to receive 

contracted care whenever and wherever they choose. We have 

strong concerns about the viability of the VA healthcare system 

should this be enacted. Although this bill intends to expand coverage available to veterans, we believe it would only dilute the 

quality and quantity of service provided to new and existing veterans into the future. 

Next under discussion is House Resolution 1470, the ‘‘Chiropractic Care Available to All Veterans Act.’’ The VFW supports this 

bill. 

Next under discussion is House Resolution 1471. The VFW opposes this legislation which would allow veterans to receive direct 

access to chiropractic services. It is important to remember that no 

other VA healthcare specialty allows for direct access to patients. 

Next under discussion is House Resolution 1527. We also support 

the intent of this legislation, which, like House Resolution 315 as 

discussed, allows for contracting of care to veterans in rural areas. 

Again, we urge that the Committee consider the results of Project 

HERO before going further with this bill. 

Also under discussion is House Resolution 1944. The VFW offers 

our strong support for this legislation which would require VA to 

implement screening programs for traumatic brain injuries which 

is the signature disability of this particular conflict, something with 

consequences going far into the future. 

Last under discussion is the draft bill, the ‘‘Rural Veterans 

Healthcare Act.’’ The VFW supports this bill which would make 

changes and improvements to the availability of veterans’ rural 

healthcare. With over 44 percent of returning servicemembers living in rural areas access problems are all to clear and need to be 

addressed. We are happy to support this bill. 

Mr. Chairman, this concludes my testimony. 

[The prepared statement of Mr. Cullinan appears on p. 89.] 

Mr. MICHAUD. Thank you very much. 

Mr. Weidman. 

STATEMENT OF RICHARD F. WEIDMAN 

Mr. WEIDMAN. Mr. Chairman, Vietnam Veterans of America 

thanks you for this opportunity to present our views here today. 

Quite a number of these bills that are under consideration really 

revolve around a funding issue and only point up the need for assured funding that is predictable, that is adequate to meet all the 

needs of veterans. 


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And I am sure you are familiar with this. The partnership, sir, 

which nine organizations including the six represented at this table 

have agreed upon and urge that the 110th Congress move to address this chronic problem and to do so before the end of the first 

session because it would obviate the need for many of these wellintentioned bills that just nibble around the edges. 

In regard to the Priority 8 veterans, in January of 2003, the Executive Directors, and I am that for VVA, of the six organizations 

represented before you met with Secretary Principi and the then 

Under Secretary for Health and were told that they were going to 

limit, because of the short-term funding problem, we are going to 

temporarily suspend enrollment of Category 8’s on the basis that 

it was a temporary suspension. We backed them at great political 

cost, I might add, within our organizations. 

Five weeks later, I was in a briefing on the so-called CARES procedure and they flipped up a slide. I said stop, go back. The slide 

before projected 20 years out was a still freezing out Category 8 

veterans. I said how did we go from a 1-year, temporary freeze to 

a permanent barment of veterans who are not indigent. 

We resented that. I can assure you that I asked who authorized 

this and ended up on the 10th floor of VA saying I do not know 

how we can trust you all again because you sold us a pig in a poke. 

And this is not right. It is not right to do this on a permanent 

basis. 

If, in fact, you all asked for enough money to serve the veterans 

whom you are legally obligated to serve correctly and they do not 

give it to you, shame on the Congress. But if you continue not to 

ask for that money, then shame on you. And it is time once again 

to address the funding issue. 

Similarly to that, if I may suggest, and this also goes along with, 

VVA strongly supports the TBI bill, the screening bill, and at the 

same time would encourage you to add in that a requirement that 

as they are in the process now of redesigning the automated patient treatment record that VA be required, since they do not seem 

to be able to do it on their own, be required to take a complete military history and include it in the automated patient treatment 

record based on branch of service, when did you serve, where did 

you serve, what was your military occupational specialty, and what 

actually happened to you. And based on the answers to those five 

questions to automatically screen for things like traumatic brain 

injury as one example along with many other things such as posttraumatic stress disorder (PTSD). And it would be high time to do 

that. 

Doing the look-back and the proper training on TBI throughout 

VA is absolutely essential. I would bring to the Committee’s attention that 17 percent of the active-duty troops serving at Fort Carson in a survey that was completed 2 weeks ago done by the Army 

that were diagnosed, most of these people were not diagnosed as 

TBI; 17 percent of those active-duty troops who had been in Iraq 

were screened and found to have traumatic brain injury of one degree or another. 

This is a huge problem. It is going to be a huge problem that unfortunately is moving from the military medical system, and not 

being adequately addressed there, into the VA healthcare system. 


smartinez on PROD1PC64 with HEARING
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And VA needs to do its part and urge that Mr. Snyder and those 

folks on Armed Services ensure that military medical system carries more of its load. 

On a number of the other bills, rural access to veterans and 

building a hospital in south Texas, VVA strongly favors that. It is 

a need that goes back very far and these veterans have been underserved for many, many years, and urge that the Committee move 

expeditiously on that and the Congress move expeditiously. 

Once again, we agree with our distinguished colleagues from the 

VFW in the intent of the ‘‘Veterans Timely Access To Healthcare,’’ ‘‘Richard Helm Access To Healthcare Options And Resources Act,’’ and the ‘‘Rural Veterans Access To Care Act’’ are well-intentioned. 

However, we come back to the point that if you are not adequately 

funding the system to serve folks within the system, where are you 

going to get the money in order to contract out? 

Mr. Snyder hit it right. At the moment, it is a zero sum game. 

And if you take away from that, then you are going to be taking 

away resources from within the system. 

We are philosophically not opposed to contracting out where it is 

in the best interest of the veteran. However, we need adequate 

funding before you start taking money out of the system. 

Because I am out of time, I will stop there. And the rest of the 

statement on the other bills, I think is contained therein. I would 

be happy to answer any questions, Mr. Chairman. Thank you. 

[The prepared statement of Mr. Weidman appears on p. 92.] 

Mr. MICHAUD. Well, once again, I would like to thank all the 

panelists for your testimony. It was very interesting. There are a 

lot of common themes throughout each of your statements. 

I just have a few questions for VFW. You mentioned Project 

HERO. This might be a more appropriate question for the VA. 

When is that report due out? Do you have any idea? 

Mr. CULLINAN. I talked with our health policy person and there 

seems to be some uncertainty as to when exactly it is going to come 

out. The only thing is it is, from our understanding, it is gathering 

very valuable information with respect to these kinds of projects. 

So it is something worth waiting for. 

Mr. MICHAUD. Okay. Mr. Weidman. 

Mr. WEIDMAN. If I may comment. Originally Project HERO was 

designed because there was a strong interest on the part of the 

Congress to standardize across Veterans Integrated Services Networks (VISNs) and between hospitals the cost of various goods and 

services. And this was a laudable goal on the part of the Congress, 

pointing out the fact that it was all over the map in terms of what 

we were paying for the same service or same good from hospital 

to hospital. 

So Project HERO, inappropriately named as VVA would maintain, was supposed to standardize that. And, in fact, the first draft 

RFP was a fire sale on clinical care across the board to the private 

sector. We said time out. What do you all think you are doing. This 

is not what the Congress intended. They intended you to rationalize that which you were already contracting out. And it has 

scaled back several times. 

But the problem with all of this contracting out right now is that 

you give them an inch, they take a mile. And until we can have 


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confidence that the intent of the Congress is not going to be distorted by the way in which it is actually implemented, VVA has no 

choice but to oppose it, sir. 

Mr. MICHAUD. You mentioned support of the legislation dealing 

with the hospital in Texas. As you all know, VA went through an 

extensive process, the CARES process, and hopefully we will be 

able to move forward on that more aggressively than we have in 

the past. 

Do you think the Texas hospital should be put before the CARES 

process or should we follow the CARES process first? 

Mr. HOLLINGSWORTH. Mr. Chairman, AMVETS, as I indicated, 

did support the CARES process and there were some decisions. I 

think there was 18 studies. Some of those were going to require 

further analysis. To the best of my knowledge, the VA has not responded to some of those. 

In addition, I would like to add that during the 108th Congress, 

there was a separate study that VA, I believe, was mandated to do 

with regards to that specific region and that report is still supposed 

to be forthcoming. 

Mr. MICHAUD. Okay. Great. 

Mr. WEIDMAN. Unlike our colleagues, Mr. Chairman, VVA does 

not support the CARES process in its current form. We would characterize it as an organized way of going wrong with confidence. It 

is based on a civilian medical formula for people who can afford 

HMOs and PPOs. They have adjusted somewhat for mental health 

and somewhat for blind and visual and for prosthetics, but they 

only adjusted a formula that is fatally flawed. It does not address 

veterans’ healthcare and as a result is always going to underestimate the needs. Let me give you one example, if I may. 

That formula is predicated on one to three presentations per individual who walks through the door. VA averages at their hospitals five to seven presentations per individual who comes through 

the front door. So the burn rate, if you will, of clinical resources 

is much higher among veterans than it is among the civilian population who are middle class, well fed who that formula is based on. 

As a result of that, it is going to continually underestimate not 

only the amount of care needed but the shape of care needed. 

There is a dramatic difference between civilian medicine and veterans’ healthcare medicine. And until we start to think of veterans’

healthcare as a set of occupational healthcare entities or occupational health for a set of very dangerous occupations, we are going 

to continue to go wrong. 

So we think that the need for the south Texas facility is self-evident and we should move on it immediately, sir. 

Mr. MICHAUD. Thank you. 

And my last question, and I will preface it with some comments, 

deals with access to healthcare. And I agree with the comments 

that you have all made. We have definitely got to adequately fund 

VA which is extremely important. And I think a lot of problems related to the bills that we have heard today and ones that we will 

be hearing hit on that core issue about not adequately funding VA. 

However, even if VA was adequately funded, my concern still 

would be the access issue in rural areas. And I know in some of 

the comments, there was talk about it being more expensive and 


smartinez on PROD1PC64 with HEARING
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less cost-effective. That is probably true, but when you look at veterans in rural areas, if they are going to get the services that they 

need, we might have to pay a little bit more for those services because I do not think it would be cost-effective to have clinics 

throughout all the rural areas. 

So is that a fair assumption on all the VSOs that even if we do 

adequately fund the VA, which I think we definitely have to do, 

that there still will be a need for fee-for-service arrangements for 

veterans who live in rural areas? 

Mr. CULLINAN. Mr. Chairman, speaking on behalf of the VFW, 

we certainly have no philosophical or other kind of objection to providing contract-based care. VA has existing authority to do that. 

We would urge that they do it more judiciously, perhaps more liberally. 

The only thing we do not want to see is contract care suddenly 

supplanting the VA’s own infrastructure. That is our concern and, 

of course the cost of all this. 

Mr. MICHAUD. I agree with that comment. 

Are any of the VSOs, following up on that same line of questioning, aware of any VISNs out there now that are abusing the 

fee-for-service contracting out services? 

Mr. HOLLINGSWORTH. Mr. Chairman, AMVETS is not aware of 

that, but some of this delves into a territory I do not think we want 

to go today which has to do with the medical care cost collection 

funds and how we fund things. 

I think overall, you know, AMVETS says, hey, we need to get the 

services that veterans are entitled to receive or that they are authorized to receive and we should provide those services. 

I think our overriding concern with some of the legislation presented today is the simple fact that the Secretary does have this 

authorization and so there is no need for separate legislation to do 

this. If the needs are not being met, then let us get the VA to act 

within their existing authorizations. 

Mr. ATIZADO. Mr. Chairman, if I may, with regards to the VISNs 

that make extensive use of contractor fee-basis care, I think if you 

look to the hearing with regards to Project HERO, it was mentioned in that hearing that the four VISNs that were chosen were 

chosen specifically for their high utilization rate of contracting fee 

care. 

With regards to rural care, I think once we all agree with the 

fact that to provide this care is going to be higher than what we 

are all used to, then we would have to shift our idea of cost-effective care specifically for this population. 

The concerns that all my colleagues have here on this side of the 

table is the idea that has been presented on how to deal with this 

issue. Much of them require VA, takes out flexibility, it is a hard 

trigger legislation, which, if I may say, we could probably look more 

toward a soft trigger, something that would allow us to be more 

aware of the situation, be more cognizant, and be more prudent as 

well as take incremental steps to really address this problem. 

This is a very huge problem, particularly for the new veterans 

from OIF/OEF. And we really should take the time to take a look 

at this instead of coming up with this potentially, and I say this, 

potentially dangerous legislation with the way it is written. 


smartinez on PROD1PC64 with HEARING
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Mr. WEIDMAN. VVA is not, as I mentioned before, philosophically 

opposed to contracting out as long as it is done judiciously and as 

long as the system is adequately funded. 

I am keenly familiar with what you are talking about, Mr. 

Michaud. A decade following military service in Vietnam, I lived in 

northern New England and was 21⁄2 hours if the roads were dry, 

which you cannot assume in northern New England, from White 

River Junction. And so I am familiar with the difficulty in receiving 

care from VA when you have those kinds of distances. 

But the real issue here is if you have adequate funding for the 

overall system and using, as our good friends from the DAV put it, 

judicious use of the already contract fee provider mechanism, then 

we would have no objection whatsoever. 

Mr. MICHAUD. Great. Well, once again, I would like to thank the 

panel for your testimony today. I look forward to working with you 

as we continue moving forward in this Congress to deal with issues 

important to veterans. Our door is always open. So, once again, 

thank you for your testimony. 

Sorry for the delay. And I would ask the last panel to please 

come up. On the panel is Dr. Cross, who is the Acting Principal 

Deputy Under Secretary for Health. He is accompanied by Walter 

Hall who is the Assistant General Counsel for the Department of 

Veterans Affairs. 

And, once again, I apologize for the lengthiness of the hearing on 

these pieces of legislation. Unfortunately, votes got in the way. 

So without any further ado, Dr. Cross, once again, welcome and 

I look forward to your comments. 

STATEMENT OF GERALD M. CROSS, M.D., FAAFP, ACTING 

PRINCIPAL DEPUTY UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF 

VETERANS AFFAIRS; ACCOMPANIED BY WALTER A. HALL, 

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

Dr. CROSS. Good afternoon, Mr. Chairman and Members of the 

Subcommittee, and thank you for inviting me here today to present 

the Administration’s views on several bills that would affect programs administered by the Department of Veterans Affairs in the 

provision of healthcare to veterans. 

With me today is Walter Hall. He is the Assistant General Counsel. 

The various bills under consideration address issues that include 

wait times, expanded access to healthcare in rural areas, the provision of chiropractic care, and multilingual outreach. 

Mr. Chairman, knowing my time is limited, I will address these 

issues collectively by subject. And I would like to submit my written testimony which provides additional in-depth information for 

the record. 

Mr. MICHAUD. Without objection, so ordered. 

Dr. CROSS. House Resolution 92 deals with waiting times. Specifically House Resolution 92 addresses wait times for appointment 

scheduling as well as the issue of waiting room times. Both issues 

are important to VA and VA has no significant objection with respect to the 30-day standard for scheduling patients. 


smartinez on PROD1PC64 with HEARING
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We would, however, ask the Committee to change the bill language to clarify that it would apply only to new patients. It is these 

patients who need to be tracked to understand that there are difficulties accessing the VA system. 

Turning to waiting room times, we would like to submit to the 

Subcommittee results from our customer satisfaction survey which 

is independently done indicating nearly 80 percent of patients waiting for primary care services are seen within 20 minutes of their 

appointment time and more than 70 percent of veterans are seen 

within 20 minutes of their specialty care appointment time. 

We feel that House Resolution 92 would not remedy the wait experience of the patient for a particular visit and further that the 

remedy is based on a flawed assumption that all private care in the 

community meets the proposed standards. 

House Resolution 315 and House Resolution 1527 address expanded access to healthcare for veterans in rural and highly rural 

areas. VA is concerned that both of these bills would undermine 

further expansion of our system to facilities in rural areas. 

VHA recently established the Office of Rural Health in accordance with Congress’ mandate in the ‘‘Veterans Benefits Healthcare 

And Information Technology Act of 2006.’’ This office will determine how we can continue to build on what we have already successfully accomplished and to expand on that expertise in caring 

for our rural and highly rural veterans who, in fact, rate their satisfaction of care higher than their urban veteran counterparts. 

House Resolution 538 defines provisions of care for veterans in 

far south Texas. VA at the request of Senator Kay Bailey-Hutchinson has contracted to evaluate and to report on current needs in 

the south Texas region. The results from the study are due in July 

of this year. 

VA respectfully requests that the Subcommittee await the results 

of this ongoing evaluation before considering whether to mandate 

a particular means for addressing the healthcare needs of veterans 

in that area. 

House Resolution 1426 would provide enrolled veterans the option of receiving care outside the VA healthcare system. VA strongly opposes enactment of this bill. Not only could it lead to the 

undoing of a world-class VA healthcare system, but it would also 

fragment the care our veterans receive because they would no 

longer have a complete set of medical records reflecting their comprehensive care. 

House Resolution 463 would terminate the administrative freeze 

on enrollment of veterans in Category 8. VA strongly opposes this 

bill. The bill would render meaningless the prioritized enrollment 

system mandated by Congress in 1996. VA would have to add capacity to absorb the increased workload this bill would entail. But 

in the interim, the quality and timeliness of VA healthcare would 

suffer. 

House Resolution 1470 and 1471 deal with chiropractic care programs in the VA. VA does not oppose increasing the number of VA 

sites providing chiropractic care. However, at this time, we do not 

believe that chiropractic care at all VA medical centers is warranted. To date, 98 percent of our patients can receive chiropractic 

care within 30 days of their desired date. 


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And VA also strongly objects to extending the field of chiropractic 

care to the treatment of other medical conditions. We believe that 

it is in our patients’ best interest to continue having their individual primary care providers remain in charge of managing their 

care, particularly since our aging population exhibits complex medical conditions requiring intensive and highly integrated clinical 

management skills that are better managed in a primary care setting. 

House Resolution 542 would require VA services in a language 

other than English for veterans with limited English proficiency. 

We believe that we are already meeting the intent of this bill. 

On February 12, 2007, VHA issued a new directive updating the 

guidance previously set forth regarding services to individuals with 

limited English proficiency. Similar documents have also been 

issued by the National Cemetery Administration (NCA) and by the 

Veterans Benefits Administration (VBA). 

These action plans ensure that VA facilities and programs fully 

implement all such requirements. 

Sir, this concludes my prepared statement. Mr. Chairman, we 

are still in the process of developing cost estimates for these bills 

and we will supply them for the record when they are cleared. And 

I would be pleased to answer any questions you have. 

[The prepared statement of Dr. Cross appears on p. 94.] 

Mr. MICHAUD. Thank you very much, Dr. Cross. 

When do you think they will be cleared as far as the cost estimates? 

Dr. CROSS. Well, I do not have a date in mind at this point, but 

this is of great interest and concern. And, sir, we will cooperate 

with you and do it as quickly as possible. 

Mr. MICHAUD. Okay. Great. In your written testimony, you also 

said you will provide comments on H.R. 1944, the rural healthcare 

bill as well. When do you think you will have those? 

Dr. CROSS. H.R. 1944 is a bill that we have just seen. It just 

came over, I believe, and so we looked at it. It concerns TBI. Obviously TBI is of intense interest to us and our system right now. 

My view of it, and this is not official, is that the intent of the 

bill and many of the things in the bill are consistent with the direction that we are pursuing right now. 

Mr. MICHAUD. But when will you have it? You said you would 

have written testimony on those two specific bills. 

Dr. CROSS. Having just gotten it, I am sure that it will take a 

couple of weeks. 

Mr. MICHAUD. Project HERO, when is that report due or when 

will it be ready? 

Dr. CROSS. Actually, HERO is to some degree just being kicked 

off because it was announced in January and I believe the first 

RFPs just went out in, I believe, April. And so it is very, very early 

in the process. 

We are using four sites, four VISNs. The focus is on the effectiveness of how we do our current contracting to make it more effective. And I will have to get you in writing, sir, the answer as to 

exactly when the date is for that to be turned in. It is a 5-year pilot 

project. 


smartinez on PROD1PC64 with HEARING
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Mr. MICHAUD. And you heard from Vietnam Veterans of America 

about the enrollment ban on Priority 8 veterans, that originally 

that was put in place because of lack of funding within the VA and 

it was only supposed to be temporary. But it appears that the VA 

intends to make that permanent; is that correct? 

Dr. CROSS. It is correct that we do not have any plans to change 

the current regulation at this time. And it is more than a funding 

issue. It is also a capacity issue and it will take time and funding 

substantially to incorporate that large bolus of an additional population. 

Mr. MICHAUD. When you talked about waiting lists I believe you 

said that we ought to look at new patients, not existing veterans. 

Why is that? 

Dr. CROSS. I wanted to explain that. I am really pleased that you 

asked because we deal with a chronic disease model of care given 

the nature of the patients that we see. 

A patient who is coming in to us over a period of decades for 

their blood pressure control, for cardiac evaluation, for cholesterol, 

for PTSD, they do not necessarily need to be seen every month. 

And so we want to be careful. If you set a 30-day standard, we may 

be telling them they do not need to come back for 2 months or 3 

months or 6 months. 

So we use something called the desired date. And I have to explain that to you because that is a negotiation between the doctor, 

the scheduler, and the patient as to what is appropriate time for 

them to come in and what is convenient for them as well, what fits 

into their schedule. 

And an arbitrary standard of simply 30 days measure does not 

account for that finesse within our system. The new patients, a 

hard number of 30 days is just fine, I think, because that person 

making that initial request, we want to get them in. There is no 

desired date issue. We assume that they want to be seen as soon 

as possible. 

And so that is why I made that distinction, and we would support that. 

Mr. MICHAUD. You also mentioned the Office of Rural Health. 

Have you already hired the individual? 

Dr. CROSS. We have already established the office. We have assigned the duties to our Policy and Planning Chief, Pat Vandenberg, but our intent is to move forward with further development 

of that office. And I think we were given an end-point target date 

of the end of the summer or the end of the fiscal year. And we are 

working hard to meet that. We will meet that. 

Mr. MICHAUD. And what are you looking for for an individual to 

run the Office of Rural Health? 

Dr. CROSS. Well, I am not sure if I have the criteria all in mind, 

sir, but I would be happy to share those with you. We want someone who is committed in the same way that you are to moving this 

forward for our rural veterans. 

And may I please say, you know, we had the rural health hearing just a short time ago. This is a strategic direction for us. We 

are moving out with more and more Community-Based Outpatient 

Clinics. We are moving out with more telemedicine, telemental 

health. We want to reach out into those communities. 


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But there is a new technique that we want to add in, which we 

are already doing to some degree, outreach clinics. We always put 

the CBOCs on the map and that is a big deal. But we want to have 

also clinics that are CBOCs that are part time, that do not really 

count as a full CBOC. We call them outreach clinics. We have 

about a dozen of those so far. 

And those serve that need of that very small population going 

into perhaps leased space in the community part time, 1 day a 

week, 2 days a week, half day a week where we can meet those 

veterans’ needs so they do not have to leave that community, can 

get their prescription refilled, can get their blood test done, and so 

forth. And that is one of our strategic directions. 

Mr. MICHAUD. You heard the testimony from my colleagues on 

both sides of the aisle this morning and unfortunately a lot of it 

relates to funding issues, and it is not only the Administration’s 

lack of looking at what we need for the VA, but it is also Congress’

lack of taking the initiative to provide the appropriate funding. 

I think if we do have appropriate funding, whether it is assured 

or mandatory funding, that a lot of these problems, a lot of the legislation we are having today, would not necessarily be here. Funding is a big issue, as is funding for rural healthcare when you look 

at the men and women who are currently serving in our military 

today in rural areas. 

My only concern, and hopefully you will keep this in mind, is 

even though rural healthcare might be important for some over at 

VA, I do not think that is necessarily true for all. And that is 

where a lot of us who represent rural regions are concerned. 

As for the CARES process, had that process been moving along 

a lot quicker than it has, I think a lot of these problems would not 

be here. 

But, again, it boils down to funding issues. A good example, is 

Maine. During the CARES process, VISN 1 had recommendations 

for a CBOC, and I believe five clinics. Yet, when we talked with 

the region one VISN Director, they never even requested a business plan. 

That does not give me a good feeling that the interests, particularly as you have heard earlier this morning from other Members 

of Congress, that if you have a VISN Director who sits in a metropolitan area, that they really understand what is happening out 

there with our men and women who served this country in rural 

areas. And I think it is very important that we do have a focus on 

taking care of veterans regardless of where they live. 

I look forward to working with you, Doctor, as we move forward 

in this Congress on a lot of the issues that we have to deal with. 

And I look forward to working with my colleagues on both sides of 

the aisle because, as I stated over and over again, veterans’ issues 

are not Democratic or Republican issues. They are American 

issues. 

The situation at Walter Reed, the situation with Bob Woodruff, 

some of the articles that have come out as far as taking care of our 

men and women who are serving and who have served our Nation, 

have not been good. But the bottom line is good, particularly when 

you look at the budget that was passed about a month ago as it 

relates to VA. 


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And we have to make sure that we continue onward in this area, 

and I appreciate all the work that you are doing, Doctor and Mr. 

Hall, within the VA system and I look forward to working with 

both of you as we move forward along with the VSOs. 

At this time, I would actually ask, since Mr. Miller was unable 

to make it back, if Counsel on either side might have any questions? 

Ms. DUNN. No. 

Mr. TUCKER. I do have two quick questions. 

Mr. MICHAUD. Okay. Yes, Mr. Tucker. 

Mr. TUCKER. Thank you. 

Dr. Cross, just two quick questions. One a little more philosophical than the other. 

You state that you are looking at outreach clinics as providing 

some of the primary care in rural areas. Is this similar to what 

HHS is doing and is there any overlap between what you are doing 

or trying to do and what HHS is currently doing? 

Dr. CROSS. I think there is a very important distinction on a couple of aspects of that. The outreach clinics that we have, like our 

CBOCs, are tied into our system. For instance, they are tied in by 

our electronic health record system. That promotes a level of safety, for instance, in prescribing that, you know, I think is different 

from the civilian community that uses paper prescriptions. 

The same screening criteria, and we are very proud of this, this 

is so important as was mentioned by one of the VSOs, that this is 

a unique thing that we must do for our veterans. So we screen 

them for PTSD. We screen them now for TBI, all of the OIF and 

OEF that we see. We screen them for alcoholism and so forth. 

We are focused on those issues. And it is hard to explain sometimes what that distinction is, but I think that distinction is very 

important. 

Mr. TUCKER. And my last one is more philosophical. As we are 

trying to address rural healthcare needs and trying to figure out 

the best mix of VA services and possibly other services and how to 

provide that care, how do you see the VA providing healthcare in 

the next decade or next two decades? Is it going to be based on the 

system that we have today with a VA medical center and a hub 

and spoke system with Community-Based Outpatient Clinics? Are 

we going to be looking at building more and more CommunityBased Outpatient Clinics in rural areas to provide primary care 

and other services or how is the VA approaching what healthcare 

will be like in the next decade or so? 

Dr. CROSS. Dr. Kussman just led a summit meeting where we 

looked at the future of VA healthcare as a group with our VISN 

Directors and Program Chiefs. VA healthcare is going to look very 

different in a lot of respects. We are going to become less institutionalized. 

The idea that the patient has to leave home to get medical care 

is not necessarily the way that we want to go. We think that much 

more can be done in the community and at home. Let me give you 

a couple of examples. 

Information, we have the My HealtheVet Web site so that they 

can get the information that is wholesome and reliable in their own 

home for those who have a computer and Internet access. We let 


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them refill their prescriptions sitting at their desk at home and 

just log in and take care of that. 

We will download their medical records to the individual electronically. So if by chance we do send them off somewhere, we do 

fee-basis care in the rural environment and other places, they can 

print off and take the relevant materials with them to that institution that does not have electronic records. 

I think that we are going to have less focus on grand, large, giant 

institutions and much more on meeting the needs in other ways. 

We are doing that with nursing homes, moving away from the 

standard model to a less restrictive model. We are doing homebased primary care where we send people out to visit in the home. 

We are spending $175 million on 2008 budget for home-based permanent care. 

I think that is the direction, and I think it will look different. I 

think it will be innovative and I think it will meet the needs of our 

patients actually better. 

Mr. MICHAUD. Just one last question. I know money is an issue 

and it will help. I am also concerned that we make sure that we 

provide adequate healthcare but in a manner that is cost-effective. 

And this just is a rough idea I am throwing out to get your 

thoughts. 

When you look at what we have for a system in State Veterans 

Homes, have you looked at trying to partner with the State Veterans Homes, for instance, if they have a Veterans Home to take 

care of our veterans long term but also saying, well, maybe that 

might be an area where the Veterans Home might be able to build 

a CBOC or a clinic and have a community, veterans’ community 

there by utilizing another entity as far as partnerships? Is that 

something that you are looking at? 

Dr. CROSS. I think we are very open to that idea. I think that 

is a good idea. I think we are actually doing that in some locations 

already where we have a little campus, not necessarily the traditional VA campus, but elsewhere where we put a number of services collocated, regional office, VBA services, and State Veterans 

Homes, those kind of things. 

A number of State Veterans Homes, I believe, and I am not sure 

of the number, are located actually on campuses with the VA. So 

that works in the other direction as well. 

Mr. MICHAUD. Okay. Great. Once again, I want to thank both 

you, Dr. Cross, and Mr. Hall, for your testimony as well as all the 

other previous panels, and look forward to working with you as we 

move forward in this Congress. Once again, thank you very much. 

With no further questions, the hearing is adjourned. 

[Whereupon, at 1:23 p.m., the Subcommittee was adjourned.] 


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A P P E N D I X 

Prepared Statement of Hon. Michael H. Michaud 

Chairman, Subcommittee on Health 

I would like to thank everyone for coming today. 

Today’s legislative hearing will be the first of many this Subcommittee plans on 

holding to provide Members of Congress, veterans, the VA and other interested parties with the opportunity to discuss legislation within the Subcommittee’s jurisdiction in a clear and orderly process. 

I don’t necessarily agree or disagree with the bills before us today, but I believe 

that this is an important process that will encourage frank discussions and new 

ideas. 

We have 11 bills before us and one discussion draft. 

The discussion draft represents some of my ideas to improve the quality of care 

available to our rural veterans and the ability to access that care such as: 

• Establishing mobile vet centers, improving information technology and technology sharing between VA and non-VA providers; 

• Establishing a Rural Veterans Advisory Committee; 

• Creating Centers of Excellence to encourage research and innovative healthcare 

to address the needs of rural veterans; and 

• Encourage more healthcare professionals to work in rural areas. 

I look forward to hearing the views of our witnesses on this discussion draft and 

the other bills before us. 

I also look forward to working with everyone here to improve the quality of care 

available to our veterans. 

f 

Prepared Statement of Hon. Jeff Miller 

Ranking Republican Member, Subcommittee on Health 

Thank you, Mr. Chairman. 

I appreciate your holding this legislative hearing today and welcome the opportunity to discuss the 12 different legislative proposals before us focusing on providing better healthcare access for veterans. 

There has been an unprecedented demand for the Department of Veterans Affairs 

(VA) healthcare. Since 2003, the number of patients VA is treating has grown from 

4.8 million to an expected 5.8 million in FY 2008. In 2008, VA anticipates treating 

263,000 Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) 

veterans, 25.8 percent more than the 2007 level. This surge in demand for healthcare is expected to continue and creates new challenges for VA’s capacity to deliver 

both primary and specialty care. 

Two of the bills we will consider today, H.R. 92, the Veterans Timely Access to 

Healthcare Act, and H.R. 339, the Veterans Outpatient Care Access Act of 2007, 

would require VA to contract for care for veterans who are unable to be seen in a 

VA facility in a timely manner. Since 2004, VA has reported a substantial improvement in the percent of veterans who receive appointments within 30 days of a patient’s desired date, stating they are meeting their established 30 day goal for 96 

percent of primary care and 94 percent of specialty care patients. However, statistics mean nothing to a veteran who is delayed care because they are placed on a 

waiting list. If VA cannot meet its own established standard for any veteran, that 

patient should be given the choice to receive care in a non-VA facility. 

Last week, this Subcommittee held a hearing on veterans’ access to care that 

highlighted our concern that veterans in rural areas face additional challenges to 

receiving healthcare as these areas are traditionally underserved. In the Pensacola 

area of Florida, in my district, the nearest inpatient VA facility is located approximately 125 miles away in Biloxi, Mississippi. 


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Several of the bills we will examine would specifically address the needs of veterans living in rural or geographically remote areas. One of the bills, H.R. 1527, the 

Rural Veterans Access to Care Act, introduced by our fellow Subcommittee Member, 

Jerry Moran, would allow a highly rural veteran enrolled in VA healthcare to receive services through a local provider if that veteran chooses to receive non-Department care. It would also allow VA pharmacies to fill prescriptions written by nonDepartment providers for these veterans. 

In March, this Subcommittee held a hearing to assess the rehabilitation needs 

and care of our injured servicemembers with Traumatic Brain Injury (TBI). These 

injured servicemembers and their families are relying on VA to provide a full continuum of first class care and support for their complete recovery—from inpatient 

services at the Polytrauma Rehabilitation Centers, to outpatient rehabilitation to 

long-term care services in their home communities. At this hearing we will consider 

H.R. 1944, the Veterans Traumatic Brain Injury Treatment Act of 2007. This bill 

would among other requirements, establish a comprehensive program of long-term 

care for post-acute TBI in four geographic regions. 

Additionally, we will discuss legislation to improve the provision of chiropractic 

care through VA medical centers. According to a November 2006 VA study, musculoskeletal ailments are among the top health problems of veterans returning from 

Iraq and Afghanistan. 

We will also consider H.R. 463, the Honor Our Commitment to Veterans Act. This 

legislation would change the law to require the Secretary of Veterans Affairs to administer the VA healthcare enrollment system as to enroll any eligible veteran who 

applies. The President’s Task Force to Improve Healthcare Delivery For Our Nation’s Veterans, in their 2003 Final Report, issued a recommendation that ‘‘The 

present uncertain access status and funding of Priority Group 8 veterans is unacceptable. Individual veterans have not known from year to year if they will be 

granted access to VA care. The President and Congress should work together to 

solve this problem.’’

In closing, I want to thank the Members who have brought these bills before us 

and all of our witnesses appearing here today. I look forward to engaging in a productive discussion about legislation that will help us provide the best care for our 

veterans, whether it is through contract care, or requiring more VA medical centers 

to provide chiropractic services. 

Thank you, Mr. Chairman, I yield back. 

f 

Prepared Statement of Hon. Steve Pearce, a Representative in Congress 

from the State of New Mexico 

I would like to thank Chairman Filner, Ranking Member Buyer, Subcommittee 

on Health Chairman Michaud and Ranking Member Miller for the opportunity to 

discuss this issue that is critical to the veterans of the State of New Mexico. Today 

I am calling on you and Members of the Veterans Affairs Committee to support my 

legislation, H.R. 315, the Help Establish Access to Local Timely Healthcare for Your 

(HEALTHY) Vets Act. 

In New Mexico’s rural communities, many of our veterans are deprived of accessible medical facilities and face the high cost of gasoline to travel and to obtain care. 

My legislation would require the Secretary of Veterans Affairs to contract with local 

doctors and hospitals on a case-by-case basis to provide medical services, including 

primary care, for those veterans who live far away from VA medical facilities. This 

would expand the ability of our local health providers in southern New Mexico to 

provide more convenient, efficient medical services for veterans who live in areas 

that are far away from established VA facilities. 

Currently, veterans residing in southeast New Mexico must drive between 400 

and 500 miles roundtrip to receive care at New Mexico’s only VA Hospital located 

in Albuquerque. I consistently hear stories from my constituents about the detrimental impact this long-distance drive has on their ability to access timely care and 

overall health. One Marine veteran amputee began having uncontrollable drainage 

from his ‘‘good’’ foot and was making 2 to 3 trips a week to the Albuquerque VA 

hospital. This equates to 18 hours of drive time a week. After 4 months, he finally 

lost his foot. Several local civilian healthcare experts feel the unfortunate travel 

‘‘marathon’’ contributed to the failure to save his foot. 

Another 87-year-old Bataan veteran developed a serious bladder infection and was 

directed to make the 6 hour roundtrip drive along with his 85-year-old wife. Halfway through his treatments prostate cancer was found and additional trips had to 

be made for chemotherapy. After 7 months of trips, he died and his wife’s health 

was seriously damaged after the strain of such long-distance care. 


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Today, I know you will hear from several National Veterans Service Organizations 

who may not support my bill and others under consideration today. That is because 

many of these groups have committed themselves to the goal of ‘‘keeping VA dollars 

inside the VA.’’ I understand this concept and believe at first glance it sounds like 

a commonsense approach to VA budgeting. But following this logic, the only way 

to get more localized access to care for veterans in my district would be to build 

new facilities in areas closer to their homes. 

I believe there is a need for a full-service Veterans Health Center in southern 

New Mexico and would love to see that come to fruition. However, I am a realistic 

man as are the veterans living in rural New Mexico. With the tight budgetary constraints our Nation faces, and the smaller population in States like New Mexico, 

that idea is much easier said than done. This is a reality veterans living in rural 

areas have been forced to accept. 

Since that solution is not realistic at this time, we must work to find other solutions to this problem that is hurting our veterans with every 6–8 hour roundtrip 

journey to the hospital. Unfortunately, the idea of expanded contracting authority 

raises flags with certain Veterans Service Organizations that see it as a step toward 

privatization. They characterize this as the Federal Government brushing aside its 

commitment to care for the men and women who have served our Country. 

Well I will tell you that the Federal Government and the VA are not adequately 

living up to their commitment and serving my constituents under the current system. John Taylor, a life member of the Military Order of the Purple Heart and life 

member of the Disabled American Veterans, lives in Roswell, NM which is approximately 200 miles away from Albuquerque. In a letter John wrote to me: 

‘‘Rural veterans in New Mexico are dying and losing body parts because 

of a 6 hour, roundtrip drive to the nearest VA hospital in this State. . . . 

Our VSO legislative representatives from the DAV, etc. have no experience 

or live in contact with this issue, as they are from large urban areas with 

massive facilities and infrastructure for support. The classic response to invitations requesting visits to our rural areas has historically been, ‘we’ll try, 

but it takes time to get out there, and we have a very busy schedule.’ I submit the same time that is an inconvenience to executives is the same time 

killing my fellow veterans or at the very least, causing serious exacerbation 

of their medical problems.’’

U.S. Army Retired LTC Charlie Revie, a member of the Uniformed Services Disabled Retirees, noted that the drive from Las Cruces to our only major VA facility 

is a 250 mile one way trip—from Hobbs, the distance is 320 miles. 

The notion that providing contracted care to veterans through local doctors at 

non-VA facilities is somehow a way to finagle out of caring for them is absurd. 

Under my legislation, the VA will clearly still pay for the care veterans obtain at 

non-VA facilities. Veterans in my district and across rural America have been hearing politicians talk about increasing access for years. It is simply imperative Congress take these issues seriously this year. 

After the reports regarding conditions at Walter Reed Army Medical Center, the 

House passed the Wounded Warrior Assistance Act, which takes steps to shed light 

on the bureaucratic process that plagues the VA. It improves communications 

amongst DoD, VA and Congress and strengthens the process for returning soldiers 

transitioning into the VA healthcare system. All these measures are extremely important and I hope the Senate works to pass similar legislation. But we must not 

just be a reactionary Congress that only finds time to fix issues in light of displeasing media reports. Without any changes to allow veterans more localized access 

to care, many soldiers returning from Iraq and Afghanistan who return home to 

their families in southern New Mexico will face the extensive 400+ mile trek to the 

VA medical center in Albuquerque. 

I appreciate the opportunity to present my legislation to the Committee and speak 

on this issue which deserves the attention of Congress. Our veterans in rural America deserve no less. 

f 

Prepared Statement of Hon. Ginny Brown-Waite, a Representative in 

Congress from the State of Florida 

Thank you for allowing me to appear before the Subcommittee today. 

I appreciate the opportunity to testify on my legislation, H.R. 92, the Veterans 

Timely Access to Healthcare Act. 

When I first came to Congress in 2003, I introduced this measure after hearing 

of the long wait times facing some veterans in need of healthcare at the VA. FrankVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00051 Fmt 6604 Sfmt 6621 E:\HR\OC\35636.XXX 35636

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ly, the stories many of us have heard about these delays are unacceptable. These 

holdups can worsen the veteran’s health and impose a greater financial hardship 

on everyone involved. In some situations, these wait times can be the difference between life and death. 

Events in Iraq and Afghanistan also remind us of the urgent matter at hand. 

With thousands of soldiers returning from the front lines, many of whom will require immediate healthcare, VA medical facilities face a difficult task. Unless Congress takes action, wait times will only continue to grow. 

My legislation would help ensure that our Nation’s veterans receive timely healthcare. For veterans seeking primary care from the VA, my bill would establish a 30- 

day timeframe as the standard for access to medical services. This standard would 

cover from the time an individual schedules a visit until they actually see a medical 

provider. In the event this standard is unachievable, the VA would have authorization to contract for care from a private provider. At the same time, my bill also 

grants the VA some flexibility in meeting this standard. For those facilities in geographic areas that have a 90 percent or greater rate of complying with this requirement, the contracting provisions would not be necessary. Finally, this legislation 

would establish comprehensive reporting requirements on wait times for individuals 

seeking care at VA medical facilities. 

As Members of Congress, we have an extraordinary responsibility to veterans. 

These brave men and women answered the call in our time of need; it is only fitting 

that we take care of them in their own. I look forward to working with my colleagues on the critical issue of wait times. I would be happy to take any questions 

regarding my legislation. 

Thank you. 

f 

Prepared Statement of Hon. Solomon Ortiz, a Representative in Congress 

from the State of Texas 

Mr. Chairman, thank you for this opportunity to speak on behalf of south Texas 

veterans and help this Subcommittee understand the urgent need for a veterans’

hospital for the men and women who fought for us. 

Here with me today are members of the Veterans Alliance of the Rio Grande Valley—so you can see the faces of the south Texans affected by the lack of a hospital 

. . . the Rio Grande Valley is the southernmost tip of my district. 

Here with me are: Jose Maria Vasquez, Ruben Cordoba, and Max Balamaris, Polo 

Uresti, Frank Albiar, and Mr. Felix Rodriguez. 

My legislation gives the government flexibility in establishing a way to deal with 

hospital services in south Texas . . . but the only real solution for the area is a hospital. 

Bottom line: veterans’ inpatient healthcare must be available where the veterans 

live, not several hours away. 

These guys have fought, bled and sacrificed for this Nation—they need something 

that belongs to them . . . a hospital that get’s them the care they need where they 

live—not 5 hours away. 

We know the VA plays the numbers game—but the numbers do not reflect the 

need . . . particularly in the Rio Grande Valley. 

When the VA commissioned their CARES study they recognized the far south 

Texas area was in need of acute inpatient care. 

They decided to meet this demand through contracting or leasing beds in local 

communities, an approach simply not working. 

Veterans are still traveling in large numbers to Audie Murphy in San Antonio for 

care, and for many who are treated for emergencies at area hospitals, the bills go 

unpaid by VA. 

Many veterans are so disgusted by the level of VA health services, they simply 

do not sign up for VA healthcare. 

You have heard me describe the conditions of south Texas vets; today I want to 

show you experiences of veterans themselves . . . veterans who shed blood for our 

Nation . . . veterans whose healthcare is utterly inferior. 

South Texas veterans regularly travel 5 hours there and back to a 15 minute appointment that took months to get. 

Sometimes they need to stay overnight in San Antonio . . . sometimes, veterans 

find after the strenuous trip, their appointment has been canceled. 

We’ve scrubbed the names to prevent any retaliation for truth telling. . . . And 

my time will run out before I’m done, but I want you to hear the stories I hear. 

. . . 

A 21-year-old Iraq war veteran came home badly wounded in his spine. 


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He’s now at Audie Murphy in San Antonio. 

He was being moved by hospital staff from the bed to a wheelchair—but they 

moved too quickly and damaged his spine even more. 

He has a lifetime of going back and forth to San Antonio for treatment . . . and 

his family has a lifetime of committing to take him there regularly. 

One veteran underwent emergency heart surgery; his wife called the local clinic 

and she was directed to call 911; he was admitted for the emergency surgery locally. 

His benefits coordinator told him to follow up with a local cardiologist to chart 

his progress since there wasn’t a cardiologist at the clinic. 

He did, but VA did not pay and on the 3rd visit, the cardiologist’s office told him 

to pay upfront for all services. 

The VA clinic then told him he should have gone to a cardiologist in San Antonio. 

By now, his sutures were infected and leaking. 

Eventually, he got an appointment to see a VA cardiologist 5 weeks later. 

The stress from all this prompted his psychiatrist to increase the dosage on his 

meds. 

When he got to San Antonio, the cardiologist was surprised to learn he had surgery. 

He was prescribed more high blood pressure medication. 

That made him faint from low blood pressure, panicking his wife . . . she called 

a home health nurse who suggested stopping all meds and going immediately to the 

hospital. 

He did not want to go to the hospital because they had not been paid and he 

might be refused. 

He was poor—so the nurse recommended that he drink a Coca-Cola with crackers, 

which helped temporarily. 

Due to a faulty medical records system, he was prescribed too much medication. 

Since then, he travels to San Antonio to monitor his heart. 

He travels 5 hours, has a 10 minute procedure done, and once was told to return 

in 48 hours. 

He did not qualify for lodging so he returned to the Valley. After 2 days he returned for a procedure that took under 5 minutes. 

That equals 2 trips to San Antonio in 2 days . . . traveling about 25 hours . . . 

to be seen a total of 15 minutes. 

A retired disabled veteran is in the midst of several surgeries to correct service 

injuries, in numerous visits to San Antonio, the nearest VA hospital to the Valley. 

When he had shoulder surgery, he spent the night in his car so the anesthesia 

could wear off . . . and he didn’t take any pain medication so he could make the 

4 hour drive back home. . . . 

He had to stop several times along the way to vomit from the pain. 

He also had to sleep once in his car in San Antonio to make an early appointment 

because by the time he arrived in San Antonio all the rooms available for veterans 

had been taken. 

A constituent’s brother had a triple bypass done in San Antonio Audie Murphy 

Veterans Hospital in 2005. 

During the course of his recovery at home, he developed complications that needed to be monitored closely. 

The VA medical provider told him that he needed to be monitored closely; then 

later that day, he got a call from the VA clinic that he needed to go to the nearest 

hospital taking veterans. 

Once there, he was moved by ambulance to another area hospital, where he was 

admitted after advising the hospital he was a veteran and showing his ID card. 

The hospital got the clearance from San Antonio VA and admitted him. 

His medical bills there have not been paid because the VA is claiming that ‘‘VA 

facilities were feasibly available to provide the care.’’

The VA said his brother could have traveled to San Antonio under the dangerous 

medical problems he was having. 

His brother does not want to ‘‘rock the boat’’ because of his heart condition and 

other medical problems. 

In a sense, he is held hostage by our government. 


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A family member said this: Congress should also hear about the hardship that 

the vet’s family must also endure. 

She has a full-time job but must miss work, taking leave, to take a loved one to 

San Antonio. 

She cannot let him go by himself whenever they do procedures that require anesthesia or manipulation of his neck or spine. 

He is usually in so much pain and/or drowsy with medication that he cannot 

drive. 

He has a hard time sitting for long periods, and San Antonio is 5 hours away. 

They must also make arrangements for the kids if they are not getting back before school’s out. 

A couple of times he’s had to go alone because she couldn’t leave work or find another driver. 

Then she is so worried about him driving that she cannot function at work, going 

out several times to call to make sure he is OK. 

She also notes the travel pay is woefully insufficient, given gas prices. 

They have to fill up twice to get there and back, plus pay for meals. 

She notes that hospitalized vets would be better off near friends and family to 

keep them in good spirits. 

A Vietnam vet still being treated for post-traumatic stress disorder; has two sons, 

both active-duty military, who have served multiple tours in Iraq. 

After a late-night phone call from a son saying that he’d been hurt in an IED explosion, his post-traumatic stress surfaced . . . when he called to see the psychiatrist, he was told the soonest appointment was in 6 months. 

The district director for the Veterans of Foreign Wars in the Valley says VA provides good medical care. 

The doctors and staff do the best they can with what they have. 

The problem is getting into the system to get the care. 

He says, ‘‘We believe we’ve earned the right to see a doctor where we live.’’

Veteran and State Rep. Aaron Pen ̃ a says what isn’t spoken is the sense that they 

are being ignored despite the long history of Hispanics’ service to the U.S. military. 

We’ve fought in almost every American war . . . and we’re still being ignored. 

The disabilities of a Port Isabel veteran who served two tours in Vietnam are 

made worse by a round trip on a crowded van, and an overnight stay in a dirty 

hotel. 

Fourteen months ago he went to a private emergency room, which then sent him 

by ambulance to San Antonio to treat a kidney infection. 

VA still has not paid for the emergency visit—ironically today, April 26, is his 

deadline to pay the local hospital $10,000 since VA won’t pay. 

An Iraq veteran is haunted by some of the terrible things he saw in combat leading to depression and thoughts of suicide. 

His friend got him to go to the VA office . . . where he was referred to the VA 

hospital in Waco for evaluation for post-traumatic stress. 

He was told he needed to begin regular sessions, and he’d get an appointment in 

the mail. 

Three weeks later, he got a letter from VA that he could see the doctor in 8 

months. 

Another veteran notes: ‘‘It’s hard to hold a job when you have to miss work four 

or five times a month to travel to San Antonio for medical appointments.’’

One veteran has utilized the VA healthcare systems in Reno, Nevada and Fargo, 

North Dakota, and he reports both were very good. 

Conversely, his experience with the clinics in Harlingen and McAllen are ‘‘ongoing 

nightmares.’’

Lately he’s been trying to get an appointment with the psychiatrist in Harlingen. 


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Every time he calls, he’s put on hold and eventually hangs up after waiting and 

waiting. 

He was not alone among veterans who suspect some manner of ‘‘Federal racism’’ when our Nation is only anxious to send border patrol agents, but no hospital to 

treat military veterans who live here. 

A daughter who misses her dad says her father served in the U.S. Army and came 

home needing psychological care catered to what a veteran experiences—and taking 

into consideration the stigma a Hispanic man feels with depression. 

She lost her father to suicide and wishes that care was available. 

Another veteran learned the VA now accepted that Agent Orange could have affected sailors in the Tonkin Gulf. 

The VA did not respond to him since he was not a ‘‘wounded veteran.’’ He also has diabetes for which they will not treat him. 

He believes they want to wait until he cannot care for himself at all rather than 

helping him prevent the devastation of diabetes while he can. 

A former military wife said her ex-husband and daughter now live in San Antonio 

and her son has plans of retiring there too—merely to be closer to military medical 

facilities. 

Veterans are forced to choose between living near home and family, or living near 

healthcare. 

Another veteran notes many soldiers from the Valley can not afford the trip, much 

less the expense it takes to visit these facilities. 

He notes many veterans have died never getting the medical attention they needed. 

He calls the VA health system in south Texas a ‘‘disastrous situation.’’

A former sergeant says: The cruel irony of extra stress on various disabilities 

caused by traveling 5 hours to a VA hospital makes conditions even worse. 

And like several others I heard from, he issued an invitation for any of my colleagues here today to join them on the 5 hour ride to San Antonio in the van. 

A retired major notes local access would promote early diagnosis and early cure 

for ailments that would otherwise generate higher treatment costs if left untreated. 

He also has the novel suggestion of using hospital ships as a veteran’s hospital. 

A retired Air Force sergeant—who is covered by TRICARE benefits—knows he is 

lucky to have access to local medical facilities. 

Always a soldier, he volunteered to drive the van to San Antonio. 

He would drive from Raymondville to Brownsville to pick up veterans at 6 a.m. 

then to San Benito then Harlingen and then back to Raymondville, where the actual 

trip to San Antonio commenced. 

He reiterated what many people said: It’s not a straight 51⁄2 hour trip since they 

had to stop various times for restroom breaks. 

And he was prohibited from helping the vets in and out of the van out of liability 

concerns. 

Most veterans he drove had to wait hours to be seen for just a 15 minute visit, 

then they began the long trek back. 

The widow of a Vietnam-era vet said he died 9 years ago of a heart attack and 

almost certainly from a lung problem associated with his exposure to Agent Orange. 

He never pursued a diagnosis because the San Antonio facility was too far and 

he was not able to make the trip. 

The one time he did for hearing loss from a mortar concussion while in Vietnam, 

he found that the number of people they were trying to serve was too great for quality care. 

He never went back again. 


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A captain with the 1st Cavalry in Iraq was wounded in 2003 by an IED that ruptured both ear drums and left his right side littered with pieces of shrapnel, many 

still remain. 

He plans to retire in the next 4 years. 

He said he’s gotten good treatment while on active duty, but worries about the 

time when he retires, with no local VA hospital in the area. 

He talks regularly with local veterans that can not afford to make the drive to 

San Antonio because they can’t afford the gas or can’t drive or have no one to take 

them. 

Another veteran echoes many voices in saying south Texas veterans should be 

treated by local medical resources. 

He lives in Corpus Christi, but worries about what the cost of transportation does 

to an aging veteran’s population with higher poverty rates in the Rio Grande Valley. 

Extended trips place unnecessary physical stress on veterans, it places a financial 

burden on Valley veterans and their families as well. 

He sustained a head injury, which resulted in a visible dent in the skull. 

After headaches and memory issues, the VA physician sent him to Audie Murphy 

for a CT scan; and he had no option but to drive the 300 mile round trip to the 

VA facility. 

That trip not only put him at risk, but the safety of other drivers as well. 

Another veteran invites all of us to come experience the long and painful ride 

from south Texas to San Antonio to visit a doctor. 

A south Texan speaks on behalf of friends married to veterans; she is incensed 

that for healthcare they must be inconvenienced financially (gas, food, overnight 

stays for vets and families) and time-wise, which interferes with their jobs. 

The brother of a constituent is medically retired from the Air Force and must 

travel to San Antonio every month for his medical treatments. 

It takes a day out of his life and requires a long ride back and forth. 

Another retired veteran chooses the expense of private care over the time it takes 

waiting at the local clinic or taking the time to travel to San Antonio. 

Another veteran also speaks to the trouble and time consuming nature of going 

so far for procedures. 

He knows that by the time you arrive your problems just seem to increase. 

A Corpus Christi veteran laid out the context of getting treatment in San Antonio: 

She said it is a 12 hour ordeal to get to San Antonio, get tended to at Audie Murphy, and return home. 

It costs two tanks of gas and a whole day of work. The $26.00 for travel does not 

cover nearly the cost. 

Placido Salazar, State Veterans’ Affairs Officer of The American GI Forum of 

Texas, tells me that some veterans from the Valley were recently in San Antonio 

for 3 days of appointments; they told him that a manager at the associated hotel 

would not release a room to them until 6:00 p.m., (using very abusive language); 

with one of the veterans not getting a meal in more than 24 hours. 

[PETITIONS SUBMITTED BY REPRESENTATIVE ORTIZ ARE BEING RETAINED IN THE PERMANENT COMMITTEE HEARING FILES AND ARE NOT 

BEING PRINTED.] 


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ADDENDA—LETTERS AND STORIES OF SOUTH TEXAS VETERANS 

Last week, some veterans from the Valley that were in San Antonio for 3 days 

of appointments at Audie Murphy called me to inform me that one of the managers 

at the Oak Hill Hotel on Wurzbach Road had given them a hard time, in not releasing a room to them until 6:00 p.m., (using very abusive language) with one of the 

veterans not getting a meal in more than 24 hours. 

THAT is totally unacceptable, but I believe we got the situation corrected. If anybody else should have trouble at that hotel or any other type of problem, I will be 

glad to try to assist. Just call me, any day—any time (210) 658–9756. 

Placido Salazar 

State Veterans’ Affairs Officer of The American GI Forum of Texas (210) 658–9756 


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My father served in the U.S. Army and came home to marry the girl next door, 

raise a family consisting of four kids, but never truly felt at peace because he suffered from what he was exposed to while he was in the Army. 

He needed psychological care catered to what a veteran experiences taking into 

consideration the stigma a Hispanic man must deal with for feeling depressed. 

He ended up committing suicide years later leaving us all behind to miss him 

dearly. Please build a complete veterans hospital in the Valley, our veterans deserve 

and need it. 

Thank you, Army Veterans Daughter 

I am a veteran here in south Texas and would be willing to go to Washington 

next week, in order to prepare the Congressman for his testimony. 

I live on a fixed income but will drive if I have to be there. 

I am sure I can get at least two other vets from here to go with me. Please call 

me ASAP to speak of this. 

Thanks, Lydia 

Congressman Ortiz, 

It is with great pleasure and honor that I congratulate you for your efforts to 

bring a veterans hospital to south Texas. While south Texas is one of the homes 

of many heroes who have given their lives in foreign wars for the sake of freedom 

in America, south Texas remains one of the poorest areas in the Nation where veterans have difficulties finding jobs and medical care. As a Navy veteran of the Vietnam War, I served on a destroyer for several months in the Tonkin Gulf and also 

on an expedition to the Sea of Japan during the USS Pueblo incident where the 

North Koreans boarded one of our ships and took our men prisoners. 

At some point in my life I became diabetic while no one in my immediate family 

(father, mother, or grandparents), were diabetic. For 10 years I have addressed diabetes on my own. One day a Vietnam vet friend told me that I could have been affected by Agent Orange even though I was aboard a destroyer and that the VA was 

now accepting that Agent Orange could have affected sailors in the Tonkin Gulf. I 

reported to the VA clinic in Corpus Christi and basically they did not respond to 

my request for nothing more than diabetic medication which is extremely expensive. 

I am one of those individuals that will address health issues with or without VA 

assistance. However, my DD 214 clearly states that I served in the Tonkin Gulf and 

shows my veterans status, but somehow no one seemed to know what I was talking 

about when I visited the VA clinic in Corpus Christi. They told me they needed 

more documentation and that I was not a wounded veteran. Nevertheless, I was not 

looking for any kind of monetary compensation, but rather for help with medication 

for my diabetes only. 

The thought occurred to me that one day I will probably need assistance from the 

VA hospital in San Antonio, but will not get it because I am not a wounded veteran, 

but have been afflicted with diabetes that may have occurred in the Tonkin Gulf. 

The VA made available benefits for veterans of the Tonkin Gulf, but no one at the 

VA clinic seems to know that. 

While I have assisted many veterans by taking them for medical service at Audie 

Murphy, many were not wounded veterans. I suppose that they want to wait until 

I am unable to care for myself entirely to provide service, if any, instead of helping 

me now prevent the devastation of diabetes while I can. I have seen many veterans 

struggle with transportation to San Antonio for service and as you well know I provided services for many senior citizens from Kleberg for many years that needed to 

go to Audie Murphy. Now I am one of them and a veteran who volunteered during 

the Vietnam War. 

I know that many vets struggle getting to San Antonio from the coastal bend to 

receive services. A hospital closer to us would be appreciated by all veterans and 

in fact every region across America should have one more so we need to spend 

money on expanding economic efforts rather than basically serving special interests 

like oil and uranium mining. I for one am disappointed with the reception I received 

at the Corpus Christi VA and surely I am not going to beg for their attention to 

my need and get kicked in the face every time I ask. 

Hopefully, you will be successful in your bid for a VA hospital for veterans that 

is long overdue and maybe a revamping of existing VA clinics and services so that 

vets like myself who need assistance are not turned down because someone there 

does not understand what being aboard a destroyer in the Tonkin Gulf means. 


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I remain your friend and supporter of many years, 

Ben Figueroa, BA, MA, LCDC, CPS, CPM 

Dear Congressman Ortiz, 

Thank you so very much in you support of our veterans and their welfare. Though 

I am not a veteran, my daughter, son and ex-husband are veterans along with other 

family members. 

I feel that a veteran’s hospital is greatly needed in the Valley. My ex-husband 

along with my daughter are now living in San Antonio and my son has plans of 

retiring there too. Why? You guessed it. . . . Military medical facilities. 

My ex-husband was diagnosed with cancer along with other Vietnam medical 

issues and has had to leave his immediate family and move to San Antonio in order 

to be closer to medical assistance. 

Thank you so much, again, for taking on this task. My prayers are with you. 

Sincerely, 

Beatrice Weaver 

To whom it may concern: 

My name is Jim Hodges, Jr., a Vietnam veteran from Brownsville, Texas. I am 

the proud Past-Commander of America’s Last Patrol Inc., Post 2. I am also the son 

and nephew of a couple WWII veterans. I am also involved in trying to get a veterans hospital in the Rio Grande Valley. 

My relatives served in WWII, Korea, Vietnam and every conflict our wonderful 

country has ever been involved in. They have had and have an extremely hard time 

getting the medical attention that they earned. Many of my relatives and friends 

can not go to the VA hospitals in Houston, San Antonio and/or Fort Bliss. Most of 

these soldiers are ‘‘POOR’’ and can not afford the trip much less the expense it takes 

to visit these facilities. 

Many have past away never getting the medical attention they needed. I am 

blessed that I can go to the VA here in the Houston area where I live. BUT, there 

are many in this area who can not. 

That is why there is a ‘‘shuttle’’ to help those veterans who can not afford it and/ 

or are not able to drive. How can we expect our veterans to make that 300 to 500 

mile trip to a veterans hospital? Thank you for your help and attention to this ‘‘disastrous situation.’’

In service to our country, 

Mr. Jim Hodges, Jr. 

832–228–2758 

To whom it may concern! 

My problem with VA healthcare is the extra stress on our disabilities caused by 

traveling 5 hours to a VA hospital. That is one way only. Also, 24/7 medical care 

that is needed by service-connected veterans. Let the Veterans’ Affairs Committee 

come to the Rio Grande Valley and travel to VA on a van? 

Sgt. James Krummel 

April 21, 2007 

Congressman Solomon Ortiz 

3649 Leopard Street 

Corpus Christi, Texas 7841 

Subject: VA Hospital in South Texas 

Dear Congressman Ortiz: 

It is most encouraging to hear of your fight to provide the veterans of south Texas 

with a VA hospital. Please allow me to offer some suggestions that may help. 

Among the most salient reasons for locating such a facility in this area are the following points: 

1. Local access would enhance participation by some veterans who are discouraged by the travel distance to out-of-town VA facilities. This in turn would proVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00059 Fmt 6604 Sfmt 6621 E:\HR\OC\35636.XXX 35636

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mote early diagnosis and early cure for ailments that would otherwise generate 

higher treatment costs if left untreated. Equally, it would also benefit those 

who are too seriously ill to tolerate the commuting stress. All of this would lead 

to more efficient expenditure of VA healthcare dollars. 

2. With the Port of Corpus Christi’s expanded terminal now able to handle large 

volume military hardware shipping, it lends itself to accept hospital ships that 

have become a major factor in saving military lives. At a time when America’s 

freedoms are challenged in all parts of the globe, the ability to have a hospital 

facility that could accept large numbers of military patients from a waterborne 

hospital vehicle, would be strategically and economically prudent. It makes little sense to dock such a vehicle in outer ports and then air-transport the patients to inland hospitals. Corpus Christi could service all of that need in one 

location, and could easily provide contingency plans for expansion in national 

emergencies. Also, the government could save by incorporating the ancillary 

services such as lab, X-ray, and pharmacy, in a location that could handle both 

active and retired military personnel. This would provide economy of scale in 

areas of high cost medical technology, which is a primary reason for escalating 

health costs. 

3. A large VA hospital facility would help mend the region’s physician shortage. 

Logically, some VA physicians serving the region would elect to remain here 

in private practice. This would provide relief in Medicare services, such as 

rheumatology (among other specialties), that are heavily skewed to a narrow 

panel of physicians who accept and treat Medicare patients in this region. 

Again, this would deliver Medicare budget economies by early diagnosis and 

treatment. 

The above three points are only a sample of the issues that stress a need for a 

VA hospital in this region. I truly hope you are successful in your effort. If I can 

be of further assistance, please do not hesitate to call upon me. I can be reached 

at 361–993–6905. 

With best personal regards, 

John D. Falcon 

Major, USA (Ret.) 

Dear Congressman Ortiz, 

I myself a veteran retired of 20 years serving in the U.S. Air Force do not need 

to travel the long distance being I have TRICARE benefits to visit local medical facilities. I was a volunteer driver for 8 months and at one time I drove twice a week 

for 2 months being there wasn’t other drivers. The trip was to leave on Sunday and 

return on Monday. The other to leave on Wednesday and return on Thursday. 

I would drive from Raymondville to Brownsville, Texas to pick up veterans early 

in the morning, 6 a.m., to return to San Benito then Harlingen and then back to 

Raymondville. After picking up the remaining vets at Raymondville we started the 

longer trip to the VA hospital in San Antonio, TX. 

The trip was not a straight 51⁄2 hours, we had to stop various times due to some 

of the vets needing to use the restrooms due to medical problems such as prostate 

illnesses and others needing to stretch out, as you know or can visualize a WWII 

veteran sitting on such a long trip and of course also climbing on and off a 15 passenger van. We as driver were not, repeat not, able to help him on or off the van 

due to liability. The veterans had to be ambulatory. 

Upon arrival, the veterans would be dropped off at the entrance and from then 

on they were on their own, able to walk on their own or not he or she needed to 

walk to report to their appointment for the same day or the next. Most of the veterans had to wait hours to be seen for just a 15 minute visit and be released for 

the rest of the day and wait to return on the 51⁄2 hour trip. 

Before departing back to the Valley, Raymondville, Harlingen, San Benito and 

Brownsville, the veterans needed to be located from wherever their appointment 

was at, which wasn’t very simple due to the other ‘‘many’’ veterans who had similar 

appointments. 

Yours truly, 

Tsgt. Rafel M. Cisneros III 

U.S. Air Force, Retired 


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My name is CPT Martin Albert Longoria and I am currently serving with the 1st 

Cavalry Division which is in Iraq. 

I was wounded in November 2003 by an IED that ruptured both of my ear drums 

and left the right side of my body littered with pieces of shrapnel that are affecting 

me today. I have pieces that are in my hands which I am having trouble with as 

we speak to include my calf and thigh. 

The pieces that were left in me for the last 3 years are working their way out 

and some have already been removed. In the next 4 years I plan on retiring, but 

I will still have pieces of shrapnel that will eventually work their way out too. While 

being on active duty I have received good treatment. When a piece of shrapnel needs 

to be removed it is. 

However, the day will come when I retire and having a local VA hospital in the 

area would make a difference to those that are not as financially stable as others. 

I have talked with local veterans that can not afford to make the drive to San Antonio because they can’t afford the gas and can’t drive for some health reason or have 

no one to take them. 

We as local veterans have served our country when called upon to PROTECT IT 

and DEFEND IT no matter what and some have died doing it. I have served with 

many local soldiers from the south Texas area in war and peace, but who is going 

to take care of this generation of veterans. We as a country seem to make the same 

mistakes from past conflicts in not providing adequate healthcare for our past veterans. When its budget time you will not hesitate to give yourself a raise, but when it 

comes to us the veteran it seems we are put on the back burner for political jargon. 

I hope what I have expressed helps with this cause that is taking place and I hope 

it helps the veterans that have served as proudly as I have. Please remember this 

when you are sitting at home or in your office. We have served being away from 

loved ones and doing what is asked of us. 

Thank you for the opportunity to provide comments on the availability of vet- erans’ healthcare in south Texas. It is common knowledge to everyone in the region 

that south Texas veterans’ are underserved as far as veterans’ healthcare is concerned. 

The problem didn’t occur overnight and has been a gradual process. No blame is 

being assessed. The time has come, however, to rectify the problem for both current 

and future veterans. 

The south Texas veteran population is spread over a large area with many veterans living in rural environments. Many south Texas counties have no significant 

metro type area and consequently are limited in any medical resources, much less 

those for the veteran populations. 

This particular concern could be addressed in Congressman Ortiz’s bill which in 

part provides south Texas veterans be treated by local medical resources. That 

would insure that every veteran would have access to appropriate medical care in 

a timely manner. Often, it can take months for a veteran to get scheduled for what 

would otherwise be a routine medical visit. That needs to be changed. 

The Veterans’ Health Administration (VHA) is well known for its quality care especially preventive medicine. In some cases veterans have to go to extraordinary 

lengths to receive the preventative care. First hand experience may illustrate some 

of these inequities. 

This veteran suffers from Chronic Obstructive Pulmonary Disease (COPD). It’s a 

progressive lung disease with no known cure. Competent medical practices contend 

a COPD patient take a pulmonary function test (PFT) twice a year or at a minimum 

of once a year. A complete PFT takes around 45 minutes. 

COPD is typically diagnosed in patients at around middle age thereby suggesting 

that the COPD population is older than the rest of the veteran population. The pulmonary function lab at Audie L. Murphy Memorial Veterans Hospital in San Antonio, Texas is the only PFT resource available to south Texas veterans enrolled in 

the VHA system. There are, however, facilities in Corpus Christi as well as in the 

Rio Grande Valley where the test can be taken. 

The round trip for this writer is about 300 miles or maybe a bit more than 5 

hours driving time. Therefore, it takes nearly 6 hours to get the test. Of those 6 

hours, more than 5 are driving time. For older patients that becomes a real issue. 

For veterans in the Rio Grande Valley, the distance and drive time is slightly 

more than doubled. That would mean a veteran and probably a veteran getting up 

in years would be required to drive 10 or 11 hours for a 45-minute test. That is 

problematic and raises a legitimate issue about the burden and travel stresses on 

an older veteran with a disease, which will probably end his or her life. 


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Another issue is the cost of transportation be it by private accommodation or some 

commercial means. The Valley has an aging veterans population according to the 

last census data. It also has higher poverty rates. In addition to an extended trip 

placing unnecessary physical stresses on veterans, it places a financial burden on 

Valley veterans and their families as well. That needs to be remedied. 

There are other routine procedures, which necessitate a trip to Audie Murphy. 

This veteran had sustained a head injury, which resulted in a visible dent in the 

skull. After discussing ongoing headaches and memory issues, the VA physician said 

a skull series or CT scan was necessary. 

That routine procedure necessitated a trip to Audie Murphy. The veteran had no 

option but to drive the 300 mile round trip to the VA facility. The safety of that 

endeavor is questionable at best. Not only was the veteran put at risk, but the safety of other drivers as well. 

There was about a 10-minute wait for the X-ray procedure and the scan itself took 

6 or 7 minutes. A cup of coffee left in the car was still hot for the return drive home. 

Out of 5 hours and 15 minutes for the CT scan, 5 hours was driving. The same imaging could have been done locally or in the Valley. 

It was later learned that the injury triggered two strokes as well as a bifrontal 

hygroma. The hygroma is dead brain tissue that has filled with fluid. The wisdom 

of having a patient make that kind of drive is indeed questionable. Consider the patient, made maybe more frail making that trip from Brownsville, Texas. An argument could be made that such a trip would simply be reckless. 

One other trip to Audie Murphy is especially haunting. This veteran needed to 

go to the cardiac lab in San Antonio for a thallium stress test. That’s a routine procedure for evaluation of the heart. The procedure was scheduled for morning. 

In order to make the appointment, it was necessary to leave Corpus Christi before 

daylight. It was soon learned that the veteran’s night vision had deteriorated to the 

point of making the trip dangerous. That is now a new concern for Valley veterans. 

The thallium stress test is available nearly everywhere and in most communities 

with a hospital. 

The test itself is a simple procedure with an 8-minute protocol on a treadmill. At 

the end of the treadmill a nuclear dye is injected. Next, the patient waits for a period of time measured in hours for the dye to circulate. Then multiple images of the 

heart are taken. 

While waiting for the imaging in the lobby of Audie Murphy, an elderly man was 

encountered. We visited for a while. He said that he caught a ride in a VA van in 

Cameron County, Texas. He continued that he got on the van way before daybreak 

for the ride to San Antonio. 

Although the purpose of his visit is not recalled, he said only 15 to 20 minutes 

of his time was needed at the hospital. Then he had to wait hours until 3:00 p.m. 

to catch the van back to Cameron County. He said it would probably be dark when 

he got back. 

He was clearly tired. He had family in Corpus Christi. We talked about his staying with them and then going back to Cameron County the day after. We called his 

family who thought that it was a great idea. He rode to Corpus Christi with this 

veteran. 

Ever since, there has been a concern about other Valley residents who have had 

to endure the same travel stresses. That man should have never been put into that 

position. Whatever services he needed should have been obtainable in or near Cameron County. 

While having to make a trip to Audie L. Murphy may be an inconvenience to this 

veteran, to Valley veterans it is a more serious matter. First the trip is onerous, 

especially on the older or frailer veterans. Secondly, the cost of the trip in some 

cases could conceivably cause veterans to avoid necessary medical care, simply because they couldn’t afford the transportation. 

The current delivery of veterans’ health is inadequate and in many cases not 

being made reasonably available. A case for making what would be customarily considered outpatient services available through existing private sector resources 

should be relatively easy to see and make. A veteran should be able to get procedures as those discussed above near his or her home town. 

A matter not clear in the bill is that of emergency room care. An uninsured visit 

to an emergency room can be financially catastrophic. Today, if a veteran calls facilities as the Corpus Christi Outpatient Clinic or even Audie L. Murphy Memorial 

Veterans’ Hospital, the caller will hear a recording to the effect that if the call is 

an emergency, call 911. 

Any such medical care is at the veteran’s expense. On the other hand, should 

there be a VHA hospital nearby or an ER that contracts with the VHA, the veteran 


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is covered. Acute medical care should be available to any veteran wherever they are 

situated. 

Within the last several years, a sibling sustained a head injury in a fall. Although 

the sibling died after a few days, the emergency room and intensive care bill was 

around $70,000. Such could be devastating to a veteran’s survivors. 

With or without a new hospital many of the routine medical services such as 

stress tests, pulmonary function tests and numerous radiological procedures can be 

done competently, cost effectively, and with fewer burdens on the veteran. 

As far as inpatient care is concerned, this veteran would prefer to get to a real 

veterans’ hospital if able. It would make no difference if the facility were located 

in either the Valley or San Antonio. If it were an acute matter, the preference would 

be the first facility contracted with VHA if a VHA facility were not nearby. 

The ability to provide routine medical procedures as well as acute or emergency 

room care should be available in nearly every community in south Texas. That 

would necessarily contemplate the public-private component of the bill or some combination of the other provisions. 

Your consideration of these remarks is appreciated. 

Claude V. D’Unger 

To whom it may concern: 

I’m a decorated veteran who served two tours in Vietnam, 1967 through 1969. I’m a 100% permanent disabled veteran. The 5-hour trips I have to make to San Antonio for any special needs the clinics can’t perform is making my disabilities worse. 

The round trip is made on a crowded van, and the overnight stay in a dirty hotel 

is a hardship. I’m too sick to drive myself. If you are in a wheelchair you can’t ride 

the vans. I’m saddened to see the old WWII veteran of 90 years old suffer this way 

as well. I went to an emergency room at a private hospital 14 months ago and then 

was sent up by ambulance to the Audie Murphy veterans hospital in San Antonio 

Texas for a kidney infection. To this day I’m still waiting for so-called due process. 

I’ve talked to three different people in fee-basis with the most recent being the supervisor. They all told me it would be 45 days with the last contact on April 3rd. 

Well guess what, nothing yet. I’m currently being threatened and I have until April 26, 2007 before bill collectors are given the job to collect $10,000 from me, for what 

I shouldn’t have to be concerned about. My credit is at risk because fee-basis is 

backlogged, so they keep saying. This is a big mess with a lot of stress. I truly have 

lost faith in this VA nightmare. Give the veterans what they deserve or tear down 

this VA system and close the doors and let us use our cards like (Medicare) and 

pick and choose our own doctors and hospitals. I’m not too proud being a veteran 

because there’s too much disgrace and shortcomings from a broken-down system. 

Another disgruntled veteran? Maybe so but it shouldn’t be this way. This substandard treatment for veterans in the Rio Grande Valley is unacceptable as it is 

anywhere in the U.S.A. Please let our voice be heard, we the people. Veterans don’t 

want our new veterans to endure these shortcomings. Do what’s right—PROVIDE 

FOR ALL WHO DESERVE. 

Dan Kerkow, 

Port Isabel Texas 

Honorable Sir: 

I do not know if you have heard from any of the family members of the disabled 

veterans from the Rio Grande Valley that require travel to San Antonio for appointments, but I believe that Congress should also hear about the hardship that the 

vet’s family must also endure. I have a full-time job at one of the area hospitals. 

When my fiance ́e needs to go to San Antonio for certain procedures, I have to take 

time off from work to accompany him. It causes me to lose work time, and the only 

way I can make up that money is to use my vacation days. I cannot let him go by 

himself whenever they do procedures that require anesthesia or manipulation of his 

neck or spine. He is usually in so much pain and/or drowsy with medication that 

he cannot drive. He has a hard time sitting for long periods, and San Antonio is 

4 hours away, and sometimes longer when we have to stop so that he can stretch 

to relieve the pain. A couple of times he has had to go on his own because I cannot 

take off from work and we cannot find anyone else to go with him. He has had to 

lie to the staff that he has a driver. Then I am so worried about him driving that 

I cannot even function at work, and am having to go out several times to call him 

to make sure he is OK. We also have to make arrangements for our kids if we are 

not getting back before they get home from school. We have had to go to San AntoVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00063 Fmt 6604 Sfmt 6621 E:\HR\OC\35636.XXX 35636

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nio just to get a result of an X-ray or CT scan. This requires at least 8 hours of 

driving for an appointment that lasts 10 minutes. Where is the justice in that? 

I know several veterans that have to go to San Antonio for treatments or procedures; some do not have family members that can drive them to San Antonio or reliable vehicles or they are taking care of small children at home. What are they supposed to do? The van that is supposed to be available to these vets is not really 

available; it only runs on certain days and with limited space and with no handicap 

accommodations. Sometimes some procedures have to be scheduled for the weekend; 

like my fiance ́e’s MRI that’s scheduled for a Sunday; he also has another appointment scheduled for Monday for a spinal procedure. I cannot even make that appointment with him because I cannot take the time off. This means we have to call 

around and see who can go with him. What happens to those vets that have no one 

to take them and no bus available? Rescheduling appointments can take up to 6 

months or more. 

I have heard several horror stories from these vets and I think it is a shame that 

our vets are having to sleep in their cars overnight because there is no room available at the designated hotel and they have to be there for an early morning appointment. And travel pay?? You have got to be kidding; with gas prices the way they 

are, we barely get enough for one tank full of gas. We have to fill up twice to get 

there and back, plus pay for meals. How about when these vets are hospitalized up 

there? Isn’t it better for them to be near friends and family that can visit and keep 

him/her in good spirits? Isn’t this supposed to be better for them, rather than being 

all alone away from everyone? 

The Valley has several thousand vets already and will have more when these 

young men and women return home from our current conflicts. Are they going to 

have to suffer the same hardships? 

Congress needs to stop turning a deaf ear and a blind eye to our situation in the 

Rio Grande Valley. Our veterans have willingly given their service to the United 

States. It is time to return that service. How can Congress appropriate money for 

every other cause except this one, when it means taking care of our own? These men 

and women deserve better; we all owe it to them. 

Sincerely, Anabeth Molina 

I am a strong supporter of establishing a veterans hospital in south Texas as soon 

as possible. Veterans who have to visit a hospital have to travel all the way to San 

Antonio, TX to take care of their medical needs. I venture to say that the majority 

of the personnel voting against this issue have never been in the military. I will 

ask these opponents of the medical facility in south Texas to please take a trip all 

the way from south Texas to San Antonio to visit a doctor. 

But take this trip when he/she/they are in pain or sit in a wheelchair for the trip 

and see how they like it. I dare any one of those opponents to try taking this trip! 

If he/she/they decide to do so please let me know so I can get the news media to 

cover this trip. You may quote me on any or all of the above statements. 

Lino Trevino, 

305 Beverly Dr., 

Schertz, TX 78154 

I HAVE SEVERAL CLOSE FRIENDS WHO’S HUSBANDS ARE VETERANS 

AND THEY TELL ME, AND I CAN ALSO SEE, WHAT THEY HAVE TO GO 

THROUGH EVERY TIME THEY HAVE TO LEAVE FOR SAN ANTONIO. IT IS 

SUCH AN INCONVENIENCE FOR THEM AND THEIR FAMILY, PLUS THE 

COST FOR THEM AS WELL, SINCE THE COST OF GAS HAS GONE UP AND 

THEN THE COST OF A HOTEL IF THEY HAVE TO STAY PLUS FOOD ETC. 

. . . 

COULD WE NOT USE THE HOSPITAL AT THE CORPUS CHRISTI ARMY 

DEPOT ON BASE, BUILD IT UP AND MAKE IT BIGGER, HIRE THE DOCTORS 

AND NURSES NEEDED TO MAKE LIFE A LITTLE EASIER FOR ALL OUR DESERVING VETERANS. 

I AM DEFINITELY FOR A VETERAN’S HOSPITAL IN THE SOUTH TEXAS 

AREA. 

YOURS TRULY, OLGA RODRIGUEZ 

Olga V. Rodriguez, CCISD Office of Food Services, 4922 Westway, Corpus Christi, 

TX 78408, (361) 844–0222, Fax: (361) 844–0226. 


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The Honorable Congressman Ortiz, 

My husband is a Vietnam War veteran and my father is a World War II veteran. 

Both had injuries due to the war and both have to make trips to San Antonio at 

the Audie Murphy Hospital. My father is in his mid 80’s and it is getting harder 

and harder for him to make trips to San Antonio. My husband also has had problems getting to San Antonio. . . . I feel they both served their country and gave 

their all while doing so and they need to have you be their voice to tell Congress 

that there is a great need here in south Texas to have a veteran’s hospital. Thank 

you for what you are trying to do for our loved ones that have served their country 

because they believe in our traditions and also served with honor. 

Many blessings to you. 

Sincerely, Elizabeth Jasso, 

Food Service Coordinator, 

Corpus Christi ISD 

Dear Congressman Solomon P. Ortiz: 

I have a brother who is medically retired from the U.S. Air Force. He must travel 

to San Antonio every month for his medical treatments. It takes a day out of his 

life and requires a long ride back and forth. I am also a retired veteran but choose 

to see my own doctors rather than spend a long time waiting at the local clinic or 

taking the time to travel to San Antonio. It would be a blessing to many of us veterans if we had a hospital here in Corpus Christi or nearby. 

I would like for you to know that I am a registered Republican but I started voting for you when you ran and was elected sheriff of Nueces County. You may remember I was an active member of Associated Clubs of Texas (ACT). I have voted 

for you each time you ran for Congress. I am confident that you can get the veterans 

hospital for us. 

Respectfully, Richard D. Hanson 

Dear Sir: 

I appreciate this opportunity to give my opinion on veteran’s care in south Texas. 

I have been a part of the VA healthcare systems in Reno, Nevada and Fargo, North 

Dakota. Both Reno and Fargo were very good. These were medical hospitals, not 

clinics. My experience with the clinics in both Harlingen and McAllen are ongoing 

nightmares. Lately I have been trying to simply get an appointment with my psychiatrist in Harlingen. Every time I call I get put on hold and eventually I hang 

up after waiting and waiting. I finally gave up but I will try again soon. This is 

just one example. I dread trying to do anything with the veterans care facilities 

here. I have tried to figure out why it is that an area that seems to have more veterans per capita than any other area of the Nation has the poorest healthcare for 

them. I suspect a type of Federal racism. I can’t understand what else it might be. 

The employees in both clinics are overworked way beyond the point of laughability. 

The thought that maybe we don’t need a VA hospital in this area is so ridiculous 

I feel embarrassed for whoever might be thinking this. Many veterans won’t use the 

facilities here. They self-diagnose and then pick up meds in Mexico. 

I am Douglas R. Brown. My phone is 956–579–4441. I will reveal any other personal information about myself if you need it. I am available to talk to anyone. 

Congressman Ortiz: 

We need a Veterans Administration hospital in the Rio Grande Valley so that we 

do not have to travel to San Antonio for acute care. I have had a couple of neardeath experiences dealing with the bureaucracy of the Veterans Administration as 

it provides healthcare to us veterans. 

I underwent bypass heart surgery under an emergency basis as a result of a heart 

attack. My wife called our local clinic and she was directed to call 911 and that if 

I was service-connected the VA would cover. I in fact did have the surgery. I had 

no problem being admitted, but after my release from the hospital everything 

changed. Upon release we provided the VA clinic with the hospital doctors’ recommended post surgery instructions. I was placed under new medication. 


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Unfortunately, the nurse which received those medical instructions did not input 

them into my computer medical records. I was at home without medication and had 

to turn to a private pharmacist to obtain them. No one at the VA had requested 

the new medication. I went to the benefits coordinator and told him that I needed 

to follow up with a cardiologist to chart my progress. He told me since there wasn’t 

a cardiologist at the clinic that he saw no problem if I followed up with the local 

cardiologist. I did and VA did not pay. I was taking Coumadin and had to be monitored weekly. 

After three visits, the cardiologist’s office advised me of the problem with the VA 

and requested that I pay up front for all services. I called the clinic and was told 

that the VA says that I should have gone to a cardiologist in San Antonio. By this 

time, my sutures had become infected and I was leaking fluids. I went to the clinic 

and was told that they would assign a home health nurse to monitor the sutures. 

She was given very specific instructions and was limited on what she could do. 

I then attempted to get an appointment to see a VA cardiologist which had been 

seeing me, but was told at the local VA that they did not do that and I should call 

San Antonio directly. I did and was able to get an appointment 5 weeks after my 

release. By this time I was all stressed out and had to see my psychiatrist. He doubled my dosage on my medication in order to help me. When I arrived in San Antonio, the cardiologist did not know that I had had surgery. 

She was surprised because she thought that I was coming up to San Antonio for 

a heart catheterization. She thought that I had a valve problem and was surprised 

that they had found two arteries that were clogged. She was irritated because she 

did not have my up to date medical records. I showed her my sutures and she was 

visibly irritated because they were infected. 

She tried calling the local VA clinic but could not get the line. She immediately 

called the surgeon’s office and made arrangements that I be seen immediately. She 

reviewed all my medications and made changes. The surgeon cleansed my sutures 

and told me to return to the surgeon that had done my surgery so that he could 

follow up locally. I returned home and continued with problems with my sutures. 

I was also prescribed more high blood pressure medication. I was taking so much 

medication that my blood pressure fell down almost to the point that I was fainting. 

There was no way to reach the VA because it happened on a weekend, not even 

the toll-free nurses number. My wife panicked and called the home health nurse 

which suggested that I quit taking the medications and go immediately to the hospital. I did not want to go because the hospital had not been paid and I might be 

refused. 

The nurse recommended that I drink a Coca-Cola with crackers, which I did. 

Thank God that the home remedy that the nurse recommended worked. On Monday 

I called San Antonio and told them what had happened and they took me off some 

medication and I was told that I was taking too much medication. (The reason for 

this is the faulty medical records system.) I returned to the surgeon that performed 

the surgery and I told him that the VA had sent me back to him. 

His office called the VA and I assumed it had been approved. He saw my sutures 

and was very concerned and wondered what the VA was doing. He immediately ordered wound therapy and I was given a 3 times a week regimen for about 2 months. 

Since then, I have had to travel to San Antonio to have a halter placed to monitor 

my heart. I traveled 5 hours. When I arrived I had the procedure done, which took 

about two (2) minutes. I was told to return in 48 hours. I did not qualify for lodging 

so I returned to the Valley. After 2 days I returned to have it removed. Again I traveled 5 hours to get there. The procedure to remove it took 45 seconds to a minute. 

I had to make two (2) trips to San Antonio to be seen a total of 21⁄2 to 3 minutes. 

Why? Because this procedure could not be done at the local clinic? 

On my last visit to my medical provider at the clinic I was assigned a new doctor. 

When I was being triaged, the nurse asked me if I had any past surgeries. I told 

her, hell yes, I just had a bypass, isn’t it in the records. I told her that I even had 

to go to San Antonio to have a halter to monitor my heart. She wondered out loud 

as to why they had sent me to San Antonio for a procedure that could have been 

done locally. The doctor and I reviewed my medical and I was surprised that some 

of the medication that I had been ordered to stop was still on the active list. I told 

him that I had not refilled those prescriptions. He deleted them from my record. 

I had to update him on what had happened since my surgery. 

The hospital and the doctors that did the surgery have not been paid and I am 

getting medical billings from them. The fee service people at the VA told me that 

I could have gone to San Antonio for the medical services. They did not have any 

records in their files indicating that a VA doctor had approved the medical. I told 

him that the hospital had called and that they were given the okay or they would 

not have allowed the services. I told him that I had no choice but to go to a local 


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hospital because it was an ‘‘emergency.’’ And since the clinic had not provided post 

surgery care, I had had to follow up with the doctors. 

I am doing fine now. I am gradually recovering from the surgery. But while I was 

suffering with the infection to my surgery and the delicacy of the operation I had 

to make two (2) trips to San Antonio, a total of almost 20 hours in a car. The pain 

and discomfort that I suffered made me think, why in the hell did I choose the VA 

for my medical. 

I have gone to San Antonio on previous occasions to see the cardiologists only to 

find out that the echograms and ekg’s done at a local hospital were not available. 

They were not sent up there because the VA had not paid. The cardiologist was visibly disturbed by this and she ordered new ones done since I was in San Antonio 

already. She showed concern that I had traveled all the way from the Valley and 

that I would not be seen due to the lack of the medical being sent to her. 

I have had to go to San Antonio for other minor exams that took 15 to 20 minutes. 

The stress test could have been done locally, the allergy tests could have been done 

locally, the breathing test could have been done locally, and my skin rash exams 

could easily have been done locally. But I had to travel to San Antonio for them 

because the Rio Grande Valley does not have acute care to provide healthcare for 

us. 

Sincerely, 

Arturo Treto Garza 

Honorable Solomon Ortiz, 

Thank you for getting our needs in the Rio Grande Valley heard. Yes, we do need 

a hospital for us. Having to travel to San Antonio is just so much trouble and time 

consuming. Sometimes it just does not help, by the time you arrive your problems 

just seem to increase. We need all the help we can muster. 

Respectfully, 

Jose Benavides, 

334 McDavitt Blvd., 

Brownsville, Texas 78521 

Dear Congressman Ortiz: 

My brother had a triple bypass done in San Antonio Audie Murphy Veterans Hospital in 2005. He returned after a 2 week stay at Audie Murphy and continued with 

his post-surgery care. During the course of his recovery, he developed complications 

with a blood thinning medication called Coumadin. That medication had to be monitored closely. On one occasion he went to the Harlingen Outpatient Clinic with 

problems. 

His VA medical provider told him that he needed to be monitored closely for his 

PT INR and that he needed to take vitamin K. He sent him home while he ordered 

his new dosage of medication. 

He told my brother that maybe the pharmacy in McAllen might deliver the medication later that day. As soon as my brother arrived at his home, he received a call 

from the VA clinic that he needed to go to the nearest hospital immediately and 

was told that Dolly Vinsant Memorial Hospital in San Benito was taking veterans. 

My sister-in-law drove him right away to DVMH. At DVMH he was told that he 

was very sick and he was immediately transferred to Valley Baptist Medical Center 

in Harlingen, TX by ambulance. He was admitted because he advised the hospital 

that he was a veteran and showed his ID card. The hospital got the clearance from 

San Antonio VA and admitted him. He was given two pints of blood and was required to stay for 4 days to recover. 

His medical billings have not been paid because the VA is claiming that ‘‘VA facilities were feasibly available to provide the care.’’ In other words, the VA felt that 

my brother could have traveled to San Antonio under the dangerous medical problems he was having. 

He barely made it to the local hospital let alone to San Antonio which is 4 to 5 

hours away by car. The VA clinic did not tell him that they would provide an ambulance for him to take him to San Antonio, they know better. There is no such thing. 

What his VA medical provider did do and under an abundance of caution was referred him to the nearest local hospital. 

If the VA feels that our veterans can immediately fly or magically transfer themselves to San Antonio for medical care under emergency conditions, then I wish they 

would let us in on the secret. 


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Once again the VA is using the excuse that medical VA facilities were feasibly 

available. The local VA clinic does not even have a cardiologist. VA facilities are not 

‘‘feasibly available’’ for veterans with emergencies and or acute care problems. 

This is another reason why we need a VA hospital for the Rio Grande Valley. My 

brother does not want to rock the boat because of his heart condition and other medical problems which have developed. He does not want to jeopardize the healthcare 

that he does receive from the VA. In other words, he is in a sense held hostage by 

our government. 

Sincerely, 

Arturo Garza 

Dear Congressman Ortiz, 

My husband, Alfonso X. Soto, an army veteran of the Vietnam War died 9 years 

ago. I believe that at the time of his heart attack he was also suffering from a problem with his lungs possibly due to his exposure to Agent Orange while in Vietnam. 

He never persued a diagnosis mainly because the San Antonio facility was too far 

and he was not able to make the trip. The one time he did go due to hearing loss 

from a mortar concussion also while in Vietnam, he found that the number of people 

they were trying to serve was too great for quality care. He never went back again. 

My husband is gone, but for the sake of other veterans who deserve our support 

and in light of the number of young men and women from our area serving in Iraq, 

who will need physical and psychological support when they return, I ask that you 

actively pursue a facility in the south Texas area. Each time I drive by the old Valley Regional facility just sitting there with no purpose, I wonder at the possibility 

of a veteran’s hospital in Brownsville, Texas. Congressman, I know you are a man 

of vision. Please do what you can. 

Sincerely, 

Neida Ruth Soto 

Mr. Ortiz: 

I am a 54-year-old black female veteran and I retired and live in Corpus Christi, 

Texas. I have 60% service-connected disability and find it ridiculous and cumbersome to have to travel to San Antonio for visits to Audie Murphy. I have to take 

off from work for a day as opposed to 1 to 2 hours to have a mammogram, an Xray, consults which take all day waiting, and 10 minutes to get done. 

I usually have appointments at 12 p.m. which means I must go to bed early 

enough, to get up around 6 a.m. leave Corpus no later than 7:30 to make sure I 

get to Audie 30 minutes prior to my appointment. Once I am checked in; and I will 

take my last appointments for instance, I wait for 1 hour to be called, and another 

2 hours before I am seen. They reimburse me $26.00 for the appointment and we 

know that does not even fill a tank. 

I must miss a day of work of course because it is a full day evolution to get this 

completed. I work on the military base located at NASCC. It has a large hospital 

that is being used as a clinic. I do not know why the government is underutilizing 

the facility and requiring veterans from our surrounding cities as well as those here 

in Corpus to travel miles for services that can be provided right here. This will show 

the appreciation for the veterans, employ qualified physicians, get adequate services 

and probably allow the people that have fought for our country the availability to 

convenience in knowing what some of our brothers and sisters died for was not in 

vain. 

The last visit to San Antonio I was in a room with several other veterans. We 

all realized through conversation that we were all from either Corpus, Robstown, 

Brownsville, and other surrounding areas of Corpus. This was ridiculous because 

some had been there since 8 a.m. and it was already 11 a.m. and they had not been 

serviced. My appointment was 11 a.m. and I was seen at 1 p.m. and left at 4 p.m. 

This was a full day of work and not counting me driving up there and returning 

home, which by the way I arrived at 7 p.m. 

So basically from beginning to end it took me 12 hours to get to San Antonio, get 

serviced at Audie Murphy, caused me to fill my tank twice, going and coming, I took 

off a whole day of work and got 26 dollars for my troubles and all of this could have 

cost nothing but probably 4 hours of time if I could have used the hospital already 

in Corpus or some facility that is comparable. 

I sincerely appreciate you fighting this battle for us because it is becoming increasing difficult to travel those miles for treatment that can be completed in CorVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00068 Fmt 6604 Sfmt 6621 E:\HR\OC\35636.XXX 35636

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pus Christi. I cannot say enough that finally someone is noticing that we veterans 

do not ask for much but when we do it is because we feel we need it, deserve it 

and it is a doable request. 

Thanks for the time and energy put forth for this cause. 

Billie P. Harvey, USN–Ret. 

I favorably support the proposal(s) concerning the establishment of a VA hospital 

in the Rio Grande Valley, not just ‘‘south Texas.’’

Even though I am a retired and VA-disabled U.S. Army Vietnam War veteran, 

I have not used VA facilities, other than the Disabled Veteran license plate benefit. 

Perhaps I will need their services in the future. 

I do, however, recognize and support the efforts of you, and our VA-eligible brothers and sisters, to gain relatively local access to VA care, other than crowded, overloaded VA clinics. 

This effort needs to be sustained to fruition even though this may not be the year 

for success. 

Carry on, sir. 

Most respectfully yours, 

John M. Lawrence, 

1SG, U.S. Army (Ret.), 

26 Winterhaven Lane, 

Brownsville, TX 78526 

We need all the support from you to make this recommendation become a reality. 

For several years I have seen and helped other veterans travel to San Antonio for 

their medical problems. 

It is time to open their eyes, that we do need a hospital here in the Valley. The 

Harlingen area will be getting a new outpatient clinic within the next few months 

but this will not help because we still need to travel to San Antonio. 

It’s great but we need a hospital here. There’s too many of us veterans who need 

a hospital. It’s very difficulty for us to travel because of our illnesses and no support 

for our families when we are there. I have advised those veterans that they need 

to speak out so that our congressmen hear us. 

Our vote means a lot and if we get together we can have a great impact in our 

coming elections. Once again, thank you for your support and I hope that you can 

convince the VA Committee. 

Miguel Rangel 

My opinion on this matter is that in the Rio Grande Valley, there is a serious 

need of a VA hospital. 

There are many vets that because of the drive to San Antonio most of them would 

rather just not worry about being seen at the VA. For those who make that 4-hour 

drive it is not as easy at it seems. 

It is very tiring and the fuel cost, lodging, and food is very costly for those that 

depend on a family member to take them to their appointments. The travel pay assistance that one receives is not enough to cover these expenses. 

Having a hospital in the Valley would benefit the vets that have supported this 

Nation and now it is time for the Nation to step up to the plate and assist our south 

Texas veterans. I am a Navy vet and hearing their stories of war and their sacrifice 

that they face each and every day is something I do not wish on anyone. 

Mr. Ortiz, we in south Texas are behind you 100% and do appreciate everything 

you have done for us. We stand next to you in this battle and I pray that those 

who make this decision will hear our cries for help. 

God Bless, 

Joseph D. Ramos 

Dear Rep. Ortiz: 

I’m a Vietnam veteran with several service-related health problems. I’ve made 

about 8 trips to Audie Murphy in San Antonio this past year and am scheduled to 

make several more in the next month or so. My health is still well enough where 


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I can make the trips OK. As my conditions worsen I know it will get harder and 

harder to make the 5-hour trip each way. 

I see a lot of veterans from the Valley every time I go there. There are a lot of 

veterans who cannot make the trip on their own. They make the trip by bus or take 

relatives who I’m sure have to make sacrifices missing work, caring for children and 

other parents to make the trip. It is a real hardship for most veterans and their 

families to have to go all the way to San Antonio for medical care. 

Americans from the Rio Grande Valley have always responded with great patriotism when our country had called. PLEASE HELP THE MANY, MANY VETERANS 

FROM THE VALLEY GET A VA HOSPITAL IN THE VALLEY. 

Filiberto Conde, 

Rancho Viejo, Texas 

April 24, 2007 

Dear Congressman Ortiz: 

I’m a disabled vet from WWII who used to drive 357 miles to San Antonio for 

treatment but I can’t do that anymore. I now visit the Harlingen outpatient clinic 

and the McAllen outpatient clinic for podiatry. They do the best they can with limited space and equipment and time. 

This Valley is in dire need of a hospital or more inpatient clinics to deal with the 

thousands of vets from the previous war era and now the Iraq War. 

Congressman Ortiz, I know you will do your best to remedy this situation, anything you do will be appreciated. 

Sincerely, 

Bernard Reyes 

Staff Sergeant 

99th Infantry Division 

1st and 3rd Army 

World War II 

Mr. Ortiz: 

First of all I’m not a veteran but I do work with them. I was a scout leader and 

I teach all my kids the importance of honoring a vet (a warrior). Here in the Valley 

our warriors have given up 3% of all deaths compared to 1% in any community in 

all the Nation in all wars and are the most highly decorated in the Nation. Just 

on that alone our Valley warriors deserve more than what they are getting. 

Epifanio Valdez III 

Respectable Congressman Ortiz: 

You have our support and encouragement. Do us well. And, thank you in advance. 

Tomorrow, my husband and I will get up at 4:30 a.m. to get ready and be on our 

way to San Antonio by 6:00 a.m. My husband has an appointment with the cardiologist. He has a heart condition and we have to make that trip periodically. Our trip 

is not any longer than the veterans that come from Brownsville, McAllen and all 

those other small towns. Many of our veterans can not afford private supplemental 

insurance. If we have a medical emergency after the hours of operation of our local 

VA clinic or during the weekend that requires hospitalization we are encouraged to 

go to our local emergency room, but that leaves us with the total expenses. The 

other alternative is to drive to the VA hospital in San Antonio at whatever time 

and with a near-death condition. The services and attention in Audie Murphy are 

excellent, but Audie Murphy is overextended. It is a problem to find a parking space 

due to the number of patients they see daily. Every time we go we see the increase 

in patients and it will only get worse especially with soldiers coming from the war. 

Also, because south Texas is the temporary home for many veterans that come for 

the winter. Yes, we need a veterans’ hospital in south Texas. 

Sincerely, 

Miltan Martiz 

Rudolph Salinas, Sr. 

Korean War Veteran 


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Vets fight for hospital in Valley 

They endure long trips, long waits, lots of red tape to get healthcare 

12:37 AM CDT on Sunday, April 22, 2007 

By DAVID McLEMORE / The Dallas Morning News 

Brad Doherty/Special Contributor 

Veteran Steve Dunn of Harlingen must travel hundreds of miles to receive 

treatment at the VA hospital in San Antonio 

WESLACO—Every Sunday and Wednesday morning, small groups of military veterans, some in their faded camouflage shirts, stand patiently at designated locations 

in the Rio Grande Valley, waiting for the ‘‘vet van.’’ Veteran Steve Dunn of Harlingen must travel hundreds of miles to receive treatment at the VA hospital in San Antonio. Eventually, two government-leased, 15-passenger vans will weave their way to the stops between McAllen and Brownsville, 

picking up the passengers for the 240-mile drive to the Audie Murphy Veterans Memorial Hospital in San Antonio. 

They’ll travel 5 hours to an appointment that took months to get. Sometimes, it’s 

for a specialized X-ray that takes 15 minutes. Sometimes it’s for a procedure that 

requires an overnight stay in San Antonio. And sometimes, veterans find, their appointment has been canceled. 

On most days, the vans leave behind people who reserved a place weeks in advance or waited in line in the hope that someone would miss the van, veterans say. 

‘‘It’s a long trip. But it’s the only way to get to the hospital,’’ said Ruben Cordova, 

a Navy veteran with Persian Gulf service. ‘‘The buses aren’t handicapped accessible 

and you have to tell the driver if you need to go to the bathroom. People bring their 

breakfast tacos and pain meds and hope for the best.’’

For years, veterans in the VA system in south Texas—which at last count numbered more than 107,000 for the 60-county service area—have been asking for their 

own VA hospital. They’re tired of traveling hundreds of miles, enduring long waits 

for care and putting up with bureaucratic snarls. 

And with their numbers on the rise, they want the hospital now. The patient load 

at the south Texas VA facilities has grown 31 percent since 2001. 

‘‘We’ve never said VA doesn’t provide good medical care,’’ said Felix Rodriguez, 

district director for the Veterans of Foreign Wars in the Valley. ‘‘The doctors and 

staff do the best they can with what they have. The problem is getting into the system to get the care. There are too many barriers to eligibility.’’

There is also a sense of promises not kept, Mr. Rodriguez added. 


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Their complaints come at a time when VA facilities are coming under attack following reports of inadequate care at Walter Reed Army Medical Center in Washington, D.C. ‘‘We did what we were asked by this country and we don’t believe there is any 

excuse, any reason for VA to refuse to build a veterans hospital here,’’ he said. ‘‘We 

believe we’ve earned the right to see a doctor where we live.’’ The Department of Veterans Affairs operates two routine healthcare clinics in the 

Valley—one in McAllen, the other in Harlingen. The clinics are part of the south 

Texas Veterans Healthcare System, which also includes the Audie Murphy hospital 

in San Antonio, a smaller facility at Kerrville, and outpatient clinics in Corpus 

Christi, San Antonio and the Valley. 

For the more complicated procedures, veterans have no choice but to drive to San 

Antonio. 

The VA takes the veterans’ concerns seriously, said Amjed Baghdadi, spokesman 

for the San Antonio-based south Texas health system. 

It’s launched a feasibility study for either a hospital or expanded outpatient services in the Valley. And in 2003, the VA received approval for an outpatient clinic 

at Harlingen as a temporary measure pending construction of a primary care clinic 

scheduled for completion later this year, Mr. Baghdadi said. 

The new clinic will provide expanded audiology, dental and pharmacy services, as 

well as physical therapy, mental health and social work services not now available. 

Veterans groups are glad for the new clinic. But they believe a fully staffed hospital would better fit their needs. 

Unprecedented growth 

Nationally, VA’s medical system has experienced unprecedented growth, ballooning 22 percent since 2001 when it had 4.1 million veterans registered. It now 

has 5.3 million, including 1.7 million in Texas. And while the largest single group 

is Vietnam-era vets, the number of Iraq and Afghanistan vets is growing. 

The Texas Veterans Commission reports it has received about 2,000 discharge 

documents a month since 2001. ‘‘Iraq and Afghanistan veterans are a rapidly growing component of VA care,’’ said 

Terry Jemison, VA spokesman. ‘‘Just a year ago, they made up 2 percent of our 

caseload. With the war continuing, we anticipate their numbers will continue to rise.’’ In south Texas, about 3 percent of the patient load is veterans of Iraq and Afghanistan. 

Yet VA projections about 3 years ago showed veterans requiring VA services diminishing. A report by a special commission appointed to study Valley veteran 

health needs, said only 10 beds were needed for both the Lower Rio Grande Valley 

and the Coastal Bend area near Corpus Christi. 

Homer Gallegos, a Vietnam vet and a member of VFW Post 8788 in McAllen, 

fears returning modern vets will soon face the same inadequate reception at VA 

that veterans of his war did. ‘‘When I returned home after Vietnam, there were few resources here for veterans 

and VA wasn’t equipped to handle the number of veterans coming back,’’ he said. ‘‘Now, we’re seeing some of the same things with the Iraqi vets. I’m really afraid 

these guys are going to fall through the cracks.’’ Young vets are dealing with a host of different problems, Mr. Gallegos said, from 

an increasing number of head and brain injuries and amputations to emotional 

problems resulting from the combat they saw and the strain of multiple deployments to the war zones. ‘‘Right now, the younger guys don’t feel comfortable with the VA system and they 

don’t relate much to the concerns of the older vets,’’ Mr. Gallegos said. 

The younger vets are more worried about ‘‘getting jobs, getting married and aren’t 

too concerned with long-term health issues,’’ he said. ‘‘I just don’t want them to get 

lost.’’

More sad than angry 

State Rep. Aaron Pen ̃ a, D–Edinburg, who represents part of Hidalgo County and 

is also a military veteran, has joined the call for construction of a VA hospital in 

the Valley. ‘‘What the veterans in my district tell me is that health services to vets is lacking, 

distant and bureaucratic,’’ he said. ‘‘There is more sadness than anger when they 

talk about this. They want to believe the system will respond to their needs. They 

gave so much and they feel forgotten. 

‘‘But what isn’t spoken is the sense that they are being ignored despite the long 

history of Hispanics’ service to the U.S. military,’’ he said. ‘‘We’ve fought in almost 

every American war and we feel we’ve suffered disproportionately in the current 

war. And we’re still being ignored.’’


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Approximately 10 percent of the 320 Texans killed in Iraq and Afghanistan are 

from south Texas. According to Defense Department data, 100,000 Hispanics currently on active duty make up about 9 percent of the military. 

Mike Escobedo, 38, returned home to the Valley in 1982 after a 4-year hitch in 

the Marines. But it wasn’t until 17 years later that he learned he could get his hearing loss—a result of working around aircraft—treated at a VA clinic. 

To go to the audiologist, he must still periodically travel to San Antonio. 

‘‘It’s not so bad for me, but we have a lot of older vets and people without arms 

or legs who need more care,’’ he said. ‘‘They shouldn’t have to spend 5 hours in a 

van to see the doctor.’’

Seeking help 

Jesus Bocanegra, 25, a veteran of Iraq, came home to Progresso nearly 3 years 

ago. After he was discharged, memories of some of the terrible things he saw in 

combat led to severe depression and thoughts of suicide. 

A friend talked him into going to the VA office in McAllen. He was subsequently 

referred to the VA hospital in Waco for evaluation for post-traumatic stress disorder 

and intensive treatment. 

Caseworkers there told him he needed to begin regular sessions with a therapist 

once he returned to the Valley. 

‘‘They told me I’d get an appointment in the mail,’’ Mr. Bocanegra said. ‘‘Three 

weeks later, I got a letter from VA that I could see the doctor in 8 months. I had 

heard about red tape, but I didn’t realize how bad it was.’’

Currently, there are five full-time VA psychological counselors and two part-timers for the entire Valley, a VA spokesman said. 

Mr. Bocanegra said only three are available at any given time. The veteran clinics 

in Harlingen and McAllen are closed on the weekends. The PTSD hotline is available from 8 a.m. to 5 p.m., he said. 

‘‘There’s a lot of people not getting the help they need and they’re falling off a 

cliff and there’s no net,’’ Mr. Bocanegra said. ‘‘The Viet vets have been dealing with 

this kind of stuff for 30 years. But there’s a lot of Iraq vets coming back, and we’re 

not going to wait that long to get someone’s attention.’’

In late 2005, Mr. Bocanegra and two dozen other veterans participated in a 5- 

day march from the Valley to San Antonio to promote the need for a VA hospital. 

Shortly thereafter, the VA commissioned the study to determine whether a VAstaffed hospital in south Texas is warranted. 

‘‘Let’s face it. This is a largely Hispanic area that the feds routinely ignore unless 

they want to send more Border Patrol agents,’’ he said. ‘‘But Hispanics have a lot 

of pride and they’re proud to serve our country. In return, we get a lot of promises, 

but no one does anything about it.’’

VA officials said the study, later expanded to include evaluation for specialty outpatient care, should be completed this summer. 

In the meantime, the outpatient clinic expansion in Harlingen will result in increased mental health services, as well as improved access to some of the services 

now available only in San Antonio, Mr. Baghdadi said. ‘‘The south Texas Veterans 

Healthcare System is actively working to increase access to services throughout the 

system,’’ he said. 

U.S. Sen. Kay Bailey-Hutchison, a Ranking Member of the Veterans Affairs Appropriations Subcommittee, recently pushed VA Secretary Jim Nicholson on the 

delay of the report. 

‘‘Secretary Nicholson assured me that the study I requested in February 2006 to 

determine the need to establish a veterans hospital in the Valley will be completed 

by July,’’ Ms. Hutchison said. ‘‘This study has taken an awfully long time and I am 

anxious to learn the results. Our veterans in the Valley deserve accessible, quality 

care.’’

Twenty-five year effort 

U.S. Rep. Solomon Ortiz, whose district covers much of the Valley, said he’s tried 

for 25 years to get a VA hospital in south Texas. Time and again, VA officials said 

there weren’t enough veterans or enough in the budget. 

‘‘Congressman Ortiz has been at this so long, it’s gotten to the point he’s boiled 

the argument down to its essence out of frustration,’’ said Cathy Travis, the congressman’s spokeswoman. ‘‘We want south Texas veterans to get the healthcare 

they need where they live. However it gets done, let’s do it.’’

Veterans in the Valley have no shortage of stories about treatment delayed, appointments scheduled months in advance, long waits, and piles and piles of paperwork to receive medical treatment. 


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Mr. Cordova received a referral for an MRI for persistent shoulder pain. It took 

the VA 3 weeks to notify him that he would have an appointment in San Antonio 

4 months later. After a 5-hour drive, the procedure took 15 minutes. ‘‘You can’t afford not to make an appointment,’’ he said. ‘‘If you miss an appointment or have to reschedule, everything starts back at ground zero and it’s many 

more months before you see a doctor.’’ Mr. Cordova is 90 percent disabled. Like many Valley veterans, he finds that the 

difficulties in getting appointments and traveling to meet them make it hard to 

maintain a sense of normalcy. ‘‘It’s hard to hold a job when you have to miss work four or five times a month 

to travel to San Antonio for medical appointments.’’ Apolonio Uresti is a Vietnam veteran still being treated for post-traumatic stress 

disorder. His father is a World War II veteran. His two sons, both active-duty military, have served multiple tours in Iraq. 

Recently, a late-night phone call from one of his sons saying that he’d been hurt 

in an IED explosion dredged up memories of Mr. Uresti’s own war experiences. 

He called the clinic in Harlingen about seeing the psychiatrist. He was told the 

soonest appointment was in 6 months. ‘‘You get tired of waiting,’’ he said. ‘‘When my sons leave active duty, I’ll have to 

tell them that they will have to fight to make the government keep its end of the 

bargain. I’ve seen it in my Dad’s life and in mine.’’

Ortiz wants to hear from south Texas veterans ahead of key hearing 

20 April 2007 

Steve Taylor, Rio Grande Guardian 

WASHINGTON—U.S. Rep. Solomon Ortiz wants to hear from south Texas veterans 

about the healthcare they are receiving and the efforts they have to make to get 

it. And he wants it in a hurry. 

Ortiz, D–Corpus Christi, is set to testify at a hearing of the House Veterans’ Affairs Subcommittee on Health regarding his legislation to establish a veterans hospital in south Texas next Thursday. 

Ortiz said he wants south Texas veterans to send him messages, stories, petitions—anything that will help the Veterans’ Affairs Subcommittee on Health understand the context of the difficulties south Texas veterans face. 

‘‘I know the time is short, but our veterans need to ‘surge’ now to help me characterize for Congress the everyday difficulties they encounter in terms of healthcare,’’

said Ortiz, a veteran himself. ‘‘I want to tell these guys the personal stories of south 

Texas veterans.’’

In January, Ortiz introduced the South Texas Veterans Access to Care Act, which 

requires the VA to advise Congress in 180 days how they will tend to the acute 

healthcare needs for south Texans. 

Ortiz introduced the same bill last year in an attempt to get the Administration 

to deal realistically with the massive number of wounded veterans in south Texas. 

Ortiz has asked in for the construction of a veterans’ hospital for south Texas in 

each Congress that he has served. ‘‘Each year, the bill is rebuffed, mostly for financial reasons,’’ he said. ‘‘Testifying before the Health Subcommittee next week will 

be a step forward for this legislation.’’

Perhaps one of the Rio Grande Valley veterans the House Veterans’ Affairs Subcommittee on Health would like to hear from is Ruben Cordova, a USN retired disabled veteran. 

Cordova is waiting to have several surgeries to correct injuries he had sustained 

while in the service. That means numerous visits to the Audie Murphy hospital in 

San Antonio, the nearest VA hospital to the Valley. 

‘‘The worst case was when I had shoulder surgery and I spent the night in my 

car so that the anesthesia would wear off. I didn’t take any pain medication so that 

I could make the 4-hour drive back home,’’ Cordova said. 

‘‘The pain was unbearable and I had to make several stops along the way to vomit 

from the pain. But that was what I had to do because it is the only place for veterans to have surgery.’’

Cordova said he had also slept in his car in San Antonio to make an early appointment. 

‘‘By the time I arrived in San Antonio all the rooms available for veterans had 

been issued out,’’ he said. 

Cordova said he knew of many veterans that cannot sit for very long periods and 

have to lay down while in transit to San Antonio. ‘‘Their family has to make arVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00074 Fmt 6621 Sfmt 6621 E:\HR\OC\35636.XXX 35636

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rangements to transport their loved ones in these conditions to make their appointments,’’ he said. ‘‘If a veteran doesn’t make their appointment they sometimes have 

to wait until there is an available appointment—usually another 6 months.’’ Cordova said people who don’t have to live these ordeals don’t know what veterans and their families have to endure. ‘‘I wish you would live through a trip with a veteran and see what it takes to 

have medical attention,’’ Cordova told the Guardian. ‘‘Veterans don’t want a handout they want what is rightfully theirs. We want 

service from our government without questions just like we served without questioning what was asked of us. We were ready to do or die for our country. Now it’s time to receive.’’ Ortiz said his legislation gives the government three different options in establishing a method to better provide acute healthcare services for veterans in south 

Texas. ‘‘They can either establish a public-private venture to provide inpatient services; 

or they can build a hospital there; or they can utilize an existing military treatment 

facility with a sharing agreement,’’ Ortiz said. ‘‘The end result is that veterans’ inpatient healthcare are attended to, near where the veterans live, not several hours 

away.’’ Ortiz said veterans should email their stories to: ortizvets@mail.house.gov or 

hand-deliver them to his Brownsville office by noon Wednesday, April 25. 

 Copyright of Rio Grande Guardian, www.riograndeguardian.com; 2007

f 

. 

Prepared Statement of Hon. Steven R. Rothman, a Representative in 

Congress from the State of New Jersey 

Let me begin by thanking the Committee on Veterans’ Affairs for allowing me to 

testify. I want to especially recognize the leadership of Chairman Bob Filner and 

Ranking Member Steve Buyer. Under your stewardship, this Committee is continuing its important work in looking after our veterans. 

Mr. Chairman and Members of the Committee, I am here today to testify about 

the moral responsibility and practical obligation of the Federal Government to honor 

its commitment to all of our veterans—namely, the commitment to provide them 

with quality, affordable healthcare. 

It is a moral responsibility because the American Government makes a promise 

to every veteran. We say that because you have volunteered to put your lives on 

the line for freedom—because you are willing to sacrifice yourself for the good of 

all Americans—because of this courage, we will take care of you when you leave the 

service. 

We don’t make that promise with our fingers crossed. We don’t tack on fine print 

or attach a bunch of strings to the promise. We make that promise freely because 

our veterans gave freely of themselves in the service. 

It is a practical obligation because how on Earth can a young soldier fight with 

all of his willpower on behalf of a government if he meets a 60-year-old veteran who 

is battling cancer without any healthcare because he has been banned by his own 

President from enrolling in the healthcare service for veterans? 

It’s outrageous. Yet, as the representative for more than 156,000 veterans, I have 

heard story after story from veterans in Bergen, Hudson, and Passaic Counties who 

tell me that their government has broken its promise to them. 

That’s because in January 2003, the Bush Administration decided to cut costs by 

telling veterans designated as ‘‘Priority 8’’ that they are banned from enrolling in 

the VA health system and will no longer have access to VA hospitals, clinics and 

medications. 

The Administration defended its decision by saying that Priority 8 veterans make 

too much money to be worth the added expense. I say that’s hogwash. 

Hogwash because a veteran is a veteran is a veteran. Hogwash because we made 

a promise to those men and women to take care of them and there is absolutely 

no justification whatsoever for breaking that word. And hogwash because those veterans often live in areas where the cost of living eats up all of the income that the 

Bush Administration seems to think they have. 

In fact, the national income threshold for Priority 8 veterans is $26,902. I don’t 

know of any town in America where that qualifies as Bill Gates-style wealth. And 

in towns where the amount is slightly higher, it is still much too low to account 

for the high cost of living. Bergen County—which I represent—has the second largest concentration of veterans in the State of New Jersey and the largest number 

of Priority 8 veterans. All in all, it is estimated that nearly 5,000 veterans in New 


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Jersey alone have been turned away from the VA healthcare system. Nationwide, 

the number of veterans turned away is over 273,000. 

Turned away—listen to those words. I don’t have to tell the good Members of this 

Committee how terrible a message we send to young soldiers when we ‘‘turn away’’ 273,000 veterans from the VA healthcare system. 

We ‘‘turned away’’ hundreds of thousands of brave servicemembers who said they 

were willing to die for the freedom of all Americans when they are at their most 

vulnerable. 

The fact is that ‘‘turned away’’ is another way of saying we broke our promise. 

We broke our promise to 273,000 veterans. We broke our promise to people who said 

they were willing to die for the freedom of all Americans and we broke our promise 

when they were at their most vulnerable. 

Imagine: You have a loved one who is 60 years old. He served bravely for 10 years 

as a young man and afterward worked hard as a civilian for decades, raised a family. But suddenly, he is diagnosed with cancer. He doesn’t have health insurance. 

He can’t afford private health insurance. So he turns to the Veterans Administration to save his life. But our VA says to him: ‘Sorry, Charlie. You should’ve come 

to us before January 2003. We can’t care for you. You’re out of luck.’

Can you imagine? Can you imagine what that does to the faith of all our veterans 

in their government? Can you imagine what that does to the morale and trust of 

our current soldiers serving in Iraq and Afghanistan? 

It’s not right and I believe this Committee must ensure that we stop breaking our 

promise. 

That’s why I have introduced the Honor Our Commitment to Veterans Act, which 

tells the Bush Administration that it can’t just promise to care for our veterans, but 

has to actually care for them. I strongly urge the good Members of this Committee 

to consider and move on this legislation. 

Republicans and Democrats will never agree on everything, but we should all 

agree on the importance of keeping our promises to veterans. 

As I said earlier, those promises weren’t made with our fingers crossed behind our 

backs. They were promises made in earnest and they are promises that we must 

keep—for the good of our veterans and of our country. I will submit my full remarks 

for the record. 

Once again, I thank the Committee, Chairman Filner, and Ranking Member 

Buyer for your time and consideration of the Honor Our Commitment to Veterans 

Act and the very important issue of providing healthcare to all of our veterans. 

f 

Prepared Statement of Hon. Tom Latham, a Representative in Congress 

from the State of Iowa 

Mr. Chairman and Members of the Subcommittee, I am honored to have the opportunity to testify before you today regarding H.R. 1426, the Veterans’ Access to 

Local Healthcare Options and Resources Act, known as the VALOR Act. 

I introduced this legislation in response to growing concern expressed by veterans 

in my district regarding access to VA healthcare. Veterans who live in rural parts 

of my district must travel long distances to VA medical facilities to receive the 

healthcare promised to them. Oftentimes they have to wait months for an appointment. They are frequently forced to give up a full day, sometimes in fragile condition, to travel for care. Despite the remarkable improvement in the quality of VA 

healthcare during the past decade, the fact remains that not all America’s veterans 

have equal access to these services. 

One example of this inequity is the story of a Vietnam Army veteran from Fort 

Dodge, Iowa. This recipient of the Bronze Star is service-disabled, and he estimates 

that he has made the 4-hour round trip from Fort Dodge to the VA medical center 

in Des Moines more than 100 times over the last 3 years. Because he cannot drive, 

he relies, like many veterans, on a shuttle graciously provided by one of the Veterans’ Service Organizations, which takes up to 10 or more veterans to Des Moines 

at a time. Since they have to wait until the last appointment to return, the trip 

takes an entire day, starting at 5:00 a.m. and returning late in the evening. 

Countless similar cases have been reported to me by veterans in my district. This 

situation leads me to ask the question, ‘‘Can we really say that we are providing 

‘top quality’ care for our veterans when so many have limited access to it?’’ Out of 

nearly 8 million veterans enrolled in the VA healthcare system last year only 5 million veterans actually used VA healthcare. Recent reports show that the VA healthcare system continues to match or outrank private-sector healthcare in overall quality and consumer satisfaction. Out-of-pocket costs are extremely low, particularly for 


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service-connected veterans. So why are less than two-thirds of the veterans enrolled 

in the system actually using it? I believe that access problems account for a great 

deal of this disparity. For millions of veterans, VA healthcare is simply not readily 

accessible, especially in rural areas. 

VA-funded research conducted by Dr. William Weeks and his colleagues from the 

VA Outcomes Group highlights the urgent need for action to increase healthcare access for our rural veterans. This research supports the conclusion that, compared 

with their urban counterparts, rural veterans have a higher prevalence of mental 

and physical health problems, but the least access to VA healthcare. 

I am concerned that this disparity will continue to grow over time unless we do 

something to stop it. First, rural residents are overrepresented among veterans. The 

VA Outcomes Group found that 22% of veterans are rural, compared with 14% 

among the general population. Furthermore, rural veterans are overrepresented 

among those serving in Iraq and Afghanistan, due to increased use of the National 

Guard and Reserve units. These units are often dispersed in rural areas, far from 

large urban centers or concentrations of veterans where VA facilities tend to be located. As I previously mentioned, rural veterans are already more likely to experience health problems. With large numbers of these veterans returning from combat, 

the need for VA healthcare in rural areas will increase dramatically in coming 

years. 

The VALOR Act aims at meeting this need by providing veterans with an option 

to receive care they would otherwise be eligible to receive in a VA facility, at a local 

hospital or physician’s office. To provide this option the legislation builds on the existing VA system for contracting with non-VA providers known as fee-basis care. 

The VA already has specific statutory authority to contract with non-VA facilities 

for medical care, but it is subject to a number of restrictions that limit its use. 

The VALOR Act would require an expansion of fee-basis care to allow greater access to VA-funded healthcare in local communities. Under the bill, covered services 

include hospital care, medical services, rehabilitative services and preventative 

health services that a veteran would be eligible to receive at a VA facility. It also 

clarifies that VA drugs can be obtained with prescriptions written by contracted providers. 

In region 23, which includes Iowa, the VA already spends roughly 10 percent of 

its regional healthcare budget on fee-basis care. The fee-basis system is already in 

place, and I believe expanding this system would be a very practical way to address 

the rural access problem. I understand that some are concerned about ensuring 

quality of care for veterans in expanding fee-basis. I would answer that access to 

care is a key component of quality, which is currently lacking for many rural veterans. 

I also understand there are concerns about the integrity of VA medical records 

for veterans moving between VA and non-VA providers. This is one of the issues 

being addressed in the VA’s Project HERO demonstration programs. It is not an insurmountable problem, and I applaud the Chairman for including in his draft rural 

health bill a provision specifically establishing a health information technology pilot 

program to examine ways to improve quality of care for veterans who use fee-basis 

care. 

I know that many of my colleagues representing rural districts share my concerns 

about access to care for veterans. I applaud Jerry Moran and Steven Pearce for also 

bringing legislation forward that would allow veterans to get care closer to home. 

I ask Members of the Subcommittee to carefully consider H.R. 1426 and I look forward to working with you to improve access to healthcare for our rural veterans. 

f 

Prepared Statement of Hon. Jason Altmire, a Representative in Congress 

from the State of Pennsylvania 

I would like to thank Chairman Michaud, Ranking Member Miller and Members 

of the Committee for the opportunity to testify today about H.R. 1944, the Veterans 

Traumatic Brain Injury Act of 2007, bipartisan legislation that I introduced to increase the screening and treatment of traumatic brain injuries (TBI) for our Nation’s veterans. 

Mr. Chairman, we are facing an impending crisis in this country. Our brave men 

and women are returning from Iraq and Afghanistan with TBI at an alarming rate. 

Of those treated at Walter Reed Army Medical Center, 65 percent have been diagnosed with TBI as a primary or co-morbid diagnosis. Many now consider TBI to be 

the signature injury of the wars in Iraq and Afghanistan. 


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I am concerned that the Veterans Affairs Administration may not be properly 

identifying and treating TBI among the Nation’s veterans. It is estimated that more 

than half of all combat casualties have associated brain injuries. Most of them include mild TBI, which is often missed in initial exams as physicians attend to other 

more apparent injuries. 

The Veterans Traumatic Brain Injury Act improves the coordination of TBI care 

for our Nation’s veterans by requiring the Veterans Affairs Administration to screen 

veterans for symptoms, develop and operate a comprehensive program of long-term 

care for post-acute TBI rehabilitation, establish TBI transition offices at all polytrauma network sites, and create and maintain a TBI veteran health registry. 

In our first 4 months, the 110th Congress has taken enormous strides in meeting its commitment to veterans. We have provided more than $11 billion in increased 

funding for veterans’ healthcare and passed the Wounded Warrior Assistance Act 

to improve the management of their medical care. 

I believe that we owe no greater debt than to our veterans and, while we have 

made some progress, we can do more to improve their healthcare. To this end, the 

bipartisan Veterans Traumatic Brain Injury Act will allow us to properly screen 

America’s returning heroes for TBI and improve their treatment. 

Thank you for the opportunity to speak today. I would be pleased to answer any 

questions that you may have. 

f 

Prepared Statement of Hon. Bob Filner 

Chairman, Committee on Veterans’ Affairs 

I appreciate the opportunity to speak on two bills of importance to veterans, especially to the veterans returning from the wars in Iraq and Afghanistan. 

Right now, a special opportunity presents itself!! Forty-two percent of the medical 

problems in the returning servicemembers from Iraq and Afghanistan are musculoskeletal, and many can undoubtedly benefit from chiropractic care. I am one American who has benefited from chiropractic care, so I can promote it in absolute good 

faith. 

H.R. 1470, which former Congressman Jeb Bradley introduced last session, is the 

Chiropractic Care Available to All Veterans Act. It requires that chiropractors are 

phased into the VA, with not fewer than 75 medical centers by the end of December 

2009 and all by the end of 2011. 

H.R. 1471, re-introduced from my bill (H.R. 917) in the last session, is the BACK 

Our Veterans Health Act (The Better Access to Chiropractors to Keep Our Veterans 

Healthy Act.) It requires that veterans have direct access to chiropractic care at VA 

hospitals and clinics, so that veterans do not have to go through a general practitioner, or ‘‘gatekeeper’’ as this doctor is sometimes called. 

We must remember that since the creation of the VA healthcare system, the Nation’s doctors of chiropractic have been kept outside and all but prevented from providing proven, cost-effective, and much-needed care to veterans. So we are grateful 

that access is becoming greater. 

The support for VA chiropractic care is bipartisan in nature. You may recall that 

former Secretary Anthony Principi released a policy directive before his departure 

regarding the true and full integration of chiropractic care in the VA. 

Now, Secretary Nicholson and I have developed a truly working relationship, so 

chiropractic is an area that I will be working on with him. Both Republican and 

Democratic VA Committee Members have supported the inclusion of chiropractic 

care in the VA. 

I have worked closely with chiropractic patients, particularly our veterans, on 

these two bills, as well as with the American Chiropractic Association. Hopefully, 

the two bills I have introduced might not even be necessary, because the VA will 

continue on its own to do what is right. 

But as insurance, it is important to pass H.R. 1470 and H.R. 1471. 

f 

Prepared Statement of Shannon Middleton, Deputy Director for Health 

Veterans Affairs and Rehabilitation Commission, American Legion 

Mr. Chairman and Members of the Subcommittee: 

Thank you for this opportunity to present The American Legion’s view on the several pieces of legislation being considered by the Subcommittee today. In recent 

years, The American Legion conducted a program, ‘‘I Am Not a Number,’’ that identified many of the access problems identified in these bills. In addition, The AmerVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00078 Fmt 6621 Sfmt 6621 E:\HR\OC\35636.XXX 35636

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ican Legion’s series, A System Worth Saving, has also validated many of the issues 

addressed. Research conducted by the Department of Veterans Affairs (VA) indicated that veterans residing in rural areas are in poorer health than their urban 

counterparts. Providing quality healthcare in a rural setting has proven to be very 

challenging, given factors such as limited availability of skilled care providers and 

inadequate access to care. The American Legion commends the Subcommittee for 

holding a hearing to discuss these very important and timely issues. 

Improving Timeliness of Healthcare 

H.R. 92, Veterans Timely Access to Healthcare Act, seeks to establish standards of access to healthcare provided by the Department of Veteran Affairs (VA). 

Although timeliness of care is not a challenge unique to rural areas, veterans who 

reside in rural areas face an additional challenge to accessing care. Setting standards for timeliness in the delivery of healthcare and requiring VA to report on how 

these standards were executed will provide a realistic illustration of the ongoing 

challenges of rural veterans in gaining timely access to care. It will allow VA and 

lawmakers to determine the best ways to improve timely access for rural veterans. 

The American Legion supports this endeavor. 

H.R. 315, Help Establish Access to Local Timely Healthcare for Your Vets 

(HEALTHY Vets), would require the VA to contract with community healthcare 

providers to improve access to healthcare for veterans in highly rural areas. The 

American Legion believes that, where there is very limited access to VA healthcare, 

it is in the best interest of veterans residing in highly rural areas that local care 

be made available to them. Some of these veterans have physical limitations or suffer from conditions that make extensive travel dangerous. Many veterans have expressed concerns to The American Legion about their limited financial resources 

prohibiting travel, citing the rising cost of gas, the limitations of the mileage reimbursement rate, and the need to pay for overnight accommodations, as huge obstacles. Providing contracted care in highly rural communities—when VA healthcare 

services are not possible—would alleviate the unwarranted hardships these veterans 

encounter when seeking access to VA healthcare. 

H.R. 339, Veterans Outpatient Care Access Act of 2007, would improve access at outpatient clinics with exceptionally long waiting periods by allowing veterans to utilize non-VA providers. The American Legion has no official position on 

this issue, but believes that more focus should be placed on remedying the causes 

of the long wait periods to ensure timeliness of care. Doing otherwise would perpetuate the problem. 

Improving Eligibility for Healthcare 

H.R. 463, Honor Our Commitment to Veterans Act, discusses lifting the 

healthcare enrollment restriction on Priority Group 8 veterans. A total of 378,495 

Priority Group 8 veterans have been denied enrollment from the time the restriction 

was instituted in January 2003. The American Legion believes that a more effective 

method of ensuring that VA can continue to provide quality care to veterans would 

be to ensure that VA is sufficiently funded to care for their needs, not limiting access for those who have incomes that fall above means tests thresholds. These veterans are required to make copayments, in addition to identifying their third-party 

health insurance that will reimburse VA for reasonable charges. Many of these Priority Group 8 veterans may very well be VA employees, Medicare beneficiaries, 

TRICARE or TRICARE for Life beneficiaries, or enrolled in the Federal Employees 

Health Benefits Program. The American Legion supports the lifting of the current 

prohibition on healthcare enrollment restriction for Priority Group 8 and exploring 

effective means to improve third-party reimbursement collections. 

Improving Access to Healthcare 

H.R. 538, South Texas Veterans Access to Care Act of 2007, addresses the 

healthcare needs of those who reside in south Texas. Although The American Legion 

has no official position on this proposal, we believe that VA should do everything 

in its power to improve access to its healthcare system for those residing in rural 

areas. H.R. 542, bill to Require the Department of Veterans Affairs to Provide 

Mental Health Services in Languages other than English, seeks to make mental health services available in languages other than English for those who have 

limited English proficiency. The American Legion strongly supports English as the 

official language of the United States. However, The American Legion believes that 

VA needs to remove any hindrance that prevents veterans from obtaining the care 

they have earned through their military service. This is an extremely important 

issue for family members who may be required, by law, to make medical procedure 

decisions on behalf of a veteran. 


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H.R. 1426, the Richard Helm Veterans’ Access to Local Healthcare Options Resources Act, would provide veterans enrolled in the VA healthcare system 

the option of receiving covered health services through non-VA facilities. It also 

would allow VA to fill prescriptions obtained from non-VA doctors. The American 

Legion believes that VA is a Federal healthcare provider not a Federal health insurer like the Department of Health and Human Services (Centers for Medicare and 

Medicare Services). Clearly, there will be unique situations in which VA should and 

must reimburse other healthcare providers, but this should be the exception to the 

rule, not a standard practice. Veterans should not have to travel hundreds of miles 

for healthcare or rehabilitation. 

The American Legion believes veterans should not be penalized or forced to travel 

long distances to access quality healthcare because of where they choose to live. It 

is more important that VA is adequately funded at a level that would allow it to 

service the needs of veterans and to improve access to quality primary and specialty 

healthcare services, using all available means at their disposal, for veterans living 

in rural and highly rural areas. 

The American Legion also supports VA pharmacy benefits for enrolled veterans 

when prescribed by an authorized VA physician or provider in the course of providing medical care. 

Improving Healthcare and Treatment 

H.R. 1470, the Chiropractic Care Available to All Veterans Act, seeks to 

make chiropractic care available at all VA medical centers. The American Legion 

has no official position on this issue. 

H.R. 1471, Better Access to Chiropractors to Keep Our Veterans Healthy 

Act (BACK Our Veterans Health Act), would allow eligible veterans direct access 

to chiropractic care. The American Legion has no official position on this issue. 

H.R. 1527, the Rural Veterans Access to Care Act, would allow highly rural 

veterans who are enrolled in the VA healthcare system to receive covered healthcare 

services through non-VA providers. It would also allow VA to fill non-VA prescriptions for highly rural veterans. As stated previously, The American Legion believes 

that, when there is no other acceptable VA healthcare option, veterans residing in 

highly rural and rural areas should be able to receive healthcare services through 

non-VA providers. 

The American Legion supports VA pharmacy benefits for enrolled veterans when 

prescribed by an authorized VA physician or provider in the course of providing 

medical care. 

Draft Discussion, Rural Veterans Healthcare Act of 2007, discusses a pilot 

program utilizing mobile vet centers in rural areas for a period of 5 years. The provisions in this bill are essential in addressing the challenges to providing quality 

care for rural veterans: 

Section 2 establishes mobile vet centers. The mobile vet centers would provide a 

glimpse of health issues affecting rural veterans, while providing care to mitigate 

the problem of inaccessibility. 

Section 3 establishes a health information technology program. The health information technology program would ensure that rural veterans receive continuum of 

care. 

Section 4 describes the establishment and duties of an Advisory Committee. The 

Advisory Committee on Rural Veterans would regularly assess the needs of rural 

veterans and identify gaps in policy and care. 

Section 5 addresses research and training. Rural health research, education and 

clinical care centers would afford VA the opportunity to build strategies to improve 

its system of care for rural veterans, as well as educate and train healthcare professionals on health issues prevalent in specific rural veteran populations. It also mandates the designation of centers for rural health research, education and clinical activities. 

Section 6 addresses homelessness. It identifies that homeless veterans in rural 

areas have more challenges in obtaining local resources. 

Section 7 discusses rotations and medical residents in rural areas, establishing 

programs to enhance education/training/recruitment and retention of nurses and allied health professionals in rural areas. Since VA has had challenges with finding 

providers who can furnish the types of services needed by veterans in rural areas, 

this section offers a remedy that would result in the ability of VA to provide quality 

care to rural veterans in their communities. 

H.R. 1944, Veterans Traumatic Brain Injury Treatment Act of 2007, seeks 

to have certain veterans screened for symptoms of traumatic brain injury. It also 

discusses the creation of a comprehensive program for long-term care and rehabilitation that includes residential, community and home-based components. The AmerVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00080 Fmt 6621 Sfmt 6621 E:\HR\OC\35636.XXX 35636

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ican Legion believes that the provisions in this bill are both necessary and timely. 

Symptoms of traumatic brain injury may not be obvious and may be dismissed or 

may occur over time. Screening those who were known to have been subjected to 

blast trauma in theater—even if they have no visible physical wounds—would aid 

in diagnosing injuries more quickly. Early diagnosis would also help to mitigate the 

effects of the trauma and improve the chances of a successful rehabilitation. 

Mr. Chairman, a critical element in screening veterans from traumatic brain injury will begin with the quality of the military health records. The Department of 

Defense (DoD) and VA must work in close harmony on this newest identified medical condition. DoD healthcare providers must work to identify and document ‘‘blast 

injuries,’’ especially non-penetrating traumatic brain injury. DoD and VA established the Defense and Veterans Brain Injury Center. However, there remains little 

expertise to formulate an effective definition, clinical guidelines, and treatment for 

returning Operation Enduring Freedom and Operation Iraqi Freedom veterans. 

In most cases, not only is the diagnoses of the less visible injuries of war difficult, 

physical wounds may ‘‘mask’’ the accurate diagnosis and treatment of traumatic 

brain injury. Blast impacts may not be properly documented and consequently the 

patient may have potential brain injuries that may very well go undetected until 

much later after behavioral changes become more evident. 

Currently, DoD does not measure individual cognitive ability upon enlistment or 

pre-deployment; therefore, it is much more difficult to measure any decrease in cognitive ability after deployment that is due to military service. This clearly complicates diagnosis, treatment, and service-connection determinations. 

Again, thank you, Mr. Chairman, for giving The American Legion this opportunity 

to present its views on such an important issue. The hearing is very timely and we 

look forward to working with the Subcommittee to bring an end to the disparities 

that exist in access to quality healthcare in rural areas. 

f 

Prepared Statement of Kimo S. Hollingsworth 

National Legislative Director, American Veterans (AMVETS) 

Mr. Chairman and Members of the Subcommittee: 

I am pleased to appear today to offer testimony on behalf of American Veterans 

(AMVETS) related to pending Department of Veterans Affairs (VA) healthcare bills 

before this Subcommittee. 

The VA healthcare system has evolved into one of the best healthcare systems in 

the Nation. The Veterans Health Administration (VHA) is uniquely qualified to care 

for veterans’ needs because of its highly specialized experience in treating serviceconnected injuries. The VHA provides a wide array of specialized services to veterans and this type of care is extremely expensive. It is absolutely critical that the 

VA healthcare system be fully funded. 

The central problem for veterans with regards to the VA healthcare system is how 

to access the system in a timely fashion. Over the years VA has become increasingly 

efficient in providing timely care, though problems still remain. 

As this Committee is aware, AMVETS hosted the ‘‘National Symposium for the 

Needs of Young Veterans’’ in Chicago, Illinois last year. More than 500 veterans, 

active duty and National Guard and Reserve personnel, family members, and others 

who care for veterans examined the growing needs of our returning veterans. Some 

of the issues relevant to today’s hearing identified at the Symposium include timely 

access to VA healthcare and funding for the Department. AMVETS believes these 

issues are inextricably linked. 

Regarding the 12 bills that this hearing is supposed to cover, AMVETS will discuss the nature of the overriding issue(s) of these proposals and some of our recommended solutions. Overall, AMVETS is concerned about the ‘‘wave’’ of legislative 

proposals to mandate the Secretary of the VA to contract out medical and other 

services. AMVETS recognizes that many of these bills are well intentioned and our 

organization supports veterans being able to access the benefits and healthcare they 

are legally authorized to receive. 

Mr. Chairman, veterans enrolled in the VA are already allowed to elect coverage 

in a non-VA facility. Veterans are free to choose when and where they receive medical care. One of the common themes for all of these proposals is allowing veterans 

to receive care at non-VA facilities and providers and having the Secretary of Veterans Affairs be responsible for the cost of coverage. 

AMVETS reaffirms its commitment that service-disabled veterans should have the 

highest priority access to VA healthcare services and these services should be of the 

highest quality. AMVETS believes that service-connected veterans currently have 


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that level of access and quality in VA today. VA’s current policy statement on this 

issue clearly affirms this priority, as follows: 

‘‘VA is committed to providing priority care for non-emergent outpatient 

medical services and inpatient hospital care for any veteran seeking treatment of his or her service-connected disability. It is VA’s policy to provide 

priority access to outpatient medical care and elective inpatient hospital 

care for any veteran who requires non-emergent care for a service-connected disability. . . . For veterans who are 50 percent service-connected or 

higher, VA’s policy is to provide priority access to medical services and inpatient care, regardless if treatment is needed for their service-connected 

disability.’’

Many of today’s proposals risk some potential unintended consequences to include 

quality control and safety, and potential adverse impact on the statutory requirement by VA to maintain the capacity of specialized medical programs in Public Law 

104–262. Overall, these proposals would seem to move VA toward higher costs. The 

escalating costs of healthcare in the private sector are well documented and VA has 

done an excellent job of holding down costs compared to the private healthcare industry. 

AMVETS believes the central question to all of these ‘‘contract’’ proposals is 

whether or not Members of Congress believe the VA healthcare system is a national 

asset worth preserving or a system that should be abandoned. AMVETS believes the 

problem with VA continues to be access to the system. This in turn is reliant on 

appropriate levels of funding to hire staff, operate facilities and clinics and provide 

unique and specialized services. Appropriate levels of funding would also allow VA 

to open outpatient clinics and provide other contractual arrangements to provide VA 

sanctioned healthcare. 

As we are all well aware, the Secretary of VA already has the authority to enter 

into contracts for medical services. Many of these proposals have some ‘‘triggering’’

mechanism that would mandate the Secretary to contract care. These ‘‘triggering’’

mechanisms appear to be a ‘‘one-time’’ event that authorizes veterans to ‘‘opt out 

of the system’’ and have VA pick up the costs. For lack of a better word, these bills 

appear to authorize a ‘‘vouchering system.’’

Sections 212 and 213 of Public Law 109–461 are specifically targeted at advancing 

the healthcare needs of veterans living in rural areas. VA is mandated to establish 

an Office of Rural Health within the Veterans Health Administration (VHA). The 

office is charged with improving VA healthcare for veterans living in rural and remote areas. Among other provisions, the law requires an extensive assessment of 

the existing VA fee-basis system of private healthcare, and eventual development 

of a VA plan to improve access and quality of care for enrolled veterans who live 

in rural areas. AMVETS would encourage Congress to fully fund the Office of Rural 

Health and allow VA to conduct the mandated assessment. 

Regarding the overall issue of VA providing timely access to care, the Government 

Performance and Results Act, Public Law 103–62, requires that agencies develop 

measurable performance goals and report results against these goals. In the President’s Fiscal Year 2008 budget request, VA focuses on the Secretary of Veterans Affairs priority of providing timely and accessible healthcare that sets a national 

standard of excellence for the healthcare industry. VA generally tracks the timeliness of care in two broad areas—primary and specialty clinic appointments. Over 

the next year, the percent of appointments scheduled within 30 days of the desired 

date is expected to reach 96 percent for primary care appointments and 95 percent 

for specialty care appointments. 

In July 2005, the VA Office of Inspector General reported that VHA’s scheduling 

procedures needed to be improved and issued eight recommendations. As of September 2006, five of the eight recommendations for improvement remained open and 

AMVETS would encourage the Department to implement the remaining recommendations. 

The issue of nonservice-connected veterans accessing VA healthcare is not new. 

Since colonial times, this country has pledged its continued support for medical care 

and other benefits for those who served in the military. During the 1920s, three 

Federal agencies—the Veterans Bureau, the Bureau of Pensions in the Interior Department, and the National Home for Disabled Volunteer Soldiers—administered 

various benefits for the Nation’s veterans. The Congress, in 1924, gave wartime veterans with nonservice-connected conditions access to Veterans’ Bureau hospitals. 

With the establishment of the Veterans Administration (VA) in 1930, previously 

fragmented care for veterans was consolidated under one agency. Over the years, 

Congress expanded eligibility for hospital care and it was gradually extended to 


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wartime veterans with low incomes; then, in 1973, to peacetime veterans with low 

incomes; and finally, in 1986, to higher-income veterans. 

In 1996, Congress passed and the President signed H.R. 3118, the Veterans’

Healthcare Eligibility Reform Act. This veterans’ healthcare bill updated and simplified many of the outdated and existing eligibility rules in effect at that time. Most 

importantly, the bill established a ‘‘medical need’’ as the sole test for veterans who 

enroll for care with VA. In short, veterans have generally always had access to the 

VA healthcare system and they should not now be denied access because of a lack 

of funding; especially if they are willing to pay for these healthcare services. 

The Capital Asset Realignment for Enhanced Services (CARES) was supposed to 

be a systemwide process to prepare the VA for meeting the current and future 

healthcare needs of veterans. CARES addressed the appropriate clinical role of 

small facilities, vacant space, the potential for enhanced use leases and the consolidation of services and campuses. To date, it is the most comprehensive analysis of 

VA’s healthcare infrastructure conducted. 

In May 2004, the VA issued a Decision Document that was supposed to serve as 

VA’s guide for capital planning decisions. Annual updates with new forecasts of future demand were supposed to be incorporated in VA’s strategic planning process. 

The May 2004 Decision Document identified 18 sites for additional analysis and 

studies. Overall AMVETS supported the CARES Commission process. 

As a veteran and patriotic organization, AMVETS also associates itself for the 

purpose ‘‘to help unify divergent groups in the overall interest of American democracy.’’ Veterans earn benefits and services, and are granted access to the system by 

virtue of their qualifying military service. This should continue to be the overriding 

principle when discussing veterans’ issues. Mandating the Secretary to provide services in other than the English language only serves to create division and separation 

among veterans that took an oath to uphold and defend the Constitution of the 

United States in English. 

Mr. Chairman, Public Law 107–135 mandated the VA to require implementation 

of a nationwide chiropractic care program. VA was less than enthusiastic about this 

endeavor and it took the Department until June 2004 to actually make these services available. Overall, chiropractic care is a complementary and alternative healthcare profession with the purpose of diagnosing and treating mechanical disorders of 

the spine and musculoskeletal system with the intention of affecting the nervous 

system and improving health. A similar program was mandated on the Department 

of Defense (DoD) around the same timeframe and DOD. It is AMVETS understanding that the DoD program has been highly successful and we would like to see 

similar results at the VA. 

VA’s approach to Post-Traumatic Stress Disorder (PTSD) is to promote early recognition of this condition for those who meet formal criteria for diagnosis and those 

with partial symptoms. The goal is to make evidence-based treatments available 

early to prevent chronicity and lasting impairment. The same must be done for 

Traumatic Brain Injury (TBI). However, there is no medical diagnostic code specific 

to TBI—a patient may carry more than one diagnostic code (fracture of facial bones, 

concussions, and/or brain injury of an unspecified nature, etc.). AMVETS is asking 

Congress to increase funding for PTSD and TBI, with an emphasis on developing 

improved screening techniques and assigning a new medical code specifically for 

TBI. 

Mr. Chairman, this concludes my testimony. 

f 

Prepared Statement of Adrian M. Atizado 

Assistant National Legislative Director, Disabled American Veterans 

Mr. Chairman and Members of the Committee: 

On behalf of the more than 1.3 million members of the Disabled American Veterans (DAV) and its auxiliary, I wish to express my appreciation for this opportunity to present the views of our organization on healthcare legislation before the 

Subcommittee. 

The DAV is an organization devoted to advancing the interests of service-connected disabled veterans, their dependents and survivors. For the past 8 decades, 

the DAV has been devoted to one single purpose: building better lives for our Nation’s disabled veterans and their families. 

The measures before the Subcommittee today cover a range of issues important 

to DAV, to veterans and their families. My testimony includes a synopsis of each 

of the bills you are considering, along with DAV’s position or other commentary. We 


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ordered our testimony numerically by bill in the same way you listed the bills in 

your letter inviting our testimony. 

We have previously testified that through their extraordinary sacrifices and contributions in military service, veterans have earned the right to the Department of 

Veterans Affairs (VA) healthcare as a continuing cost of national defense. Moreover, 

we adamantly believe America’s free citizens, as beneficiaries of veterans’ service 

and sacrifices throughout our history, desire that the government fully honor its 

moral obligation to provide quality and timely healthcare services to wartime service-connected disabled veterans. 

This Subcommittee is aware the DAV is opposed to any initiative that would turn 

VA into a primary insurer rather than a provider of healthcare to veterans. We believe VA must use its resources to maintain the base of its healthcare services, 

which is provided through and by VA healthcare facilities and healthcare providers. 

This current form of VA healthcare has served well to the benefit of all veterans, 

offers an uninterrupted flow of services to veterans in need, and ensures the quality 

of those services. VA is well recognized as America’s best healthcare value, with the 

lowest error rates, highest satisfaction rate and lowest cost. Why would Congress 

want to contract out some of those services, at higher error rates, lower satisfaction, 

and higher cost? 

Notably, VA currently spends $2 billion or more each year on contract healthcare 

services, from all sources. Unfortunately, as VA’s contract workloads have grown 

significantly, it has not been able to monitor this care, consider its relative costs, 

analyze patient care outcomes, or even establish patient satisfaction measures for 

most contract providers. VA has no systematic process for contracted care services 

to ensure that: 

• care is safely delivered by certified, licensed, credentialed providers; 

• continuity of care is sufficiently monitored, and that patients are properly directed back to the VA healthcare system following private care; 

• veterans’ medical records accurately reflect the care provided and the associated 

pharmaceutical, laboratory, radiology and other key information relevant to the 

episode(s) of care; and 

• the care received is consistent with a continuum of VA care. 

The DAV is deeply concerned that any bill seeking to contract for care outside VA 

without addressing these concerns would essentially shift medical resources and veterans from VA to the private sector to the detriment of the VA healthcare system 

and eventually sick and disabled veterans themselves. Any proposal to contract for 

care with non-Department facilities and providers would encourage VA to refer patients, and thereby spend dollars for their care outside a system that is specifically 

created for veterans. Such a proposal sets a dangerous precedent that, if allowed 

to expand, could endanger VA facilities’ ability to maintain a full range of specialized inpatient and outpatient services for all enrolled veterans. It would erode Veterans Health Administration’s (VHA) patient resource base, undermine VHA’s ability to maintain its specialized service programs, and endanger the well-being of veteran patients under care within the system. 

This Subcommittee is well aware of the funding crisis VA healthcare is experiencing and its impact on sick and disabled veterans who depend on VA’s specialized 

programs. In the years since open enrollment was terminated, VA has been forced 

to do more with less. Even though over the past two budget cycles, Congress has 

provided increased discretionary appropriations for veterans’ healthcare, the funding 

levels have not kept pace with VA’s current services costs and the steady and significant increases in demand for services from enrolled veterans. If given sufficient 

funding on time to meet the growing need of all enrolled veterans’ healthcare, including rural veterans, VA should be held accountable for meeting demand in a 

timely manner. Only as a last resort would we want care to be contracted out. Moreover, if VA timely receives adequate appropriations, it should be expected to plan 

for the appropriate number of staff, infrastructure, and other resources necessary 

to provide veterans medical care in a cost-effective manner. 

H.R. 92 

The stated goal of this bill is to provide timely access to VA healthcare. To accomplish this, a 30-day standard would be established as the maximum length of time 

that a veteran would have to wait to receive an appointment for primary care in 

a VA facility. It would also direct VA to establish a standard for the maximum 

length of time that a veteran would have to wait to actually see a provider on the 

day of a scheduled appointment. Under the bill, if the Secretary found that any particular VA geographic service area failed to substantially comply with the time 


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standards, facilities in that area would be required to contract for the care of a veteran in each instance in which facilities would be unable to meet those standards. 

The contracting requirement would be mandatory for veterans who are classified 

within enrollment Priority Groups 1 through 7, and discretionary for those within 

Priority Group 8. 

The bill would require the Secretary to carry out a one-time examination of waiting time data for the entire system, stratified by geographic service area. The Secretary would be required to issue a determination regarding compliance with the 

standard in each geographic service area. If the compliance rate for any area were 

below 90 percent, then facilities located in that area would be subject to the requirement that they contract for care whenever they are unable to meet those standards. 

The bill would also require that the Department of Veterans Affairs (VA) submit 

a variety of reports to the Committees on Veterans’ Affairs concerning the purposes 

of the bill. 

In addition, the bill’s language pertaining to the payment mechanism VA would 

use for outpatient services provided under the terms of the bill is unclear. Specifically, if VA’s reimbursement rate were linked to current policy under Part B of the 

Medicare Program, VA would be required to pay private providers 80 percent of the 

scheduler fee amount for which Medicare is ordinarily responsible. Under Medicare, 

beneficiaries must meet an annual Part B deductible for all outpatient services. Participating physicians under the Part B program can only receive equitable reimbursement for services rendered by invoicing Medicare beneficiaries the remaining 

20 percent of the scheduler amount, and collect deductibles for given services or procedures. 

DAV has a longstanding legislative resolution stating our firm opposition to copayments in VA healthcare. Under this measure, if a non-Department facility or 

provider were to receive the standard 80 percent of the fee schedule amount for 

which Medicare pays for a particular service, and they are forbidden to bill the veteran for any difference between the billed charges and the amount paid by VA, then, 

we believe this may act as a strong disincentive for private healthcare providers to 

accept and treat veterans under this authority, frustrating the very purposes of the 

bill. 

Mr. Chairman, this Subcommittee held a thoroughgoing legislative hearing on 

September 30, 2003 (Serial No. 108–24) to consider an earlier version of this same 

bill. Among the statements made at that hearing was the following, by the thenUnder Secretary for Health, Dr. Robert Roswell: 

‘‘My concern is that in the long run, I believe veterans are better served 

if we build a system of care that will address their needs, not leave it up 

to geographic location or a particular clinic that they might choose to use 

to determine what their healthcare benefit is on any particular day or any 

particular month. Ultimately, I think we have to build the system that addresses those needs. And purchasing care, because we are frustrated with 

waiting times, may not be the best way to do it. It might be, I don’t know. 

I think we have to explore that in greater detail. I do believe there are a 

number of things that this Committee could do to enhance veterans’ access 

to care. And I appreciate the leadership of the Committee in seeking those 

issues.’’ 

The Subcommittee apparently agreed with Under Secretary Roswell. After considering all the views of witnesses and Members, and reviewing a series of policy 

issues raised by that bill, the Subcommittee took no further action on that bill for 

the duration of that Congress. We do not believe circumstances have changed since 

that time that would warrant this Subcommittee to take any action on the bill now. 

While we appreciate that on its surface this bill would seem helpful in the short 

run to some veterans, its probable but unintended destructive consequences demand 

that we oppose it. 

H.R. 315 

This bill would expand VA’s existing authority to contract for private healthcare 

by redefining ‘‘geographic inaccessibility’’ through the use of population density 

markers and highway mileage distance from VA facilities. Under the bill, if a veteran’s home of residence met a given inaccessibility standard, the Secretary would 

be required to permit that veteran to receive private healthcare for primary care, 

acute or chronic symptom management and for ‘‘nontherapeutic medical services.’’

Most likely the Congressional Budget Office would conclude this bill constitutes 

mandatory spending under the PAYGO policy of the House. 


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As indicated in many other forums including this one, DAV supports passage of 

mandatory, guaranteed or assured VA funding to ensure sick and disabled veterans 

receive adequate VA healthcare, but we do not support mandatory funding for private providers to care for veterans via a VA insurance function. Thus, similar to 

H.R. 92, we do not support this bill. 

H.R. 339 

This bill would require the Secretary, in the case of a VA facility with a waiting 

list of 6 months or greater, to provide for any veteran so informed of that waiting 

period, contract services by private providers under the same terms and conditions 

as those services would be provided in a VA facility. 

DAV opposes this bill for the same reasons we are concerned about the two earlier 

bills dealing with access. Insufficient resources is a primary cause of delayed access 

to care. This can be surmounted with new resources. This measure, like the others 

similarly aimed, would exacerbate VA’s problems by stripping it of what limited resources it possesses to care for the patients now in the VA system, making its rationing and waiting lists even worse. 

H.R. 463 

This bill would legislatively moot Title 38, section 1705, thereby rescinding the 

Secretary’s authority to establish and operate a system of annual enrollments for 

VA healthcare, and it would make every American veteran entitled to enrollment 

for VA healthcare on request. Over 1,000,000 veterans have unsuccessfully attempted to enroll in VA healthcare since the cut-off of enrollments for Priority 8 veterans occurred in 2003. While we certainly support the proponent’s premise that 

every veteran who wants it should be able to enroll in VA healthcare, without a 

major infusion of new funding, enactment of this bill would worsen VA’s financial 

situation, not improve it, and would not serve veterans well. We recommend the 

Subcommittee defer action on this bill until after Congress enacts mandatory, guaranteed or assured funding for VA healthcare. 

H.R. 538 

This bill would establish a requirement for a special study of the needs of veterans in 24 counties of ‘‘far south Texas,’’ with the goal of establishing either a public-private venture, a full service VA facility, or a shared VA-military facility to meet 

their healthcare needs. 

In accordance with our Constitution and Bylaws, the DAV’s legislative agenda is 

determined by mandates formed by resolutions adopted by our membership. We 

have no resolution specific to the provisions of this measure. While we have some 

concerns about whether this bill would contravene the results of the recent Capital 

Assets Realignment for Enhanced Services (CARES) process in one particular geographic area, to the exception of all others, we take no official position on its passage. 

H.R. 542 

This bill would require VA mental health counseling to be provided in languages 

other than English when veterans are not English-proficient. The bill would also require the VA Secretary to ensure the purposes of Executive Order 13166, dealing 

with English as a second language among Federal beneficiaries, are carried out. 

Again, we have no resolution relevant to the provisions of this measure; however, 

its purposes appear beneficial and therefore DAV would not oppose passage of this 

measure. 

H.R. 1426 

This bill would empower an enrolled veteran to elect to receive VA healthcare 

from private sources. Under its terms, the Secretary would have no discretion to 

deny such an election once it was made. The bill would also provide a medication 

benefit to all enrolled veterans for the dispensing of VA pharmaceuticals based on 

prescriptions written by private physicians. For similar reasons supporting our opposition to H.R. 92, H.R. 315 and H.R. 339, we oppose this bill. 

H.R. 1470 and H.R. 1471 

H.R. 1470 would expand VA chiropractic care by requiring such services to be 

available in at least 75 VA medical centers before the end of 2009 and available at 


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all medical centers by the end of 2011. VA was authorized to offer chiropractic care 

and services under the provisions of section 204 of Public Law 107–135, the Department of Veterans Affairs Healthcare Programs Enhancement Act of 2001. We believe chiropractic care offers a valuable healthcare service to veterans and DAV 

members support the systemwide availability of chiropractic services within the VA 

healthcare system. 

While we support broader availability of chiropractic in VA facilities that would 

be brought about by enactment of H.R. 1470, the purpose of H.R. 1471 raises concerns. This bill would establish chiropractic service practitioners on the same level 

as VA medical doctors in the direct provision of primary care services. Each veteran 

receiving care in VA is assigned a single primary care provider, a medical doctor. 

A VA primary care provider is part of a primary care team charged with the responsibility for addressing the healthcare needs of the veterans assigned to that team. 

Accordingly, we believe in the VA healthcare system, access to chiropractic services 

should be provided in consultation with VA primary care providers responsible 

for maintaining the overall health of patients assigned to them. Thus, we oppose 

H.R. 1471. 

H.R. 1527 

Similar to H.R. 315, reviewed above in this testimony, this bill would grant election to veterans living at considerable distances from VA facilities to choose private 

care instead of care in VA facilities. The Secretary would not be able to deny this 

election, and VA would be required to pay associated costs. Furthermore, this measure would provide a pharmaceutical service similar to that of H.R. 1426. DAV opposes this bill for the same reasons as we oppose the earlier measures. 

Draft Bill—Veterans’ Rural Healthcare 

The bill would require the Secretary to establish a mobile ‘‘vet center’’ pilot program in rural areas, and a pilot program for health information exchange with rural 

clinics, critical access hospitals and community health centers in rural areas. It 

would create an Advisory Committee on Rural Veterans and specify its membership 

and mission. The bill would establish at least four VA rural health research, education and clinical activities centers in VA medical centers in rural areas. It would 

amend section 2061 of Chapter 20, Title 38, United States Code, by adding the term 

‘‘rural’’ as one of several groups defined with special needs to be addressed through 

VA’s homeless assistance programs. The bill would expand VA’s graduate medical 

educational mission into rural areas and enhance the education, training, recruitment and retention of nurses in rural areas. Finally, the bill would require a series 

of reports from the VA Secretary dealing with several of the matters contained in 

the bill. 

As this Committee is aware, the cost of providing care in rural and remote areas 

is higher than in urban settings. In much of our deliberation on this issue, we struggle to find a way to fill the indeterminate gap between limited resources and the 

demand for rural healthcare. We are hopeful the creation of an Advisory Committee 

on Rural Veterans and the Rural Health Research, Education and Clinical Care 

Centers will strive to strike the balance we seek when providing better outreach and 

high quality VA medical care to veterans residing in rural and remote areas. Moreover, when striving for good stewardship of taxpayer dollars we ask due consideration be given to the cost effectiveness of the mobile vet center program, which is 

a concern for such a program serving rural areas. Much of the content of this bill 

is consistent with recommendations of the Independent Budget. Further, we believe 

this measure is a good first step in addressing the healthcare needs of rural veterans, thus; DAV fully supports its purposes. 

H.R. 1944 

The Veterans Traumatic Brain Injury Act of 2007 would require the VA to establish a screening program for all veterans of Operations Iraqi and Enduring Freedom, of the Persian Gulf War and earlier conflicts dating from 1998. The bill would 

require the Secretary to report the results of such screening to Congress on an annual basis. The bill would require the Secretary to establish comprehensive traumatic brain injury (TBI) rehabilitation programs in four geographically dispersed 

polytrauma network sites (presently centered in Richmond, Minneapolis, Tampa and 

Palo Alto VA medical centers), and to report that establishment within 1 year of 

enactment, with additional information about the veterans so served. The bill would 

establish a TBI transition office within each polytrauma network to coordinate 

healthcare delivery and other services. The bill would require VA to establish cooperative agreements with other entities capable of providing appropriate services to 


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veterans with TBI. Finally, the bill would establish a TBI registry to identify, track 

and communicate with, veterans suffering from TBI. 

Mr. Chairman, much of the content of this bill is consistent with our review of 

TBI and our recommendations in the Independent Budget for fiscal year 2008. 

Clearly, TBI is going to remain a major focus of VA healthcare for the next several 

decades. Press reports indicate that over 12,000 improvised explosive devices (IEDs) 

have been detonated in the current OIF/OEF campaigns. This means the average 

soldier or marine has been exposed to concussion, possibly multiple times. VA needs 

to prepare for this coming healthcare challenge, particularly for those veterans 

whose exposure may be classified as ‘‘mild,’’ or ‘‘moderate’’ in nature and when no 

head wound resulted from that exposure. We believe this is going to be one of VA’s 

greatest healthcare challenges in the near term. This bill will aid VA in making 

those preparations; thus, we fully support its enactment. 

In previous testimony, the DAV has raised concerns regarding the lack of effective 

screening and clinical assessment tools for mild to moderate TBI. While we applaud 

the Committee for considering this bill, and we support it, we note that VA issued 

a directive in the past 2 weeks (VHA Directive 2007–013), implementing a TBI initiative that features a screening ‘‘pop up’’ within the VistA clinical software system. 

The directive also makes reference to a screening protocol and the mandatory continuing education requirement for specialized training in TBI. The directive makes 

no mention of the clinical assessment tool, which was the subject of a vigorous discussion at the Committee’s hearing on September 28, 2006. We understand that earlier this year, VA established a clinical task group to develop that clinical assessment tool, and we urge the Subcommittee to closely monitor this development to ensure that tool is put into the hands of VA practitioners at the earliest possible time. 

Furthermore, we recommend greater flexibility be afforded to the Secretary regarding the number of locations for which the comprehensive program for long-term 

traumatic brain injury rehabilitation shall be carried out, such that if the need 

arises to expand the program, the current language limits VA’s ability to meet that 

need. Also, the legislative language for eligibility of a veteran to receive care under 

this program may preclude veterans suffering from service-connected TBI. Finally, 

a provision of this measure encourages the Secretary to provide the comprehensive 

program for long-term traumatic brain injury rehabilitation through cooperative 

agreements with appropriate public or private entities. We are cognizant of the opportunities a cooperative agreement may offer but left undefined as currently written, we are concerned that this provision may overtime erode VA’s special emphasis 

program of TBI care. 

Mr. Chairman, this concludes my testimony. I and other members of the DAV 

Legislative Staff will be pleased to make ourselves available to you and your staffs 

for further discussion of our positions on any of these issues, in hopes of working 

toward compromise on measures that we can eventually support. Thank you for asking DAV to testify today. I will be pleased to respond to any of your or other Committee Members’ questions. 

f 

Prepared Statement of Carl Blake 

National Legislative Director, Paralyzed Veterans of America 

Mr. Chairman and Members of the Subcommittee, on behalf of Paralyzed Veterans of America (PVA), I would like to thank you for the opportunity to testify 

today regarding the proposed legislation. We recognize that the Department of Veterans Affairs (VA) faces serious challenges as it continues to face rapidly growing 

demand on its healthcare system. It seems ironic that in the face of some criticism 

about the care being provided in VA facilities that the demand on the system has 

never been higher. 

H.R. 92, THE ‘‘VETERANS TIMELY ACCESS TO HEALTHCARE ACT’’

H.R. 92, the ‘‘Veterans Timely Access to Healthcare Act,’’ would establish standards of access to care within the VA healthcare system. Under the provisions of this 

legislation, the VA will be required to provide a primary care appointment to veterans seeking healthcare within 30 days of a request for an appointment. If a VA 

facility is unable to meet the 30-day standard for a veteran, then the VA must make 

an appointment for that veteran with a non-VA provider, thereby contracting out 

the healthcare service. The legislation also requires the Secretary of the VA to report to Congress each quarter of a fiscal year on the efforts of the VA healthcare 

system to meet this 30-day access standard. 


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Access is indeed a critical concern of PVA. The number of veterans enrolled in 

the VA is approaching 8 million and the number of unique users is nearly 6 million. 

Despite the ongoing policy to deny enrollment to Category 8 veterans, the numbers 

of enrolled veterans will continue to increase, particularly as more and more veterans of the Global War on Terror take advantage of the services in VA. 

Unfortunately, funding for VA healthcare has not kept pace with the growing demand. Furthermore, Congress has failed to live up to its responsibility to provide 

adequate funding in a timely manner. Despite a positive funding outlook for this 

year, we remain skeptical. As long as VA continues to receive funding months into 

its fiscal year, it will never be able to properly plan to meet demand. To that end, 

access standards without sufficient funding provided by the start of the fiscal year 

are standards in name only. 

PVA is concerned that contracting healthcare services to private facilities when 

access standards are not met is not an appropriate enforcement mechanism for ensuring access to care. In fact, it may actually serve as a disincentive to achieve timely access for veterans seeking care. Contracting out to private providers will leave 

the VA with the difficult task of ensuring that veterans seeking treatment at nonVA facilities are receiving quality healthcare. We do think that access standards are 

important, but we believe that the answer to providing timely care is in providing 

sufficient funding in the first place in order to negate the impetus driving healthcare rationing. For these reasons, PVA cannot support H.R. 92. 

H.R. 315, THE ‘‘HELP ESTABLISH ACCESS TO TIMELY HEALTHCARE 

FOR YOUR VETS (HEALTHY VETS) ACT’’

H.R. 1527, THE ‘‘RURAL VETERANS ACCESS TO CARE ACT’’

Because these two bills principally address the same issue, I will outline our concerns with the proposed bills in one statement. PVA is fully aware of the challenges 

the VA faces every day to provide timely access to quality healthcare for veterans 

who live in rural areas of the country. However, we are concerned that in addressing the problem of access for these veterans, the long-term viability of the VA 

healthcare system may be threatened. PVA members rely on the direct services provided by VA healthcare facilities recognizing the fact that they do not always live 

close to the facility. The services provided by VA, particularly specialized services 

like spinal cord injury care, are unmatched in the private sector. If a larger pool 

of veterans is sent into the private sector for healthcare, the diversity of services 

and expertise in different fields is placed in jeopardy. 

Ultimately, PVA has serious concerns about the provisions of this legislation that 

would give VA additional leverage to broaden contracting out of healthcare services 

to veterans in geographically remote or rural areas. If you review the early stages 

of VA’s Project HERO, it is apparent that this is a direction that some VA senior 

leadership would like to go. We believe that this pilot program would set a dangerous precedent, encouraging those who would like to see the VA privatized. Privatization is ultimately a means for the Federal Government to shift its responsibility of caring for the men and women who served. 

Current law limits VA in contracting for private healthcare services to instances 

in which VA facilities are incapable of providing necessary care to a veteran; when 

VA facilities are geographically inaccessible to a veteran for necessary care; when 

medical emergency prevents a veteran from receiving care in a VA facility; to complete an episode of VA care; and, for certain specialty examinations to assist VA in 

adjudicating disability claims. The VA could better meet the demands of rural veterans through more judicious application of its fee-for-service program. 

In the end, we believe that in order for the VA to best meet this demand, adequate funding needs to be provided for VA healthcare in a timely manner. As we 

previously stated, placing the VA in the position it has dealt with for many years 

because Congress continues to wrangle over Federal budgets, does not prepare the 

VA to properly meet demand, including demand in rural areas. 

Finally, we realize that it is an extremely difficult task to establish a standard 

for when a veteran’s home is considered to be rural. This legislation attempts to do 

so by stating defining ‘‘geographically inaccessible’’ in terms of a population density 

as it relates to a distance from a VA facility. However, this is very much a subjective idea. Access to VA healthcare is subject not only to population density or distance, but time as well. The difficulty in addressing this subject is apparent just by 

comparing the methods that the proposed bills take to define rural accessibility. 

However, due to the concerns that we have outlined, PVA cannot support H.R. 315 

or H.R. 1527. 


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H.R. 339, THE ‘‘VETERANS OUTPATIENT CARE ACCESS ACT’’

PVA opposes H.R. 339, the ‘‘Veterans Outpatient Care Access Act.’’ As with the 

previous bills discussed, this bill would simply encourage broader contracting out of 

healthcare services without attempting to fix the problems that exist as a result of 

insufficient funding. With adequate resources and staffing, the challenges faced by 

outpatient clinics could be minimized. However, with the passage of this legislation, 

the VA would be discouraged from doing the right thing. For example, if a local clinic loses a particular specialty doctor, that clinic would likely turn to a contract provider without trying to refill that position. 

Legislation such as this, once again, allows the Federal Government to absolve 

itself from the responsibility to care for the men and women who have served and 

sacrificed for this country. It is time for Congress to stop trying to pass the buck 

and provide the resources it will take the VA to provide this critical care. It makes 

no sense to continue to consider legislation that would lead veterans away from the 

best healthcare system in America. 

H.R. 463, THE ‘‘HONOR OUR COMMITMENT TO VETERANS ACT’’

PVA fully supports H.R. 463, the ‘‘Honor Our Commitment to Veterans Act.’’ The 

provisions of this legislation are in accordance with the recommendations of The 

Independent Budget. We have continued to advocate for this policy to be overturned 

since it was put into place. It is unacceptable that these veterans are being denied 

access to healthcare simply because the Administration and Congress have been unwilling to provide the necessary funding to reopen the VA healthcare system to 

them. We believe this policy should be overturned and that adequate resources 

should be provided to overturn this policy decision. 

VA estimates that more than 1.5 million Category 8 veterans will have been denied enrollment in the VA healthcare system by FY 2008. Assuming a utilization 

rate of 20 percent, in order to reopen the system to these deserving veterans, The 

Independent Budget estimates that VA will require approximately $366 million in 

discretionary dollars. 

H.R. 538, THE ‘‘SOUTH TEXAS VETERANS ACCESS TO CARE ACT’’

PVA has no official position on this legislation. We believe that this is a local access issue. If a demonstrated need is there, then the VA must develop a solution 

to meet the needs of the men and women in this region. 

H.R. 542 

PVA has no opposition to the provisions of H.R. 542. Overall, we are pleased with 

the direction that VA has taken and the progress it has made with respect to its 

mental health programs. A great deal of time and resources have been invested in 

the VA’s mental health programs in recent years to meet the growing demand of 

new veterans from Operation Enduring Freedom and Operation Iraqi Freedom 

(OEF/OIF). The War Supplemental currently being debated even includes significant additional resources to meet the mental health needs of OEF/OIF veterans. 

Many of the servicemembers who have served in OEF/OIF have experienced mild 

to severe mental health problems. Our only concern is that the VA does not invest 

considerable resources into the requirements of this legislation if the demand for 

such services is not really there. However, given that we do not have specifics about 

this type of demand, we would simply urge the VA to proceed with caution. 

H.R. 1426, THE ‘‘RICHARD HELM VETERANS’ ACCESS TO LOCAL 

HEALTHCARE OPTIONS AND RESOURCES ACT’’

PVA finds it difficult to comprehend the rationale for establishing a precedent for 

veterans in the VA healthcare system to leave that system and seek services elsewhere, as this proposed legislation would do. Over the past year we have read, as 

I am sure every Member of Congress has, all of the accolades given to VA healthcare by independent observers, newsweeklies and other publications. While we believe VA represents the best available care, oversight is needed to provide an additional guarantee that VA-provided services are of the highest quality for all veterans 

who use VA, especially for those with service-connected disabilities. 

While this legislation may be well intentioned, the potential unintended consequences far outweigh any benefit that this bill might provide. There would almost 

certainly be a diminution of established quality, safety and continuity of VA care 

if veterans were to leave the system. It is important to note that VA’s specialized 

healthcare programs, authorized by Congress and designed expressly to meet the 


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needs of combat-wounded and ill veterans, such as the blind rehabilitation centers, 

prosthetic and sensory aid programs, readjustment counseling, polytrauma and spinal cord injury centers, the centers for war-related illnesses, and the national center 

for post-traumatic stress disorder, as well as several others, would be irreparably 

affected by the loss of service-connected veterans from those programs. The VA’s medical and prosthetic research program, designed to study and hopefully cure the 

ills of disease and injury consequent to military service, would lose focus and purpose were service-connected veterans no longer present in VA healthcare. Additionally, Title 38, United States Code, section 1706(b)1 requires VA to maintain the capacity of these specialized medical programs, and not let their capacity fall below 

that which existed at the time when Public Law 104–262 was enacted. 

While as a consequence of enactment of this bill some service-connected veterans 

might seek care in the private sector as a matter of personal convenience, they 

would lose the many safeguards built into the VA system through its patient safety 

program, evidence-based medicine, electronic medical records and medication 

verification program. These unique VA features culminate in the highest quality 

care available, public or private. Loss of these safeguards, that are generally not 

available in private sector systems, would equate to diminished oversight and coordination of care, and ultimately may result in lower quality of care for those who 

deserve it most. 

With regards to the prescription drug provisions included in the legislation, P.L. 

108–199, the ‘‘Consolidated Appropriations Act of 2004’’ provided the Secretary of 

VA the authority to dispense prescription drugs from Veterans Health Administration (VHA) facilities to enrolled veterans with prescriptions written by private physicians. Included in the public law, and further explained in the Conference Report 

H. Rpt. 108–401, was the requirement that the VA would incur no additional cost 

in providing such a benefit. 

VA physicians, by being the sole source of care, have been fully able to monitor 

patients for potentially contra-indicative prescriptions. PVA is concerned that if VA 

is to accept non-VA physician written prescriptions, veteran patients may be put at 

risk with this loss of monitoring should the patient seek treatment both inside and 

outside the VA healthcare system. 

H.R. 1470, THE ‘‘CHIROPRACTIC CARE AVAILABLE TO ALL VETERANS 

ACT’’

PVA has no opposition to H.R. 1470, the ‘‘Chiropractic Care Available to All Veterans Act.’’ Chiropractic care is another medical service that could benefit many veterans and disabled veterans who face spinal and musculoskeletal difficulties. Currently, the VA provides chiropractic care in selected sites in accordance with P.L. 

107–135, the ‘‘Department of Veterans Affairs Healthcare Programs Enhancement 

Act of 2001.’’ We see no problem with expanding this specialty care to the broader 

VA healthcare system; however, we must emphasize that adequate resources must 

be appropriated to allow VA to provide this care. 

H.R. 1471, THE ‘‘BETTER ACCESS TO CHIROPRACTORS TO KEEP OUR 

VETERANS HEALTHY ACT’’

As we previously stated, PVA has no objection to the provision of chiropractic care 

within the VA healthcare system. However, we do not support section 3 of this legislation which would elevate chiropractors to the status of a primary care physician 

in the VA. The primary care provider is responsible for assessment of illness and 

injury and triage to the appropriate specialty care. The primary care provider also 

provides basic care far beyond the scope of musculoskeletal conditions and the interaction with the nervous system—the principal focus of chiropractors. We believe 

that chiropractic care should be provided in consultation with the primary care provider responsible for the total healthcare needs of the veteran. 

H.R. 1944, THE ‘‘VETERANS TRAUMATIC BRAIN INJURY TREATMENT 

ACT’’

PVA supports H.R. 1944, the ‘‘Veterans Traumatic Brain Injury Treatment Act.’’

It is fair to say that traumatic brain injury (TBI) is considered the signature health 

crisis for Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) 

veterans. We believe that the provisions of this legislation will enhance the ability 

of the VA to provide comprehensive care for veterans with TBI; however, we also 

have a couple of concerns with the legislation. 

Proper screening for this newest generation of veterans is critical to their immediate and long-term care. Unofficial statistics suggest that many OEF/OIF veterans 


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have suffered mild brain injuries that have gone undiagnosed. In many cases, symptoms have manifested themselves after the veterans have returned home. The Department of Defense (DoD) admits that it lacks a systemwide approach for proper 

identification, management, and surveillance for individuals who sustain mild to 

moderate TBI. It is only appropriate that the VA be able to fill the gap left by DoD. 

Furthermore, it will allow the VA to identify veterans who have experienced a 

TBI but whose symptoms have been masked by other conditions. We have heard 

anecdotally that this is a particular problem for veterans who have incurred a spinal cord injury in the upper cervical spine. Veterans who have incurred this level 

of injury as a result of a blast incident often have experienced a traumatic brain 

injury as well. However, their symptoms may be diagnosed as the result of their 

significant impairment at the cervical spinal level. 

PVA certainly supports the need for a comprehensive long-term care program for 

veterans who have experienced TBI. The VA is the only real healthcare system in 

America capable of providing complex sustaining care over the life of the seriously 

disabled veteran. Private treatment options often give no consideration whatsoever 

to the long-term care needs of the veteran. Meanwhile, the VA has developed its 

long-term care program across the broad spectrum of services for many years. 

However, we have some concern about the provision of this legislation that defines 

an eligible veteran as one who has served on active duty in a combat theater of operations. Recognizing that the vast majority of newly injured TBI veterans have experienced their injury as a result of combat service, this should not preclude the VA 

from providing long-term care services to any TBI veteran whose condition is service-connected. 

PVA also is concerned about the provision within the section establishing TBI 

transition offices that further encourages cooperation with public and private entities. We understand that outside facilities and programs can bring some level of expertise to this population of veterans. However, we would hope that the VA would 

see fit to invest the majority of its resources in improving its own TBI programs, 

even as it taps into outside expertise. We urge the Congress, and VA, to proceed 

with caution as it looks to services provided outside of the VA healthcare system. 

THE ‘‘VETERANS RURAL HEALTHCARE ACT’’

PVA recognizes that there is no easy solution to meeting the needs of veterans 

who live in rural areas. These veterans were not originally the target population of 

men and women that the VA expected to treat. However, the VA decision to expand 

to an outpatient network through the Community-Based Outpatient Clinics reflected the growing demand on the VA system from veterans outside of typical 

urban or suburban settings. 

PVA has no objection to the proposal to create two mobile vet centers. However, 

the one caution we would offer is that services provided in this manner tend to be 

more expensive and less cost-effective. I would suggest that mobile services tend to 

be much more cost-effective in areas where a large segment of the target population 

can be served because it drives down the overall cost-per-patient. This implies that 

mobile centers would be best served in urban areas. However, we are willing to 

allow this pilot program to test the waters. We would suggest that the length of the 

program be shortened to 3 years or less so as to allow a sooner cost-benefit analysis 

of that program. 

We fully support the creation of an Advisory Committee on Rural Veterans. We 

are particularly pleased that the legislation includes a provision for Veterans Service Organization representation; however, we believe that more than one voice 

should be included. While the proposal includes the Secretary of Health and Human 

Services and the Director of the Indian Health Service as ex officio Members of the 

Committee, we believe that the Department of Defense Under Secretary for Personnel and Readiness or the Assistant Secretary of Defense for Health Affairs 

should also be included. This committee could provide well-researched and reasonably considered alternatives for rural healthcare. 

We also support the creation of rural health research, education, and clinical care 

centers. These centers would essentially serve as centers-of-excellence for rural 

healthcare. This could allow the VA to address the needs of rural veterans through 

broad application of the ‘‘hub-and-spoke’’ principle. This is the same structure utilized in the spinal cord injury service. A veteran can get his or her basic care at 

a Community-Based Outpatient Clinic (spoke). However, if the veteran requires 

more intensive care or a special procedure, he or she can then be referred to the 

larger rural research, education, and clinical care center (hub). This would ensure 

that the veteran continues to get the best quality care provided directly by the VA, 

thereby maintaining the viability of the system. It will also allow the VA to develop 


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excellence within the actual VA healthcare system, instead of farming out these 

services to the private sector. 

Mr. Chairman and Members of the Subcommittee, we recognize that the challenges the VA faces in the healthcare arena are difficult. However, we must reiterate that the VA will struggle to meet the ever-growing demand of veterans, particularly rural veterans, as long as it does not receive adequate resources in a timely 

manner. It is unreasonable, and frankly unacceptable, to place expectations on VA 

to meet certain types of demand, if it is not given the resources and tools necessary. 

Furthermore, allowing the VA to send veterans out into the private sector for care 

will absolutely not be the most cost-effective approach, nor will it allow veterans to 

get the best quality of care. 

We look forward to working with the Subcommittee to develop workable solutions 

that will allow veterans to get the best quality care available. I would like to thank 

you again for allowing us to testify on these important measures. I would be happy 

to answer any questions that you might have. 

f 

Prepared Statement of Dennis M. Cullinan 

Director, National Legislative Service 

Veterans of Foreign Wars of the United States 

MR. CHAIRMAN AND MEMBERS OF THIS COMMITTEE: 

On behalf of the 2.4 million members of the Veterans of Foreign Wars of the U.S. 

(VFW) and our auxiliaries, I would like to thank you for your invitation to testify 

at today’s important hearing on healthcare legislation. 

The bills under consideration today mostly revolve around what has been the 

most critical issue confronting the Department of Veterans Affairs (VA) healthcare 

system: access. We have long argued that the primary reason for most of the access 

problems veterans have is because of the lack of adequate and timely funding given 

to VA. We appreciate the increases of the last few years, and this year’s historic 

budget resolution, but we need to ensure that VA receives the money on time, and 

that subsequent increases in future years keep pace with the needs of the veterans’ population. 

H.R. 92, the Veterans Timely Access to Healthcare Act 

This legislation would establish access standards within VA for veterans seeking 

care. For primary healthcare appointments, it would require veterans to be seen 

within 30 days. In certain circumstances, it would require VA to contract for care 

when VA is unable to live up to that access standard. 

The VFW strongly supports the intent of this legislation, but we do have some 

concerns about the contracting aspect. There is no doubt that veterans should not 

have to wait to access healthcare, especially for primary appointments. A few years 

ago, there were over 300,000 veterans throughout the country who were waiting 6 

months or more for primary healthcare appointments, but VA has made great 

strides to reduce this and most initial appointments are being made within that 30- 

day standard. We do understand that there are certain geographical areas where 

this is not the case, however. 

We are concerned about the cost of contract care, especially when VA is acknowledged to provide healthcare at a lower cost than other providers. While it would 

greatly benefit veterans in areas with long waiting times, we must be mindful of 

it not eating into the healthcare budget for other locations. If other areas have fewer 

funds to work with they, too, will ration healthcare, increasing waiting times systemwide. We must be mindful of these unintended effects, and ensure that the entire healthcare system has the funding and resources it needs to adequately care 

for all veterans. 

H.R. 315, the HEALTHY Vets Act 

This legislation aims to improve healthcare access for rural veterans by increasing 

contracting opportunities for veterans in geographically remote areas. This issue is 

of particular concern to our members, as a great number of them live far from VA 

medical centers, and often have difficulty accessing their earned healthcare. 

We strongly support the intent of this legislation, which creates a sliding scale 

for contracting eligibility depending on distance and county density to determine 

whether a veteran lives in a rural area. 

We do have concerns, however, with the potential for overuse of contracting care, 

as we did with H.R. 92, but there are certainly areas where its use is proper. We 

must be mindful of a demonstration project VA is currently undergoing, Project 

HERO. We have been supportive of Project HERO’s aims, and think it might be 


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wise to see how effective the demonstration project is, and what lessons can be 

learned from it before making a sweeping legislative change. 

Despite this, there are areas, particularly with respect to the challenges faced by 

today’s returning servicemembers suffering from traumatic brain injuries and other 

blast injuries that could be supplemented with fee-basis care, but this is an area 

that is going to require strong Congressional oversight to ensure that these wounded warriors are receiving optimal care. 

H.R. 33 

The VFW supports the intent of this legislation, which is similar to H.R. 92, in 

that it establishes standards of care for veterans waiting to receive care from VA. 

In the case of H.R. 339, it establishes a 6-month access standard for any care a veteran is to receive, and if that standard is not met, VA must provide fee-basis care. 

In the wide majority of cases, this standard would not come into play for primary 

care, but there are a great many places, especially in more rural areas, where specialty care presents unique access problems. In these areas, VA might not have the 

full number of specialists it needs, or they have overwhelming patient loads. Regardless, a 6-month wait is inexcusably long, and we cannot expect our sick and disabled veterans to wait that long, especially when none of us in the room today 

would wait that long for our care. 

H.R. 463 

The VFW strongly supports the goal of this legislation, which would end the 4- 

year freeze on the enrollment of new Category 8 veterans. Category 8 veterans are 

those mostly nonservice-connected veterans making above a geographically adjusted 

amount, and it includes veterans making as little as $26,902. These veterans, since 

January 2003, are no longer allowed to enroll in the healthcare system, and are 

turned away from their earned healthcare. VA estimates that 1.5 million veterans 

will have been denied enrollment by the end of fiscal year 2008. 

If this legislation is enacted, Congress must also ensure a corresponding funding 

increase to pay for the care of these veterans. It is not enough to have VA make 

do; that will just result in the return of healthcare rationing and growing lines for 

care. Further, this cannot be a 1-year fix. Congress must continuously and fully 

fund VA healthcare in a timely manner in future years. 

The VFW believes that all veterans have earned access to high-quality healthcare 

in a timely manner through their service to this Nation. When the freeze was put 

into place, it was a time of severe budget shortages and extreme waiting times. We 

believe that the policy was a short-term fix to allow VA to manage the crisis and 

feel that it is time to end this unfair policy. 

H.R. 542 

The VFW supports this bill, which would make mental health services available 

for veterans with limited English proficiency. 

An increasing number of service men and women are coming from foreign countries. There are approximately 30,000 non-citizens serving in the military today, 

coming from around the globe. The vast majority of these heroes plan to use their 

military service as a springboard for citizenship, and their dedication to this country’s ideals and their patriotic spirit, as manifested through their willingness to 

serve, cannot be questioned. These men and women put their lives on the line the 

same way any American-born servicemember does as they fight side-by-side. And 

they often suffer the same disabilities and illnesses. 

Although we understand the difficulty some would have with providing options for 

treatment in other than English, we must be mindful that this legislation only covers mental health services, where clear and direct communication is integral to 

treatment and recovery. It is often difficult enough for English-speaking natives to 

communicate the emotions and problems they are facing; we cannot throw another 

barrier up for the treatment of those who have given much for this country. Their 

service is just as valuable as that of an English speaker, and the care and treatment—to make them whole—is just as essential. 

H.R. 1426 

The VFW strongly opposes this legislation, which would allow any veteran to elect 

to receive contracted care whenever they choose. As we have acknowledged in our 

comments to previous legislation, there are certainly cases where contract care is 

appropriate. A blanket and widespread use of it to anyone and everyone, however, 

is shortsighted and misguided. 

First, we reiterate our concerns with the costs of such care. Fee-basis care is more 

expensive than that of VA, and we believe that it would do great harm to those vetVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00094 Fmt 6621 Sfmt 6621 E:\HR\OC\35636.XXX 35636

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erans who elect to stay in the high-quality VA healthcare system by taking away 

funding for the system as a whole. 

Second, we have strong concerns about the viability of the healthcare system 

should this bill be enacted. VA has four essential missions, all of which depend on 

one another, and which greatly improve the quality of care for all Americans, not 

just our veterans. (1) It serves as the healthcare system for this Nation’s sick and 

disabled veterans; (2) It acts as the primary education and training grounds for 

America’s healthcare professionals (48,000 medical residents and students receive 

training at VA each year); (3) It provides world-class research opportunities and the 

development of new medical technologies; and (4) It is the backup to the Department of Defense healthcare system in national emergencies. 

We cannot lessen one of these missions without sacrificing the others. Reducing 

the number of veterans seeking care from VA would do irreparable damage to the 

others, affecting all Americans. 

Further, contract care would present problems, especially with the continuum of 

care and VA’s ability to monitor and track the healthcare needs of veterans over 

their entire lives. It would also potentially erode the quality of care VA provides, 

especially with respect to the illnesses and disabilities veterans suffer from, such 

as gunshot wounds or prosthetics, and for which VA is uniquely qualified to treat. 

Although this legislation aims to expand the coverage available to veterans, it 

would only dilute the quality and quantity of the services provided to new and existing veterans today and into the future. That is unacceptable. 

H.R. 1470, the Chiropractic Care Available to All Veterans Act 

The VFW supports this legislation which would require VA medical centers to 

begin hiring chiropractors at each facility. Currently, VA averages around one chiropractor per VISN. 

A great number of veterans suffer from musculoskeletal injuries, and although 

chiropractors are not for every veteran, they should be available as an option. As 

part of a team that includes pain management and orthopedic specialists as well 

as physical therapists, a great number of injuries can be managed and symptoms 

improved. 

H.R. 1471 

The VFW opposes this legislation, which would allow veterans to receive direct 

access to chiropractic services. Although we support these services, we believe that 

they should be part of the specialty care process, requiring a referral from a primary 

care physician. This is important for case management and to ensure that a veteran’s primary physician is fully aware of the treatments a veteran is undergoing, 

especially if that chiropractor service is a part of the team-based approach we discussed in our comments on H.R. 1470. 

Further, it is important to remember that no other VA healthcare specialty allows 

for direct access by patients. 

H.R. 1527 

We also support the intent of this legislation that would, like H.R. 315 discussed 

above, allow for the contracting of care for certain veterans in rural areas. 

Despite our support, our concerns about this legislation are similar to those of 

that bill as well. 

Namely, we are concerned with the continuity of care, as records would need to 

be transferred back and forth, which could create difficulties with VA’s state-of-theart electronic medical records system. We are also concerned with the costs that 

such a program could incur as fee-basis care is more expensive than that provided 

by VA. 

We would urge the Committee to consider the results of Project HERO before passage of this bill, though. The lessons we can learn from this—which would answer 

some of these questions we have laid out—would be beneficial to the entire system, 

and determine whether a large-scale proposal such as this is truly feasible. 

H.R. 1944 

The VFW offers our strong support for this legislation which would require VA 

to implement a screening program for traumatic brain injuries (TBI). 

TBI is the signature wound of this war, as thousands of our men and women in 

uniform are being exposed to blasts and other traumas which are doing great damage to their brains. This is an area where this Nation clearly must do more to care 

for our sick and disabled, the wounded warriors of this war. 

TBI manifests itself in a number of ways. While some are able to live with its 

effects, it makes life extremely difficult for others. We know much about its causes 

and immediate symptoms, but we must know more about it. We have repeatedly 


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called for more studies to fully understand the injuries, their causes, their effects, 

and especially their long-term impacts. 

This legislation considers the long-term impact, and for those who need it, it 

would establish programs to provide long-term care and rehabilitation. This is sorely 

needed. 

Further, it fosters the development of partnerships with other healthcare institutions through the creation of a TBI transition office, which is charged with coordinating services that are not readily available through VA. Given the difficulties we 

have sadly seen with some of these wounded warriors receiving the care they need, 

especially for those who live far from the polytrauma centers, this is an excellent 

step. Many of these clinics and specialty care facilities have great experience with 

brain injuries and can provide these patients the care they desperately need, and 

VA with the expertise and training it needs to fulfill its most sacred of missions. 

Draft Bill, the Rural Veterans Healthcare Act 

The VFW supports this bill which would make changes and improvements to the 

availability of healthcare for rural veterans. 

This legislation includes important provisions that would expand vet centers, and 

create an Advisory Committee on rural veterans. In concert with last year’s passage 

of a law that creates an Office of Rural Health within VA, there is much potential 

to reach those veterans who have difficulty accessing their earned VA healthcare. 

It also would create four VA healthcare centers on rural health research, education and clinical care. These centers would allow for research into the delivery of 

healthcare to rural veterans, education and training for healthcare professionals, 

and for the innovation of clinical activities to benefit rural veterans. 

With over 44% of returning servicemembers living in rural areas, the access problems they and all veterans face is of increasing importance. This legislation acknowledges that, and we are happy to support it. 

Mr. Chairman, I thank you for the opportunity to present the VFW’s views on 

these important bills today, and I look forward to any questions that you or the 

Members of this Subcommittee may have. 

f 

Prepared Statement of Richard F. Weidman 

Executive Director for Policy and Government Affairs 

Vietnam Veterans of America 

Chairman Michaud, Ranking Member Miller, and Members of the Subcommittee 

on Health, Vietnam Veterans of America (VVA) thanks you for the opportunity to 

testify here today. And on behalf of our officers, our Board of Directors, our members and their families, we thank you, too, for the important work you are doing, 

and the initiatives you are taking, on behalf of our Nation’s veterans. 

We would like to focus our comments this morning on three of the bills up for 

your consideration. They are H.R. 463, H.R. 1944, and the discussion draft of the 

‘‘Rural Veterans Healthcare Act of 2007.’’

Priority 8 Veterans/H.R. 463, the ‘‘Honor Our Commitment to Veterans 

Act,’’ would re-open the VA healthcare system to Priority 8 veterans. These are veterans with an income of less than $28,000 a year who are not afflicted with a service-connected disability and who agree to make a co-payment for their healthcare 

and prescription drugs. 

Back in 1996, when Congress passed the Veterans Healthcare Eligibility Reform 

Act, the VA was able to implement major cornerstones of its plan to reform how 

it provided healthcare. The rationale behind this initiative was to ensure a patient 

base that would support the infrastructure needed to develop a modern, integrated 

healthcare system. This the VA has done, and in the process it has transformed a 

mediocre, inefficient system into a national model. 

However, the law—that’s Public Law 104–262—gave the Secretary of Veterans Affairs the authority and responsibility to determine eligibility for enrollment based 

on available resources in any given fiscal year. Although the law did not mandate 

a level of funding or a standard of care, it did establish an annual enrollment process and categorized veterans into ‘‘priority groups’’ to manage enrollment. 

On January 17, 2003, the Secretary made the decision to ‘‘temporarily’’ suspend 

Priority 8 veterans from enrolling. While this decision may be reconsidered on an 

annual basis, every budget proposal from the Administration since has omitted 

funding for unenrolled Priority 8 veterans and attempts to discourage use and enrollment of those ‘‘higher income’’ veterans. 


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Priority 8 veterans are, for the most part, working- and middle-class Americans 

without compensable disabilities incurred during their military service. In its budget proposal for fiscal year 2007, the VA estimated that some 1.1 million of these 

‘‘higher income’’ veterans would be discouraged from using their healthcare system because of a $250 enrollment fee and increased co-pays for prescription drugs. 

Thankfully, you in Congress have not let this scheme get much beyond the proposal 

phase. 

H.R. 463 would amend Section 1705 of Title 38, United States Code, by 

adding this new subsection: The Secretary shall administer the healthcare enrollment system under this section so as to enroll any veteran who is eligible under this 

section for such enrollment and who applies for such enrollment. 

Enacting this bill into the law of the land would keep the promise, keep the covenant with those veterans who, for whatever reasons, would choose to use the VA 

for their healthcare needs. We believe that their addition to the rolls would ease 

some of the fiscal pressures experienced by the VA insofar as it is Priority 7 and 

8 veterans whose private health insurance accounts for some 40 percent of the VA’s third-party collections. 

Of course, the bottom line is funding—the funding Congress provides—to enable 

the VA to accommodate those Priority 8 veterans who want to avail themselves of 

the VA’s medical services. VVA will be releasing shortly a White Paper on veterans’ healthcare funding, which will place this issue in context. 

TBI/Traumatic brain injury suffered by our troops in Afghanistan and Iraq has 

become so relatively common that it is referred to by its acronym, TBI. This affliction is not new; it has only been so codified because of the carnage caused by IEDs, 

improvised explosive devices, another acronym that has been incorporated into the 

dialect of war. 

We understand that the Administration is going to order the military to screen 

all returning troops for mild to moderate cases of TBI; those whose brain injuries 

are more serious are quite obvious to clinicians. H.R. 1944, the ‘‘Veterans Traumatic Brain Injury Treatment Act of 2007,’’ would go a long way toward assuring troops afflicted with this debilitating condition that help will be there for them. 

Focusing TBI care at four VA polytrauma centers, establishing and maintaining a 

registry of veterans diagnosed with TBI, and developing and inaugurating a comprehensive program for long-term TBI rehabilitation will go a long way toward healing the wounded from these latest military ventures. 

Rural Veterans Access to Care/How to provide more convenient access to quality healthcare for veterans residing in rural areas has been the subject of more than 

a few hearings over the past two sessions of Congress. The language in this proposed bill is as sensible as it is needed. It would establish pilot projects to see what 

is most effective in providing care. One of these pilots would expand access to vet 

centers via mobile centers in rural areas. Another would establish a health information technology program. 

Perhaps more importantly, this legislation would direct the Secretary of Veterans 

Affairs to establish an Advisory Committee on Rural Veterans, which would identify 

specific problems and areas of concern and suggest cost-effective solutions. It would 

require the Under Secretary for Health to designate a minimum of four VA healthcare facilities as the locations for centers of rural health research, education, and 

clinical activities. And it would establish programs to enhance the education, training, recruitment, and retention of nurses and other health professionals in rural 

areas. 

In seeking ways to better serve our rural veterans, this bill would not impose bureaucratic ‘‘solutions’’ that could and, we believe, would only serve to undermine the 

VA healthcare system. H.R. 92, the ‘‘Veterans Timely Access to Healthcare 

Act,’’ would give the VA a scant 30 days to set up an appointment with a primarycare provider; if a VA medical center is unable to meet this standard for access to 

care, the option would be to send a veteran to a non-VA facility. H.R. 1426, the 

‘‘Richard Helm Veterans’ Access to Local Healthcare Options and Resources Act,’’ would offer an eligible veteran the option of obtaining healthcare 

from a non-VA facility or provider. H.R. 1527, the ‘‘Rural Veterans Access to 

Care Act,’’ would expand the use of fee-basis care through which private hospitals, 

healthcare facilities, and other third-party healthcare providers are reimbursed. It 

would impose a series of conditions, or distances, to help define ‘‘rural.’’ Like H.R. 

1527, H.R. 315, the inelegantly named ‘‘Help Establish Access to Local Timely 

Healthcare for Your Vets (HEALTHY Vets) Act of 2007’’ would add bureaucratic clutter to those whose responsibility it is to provide healthcare for veterans 

in ‘‘geographically inaccessible’’ areas. 

Rather than improve healthcare for veterans, this quartet of bills, along with H.R. 

339, the ‘‘Veterans Outpatient Care Access Act of 2007,’’ would, if enacted, 


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usurp the VA healthcare system. Today, one out of every ten VA healthcare dollars 

goes to clinicians and facilities outside the VA system. Through a scheme called 

Project HERO—the acronym for Healthcare Effectiveness through Resource Optimization—the VA is attempting to get a better handle on the dollars spent by VA medical centers on care provided outside of the system. We believe that HERO—and 

this quartet of bills—would only serve to hurt what has developed into one of the 

best-managed care systems in the Nation. HERO is a pilot in four VISNs, one that 

we believe will eventuate in half care for twice the cost. 

One bill we do applaud is H.R. 538, the ‘‘South Texas Veterans Access to 

Care Act of 2007.’’ ‘‘They’ve been looking at this for a long time,’’ one VVA leader 

in Texas told us. ‘‘We did get an outpatient clinic in Conroe, in east Texas, but there 

are a lot of veterans in south Texas who are poorly served.’’ If one in five of the 

114,000 veterans there uses the VA as their healthcare provider, that’s 11,400 who 

have to trek up to San Antonio for any real care. 

H.R. 538 basically says, let’s find out the facts, whether the needs of veterans in 

far south Texas for acute inpatient care would best be met through a project for a 

public-private venture to provide inpatient services and long-term care in an existing facility, through construction of a new full-service, 50-bed hospital with a 

125-bed nursing home, or through a sharing agreement with a military treatment 

facility. 

This is a very worthy bill, one that deserves serious consideration by this Subcommittee and by the HVAC at large. 

VVA also endorses H.R. 542, which would require the VA to provide mental 

health services in languages other than English, as needed, for veterans with limited English proficiency. While it can be argued that, to make it in today’s military 

a troop needs proficiency in English, it is quite possible that (s)he is more conversant, and more comfortable, speaking in his/her native language. And many families 

of our diverse population of servicemembers are hardly fluent in English. When 

troops return from places like Iraq, which have seared their soul and messed up 

their mind, and need counseling, it is highly beneficial to have a trained and competent counselor or therapist who can ‘‘relate’’ better because (s)he speaks Spanish, 

or French, or Vietnamese. 

Finally, two bills that would effectively expand chiropractic care in VA medical 

centers, H.R. 1470 and H.R. 1471, are also worthy of passage—if proper standards 

of care are spelled out and enforced. We also would encourage, as part of these bills, 

a mandate for the VA to examine other ‘‘alternative’’ forms of medicine, so long as 

they conform to VA’s evidence-based medical study. To this end, VVA suggests that 

part of this legislation should direct the Secretary of Veterans Affairs to appoint a 

committee to look at the efficacy of these alternative medical techniques with an eye 

toward integrating the most worthy of them into the VA healthcare system. 

This concludes our testimony. Again, VVA is appreciative of having been afforded 

the opportunity to testify on the merits of these bills. We would be pleased to respond to any of your questions. 

f 

Prepared Statement of Gerald M. Cross, M.D., FAAFP 

Acting Principal Deputy Under Secretary for Health 

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

Good morning, Mr. Chairman and Members of the Subcommittee: 

Thank you for inviting me here today to present the Administration’s views on 

several bills that would affect Department of Veterans Affairs (VA) programs that 

provide veteran healthcare benefits and services. With me today is Walter Hall, Assistant General Counsel. We are able to present views for most of the bills on the 

Subcommittee’s agenda. However, because of the limited time we have had to evaluate these bills, we stand ready to work with you to provide further information, including costs, at a later time for those pieces of legislation we are not able to fully 

address today. 

H.R. 92—Standards of Access to Care 

Mr. Chairman, I will begin by addressing H.R. 92. This bill would establish 30 

days as the standard within which VA must provide a veteran with primary care 

(measured from the day the veteran contacts VA seeking primary care to the day 

on which the primary-care visit is completed). The bill would also require VA to establish a standard for how promptly patients must be seen in relation to their 

scheduled appointments in VA facilities (measured from the time of day of the veteran’s scheduled appointment to the time of day the veteran actually sees the proVerDate Aug 31 2005 06:35 Apr 23, 2008 Jkt 035636 PO 00000 Frm 00098 Fmt 6621 Sfmt 6621 E:\HR\OC\35636.XXX 35636

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vider). There would be consequences for those facilities that do not meet these 

standards 90 percent of the time. In such facilities, if VA is unable to meet either 

of these standards with respect to a veteran, VA would be required to contract for 

that veteran’s care in non-VA facilities if the veteran is enrolled in Priority Groups 

1–7. VA would be authorized (but not required) to contract for such care if the veteran is enrolled in Priority Group 8. 

The bill provides that payments under these contracts could not exceed the reimbursement rate under Medicare, and the non-VA facility or provider would be prohibited from billing the veteran for the difference between the billed amount and 

the amount of VA’s payment. 

We have no significant objection to H.R. 92 with respect to the 30-day standard 

for the scheduling of patients but ask the Committee to change the bill language 

to clarify that it would in fact apply only to new patients. It is these patients who 

need to be tracked to understand if there are difficulties accessing the VA system 

of care. In most areas, VA already complies with and exceeds these standards. Almost all VA facilities currently comply with the 30-day standard 90 percent or more 

of the time. We note, however, that in those situations where this bill would require 

VA to contract for care, restricting VA to paying the Medicare rate could make it 

difficult for VA to obtain the care in the private sector. There is no requirement in 

the bill that contractors, even if they are Medicare providers, agree to accept the 

Medicare rate from VA. This would limit the services that the VA could provide to 

veterans if the services cannot be purchased in the community at that rate. 

VA already has in place a standard requiring that a patient see his or her provider within 20 minutes of the scheduled appointment. We monitor facilities’ compliance with this standard periodically through the use of quarterly patient satisfaction surveys. These surveys are based on a sampling of patients who report retrospectively on their perception of their last outpatient VA experience. I’ll emphasize 

here that these ‘‘waiting room times’’ are important to VA as a matter of customer 

service. Results from the Fiscal Year 06 Customer Satisfaction Survey indicate that 

77.8% of our patients waiting for primary care services are seen within 20 minutes 

of their appointment, and 70.5% of veterans obtaining specialty care services are 

seen within 20 minutes of their appointments. We are unaware of any other metric 

that could be used to implement the bill’s requirements. 

We also believe the bill’s approach is overly prescriptive and, as a result, would 

not provide latitude that is in the patient’s best interest. Quality of care would be 

interrupted and fragmented with an increased requirement to send veterans outside 

the system. Moreover, the requirement that VA contract for care for patients waiting more than 20 minutes would not remedy the wait-experience of the patient for 

that visit. The bill is also flawed in that it assumes that all private care in the community meets the proposed standards. There are no measures available to support 

this assumption. 

Please be assured that VA, from top to bottom, considers within-room-time an important aspect of customer service. 

We are still in the process of developing costs for H.R. 92 and will provide them 

for the record. 

H.R. 463—Termination of the Administrative Freeze on Enrollment of Veterans in Category 8 

Mr. Chairman, as you and the Subcommittee are well aware, VA suspended the 

enrollment of new veterans in the lowest statutory enrollment category (Priority 

Category 8—veterans with higher incomes and no compensable service-connected 

disabilities) in January of 2003. This action was taken to protect the quality and 

improve the timeliness of care provided to veterans in higher enrollment-priority 

categories. H.R. 463 would require VA to enroll all eligible veterans. VA strongly 

opposes enactment of H.R. 463. 

In 1996, Congress passed an Eligibility Reform law that allowed VA to treat veterans in the most appropriate treatment setting. Additionally, in order to protect 

the traditional mission of VA (to cover the healthcare needs of service-disabled and 

lower-income veterans), that law originally defined seven priority levels (PL) of veterans—PL 7 veterans (higher-income and not service-disabled) were the lowest priority. The law mandated that beginning in FY 1999, VA use its enrollment decision 

to ensure that care to higher-priority veterans was not jeopardized by the infusion 

of lower-priority veterans into the system for the first time. In FYs 1999 through 

2002, the VA Secretary determined in each year that all veterans were able to enroll. Prior to 1999, PL 7 veterans’ care was not funded in budgets, but they could 

use the system on a space available basis. Consequently, they were only about 2% 

of the annual users. In FY 2001, 25% of enrollees and 21% of users were PL 7 veterans (using 9% of the resources). In 2001 PL 7 veterans were split into two parts—


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those making above the geographic-specific HUD threshold for means tested benefits 

were moved to a new PL 8 category. More than half of the 830,000 new enrollees 

in FY 2002 were in Priority Group 8 and VA was not able to provide service-connected and lower-income enrolled veterans with timely access to healthcare services 

because of the unprecedented growth in the numbers of the newly eligible category 

of users. When the appropriation was finally enacted for FY 2003, VA’s Secretary 

made the decision that the Department would not enroll any new PL 8 veterans— but those currently in the system would retain their right to care. Every appropriation since 2003 has supported this enrollment decision. 

H.R. 463 would essentially render meaningless the prioritized enrollment system, 

leaving VA unable to manage enrollment in a manner that ensures quality and access to veterans in higher priorities. VA would have to add capacity and funding 

to absorb the additional workload that this bill would entail, and so the quality and 

timeliness of VA healthcare to all veterans, including service-disabled and lower-income veterans, would unavoidably suffer until this capacity is added. 

We note VA has authority to enroll combat-theater veterans returning from Operation Enduring Freedom and Operation Iraqi Freedom in VA’s healthcare system 

and so they are eligible to receive any needed medical care or services. 

H.R. 1426—Option for Enrolled Veterans to Receive Covered Health Services through Non-VA Facilities 

Mr. Chairman, H.R. 1426 would permit enrolled veterans to elect to receive any 

and all hospital and outpatient care in non-VA facilities. Veterans would make their 

election by simply submitting an application to VA. VA would be required to authorize payment for such care pursuant to a contract entered into with the facility. In 

addition, the bill would require VA to fill veterans’ prescriptions written by non-VA 

physicians. 

VA strongly opposes enactment of H.R. 1426. We fully concur in the views of several of the major Veterans Service Organizations, who recently wrote to the Chairman of the Senate Committee on Veterans’ Affairs in opposition to a more modest 

proposal, S. 815, which would permit veterans with service-connected disabilities to 

obtain their healthcare at any private medical facility. (We will provide this letter 

to the Committee for the record.) Legislation to similarly cover all enrolled veterans, 

as proposed by H.R. 1426, would be all the more problematic. At bottom, H.R. 1426 

could lead to the undoing of the VA healthcare system—a world-class healthcare 

system—as we know it today. For this fundamental reason, we must oppose H.R. 

1426. 

We also have other concerns. The proposal would fragment the care of our veterans. VA would no longer have a complete record of all the care a veteran has received. This could lead to VA duplicating care already provided in the private sector 

or providing care that conflicts with what the veteran is receiving in the private sector. As you are aware, some in the private sector rely on paper records while the 

VA uses a comprehensive electronic health record. Electronic records promote patient safety. We are concerned that the bill, if enacted, could jeopardize continuity 

of care for our patients. 

These patient safety concerns also extend to the requirement that VA fill veterans’ prescriptions written by non-VA physicians. We are a provider of care, including pharmacological services. VA should not serve as a mere pharmacy; rather VA 

facilities should continue to be a point of care where a veteran can receive all needed care in a safe, coordinated, and fully integrated fashion. We provide comprehensive care and continuity of care. 

We also point out that VA has neither the capacity to meet this demand nor the 

resources to carry out H.R. 1426. In fact, VA’s mail order pharmacy service is already at full capacity. Increasing this workload would require adding additional capacity, in addition to the cost of the additional drugs. 

Although we have not completed our cost projections for this bill, we underscore 

that the bill could have significant cost implications. As soon as the cost estimates 

become available, we will supply them for the record. 

Mr. Chairman, I now turn to the two bills currently under consideration by the 

Subcommittee that would address access to healthcare for rural veterans. 

H.R. 315—Fee Basis Authority for Veterans for Whom VA Facilities are Geographically Inaccessible 

H.R. 1527—Rural Veterans Access to Care Act 

H.R. 315 would require the Secretary to contract with non-VA facilities to furnish 

primary care services, acute or chronic symptom management, non-therapeutic medical services, and other medical services as deemed appropriate to veterans for 

whom VA facilities are geographically inaccessible. Veterans covered by this bill 


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would include those who live in a county with a population density of less than 7 

people per square mile and who live more than 75 miles away from the nearest VA 

healthcare facility; those who live in a county with a population density of more 

than 7 and less than 8 people per square mile and who live more than 100 miles 

from the nearest VA healthcare facility; and those who live in a county with a population density of more than 8 and less than 9 people per square mile and who live 

more than 125 miles from the nearest VA medical facility. This bill would take effect at the end of a 120-day period beginning on date of the enactment. 

H.R.1527 also relates to healthcare for enrolled veterans who reside in highly 

rural areas. 

Section 2 of H.R. 1527 would permit an enrolled eligible veteran to elect to receive 

healthcare through a non-VA healthcare provider. Veterans covered by this bill 

would include: veterans seeking primary care services who reside more than 60 

miles driving distance from the nearest VA facility that provides primary care services; veterans seeking acute hospital care who reside more than 120 miles driving 

distance from the nearest VA hospital providing acute care; and, veterans seeking 

tertiary care who reside more than 240 miles driving distance from the nearest VA 

facility providing tertiary care. 

Also covered by section 2 of H.R. 1527 would be veterans whose distance from the 

nearest appropriate VA healthcare facility does not exceed the above-stated parameters but who experience hardship or other difficulties in traveling to a VA facility 

such that the Secretary deems travel to a VA facility not to be in the veteran’s best 

interest, as determined under VA regulations. 

In carrying out section 2, the Secretary would be required to consult with the Secretary of Health and Human Services to establish a partnership to coordinate care 

for rural veterans at critical access hospitals, community health centers, and rural 

health clinics. 

Section 3 of H.R. 1527 would require the Secretary to furnish covered veterans 

with prescription drugs that are ordered by licensed, non-VA physicians. Under this 

section, VA would be required to furnish these medications in the same manner, 

and subject to the same conditions, as apply to medications that are prescribed by 

VA physicians. 

Both bills would give rise to obstacles to successful implementation and further 

expansion of our strategic plans, which focus on delivering healthcare services 

through sources that are nearest to a rural veteran’s home. Both bills would create 

administrative issues, and implementation may simply be unworkable. We are also 

concerned that the requirements of section 3 of H.R. 1527 would result in fragmentation of a veteran’s medical care and the undermining of the VA formulary 

process, both of which put the patient at increased risk. 

Mr. Chairman, while we share the Subcommittee’s concern for ensuring that rural 

veterans have adequate access to needed healthcare and services, we ask that the 

Subcommittee forbear in its consideration of either H.R. 315 or H.R. 1527. In accordance with Congress’ mandate in the ‘‘Veterans Benefits, Healthcare, and Information Technology Act of 2006,’’ VA just recently established the Office of Rural 

Health (ORH) within the Veterans Health Administration. Part of that office’s 

charge is to see how we can continue to expand access to care for rural veterans. 

We therefore recommend that no legislative action be taken in this area until VA 

has had sufficient time to complete and review the internal assessments currently 

underway by ORH and other Department components. We will of course share those 

findings with the Subcommittee along with our recommendations. 

VA has already done much to remove barriers to access to care for enrolled veterans residing in rural areas. Currently, over 92 percent of enrolled veterans reside 

within 1 hour of a VA facility, and 98.5 percent of all enrollees are within 90 minutes. Still, we continue our efforts to try to ensure that all enrolled veterans living 

in rural areas have adequate and timely access to VA care. We expect the data for 

this year to be even better. 

Community-Based Outpatient Clinics (CBOCs) have been the anchor for VA’s efforts to expand access to veterans in rural areas. CBOCs are complemented by contracts in the community for physician specialty services or referrals to local VA medical centers, depending on the location of the CBOC and the availability of specialists in the area. In addition, there are a number of rural outreach clinics that are 

operated by a parent CBOC to meet the needs of rural veterans, and several additional outpatient clinics are positioned to provide care for veterans in surrounding 

rural communities. VA’s authority to contract for care under 38 U.S.C. 1703 provides a local VA medical center director with another avenue through which to meet 

the needs of many rural veterans. 

These efforts have borne fruit. Rural veterans tell us that they are satisfied with 

the services and high-quality care we are providing to them. This is substantiated 


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by their reporting higher satisfaction with VA services in comparison to their urban 

counterparts. Moreover, performance measure data indicate that as a result of our 

intensive efforts to expand services for rural veterans, veterans have access to services much nearer to home. In 1996, VA users of mental health services lived an average of 24 miles from the nearest VA clinic; as of 2006, they now live only 13.8 

miles away. Quality of care in the rural environment matches that of urban care 

on 40 standard measures. 

Finally, we note that among the services that VA would be required to provide 

under H.R. 315 are ‘‘non-therapeutic medical services.’’ The meaning of this term 

is unclear. If the Subcommittee is to act on H.R. 315, we ask it specify what services 

this provision is intended to cover. 

We are still in the process of developing cost estimates for both H.R. 315 and H.R. 

1527. We will supply them for the record as soon as they become available. 

H.R. 1470—Enhancement of Chiropractic Care Program 

Mr. Chairman, H.R. 1470 is one of two bills relating to the provision of chiropractic care. It would require VA to increase to not fewer than 75 the number of 

VA facilities directly providing chiropractic care through VA medical centers and 

clinics. H.R. 1470 would require this to be implemented by not later than December 31, 2009. In addition, H.R. 1470 would require that chiropractic care be provided at all VA medical centers by no later than December 31, 2011. 

VA does not support H.R. 1470. VA does not oppose eventually increasing the 

number of VA sites providing chiropractic care. Currently, there is a facility with 

an in-house chiropractic care program in each of our geographic service areas. However, we do not believe, based on current usage rates, that sufficient demand for 

chiropractic care will exist to justify the mandate to provide chiropractic care at all 

VA medical centers by the end of 2011. Currently, 98% of VA patients are able to 

get chiropractic care within 30 days of their desired date. 

Mr. Chairman, costs for H.R. 1470 are not yet available. We will supply them for 

the record. 

H.R. 1471—Chiropractic Care Practice Expansion 

The second bill on chiropractic care is H.R. 1471. This bill would appear to permit 

eligible veterans to elect to receive needed medical services, rehabilitative services, 

and preventive health services from a licensed chiropractor on a direct access basis, 

as long as the chiropractor acts within the scope of practice authorized under his 

or her State license. 

VA uses chiropractic care to address certain muscular-skeletal conditions. However, we strongly object to extending, through legislation, the field of chiropractic 

care to the treatment of other medical conditions. In our view, because VA’s healthcare system is national in scope, it should limit the scope of practice of the chiropractors to those procedures that are generally recognized to be within the scope 

of their practice, notwithstanding that some States may authorize them to provide 

other procedures. 

We have built our success on the primary care model using physicians who are 

trained and educated in primary care medicine. Primary care providers not only coordinate the delivery of healthcare services but also make referrals for specialty 

care, as needed and appropriate. We believe it is in our patients’ best interest to 

continue having their individual primary care providers remain in charge of managing their care. 

H.R. 1471 could also place our patients at serious risk. Our aging patient population is characterized by a high degree of co-morbidities and complex medical conditions that require intensive and highly integrated clinical management skills. Their 

care should remain under the care of individual primary care providers and/or 

teams. 

Finally, this bill would prohibit the Secretary from discriminating among licensed 

healthcare providers in the determination of needed services. However, the meaning 

and intent of this provision is not clear to us. 

H.R. 339—Provision of Care from Non-VA Sources When There is an Extended Waiting Period for VA Care 

Mr. Chairman, H.R. 339 would require VA to furnish needed medical services 

from sources outside the Department to veterans who seek medical services at a VA 

outpatient clinic but are informed by the clinic that the waiting period for treatment 

of patients is 6 months or longer. This bill would also require such services to be 

provided under the same terms and conditions with respect to eligibility and copayments as would apply if such services were provided directly by the VA clinic. H.R. 

339 would require the Secretary to issue regulations to implement this provision, 

which would take effect 90 days after enactment of the Act. 


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Mr. Chairman, we have not had sufficient time to evaluate H.R. 339 and its costs. 

We will provide written comments on this bill for the record. 

H.R. 538—Access to Care for Veterans Residing in Far South Texas 

H.R. 538 sets out a series of findings regarding the healthcare needs of veterans 

residing in far south Texas, a geographical area defined in the bill. Within 180 days 

following enactment, the Secretary would be required to determine whether the 

needs of veterans in far south Texas would best be met—(1) through a public-private venture to provide inpatient services and long-term care to veterans in an existing facility in far south Texas; (2) through a project for construction of a new fullservice, 50-bed hospital with a 125-bed nursing home in far south Texas; or (3) 

through a sharing agreement with a military treatment facility in far south Texas. 

H.R. 538 would require the Secretary to notify Congress as to the Secretary’s findings and to submit a report to Congress identifying which of these options has been 

selected, along with a prospectus that includes projected timelines and additional 

specified data. 

We do not support H.R. 538. At the request of Senator Kay Bailey-Hutchison, VA 

has contracted with Booz Allen Hamilton to evaluate and report on current needs 

in this region of the country. This report is due to be delivered to VA in July 2007. 

VA recommends that Congress await the results of this ongoing evaluation before 

it considers whether to mandate a particular means for addressing the healthcare 

needs of these veterans. 

H.R. 542—Provision of VA Services in Languages Other Than English for 

Veterans With Limited English Proficiency 

Mr. Chairman, section 1 of H.R. 542 would require the Secretary to ensure that 

counseling and other authorized mental health services are available in both 

English and a language other than English, if requested by a veteran who has limited proficiency in the English language. H.R. 542 would further mandate that the 

Secretary develop procedures to identify veterans with limited English proficiency 

and inform them of this provision. 

Section 2 of H.R. 542 would require the Secretary to implement a system by 

which persons with limited English proficiency can meaningfully access VA services 

consistent with, and without unduly burdening, the fundamental mission of the Department. This section would require the Secretary to work to ensure that recipients 

of financial assistance under VA programs, in turn, provide meaningful access to applicants and beneficiaries with limited English proficiency. 

Under section 2, the Secretary would also be required to implement a plan to improve access to VA programs and activities by eligible persons with limited English 

proficiency, and to ensure that the plan is consistent with a guidance document 

issued by the Attorney General in conjunction with Executive Order 13166. The 

plan would have to include specific steps that the Secretary would take to ensure 

that these persons can meaningfully access VA programs and activities. 

Section 3 of H.R. 542 would require the Secretary to carry out a number of specified tasks, in developing and implementing the plan required by section 2. These 

tasks would include: (1) conducting a thorough assessment of the language needs 

of the population served by VA and identifying the non-English languages that are 

likely to be encountered; (2) developing a comprehensive language assistance program to include hiring bilingual staff and interpreters for patient and client contact positions; (3) translating written materials into languages other than English; 

(4) training staff on this VA access policy and its implementation; (5) establishing 

vigilant monitoring and oversight to ensure that persons with limited English proficiency have meaningful access to healthcare and services; (6) establishing a task 

force to evaluate the implementation and prioritize needed actions to implement the 

access plan; (7) developing a specific plan to ensure seamless transition of veterans 

and their families from Department of Defense services and benefits to VA services 

and benefits, including bilingual readjustment and bereavement counseling; (8) establishing a process to translate vital documents and other materials, including materials available on the World Wide Web, outreach brochures provided to 

servicemembers transitioning into civilian life, and the post-deployment health reassessment program; and (9) conducting outreach to veterans and their families in 

communities which may have higher proportions of populations with limited English 

proficiency. 

Finally, section 4 of H.R. 542 would require the Secretary to report to Congress 

on VA’s implementation of VHA Directive 2002–006 (prohibiting discrimination on 

the basis of national origin for persons with limited English proficiency in federallyconducted programs and activities and in Federal financial assisted programs). This 


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report would also have to include an analysis of VA’s capacity to provide services 

to members of the Armed Forces with limited English proficiency. 

Because we received a copy of H.R. 542 only very recently, we are still in the process of developing views and cost estimates for this bill. Once completed, we will provide them for the record. But we would like the Subcommittee to know that VA has 

taken significant steps to ensure that Executive Order 13166 is fully implemented 

throughout the Department. On February 12, 2007, VHA issued Directive 2007–009, 

Limited English Proficiency (LEP) Title VI Prohibition Against National Origin Discrimination in Federally-Conducted and Federally-Assisted Programs and Activities. This new policy updates the guidance previously set forth in VHA Directive 2002– 006 and sets forth VHA’s guidance on services to individuals with LEP. Similar 

guidance documents have also been issued by the National Cemetery System and 

the Veterans Benefits Administration. These LEP actions plans ensure that VA facilities and programs fully implement all LEP requirements. 

Mr. Chairman, in anticipation of this hearing, we also received a draft bill entitled the ‘‘Rural Veterans Healthcare Act of 2007’’ and a copy of H.R. 1944, the ‘‘Veterans Traumatic Brain Injury Treatment Act of 2007.’’ Because we received these 

two bills only very recently, we do not have cleared positions or costs to provide on 

the measures. We will provide written comments on the draft bill and H.R. 1944 

for the record. 

This concludes my prepared statement. I would be pleased to answer any questions you or any of the Members of the Subcommittee may have. 

f 

Statement of the American Academy of Neurology 

The American Academy of Neurology (AAN), representing over 20,000 neurologists and neuroscience professionals, believes that our veterans deserve the best 

possible care and treatment for neurological injuries sustained in their service to 

our country. The conflicts in Iraq and Afghanistan have created an emerging epidemic of traumatic brain injury (TBI) among combat veterans. TBI is associated 

with cognitive dysfunction, post-traumatic epilepsy, headaches and other motor and 

sensory neurological complications. 

It is essential that the Federal Government allocate the resources to ensure all 

veterans have access to the necessary neurological interventions and long-term 

treatments that their injuries require. The AAN believes that Congress should fund 

and the Department of Defense (DoD) should fully implement pre- and post-deployment cognitive and memory screening of all active duty and reserve personnel. Recognizing that this is not yet a reality, the AAN supports the goal of H.R. 1944 to 

establish a program within the Department of Veterans Affairs (VA) to screen veterans who are eligible for hospital care, medical services, and nursing home care. 

The AAN also supports the effort to create a comprehensive program for long-term 

traumatic brain injury rehabilitation, but would recommend the inclusion of a specific program to address the impacts of TBI including seizure disorder. TBI is a 

major cause of epilepsy. We estimate that up to 40 percent of returning service personnel who experience TBI will develop epilepsy making this a significant serviceconnected disorder for many veterans. 

Given the likely high rate of service-connected post-traumatic epilepsy that veterans with TBI will experience, Congress should authorize and the VA should fully 

implement a national epilepsy program. This program should include a statutory 

mandate and the necessary appropriations for Epilepsy Centers of Excellence 

(CoEs), available to all veterans with epilepsy and related seizure disorders. Congress should authorize no less than six Epilepsy CoEs to ensure adequate geographic distribution and access by veterans to these centers. The VA should also implement epilepsy referral clinics in all Veterans Integrated Service Networks 

(VISNs). 

Congress should also appropriate adequate funds to improve the integration and 

coordination of neurology, mental health and rehabilitative services in the VA’s 

polytrauma program. Every TBI veteran should have a neurologist as part of the 

rehabilitation team. The Neurology and Mental Health Services should become 

equal partners with the Rehabilitation Services with respect to TBI in the polytrauma centers and subsequent initiatives involving TBI. 

We support the Committee’s efforts to improve VA’s delivery of care to rural veterans. We recommend that the draft Rural Veterans Healthcare Act of 2007 include 

a provision to improve care to those in rural areas with an expansion in telehealth 

and telemental health services offered by the VA to improve the surveillance and 

treatment of veterans with TBI and related seizure disorders. Specifically, VA needs 


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to develop its telemedicine capacity to transmit and review Electroencephalograms 

(EEGs), a diagnostic test which measures and records brain electrical activity, to VA 

specialists in epilepsy for interpretation as needed. The recommended Epilepsy Centers of Excellence would play a vital role in expanding VA’s capacity to provide rural 

veterans with state-of-the-art diagnosis and clinical care through improvements in 

telemedicine. 

The American Academy of Neurology appreciates the opportunity to comment on 

H.R. 1944 and the draft Rural Veterans Healthcare Act of 2007. We stand ready 

to assist the Health Subcommittee and the full Committee in any efforts to help veterans who experience TBI. f 

Statement of Hon. Corrine Brown, a Representative in Congress from the 

State of Florida 

Thank you, Mr. Chairman. 

I appreciate your calling this hearing today to listen to the many important bills 

introduced this Congress relating to veterans. 

As I have known since I was first sworn into Congress in 1993, when I first began 

my service on this Committee, veterans are very important to the security and defense of this country. 

Under the leadership of you, Chairman Michaud, and Chairman Filner, we are 

taking back the leadership of veterans issues to this Committee. It is important for 

the Veterans Committee to be the conduit for the veterans of this country to the 

Department of Veterans Affairs. 

Thank you again for holding this hearing and I look forward to hearing the testimony of the witnesses. f 

Statement of Hon. Rube ́n Hinojosa, a Representative in Congress from the 

State of Texas 

I want to thank Chairman Michaud and Ranking Member Miller for holding this 

important hearing today on legislation that will help improve the quality of healthcare for our veterans. I am here to express my strong support for H.R. 538, offered 

by my colleague from south Texas, Congressman Solomon Ortiz, of which I am a 

cosponsor. 

South Texas has a proud history of patriotism and thousands of south Texans 

have fought in all of this country’s major wars. They have returned to south Texas 

with a variety of injuries and illnesses as a result of their military service. Unfortunately, the closest veterans’ hospital is more than 300 miles away in San Antonio. 

Many south Texas veterans do not have the financial means to travel to San Antonio and stay overnight in hotels waiting for appointments and procedures. The VA 

provides some transportation in cramped vans, but the journey is long and many 

veterans are unable to make the trip. 

In addition to the veterans who make their permanent residence in south Texas, 

my region also sees hundreds of so-called ‘‘Winter Texans’’ who travel to south 

Texas to avoid the cold winters. These veterans use the limited clinic services currently available and in the past the local Veterans Service Region has not even been 

reimbursed for their care. Although the VA has worked to resolve this problem, it 

still has not resolved the problem of how to provide adequate health services to this 

additional population. 

Since coming to Congress, I have been working to get a full-service veterans hospital in south Texas. I have brought several Secretaries of Veterans’ Affairs to the 

region and they all agree that the service is inadequate. Still, nothing has been done. 

The veterans in my community are tired of waiting and have taken action. Last 

year, they organized a march to San Antonio to show their commitment to getting 

their own hospital. Hundreds of veterans made the 300 mile trek to San Antonio 

in the heat to show the Veterans Administration that they were serious. 

I hope the Committee will approve a new veterans’ hospital in south Texas so that 

these veterans will finally receive the healthcare they deserve. 

Attached to my testimony is a petition signed by over 10,000 veterans in south 

Texas in support of a veterans hospital. I ask that it be made a part of the hearing 

record. 

Thank you for your consideration and for holding this important hearing. 

[THE PETITION IS BEING RETAINED IN THE PERMANENT COMMITTEE 

HEARING FILES AND IS NOT BEING PRINTED.] 

Æ 


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