October 2, 2008 CONGRESSIONAL RECORD — SENATE S10439 

Through the years, I have found his 

perspective on controversial issues, 

such as forests, mining and agriculture 

especially the potato and sugar-beet 

issues to be very valuable and informative. 

LARRY CRAIG and I also share an interest in the fine arts. My hobby is 

painting in oil; his is drawing with meticulous design. His creations are extraordinary in their detail. I hope, as 

he leaves the Senate, he will have opportunities to further utilize these exceptional talents to create pieces of art 

to be enjoyed by others. 

I wish him and his family well. 

f 

VETERANS’ MENTAL HEALTH AND 

OTHER CARE IMPROVEMENTS ACT 

Mr. AKAKA. Mr. President, I rise 

today to urge swift Senate passage of 

S. 2162, the proposed Veterans’ Mental 

Health and Other Care Improvements 

Act of 2008, as amended. This is an omnibus health care measure, which responds to the burgeoning mental 

health concerns of veterans and their 

families. The bill, as it comes before 

the Senate, is a compromise agreement 

developed with our counterparts on the 

House Committee on Veterans’ Affairs. 

I thank Chairman FILNER and Ranking 

Member BUYER of the House committee 

for their cooperation in this endeavor. 

I also thank my good friend, the committee’s ranking member, Senator 

BURR, for his great energy and cooperation as we have developed this bill. 

This compromise agreement is also 

focused on addressing homelessness 

among veterans, increasing VA’s efforts on pain management, promoting 

excellence in VA’s efforts relating to 

epilepsy, and improving access to care 

in rural areas. It also includes a series 

of necessary programmatic authorization extensions as well as major medical facility construction authorizations. 

The framework for this bill is my legislation, S. 2162 as originally introduced. This bill represents a bipartisan 

approach and was cosponsored early on 

by the ranking member, Senator BURR, 

along with Senators MIKULSKI, ENSIGN, 

ROCKEFELLER, SMITH, BINGAMAN, DOLE, 

CLINTON, COLLINS, SESSIONS, and STEVENS. 

Mr. President, I want to share how 

we began this process. The legislation 

did not stem from a lobbyist or an interest group. It came about because of 

one letter—a letter to me from the parents of Justin Bailey—Mary Kaye and 

Tony Bailey. 

Justin Bailey was a war veteran who 

survived Iraq only to die while receiving care from VA for PTSD and substance use disorder. A week after his 

death last year, Justin’s parents were 

naturally heartbroken by the death of 

their only son, but even more than 

that, they were concerned that other 

veterans might share his fate if VA 

mental health care did not improve. 

In their own words, they asked, ‘‘Everyone talks about the costs of sending 

troops to Iraq—what about the cost of 

caring for their injuries, both physical 

and psychological, when they return?’’ 

From this first letter, the Committee 

on Veterans’ Affairs held various hearings on the mental health needs of veterans. The media carried so many stories of veterans who were suffering, and 

various studies showed how prevalent 

mental health difficulties are in those 

who return from duty in Iraq and Afghanistan. 

We worked with experts in the mental health field and others who were 

advocating for veterans, including 

those at the Disabled American Veterans, to craft a bill that responded to 

the problem. This legislation responds 

to the concerns of the Baileys and 

many others who have come to the 

committee to tell their stories, and 

does so with the clear understanding 

that veterans care is a cost of war. If 

we neglect to pay these costs when the 

service members first return from deployment, we as a nation will suffer incalculable human costs that can never 

be repaid. 

Provisions included in this compromise agreement are drawn from various bills which have all been reported 

favorably by the Senate Committee on 

Veterans’ Affairs, including S. 1233 as 

ordered reported on August 29, 2007; S. 

2004, S. 2142, S. 2160, S. 2162, as ordered 

reported on November 14, 2007; and S. 

2969, as ordered reported on June 26, 

2008. 

I will briefly outline some of the key 

provisions in the compromise agreement. 

This legislation would make comprehensive changes to VA mental 

health treatment and research. Most 

notably, it would ensure a minimum 

level of substance use disorder care for 

veterans who need such care. It would 

also require VA to improve treatment 

of veterans with PTSD co-occurring 

with substance use disorders. Additionally, in order to determine if VA’s residential mental health facilities are appropriately staffed, this bill would 

mandate a review of such facilities. It 

would also create a vital research program on PTSD and substance use disorders, in cooperation with, and building on the work of, the National Center 

for PTSD. 

It is not uncommon for veterans with 

physical and mental wounds to turn to 

drugs and alcohol to ease their pain. 

Many experts believe that stress is the 

primary cause of drug abuse and of relapse to drug abuse. Sixty to eighty 

percent of Vietnam veterans who have 

sought PTSD treatment have alcohol 

use disorders. VA has long dealt with 

substance abuse issues, but there is 

much more that can be done. This legislation would provide a number of solutions to enhance substance use disorder treatment, including an innovative approach to substance use treatment via Internet-based programs. 

Furthermore, the inclusion of families in mental health and substance use 

disorder treatment is critical. To that 

end, the compromise agreement would 

fully authorize VA to provide mental 

health services to families of veterans 

and would set up a program to 

proactively help veterans and their 

families to transition from deployment 

to civilian life. 

Beneficiary travel reimbursements 

are essential to improving access to VA 

health care for veterans in rural areas. 

This legislation would increase the 

beneficiary travel mileage reimbursement rate from 11 cents per mile to 28.5 

cents per mile and permanently set the 

deductible to the 2007 amount of $3 

each way. Senator TESTER has been a 

leader on this issue, and I thank him 

for that. 

Too often, veterans suffer from lack 

of care not only because they reside in 

rural areas but also because they are 

unaware of the services available to 

them. This legislation would enhance 

outreach and accessibility by creating 

a pilot program on the use of peers to 

help reach out to veterans. It would 

also encourage improved accessibility 

for mental health care in rural areas 

through coordination with communitybased resources. Mental Health America and Iraq and Afghanistan Veterans 

of America brought to the committee 

the concept of using peers to help veterans, and I think it is a good one. 

It is crucial that all veterans have 

access to emergency care. This bill 

would make corrections to the procedure used by VA to reimburse community hospitals for emergency care provided to eligible veterans to ensure 

that both veterans and community 

hospitals are not unduly burdened by 

emergency care costs. This provision is 

based on legislation introduced by Senator BROWN in response to a situation 

in his own State of Ohio, where community hospitals were not being reimbursed timely from VA. 

The compromise agreement also addresses homelessness among veterans, 

a far too prevalent problem. The bill 

would create targeted programs to provide assistance for low-income veteran 

families. It would also increase the 

total amount that VA is authorized to 

spend on its successful Grant and Per 

Diem Program, which assists community-based entities that serve homeless 

veterans. Finally, the bill would expand a program to help formerly incarcerated veterans reintegrate into life 

and ensure facilities are up to par for 

women veterans who are homeless. 

Epilepsy is often associated with 

traumatic brain injury. This legislation would establish six VA epilepsy 

centers of excellence, focused on research, education, and clinical care activities in the diagnosis and treatment 

of epilepsy. These centers would restore VA to the position of leadership 

it once held in epilepsy research and 

treatment. Senators MURRAY and 

CRAIG worked together to bring this 

critical legislation to the forefront. I 

also add that the Epilepsy Foundation 

of America and the American Academy 

of Neurology were very helpful to the 

committee on this issue. 


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S10440 CONGRESSIONAL RECORD — SENATE October 2, 2008 

The medical community has made 

impressive advances in pain care and 

management, but VA has lagged behind 

in implementing a standardized policy. 

S. 2162 would establish a pain care program at all VA inpatient facilities, to 

prevent long-term chronic pain disability. It also provides for education 

for VA’s health care workers on pain 

assessment and treatment and would 

require VA to expand research on pain 

care. We relied on the Pain Care Forum 

and their many organizations devoted 

to the relief of pain, and I thank them 

for their efforts on behalf of veterans. 

Finally, S. 2162 contains extensions 

of authorities for VA to provide some 

essential services to veterans, such as 

both institutional and non-institutional long-term care and caregiver assistance. It would also authorize a series of major medical facility construction projects and clinic leases in California, Texas, Puerto Rico, Florida, 

Louisiana, Colorado, Nevada, Pennsylvania, Wisconsin, South Carolina, 

Ohio, Arizona, Georgia, and Illinois. 

Mr. President, before I close, I recognize and thank the individuals involved 

in putting together this comprehensive 

measure. Specifically, I thank Cathy 

Wiblemo and Dolores Dunn from the 

House committee and Jon Towers from 

the minority on the Senate committee. 

I also thank my own staff who assisted 

me in forging this bill. Kim Lipsky and 

Alex Sardegna heard the needs of veterans, sought creative solutions to 

some very complex problems, and 

worked tirelessly to make this bill a 

reality. 

In closing, I thank Mary Kaye and 

Tony Bailey, who set aside their own 

grief about Justin and fought for better 

mental health care for all veterans. We 

all owe the Baileys a debt of gratitude 

for so many reasons. 

I urge all of my colleagues to support 

swift passage of S. 2162, as amended. It 

would bring relief, support, and needed 

services to so many veterans and their 

families across the country. 

I ask unanimous consent to have the 

Joint Explanatory Statement printed 

in the RECORD. 

There being no objection, the material was ordered to be printed in the 

RECORD, as follows: 

JOINT EXPLANATORY STATEMENT FOR S. 2162, 

VETERANS’ MENTAL HEALTH AND OTHER

CARE IMPROVEMENTS ACT OF 2008 

The ‘‘Veterans’ Mental Health and Other 

Care Improvements Act of 2008’’ reflects a 

compromise agreement that the Senate and 

House of Representatives’ Committees on 

Veterans’ Affairs reached on certain provisions of a number of bills considered by the 

House and Senate during the 110th Congress, 

including: S. 2162, to improve the treatment 

and services provided by the Department of 

Veterans Affairs to veterans with post-traumatic stress disorder and substance use disorders, and for other purposes, passed by the 

Senate on June 3, 2008 [hereinafter, ‘‘Senate 

Bill’’]; H.R. 5554, to expand and improve 

health care services available to veterans 

from the Department of Veterans Affairs for 

substance use disorders, and for other purposes, passed by the House on May 20, 2008 

[hereinafter, ‘‘House Bill’’]; S. 1233, to provide and enhance intervention, rehabilitative treatment, and services to veterans with 

traumatic brain injury, and for other purposes, placed on the Senate calendar on August 29, 2007. 

H.R. 1527, to conduct a pilot program to 

permit certain highly rural veterans enrolled 

in the health system of the Department of 

Veterans Affairs to receive covered health 

services through providers other than those 

of the Department, passed by the House on 

September 10, 2008; H.R. 2623, to prohibit the 

collection of copayments for all hospice care 

furnished by the Department of Veterans Affairs, passed by the House on July 30, 2007; 

H.R. 2818, to provide for the establishment of 

epilepsy centers of excellence in the Veterans Health Administration of the Department of Veterans Affairs, passed by the 

House on June 24, 2008; H.R. 2874, to make 

certain improvements in the provision of 

health care to veterans, and for other purposes, passed by the House on July 30, 2007; 

S. 2969, to enhance the capacity of the Department of Veterans Affairs to recruit and 

retain nurses and other critical health care 

professionals, and for other purposes, placed 

on the Senate calendar on September 18, 

2008. 

H.R. 3819, to reimburse veterans receiving 

emergency treatment in non-Department of 

Veterans Affairs facilities for such treatment until such veterans are transferred to 

Department facilities, and for other purposes, passed by the House on May 21, 2008; 

H.R. 4264, to name the Department of Veterans Affairs spinal cord injury center in 

Tampa, Florida, as the ‘‘Michael Bilirakis 

Department of Veterans Affairs Spinal Cord 

Injury Center,’’ passed by the House on June 

26, 2008; H.R. 5729, to provide comprehensive 

health care to children of Vietnam veterans 

born with Spina Bifida, and for other purposes, passed by the House on May 20, 2008; 

H.R. 6445, to prohibit the Secretary of Veterans Affairs from collecting certain copayments from veterans who are catastrophically disabled, and for other purposes, 

passed by the House on July 30, 2008; H.R. 

6832, to authorize major medical facility 

projects and major medical facility leases for 

the Department of Veterans Affairs for fiscal 

year 2009, to extend certain authorities of 

the Secretary of Veterans Affairs, and for 

other purposes, passed by the House on September 11, 2008; S. 2969, to enhance the capacity of the Department of Veterans Affairs to 

recruit and retain nurses and other critical 

health care professionals and for other purposes, which was placed on the Senate legislative calendar on September 18, 2008. 

The House and Senate Committees on Veterans’ Affairs have prepared the following 

explanation of the compromise bill, S. 2162 

(hereinafter referred to as the ‘‘Compromise 

Agreement’’). Differences between the provisions contained in the Compromise Agreement and the related provisions in the bills 

listed above are noted in this document, except for clerical corrections and conforming 

changes made necessary by the Compromise 

Agreement, and minor drafting, technical, 

and clarifying changes. 

TITLE I—SUBSTANCE USE DISORDERS AND

MENTAL HEALTH CARE

Tribute to Justin Bailey (sec. 101) 

The Senate bill contained a provision (sec. 

306) to specify that this title is enacted in 

tribute to Justin Bailey, who, after returning to the United States from service as 

member of the Armed Forces in Operation 

Iraqi Freedom, died in a domiciliary facility 

of the Department of Veterans Affairs while 

receiving care for post-traumatic stress disorder and a substance use disorder. 

Section 6 of the House bill contained the 

identical provision. 

The Compromise Agreement contains this 

provision. 

Findings on substance use disorders and mental 

health (sec. 102) 

The Senate bill contained a provision (sec. 

301) that would express the sense of the Congress that: 

(1) More than 1,500,000 members of the 

Armed Forces have been deployed in Operation Iraqi Freedom and Operation Enduring 

Freedom. The 2005 Department of Defense 

Survey of Health Related Behaviors Among 

Active Duty Personnel reports that 23 percent of members of the Armed Forces on active duty acknowledge a significant problem 

with alcohol use, with similar rates of acknowledged problems with alcohol use 

among members of the National Guard. 

(2) The effects of substance abuse are wide 

ranging, including significantly increased 

risk of suicide, exacerbation of mental and 

physical health disorders, breakdown of family support, and increased risk of unemployment and homelessness. 

(3) While veterans suffering from mental 

health conditions, chronic physical illness, 

and polytrauma may be at increased risk for 

development of a substance use disorder, 

treatment for these veterans is complicated 

by the need to address adequately the physical and mental symptoms associated with 

these conditions through appropriate medical intervention. 

(4) While the Veterans Health Administration has dramatically increased health services for veterans from 1996 through 2006, the 

number of veterans receiving specialized substance abuse treatment services decreased 18 

percent during that time. No comparable decrease in the national rate of substance 

abuse has been observed during that time. 

(5) While some facilities of the Veterans 

Health Administration provide exemplary 

substance use disorder treatment services, 

the availability of such treatment services 

throughout the health care system of the 

Veterans Health Administration is inconsistent. 

(6) According to the Government Accountability Office, the Department of Veterans 

Affairs significantly reduced its substance 

use disorder treatment and rehabilitation 

services between 1996 and 2006, and has made 

little progress since in restoring these services to their pre–1996 levels. 

The House bill contained no similar provision. 

The Compromise Agreement contains the 

Senate provision but modifies finding (6) to 

include the year of the Government Accountability report and cites the National Mental 

Health Program Monitoring System report. 

Expansion of substance use disorder treatment 

services provided by the Department of Veterans Affairs (sec. 103) 

The Senate bill contained a provision (sec. 

302) that would require that the Secretary of 

Veterans Affairs ensure the provision of 

services and treatment to each veteran enrolled in the health care system of the Department who is in need of services and 

treatments for a substance use disorder, and 

the bill included a specific list of services. 

The Senate bill would also authorize that 

the services and treatments may be provided 

to a veteran: (1) at Department of Veterans 

Affairs medical centers or clinics; (2) by referral to other facilities of the Department 

that are accessible to such veteran; or (3) by 

contract or fee-for-service payments with 

community-based organizations for the provision of such services and treatments. 

The House bill contained a similar provision (sec. 2) that would require the Secretary 

to provide a full continuum of care for substance use disorders to veterans in need of 

such care and included a specific list of services, including three services not included in 


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October 2, 2008 CONGRESSIONAL RECORD — SENATE S10441 

the Senate bill: marital and family counseling, screening for substance use disorders, 

and coordination with groups providing peer 

to peer counseling. The House bill (sec. 3) 

would also require the Secretary to ensure 

that the amounts made available for care, 

treatment, and services are allocated evenly 

throughout the system, including an annual 

reporting requirement. 

The Compromise Agreement includes the 

listing of substance use disorder services included in both the Senate and House bills, 

and follows the Senate bill with respect to 

the locations of where services would be provided. The Compromise Agreement follows 

the House bill with respect to ensuring the 

equitable distribution of resources for substance abuse services but does not include 

the annual reporting requirement. 

Care for veterans with mental health and substance use disorders (sec. 104) 

The Senate bill contained a provision (sec. 

303) that would ensure that if the Secretary 

of Veterans Affairs provides a veteran inpatient or outpatient care for a substance use 

disorder and a comorbid mental health disorder, that the treatment for such disorders 

be provided concurrently: (1) through a service provided by a clinician or health professional who has training and expertise in 

treatment of substance use disorders and 

mental health disorders; (2) by separate substance use disorder and mental health disorder treatment services when there is appropriate coordination, collaboration, and 

care management between such treatment 

services; or (3) by a team of clinicians with 

appropriate expertise. 

The House bill contained no similar provision. 

The Compromise Agreement contains the 

Senate provision. 

Pilot program for Internet-based substance use 

disorder treatment for veterans of Operation 

Iraqi Freedom and Operation Enduring 

Freedom (sec. 105) 

The House bill contained a provision (sec. 

4) that would express the sense of the Congress that: 

(1) Stigma associated with seeking treatment for mental health disorders has been 

demonstrated to prevent some veterans from 

seeking such treatment at a medical facility 

operated by the Department of Defense or 

the Department of Veterans Affairs. 

(2) There is a significant incidence among 

veterans of post-deployment mental health 

problems, especially among members of a reserve component who return as veterans to 

civilian life. 

(3) Computer-based self-guided training has 

been demonstrated to be an effective strategy for supplementing the care of psychological conditions. 

(4) Younger veterans, especially those who 

served in Operation Enduring Freedom or 

Operation Iraqi Freedom, are comfortable 

with and proficient at computer-based technology. 

(5) Veterans living in rural areas find access to treatment for substance use disorder 

limited. 

(6) Self-assessment and treatment options 

for substance use disorders through an Internet website may reduce stigma and provides 

additional access for individuals seeking 

care and treatment for such disorders. 

This provision would also require the Secretary of Veterans Affairs to carry out a 

pilot program to test the feasibility and advisability of providing veterans who seek 

treatment for substance use disorders access 

to a computer-based self-assessment, education, and specified treatment program 

through a secure Internet website operated 

by the Secretary. 

The Senate bill contained no similar provision. 

The Compromise Agreement contains the 

House provision. 

Report on residential mental health care facilities of the Veterans Health Administration 

(sec. 106) 

The Senate bill contained a provision (sec. 

305) that would require the Secretary of Veterans Affairs, acting through the Office of 

Mental Health Services of the Department of 

Veterans Affairs, not later than six months 

after the date of the enactment of this Act, 

conduct a review of all residential mental 

health care facilities, including domiciliary 

facilities, of the Veterans Health Administration; and not later than two years after 

the date of the completion of the first review 

conduct a follow-up review of such facilities 

to evaluate any improvements made or problems remaining since the first review was 

completed. Not later than 90 days after the 

completion of the first review, the Secretary 

would be required to submit to the Committee on Veterans’ Affairs of the Senate 

and the Committee on Veterans’ Affairs of 

the House of Representatives a report on 

such review. 

The House bill (sec. 5) contained a similar 

provision, except there was no provision for 

a two-year follow-up review, and the six 

month review would be carried out by the Office of the Medical Inspector. 

The Compromise Agreement includes the 

Senate provision which specifies the twoyear follow-up review, but would have the Inspector General carry out the reviews. 

Pilot program on peer outreach and support for 

veterans and use of community mental 

health centers and Indian Health Service 

facilities (sec. 107) 

The Senate bill contained a provision (sec. 

401) that would require the Secretary of Veterans Affairs to carry out a pilot program to 

assess the feasibility and advisability of providing the following to veterans of OIF/OEF 

in at least two Veterans Integrated Service 

Networks: (1) peer outreach services; (2) peer 

support services provided by licensed providers of peer support services or veterans 

who have personal experience with mental 

illness; (3) readjustment counseling services; 

and other mental health services. Services 

would be provided through community mental health centers or other entities under 

contracts or other agreements and through 

the Indian Health Service pursuant to a 

memorandum of understanding entered into 

by the Secretary of Veterans Affairs and the 

Secretary of Health and Human Services. 

Section 6 of H.R. 2874 required the Secretary to carry out a program to provide 

peer outreach services, peer support services, 

and readjustment and mental health services 

to covered veterans. This provision was not a 

pilot program and did not provide for the 

means to collaborate with the Indian Health 

Service. 

The Compromise Agreement contains the 

Senate provision with an amendment that 

would authorize at least three pilot sites. 

TITLE II—MENTAL HEALTH RESEARCH

Research program on comorbid post-traumatic 

stress disorder and substance use disorders 

(sec. 201) 

The Senate bill contained a provision (sec. 

501) that would require the Secretary of Veterans Affairs to carry out a program of research into comorbid post-traumatic stress 

disorder (PTSD) and substance use disorder. 

This research program shall be carried out 

by the National Center for Posttraumatic 

Stress Disorder. In carrying out the program, the Center shall: (1) develop protocols 

and goals with respect to research under the 

program; and (2) coordinate research, data 

collection, and data dissemination under the 

program. 

The House bill contained no similar provision. 

The Compromise Agreement contains the 

Senate provision. 

Extension of authorization for Special Committee on Post-Traumatic Stress Disorder 

(sec. 202) 

The Senate bill contained a provision (sec. 

502) that would modify section 110(e)(2) of the 

Veterans’ Health Care Act of 1984, P.L. 98– 

528, to extend the reporting requirement for 

the Special Committee on Post-Traumatic 

Stress Disorder. Currently, the reporting requirement is set to expire in 2008; this provision would extend it through 2012. 

Section 209 of H.R. 6832 contained an identical provision. 

The Compromise Agreement contains the 

provision. 

TITLE III—ASSISTANCE FOR FAMILIES OF

VETERANS

Clarification of authority of Secretary of Veterans Affairs to provide mental health services to families of veterans (sec. 301) 

The Senate bill contained a provision (sec. 

601) that would amend section 1701(5)(B) of 

title 38, United States Code, to clarify the 

authority of the Secretary of Veterans Affairs to provide mental health services to 

families of veterans. 

Section 3 of H.R. 6445 contained a provision 

that would modify section 1782(b) of title 38 

so as to eliminate the requirement that family support services be initiated during the 

veteran’s hospitalization and deemed essential to permit the veteran’s discharge. 

The Compromise Agreement follows the 

House bill with respect to the provision 

eliminating the need for services to be initiated during a veteran’s hospitalization and 

essential to the veteran’s discharge, but follows the Senate bill with respect to the provision to clarify the authority of the Secretary of Veterans Affairs to provide mental 

health services to families. 

Pilot program on provision of readjustment and 

transition assistance to veterans and their 

families in cooperation with Vet Centers 

(sec. 302) 

The Senate bill contained a provision (sec. 

402) that would establish a pilot program to 

assess the feasibility and advisability of providing additional readjustment and transition assistance to veterans and their families 

in cooperation with Readjustment Counseling Centers. The pilot would be similar to 

family assistance programs previously conducted at ten Army facilities around the 

country. 

The House bill contained no similar provision. 

The Compromise Agreement contains the 

Senate provision with an amendment to 

begin the pilot program no later than 180 

days after the enactment of the Act. 

TITLE IV—HEALTH CARE MATTERS

Veterans beneficiary travel program (sec. 401) 

The Senate bill contained a provision (sec. 

101) that would direct the Secretary to reimburse qualifying veterans at the rate authorized for Government employees under section 5707(b) of title 5. The Senate provision 

would also strike a provision that allows the 

Secretary to raise or lower the deductible for 

reimbursements in proportion to a change in 

the mileage rate. Finally, the Senate provision would reinstate the amount of the deductible for the beneficiary travel reimbursement program to the amount in effect 

prior to the Secretary’s February 1, 2008, decision on beneficiary travel. 

The House bill contained no similar provision. 

The Compromise Agreement contains the 

Senate provision. 


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S10442 CONGRESSIONAL RECORD — SENATE October 2, 2008 

Mandatory reimbursement of veterans receiving 

emergency treatment in non-department of 

veterans affairs facilities until transfer to 

department facilities (sec. 402) 

The Senate bill contained a provision that 

would amend section 1725 of title 38 in subsections (a)(1) and (f)(1). Subsection (a)(1) 

would be amended by replacing ‘‘may reimburse’’ with ‘‘shall reimburse.’’ This change 

would make reimbursement for emergency 

care received at non-VA facilities mandatory 

for eligible veterans, rather than at the discretion of the Secretary. Subsection (f)(1) 

would be amended to provide greater specificity regarding the termination of VA’s obligation to reimburse. The Senate bill would 

also amend section 1728 of title 38 so as to 

make that section, which relates to reimbursement for the emergency treatment of 

service-connected conditions, consistent 

with section 1725, as amended. Thus, reimbursement would also be made mandatory 

under Section 1728. The existing criteria, defining veteran eligibility for reimbursement 

for emergency care services, would be carried over in the revised statutory language. 

In addition, the Senate bill would further 

amend section 1728 so as to strike the phrase 

‘‘care and services’’ in current subsection (b) 

of section 1728, and replace that phrase with 

‘‘emergency treatment.’’ This proposed 

change is designed to promote consistency 

between sections 1725 and 1728. 

H.R. 3819 contained similar provisions. 

The Compromise Agreement contains these 

provisions. 

Pilot program of enhanced contract care authority for health care needs of veterans in 

highly rural areas (sec. 403) 

H.R. 1527 (sec. 2) would require the Secretary to conduct a pilot program which permits highly rural veterans who are enrolled 

in the system of patient enrollment established under section 1705(a) of title 38, and 

who reside in Veterans Integrated Service 

Networks (VISNs) 1, 15, 18, and 19, to elect to 

receive covered health services for which 

such veterans are eligible, through a non-Department health care provider. 

The Senate bill contained no similar provision. 

The Compromise Agreement follows the 

House bill, with an amendment that specifies 

that the pilot program will be carried out in 

5 VISNs, four of which shall include at least 

three highly rural counties (as determined 

by the Secretary based upon the most recent 

census data), and one of which shall include 

one highly rural county. All VISNs selected 

must include an area within the borders of at 

least four states, and not be already participating in Project HERO. Eligibility for participation in the pilot program would be limited to those veterans already enrolled in the 

VA health care system at the time of commencement of the program, as well as OIF/ 

OEF veterans who are eligible for VA health 

care under section 1710(e)(3)(C) of title 38. 

Epilepsy centers of excellence (sec. 404) 

The Senate bill contained a provision (sec. 

103) that would require that the Secretary, 

upon the recommendation of the Under Secretary for Health, to designate not less than 

six Department health care facilities as locations for epilepsy centers of excellence. 

H.R. 2818 (sec. 2) would require the Secretary to designate an epilepsy center of excellence at each of the 5 centers designated 

under section 7327 of title 38 (Centers for research, education, and clinical activities on 

complex multi-trauma associated with combat injuries). 

The Compromise Agreement specifies that 

Secretary shall designate at least four but 

not more than six Department health care 

facilities as locations for epilepsy centers of 

excellence. Not less than two of these centers shall be collocated with centers designated under 7327 of title 38. 

Establishment of qualifications for peer specialist appointees (sec. 405) 

The Senate bill contained a provision (sec. 

104) that would amend section 7402(b) of title 

38 so as to define qualifications for peer specialist positions employed by the Veterans 

Health Administration. Specifically, in order 

to be eligible to be appointed to a peer specialist position, a person must be a veteran 

who has recovered or is recovering from a 

mental health condition; and be certified by 

a not-for-profit entity engaged in peer specialist training by having met such criteria 

as the Secretary shall establish for a peer 

specialist position; or a State by having satisfied relevant State requirements for a peer 

specialist position. The Senate bill would 

also amend section 7402 of title 38 so as to 

add a new subsection providing authority for 

the Secretary to enter into contracts with 

not-for-profit entities to provide peer specialist training to veterans and certification 

for veterans. 

The House bill contained no similar provision. 

The Compromise Agreement contains the 

Senate provision. 

Establishment of consolidated patient accounting centers (sec. 406) 

Section 5 of H.R. 6445 contained a provision 

that would amend chapter 17 of title 38 to insert a new section mandating that not later 

than 5 years after the date of enactment of 

this bill, the Secretary of Veterans Affairs 

shall establish not more than seven consolidated patient accounting centers for conducting industry-modeled regionalized billing and collection activities of the Department. 

The Senate bill contained no comparable 

provision. 

The Compromise Agreement contains the 

House provision. 

Repeal of limitation on authority to conduct 

widespread HIV testing program (sec. 407) 

Section 217 of S. 2969 would repeal section 

124 of Public Law 100–322, which permits VA 

to test a patient for HIV infection only if the 

veteran receives pre-test counseling and provides written informed consent for such testing. Eliminating this section from the law 

would bring VA’s statutory HIV testing requirements in line with current guidelines 

issued by the Centers of Disease Control and 

Prevention. 

Section 6 of H.R. 6445 contained an identical provision. 

The Compromise Agreement contains the 

provision. 

Provision of comprehensive health care by Secretary of Veterans Affairs to children of 

Vietnam veterans born with spina bifida 

(sec. 408) 

H.R. 5729 would amend section 1803(a) of 

title 38 so as to expand the existing VA 

Spina Bifida Health Care Program and provide a comprehensive health benefit to beneficiaries. 

The Senate bill contained no comparable 

provision. 

The Compromise Agreement contains the 

House provision. 

Exemption from copayment requirement for veterans receiving hospice care (sec. 409) 

Section 309 of S. 1233 would amend section 

1710 of title 38 so as to exempt hospice care 

provided in all settings from the copayment 

requirement for VA long-term care. Under 

current law, only hospice care provided in a 

VA nursing home is exempted from copayment. 

H.R. 2623 contained a similar provision. 

The Compromise Agreement contains the 

provision. 

TITLE V—PAIN CARE

Comprehensive policy on pain management (sec. 

501) 

The Senate bill contained a provision (sec. 

201) that would require the Secretary of Veterans Affairs to develop and implement a 

comprehensive policy on the management of 

pain experienced by veterans enrolled for VA 

health care services no later than October 1, 

2008. 

The policy would be required to cover the 

following: the Department-wide management 

of acute and chronic pain experienced by veterans; the standard of care for pain management to be used throughout the Department; 

the consistent application of pain assessments to be used throughout the Department; the assurance of prompt and appropriate pain care treatment and management 

by the Department, system-wide, when medically necessary; Department programs of research related to acute and chronic pain suffered by veterans, including pain attributable to central and peripheral nervous system damage characteristic of injuries incurred in modern warfare; Department programs of pain care education and training 

for health care personnel of the Department; 

and Department programs of patient education for veterans suffering from acute or 

chronic pain and their families. 

Section 4 of H.R. 6445 contained identical 

provisions. 

The Compromise Agreement contains the 

provisions, but would require the Secretary 

of Veterans Affairs to develop and implement a comprehensive policy on pain management no later than October 1, 2009. 

TITLE VI—HOMELESS VETERANS MATTERS

Increase in authorization of appropriations for 

the Homeless Grant and Per Diem Program 

(sec. 601) 

Section 506 of S. 2969 would amend section 

2013 of title 38, to increase the authorization 

of appropriations for the Homeless Grant and 

Per Diem Program from $130 million to $200 

million. 

The House bill contained no comparable 

provision. 

The Compromise Agreement contains the 

Senate provision but changes the authorization amount to $150 million. 

Expansion and extension of authority for program of referral and counseling services for 

at-risk veterans transitioning from certain 

institutions (sec. 602) 

Section 403 of S. 1233 would amend section 

2023 of title 38 so as to extend and expand the 

authority for a program to aid incarcerated 

veterans in their transition back to civilian 

life. The program would be extended until 

September 30, 2011, and would be expanded 

from six to twelve sites. 

Section 7 of H.R. 2874 contained identical 

provisions. 

The Compromise Agreement contains the 

provision, but would extend the program 

until September 30, 2012. 

Permanent authority for domiciliary services for 

homeless veterans and enhancement of capacity of domiciliary care programs for female veterans (sec. 603) 

Section 405 of S. 1233 would amend section 

2043 of title 38 to make permanent an existing authority to expand domiciliary care for 

homeless women veterans. 

Section 8 of H.R. 2874 contained identical 

provisions. 

The Compromise Agreement contains the 

provisions. 

Financial assistance for supportive services for 

very-low income veteran families in permanent housing (sec. 604) 

Section 406 of S. 1233 would amend title 38 

so as to add a new section 2044, relating to 


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supportive services for very low-income veterans and their families occupying permanent housing. Proposed new section 2044 

would direct VA to provide grants to eligible 

entities to provide and coordinate the provision of a comprehensive range of supportive 

services for very low-income veteran families occupying permanent housing, including 

those transitioning from homelessness to 

such housing. 

Those families may be occupying permanent housing, moving into permanent housing within 90 days, or moving from one permanent residence to another to better suit 

their needs. Entities eligible to receive 

grants under this provision are public or private non-profit organizations which have 

demonstrated the capacity and experience 

necessary to deliver the services outlined in 

the proposed new section. Under the provisions of the proposed new section 2044, grants 

would be provided for a wide range of services, so as to give families a broad set of 

tools to maintain a permanent residence. To 

this end, providers could receive grants to 

furnish outreach, case management, assistance in obtaining and coordinating VA benefits, and assistance in obtaining and coordinating other public benefits provided by federal, state, or local agencies or organizations. 

Section 9 of H.R. 2874 contained similar 

provisions but provided a more expansive list 

of supportive services, and authorized for appropriations a different funding level. 

The Compromise Agreement contains the 

Senate provision. 

TITLE VII—AUTHORIZATION OF MEDICAL FACILITY PROJECTS AND MAJOR MEDICAL FACILITY

LEASES

Authorization for fiscal year 2009 major medical 

facility projects (sec. 701) 

Section 701 of S. 2969 would authorize: 

$54,000,000 to construct a facility to replace a 

seismically unsafe acute psychiatric inpatient building in Palo Alto, California; 

$131,800,000 for an outpatient clinic in Lee 

County, Florida; $225,900,000 to make seismic 

corrections at a VA Medical Center in San 

Juan, Puerto Rico; and $66,000,000 to construct a state-of-the-art polytrauma health 

care and rehabilitation center in San Antonio, Texas. 

Section 101 of H.R. 6832 contained the same 

provisions, except for Lee County, Florida. 

Instead, H.R. 6832 authorizes the Lee County 

project under a different section. 

The Compromise Agreement contains the 

House provision. 

Modification of authorization amounts for certain major medical facility construction 

projects previously authorized (sec. 702) 

Section 702 of S. 2969 would modify previous authorizations by providing $625,000,000 

for restoration, new construction, or replacement of the medical care facility for the VA 

Medical Center at New Orleans, Louisiana. 

Section 102 of H.R. 6832 contained the same 

provisions and the following additional provisions: $769,200,000 for the replacement of 

the VA Medical Center at Denver, Colorado; 

$131,800,000 for an outpatient clinic in Lee 

County, Florida; $136,700,000 to correct patient privacy deficiencies at the VA Medical 

Center in Gainesville, Florida; $600,400,000 to 

build a new VA Medical Center in Las Vegas, 

Nevada; $656,800,000 to build a new medical 

center in Orlando, Florida; and $295,600,000 to 

consolidate the campuses at the University 

Drive and H. John Heinz III Divisions in 

Pittsburgh, Pennsylvania. 

The Compromise Agreement contains the 

House provision with an amendment to provide $568,000,000 for the replacement of the 

VA Medical Center at Denver, Colorado. 

Authorization of fiscal year 2009 major medical 

facility leases (sec. 703) 

Section 703 of S. 2969 would authorize fiscal 

year 2009 major medical facility leases as follows: $4,326,000 for an outpatient clinic in 

Brandon, Florida; $10,300,000 for a community-based outpatient clinic in Colorado 

Springs, Colorado; $5,826,000 for an outpatient clinic in Eugene, Oregon;. $5,891,000 

to expand an outpatient clinic Green Bay, 

Wisconsin; $3,731,000 for an outpatient clinic 

in Greenville, South Carolina; $2,212,000 for a 

community-based outpatient clinic in Mansfield, Ohio; $6,276,000 for a satellite outpatient clinic in Mayaguez, Puerto Rico; 

$5,106,000 for a community-based outpatient 

clinic in Southeast Phoenix, Mesa, Arizona; 

$8,636,000 for interim research space in Palo 

Alto, California; $3,168,000 to expand a community-based outpatient clinic in Savannah, 

Georgia; $2,295,000 for a community-based 

outpatient clinic in Northwest Phoenix, Sun 

City, Arizona; and $8,652,000 for a primary 

care annex in Tampa, Florida. 

Section 102 of H.R. 6832 included the same 

provisions, except that it provided $3,995,000 

for Colorado Springs. 

The Compromise Agreement includes the 

Senate provisions. 

Authorization of appropriations (sec. 704) 

Section 704 of S. 2969 would authorize for 

appropriations: $477,700,000 for the aforementioned list of major medical facility projects 

authorized for fiscal year 2009. $625,000,000 for 

the aforementioned list of major medical facility construction projects previously authorized; $66,419,000 for the aforementioned 

list of major facility leases authorized for 

fiscal year 2009. 

S. 2969 also identified funding sources 

which may be used to carry out major medical facility projects authorized for fiscal 

year 2009 and for those projects previously 

authorized. 

Section 105 of H.R. 6832 would authorize for 

appropriations: $345,900,000 for the aforementioned list of major medical facility projects 

authorized for fiscal year 2009; $1,694,295,000 

for the aforementioned list of major medical 

facility construction projects previously authorized; $54,475,000 for the aforementioned 

list of major facility leases authorized for 

fiscal year 2009. 

The Compromise Agreement includes the 

House provision, with amendments to provide $1,493,495,000 for major facility construction projects previously authorized and 

$70,019,000 for major facility leases authorized for fiscal year 2009. The Agreement also 

includes the provision in S. 2969 on allowable 

funding sources to carry out major medical 

facility projects. 

Increase in threshold for major medical facility 

leases requiring congressional approval (sec. 

705) 

Section 705 of S. 2969 would increase the 

threshold for major medical facility leases 

requiring Congressional approval from 

$600,000 to $1,000,000. 

H.R. 6832 contained no comparable provision. 

The Compromise Agreement contains the 

Senate provision. 

Conveyance of certain non-Federal land by city 

of Aurora, Colorado, to Secretary of Veterans Affairs for construction of veterans 

medical facility (sec. 706) 

Section 706 of S. 2969 would allow the city 

of Aurora to donate non-Federal land for use 

by the Secretary of Veterans Affairs no later 

than 60 days after the enactment of this section. 

H.R. 6832 contained no comparable provision. 

The Compromise Agreement contains the 

Senate provision. 

Report on facilities administration (sec. 707) 

Section 106 of H.R. 6832 would require the 

Secretary of Veterans Affairs to submit a report on facilities administration no later 

than 60 days after the date of the enactment 

of this section. 

S. 2969 contained no comparable provision. 

The Compromise Agreement includes the 

House provision. 

Annual report on outpatient clinics (sec. 708) 

Section 107 of H.R. 6832 would require an 

annual report on outpatient report no later 

than the date on which the budget for the 

next fiscal year is submitted to the Congress 

under section 1105 of title 31. 

S. 2969 contained no comparable provision. 

The Compromise Agreement includes the 

House provision. 

Name of Department of Veterans Affairs spinal 

cord injury center, Tampa, Florida (sec. 709) 

H.R. 4264 would name the VA spinal cord 

injury center in Tampa, Florida, ‘‘Michael 

Bilirakis Department of Veterans Affairs 

Spinal Cord Injury Center.’’ 

S. 2969 contained no comparable provision. 

The Compromise Agreement includes the 

House provision. 

TITLE VIII—EXTENSION OF CERTAIN

AUTHORITIES

Repeal of sunset on inclusion of non-institutional extended care services in definition of 

medical services (sec. 801) 

Section 201 of S. 2969 would amend section 

1701 of title 38 to repeal the December 31, 

2008, sunset on the inclusion of non-institutional extended care services in the definition of medical services. 

Sec. 201 of H.R. 6832 contained an identical 

provision. 

The Compromise Agreement contains the 

provision. 

Extension of recovery audit authority (sec. 802) 

Section 202 of S. 2969 would amend section 

1703(d)(4) of title 38 to extend the recovery 

audit authority for fee-basis contracts and 

other medical services contracts in non-VA 

facilities from September 30, 2008, to September 30, 2013. 

Sec. 202 of H.R. 6832 contained an identical 

provision. 

The Compromise Agreement contains the 

provision. 

Permanent authority for provision of hospital 

care, medical services, and nursing home 

care to veterans who participated in certain 

chemical and biological testing conducted 

by the Department of Defense (sec. 803) 

Section 203 of S. 2969 would amend subsection (e)(3) of section 1710 of title 38 to provide permanent authority for the provision 

of hospital care, medical services, and nursing home care to veterans who participated 

in certain chemical and biological testing 

conducted by the Department of Defense. 

Section 203 of H.R. 6832 contained an identical provision. 

The Compromise Agreement contains the 

provision. 

Extension of expiring collections authorities 

(sec. 804) 

S. 2969 contained no comparable provision. 

Section 204 of H.R. 6832 would extend the 

expiring collections authorities for the following: a) amend section 1710(f)(2)(B) of title 

38 to extend health care copayments from 

September 30, 2008, under current law, to 

September 30, 2010; and b) amend section 1729 

(a)(2)(E) of title 38 to extend the medical 

care cost recovery from October 1, 2008, to 

October 1, 2010. 

The Compromise Agreement contains the 

House provision. 

Extension of nursing home care (sec. 805) 

Section 202 of S. 2969 would amend 1710A(d) 

of title 38 to provide nursing home care to 


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S10444 CONGRESSIONAL RECORD — SENATE October 2, 2008 

veterans with service-connected disability, 

which expires on December 31, 2008, to December 31, 2013. 

Section 205 of H.R. 6832 contained an identical provision. 

The Compromise Agreement contains the 

provision. 

Permanent authority to establish research corporations (sec. 806) 

Section 607 of S. 2969 would strike section 

7368 of title 38 to provide permanent authority to establish research corporations. 

Section 207 of H.R. 6832 contained an identical provision. 

The Compromise Agreement contains the 

provision. 

Extension of requirement to submit annual report on the committee on care of severely 

chronically mentally ill veterans (sec. 807) 

Section 210 of H.R. 6832 would amend section 7321(d)(2) of title 38 to extend the requirement to submit an annual report on the 

committee on care of severely chronically 

mentally ill veterans through 2012. 

S. 2969 contained no comparable provision. 

The Compromise Agreement contains the 

House provision. 

Permanent requirement for biannual report on 

women’s advisory committee (sec. 808) 

Section 211 of H.R. 6832 would amend section 542(c)(1) of title 38 to provide for a permanent requirement for a biannual report by 

the women’s advisory committee on the 

needs of women veterans including compensation, health care, rehabilitation, outreach, and other benefits and programs administered by the VA. 

S. 2969 contained no comparable provision. 

The Compromise Agreement contains the 

House provision. 

Extension of pilot program on improvement of 

caregiver assistance services (sec. 809) 

Section 222 of S. 2969 would extend the 

pilot program on improvement of caregiver 

assistance services for a three-year period 

through fiscal year 2009. 

H.R. 6832 contained no comparable provision. 

The Compromise Agreement includes the 

Senate provision. 

TITLE IX—OTHER MATTERS

Technical amendments (sec. 901) 

Section 303 of H.R. 6832 would provide for 

technical amendments for the following sections of title 38: 1712A; 2065(b)(3)(C); 

4110(c)(1); 7458(b)(2); 8117(a)(1); 1708(d); 7314(f); 

7320(j)(2); 7325(i)(2); and 7328(i)(2). It also 

would provide for technical amendments to 

the table of sections at the beginning of 

chapter 36 and chapter 51, as well as amend 

section 807(e) of the Veterans Benefits, 

Health Care, and Information Technology 

Act of 2006 (Public Law 109–461) to replace 

the phrase ‘‘Medical Care’’ with ‘‘Medical 

Facilities’’. 

S. 2969 contained no comparable provision. 

The Compromise Agreement contains the 

House provision. 

f 

VETERANS’ BENEFITS 

IMPROVEMENT ACT OF 2008 

Mr. AKAKA. Mr. President, I am 

pleased that the Senate is acting on S. 

3023, as amended, the proposed Veterans’ Benefits Improvement Act of 

2008, as passed by the House of Representatives earlier this week. The bill, 

as it comes before the Senate, is a compromise agreement developed with our 

counterparts on the House Committee 

on Veterans’ Affairs. I thank Chairman 

FILNER and Ranking Member BUYER of 

the House committee for their cooperation on this legislation. I also thank 

my good friend, the committee’s ranking member, Senator BURR, for his cooperation as we have developed this 

bill. 

This omnibus veterans’ benefits bill 

will provide much needed support to 

our Nation’s veterans. It contains provisions that are designed to enhance 

compensation, claims processing, housing, labor and education and insurance 

benefits for veterans. A full explanation of the Senate and House negotiated agreement can be found in the 

Joint Explanatory Statement, which I 

will ask appear in the RECORD at the 

conclusion of my remarks. 

I will highlight a few of the provisions that I have sponsored in the legislation that is before us today. 

This legislation would result in improved notices being sent to veterans 

concerning their claims for VA benefits. Following a number of decisions 

by the U.S. Court of Appeals for Veterans Claims and the U.S. Court of Appeals for the Federal Circuit, VA’s notification letters to veterans about the 

status of their claims have become increasingly long, complex, and difficult 

to understand. These notification letters must be simplified, as veterans, 

VA, veterans’ advocates, and outside 

review bodies have all recommended. 

The notices should focus on the specific 

type of claim presented. They should 

use plain and ordinary language rather 

than bureaucratic jargon. Veterans 

should not be subjected to confusing 

information as they seek benefits. 

To further improve the VA compensation system, this legislation 

would end the prohibition on judicial 

review in the U.S. Court of Appeals for 

the Federal Circuit of matters concerning the VA rating schedule. VA 

issues regulations which are used to assign ratings to veterans for particular 

disabilities. Under current law, actions 

concerning the rating schedule are not 

subject to judicial review unless a constitutional challenge is presented. This 

legislation would amend the law to 

treat actions concerning the rating 

schedule in the same manner as all 

other actions concerning VA regulations. 

I expect VA to comply with all laws 

passed by Congress in developing and 

revising the rating schedule. However, 

justice to our Nation’s veterans requires that actions concerning the rating schedule be subject to the same judicial scrutiny as is available for the 

review of actions involving other regulations. 

VA’s Home Loan Guaranty Program 

may exempt homeowners from having 

to make a downpayment or secure private mortgage insurance, depending on 

the size of the loan and the amount of 

the VA guaranty. 

Public Law 108–454 increased VA’s 

maximum guaranty amount to 25 percent of the Freddie Mac conforming 

loan limit determined under section 

305(a)(2) of the Federal Home Loan 

Mortgage Corporation Act for a singlefamily residence, as adjusted for the 

year involved. 

The Economic Stimulus Act of 2008, 

Public Law 110–185, temporarily reset 

the maximum limits on home loans 

that the Federal Housing Administration may insure and that Fannie Mae 

and Freddie Mac may purchase on the 

secondary market to 125 percent of 

metropolitan-area median home prices 

but did so without reference to the VA 

home loan program. This had the effect 

of raising the Fannie Mae, Freddie 

Mac, and FHA limits to nearly $730,000, 

in the highest cost areas, while leaving 

the then-VA limit of $417,000 in place. 

On July 30, 2008, the Housing and Economic Recovery Act of 2008 was signed 

into law as Public Law 110–289. That 

law provided a temporary increase in 

the maximum guaranty amount for VA 

loans originated from July 30, 2008 

through December 31, 2008, to the same 

level as provided in the stimulus act. 

The compromise agreement would 

extend the temporary increase in the 

maximum guaranty amount until December 31, 2011. This would enable 

more veterans to utilize their VA benefit to purchase more costly homes. 

The compromise agreement would 

also increase the maximum guaranty 

limit for refinance loans and increase 

the percentage of an existing loan that 

VA will refinance under the VA home 

loan program. 

Under current law, the maximum VA 

home loan guaranty limit for most 

loans in excess of $144,000 is equal to 25 

percent of the Freddie Mac conforming 

loan limit for a single-family home. 

Public Law 110–289 set this value at approximately $182,437 through the end of 

2008. This means lenders offering loans 

of up to $729,750 will receive up to a 25- 

percent guaranty, which is typically 

required to place the loan on the secondary market. Under current law, this 

does not include regular refinance 

loans. 

Current law limits to $36,000 the 

guaranty that can be used for a regular 

refinance loan. This restriction means 

VA will not guarantee a regular refinance loan over $144,000, essentially 

precluding a veteran from using the VA 

program to refinance his or her existing FHA or conventional loan in excess 

of that amount. 

VA is also currently precluded from 

refinancing a loan if the homeowner 

does not have at least 10 percent equity 

in his or her home. 

The compromise agreement would remove the equity requirement for refinancing from an FHA loan or conventional loan to a VA-guaranteed loan. 

This would allow more veterans to use 

their VA benefit to refinance their 

mortgages. Many veterans do not have 

10 percent equity and thus are precluded from refinancing with a VAguaranteed home loan. 

Given the anticipated number of nonVA-guaranteed adjustable rate mortgages that are approaching the reset 

time when payments are likely to increase, the committee believes that it 


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