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C O N T E N T S
May 27, 2010

Legislative Hearing on H.R. 4062, H.R. 4465, H.R. 4505, and Draft Legislation

OPENING STATEMENTS

Chairman Michael H. Michaud
    Prepared statement of Chairman Michaud
Hon. Henry E. Brown, Jr., Ranking Republican Member
    Prepared statement of Congressman Brown
Hon. Harry E. Teague

WITNESSES

U.S. Department of Veterans Affairs, Robert Jesse, M.D., Ph.D., Acting Principal Deputy Under Secretary for Health, Veterans Health Administration
    Prepared statement of Dr. Jesse

Adler, Hon. John, a Representative in Congress from the State of New Jersey
    Prepared statement of Congressman Adler
American Legion, Barry A. Searle, Director, Veterans Affairs and Rehabilitation Commission
    Prepared statement of Mr. Searle
Iraq and Afghanistan Veterans of America, Tim Embree, Legislative Associate
    Prepared statement of Mr. Embree
Kissell, Hon. Larry, a Representative in Congress from the State of North Carolina
    Prepared statement of Congressman Kissell
Thornberry, Hon. Mac, a Representative in Congress from the State of Texas
    Prepared statement of Congressman Thornberry
Veterans of Foreign Wars of the United States, Eric A. Hilleman, Director, National Legislative Service
    Prepared statement of Mr. Hilleman
Vietnam Veterans of America, Richard F. Weidman, Executive Director for Policy and Government Affairs
    Prepared statement of Mr. Weidman

SUBMISSIONS FOR THE RECORD

Disabled American Veterans, Adrian Atizado, Assistant National Legislative Director, statement
Paralyzed Veterans of America, statement
Gold Star Wives of America, Inc., Vivianne Cisneros Wersel, Au.D., Chair, Government Relations Committee, statement

MATERIAL SUBMITTED FOR THE RECORD

Post-Hearing Questions and Responses for the Record:

Hon. Michael Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs to Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans Affairs, letter dated June 14, 2010, and VA responses

LEGISLATIVE HEARING ON H.R. 4062, H.R. 4465, H.R. 4505, AND DRAFT LEGISLATION

Thursday, May 27, 2010
U. S. House of Representatives,
Subcommittee on Health,
Committee on Veterans' Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:02 a.m., in Room 334, Cannon House Office Building, Hon. Michael Michaud [Chairman of the Subcommittee] presiding.

Present:  Representatives Michaud, Teague, Rodriguez, Brown of South Carolina, and Boozman.

OPENING STATEMENT OF CHAIRMAN MICHAUD

Mr. MICHAUD.  I would like to call the Subcommittee to order.  It is my understanding we have votes as early as 11:00 or 11:30, so we will get started, and Mr. Brown is on his way down.  I would ask unanimous consent that my full statement be submitted for the record.  Without objection, so ordered. 

I would like to thank everyone for coming today.  Today’s legislative hearing is an opportunity for Members of Congress, veterans, the U.S. Department of Veterans Affairs (VA), and other interested parties to provide their views and discuss  the legislation that has been introduced within this Subcommittee’s jurisdiction in a clear and orderly fashion.  This is an important part of the legislative process that will encourage frank and open discussion of new ideas. 

We have five bills before us, which address a number of important issues.  First, we have a radiation safety bill that requires proper training of all employees at VA hospitals.  Second, we have a bill that will require the VA to consider children under legal guardianship of veterans when determining the veterans’ copayment amount for medical treatment.  And we also have a bill that would allow Gold Star Parents access to a State Veterans Home if they have had any children who died while serving in the armed forces.  Then finally we have two draft pieces of legislation on improving VA’s outreach to veterans and another bill that would allow VA to provide hearing aids to World War II veterans. 

I want to thank our first panel for coming here today to discuss this legislation, as well as the draft legislation that we will hear afterwards.  On the first panel we have Representative Adler from New Jersey, Representative Thornberry from Texas, and Representative Kissell from North Carolina.  And we will start with Mr. Kissell and his legislation. 

[The prepared statement of Chairman Michaud appears in the Appendix.]

STATEMENTS OF HON. LARRY KISSELL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NORTH CAROLINA; HON. MAC THORNBERRY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS; AND HON. JOHN ADLER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY

STATEMENT OF HON. LARRY KISSELL

Mr. KISSELL.  Thank you, Mr. Chairman, and to my friends and colleagues on this Subcommittee.  I thank you for the opportunity to come to you today to talk about H.R. 4465.  And in light of time and recognizing that we need to move on, and in talking to the Chairman earlier that maybe the language of our bill might be a little bit confusing.  But the intent is not, I am going to stick, Mr. Chairman, with the intent. 

In today’s society, if we ever did have a nuclear family and structured a certain way, certainly today that has changed.  We know that for many reasons grandparents and great-grandparents are involved, and oftentimes in their late stages of life, in raising their grandchildren or great-grandchildren.  We have a particular case in our district where a couple aged in their seventies, on low income, fixed income, had a situation within their family where they took legal guardianship of their great-grandchildren 5 years ago.  They still have that legal guardianship.  The children are now 5 and 10 years old, and once again these are their great-grandchildren. 

In all ways, by the Internal Revenue Service (IRS), the schools, in all ways within society they are recognized as the legal guardians of these children.  But however, with the VA rules when it comes to figuring copays and the income versus dependents, they are not given consideration for these being dependents and, therefore, they do have to pay a copay.  Very clearly, if these children were recognized as being the dependents that they are, once again in all other aspects of society but with this, then they would not have to pay the copayment.  With such fixed income we are asking within H.R. 4465 that this legal guardianship with grandparents and great-grandparents or other relationships be recognized for our veterans.  If they have legal guardianship for more than 1 year, we ask that it be recognized that this is a dependency and it should be taken into account. 

We recognize this will not affect many people.  The Congressional Budget Office has said that this will not affect many people.  But the ones it will affect, we feel that we need to make this change in recognition for their status, and in trying to take care of some of our children in whatever way it came to them.  And I thank you, Mr. Chairman, and the Committee for the opportunity to discuss this with you.

[The prepared statement of Congressman Kissell appears in the Appendix.]

Mr. MICHAUD.  Thank you very much, Mr. Kissell.  Mr. Thornberry?

STATEMENT OF HON. MAC THORNBERRY

Mr. THORNBERRY.  Thank you, Mr. Chairman.  And I do appreciate you having this hearing.  I appreciate Dr. Snyder, who introduced this legislation, H.R. 4505, with me, and I appreciate your cosponsorship of it as well. 

With your permission I would like to make my full statement with some attachments part of the record.

Mr. MICHAUD.  Without objection, so ordered.

Mr. THORNBERRY.  And then I would just summarize.  Mr. Chairman, as you know there are 137 State Veterans Homes in all 50 States around the country, and they serve something over 28,000 veterans and dependents. 

We all know of Gold Star Parents and think of Gold Star Parents as someone who has lost a child in the military.  But for the purposes of being admitted to one of these State Veterans Homes the definition of a Gold Star Parent is you have to have lost all your children.  So theoretically, you could have had three of your children die in the military, if you have one still surviving you are not eligible.  And so what this bill does, it just changes that definition and says a Gold Star Parent is someone who has lost a child in the military, and would then be eligible for one of these State Veterans Homes.  That is the basis of what this legislation does. 

Now, these State Veterans Homes have an occupancy rate that is about 86 percent, 87 percent, so there is room for additional people.  The admissions criteria is still run by the States.  So the States will decide if you have a veteran who wants to get in, and a Gold Star Parent, they still make that decision.  But it just, this bill would just eliminate that Federal regulation that makes it very difficult for any parent to get into one of these State Homes. 

I might mention that the Consolidated Appropriations Act of 2010 asked the VA to study this issue and figure out how much it would cost to allow a Gold Star Parent who has lost a child to get in one of these homes.  VA came back and said, “It is not going to cost us anything so there is no use for us to do a study on it.”  But they did say in their response that legislation is required to change this, indicating they cannot do it with a regulatory change, the burden is on our shoulders to make a change.  And so this bill is supported by the American Legion, the National Association of State Veterans Homes, and other who I think you will hear from.  I know of no opposition to it, Mr. Chairman.  I think it is a basic issue of fairness.  When you have capacity, you have some folks who would like to be admitted to these homes, to just remove this really Federal restriction that makes no sense, I think, to any of us.  And I would appreciate the Committee’s consideration of it.

[The prepared statement and attachments of Congressman Thornberry appear in the Appendix.]

Mr. MICHAUD.  Thank you very much.  Mr. Adler?

STATEMENT OF HON. JOHN ADLER

Mr. ADLER.  I thank you, Chairman Michaud, and Ranking Member Brown, and Members of the Subcommittee for the opportunity to testify on behalf of H.R. 4062.  The need for H.R. 4062 came from a very serious matter that occurred at the Philadelphia Veterans Affairs Medical Center.  Starting in 2003, the brachytherapy program at the Philadelphia VA was operated by a rogue doctor who botched approximately 86 percent of the prostate cancer treatment procedures he was contracted to perform on our veterans.  These multiple failures, which went undetected year after year, highlighted significant problems in the VA’s oversight system.  The VA failed until 2008 to catch this pattern of failure. 

H.R. 4062, the "Veterans' Health and Radiation Safety Act," is a comprehensive piece of legislation that seeks to remedy many of the mistakes that led to the problems surrounding the brachytherapy program at the Philadelphia VA Medical Center.  This bill has three major components.  First, the bill mandates that the VA conduct an evaluation of all of the low volume programs that are currently operating in its medical facilities to ensure that they are meeting their safety standards.  The brachytherapy program at the Philadelphia VA was not subjected to independent peer review due to the fact that it was such a low volume program, serving only 116 patients over a 6-year period.  Because of this lack of oversight errors that should have been caught and rectified, were allowed to continue for 6 years unnoticed.

Second, H.R. 4062 requires that every VA employee and independent contractor working in a VA medical facility be trained in what constitutes a medical event, as that term is defined by the Nuclear Regulatory Commission (NRC), as well as when such an event should be reported, and to whom.  Over the course of the 6-year period in which the brachytherapy program at the Philly VA was in operation, 86 percent of the patients were subjected to reportable medical events.  However, because many of the medical personnel in the program, including the independent contractors, were not trained in what constitutes a medical event as that term is defined by the NRC, or to whom such an event should be reported, these errors were allowed to continue, and our veterans remained susceptible to substandard medical care for far too long.

Lastly, this bill requires the Secretary to evaluate all medical services provided pursuant to a contract with a nongovernment entity.  Such evaluations shall include independent peer reviews of such medical services, and written evaluations of a independent contractor’s performance by that contractor’s supervisors.  The bill also states that before a contract for medical services can be renewed, the above evaluations must be conducted.  In Philly one of the problems was that year after year that contracts were renewed every 6 months without any review by anybody, and this doctor continued to hurt good veterans.

The veterans who sought treatment for prostate cancer at the Philadelphia VA did not receive the quality of care they deserve.  Such mistreatment of our veterans is not only unacceptable, it violates the bond our country made with them when they agreed to fight for our safety and security.  It is my hope that H.R. 4062 will ensure that the failures that occurred at the Philadelphia VA will never happen again.

I thank the Chairman, and the Ranking Member, for letting me speak on this bill.

[The prepared statement of Congressman Adler appears in the Appendix.]

Mr. MICHAUD.  Thank you very much.  And once again I would like to thank all three of you for bringing forward these very important pieces of legislation.  Having reviewed them, and pending the next couple of panels, I think we can actually work on all three of them, because I think all three are very important, I look forward to working with my Ranking Member Mr. Brown to see how we can move forward these pieces of legislation.  I have no questions.  Mr. Brown?

OPENING STATEMENT OF HON. HENRY E. BROWN, JR.

Mr. BROWN OF SOUTH CAROLINA.  Thank you, Mr. Michaud.  I apologize for being late.  We had about 35 businessmen from Canada come by my office at 10:00 for a tour.  And, you know, Canada is a big trading partner with us.  And so, I am sorry I am late. 

But let me just make a brief statement.  Thank you all for coming today.  When we honor the bravery and service of our military members and veterans, we must also honor the sacrifice and selflessness of their families.  I do not think the loss of a child, whether one or many, can be differentiated, and I thank Mac for introducing his legislation.  We look forward to further proceedings on these bills.  Thank you. 

[The prepared statement of Congressman Brown appears in the Appendix.]

Mr. MICHAUD.  Thank you.  Mr. Teague, do you have any questions or opening statement?

OPENING STATEMENT OF HON. HARRY TEAGUE

Mr. TEAGUE.  Yes.  Chairman Michaud, thank you.  Ranking Member Brown, thank you for allowing me a few moments to speak on my draft legislation, the "World War II Hearing Aid Treatment Act" and its importance to the veterans of our country. 

While many look back at World War II as one of the most significant events that the Unites States and humanity was ever involved in, it has only been recently as many of yesterday’s soldiers are passing away that we as a country have really reflected on its importance and what it meant to us as a Nation.  I do not know why that is.  I do not know why it has taken so long to recognize the sacrifices that were made in North Africa, Europe, and the Pacific Theater.  Maybe it is because those individuals never wanted to make a big fuss over what they had done.  They were just doing their job.

As the son of a World War II veteran, my father talked about the War occasionally.  It was not something he bragged on.  Instead, it was something that he would mention as part of his story.  It was just a part of what he was supposed to do.  He felt it was his duty to go when called.  Maybe that is why we have taken so long to recognize the many sacrifices of this War, because those that fought it were humble and did not want to make a big deal about it.

What I do know is that, as was said by President Clinton, “when these men and women were young they saved the world.”  That is no exaggeration.  That is not just us saying something to be nice.  That is the truth.  Now we are losing World War II veterans at a faster rate than any other veteran group.  It is important that we make sure that we are doing all that we can to honor these men and women now while they are still with us. 

I believe that the "World War II Hearing Aid Treatment Act" is one of the ways we can do that.  It will authorize the Secretary to furnish a hearing aid device to any veteran who served in the active military, naval, or air service during World War II, and who is being diagnosed with a hearing impairment.  It is a simple act that can ensure that we are taking care of these historic veterans that did so much for us.  Thank you, Mr. Chairman.  That concludes my statement.

Mr. MICHAUD.  Thank you, Mr. Teague.  Mr. Rodriguez, do you have any questions, or a statement?  If not, once again I want to thank all three of you for coming today and I look forward to working with you as we markup these pieces of legislation.  So once again, thank you very much. 

I would like to call the second panel forward, and while they are coming forward I will introduce them.  It is Barry Searle, who is the Director of the Veterans Affairs and Rehabilitation Commission for the American Legion; Eric Hilleman from the Veterans of Foreign Wars (VFW); Rick Weidman, who is with the Vietnam Veterans of America (VVA); and Tim Embree, who is with the Iraq and Afghanistan Veterans of America (IAVA).  I want to thank all four of you for coming this morning, and look forward to your testimony.  We will start with Mr. Searle. 

STATEMENTS OF BARRY A. SEARLE, DIRECTOR, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; ERIC A. HILLEMAN, DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES; RICHARD F. WEIDMAN, EXECUTIVE DIRECTOR FOR POLICY AND GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA; AND TIM EMBREE LEGISLATIVE ASSOCIATE, IRAQ AND AFGHANISTAN VETERANS OF AMERICA

STATEMENT OF BARRY A. SEARLE

Mr. SEARLE.  Mr. Chairman and Members of the Subcommittee, thank you for the opportunity to present the views of the American Legion on legislation and proposed legislation important to veterans. 

H.R. 4062, the "Veterans’ Health and Radiation Safety Act," this legislation would require the Secretary of Veterans Affairs to ensure that all employees at a VA hospital where radioactive isotopes are used in the administration of medical services receive appropriate training on what constitutes a medical event and when to whom a medical event should be reported.  It would require specific evaluations and peer review of all medical services provided under contract with a nongovernment entity.  The American Legion’s System Worth Saving Task Force annually conducts site visits at the VA medical centers nationwide to assess quality and timeliness of VA health care.  During task force visits, we have found that turnover of personnel and shortage of personnel require renewed emphasis on standardized procedures, quality review, and individual training as well as documentation of that training.  As technologies continue to change and treatments and procedures continue to develop, it is critical that the VA staff delivering care be properly trained and are accountable.  The American Legion supports not only the specified training and accountability highlighted in H.R. 4062 but also the standardization of all patient care delivered across the VA system. 

H.R. 4505, expansion of State Home care for parents of veterans who died while serving in the armed forces.  The legislation permits a State Home to provide VA nursing home care to parents who suffered the loss of a child who died during service in the armed forces.  The American Legion believes that a commitment is made not only by servicemembers who commit to the service of their country but also family members who must say goodbye to their loved ones.  The American Legion believes that when a servicemember is killed in the line of duty and a dependent parent is deemed medically eligible for nursing home admission, that parent should be entitled to VA Nursing Home Care.  We believe the current regulation imposes too high a threshold of suffering on surviving parents when it requires that all children must have died in the service while on active duty.  We understand that currently the occupancy rate of the nursing homes remains at approximately 85 percent nationally.  It is felt that the number of parents who would utilize the opportunity is small enough to not significantly impact occupancy.  The American Legion supports H.R. 4505. 

H.R. 4465, the determination of attributable income for veterans with children.  This legislation would direct the VA Secretary, when examining a veteran’s attributable income, to treat as a dependent child of such a veteran any other person who is placed in the legal custody of the veteran and has not attained 21, or has not attained age 23 and is enrolled in a full-time course of study, or is incapable of self-support due to mental or physical incapacity.  The American Legion supports H.R. 4465. 

Proposed legislation, the "World War II Hearing Aid Treatment Act."  The American Legion recently adopted a resolution acknowledging current advances in scientific research, which require review of prior and potential environmental threats to servicemembers.  It is understood that past acceptable norms in environmental exposure for noise have been found to be unacceptable in today’s environment.  Especially in the case of World War II veterans the state of the art for working environment protection of servicemembers had not evolved to the current levels.  The fact of service and exposure to these environmental exposures would imply the potential for hearing loss.  The American Legion supports this proposed legislation to furnish World War II veterans with hearing aids.

We would further submit, for the Subcommittee’s consideration, the fact that environmental issues for hearing loss were in existence through the Vietnam War.  It was not until recently that significant efforts have been made to protect the hearing of servicemembers.  The American Legion suggests expanding this bill to cover veterans for the Korean and Vietnam War eras also. 

Improved "VA Outreach Act of 2010," the American Legion has testified concerning improvements VA could make to further outreach to veterans.  VA continues to make progress to improve its outreach to program veterans.  Currently the VA in many cases informs veterans service organizations (VSOs) on system improvements accomplished.  VSOs in turn advise veterans on these efforts.  This partnership between VA and the VSOs in informing veterans is critical to the success in the VA’s outreach program.

However, issues remain with the VA’s outreach to veterans.  Earlier this month the American Legion testified that the VA continues to struggle with informing veterans of entitlements such as efforts to assist transitioning servicemembers through the Benefits Delivery at Discharge Program, and the Transition Assistance Programs.  In particular, Reserve component members released from active duty mobilizations at times are rubber stamped and returned home with little or no understanding of what entitlements they have earned due to their honorable service.  The American Legion also understands that policies developed at Central Office with the best of intentions are for the most part executed at the discretion of the director at the local level, and therefore, vary in local implementation.  For example, VA has a veteran employment hiring program policy to recruit veterans as outlined in Secretary Shinseki’s Memorandum dated 21 October, 2009.  However, the American Legion has seen a variation of hiring from about 25 percent to 79 percent.  We feel this variation is due to the Director’s emphasis on outreaching to veterans.

Many veterans are moving to rural and extremely rural areas.  Nevertheless, these veterans have earned the right to receive information and updates on changes that impact their earned benefits.  While the VA has made efforts to become more user friendly we continue to hear, especially from older veterans, that the system requires documentation that is still too complicated.

We are concerned that the VA does not consistently utilize this proven partnership between veterans service organizations and the VA to optimize outreach to veterans.  The establishment of a VA Advisory Committee on Outreach as proposed in draft legislation requiring representation from members of the VSO community and reporting to the VA Secretary will enhance VA’s outreach program and ultimately better serve America’s veterans.  The American Legion supports the outreach to veterans, and in particular Improved VA Outreach Act of 2010.  Thank you. 

[The prepared statement of Mr. Searle appears in the Appendix.]

Mr. MICHAUD.  Thank you, Mr. Searle.  Mr. Hilleman? 

STATEMENT OF ERIC A. HILLEMAN

Mr. HILLEMAN.  Thank you, Mr. Chairman, Ranking Member Brown, Members of the Subcommittee.  On behalf of the 2.1 million men and women of the VFW and our auxiliaries, it is my pleasure to be here representing them before you today.  Due to the number of bills before this Committee today, I would like to limit the bulk of my remarks to two bills and briefly comment on the remaining bills.

H.R. 4505, a bill to enable State Veterans Homes to furnish nursing home care to parents whose children died while serving in the armed forces.  The VFW is proud to support this legislation, which would authorize State-run nursing homes to accept surviving parents of a child who died while serving in the armed forces.  Current law requires that a parent must have lost all of their children to military service to qualify for nursing home care.  The VFW believes the care of a Gold Star Parent is a sacred trust, and this bill would provide a critical benefit at a time when they may need the long-term care State Homes offer.  We ask Congress to act quickly to enact this legislation.

The next bill is the draft bill, "World War II Hearing Aid Treatment Act."  The VFW admires the goal of this legislation, but cannot support it as written.  Millions of Americans participated in combat in World War II, where over 416,000 were killed, and hundreds of thousands were wounded.  Almost everything about modern warfare involves loud and often incredibly loud noise.  Acoustic trauma is a major cause of hearing loss.  Those who fought in the island campaigns of the Pacific, North Africa, Normandy, and the Battle of the Bulge, or flew through the flak and fighter filled skies over Germany and France were exposed to incredibly loud noises that left damage throughout their lives. 

However, training for and fighting a war in terms of noise exposure is virtually identical in younger veterans, who trained and fought in every other war from Korea, Vietnam, to the current conflicts in Iraq and Afghanistan.  The Institute of Medicine (IOM) studied hearing loss in the military.  Essentially they said servicemembers are exposed to a wide range of noise, from occupational, i.e. trucks, generators, planes, to acoustic trauma, machine gun fire, artillery, and improvised explosive devices.  Their recommendations focused on prevention in the military.  But they suggested, “given the likely occurrence of maximum noise included hearing loss at 6,000 hertz, include the measurement of hearing thresholds at 8,000 hertz in all audiograms to allow for detection of the noise notch pattern of hearing loss associated with noise exposure.” 

The military widely recognizes that servicemembers are exposed to potential hearing damage throughout their training and average duties.  In addition to exchange of gunfire, mortars, and explosions, and those associated with combat, the Army has rated and recognizes the basic acoustic trauma that is caused by machinery, equipment, and weapons as well.  For example, a basic Humvee produces between 75 to 100 decibels of noise, while a mortar operator endures 180 decibels of noise with every mortar fired.  The VFW cannot support this legislation between the only factual difference World War II veterans’ exposure to noise and that of every other generation are the age of the veterans.

H.R. 4062, Veterans’ Health and Radiation Safety Act, the VFW supports the legislation that would amend title 38 of the U.S. Code to make certain improvements in the administration of medical facilities within the Department of Veterans Affairs. 

H.R. 4465, to amend title 38 of the U.S. Code to direct the Secretary of the VA to take into account dependent children when determining a veteran’s financial status when receiving hospital care or medical services.  The VFW supports this legislation to allow certain dependents to be counted in determining earnings threshold for the purposes of seeking services with VA.

Finally, draft bill Improved VA Outreach Act of 2010, the VFW supports this Act which would improve outreach within the Department of Veterans Affairs by coordinating the efforts among the Secretary of Public Affairs, the Veterans Health Administration, the Veterans Benefits Administration, and the National Cemetery Administration.

Thank you, Mr. Chairman.  This concludes my testimony, and I am happy to answer any questions this Committee may have.

[The prepared statement of Mr. Hilleman appears in the Appendix.]

Mr. MICHAUD.  Thank you.  Mr. Weidman?

STATEMENT OF RICHARD F. WEIDMAN

Mr. WEIDMAN.  Mr. Chairman, thank you for the opportunity for Vietnam Veterans of America to present our views here today. 

In regard to H.R. 4062, "Veterans’ Health and Radiation Safety Act," one would think that this piece of legislation would not be needed but clearly demonstrated by the situation at Philadelphia VA Medical Center, it is.  VVA is generally in favor of anything that promotes greater reporting and is accompanied by greater accountability for quality assurance by the VA health care system.  And in this particular instance you can code the metrics into VistA, and do so without additional burdens on the clinician, which takes away from patient-centric care.  And so we favor this legislation at this point.  And to add to the analysis of the annual report would also add something that we do not talk about very often.

The size of the staff at the VA has swollen enormously since 1994.  But the staff, numbers of staff working for the Congress and for the Committees on both sides of the Hill is less today than it was in 1994.  And you need the organization capacity here to be able to go through all of the reporting mechanisms that you put in place, to be able to absorb that information and assimilate it, and work with the Members of the Committee to help them understand what situations need more close monitoring and oversight hearings.  And so we would just put in a pitch for, and we will reiterate that to the Speaker and to the Republican Leader as well.

H.R. 4505, which authorizes the VA Secretary to authorize VA State Nursing Homes to take in Gold Star Parents is something we are very much in favor of.  Of all weeks in the year, this is the most appropriate week that we all should be thinking about Gold Star Families.  Not just the moms and dads, but also the spouses and the children who are left behind, as well as siblings.  We very much favor this.  The Gold Star Manor in California cannot possibly handle most of the folks whose sons, primarily, and daughters are not around to care for them in their later years.  And so this is a needed step.  It is not a heavy lift.  And we very much favor early passage.

The draft to Improve VA Outreach Act of 2010, we do favor this.  VA’s testimony this morning, written statement says it is redundant.  But gosh, we cannot see it.  There is so little outreach and education of the veterans’ community as to what are the benefits and services available to them, and what are the long-term health care risks that result from military service depending on what branch did you serve in, when did you serve, where did you serve, that we at VVA started Veterans Health Council.  VVA, it is www.veteranshealth.org.  And we are partnered with a number of other organizations, more than fifty organizations, primarily medical societies, like the American Academy of Ophthalmology, American Psychiatric Association, disease advocacy groups, like American Diabetes Association, Men’s Healthcare Network, and other veterans service organizations like National Association of Black Veterans, the United Spinal Cord Association, Veterans First Project, and National Association of Uniformed Services, in order to do outreach directly to those folks.  We have given out over 100,000 brochures and are getting about 5,000 hits a month on our Web site because people are not getting that information in a succinct form from VA, one.  Two, is to do the outreach through the U.S. Department of Health and Human Services (HHS).  The reason why that is so important is we have to reach out to civilian medicine.  Less than 20 percent of the VA population eligible, potentially eligible, uses the VA medical system as their primary health care system.  We have to reach that 80 percent outside in order that they understand what is available to them.  So we are very much in favor of this. 

Last but not least, I see I am out of time, the WWHAT bill, which is, love the name.  But we would like to commend you.  The IOM study that was cited before that was September 2005 that looked in depth basically said there was no recordkeeping, there was no longitudinal study of any human beings, much less military veterans of World War II.  Therefore, trying to prove that you were exposed to those kinds of noises in World War II, they are all octogenarians now, and nonagenarians.  It is time to give them a hearing aid to improve the quality of their lives in the time that they have left.  In regard to other comments about including the Korean War, we would concur with that, as well as other military service.  But the bill as it is, we favor. 

Thank you very much, Mr. Chairman, for the opportunity. 

[The prepared statement of Mr. Weidman appears in the Appendix.]

Mr. MICHAUD.  Thank you very much, Mr. Weidman.  And Mr. Embree?

STATEMENT OF TIM EMBREE

Mr. EMBREE.  Thank you, sir.  Mr. Chairman, Ranking Member, and Members of the Subcommittee, on behalf of Iraq and Afghanistan Veterans of America’s 180,000 members and supporters, I would like to thank you for inviting us to testify before your Subcommittee today. 

My name is Tim Embree.  I am from St. Louis, Missouri.  I served two combat tours in Iraq with the United States Marine Corps Reserve.  This legislation being considered today will profoundly affect veterans of all generations and their families.  We appreciate this opportunity offer our feedback. 

IAVA proudly supports the Improved VA Outreach Act of 2010.  Too many men and women discharging from the military are not enrolling in the Department of Veterans Affairs for their well earned benefits.  Currently, the burden is on the veteran to seek out their benefits within a passive VA.  This is unacceptable.  The VA must develop a relationship with the servicemembers while they are still in the military, not after the servicemember has traded in his uniform for a t-shirt and blue jeans.  The VA should learn from successful college alumni associations.  Those folks did not wait until graduation day to find their newest members.  They greeted on the 1st day of freshman year, and repeatedly engaged them throughout their education with planned activities and social events.  The VA should do the same. 

They should greet servicemembers once they complete basic training and build on that relationship throughout the servicemember’s time in uniform.  When a person leaves the service the VA should create a regular means of communicating with them about events, new programs, and opportunities.  The VA must aggressively promote VA programs to veterans who have not yet accessed their Department of Veterans Affairs benefits.  If I have half as many letters and emails from the VA as I do from my college alumni association that would be a good start. 

To transfer the VA from reactive to proactive, IAVA believes the Department of Veterans Affairs must invest in aggressive, modern, and innovative outreach.  This is not happening now and veterans are clearly suffering as a result.  IAVA was disappointed when there were only a few brief mentions of outreach activities in the President’s VA budget submission, none of which were for a dedicated outreach campaign.  We believe the VA must include a distinct line item for outreach within each VA appropriation account.  This line item should fund outreach programs such as the Operating Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) outreach coordinators, mobile Vet Centers, and the VA’s new social media presence on Facebook and Twitter. 

The VA’s current outreach campaign is disappointing.  When the VA announced it had placed ads on more than 21,000 buses nationally in order to spread the word about the suicide prevention lifeline, we were initially enthusiastic.  But then we saw the ad.  We saw another missed opportunity.  The VA bus ad had over 30 small print words.  The average bus ad is limited to five to ten words.  In the short time when a bus passes, a veteran would have to go by the bus repeatedly to even read the hotline number. 

IAVA has run one of the largest nongovernmental outreach campaigns in history.  We have partnered with the Ad Council and some of the world’s best advertising firms.  We have learned a lot about the best ways to communicate complex and series issues through television and print, and we are ready to work with the VA to share our expertise. 

The Improved VA Outreach Act will help the VA take their current outreach efforts to a whole new level.  This bill requires the VA to effectively coordinate outreach efforts among the different parts of the Department, as well as other agencies offering services to returning servicemembers.  To work closely with HHS in order to promote community health centers.  These community health centers may be the only medical facility a rural vet can reasonably access without spending a full day riding in a car or bus.  To set up an outreach committee tasked with coordinating efforts, which currently are being done on an ad hoc basis among many of the VA’s separate departments, and to submit a 2-year plan fully explaining their outreach activities. 

To bring America’s next generation of veterans into the VA to receive the benefits they have earned will require an unprecedented VA outreach program.  The Improved VA Outreach Act of 2010 is the first step in getting us there. 

Stories about veterans leaving VA facilities sicker than when they entered cast a cloud over the confidence veterans place in the system charged with their care.  Therefore, IAVA endorses H.R. 4062, the "Veterans’ Health and Radiation Safety Act."  Improper use of medical equipment, especially radioactive isotopes, can lead to unexplained illness, cancer, and even death.  The VA was recently issued the largest fine by the Nuclear Regulatory Commission for misuse of radioactive isotopes in the treatment of nearly 100 veterans in Philadelphia.  H.R. 4062 mandates the proper oversight of these treatments so veterans can be confident in the safety of the care they receive. 

It is common sense to support of Gold Star Parents, who have given so much to our Nation.  That is why IAVA supports H.R. 4505.  This bill expands access for Gold Star Parents to State Nursing Homes.  H.R. 4505 changes the requirements to include Gold Star family members who have no remaining sons or daughters, but have lost one of their children in service to their country. 

IAVA is proud to continue working with this Committee on the many issues facing today’s veterans.  Thank you very much for your time today and I look forward to answering any questions you may have. 

[The prepared statement of Mr. Embree appears in the Appendix.]

Mr. MICHAUD.  Thank you very much, Mr. Embree.  Mr. Brown, do you have any questions for the panel?

Mr. BROWN OF SOUTH CAROLINA.  Thank you, Mr. Chairman, no I do not.  I appreciate the input on these bills.  I know we are pretty much in agreement, except maybe on the hearing aid issue.  And we will certainly look forward to further discussion on that.  Tthank you all for being here. 

Mr. MICHAUD.  Mr. Teague?

Mr. TEAGUE.  No, I do not have any questions at this time.  And for the sake of speed, we will save them for later.  Thank you.

Mr. MICHAUD.  Mr. Boozman?

Mr. BOOZMAN.  No, I also do not have any questions.  Again, we appreciate your guys’ hard work, and all that you represent, and giving us your opinion regarding this.  So thank you very much.

Mr. MICHAUD.  Mr. Rodriguez?

Mr. RODRIGUEZ.  Yes, let me also just take this opportunity to thank you and maybe inquire about one comment.  The 84 percent vacancies in the nursing home, is this nationwide?  Because I know in Texas we only have about six or seven of them, and we do not have too many nursing homes for veterans.  I am not sure if we even have any vacancies.  Does anybody want to make any comments on that?  I know we usually have a waiting list.

Mr. SEARLE.  Yes, sir.  Those come from VA’s numbers themselves that they reported on average that that is where their numbers are.  There are some homes that are less.  But on a national average it is about an 84 percent occupancy rate in the nursing homes. 

Mr. RODRIGUEZ.  Yes, because I know in Texas we never had them until just in the last decade or so, perhaps the last two decades.  I do not have any in my district, and in my previous district, I only had one.  Okay, thank you. 

Mr. MICHAUD.  Thank you.  I have a question for everyone on the panel, and which some of you touched upon in your testimony.  VA states in their written testimony that they do not support H.R. 4062, the "Veterans’ Health and Radiation Safety Act," because they either met or are working to meet the recommendations provided in the May 2010 Inspector General (IG) report.  What is your response to VA’s rationale for not supporting this legislation?  And can you explain whether you believe the VA has made sufficient progress in improving the handling of radioactive isotopes at the VA medical facilities?  I know some of you have touched upon this question in your opening remarks.  Mr. Searle, do you want to start? 

Mr. SEARLE.  Again, through our System Worth Saving Task Force we have gone to the various medical centers.  We have found that there are, and we can forward to you in detail some of the results, but we have found that there is a turnover of personnel, and that the training of the personnel needs to be standardized and it needs to be reinforced.  Because new personnel with the activities that are going on need to be reinforced. 

Mr. HILLEMAN.  Mr. Chairman, thank you for this question.  In the mind of the VFW it is a confidence issue.  Here we had an incident where a number of veterans were harmed by medical procedures that they trusted, doctors that they had faith in.  And that faith has been undermined.  So Congress taking action to ensure that an event like this never happens again is something we strongly support.  Not only that, but the reporting mechanisms in the bill will help to ensure that the steps VA is already taking are followed through on.  Thank you, sir.

Mr. WEIDMAN.  Much of what happens in this room and with the distinguished Members of this Committee that you focus on are things that all you have to do is have common sense and VA would already be doing.  And in some instances they do not have the authority to move forward, but in many others they do.  And this is one of those instances.  Clearly, there has not been put in place the metrics to measure this systemwide and to report on it.  And once again, as I said in both our written statement and in the oral statement, it can be designed to have metrics that are not onerous on the service providers that will allow VA to know what is going on at X, Y, and Z service delivery point. 

The biggest problem within the VA systemwide, and certainly with in the medical health care system, is what you measure and how do you measure it, and how well do you measure it?  It is the quality assurance that is the primary failure of this system.  To know where there are deficiencies, one, and two, holding people accountable at the supervisory and management level has been lacking, in our view, for a very long time and that is where we need to go with this system.  To ensure that we are getting the bang for the buck, we have had over a third increase in the health care budget in the last 4 years.  And the question is whether or not we are getting the bang for the buck.  We are not convinced that we are yet, but it is certainly possible.  But it is going to take a lot of oversight on a bipartisan basis but this Committee and we encourage you to do that.  And this is one more step in that road. 

Mr. EMBREE.  Mr. Chair, thank you for the question.  Actually, this kind of ties into the VA outreach.  Right now from the OIF and OEF era veterans, it is tough enough to get these folks into the VA system, for them to learn about the VA system.  And to learn about the quality of VA health care.  VA health care is very, very good.  Unfortunately, when situations like this arise where it breaks down the trust, and it hurts the appearance of the VA health, then we need to fix that right away.  And there needs to be strong oversight.  And we need to restore confidence in this system.  And that helps with the outreach to these young veterans that are now coming from the battlefields of Afghanistan and Iraq.

So it is so important for programs like this to have strong oversight to instill confidence in the new veterans that are now trying to come into the system.  Because we want to bring these new veterans into the system, but we want them to have confidence in the system that we are trying to convince them to enter.

Mr. MICHAUD.  Great.  Once again, I want to thank each of you for your testimony this morning.  I look forward to working with you as we move forward with the legislation that we heard this morning.  And I am sure there will probably be additional questions that staff will submit to you in writing.  So once again, thank you very much. 

I would like to ask the third panel to come forward.  And while they are coming forward, the third panel includes Dr. Jesse, who is the Acting Principal Deputy Under Secretary for Health with the VHA.  He is accompanied by Walter Hall, who is the Assistant General Counsel to the VA.  I want to thank you both for coming this morning.  And we will turn it over to Dr. Jesse. 

STATEMENT OF ROBERT JESSE, M.D., PH.D., ACTING PRINCIPAL DEPUTY UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY WALTER A. HALL, ASSISTANT GENERAL COUNSEL, OFFICE OF GENERAL COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS

Dr. JESSE.  Yes, good morning Mr. Chairman and Members of the Subcommittee.  It is a pleasure to appear before you for the first time today as Acting Principal Deputy Under Secretary for Health.  I am accompanied by Mr. Walter Hall, the Assistant General Counsel.  We appreciate the opportunity to testify on five pending bills and offer VA’s views.

H.R. 4062, the "Veterans’ Health and Radiation Safety Act," would require VA to submit an annual report to Congress on low volume programs, require employees working at VA hospitals where radioactive isotopes are used to receive training in recognizing medical events, and require VA to provide frequent evaluations of nongovernment medical service contractors.  While we appreciate the intent of H.R. 4062, there are a number of reasons why VA does not support it at this time.

Mr. Chairman, we all acknowledge the lapses that occurred at a brachytherapy program at one of our facilities and as a result the Office of the Inspector General has issued a report with five recommendations.  VA has taken specific actions to comply with all of these recommendations, which are detailed in my written statement.  Consequently, we believe we have addressed most of Congress’ concerns that are reflected in H.R. 4062.  We have other issues with the legislation that are specifically related to terminology, the scope of the legislation, and reporting requirements, and these are also expanded in my written testimony. 

VA would like to work with the Committee to better understand the intent of H.R. 4465, which would change the attributable income for the purposes of determining eligibility.  On its face the bill benefits only a small population, namely those persons placed in the legal custody of a veteran as a result of a court order.  Such persons would be considered children under more generous criteria than the veteran’s natural children.  If this differentiation was not Congress’ intent, and it does not appear that it is, VA is ready to work with the Committee to develop a proposal that would achieve its objective. 

VA supports H.R. 4505, which would permit a State Home constructed with VA’s resources to provide services to the parents of veterans if any of the parents’ children died while serving in the armed forces.  The legislation provides for fair and more equitable treatment of all parents whose son or daughter died while on active military duty.  There are not additional costs to the VA for this.

The first draft bill under consideration is the Improved VA Outreach Act of 2010.  I am pleased to report that VA is already meeting the intent of the legislation.  VA recently created a National Outreach Office in the Office of Public and Intergovernmental Affairs, which is responsible for ensuring the effective coordination of outreach activities across all VA sectors.  In addition, VA has five advisory committees on homeless veterans, minority veterans, women veterans, readjustment, and rural health that provide outreach direction in their annual reports to the Secretary and to Congress.  VA has already established a work group to better coordinate services between Indian Health Service and VA, and is working on a memorandum of agreement to improve that coordination. 

The final bill on the docket today is a draft bill that would expand eligibility for hearing aids to all veterans of active duty service in World War II, even if those veterans are not otherwise entitled to compensation under title 38 of the United States Code.  We currently have authority to provide hearing aids to veterans with service-connected hearing loss as well as to veterans whose hearing loss is not service-connected but is so severe that it impedes their communication and participation in their medical care. 

While hearing loss can be frustrating and dangerous, especially for older adults, VA does not support the legislation as it would result in inequitable treatment of non-World War II veterans with hearing loss.  The legislation would also create special benefits for veterans needing hearing aids in relation to veterans needing other prosthetic appliances that are equally crucial to the veterans, well being and quality of life.  The discretionary cost of this legislation would be approximately $14.8 million in the 1st year, $350 million over 5 years, and $509.7 million over 10 years.

This concludes my statement, Mr. Chairman.  I would be pleased at this time to answer any questions you or other Members of the Subcommittee may have. 

[The prepared statement of Dr. Jesse appears in the Appendix.]

Mr. MICHAUD.  Thank you very much, doctor.  I have a question concerning the facts that you just stated, about all the veterans who are eligible for hearing aids.  There are approximately 2.4 million World War II veterans who are service-connected.  You mentioned even those that might not be service-connected still access hearing aids?

Dr. JESSE.  Yes, sir.

Mr. MICHAUD.  How did you come up with that outrageous number?  The cost?

Dr. JESSE.  I would have to go back through the math of all that.  But we can certainly get that to you for the record.

Mr. MICHAUD.  I would hope so, and I would hope that it is very explicit, because that math does not seem to add up.  Once you exclude those veterans who are not service-connected, it jus