Apr112013
Hearing Transcript on Legislative Hearing on H.R. 5730, H.R. 5554, H.R. 5622, H.R. 2818, H.R. 5595, and H.R. 5729.
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LEGISLATIVE HEARING ON H.R. 2818, H.R. 5554, H.R. 5595, H.R. 5622, H.R. 5729, AND H.R. 5730
HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED TENTH CONGRESS SECOND SESSION APRIL 15, 2008 SERIAL No. 110-82 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director SUBCOMMITTEE ON HEALTH
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined. |
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C O N T E N T S
April 15, 2008
Legislative Hearing on H.R. 2818, H.R. 5554, H.R. 5595, H.R. 5622, H.R. 5729, and H.R. 5730
OPENING STATEMENTS
Chairman Michael Michaud
Prepared statement of Chairman Michaud
Hon. Jeff Miller, Ranking Republican Member, prepared statement of
Hon. Phil Hare
Hon. Shelley Berkley
Hon. John T. Salazar, prepared statement of
WITNESSES
U.S. Department of Veterans Affairs, Gerald M. Cross, M.D., FAAFP, Principal Deputy Under Secretary for Health, Veterans Health Administration
Prepared statement of Dr. Cross
American Legion, Joseph L. Wilson, Deputy Director, Veterans Affairs and Rehabilitation Commission
Prepared statement of Mr. Wilson
Brown-Waite, Hon. Ginny, a Representative in Congress from the State of Florida
Carney, Hon. Christopher P,. a Representative in Congress from the State of Pennsylvania
Prepared statement of Congressman Carney
Disabled American Veterans, Joy J. Ilem, Assistant National Legislative Director
Prepared statement of Ms. Ilem
Ellsworth, Hon. Brad, a Representative in Congress from the State of Indiana
Filner, Hon. Bob, Chairman, Full Committee on Veterans' Affairs, and a Representative in Congress from the State of California
Michaud, Hon. Michael H., Chairman, Subcommittee on Health, Committee on Veterans' Affairs, and a Representative in Congress from the State of Maine
Prepared statement of Congressman Michaud
Perlmutter, Hon. Ed, a Representative in Congress from the State of Colorado
Prepared statement of Congressman Perlmutter
Veterans of Foreign Wars of the United States, Christopher Needham, Senior Legislative Associate, National Legislative Services
Prepared statement of Mr. Needham
Vietnam Veterans of America, Bernard Edelman, Deputy Director for Policy and Government Affairs
Prepared statement of Mr. Edelman
SUBMISSIONS FOR THE RECORD
American Veterans (AMVETS), Raymond C. Kelly, National Legislative Director
National Association of State Alcohol and Drug Abuse Directors, Inc., Lewis E. Gallant, Ph.D., Executive Director
Paralyzed Veterans of America
MATERIAL SUBMITTED FOR THE RECORD
LEGISLATIVE HEARING ON H.R. 2818, H.R. 5554, H.R. 5595, H.R. 5622, H.R. 5729, AND H.R. 5730
Tuesday, April, 2008
U. S. House of Representatives,
Subcommittee on Health,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:00 a.m., in Room 334, Cannon House Office Building, Hon. Michael Michaud [Chairman of the Subcommittee] presiding.
Present: Representatives Michaud, Hare, Berkley, Salazar, Miller, and Brown of South Carolina.
OPENING STATEMENT OF CHAIRMAN MICHAUD
Mr. MICHAUD. I would like to thank everyone for coming this morning.
Today's hearing is an opportunity for Members of Congress, the Veterans Service Organizations (VSOs), and the U.S. Department of Veterans Affairs (VA), and other interested stakeholders and parties to provide their views and discuss recently introduced legislation within the purview of this Subcommittee.
The six bills before us today will cover a wide range of topics that are germane to veterans' healthcare issues. Issues addressed in today's hearing are bills that would address spina bifida, Epilepsy Research Centers, substance use disorder treatment and prevention, expansion of dental care, timely access to care, and a bill of rights.
I do not necessarily agree or disagree with all these bills, but I think it is a very important part of the legislative process to hear the legislation before us.
I want to thank our first panelists here today, and I would now like to ask Mr. Hare if he has any comments he wants to make?
[The statement of Chairman Michaud appears in the Appendix.]
Mr. HARE. No, Mr. Chairman.
Mr. MICHAUD. Thank you. We will start right off with the Honorable Chairman of the full Committee on Veterans' Affairs who has a long history of fighting for veterans issues.
Mr. Filner, I want to thank you for your leadership as it relates to Veterans' Affairs. And your tenacity in making sure that Congress does whatever we can do to help our veterans.
And you presented us today H.R. 5730. So without any further ado, Mr. Filner.
STATEMENTS OF HON. BOB FILNER, CHAIRMAN, COMMITTEE ON VETERANS' AFFAIRS, AND A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA; HON. ED PERLMUTTER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF COLORADO; HON. CHRISTOPHER P. CARNEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA; HON. BRAD ELLSWORTH, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF INDIANA; AND HON. GINNY BROWN-WAITE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA
Mr. FILNER. Thank you, Mr. Chairman and thank you for your leadership. We have passed, under your leadership as Chairman, a wide variety of bills on veterans' health care. And we will continue to do so. I think the veterans across the Nation will be better off because of the work of this Subcommittee.
As you said, I am speaking on H.R. 5730, the "Injured and Amputee Veterans Bill of Rights." As we see servicemembers returning from Iraq and Afghanistan with amputations and musculoskeletal injuries, many will require prosthetic and orthotic care and will be entering the VA healthcare system for that care.
In order to mitigate the impact of these potentially debilitating injuries, I believe the VA should establish a set of standards outlining the expectations and rights that returning veterans with musculoskeletal injuries have with respect to their prosthetic and orthotic needs.
H.R. 5730, which I introduced, requires that the Secretary of Veterans Affairs prominently display an “Injured and Amputee Bill of Rights” at every VA prosthetic and orthotic clinic.
This bill of rights outlines standards of care to ensure that injured and amputee veterans across the country have the same access to the highest quality of orthotics and prosthetics care in the most timely manner and using the most effective technology and treatments available.
For the most part, VA has provided quality orthotic and prosthetic care to injured veterans. But there are some areas where there are inconsistencies that require improvement.
Adoption of this bill of rights will establish a consistent set of standards that will form the basis of expectations of all veterans who have incurred an amputation or musculoskeletal injury requiring the prosthetic and orthotic care.
Our injured veterans deserve the assurance that they will receive the best care possible. And I believe this bill will provide a step in that direction.
Mr. Chairman, I thank you for taking up all these bills today. This bill was inspired by a wide variety of experiences. I have talked to both patients and healthcare professionals both with staff within and those outside the VA who provide the prosthetics that are necessary.
So I look forward to working with you to get this bill done.
Mr. MICHAUD. Thank you, Mr. Chairman, and I look forward to working with you as well as we move forward with this piece of legislation.
The next bill is H.R. 2818, the Epilepsy Centers for Excellence, by Mr. Perlmutter.
STATEMENT OF HON. ED PERLMUTTER
Mr. PERLMUTTER. Thank you Mr. Chairman, and Mr. Miller, and Mr. Hare. Good Morning. I want to thank you for holding this hearing on H.R. 2818, the "Veterans' Epilepsy Treatment Act of 2008."
The VA Epilepsy Centers of Excellence Act, which I introduced on June 21, 2007, will create at least six VA Epilepsy Centers within the VA care system. A companion bill introduced by Senator Patty Murray passed the Senate VA Committee on December 12, 2007.
The Centers of Excellence will care for all veterans experiencing seizures and especially those we predict will develop epilepsy as a result of suffering a Traumatic Brain Injury (TBI) while serving in Operation Iraqi Freedom and Operation Enduring Freedom.
Epilepsy is defined as two or more seizures. During Vietnam, a number of men and women returned home with head wounds and head injuries. Of those who came home with these types of injuries, some 53 percent developed epilepsy within 15 years. And 15 percent of those who developed epilepsy did so five or more years after their combat injury.
Last year, I met with Dr. John Booss, the former Director of Neurology for the VA. He advised me that in 1972, the VA responded to the rise in veterans returning with seizures by creating VA Health Centers around the Nation that specialized in the treatment and research of epilepsy. The VA Centers partnered with medical schools to assist it in treating veterans with seizures and building a body of knowledge concerning epilepsy.
However, sometime in the 1980s or early 1990s, the increase in veterans developing epilepsy subsided, funding dissipated, and the centers were curtailed. At this time, the VA operates seven epilepsy monitoring sites. But these sites lack the resources and capacity to care for our current veterans with epilepsy.
Dr. Booss and a number of organizations such as the American Academy of Neurology, the Epilepsy Foundation of America, the Brain Injury Association, and the Citizens United for Research in Epilepsy have highlighted the need to rebuild the Epilepsy Centers of Excellence for the many men and women returning from the Middle East with head wounds and brain injuries.
Your Committee is only too aware of the injuries suffered by our servicemen and women in Iraq and Afghanistan. It is estimated that today some 89,000 veterans have epilepsy of which 42 percent of that number is service connected. If our country's experience in Vietnam is any indication of what to expect in the future, the number of veterans with epilepsy is surely bound to rise.
As an example, after I introduced this bill, I was contacted by one of my constituents, Naval Reserve Petty Officer Brian Johnson. He suffered a TBI while assigned to Navy Mobile Construction Battalion 7 just outside of Fallujah, Iraq.
And on November 7th, 2004, his position came under fire and he sustained a brain injury when he was blown against a wall when two mortars exploded nearby. After returning home, he resumed his small plumbing business but eventually lost it due to the incidence of seizures.
Petty Officer Johnson's story is just one of many emerging from the experiences our servicemen and women are having after returning home.
H.R. 2818 establishes a process where VA Medical Centers partner with medical schools across the country to compete for the designation of a VA Epilepsy Center of Excellence. Six of these centers would be selected by the VA and would be disbursed across the country.
The VA's telemedicine capacity would also be expanded to track the neurological diagnostic tests of our rural veterans. And it is anticipated that each of these centers would cost about a million dollars for the first four years.
I want to thank the Disabled American Veterans, the Paralyzed Vets, the Blinded Veterans, and the Vietnam Veterans of America, and the other organizations I mentioned for their support of this bill.
I want to thank you for your time. And I look forward to answering any of your questions.
[The statement of Congressman Perlmutter appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Mr. Perlmutter. The next piece of legislation is H.R. 5595, the "Make Our Veterans Smile Act of 2008," presented by Mr. Carney.
STATEMENT OF HON. CHRISTOPHER P. CARNEY
Mr. CARNEY. Good morning, Mr. Chairman, Mr. Michaud, and Ranking Member Miller, and our distinguished colleagues. I appreciate having this opportunity to discuss the bill I introduced with Congressman Mark Kirk, H.R. 5595, the "Make Our Veterans Smile Act of 2008."
The "Make our Veterans Smile Act" will expand dental care offered by the Department of Veteran Affairs to all service-connected disabled veterans. The VA has done an excellent job of providing dental services to those that are able to receive them and the VA should continue to provide these services.
However, the VA does not provide dental services to disabled veterans who are 90 percent or less disabled. The Make our Veterans Smile Act will fix this problem by allowing all service-connected veterans to receive dental care through the VA. This will add another 2.4 million disabled veterans to the VA dental program.
I believe we have a moral obligation to care for these veterans. And I understand that the VA might have problems meeting the demand for dental services that will occur because of this legislation.
That is why this legislation allows service-connected disabled veterans to use contractor facilities for dental care. However, this legislation does not mandate contractor facilities be used. Instead it simply gives the VA greater authority to use these facilities.
The cost of this bill is a cost of the war. It is an investment in our way of life and our future. As every Member of this Subcommittee knows, to ensure a ready fighting force for tomorrow, we need to take care of our veterans today.
I would also like to point out that conditions such as missing teeth and cavities can be barriers in seeking employment. And I believe every effort must be made to ensure that there is a smooth transition for our military members who are entering the civilian work force.
We must also ensure that disabled veterans from past wars are also given every tool to keep meaningful jobs and this includes dental care.
I would like to point out that numerous studies have shown that there is a clear correlation between dental health and someone's overall health.
I would like to thank the Enlisted Association of the National Guard of the United States, the Navy Reserve Association, the Air Force Association, the Military Order of the Purple Heart, and AMVETS for support of this bill.
I would also like to thank you again, Chairman Michaud, and Ranking Member Miller, and our distinguished colleagues, for holding this hearing and for allowing me to testify. I would be happy to answer any questions you might have.
[The statement of Congressman Carney appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Mr. Carney. The next bill is H.R. 5729, the "Spina Bifida Health Care Program Expansion Act," presented by Mr. Ellsworth.
STATEMENT OF HON. BRAD ELLSWORTH
Mr. ELLSWORTH. Thank you, Chairman Michaud, Ranking Member Miller, and Members of this Subcommittee. I would like to thank you all for inviting me to testify in support of my bill, H.R. 5729, the "Spina Bifida Health Care Program Expansion Act."
Last year I testified in front of the Veterans' Affairs Subcommittee on Disability Assistance and Memorial Affairs on behalf of my constituents, Honey Sue Newby and the Nesler family of New Harmony, Indiana. I shared the heart-wrenching story of Honey Sue. This is a woman who lives with a complicated neurological disorder rooted in spina bifida and her parents Susan and Ron Nesler. They provide around-the-clock, 24-hour attendance and care.
Honey Sue's biological father served eight years in the Marine Corps and completed three combat tours in Vietnam. The VA concedes and testifies that Honey Sue's condition is the direct result of her biological father's exposure to Agent Orange, a defoliant and herbicide used to protect our armed forces in Vietnam.
I introduced H.R. 5729 in an attempt to clear this seemingly insurmountable bureaucratic hurdles that continue to frustrate the Neslers. Each time the Neslers seek medical care for Honey Sue, they must provide a letter from a doctor from the VA stating that her condition is directly related to spina bifida. That is a given. It has been testified to and it is proven.
The Neslers must repeat this routine despite the fact that Honey Sue is recognized as a Level III child. And as you know, Level III children are eligible for the same full healthcare coverage as a military veteran with 100 percent service-connected disability.
It is my hope that H.R. 5729 will provide people facing the same challenges as Suzanne and Ron immediate relief from the paperwork and give them the piece of mind that their children will have unconditional access to attendant care when they are no longer capable of providing it themselves.
With the passage of this bill, Honey Sue and the estimated 1,200 children—I would like to emphasize, this is only 1,200 children with Levels I, II, and III spina bifida as caused by parents exposure to Agent Orange that we dropped on that country and dropped on our veterans. They will receive the same full healthcare coverage as the 100 percent service-connected military veterans.
I look forward to working closely with Dr. Gerald Cross at the Veterans Health Administration (VHA) and House VA Committee to ensure this legislation provides the Neslers and other families caring for children suffering from spina bifida with the much needed and long overdue relief from the tremendous bureaucratic hurdles that they currently face. I would also like to take just a moment to thank Cathy Wimblemo and Mark Heyman with the Subcommittee staff for being so helpful in this process.
I look forward to hearing the expert testimony from the witnesses on panel two and from Dr. Gerald Cross on panel three. Thank you and I yield back.
Mr. MICHAUD. Thank you very much, Mr. Ellsworth. The next piece of legislation is H.R. 5622, the "Veterans Timely Access to Health Care Act."
STATEMENT OF HON. GINNY BROWN-WAITE
Ms. BROWN-WAITE. Thank you, Mr. Chairman and Ranking Member Miller, for the opportunity to testify before this Subcommittee today.
I am pleased to have the opportunity to discuss this bill known as the "Veterans Timely Access to Health Care Act." This bill makes a responsible and reasonable commitment to veterans throughout the country by ensuring that veterans receive the care that they deserve.
Under H.R. 5622, if a veteran cannot get an appointment with a primary care physician within 30 days of a request, the veteran may see a private physician at no additional cost.
This bill contains provisions similar to those found in other bills that I have introduced in the past. However, this bill is unique in several ways. First, H.R. 5622 would create just a pilot program. It wouldn't go nationwide. It would be a pilot program that encompasses the Veterans Integrated Service Network (VISN) 8, which includes most of south Georgia, Florida, Puerto Rico, and the U.S. Virgin Islands.
The pilot program would give veterans receiving healthcare in VISN 8 the opportunity to seek healthcare from a primary care provider outside the VA if they have to wait more than 30 days for an appointment through the VA.
Mr. Chairman, it is more than reasonable for a veteran to expect to be seen by a primary care physician within 30 days. If the VA cannot provide this basic service to our veterans, then our veterans should have the option to look elsewhere.
My bill—and I would like to emphasize this does not force any veteran out of the VA healthcare system. It simply provides them another option to go outside the VA if they desire.
Should a veteran seek to see a physician outside the system, it is imperative that the VA be able to keep track of that veteran's medical records to ensure continuity of care. Therefore, this bill directs the Secretary to provide a form to veterans that would authorize the VA to obtain the records from these out-of-network visits. This provision is critical as the goal of H.R. 5622 is to ensure veterans not only receive access to timely healthcare, but to quality healthcare as well. This makes sure that there is a continuity of care and information sharing.
Mr. Chairman, as a Member of Congress from VISN 8, I would like to make this option available to the veterans in and around VISN 8 and certainly to expand it nationwide. There is no reason why any veteran should have to wait more than 30 days to receive basic care.
Thank you, Mr. Chairman.
Mr. MICHAUD. Thank you very much, Ms. Brown-Waite. We have one more bill, which is actually my bill. So we will not hold up the rest. The panel will start taking questions. The first bill, H.R. 2818, Mr. Perlmutter's bill on Epilepsy Centers of Excellence. I will open it up for any questions or comments. Mr. Miller?
Mr. MILLER. The one thing on H.R. 2818, the "Veterans' Epilepsy Treatment Act of 2008," I think that I was—and I apologize, I was looking at another bill. I am trying to get my things together.
Last year in H.R. 2199, the "Traumatic Brain Injury Health Enhancement and Long-Term Support Act of 2007," we talked about establishing five TBI centers. We did address the epilepsy issue, albeit not to the extent that you have, and said that one of those five centers needed to focus on the issue, the epilepsy issue.
Do you think if we just expanded what is currently in place with those TBI centers to go from one to all five, that that would assist in what you are trying to accomplish?
Mr. PERLMUTTER. I think—yes. I think the goal is to have geographically dispersed centers of excellence to study epilepsy, because when you start having seizures, it is different in many ways. And I should state, as full disclosure, I have a daughter with epilepsy. And so one of the things that clearly happens here is when the VA brings its force to bear and its knowledge is developed, it is—you know, that—there is a great spillover effect to society as a whole from the research that they develop.
But the goal here is to provide the men and women that are coming back, and then develop seizures, and develop epilepsy with the best lives possible and with the best treatments possible. And, you know, cures where, you know, the research centers and the VA hospitals can develop them.
And so under the bill, we couple a medical school with a VA hospital. They have to compete for it. If the TBI centers wish to do that, that is fine with me. The goal is to be able to provide the best service possible to the people having seizures that they—and we know that coming back from Iraq and Afghanistan, our servicemen and women who have had these head injuries are going to—some of them are going to start developing epilepsy.
Mr. MILLER. Thank you very much. Ms. Brown-Waite, my colleague from Florida, could you talk a little bit about the rationale requiring veterans to provide a written notification of his or her choice to receive care at a VA facility if available following care at a non-VA facility?
Ms. BROWN-WAITE. Well, certainly you want to have continuity of care. And if their preference and if their records—they want their records because of financial reasons or any other reasons, that they would want to have the non-VA information shared with the VA. I know that many of our veterans—and one year I had the highest number and one year you had the highest number of any Member of Congress. I know that they like having the services and the economy of going to the local community-based outpatient clinic (CBOC) and/or the local hospital.
But if they can't get that appointment within 30 days, it is almost like justice delayed is justice denied. Healthcare delayed is healthcare denied.
Mr. MILLER. Thank you very much for bringing this forward. I have no further questions, Mr. Chairman.
Mr. MICHAUD. Mr. Hare, any questions?
OPENING STATEMENT OF HON. PHIL HARE
Mr. HARE. Not really, Mr. Chairman. Just a couple of comments. Let me just say to all of you, first of all, thank you for being here. Each of these bills—it seems to me, you know, we sit on this Committee and we have talked a lot. We really have a moral obligation. I think that was mentioned by you Mr. Carney in terms of what we need to be doing here to assist our veterans.
And I was struck, Mr. Ellsworth, when you were talking about Agent Orange and the defoliant. My predecessor spent eight years trying to get the VA to admit that Agent Orange caused more than severe acne in our veterans. And now we find out, because of, you know, spina bifida.
So I would just to all of you every—each one of these pieces of legislation is critical to our veterans. And the question isn't how can we afford to do this? The question is how can we afford not to do this?
Whether it is—as you said, Ms. Brown-Waite, on a trial basis and hopefully to expand this nationwide, because at the end of the day what I have—what I have said all the time since I have been on this Committee, and as you know I am new here, but if we make a promise to our veterans that we are going to take care of them and their families, we have to keep the promise or we have no business making that promise.
And, you know, with all due respect to the VA who I know might have some problems with some of these pieces of legislation, you know, lets fix the problem but lets enact the legislation. So at the end of the day those families, those veterans, the people that need help, have an opportunity.
And I just want to let you know that from my end, you have a very easy lobby, a lobby on me here today. If I am not on these bills, I will tell you I will be on them by the end of the day. But I commend you for standing up for our veterans. I appreciate the time and the effort that you have, you know, put into this. And anything that I can do to help you and, you know, I stand ready to do it.
So, Mr. Chairman, I don't have any questions. I just really want to compliment all of you for standing up for the men and women and their families. Mr. Ellsworth, particularly with these kids with spina bifida who are so profoundly impacted.
And one last thing. You know, Mr. Carney, yours is on dental. And I will tell you, sometimes I think that is the last thing people really think about. And I have to tell you, I think that is one of the first things we should be looking at too. It is just as important in healthcare for our veterans as anything we can talk about. So I really appreciate your being here.
And with that, Mr. Chairman, I would yield back.
Mr. MICHAUD. Thank you very much, Mr. Hare. Ms. Berkley?
OPENING STATEMENT OF HON. SHELLEY BERKLEY
Ms. BERKLEY. Thank you, Mr. Chairman. And thank all of my colleagues for being here. I embrace everything that my colleague just said.
But for me, the cost of taking care of our veterans is the cost of going to war. And if you are not prepared to take care of our veterans when they come home from serving and sacrificing for their fellow citizens and our Nation, then you ought not send them in the first place.
But I am also agonizing over how we intend to pay for this. And you know there is a movement to make the President's tax cuts permanent. I think as a Nation and as a Congress we are going to have to figure out what our priorities are and fund them appropriately.
And as far as the VA is concerned, and as you know I work very closely with the VA given the number of veterans in my district that you hear about quite often, but if we are going to continue to pile more responsibility on the VA and all of these pieces of legislation are very laudatory and important, but we better provide the VA with the necessary amount of money that they are going to need to carry out our will. And so far I haven't seen that happening.
As we all know for those of us who are veterans of this Committee, you know the last seven years we just saw a very inattentive VA with an Administration that always underfunded the VA. We are playing catch-up now. But the needs are so dramatic, from everything from post traumatic stress disorder (PTSD) to making sure that our veterans get the care that they need in a timely manner, that I just think unless we have a national recognition that this is a major priority to take care of our veterans, and adequately fund them, and adequately fund the VA, and give them the necessary personnel to carry out the tasks that we are giving them, then we better just forget the whole thing.
And I think that is an important—that is important to me. And I thank you for listening to my soapbox.
Oh, and, Mr. Carney, may I call on you?
Mr. CARNEY. Yes.
Ms. BERKLEY. May I ask the Chair to call on him?
Mr. CARNEY. Well, however you guys do it here. That is fine. I just wanted to comment that I am a veteran myself. And if we don't live up to the promises that we make to our veterans, no one is going to enlist anymore. We are an all-volunteer force. And if we ignore the problems that are created by the service that young men and women provide to our country, we will not be able to have an all-volunteer force anymore. We will have to institute a draft again. And our sons and our daughters will feel that pain. And we don't want that.
Ms. BERKLEY. Mr. Carney, we are spending $4,000 a second. Let me be precise, $3,919 a second in Iraq. And if we are going to spend that kind of money, we better make sure that we spend a requisite amount of money when these veterans come home.
And when I hear the President and Administration officials talking about supporting the troops, the best way to support our troops is to support the veterans when they come home.
Mr. CARNEY. Well, Ms. Berkley, I agree 100 percent with that. You know, if we could just somehow figure out a way to siphon off even 20 or 25 percent of the graft and corruption going on in Iraq, we could fund all these programs and many, many more.
Ms. BERKLEY. And let me mention something else that we are working on. And let me give an effort to give full disclosure. My husband is a nephrologist. And they have a very, very busy practice. It is a kidney doctor. They have a very, very busy practice in Las Vegas. They also contract with the VA. They have not been paid in over a year. And talk about people not enlisting and volunteering to serve this Nation. If these doctors don't get paid, I mean I am not talking in a timely manner. I am talking about not getting paid. You are not going to get any doctors treating these veterans when they get home, especially those that are contracting with the VA.
So we have got a ton of problems in the VA right now. And we are going to have to work through those. And, again, give the VA the necessary resources in order to provide the services that our veterans demand and we are obligated to provide.
Mr. CARNEY. I couldn't agree more.
Mr. MICHAUD. Ms. Berkley, if you didn't talk about Nevada and the VA system, I would think something was wrong.
Ms. BERKLEY. I would never disappoint you, Mr. Chairman.
Mr. MICHAUD. Thank you. Mr. Salazar?
Mr. SALAZAR. Thank you, Mr. Chairman. And I would like to take this opportunity to give a special welcome to my friend and colleague from Colorado, Mr. Perlmutter, who has been a champion on veterans' issues.
People on this Committee and people who work on veterans' issues don't do it because it is a glamorous job. They do it because they care. I just want to commend each and every one of you for the incredible work that you have done on veterans' issues.
I agree with everything that my colleagues have said this morning. Ms. Brown-Waite, I do not oppose your bill, I am very supportive of what you want to do.
Have you taken into account or do you have a cost estimate as to what your bill would do should we adopt it nationwide? The reason I am asking is not because I oppose it. I am very supportive. We just need to start getting prepared for budget requests, in the future.
Ms. BROWN-WAITE. The bill was never heard before the full—even a Subcommittee before to take it nationwide. That is why I decided to truncate it. We did not—all we were told was it was too expensive. It would be too costly.
And, again, I want to reiterate, this doesn't—this gives the veteran the opportunity. It doesn't mandate that he has to go to a healthcare provider outside of the VA system. It is an option that I think we should be giving to our veterans.
But the answer is no. I do not—I never did—we never did get a full Congressional Budget Office scoring on taking it nationwide.
Mr. SALAZAR. I think what you have is a very important bill. In Craig, Colorado, with Secretary Nicholson before he left, we were able to establish a CBOC, which had been in place. Scott McInnis, my predecessor, had been working on it for 12 years.
An area where veterans had to drive five to six hours in order to get to a primary healthcare physician within the VA center. Mountainous areas can be very dangerous especially for veterans who are older. It was very difficult for them to get there and still in very remote and rural areas. Many of you know it is very difficult to get to a primary healthcare physician.
I had a friend in Colorado who was suffering from chest pains. He was a veteran who actually served at the same time I did. We couldn't get him an appointment at the VA health center in Colorado for almost six months. And we were able to get him an appointment to go to the VA hospital in Albuquerque. Two days after they saw him in Albuquerque, they gave him a quintuple bypass on his heart. That shows how critical this is.
There is a long waiting list of people waiting to get healthcare.
So I applaud each and every one of you, and thank you very much for being here today.
Mr. MICHAUD. Thank you, Mr. Salazar.
One question I have actually is for Mr. Carney dealing with dental care. As you probably noticed, the VA estimate that the cost for your bill is $817 million for fiscal year 2008 alone and almost $11.3 billion over the next ten years, which is pretty costly.
Is your interest primarily in making sure that they get dental care? And if so, would you be amenable to working with the Armed Services Committee in opening up dental care? A good example is the Army National Guard. Even though they might have a dentist in the facility—in their State, all that they can do is look into your mouth and say you have a problem. They can't take care of it.
Would you be amenable in trying to change the rules and regulations so that maybe the U.S. Department of Defense (DoD) or Army National Guard might be able to take care of some of the dental care?
The other area you mentioned is contracting out. I know in Maine for instance, that some dentists they make their own right there on site. Other dentists actually contract out with a denturist. However, when they bill for the dentures, it is six-seven times higher than what they actually paid for it.
Would you be amenable to looking at having more denturists within the VA system and making them in-house versus contracting that out?
Mr. CARNEY. Of course. Anything that would help the dental health of our veterans I would support. And, of course, we are very sensitive to the costs of these things. The $11 billion number was much higher than the one that we had.
But whatever we can do to assure that we are taking care of our veterans and covering this 90 percent of the population of service disabled that don't have the dental coverage I think we should explore.
It is not about us. It is not about any particular bill. It is about doing the right thing by our veterans. And of course I will be able to do that.
Mr. MICHAUD. Okay. Thank you. Once again I would like to thank our four panelists for your testimony this morning. I look forward to working with you as we look at each one of these individual pieces of legislation. Thank you very much for coming here this morning. Thank you. We have one more piece of legislation this morning, which I am presenting. So I will turn the gavel over to Mr. Miller.
Mr. MILLER. Thank you, Mr. Michaud. Also, I would like to ask unanimous consent that my opening statement be placed into the record.
[The statement of Congressman Miller appears in the Appendix.]
Mr. MICHAUD. Without objection.
Mr. MILLER. [presiding] Thank you. I also might add there was a comment by a colleague earlier in regards to tax cuts and spending, and certainly we all understand we need to be prudent with our expenditures.
If we have $50 billion that this Congress can pass for AIDS in Africa, certainly we have the ability to spend the necessary dollars, and we all agree on veterans. The money is there. It is how this Congress decides to allocate that money.
Mr. Michaud, you are recognized.
STATEMENT OF HON. MICHAEL H. MICHAUD, CHAIRMAN, SUBCOMMITTEE ON HEALTH, COMMITTEE ON VETERANS' AFFAIRS, AND A REPRESENTATIVE ON CONGRESS FROM THE STATE OF MAINE
Mr. MICHAUD. Thank you very much. I present H.R. 5554.
Nearly 300,000 veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have been seen by the VA healthcare system. And over 40 percent of these individuals were diagnosed with mental health conditions.
Separating from military service can be a very difficult transition. Mental and physical wounds make it even more difficult for veterans to adjust.
According to the VA Office of Public Health and Environmental Hazard, 48,661 OEF and OIF veterans have met criteria for substance use disorder. This number only reflects—the veterans who have been seen by the VHA, which means that the total number of veterans with substance use disorder is likely higher than that number. Also when you look at the lower-income veterans they too have a higher prevalence of substance use disorder.
To address this issue, Ranking Member Miller and I introduced the Veterans Substance Use Disorder Prevention and Treatment Act of 2008.
Our legislation will require the VA to provide the full continuum of care for substance use disorder, and it will require this full spectrum of care to be available at every VA medical center.
Our legislation will also direct the VA to conduct a pilot program for internet-based substance use disorder treatment for veterans of OEF and OIF veterans. This will enable our newest generation of veterans to overcome the stigma associated with seeking treatment and receiving the necessary care—in a comfortable and secure setting.
We heard from individuals in the past that internet-based substance abuse disorder treatment can be very beneficial and helpful. So I think that is definitely an option.
This bill is not a finished product. I appreciate the comments from the witnesses today.
Substance abuse can tear apart a family and individual lives. We have heard it over and over again from veterans, from thier spouses, what effect it has on the family. I think it is very important that this Committee do whatever we can to provide service in this particular area.
With that, Mr. Miller, I will yield back the balance of my time and answer any questions that anyone might have.
[The prepared statement of Congressman Michaud appears in the Appendix.]
Mr. MILLER. Ms. Berkley. Mr. Hare, excuse me. No, Ms. Berkley.
Ms. BERKLEY. Thank you very much. And I think this is an important piece of legislation. It dovetails nicely with my legislation.
And if I can refresh your memory, I had a constituent by the name of Justin Bailey who developed a substance abuse problem when he came back from Iraq. And his parents insisted that he check himself into a VA facility. It was very poorly run, very poorly administered, and even though Mr. Bailey was already taking five—was hooked on five medications, the VA treated him with yet another medication. And he OD'd in the facility. And he died under the care of the VA.
So we definitely need to get in front of this crisis, because it is nothing less than a crisis. But I would like to have more information about the internet component. I mean, if you are somebody like Justin Bailey, going on the internet and getting information isn't going to do squat for you.
And I don't—I mean, given the fact that our resources are limited, how does that—if you can explain this to me I would appreciate it, because I think this is far more serious than going on the internet and getting some practical advice on how to get yourself off of—wean yourself off of drugs.
Mr. MICHAUD. No. That is a very good question. It is something that I was kind of skeptical about at first, but having talked to those in the healthcare provider area, that is actually one area that has been very beneficial.
That is why I am recommending that they do a pilot project dealing with the internet-based substance use disorder treatment to see how it actually works.
That is not the primary focus of this legislation. It is only one component. The area we have heard about over and over again from our veterans is, the stigma that is attached to substance abuse and drug abuse. No matter what it is, there is a stigma attached to it. Quite frankly, some people actually feel more comfortable dealing with the internet.
If you look at our troops today, they are very internet savvy. This is one option. It is not the primary focus of this legislation. But I think it is very important that we provide whatever effective tools that we can for our servicemen and women.
That is why I thought it was important to set up a pilot project to actually see how it works.
Ms. BERKLEY. And thank you for that. And, again, my only admonishment is if we are going—I think this is very important. But we better make sure the VA has the tools, and they have personnel trained, and enough personnel trained to take—to address these issues.
When some kid like Justin Bailey checks himself into a VA facility, there should be an expectation by his or her family that someone there is going to know what they are doing and not—you know, like maybe read his medical records before they give him yet another medication.
And I am not sure that exists right now. So we better make sure that the medical personnel that we are paying, actually knows what they are doing and can treat these kids that we are sending to the VA or we are—I mean, we are creating, not creating, we are no better than, you know, doing malpractice on these people. If we are telling them this is an opportunity and a treatment that is available to you, we better make sure it is available with expertise and knowledge, because I feel that we would be contributing to the death and mental instability of these kids if we are sending them there with the expectation that they are going to get treatment and they are not.
Mr. MICHAUD. Thank you.
Mr. MILLER. Any further questions? Thank you, Mr. Chairman.
Mr. MICHAUD. Thank you.
Mr. MILLER. I yield back the gavel also.
Mr. MICHAUD. [presiding] Thank you. I would like to call up the second panel.
The second panel will include Joseph Wilson who is the Deputy Director of Veterans Affairs and Rehabilitation Commission of the American Legion; Joy Ilem, Disabled American Veterans (DAV); Christopher Needham who is with the Veterans of Foreign Wars (VFW) of the United States and Richard F. Weidman who is—it is Bernie Edelman from the Vietnam Veterans of America (VVA).
So I want to thank this panel for coming today. I look forward to your testimony. And I would now recognize Mr. Wilson for your testimony.
STATEMENTS OF JOSEPH L. WILSON, DEPUTY DIRECTOR, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; JOY J. ILEM, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; CHRISTOPHER NEEDHAM, SENIOR LEGISLATIVE ASSOCIATE, NATIONAL LEGISLATIVE SERVICES, VETERANS OF FOREIGN WARS OF THE UNITED STATES; AND BERNARD EDELMAN, DEPUTY DIRECTOR FOR POLICY AND GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA
Mr. WILSON. Thank you, Mr. Chairman. Mr. Chairman and Members of the Subcommittee, thank you for this opportunity to present the American Legion's views on these pieces of legislation.
We will begin with H.R. 2818. This bill seeks to amend title 38 to provide for the establishment of Epilepsy Centers of Excellence within the VHA of the Department of Veterans Affairs.
According to VA research, approximately 53 percent of veterans who suffered a penetrating traumatic brain injury or TBI in Vietnam developed epilepsy within 15 years. The VA, in its effort to treat this condition, became the leader in epilepsy research. However, due to lack of funding, research resources eventually diminished.
According to the American Academy of Neurology or AAN, returning veterans with TBI injuries will eventually develop post traumatic epilepsy. Currently there is an increasing need for the presence of epilepsy centers throughout the Nation. This is due to the high count of Operation Iraqi Freedom/Operation Enduring Freedom or OIF/OEF troops returning with TBI.
The American Legion supports the efforts of H.R. 2818, which proposes to establish Centers of Excellence within the Department of Veterans Affairs for the various injuries related to blast trauma.
This would also ensure the best quality of care and treatment is accessible to current and future veterans suffering from the effects of blast injuries, to include epilepsy.
Next are H.R. 5554. This bill seeks to amend title 38 to expand and improve healthcare services available to veterans from the Department of Veterans Affairs for substance abuse disorders and for other purposes.
This bill also proposes that the medical center provides ready access to a full continuum of care for substance use disorders for veterans in need of such care.
The American Legion has no official position on this issue. However, when substance abuse disorders are secondary to service-connected conditions, it is our position that veterans should have full access to the quality and adequate healthcare in which they are entitled.
H.R. 5595, this bill seeks to amend title 38 to direct the Secretary of Veterans Affairs to provide dental care to veterans with service-connected disabilities and for other purposes.
The American Legion has no official position on this issue.
H.R. 5730, this bill seeks to direct the Secretary of Veterans Affairs to display in each prosthetic and orthotic clinic of the Department of Veterans Affairs an Injured and Amputee Veterans Bill of Rights.
The American Legion has no official position on this issue.
H.R. 5729 seeks to direct the Secretary of Veterans Affairs to provide comprehensive healthcare to children of Vietnam veterans born with spina bifida.
The American Legion endorses the expansion of the spina bifida program provided by H.R. 5729. It will ensure that the child of any veteran who suffers from this crippling birth defect resulting from their parent's exposure to Agent Orange during military service receives complete medical care.
H.R. 5622 seeks to direct the Secretary of Veterans Affairs to carry out a pilot program to establish standards of access to care for veterans seeking healthcare from certain Department of Veterans Affairs facilities.
The American Legion agrees with H.R. 5622. However, in the event VA is unable to schedule the veteran for an appointment within 30 days and VA contracts with non-VA facilities, it must be ensured these facilities are in par with VA standards.
Mr. Chairman and Members of the Committee, the American Legion sincerely appreciates the opportunity to submit testimony on these pieces of legislation. Thank you.
[The statement of Mr. Wilson appears in the Appendix.]
Mr. MICHAUD. Thank you. Ms. Ilem?
Ms. ILEM. Thank you, Mr. Chairman and Members of the Subcommittee.
We appreciate the opportunity to present the views of the Disabled American Veterans on the healthcare measures before this Subcommittee today, which cover a range of issues important to DAV, veterans and their families.
The first measure under consideration, H.R. 2818, would require the VA Secretary to designate not less than six healthcare facilities as centers of excellence in research, education, and clinical care in the diagnosis and treatment of epilepsy to ensure improved access to state-of-the art treatment throughout the VA healthcare system.
While DAV has no adopted resolution from our membership on this matter, we have been concerned about literature emerging to suggest the incidence of co-morbid epilepsy in veterans with traumatic brain injury.
Therefore, we believe this legislation addresses a real need and DAV would have no objection to its passage.
H.R.5554, the "Substance Use Disorders Prevention and Treatment Act of 2008." would mandate that VA provide system-wide access to a full continuum of care for substance use disorders with a special emphasis on outreach to veterans who served in Operations Enduring and Iraqi Freedom.
This measure would require an annual report on the availability of the substance use disorder treatment throughout the system, the number of veterans receiving such care, the barriers to accessing these services, and the quality of care provided.
Finally, the bill would require a pilot program specifically designated to offer web-based—designed to offer web-based options for self-assessment, education, and specified treatment of substance use disorders.
DAV has a growing concern about the reported effects of combat deployments in Iraq and Afghanistan on our newest generation of war veterans and the converging evidence that substance abuse is a significant problem for many of these veterans.
For these reasons, DAV fully supports this comprehensive measure aimed at substance use disorder prevention, early intervention, outreach, education and training for veterans and their families to close the current gaps in VA's existing efforts.
H.R. 5595, the "Make Our Veterans Smile Act of 2008," would extend eligibility for outpatient dental services and treatment to all veterans with service-connected disabilities.
DAV recognizes that the oral health is integral to the general health and well being of a patient and is part of comprehensive healthcare. Consequently, DAV supports the passage of this bill.
H.R. 5622, the "Veterans Timely Access to Health Care Act," would establish a five-year pilot program in VISN 8 to ensure a 30-day standard of access to primary care for enrolled veterans.
In the case where VA is unable to meet the 30-day access standard, the bill would require VA to contract for private healthcare.
DAV supports contract care options when needed services are unavailable in VA facilities and in other circumstances authorized by law.
However, we believe contract care should be used judiciously and that VA needs to better coordinate the contracted care it currently authorizes to ensure high quality, safety, and cost effectiveness.
While we appreciate the sponsor's intentions to improve access to care and acknowledge that enactment of this bill would be helpful for some veterans, it potentially could damage the VA system by eroding funding needed to sustain VA's viability to continue providing specialized services to service-disabled veterans.
For these reasons, we are unable to support this measure.
H.R. 5729, the "Spina Bifida Health Care Program Expansion Act," would amend the existing authority to provide a more comprehensive range of healthcare services for Vietnam veterans' children afflicted with spina bifida, including access to domiciliary care.
DAV believes the goals of the bill are in the best interest of the children involved. Therefore, we have no objection to enactment of this measure.
H.R. 5730 would require VA to establish and prominently display in each VA healthcare prosthetic and orthotic clinic a bill of rights for veterans who are injured or have amputations.
The bill of rights would include the right to timely, high-quality prosthetic and orthotic care, qualified parishioners, and continuity of these services throughout the VA healthcare system.
We believe this measure is consistent with providing comprehensive, high-quality, patient-centered healthcare services for our Nation's sick and disabled veterans, especially those with specialized needs. Thus, we would have no objection to its enactment.
Mr. Chairman, that concludes my testimony. And I would be pleased to answer any questions from you or other Members of the Subcommittee. Thank you.
[The statement of Ms. Ilem appears in the Appendix.]
Mr. MICHAUD. Thank you. Mr. Needham?
STATEMENT OF CHRISTOPHER NEEDHAM
Mr. NEEDHAM. Chairman Michaud, Ranking Member Miller, and Members of this Subcommittee, on behalf of the 2.3 million members of the Veterans of Fore
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