May212013
Hearing Transcript on Legislative Hearing on H.R. 949, H.R. 1075, H.R. 2698, H.R. 2699, H.R. 2879, H.R. 3926, H.R. 4006, H.R. 84, and 3 Discussion Drafts
|
LEGISLATIVE HEARING ON H.R. 949, H.R. 1075, H.R. 2698, H.R. 2699, H.R. 2879, H.R. 3926, H.R. 4006, H.R. 84, AND THREE DISCUSSION DRAFTS
HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION MARCH 25, 2010 SERIAL No. 111-69 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
|
|
COMMITTEE ON VETERANS' AFFAIRS |
|||||
|
|
CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
|
||
|
|
|||||
|
|
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. |
|
|||
C O N T E N T S
March 25, 2010
Legislative Hearing on H.R. 949, H.R. 1075, H.R. 2698, H.R. 2699, H.R. 2879, H.R. 3926, H.R. 4006, H.R. 84, and Three Discussion Drafts
OPENING STATEMENTS
Chairman Michael Michaud
Prepared statement of Chairman Michaud
Hon. Henry E. Brown, Jr., Ranking Republican Member
Prepared statement of Congressman Brown
WITNESSES
U.S. Department of Veterans Affairs, Gerald M. Cross, M.D., FAAFP, Deputy Chief for Patient Care Services and Chief Consultant for Primary Care, Veterans Health Administration
Prepared statement of Dr. Cross
American Legion, Denise A. Williams, Assistant Director, Veterans Affairs and Rehabilitation Commission
Prepared statement of Ms. Williams
Boswell, Hon. Leonard L., a Representative in Congress from the State of Iowa
Prepared statement of Congressman Boswell
Brown-Waite, Hon. Ginny, a Representative in Congress from the State of Florida
Prepared statement of Congresswoman Brown-Waite
Disabled American Veterans, Joy J. Ilem, Deputy National Legislative Director
Prepared statement of Ms. Ilem
Filner, Hon. Bob, Chairman, Committee on Veterans' Affairs, and a Representative in Congress from the State of California
Prepared statement of Congressman Filner
Giffords, Hon. Garbrielle, a Representative in Congress from the State of Arizona
Prepared statement of Congresswoman Giffords
Kirkpatrick, Hon. Ann, a Representative in Congress from the State of Arizona
Paralyzed Veterans of America, Blake C. Ortner, Senior Associate Legislative Director
Prepared statement of Mr. Ortner
Scalise, Hon. Steve, a Representative in Congress from the State of Louisiana
Prepared statement of Congressman Scalise
Veterans of Foreign Wars of the United States, Eric A. Hilleman, Director, National Legislative Service
Prepared statement of Mr. Hilleman
SUBMISSIONS FOR THE RECORD
American Federation of Government Employees, AFL-CIO
National Association of Government Employees (SEIU/NAGE), David J. Holway, National President
National Federation of Federal Employees, William R. Dougan, National President
LEGISLATIVE HEARING ON H.R. 949, H.R. 1075, H.R. 2698, H.R. 2699, H.R. 2879, H.R. 3926, H.R. 4006, H.R. 84, AND THREE DISCUSSION DRAFTS
Thursday, March 25, 2010
U. S. House of Representatives,
Subcommittee on Health,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:05 a.m., in Room 334, Cannon House Office Building, Hon. Michael H. Michaud, [Chairman of the Subcommittee] presiding.
Present: Representatives Michaud, Brown of South Carolina, and Boozman.
OPENING STATEMENT OF CHAIRMAN MICHAUD
Mr. MICHAUD. I want to thank everyone for coming out this morning.
Today's legislative hearing is an opportunity for Members of Congress, veterans, and the U.S. Department of Veterans Affairs (VA) and other interested parties to provide their views and discussions on recently-introduced legislation within this Subcommittee's jurisdiction. This is an important part of the legislative process that will help encourage frank discussions and new ideas.
We have a number of bills before us today. They cover a wide range of important issues dealing with access to VA) health care; collective bargaining rights for VA employees; mental health care and counseling for individuals discharged or released from active duty; emotional and peer support for family members of the Armed Services; breast cancer among members of the Armed Forces and veterans; and rural health issues including the unique needs of Native American veterans. We also have draft bills before us today on reimbursement for continuing education, mental health counseling and bargaining rights and performance criteria.
I would ask unanimous consent that my full opening remarks be submitted for the record. Are there any objections? Hearing none, so ordered.
I look forward to hearing the views of the different panels today and at this time I would like recognize Ranking Member Mr. Brown for any opening statement he may have.
[The prepared statement of Chairman Michaud appears in the Appendix.]
OPENING STATEMENT OF HON. HENRY E. BROWN, JR.
Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Chairman. I appreciate your holding this hearing today and look forward to working with you and the rest of our esteemed colleagues on these important legislative subjects.
The ten bills being discussed this morning cover a wide array of veterans' issues and I look forward to learning more about them. Of particular interest to me is H.R. 1075, the "RECOVER Act," introduced by Mr. Scalise. H.R. 1075 would provide medical service to veterans in a disaster area by allowing VA to contract with one or more non-VA facilities.
Making sure our veterans have access to the very finest care is always a top priority of this Committee, but in times of real emergency, that priority takes on a whole new level of importance. Serving a district with facilities that are vulnerable, to the sometimes destructive whims of nature, as I do in Charleston and along the coast of South Carolina, makes this a personal issue for me and I support Mr. Scalise in his efforts.
I am also excited to hear more about H.R. 84, the "Veterans Timely Access to Health Care Act," introduced by my friend Ms. Browne-Waite.
Among other provisions, this bill would make the standards of access to care for a veteran seeking primary care from the VA 30 days from the date the veteran contacts the Department. Ms. Brown-Waite has long been committed to making sure America's veterans do not have to endure long waiting periods before they can have access to VA care and I applaud her efforts.
To all the witnesses appearing in front of us this morning, thank you for your dedication to improving the lives of our veterans. Your work does not go unnoticed, and I am eager to begin our discussion on the matters at hand.
It is only by working together to advance meaningful and appropriate legislation that we can completely fulfill the promise we made to provide veterans with the best care anywhere. The men and women who served so bravely in uniform deserve nothing less.
Again, thank you, Mr. Chairman. I yield back.
[The prepared statement of Congressman Brown appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Mr. Brown.
So we may as well begin. I will recognize the distinguished Chairman of the full Committee on Veterans' Affairs, Bob Filner of California. I want to thank you, Mr. Chairman, for all the hard work that you have done over the years fighting for our veterans. We have made a lot of progress under your leadership and look forward to continuing to work with you as we move forward to take care of the needs of those who have bravely served this great Nation of ours.
Mr. Filner?
STATEMENT OF HON. BOB FILNER, CHAIRMAN, COMMITTEE ON VETERANS' AFFAIRS, AND A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA; HON. STEVE SCALISE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF LOUISIANA; HON. GARBRIELLE GIFFORDS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ARIZONA; HON. ANN KIRKPATRICK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ARIZONA; HON. LEONARD L. BOSWELL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF IOWA; AND HON. GINNY BROWN-WAITE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA
Mr. FILNER. Thank you, sir. Mr. Chairman, we thank you for your leadership on this Subcommittee and your fine working relationship with Mr. Brown. We appreciate the leadership that both of you have shown and I know I speak for all of my colleagues in saying that we appreciate the opportunity to talk about our legislation today.
The bill that I am speaking on, H.R. 949, would improve the collective bargaining rights and procedures for reviews of adverse actions of certain VA employees. This bill is about ensuring equity amongst the health care professionals employed at VA so that the providers such as doctors, nurses, dentists, chiropractors, optometrists, and podiatrists who are hired under the so-called "Pure Title 38" system have the same rights as their fellow VA health care professionals hired under different hiring systems.
Without this bill, the "Pure Title 38" providers do not have the right to challenge errors in pay computations and lack other key bargaining rights enjoyed by their colleagues at the VA.
To address this problem, H.R. 949 would clarify that these "Pure Title 38" providers have equal rights to collective bargaining. This means they would be able to challenge personnel actions through such methods as grievances, arbitrations, and labor-management negotiations.
This bill would also require the VA to review the adverse personnel action and issue a final decision no later than 60 days after the employee appeals the adverse personnel action.
Finally, the bill would subject the VA's final decision on the employee's appealed adverse personnel action to judicial review in the appropriate U.S. District Court or the U.S. Court of Appeals for the Federal Circuit.
I know the VA has some concerns with this and they are in discussions with the stakeholders. I look forward to working with all of them as we move forward on this legislation.
Again, thank you again for the opportunity of sharing these thoughts with you.
[The prepared statement of Congressman Filner appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Mr. Chairman.
Mr. Scalise.
STATEMENT OF HON. STEVE SCALISE
Mr. SCALISE. Thank you, Mr. Chairman and Ranking Member Brown, as well as all the distinguished Members of the Subcommittee for the opportunity to testify. I want to just let you know this bill, H.R. 1075 is bipartisan legislation with over 19 co-sponsors. It seeks to maintain vital health services to veterans in the event that a VA hospital is closed due to a Federally declared disaster.
Before I begin discussing my bill, I would like to thank you and all of the Members of the Committee for the work that you do on behalf of our Nation's veterans. The welfare of our veterans and their families is of great importance to me. I first filed this legislation during the 110th Congress when I served as a Member of the Veterans' Affairs Committee.
Our Nation is grateful for the courage our veterans have displayed and the sacrifices they have made in order to protect America and the freedoms we enjoy today. I believe as you do, that it is our obligation to provide them the same honor and dedication that they provided us during their service.
Hurricane Katrina flooded and closed the New Orleans VA Medical Center, leaving our veterans without the full services of their medical home. Unfortunately, nearly 5 years later, our VA hospital still remains closed. As a result, veterans throughout Southeast Louisiana face increased challenges and hardship to obtain the quality health care they deserve. The VA made a commitment to open a new hospital, which won't occur until as early as 2013, but with the current delays, I remain concerned about the status of veterans health care in the interim and want to make sure this doesn't happen again to any of our Nation's veterans in the future.
That is why I introduced H.R. 1075, the "RECOVER Act." My bill would ensure that the VA must establish a contract with at least one non-VA facility to provide inpatient services in the event that a VA hospital will be closed for at least 6 months due to any Federally declared disaster.
Nothing in this bill would prevent a veteran from seeking care within the VA system, if he so chooses.
Just last week I spoke with a veteran who had to travel to another State for post-operative care because the New Orleans VA Hospital is still not open. Veterans still have to travel more than 350 miles for cardiac surgery and also have to travel to other States for mental health care as well.
Several veterans with chronic conditions did not seek care after the storm because they did not know what their options were. This concerns me very much, and my bill seeks to eliminate these hardships. The RECOVER Act will also prevent families from having to travel hundreds of miles just to visit their loved ones who are undergoing treatment in the hospital.
As the respected group Disabled American Veterans (DAV) said, when they expressed their support for this act, "Family support and caregiving have been shown to accelerate recovery time and reduce costs and length of hospital stays."
In the aftermath of a disaster, the last thing our veterans and their families should have to worry about is where to seek basic care. I commend the Southeast Louisiana Veterans Health Care System for the initiative they have taken to provide health care in light of the hospital's closure. The community outpatient clinics have been extremely valuable in delivering primary care and other services. We learned valuable lessons after Hurricane Katrina, and I want to make certain that no veteran has to travel long distances or experience long wait times to receive basic care in the event that their local VA hospital is closed due to a natural disaster, whether it be a hurricane, tornado, earthquake or any other disaster.
My office is working with the veterans service organizations (VSOs) to address any issues they have as this bill moves through the legislative process. Let me also emphasize that this in no way undermines our strong commitment to the VA health care system. Our goals are the same. Veterans and their families need to have options for receiving quality care close to home in the most convenient way possible, all while working to expedite the rebuilding of our VA hospital that was closed due Hurricane Katrina.
I continue working hard to cut through the red tape and expedite the rebuilding of the New Orleans Medical Center that was devastated and closed by Hurricane Katrina's devastation. I look forward to working with you and Members of the full Committee as we move forward.
Again, I thank you for your dedication to our Nation's military veterans and I appreciate this opportunity to testify before the Subcommittee. I yield back.
[The prepared statement of Congressman Scalise appears in the Appendix.]
Mr. MICHAUD. Thank you very much for your testimony.
Mr. Boswell?
STATEMENT OF HON. LEONARD L. BOSWELL
Mr. BOSWELL. Thank you, Mr. Chairman and Mr. Brown. We have spent a few hours together and I know both of you are patriots and you care about veterans and I thank you for your service and I appreciate the kind words you said to Chairman Filner.
This Committee has done a lot of good work the last several years and you are to be commended.
That's why I thank you for inviting me here today to share some of the things with you that I want to talk about. As you know, women are currently the fastest growing veteran population, today, representing 8 percent of the population.
As the demographics of the military continue to change, we find our VA system is struggling to serve the unique needs of this growing population and it is believed that by 2020, 15 percent of veterans using the VA for health care will be women, and I would like to maybe step out of order a bit and introduce to you, if I could, Mr. Chairman, Alexis Taylor.
Alexis, please stand up. I hope I don't embarrass her too much, but she's my Legislative Director, she's an Iraqi veteran and because of what I am about to share with you has a lot to do with why I hope that this legislation will get serious consideration.
What this means is veterans health care, which is now primarily tailored to men needs to undergo significant changes and needs to do it quickly. In particular, one health concern that has been largely ignored is the prevalence of breast cancer in our servicewomen and women veterans. So that is why we have introduced, and I say "we”, Alexis and I, H.R. 3926, the "Armed Forces Breast Cancer Research Act."
This legislation would require the Secretary of Defense and the Secretary of Veterans Affairs to collaboratively study the incidence rate of breast cancer in servicemembers and veterans. This study would focus on the number of servicemembers who have deployed in support of Operation Iraqi Freedom and Operations Enduring Freedom, the demographic information of those servicemembers and veterans, an analysis of the clinical characteristics of breast cancer diagnosed and possible exposures to cancer-at-risk factors.
The idea of this bill came about when a member of my staff, which you have just met, Alexis, who is an Iraq veteran, went back to Iowa for a 5 year post-deployment reunion with her unit and others, and one of the women of her unit had returned home from serving her country, and was diagnosed with breast cancer and had to undergo a double mastectomy at age 25.
Through the course of the night, the servicemembers at the reunion were able to piece together, talk to one another, about six women that were deployed, they were deployed with, who had come back from their deployment in Iraq with breast cancer, all between the ages of 25 to 35 years old.
Also, there were another half a dozen women who returned with new lumps in their breasts and needed additional tests such as mammograms, ultrasounds and/or biopsies. With 70 women deployed at the battalion of about 700, the incidence rate in these young women seemed high and alarming as Alexis brought this to my attention.
I would like to note that this legislation has been endorsed by the Veterans of Foreign Wars (VFW) and the Iraq and Afghanistan Veterans of American (IAVA) and I would like to submit both letters, which I have here with me into the record.
Mr. MICHAUD. Without objection, so ordered.
Mr. BOSWELL. Thank you. In recent years the U.S. medical and research communities have stepped up their efforts on breast cancer detection, research and treatment in the country's civilian population. However, women who have served in our Nation's Armed Force have largely been excluded from these studies, despite their exposure to cancer risk factors and access to medical care.
A recent study of U.S. Department of the Defense (DoD) and National Cancer Institute compose the prevalence of certain types of cancer among active duty military personnel of the general public. The study found that breast cancer among women is more common in the military than in the general population and that further studies are needed to confirm these findings and explore contributing factors.
So that is our goal for this legislation, to find out if our servicewomen do have a higher risk of breast cancer than the rest of the women in the country and why that might be, so that ultimately we can determine if breast cancer, as a service-connected disability, which I truly believe it is, if it is, we need to know.
At this moment in history it is particularly important to consider what we can do to better serve the brave individuals who fight for our security and liberty once they return home.
And I would like to thank you again for allowing us to come before this Committee. And I have a personal passion about this somewhat. As you already know and I am not going to elaborate on it, I am a veteran, too and I know that some of the maladies I have shared with you and you know about is because a of thing called Agent Orange, new at that time. This caused a lot of problems. I was very much exposed to it.
And if something's going on in this theater of operations that exposed our women to breast cancer and we could do something about it and we don't, shame on us. I feel very strong about it and I know that you do, too. So I ask you to do everything we possibly can do to move forward on this issue, and I would look forward to any questions you might have. Thank you.
[The prepared statement of Congressman Boswell, and the referenced letters, appear in the record.]
Mr. MICHAUD. Thank you very much, Mr. Boswell. And Alexis, thank you for your service to our great country, as well as keeping Mr. Boswell. Thank you very much.
Ms. Brown-Waite?
STATEMENT OF HON. GINNY BROWN-WAITE
Ms. BROWN-WAITE. Thank you, Mr. Chairman and Ranking Member Lamborn. I, as you can tell, I have a little bit of laryngitis, which my husband used to call "a husband's prayers answered."
First of all, I want to say that the Committee does great work and I truly miss being on this Committee.
As of November 2009, there were nearly 8 million veterans enrolled in the VA health system. With new veterans entering the system every day and approximately 174,000 Operation Enduring Freedom and Operation Iraqi Freedom patients receiving VA care, it is clear that it is our duty, our Nation's duty to serve our veterans and I believe that that duty is as strong now as it ever was. Today, there are 153 VA medical centers and 768 community-based outpatient clinics available to serve these veterans.
When a veteran calls to schedule an appointment in one of these facilities, they should be able to receive an appointment that is timely and appropriate to their medical needs. Unfortunately, for many veterans this simply does not happen. The VA lauds itself for completing 99 percent of primary care appointments within 30 days of the desired date. However, this means if their figures are accurate, that nearly 32,000 patients are still waiting beyond the 30 days.
Additionally, there is a very discernable difference between existing patients and new patients as only 88.8 percent of new patients complete their appointments within 30 days of their desired date. We all know that health care delayed is health care denied and our Nation's veterans deserve much better than this.
In September of 2007, the VA Office of the Inspector General found that the Veterans Health Administration's method of calculating waiting times of new patients understates the real waiting times. In this report, the Inspector General made five recommendations to reduce these wait times. To date, four of the five recommendations remain unresolved.
When I was first elected to Congress, I inquired about wait times from my local VA community-based outpatient clinics and hospitals. The numbers the VA gave me, both for Veterans Integrated Services Network (VISN) 8 and nationwide, quite honestly did not match the stories that I was hearing from my veterans. I challenged them on it and I told them that I was going to be in their offices watching and waiting and talking to individuals.
What was happening was, they were making the appointments within 30 days, but then around the 20th day they would call and change the appointment to a later date, so it would be maybe 40, maybe 50 days.
For this reason, I introduced the bill H.R. 84, the "Veterans Timely Access to Health Care Act." It would make the standard for a veteran seeking primary care from the Department of Veterans Affairs 30 days from the date the veteran actually contacts the Department with no games allowed to be played. Veterans shouldn't have to wait more than 30 days to receive an appointment.
The VA does provide a high level of care to all of the veterans who are enrolled in the system. This is why the majority of patients actually rank their care, their overall satisfaction as "very good" or "excellent," regardless of whether they are receiving inpatient or outpatient care.
I want to make sure that it is clear that this bill is not a scheme to move the VA toward privatization. I simply want to make sure that the veterans receive care in a very timely and appropriate manner.
As Members of Congress, we have an obligation to ensure that those veterans do receive the best health care available to them. If they are having problems receiving it within 30 days, then Congress needs to allow them to look for an alternative, and that's exactly what this bill does. And I appreciate this hearing today to determine whether the VA is meeting the goal of timely access to health care.
You know, our Nation's veterans did not wait 30 days to answer the call of duty. They answered the call, took up arms and protected our very freedoms. They deserve that same dedication and steadfastness from us.
With over 116,000 veterans living in my district, I have the distinguished honor to meet with these true American heroes on a regular basis. And over and over again, I still hear about how difficult it is to schedule an appointment with a doctor in a timely manner.
Congress recently allowed for advanced appropriations for the VA, and I think that is an excellent idea. This new funding structure should allow the VA to properly manage their funds and hire the necessary staff to meet the demand at the VA facilities.
Congress and the administration must not turn the care of our Nation's veterans into a political issue. Instead, we must all work together to ensure that they receive health care they risked so much to earn. We must continue these practices that already work and improve on those that may be failing. H.R. 84 does just that.
And with that, Mr. Chairman and Members, I yield back the balance of my time.
[The prepared statement of Congresswoman Brown-Waite appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Ms. Brown-Waite and also thank you for your years serving on this Committee as well.
Ms. Giffords?
STATEMENT OF HON. GABRIELLE GIFFORDS
Ms. GIFFORDS. Good morning, Mr. Chairman. Thank you and Ranking Member Brown for allowing me the opportunity to testify. I'd like to talk to this Committee because this is the Committee that has been specifically looking at supporting the needs of America's veterans, and I look forward to working with all of you on this Committee towards this endeavor.
I also want to thank the veterans service organizations that are in attendance today or perhaps watching, for their commitment to the men and women in uniform and their lifetime of service to our country.
The two bills that I have brought before you today that I have sponsored, H.R. 2698 and H.R. 2699, will have a direct impact on improving the behavioral health of our Nation's heroes and their families in our communities.
As a Member of the House Armed Services Committee who represents more than 25,000 servicemembers and dependents and nearly 96,000 veterans and retirees in my southern Arizona district, we have really seen firsthand the trials and tribulations of our servicemembers who are returning home from the front lines.
I know this issue is one that is close to all of our hearts, and I am hopeful that today's hearing signifies an important step in moving this vital legislation forward and passing it this Congress.
There is no cause more honorable than service to our country. As our Nation's warriors bravely step into the breach, we must be prepared to care for them when they return home, no matter what condition they return home in.
In war, our Soldiers, Sailors, Airmen and Marines face unspeakable horrors, sometimes on a daily basis, and readjusting to every day life is a long and complicated process. Every day thousands of our Nations bravest men and women are suffering from different degrees of post-traumatic stress disorder (PTSD). In recent years, diagnosed cases of PTSD have increased by more than 50 percent for servicemembers returning from overseas deployments, and many experts believe that the actual number is much higher because a large number of servicemembers are reluctant to seek care and seek treatment.
For an untold many diagnosed with the worst warning signs of PTSD, there simply are no easy fixes. We see each month the unfortunate and deeply saddening results of the Department of Defense when it releases its numbers of servicemember suicides. The trend is currently hovering slightly above the national average, more than double what it was 5 years ago.
PTSD and other related behavioral health issues severely affect an individual's ability to perform every day functions that we take for granted. PTSD, though, is treatable through a variety of methods, including behavioral therapy and medication with the majority of servicemembers seeing an improvement after just one or two sessions with a behavioral therapist.
Unfortunately, we all know there are not enough of these behavioral health care providers within the military or the VA to treat our servicemembers, their families or surviving spouses for the anguish that they are suffering. What is worse still is that there aren't enough therapists to treat one another.
Ultimately, our ailing heroes or the families they leave behind, must wait to see a caregiver, they often receive incomplete or inadequate care or in some cases do not receive care at all, leading to one of the few inevitable conclusions—depression, anger management problems, substance abuse or, the worst case, death.
This is the first of many clear signs the system is failing our men and women in uniform and badly needs to be fixed. H.R. 2698 establishes a scholarship for service program that provides educational benefits to those training in behavioral health care specialties critical to the operations at Vet Centers. These individuals would then pay back the investment by serving as a behavioral health care specialist at Vet Centers across the country.
Because of the unprecedented nature and a lingering lack of understanding surrounding PTSD and its symptoms, many former servicemembers do not realize they are suffering until long after they have left service. My bill, H.R. 2699, would permit our Nation's Guardsmen and Reservists to access behavioral health care at Vet Centers even after they have been released from active duty and it will then provide referrals to assist them to the maximum extent possible in obtaining behavioral health care and services from sources outside of the Department.
H.R. 2698 and 2699 will ensure that the Veterans Administration carries out a competitive grant program for non-profit organizations that provide peer-to-peer emotional support services for servicemembers, veterans, and survivors, including members of the National Guard and Reserve who are often left out because of the changing nature of their service or the accessibility of care in local communities.
I underscore that.
Mr. Chairman, you have been to my district. It is over 9,000 square miles. Many of these servicemembers return home to areas that are very far from any local Vet Center and partnering with non-profits that have the training and expertise so that they don't have to drive 3, 4, 5 hours to receive treatment is critical.
The unfortunate fact is that 10 years ago, we hardly understood the existence of PTSD, we didn't understand it quite to the extent that we do today and today we have only a patchwork quilt of treatments, forms and meetings, training seminars and online courses that these servicemembers must complete, alongside other regular recertifications and proficiency tests.
What we are not doing is taking a comprehensive look at this problem and designing a smarter and more realistic solution.
I am committed to fixing these problems and I know Mr. Chairman and Members of this Committee are committed as well, and I just want to thank you for allowing me the opportunity to share the story and to introduce these bills because I really do think it would make a significant difference to our servicemembers. Thank you.
[The prepared statement of Congresswoman Giffords appears in the Appendix.]
Mr. MICHAUD. Thank you, too, for your commitment to helping our veterans.
Mrs. Kirkpatrick?
STATEMENT OF HON. ANN KIRKPATRICK
Mrs. KIRKPATRICK. Mr. Chairman, Ranking Member Brown and Members of the Committee, thank you for holding this hearing and providing me with the opportunity to address two bills that I have introduced, H.R. 4006, the "Rural, American Indian Veterans Health Care Improvement Act of 2009," and H.R. 2879, the "Rural Veterans Health Care Improvement Act of 2009."
The Rural, American Indian Veterans Health Care Improvement Act will make it easier for many Native American veterans living in rural areas to access quality health care options. So many Native Americans have sacrificed and given their lives in service to this country throughout our Nation's history with the brave and honorable service of the Navajo Code Talkers being just one example.
In fact, the VA estimates that 22 percent of Native Americans are veterans or are currently serving, more than any other ethnic group. America has a sacred obligation to keep its promises to them. Too often Washington has not met that obligation and Native American veterans frequently struggle to get the benefits they have earned.
For instance, my district is home to 11 tribal communities spread out across an area larger than 26 States and yet it is served by only one VA medical center. Many veterans in Arizona who live on tribal lands have to drive for hours to get basic care. My bill directs the VA to establish Indian Health coordinators in areas with a high population of Native American veterans.
These coordinators will work directly with Native American veterans to find innovative ways to improve outreach to tribal communities and help those veterans work with the VA. My bill would also explore common sense ways for the VA to coordinate with the Indian Health Service (IHS).
At the national level, the Secretary of Veterans Affairs would be directed to work with the Secretary of the Interior to streamline the electronic transfer of health records for Native American veterans between the VA and IHS.
At the local level, Indian Health coordinators would work with their IHS counterparts to better serve the medical needs of veterans in tribal communities.
Finally, my bill would require a joint report by the Secretaries of Veterans Affairs and Health and Human Services (HHS) to find other methods to expand service to Native American veterans including through the establishment of new clinics.
My other bill, the Rural Veterans Health Care Improvement Act builds on the Rural, American Indian Veterans Health Care Improvement Act with an even more comprehensive effort at allowing veterans living in rural areas to access medical services.
The health care provided by the VA is undeniably among the best in the world, but that does little good to veterans in rural areas who have trouble making the trip to the clinic. This bill helps them address this challenge by making it easier and cheaper for veterans to actually get to VA health care providers. This bill would lock in the current health care travel reimbursement rate for disabled veterans at 41.5 cents per mile, up from 11 cents just a few years ago.
Further, it authorizes the VA to award grants to veterans service organizations that transport veterans to their appointments, making it possible for them to expand and improve these helpful services.
When I visited with our troops in Afghanistan last May, I was told time and again that our brave men and women need better access to mental health services. That is why this bill also expands peer support programs and allows the VA to cooperate with community providers already in place to ensure that those who need care can get it.
I believe that it is our Nation's sacred duty to pay back the eternal debt of gratitude we owe to our veterans, starting at the very moment a citizen signs up to serve.
As the daughter and niece of veterans, this is incredibly important to me personally and I am determined to push Washington to live up to its responsibilities. I believe that these two bills are important steps in the right direction.
I thank you again for this chance to discuss these measures and I stand ready to answer any questions you may have.
Mr. MICHAUD. Thank you very much, Mrs. Kirkpatrick. I want to thank all the panel Members for bringing forward these very important pieces of legislation. I look forward to working with you as we move forward with markups later this year.
I have no questions for the panel. I understand neither does Mr. Brown, so I would recognize the Ranking Member of the Economic Opportunity Subcommittee, Mr. Boozman, who has done a phenomenal job, along with Chairwoman Herseth Sandlin, in that Subcommittee and I want to thank you for working very hard with our Congresswoman Herseth Sandlin to move forward legislation on your Subcommittee in such a bipartisan manner, Mr. Boozman?
Mr. BOOZMAN. Well, Thank you very much, Mr. Chairman. First of all, I would like to introduce—I have three students here that have come by. They are up here trying to figure out how Washington works, which is kind of scary, but let me introduce them real quick—Kaity Dye, Christopher Jordan and Caleb McDaniel. And these are all students from Arkansas that are part of a program that is learning more about—I think it is so neat that they are here today in the Veterans' Affairs Committee because we hear so much about all the rancor that is going on here and the lack of working together, but truly in this Committee, it comes down to veterans and we are totally, Mr. Filner's left, but under his leadership and Mr. Buyer, who truly are committed to helping veterans and I appreciate your leadership on this Subcommittee.
I would like to just—you guys can go ahead and sit down. I know you have to go. Again, thank you for being here.
I would like to comment just briefly on Mr. Scalise's bill, H.R. 1075, and it brings to the forefront a very serious and important issue regarding how VA is providing care to veterans when a medical center is destroyed as a result of a natural disaster. Quite honestly in such cases, the entire VISN, not such that area but the entire VISN is impacted by the extra resources needed to provide fee basis care. It creates a shortfall for all of the medical facilities in the VISN. So I ask you when a disaster creates a need for a VISN to incur a substantial increase in fee basis care expenses, why that money comes from the VISN's budget. I am really not directing that to you, Congressman. I guess that—again, this a problem that I am asking that question since this is something that we have to figure out.
The funding should come out of VA Central, the office budget, and I look forward to working with you, Steve, to see if we can maybe insert something or work with you with your legislation to really—we just have a number of different problems that are incurred as a result of these whenever incidents occur. So we look forward to working with you.
Mr. SCALISE. Thank you and I will continue to work with you and other groups. And I will commend—the Congresses over the last few years after Katrina have made a strong commitment to ensure that our VA hospital will be rebuilt and, in fact, the monies have been appropriated. Unfortunately, there have been a lot of delays for a number of reasons why we haven't even still been able to break ground.
So at the earliest it would be 2013 before this new facility is going to be built and our veterans have been in limbo for almost 5 years now, and you know, the funding issues we will continue to work on. I understand there are some agreements now that are being put in place by the VA to at least provide some alternative sources of care in that interim. Unfortunately, some of those agreements didn't even occur for 4 years, and so this bill is just focused on making sure that the veterans are taking care of and can still get care without being shuttled around to other States in some cases, but not at the detriment of any other hospitals within the VISN. But clearly our commitment to making sure the rebuilding occurs is still strong. But in the meantime, we just want to make sure our veterans have somewhere to go to get that basic care and I will continue to work with you.
Mr. BOOZMAN. I agree with you totally. I guess, the problem is, is not only are you impacted in the New Orleans area by not having that facility, but your veterans' care throughout the entire State is impacted because instead of the money coming from the Central Office, it comes from all of our resources in the VISN, so it is kind of a two-edged sword. Not only are veterans impacted but your veterans in the rest of Louisiana and then Arkansas, the rest of the VISN, they are also impacted because instead of the money coming, like I say, from the Central Office, it is coming from the VISN, which is unfair. I mean, this is—
Mr. SCALISE. Right.
Mr. BOOZMAN [continuing]. This is not a VISN problem. This is a total—
Mr. SCALISE. It is a national problem.
Mr. BOOZMAN. It is a national VA problem, so, but we appreciate your leadership very, very much.
Mr. SCALISE. Thank you.
Mr. BOOZMAN. Thank you. I yield back.
Mr. MICHAUD. Thank you very much, Mr. Boozman, and the Veterans Equitable Resource Allocation model is another big issue that we have been trying to get a handle on and we will continue to look forward to seeing what we can do to improve on that model to make sure that areas, especially rural areas, are not hampered in that effort, so thank you. Thank you very much.
Mr. Buchanan, do you have any questions for the panel before we dismiss them?
Mr. BUCHANAN. No.
Mr. MICHAUD. Once again, I would like to thank the panel for coming today and for bringing forward your legislation. I look forward to working with each of you as we move forward later on this year. So once again, thank you very much. And thank you for your dedication in making sure that veterans get the help that they need. Thank you.
I would ask the second panel to come forward, please. On the second panel we have Denise Williams from the American Legion, Blake C. Ortner from the Paralyzed Veterans of America, Eric Hilleman from the VFW, and Joy J. Ilem from the Disabled American Veterans. I want to thank all of you for coming here this morning. I look forward to your testimony and we will start with Ms. Williams.
STATEMENTS OF DENISE A. WILLIAMS, ASSISTANT DIRECTOR, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; BLAKE C. ORTNER, SENIOR ASSOCIATE LEGISLATIVE DIRECTOR, PARALYZED VETERANS OF AMERICA; ERIC A. HILLEMAN, DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES; AND JOY J. ILEM, DEPUTY NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS
STATEMENT OF DENISE A. WILLIAMS
Ms. WILLIAMS. Mr. Chairman and Members of the Subcommittee, thank you for the opportunity to present the American Legion's views on the several pieces of legislation being considered by the Subcommittee.
I will give oral comments on three pieces of legislation in the interest of time. H.R. 1075, timely and open access of quality care for veterans is a major priority for the American Legion and this legislation is consistent with our efforts in this regard.
The American Legion does, however, have some concerns. Although such contracts would certainly be helpful during a disaster in which VA medical facilities are not available, we do not want such an arrangement to become a disincentive for VA to quickly repair or replace damaged facilities. This bill also does not address length of the contracted care, long-term care or how quality of care would be assessed.
H.R. 3926, the "Armed Forces Breast Cancer Research Act." The American Legion fully supports this timely and important legislation given the recent breast cancer incidents among male veterans that were stationed at Camp Lejeune. Moreover, according to the Clinical Breast Care Project at Walter Reed Army Medical Center, there have been over 2,000 cases of breast cancer diagnosed in both males and female active-duty servicemembers within the last decade.
The Center further stated that breast cancer is the single greatest cause of cancer death among women under 40 and is a significant cause of mortality for women in the Armed Forces. The American Legion would also encourage inclusion of the Reserve component in this study.
Proposed legislation to amend title 38 concerning mental health counselors.
The American Legion believes VA should be staffed with the best qualified professionals to ensure this Nation's veterans receive timely access to quality health care, especially mental health services. With servicemembers returning from Iraq and Afghanistan with complex and overlapping illnesses and injuries, it is imperative VA maintains its charge to ensure its medical professionals are properly trained and fully qualified to provide quality care. According to the National Institutes of Health, injuries and illnesses such as mild traumatic brain injury (TBI) and post-traumatic stress disorder respectively, have several symptoms in common. Among these are irritability, concentration deficits, amnesia for the causal event, reduced cognitive processing ability and sleeping disturbances.
Clearly, this situation adds to the difficulty in diagnosing PTSD in patients with TBI. The American Legion contends that due to the complexity of these illnesses and injuries, such as TBI and PTSD, the most qualified mental health professionals are required. Therefore, the American Legion is opposed to waiving current requirements relating to mental health counselors.
Mr. Chairman, once again, the American Legion appreciates the opportunity to address these issues and looks forward to working with your colleagues and the staff in advancing legislation that will make a positive difference in the lives of our servicemembers, veterans and families. This concludes my written statement and I welcome any questions that you or your colleagues may have concerning the American Legion's views, comments and recommendations.
[The prepared statement of Ms. Williams appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Ms. Williams.
Mr. Ortner?
Mr. ORTNER. Mr. Chairman, Ranking Member Brown and Members of the Subcommittee, on behalf of Paralyzed Veterans of America, I would like to thank you for this opportunity to present PVA's position on the legislation before the Subcommittee.
PVA generally supports most of the bills presented here today. In the interest of time, I will highlight details only for legislation with which we have specific issues.
PVA cannot support H.R. 84, the "Veterans Timely Access to Health Care Act," which would establish standards of access to care within the VA health system. PVA has testified on similar legislation in the past and is still unable to support it.
Under the provisions of this legislation, VA will be required to provide a primary care appointment to veterans seeking health care within 30 days of a request for an appointment. If a VA facility is unable to meet the 30-day standard, then the VA must make an appointment with a non-VA provider, thereby contracting out the health care service.
While access is indeed a critical concern of PVA, the number of veterans enrolled in the VA is continuing to increase. Unfortunately, funding for VA health care in the past has had difficulty keeping pace with the growing demand. Even with the passage of Advance Appropriations and the record budgets in recent years, funding is not guaranteed to be sustained at those levels. PVA is concerned that contracting health care services to private facilities when access standards are not met is not an appropriate enforcement mechanism for ensuring access to care. In fact, it may actually serve as a disincentive to achieve timely access for veterans seeking care.
PVA is also concerned about the continuity of care. If veterans are shifted between the VA and non-VA facilities each time the imposed standard is not met, how will this affect the quality of care these veterans receive? This is neither an effective nor efficient way to supply health care and in the long run may be detrimental to the veteran. For these reasons, PVA cannot support H.R. 84.
PVA supports H.R. 949 introduced by Chairman Filner that will more quickly resolve adverse actions and set deadlines for final decisions and strongly supports H.R. 1075, the "RECOVER Act."
During periods of major disasters, ensuring veterans have uninterrupted access to health care is critical to their well-being. PVA would only caution that this arrangement should not inadvertently lead to delays in repairing or replacing VA facilities damaged during the disaster. More critically, this contracting authority should not become the default health care policy for meeting the needs of veterans in a disaster area.
PVA supports H.R. 2698, the "Veterans and Survivors Behavioral Health Awareness Act," and H.R. 2699, the "Armed Forces Behavioral Health Awareness Act."
While the scholarship provisions in the legislation are not targeted or reserved for veterans, PVA would encourage VA to market the scholarships to veterans who will best be able to relate to veterans visiting the Vet Centers or other facilities.
PVA supports H.R. 2879, the "Rural Veterans Health Care Improvement Act of 2009," and H.R. 4006, the "Rural, American Indian Veterans Health Care Improvement Act of 2009."
PVA recognizes that there is no easy solution to meeting the needs of veterans who live in rural areas and that Native Americans often face even tougher challenges. These rural veterans were not originally the target population of men and women that the VA expected to treat. However, the VA decision to expand to an outpatient network through community-based outpatient clinics reflected the growing demand on the VA system from veterans outside typical urban or suburban settings.
However, while these paths may show promise, they should still fit within the policies that promote the use of VA facilities and should not be used as a method to eliminate VA facilities in rural areas. While all of these ideas are welcome, the greatest need still is for qualified health care providers to be located in rural settings. Only significant incentives and opportunities for these professionals will bring them to these often remote areas.
PVA strongly support H.R. 3926, the "Armed Forces Breast Cancer Research Act." With the growing number of women that comprise members of the Armed Forces and their increasing involvement in forward operating areas and combat activities, it only makes sense to examine the potential increased risk of breast cancer among this population.
Regarding the Draft Legislation before us today, PVA supports the legislation to raise the reimbursement rate for health professionals from $1,000 to $1,600 and cautiously supports the legislation to waive certain requirements relating to mental health counselors, but want to ensure that this is done only in the circumstances that will benefit veterans and VA health care.
Regarding collective bargaining, PVA generally supports the provisions of the draft legislation that would improve the collective bargaining rights and procedures for certain health care professionals in the VA.
VA must work with their employees to achieve a less hostile work relationship, but any changes or modifications to either side of the issue must first address the care of veterans. Furthermore, this care should not be used as a rallying cry on either side as an argument for their position. Veterans deserve better.
PVA appreciates the opportunity to comment on these bills being considered and I would be happy to answer any questions that you may have. Thank you very much.
[The prepared statement of Mr. Ortner appears in the Appendix.]
Mr. MICHAUD. Thank you very much.
Mr. Hilleman?
Mr. HILLEMAN. Thank you, Chairman Michaud, Ranking Member Brown, Members of the Subcommittee.
On behalf of the 2.1 million men and women of the Veterans of Foreign Wars and our Auxiliaries, I thank you for the opportunity to testify before you today on the bills pending before the Subcommittee
The VFW supports the Draft Bill for continuing education at Veterans Health Administration (VHA), of VHA staff. We also support the Draft Bill to improve performance pay and bargaining rights.
The VFW further supports H.R. 2698, the "Veterans and Survivors Behavioral Health Awareness Act," and H.R. 2699, the "Armed Forces Behavioral Health Awareness Act."
Further, VFW supports H.R. 2879, the "Rural Veterans Health Care Improvement Act of 2009," and we strongly support H.R. 3926, the "Armed Forces Breast Cancer Research Act," and we support H.R. 4006, the "Rural, American Indian Veterans Health Care Improvement Act of 2009."
If I may, Mr. Chairman, I would like to speak exclusively to our support for one piece of legislation that is of particular importance to the overall preparedness of the VA hospital network, H.R. 1075. This bill would require the VA Secretary to seek outside contacts in the event a VA hospital is closed for greater than 180 days due to a national disaster. Currently, when VA hospitals are closed, veterans must travel long distances to other VA facilities, which may be impractical or impossible following a disaster. This bill ensures that the VA secures alterative arrangements for local medical care to include non-emergency care and inpatient services.
The VFW supports this legislation. However, we feel 180 days is far too long for a veteran to wait for medical services. We u
Sign Up for Committee Updates
Stay connected with the Committee