May212013
Hearing Transcript on Providing Essential Services and Benefits to Veterans in New Mexico and Across America.
|
PROVIDING ESSENTIAL SERVICES AND BENEFITS FOR VETERANS IN NEW MEXICO AND ACROSS AMERICA FIELD HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION MARCH 29, 2010 SERIAL No. 111-70 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
|
|
|
|||||
|
|
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 29, 2010
Providing Essential Services and Benefits to Veterans in New Mexico and Across America
OPENING STATEMENTS
Chairman Michael Michaud
Prepared statement of Chairman Michaud
Hon. Harry Teague
WITNESSES
U.S. Department of Defense, Shirley Bratton, Director, Airman and Family Readiness Center, Holloman Air Force Base, NM, Department of the Air Force
Prepared statement of Ms. Bratton
U.S. Department of Veterans Affairs:
Susan P. Bowers, Director, Veterans Affairs Southwest Health Care Network,
Veterans Health Administration
Prepared statement of Ms. Bowers
Grant Singleton, Director, Albuquerque Veterans Affairs Regional Office,
Veterans Benefits Administration
Prepared statement of Mr. Singleton
Guy McCommon, Team Leader, Las Cruces Vet Center, Readjustment
Counseling Service, Veterans Health Administration
Prepared statement of Mr. McCommon
Mesilla Valley Community of Hope, Las Cruces, NM, Pamela Angell, Executive Director
Prepared statement of Ms. Angell
New Mexico Department of Veterans' Services:
Dalton Boyd, Veterans Service Officer, Hobbs, NM
Prepared statement of Mr. Boyd
John M. Garcia, Secretary, Santa Fe, NM
Prepared statement of Mr. Garcia
Veterans of Foreign Wars of the United States, Department of New Mexico, Alamogordo, NM, Raul V. Sanchez, Commander
Prepared statement of Mr. Sanchez
PROVIDING ESSENTIAL SERVICES AND BENEFITS FOR VETERANS IN NEW MEXICO AND ACROSS AMERICA
Monday, March 29, 2010
U. S. House of Representatives,
Subcommittee on Health,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 2:00 p.m., at the New Mexico State University, Corbett Center Student Union, Senate Gallery, Las Cruces, New Mexico, the Hon. Michael H. Michaud [Chairman of the Subcommittee] presiding.
Present: Representatives Michaud and Teague.
OPENING STATEMENT OF CHAIRMAN MICHAUD
Mr. MICHAUD. I'd like to call the Subcommittee on Health to order, and I'd also like to thank everyone for coming out this afternoon. I look forward to hearing your testimony. I want to thank Congressman Teague for inviting me out here, and I also want to thank New Mexico State University for their hospitality in hosting this hearing today.
The weather here is a little different than in the State of Maine. When I left, it was about 20 degrees, so I want to thank you, Mr. Teague, for bringing some warm weather as well.
Today's hearing would not have been possible, quite frankly, without the efforts of Mr. Teague, and I want to thank Mr. Teague for his work on veterans' issues. He's definitely been a very active member of the Veterans' Affairs Committee. I'd also like to thank him for inviting me here today to hear what this area of the country has to say about veterans issues.
Today's hearing will cover a wide range of issues, to ensure that our veterans in New Mexico and across the United States receive the essential services and benefits that they need and deserve. Among the issues that we'll be discussing today will be homeless veterans issues, mental health issues, reintegration, and outreach and health care for rural veterans.
In this Congress, we have had several hearings on these issues already. For example, the Health Subcommittee, which I Chair, held a hearing on rural veterans issues in March of 2009 and an outreach hearing in May, also in 2009. And under the leadership of Chairman Filner, on the full Committee, we also had a hearing on homeless veterans in June of last year.
I'm happy to share that the house passed H.R. 4810, a comprehensive bill to help homeless veterans, on March 22nd of 2010. H.R. 4810 included two very important provisions that Mr. Teague introduced in his bill, H.R. 2504, which would increase funding for the Grant and Per Diem Program, and H.R. 3906, which would increase funding for supportive service for low-income veterans family in permanent housing. This year, the full Committee also held a roundtable discussion on issues facing veterans who live in rural areas, in January, and another roundtable discussion on reintegration issues in March.
We have learned a lot from the series of hearings and roundtable discussions that we have held in Washington. However, these issues are of such magnitude that they warrant further discussion here today, because each region of the country has its own, different issues. I'm pleased to be here, and I look forward to the two panels that we have here today and listening to what the witnesses have to say about the unique challenges facing veterans here in New Mexico.
I'd like to now recognize Mr. Teague for any opening statement that he may have.
[The prepared statement of Chairman Michaud appears in the Appendix.]
OPENING STATEMENT OF HON. HARRY TEAGUE
Mr. TEAGUE. Thank you. Thank you, Mr. Chairman. First, let me begin by thanking you for traveling to the beautiful State of New Mexico and holding this field hearing in my district. One of the biggest goals that I have set for myself is to make sure that we are providing the people of southern New Mexico was the direct link to the decision makers in Washington, and I believe that a field hearing, like this one, is one way in which local residents can participate in shaping the discussions on and the decisions that take place in our Nation's capital. Your help today will help give people a voice in our Nation's capital, and I think that's a very valuable opportunity for them. Thank you for coming, and I hope that you have enjoyed your visit.
Today, we're going to hear from individuals that are on the front lines, in terms of providing for veterans care and improving their overall quality of life. The witnesses before us today spend their days serving veterans in a variety of different and important ways. Whether it is trying to find veterans homes, assisting them in filing a U.S. Department of Veterans Affairs (VA) claim, or helping them cope with mental issues that they are having, these individuals all share in a part of that process.
And while I honestly believe that everyone in the VA is committed to providing care of the highest quality to our veterans, there is always room for improvement and we, as elected officials, are charged with the duty of overseeing the VA. We must be diligent in our efforts to ensure that we are giving VA the resources that they need, exercising the proper oversight, and when necessary, changing or creating laws to provide better service for our veterans. Over the last 3 years, I believe that the Congress has done much in the way of honoring the commitment that we make to these veterans. Our Nation asked them to make the ultimate sacrifice, so that our Nation could remain free.
Let me say to all that are in attendance here, that this Congress places the highest priority on veterans and the care that they receive. I'm proud to say that over the last year alone, our Committee has passed significant legislation to improve on that care. That, we will be building on those successes.
We were able to provide record increases to the VA budget, adding an additional $14.5 billion to the VA over fiscal year 2009. This amounted to the largest increase in the history of the VA. We passed H.R. 1016, which created for the first time advanced appropriations for the veterans health accounts, ensuring that the management of our medical facilities are never denied the funding that they needed to accomplish the mission that they have.
Now, this care of our veterans will not be held hostage due to partisan wrangling in Washington, DC. We've worked to respond to the changing times by creating a new GI Bill of Rights, that ensures that returning veterans will be able to pursue an education after they've served their country. The Post-9/11 GI Bill of Rights ensures not only that we can open the door of higher education to the veterans, but also allows them to transfer the benefits to their family members, if they so choose.
We are also working to end some of the problems that we, as a Nation, have ignored for far too long. The most glaring example of this has been the mental health of our troops and our veterans. For far too long, we have not treated the invisible wounds of war that many of our troops bear. Whether it was because we didn't fully understand the problems ourselves or whether it was because we were just glad to have our veterans return home to us, there was never a comprehensive answer to these afflictions; and, thus, we have been paying a terrible price.
This Congress, working together in a bipartisan manner, was able to begin to tackle the problem of mental health amongst our troops. I had the distinct honor and privilege of working with veterans groups and other more senior members of the House, like Mr. Michaud, to insert language in the National Defense Authorization Act of 2010, that mandates private face-to-face mental health assessments for troops that are being deployed and returning home from combat. This measure will help us to diagnose mental health issues, such as post-traumatic stress disorder (PTSD), earlier, and will, in the end, provide all of us with the keys to create a healthy homecoming for the troops.
Another issue that we must recognize is that there are a growing number of women that are serving in uniform that have made huge sacrifices in the service to their country. The military is changing, and we must make sure that the VA is changing along with it. Women are due the same treatment, services, and benefits available to their male counterparts, and in many cases, they require a different approach in the delivery of their care. Sadly, when we look at the current VA system, there are still far too many barriers that exist in providing quality care to women warriors, and we need to knock them down, and that can't begin to happen quickly enough.
Seeing that change was needed, the 111th Congress took up H.R. 1211, which will begin to change the way we care for women veterans. It will provide an expansion of VA services to an estimated 1.8 million veterans, and it's long overdue.
Unfortunately, while the makeup of the military has changed, the nature of war has changed as well. While we're lucky to live in a day and age in which medical science has provided new ways in saving the lives of military personnel that have been deployed, we have much to do in assisting those wounded warriors with the tools that they need to transition back into civilian life.
We, as a government, did not have the foresight to see what types of benefits and services needed to be available to disabled veterans that were coming home from the Global War on Terrorism (GWOT), and the wounded warriors are not the only persons that need assistance. In the vast majority of these cases, family members become the full-time caregivers, and support for them is needed as well.
That's why this Committee, under the leadership of Chairman Michaud, drafted H.R. 3155. This bill will provide a new set of measures to assist family caregivers of our wounded warriors. The bill will provide outreach, training, and counseling for these family members. It also includes provisions of a bill that I drafted, which provides for lodging and sustenance for caregivers accompanying a disabled veteran to a medical appointment. We recognize that when someone serves their country, it is not their sacrifice alone, but the shared sacrifice of their family and loved ones, and remember that we must honor our commitment to them as well.
Lastly, this Congress has worked to address an issue that is a great shame of our country. It's an issue that we will hear a lot about today: Homeless veterans. Every night, thousands of homeless veterans sleep in the city streets and the country fields of the Nation that they have defended. They move about us, while too many citizens look the other way, rather than do something to provide them with aid and comfort.
Working with groups and organizations like the Community of Hope, this Congress is taking up the challenge of ending homeless veterans once and for all. H.R. 4810, the "End Veterans Homeless Act of 2010," takes great steps toward providing the VA and local groups the tools that they need to accomplish this goal. The bill includes two bills that I originally authored to provide an increase to the Grant Per Diem Program that provides funding for homeless veterans programs, as well as funding for homeless prevention.
While the Congress has provided a new direction for America's veterans, there is much to be done for those that fought for this country. While we draft new laws and programs in Washington, it is important that we work with individuals on the ground, like our witnesses today, to ensure that we are counseled by the folks on the front line.
Once again, I would like to thank Mr. Michaud for his leadership, his dedication to our veterans, and for his willingness to come here. I would like to thank the staff of the Health Subcommittee for their hard work and efforts and the witnesses for testifying here today.
And last, but certainly not least, I would like to ask that every veteran that is here today stand up and be recognized, because if it weren't for your service and your commitment, we would not be here today. Thank you.
And thank you, Mr. Chairman.
Mr. MICHAUD. Thank you very much, Mr. Teague.
And I'd ask the first panel to come up.
And while the first panel is coming up, I do want to thank all the veterans service organizations (VSOs) for all the hard work that they do. As you heard, from the lengthy list of bills that we've been able to get passed in Congress, from increased funding to advanced appropriations, if it weren't for the veterans service organizations, they would not have been passed. I want to thank all of you for your continued service to our country and for your continued commitment to making sure that veterans get the services that they need.
I will now turn it back over to Mr. Teague to introduce the first panel. But before I do, Mr. Teague made a comment about working with senior Members of Congress, such as myself. He was making reference to time of service, not necessarily age. With that, I turn it over to Mr. Teague for the introduction of our first panel.
Mr. TEAGUE. I thought that that went without an explanation. I sure would have, yes, thank you all for coming. I would like to recognize the panel that is here. First is Pamela Angell from the Community of Hope for the homeless shelters.
And, you know, I can't thank you enough for the work that you continue to do there, and I want to thank you for that.
Next is Dalton Boyd. And it's a long way over here, isn't it?
Mr. DALTON. It's a long drive.
Mr. TEAGUE. Yes, I make that drive a lot, and I'm glad to see you come over from the east side to participate today.
And then, of course, we have Mr. Raul Sanchez, who is the State Commander of the Veterans of Foreign Wars (VFW), field director. It's quite an honor for all of us here in southern New Mexico to have Raul be there and to have him be here to participate today.
And then, at the end, we have Secretary John Garcia, who very possibly could be the best friend that veterans in New Mexico have, because he's constantly working for the benefit of them.
And I want to thank all of you for coming and participating today. It means a lot to me that not only that the Chairman came, but that you would come from everywhere to be here, too.
So, Ms. Angell, could we start, please? Thank you.
STATEMENTS OF PAMELA ANGELL, EXECUTIVE DIRECTOR, MESILLA VALLEY COMMUNITY OF HOPE, LAS CRUCES, NM; DALTON BOYD, VETERANS SERVICE OFFICER, NEW MEXICO DEPARTMENT OF VETERANS' SERVICES, HOBBS, NM; RAUL V. SANCHEZ, COMMANDER, VETERANS OF FOREIGN WARS OF THE UNITED STATES, DEPARTMENT OF NEW MEXICO, ALAMOGORDO,NM; AND JOHN M. GARCIA, SECRETARY, NEW MEXICO DEPARTMENT OF VETERANS' SERVICES, SANTA FE, NM
Ms. ANGELL. Thank you very much for having me. It's really an honor to be able to speak today before this panel. My name is Pamela Angell, and I'm the Executive Director of the Mesilla Valley Community of Hope, an agency that serves homeless people in Las Cruces and Dona Ana County. We have a daytime drop-in center and, also, we have several U.S. Department of Housing and Urban Development (HUD) housing programs and outreach services, like laundry and showers and some training programs.
I am here to address, really, one specific segment of the homeless population. I think that a lot of your very new programs and the more established Grant Per Diem Program really work and will address a lot of homeless issues. But there is a population that a lot of us forgot about back in the day, when they served in Vietnam and earlier wars, and that there really are lost homeless who are forgotten today as well. So I'm really only going to be focusing on chronic homelessness and what I think is a better answer to help solve their homeless problems.
President Obama and the Department of Veterans Affairs have made ending homelessness among veterans a top priority, with a 5-year goal. If, indeed, the VA and the Obama Administration wish to meet this goal, they must shift their policies so they can address the needs of all homeless veterans, including those we characterize as chronically homeless. And chronically homeless is someone who's been homeless four times in the last 3 years or for 1 year continuously and someone who has a disability, whether they recognize it or not.
In the case of many of our veterans—and here locally, in Las Cruces, we've seen 211 veterans signed in during 2009 at our agency, and we've met with 84 homeless veterans on a case management level. Seventy eight of those were male, and six of those were female. And their disabilities ranged from about 37—so that's about 50 percent—said that they were physically disabled. About 28 had mental disabilities. Twenty three so that's about almost a quarter—have drug/alcohol issues, and then another quarter said they have no disability whatsoever.
But nationwide, it's estimated that about a third of our adult homeless population are chronically homeless—or I'm sorry—a third of our adult homeless population are veterans. And there are no estimates that we have for chronic homelessness, but, usually, the chronically homeless are the ones that serve earlier. They can be an older population, in their 50s and 60s. So those are the ones that I'd like to address.
And I think the VA, with all of its good housing programs that it's developing and the vast outreach in that—expanding the Grant and Per Diem Program is great, but they come with a lot of strict rules and requirements. So I would like the VA to consider Housing First. This is a model that's used in HUD, that's been used in our Nation for the past 20 years, and it's a model that puts housing as the first place you go. It's not get sober, get treatment first. It's, here's a house. Then we'll let you deal with your issues.
But the most important thing, I think, for homeless people is housing, and a lot of the veterans that we see that are homeless and that are chronically homeless, they are very disenfranchised. They don't want a lot of services attached to their housing. So there's great models out there and programs. We have one that we're working on in Las Cruces for chronically homeless people. Some of those that are living there are veterans, and so far, it has a 66 percent retention rate, as far as permanent housing. And that's pretty good for the chronically homeless population.
But Housing First services are client driven. A lot of these people do have chronic alcoholism or drug abuse. I'd say more alcohol than drugs. And then, also, mental health issues. But as long as we dictate and mandate to them, you know, you can get housing if you get treatment first, a lot of them are going to stay on the streets, and I think that's why a lot of them are still on the streets.
Housing First is housing without a lot of stipulations, and from there, they can find it within themselves to get the services that they need. And a lot of them will, because a lot of them are on the streets with no hope. Once they have a house, then they can see a better future for themselves, and they will get treatment.
And it looks like I'm out of time.
[The prepared statement of Ms. Angell appears in the Appendix.]
Mr. MICHAUD. Mr. Boyd?
Mr. BOYD. Before I begin, I would like to thank Chairman Michaud, Congressman Teague, for the opportunity to address you today. The issues being discussed in today's hearing are critically important to our veterans, to whom I believe deserve the full measure of our efforts to provide for them the rights and the services they deserve.
My name is Dalton Boyd. I am employed by the New Mexico Department of Veterans' Services. I have the privilege of serving our veterans as a veterans service officer. As one who works for our veterans on a daily basis, I feel I have a unique perspective concerning the needs of our veterans. I see their individual needs daily and draw from the resources available to aid them in addressing those needs.
I would like to begin by addressing VA health care for veterans in rural areas. I personally believe that the VA provides world-class health care, but, as with anything else, there's always room for improvement. Veterans in rural areas face some unique problems, with fragmented health care being one of those problems.
We have a very good community-based outpatient clinic (CBOC) in my hometown of Hobbs, but they provide only basic services, with preventive health care being their primary focus. Veterans with special needs must travel hundreds of miles for treatment by specialists or facilities that can meet their needs. For example, veterans from Hobbs with cardiology or orthopedic conditions have to travel to Albuquerque for treatment, a round trip of 640 miles. Often, these are older World War II veterans in their 80s, in poor health, and for whom a trip of 640 miles or more for medical care is very difficult, if not impossible.
I realize that fee basis is a very costly undertaking for the VA, and I understand the concept that if the VA can treat a veteran, they'll provide that treatment at a VA facility in part, as a cost-cutting measure. It's my opinion that fee basis should be more readily available to veterans in certain circumstances. For example, an 85-year-old World War II veteran with a serious heart condition or veterans taking chemotherapy should be given consideration for care locally through fee basis.
I would also like to address the lack of resources available for homeless vets in rural areas. A lot of progress has been made in caring for our homeless veterans, to include H.R. 4810. Homeless veterans in metropolitan areas have numerous options, and we're all grateful that they have those options. Those options often do not exist in rural areas. In practical terms, homeless veterans that I see in Hobbs have two options: Treatment at a shelter locally in Hobbs or enter into the substance abuse treatment program at the VA Hospital in Big Springs, Texas.
We do have the New Mexico Veterans Integration Center in Albuquerque, the Mesilla Valley Community of Hope in Las Cruces, and the New Mexico State Veterans' Home in Truth or Consequences (T or C). Our homeless veterans in rural areas often are not able to relocate or do not want to relocate to areas far from what has been their home and comfort zone. What they often seek is temporary assistance within their community.
I would also like to speak about services for veterans transitioning from military to civilian life. New Mexico veterans receive readjustment counseling services from the Vet Centers located in Albuquerque, Farmington, Santa Fe, and Las Cruces. Lea County veterans are serviced by the Midland, Texas, Vet Center. The Vet Centers provide readjustment counseling services to combat veterans. Most of the veterans they serve suffer from PTSD and depressive orders. The Vet Centers serve veterans from World War II through present-day combat veterans.
According to the New Mexico Department of Veterans' Services 2008 annual report, there are approximately 179,000 veterans in New Mexico, with 39,246 Gulf War, Iraq, and Afghanistan-era veterans and 52,011 Vietnam-era veterans. The bulk of the Vet Centers' clients are Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) and Vietnam veterans. Of course, the VA provides mental health care on a number of levels, through the CBOCs, hospitals, and telehealth.
The Vet Center counselors, as I see them, are the front-line troops in the battle with mental health problems. They have the mobility, they conduct the outreaches, and they take their expertise directly to the veterans. Critically important is the fact that the Vet Center also provides services to family members.
An article in Psychiatric Times reports rates of PTSD in returning troops average 15 to 16 percent and that up to 35 percent meet the criteria for major depressive disorder. Clearly, these rates represent a large number of veterans in need of mental health care. As the number of deployed troops is reduced and the troops are brought home, the number of troops in need of mental health care services will rapidly increase. We have to be prepared to meet the needs of the growing number of veterans in need of mental health care.
I appreciate the opportunity to address you today. I hope that I've given you a clearer understanding of some of the issues facing veterans in rural areas and the tasks the VA mental health care providers are confronted with.
Thank you.
[The prepared statement of Mr. Boyd appears in the Appendix.]
Mr. MICHAUD. Thank you.
Mr. Sanchez?
Mr. TEAGUE. You may have to scoot the microphone a little closer, because it seems to kind of fade out a little bit.
Mr. SANCHEZ. How is this?
Mr. TEAGUE. Okay.
Mr. SANCHEZ. Chairman Michaud, Ranking Member Brown, Member Teague, and distinguished Members of the Subcommittee, it is my honor to be here today to represent the VFW members in New Mexico, here in Las Cruces, and around our wonderful, wonderful State.
I come before you as an advocate for our brave servicemen and women and for veterans and their families from all eras. I come before you as a reminder that those who go to war return home with an obligation to make things better for every ensuing generation who follows. This is central to the VFW's core value, "to honor the dead by helping the living."
With these thoughts in mind, I would like to address a number of issues that we are facing here in New Mexico. All of the issues in my statement are of extreme importance to our State's veterans: The OEF/OIF health care, women veterans health care, traumatic brain injury (TBI), mental health, the alarming suicide rate of veterans, veterans homelessness, employment, and quality of life issues. The number-one issue, though, that's affecting our New Mexico veterans is the VA claims backlog and unacceptable waiting times for those seeking care.
VA currently has more than 1.1 million individual claims and appeals for compensation, pension, and education benefits. Right here in New Mexico's own regional office (RO) of Albuquerque, there are 6,240 disability compensation claims and appeals pending. Over the past year, this backlog has grown by more than ten percent. Of the nearly 3,400 claims requiring rating action, 38 percent are pending over 125 days. Reading quality reviews show a whopping 19 percent error rate; and that is, one in every 5 cases, VA decides that New Mexico is wrong. The evidence shows that the Albuquerque VA regional office fails to provide adequate services in all three areas the VA measures: workload, timeliness, and quality. This is totally unacceptable.
VFW has made reforming the VA claims processing system a top legislative priority. The VFW realizes there's no silver bullet to fix the Veterans Benefits Administration (VBA), but there are opportunities for steady and deliberate improvement. We also know that any single plan to make the overall claims process simpler could occur at the expense of the rights and benefits earned by veterans, their dependents, and survivors.
A quick-fix plan is simply unacceptable, because fixing the backlog would require thoughtful solutions to avoid harming our veterans and exacerbating the problem.
VBA is a key to everything the VA does, so the VFW will continue to offer its expertise to the VA and your Committee, so we can solve this backlog problem together. Veterans have grown tired of the excuses. They want and deserve action. The VFW wants to help.
The VFW has offered potential solutions in testimony and in the Independent Budget, but we cannot wave a magic wand to make the problem go away. Our suggestions have included improvements to the funding process; increased emphasis on ratings decision and accuracy, instead of speed; improvements in staff education and training; and increased use of technology.
Unfortunately, it may be years before VBA will be able to reduce the backlog and improve rating timeliness and accuracy. We believe, however, that the VA can still make incremental improvements to demonstrate to veterans that it is both candid in its problems and responsive to their needs.
Some of the first steps would be to demand a total commitment from VA leadership to do every claim properly the first time; improve the VA's information technology and infrastructure, to include adopting paperless initiatives; upgrade and enhance training systems that invest in skills and knowledge of VA employees, reducing turnover and improving quality; higher accountability. We also ask Congress to commission a third-party study of the quality assurance of claims processing.
We envision a VBA of the 21st Century, one in which veterans receive accurate and timely decisions. Congress must invest in the long-term success of VBA, which only is achieved through constant improvement.
The VFW and other VSOs have a nationwide network of excellent service officers, including our own vet, Fred Ortiz, but we can only help those who seek us out. For a veteran to navigate the bureaucratic process without a service officer to guide them, it can be a nightmare, and a number of them simply give up, which means they lose their earned benefits, disability compensation, and access to VA health care.
In closing, we ask that your Committee work with the VFW and other veterans service organizations to help effect all of the health care program provided by the U.S. Department of Defense (DoD) and Department of Veterans Affairs under the new national health care bill that was signed to law by President Obama last Tuesday.
Thank you.
[The prepared statement of Mr. Sanchez appears in the Appendix.]
Mr. MICHAUD. Mr. Garcia?
Mr. GARCIA. Mr. Chairman, Congressman Teague, Members of the committee, my name is John Garcia. I'm the Cabinet Secretary for the New Mexico Department of Veterans' Services. I'm also the Past President of the National Association of State Directors of Veterans Affairs. On behalf of Governor Bill Richardson, 200,000 veterans of the State, of which 30,000 are OEF/OIF veterans, and a rich military legacy, I'd like to welcome all of you to the State of New Mexico.
I just recently returned last night from DC, as part of a commission appointed by Secretary Shinseki to select the Under Secretary for Benefits, and I believe we've selected three recommendations we'll be presenting to your committee and the President. And there will be a well-qualified individual in that position in the future.
Mr. Chairman, my comments are such—as the State Department of Veterans' Services, I want to make sure that you, as the Chairman of the Committee and Member of Congress, understand the role of State directors and the office that I represent. We're a vital partner with the Federal VA in delivering services. We're the second largest provider of services to veterans, and our roles continue to grow.
Collectively, States contribute more than $5 billion each year in support of our Nation's veterans and their families, even in the face of constrained budgets. Our duties include honoring and working with all veterans at the various organizations, both within our State and nationally. I applaud the cultural change at Federal VA in recognizing the importance of the VA partnership and the State Departments of Veterans Affairs and a concerned compassionate leadership demonstrated by our Secretary Shinseki and his senior leaders.
The State Departments of Veterans Affairs are governmental agencies, and they're not membership organizations. They're tasked by our respective governors, boards, and commissions with the responsibility to address the needs of our veterans, irrespective of age, era of service, military branch, or services.
On a daily basis, State directors and their staff are confronted with unique situations in caring for all veterans, which often needs to be addressed in a timely manner. Delivery of meaningful services and support many times is best orchestrated at local levels, our offices, our veterans service officers, and our facilities, along with Federal VA facilities, Mike at the country.
Several of my staff are here, which are veterans service officers. I'd just like to take a moment, sir, to introduce them to you. J.R. Turner, our veterans service officer from Las Cruces, and he can stand. Virginia C. Bell, a veterans service officer from Las Cruces; Mr. Reggie Price, out of Silver City; Dalton Boyd, who's at the table here, from Hobbs; Tony Woodard, out of Alamogordo; and Armando Amador, who's out of Silver City, a member of my State advisory board. I mention these names to you because they're very engaged with us and our delivery of services around the State of New Mexico.
New Mexico appreciates the efforts of the Administration and Congress to improve overall funding of health care, homeless veteran programs, community clinics, and claims processing. Increases in VA funding, as reflected in the 2010 and 2011 budget, provides a 20 percent increase over FY 2009. The budgeting change for an advanced appropriation of 2012 will provide continuity for programming and services.
We are now serving a new generation of veterans from 8 years of war who must receive medical care, establishment of benefits, and need assistance transitioning to civilian life after dedicated service. This funding supported by Congress will provide the wherewithal in three major areas.
First, the overall access to the VA. In essence, the VA should be the provider of choice for veterans. Second, reducing the backlog of claims processing. And, third, the stated goal by Secretary Shinseki of eliminating homelessness among veterans and ongoing challenges to meet the critical demand of mental health, including PTSD and TBI, which needs continued funding and focus. Likewise, there should be an increased funding to veterans health care in rural areas and better known businesses through the Small Business Administration (SBA).
New Mexico supports continuing efforts to reach out to our veterans, and I firmly believe all veterans, regardless of where they reside, should have equal access to Federal and State benefits and services, and that Federal and State governments must collaborate to achieve this goal nationally.
Many areas of the country are still shortchanged due to the veterans lack of information, awareness of their benefits. This directly impacts their access to the VA services. Federal VA and States must work together to reduce this inequity by reaching out to veterans regarding their earned benefits, and New Mexico supports an implementation of a grant program that would allow VA to partner with the States to perform outreach at local levels.
State directors and myself actively support increasing veterans access to the VA health care. This involves being engaged with VA Medical Centers on establishing, locating additional community-based outpatient clinics, included on tribal reservations. With mental health services, expansion of Vet Centers, and the creation of veteran wellness centers, we applaud the efforts by the VA to address particular issues of health care for women veterans and veterans residing in rural areas.
Future health care funding to expand outreach and access will have to include telehealth, telehome health, telemedicine; and, likewise, we support VA contracting out some specialty care to private-sector facilities, where access is difficult. VA research and development needs to focus on enhancing long-term health and well-being of veteran population; particularly, the new conditions, such as Gulf War Syndrome, PTSD, and effects of TBI.
And attention must be given to the continued funding support at large capital projects identified and recommended by the Capital Asset Realignment for Enhanced Services (CARES) assessment, while maintaining the Veterans Health Administration's (VHA's) infrastructure of 153 hospitals, 951 CBOCs, and 232 Vet Centers. New Mexico fully agrees the support and efforts of VA and DoD is developing the seamless integration of electronic health records and recommends further integration of electronic records between the VA and State Departments of Veterans Affairs.
New Mexico also recommends an in-depth examination of long-term care and mental health services, as well as wellness treatment centers, to include gap analysis clearly identifying where services are lacking, and any studies should include consultation with State Directors of Veterans Affairs.
State veteran homes are a critical component of long-term health care for veterans and a model of cost efficient of partnerships between the Federal and State. State Homes, over half of the national long-term health care workload are infirm and aging veteran population. The Federal Government should continue to fulfill its important commitment to the States and, ultimately, to the individual veterans in need of this care.
We strongly recommend that the VA review regulations, ensure that their implementation of Public Law 109-461, the Veterans' Benefit, Health Care, and Information Technology Act, does not threaten the future of State veteran homes and their continued ability to meet the needs of our veterans.
We also support full reimbursement of care of State veteran homes who have a 70 percent or more service-connected disability or who require nursing home care because of service-connected disability. There are two very important issues to implement this reimbursement. First, there needs to be a clear definition and understanding for calculation of the full cost of care; and, second, the Congressional legislation needs to allow States to bill Medicare and Medicaid.
We also support the recommendation of the Veterans' Disability Benefits Commission to streamline the delivery of disability benefits by updating the VA rating schedule, realigning the DoD and VA process for rating disabilities, and developing and implementing new criteria specific to rating post-traumatic stress disorder.
We also applaud the initiative of Secretary of Veterans Affairs for establishing a goal to end homelessness among veterans and within 5 years, and encouraging the VA to partner with State Directors of Veterans Affairs. Programs should address the barriers to homeless veterans, medical issues, mental and physical, legal issues, limited job skills, and work history. We appreciate the increased funding for specialized homeless programs, such as the Homeless Providers Grant and the Per Diem Health Care for homeless veterans.
We, in New Mexico, have a unique program, the New Mexico Veteran Integrations Center, which I believe could be a model. It could be reviewed by the VA and other agencies. It's vital to continue the Veterans Affairs partnership with community organizations to provide transitional housing, and the VA HUD partnership with public housing authorities to provide permanent housing for veterans and their families.
And there should be official coordination between the VA program, the office for homeless veterans, and the State Department of Veterans Affairs, for grant application and awards for organizations, with the respective State, to homeless veterans, and this would assist in fiscal accountability and local oversight of the services provided.
New Mexico also supports efforts to diminish the national disgrace of homelessness among veterans. We applaud the permanent authority of the Homeless Providers Grant and Per Diem Program and propose authorization to increase annual spending to $130 million. State Directors of Veterans Affairs would prefer a Per Diem fund for homeless veterans pass through the State to nonprofit organizations to ensure greater coordination.
Mr. Chairman, distinguished Members of the Committee, I respect the important work that you are doing to improve and support veterans who answered the call and service to our country. As a representative of the State Directors of Veterans Affairs and as Secretary of Veterans Affairs for my State, I'm dedicated to doing our part, but I also urge you to be mindful of the increasing financial challenge that States face, just as you addressed the fiscal challenges at the Federal level. I'd like to also emphasize again that the State Directors of Veterans Affairs, with the VA, in the delivery of services and care to our Nation's patriots.
Mr. Chairman, Members of the Committee, this concludes my statement. I'll be glad to provide you a copy of this statement and answer any questions that you may have.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Garcia appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Mr. Garcia, and other the three panelists.
My first question is for Ms. Angell. As part of VA's 5-year plan to end veterans homelessness, the VA also plans to implement a national referral call center and a national homeless register. What are your thoughts on these new initiatives, and what other new initiatives do you think VA should include on their list? You mentioned the concept of housing first. What other new initiatives, such as that concept, do you think the VA should look at as it tries to address homelessness?
Ms. ANGELL. Well, I think that using nonprofits, us and community-based centers, as a tool for veterans is good. I think a lot of—and, again, speaking just the chronically homeless, a lot of them are very disenfranchised. Some of them don't even admit they're veterans. They have spoken to some of the local agencies, and they have, like, this—I don't know. They don't have a great view of the VA. And that's that small group. I mean, I'm talking very specifically to the chronically homeless.
But I also think that housing, if you go for permanent housing, the Grant Per Diem Program, it's great, but it's transitional, so it's 2 years limited. So you get into this program, and then you have to move into permanent housing. But if we can go straight from the streets to permanent housing—that's why Housing First is important. It takes people and puts them into permanent housing right away, and then delivers services that people want.
So I think, with emergency and transitional housing, it's temporary, and it's so much easier to fall out of the cracks—fall into the cracks there. If we can get people straight into permanent housing, then they can move on to other permanent housing.
And that's what we're seeing in our permanent housing development. We put people in group homes, where we're taking people off the streets and into these group homes, where they can live forever. And a good portion of them have moved out into other permanent situations. But during that time, they don't feel threatened, like they have a limit of time.
But during the time that they move in there, a lot of them are getting benefits and on Social Security and getting physical care. A lot of them are getting to doctors for the first time in decades. And so that kind of program, I think, is really good, in addition to the emergency and transitional housing. But those are mandates—permanent housing is the—you know, permanent.
Mr. MICHAUD. Thank you.
Mr. Boyd, to help expand access to health care among our rural veterans population, you recommend making the fee-based care more readily accessible. I think that's important, particularly for rural States. However, there has been some concern among some of the VSOs about ensuring the continuity of care among our veterans with fee-based care, as well as concern that they might be pushing farther away from the VA out to contract care.
Do you share those same concerns about continuity of care and quality of care and—
Mr. BOYD. To a—
Mr. MICHAUD [continuing]. Loss of VA's control?
Mr. BOYD [continuing]. To a degree, yes, I do. However, you know, with continuity of care, a lot of times, the veterans that are in the rural areas like this, they'll travel their 640 miles to Albuquerque from Hobbs, and they'll receive their treatment. Three months later, when they go back, oftentimes, it's not the same physician that's attending to them. And so the continuity of care—it may be the same facility, but quite often, it's not the same physicians. I understand the oversight, but the VA needs to follow through on that.
Mr. MICHAUD. I've heard concerns from veterans service organizations in Maine. For instance, the distribution of funding for rural health care, through the Veterans Equitable Resource Allocation (VERA) model places a lot of pressure on CBOCs and hospitals in rural areas that are part of the Veterans Integrated Services Network (VISN), but not directly in that region.
Are you concerned, or have you heard complaints about how the funding gets distributed from the VISN office out to rural CBOCs or other areas? In some cases, I've heard they're actually looking at cutting back on fee-basis service, because they've got to make their budget balance.
Mr. BOYD. And I don't see a problem with that at all. As a matter of fact, I'm on the veterans council with the Big Spring hospital, the VA hospital, and, actually, funding has increased for our CBOCs, as well in Hobbs. That's not an issue.
We have expanded. They're attracting a larger number of veterans. They do an outstanding job at our CBOC. The problem is, they're restricted and limited in their care that they can provide to a veteran, and my concern has always been with those veterans, for example, the World War II veterans, that a lot of times, they're just not physically able to travel those long distances. That's my concern.
Mr. MICHAUD. Mr. Sanchez, we've heard a lot about the VA working collaboratively with the State veterans service coordinators in certain States. Do you feel that the VA has worked collaboratively with the VSOs in this region? For instance, have you looked at whether they're looking at building a new CBOC or how they're going to deliver services in rural areas? How is the VA working with the VSOs in this area of the country?
Mr. SANCHEZ. You know, that's a very good question, Chairman. Our State—that's why I brought my State service officer today and my District 3 service officer today. And if I can, with your permission, defer this question to him, since he is more in day in and day out.
Mr. MICHAUD. Yes. That'll be no problem. If you'd state your name for the record.
Mr. ORTIZ. Fred Ortiz, Department Service Officer for the VFW.
Mr. Chairman, it's quite evident that there is a problem here, and I completely concur with Mr. Boyd, that sometimes the VA, as you put it—you've referred to the Medical Center; is that correct?
Mr. MICHAUD. Yes, CBOC centers and—
Mr. ORTIZ. Okay. The Medical Center sometimes does not treat the very ill people that travel a long distance with the same doctor every time they come by, and that does create a problem. As a matter of fact, a lot of times, they wind up having some problems with housing. They travel 300 to 325 miles from home to go to the Medical Center. They want to have some place to stay, and a lot of them can't afford it.
They do have some small quarters at the Medical Center now, but it's just simply not enough. It would be nice if the Medical Center had a little bit more money to probably to expand the housing that they presently have, which I believe it's like 20—24, I think. Twenty-four people is all it'll house.
Mr. MICHAUD. Do you feel the VA works with the veterans service organizations or—
Mr. ORTIZ. No, sir. We don't work with the Medical Centers quite—all that much, but we do try to get some information from them. If we can't get the person that has the information; therefore, we have to go to a second or third party, and we wind up getting a lot of information that is not correct, when it comes to accomplishing some task that is important to the veteran.
I myself and my office have received probably in the neighborhood of 15 or 20 major complaints, and I forward them to the public affairs person there at the Medical Center.
Mr. MICHAUD. Thank you very much.
Mr. ORTIZ. Yes, sir.
Mr. MICHAUD. Mr. Garcia, you brought up an issue concerning State Veterans Nursing Homes, and the Subcommittee had a hearing 2 or 3 weeks ago on that very issue. Congress passed legislation, then when VA ultimately adopted rules and regulations, defining what they considered to be the full cost of nursing home care. The VA regulations are troubling to a lot of the Veterans Nursing Homes around the country.
During that hearing, we heard some testimony that was very disturbing. For instance, in Maine, we have six State Veterans Nursing Homes. If the rules were to be implemented, the State nursing home director said they would lose anywhere from $8 to $16 million a year. They would be forced to stop taking veterans in the State Veterans Nursing Homes because of that law.
We heard from the State Veterans Nursing Home Director in Nevada that a wife of a veteran who was 100-percent disabled was not able to get her husband into the State Veterans Nursing Home because of the way the rules were being implemented. And even though the wife kept calling every week, ultimately the veteran passed away before he got into the facility.
We also heard from another State Veterans Nursing Home that, what it's going to force them to do is avoid taking care of the most severely disabled veterans because it costs more to take care of 100-percent disabled veterans, because of the chronic illnesses that they have. Instead, they're looking at taking the 70-percent disabled, the less severely wounded veterans, because of the rate of reimbursement and the issues with Medicare and Medicaid.
What have been some of the stories that you've heard from State Veterans Nursing Homes here in New Mexico, as far as what they might do and how they're going to treat the veterans in light of this?
Mr. GARCIA. Well, Mr. Chairman, Congressman Teague, one of the issues that we have in New Mexico—and I think it's replicated across the country, and you hit on a couple there—is that we're an aging population. Vietnam vets are in their mid-60s, World War II guys are in their 90s, and Korean veterans are in their—age 75. And on one hand, as the aging vet population in my State—we have one veteran home, the T or C Vet Home. It does an outstanding job. They have 110 beds available for my vets. There are 5,000 beds available statewide that are not tied into the Veterans Home. Your State has four or five veterans homes.
And as a population begins to age, there's a need for more beds. We're running into a lot of issues that you just articulated. We're no different than other States. We had a medal of honor recipient, Korea, suffering from Alzheimer's; yet, we only had 12 beds available in the State, and we had to get him accommodations up in the State of Colorado.
I think the State Veterans Homes need more funding. We need more ways to help fund these State Veteran Homes, as the veteran population ages. We are currently working with our Department and Agency on Aging, performing collaborative—see what other ways we can treat aging veterans and their needs.
You know, aside from the Veterans Homes, is that we're a huge rural State, and I have veterans who live in Clayton, New Mexico, or Farmington, have to drive 4 hours to come to the VA Medical Center, which is a very fine Medical Center. Though there are 200,000 vets in my State, VISN 18 is responsible for 135,000 veterans.
And so transportation and needs for my aging veterans and accommodations—I know the VA is looking at home care, day care for aging vets, but I think it's a matter of Medicare or Medicaid helping to cover the costs of this and trying to come up with other means that could take care of an aging veteran population.
And on one hand, then I've got this young veteran population. So we have some real unique challenges that we're facing, an aging veteran population, with the young veteran population that's a mirror image of the Vietnam generation. They're just not showing up. So we're looking at ways to expand our Veterans Home and provide rural service, rural care to aging vets.
I think you articulated some of the answers that I think we're looking for. We're all finding problems with long-term care for vete
Sign Up for Committee Updates
Stay connected with the Committee