May212013
Hearing Transcript on The State of the U.S. Department of Veterans Affairs.
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THE STATE OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS
HEARING BEFORE THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS FIRST SESSION FEBRUARY 4, 2009 SERIAL No. 111-1 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined. |
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C O N T E N T S
February 4, 2009
The State of the U.S. Department of Veterans Affairs
OPENING STATEMENTS
Chairman Bob Filner
Prepared statement of Chairman Filner
Hon. Steve Buyer, Ranking Republican Member
Prepared statement of Congressman Buyer
Hon. Corrine Brown
Prepared statement of Congresswoman Brown
Hon. Vic Snyder
Hon. David P. Roe
Hon. Stephanie Herseth Sandlin
Hon. Brian P. Bilbray
Hon. Harry E. Mitchell
Prepared statement of Congressman Mitchell
Hon. Henry E. Brown, Jr.
Hon. John J. Hall
Hon. Cliff Stearns, prepared statement of
Hon. Ciro D. Rodriguez, prepared statement of
Hon. Jeff Miller, prepared statement of
Hon. Joe Donnelly, prepared statement of
Hon. Timothy J. Walz, prepared statement of
Hon. Glenn C. Nye, prepared statement of
WITNESSES
U.S. Department of Veterans Affairs, Hon. Eric K. Shinseki, Secretary
Prepared statement of Secretary Shinseki
SUBMISSION FOR THE RECORD
Kirkpatrick, Hon. Ann, a Representative in Congress from the State of Arizona, statement
MATERIAL SUBMITTED FOR THE RECORD
Post-hearing Questions and Responses for the Record:
THE STATE OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS
Wednesday, February 4, 2009
U. S. House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10:05 a.m., in Room 334, Cannon House Office Building, Hon. Bob Filner [Chairman of the Committee] presiding.
Present: Representatives Filner, Brown of Florida, Snyder, Michaud, Herseth Sandlin, Mitchell, Hall, Halvorson, Perriello, Teague, Rodriguez, Donnelly, Walz, Adler, Nye, Buyer, Stearns, Brown of South Carolina, Miller, Bilbray, Lamborn, Bilirakis, Buchanan, and Roe.
OPENING STATEMENT OF CHAIRMAN FILNER
The CHAIRMAN. We are pleased to open up our hearing to hear from our new Secretary, General Shinseki.
Mr. Secretary, I think you're one of the first cabinet members on the Hill and we feel honored that you are here. Your reputation precedes you. We know you are a man of courage and intellectual honesty. You have been called a "soldier's soldier," which is one of the highest accolades I think your troops can give to you, and we look to you to care for the veterans now under your command. We have seen some of your previous testimony and your confirmation hearing. We have had some conversations with you, and we are glad that you are here today.
We have a great job to do, an important job, not only with our young men and women coming back from Iraq and Afghanistan, but we cannot forget the older veterans who made this country what it is today. And you have a big job before you. We intend to support you in that. We intend to make sure you have the resources to carry out your job and give you the backing that you need.
I think you are familiar with many of the issues already, and you talked in your confirmation hearing about a transformation into a 21st Century U.S. Department of Veterans Affairs (VA). We look forward to making sure that occurs and that every one of our brave young men and women and brave older men and women get all the care, attention, love, dignity, and honor that this Nation can give, and I know that you will lead us to do that.
Mr. Buyer, I will yield to you for a few minutes and then we will hear from the Secretary.
[The prepared statement of Chairman Filner appears in the Appendix.]
OPENING STATEMENT OF HON. STEVE BUYER
Mr. BUYER. Thank you.
Thank you, Mr. Secretary, for being here. We look forward to hearing from you as you present your Department's budget. I know from my tenure on the Armed Services Committee that you are a man of principle and you are a man that reflects the Army's values, and I think that is extremely important. I also want to compliment you on the selection of your predecessor years ago to lead the Health Affairs Department within the Army. And now you replace him as Secretary, and I only regret that we didn't have more time to have worked with him. He was a man of great experience. He brought a lot of talents and made a real difference in a short period of time, and I am quite certain he will be a valuable counsel to you. Don't hesitate to lean on him as you have done throughout the years.
Even in the short time that I turned to him, when there were challenges and I think even some of the veterans service organizations (VSOs) would compliment his leadership. There is no moss on that man's stone. He is always moving.
I was pleased to see the performance goals that you outlined. I think that is extremely important whenever you take over a great challenge. So those are enduring themes that I believe will be essential for you as you navigate at one of the most critical moments in the Department's history.
I just want to touch on a few things. There are some obviously in front of us. One is the disability claims backlog. Congress asked for a disability commission. These are individuals that put their eyes on this with a lot of effort and it seems to be collecting dust, and it is very bothersome to me. We have the Dole-Shalala Commission presidential task force, and so there are a lot of people that have placed their eyes on these challenges; yet what we have is an absence of leadership.
Richard Burr and I, we stepped forward and we introduced a bill. It is interesting in this town, anytime there is any form of leadership, the critic who lurks in the shadows is always very quick to attack. But this is one that requires an enjoined solution, whether from you, whether it is from us, whether it is with the VSOs. But at some point, it is one that requires real leadership, so I submit that to you.
The other is building on the synergies of excellence between U.S. Department of Defense (DoD) and the VA. This is one that requires constant maintenance and also is an issue that will take up much of your time, whether it is the VA/DoD sharing of facilities, electronic medical records, or the benefits delivery at discharge.
The other is the issue on collaboration with regard to how we construct VA facilities; Denver, Las Vegas, Charleston, Orlando, New Orleans, there are opportunities here and we need to break into a new paradigm on how we deliver our health services.
The other is information technology (IT) consolidation. I am quite certain that the gargoyles that defend bureaucracies and the old way of doing business will be very eager to take advantage of your new leadership to try to convince you as to why we should return to the days of old in a de-centralized model on IT. I would ask of you to keep your eyes wide open as you step into this new position and seek the best of counsel here as to why this Committee on a unanimous basis has endorsed the centralized IT, and I just ask of you to keep your eyes on that.
We also recognize that when we created legislation, we probably came in a little too strong with regard to our identifying of—we really wanted to know what you were spending at the VA on the IT budget, and I think we probably came in, Mr. Chairman, with a little too much specificity.
And we will be more than willing to work with you how to build that transparency in a manner where your down-line leaders are able to do their jobs. So the Chairman and I, and the Committee, will work with you to do that. We just recognize that there are some failed major IT projects out there.
On the third-party collections, you will be accepting leadership exerted by your predecessor in the build-out of the Consolidated Patient Accounting Centers (CPACs) on revenue cycle management. This is extremely important. The Chairman and I, and others of the Committee, have placed our eyes on this over the last 7 years, and it is the very best way that we can continue to increase our revenues. So please, it is within your discretion right now with regard to priority on how you want to do the CPAC. I know that the last conversation I had with your predecessor they had the West going last. You might want to relook at that, because that would probably be the greatest amount of revenue; so you might want to look at redoing the order with regard to that build-out.
The other is please—off the heels and on your toes with regard to the energy initiatives. I was really pleased that he stepped forward and committed about $49 million on the 16 solar projects, and I am really anxious to see the order in which you are proceeding not only on solar, wind, and alternative fuel, but also with the construction of these mega solar super nova systems with regard to the heating of water and how that can be utilized at the health systems.
The implementation of the GI Bill procurement reform.
The last I want to touch on is the dental issue. And I want to thank the Chairman. He has been very helpful along with Chairman Ike Skelton to give me great latitude to jump really on the Army Dental Corps. It was when the commander of the Army Dental Corps told me that it was not their mission to take care of the National Guard as they returned from theater. What was happening was the Army was just turning them over to the VA, and that was wrong. To me, Army green is Army green, and if we are going to build a model that takes care of our equipment and we don't take care of our people, that was wrong. And that General really should be fortunate that I wasn't Chief of Staff of the Army because I would have sent him to pasture.
Fortunately, what has happened I would like for you to know that the Army is leaning forward, the brigades that have been returning from October 1 on, now are taking care of those class 3s, and about 90 percent of those are coming back in.
So finally they have gotten the message. But the Army has used the VA as a bill payer. So I want to let you know about these kinds of things. They are leaning too much our way, and that is really sort of a budget issue and a leadership issue. But I look forward to working with specificity on a lot of these projects.
With that I yield back.
[The prepared statement of Congressman Buyer appears in the Appendix.]
The CHAIRMAN. Thank you, Mr. Buyer.
Mr. Secretary, I don't have to tell you that the whole Nation is looking with a lot of hope to the Obama Administration, and certainly our 25 million veterans and their families are looking to you with that hope. We are confident—I know the President is confident, but we are also confident that you are going to fulfill those hopes. We look forward to hearing from you today. Your written statement will be made a part of the record, and you have the floor.
STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS
Secretary SHINSEKI. Mr. Chairman, Ranking Member Buyer, distinguished Members of this Veterans' Affairs Committee, I am very honored to be with you here today. Thank you for this opportunity to appear before you this morning and so early in the cycle.
I am also most honored to be entrusted by President Obama with the responsibility of leading great professionals at the Department of Veterans Affairs and serving the men and women whom we and, in fact, all of us in this country owe so much. Generations of Americans who have done their duty, some of whom have seen this country through some of its darkest hours. And so to those veterans both there on the dais and those sitting back here in the audience and even some who may be watching these proceedings from remote locations in this country, thank you for your service. Thank you for your sacrifice.
I am honored to be serving as your Secretary. And for me the privilege of leading the Department of Veterans Affairs is a noble calling. I willingly took this assignment. I see it as one that offers an opportunity for me to give back to those who have served in uniform, those who served with and for me, and those on whose shoulders all of us stood as we were growing up in the profession of arms.
I would like to acknowledge the presence of some of our key veterans service organizations this morning. They are here representing many other veterans organizations who could not be here. Together, we share the mission of fulfilling Lincoln's charge of caring for him who shall have borne the battle and for his widow and his orphan. Their advice and support on how to do this better will always be advice that is welcome.
I am committed to fulfilling President Obama's vision for transforming the Department of Veterans Affairs into a 21st Century organization worthy of those who, by their service and sacrifice, have kept this Nation free. This is a time of great change, even greater challenge. But it is also a time of opportunity. At least I see it that way. A time to reset the VA's vectors for the 21st Century. And those vectors will be based on three fundamental principles to begin with, as far as I am concerned:
We will be veterans centric. We will be results driven, and we will be forward looking. Our operating standards must embrace these fundamentals as the Department delivers on its obligation, obligation to provide veterans the highest quality care and services in a timely, consistent, and fair manner.
First, veterans are the focus of all of our efforts. As our clients, they are the sole reason for our existence and our number one priority bar none. At the end of the day, the only true gauge of our success is the excellence of our programs and the timeliness of the services and benefits we provide. We will be measured by our accomplishments, not by our promises.
Second, VA must be results oriented. We must put veterans first by first putting in place the management tools we need to achieve positive, well thought through initiatives and outcomes. I am convinced that if we are to achieve our goals, we must set clear objectives, create even clearer metrics and then follow up relentlessly. Success in this broad but foundational area is and will be a function of leadership, and it begins with me.
Third, we must be forward looking. We must continually seek to challenge ourselves to accomplish our mission more effectively, more efficiently, more innovatively. Always rigorously mindful of husbanding our resources and using taxpayer dollars responsibly. VA will put a premium on working smart, leveraging best practices, cutting-edge technologies, and strong and determined leadership to better serve our veterans.
To the Members of this Committee, the Department of Veterans Affairs has an opportunity to renew and strengthen the long-standing covenant between America and her veterans. We have a committed workforce whose professionals can and will undertake the kind of change that will restore this Department to preeminence in government. With their support and assistance, I am privileged to undertake this mission. And with your support, I am confident we will succeed.
Thank you, Mr. Chairman. I look forward to your questions.
[The prepared statement of Secretary Shinseki appears in the Appendix.]
The CHAIRMAN. Thank you, Mr. Secretary, and we appreciate the time to deal with some of our Members' concerns.
We will start with Ms. Brown from Florida.
OPENING STATEMENT OF HON. CORRINE BROWN
Ms. BROWN OF FLORIDA. Thank you. Thank you, Mr. Chairman, for holding this hearing today. And I want to welcome the Secretary.
Mr. Secretary, thank you for coming here today. And I am pleased with your testimony where you said you have much yet to learn about veterans' affairs. I am pleased that you admit that you do not have all of the answers.
And let me just tell you, the Members of this Committee do not have all of the answers either, but we are willing to work together to make things better.
And I always like to quote the first President of the United States, George Washington, the willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional as to how they perceive the veterans of earlier wars were treated and appreciated by their country.
I am looking forward to working with my colleagues on this Committee, which I am very proud of. It has always been bipartisan. When a person goes to war to served the country, it does not matter whether they are Democrat or Republican, they are serving our country and we as Members of the Veterans' Affairs Committee, and I have been on this Committee for 17 years, have always worked to that end. And I am looking forward to working with you.
And I personally want to extend an invitation to you to come to Florida. You have not been to Florida since basic training and we know how many years ago that was. So things have changed in Florida and we are looking forward to you coming and meeting with our veterans. I am glad to get you the first invitation before anyone else. Thank you.
I yield back the balance of my time.
[The prepared statement of Congresswoman Brown appears in the Appendix.]
The CHAIRMAN. I hope you brought your travel consultant with you, Mr. Secretary. I think you will be receiving many invitations.
Mr. Stearns?
Mr. STEARNS. Thank you, Mr. Chairman. At this point then, we can ask questions?
General, thank you very much for serving. We are honored to have your leadership and your background in this position. And there have been great leaders before you, but I know you will be serving in a high capacity and we look forward to it.
The Ranking Member, Mr. Buyer, talked a little bit about IT and I just want to follow a little bit along this line.
The goals of VA FLITE are to implement a One-VA information technology framework that enables the consolidation of IT solutions and the creation of cross-cutting common services to support the integration of information across business lines and provide secure, consistent, reliable, and accurate information to all interested parties, improve the overall governance and performance of VA by applying sound business principles, ensuring accountability, employing resources effectively through enhanced capital asset management, acquisition practices, and strategy sources, and linking strategy planning to budgeting and performance.
My question is, given the new Administration's focus on IT, President Obama has talked about using IT across the lines in health care to create a more efficient government, how will the VA leverage IT to modernize and drive more standardization which increase productivity and efficiency? For example, how will you use IT to have better access to data, to make quicker, more informed decisions, and do you see IT as being critical to improving the mission of the VA to provide better health care and benefits to our veterans?
Secretary SHINSEKI. Thank you, Congressman.
In answering your question, I will try to touch on what the Ranking Member also raised.
Let me just give you a picture of what the disability claims process looks like. If you were to walk into one of our rooms where adjudication or decisions are being made about disability for veterans, you would see individuals sitting at a desk with stacks of paper that go up halfway to the ceiling. And as they finish one pile, another pile comes in.
There are 11,100 people doing this today for the Veterans Affairs Department, good people. It is hard to do this rather challenging job in which they are trying to apply judgment to situations that occurred years ago and, in some cases, situations that they do not have a full appreciation for the context of, combat.
Eleven thousand one hundred people equates to the 82nd Airborne Division. That is sort of my reference point here. If we do not take this and create a paperless process, I will report a year from now that we hired more people to do this. In the last two years, we have hired 4,000 additional adjudicators. This year, we are hiring another 1,100 to address the backlog problem.
In my opinion, this is a brute-force solution and we need to very quickly take this into an IT format that allows us to do timely, accurate, consistent decision making on behalf of our veterans. And this is part of what the backlog is about.
And I will also tell you in the other part of the Department of Veterans Affairs, we have an electronic medical record that is probably well-respected and complimented by others in the medical profession. And so some place between these two applications of information technology we have got to bring goodness to what we live with day to day in the VA.
Mr. STEARNS. General, let me just follow-up. You mentioned the idea of a paperless electronic system certainly with the benefits claim system. Part of your whole answer obviously includes training.
And I know it is too early, but do you have any idea? Are you going to try and put a benchmark in place when we are going to have a paperless electronic benefits claim system?
Secretary SHINSEKI. I will share with you the benchmark that has been shared with me in the first two weeks of my arrival. That is 2012.
Mr. STEARNS. Okay.
Secretary SHINSEKI. I do not know whether that is a—
Mr. STEARNS. Realistic?
Secretary SHINSEKI [continuing]. —good date or not. I have not gotten into what it will take us to get there. But my intent is to get to a paperless solution here as soon as possible.
Mr. STEARNS. Thank you, Mr. Chairman.
Secretary SHINSEKI. And that will take investment, of course, in information technology, significant. I have also drafted, and it is in final staffing, a policy letter to the Department that says I support and will continue the centralization of IT within the Department. So that should be signed and out of here in about a week.
The CHAIRMAN. Thank you, Mr. Stearns.
Mr. Snyder?
OPENING STATEMENT OF HON. VIC SNYDER
Mr. SNYDER. Thank you, Mr. Secretary. I appreciate you being here. And I am going to be very brief and let somebody else ask questions also.
But following up on this conversation of IT, you referred to the stack of files sitting on the desk, so obviously you have done some tours already and visited some facilities. But have you had occasion to go into the file room?
I would encourage you on your next visit to an area or any time you go to visit to have them take you into the file room. It is almost dangerous as some of these file rooms are overwhelmed by individual files that will literally be three and four and five volumes.
And I am told that a lot of it is that there will be something on the internet that will be applicable to a specific illness or injury. It will get printed out. The veteran will request it be added to the file and the files just keep growing and growing and growing.
But it is ironic, I think, that information technology has in some ways contributed to the thickness of the files because there is so much information out there. But we have got to get a handle on that whole thing of how you store this stuff and what you are going to do with it. But I would encourage you to visit the file rooms also.
I just want to make three quick points that I think that our Chairman and Ranking Member had mentioned them.
The GI Bill is so important to every American, but certainly every Member of this Committee. And I think once again the GI Bill has the potential of transforming America at this very important time. And you are going to be the key person seeing that that happens. And I know this Committee is interested in working along with you.
Medical research, as you know from your past experience, there is not many good things about wars, but one of them is that we learn about things medically and there are opportunities now if we apply money appropriately and in adequate amounts to really do some good for a lot of people and families in terms of finding new ways of dealing with things like post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), but other things also. And I hope that you will be an advocate for medical research within the VA system.
And, finally, you have inherited America's problems. We want you to provide perfect health care in all areas, whether it is for PTSD or amputees or whatever it is, when we, in fact, as a country have not solved that problem. And I think you should feel free to lay it back on the Congress, which is, you know, it would be easier for us if we actually had a network of mental health services throughout America, including rural America, including under-served areas, and let us know when our American health care system is part of a problem that you have inherited.
And I think it is going to be hard for you to have the level of care you want for every veteran until we as a country come to terms with what I think President Obama wants to do and address the health care issues that we have.
But thank you for your service once again. We certainly look forward to working with you.
The CHAIRMAN. Mr. Miller?
Mr. MILLER. Thank you, Mr. Chairman.
Mr. Secretary, it was a pleasure visiting with you. And we do look forward to hosting you in Florida when you have the opportunity to come down.
Following on to Dr. Snyder's comments in regards to medical research, there are even some exciting things going on down in the panhandle right now with hyperbaric oxygen therapy for TBI folks. And we are real excited there with some of the cutting-edge stuff going on down there with some of things that were talked about in October in the Consensus Conference up here in Washington.
Mr. Stearns was talking about IT and the issues of medical records. And I think we all agree that that is an extremely important thing and certainly should lend a great chance of solving some of the backlog, too, but we know that it is not going to be implemented quickly. But we do know that it is very important. I think we all are committed to helping you meet that goal if not by the date, prior to.
But one of the other areas that you may see or even pick one stumbling block that is out there for the transition for military personnel from DoD to VA, what would you see as one or a couple?
Secretary SHINSEKI. Well, I would say that I will begin with leadership. If this is going to happen faster and at higher quality than is happening now, and by the way, we have made tremendous progress in the last year to 18 months thanks to the leadership of Secretary Peake and others, but this is not a technical issue in my opinion, and so if it is going to be solved any faster, it is going to take leadership.
Last Friday, I requested and had a personal meeting with the Secretary of Defense and we both agreed that in this interim when he and I are both sort of without deputies, and the two deputies chair the Senior Oversight Committee that is looking specifically at how to transition active-duty personnel into the ranks of the VA, he and I agreed that we would chair the next meeting which will occur sometimes this month and maybe the next two meetings personally to provide the leadership, establish the priorities, and keep the momentum on finding solutions for what seems difficult right now.
A single electronic medical record is something I would be interested in working on with him. An individual enters the ranks as a youngster and stays for several years or stays for 20 and comes to us as a veteran. Those records ought to be transferrable and ought to be accurate and complete and not just medical records but personnel records as well because the personnel records are also part of the disability adjudication process.
If we can get to this agreement on what an electronic medical record looks like, we will solve the challenges we are wrestling with today where we have two different records.
And I would add that I have asked about the relative qualities of both and I am told that the medical record that is used in the Department of Veterans Affairs is very highly regarded both in Veterans Affairs but also in the military departments.
And so I went and sat with a couple of doctors here locally, the military doctors at Walter Reed, a small sample of three. Everyone said VistA is the way to go. VistA happens to be the VA's version.
And so, I think if you put the issue before medical professionals, they can come to an agreement what a requirement for a medical record is. Once we get that, we can put then the smart people with the technical skills to be able to deliver what we think works. When we do that, we will be able to make this seamless transfer of information.
But to get to that point of having the single electronic medical record, single personnel record, is going to take leadership. And I think that is where Secretary Gates and I can do a lot to leverage better and faster outcomes than we are currently facing.
Mr. MILLER. Thank you, Mr. Secretary.
Also, I would like to ask unanimous consent to enter my statement into the record as well.
The CHAIRMAN. Without objection, all Members' statements will be entered into the record.
[The prepared statement of Congressman Miller appears in the Appendix.]
The CHAIRMAN. Mr. Michaud chairs our Health Subcommittee. Mr. Michaud?
Mr. MICHAUD. Thank you very much, Mr. Chairman, Mr. Ranking Member, for having this hearing.
I want to thank you as well, Mr. Secretary, for coming here and congratulations. I look forward to working with you over the next couple of years.
I have a couple of questions. There has been a lot of time about the stimulus package and the economy.
My first question deals with Priority 8 veterans. If you look at what is happening out in the real world, if you have a factory that shuts down, you have a lot of workers who are veterans who do not utilize the VA system. They do not need to because they have good health care at the place where they work.
My question is, once they get laid off and need health care, they go to the VA system. When they look at the application, what they have made during the previous years' wages, they get denied. Then they appeal it. Then they get accepted.
My question is, is there a way they can get accepted the first time around because their economic status has changed? That is my first question.
My second question is, we have done a lot over the years with rural health care issues and access to health care. One of the biggest complaints we hear is veterans' in rural areas being able to get access to health care when they need it.
Under the 2004 Capital Asset Realignment for Enhanced Services (CARES) process, they have brought forward, access points and new hospital facilities.
My second question is, do you think we ought to revisit the CARES process to make sure that it is still valid. If so, is there a way that we can speed up that process, i.e., if there is an access point in a rural area and you have a rural hospital or a Federally qualified health care clinic in that rural area, would it not make more sense to work collaboratively with them to get access in that particular rural area?
And my last and final question. Now that the campaign is over, you heard the Chairman talk about hope and everyone is really optimistic with the new Administration moving forward. A lot of campaign promises were made during the election cycle. One of the issues that I heard the President talk about is taking care of our veterans' the funding issues.
Funding is only one component of it. The second component of funding is to make sure funding is on time, whether it is some type of mandatory funding, advance budgeting, or some type of assured funding, whatever you want to call it.
What is your feeling on an advance budget for the VA system and how quickly can we get that moving? Those are the three questions.
Secretary SHINSEKI. Congressman, just very quickly on the Priority 8s, I am still sizing the population here. Today at least, I do not have a good feel for what it is, but we are going to begin including Priority 8s based on the funding and support Congress provided last year. And that will begin sometime this summer. We anticipate about 266,000 Priority 8 veterans being picked up as a result of this.
As we look at the Priority 8 population, the economic downturn you described is going to affect folks in the upper seven priority levels as well. And there are veterans in those categories who are not using our services today who may or may not be enrolled.
My guess is we are going to see some movement in some of those categories as well. And so even as we think about the impact to Priority 8s, there is a broader range of higher priorities that we have to be sensitive to. And I have got to try to get a handle on that as we go forward.
But Priority 8s will begin this year, based on the funding we are provided. And probably the July time frame you will see that.
Rural health, just a tough issue. And I know there are many locations here that go from rural to very highly rural. And as I said earlier, I am trying to ensure that sitting in Washington and not trying to fine tune things out there with thousand mile screwdriver. I will have to go out and listen and find out.
But I think both rural health and our concerns about not understanding our mental health challenges as well has caused the VA to put a lot of energy into coming up with what I think are fairly creative solutions and not just hospitals, but health centers and outpatient clinics and Vet Centers and mobile vans, 50 of them, that provide both primary care in a limited way but also health care.
And these opportunities allow us to address some of the rural challenges. Contracting is an opportunity as well with local primary care providers. My only concern here would be that we maintain the standards that a veteran would find in any VA facility. And if we can do that, we will try to address those concerns as well.
I forgot the third issue.
Mr. MICHAUD. Advance funding.
Secretary SHINSEKI. I would say just up front my preference would be for a timely budget. And I will assure you I will do my part to get a mature request from the VA into the President in time. And I have been assured that he will support funding for VA medical.
And in a prior life, I lived with continuing resolutions and I know full well the impact that they bring. And so timely budgets would be my preference. If that is not possible, I am sure there will be discussion about other options.
The CHAIRMAN. Thank you, Mr. Michaud.
We welcome Mr. Roe to our Committee, and you have the floor for any comments you would like to make.
OPENING STATEMENT OF HON. DAVID P. ROE
Mr. ROE. General, congratulations.
I remember when I was in the service, I served as a medical officer in the 2nd Infantry Division and this piece of paper was your medical record. You carried it around. And we have some experience locally, you are correct, that the VA medical records system is a terrific system, and look forward to working with you.
I have had the privilege, of the pain, I should say, of going through and converting our office to an electronic medical record, but it is an advantage and you can handle data much better.
In my previous life, I was the Mayor of our city and we converted all of our police to electronic, so there is no paper at all. It has been a tremendous success.
I really look forward to working with you. We have a huge VA campus in my district and I am going to make the third invitation here to invite you to Tennessee to visit.
There is no higher calling in my mind than to take care of our veterans who protect our Nation. And it is a privilege to be on this Committee and to work with a person of your caliber. And I look forward to doing that.
I also will point out that already in our local VA, it is completely heated and cooled by renewable energy. We use a landfill and treat the methane and the entire campus is heated and cooled by renewables.
So this is something I would like to implement in other VA facilities, and look forward to working with you.
I think we have something to offer as far as my background as a physician to work with some of these issues. And there are a lot of issues out there. There is no question about it.
One in particular, there are people who do not meet the income threshold in our area, who make a little bit too much money, but do not work in a job that has health insurance. And I really believe we need to help those veterans. It is a tremendous problem and may be more a national problem as pointed out also.
But we have a sheriff in a local county that I represent who the county does not provide health insurance and he cannot get in the VA. He is an honorably discharged veteran, four years in the military, in the Army, and cannot get in. That is wrong. And I would like to see that corrected.
So these are just a few comments for your consideration. Thank you very much. I think we certainly have a great Secretary to work with.
The CHAIRMAN. Thank you, Mr. Roe.
The Chair of our Economic Opportunity Subcommittee, Ms. Herseth Sandlin.
OPENING STATEMENT OF HON. STEPHANIE HERSETH SANDLIN
Ms. HERSETH SANDLIN. Thank you, Mr. Chairman.
Thank you, Mr. Secretary, for your testimony today. Congratulations again on your recent appointment. And thank you for your many years of military service.
It was a pleasure to meet with you last week. And as others have done, I extend the invitation to you once again as I did last week to South Dakota understanding that the summer months would be preferable than the dead of winter in South Dakota.
But I want to reiterate just a couple of items that we discussed and bring two others to your attention.
We did talk about the post GI Bill, post 9/11 GI Bill and the August 2009 deadline. And as we work to achieve that goal, as you know, the week of February 26th, the Economic Opportunity Subcommittee will be having a hearing to evaluate both the short-term and long-term goals and where those time tables are and the strategies for implementing the new veterans' education benefits.
And we also discussed the VA facility leasing initiative, community-based outreach clinics (CBOCs), as you know, and Mr. Michaud pointed out, are so important to highly rural areas, advance funding, as well as "The Women Veterans Health Care Improvement Act."
And I appreciated your comments and thoughts on a variety of issues, including the PTSD conversation that we had last week as well.
Two other issues that I wanted to bring to your attention are long-term care and the polytrauma rehabilitation centers within the VA health system.
The number of veterans 85 or older is projected to increased 110 percent between 2000 and 2020. Estimates indicate that this number will peak in 2012. And I believe meeting the long-term health care needs of our Nation's veterans is one of the most important and difficult challenges facing the VA today. And I hope that you and your staff will work with this Committee as we develop a comprehensive, strategic plan for long-term care.
The other issue, as you know, with the polytrauma rehabilitation centers and the important work that they have been doing, particularly in working with our wounded warriors from the wars in Iraq and Afghanistan that have produced thousands of severely wounded active-duty servicemembers and veterans, many of the veterans receive treatment at one of these four centers. And for the most part, these centers are providing extraordinary care.
The VA, however, I think, needs to develop guidelines that ensure that the polytrauma centers are not prematurely moving patients out of the centers and into long-term care before they reach optimal function given that individual's potential through rehabilitation.
And my opinion stems from an experience that one of my constituents had. He received a traumatic brain injury from an improvised explosive device (IED) in December of 2005 in Iraq. And he was informed that he would be transferred out of the Minneapolis Polytrauma Center and into a long-term care facility before his family believed he had received the level of rehabilitative care that he deserved. And I agreed with them.
And at the time, based on my conversations with the family, their terrible experience with the caseworker that was assigned to them at the time, and my concerns that this was another perhaps budget issue because the Department of Defense was not paying because he was still active duty, and the polytrauma center basically said if he has not achieved a certain level after 90 days, we are moving him.
And we were able to intervene with the Army and worked with the VA as well and got him into a private rehabilitation center. And this constituent made dramatic improvement in a matter of weeks that he had not been making in the Polytrauma Center in Minneapolis. And he has now been able to return home and improves his functioning every week and every month.
And so I just wanted to bring this issue to your attention in terms of the importance of those guidelines, that we are not giving up on many of these vulnerable young men and women and prematurely moving them into long-term care based on some fairly arbitrary standards that I think this particular family that I represent was dealing with at the time.
Thank you. Thank you, Mr. Chairman.
The CHAIRMAN. Thank you, Madam Chair.
Mr. Bilbray?
OPENING STATEMENT OF HON. BRIAN P. BILBRAY
Mr. BILBRAY. Thank you, Mr. Chairman.
Mr. Secretary, I appreciate the time we were able to spend together.
I think, Mr. Chairman, I have had the pleasure of having a very frank and open discussion with the Secretary. And I have to say that I know a lot of Members are very concerned about rural services, whatever, and I would just like to assure the rest of the Committee that anybody who has grown up in one of the out islands in Hawaii knows the challenges of being provided all the essential services and the logistical challenges there.
And I think the Secretary brings a personal experience with the challenges as growing up in one of the out islands that I think all of you will appreciate if a major concern is rural services.
So, Mr. Chairman, I yield back.
The CHAIRMAN. Thank you, Mr. Bilbray.
And the Chair of our Oversight Subcommittee, Mr. Mitchell.
OPENING STATEMENT OF HON. HARRY E. MITCHELL
Mr. MITCHELL. Thank you, Mr. Chairman.
And I want to welcome Secretary Shinseki and thank him for appearing before our Committee.
Mr. Secretary, given your long and dedicated service to the U.S. Army, I know that veterans will be well served by your leadership.
The Subcommittee on Oversight and Investigations, which I am honored to chair, has focused on a number of issues, including VA outreach, record sharing with the Department of Defense, and implementation of effective information technology.
At a time when less than 8 million of our Nation's 25 million veterans are enrolled in the VA, we have pressed the VA to do outreach to the remaining 17 million. We asked the VA to find ways to bring the VA to these veterans. And the VA has since begun using modern media tools to do so and I believe this was a great step in the right direction.
And turning to the records sharing, the VA and the Department of Defense have been working on shared electronic medical records for the last 20 years and much progress has been made in the last 2. A commitment from both departments will be required to finish this job.
And finally let me say that I believe when the VA and its dedicated workforce of public servants are doing their best, they can provide excellent health care and timely benefits. However, the VA needs strong leadership to solve significant management problems.
The Department's financial inventory management systems are completely inadequate and its outside auditor has found material control weaknesses for 3 years in a row. With enhanced information technology systems, the VA's management will need to implement a high standard of achievement and help employees to reach it.
And beyond these three issues, there are many challenges which face us, including the implementation, as has been mentioned before, of the GI Bill, sorting through miles of disability claims. And we all have our work cut out for us.
But, Mr. Chairman, with your leadership and with the leadership of Secretary Shinseki and the VA, I believe that we can make great progress. And I yield back.
[The prepared statement of Congressman Mitchell appears in the Appendix.]
The CHAIRMAN. Thank you, Mr. Chairman.
Mr. Brown?
OPENING STATEMENT OF HON. HENRY E. BROWN, JR.
Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Chair.
And thank you, Mr. Secretary, for being here today.
This is my ninth year on the Veterans' Committee and I serve now as the Ranking Member on the Health Subcommittee. And so health care for our veterans is pretty important for Charleston, South Carolina, and my district down along the coast.
And I guess as far as the whole Nation as a whole, we certainly want to keep in mind those veterans that have paid the price for our freedom. And we certainly want to be there for them when their needs are there.
And one of the things that we are working with down in Charleston and which we hope would be a model for the country is to try to collaborate as much health care delivery as possible. We recognize that sophistication now of the health care delivery for those veterans is coming back under much more extreme conditions than they were in previous conflicts. And so we want to be as flexible and as creative as possible.
And so one of the projects that we have been working on is to try to bring more collaboration between the VA community and the other health care deliveries around the country.
And more specific, we have been working with the Medical University of South Carolina to try to draw the strength from both of those health care delivery systems to better benefit the health care delivery of our veterans.
And so we have gone through the process of establishing some of the reasons that we can combine, you know, some of the resources. And we, even as we speak, the Medical University is in the process of actually replacing all of their current campus.
And what we were hoping to do is include the VA hospital into that development plan. In fact, we were able to get $36.8 million in the reauthorization bill. And so that we hope that somehow that we can continue to move that forward because of the timeliness of the development of the Medical University.
So we hope that you would be supportive of that effort and any information we might be able to bring you up to date on, we would be happy to do so.
Thank you for your service.
The CHAIRMAN. Thank you, Mr. Brown.
Secretary SHINSEKI. Mr. Chairman—
The CHAIRMAN. Please.
Secretary SHINSEKI [continuing]. —may I make a comment?
The CHAIRMAN. Yes, of course.
Secretary SHINSEKI. I think most Members know we have 153 VA hospitals across the country and well in excess of 100 of them are affiliated with medical schools. And I am told that 50 percent of the physicians in this country have come through a VA experience.
I think it is important. I mentioned providing leadership in the area of regaining our position as well-respected in this country and the health care business. I think that affiliation is an important part of it and we will continue to do that.
And to Mr. Buyer's comment, we ought to also look for where it makes sense to have an affiliation with DoD activities and see if we cannot harness talent, creativity, and perhaps save on funding for some of these initiatives.
And I know there is legislation that sort of dictates how we might be able to do this, but I think willing minds would be able to help us get more energy out of this.
I know when I came through the VA as a youngster out in Hawaii and dealing with an issue, as an amputee dealing with a surgical procedure, I must tell you, and this was in a military medical center, I must tell you that I have watched what the VA has done in terms of research and creative solutions.
The Seattle Foot that allows amputees to run was designed, I am told, in the VA. And I think if we can continue to have these kinds of successes, it will benefit the Nation at large and certainly benefit the military where we see a lot of youngsters now being able to stay in the military because they choose to and because they have been given functionality back, not just form, but functionality.
Mr. BROWN OF SOUTH CAROLINA. Thank you very much for that support. And we look forward to working with you.
I know we also have a DoD/VA joint outpatient clinic in Charleston, South Carolina, and so we are looking forward to seeing how that is going to actually operate too. So thank you very much.
The CHAIRMAN. Thank you, Mr. Brown.
The Chairman of our Disability Assistance and Memorial Affairs Subcommittee, Mr. Hall.
OPENING STATEMENT OF HON. JOHN J. HALL
Mr. HALL. Thank you, Mr. Chairman.
And thank you, Mr. Secretary, for your service and now for your willingness to serve again in this most important time.
We had the opportunity to speak before and I had the opportunity and will again extend the congratulations of the West Point community. And they and the 70,000 or so veterans of the 19th District in New York and all the vets of New York state, I think, are looking forward to your taking on the challenges that you have described and you have heard us talking about.
There are a couple of things I wanted to mention, in particular one that just came from a conversation I had this morning at the Military Association of New York breakfast with some Guard officers who are working on 30-day, 60-day, 90-day interviews with returning National Guard troops and their families who were coming back from Iraq and Afghanistan and having counselors interview the families separately in one room and the soldiers in another to try to assess the problems of readjustment, in particular PTSD. One of the priorities that I hope we will succeed in the Subcommittee's work this term in addressing is to provide the presumptive service connection for PTSD, for those who have the diagnosis by the doctor or psychiatrist, diagnoses a veteran as suffering from PTSD and they served in a war zone as defined by the Secretary or in an area of hostilities, that they do not have to jump through any hurdles or, you know, through hoops to prove that that was the cause.
And I would look forward and I do look forward to working with you on fine tuning, and with Members of the Committee and the Subcommittee on fine tuning that legislation.
But they are finding, as I was told this morning, that the Guardsmen that they are working with are reluctant to talk to the brass. They are reluctant to talk to officers. They will talk to other soldiers. They will talk to counselors. You know, the families will first open up to a counselor. But once they do open up, I would like it to be, if the diagnosis is there, the treatment should be automatic and as quick as possible.
The second thing that was mentioned by a couple people, I think, was the CARES process and whether there is any adjustment that needs to be made there.
And particularly in my district, we have Castle Point and Montrose VA hospitals, a CBOC in Middletown, New York, in Orange County.
But Montrose is a big and beautiful site on the east bank of the Hudson River which is being looked at right now for highest and best use conversion which I think should mean highest and best use for veterans.
And what I am concerned about is that in the name of a short-term revenue hit that some of this or some or all of the site may be converted to condos, marinas, retail space for profit and for private developers.
And we have severe need for transitional housing for homeless veterans, for independent living, assisted living, and nursing care for our more elderly veterans and for rehabilitation housing where vets can live with their families while they are being rehabilitated from injuries as they are in Silver Spring at the Homefront Village that some of us visited last year.
So with all those things, with all those needs and the veterans returning from Iraq and Afghanistan, I think it might be premature to close or knock down empty buildings at the Montrose facility.
And in the course of inviting you to the Hudson Valley and to West Point again, your alma mater, I would ask you to visit Montrose with me and have a look at that.
And I look forward to working with you very much. Thank you.
The CHAIRMAN. Mr. Walz?
Mr. WALZ. Thank you, Mr. Chairman and Ranking Member.
And thank you, Mr. Secretary. It is a real honor to be here with you. And, of course, having served at a time when you were serving, also to serve under you was a great honor.
And I would like to especially thank your wife who—as you all know, no warrior deploys alone or takes a mission alone—so your wife is giving up those well-deserved retirement years that you worked so hard for in this Nation. So to step back, thank her for all of us. It is a just service to the Nation again.
It is a great scene that I have here in seeing you. Sitting behind you are the men and women who literally represent millions of our veterans. They are the voice for those veterans. And I know you already know many of them on a first name basis. They are here every day. They are speaking and they have been doing it for decades.
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