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Legislative Presentation of the

Vietnam Veterans of America

before a Joint Hearing of the

House and Senate Committees on Veterans' Affairs

March 25, 1998

345 Cannon

INTRODUCTION: CELEBRATING 20 YEARS, IN SERVICE TO AMERICA

Chairman Specter, Chairman Stump, and members of the Veterans' Affairs Committees, on behalf of the board of directors and membership of Vietnam Veterans of America (VVA), I am pleased to have this opportunity to present our 1998 government relations agenda for your consideration. I also have the distinct pleasure of being VVA’s National President as our organization celebrates 20 years of service to our nation’s veterans.

VVA is the only Congressionally chartered national veterans service organization exclusively dedicated to Vietnam-era veterans and their families. Our record of achievement is a profile in tenacity and effectiveness.

In the late 1970s, with America’s longest and most divisive war just over, the concerns of Vietnam veterans were not being addressed by either the federal government or the veterans community as a whole. Many still failed to make the distinction between the war and the warrior. Where there was not outright hostility, Vietnam veterans found indifference.

In January 1978, a small group of Vietnam veteran activists came to Washington, D.C. to create an advocacy organization that would push for action on the unmet needs of this unique population. VVA, initially known as the Council of Vietnam Veterans, began its work. The initial focus was on dissemination of information and relations with the federal government, rather than on developing membership.

In time, it became apparent that arguments couched simply in terms of morality, equity, and justice were not enough. Congress would respond to the legitimate needs of Vietnam veterans only when the organization professing to represent them had political strength. By the summer of 1979, the Council of Vietnam Veterans had become Vietnam Veterans of America, a veterans service organization made up of and devoted to Vietnam veterans.

The growth of membership was slow at first. The big breakthrough came when the American hostages were returned from Iran in January 1981. America went through an emotional catharsis that put the issues of the Vietnam Era on the table for public discussion. The question was asked, why parades for the hostages but not for Vietnam veterans? Many veterans complained about the lack of recognition and appreciation for past national service. Vietnam veterans wanted action in the form of programs that would place the latest generation of wartime veterans on the same footing as veterans from previous wars -- and that of their non-veteran counterparts who did not delay education and career for service in the military.

From that point, membership grew steadily. The public became more willing to deal with the Vietnam War and the basic issues it raised. The veterans themselves began to come forward and come to terms with their war. All of this culminated in the nation's dedication of the Vietnam Veterans Memorial in November 1982. The week-long activities rekindled a sense of camaraderie among the veterans and a feeling that they shared an experience that was too significant to ignore. The American people also realized that the three million men and women who came home from Vietnam had been treated unfairly and with indifference, and many still needed real help.

In 1983, VVA took a significant step by founding Vietnam Veterans of America Legal Services (VVALS) to provide assistance to veterans seeking benefits and services from the government. VVALS published the most comprehensive manual ever developed for veteran service representatives, and in 1985, VVALS wrote the widely acclaimed Viet Vet Survival Guide. The VVA Service Representative program currently has some 300 trained and accredited advocates nationwide. These volunteers, along with VVA personnel and contract attorneys, represent veterans at the Board of Veterans' Appeals, U.S. Court of Veterans Appeals, and military discharge review boards. VVA has published "VVA Self Help Guides" on Agent Orange, Post Traumatic Stress Disorder (PTSD), and Claims and Appeals, as well as a newsletter covering recent developments in veterans law.

Throughout the 1980s, VVA grew in size, stature, and prestige. VVA's combination of hard-working volunteers at the chapter, state and national levels, and its professional advocacy, claims work and other services gained the respect of Congress and the veterans community.

In 1986, VVA's remarkable efforts and achievements were formally acknowledged by the granting of a Congressional charter (P.L. 99-318, signed May 23, 1986). This landmark event provided the only national Vietnam veterans membership organization with not only stature, but new opportunities to serve.

VVA's ambitious agenda has always aimed to find creative, pragmatic solutions to the programmatic concerns of Vietnam-era veterans, while at the same time fulfilling VVA’s founding principle that, "Never again will one generation of veterans abandon another." VVA’s legislative victories have included:

• the establishment and extension of the Vet Center system, a network for individual and family counseling, particularly for post traumatic stress disorder;
• passage of laws providing for increased job-training and job-placement assistance for unemployed and underemployed Vietnam-era veterans;
• the first laws assisting veterans suffering from Agent Orange, as well as subsequent laws providing care and compensation on a presumptive basis;
• landmark judicial review legislation permitting veterans to challenge adverse VA decisions in federal court;
• and most recently, passage of legislation in 1996, establishing the first ever disability benefits for the offspring of Vietnam veterans who have the birth defect spina bifida, related to their veteran parent’s Agent Orange exposure.

All these and numerous other important laws were enacted largely as a result of VVA's legislative initiatives and partnerships. The Vietnam-era Veterans in Congress (VVIC) was formed in 1978, in part through the efforts of VVA.

VVA also helps to provide greater public and member awareness of critical issues affecting Vietnam-era veterans and their families. First published in 1980, The VVA Veteran, VVA's award-winning newspaper, is distributed to all VVA members, members of Congress, key Executive Branch officials and other friends of the organization.

Today, Vietnam Veterans of America has a national membership of over 52,000, with more than 500 chapters. VVA state councils coordinate the activities of local chapters in 43 states. VVA places great emphasis on coordinating its national activities and programs with the work of its local chapters and state councils.

VVA takes great pride in its record of accomplishments. For many years, VVA’s motto has been "In Service to America." We have faced many challenges along the way -- both in policy matters and organizationally. In retrospect, we have weathered the organizational development process remarkably well. Some of our greatest policy victories involved cutting-edge ideas which are now mainstream veterans programs. VVA is proud to have led the charge on issues such as Agent Orange, Post Traumatic Stress Disorder, women and minority veterans concerns, POW/MIA issues and the "Veterans Initiative," homelessness among veterans, judicial review, and programs to assist veterans who are incarcerated. These are areas in which VVA helped to identify program deficiencies or inconsistencies, and proposed effective solutions.

VVA is proud of its continuing and growing tradition of service to America, and we look forward to the challenges of veterans advocacy in the 21st Century, and to VVA’s continued growth and development as a leader among veterans service organizations.

VVA’s current government relations objectives were adopted unanimously by our National Board of Directors on January 24, 1998. These primary objectives and priority goals are based upon our most recent Convention Resolutions adopted by delegates to our 1997 national convention, VVA’s highest organizational authority. These convention mandates create the foundation for the VVA government relations and organizational agenda on a wide range of issues set forth below.

THE BUDGET & THE TOBACCO ISSUE

Certainly the most timely and urgent concern throughout the veterans community right now is the budget, and how veterans programs are going to be effected in the new environment of Fiscal Year 1999. Talks of a budget surplus -- in an election year, no less -- seem to create a feeding frenzy, in which different interest groups outside and inside Congress are positioning themselves to get a piece of the pie. At the same time, VA and veterans programs are struggling to keep afloat.

VVA is very disturbed that the President’s budget proposed flatline funding for VA, and at the same time proposes substantial increases in other agencies. In comparison with the overall federal budget proposal, VA comes up far shorter than most agencies. The President proposes an increase of $20 billion for the Department of Health and Human Services (HHS), $4 billion over the FY 1998 budget for both the Departments of Labor (DOL) and Justice (DOJ), a $1.6 billion increase for the Department of Defense (DOD), and $600 million increase for the Department of Housing and Urban Development (HUD).

The FY 1999 budget request calls for $42.8 billion in total VA spending. This compares to actual total expenditures for FY 1997 of $39.9 billion, and $42.8 billion expected for the current year (FY 1998). Thus, there is no accommodation for inflation. The President’s budget claims that it provides an increase of $142 million for FY 1999. But this increase comes entirely from moneys VA would collect from insurance companies and veterans for their medical care. Therefore this "increase" is not a product of actual federal spending.

The proposed $18.9 billion for total discretionary program funding represents a cut of $32 million below the FY 1998 level, eroding VA medical care funding particularly. The $17 billion recommended for medical care amounts to a $40 million cut in actual spending, because the Administration assumes that $677 million will be collected by VA from insurance, copayments and medical fees.

The veterans community agreed to this provision of last year’s budget reconciliation, allowing VA to keep the funds it collects (rather than directing these moneys to the federal treasury for deficit reduction), on the premise that overall federal spending on VA programs would not be reduced as an offset of these new moneys. The Administration’s request is an indication that this commitment is not being upheld; we must depend, then, on Congress authority to reinstate this principle.

VA has made a number of large strides in improving efficiency and the range of outpatient services since these committees passed eligibility reform in the 104th Congress. But as the system has become more budget driven in a private-sector HMO model, we have seen access to specialized treatments shrink -- particularly inpatient PTSD and substance abuse units. And many of these VA specialized treatments are programs for which there are very limited private sector options for veterans. The reforms underway make this an absolutely inappropriate time to make cuts to VA health-care spending.

Equally if not more disturbing is the President’s proposal to eliminate VA compensation benefits for veterans with smoking-related illnesses. The President’s position on this issue seems contradictory at best and outright illogical at its worst. While on the one hand advocating that the Food and Drug Administration (FDA) be given broad authority to regulate tobacco products as a mechanism for dispensing the highly addictive drug nicotine, the Administration seems to assume that veterans -- unlike the broader population -- are somehow immune to or have greater willpower against the addictive nature of this drug.

While American society was also exposed to the barrage of tobacco advertising and glamorization of smoking by entertainers and sports figures, no other sector was force-fed tobacco products in the same manner as military veterans. The Department of Defense (DOD) distributed these products to service members free of charge at basic training, within K- and C-rations in the field, and at substantial discounts in military exchange stores. We are aware that studies show higher rates of smoking -- and consequently greater incidence of tobacco-related illnesses -- among veterans than the civilian population.

Current law and VA policy allow for compensation of tobacco-related illnesses on the premise that nicotine addiction is not "willful misconduct," and that many veterans’ began smoking while serving in the U.S. military. Furthermore, the military did much more than tolerate smoking among its ranks -- it irrefutably encouraged and subsidized smoking. It is for these reasons that we are absolutely and inalterably opposed to the Administration’s proposal and any Congressional consideration of amending Title 38 to prohibit service-connection for veterans’ tobacco related disabilities. Veterans should not be denied disability benefits and health care in cases where the federal government is clearly culpable. Nicotine addiction and related illnesses suffered by veterans fall into this category.

The rumors in recent weeks that Congressional leaders are considering the President’s proposal to eliminate veterans benefits for tobacco-related illnesses, in order to divert these funds to election-year transportation spending is an outrage. VVA is strongly opposed to any election year attempts to increase transportation spending by building these new pork-barrel transportation projects on the backs of disabled veterans.

A recent article in Congressional Quarterly details, "House Republican leaders have not publicly identified what programs they would cut to pay for the boost in spending; Domenici has mentioned only savings of between $10 billion to $17 billion from a change in Clinton’s budget to deny benefits to veterans for smoking-related ailments..." Such closed door decision-making is shameful, political deal-making at its worst. VVA strongly urges the Veterans’ Affairs Committees to block any and all efforts to eliminate veterans benefits for smoking-related illnesses.

VETERANS HEALTH CARE

As noted above, the effects of budget cuts will have a significant impact on the ongoing evolution of the veterans health-care system. Health care continues to be one of the foremost, daily concerns -- in terms of access, quality and cost -- of individual veterans, military retirees, transitioning service members, and their families. In addition, the broader health care environment in which the VA and DOD systems operate is an incredibly complex and ever changing dynamic. The national commitment to provide for the health-care needs of veterans -- particularly service-connected, disabled and poor veterans -- must be maintained.

Eligibility reform and the shift toward outpatient care, the enrollment system and more aggressive third-party collections, decentralizing of decision-making to the Veterans Integrated Service Networks (VISNs), and budget allocations through the Veterans Equitable Resource Allocation (VERA) program are each mammoth reforms. Taken together, this transition is very rapid and widespread and does pose dangers of service disruption. There is already evidence that in many locations the best plans and intentions from the Central Office administrators are not being implemented with the same care, nor even the same objectives. And we remain skeptical that VA can collect the targeted $677 million in FY 1999, to supplement the federal medical care appropriation. It is very distressing to consider the risk posed by this proportionate cut in the appropriation.

Many of these changes are frightening to the veterans community; change is often misunderstood and therefore disconcerting to veteran consumers, VA employees and program administrators, and the community at large. The new enrollment system has already created some confusion and concern. And changes in the way resources are allocated is creating fears of reduced accessibility. The projection of flatline budgets (with absolutely no accommodation for high medical inflation rates) for the next five years is a major concern to everyone, as reforms are a lot more difficult to accomplish with resource limitations.

Many of the changes are very welcome too. We hear more and more favorable reports from veterans about better customer service. And primary care teams have fostered more consistency in seeing the same doctors on repeat visits. Even the General Accounting Office (GAO), in a recent report titled, "VA Health Care: Status of Efforts to Improve Efficiency and Access," noted improvements in preventive care, timeliness of appointments, reduced waiting times, and an overall increase in outpatient services and reduction of inpatient admissions.

On the whole, VVA feels that VA health care is evolving in an appropriate direction. We understand that facility missions may be realigned or even abolished as the system evolves to a more outpatient emphasis. Care may be provided more and more in a larger number of small clinics, rather than large medical centers, or even through contract or sharing arrangements with DOD or private-sector providers. The infrastructure is less important than the actual services provided. So long as services -- especially specialized services for service-connected disabled and lower-income veterans -- are maintained and protected, there should be minimal complaints. In fact, it seems to be elected officials who have more difficulty with reductions in identifiable infrastructure than those within the veterans community.

In the coming months, though, the aforementioned constituency groups may generate concerns among many of your colleagues who do not sit on the Veterans’ Affairs Committees, and thus don’t have a clear understanding of how these changes are designed to improve the overall health care programs. Already we have seen various members of Congress from certain geographic areas raising red flags about VERA, in particular. VVA urges the Veterans’ Affairs Committees to be vigilant and rigorous in exercising your oversight responsibilities on the multitude of concerns surrounding the transitions in the provision of veterans health care.

This oversight is critical to ensure two overall goals. First, Congress should examine the nationwide and local implementation of broad strategic plans outlined by VA Central Office, which have been given a nod by Congress and the veterans community. Often the plans and commitments made by VA Central Office are interpreted and implemented quite differently in the field. This is where disruption of services can develop and cause major public perception problems. Implementation can vary a great deal. And sometimes the primary concerns of the national veterans community get obscured at the local level.

One classic example of this problem is the budgetary squeeze facing most specialized medical services. Looking at the various reforms underway from a VISN or facility director’s position, one can see that in an age of capitated funding, they are going to look for easy ways to cut spending. High-cost specialized services are an easy target. Programs like inpatient PTSD and substance abuse treatments, homeless programs, services for the seriously mentally ill, and various rehabilitation programs are resource-intensive and are not likely to bring new revenue into the system.

Just like we see in private sector health-care systems, these are the type of programs which are completely closed or access becomes very restrictive. Yet these are also the core programs designed to meet the needs of VA’s most important and deserving veterans -- disabled and needy veterans. Proper implementation of the overall reforms must protect these programs -- just as we were assured at the outset of the planning -- because the future viability of the system depends upon continued access and high-quality of health care for VA’s core consumers. VA is the safety net for tens of thousands of at-risk veteran patients.

We need to ensure high quality, improved efficiency, and consistency of access and service-delivery. Oversight attention must be specifically directed to the maintenance and improvement of VA’s specialized programs, such as PTSD and substance abuse treatments, as well as VA’s other mental health programs. Because our nation has seen these kinds of programs undermined in private-sector shifts toward managed care, there is a very real threat that similar trends may develop within VA at the expense of those veterans who rely upon these types of care, as well as programs for the homeless and the mentally ill. Careful monitoring by Congress of the quality and access is necessary to ensure that the veterans community -- your constituents and ours -- is not inadvertently harmed in the course of this transition.

A second reason Congressional oversight is so very important is because of the very real threat of misunderstandings and fear among veteran consumers, VA employees and program administrators, and the community at large. VVA, and we believe all of our colleague organizations, wants to see the overall reform measures work to make VA a more effective and efficient health care provider for veterans. Rigorous Congressional oversight can help to avoid problems escalating to a public outcry -- and a corresponding political outcry from your colleagues -- based on rumor, innuendo and misinformation. This will help all of us -- the VSOs, Congress and the VA -- to keep our eye on the ball in terms of the overall reforms and what is good for the greatest number of veterans, and resist being drawn into disruptive and divisive matters of minimal consequence.

One consumer input and oversight tool made available to VSOs and veterans in the local communities, was the VISN Management Assistance Councils (MACs). Unfortunately, this is another example of well-laid plans which haven’t come to fruition with implementation. The MACs were designed to be a management tool, incorporating the advice and counsel of stakeholders into VISN decision-making. The broad VSO support of the original VISN reorganization plan was based in part upon the formation of MACs to allow input by and information flow to local veterans.

The problem is that in many instances these bodies have become a public relations tool for the VISNs, rather than a management tool, with information flowing in one direction only. The MAC system is currently piecemeal and often ineffective for VSO stakeholders. The VISNs are frequently using MACs to disseminate information to the veterans community after decisions are made, rather than involving veteran leaders in the up-front decision-making stage itself. We have discussed these concerns with Dr. Kizer, and he shares our perspective on the need for more effective accountability in a rapidly decentralized system. And with decentralization, that accountability must be maintained with veterans at the local level, in addition to the Central Office program administration.

It is important that VA central office provide better policy guidance and direction to the VISNs about how to implement and operate these advisory bodies. And it is equally important that the Veterans’ Affairs Committees emphasize the proper intent and the necessity of using the MACs as a management tool. VVA also suggests that the Veterans’ Affairs Committees explain the MAC function to your colleagues and encourage them to have their district staff -- probably the veterans caseworker -- participate in the MAC process, as well. This would also assist in educating your colleagues about the broader VA reforms, and would hopefully assure an information flow in both directions.

The VA’s "30-20-10" budget plan, aimed at reducing per-patient cost by 30 percent, serving 20 percent more veterans, and increasing to 10-percent the portion of VA’s medical care operating budget that is obtained from non-appropriated sources over five years, is very ambitious. If done effectively, this has the potential for improving services for all veterans in order to attract paying customers. At the same time, it will be dependent upon the broad implementation of Medicare subvention for 65-and-older beneficiaries.

Permitting all eligible military retirees and veterans over age 65 -- who have paid into the Medicare fund through the years -- to use those funds at VA is not only an issue of salvaging VA finances. This is also a health care access and choice of providers issue, which may in fact prove to enhance efficiency and reduce costs for the Medicare program. If an individual with Medicare eligibility chooses to use VA or DOD facilities, there is no reason Medicare should not pay. For years, VA has subsidized Medicare for those beneficiaries who choose to use VA medical care.

VVA supported the provision included in the Balanced Budget Act of 1997, establishing a pilot project to test Medicare subvention at six military facilities. In addition, it is critical that a similar VA/Medicare pilot project be enacted to get the ball rolling for this system. We believe, along with our colleagues from other VSOs, that enactment of Medicare Subvention is critical to the long-term viability of both the VA and DOD retiree health care systems. Without this additional funding for the treatments provided to the over-65 beneficiaries (especially when this sector of the veterans and retiree population grows because of longer life expectancy), financial stability is in serious jeopardy of both the VA and DOD systems.

Without additional monies, many veterans may be denied services by an ever-shrinking VA health-care system. Passage of legislation to allow VA to be a Medicare provider for high-income, non-service connected veterans would allow increased VA efficiency and fairness as well. It is our belief that a significant portion of the Category C veterans seen by the VA are, in fact, Medicare eligible. Through passage of such legislation, VA can provide Medicare-eligible veterans with another health-care option. Furthermore, Medicare can save money on the care of veterans using VA because of reduced rates since VA would not build a profit margin into its billing, as do private sector providers. And VA could provide more care to more veterans with these additional revenues.

As discussed above, VVA is very concerned that the high quality and clinical integrity of VA’s specialized programs be maintained. Already, most inpatient programs for PTSD and substance abuse have been closed, restricting access to treatment for those that remain. We feel compelled to reiterate our recommendation that the Veterans’ Affairs Committees aggressively direct oversight attention to the maintenance and improvement of PTSD and substance abuse treatment programs, as well as VA’s other mental health programs. We strongly caution against the complete elimination of specialized inpatient units. Some veterans will continue to need inpatient programs for clinical reasons, so an appropriate level of inpatient capacity must be maintained. Or, at the very least, appropriate alternatives must be made available through contracting or cooperation with community-based programs.

Congress and VA management must help us emphasize that proper attention be given to the viability of VA’s specialized services which are designed to meet the unique needs of veterans. In this regard, the VA is a national health-care resource that fulfills a number of missions the private sector is unable to comparably accommodate. Another fact to keep in mind is that much of VA’s current patient base is needy or homeless and would have no access to basic health services without VA. And without a stable, therapeutic environment to reside in during their recovery, many of these treatment dollars will be wasted due to recidivism.

VVA would also recommend that additional VA research be conducted to further evaluate both inpatient and outpatient treatment modalities for PTSD and substance abuse. Innovations in methods of providing inpatient care should be examined to maintain effective outcomes, achieve greater efficiency and, in so doing, increase capacity. In addition, VVA would like to see research conducted on the effectiveness of lifestyle modification and family therapy programs, such as that implemented by the Australian government for its Vietnam veterans. Preliminary data suggests that these kinds of innovative programs can have very high success rates in helping veterans to manage PTSD symptoms.

VVA also feels strongly that growing usage rates of the Vet Centers must be examined, and a corresponding assessment of resource adequacy be done. From 1997 to 1998, patient visits to the 206 nationwide Vet Centers increased from 728,958 to 767,000. In 1999, patient visits are expected to grow further to 774,000. This community-based program has proven a useful VA outreach tool and an access point to needed care for hundreds of thousands of veterans. And Vet Centers have proven to be an effective, user-friendly and cost-efficient treatment modality according to consumer surveys, VA’s internal reviews, and multiple General Accounting Office (GAO) analyses.

VVA advocates increased coordination between the Vet Centers and mainstream VA health-care system to create additional points of VA outpatient access, with the caveat that the Vet Centers’ mission, clinical integrity, and line authority must be maintained and protected. In many locations, Vet Centers already coordinate very effectively with VA medical centers to provide medical screening, physician site visits and other services. The VA health-care system needs to increase outpatient access points and the Vet Center program represents a successful, ready-made model.

VVA would like to see use of Vet Centers by Persian Gulf veterans evaluated as well. Congress should also examine the effects on the Vet Center program of VA health-care eligibility reform and the VISN reorganization. If usage of the Vet Center program continues to increase due to any of the aforementioned factors, additional funding for the Vet Center program must be provided through administrative or Congressional appropriations processes.

As the veterans population grows older and life expectancy continues to grow, a strategy must be developed to manage the present and future long-term care needs of veterans. While long-term care is not an "entitlement," per say, it would be a national disgrace if this population were neglected. The State Veterans Home Construction Grant Program is a key component in developing and implementing a successful plan of action.

The VA appropriation that provides grants to help states acquire or construct state veterans nursing and domiciliary homes is a win-win program that must be given a higher priority and significantly increased funding levels. The states contribute 35% of the costs for the construction or renovation of buildings. Once facilities are completed, the VA contributes less than 30% of the operating costs. This program has become a prime example of how the federal and state governments, working collaboratively as partners, can be more cost effective in providing veterans services.

The State Veterans Home Program proves to be a very cost-effective method for VA to provide long-term care. This can readily be seen by comparing average per patient daily costs. During FY 1997, state veterans homes furnished more than five million days of nursing care and over one million days of domiciliary care. At that time, VA spent $242.43 per day to care for each VA long-term nursing care resident, while paying private-sector contract nursing homes an average per diem of $134.10. During the same period, VA reimbursed state veterans homes $39.74 per diem per nursing care resident, or 29% of the average daily cost of $136.35. VA’s savings for domiciliary care provided at State Veterans Homes is comparable, with VA covering only 21% of the cost.

These numbers are a strong indication that the states can do a very efficient job at providing long-term and domiciliary care. This is in part because the states can accept various funding streams not available to VA, including Medicaid and some Medicare payments. Last year, Congress demonstrated concern for the long-term care situation by doubling the Administration proposal for the FY 1998 appropriation. Now again, the Administration has proposed an inadequate funding level for this program. VVA recommends that the State Veterans Home Construction Program be funded at a minimum level of $100 million. We further urge the Committees to vigorously advocate that VA implement adult day care programs in the State Veterans Homes, which were previously authorized and can provide a very cost-effective and quality-of-life enhancing alternative to long-term institutional care.

VVA also recommends that the Veterans’ Affairs Committees authorize a pilot project to evaluate the cost, usage, and customer satisfaction of allowing veterans residing an inaccessible travel distance from the nearest VA medical facility to use VA fee-for-service or contract services. Program eligibility could be determined based on distance and terrain and/or physical ability to travel. A similar initiative was included in an early draft of eligibility reform legislation in the 104th Congress. We believe such a study would be useful in determining how best to serve the health-care needs of veterans using the VA.

Another matter of concern is the potential adverse treatment outcomes which may result from VA’s very restrictive prescription drug formulary. We have heard anecdotal incidences of problems resulting when the pharmacy, under the authority of the VHA national drug formulary, switches patient prescriptions to the cheaper drugs without consulting the patient’s physician and without taking into consideration potential adverse side effects. This is an area of grave concern and should be examined by the Veterans’ Affairs Committees.

PERSIAN GULF ILLNESSES

VVA is very proud of our tradition and commitment to advocating for and assisting all generations of veterans. In the spirit of our founding principle, "Never again will one generation of veterans abandon another," VVA has established a working relationship with our colleague organization -- the National Gulf War Resource Center (NGWRC). Through a grant from VVA, the Resource Center is able to have a national presence in our nation’s capital to advocate their constituency concerns.

Particularly as VVA celebrates our 20th anniversary, it is very rewarding to observe the NGWRC’s development and the progress made by Persian Gulf War veterans. We firmly believe that their path has been made somewhat easier because of the work done by VVA and Vietnam veterans through the years. In addition, our two organizations -- as single-generation advocacy groups -- have very similar genesis and growth patterns. It is rewarding for our members to work with this younger generation, reflecting upon the progress made from VVA’s origin back in 1978. And, we are hopeful that working with VVA is beneficial for NGWRC members, who can look forward and be encouraged by what VVA has accomplished.

There has been significant public, press and Congressional attention to Persian Gulf illnesses, and much progress has been made in identifying potential causal factors and research initiatives. VVA believes that this more aggressive approach is in part a recognition of the government’s errors and initial insensitivity in addressing the concerns of Vietnam veterans exposed to Agent Orange/dioxin. We are very pleased that Persian Gulf veterans are not being forced to wait decades for work to begin on an appropriate resolution to their health issues. But the fact remains that they continue to suffer and we still have no answers as to the cause(s) of their illnesses or what can be done to cure them.

The Presidential Advisory Committee on Gulf War Veterans’ Illnesses has completed its work. The House Government Reform and Oversight Subcommittee on Human Resources and Intergovernmental Affairs, chaired by Rep. Christopher Shays, has done an extensive investigation of these issues as well. Both have made some very useful recommendations. In addition, we look forward to the findings of the Senate Veterans’ Affairs Committee, Special Investigating Unit (SIU).

VVA strongly endorses the "Persian Gulf Veterans Act of 1998," (H.R. 3279) introduced by House Veterans’ Affairs Committee Ranking Member Lane Evans, to address the ongoing challenges faced by Persian Gulf War veterans. We also commend Senator John D. (Jay) Rockefeller, Ranking Member of the Senate Veterans’ Affairs Committee, for introducing a very similar bill in that body. In many ways, this issue closely resembles the circumstances surrounding Agent Orange/Dioxin following the Vietnam War.

The Evans bill builds upon the experience of the Agent Orange Act of 1991, to establish a framework in which unbiased, independent scientists examine the research data on Persian Gulf illnesses to make recommendations about what illnesses should be granted VA service-connection. The bill would require VA to give benefit of the doubt to the ailing Persian Gulf War veteran, in cases where medical science is equally divided on the relationship of service in the Persian Gulf to particular illnesses. Importantly, the bill creates a presumption of exposure, similar to that of the Agent Orange Act. The bill would leave in place, for a period of 10 years, the current "undiagnosed illnesses" statute which allows these ailing veterans to receive compensation for disabling conditions which medical research is not yet able to identify.

In addition, and because of the widely varying successes of Persian Gulf illnesses treatment modalities employed within VA and DOD, this legislation aims to foster additional research on effective treatment protocols. Most sick Persian Gulf veterans are still quite young and would much prefer to regain their health and their productive lifestyles, rather than collect disability payments. Unfortunately, much of the focus of DOD and VA research until recently, has been to find the cause(s) of the ailments or to outright discredit veterans’ claims of toxic exposures. Finding the cause(s) of Persian Gulf War veterans’ illnesses is certainly an important prospective goal, in order to prevent such health effects in future wars and armed conflicts. But the immediate needs of these ailing veterans are for effective treatments. This bill will push medical science in the proper direction.

VVA strongly encourages the Veterans’ Affairs Committees to expedite consideration and approval of the "Persian Gulf Veterans Act of 1998." This legislation will do a great deal to ensure that VA’s compensation decisions are made on sound scientific grounds, and that appropriate research is accelerated.

One thing that is immediately clear is that more research must be done to learn the potential causes and, more importantly, the appropriate treatment modalities for Persian Gulf illnesses. As noted above, VVA believes a review process such as the ongoing evaluations by the National Academy of Sciences (NAS) established in the Agent Orange Act of 1991 should be instituted. However, for such a program to be effective in finding these answers, there must be extensive and valid research data on the wide range of relevant issues. VVA is adamant that DOD should not be tasked with conducting this research because of the justifiable perception that DOD lacks credibility and objectivity. And we are equally concerned about VA conducting such research, as we have historically seen a bias in this agency, during prior administrations, on the issue of Agent Orange. VVA strongly recommends that the federal government earmark and prioritize funding for independent research on Persian Gulf illnesses.

There are also a number of areas which Congress should continue to examine related to the prospective goal of ensuring that DOD does not make the same egregious errors and/or omissions in future conflicts which many believe put U.S. military personnel at significant risk in the Persian Gulf and after the war. VVA is adamant that future generations of veterans must be protected. Our nation must learn from its past mistakes. It is clear that many equivalent past lessons (e.g. radiation exposures, use of Agent Orange, unapproved FDA immunizations) have not been learned. We continue to be troubled that issues raised by concerned veterans immediately after the Persian Gulf War have not been adequately addressed by DOD, even as the U.S. was poised just last month on the brink of another armed conflict in the same theater.

We are aware that several members of the Senate Veterans’ Affairs Committee share these concerns, and addressed these issues in a February 17th letter to Defense Secretary Cohen. We would like to reinforce and reiterate these areas, to emphasize the gravity that future veterans might face if DOD does not adequately protect their health:

• DOD equipment for detecting release of chemical weapons, as well as devices for protecting personnel from such exposures, remain inadequate.

• DOD must be prepared to conduct pre-deployment physical examinations. Assessing health prior to deployment can help to avoid certain medical complications in theater, and can assist in measuring, understanding and treating changed health status.

• DOD seems to have no improved implementation plan for use of prophylactic drugs and vaccines, such as the Pyridostigmine Bromide. From our perspective, DOD is not yet prepared to provide deploying personnel with appropriate information about the substance, purpose and potential side effects of any prophylactic drugs or vaccines.

• DOD seems indecisive or potentially outright negligent in its education of the troops about the dangers of Depleted Uranium. Recent reports indicate that the risks have been known for nearly two decades, but appropriate protective measures have not been implemented aggressively and consistently.

• DOD has not made adequate updates and/or computerization of its battlefield medical records systems to ensure that any drugs administered or illnesses initially experienced during deployment are recorded and maintained. Many veterans’ medical records were lost during the Persian Gulf War. Military medical records are often a critical piece of evidence for VA disability claims.

• DOD appears unable to track unit locations, and thus determine which personnel are located where at any given point in time. This, too, can be a critical piece of evidence for proving exposure to toxic substances in VA disability claims.

There are innumerable factors in a battlefield combat setting which cannot be controlled even with the best strategic planning. Yet the above issues can and should be corrected to eliminate unnecessary risks for U.S. military personnel. VVA adamantly believes that additional congressional oversight, by both the Veterans’ Affairs Committees and the Armed Services/National Security Committees, must be done to ensure that DOD devotes the fullest possible attention to correcting these problems.

VVA understands that our colleague organization, the National Gulf War Resource Center, may approach the 105th Congress later this year to obtain a Congressional charter. As you know, Public Law 99-318 granted Vietnam Veterans of America a Congressional charter in 1986. This landmark event provided VVA with stature and an enhanced ability to advocate for and provide service to veterans. Therefore, VVA wholeheartedly supports the impending petition of the National Gulf War Resource Center for a Congressional charter. The services this unique organization aims to provide are quite necessary. Persian Gulf veterans need direct access to Congress and the agencies for advocacy and representation. A Congressional charter will provide the National Gulf War Resource Center with a critical tool to carry out this mission effectively.

In addition, VVA recommends that Congress authorize and appropriate funds for -- or VA contracts directly with -- the Resource Center to conduct outreach to the Persian Gulf veterans community. These veterans need a unified program for providing accurate information about benefits, health risks and updates on these issues. Many Persian Gulf veterans do not currently have confidence in the DOD or the VA. The NGWRC presents an ideal structure to reach out to Persian Gulf veterans and disseminate information. Providing the NGWRC with appropriate and necessary legislation and funds will allow this young organization to assist VA and DOD with carrying out their objectives of locating, informing and serving the Persian Gulf veteran community.

AGENT ORANGE/DIOXIN

VVA believes the structure set forth within the Agent Orange Act of 1991, in which the National Academy of Sciences (NAS) Institute of Medicine (IOM) provides independent analysis of scientific literature on Agent Orange/dioxin, has provided significant improvement in the fairness and scientific basis upon which compensation determinations are made. Nevertheless, there continues to be disagreement over whether certain conditions are related to exposure. It is critical that more research be done by independent scientists to allow the NAS reviews to provide more conclusive determinations.

VVA does not propose that VA compensate veterans for conditions that are clearly not related to their military service. In cases where the scientific data presents an unclear determination of exposure and risk, however, the benefit of the doubt must go to the veteran. In order to more conclusively determine what conditions are and are not related to service in Vietnam, VVA strongly recommends that additional government-funded, independently conducted research be done.

VVA has taken our responsibility to make the Agent Orange Act work appropriately and effectively very seriously. We have members who painstakingly review all the available scientific literature on Agent Orange/Dioxin themselves. And we bring relevant studies to the attention of the NAS/IOM panel for their review process.

The next NAS/IOM report on Agent Orange is due to be published this April. VVA strongly urges either an administrative or statutory extension of VA disability compensation for any additional diseases/conditions which fall into the categories "Sufficient Evidence of an Association," or "Limited/Suggestive Evidence of an Association." This has been the practice in past years. And we strongly believe that this is the fair and compassionate policy for dealing with service-connection of Agent Orange-related conditions.

In a similar vein, should the report detail any additional birth defects or adverse reproductive consequences resulting from Agent Orange/Dioxin exposure, VVA strongly urges Congress to take immediate steps to implement a benefits program for the effected offspring of these Vietnam veterans. The Agent Orange Benefits Act of 1996, which established a comprehensive benefits program for Vietnam veterans’ children with spina bifida, was a landmark bill. And we firmly believe additional research will show disproportionate numbers of Vietnam veterans’ children with other types of birth defects and disabilities. The precedent must be followed.

We continue to propose that Agent Orange/Dioxin research be conducted in Vietnam which presents an ideal laboratory. Unfortunate as it is, the Vietnamese population presents a ready-made study group because of long-term exposures to the groundwater, contaminated food and the environment of the defoliated jungles in the South. Preliminary evaluation and anecdotal information shows a wide range of diseases and birth defects in this population. An appropriate control group exists in the North, where there was no spraying but diet and lifestyle are comparable. There is also minimal industrial dioxin in the environment in either area. The support of the Veterans’ Affairs Committees for such research would be instrumental in assuring that veterans get answers to the questions that have plagued them since leaving the battlefield. We urge you to support an earmarked funding for this research in Vietnam.

VVA has appealed to Environmental Protection Agency (EPA) Administrator Carol Browner to immediately issue the long-awaited Dioxin Reassessment that the agency has been working on for several years. VVA is vitally interested in this document, as the issue of Agent Orange compensation is inextricably linked to the toxic effects of 2,3,7,8-TCDD (dioxin). We are aware that the Veterans’ Affairs Committees do not have jurisdiction over EPA, but we are hopeful that you might work with your colleagues to expedite this process.

Vietnam veterans and their families would like to see a resolution of the Agent Orange/dioxin issue. But historically, the scientific evaluation has often been sketchy, misguided or outright biased in favor of the industries which produce these toxins. EPA’s Dioxin Reassessment becomes instrumental because of the ambiguity of various federal, independent and industry-sponsored research. We are hopeful that, finally, the EPA document will prove to be an effective and useful digest of the scientific literature on this topic.

Although past evidence of dioxin’s effects have been equivocal, recent international evidence confirms that dioxin is a human carcinogen. Also, evidence on dioxin exposure and paternally mediated birth defects in humans is growing. VVA has actively participated in the public review process of the various chapters of the Dioxin Reassessment. And we do feel strongly that this process, unlike those of the past, has been more open to the victim’s perspective and data on negative health effects.

The EPA Dioxin Reassessment has been delayed many times over the last two to three years, on the premise that bias must be removed. VVA strongly feels that any bias should have been eliminated at this stage, and a far greater danger lies in further delays. The truth about dioxin’s hazardous health effects must be disclosed, and EPA has a major responsibility and obligation to facilitate this process.

For these reasons, VVA strongly urges EPA to release the Dioxin Reassessment in 1998. The lives of many thousands of Vietnam veterans, their families and the broader public health are dependent upon EPA’s work in this area and the timely issuance of the Dioxin Reassessment. We urge the Congress to demand expedited publication of EPA’s Dioxin Reassessment.

VVA has also endorsed the "Children’s Environmental Protection and Right to Know Act of 1997." This bill would require disclosure of environmental risks to children’s health and expand the public’s right to know about toxic chemical use and release, including that of dioxin.

HOMELESS VETERANS

VVA continues to recommend that the Veterans’ Affairs Committees and Congress as a whole examine how federal funds are allocated and used to provide assistance for homeless veterans. Public and private studies suggest that more than one-third of our nation’s homeless are veterans -- some 270,000 veterans are homeless on any given night. Despite these abhorrent statistics, the Department of Housing and Urban Development (HUD) controls over 75 percent of the appropriated discretionary dollars allocated for the homeless each year. Yet HUD fails to assure that state and local communities which are awarded nearly $1 billion in grants each year respond to "veterans specific" needs in the homeless population.

These veterans have unique problems related to their military service, such as: Post Traumatic Stress Disorder (PTSD), substance abuse, difficulties in transitioning to civilian employment, and physical disabilities. Equally important, however, is the fact that homeless veterans -- by virtue of their military service -- also have unique assets that make veterans particularly good candidates for homeless rehabilitation and reintegration back to productive life. These assets include: a proven ability to hold a job, higher levels of education and training, responsibility and discipline, and capacity for teamwork. Veterans may also have access to VA health care and benefits as well as other veterans services which can assist in the transition back to mainstream society.

There is evidence that programs designed to treat homeless veterans together as a support group have significantly higher rehabilitation success rates. This is because these veterans have a common base of understanding through their shared military experience, which fosters restoration of self-esteem, pride and collective rehabilitation. Most community-based programs servicing the general homeless population don’t meet the unique needs of homeless veterans, and do not capitalize on the assets that homeless veterans can bring to their recovery. If the mainstream homeless programs administered by HUD were effectively serving veterans, there would not be a homeless problem among veterans of the disproportionate magnitude that now exists.

Some members of Congress outside of these committees, as well as the general public, may be under the illusion that the VA will meet the needs of homeless veterans. We have certainly heard this argument from some HUD officials and from general homeless providers around the country. The Veterans’ Affairs Committee knows, like we do, however, that the VA was never designed to meet the comprehensive needs of homeless veterans. It is a hospital and health care system. Trends in managed medical care and federal budget cuts, which are causing VA to emphasize outpatient programs for substance abuse and mental health, are even further diminishing VA’s capacity to meet the needs of homeless veterans as inpatient beds are reduced. Therefore, the need for safe, clean, sober transitional housing for veterans to reside in while they benefit from VA outpatient and partial-hospitalization services is rapidly increasing. But the disconnect in delivery of these services results from the fact that a non-veteran oriented HUD is the primary federal provider of these housing services and homeless assistance.

We are confident that the Veterans’ Affairs Committees share our belief that the disproportionate representation of veterans among the homeless population (approximately one-third) is truly a national tragedy. And it is equally shameful that so few of the federal tax dollars spent each year on homelessness are directed toward programs which specifically target the needs of veterans. Less than 3 percent of the federal homeless assistance dollars administered by HUD are directed at programs which address the specific needs of veterans.

For these reasons, VVA has enthusiastically endorsed the "Robert Stodola Homeless Veterans Assistance Act" (H.R. 1754). This bill, introduced by Rep. Jack Metcalf of Washington, would specify that 20 percent of McKinney Act homeless funds are directed toward veteran-specific programs. Rep. Metcalf was able to work with Housing and Community Opportunities Subcommittee Chair Rick Lazio to incorporate a number of key "veterans" provisions into H.R. 217, the "Homeless Housing Programs Consolidation and Flexibility Act," passed in late February by the full House. VVA strongly supports H.R. 217 and urges the Senate to introduce a similar bill, and even to include the 20-30 percent set-aside for homeless veterans. Strong support from members of the Veterans’ Affairs Committees can only help this effort.

Our experience in working with local homeless veterans service providers, as well as working with HUD at the national level, leads us to believe that federal homeless monies spent on veteran beneficiaries which do not address the underlying "veteran specific" cause of their homelessness are doomed to be wasted. This is because the veteran will likely circulate in and out of various homeless services, never really being rehabilitated or stabilized. Some of VA’s own statistics showing the revolving door of their patient base attests to this recidivism. HUD contends that these veterans are being served within their general homeless programs, yet there is no verifiable accountability other than the grantees checking "Yes" on a questionnaire about services to this sub-population. We reiterate our belief that if HUD’s general programs were effectively serving veterans, there would not be such a disproportionate number veterans on the streets each night.

Currently many homeless service providers which target the special needs of veterans are unable to get a seat at the table as representatives in the local homeless planning boards which administer HUD homeless assistance monies. Without this access, HUD grant monies are not forthcoming. There are a variety of reasons for this problem. Mr. Lazio and Mr. Metcalf were able to include provisions in H.R. 217 aimed at correcting this problem. The bill would:

• Identify veterans who are homeless as a "special needs" population, which must be incorporated into the development of HUD comprehensive plans at all levels -- federal, state and local. This would also be a part of HUD’s reporting requirements to Congress under the Government Performance and Results Act (GPRA).

• In addition to requiring coordination with the Department of Health and Human Services (HHS), HUD and its grantees would be required to coordinate with VA for the planning of services to veterans who are homeless at all levels -- federal, state and local. This should particularly be the case for health care services -- many homeless veterans may be eligible for VA care by virtue of their income.

• Require local or state planning boards which will administer HUD block grants to have some representation of veterans service organizations or veterans homeless service providers.

• Incorporate into all HUD pre- and post-grant reporting requirements the statistical analysis of veterans served within all homeless service providers. This will assist Congress and the Administration with oversight and accountability assessments.

It is our belief that targeting these special needs and assets of homeless veterans will help HUD meet the McKinney Act goals of transition and rehabilitation, will better serve U.S. taxpayers by more efficiently and effectively spending these federal homeless assistance funds, and will assist Congress and the agency in setting and evaluating program goals as required by the Government Performance and Results Act (GPRA). In addition, programs that provide a continuum of care to homeless veterans have often achieved more effective results, and can therefore serve as models to be emulated for addressing all homeless.

Recognizing the challenges the veterans community faces in receiving a fair share of the HUD-administered homeless program funds, VVA supports Chairman Stump’s effort to put additional tools into the hands of non-profit homeless veteran providers to get additional funding resources from private lenders. The VA loan guaranty program contemplated in H.R. 3039 will not only give these organizations an opportunity to access direct funds through the loans, but may help them to leverage these monies to get additional private, state and community resources.

The program model upon which this legislation is based is among the most successful methods of turning homeless veterans lives around. VVA firmly believes that the "Veterans Transitional Housing Opportunities Act of 1997" has significant potential to make more services available to a larger number of homeless veterans. And one of the very appealing aspects of this bill is the "recyclable" nature of the guaranty funds; as borrowers pay off their loans, VA will be able to reinvest these funds into additional loan guaranties to other homeless veteran providers.

VVA understands the concerns raised by some about the funding offset proposed in this bill. But on the whole, we believe that VA should have the authority to invest the current veterans life insurance funds more aggressively, while still administering the fund in a safe, financially sound manner. This is really a "good government" concept. We believe that effective public information could alleviate any perception or fear that NSLI beneficiaries would not see any less in their dividends, nor in the death claim payments to family members. We are disappointed that this funding mechanism was deleted from the bill voted out by the House Veterans’ Affairs Committee, because we are fearful that the program will never achieve its full potential without a substantial, one-time federal investment that is unlikely if dependent upon the appropriation process.

We are pleased about the inclusion of provisions to encourage lenders to make prudent loans, thereby reducing the possibility of default through risk sharing. This was accomplished by authorizing a maximum loan guarantee of 90 percent of the total cost of the project. We believe also that having VA contract with an experienced non-profit lender to assist with administration of this program will also help to maximize "good" loans and minimize defaults. Furthermore, coordination with VA, state and local authorities, and private lenders is absolutely critical to ensure the most efficient use of resources and to prevent duplication of services. A smooth continuum of care is the ideal goal of any such program.

The new tool this bill would create for addressing the problems of homeless veterans is not comprehensive; elderly and disabled veterans who cannot work to sustain themselves would not be impacted. But at the same time, it is a strong, positive step toward increased funding for homeless veterans assistance.

Additionally, VA’s Homeless Provider Grant and Per Diem Program and DOL’s Homeless Veteran Reintegration Project should be expanded and provided with additional funding. We were extremely disappointed to see that the President’s budget called for only $2.5 million for HVRP, a reduction of $500,000 below the FY 1998 appropriation. VVA supports an appropriation at the $10 million authorized level. This is such a small amount of money in the grander budget picture. But it can provide a great deal more needed assistance to homeless veterans.

Late last year, the President and HUD Secretary Cuomo announced a new initiative for the homeless, calling for an additional $327 million for homeless assistance in the FY 1999 budget request. VVA has called upon the President and Secretary Cuomo to specifically designate that one-third -- a proportionate share -- of these new monies be directed to programs which target homeless veterans. This could be very easily accomplished by transferring and redirecting this amount to VA to supplement its own homeless assistance efforts and to increase the VA Homeless Providers Grant and Per Diem Program, which provides grants to community based organizations. If Congress does appropriate these additional monies for homeless assistance, we urge you to call upon the Appropriations Committees and upon the Administration to earmark at least one-third toward homeless veterans.

VVA urges the Veterans’ Affairs Committees to ensure that VA’s homeless programs are not adversely effected by tight budgets, or even budget surpluses divvied up for political initiatives. Investing in comprehensive programs to assist homeless veterans to be reintegrated into society is a win-win proposition. These targeted programs, among which VVA is a recognized leader, have proven very effective in addressing the unique needs of homeless veterans, transitioning these individuals back into mainstream society and reducing recidivism toward homelessness. Many of these men and women are ready and able to work and contribute back to the community as tax-paying citizens. These veterans simply need a helping hand -- not a handout.

EMPLOYMENT

Employment and training programs remain a needed service for veterans of all ages. For younger veterans just leaving the military as well as career service personnel, there are obvious transition needs. But also for the Vietnam veterans in the midst of career changes, the Veterans Employment & Training Service (VETS) provides a key mission. The changing dynamics of the American workforce, the consolidation and block-granting of employment and training programs, and the changing demographics of the military make VETS critical for our veterans population.

Recent statistics show an increasing number of Vietnam veterans using these services. More analysis needs to be done to determine the reasons behind this trend, and to address any emerging needs. VVA urges Congress to examine the needs of those veterans who access supportive services from the Local Veterans’ Employment Representatives (LVER) and Disabled Veterans’ Outreach Programs (DVOP), and assess how best to meet these needs. In addition, VVA urges full funding of the VETS programs.

VVA strongly supports enactment of H.R. 240, sponsored by Rep. John Mica, Chair of the House Government Reform and Oversight Subcommittee on Civil Service, and the Senate companion bill S. 1021, introduced by Senators Chuck Hagel and Max Cleland. This legislation aims to bring our nation’s 50 year old Veterans Preference laws up to date with the current federal employment realities. We appreciate the widespread support shown by the House for this bill, and urge the Senate Veterans’ Affairs Committee to act quickly to press for full Senate passage.

The "Veterans Employment Opportunities Act" will provide an appeal and enforcement mechanism for veterans who feel their preference rights have been violated. VVA points to analysis by the General Accounting Office (GAO), as well as anecdotal cases that cross the desks of VSO employment advocates every week, to demonstrate the need for this legislation. Veterans preference laws appear to be circumvented at an alarming rate.

Why, one might ask, would anyone in the federal government wish to violate veterans preference? Theories vary, but the seemingly obvious reasons are threefold: a) a severe lack of understanding of the contributions and needs of veterans, as well as the objective of veterans preference; b) a misconception that veterans preference laws conflict with affirmative action programs for women and minorities, and that these groups’ employment opportunities are damaged by veterans preference; and c) an effort to ease future personnel actions related to the ongoing federal downsizing through RIFs.

Advocates of this legislation can point to numerous incidents in which veterans were denied jobs for which they were rightfully qualified or inappropriately lost their jobs through Reduction-In-Force (RIF). And under current law, these veterans have minimal recourse within a system which has proven very unresponsive. The bill does not aim to put veterans in jobs for which they are not qualified nor does it aim to keep veterans in jobs which should be eliminated. Rather, the "Veterans Employment Opportunities Act" would create an effective, efficient, user-friendly redress system. The bill does not change the original intent or benefits associated with Veterans Preference. It simply makes the system more workable and discourages violations by hiring managers.

VVA urges expeditious passage of this legislation by the 105th Congress. It is very important that Congress send a strong message to the federal agencies that violating Veterans Preference will no longer be tolerated. As the federal government continues to downsize, this bill will become an increasingly important tool for veterans.

VETERANS BENEFITS ADJUDICATION

VVA is optimistic that the new leadership of the Veterans Benefits Administration (VBA) will be innovative in developing solutions to resolve the inefficient procedures which cause excessive delays and backlogs in adjudicating claims. Under Secretary Joseph Thompson has a record of achievement in this area. There are many challenges, including resource limitations and computerization complications. We plan to work with VA and Congress to improve processing of VA benefits.

VVA believes that a critical part of the problem stems from performance quality at the initial decision-maker level -- the rating specialists. Reducing appeals can be accomplished by making sure VA "gets it right the first time" on initial claims. To address this, VVA believes that Congress and VBA should review decisional data from Hearing Officers, Board of Veterans’ Appeals, and Compensation & Pension Service administrative reviews to determine which rating specialists repeatedly make the same types of errors. This data should be used for retraining, as well as performance evaluations and appropriate personnel actions.

Another identified deficiency relates to coordination between VBA and VHA regarding the quality and appropriateness of compensation and pension exams. Often the VHA exams are significantly delayed, inappropriate to the specific nature of the claim, or incomplete -- sometimes causing not only delays but added inconvenience for the veteran who must be subjected to an additional examination. The new pilot program to contract physical evaluations to private doctors may lead to improved timeliness and accessibility for veteran claimants.

VVA has called upon the Administration to nominate a veterans advocate to fill the current vacancy as Chair of the Board of Veterans Appeals (BVA). This position has been vacant for a significant period of time, which has delayed making necessary improvements in BVA’s appeals processing. Placement of a veterans advocate with significant management skills and knowledge of the adjudication process in this position will be critical to improving the quality and efficiency of the Board’s work.

Similarly, VVA strongly encourages the appointment of a VA General Counsel who is a veterans advocate. This position also requires legal interpretation of veterans benefits and programs. As such, a perspective on VA benefits, the adjudication process and the role of veterans in our nation’s history is important.

Another program enhancement which could greatly improve services and the adjudication process is expansion and improvement of the VA Hearing Officer program to allow independent review of the Adjudication Division’s denial decisions at the VA Regional Office (VARO) level. The program is very useful because a VARO hearing highlights the key areas that require development, and gives the veteran and the VARO a valuable opportunity to work on the case before it is perfected for appeal to the BVA. VVA is encouraged by the initial success of the VA’s Decision Review Office pilot program.

In order to create more equity in the program, VVA recommends that the Hearing Officer be removed from the Adjudication Division chain of command, thus upgrading the position within VARO hierarchy. This is necessary to eliminate any potential conflict of interest, as it may be difficult for a Hearing Officer to reverse a decision made by a colleague or a supervisor in the Adjudication Division.

Additionally, the program should be expanded with an increase in the total number of Hearing Officers to conduct hearings, as well as greater publicity that this form of appeal is available to veterans. VVA urges Congress to examine the merits of this program, and to encourage VA to make these recommended program enhancements either administratively or by passage of legislation.

HOME OWNERSHIP

VVA favors an extension of eligibility for various state-run veterans home loan programs to veterans who served after January 1, 1977. Five states currently provide state-run home-loan programs, funded through "Qualified Veteran Mortgage Bonds" -- Alaska, California, Oregon, Texas, and Wisconsin. Participation is restricted to veterans who served prior to January 1, 1977, by a 1984 provision of the Internal Revenue Service (IRS) code defining eligibility.

Prior to the 1984 Tax Reform Act, each of these states provided low-interest mortgage loans to veterans residing within their boundaries. These programs began as a "Thank-You" to those men and women who honorably served their country. Adjustments were made to amend state statutes for the inclusion of Korean veterans and Vietnam veterans. Subsequent generations of veterans who served in Central America, Grenada, Lebanon, the Persian Gulf, and elsewhere in the Middle East are denied access only due to the 1984 federal tax change.

VVA endorses the "Veterans American Dream Homeownership Assistance Act of 1997" (H.R. 1241), introduced by Rep. Jerry Kleczka, and the companion bill (S. 632), introduced by Senator Herbert Kohl, both of Wisconsin. These bills would correct the expiration of this program by requiring the IRS to defer to state law in determining eligibility for these programs. VVA has consistently endorsed benefits being extended to all veterans, equally, regardless of the military action in which they participated, and urges Congress to pass this legislation.

WOMEN & MINORITY VETERANS

VVA has been pleased by the progress made on the unique concerns of women and minority veterans in recent years. We continue to work with the VA’s Centers for Women and Minority Veterans to identify and propose solutions for the issues these veterans face. In most cases, the needs of women and minority veterans do not require additional or separate programs. Rather, distinct outreach efforts are necessary to address the barriers these veterans face in receiving VA services -- whether that be language or cultural barriers or perhaps privacy accommodations for women in VA medical facilities.

VVA advocates that full-time women veteran coordinators be appointed in each VISN to address the unique medical concerns and access issues of women veterans. Each VA medical center currently has a Women Veterans Coordinator; some are full-time positions and some have collateral responsibilities. The new VISN positions should monitor, coordinate and facilitate the functions of the local Women Veterans Coordinators and assure a VISN-wide approach to women’s issues. Additionally, VBA should appoint a full-time Women Veterans Coordinator in each state to ensure that women’s issues are addressed in each Regional Office.

VVA also endorses the "Veterans Sexual Trauma Treatment Act" (H.R. 2253), introduced by Rep. Luis Gutierrez, which would make provision of trauma counseling a mandatory, permanent program authority. This bill has been carefully crafted to address those former military personnel who may currently be falling through the cracks and forced to deal with their trauma alone because the statute limits which veterans can access VA’s sexual trauma counseling programs. This program expires in 1998, so we urge the Veterans’ Affairs Committees to act on this legislation expeditiously.

Recent events with the cases at Aberdeen Proving Grounds and others make it evident that sexual harassment and sexual assault remain serious concerns within the armed services, as well as throughout society. Many of the individuals involved in the situation at Aberdeen currently may not be eligible for this program within the VA because of their abbreviated length of service. Also, members of a reserve component called to active duty during the Persian Gulf War may not have a full two-years of active duty service to qualify for these needed treatments. Additionally, because this program is discretionary under the current statute some veterans could be denied care for this distinctly service-related trauma if it is unavailable at a particular facility, or if sufficient resources are not available.

We are hopeful that the Congress will enact H.R. 2253 to extend VA's authority to provide sexual trauma counseling permanently and to eliminate restrictions on who can and cannot access this therapy. We also believe it is appropriate for VA and DOD to coordinate outreach to provide benefits information to any veteran who may need these services. As our nation’s attention is drawn toward prosecuting the offenders in military sexual harassment/trauma cases, we must also be mindful of the needs of the victims.

VVA has been at the forefront of advocating for the needs of women veterans since the Vietnam War. And we have seen a number of positive changes in the way the VA treats women who served in the military. Sexual harassment and misconduct have long been problems in the military. And just as we expect to have appropriate counseling and medical services available to civilians who are harassed or assaulted in the workplace, military and VA programs should also be available to victims of sexual trauma or harassment in a military setting.

POW/MIA ISSUES

The issue of Prisoners Of War/Missing In Action (POW/MIA) from the Vietnam War remains an extraordinarily sensitive issue -- one that has a tendency to be divisive for veterans advocates and government officials alike. While VVA remains opposed to the administration’s movements toward full normalization of relations with the government of Vietnam, we remain committed to achieving the fullest possible accounting of our nation’s POW/MIAs. Although the House and Senate Veterans’ Affairs Committees have no direct jurisdiction of this issue, it remains a major concern of veterans service organizations and family organizations.

Passage last year of thirteen of the twenty provisions of the "Missing Service Personnel Act" as part of the FY 1998 Defense Authorization bill is a very strong measure toward assuring DOD accountability. VVA congratulates Rep. Steve Buyer, Chair of the House National Security Subcommittee on Military Personnel, for his diligent work and skillful negotiating with Senate leaders to ensure passage of these provisions. The new law will assist family members of POW/MIAs in gaining access to information which may help in resolving the fate of their loved ones, and delineate procedures for DOD to carry out in relation to investigating and compiling data on individual MIA cases. VVA urges the National Security Committee to continue rigorous oversight of the Defense POW/MIA Office, in order to ensure that the new law is effective and that the DOD agency is accountable to POW/MIA families, the veterans community and the public at large.

VVA, through a long-standing convention resolution, proposes another creative initiative aimed to find new avenues for collecting information about American POW/MIAs. We would like to see legislation passed to allow and facilitate the repatriation of any missing American without punitive action or monetary penalty against this individual and/or his family, who has been living in Southeast Asia or any other foreign country since the end of the Vietnam War.

The objective of this initiative is to gain access to any information such an American might be able to provide about his circumstances and that of other missing Americans. The feeling of our membership is that this legislation should be no more objectionable to the American people than the granting of amnesty to former Vietnam War protesters who left the country to avoid being drafted. VVA urges members of the Veterans’ Affairs Committees to work with your colleagues to enact such legislation.

CONCLUSION: WHAT DOES THE FUTURE HOLD?

VVA is proud of our record of creativity, fiscal integrity, and innovative solutions. Through the last two decades, VVA has consistently aimed to improve veterans programs in pragmatic, cost-effective ways. Since our organization’s inception, VVA has accomplished a great deal to draw attention to and address the unique concerns of Vietnam veterans. That mission is not yet complete.

VVA, by virtue of being a single-generation organization, has perhaps a more clear outline of the future and more security than does the rest of the veterans community... at least in the short term. We do not find ourselves facing a declining membership and the need to recruit the new, younger generation. A significant shift must be made across the board, however, in order to ensure that the needs of younger veterans are being addressed by the VA, Congress and the veterans community as a whole. This is important not only to the survival of the veterans service organizations, but to our national defense as well. It is troubling to see Persian Gulf veterans remain disenfranchised from the government and the veterans community, and to anticipate the effect this might have on volunteer recruitment for our nation’s armed services. The programmatic needs of younger veterans are obviously different from the aging World War II population, and a corresponding shift in mind set must take place.

As veterans advocates, we all have a responsibility to ensure that our nation’s comprehensive veterans programs evolve to meet the new realities of the changing nature of the veterans population. Vietnam veterans now represent the largest portion of the veterans population. Methodologies and trends in American heath-care delivery have changed dramatically since the Department of Veterans Affairs (VA) hospital system was originally developed. The nature of warfare -- and consequently the needs of veterans -- continues to require reassessments in the way VA administers and grants disability benefits. And women represent a growing percentage of the total U.S. military personnel. Clearly, the veterans programs of the future will be different than those required by our generation and the generations of our parents and grandparents, to readjust to civilian life decades ago and up to the present. In this regard, we look forward to the findings of the Commission on Servicemembers and Veterans Transition Assistance.

Most veterans, as you know, never use any federal veterans programs. They are hard working citizens who are pleased to provide taxpayer support for their colleagues who do require assistance for unique veterans needs. The majority of the veteran population asks only for respect and the assurance that if they ever do need help, the nation that called them to serve and sacrifice in the military will provide it.

Recognizing fiscal realities, the veterans community no longer expects nor demands that the VA be all things to all veterans. VA cannot provide health care and benefits to all 27 million veterans. We do, however, expect VA to maintain a range of necessary services for a core group of the most deserving and needy veterans. And Congress must provide an appropriate level of funding to carry out this principle mission.

It must be noted, again, that veterans have repeatedly made sacrifices for budgetary purposes throughout the last two decades. Access to health-care services have been progressively limited to the point that very few of our nation’s veterans can even get into a VA medical center door; only ten percent of the total veteran population receives VA health care. And the out-of-pocket costs have escalated. Outside of the veterans advocates who serve on this committee, very few members of Congress have an understanding of the services VA does -- and more importantly does not -- provide. Many still believe that any veteran can get any services they want from the VA. This is simply not true.

Similarly, not all veterans who are potentially eligible for VBA-administered benefits apply. That agency’s ability to process benefits in an appropriate and timely manner has also been hampered by further and further staff cuts. And there is also a desperate need to upgrade and integrate computer systems. As such, the circumstance requires more resources -- not less. We are disappointed with the President’s budget recommendation in this area, because further resource restrictions will cause veteran claimants to suffer from longer delays in the adjudication of compensation and pension claims.

We urge these Committees to work with us and the rest of the veterans community in the process of educating your colleagues on the Budget and Appropriations Committees about the federal government’s responsibility to provide services to our disabled and needy veterans, about the personal sacrifices made by veterans in defense of our nation, as well as the prior budgetary sacrifices made to eliminate or cut back veterans programs in the interest of broader federal fiscal responsibility. And we urge you to help us educate the remainder of Congress about what VA does and does not provide to veterans, so that there will be no misconceptions about the severe impacts of budget cuts on these programs and the beneficiaries who depend upon them. We must encourage solutions which produce equal or better outcomes, while also costing less federal resources.

VVA has worked with you on many of these issues in the past. We appreciate the support the Veterans’ Affairs Committees have consistently demonstrated for all veterans and their families. VVA remains committed to working collaboratively to improve and protect these programs, and to enhance government efficiency and effectiveness. We strongly urge Congressional leaders from both parties to continue working together in a bipartisan tradition on all veterans issues.

We appreciate this opportunity to present VVA's government relations agenda and look forward to working with both Veterans' Affairs Committees to successfully address these issues.

GEORGE C. DUGGINS

George C. Duggins, the national president of Vietnam Veterans of America, is 54 years old and lives in Chesapeake, Virginia. Mr. Duggins served with the U.S. Army Security Agency (ASA) from July 1965 to April 1969, attaining the rank of Specialist Five. Mr. Duggins served two tours in Vietnam: with the ASA in Phu Bai from May 1966 to December 1967, and in Pleiku from April 1968 to April 1969. After his second tour, Mr. Duggins was honorably discharged.

A graduate of Tidewater Community College with a degree in computer technology, Mr. Duggins has been a long-time veterans advocate and has received numerous awards for his service to veterans. He is a life member of Vietnam Veterans of America, holding membership in VVA’s Tidewater, Virginia, Chapter 48. Mr. Duggins has been on VVA’s national Board of Directors, has served as national chair of VVA’s membership, credentials, convention, scholarship, and minority affairs committees. Duggins was elected VVA National President in 1997, following his 1995 election to the position of national Vice President and ascendance to fulfill a vacancy in the position of National President. In 1996, he was a member of an official U.S. delegation sent to Vietnam, Laos, and Cambodia by President Clinton to investigate the POW/MIA issue.

Mr. Duggins is the past chair of the City of Chesapeake’s Mayors Committee on Veterans Affairs and is the chairman of the Board of Trustees at Metropolitan A.M.E. Zion Church. He also serves on the Citizens Advisory Board for Huntsman’s Chemicals and the Aeolin Club.

Mr. Duggins is employed at OPTIONS Health Care, Inc., in Norfolk, Virginia, as a computer analyst/programmer. OPTIONS Health Care is a national managed behavioral health care company and is the official coordinator of behavioral health care for the U.S. military in the Hampton Roads, Virginia, area and at Fort Bragg, North Carolina. In partnership with Humana, OPTIONS delivers health care to more than one million military beneficiaries throughout the southeastern United States.

Mr. Duggins is married to the former Blanche L. Neal. They have two daughters, Stacey Davida, who attends Virginia Tech University, and Shana Tennell, a senior at Oscar Smith High School in Chesapeake.

VIETNAM VETERANS OF AMERICA, INC.

The national organization Vietnam Veterans of America, Inc. (VVA) is a non-profit veterans membership organization registered as a 501(c)(19) with the Internal Revenue Service. VVA is also appropriately registered with the Secretary of the Senate and the Clerk of the House of Representatives in compliance with the Lobbying Disclosure Act of 1995.

VVA is not currently in receipt of any federal grant or contract, other than the routine allocation of office space and associated resources in VA Regional Offices for outreach and direct services through its Veterans Benefits Program (Service Representatives). This is also true of the previous two fiscal years.

For Further Information, Contact:

Director of Government Relations

Vietnam Veterans of America, Inc.

(202) 628-2700, extension 127

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