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Submission For The Record of Michael O'Rourke, Veterans of Foreign Wars of the United States, Assistant Director, National Veterans Service

CHAIRMAN MICHAUD, RANKING MEMBER BROWN AND MEMBERS OF THE SUBCOMMITTEE:

On behalf of the 2.1 million members of the Veterans of Foreign Wars of the United States and our Auxiliaries, the VFW would like to thank this committee for the opportunity to present our views on today’s pending legislation.

HR 3843, To amend title 38, United States Code, to direct VA to publish redacted medical quality-assurance records of the Department of Veterans Affairs on the Internet website of the Department

VFW supports the Transparency for America’s Heroes Act.  This bill would require VA to publish and make available inspection reports of VA facilities thirty-days after completion of the review on its website.

Recent reports of contaminated instruments, unsupervised medical procedures and adverse conditions at a Philadelphia long-term care facility erode faith in the VA health care system. We believe that having information easily available to patients and stakeholders renews the emphasis on quality, accountability and sound healthcare procedures provided by all staff in every VA facility.

By providing quality assurance records on VA’s website you will close the gap between patient, VA and quality health care.  It also offers a sense of accountability and willingness by VA to clarify procedures within its health care system.

We would ask that resources and funding for VA’s IT Department remain at appropriate levels to ensure continued efforts are made toward providing the information needed to implement this new effort toward transparency.

HR 4041, To authorize certain improvements in the Federal Recovery Coordinator Program, and for other purposes

VFW supports this bill as it would improve the current Federal Recovery Coordinator Program (FRCP) by authorizing and funding forty-five recovery care coordinators to be trained at qualified nursing and medical schools selected by VA. It would also provide for the development of evidence-based guidelines for care coordination and best practices for models of care used as part of the FRCP.   

The FRCP was established to assist recovering servicemembers and their families by providing information with access to care, services and benefits within VA and DOD.

In 2007, DOD and VA partnered to create a Federal Recovery Coordination Program to coordinate clinical and nonclinical care for the most severely injured and ill servicemembers. Today, the program is up and running at six military treatment centers and two VA medical centers, but predicting the total number of coordinators needed is difficult. The program itself has struggled with referrals as it depends on the number of eligible servicemembers and veterans enrolling and their specifics needs.

VFW believes that utilizing nursing and medical schools to train coordinators is a positive step forward and highlights the need for fundamental changes in care management. Today’s injured servicemembers deserve greater coordination as they struggle with complex injuries that often hinder their transition from military to civilian life.  Having someone trained properly to guide the way is only the first step toward recovery.

H.R. 5428, To direct the Secretary of VA to educate certain staff of the Department of Veterans Affairs and to inform veterans about the Injured and Amputee Veterans Bill of Rights, and for other purposes

The VFW supports this legislation, which would require the display of an injured and amputee veterans bill of rights.  The display reaffirms and clarifies the rights of these injured service men and women, letting them know what they can expect from VA.

We believe that this bill would ensure consistency in the orthotic and prosthetic (O&P) benefit program under the VA health care system. It would also allow veterans to select the practioner that best meets their needs, and provide them ample access to vocational rehabilitation, employment and housing assistance. The bill also goes one step further by requiring all VA O&P clinics to post the bill of rights and create a mechanism of enforcement by establishing a complaint system so that veterans can report mistreatment or a lapse in care.

HR 5516, The Access to Appropriate Immunizations for Veterans Act of 2010

VFW supports legislation that would improve health outcomes for veterans by expanding VA performance measures to cover vaccines recommended by the Center for Disease Control and Prevention (CDC). The recommended adult immunization schedule is periodically reviewed and revised so that vaccinations are scheduled at the time in which they are needed most.

Currently VA only administers the influenza and pneumococcal vaccinations. Congressman Stearns’ legislation would authorize VA performance measures to cover all vaccinations recommended by VA and CDC so veterans, especially those in “high risk” categories, would receive timely access to vaccines that may help prevent diseases and long-term hospital stays. By following suggested vaccine protocols, we see a win-win in the delivery of health care and improved health care outcomes within VA.

H.R. 5543, A bill to alter collective bargaining rights of VA employees

This bill would permit VA employees to contest aspects of their pay.  Under this legislation, employees would be able to file grievances and negotiate all compensation that is not considered basic pay, to include bonuses, merit pay, and other compensable items.  It would still bar VA employees from petitioning for a basic pay structure that differs or is inconsistent with the General Schedule or other federal basic pay structures; it would merely give them the option to file a grievance with respect to additional pay.  The VFW has no position on this legislation.

H.R. 5641, Legislation that would authorize the Secretary of Veterans Affairs to enter into contracts to transfer veterans that are unable to live independently into adult foster homes. 

The VFW supports this bill, which would add language to Section 1720 of Title 38 to allow veterans who receive VA care and require a protracted period of nursing home care to transfer into an adult foster home.  Under the bill, such homes must have the goal of providing non-institutional, long-term, supportive care.  VA currently has the authority to reimburse institutional care facilities such as nursing homes for long-term domiciliary care, but veterans living in adult foster homes must do so at their own expense.  To grant VA authority to reimburse adult foster homes would provide veterans with an additional residency choice and improve the quality of life for those who would prefer this option. 

The language protects veterans who may wish to reside in such a setting by requiring caregivers to reside on premises, to receive annual training, and to provide 24-hour care.  The adequacy of their living conditions would be ensured through language that would grant needed devices in the home, such as lifts or closed captioning devices.  As part of the contracting process, adult foster homes would be required to accept announced and unannounced visits, and the caregivers who run them would be screened by the VA in addition to being required to pass a federal background check. 

We believe this language defines what and who can serve veterans through an adult foster home in an adequately narrow way, while also responsibly providing the chance to live in a family setting that will be more beneficial for the physical and mental health of veterans of all ages. 

H.R. 5996, Legislation to direct the Secretary of Veterans Affairs to take a more aggressive posture in its treatment of Chronic Obstructive Pulmonary Disease.

The VFW supports this effort.  Chronic Obstructive Pulmonary Disease (COPD) affects our veterans at a rate approximately three times higher than their civilian counterparts, and it is the fourth most common diagnosis among hospitalized veterans.  And among veterans age 65-74, it is the most common diagnosis leading to hospitalization. 

This legislation would improve our response to COPD by requiring VA to develop treatment protocols to prevent, diagnose, treat and manage the disease and also to improve biomedical and prosthetic research.  It also requires the VA to develop pilot programs to gain a better understanding of best practices in this area of medicine.  Finally, the bill contains provisions that require VA to develop better smoking cessation programs to improve techniques and best practices to assist veterans who want to improve their health outlook by successfully quitting smoking. 

HR 6123, To amend title 38, United States Code, to improve the provision of rehabilitative services for veterans with Traumatic Brain Injury

The VFW supports this legislation, as it would make significant improvements to Chapter 17 of Title 38 by expanding the plan for rehabilitation and reintegration of TBI patients to account for the individual’s independence and quality of life. 

It expands objectives for the rehabilitation of veterans suffering from a TBI to include behavioral and mental health concerns.  As a result of this bill, the phrase ‘rehabilitative services’ vice treatments  would be an overarching theme in Chapter 17, thereby conforming the code to the prevailing wisdom that TBI patients deserve more than mere treatment of their injuries—rather, they deserve ongoing evaluation and additional intervention where necessary to ensure a full recovery.  We believe the changes in this bill would make it easier for veterans struggling with the aftermath of a TBI to receive such coverage.

Finally, this bill would also support TBI patients by associating sections of the law related to TBI rehabilitation and community reintegration to a broader definition of the term ‘rehabilitative services’ in Title 38 that comprises a range of services such as professional counseling and guidance services.  Our veterans deserve an optimal chance to lead productive lives, and this bill would help to ensure our response to Traumatic Brain Injuries consists of more than just healing the physical wounds of war. 

HR 6127, A bill to provide for the continued provision of health care services to certain veterans who were exposed to sodium dichromate while serving as a member of the Armed Forces at or near the water injection plant at Qarmat Ali, Iraq, during Operation Iraqi Freedom

Over the course of the last several months, information has surfaced revealing that approximately 800 servicemembers were exposed to harmful chemicals while guarding sensitive infrastructure in Iraq during the first half of 2003.  These servicemembers, Guardsmen and women from a number of different states, were not exposed to a quantity of contaminant considered to be causal to any harmful effects; however, the VFW fully supports taking extraordinary precautions in this case. 

This legislation would extend enrollment eligibility into the VA health care system for all veterans exposed to sodium dichromate at Qarmat Ali by five years from the day they were notified of their exposure.  We have been assured that the VA is reaching out to inform those exposed of their options for care and to advise them on VA recommended examinations and treatments, and the VFW appreciates this effort on their behalf.  We support this legislative effort to give them every reasonable opportunity to seek VA health care as a result of their sacrifice and selfless service to our country. 

Draft bill, To amend title 38, United States Code, to make certain improvements in programs for homeless veterans administered by the Secretary of Veterans Affairs and for other purposes.

VFW supports draft legislation that would enhance many homeless veterans programs.  This bill greatly increases funding for various homeless programs and expands the availability of resources needed by homeless veterans, while including provisions that encourage treatment facilities providing care to homeless veterans to use the available funding effectively.

The bill also addresses the shortfall in funding for aiding homeless veterans.  Prior to this bill funding for health care facilities for treatment of homeless veterans was $5 million a year.  With this bill funding would increase in FY 2011 to $10 million, $15 million in FY 2012, and top out at $21 million in FY 2013.  The increase in funding is needed and would help to expand services across the board for homeless veterans programs. 

The VFW commends the committee for taking a step in the right direction; however, we are concerned that the structure of this temporary increase does not adequately reflect the needs of our veterans. Thousands of Iraq and Afghanistan veterans are returning home to tough economic conditions, often having to give up homes and housing to support the mission, and we believe there is a clear preponderance of data that demonstrates the need for scrutiny of these programs in addition to this supplemental funding.  All veterans should have access to every resource they are entitled to when they are in need, and the VFW is convinced that in order to meet that need, funding levels should not be reduced to levels prior to FY 2011.

The VFW recognizes the many challenges our nation faces in addressing homelessness among our veterans.  For many, the road to homelessness is littered with complications related to medical conditions such as post-traumatic stress disorder, traumatic brain injury, or drug and alcohol addiction.  The provision of temporary housing and/or job placement is only a treatment of some of the symptoms of homelessness, and is far from a cure. 

By striking the term “health care facilities” and amending it to read “eligible entities for the purpose of establishing programs, or expanding or modifying programs that provide assistance to homeless veterans” they would have at their disposal an improved array of options.  Specifically, rehabilitation facilities, work placement services, and homeless shelters that do not necessarily provide medical care would be authorized to receive funding in exchange for their services.  This multi-pronged approach represents a long overdue tactical change that will help to combat homelessness among the veteran population. 

We also applaud the changes in Section 2061 that will institute various safeguards to ensure that funding is used properly by approved facilities.  Proper use of funding and proper oversight – wise stewardship of the taxpayer’s dollar—should never be an ancillary concern, particularly in this fiscally constrained environment.  Making sure that the funds available are spent wisely or be returned to the VA encourages programs to use every available dollar to improve and expand their services. With countless veterans suffering from both the visible and invisible wounds of war completing their overseas tours and separating from the military with bleak job prospects at home, we must ensure an adequate safety net for those veterans who are experiencing hard times. 

 Draft bill, To amend title 38, United States Code, to ensure that health care professionals of VA provide veterans with information concerning service-connected disabilities.

VFW supports draft legislation that would encourage VA health care professionals to furnish information to veterans about benefits provided by the Veterans Health Administration, including guidance on how to apply for compensation relating to a service-connected disability.  Far too many veterans seeking health care services from VA are not aware of the full range of their earned benefits or how to acquire them. VA health care professionals should be providing needed information, advice and assistance.  We believe such a change would help facilitate the acquisition of earned and needed compensation, pension, and other benefits.   We believe that this is an important opportunity for VA to continue to improve upon their outreach services on behalf of those who have worn the uniform and served our great nation.

Thank you for the opportunity to present our views before this Subcommittee.