Mr. Chairman and members of the Subcommittee, Paralyzed Veterans of America (PVA) would like to thank you for the opportunity to submit a statement for the record on H.R. 2818; H.R. 4915, the “Veterans Access to Local Options for Recovery Act;” H.R. 5554, the “Veterans Substance Use Disorders Prevention and Treatment Act;” H.R. 5595, the “Make Our Veterans Smile Act;” H.R. 5622, the “Veterans Timely Access to Health Care Act;” and the “Spina Bifida Health Care Program Expansion Act.”  PVA appreciates the emphasis this Subcommittee has placed on critical issues facing all generations of veterans, such as substance abuse disorders.  We hope that addressing the issues outlined in this legislation will better benefit today’s veterans and the veterans of tomorrow.

H.R. 2818, Epilepsy Centers of Excellence

PVA principally supports H.R. 2818, a bill that would create six Epilepsy Centers of Excellence within the VA health care system.  Much like the Multiple Sclerosis (MS) and Parkinson’s disease Centers of Excellence permanently authorized during the 109th Congress, this proposal recognizes the successful strategy of the Veterans Health Administration (VHA) to focus its system-wide service and research expertise on a critical care segment of the veteran population.  The designation of these six Centers of Excellence will provide open access to centers engaged in marshaling VA expertise in diagnosis, service delivery, research and education.  Furthermore, these programs will be available across the country through the “hub and spokes” approach. 

We also hope that this legislation will sow the seeds for broader based research and development into traumatic brain injury (TBI), as we believe the same concept could be crucial for better treatment for veterans in the future.  This is particularly important in light of the number of veterans returning from service in Iraq and Afghanistan who have incurred a traumatic brain injury. 

H.R. 4915, the “Veterans Access to Local Options for Recovery Act”

PVA strongly opposes the proposed legislation which would essentially allow the VA to expand contract health care opportunities.  This legislation would give the VA additional leverage to contract out any type of medical services.  If you review the early stages of VA’s Project HERO, it is apparent that this is a direction that some VA senior leadership would like to go.  We believe that this legislation would set a dangerous precedent, encouraging those who would like to see the VA privatized.  Privatization is ultimately a means for the federal government to shift its responsibility of caring for the men and women who served. 

As we have stated in the past, we believe legislation such as this is wholly unnecessary.  In fact, we would like to point out that current law allows VA to contract for care with private health care providers in instances where VA facilities are incapable of providing necessary care to a veteran; when VA facilities are geographically inaccessible to a veteran for necessary care; when medical emergency prevents a veteran from receiving care in a VA facility; to complete an episode of VA care; and, for certain specialty examinations to assist VA in adjudicating disability claims.  With this in mind, this legislation serves no real purpose other than to encourage contract health care. 

H.R. 5554, the “Veterans Substance Use Disorders Prevention and Treatment Act”

PVA fully supports H.R. 5554, a bill that would expand health care services to veterans dealing with substance use disorders.  The stress and pressure associated with military service, and by extension combat service, place veterans at much greater risk for alcohol abuse and dependence.  In fact, surveys have demonstrated that veterans report higher rates of alcohol abuse and dependence.

We are please that the Subcommittee has chosen to address this critical need among the veteran population.  In fact, the legislation would mandate that the VA provide services as recommended in The Independent Budget for FY 2009:

We urge VA to provide a full continuum of care for substance-use disorders, including more consistent and universal periodic screening of OEF/OIF combat veterans in all its health facilities and programs—especially primary care.  Outpatient counseling and pharmacotherapy should be available at all larger VA community-based outpatient clinics, and short-term outpatient counseling, including motivational interventions, intensive outpatient treatment, residential care for those most severely disabled, detoxification services, ongoing aftercare and relapse prevention, self-help groups, opiate substitution therapies, and newer drugs to reduce craving, should be included in VA’s overall program for substance abuse and prevention. 

PVA also particularly appreciates the Subcommittee considering innovative new techniques to address the needs of today’s newest generation of veterans by instituting an internet-based pilot program.  These new veterans are very technology savvy and drawn to non-traditional methods for treatment.  We believe that this pilot program could be a positive first step in better addressing the needs of these veterans who are battling substance use problems. 

H.R. 5595, the “Make Our Veterans Smile Act”

PVA supports H.R. 5595, a bill that would allow veterans with a service-connected disability to receive dental care through the VA.  Current law limits this service to veterans whose dental issues are either service-connected or aggravated by another service-connected condition.  The VA is also authorized to provide dental care to veterans who are rated as totally disabled.  We have no problem with providing dental care to any service-connected veteran as it will enhance the full continuum of care available to these individuals.

H.R. 5622, the “Veterans Timely Access to Health Care Act”

H.R. 5622, the “Veterans Timely Access to Health Care Act,” would require the VA to carry out a pilot program to establish standards of access to care within the VA health system.  Under the requirements of the pilot program, the VA will be required to provide a primary care appointment to veterans seeking health care within 30 days of a request for an appointment.  If a VA facility is unable to meet the 30-day standard for a veteran, then the VA must make an appointment for that veteran with a non-VA provider, thereby contracting out the health care service.  The legislation also requires the Secretary of the VA to report to Congress each quarter of a fiscal year on the efforts of the VA health system to meet this 30-day access standard.  The concepts of this legislation are not unlike similar legislation—H.R. 92—that was considered by this Subcommittee last year. 

Access is indeed a critical concern of PVA.  The number of veterans enrolled in the VA is approaching 8 million and the number of unique users is nearly 6 million.  Despite the ongoing policy to deny enrollment to Category 8 veterans, the numbers of enrolled veterans continues to increase, particularly as more and more veterans of the Global War on Terror take advantage of the services in VA.

PVA is concerned that contracting health care services to private facilities when access standards are not met is not an appropriate enforcement mechanism for ensuring access to care.  In fact, it may actually serve as a disincentive to achieve timely access for veterans seeking care.  Contracting out to private providers will leave the VA with the difficult task of ensuring that veterans seeking treatment at non-VA facilities are receiving quality health care.  We do think that access standards are important.  We believe that the answer to providing timely access to quality care in the VA is sufficient, predictable, and timely funding coordinated with sufficient staff and capacity.  For these reasons, PVA cannot support H.R. 5622.

H.R. 5729, the “Spina Bifida Health Care Program Expansion Act”

PVA supports the proposed legislation that would allow for more comprehensive health care services to the children of Vietnam veterans who suffer from spina bifida and related conditions.  We have heard anecdotally that some of these individuals have experienced difficulties in receiving proper care due to the burden of trying to prove that the health issue that they are dealing with is in fact related to the spina bifida.  This legislation would eliminate that concern by ensuring that they can get a full continuum of health care services, regardless if a connection to spinal bifida can be proved.  As an aside, we would like to know if the VA has a record of how many individuals it is providing for under the current spina bifida statute and if it would be willing to share that information?

H.R. 5730, Injured and Amputee Veterans Bill of Rights

PVA generally supports the intent of the proposed legislation.  This bill would ensure that VA prosthetics clinics around the country prominently display the “Injured and Amputee Veterans Bill of Rights.”  This reaffirms the idea that a veteran in need of an assistive device or prosthetic gets the highest quality item available and in a timely manner.  The only concern that we have about this legislation is that the language seems to ignore veterans who may be in need of special equipment who suffer from a specific disease and not a physical injury.

Mr. Chairman and members of the Subcommittee, PVA would once again like to thank you for the opportunity to provide our views on this important legislation.  We look forward to working with you to continue to improve the health care services available to veterans. 

Thank you again.  We would be happy to answer any questions that you might have.