Chairman Mitchell, Ranking Member Space and members of the Subcommittee:

On behalf of AMVETS (American Veterans) I want to thank you for providing me the opportunity to testify before this Subcommittee concerning pending legislation.

AMVETS supports H.R. 2818 which will amend Chapter 73, title 38, U.S.C., to provide for the establishment of Epilepsy Centers of Excellence. AMVETS believes that with the number of servicemembers who have been exposed to Improvised Explosive Devices (IEDs), VA must take every action possible to develop Epilepsy Centers of Excellence to conduct research, education, and the highest quality clinical care for our veterans who will undoubtedly become epileptic. Research has shown that more than 50% of service related TBI from the Vietnam War became epilepsy within 1-15 years from the date of the trauma.More recent studies have shown that mild to moderate TBI victims, even those who did not lose consciousness, are at risk of having cognitive deficits. When the brain is working to repair the damage caused by TBI, excessive neuroexcitation occurs. When these neuroexcitations misfire it can cause, among other symptoms, seizures. Data from a 2003 report found that 61% of returning servicemembers were exposed to IED blasts. It is unrealistic to predict the number of veterans from current conflicts who will become epileptic from TBI, but it is very realistic to predict from past evidence and the IED exposure rate that thousands of veterans are susceptible to epileptic seizures. It would be irresponsible for Congress to wait until there is an epileptic crisis to provide VA with the means to research and treat this condition.

Although AMVETS understands the benefits of being able to be near one’s home when recovering, we historically oppose contract for care when there is timely access to a VA facility. Therefore, AMVETS opposes H.R. 4915, the “Veterans’ Access to Local Options for Recovery Act of 2007” (VALOR Act).

H.R. 5554, the “Veterans Substance Use Disorders Prevention and Treatment Act” expands and improves health care services available to veterans from the Department of Veterans Affairs for substance use disorders. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), one fifth of veterans of wars in Iraq and Afghanistan who received care from the Department of Veterans Affairs between 2001 and 2005 were diagnosed with substance use disorder (SUD). In November of 2007 SAMHSA published the National Survey on Drug Use and Health (NSDUH) which stated that an annual average of 7.1 percent of veterans (an estimated 1.8 million persons) met the criteria for SUD. From 2004 to 2006 approximately 1.5 percent of veterans aged 18 or older (an estimated 395,000 persons) had co-occurring serious psychological stress (SPD) and SUD. AMVETS recognizes the importance of ensuring veterans have access to a full continuum of care and for this reason support the expansion of veterans substance use disorder programs.

AMVETS is concerned, however, with Section 4 of this bill which provides $1.5 million dollars in 2009 and 2010 for a pilot program for Internet-based substance use disorder treatment for veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). AMVETS does not believe the Internet is an appropriate medium for substance use disorder treatment. It is impossible to provide the continuum of care outlined in Section 2 of the bill without inpatient or intensive outpatient treatment. AMVETS would support appropriating those funds to ensure veterans access to more traditional and proven treatment options.

AMVETS wholly supports H.R.5595 the “Make Our Veterans Smile Act of 2008.” This will ensure dental service for those who have sacrificed so much. Currently, Section 1712, Title 38 U.S.C., provides dental care for certain eligible veterans. This legislation will provide dental services to all disabled veterans. It is well documented that poor oral health can attribute to poor physical health. Therefore, VA should view dental care as an important aspect of overall health of veterans. This legislation would be most beneficial to veterans who are rated 100% disabled and have begun dental care through VA, and due to reevaluation the disability rating is reduced, leaving the veteran with partially completed dental care with no means to complete the care. This was the case for one veteran, who has requested to stay anonymous, who was rated 100% disabled with PTSD and upon reevaluation his rating was reduced to 90%, leaving him with partially completed bridge work that was initiated by VA, but because of the rating reduction was no longer eligible for dental care. If Congress truly wants to provide a full continuum of care for our veterans, then dental health should be a part of that care.

AMVETS views Section 2, Subsection (b) of H.R. 5595 as an administrative amendment of contract for care and not new authority for the Secretary to enter into contracts. Additionally, AMVETS would prefer H.R. 5595 be enacted as written, but would consider supporting an amendment, based on cost estimates, that would reduce coverage to those already receiving care under Section 1712, title 38 U.S.C., and Priority Group 1 veterans who are not currently covered by that same section.

H.R. 5622 the “Veterans Timely Access to Health Care Act,” provides a five-year pilot program to evaluate the standard for access to care for veterans. AMVETS opposes this legislation. VBA currently tracks primary care standard for access; therefore, AMVETS believes this program would build unnecessary redundancy in tracking. Current tracking should be used to trend VA’s need for primary care FTE. Also, AMVETS is opposed to contracting primary care. Even though VA can be billed by non-department care providers at no cost to the veteran, under current VA regulation VA is not allowed to honor non-department prescriptions, so the veteran would be obligated to pay for any medications the non-department physician would write. Again, AMVETS supports tracking of standard of access to care, but only for the purpose of evaluating hiring needs.

Mr. Chairman, this concludes my testimony.  I thank you again for the privilege to present our views, and I would be pleased to answer any questions you might have.