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Witness Testimony of Bill Lawson, Paralyzed Veterans of America, National President

Chairman Murray, Chairman Miller and members of the Committees, I appreciate the opportunity to present the legislative priorities for 2011 of Paralyzed Veterans of America (Paralyzed Veterans).  Since its founding, Paralyzed Veterans has developed a worthy record of accomplishment, of which we are extremely proud.   Again, this year, I come before you with our views on the current state of veterans’ programs and services and recommendations for continued improvement in the services and benefits provided to veterans.

BACKGROUND -- Paralyzed Veterans was founded in 1946 by a small group of returning World War II veterans, all of whom had experienced catastrophic spinal cord injury and who were consigned to various military hospitals throughout the country.  Realizing that neither the medical profession nor government had ever confronted the needs of such a population, the returning veterans decided to become their own advocates and to do so through a national organization.

From the outset the founders recognized that other elements of society were neither willing nor prepared to address the full range of challenges facing individuals with a spinal cord injury, be they medical, social, or economic.  Paralyzed Veterans’ founders were determined to create an organization that would be governed by the members, themselves, and address their own unique needs.  Being told that their life expectancy could be measured in weeks or months, these individuals set as their primary goal actions that would maximize the quality of life and opportunity for all veterans and individuals with spinal cord injury - it remains so today.

To achieve its goal over the years, Paralyzed Veterans has established ongoing programs of research, sports, service representation to secure our members’ and other veterans’ benefits, advocacy in promoting the rights of all citizens with disabilities, architecture promoting accessibility, and communications to educate the public about individuals with spinal cord injury.  We have also developed long-standing partnerships with other veterans’ service organizations.  Paralyzed Veterans, along with AMVETS, Disabled American Veterans, and the Veterans of Foreign Wars, co-author The Independent Budget—a comprehensive budget and policy document that has been published for 25 years. 

Today, Paralyzed Veterans is the only congressionally chartered veterans’ service organization dedicated solely to the benefit and representation of veterans with spinal cord injury or disease. 

SUFFICIENT, TIMELY AND PREDICTABLE FUNDING FOR VA HEALTH CARE – Last year the Administration recommended an advance appropriation for FY 2012 of approximately $50.6 billion in discretionary funding for VA medical care.  The House of Representatives recently supported this recommendation in H.R. 1, the “Continuing Resolution for FY 2011.”  When combined with the $3.7 billion Administration projection for medical care collections, the total available operating budget recommended for FY 2012 is approximately $54.3 billion.  However, included in the President’s Budget Request for FY 2012, the Administration revised the estimates for Medical Care down by $713 million due to the proposed federal pay freeze (a factor not included in H.R.1). 

Of particular concern to Paralyzed Veterans of America and the other co-authors of The Independent Budget is an ill-defined contingency fund that would provide $953 million more for Medical Services for FY 2012.  The VA clearly believes that it needs this additional funding as evidenced by the fact that they include it in their budget request; and yet, they seem to be unwilling to stand behind their recommendation as they offer this funding as a possible “contingency.”  We urge the VA to have the courage to stand behind the recommendations that it makes when it comes to funding for the critical operations of the health care system. 

Moreover, we are especially concerned that the VA presumes “management improvements” of approximately $1.1 billion to be directed towards FY 2012 and FY 2013.  The use of management improvements or efficiencies was a gimmick commonly used in the past to reduce the requested level of discretionary funding; and yet, rarely did the VA realize any actual savings from those gimmicks.  Additionally, we are concerned about the revised estimate in Medical Care Collections from the originally projected $3.7 billion to now only $3.1 billion.  Given this revision in estimates, the VA budget request may arguably be short $600 million in budget authority for next year. 

For FY 2012, the Administration recommends $53.9 billion for total Medical Care spending.  The Independent Budget recommends approximately $55.0 billion for total medical care.  This includes approximately $43.8 billion for Medical Services.      

We are also concerned about the steep reduction in spending for Medical and Prosthetic Research.  The Independent Budget recommends $620 million, approximately $111 million more than the Administration’s request.  Research is a vital part of veterans’ health care, and an essential mission for our national health care system.  At a time of war, the government should be investing more, not less, in veterans’ biomedical research programs. 

We are pleased to see that the Administration has proposed an increase in the Medical Care accounts for FY 2013.  The Administration recommends $55.8 billion for total medical care budget authority for FY 2013.  However, we urge Congress to remain vigilant to ensure that the proposed funding levels for FY 2013 are in fact sufficient to meet the continued growth in demand on the health care system. 

Additionally, we believe that Congress must conduct aggressive oversight to ensure that appropriated dollars are being spent the way that Congress intended.  We have increasingly received reports from PVA staff members located in medical facilities that funding is running short.  We have heard anecdotally that medical facilities are putting into place hiring freezes and staffing caps; and yet, they presume to have approximately $1.1 billion in carryover funds this year.  We find this particularly troublesome in light of the significant increases that have been appropriated for the VA health care system in recent years. 

Similarly, we believe Congress needs to examine the Veterans Equitable Resource Allocation (VERA) model.  We have heard concerns that allocations for caring for severely disabled veterans, including veterans with spinal cord injury, are decreasing.  Without a detailed explanation of these decisions, we remain skeptical that appropriated dollars are getting to the intended end user—the direct providers of health care services. 

MODERNIZING THE VA CLAIMS PROCESS – Paralyzed Veterans appreciates the interest and effort that has been given to updating and modernizing the VA disability system in recent years.  The Veterans Benefits Administration (VBA) is at a critical junction in its efforts to reform an outdated, inefficient, and overwhelmed claims processing system.  After struggling for decades to provide timely and accurate decisions on claims for veterans benefits, VBA over the past year has started down a path that may finally lead to essential transformation and modernization, but only if it has the leadership necessary to undergo a cultural shift in how it approaches the work of adjudicating claims for veterans benefits.

To achieve real success, VBA must focus on creating a veterans’ benefits claims processing system designed to “get each claim done right the first time.”  Such a system would be based upon a modern, paperless information technology (IT) and workflow system focused on quality, accuracy, efficiency and accountability.  The foundation of this new system must be continuous improvement; VBA must evolve its corporate culture to focus on information gathering, systems analysis, identification of problems, creative solutions and rapid adjustments.  If VBA stresses quality control and training, and continues to receive sufficient resources, timeliness will improve and production will increase and then and only then can the backlog be reduced and eventually eliminated.

Meanwhile, the VBA has undertaken a number of initiatives and pilot programs to address the claims backlog and reform the claims process simultaneously.  However, we remain concerned about whether VBA will successfully extract and then integrate the best practices from so many ongoing initiatives, while simultaneously meeting the Secretary’s ambitious goals with regards to “breaking the back of the backlog.”  Given the enormous pressure to reduce the backlog, we are concerned that there could be a bias towards process improvements that result in greater production over those that lead to greater quality and accuracy.  We urge the Committees to provide sufficient oversight of the VBA’s myriad ongoing pilots and initiatives to ensure that best practices are adopted and integrated into a cohesive new claims process and that each pilot or initiative is judged first and foremost on its ability to help VA get claims “done right the first time.”

Finally, we believe that VBA must accelerate the progress toward an electronic claims record system.  Undoubtedly the most important new initiative underway at VBA is the Veterans Benefits Management System (VBMS), which is designed to provide VBA with a comprehensive, paperless, and ultimately rules-based method of processing and awarding claims for VA benefits, particularly disability compensation and pension.  While the development and deployment of a modern IT system to process claims in a paperless environment is long overdue, Paralyzed Veterans is concerned about whether the VBMS is being rushed to meet self-imposed deadlines in order to show progress towards “breaking the back of the backlog.”  While we have long believed that VBA’s IT infrastructure was insufficient, outdated and constantly falling farther behind modern software, web and cloud-based technology standards, we are equally concerned about a rushed solution that ultimately produces an insufficiently robust IT system.

Ultimately, it is imperative for all key stakeholders—the VA, Congress, and veterans service organizations—to be fully involved in the reformation of the claims processing system as a whole.  Moreover, there remains a broader range of issues within the scope of the claims processing system that can be addressed.  Much of this information is discussed in great detail in The Independent Budget for FY 2012. 

PROTECTION OF THE VA HEALTH CARE SYSTEM – The Department of Veterans Affairs (VA) is the best health care provider for veterans.  Providing primary care and specialized health services is an integral component of VA’s core mission and responsibility to veterans.  Across the nation, VA is a model health care provider that has led the way in various areas of medical research, specialized services, and health care technology.  In fact, the VA’s specialized services are incomparable resources that often cannot be duplicated in the private sector.  However, these services are often expensive, and are severely threatened by cost-cutting measures and the drive toward achieving management efficiencies.

Over the years, VA has earned a reputation as a leader in the medical field for its quality of care and innovation in both the health care and medical research fields.  However, even with VA’s advances as a health care provider, some political leaders and policy makers continue to advocate for VA enrollment restrictions, use of vouchers, or increased fee basis care.  Such changes to the Veterans Health Administration (VHA) would result in moving veterans from “veteran-specific” care within VA and into the private health care industry.  Ultimately, these proposals would lead to diminution of VA health care services, and increased health care costs in the federal budget.  Despite these recent calls for providing veterans with vouchers for private care or the expansion of fee basis care, Paralyzed Veterans strongly believes that VA remains the best option available for veterans seeking health care services.

The VA’s unique system of care is one of the nation’s only health care systems that provide developed expertise in a broad continuum of care.  Currently, VHA serves more than 8 million veterans, and provides specialized health care services that include program specific centers for care in the areas of spinal cord injury/disease, blind rehabilitation, traumatic brain injury, prosthetic services, mental health, and war-related poly-traumatic injuries.  Such quality and expertise on veterans’ health care cannot be adequately duplicated in the private sector.

As VA services are catered to the needs of veterans, VHA has received excellent ratings from patient satisfaction surveys, and garnered much recognition for its national safety program.  The VA’s system of patient-centered and coordinated care helps to ensure safe and consistent delivery of services.  Additionally, independent research organizations have also found VA to be the lowest cost provider when compared to private industry. 

For decades, VA has provided services and benefits to ensure that the unique health care needs of veterans are adequately provided for and that the quality of those services is of the highest caliber possible.  Providing primary care and specialized health services is an integral component of the Department of Veterans Affairs’ core mission and responsibility to veterans. 

IMPLEMENTATION OF P.L. 111-163, THE “CAREGIVERS AND VETERANS OMNIBUS HEALTH SERVICES ACT” – Paralyzed Veterans and its partners worked extremely hard to get comprehensive caregiver legislation enacted during the 111th Congress.  Fortunately, on May 5, 2010, the President signed into law P.L. 111-163, the “Caregivers and Veterans Omnibus Health Services Act.”  This legislation created an innovative new caregiver program to be administered by the Department of Veterans Affairs (VA).  The law called for the VA to begin implementation of this important new program within 270 days of enactment of the bill.  This placed the deadline for implementation of this legislation in February of this year.  However, the VA’s efforts have fallen flat, to say the least. 

As you know, the VA recently published its interim final rules regarding the implementation of the caregiver provisions of P.L. 111-163.  Paralyzed Veterans was very disappointed to see that the VA tailored its eligibility criteria very narrowly to provide for services for a much smaller number of veterans than Congress intended.  The VA essentially explained that it will base eligibility for the new caregiver provisions on whether or not the veteran being cared for would otherwise be kept in an institutional setting.  This simply ignores the call for more home and community-based care settings, particularly for the newest generation of veterans.  Moreover, it ensures the narrowest scope of eligibility for the caregiver benefits.  This is totally unacceptable. 

We were already concerned about the fact that the original legislation divided the levels of services provided between Pre-9/11 and Post-9/11 service-connected disabled veterans.  And yet, we ultimately supported the final legislation because it will do a great deal of good for the newest generation of severely disabled veterans while allowing for the VA to expand the broad range of caregiver services to Pre-9/11 veterans in the future. 

Paralyzed Veterans has over 60 years of experience understanding the complex needs of spouses, family members, friends, and personal care attendants that love and care for veterans with life-long medical conditions.  The aspects of personal independence and quality care are of particular importance to veterans with spinal cord injury/dysfunction.  As a result of today’s technological and medical advances, veterans are withstanding combat injuries and returning home in need of medical care on a consistent basis.  Such advances are also prolonging and enhancing the lives and physical capabilities of injured veterans from previous conflicts.  No matter the progress of modern science, these veterans need the health-care expertise and care from a health team comprised of medical professionals, mental health professionals, and caregivers.  As a part of the health care team, caregivers must receive ongoing support to provide quality care to the veteran. It is for this reason, that we strongly urge VA to develop support and educational programs by conducting caregiver assessments that identify the needs and problems of caregivers currently caring for veterans. 

Our experience has shown that when the veteran’s family unit is left out of the treatment plan, the veteran suffers with long reoccurring medical and social problems.  However, when family is included in the health plan through services such as VA counseling and education services, veterans are more apt to become healthy, independent, and productive members of society.

With regard to family caregiver services, we ask that VA continue its effort to enhance the support and educational services provided to family members caring for veterans.  There are approximately 44 million individuals across the United States that serve as caregivers on a daily basis.  The contributions of caregivers in today’s society are invaluable economically as they obviate the rising costs of traditional institutional care. 

As the veteran community is aware, family caregivers also provide mental health support for veterans dealing with the emotional, psychological, and physical effects of combat.  Many Paralyzed Veterans members also have a range of co-morbid mental illnesses, therefore, we know that family counseling, and condition specific education is fundamental to the successful reintegration of the veteran into society.  Combat exposure coupled with long and frequent deployments are associated with an increased risk for Post Traumatic Stress Disorder (PTSD) and other forms of mental illness.  In fact, the VA reports that Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans have sought care for a wide array of possible co-morbid medical and psychological conditions. 

We believe that Vet Centers should increase coordination with VA medical centers to accept referrals for family counseling; increase distribution of outreach materials to family members with tips on how to better manage the dislocation; improve reintegration of combat veterans who are returning from deployment; and provide information on identifying warning signs of suicidal ideation so veterans and their families can seek help with readjustment issues.  Paralyzed Veterans believes that an effective mental illness family counseling and education program can improve treatment outcomes for veterans, facilitate family communication, increase understanding of mental illness, and increase the use of effective problem solving and reduce family tension.

INAPPROPRIATE BILLING – In recent years, as we have seen significant increases in both medical care collections estimates as well as the actual dollars collected, we have received an increasing number of reports from veterans who are being inappropriately billed by the Veterans Health Administration (VHA) for their care.  Moreover, this is not a problem being experienced by just service-connected disabled veterans, but non-service connected disabled veterans as well. 

The Independent Budget has repeatedly focused attention on this issue.  Unfortunately, little action has been taken to address this problem while medical care collections continue to grow at an alarming rate.  Inappropriate charges for VA medical services places unnecessary financial stress on individual veterans and their families.  These inaccurate charges are not easily remedied and their occurrence places the burden for correction directly on the veteran, their families or caregivers. 

In order to understand inappropriate billing, it is important to emphasize that service-connected and non-service connected veterans have experienced this problem.  However, the problems that these two populations of veterans have faced are uniquely different.  Service-connected veterans are faced with a scenario where they, or their insurance company, may be billed for treatment of a service-connected condition.  Meanwhile, non-service connected disabled veterans are usually billed multiple times for the same treatment episode or have difficulty getting their insurance companies to pay for treatment provided by the VA. 

We recently reached out to our national service officers to help us identify why these issues may be occurring.  First, it is important to note that the vast majority of PVA members who are service-connected are rated as 100 percent PERMANENT and TOTAL.  To be clear, PERMANENT and TOTAL suggests to us that any condition that a veteran experiences is related to his or her service-connected condition.  In our opinion, this should mean that 100 percent PERMANENT and TOTAL service-connected disabled veterans should not be billed, nor should their insurance company be billed, for any treatment they receive.  However, this is not how the VHA sees it. 

In fact, the VA has gone so far as to recommend to veterans who have been billed for treatment of well-known, but non-rated, secondary conditions should re-file or reopen their claims.  If the VA thinks it has a problem with the claims backlog now, we can only imagine what the backlog will look like if all veterans experiencing this problem go back to the Veterans Benefits Administration (VBA) for consideration of something that will almost certainly be granted months later. 

We recommend that the VA immediately change its regulations to reflect the fact that a PERMANENT and TOTAL rating means exactly that.  If the VA is unwilling to make this absolutely necessary change, then we call on these Committees and Congress to fix this statutorily. 

While it is shameful that VHA takes advantage of veterans with service-connected conditions like this, it is equally disappointing that veterans who depend on the VA for their care but who are not rated for service-connected conditions are also being taken advantage of.  Non-service connected veterans are also constantly frustrated with VA’s billing process.  Over-billing and inappropriate charging for co-payments is becoming the norm rather than the exception.  Frequently, veterans are experiencing multiple billing episodes for a single medical treatment or health care visit.  While the passage of P.L. 111-163 should alleviate some of the difficulties catastrophically disabled veterans are experiencing with this problem, many other non-service connected veterans continue to face this situation. 

It is time that the VA really be taken to task for its billing practices.  If Congress and the Administration are going to continue to rely on massive collections estimates and dollars actually collected to support the VA health care budget, then serious examination of how the VA is achieving these numbers is necessary.  As long as we know that the VA is taking advantage of veterans and inappropriately billing them, both service-connected and non-service connected, we will continue to express opposition to building VA budgets on collections. 

ANCILLARY BENEFITS FOR SEVERELY DISABLED VETERANS – Paralyzed Veterans would like to thank the Committees for their efforts to make real improvements to some of the most important ancillary benefits for severely disabled veterans during the 111th Congress.  Specifically, we were pleased that Congress enacted legislation to increase the adaptive automobile grant and the Specially Adapted Housing grant.  More importantly, we appreciate the fact that Congress included annual indexes to these grants to ensure that their values will no longer erode over time due to inflation. 

One particular change that we believe still must be made is to separate the Temporary Residence Adaptation (TRA) grant from the Specially Adapted Housing grant.  As you know, the purpose of the TRA is to provide assistance for disabled veterans who are temporarily residing in housing owned by a family member.  The maximum amount of the grant is $14,000.  A recent GAO report indicated very few veterans have used this grant since it was created in 2006.   Paralyzed Veterans and other veterans’ service organizations have repeatedly stressed that the reason this grant is not used is because the dollar amount is subtracted from the veteran’s total funds available from the Specially Adapted Housing grant.

However, we believe there is more than can and must be done to support the needs of severely disabled veterans.  Specifically, we believe that the Committee needs to address the well-established shortfall in the rates of Special Monthly Compensation (SMC) paid to the most severely disabled veterans that the VA serves.  SMC represents payments for “quality of life” issues, such as the loss of an eye or limb, the inability to naturally control bowel and bladder function, the inability to achieve sexual satisfaction or the need to rely on others for the activities of daily life like bathing, or eating.  To be clear, given the extreme nature of the disabilities incurred by most veterans in receipt of SMC, we do not believe that the impact on quality of life can be totally compensated for; however, SMC does at least offset some of the loss of quality of life.  Paralyzed Veterans believes that an increase in SMC benefits is essential for veterans with severe disabilities.  Many severely injured veterans do not have the means to function independently and need intensive care on a daily basis.  Many veterans spend more on daily home-based care than they are receiving in SMC benefits.  This fact was supported by the testimony of numerous witnesses at a hearing conducted by the Subcommittee on Disability Assistance and Memorial Affairs in July 2009. 

One of the most important SMC benefits to Paralyzed Veterans is Aid and Attendance (A&A).  Paralyzed Veterans would like to recommend that Aid and Attendance benefits should be appropriately increased.  Attendant care is very expensive and often the Aid and Attendance benefits provided to eligible veterans do not cover this cost.  In fact, many Paralyzed Veterans members who pay for full-time attendant care incur costs that far exceed the amount they receive as SMC-Aid and Attendant beneficiaries at the R2 compensation level (the highest rate available).  We encourage the Committee to consider the provisions of legislation introduced during the 111th Congress, H.R. 3407, the “Severely Injured Veterans Benefits Improvement Act of 2009,” that specifically address increases to the R1 and R2 rates for SMC. 

HUMAN RESOURCE CHALLENGES FACING THE VA – As service members return home from the wars in Afghanistan and Iraq, and veterans who have served previously, are serving today, and will serve in the future, seek VA services, VA must make certain that it is adequately staffed with a well trained workforce committed to providing veterans with high quality care and services.  To ensure that such a workforce exists, VA must update existing human resources policies and procedures to ensure that VA is attracting the highest caliber of professionals, and providing VA employees with sufficient professional training and opportunities for career development.

As it relates to human resources, for many years VA has been faced with issues such as the timeliness of hiring new employees, providing employment benefits that are competitive with private sector employers, and implementing aggressive recruitment strategies.  PVA believes that VA must combine competitive compensation packages with hiring incentives such as signing and retention bonuses, and educational benefits in an effort to recruit and retain qualified professionals.  Recruitment incentives are particularly important for attracting medical professionals with the skills and expertise to provide care in VA’s specialized service programs such as spinal cord injury/dysfunction, blind rehabilitation, mental health, and brain injury. 

Professional training for VA employees is another critical element to ensuring that veterans receive their VA benefits and have access to VA services in a timely manner.  Continuous on the job training is essential to VA employees carrying out their duties and meeting veterans’ needs.  VA must work to provide professional training programs for qualifying employees to ensure that its staff is equipped to deliver the quality services that are promised to the men and women who have served our country. The VA’s ability to care for America’s veterans directly depends on its ability to sustain a full complement of skilled and motivated personnel.  In recent years, VA has revised recruitment strategies and re-evaluated employee benefits packages.  While PVA recognizes the VA’s effort to address the challenges facing its human resources programs, we believe that more must be done to address these issues and ensure that veterans receive the services they deserve.  We continue to support VA as it works to improve its human resources processes and policies, and hope that Congress will do the same. 

INCREASE IN CHAMPVA BENEFICIARY AGE – P.L. 111-148, the “Patient Protection and Affordable Care Act,” extended the eligibility age for dependent children being carried on their parents’ health insurance policies to 26 years old.  Unfortunately, this benefit was not initially provided to TRICARE and CHAMPVA beneficiaries.  The extension was subsequently provided to dependent children of military personnel (those on TRICARE) by P.L. 111-383, the “National Defense Authorization Act (NDAA) for FY 2011.”

Unfortunately, CHAMPVA beneficiaries were omitted from the NDAA when it became law.  At this time, the only qualified dependents that are not covered under a parent’s health insurance policy are those of 100 percent service-connected disabled veterans covered under CHAMPVA.  To address this issue, legislation was introduced in the House of Representatives—H.R. 115, the “CHAMPVA Children’s Protection Act of 2011.”  At this time, similar legislation has not been introduced in the Senate; however, we have been assured by the Senate Committee on Veterans’ Affairs that companion legislation will soon follow. 

LONG-TERM CARE – Paralyzed Veterans continues to be concerned about the lack of VA’s long-term care services for veterans with spinal cord injury or dysfunction (SCI/D).  Approximately 6,000 of our members are now over 65 years of age and another 7,000 are currently between 55 and 64.  These aging veterans are experiencing an increasing need for VA’s home and community-based services and VA’s specialized SCI/D nursing home care.

The ability to remain home for these veterans is based on their ability to receive VA home and community-based services such as hospital based home care or respite services.  For others, their living status and independence is based on the health of a primary caregiver, usually a spouse, who is also aging and may no longer be able to provide the level of support they once could.  VA’s non-institutional long-term care services are keys to supporting aging SCI/D veterans and their caregivers and their desires to remain home as they grow older.

Unfortunately, the ability of veterans with SCI/D to access a full range of VA home and community-based care varies across the country.  Waiting lists exist at almost all VA facility locations and many other VA facilities don’t offer the full range of services mandated by the Millennium Health Care Act.  Additionally, VA program geographic boundaries often limit access to long-term care services provided by a regional VA SCI center. 

The availability of these services is necessary to support veterans with SCI/D and their aging caregivers in their own homes, where they most want to be, and at a dramatically lower cost of care to VA.  Paralyzed Veterans requests your Committees encourage VA to provide the full range of home and community-based long-term care services, as mandated by P.L. 106-117, the “Veterans Millennium Health Care and Benefits Act of 1999,” at each and every VA facility within the system.

Regarding specialized SCI/D nursing home care, VA currently only provides specialized nursing home care services for veterans with SCI/D in four locations.  Combined these four locations only provide 152 staffed specialized nursing home care beds and they are all located east of the Mississippi River.  While the VA CARES process called for additional SCI/D nursing home care beds the VA construction process has been slow to respond.  CARES called for additional beds to be located in Cleveland, Ohio; Long Beach, California and in Memphis, Tennessee.  However, after almost 10 years, Paralyzed Veterans is still pushing VA to proceed with these recommendations.

While additional VA SCI/D nursing home capacity is on the horizon it will take years for these beds to become a reality.  New SCI/D LTC beds are in the VA preliminary design phase at Brockton, Massachusetts; Dallas, Texas; Bronx, New York; San Diego, California and in Orlando, Florida but it will take years to bring them on line. 

Paralyzed Veterans of America appreciates the opportunity to present our legislative priorities and concerns for the first session of the 112th Congress.  We look forward to working with the Committees to ensure that sufficient, timely, and predictable resources are provided to the VA health care system so that eligible veterans can receive the care that they have earned and deserve.  We also hope that the committees will take the opportunity to make meaningful improvements to the benefits that veterans rely on.

Chairmen Murray and Miller, I would like to again thank you for the opportunity to testify.  I would be happy to answer any questions you have.