Mr. Chairman and members of the Committee, I am pleased to be here today to provide the Department of Veterans Affairs’ (VA) views on pending benefits legislation.  Accompanying me is Richard J. Hipolit, Assistant General Counsel.  VA is still reviewing H.R. 5448 and will provide views on that bill in a subsequent views letter.

H.R. 1197

H.R. 1197, the “Prisoner of War Benefits Act of 2007,” would:  (1) repeal the current minimum 30-day internment period required for veterans who are former prisoners of war (POWs) to be entitled to presumptive service connection for the disabilities listed in 38 U.S.C. § 1112(b)(3); (2) add type-2 diabetes and osteoporosis to the list of disabilities presumed service connected for former POWs; and (3) authorize VA to administratively determine, and establish procedures for such determinations, whether to add or remove diseases from the list of POW presumptions.  The bill would require VA, in making such determinations, to take into account the recommendations received from the Advisory Committee on Former Prisoners of War and, whenever that committee recommends that a presumption of service connection be established for a disease, to make the determination not later than 60 days after receipt of the recommendation.  VA would have 60 days after that to either propose regulations to implement a positive determination or publish a notice of a negative determination.  Final regulations would be required not later than 90 days after any proposed regulations are issued.

VA does not support this bill for the following reasons:

The diseases already listed in section 1112 have been medically and scientifically associated with the harsh physical and psychological conditions associated with POW internment.  It is unreasonable to assume that the extreme deprivation associated with the diseases listed in section 1112(b)(3) occurred during internment periods of less than 30 days, particularly those diseases associated with nutritional deprivation.  These diseases include avitaminosis, chronic dysentery, helminthiasis, malnutrition, pellagra, cirrhosis of the liver, peripheral neuropathy, irritable bowel syndrome, peptic ulcer disease, atherosclerotic heart disease or hypertensive vascular disease and their complications, and stroke and its complications.  

VA is not aware of any credible scientific or medical literature or study that has associated type-2 diabetes mellitus or osteoporosis with POW internment.  

The timeline S. 1197 would mandate for making determinations and publishing regulations is untenable.  Determination of whether any particular malady should be added to the list of diseases warranting presumptive service connection must reasonably involve a lengthy process of scientific study.  Sixty days is insufficient time for the Secretary to be able to evaluate a recommendation to create a new presumption.  

We estimate the benefit costs of this bill to be $61.1 million during fiscal year (FY) 2009, $440.1 million for 5 years, and $798.2 million over 10 years.  The bill would minimally affect workload, so full-time employee (FTE) costs would be insignificant.  

H.R. 3008

H.R. 3008, the “Rural Veterans Services Outreach and Training Act,” is intended to improve outreach and assistance to veterans and their dependents who may be eligible to receive VA benefits and are residing in rural counties, through the training of rural county veteran service officers.  To this end, H.R. 3008 would establish a competitive grant program to provide financial assistance to state departments of veterans affairs.  

Although VA supports the intent of H.R. 3008, we oppose the bill because it would duplicate ongoing efforts by the Veterans Health Administration’s Office of Rural Health (ORH) to address the health care needs of veterans in rural areas, as well as duplicate other outreach activities already conducted by VA for veterans in rural areas.  

The ORH has been initiating innovative programs to improve care and services for veterans who reside in geographically isolated areas, including the following:

• Rural Mobile Health Care Clinic:  The ORH recently disseminated a nationwide Rural Mobile Health Care (RMHC) Clinic Pilot Request for Proposals, to extend access to primary care and mental health services in rural areas where it is not feasible to establish a fixed access point.  Although the primary focus of RMHC is to enhance the delivery of care to rural veterans, secondarily it can address outreach and collaborate with community partners.  The ORH expects to complete the selection of the pilot sites by the end of summer 2008. 

•  Veterans Integrated Service Networks Rural Consultants:  The use of Veterans Integrated Service Networks (VISN) Rural Consultants was mandated by section 212 of Public Law 109-461.  The consultants will enhance service delivery to veterans residing in rural areas, will lead activities in building an ORH Community of Practice to facilitate information exchange and learning within and across VISNs, and support a stronger link between ORH and the VISNs.  The ORH recently disseminated a nationwide Request for Proposals and intends to fund eight consultants.  We expect to complete selection of consultants by the end of 2008.  

VA believes the results of the RMHC Pilot Initiative and the VISN Rural Consultants program will enhance health care services for veterans and guide the future direction of other potential initiatives, such as those contemplated by H.R. 3008.  

In addition to the abovementioned rural health care initiatives, the following are examples of other outreach services occurring in rural areas:

Vet Centers provide readjustment counseling and outreach services to all veterans who served in a combat zone.  Certain services are also available for their family members.  The goal of the Vet Center program is to provide a broad range of counseling, outreach, and referral services to eligible veterans to help them successfully readjust to civilian life.  The Vet Centers are community-based and staffed by small multi-disciplinary teams of dedicated providers, many of whom are combat-veterans themselves.  The Vet Center staff routinely visits rural communities to provide outreach and direct readjustment services.  The Vet Center program has initiated its own community outreach vehicle project and is in the process of selecting sites for 50 outreach vehicles.  The measures outlined in H.R. 3008 would be duplicative of their efforts. 

•  VA is conducting a substantial amount of outreach, counseling, and education for returning Reserve and National Guard members and their families.  Effective May 1, 2008, at the Secretary’s request, an estimated 570,000 Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans are being contacted and given information on VA medical services and other benefits available to them.

•  VA currently engages in a range of activities to educate VA staff and other agencies and organizations involved in helping veterans and dependants, such as community service providers, school officials, lenders, service organizations.

•  The Health Care for Homeless Veterans Outreach program.

•  The Tribal Veteran Representative programs.

•  Seamless transition programs for OEF/OIF veterans.

•  Educational patient support groups

VA’s outreach efforts also include activities that assist veterans generally, such as attending benefit fairs and exhibits at conferences, conventions, veteran service organization meetings, federal boards, and town halls, and participating in a range of Department of Defense-related activities such as Transition Assistance Program (TAP) briefings and National Guard and Reserve component conferences.  

H.R. 3008 has insufficient detail to fully develop a cost estimate.  The grant costs associated with this bill could range anywhere from no cost to $50 million annually.  VA would incur additional costs to administer the program, but we are unable to determine FTE costs at this time.

H.R. 3795

H.R. 3795, the “You Were There, You Get Care Act of 2007,” would add to the list in current law of diseases presumed to be service connected for a radiation-exposed veteran any other disease “covered” under 38 C.F.R. § 3.309 or 3.311, as well as any other disease found by VA to result from exposure to depleted uranium or the by-products of the burn-off that occurs when a depleted uranium munition penetrates a target.  H.R. 3795 would also require that a veteran who served in the Persian Gulf War or any subsequent conflict in which depleted uranium munitions were used, if that service was in a theater of operations or involved the clean-up or servicing of vehicles or equipment that had been in such a theater of operations, be considered a “radiation-exposed veteran” for purposes of the presumptions of service connection for such veterans.  The bill would require the Secretary to provide for an independent in-depth medical study to be conducted by civilian medical entities to determine other diseases that may result from exposure to depleted uranium.  Upon receiving the report of the study, the Secretary would have to transmit a copy of the report to the Congressional veterans' affairs committees.

VA does not support this bill because it would create an overly broad presumption.  Although the statutory provision the bill would amend provides a presumption for diseases associated with exposure to ionizing radiation, section 3.309 covers many conditions not associated with radiation exposure, such as chronic diseases, tropical diseases, diseases specific to former POWs, and diseases associated with exposure to certain herbicide agents.  H.R. 3795 would extend the presumption of service connection for radiation-exposed veterans to all of these unrelated diseases.

The scope of H.R. 3795 is also extremely broad in covering veterans who served in the theater of operations in a conflict in which depleted uranium  munitions were used.  Depleted uranium munitions are used primarily as anti-tank rounds.  The bursting radius of those rounds is much smaller than that encountered in above-ground nuclear tests.  Furthermore, the provision could be read to include “in the theater of operations” servicemembers who served at sea or in airborne operations whose service occurred far from where these weapons were used.  Exposure to hazards from depleted uranium would be very unlikely, if not impossible for such servicemembers. 

We are developing a benefit-cost estimate for this bill and will submit it for the record.  No additional FTE costs would be associated with this bill because a minimal impact on workload would be expected.  We estimate that discretionary costs related to the study, based on previous contracts, would be less than $2 million.

H.R. 4274

H.R. 4274, the “Gold Star Parents Annuity Act of 2007,” would provide a monthly benefit of $125 to parents of servicemembers who lost their lives while on active duty in certain military operations described by 10 U.S.C. § 1126(a).  If more than one parent is eligible for the benefit, it would be divided equally among the eligible parents.

VA honors the sacrifice of the servicemembers who have lost their lives in the service of their country.  VA also recognizes and honors the supreme sacrifice of Gold Star parents, who have lost a son or a daughter serving in the Armed Forces.  However, VA does not support this bill because VA already provides a monthly benefit to certain qualifying parents.  

Parents’ dependency and indemnity compensation (DIC) is a monthly benefit that is currently paid to eligible surviving parents of a veteran who died while on active duty, or after service as a result of service-connected disability.  Parents’ DIC is a need-based income-support benefit.  

 H.R. 4274 would authorize a small benefit, which would be divided among eligible parents if there is more than one.  The administrative burden of paying this benefit would be great relative to its size.  Additionally, the bill would provide disparate treatment.  Although it may be appropriate for the Congress to distinguish between combat-related deaths and other service-related deaths, the requirement that the servicemember have died while engaged in combat operations and on active duty fails to acknowledge that some post-service deaths, particularly in the early years following separation, can be tied directly to battle wounds and thus creates at least the appearance of disparate treatment.

Costs for this bill cannot be estimated at this time.

H.R. 5155

H.R. 5155, the “Combat Veterans Debt Elimination Act of 2008,” would prohibit VA from collecting all or part of a debt owed to the United States under any program under the laws administered by VA (other than a housing or small business program under chapter 37 of title 38, United States Code) by a veteran who dies as a result of a service-connected disability incurred or aggravated while serving in a theater of combat operations in a war after the Persian Gulf War or in combat against a hostile force during a period of hostilities after September 11, 2001, if the Secretary determines that termination of collection is in the best interest of the United States.  The amendments made by the bill would be effective on the date of enactment and would apply “with respect to collections of indebtedness of veterans who die on or after September 11, 2001.”

VA supports the intent behind this bill, but does have a concern with the effective-date provision.  That provision is unclear as to whether the prohibition on debt collection would apply retroactively to a debt already collected before the date of enactment or apply only prospectively.  We recommend that the bill be amended to require VA to refund any amount of a debt of a covered veteran collected after September 11, 2001, but before the date of enactment.

We estimate that enactment of this bill, if amended as recommended, would result in additional benefit costs of $5,000 for FY 2009 and a 10-year cost of $50,000.

H.R. 5454

H.R. 5454, would establish a presumption of service connection for amyotrophic lateral sclerosis (ALS), a rare disease of unknown cause, for any veteran who develops the disease to a compensable level at any time after separation from service.  

VA does not support this bill.  Current evidence does not justify the establishment of a presumption for ALS.  There is insufficient credible scientific evidence that ALS is caused by service or more likely to develop in veterans as opposed to the general population.  Although the Institute of Medicine (IOM) found limited suggestive evidence of an association between the development of ALS and military service, the IOM clearly indicated that the disease’s cause is unknown.  A review of the literature cited seems to suggest that ALS is associated with vigorous people, as would be found in military service, but is not unique to the military.  

We estimate benefit costs of this bill to be $23.5 million during FY 2009, $214.2 million over 5 years, and $505.8 million over 10 years.  This bill would minimally affect workload, so FTE costs would be insignificant.

H.R. 5709

H.R. 5709, the "Veterans Disability Fairness Act,” would require the Secretary to carry out quality assurance activities with respect to the administration of disability compensation to ensure accuracy and consistency across different VA offices with respect to whether a disability is service connected and disability ratings.  The Secretary would be required to retain, monitor, and store data for each claim for disability compensation, to include:  (1) the state the claimant resided in when the claim was submitted; (2) the Secretary’s decision with respect to the claim; (3) the regional office and individual employee responsible for evaluating the claim; (4) the results of adjudication; and (5) such other data as the Secretary determines is appropriate for monitoring the accuracy and consistency of decisions.  

H.R. 5709 would further require VA to conduct reviews and audits, at least annually, to identify and correct any adjudication inaccuracies or inconsistencies.  The reviews and audits would have to include a sample large enough to draw statistically valid conclusions.  Additionally, the Secretary would have to consider factors relating to consistency and accuracy when evaluating adjudication employees.  The bill would require the Secretary to report to Congress, within 60 days of enactment, on the implementation of this legislation and to include information on consistency in the annual report required by 38 U.S.C. § 7734(2). 

VA does not support H.R. 5709.  VA already has measures in place, and is implementing additional measures, that address most of the subjects covered in H.R. 5709.  VA has a robust quality assurance program.  Quality reviews are conducted on a statistically valid sample of adjudicated claims.  VA will begin routinely monitoring the most frequently rated diagnostic codes in FY 2008 to assess consistency of service-connection determinations and degree of disability assigned for various disabilities across regional offices.  VA conducts regular site visits at VA regional offices to assess operations for consistency and accuracy.  In addition, a random sample of cases adjudicated by employees responsible for adjudicating claims is reviewed for quality at the regional offices.  The results of this review represent one element of employee performance.  

Training is an integral part of VA’s quality assurance program.  The Center for Naval Analyses reviewed VA’s training efforts for the Veterans’ Disability Benefits Commission and was highly complimentary of VA’s training efforts in testimony before the Commission.  Also, in a recent assessment of the Department of Defense (DoD) Disability Evaluation System, the Government Accountability Office referred to the VA Compensation and Pension quality review program as a favorable model for adoption.  

Because the bill would not affect benefit entitlement, no mandatory costs would be associated with it.  There would be no additional FTE costs because the bill would not affect workload, and VA already maintains a staff to conduct quality and consistency reviews.  

H.R. 5954

H.R. 5954 would:  (1) establish a presumption of service connection for any diagnosed disease determined by the Secretary to have an increased incidence in veterans exposed to a biological, chemical, or other toxic agent known or presumed to be associated with service during which the veteran was directly or indirectly subjected to a chemical or biological warfare test or project under Project 112; (2) require the Secretary to determine the presumptive period during which such disease must manifest itself to warrant a presumption of service connection; (3) establish a presumption of such exposure if the veteran was subjected to a Project 112 test; and (4) require the Secretary to notify, under regulations prescribed not later than 180 days after enactment, all veterans who were potentially exposed to any biological or chemical agent, simulant, tracer, or decontaminant during Project 112 of the potential exposure.

Further, this bill would require DoD, in consultation with VA, to submit to Congress, within one year after enactment, a report that would:  (1) document the costs, benefits, and challenges associated with continuing the search for additional Project 112 participants; (2) provide a full accounting of all information known concerning Project 112 participants; and (3) address other concerns regarding Project 112 held by the VA, veterans, or veterans service organizations.  

Project 112 was a comprehensive program initiated in 1962 by DoD to protect and defend against potential chemical and biological warfare threats.  Project SHAD (an acronym for Shipboard Hazard and Defense), a component of Project 112, encompassed a series of tests by DoD to determine the vulnerability of U.S. warships to attacks with chemical and biological warfare agents, and the potential risk to American forces posed by these agents.  Project 112 also involved similar tests conducted on land rather than aboard ships.

VA opposes this bill.  VA has already contracted for a significant long-term study concerning the health effects on SHAD participants and received the report from the IOM.  The Secretary has authority to contract for an additional study if it is deemed necessary.  We believe that enactment of this bill is unwarranted at this time due to the lack of credible scientific and medical evidence that adequately demonstrates any statistically significant correlation between participation in SHAD tests and the subsequent development of any disease.  

DoD continues to release declassified reports about sea- and land-based tests of chemical and biological materials associated with Project 112.  VA is working with DoD to obtain information regarding the tests, including who participated, duration, and agents used.  DoD estimates that about 6,000 veterans may have been involved in Project 112/SHAD.  To date, DoD has provided VA with the names of approximately 5,000 veterans who participated in the tests.  In May 2002, VA began to contact veterans who participated in Project SHAD about medical care and benefits to which they may be entitled.  

In October 2002, VA contracted with the IOM to conduct a 3-year, $3-million study of potential long-term health effects of tests conducted aboard Navy ships in the 1960s.  IOM’s report, “Long-Term Health Effects of Participation in Project SHAD,” was published in May 2007 and found no clear evidence that specific long-term health effects are associated with participation in Project SHAD.

We are in the process of estimating the costs that would be associated with enactment of this bill, and we will provide them for the record.

H.R. 5985

H.R. 5985, the “Compensation for Combat Veterans Act,” would require VA to treat certain veterans as having engaged in combat with the enemy for purposes of 38 U.S.C. § 1154(b), thus permitting the use of lay or other evidence for proof of service incurrence of a combat-related disease or injury.  The veterans who would qualify for this treatment are veterans who, during active service with a U.S. military, naval, or air organization during a period of war, campaign, or expedition, served in a combat zone for purposes of section 112 of the Internal Revenue Code of 1986, or a predecessor provision of law.  In essence, this bill would equate service in a combat zone with engaging in combat with the enemy.  VA does not support this bill.

Section 112(c)(2) of the Internal Revenue Code of 1986 defines “combat zone” as any area that the President by executive order designates as an area in which U.S. Armed Forces are engaging or have engaged in combat.  Section 112 governs the computation of gross income for tax reporting purposes based upon service and applies to all veterans who serve in a combat zone regardless of actual involvement in combat.  The executive order designates which geographical areas are combat zones and the date of commencement of combat activities.    

Section 1154(b) of title 38, United States Code, relaxes the evidentiary requirements a combat veteran must meet to prove service incurrence or aggravation.  The language of section 1154(b) makes it clear that its purpose is to liberalize the method of proof for claims based on injuries incurred or aggravated while engaged in combat with the enemy.  This provision recognizes the unique circumstances of combat, which are not favorable for documentation of injury or illness because treatment for such injury or illness may be administered in the field under exigent conditions that do not permit concurrent documentation.  Supporting evidence is often difficult to obtain when a veteran later files a claim for disability compensation for a combat-related disability.  This bill contemplates that all veterans in a combat zone are faced with the same difficulty in documenting treatment for injury or illness.  However, the same difficulty does not exist for service members who, although serving in a combat zone, have access to a medical facility for treatment and whose treatment would be documented in service treatment records.  The purpose of section 1154(b) was to recognize the unique circumstance of actual combat.

We cannot estimate benefit costs that would result from enactment of this bill because there are no data available upon which to estimate the number of claims for service connection filed by veterans for disabilities incurred in a combat zone.  

H.R. 6032

H.R. 6032 would establish a presumption of service connection for Parkinson’s disease for any veteran who served in the Republic of Vietnam during a certain period and develops the disease to a compensable level at any time after separation from service.  

VA does not support this bill.  The Agent Orange Act of 1991, codified at 38 U.S.C. § 1116, requires that, when the Secretary, on the basis of sound medical and scientific evidence, determines that a positive association exists between herbicide exposure and a disease, the Secretary will issue regulations providing a presumption of service connection for such disease.  The Agent Orange Act further directs that the Secretary take into account reports from the National Academy of Sciences.  

The IOM of the National Academy of Sciences has consistently determined that there is insufficient evidence to associate Parkinson’s disease with herbicide exposure.  The IOM continued this determination in its most recent report, “Veterans and Agent Orange, Update 2006.”  VA believes that it should recognize diseases as presumptively associated with service only if such association is adequately established by credible medical and scientific evidence.  Such evidence has consistently failed to demonstrate an association between Parkinson’s disease and herbicide exposure. 

We are in the process of estimating the costs that would be associated with enactment of this bill and will provide them for the record.   

This concludes my statement, Mr. Chairman.  I would be happy to entertain any questions you or the other members of the Subcommittee may have.