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Witness Testimony of Carl Blake, Paralyzed Veterans of America, National Legislative Director

Chairman Michaud and members of the Subcommittee, on behalf of Paralyzed Veterans of America (PVA), I would like to thank you for the opportunity to present PVA’s views on legislation pending before the Subcommittee.  PVA appreciates the efforts of the Subcommittee to support the Department of Veterans Affairs (VA) and the care of our nation’s veterans.  With the inevitable future budget challenges to come, PVA looks forward to your support to protect those who have done so much to protect us all, America’s veterans.  In particular, we hope for your continued support of those requiring specialized health care, a vital service that is often unmatched in the civilian health care sector.

H.R. 3843, the “Transparency for America’s Heroes Act”

PVA cautiously supports H.R. 3843, the “Transparency for America’s Heroes Act.”  Transparency is critical for the public to be able to see and understand what its government is doing.  In the case of VA quality-assurance records, it only makes sense that this transparency is critical to veterans, and those who serve veterans such as Veterans Service Organizations (VSO), and their understanding of how well VA is doing its job.  Requiring VA to publish redacted medical quality-assurance records on the VA’s website will provide users of the VA a better understanding of the successes or failures of the VA in the quality of care they provide our veterans.  This may encourage greater efforts on the part of VA employees, staff and leaders to ensure the best care is provided to veterans while ensuring openness.  PVA’s concern stems from the need for privacy in health care records.  It is important that sufficient safeguards be put in place to prevent the unintended release of personal health information that may be detrimental to a VA patient.

H.R. 4041, to authorize improvements in the Federal Recovery Coordinator Program 

PVA fully supports H.R. 4041 that will implement the Federal Recovery Coordinator Program.  PVA agrees with the recommendation of the Dole-Shalala Commission that a nationwide Federal Recovery Coordinator Program will expand partnerships and collaborations to benefit veterans of Operation Iraqi Freedom and Operation Enduring Freedom.  As specified in the legislation, there are a large number of services available to transitioning veterans, but no good mechanism for coordinating medical care for wounded warriors.  There are so many programs that veterans can have a difficult time navigating through this sea of help.  While this coordinator program may not solve all the challenges of coordinating care, it will go a long way to providing for knowledgeable health care professionals that can help wounded warriors navigate the often confusing maze of services.

In addition, provisions of the legislation that will establish a qualified nursing or medical school lead to review and develop evidence-based guidelines for recovery coordination should ensure that the program meets the needs of those being trained and the veterans that are served.  While initially only 45 coordinators are authorized to be trained, PVA would recommend an expansion of the program dependent on its demonstrated success.

H.R. 5428, to direct the Secretary of VA to educate VA staff

PVA supports H.R. 5428 to better educate injured and amputee veterans on their rights and the requirement that VA staff who work at prosthetics and orthotics clinics or who work as patient advocates for veterans understand these rights as well.  This bill would ensure that VA prosthetics clinics around the country prominently display the “Injured and Amputee Veterans Bill of Rights” and that VA employees understand it.  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.  As expressed in previous testimony on this topic, PVA is concerned that this legislation’s language seems to ignore veterans who may be in need of special equipment who suffer from a specific disease and not a physical injury.

H.R. 5516, the “Access to Appropriate Immunizations for Veterans Act of 2010”

PVA strongly supports H.R. 5516, the “Access to Appropriate Immunizations for Veterans Act of 2010.”  It is accepted fact that proper and timely administration of immunizations can prevent the onset of more significant medical issues.  By requiring the Secretary to ensure these immunizations are administered in compliance with the recommended adult immunization schedule, and requiring quality measures to ensure this is done, it can be expected that veterans using the VA will be healthier and less likely to suffer potential medical ailments.  The Department of Defense (DOD) follows these procedures to ensure a more ready military force.  It only makes medical and economic sense that the health gains achieved by the DOD program for individuals prior to leaving service should be continued to maintain and benefit the health of veterans.  Proper and timely immunizations are a guarantee of better medical health in the VA patient population.

H.R. 5543, to repeal the prohibition on collective bargaining

PVA supports H.R. 5543 to repeal the prohibition on collective bargaining with respect to compensation for VA employees which may improve the collective bargaining rights and procedures for certain health care professionals in the VA.  As PVA testified in March of this year, these changes may be a positive step in addressing the recruitment and retention challenges the VA faces to hire key health care professionals, particularly registered nurses (RN), physicians, physician assistants, and other selected specialists.  While PVA supports the repeal, this support is contingent on determinations that such repeal will in no way affect the care provided to veterans.  This is the single purpose of the VA and its employees and must always remain so.

H.R. 5641, the “Heroes at Home Act”

PVA generally supports H.R. 5641, the “Heroes at Home Act.”  However, it is essential that proper protections are put in place to ensure that it is the desire of the veteran to be transferred to a non-VA nursing home and only in the case that the foster home meets VA standards at the time of transfer.  It is critical that to support this program, VA verifies that the home is in compliance with VA standards before a veteran is transferred.  Too often a facility may have been in compliance in the past and the same certification is used to judge the current status of the facility.  This must not be allowed to occur in the case of these vulnerable veterans.

H.R. 5996, to direct the Secretary to improve the treatment of veterans with pulmonary disease 

PVA supports H.R. 5996 to direct the Secretary to improve the treatment of veterans with chronic obstructive pulmonary disease (COPD), develop a pilot program to demonstrate best practices for diagnosis and management of COPD, and develop improved techniques and best practices for smoking cessation.  However, PVA is concerned with language in Section 1(a) that it is “Subject to the availability of appropriations provided for such purpose…”  This legislation essentially establishes an unfunded mandate that Congress is telling the Secretary he can ignore.  While this may be a result of the current tight budget environment, if this legislation is needed to provide for our nation’s veterans, the Secretary should be instructed to implement the programs and they should be appropriately funded by Congress.  This legislation outlines excellent programs to improve the health of veterans.  Without stronger requirements directing the Secretary to implement these programs, they may not be implemented by VA due to its other competing requirements.

H.R. 6123, “Veterans’ Traumatic Brain Injury Rehabilitative Services’ Improvement Act of 2010”

PVA supports H.R.6123, the “Veterans’ Traumatic Brain Injury Rehabilitative Services’ Improvement Act of 2010.”  Together with Improvised Explosive Devices (IED), Traumatic Brain Injury (TBI) has become a signature wound of the current wars in Afghanistan and Iraq.  Today, we still do not fully understand the impact or gravity of TBI.  In April 2008, the RAND Corporation Center for Military Health Policy Research completed a comprehensive study titled Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. RAND found that the effects of TBI were poorly understood, leaving a gap in knowledge related to how extensive the problem is or how to handle it.  RAND found 57 percent of those reporting a probable TBI had not been evaluated by a physician for brain injury.  Military service personnel who sustain catastrophic physical injuries and suffer severe TBI are easily recognized, and the treatment regimen is well established. In recent testimony, PVA has raised continuing concerns about servicemembers who do not have the immediate outward signs of TBI getting appropriate care.  The military has implemented procedures to temporarily withdraw individuals from combat operations following IED attacks for an assessment of possible TBI, creating a significant military impact, but believing it necessary for soldier health even if it reduced combat forces.

On July 12, 2006, the VA Office of the Inspector General (OIG) issued Health Status of and Services for Operation Enduring Freedom/Operation Iraqi Freedom Veterans after Traumatic Brain Injury Rehabilitation. The report found that better coordination of care between DOD and VA health-care services was needed to enable veterans to make a smooth transition. While VA and DOD have done extensive improvements of coordination since that report, the OIG Office of Health Care Inspections conducted follow-on interviews to determine changes since the initial interviews conducted in 2006. The OIG concluded that three years after completion of initial inpatient rehabilitation, many veterans with TBI continue to have significant disabilities and, although case management has improved, it is not uniformly provided to these patients.

Because all the impacts of TBI are still unknown, this legislation to expand services and care, providing for quality of life and not just independence, and emphasizing rehabilitative services, is important to the ongoing care of TBI patients.  It is imperative that a continuum of care for the long term be provided to veterans suffering from TBI.  PVA believes this legislation is a step toward ensuring that care.

H.R. 6127

PVA generally supports this legislation; however, we do have some concerns with the issues surrounding this bill.  While we see no real argument with granting these men and women who experienced the exposures outlined by this bill access to the VA health care system, we question why this is the only group singled out for enrollment.  Given the longstanding discussions about Operation Iraqi Freedom veterans being exposed to burns pits or service members exposed to hazardous materials in any number of settings, we believe proper consideration needs to be given to a broader spectrum of veterans and service members. 

H.R. 6188, the “Veterans Homelessness Prevention and Early Warning Act”

PVA also supports the draft legislation that outlines the VA’s notice and response requirements for defaults in loan payments guaranteed by the VA.  The recent collapse of the housing market coupled with the struggles that many veterans face in the employment market have created a situation where many veterans and their families are defaulting on home loans and often losing their homes.  This legislation will ensure that veterans who are placed in this situation are quickly identified so that they may be provided needed assistance by the VA. 

Draft Legislation on Ensuring VA Provides Veterans with Information Concerning Service-Connected Disabilities 

PVA supports the draft legislation to ensure health care professionals of VA provide veterans with information concerning service-connected disabilities and information on submitting claims, establishing service connection for a disability and contact information of appropriate VA offices.  The claims process can be cumbersome and daunting and information to ease this process will be helpful for the veterans.  PVA would also hope that as part of this process, VA would inform veterans of the availability of help from congressionally chartered Veterans Service Organizations (VSO) that can provide free help to veterans in understanding their rights and pursuing any appropriate claims for service-connected injuries.

Draft Legislation on Improvements to VA Homeless Programs

PVA generally supports the provisions of the discussion draft on improvements to VA homeless programs.  Too many veterans continue to live on the streets due to drug, mental health, financial and employment challenges.  The expansion of grant programs for improvements to facilities and increased outreach to more homeless veterans may help them receive services and rehabilitation and achieve the Secretary’s goal to end veterans’ homelessness.  In addition, the improvement of payments for providing services to homeless veterans may increase the number of veterans who can be served by homeless veteran providers.  But as PVA testified last October, we do have some concerns about the long-term effects of the legislation.

PVA has always supported the idea of comprehensive care for homeless veterans.  Seldom is there one issue that leads veterans to become homeless.  Comprehensive care can be expensive.  Additionally, often homeless veterans reside in urban areas where the cost of living is very high and there are limited opportunities for help.  Section 3 of the discussion draft allows the Secretary to increase the rates of payment to reflect anticipated changes in the cost of services and takes into account the cost of providing these services in particular geographic areas.

While we welcome this consideration, PVA is concerned about the long-term effects on VA homeless program funding.  By adjusting the payments for geographic areas, which we believe is aimed at providing greater funding to high cost localities, this may actually reduce the total number of homeless veterans that can be served if future increases in overall program funding are insufficient.  While the argument could be made that “reductions” in funding for low cost areas may offset increases to high cost areas, the funding levels provided for homeless programs are seldom sufficient to provide for all the veterans who may need to take advantage of these critical services.

PVA would recommend a very cautious approach on this legislation to ensure the most vulnerable veterans are not inadvertently hurt in efforts to provide greater funds for some of them.

Draft Health Care Legislation

PVA supports the draft legislation that would address a number of items in the VA health care system.  We are particularly pleased to see that the Subcommittee is considering the extension of the Advisory Committee on Homeless Veterans, particularly in light of the focus that the Administration has placed on eliminating homelessness among veterans. 

We do have a question about Section 4 of the legislation.  We are unclear about the additional authority beyond simple contracting for services in non-Department facilities outlined in Section 4 of the bill.  Specifically, we would like to know what purpose this expansion of authorizing language serves and how it will serve to benefit the VA’s processes? 

PVA would like to thank the Subcommittee once again for allowing us to provide testimony on these important health care issues facing our veterans.  We certainly appreciate the continued attention this Subcommittee has placed on these issues.  I would be happy to answer any questions that you might have.  Thank you.