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Witness Testimony of Christina M. Roof, National Acting Legislative Director, American Veterans (AMVETS)

Chairwoman Buerkle, Ranking Member Michaud and distinguished members of the subcommittee, on behalf of AMVETS, I would like to extend our gratitude for being given the opportunity to share with you our views and recommendations at today’s hearing regarding: H.R. 198, the “Veterans Dog Training Therapy Act,”  H.R. 1154, the “Veterans Equal Treatment for Service Dogs Act,” H.R. 1855, the “Veterans Traumatic Brain Injury Rehabilitative Services Act of 2011,” H.R. 2074, the “Veterans Sexual Assault Prevention Act,” H.R. 2530, to  amend  Title  38, United  States  Code, to provide  increased  flexibility  in  establishing rates for reimbursement of State Homes by the Secretary of Veterans Affairs for nursing home care  provided to veterans,” draft legislation, the “Veterans  Health Care Capital  Facilities  Improvement  Act of 2011,” and draft legislation, the “Honey Sue Newby Spina Bifida Attendant Care Act.” 

AMVETS feels privileged in having been a leader, since 1944, in helping to preserve the freedoms secured by America’s Armed Forces.  Today our organization prides itself on the continuation of this tradition, as well as our undaunted dedication to ensuring that every past and present member of the Armed Forces receives all of their due entitlements.  These individuals, who have devoted their entire lives to upholding our values and freedoms, deserve nothing less.

Given the fact, this testimony will be addressing multiple pieces of legislation; we shall be addressing each piece of legislation separately, as to make AMVETS testimony clear and concise on the individual subject matters of the bills.

AMVETS supports H.R. 198, the “Veterans Dog Training Therapy Act.” AMVETS lends our support to the updated language of H.R. 198 that will be submitted in committee markup. AMVETS believes the updated language will help ensure that H.R. 198 provides veterans the highest quality care, while maintaining our commitment to fiscal responsibility.

By way of background, AMVETS has worked with Assistance Dogs International (ADI) accredited Assistance Dog agency, Paws With A Cause for over 30 years, in an effort to help provide disabled veterans Service Dogs. Through this partnership, AMVETS has seen what an immeasurable asset to a veteran’s overall wellbeing these service dogs have proven to be to both the trainers and recipients. AMVETS has personally witnessed the incredible changes that occur when introducing a dog into a veterans overall treatment plan. This is often illustrated through speedier improvements to a veteran’s physical wellbeing, great improvements to the veteran’s mental health and a sustainable overall higher quality of life, when compared to the pace of improvements shown in veterans undergoing normal clinical care.

Veterans who are able to take on an active role in the training of a Service Dog have displayed great improvements to their overall wellbeing and recovery. H.R. 198  is an opportunity for a veteran to once again feel that they have purpose and will be able to play an active role in assisting his/her comrades, just as he/she did while serving in the military. H.R. 198 will also offer a structured program that has clear and concise rules, goals and measurable end results.

Furthermore, AMVETS believes H.R. 198 will prove to be beneficial to the veteran trainers, the veteran Service Dog recipient and to the Department of Veterans Affairs. AMVETS also believes H.R. 198 will aide VA in the development of stronger policies and procedures regarding Service Dogs within the VA health care system, as well as being fiscally responsible through the collaborating of VA facilities with private sector industry experts, ADI agencies for this study. The VA and ADI partnership will ensure the quality of the training process and uniform training standards for the program, provide both a therapeutic, yet professional setting for all parties involved in the study, ensure the safety of both the veterans and the dogs and provide industry expertise and job training skill sets to veterans chosen to participate.  AMVETS also applauds Congressman Grimm for going the extra step by finding multiple choices for offset funding.

AMVETS strongly supports H.R. 1154, the “the Veterans Equal Treatment for Service Dogs Act.” AMVETS believes this cost free piece of legislation will permanently eliminate an often overlooked and unwarranted hurdle to care disabled veterans are currently experiencing when seeking their necessary VA health care services. To date,, 38 CFR, Part 1, § 1.218(a)(11) states:

Dogs and other animals. Dogs and other animals, except seeing-eye dogs, shall not be brought upon property except as authorized by the head of the facility or designee”.

 AMVETS finds the aforesaid language of 38 CFR, Part 1, § 1.218(a)(11), to be inconsistent and outdated when compared to the sections of Title 38 it is to govern. While numerous parts of Title 38, specifically Section 1714, are constantly  updated to reflect the health care needs of today’s wounded warriors, 38 CFR, Part 1, § 1.218(a)(11) has been overlooked and has thus failed to be updated since July of 1985. This outdated regulation is, to date, resulting in disabled veterans utilizing VA approved Service Dogs as a prosthetic device to be denied entrance into the VAMCs and CBOCs they depend on for life sustaining care. Given the current authorities outlined by this subsection, there continues to be wide spread inconsistencies in the policies governing access to VAMCs and CBOCs. These inconsistencies are resulting in disabled veterans who may have never experienced any sort of access problems at their previous VAMC are now met with the serious issue of not being allowed to enter a VA facility with their prosthetic device.

For example, Army veteran, Sue Downes lost both of her legs when her convoy hit multiple IEDs in 2007 in Iraq. Today, after years of rehabilitation, Ms. Downes utilizes several VA-provided prosthetic devices and her Service Dog, which is considered a prosthetic device by VA, and thus is provided benefits for its upkeep.  These include her two prosthetic legs and her Service Dog, Lila. Ms. Downes depends on her prosthetic legs for mobility and her Service Dog for balance and further mobility assistance. Lila, Ms. Downes’ Service Dog, provides her with not only mobility and balance, but just as important, independence. Recently, while visiting with lawmakers in our nation’s capital, Ms. Downes stated:

 “I do not understand why VA will provide for the upkeep of both prosthetic devices, my legs and my Service Dog, yet I am only allowed to bring one of the two into VA facilities? I truly do not understand what the reasoning behind this rule is; especially since my legs, on their own, are not enough for me to safely get around. Lila was trained to and now provides me assistance that no cane or walker could ever provide. Lila has given me back my independence as a self sufficient mother of two and active member of my community.”

AMVETS believes disabled veterans, such as Ms. Downes,  using Service Dogs must have the same access rights to VA care and  facilities as currently afforded to blind veterans using Guide Dogs. AMVETS also believes VA should never refuse care to a veteran based on their disability or the prosthetic device they use to assist them. Moreover, AMVETS believes H.R. 1154 will permanently eliminate the aforesaid through updating the policies outlined by 38 CFR, Part 1, Section 1.218, as well as more accurately reflecting the policies outlined in 38 CFR, Section 1714.

Recently, VA officials stated that H.R. 1154 was unnecessary due to the fact that under existing statutory authority in 38 U.S.C. 901, VA can implement national policy for all VA properties. While AMVETS somewhat agrees with this statement, the fact remains that VA has been unwilling to exercise this authority. In March of 2011, VA did somewhat exercise this authority through the publication of VHA Directive 2011-013. However, AMVETS still believes the actual regulation must be changed, since directives expire and are much harder to track and to enforce compliance.  As such, numerous VAMCs have incomplete, inconsistent or non-existent access policies for Service Dogs. This creates a frustrating and stressful experience for a veteran Service Dog user who must receive their routine care at one VAMC, yet must go to a different VAMC for surgery or specialty care. The individual VAMC access policies, if they exist, between the two facilities will most likely be different, thereby creating an unnecessary and avoidable hurdle to care these disabled veterans must now address.

For example, take Army veteran Kevin Stone. Mr. Stone suffered a severe spinal cord injury while on active duty. Living in the foothills of the Smokey Mountains, Mr. Stone uses Mountain Home VAMC for his routine health care.Yet, the closest VA Spinal Cord Injury Care Center for Mr. Stone is Charlie Norwood VAMC in August, Georgia. Unfortunately, in mid 2009, Mr. stone was caught off guard when he was denied access to the facility for his annual SCI care. Mr. stone was informed that only blind veterans were allowed to bring their dogs into VA hospitals and that he would have to make other arrangements if he wished to receive his SCI care. Finally after nearly six months of delayed care, a member of Congress had to get involved, just so Mr. Stone could receive his life sustaining SCI care. Mr. Stone’s situation was stressful for all of the parties involved and did not have to escalate to such levels. Mr. Stone’s situation  immediately brought forth concerns and questions for AMVETS on how many other disabled veterans utilizing the assistance of a Service Dog have been denied access to a VAMC or CBOC for care. As we are all aware, the simple fact remains that not every disabled veteran using a Service Dog has access to a member of Congress for help in their case. This is only one of the many, many examples of the challenges today’s disabled veterans utilizing Service Dogs, experience when seeking care with the VA system.

While AMVETS applauds VA’s recent efforts in addressing this issue through the publication of a temporary  directive, we still strongly believe there are loopholes that still need to be addressed and corrected in order to guarantee veterans receive the care and services they need, regardless of their disability. As we are all aware, directives expire and this issue needs a permanent fix, right now. AMVETS has worked very closely with VA over the past few years to assist in the development and implementation of policies and procedures regarding Service Dogs. AMVETS strong support of H.R. 1154  is in no way intended to be a criticism of VA or their actions in addressing this issue. AMVETS strongly believes H.R. 1154 only stands to help, not hinder, VA in the efforts through the codification of the new policy outlined in their directive addressing Guide and Service Dogs on VA properties. With this in mind, H.R. 1154 will not only strengthen VA’s new efforts, but will also provide a permanent correction through closing all possible loopholes and by implementing a stronger, non-discriminatory, uniformed access policy.

AMVETS supports H.R. 1855, the “Veterans Traumatic Brain Injury Rehabilitative Services Act of 2011”.  While AMVETS is aware that Traumatic Brain Injuries (TBI) are physical injuries, we are also aware of the psychological and cognitive impact TBI can have on a veteran. The irrefutable medical data showing the correlating symptoms of TBI and several psychological disorders clearly illustrates the need for a more “holistic” approach in the treatment and care of veterans who have sustained a Traumatic Brain Injury. This being said, AMVETS strongly supports the language set forth by H.R. 1855, as we believe it will set standards of care in which all aspects of a veterans TBI will be addressed. We too often see veterans being treated for one injury at a time. AMVETS believes VA needs to address and treat the veteran and their injuries as a whole, in order to achieve the best physical and psychological outcomes of care. AMVETS applauds Congressmen Walz and Bilirakis for their initiative, through the introduction of H.R. 1855, in changing the way VA cares for TBI and its’ related symptoms. AMVETS again lends our support to H.R. 1855.

AMVETS strongly supports H.R. 2074, the ‘‘Veterans Sexual Assault Prevention Act.’’  AMVETS was, and still is, outraged by the Government Accountability Office’s (GAO) report of findings regarding sexual assault in VA facilities, released in early June 2011. AMVETS finds it even more disturbing that hundreds of sexual assaults were not reported to VA leadership officials or the VA Office of the Inspector General, which is in direct violation of VA policy and federal regulations.  AMVETS finds it to be reprehensible that any veteran receiving care in a VA facility would be subject and/or at risk of being sexually assaulted or harassed. Moreover, AMVETS finds it inexcusable that VA leadership, at all levels, has allowed such occurrences to continue to happen without taking strong actions to protect the same veterans they have vowed to protect and care for. While AMVETS also understands that top VA leadership was not made aware of nearly 300 cases of sexual assault by VISN level leadership, AMVETS still finds it inexcusable that stronger procedures and safeguards were not already in place to address these types of matters before they escalated to current levels. In 2011, VA has the ability to provide electronic limbs, state of the art surgical procedures and world-class care to the veterans they serve. With that being said, AMVETS must respectfully ask why VA cannot provide even the most basic of safety measures in these same facilities? AMVETS concurs with the Chairwomen’s statement that “Never should a warrior in need take the brave step of getting help and be met with anything less than safe, supportive, and high quality care in an atmosphere of hope, health, and healing.”  Furthermore, AMVETS also concurs with Chairman Miller’s statement  that “In the past week, some have dismissed these allegations, comparing the size of the VA system and the number of allegations, to the private sector. Let me be very clear on this point – there is no comparison. Just one assault of this nature, one sexual predator, or one veteran’s rights being violated within the VA is one too many and is absolutely unacceptable.”  AMVETS applauds Congresswoman Buerkle and Chairman Miller for their swift actions in an effort to correct these gross and intolerable errors and urges all members of Congress to follow their lead through the swift passage of H.R. 2074.

AMVETS supports H.R. 2530, to amend Title 38 to provide increased flexibility in establishing rates for reimbursement of State homes by the secretary of the Department of veterans Affairs for nursing home care provided to veterans.  At a time in our nation’s history when we simultaneously have a large influx in aging veterans requiring home care and disabled veterans returning with substantial injuries also requiring home care, it is time to revisit the policies and procedures associated with our State Veterans Homes (SVH). In December 2006, P.L. 109-461, the “Veterans Benefits, Health Care, and Information Technology Act of 2006”, authorized the VA to pay higher per-diem payments for care in SVHs to certain veterans with service-connected disabilities.  This long-awaited regulation was issued in April 2009, with a retroactive effective date of March 2007. However, it took the VA two years to issue the rules and regulations to implement P.L. 109-461 and yet the rates are still not up to par. Currently, per-diem payments do not cover the full cost of providing services to veterans residing in SVHs, which has resulted in many SVHs  to lose millions of dollars and even worse, due to these loses the inability to admit and care for more severely disabled veterans in their facilities. This has become a huge problem for the Medicare/ Medicaid certified SVHs operating in 31 states, because current statutory language notes that the “per-diem rates paid by VA constitute payment in full.”  Thus, SVHs are prohibited from billing Medicare and Medicaid for services they provide to disabled veterans, yet are not reimbursed for by VA. These services include, but are not limited to, X-Rays, labs, PET scans, dialysis and many other critical and medically necessary medical procedures and tests.  In reality the current “actual per-diem payments” provided by VA to SVHs have increased, but the total reimbursement is much lower than what SVHs received prior to the enactment of P.L. 109-461, as a result of their inability to bill Medicare and Medicaid.  This is an issue that has been overlooked for too and has resulted in too many veterans not being able to receive the care they need. AMVETS strongly supports H.R. 2530 and urges its swift passage.

AMVETS also supports draft legislation, the ‘‘Veterans Health Care Facilities Capital Improvement Act of 2011’’. AMVETS finds this piece of legislation to be of the utmost importance. While the bill addresses several different matters, AMVETS biggest concern is regarding VA’s enhanced lease program. As we are all aware, Secretary Shinseki has laid out a plan who’s ultimate goal is to end homelessness among veterans within five years. There has been no opposition to this goal from any member of congress or the VSO community. It is a fair assumption to believe we all want to end homelessness among our veteran population as soon as possible. However, AMVETS believes a critical piece of the Secretary’s plan is in danger of being eliminated. More specifically, VA’s enhanced lease program.  

VA’s enhanced lease program is responsible for, and comprised of facilities used for, over 95 percent of VA’s homeless and at risk veteran and family housing units. If this program were to be allowed to expire, thousands of veterans and their families will find themselves with nowhere to go, except back to the streets. AMVETS believes that if we are to realize the goal of ending homelessness among the population of men and women who have so selflessly served our great nation, we must pass this piece of legislation to ensure the continuance of the enhanced lease program. Again, AMVETS supports the ‘‘Veterans Health Care Facilities Capital Improvement Act of 2011’’ of legislation and urges its quick passage.

Finally, AMVETS supports draft legislation, the “Honey Sue Newby Spina Bifida Attendant Care Act”, to amend title 38, United States Code, to authorize the Secretary of Veterans Affairs to provide assisted living services to certain children of Vietnam veterans who are suffering from Spina bifida.

Chairwoman Buerkle and distinguished members of the subcommittee, AMVETS would again like to thank you for inviting us to share with you our opinions and recommendations on these very important pieces of legislation. This concludes my testimony and I stand ready to answer any questions you may have for me.


AMVETS
Lanham, MD.
July 20, 2011

The Honorable Representative Buerkle, Chairwoman
Subcommittee on Health
House Veterans Affairs Committee
335 Cannon House Office Building
Washington, D.C. 20510

Dear Chairwoman Buerkle:

Neither AMVETS nor I have received any federal grants or contracts, during this year or in the last two years, from any agency or program relevant to the July 25, 2011,  Health Subcommittee hearing regarding H.R. 198, H.R. 1154, H.R. 1855, H.R. 2074, H.R. 2530, draft legislation, the ‘‘Veterans Health Care Facilities Capital Improvement Act of 2011’’ and draft legislation, “The Honey Sue Newby Spina Bifida Attendant Care Act”.

Sincerely,

Christina M. Roof
National Acting Legislative Director