MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE:

It is my honor to be here today to represent members of the Veterans of Foreign Wars of the United States here in Bedford and around our wonderful state of Virginia.

I come before you with profound gratitude for what the VA is striving to achieve on behalf of our veterans.  No agency or department is perfect, and yet I know that with the support of the Congress and this committee, the VA is making strides forward and is working diligently to care for all generations of veterans. 

With these thoughts in mind I would like to address the rural healthcare challenges we are facing here in southwest Virginia.   

Access to VA services in rural areas is always a primary concern, and that is no different in our region.  From my hometown of Galax, VA, we have the Salem VA hospital that is approximately 100 miles to the north.  Also located in our region is the Johnson City, Tennessee, VA hospital that is approximately 125 miles to the West.  Either of these can be quite a journey, particularly when a veteran has two non-contiguous appointments.  It can be a frustrating process for a veteran to travel long distances for multiple appointments spread throughout the day. We are very thankful for our Community-Based Outpatient Clinic (CBOC) in Hillsville, and we believe that the addition of a second CBOC in Marion, although limited to three days a week, will provide even greater assistance.  There is clearly a need for the VA to open more clinics in rural areas, and the onus is on VA to find solutions for our veterans whether it be through additional private contracting,  private-public partnerships, collaboration at multiple levels of government, or other creative means to make sure veterans are getting the care they deserve. 

Another area that will potentially improve access to care is Telehealth.  The VFW believes this is a major opportunity to improve healthcare outcomes, particularly in rural communities.  Though there are privacy issues and technological limitations that must be addressed, they should not delay any expansion of telehealth services.  The House Veterans’ Affairs Subcommittee on Health recently held a hearing that spent considerable time discussing rural broadband and wireless expansion, and we encourage the committee to continue expanding the body of evidence that clearly supports a robust telecommunications infrastructure in our rural communities. 

We are also concerned that many cases of Traumatic Brain Injury (TBI) are not being properly diagnosed.  We are obviously playing catch-up in our understanding of TBI, and access to medical professionals who can properly diagnose TBI is a problem nation-wide.  As you might imagine, veterans living in rural communities are especially vulnerable to misdiagnoses and ill-suited treatment, and the VA needs to make sure a sufficient network of doctors is in place to take what we are learning and put it to use in these communities.  Moreover, post-diagnosis treatment can be time-consuming and can hinder efforts to treat rural veterans suffering with TBI.   This is a serious issue that the VA and this committee need to tackle head on. 

Closely tied to TBI is our concern with proper diagnosis and treatment of mental health conditions.  We applaud VA for raising awareness on mental health issues and for working to reduce the stigma attached to seeking mental health treatment.  We urge the Congress provide continuous oversight of VA mental health programs to ensure the need for counseling and other types of treatment is being met here and in all the rural areas of the country.  At the Salem, VA, facility alone nearly 2,500 veterans have received diagnoses that may be caused by PTSD.  One concrete step that could be taken to ensure all veterans who struggle with mental health conditions receive timely and professional care is to staff our rural CBOCs to provide inpatient mental health counseling and other specialty services. 

Specifically, strong outreach and education programs will be necessary to help eliminate the stigma of mental illness and other barriers that dissuade many from seeking care.  We also need meaningful post-deployment health assessments that will incentivize servicemen and women to provide honest responses so that can receive appropriate kinds of care and secure benefits they have earned.  Routine examinations should include mental health assessments.  VA staff should be fully competent to identify warning signs, should be aware of all available programs, and should fully utilize them. 

Suicide Among our veterans is a national priority and it is certainly a rural issue as well. 
Veterans who live in rural communities often have limited health care access. Having the resources needed to combat the isolation is critical. The VA’s suicide hotline is an effective tool for those who call, but we should work to ensure every veteran who is at the end of their rope knows there is a helping hand.  Again, it comes back to outreach.  These programs must be visible in the everyday lives of veterans.  We know this is especially challenging in highly rural areas and we hope the VA will redouble their efforts with regard to rural outreach—not only for the suicide prevention hotline, but for all their programs. 

One way the VA is reaching out to address these and other issues is through the Mobile Vet Centers (MVCs) that are literally going to where our rural vets live and work, ensuring access to services are provided where it is needed.  However, it is with some dismay that I tell you I have not seen one or heard of one being in our community.  With that in mind, the VFW hopes that the VA is devoting proper time and attention to evaluating the success of the MVCs and considering adding additional resources if there is a demand for more Mobile Vet Centers. 

In rural areas, simple word of mouth is still one of the primary ways information is distributed and the VA should not overlook hometown newspapers, local VSO chapters, and other means tailored to our older veterans.  Though they should employ email alerts, social media, and other electronic means to reach out, they should not expect this to reach every generation of veteran.  We want to be a resource for the VA to reach rural veterans, and the potential to boost outreach by using VFW posts and those of other Veteran Service Organizations cannot be overstated.  Another helpful opportunity for collaboration would be to use local VFW posts to conduct local screenings and wellness events.  Just because a Mobile Vet Center is not available that shouldn’t mean the VA can’t send a doctor or other medical professionals to a rural area.  Speaking on behalf of the VFW here in Virginia, if the VA sends us a doctor, we can supply the patients and the physical space needed to screen for mental illnesses and TBI along with other physical conditions such as glaucoma, hearing, diabetes, and other illnesses.  Such opportunities would provide a platform for further collaboration and would be a positive contact with rural communities where there is no VA presence.  Everyone benefits when mutually interested parties work together, and we hope that the VA would take seriously the many benefits of increased cooperation with the VSO community.

The Independent Budget said it best when it stated that ‘health workforce shortages and recruitment and retention of health-care personnel are a key challenge to rural veterans’ access to VA care and to the quality of that care’.  The VA must aggressively train future clinicians to meet the unique challenges rural veterans face.  The VA already has existing partnerships with over a hundred schools of medicine in the United States.  To not apply them, and expand upon them if needed, would essentially squander this vast resource.  We cannot allow that to happen. 

The VFW is also concerned that the men and women who serve in our Guard and Reserve are not fully utilizing the VA benefits that they have earned.  Demobilizing members of the Reserve Component are often so preoccupied with thoughts of family and home that they fail even to mention existing health conditions, not to mention ones that will certainly develop down the road as a result of their service.  Local VFW Posts often fund and facilitate going away and coming home parties for Guard and Reserve units.  We have successfully used these events to boost morale and to offer assistance with their VA paperwork through the Virginia Department of Veterans Service, and will continue to support our returning warriors through these events and other outreach efforts.

Finally, I would like to bring attention to the successes of our Virginia Wounded Warrior Program.  Rural veterans are a primary target population of the Virginia Wounded Warrior Program.  I hear and know very positive things about the program.  We hope that the VA will continue to look at this hallmark state program and redouble their efforts to work with all layers of government—local, state, and other federal entities—to provide an integrated, total solution for not just our wounded warriors, but for all who have served, and their families. 

Mr. Chairman, I again thank you for the honor to present our priorities to you.  I would be happy to answer any questions that you or the members of the Committee may have.