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Witness Testimony of Joseph L. Wilson, Veterans Affairs and Rehabilitation Division, Deputy Director, American Legion

Mr. Chairman and Members of the Subcommittee:

Thank you for this opportunity to present The American Legion’s views on veterans’ health care legislation being considered by the Subcommittee today. The American Legion commends the Subcommittee for holding a hearing to discuss these important and timely issues.

H.R. 2790, a bill to elevate the Physician Assistant (PA) Advisor to the VA’s Under Secretary for Health to a full-time director, located in the VA’s central office

P.L. 106-419 required the Department of Veterans Affairs (VA) to establish a PA (Physician Assistant) Advisor to advise on such PA issues as qualifications, clinical privileges, and scope of practice. Prior to the enactment of the law in 2000, VA had never had a PA Advisor and the absence of a knowledgeable resource to advise on these issues resulted in unnecessary restrictions on PA ability to provide medical care to the veteran population. In the years since the PA Advisor position was put into place, the VA PA population grew from 1,195 PAs to nearly 1,600 PAs – a 34 percent increase.

The VA’s choice to implement the PA Advisor provision as a part-time, field position has resulted in inconsistencies across VA medical facilities in their utilization of PAs. In one instance, the American Association of Physician Assistants was informed that a local facility determined that a PA could not write outpatient prescriptions, despite licensure in the state allowing prescriptive authority. Other PAs report that VA medical facilities will not hire PAs.

The Senate Appropriations Committee report on the Department of Veterans Affairs has included language recommending that the position be strengthened. In the 2002 report, the Senate expressed concern about the Veterans Health Administration’s (VHA’s) limitation of the PA Advisor to a part-time position and encouraged the VHA to implement a full-time PA Advisor in or around Washington, DC. Additionally, the Senate report urged the VHA to provide sufficient funding to support the PA Advisor position.

Although The American Legion has no specific official position on this issue, we believe VA should do everything in its power to improve access to its health care benefits, to include providing adequate funding to support programs within the VHA, as well as establishing and maintaining an immediate accessible, relative continuum between VA Central Office (VACO) and VA Medical Centers and its attachments throughout the VHA.

H.R. 3458, a bill to direct the Secretary of Veterans Affairs to carry out a pilot program on the provision of traumatic brain injury care in rural areas 

This bill directs the Secretary of Veterans Affairs to carry out a five-year pilot program, in five rural states, under which the Secretary trains and then assigns a specific VA case manager to each veteran diagnosed with traumatic brain injury (TBI), who is receiving care in a VA medical facility within that state.

The American Legion favors the intent of this bill to create a pilot program that would train and assign specified VA case managers for veterans diagnosed with TBI and residing in rural areas; however, we would encourage the implementation of this program to every venue nationwide, thereby ensuring across-the-board quality and adequate healthcare.

H.R. 3819, Veterans Emergency Care Fairness Act of 2007

This bill would require the Secretary of Veterans Affairs to reimburse veterans receiving emergency treatment in non-VA medical facilities for such treatment until such veterans are transferred to VA medical facilities, and for other purposes.

The American Legion supports provisions to allow VA to pay for emergency room care at non-VA facilities.  We believe this would prevent any delays in treating life threatening injuries or illnesses for veterans not in close proximity to a VA facility.

H.R. 4053, Mental Health Improvements Act of 2007

This bill seeks to improve the treatment and services provided by the VA to veterans with post-traumatic stress disorder (PTSD) and substance abuse use disorders, and for other purposes.

Section 102 seeks to require the Secretary of VA to ensure that the following services be available at each VA Medical Center and Community-Based Outpatient Clinic (CBOC):  short term motivational counseling, intensive outpatient care, detoxification and stabilization, relapse prevention, ongoing aftercare, opiate substitution therapy, outpatient counseling, and pharmacological treatments to reduce the craving for drugs and alcohol.  The American Legion believes this action would heighten assurance of continuous and consistent treatment to veterans nationwide.

Section 103 would require VA to ensure concurrent treatment for a veteran’s substance use disorder and co-morbid mental health disorder by professionals proficient in treating substance use and mental health disorders.  The American Legion has always held the position that veterans who succumb to alcohol or drug-abuse caused by their service-connected disability are entitled to a level of compensation that reflects all aspects of their disability.

Section 104 seeks to mandate Vet Centers as an avenue to house peer outreach programs to re-engage veterans of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) who aren’t able to attend appointments for PTSD or substance use disorder.  In this effort, The American Legion urges the Congress to authorize sufficient funding for programs, such as the aforementioned to adequately treat veterans suffering from PTSD and the effects of substance abuse.

Section 105 would require the VA to establish no less than six national centers of excellence on PTSD and substance use disorders, to provide comprehensive inpatient treatment and recovery services to veterans newly diagnosed with these disorders.  While The American Legion applauds results that would be invoked by Section 105, we also request that these centers of excellence be adequately placed to ensure veterans residing in rural areas of the country have access to treatment as well.

Section 106 seeks to require the VA to review all of its residential mental health care facilities, to include domiciliaries.  This section includes an assessment of the aforesaid facilities, along with supervision and support provided throughout the entire Veterans Integrated Services Network (VISN); an assessment of the appropriateness of rules and procedures for the prescription and administration of medications to patients in such residential mental health care facilities; the ratio of staff members at each residential mental health care facility to patients at such facility; a description of the protocols at each residential mental health care facility for handling missed appointments; and recommendations by the VA for improvements as well.

The American Legion supports this section’s request to provide up-to-standard inhabitable facilities, as well as adequate staff to ensure continuous and quality care for veterans.

Section 107 would provide for Title 1 of this bill to be enacted in tribute to Justin Bailey, an OIF veteran who died while under VA treatment for PTSD and a substance use disorder.   According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, PTSD always follows a traumatic event that causes intense fear and/or helplessness in an individual.  Typically, the symptoms develop shortly after the event, but may take years.  Psychological care is considered the most effective means of treatment for PTSD.  In addition to treatment for PTSD, other mental health conditions, such as acute reaction to stress and abuse of drugs or alcohol, require much attention.

Due to the increasing numbers of veterans seeking care at VA Medical Facilities, to include those from the Gulf War Era and OIF/OEF, The American Legion supports a bill such as HR 4053 to further improve treatment and services provided by the VA to our nation’s veterans.  The American Legion also supports quality treatment and adequate supervision, to include that which would prevent such tragedies as Justin Bailey’s.

H.R. 4107, Women Veterans Health Care Improvement Act

This bill seeks to amend Title 38, United States Code, to expand and improve health care services available to women veterans, especially those serving in OIF/OEF, from the VA, and for other purposes.  Section 101 discusses long-term study on health of women serving in OIF/OEF.  This section would also require VA to adjoin with War-Related Injury and Illness Centers (WRIICs) and contract with outside organizations to conduct an epidemiologic study on the health effects of women who served in OIF/OEF.  The American Legion concurs with the intent of this section due to the course of action in ascertaining the results of the study, which include collaborating with the Department of Defense (DoD) in acquiring relevant health care data, such as pre-deployment health and health risk assessments in conjunction with VA access to the cohort while they are serving in the Armed Forces.

Section 102 discusses study of barriers for women veterans to health care from the VA.  The current Global War on Terror illustrates a few deficiencies in services provided for women veterans.  Participation in OIF/OEF has obligated them to expand their military roles to ensure their own survival, as well as the survival of their units.  They sustain the same types of injuries as their male counterparts.  The American Legion supports studies to identify and alleviate barriers that hinder quality health care for all veterans, including women.

Section 103 discusses comprehensive assessment of VA’s women’s health care programs.  The American Legion supports assessment of such programs as disease prevention, primary care, women’s gender-specific healthcare, acute medical/surgical, and mental health treatment, domiciliary, rehabilitation and long-term care to ensure ongoing delivery of quality and adequate care to women veterans.

Section 201 discusses improvement of sexual trauma care programs of the VA.  The American Legion supports improvement of VA’s sexual trauma care programs, to include a comfortable atmosphere, which may encourage full disclosure of the veteran’s traumatic event.

Section 202 discusses dissemination of information on effective treatment, including evidence-based treatments, for women veterans with PTSD.  The American Legion supports the dissemination of information disclosing effective means of treatment for women and all veterans.

Section 203 discusses ensuring adequate provision of services for women veterans at VA vet centers.  The American Legion supports adequate provision of services for women and all veterans at VA Vet Centers.  This also includes effective communication with VA Medical Centers to adequately provide quality treatment for veterans requiring more complicated and/or long-term treatment.

Section 204 discusses a pilot program for childcare for certain women veterans receiving health care from facilities of the department.  The American Legion supports programs that allow flexibility for women and all veterans to obtain quality and adequate health care within the VHA.

Section 205 discusses a pilot program for women veterans newly separated from service for counseling in retreat settings.  It is essential that appropriate treatment be provided to veterans who require special needs treatment.

Section 206 discusses the addition of recently separated women veterans to serve on advisory committees.  It is essential that advisory committees represent the experiences of all veterans.

H.R. 4146, to amend title 38, United States Code, to clarify the availability of emergency medical care for veterans in non-Department of Veterans Affairs medical facilities

This bill seeks to amend title 38, United States Code (USC), to clarify the availability of emergency medical care for veterans in non-VA medical facilities.  Currently, veterans who are diverted to non-VA medical facilities are unfortunately overwhelmed with hospital bills incurred from their stay at the respective facilities. Section 1725 of Title 38, USC, requires that non-facilities transfer the veteran to a VA facility following his or her stabilization.

However, when there are no accommodations available at a VA medical facility and the veteran has to remain at the non-VA facility, he or she incurs the cost of the emergency care from that point.  Incurring costs for actions out of the veteran’s control is inherently unconscionable.  The American Legion supports provisions to authorize VA to cover the costs of emergency room care at non-VA medical facilities for veterans who are required to remain at these facilities due to unavailable space at VA medical facilities.

H.R. 4204, Veterans Suicide Study Act

This bill seeks to direct the Secretary of VA to conduct a study on suicides among veterans.  The American Legion receives contact from actual veterans who disclose their need for immediate help due to their thoughts of harming themselves.  As the number of calls to suicide prevention call centers increase, the need for more suicide prevention counselors throughout the VHA  is warranted.

The American Legion supports continued studies on suicides among veterans.  With a proactive stance in mind, we ask that these findings be readily communicated to suicide prevention divisions to increase the prevention of potential tragedies.

H.R. 4231, Rural Veterans Health Care Access Act of 2007

This bill creates a pilot program in seven geographically diverse VISNs across the country to provide veterans living 30 miles from a VA medical facility staffed by a licensed mental health professional with vouchers that can be used as payment-in-full for mental health services at a private, VA approved facility. 

The aim of this bill is to also help veterans who require regular, long-term care and who live in areas that don’t allow frequent trips to a VA medical facility.  This would be especially intended to make counseling for PTSD, drug/alcohol abuse and families more accessible.  Because treatment for a variety of mental conditions requires regular one-on-one sessions with a professional, we determined, with the input of veterans groups, that 30 miles was a reasonable distance.  Many veterans are disabled or economically disadvantaged, meaning that a weekly trip for counseling appointments would be prohibitive or impossible.  Thus, many vets who should be in counseling choose to forgo it.

According to research conducted by the VA, one in five veterans nationwide who enrolled to receive VA health care reside in rural areas.  The American Legion believes no veteran should be penalized or forced to travel long distances to access quality health care because of where they choose to live.  Furthermore, all care, to include pilot programs, should include outreach to every rural venue in which veterans reside.

The American Legion favors the intent of this bill to create a pilot program that would accommodate veterans residing in rural areas; however, we would encourage the inclusion of every VISN across the country, as well as, a more condensed pilot program than the abovementioned.

Again, thank you Mr. Chairman for giving The American Legion this opportunity to present its views on such important issues.  We look forward to working with the Subcommittee in continuing the enhancement of access to quality health care for all veterans.