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Witness Testimony of Ramsey Sulayman, Legislative Associate, Iraq and Afghanistan Veterans of America

Madam Chairwoman, Ranking Member, distinguished members of the subcommittee, on behalf of more than 200,000 members and supporters of Iraq and Afghanistan Veterans of America (IAVA), I thank you for the opportunity to share the views of our members on these very important pieces of legislation.

My name is Ramsey Sulayman and I am a Legislative Associate with IAVA. I am a veteran of Iraq where I was an infantry platoon commander and company executive officer. I have spent 14 years in the Marine Corps trying to execute the Marine Corps’ two missions: winning battles and making Marines. As an IAVA staff member, I don’t make soldiers, sailors, airmen or Marines but I do try to make their lives better. The views expressed in this testimony reflect the views and analysis of IAVA and not the United States Marine Corps. Thank you for your attention to the pressing issues facing our nation’s veterans.

H.R. 1460 – IAVA strongly supports H.R. 1460, ensuring that combat veterans smoothly and seamlessly transition their care from the Department of Defense (DoD) healthcare system to the Veterans Administration (VA) healthcare system by automatically enrolling service members in the VA healthcare system and requiring them to opt-out if they do not wish to be enrolled. The creation of an integrated health record and the electronic transfer of medical records are steps in the right direction but the most important step is actually getting veterans into the system. Currently, veterans must independently seek out care in the VA system. That is why only 54 percent of Iraq and Afghanistan veterans are enrolled in the VA healthcare system. The steep cost of quality healthcare through the private sector and a high rate of veteran unemployment (almost 17% among our membership) means many veterans do not have access to any other healthcare system, in many cases for service-related injuries. IAVA believes that H.R. 1460’s solution, changing enrollment for VA healthcare to an opt-out system, is easy and effective, both in terms of cost and efficacy. Combat veterans should not have to opt-in to receive a benefit they have earned through their service.

H.R. 3016 – IAVA supports H.R. 3016 which addresses the slow implementation of the Federal Recovery Coordination Program (FRCP) by mandating cooperation, setting deadlines and requiring oversight through reports to Congress. H.R. 3016 gets to the heart of the criticisms of the FRCP leveled by the General Accounting Office (GAO), specifically the lack of coordination between the DoD and VA. The remarkable advances in medical technology and treatment of traumatic injuries we have witnessed over the past decade have resulted in an increased survival rate for service members with formerly unrecoverable injuries. While great strides have been made in the treatment of these injuries, the fragmentation of care across multiple systems has resulted in difficulty and frustration for many injured service members and their families. The FRCP was a common-sense response that placed an experienced health care professional at the center of the process to help guide service members and their families through the intricate, confusing and stressful process of navigating the healthcare system. IAVA believes that those who fought for their country and were injured deserve every possible bit of help to restore their lives to order.

H.R. 3279 – IAVA endorses H.R. 3279 which seeks to rectify an oversight in eligibility for family members of service members to participate in the caregivers’ assistance program. Currently, service members who suffer a serious, life-altering illness as a result of service to their country are not afforded the option to participate. Only service members with physical injuries, loss of limbs for example, are eligible to apply for caregivers’ assistance. A service member who contracts a debilitating disease, for example malaria, is not eligible. Many programs are hailed as “important” or “vital” but fail to live up to their billing. The VA caregivers’ assistance program is vital and important, both to injured service members and their families. By promising what amounts to a very minimal safety net, caregivers’ assistance allows families to make huge sacrifices in their own lives to care for severely injured service members. Families are able to make the choice to care for their loved one at home, rather than in a medical facility. Families are given the choice to stay together. The process for receiving caregivers’ assistance is already robust and oversight is stringent. A relatively small number of veterans and their families receive assistance and explicitly stating that serious illness is covered as well as injury will not add significantly to the cost or numbers of veterans using caregivers’ assistance but will make a significant difference in their lives.

H.R. 3337 – IAVA supports H.R. 3337, the Open Burn Pit Registry Act of 2011. Burn pits have the potential to be the insidious and long-lasting health issue for our generation of veterans that Agent Orange has been for Vietnam-era veterans. H.R. 3337 seeks to be ahead of the curve in responding to potential future health concerns by establishing facts: who was exposed, where they were exposed, and for how long. These small but crucial pieces of information will be helpful in the future in ascertaining health impacts of burn pits, facilitating subject identification for epidemiological studies, and adjudicating claims. Burn pits were ubiquitous in Iraq and still are in Afghanistan. They are located in the midst of large numbers of troops. The twin facts that burn pits are the way waste is disposed and must be co-located with troops for logistical reasons guarantees exposure for most service members.  While IAVA supports H.R. 3337, we do so with a caveat. Because of the ubiquity of burn pits in these conflicts, we believe that the definition of burn pit must extend beyond solely those authorized by the Secretary of Defense. That proviso must be interpreted as broadly as possible and language should be inserted into H.R. 3337 that recognizes burn pits established by small-unit leaders to facilitate mission accomplishment. There is no garbage service for our troops to rely on in Iraq and Afghanistan and small units, by necessity, burn all the waste they have. This is a necessary addition to this important piece of legislation and IAVA urges inclusion of such language in the bill before passage.

H.R. 3723 – The goals of H.R. 3723, the Enhanced Veteran Healthcare Experience Act of 2011, are laudable and IAVA supports many of them. However, IAVA cannot support H.R. 3723 because we believe that this legislation makes several changes that are untested and do not necessarily provide hope of significantly improved patient outcomes or access to care. Increased access to healthcare for rural and underserved veterans, comprehensive care coordination, and a focus on metrics of quality care and patient satisfaction are reforms which IAVA has supported and campaigned for in the past. In addition, there are significant issues present in the VA’s fee-care program that need to be addressed for the sake of patient outcomes and providing the highest quality healthcare services possible.

The VA system has the capability to provide non-VA care to veterans who are either geographically constrained or who cannot be treated in a timely manner through VA providers. By removing the discretion of the VA to offer such options and mandating that services be provided on a contract basis, H.R. 3723 would effectively cripple VA healthcare. Entering into a contract for each veteran who would have previously fallen under the fee-care system would be unwieldy and cumbersome: would VA have to solicit several bids and pick the lowest bidder? Would the patient have to wait for care while the contracting process was being executed? Or would VA simply pay the fee charged by the healthcare provider without negotiation or comparison, a scenario under which upwardly spiraling healthcare costs and diminished access to services is easily envisioned? In addition, many medical options are not cost-effective in the private sector (i.e. prosthetics) and real questions exist regarding fiscal benefits and patient outcomes when outsourcing those types of care.

As mentioned previously, there are many issues with the current fee-care system that have been raised. The National Association of Public Administrators (NAPA) issued a report which recommended that the VA cease the fee-care program because VA lacks the infrastructure and expertise to implement fee-care in the best manner possible. This begs the question: should the fee-care system be replaced by another system that makes the VA a third-party payer (essentially replicating the scenario encountered with fee-care) or should the VA system be strengthened, funded and fixed so that the use of third-party non-VA providers is minimized and truly used out of necessity? IAVA prefers the latter option. Therefore, we do not endorse H.R. 3723.

H.R. 4079 – IAVA supports H.R. 4079, the Safe Housing for Homeless Veterans Act. This bill makes explicit what we would already assume to be the case: recipients of VA funds to house homeless veterans must be in compliance with all relevant building and safety codes. This is not an onerous burden. Rather, H.R. 4079 requires meeting minimum standards of safety and construction before an entity is eligible to receive or continue to receive federal funds. “Minimum standards” are explicitly “the least we can do.” Homeless veterans are those who have fallen on hard times after honorably serving their country. Their service and sacrifice for this country should at least earn them a safe place to get back on their feet and the Safe Housing for Homeless Veterans Act accomplishes this goal.