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Witness Testimony of René A. Campos, Commander, U.S. Navy (Ret.), Deputy Director, Government Relations Military Officers Association of America

MADAM CHAIR BUERKLE, RANKING MEMBER MICHAUD AND DISTINGUISHED MEMBERS OF THE SUBCOMMITTEE, on behalf of the 375,000 members of the Military Officers Association of America (MOAA), I am grateful for the opportunity to present MOAA’s views on several legislative provisions impacting veterans’ health care.

MOAA does not receive any grants or contracts from the federal government.

MOAA greatly appreciates the Subcommittee’s leadership in addressing the very important business of taking care of our veterans by your diligent oversight of their medical care and benefits which tangibly honors their service and sacrifice.

Our Association wants to acknowledge and thank the Department of Veterans Affairs (VA) for its hard work and persistence in transforming the agency.  Clearly, VA has made significant strides in changing the culture, policies and programs and is moving towards a more veteran-centric organization. 

MOAA’s perspectives on the seven bills being considered by the Subcommittee today are outlined below. 

·        H.R. 1460, Congressman William Owens (R-NY) — allows veterans returning from combats zones to automatically be enrolled in the VA medical system.

MOAA thanks Representative Owens for his commitment to ensuring veterans seamlessly transfer from the Department of Defense (DoD) military health care system into VA’s medical system.

While MOAA agrees with the need for seamless transition from the military to VA medical and benefits systems, we believe there should be no distinction between veterans who have served in combat areas and those who have served in other types of assignments.

Automatic enrollment of only combat theatre veterans will likely be perceived as a negative decision by non-combat veterans, causing them to view it as a form of health care rationing and the government’s attempt to diminish their contributions of service to their country.

The concept of automatic enrollment is consistent with MOAA’s longstanding support for actions that lead to the ‘seamless transition’ of service women and men into the VA system and civilian life.  Ongoing work on the bi-directional DoD – VA medical record could be advanced by automatic VA health care enrollment.  But, the provision does not eliminate the requirement for the veteran to physically enroll at a VA medical center. Perhaps VA’s outreach system could be strengthened by having advance information on separating service members put into VA’s enrollment system.

An automatic process will, of course, simplify enrollment data tracking and would likely drive the demand and cost of VA care.  For example, when Congress authorized open enrollment in the VA health system from 1999-2003 for all honorably discharged American veterans, enrollment climbed but not to unmanageable levels.  With the enormous increases in health care costs since then, more separating service members might seek VA care if they were automatically enrolled and informed of the action.  

MOAA supports the concept of H.R. 1460, automatic enrollment in VA health care and recommends H.R. 1460 be amended to authorize enrollment of all OIF – OEF veterans to advance seamless transition outcomes from military service to the VA.   

·        H.R. 3016, Congressman John Barrow (D-GA) — directs the Secretaries of VA and Defense to jointly operate the Federal Recovery Coordination Program (FRCP).

MOAA testified in September 2011 before this Subcommittee at a hearing on the FRCP, promoting a joint VA-DoD care coordination program oversight office and policy modeled after the FRCP. 

We again testified in early March 2012, during a hearing before the House and Senate Veterans’ Committees on MOAA’s legislative priorities for veterans health care and benefits, stating the need for a single, joint VA-DoD office that consolidates the two agency programs.  We did not recommend the program be modeled after the FRCP program because of the agencies’ emphasis and desire to work more closely together to improve seamless transition of this extremely vulnerable population.  

The two Departments have stepped up their collaborative efforts significantly since the DoD Recovering Warrior efforts Task Force published its 2010-2011 Annual Report last September.  Both agencies acknowledge more work needs to be done in improving care coordination.  We believe VA and DoD are doing their best to meet the intent of Sec. 1611 of Public Law 110-181 in the coordination of care require in the law. 

MOAA does, however, believe that congressional and VA-DoD leadership oversight continues to be needed until care coordination programs, policies and systems mature and are operating efficiently and effectively.  We look to Congress to determine if “a single, joint VA-DoD program and office for managing, coordinating, and assisting wounded, ill, and disabled members through recovery, rehabilitation, and retention,” is still needed as required in the law.

MOAA supports the provision in concept but recommends Congress continue to provide oversight by conducting hearings and reports from senior officials in the Departments in lieu of additional legislation in order to determine the efficacy of programs and increase accountability of the systems for care coordination . 

·        H.R. 3245, Congressman Jeff Denham (R-CA) — the “Efficient Service for Veterans Act,” directs the Secretaries of the VA and Defense to jointly ensure that the Vet Centers of the VA  have access to the Defense Personnel Record Image Retrieval system and the VA/DoD Defense Identity Repository system.

MOAA does not have enough information on these issues to take a position on

H.R. 3245 .

·        H.R.  3279, Congressman Silvestre Reyes (D-TX)  – amends and clarifies title 38, United States Code so that caregivers of veterans with serious illnesses (in addition to injuries) would be eligible for assistance and support services provided by VA.

On June 30, 2011, MOAA submitted to VA our response to the Caregiver Program’s interim final regulations concerning the new benefits program directed in title 1 of the Caregivers and Veterans Omnibus Health Services Act of 2010 (P.L. 111-163), signed May 5 of that year.

The letter highlighted our concerns about the “Definition of Serious Injury” in Section 71.15.  In the letter we stated the VA:  defines ‘serious injury’ as “any injury, including psychological trauma, or other mental disorder, incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001, that renders the veteran or servicemember in need of personal care services.”

It was not clear from the statement as to how VA will address those individuals whose conditions incurred during service worsen or change to the point of needing caregiver assistance once they are in a veteran status.  We believe the intent of Congress was to allow both active duty and veteran caregivers to qualify for the benefit.  Additionally, VA’s definition of serious injury does not specifically address illness, though it could allow for such conditions but is left open to interpretation. 

In March, MOAA checked with the VA Caregiver Support Office about the status of the regulations and response to public comments.  VA was quick to respond to our request for information letting us know that they were still coordinating the rules.   VA’s Caregiver Support Office has also been active in its efforts to educate and inform stakeholders on the program as well as responding to wounded, injured, ill, and disabled members and families when issues surface. 

 MOAA supports H.R. 3279.

·        H.R. 3337, Congressman Todd Akin (R-MO) — “Open Burn Pit Registry Act of 2011,” directs the Secretary of Veterans Affairs to establish an open-air burn pit registry to ensure that members of the Armed Forces who may have been exposed to toxic chemicals and fumes caused by open-air burn pits while deployed to Afghanistan or Iraq. 

MOAA appreciates Congressman Atkins’ concern over the health and welfare of those men and women who have served and are currently serving in uniform near burn pit operations in Iraq and Afghanistan.

For years, the Air Force provided warnings in their pre-deployment briefings and fact sheets stating that use of open burn pits “can be harmful to human health and environment and should only be used until more suitable disposal capabilities are established.”  Yet open-air burn pits continued operations in Iraq and Afghanistan. 

Over the past decade, many servicemembers have complained of headaches, nausea, and irritation of the eyes after immediate exposure while several servicemembers and veterans have contracted various symptoms and life-threatening medical conditions after being exposed to burn pits used to dispose of waste in Iraq and Afghanistan. 

MOAA fully supports H.R. 3337.  Establishing a registry of servicemembers and veterans exposed to burn pit operations will provide a potential long-term link between exposure to harmful open-air burn pits and significant, long-term health problems. 

·        H.R. 3723, Congressman Robert Schilling (R-IL) — “Enhanced Veteran Healthcare Experience Act of 2011,” amends title 38, United States Code, requiring VA to enter into contracts with health care providers to improve access to health care for veterans who have difficulty receiving treatment at a health care facility of the VA.

Our Association, like Congressman Schilling, is very much concerned about the access, adequacy, and the quality of health care for our veterans.  VA acknowledges a number of challenges to the existing fee-based care program and has committed significant resources and funds to look at alternative ways to deliver care while maintaining the integrity and quality of the medical system.  They are also taking lessons learned from the contract pilots that have been launch in recent years, continuing to look at better and more efficient ways to deliver care and services.

MOAA agrees with the Veterans’ Independent Budget (IB) conclusion that current purchased care initiatives need time to mature.  Imposing a mandate on VA could be counter-productive, disruptive, costly, and ultimately limit progress on ongoing purchased care efforts.

In addition, VA currently has no mechanism to ensure medical data from fee-based care providers are transmitted back to VA and integrated in veterans’ electronic medical records.  MOAA strongly agrees with our Veterans Service Organization partners that any non-VA care must be fully integrated into the VA health care systems to protect not only the system, but also the safety of veterans. 

MOAA does not support H.R. 3723 as written.   Rather, we urge the Subcommittee to consider the recommendations in the FY2013 IB that address the issues in VA’s purchased care system.  Specifically, we strongly recommend that:

  • VA should provide Congress and the veteran community a final analysis and evaluation of Project HERO.
  • VA should develop an effective integrated care coordination model for all non-VA purchased care to ensure eligible veterans gain timely access to care, in a manner that is cost-effective to the VA, preserves agency interests, and most important, preserves the level of service veterans have come to rely on inside the VA.
  • VA should develop identifiable measures to assess its integrated care coordination model for all non-VA purchased care.  The evaluation should be shared with Congress and the veteran community.
  • H.R. 4079, Congressman David McKinley (R-WV) — “Safe Housing for Homeless Veterans Act,”requires homeless veteran recipients of housing grants and other assistance from the Secretary of VA to comply with codes relevant to operations and level of care provided.

MOAA does not have sufficient information on the issues to take a position on

H.R. 4079.

Conclusion

MOAA thanks the Subcommittee for being champions of our veterans and their families.  We appreciate the opportunity to share our views on these important provisions and we look forward to working with the Subcommittee on ways to improve VA health care so we can further enhance the quality of lives of those individuals in our veterans’ community.