Mr. Chairman, Ranking Member Miller, Distinguished Members of the House Veterans’ Affairs Subcommittee on Health and honored guests, Vietnam Veterans of America (VVA) thanks you for the opportunity to present our views regarding  H.R. 4062, H.R. 4505, the draft legislation on Outreach, and the draft legislation entitled the WHAT Act.  With your permission, I shall keep my remarks brief and to the point.

H.R. 4062 Veterans' Health and Radiation Safety Act–

Requires the Secretary of Veterans Affairs to report annually to Congress on the low-volume (treating 100 patients or less) programs at each medical facility of the Department of Veterans Affairs (VA); and, Directs the Secretary to ensure that all employees at a VA hospital where radioactive isotopes are used in the administration of medical services receive appropriate training on what constitutes a medical event and when and to whom a medical event should be reported. Prohibits such isotopes from being used at a VA hospital where such training is not provided; and, requires the Secretary to carry out specified evaluations and peer reviews of all medical services provided under contract with a non-government entity.

The recent events at the Philadelphia VA Medical Center where veterans were harmed over an extended period by clinicians and technicians who were not properly trained have quite naturally caused great concern in the veterans’ community about both efficacy and safety.

The provisions of HR 4062 will take sensible and prudent steps to require the VHA to ensure that quality assurance mechanisms are in place so that those who are engaged in nuclear medicine activities anywhere within the Veterans Health Care system are properly trained, understand proper reporting of untoward incidents and record keeping with a view toward quality assurance in general, have proper supervision, have in place written procedures for quality assurance, and require periodic peer reviews to ensure that the treatments provided are at the proper dosing to actually work, but not so high as to cause the individual being treated harm.

VVA always favors sensible reporting that does not place undue burdens on the practicing clinician at the service delivery level. If the VHA sets up proper metrics all of the reporting that is necessary to accomplish the objective in this case (and most others) can be programmed to pick up the salient data on the VistA electronic health care records system. Therefore, requiring that a synopsis of activity over the course of a year, as well as an analysis of the program, be included in the VA’s Annual Report is a potentially useful step. VVA does not generally favor more staff for the sake of more staff in any branch of government, but it is key that the Committees on Veterans Affairs on both sides of the Hill have the organizational capacity to dig into the Annual Report, the Strategic plan for VA, and other key reporting mechanisms to be able to assist the distinguished Members of this Committee to hold the VA much more accountable than it has been in the past.

VVA favors passage of HR 4062.

H.R. 4505 Authorizes the Secretary of Veterans Affairs (VA) to permit a state home to provide VA nursing home care to parents who had any children who died while serving in the Armed Forces.

It is fitting that this proposed legislation should come for a hearing this week proceeding Memorial Day. Of all weeks in the year, this is when we should all be thinking about the terrible price of freedom in lives lost early, cut down in the early prime of life by virtue of service to country.

Each of the young people lost early left a web of bother and sister war fighters, as well as family and friends for whom the loss is particularly harsh. This is especially true for the Gold Star parents, the mothers and fathers who have lost their son or daughter in military service to country. What this proposed bill would do is give the Secretary of Veterans Affairs the authority to permit states who wish to do so to provide any needed care to these Gold Star Mothers and Gold Star fathers.

VVA certainly hopes that most states, if not all, would choose to provide such care as needed to these fine Americans who have suffered a loss so great that most of us cannot even imagine how great the pain must be. When they age their son or daughter is not there to care for them as the years take their toll. It is incumbent on the rest of us in our society to then step up and fill the void left by the early death of our comrade in arms. Insofar as possible those of us in veterans service organizations should and do step up to assist Gold Star families, and particularly gold star mothers. Supporting this move to cover nursing care as needed is the minimum we can and should do, as this is something that is beyond the span of control of the things we already do for and with the families.

VVA strongly supports early passage of this legislation.

Draft to Improve VA Outreach Act of 2010 legislation

The fact is, only twenty percent of veterans actively use the VA for their health care, and even many of these are not familiar with the health care and other benefits to which they are entitled by virtue of their service. What of the other eighty percent who never go to a VA regional office or medical center? Most of them are, quite simply, ignorant of these benefits— ignorant because they are uninformed. And they are uninformed because the VA has not in the past even tried to do a concerted, coordinated, comprehensive job of reaching out to them. 

VVA believes the VA has both a legal responsibility and an ethical obligation to reach out to all veterans and their families to inform them of the benefits to which they are entitled, and of the possible long-term health risks and problems they may experience due to where and when they served. Populating kiosks in VA medical centers with booklets and pamphlets is fine for those who make it to a VA medical facility. However, these do not get into the hands of either the very poor who do not use the system or the better off who do not need to use the system. 

What is needed is a real strategic plan, one that will employ TV and radio ads, billboards, and public service announcements, as well as cooperative efforts with civilian organizations and entities in a coordinated effort, yet one that adapts to regional and local realities.  The proposed legislation would mandate such a comprehensive plan. What VVA suggests is requiring the Secretary of Veterans Affairs to establish a separate account for the funding of the outreach activities of the Department. This would establish a separate subaccount for the funding of the outreach activities of each element of the Department of Veterans Affairs.

The way to make things happen at the VA is to make sure that they plan for it, and then require that they specifically provide the line item budget for it, and then to monitor the dickens out them to ensure that it is done, and done correctly.

VVA has specifically started a project called the Veterans Health Council (www.veteranshealth.org) because the VA does such a poor job of informing veterans and their families as to the wounds, maladies, injuries, diseases, and other adverse health risks they may be subject to depending on what branch of the military they served, when and where they served, their military occupational specialty, and what actually happened to them while in military service. The primary mission of the VHC is to partner with medical societies, professional medical organizations, disease advocacy groups, other veterans organizations, and interested parties to inform civilian medicine about these special health risks of veterans, so they can provide better care to the their patients, and so we can educate the veteran and their families through their civilian provider.

While we are making some progress with the work of the Veterans Health Council, we are under no illusion that we have or are likely to ever have the resources or the reach to get this job done correctly. But at least we have started, whereas the VA has not done so. This bill would require them to start doing what they should have been doing all along.

VVA strongly favors early passage of this much needed legislation.

Draft World War II Hearing Aid Treatment  WHAT Act legislation

The dangers and risks of military service to hearing, because of the loud noises that are so prevalent in every branch of the military, have been so well known for so long that we have tended to either ignore this important subject or to joke about aspects of it with wry military humor. Until recently we have not seriously looked at the very serious medical conditions of irreversible damage to one of the five basic human senses that is so often resulting from military service.

Earlier in this decade the Congress, led by the Members on this distinguished Subcommittee, mandated that VA contract with the Institute of Medicine of the National Academy of Sciences to take a comprehensive look at the damage to hearing as well as the generally thought of as being closely associated with hearing loss, but equally debilitating condition of tinnitus. That mandate led to a project of the little known but quite extraordinary Medical Follow Up Agency (MFUA) convening a panel of experts and conducting a consensus study that resulted in a report being issued in September of 2005.

Noise-Induced Hearing Loss and Tinnitus Associated with Military Service from World War II to the Present

Activity Description

A congressionally mandated study by the Institute of Medicine assessed noise-induced hearing loss and tinnitus associated with military service from World War II to the present, the effects of noise on hearing, and the availability of audiometric testing data for active duty personnel.

The expert committee was charged with providing recommendations to the Department of Veterans Affairs (VA) on the assessment of noise-induced hearing loss and tinnitus associated with service in the Armed Forces. The committee was asked to

• review staff-generated data on compliance with regulations regarding audiometric testing in the services at specific periods of time since World War II,
• review and assess available data on hearing loss,
• identify sources of potentially damaging noise during active duty,
• determine levels of noise exposure necessary to cause hearing loss or tinnitus,
• determine if the effects of noise exposure can be of delayed onset,
• identify risk factors for noise-induced hearing loss, and
• identify when hearing conservation measures were adequate to protect the hearing of service members.

Staff of the Medical Follow-up Agency identified populations of veterans from each of the armed services (Army, Navy, Air Force, Marine Corps, and Coast Guard) and from each of the time periods from WWII to the present. The service medical records of a sample of these individuals were obtained and reviewed for records of audiometric surveillance (including reference and termination audiograms).

The committee's final report, Noise and Military Service: Implications for Hearing Loss and Tinnitus, was released in September 2005. That report can be accessed at the link below:

http://www.iom.edu/Reports/2005/Noise-and-Military-Service-Implications-for-Hearing-Loss-and-Tinnitus.aspx

Essentially what this report detailed is what we already knew and what was not known, because there were no significant longitudinal studies of humans and audionomic hearing loss, much less such studies of military personnel. Moreover, the study confirmed that there was little if any attention made to protecting the hearing of military personnel until the 1970s, and even then the efforts were minimal and usually restricted to highly controlled training situations (e.g., the rifle ranges used in basic training). For obvious reasons, soldiers in combat situations were (and are today) unlikely to wear hearing protective gear because it does not allow them to be at the highest state of situational awareness of the enemy or potential enemies (i.e., what you can’t hear can and will hurt/kill you).

World War II veterans are now in their eighties and nineties. It is clear that there are no good records to research to prove service connection for hearing loss for these men and women who still survive today. It is as likely as not that many, if indeed not most, of them first suffered damage that led to greater hearing loss than they would have otherwise experienced started in military service. For most who experience hearing loss today being able to have access to use of decent hearing aids and devices is perhaps the one single thing that would improve the quality of life for the most of these veterans. It is long past the time when these folks should be subjected to the adversarial system of proving service connection to the satisfaction of VBA personnel (and it is adversarial, despite the assertions of VBA officials). We urge you to pass this legislation to provide the hearing devices to these men and women who need and want them without cost on  a no fault basis, without making them have to prove a nexus in military service more than sixty five years ago.

VVA commends the Chairman, Ranking Member, and the other distinguished Members of this Committee for moving to assist these men and women with early passage of the WHAT act.

I shall be glad to answer any questions you might have. Again, I thank you on behalf of the Officers, Board, and members of VVA for the opportunity to speak to this vital issue on behalf of America’s veterans.