The State of the U.S. Department of Veterans Affairs.
THE STATE OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
SEPTEMBER 18, 2007
SERIAL No. 110-42
Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE
For sale by the Superintendent of Documents, U.S. Government Printing Office
CORRINE BROWN, Florida
STEVE BUYER, Indiana, Ranking
Malcom A. Shorter, Staff Director
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined.
C O N T E N T S
September 18, 2007
The State of the U.S. Department of Veterans Affairs
SUBMISSIONS FOR THE RECORD
MATERIAL SUBMITTED FOR THE RECORD
Post Hearing Questions and Responses for the Record:
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to Hon. Gordon Mansfield, Acting Secretary, U.S. Department of Veterans Affairs, letter dated October 10, 2007, transmitting questions from Hon. Corrine Brown, Hon. Stephanie Herseth Sandlin, and Hon. Joe Donnelly
Hon. Steve Buyer, Ranking Republican Member, Committee on Veterans' Affairs, to Hon. Gordon Mansfield, Acting Secretary, U.S. Department of Veterans Affairs, letter October 5, 2007, transmitting questions from Hon. Gus M. Bilirakis
THE STATE OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS
Tuesday, September 18, 2007
U. S. House of Representatives,
Committee on Veterans' Affairs,
The Committee met, pursuant to notice, at 11:01 a.m., in Room 334, Cannon House Office Building, Hon. Bob Filner [Chairman of the Committee] presiding.
Present: Representatives Filner, Michaud, Herseth Sandlin, Mitchell, Hall, Hare, Berkley, Salazar, Space, Walz, Buyer, Brown of South Carolina, Miller, Boozman, Turner, Lamborn, Bilirakis.
The CHAIRMAN. Good morning. I am going to call this meeting of the House Veterans' Affairs Committee to order.
Thank you, Mr. Secretary, for joining us and bringing your team with you. As usual, we will have votes at some point soon. So, unfortunately, I am sorry we will have to recess, but we will have to do that to vote.
We have a very simple agenda, Mr. Secretary, and that is to thank you, to thank you for your service as Secretary, to thank you for your commitment to our veterans, for the job that you did for so many people in our society.
We want to again honor you for your service. We want to give you a chance to sum up the achievements that you have had and give us a to-do list in the future for us and for your successor.
You worked with us during very tough, challenging times. We have veterans that we have to serve from the past in World War II, Vietnam, Korea, Persian Gulf, and we have got new veterans coming back with very difficult injuries, very difficult circumstances that we are going to have to care for. That is a tough challenge. And we have worked with you to put the resources in place to meet that challenge.
I want to just personally thank you for working with us so closely during your term of office. I know my wife, Jane, thanks your wife, Suzanne, for working together on the Paralyzed Veterans of America (PVA) Gala.
And I want to thank you for taking this trip that Congressman Boozman and I, and you, took at your suggestion to Iraq and Afghanistan where we followed the trail of the wounded warrior from wounds on the battle field to medical evacuation, to surgery at a forward base hospital, to movement to the main hospital, and then on to Landstuhl. And we followed that trail, talked to people who did surgeries or medivaced the people that we are going to have to serve in the future.
And we thank you for your leadership on that. I was particularly struck with a question you asked, of the people we met, on post traumatic stress disorder (PTSD) where you were concerned very specifically for what preparation our soldiers would have before going into battle as opposed to what we have been concentrating on after battle.
And I was very struck with your concern. I was struck with the lack of responses, by the way, but your concern, your commitment, and the far-sighted kinds of programs that you have instituted in the U.S. Department of Veterans Affairs (VA).
So, again, we have a simple agenda, to thank you and for you to say goodbye on a summary note and for letting us know what you see in the future. Again, thank you for being here. Thank you for bringing your team.
[The statement of Chairman Filner appears in the Appendix.]
The CHAIRMAN. Mr. Buyer.
Mr. BUYER. Mr. Secretary, big smiles. This is your last time to testify here before the House. And I want to take the occasion to say thank you.
Those I have worked with over the years, the position as Secretary and that of Under Secretary can be a thankless job. And you also share the same intangible of the men and women you had the privilege to lead. They do not have to serve and work in the VA. They do so for a number of very personal reasons because they can sure make a lot more money doing other things.
I will agree with Mr. Filner that your sincerity is unquestionable. Your devotion to your fellow men and women is remarkable and I think you have exhibited that throughout your career, not only as an Army officer, not only in times of peace, but also in times of war.
And that has given you a tremendous amount of strength as you have also relied upon your faith to help guide you and to help guide our country among a lot of turmoil throughout the world.
So I thank you for your service representing our country to the Vatican as an Ambassador. I thank you for your service as Secretary, for having the privilege to care for America's most precious assets, the men and women who wear the uniform and have been hurt in the line of duty whether it be during peace or at war.
And your responsibilities really are not too much different from ours because the Constitution lays out those responsibilities. Ours are to fund your budgets. We also have the oversight responsibility and we also with earnest and sincerity work equally hard to right the wrongs and also then to defend that which we believe is right.
And we all want what is best for our comrades. And so there are times where we can disagree and agree to disagree, but I really believe that with all sincerity, that is the track in which we work.
And it only works when we all partner with each other, not only the House and Senate and with our interpretations of the Supreme Court's judgments of what we do, but also among Republicans and Democrats who serve on the Committee. It only works when we partner because that is, in fact, how we get the best product.
When that does not happen, then America and the comrades who we serve do not get the best product. And that is what happened the last time that this Committee was back together.
We had a markup, a bill called H.R. 760, and for the first time that I have been here—matter of fact, we cannot even remember the last time there was a party line vote in this Committee. We are deeply concerned, the members that I have had conversations with on both sides of the aisle.
We are going to work together in a bipartisan fashion. We are going to continue to do that. Those relationships we have developed over the years are too strong. I do not know the future and the way ahead. I am not the Chairman of this Committee.
Mr. Secretary, your record, I think, is pretty extraordinary. The reason I say extraordinary is because I think anyone that wants to step in to be Secretary of the VA wants to leave it better than what it was when you got there. You get the privilege of saying that.
Even though there are many challenges still in front of you, many of which you are still working on. When I think of the things that you have personally done, you have exhibited leadership, meaning you have said I will take the time to listen, to understand a problem. You accepted responsibility, accountability, and then you took positive action.
So when it was the issue on budget integrity and we worked with you on the budget modeling issues, you told this Committee that you will take ownership of the budgetary process. And when you did that and you fixed the flaws in that budgetary process, your budgets, which are 2007 and 2008, are very robust and receive compliments from not only the veterans community but also from this Committee.
When I think about the information technology (IT) systems, you have other departments of government that envy the VA. And what you have been able to do in empowering the Chief Information Officer will pay great dividends and I think you, by your actions, you are helping our entire government because, once again, the VA is at the tip of the spear setting the pace for the country.
The same with seamless transition. You are setting the pace and at times pulling the U.S. Department of Defense (DoD) begrudgingly your way. You have a partner now as the new Secretary of the DoD wants to work with you in doing that.
We also have the Presidential Commission and this Committee is eager to hear your recommendations and that of the President's Commission. And I am sure you have some comments on that.
The last thing as you are leaving that this Committee is eager to work on—Admiral Cooper will still be here—is the Disability Commission's recommendations to us and how we can address those issues.
Mr. Secretary, to you, I want you, as you leave here today, to know that we are deeply appreciative that you have taken time from your family to serve the greater family, that of your comrades.
I yield back.
The CHAIRMAN. Thank you, Mr. Buyer.
Mr. Secretary, rather than interrupting you, we are going to recess to vote and then we will reconvene to hear your statement. I apologize for the schedule, but it is not under our control.
Again, we are very gratified that you are here to be able to say goodbye and to say goodbye with a thank you for great service done to this Nation.
We will recess until the votes are over.
The CHAIRMAN. Mr. Secretary, we thank you for your service. I know you brought your team with you. We thank them all. I do not know if they know what is going on with the team after you depart, but we thank the whole team for their commitment and their service to our veterans.
Mr. Buyer has arrived, so please continue.
STATEMENT OF HON. R. JAMES NICHOLSON, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY HON. MICHAEL J. KUSSMAN, M.D., MS, MACP, UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; HON. DANIEL L. COOPER, UNDER SECRETARY FOR BENEFITS, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; HON. WILLIAM F. TUERK, UNDER SECRETARY FOR MEMORIAL AFFAIRS, NATIONAL CEMETERY ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; PAUL J. HUTTER, ACTING GENERAL COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND ROBERT J. HENKE, ASSISTANT SECRETARY FOR MANAGEMENT, U.S. DEPARTMENT OF VETERANS AFFAIRS
Secretary NICHOLSON. Thank you, Mr. Chairman and Members of the Committee. Thank you for holding this hearing and giving us the opportunity to discuss the current state of the VA.
I would like at the onset to introduce those members of my team that are here at the table with me. Starting at my right, your left is the Under Secretary for Memorial Affairs, Bill Tuerk. Next is the Under Secretary for Benefits, Admiral Dan Cooper. And to my immediate left is the Under Secretary for Veterans Health Administration (VHA), Dr. Michael Kussman. To my far right is Mr. Paul Hutter, the Acting General Counsel of the VA and to my immediate right is Bob Henke, the Assistant Secretary for Management of the VA. A group of very distinguished public servants, believe me.
It has been a real honor to serve the President and our Nation's veterans as the Secretary of Veterans Affairs these past 32 months. My own military service and the tradition of veterans go back a long way in my life.
My father was an enlisted man in the Navy during World War II. My father-in-law served in both World War II and Korea. My brother served 30 years in the Army. My son is a veteran and four of my nephews currently are Colonels in the Army and Air Force.
And I have a particular affinity for the young men and women currently serving in the Global War on Terror and to me, they are heroes, those volunteer servants.
Mr. Chairman, you and I, along with Congressman Boozman, returned recently from a trip to Iraq and Afghanistan and there we had the opportunity to speak with these young troops as well as with their leaders.
What we both saw, what we all saw was the most impressive group of Americans, a group that makes us all proud. They know their mission. They know their jobs. They are motivated. They are all volunteers. They are young, bright, and speak eloquently of their patriotism and how they see the importance of their own roles in the war we are fighting today against the radical Islamists.
That trip and others that I have taken to that region, one with then Chairman Buyer, now Minority Member Buyer, renewed my own commitment to assure that we at the VA should do everything in our power to meet the needs and those of the families of these warriors. We can do no less. They have earned no less.
So, Mr. Chairman, today I would like to give you my current assessment of the VA with that mission as our background. I would like to review our initiatives and accomplishments and discuss remaining challenges.
My emphasis will be on the transformations that we have achieved, especially with respect to Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF).
My assessment is that the VA is quite possibly the best healthcare system in the world. This is borne out by a number of sources, those who accredit and assess such things, as well as the major media of this country.
Most recently a book has come out called "The Best Care Anywhere: Why VA Healthcare is Better than Yours," written by a person named Longman whom I have never met, the fellow at a think tank.
And if you are not convinced yet, Mr. Chairman and Members of the Committee, I want to cite the ultimate source for you. The statement last week being, "The veterans hospitals, that is a completely government-run operation and it is the best healthcare in America," a statement by Bill Maher on the "Real Time With Bill Maher." So take that one to the bank.
The Veterans Health Administration really is quite extraordinary. It is a healthcare delivery system with the following characteristics, I think, which in the composite make it that world-class system.
It is a flexible organization that can change rapidly to meet the exigent needs of veterans. It leads the Nation in prevention, evaluation, and treatment of PTSD and traumatic brain injury, about which I will speak more momentarily.
It continues to lead the world in maintenance and improvement of the electronic transfer of medical information. It is a leader in applying the advances made in understanding the human genome with continuing research underway at the VA. And VA research will continue to push the frontiers of medicine and VA clinicians will lead the way in bringing the latest research advances to the bedsides of our patients.
And I would add parenthetically there, Mr. Chairman, that the VA has now successfully completed the clinical testing of a vaccine for shingles and that vaccine is now on the market and doctors can prescribe it to patients. That was done through VA research.
It will continue to improve patients' access to healthcare, reduce waiting times in virtually every area, and provide state-of-the-art prosthetic and other aids in a timely manner to all patients.
Let me speak to veterans' benefits. The Veterans Benefits Administration (VBA) is an immense institution. It provides a vast array of benefits to include educational benefits, home loan guarantees, life insurance, vocational rehabilitation, and employment programs.
It also, of course, administers the veterans pension system and the disability compensation system. Approximately 830,000 claims for disability benefits are now being filed each year. Claims for disability compensation, more than half of which are reopened claims seeking an increase in percentage of disability, present complex issues of service connection, effective date, and degree of disability.
For the veteran or his family unfamiliar with the legal and regulatory structure that defines this benefit system, navigating it can be a challenge. To assist them, the VBA now operates an extensive network of public contact and outreach.
During 2006 alone, the VBA public contact staff handled nearly seven million phone calls from veterans and we conducted more than a million interviews.
Let me mention the Advisory Committee on OIF/OEF veterans, which I created to give me a tool to assess off-line, if you will, at the grass-roots level better how we are doing. It is an Advisory Committee on veterans and their families that assists me in ways to respond better to the unique needs and improve the programs serving those veterans, their families, and their caregivers.
The Committee is composed of veterans, survivors, and families, all of whom have a unique insight into just how we are responding to their needs. The Committee will continue its work in the months and years ahead and monitor how VA is doing, how we can do it better, and point that out directly to the Secretary.
Because of the unique and immediate needs of this particular group of veterans, that is the current combatants, I directed the Veterans Benefits Administration to give priority to these veterans who apply for disability compensation or pension. These claims are now being processed on an expedited basis.
The improvised explosive device or IED is the signature weapon of the war that is being fought today in Iraq and Afghanistan. Regrettably, it has given rise to what has been referred to as the signature injuries of this war which are traumatic brain injury or TBI, and post traumatic stress disorder, or PTSD.
PTSD is different from TBI although they can coexist. The stress of the type of warfare our servicemembers are experiencing coupled with the fact that they are redeploying with their units multiple times can sometimes give rise to one or more mental health diagnoses such as PTSD, substance abuse, depression, or anxiety.
To ensure prompt identification of these issues, I have directed that servicemembers and families coming to the VA for any reason, any reason whatever, be screened thoroughly for traumatic brain injury and PTSD.
The goal is to detect it early so that we can treat it and return that veteran to a lifestyle that is mentally healthy. And the probabilities of that are much higher the earlier that we detect it.
Helping each of our patients to get better is what the VA should be doing and this applies to mental illness as well as physical injury.
One venue for providing support for veterans with readjustment issues is our Vet Center Program. Across the country, there are 209 Vet Centers each staffed with professionals who provide no-hassle counseling to veterans and their families.
The VA has, at my direction, recently hired 100 new outreach counselors to provide the service to returning OIF/OEF veterans. These outreach counselors are themselves veterans as well. They understand that group of veterans and can relate directly to them. These new coordinators are located in Vet Centers throughout the country, especially near our military processing stations.
I would like to mention some of our health initiatives that we have launched. When I came to this job, I was stunned to learn that over 25 percent of the veterans that we are treating suffer from adult onset diabetes type II and that is a disease that is often associated with obesity. And diabetes is a disease that you well know can lead to complications which in time result in blindness, renal failure, and amputations.
Because of the seriousness of the diabetes diagnosis, I commenced a major campaign to reduce this high rate of obesity and diabetes in veterans. And it is underway and showing signs of promise.
Another major health initiative that we have kicked off is what we call the MRSA initiative. That stands for methicillin resistant staph aureus which is staph infection sometimes found in hospitals. We launched a pilot of this at our Pittsburgh VA hospital and found the results of it to be very promising. And we found that by isolating patients who were carrying the bacteria and by scrupulous sanitation habits that MRSA can be virtually eliminated, and it was in the Pittsburgh hospital.
So we have now launched, using that pilot as the model, this program across the entire system of the VA. And I might add that the staff, while it impedes work, especially of doctors who have to stop and regarb and wash their hands as well as nurses, it has been embraced enthusiastically. I would also add that MRSA today kills more people in our country than are killed on the highways.
Another initiative that we have launched is to try to fulfill the shortage of nurses that we have at the VA, which is endemic to healthcare in the United States. We feel that throughout the VHA system, there is a tremendous challenge for the recruitment and retention of nurses.
So as an effort to ameliorate this situation, we have recently created a new multi-campus nursing academy through partnership with the nursing schools throughout the country to address this shortage of nurses.
Over the years, there has been a radical change in the way that healthcare is delivered in this country. At one time, individuals who were ill went to a hospital and more often than not, they stayed there for many days, especially at the VA. That is no longer the case.
Today the best medicine involves getting you into and out of a hospital as quickly as possible—now the VA has nearly 900 outpatient clinics which we call community-based outpatient clinics or CBOCs as well as outreach clinics. During my tenure, I approved 82 new CBOCs to bring the VA's top-notch care closer to veterans who have earned it by their service.
Among the things that make this system of healthcare so effective is the Veterans Health Information System or VHIS, the nationally recognized electronic medical record used universally throughout the VA such that an enrolled veteran can be treated at any one of our points of access and all of his or her relevant information will be available instantaneously at the treating healthcare facility.
Those are physical health initiatives. Let me mention mental health initiatives.
Of late, the DoD has released alarming statistics about the number of servicemembers who have committed suicide in the past year. According to a recently released Associated Press article, last year, the largest number of suicides of active-duty Army servicemembers occurred in 26 years.
Because of suicides among the veterans for whom we care, I directed the hiring of suicide prevention counselors at each of our 153 major medical centers and they are now on station. This was intended to strengthen one of the Nation's largest mental health programs.
I also directed the establishment of an around-the-clock national suicide prevention hotline. The hotline became operational in late July of this year and has now received over 4,500 telephone calls. And as a result of these calls to these suicide prevention hotline professionals, 165 veterans have been admitted to VA mental health treatment programs as a result of this new line of communication.
I want to mention IT transformation which transcends all of the things that we do. The structure of a large agency such as the VA must of necessity be adjusted over time to ensure that the institution can be responsive to its mission and the ever-changing demands thereunder.
Significantly the long, decentralized VA information technology structure needed to be updated and in my opinion centralized, and that opinion was supported by that of experts consultants.
So in 2006, we launched a major information technology transformation and consolidation or centralization. Significantly this will govern the way the VA uses and safeguards veterans' personal health information. With identity theft being among the fastest-growing crimes in the country today, this consolidation and the resulting heightened security of personal identifying information will make the VA the gold standard in the realm of information privacy and security.
In addition to the traditional VA missions relating to healthcare and benefits, the VA has a fourth mission worth mentioning which is to provide support to the country in the event of a national disaster. This is authorized through the "Stafford Disaster Relief and Emergency Assistance Act" and implemented through the National Medical Disaster Plan.
We spent a great deal of time in our operation in training and planning for this mission and we have now created, thanks to legislation that you gave us, a new Office of Operation Security and Preparedness to deal with emergency planning and security. And it is charged with the planning for the continuity of government and the continuity of operations which for us, you can imagine as seeing over a million medical patients a week in the largest hospital system in operation, is an immense contingent responsibility.
I would like to mention briefly another initiative that we have taken. And just today I signed the paperwork to come here to the Hill seeking from you the creation of an additional Assistant Secretary of VA for Acquisition, Logistics, and Construction.
Each year, the VA spends billions of dollars for products and services. And each year, there are new additional VA medical centers put into the planning process for upgrading, modernization, or in some cases construction of new facilities.
And with the VA's physical plant being on average 57 years old, plus the demographic shifts in the veteran population, it is essential, I believe, that the VA do all it can to update and modernize its facilities. Yet the cost of purchasing land, design, and construction of a new VA hospital today is in the range of $750 million. The magnitude of these numbers and the complexity of the acquisition processes indicate that there must be a very high level of competence and accountability in this mission.
Let me mention that the National Cemetery Administration (NCA), in addition to the health and monetary benefits VA provides. NCA provides memorial benefits for our fallen veterans.
In 2006, the NCA provided more than 330,000 headstones or markers for graves of veterans worldwide and currently maintains more than 2.8 million grave sites in 125 national cemeteries in 39 States and Puerto Rico, and, as most of you know, is in the largest expansion currently since the Civil War.
In the area of frustrations and challenges, I would like in candor to bring up with you, the VA claims backlog. It is a complex issue.
The VA can influence the output, that is the claims decided, but it cannot control the input. Quite the opposite, actually, because we have a very active outreach, soliciting more input. And in the midst of a war, more claims for service-connected disabilities are being filed.
In addition, veterans of previous conflicts have been filing claims at a higher number as they are reminded of incidents from their own military backgrounds by news reports of the current war.
From fiscal year 2000 to 2006, receipts of disability compensation and pension claims rose from about 575,000 to 830,000 and we expect to receive 835,000 claims this year. To control the output, we are hiring at a rapid rate additional staff. Since January of this year, we have already added 1,100 new members to help us in our commitment to reduce the claims backlog and the time it takes to process a claim.
The VBA is also working to consolidate suitable components of the work as has been recommended by the the U.S. Government Accountability Office to achieve efficiencies, more consistency in claims decisions, and better control over the process.
Let me mention another area that has been of concern to you and received quite a bit of publicity and that is in the area of bonuses at the VA.
Some months ago, it was noted that like every other government agency, the VA had paid bonuses to its senior executives. The bonuses were paid from a pool of funds created in accordance with statute and OPM regulations, that is Office of Personnel Management regulations, and the bonuses were determined by panels of senior executives acting in accord with these guidelines.
The highest Senior Executive Service salary is about $165,000. A few bonuses in the amount of $30,000 were paid in recognition of the accomplishments of highly-competent, long-serving executives.
Some criticized that one of those executives had been involved in the preparation of the fiscal year 2005 budget. And another holds a senior position in the VBA, the administration that continues to struggle with backlogs.
Well, I have personally worked with both of those individuals and I have the highest regard for their ability and their prodigious work ethic. And I believe that the criticism leveled at each of them is unwarranted in that they encountered conditions beyond their control, having used their considerable skills to minimize the problems they encountered.
So in closing, Mr. Chairman, I would like to end where I started by thanking you for allowing me to appear before the Committee to discuss the current state of affairs at the VA and many, many of the positive things that have occurred during my tenure as Secretary and to mention some that remain challenges.
But working with you and Ranking Member Buyer and other Members of this Committee, I think we made tremendous progress. Together I think we have made the VA a stronger, more focused organization, focused on the very real needs of all of our veterans certainly, but especially those currently engaged as warriors in the Global War on Terror. It has been my pleasure to serve them as well as all veterans who have served before them.
So I would like to thank you and the leadership of this Committee, the President, and the entire Congress because you have all collectively been very supportive of the VA on my watch. We have no excuses for lack of support from you and from the President.
And, finally, I would like publicly to thank the employees of the VA. There are about 244,000 of them and they are, I think, an extraordinary group of people and they are bonded and motivated by a common denominator which is their affection for and their concern for America's veterans. And it has made me very proud as an American and a veteran to serve with them.
Thank you, Mr. Chairman.
[The statement of Secretary Nicholson appears in the Appendix.]
The CHAIRMAN. Thank you, Mr. Secretary. I think we can all agree with that evaluation.
There is a famous Chinese curse, "may you live in interesting times," and I think you were Secretary at a very interesting time. And working with your agency, you have met those challenges.
Mr. Hall, would you like to—
Mr. HALL. Thank you, Mr. Chairman.
And thank you, Mr. Secretary, for your service and for your testimony.
And, Mr. Tuerk, Admiral Cooper, Dr. Kussman, Mr. Henke, and Mr. Hutter, thank you all for being here and for your service as well.
If you will excuse me, I will start with a parochial question which is regarding the Montrose VA Center in my district, New York's 19th. I am just curious.
I know the County Executive has requested a meeting with you, County Executive Andy Spano from Westchester County, about his concept for a veterans village which would incorporate continuing full healthcare facility with independent living, assisted living, nursing care, et cetera, and other uses of that facility which he is proposing along with the Town of Portland which it resides within.
And a number of us representatives in the New York Delegation from that area had written to you, I am sure you remember, asking if you would hear him out before making a decision that would preclude that kind of use of the Montrose campus. I am just curious if you have met with him or had an opinion on that yet.
Secretary NICHOLSON. I have not met with him, Congressman, but I know that I have gotten a letter requesting a meeting. I do not know where it is in the scheduling system.
I am very familiar with the situation at Montrose and Castle Point. I have been there twice and I think I know the issues well. I would be happy to meet with him.
Mr. HALL. Well, I will try to make sure that he gets down here before you are on to your next position.
And your statements on the bonuses are well taken. And I just wanted to ask, given your description of good people doing the best they can and working with a prodigious work ethic and so on and conditions being beyond their control, is there a responsibility somewhere or is this just beyond all of our control? Is this something that we or the Administration, you know, those of us in Congress should have done differently or should now be looking to do differently to make it within our control?
Secretary NICHOLSON. No. I do not think that these things are beyond our control or that there are people without responsibility. Ultimately, I have the responsibility.
And in the area of the claims backlog, I have tried to cover that briefly in my opening remarks. And I will say that I think that we can bring that time down. It is currently taking about 180 days and I think that, practically speaking, we can get that down to 145-150 days. And we have a path we have created to do that, or assuming the input remains relatively stable which is at a very high rate.
But there is an irreconcilable expectation in that arena today given the current law and the way the courts have construed that law which is totally consistent with giving the benefit of the doubt to the veteran. And it is kind of detailed.
But any time you need another document to try to confirm something and you contact a veteran, if you can find them and if the veteran can find it, it puts a tag of time onto that. They have 60 days within which to respond any time you do that.
Mr. HALL. Right.
Secretary NICHOLSON. So if we are going to leave it in that sort of modality, that is perforce going to be a pretty long process.
Now, we have hired, I think, about 1,600 new claims evaluators in the budget that you have approved. It has gone to conference. I think there are another 1,100 that will be hired. We think the average time will come down to that 150-day area. Now, just a few years ago, it was at 220.
Mr. HALL. Yeah. I appreciate your working on that and, you know, taking the ball and running with it. And I see the yellow light which means I am about to run out of time. So excuse me for interrupting.
Secretary NICHOLSON. I just wonder if I could just finish the point.
Mr. HALL. Sure.
Secretary NICHOLSON. The person that was named, personally named in this incident is not responsible for this system. In fact, the opposite. This guy has really led and worked hard and I support him a hundred percent.
Mr. HALL. Well, thank you for that endorsement.
I just wanted to ask one last question which is whether you believe the traumatic brain injury capacity of the VA itself to be adequate at this point? Do you think we need to have outside private facilities involved because there are a number of them that I know of that are coming in offering to help and are asking to be included in treatment?
Secretary NICHOLSON. I think that there is a place for both. I think that for the initial care and treatment of a severely brain damaged veteran, it is appropriate for them to be in our system and our polytrauma centers—we now have 21 of them, 4 for acute care. I am trying to get some geographic proximity for them and their families.
But I think there are cases there for the long-term therapy treatment, maybe lifetime in some cases, it would be appropriate for them to use local providers for that treatment and therapy because they are right there in their community. And the VA can do that.
Mr. HALL. Thank you very much, sir.
Thank you, Mr. Chairman.
The CHAIRMAN. Thank you.
Mr. MILLER. Thank you, Mr. Chairman.
Mr. Secretary, I echo the comments of my colleagues who have thanked you for your service at VA. We have all enjoyed having the opportunity of knowing you in your current capacity, your prior capacity, and look forward to working with you in the future and folks at VA.
Personally I am very thankful for the issues that we have worked on together for the 1st Congressional District in Florida. Even though you will not be the Secretary when the doors are opened on two CBOCs that will open next spring, please accept this as a personal invitation. We would love to see you come back through northwest Florida.
One issue that I think you and I both agree that we disagree and I probably more vehemently so than you is the issue of New Orleans and the decision to site the current facility downtown in Orleans Parish.
I still think it is a huge mistake and hope that this Committee, Mr. Chairman, will have an opportunity to debate it fully when we look at the authorization, continued authorization and funding of that particular facility in New Orleans.
In tagging on to some of the comments that you made to Mr. Hall in regards to the backlog and how long it has been taking, I have been on this Committee now six years and every time somebody comes and comments to this Committee, we hear the number is going down, but still, 150 days is an awful long time.
I would love to see VA go in and do an overkill instead of making sure we have just enough people in order to make sure things work, that we may have in this instance maybe too many people which may thereby give an advantage to the veterans in a situation.
I do not want to categorize it as excuses, excuses, but everybody that comes and testifies does bring a new opinion for the reason that we continue to have the delays. And I do not think any of us here, and certainly I do not believe you feel that they are acceptable. We salute you on bringing the number down considerably, and if you could comment on that.
My first question is even though you are departing, I know you have been looking at goals for 2008 with VA and certainly recommendations to the next Secretary when they come in, what would you say the top three goals for VA would be for the next year?
Secretary NICHOLSON. Well, this area of claims would certainly be at the top, to continue to work. You know, we are going to hire 3,100 new staff in that area this year and next year. And we are experimenting with ways that we can automate this system. So in a generic response, I would say that needs a great amount of continued command focus.
Another is for the leader of the VA to continue to emphasize greatly that transitional demands of a wartime environment for the warriors coming from DoD to the VA and the need for an efficient, effective way for that to happen. Now, I think we have gotten pretty good at that, but we still run into the exceptions. And we have taken a lot of measures to try to perfect that, but that finally, I think, would need a great deal of their attention.
And, thirdly, the physical plant, it is a huge organization and it is aging. And I just yesterday had a meeting with people in the White House to talk about alternative ways to finance VA facilities. And I think that we need to start thinking outside of the box about how we are going to do that because you know the methodology as well as I do.
But the VA has not delivered a new hospital, it has not commenced a new hospital in its planning stages for almost 20 years. And now we are going to have one in Las Vegas in hopefully a couple years or so and that will be the first new hospital the VA will have delivered in 20 years.
And the plant keeps aging and inflation keeps going up. Replacement costs keep going up. So we have to think of a new way, I think, to finance hospitals. Just like you have done with military housing, just like you do with the U.S. General Services Administration office buildings, the VA needs new tools and I am going to do my best for what it is worth to implore my replacement to pick up that cudgel and continue to carry it.
At this point, we have not come up here with that very much because we are having a lot of engagement with the Executive Branch and the Office of Management and Budget on that. That is a very important point.
The CHAIRMAN. Thank you.
Mr. HARE. Thank you, Mr. Chairman.
Thank you, Mr. Secretary. Just a couple of issues that I would like to talk to you about here.
One of the things that I am, as my friend, Mr. Miller, was talking about, is in terms of overkill on these disability backlogs. You know, I am wondering why don't we treat our veterans as we treat average taxpayers on this claim business. They file the claim. We process the claim. If there is an audit for the claim—I mean, I really believe and I hope that this Committee will come up with some legislation to err on the side of the veteran and not so much on the VA.
My fear is hiring people is a great idea and hiring additional people, but it takes time for those folks to get trained. And still the ideal thing going from 180 to 145 puts our veterans at still 145 days of waiting. One question I would like is maybe get your thoughts on saying if a veteran files a claim, I really believe that 99.9999 percent of the veterans who are going to file disability claims are not trying to take one over on the government. And why we cannot expedite that process even if it is a partial payment of the claim until that claim gets adjudicated.
The other part of that is, as you know, sometimes in the appeals process that could go on for a long, long time, if the veteran dies, his or her spouse has to start all over again at square one to pick that claim up. And it seems to me that we can do better.
The other issue, and I just want to get some thoughts, and the second issue is we had some disturbing testimony here from a young Marine and it was the story that ABC News had done about the VA or Department of Defense, whoever, identifying almost 22,000 soldiers who the claim was they had preexisting conditions. This young man, it took him five attempts to get his disability and he had gotten a Purple Heart and then they wanted, you know, $3,000 of his enlistment bonus back.
I am wondering, there again, would you share the feeling that we ought to have a moratorium put on this immediately so that we do not have additional vets who are being wounded? And as I said to him at the hearing, I am amazed that they did not ask for your Purple Heart back in the process too.
And this man, by the way, Mr. Secretary was screened three times prior to deployment. And my question when one of the witnesses was here, I said how did twenty-two or twenty-three thousand people get through the system with supposedly personality disorders.
And I think what happens with a lot of veterans is they have a backlog claims process, and this may or may not be the case, I do not know, but to them, to the veterans I have talked to, they said this is just another way of them dragging it out so we cannot get our disability. And it would appear on the surface that they are getting taken for a ride.
So I wonder if you maybe would be willing to comment on both of those and see if there is any support from you or the VA or hopefully, someone that follows you.
Secretary NICHOLSON. Let me comment first on your question about the presumption. I happen to share that view and I have been an advocate of that on a pilot basis. I have not been able to sell it internally.
And I will tell you that the veterans service organizations (VSOs) are not totally concurrent on it either and I have met with them and discussed it. But I think that would very much speed it up and then we could go back and audit and, you know, make spot checks like an Internal Revenue Service tax refund so that you have integrity in the system.
The other issue that you raised, Congressman, I think that that is mostly a DoD issue in those preexisting conditions. But having said that, I will tell you, because I am extremely involved in the work of the Dole-Shalala Commission, and they will be coming here to the Congress, I think tomorrow, and you will hear their recommendations. And I think the most significant part of their six main recommendations is that on the reformation of the disability system and trying to do away with the repetition between DoD and VA, streamline it.
I think they have some very, very good ideas in there. Some of those are controversial and you will see that, but that will greatly accelerate this never-never land that a young person is put in when they are injured about whether they are fit to stay on military duty. If not, what is their amount of compensation. That will come to the VA to make that decision from DoD.
I do not really want to preempt that, but I want also to remind you that, I mean, this business about the VA trying to delay a claim so that it will go away or somebody will—that is apocryphal.
First of all, our priority is on the current warriors and that is taking about 100 to 110 days.
Secondly, any veteran who files a claim and is successful is paid from the day they filed the claim. It is paid retroactively to that day.
Thirdly, in this body of claims, 55 percent of them are people who already are getting compensation from the VA system and they want it to be upped and that is their right. I am not contesting that.
And, fourth, we have a priority also for claimants who are 70 years old or older because they are getting a little older, so they are a priority.
Mr. HARE. Just one quick thing. I agree with you, Mr. Secretary. I do not think the VA, and I did not want to imply that, but from the veterans who are out there and they are struggling with the claim backlog as it is, you know, the anger is driving this is in terms of, well, nobody wants to help me out. So I know the VA is doing the best it can given what we have been able to give you.
Thank you, Mr. Chairman.
The CHAIRMAN. Thank you, Mr. Hare.
Mr. Boozman? And, again, thank you for participating in that very interesting and emotional trip to Iraq and Afghanistan with the Secretary and myself.
Mr. BOOZMAN. Thank you, Mr. Chairman. Thank you for inviting me. It was truly a very beneficial trip for me and enjoyed being with you guys.
I just want to thank you very quickly. You have had an interesting career being in the military and in being a very successful businessman and taking those talents and using them for government service.
And I do not know where you are going to be led to wind up next, but I feel sure that you will continue to use those talents for the benefit of your country. And so we really do appreciate you.
The other is I would like to say as somebody that has been real involved myself and Ms. Herseth Sandlin on the Economic Opportunity Subcommittee, we have all been working very hard to try and get veterans to work, you know, to try and get their education benefits and trying to provide some flexibility. And we are going to continue to do that. But I do appreciate the level of cooperation.
I think, we, you know, working together really have achieved a lot. I firmly believe if we can get veterans, get them separated, get them, you know, where they are gainfully employed, not employed, but employed to their abilities that that really does prevent a lot of problems down the line. So, again, I appreciate the level of cooperation.
One thing that we are hearing a lot about, one thing that I am in favor of is trying to expand the level of service to additional veterans, you know, veterans maybe that have fallen through the cracks, that we are unable to serve now. There is a move in Congress to perhaps include those in the future.
My concern is as we do that is that we are not prepared for that. We do not really have good data. If we add additional people into the ranks that can get benefits through the healthcare system, what that will do to the present system. We have all worked so hard to get our numbers down, you know, where people are being seen as best we can on a timely basis and things.
Can you comment about that and maybe some of the things that you see that we need to do to prepare for that or at least have the information that if we do extend, you know, the sevens and eights, whatever, what that would do as far as the system in preparing? You mentioned that we had not built a new or we had not really had the new facilities on line. You know, we are doing in Las Vegas.
But I guess what I would like is just some sort of an observation as a guy that has been fighting the battle, you know, of how we can go about logically planning for that if we do decide to hopefully extend the ability of the people to have access to veterans' care. Does that make sense?
Secretary NICHOLSON. Is the sense of your question, Congressman, how we can make it available to more veterans?
Mr. BOOZMAN. Well, yes. If Congress does, if we go forward, you know, we make it available, what is that going to do to our system? How can we plan to have enough hospital space, enough outpatient space so that we do not—you know, we do a good thing? We have got veterans coming on, but we do a bad thing in creating longer lines, you know, longer—and in that point, we do not service anybody well.
Secretary NICHOLSON. I understand. Well, you know, so much of this is resource driven and so it would depend on ultimately the amount of resources that we could get to bring to bear on that if the decision is made to open it up for more veterans.
There are about 25 million living veterans in the country today. We have nearly eight million enrolled for our healthcare system. We are paying benefits to about 3.6 million.
So you can see that there is still a lot of, as they say in the private world, a lot of market share out there that potentially could come to the VA. And then it would be a question of what it would take to still maintain the kind of priorities that we have which are for the veterans that are the most seriously injured, those that are indigent, down on their luck, special medical needs, and service-connected injuries.
I think that if there was going to be a decision to greatly expand the VA that there is definitely a need for a lot of new hospitals, both hospitals to be replaced and then there are places that would need new hospitals.
But we could do a lot and are doing a lot with this great clinic system, this preventative medical system which is really the chief characteristic of VA medicine. And it distinguishes itself from civilian medicine because, unfortunately in the civilian medical world, there is not a financial incentive for good preventative medicine. There is really nobody to pay for it.
Mr. BOOZMAN. Right.
Secretary NICHOLSON. Insurers, Medicaid, Medicare, they do not pay for it. At the VA, we emphasize it which is another reason that we can take care of so many people so economically on a per-patient per-year basis.
And I think that that characteristic could be maintained if it was greatly expanded, but the base facilities would also have to be. So the physical plant and then, of course, the accompanying personnel expansion would have to follow. But it is doable.
Mr. BOOZMAN. Thank you very much. Again, I appreciate you and appreciate the leadership and service that you provided, you know, as heading the VA. Thank you.
The CHAIRMAN. Thank you.
Mr. SALAZAR. Thank you, Mr. Chairman.
And, Mr. Secretary, I want to especially thank you for your friendship and the great working relationship that we have had over the years and you being a fellow Coloradan and all. And I want to thank you for your service to this great country.
Let me just ask you a couple of things specific to Colorado. I know that we have been working on Fitzsimmons Hospital and I understand that Ms. Berkley already is getting hers in Nevada, of course. Senator Reid has—
The CHAIRMAN. We are going to reconsider that, I think.
Mr. SALAZAR. Don't say that. We should make that a priority, of course. And, you know, this morning, I got a call from Soldiers Home in Monte Vista, Colorado, and you are well aware of that facility. It is an old facility, was badly needed as far as it is falling apart. And we need the additional funds for the construction of trying to rehabilitate it.
And we have been in constant contact with Mr. Tuerk on the new national cemetery that we are proposing for El Paso County in Mr. Lamborn's district and we passed legislation out of this Committee and out of the House, and would certainly urge you to support those issues before you leave.
And I look forward to working with you in the future and just wanted to thank you very much.
Secretary NICHOLSON. Thank you.
The CHAIRMAN. Mr. Brown?
Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Chairman.
And I also would echo the same remarks, Mr. Secretary. We are grateful for your service, of your background not only in VA but your service in Vietnam and other contributions you have made. And we are grateful for your willingness to take on the leadership of the VA.
We are grateful for the opportunity that we have had to spend together touring the Gulf after Katrina and Rita, and also your willingness to look outside the box on healthcare delivery.
I know that Congressman Boozman was talking about what is going to happen when, you know, the needs of the VA continues to rise. We looked at what we are looking at now, the VA Medical University partnership and we are grateful for your openness there.
I know Dr. Kussman was down last week to look at the ways we might be able to unite some services not only just in Charleston but around the country.
But also the VA health clinic that is being built up in Goose Creek region. There is a DoD/VA sharing clinic which is another opportunity to maximize, I guess, the resources and assets that the VA has.
We just wish you well wherever your next step might be and we are grateful for whatever you might be able to do to continue to enhance the sharing opportunity because we recognize that, you know, building is expensive and certainly some of the research equipment is awfully expensive, particularly as we deal with some of our most critically injured veterans, you know, with the brain injuries, with the loss of limbs.
We are in a different kind of environment than we have ever been. And so we need to look at ways we can better, you know, use our resources. And I think sharing between the teaching hospitals and DoD and VA all working together, I think, is the way to do it.
And thanks for your leadership along those lines.
And thank you, Dr. Kussman, for your leadership too.