Ms. Katherine Miller
Good Afternoon Chairman Runyan and Ranking Member Titus. On behalf of the Nevada Department of Veterans Services and the approximately 300,000 Nevada veterans, family members, and survivors we serve, I thank you for the opportunity to discuss outreach to disabled veterans in rural Nevada. As a veteran with 34 years of military service, I am proud to serve with the Nevada Department of Veterans Services and be part of Nevada’s drive to create opportunities for our veterans to thrive. Our agency provides vital and efficient support to and advocacy on behalf of veterans, their dependants, and survivors, and provides our community and partners the opportunity to contribute in these endeavors. Through our programs we assist veterans submit claims for benefits, provide skilled nursing care, provide burial support at our state veterans’ cemeteries, and help veterans successfully integrate into Nevada communities.
Our vision is that Nevadans across our great state understand and celebrate the legacy of America’s heroes—and working together we will ensure that veterans and their families understand and have access to opportunities that improve their lives. To realize our vision, we have invested significant effort developing initiatives to improve delivery of services to veterans in rural areas. I will share some of these efforts with you today, as well as discuss U.S. Department of Veterans Affairs initiatives that I believe have improved support to Nevada’s rural veterans and areas that need additional attention.
State of Nevada Rural Veteran Initiatives
While most of Nevada’s veterans live in the Las Vegas Metropolitan Area in southern Nevada or the Truckee Meadows area in northern Nevada, 32,000 veterans call rural Nevada home. Because of this geographical dispersion, delivery of services is difficult. Many rural veterans find it impossible because of health or expense to come to VA Veterans Benefit Administration (VBA) offices in Las Vegas and Reno. Additionally, even within urban areas there are home-bound, homeless, incarcerated, or infirm veterans that cannot visit VBA offices. This reality has driven the Nevada Department of Veterans Services to develop outreach programs that bring services to veterans wherever they may live. Today I will discuss several important initiatives that we have implemented or are implementing to improve rural area service delivery: 1) the Rural Outreach Veterans Enrichment and Resources (ROVER) Program; 2) the Green Zone Initiative; 3) the Northern Nevada Veterans Skilled Nursing Home; 4) the Veterans Tracking System; and 5) pursuit of VA grants supporting rural veterans.
The ROVER Program sends traveling Veterans Service Officers (VSO) to communities in rural Nevada. As mandated by legislative statute, these VSO assist veterans, service members, and their families regarding any problem, issue or concern they may have. This includes providing information relating to veterans benefits and opportunities, and helping veterans prepare and submit claims, to include disability compensation, hospitalization, insurance, pension, training, education, or rehabilitation. With our help, and the help of other veterans organizations, the VBA can better reach rural veterans throughout Nevada. ROVER is currently supporting 17 community clusters throughout the state. Last year Governor Sandoval approved, and our legislature funded, five additional VSO which will allow us to travel to 12 more community clusters and provide complete state coverage.
We are pursuing additional VSO to allow us to increase the frequency of visits to these areas. While the ROVER program does not touch as many lives as do our programs supporting urban Nevadans, often the rural need is much greater as is the lack of information regarding the benefits veterans have earned by serving their nation.
Our Nevada Green Zone Initiative has been identified as a best practice by the Department of Warrior and Family Support, Office of the Chairman of the Joint Chiefs of Staff. Its purpose is to ensure the successful reintegration of Nevada’s service members, veterans, and their families. The Green Zone Initiative marshals and aligns all available resources in the areas of health, education, and employment and improves service delivery through regional planning and coordination. One important component of the Green Zone Initiative was the creation of regional Veteran Community Councils. All but two of the 11 Councils are located in rural communities. These councils set local objectives and coordinate between local veterans, organizations, and service providers to connect veterans with needed services. They also identify gaps in services that cannot be filled locally and need to be addressed by state and federal providers. Another of the Green Zone Initiative’s critical components was the creation of the Green Zone Network. The Green Zone Network is a free digital platform that connects organizations and service providers with veterans in the areas of employment, education, and wellness. With the creation of the Green Zone Network, we have provided rural veterans with a window through which to see the opportunities that they might access locally and through electronic delivery.
Nevada is also in the process of designing a second veterans nursing home to be located in Reno, Nevada. Studies have shown that people generally do not move to nursing homes that are located farther than 90 miles from where they live. With only one nursing home, located in Southern Nevada, veterans in rural northern and central Nevada must either move far from family to avail themselves of the quality of care and quality of life associated with a state veterans home or live in other, often less nurturing, accommodations. We have submitted a grant request to the VA for construction and are working with state and federal officials to identify funding for the project.
Additionally, we are working with other state partners, notably Utah, to develop a state Veterans Tracking System. This system creates a database of veterans’ information gathered from many sources to include the veteran, the Department of Motor Vehicles, and state vital records. Currently these public records are not stored in a central repository which makes retrieval and analysis difficult. This system will help us identify where veterans live and enable us to provide them with information regarding state and federal benefits and opportunities.
To support these initiatives, we are pursuing several VA grants, to include a Veterans Affairs Grant for Transportation of Veterans in Highly Rural Areas. This grant, if approved, will provide veterans in rural eastern Nevada with transportation to medical appointments at the VA’s Community Based Outpatient Clinic in Elko, Nevada. We have also applied for the Rural Veterans Coordination Pilot Grant. This grant is intended to assist veterans and their families who are transitioning from military to civilian life in rural or underserved communities. If we receive this grant, we will be able to expand and improve our Green Zone Initiative to further increase access to benefits for veterans and their families living in rural communities.
Of course, much of what we do in these outreach programs is assist our veterans access state, local, federal and community services. At no time in history have we seen such an outpouring of support; both nationally and locally. In fact, the Pentagon calls this unprecedented level of support offered our veterans the “Sea of Goodwill.” Because of the many available services, the challenge lies not necessarily in the creation of new benefits but with improved delivery of existing services and benefits. Nowhere is this more evident than in the challenges associated with delivery of services offered by the VA.
U.S. Department of Veterans Affairs Support to Nevada Veterans
The professionals assigned to the VA Medical System and the Veterans Benefits Administration here in Nevada are dedicated to improving the lives of Nevada’s veterans. They have worked hard to develop innovative solutions to provide quality medical care and to provide benefits and services to veterans and their families. Several of their programs have a positive impact on the lives of our rural veterans.
U.S. Department of Veterans Affairs Health Care
In the area of health care, the establishment of Community Based Outpatient Clinics in rural areas has dramatically improved access to care. Often, however, our veterans must travel great distances to the VA hospital in Las Vegas, Reno, or Salt Lake City to seek inpatient or specialty services available only at larger facilities. Most veterans understand that it would be difficult to offer these specialty services in every small town. However, there is a desire for temporary housing options for these veterans and their families when they must seek care in a city. Local initiatives such as the Fisher House in Las Vegas or the Veterans Guest House in Reno help alleviate some of the stress and cost of this travel, but critical veteran’s needs would be met if the VA had a program to help rural veterans offset lodging and other associated costs during their visits to urban medical facilities.
Another beneficial development in the area of healthcare has been the introduction of telemedicine options for our rural veterans. The VA is now offering telemedicine services such as post-operative follow-ups, dermatology and podiatry consults, weight loss and nutrition counseling, neurosurgical evaluations, and mental health counseling, just to name a few. While these services were always available in the urban areas, advances in telemedicine have dramatically improved the delivery of health care services to rural veterans.
A final, important development in the delivery of health services to rural Nevadans has been the VA initiative to reimburse tribal health clinics for many primary care services provided to Nevada’s Indian veterans. VA now reimburses the Indian Health Service for direct care services provided to eligible Indian veterans. This is another example of the work being done to improve delivery of services to rural veterans and we applaud the VA’s efforts to improve health care to our Nation's heroes living in tribal communities.
U.S. Department of Veterans Affairs Benefits Administration
Our partners at the Reno VBA Regional Office have been working equally hard to improve support to veterans, by improving timeliness and quality of claims processing. Their efforts include supporting and training VSO in order to extend their reach into rural Nevada through our office and through the work of service officers working for national service organizations.
They have also made available and trained veterans service organizations on new technologies such as the Stakeholder Enterprise Portal, a secure entry portal that provides VA partner organizations and external stakeholders access to the web-based systems we need to assist veterans, reservists, national guard members, and their dependents. They have supported every request we have made to provide personnel resources and materials at veterans outreach events and have been very responsive to recommendations for improving services. We have also seen a dramatic improvement on the timeliness of claims, to include the elimination of the backlog of claims over two years old and the near elimination of claims over one year old.
This herculean effort, however, came at a cost. With finite resources, the Reno VBA Regional Office has not been able to keep pace with processing what are referred to as “Non-Rating End Products,” or those claims that are not directly associated with disability claims. These claims include establishment of dependency claims, Freedom of Information requests, concurrent receipt claims, rating reviews, and income, estate, and election issues. The backlog of Non-Rating End Products has risen to 3400. It is my belief that the Reno VBA Regional Office needs additional personnel resources if it is to keep up with the accelerated pace of processing Fully Developed Claims and process in a timely manner the many other claims and requests they are responsible for. The workload is only likely to grow; with the success of our outreach programs, we are increasing the number of claims filed on behalf of Nevada’s veterans.
Finally, while the creation of new technologies to help veterans file claims online may be seen as a positive move for rural veterans, we are concerned about the impact on claims’ quality. Our VSO are experiencing an upswing in appeals as a result of claims improperly or incompletely filed online. Veterans often make mistakes when filing on line or fail to include all required evidence to support a claim without the onsite support of a VSO or VA representative. As a result, the veteran can be dissatisfied with the result and seek to appeal a rating decision. If these claims were filed correctly with the assistance of an advocate, the filing of appeals, the resulting delay of benefits to veterans, and the added workload for the VBA would all be reduced. One suggestion that might help is that the VA provide sufficient qualified telephone or synchronous online operators to assist rural veterans complete these online applications.
In summary, Mr. Chairman and Ranking Member Titus, it is an exciting time to be a veteran in Nevada. Nevada has a long history of honoring and supporting its veterans and the service men and women who make their home here. Our Motto “Battle Born” attests to our warrior heritage and the pride we take in the contributions of our military. While there is much work to be done, I am encouraged by the attention to these issues and the momentum achieved thus far. As we improve delivery of service at all levels of government, more rural Nevadans are getting connected with the benefits and opportunities they earned through their service to this nation and its citizens. Be assured, the men and women in the Nevada Department of Veterans Services and Nevadans everywhere will continue to work with our federal partners to improve delivery of services to veterans wherever they may live.
Thank you again for your support to our veterans, service members, and their families—and for your interest in the ongoing collaboration and cooperation between the State of Nevada and the U.S. Department of Veterans Affairs. I appreciate the opportunity to appear before you today, and I am prepared to respond to any questions you may have.