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Shane Barker

Shane Barker, Senior Legislative Associate, Veterans of Foreign Wars

Madam Chairwoman and Members of this committee, on behalf of the more than 2 million members of the Veterans of Foreign Wars of the United States (VFW) and our Auxiliaries, the VFW would like to thank this committee for the opportunity to present its views on the following bills:

H.R. 1460, to provide for automatic enrollment of veterans returning from combat zones into the VA medical system:

The VFW supports the concept of H.R. 1460, legislation that would automatically enroll service members who have deployed to Iraq or Afghanistan for health services in the Department of Veterans Affairs (VA). For years now, our nation has provided 5 years of no-cost health care for separating service members through VA, but they must first go through the enrollment process.  This generous provision has been critically important to many veterans, and the enrollment numbers are high.  However, for a variety of reasons, many veterans have not enrolled for VA care.  We believe that this automatic enrollment could positively affect those individuals, and tip the scale in favor of them receiving the VA health care they have earned.

H.R. 1460 will take the assistance we provide one step further by having VA initiate enrollment into the system on behalf of the combat veterans of our current conflicts, and taking the cumbersome work of enrolling off their shoulders while preserving their choice through a process to opt-out.  Returning warriors have serious and pressing concerns they must address without delay when they return from combat – employment endeavors, rekindling relationships with family and friends, and coping with the emotional burden of their war experiences.  The least we can do is remove burdens to begin receiving care from the VA so they can more quickly begin to address those important needs. 

However, the VFW is concerned that it would create a paradigm in which the injuries and illnesses veterans who do not deploy incur are not given similar priority as those who deploy but do not experience any adverse health effects immediately attributable to their military service.  While it does not incentivize current conflict veterans who have deployed to hostile regions to avail themselves to VA care, it could prove to be polarizing, and send the message to non-deployed veterans that they do not qualify for VA health care.

The VFW would support this legislation if it were amended to include enrolling all separating service members into VHA.  This would allow service members who were injured or became ill during service, but who did not deploy, the same accessibility as those who have deployed.  Also, Congress would need to ensure VA has the resources to properly facilitate enrollment.

H.R. 3016, to direct the Secretary of Defense and the Secretary of Veterans Affairs to jointly operate the Federal Recovery Coordination Program:

The VFW supports H.R. 3016.  In our view, the most important aspect of this legislation is the length it goes to keep the Federal Recovery Coordination program (FRC) a top priority of the Secretaries of Defense and Veterans’ Affairs.  By mandating the administration of this program must stay in the respective offices of each secretary, we can have more peace of mind that the wounded, ill and injured warriors the program was created to serve will receive the high-level attention they deserve.  Administration of the FRC program has been shuffled around more than once since it was created in 2007, and we believe this legislation will end that by mandating in law that it be housed where it belongs – at the very top.  This committee must also conduct continued oversight over this program as practicable to ensure that the letter and spirit of this law – and the critical importance of the FRC program – are embraced within DOD and VA.   The men and women who go to war and come back with life-threatening injuries deserve no less, and we give our full support to this legislation. 

H.R. 3245, the Efficient Service for Veterans Act:

The VFW supports H.R. 3245. This legislation requires collaboration between the DOD and VA to ensure that VA’s Vet Centers have access to the two data repositories that house a service member’s DD-214.  Granting Vet Centers access to these databases means that they can independently verify a veteran’s eligibility for services without the veteran needing to provide a paper copy of the DD-214.  This instant access to service records will remove an unnecessary and often time-consuming hurdle to care for veterans needing peer support or mental health counseling from other veterans.  At a time when so many of our veterans are in need of these kinds of counseling options, we should make this change without delay and continue to look for ways we can expedite and streamline services.

H.R. 3279, to amend title 38, United States Code, to clarify that caregivers for veterans with serious illnesses are eligible for assistance and support services provided by the Secretary of Veterans Affairs:

The VFW strongly supports H.R. 3279.  The Caregivers and Veterans Omnibus Health Services Act of 2010, commonly known as the Caregiver Bill or P.L. 111-163, provided  long-overdue financial and medical support for family members or other designated individuals who are willing to be trained to provide high-quality in-home health care for severely injured veterans of the conflicts in Iraq and Afghanistan.  The Department of Defense provides similar support to family members of members of the armed forces who are catastrophically disabled, and includes disability caused by illnesses in their eligibility requirements.  Because the law does not currently provide VA caregiver support to those who are seriously disabled because of an illness, the potential exists for military members and their families to lose a critical benefit as they transition out of the military into VA care. 

The caregiver benefit must be seamless.  It is simply too important for the physical health and general well-being of the men and women who are catastrophically disabled in service to preclude those who have suffered from a debilitating illness from receiving this benefit. 

H.R. 3337, the Open Burn Pit Registry Act of 2011: 

The VFW supports H.R. 3337.  Open-air burn pits were used extensively in Iraq and Afghanistan to incinerate everything from medical supplies to automobiles, with possible hidden and grave health reactions on the military personnel exposed to them.  VA, DOD, and other partners in the civilian sector are working to give us the tools necessary to properly diagnose and treat the conditions associated with open-air burn pits and other environmental exposures.  However, much work remains to be done, and any delay means less than optimal treatment options now. 

Both DOD and VA have areas where they could improve their support to those suffering from an environmental exposure.  In addition to working to treat these conditions, the Veteran Benefits Administration must continue to improve their ability to account for their effects when evaluating claims, and DOD could make a greater effort.  Unfortunately, their lack of responsiveness to repeated requests for information from Congressman Akin in relation to this bill has made it difficult to ascertain what, if any, measures they have taken.  We lament DOD’s unwillingness to provide the requested information, and hope they will soon respond to that request.  We would also very much like to see DOD reach out to veterans and military service organizations to forge a more productive working relationship on this important issue. 

The VFW believes that this registry is essential to allow service members the peace of mind of going on record with VA at the earliest possible time to say they were exposed, and to assist VA in knowing how to best deploy advances in medicine and technology as they become available to treat the serious conditions associated with burn pit exposure.  We know that the physical effects of environmental exposures can go unnoticed for decades, and it can be extraordinarily difficult to establish causation to military service that has long since passed.  This legislation is a positive step forward, and we ask the committee to pass this measure without delay. 

H.R. 3723, the Enhanced Veteran Healthcare Experience Act of 2011:

The VFW does not support H.R. 3723. While we do not support the legislation, we understand the impetus for it and agree that improvements to the current Fee-Basis system of referring veterans to a private-sector provider are long overdue.  The program has many areas where improvements would provide more return on investment for the government and would improve the quality of care for veterans.  Currently, coordination of care between VA and the private provider is virtually non-existent.  As a result of limited controls and processes, VA does not have the ability to evaluate the quality of care provided, or integrate the associated private-sector medical records into existing medical history records the VA maintains for that veteran.  VA also has little reach into the offices of doctors caring for veterans through the Fee-Basis paradigm to ensure the services being billed were actually performed.  VA has no ability to guarantee or measure distance or timeliness standards, and veterans get no assistance from VA in finding doctors or assistance making appointments once a doctor is found.  Clearly, there is much to be desired, especially when taking into account that the VA paid out more than $4 billion in health care claims in FY 2010 alone. 

Nevertheless, the VFW cannot support this legislation at the present time.  The bill would mandate the Secretary to enter into contracts with network providers in order to provide a nationwide network of service providers to improve the non-VA care, thereby addressing many of the issues identified above.  However, the VFW is concerned that the legislation would result in VA moving veterans outside of the VA system precipitously.  Instead of working to improve processes and make the VA system more efficient and increase throughput, VA would have the obligation to move veterans into the non-VA care program when timeliness or distance standards are not met. 

Complicating matters is the reality that the only way to make such a program cost-effective is to actively manage the volume of referrals into the program.  Network providers would find it necessary to give care providers reasonable expectations of patient access and volume to negotiate a favorable rate for services being contracted. 

The VFW would also call into question the ability for contracts entered into under this paradigm to be successful without first seeing how VA executes the implementation of the Patient Aligned Care Team (PACT) model of patient-centric care within the VA.  The proponents of this legislation pre-suppose that the PACT care coordinator would act as a conduit to a care coordinator employed by the network provider.  However, we see no evidence to suggest that the PACT model will routinely and successfully coordinate the care provided internally at VA without this layer of complexity added to the equation.  The VFW believes that the PACT model must be a success. Therefore, we should ensure that it is refined to smooth out the rough edges before taking this step.

At the same time, VA is moving forward, if slowly, with their own efforts to implement the Patient Centered Community Care (PCCC) program that would establish contracts to provide a limited portfolio of services that would be more fully coordinated with VA.  Publicly available data suggests that this portfolio is limited to medical and surgical services, but excludes dialysis, mental health, and primary care.  While it is certainly true that we believe any successful program to coordinate non-VA care would include these services, we firmly believe VA must get this right.  It is imperative that these issues be resolved, and we believe that VA’s initiative must be given a chance to be executed and evaluated before fundamental and controversial changes, such that this bill would precipitate, are allowed to move forward. 

Our veterans deserve access to timely and high quality health care that is fully integrated and responsive to their needs.  To achieve this, we strongly encourage the committee to expeditiously conduct due diligence on the Fee-Basis program to have a better understanding of this and other potential options before initiating further legislative changes to this program. 

H.R. 4079, the Safe Housing for Homeless Veterans Act:

The VFW supports H.R. 4079. We believe this legislation will ensure that homeless veterans are living in housing that is deemed safe and in compliance with codes required by county and state laws. Currently, VA is required to check housing certificates before awarding grants for housing services provided to homeless veterans. However, a thorough check of fire and safety requirements, as well as structural conditions of the building, are often overlooked.

H.R. 4079 would require certification that the building has met all necessary code specifications before a grant would be awarded. It also gives priority in awarding grants to those seeking assistance for any project that would make improvements to a building in cases where plans exist to provide housing and services for homeless veterans.

The VFW believes that there is no greater need than providing a safe and secure environment for our homeless veterans and their families.  This legislation will protect the most vulnerable by making certain that the housing provided fills that need until they can return to independent community living.

Madam Chairwoman, this concludes my statement.  I would be happy to answer any questions that you or the members of the Committee may have.