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SVAC Bill Hearing

 STATEMENT OF

RAYMOND C. KELLEY, DIRECTOR

NATIONAL LEGISLATIVE SERVICE

VETERANS OF FOREIGN WARS OF THE UNITED STATES

 

FOR THE RECORD

COMMITTEE ON VETERANS’ AFFAIRS

UNITED STATES SENATE

 

WITH RESPECT TO

          S. 49, S. 62, S. 131, S. 229, S. 287, S. 325, S. 412, S. 422, S. 455, S, 522, S. 529, S. 543,                                                                                           

           S. 633, S. 800, S. 825, S. 832, S. 845, S. 851, S. 852, AND DRAFT LEGISLATION

 

WASHINGTON, D.C.                                                                                              MAY 9, 2013

 

S. 49, Veterans Health Equity Act of 2013

VA routinely assesses veterans’ health care access needs through its Strategic Capital Investment Plan (SCIP). SCIP prioritizes all levels of construction projects based on a scoring system, placing those with the highest score at the top of the list. This model of evaluation and resource allocation allows for equitable and consistent distribution of capital funding. However, for SCIP to fully be realized, sufficient funding must accompany the plan.

The requirement in S. 49 mandating VA to maintain a full-service medical center in each of the 48 contiguous states could cause funding for a higher priority construction project to be redirected. The VFW does encourage VA to reevaluate New Hampshire, to ensure at any gaps in service are identified and prioritized by SCIP.

S. 62, Check the Box for Homeless Veterans Act of 2013

The VFW appreciates the spirit of this legislation, but has some reservations about the possible negative unintended consequences of creating non-traditional funding sources for important VA programs.  This bill would give taxpayers the option of donating to a new Homeless Veterans Assistance Fund, which would be established through the U.S. Treasury, by checking a box on their annual tax returns.  That money would then be made available to VA, the Department of Labor, and the Department of Housing and Urban Development, for the purposes of supporting programs that serve homeless veterans.   It also provides for oversight of the Homeless Veterans Assistance Fund by requiring that the secretaries of the aforementioned departments submit detailed expenditure plans prior to using the funds, and that the use of the funds for the prior and upcoming years must be described in the President’s annual budget submission.

Although the VFW commends the intent of this legislation which is designed to support the administration’s goal of ending homelessness by 2015, we are concerned that the establishment of the Homeless Veterans Assistance Fund may create the rationale for future reductions in traditional funding for homeless veterans’ programs. VA has made marked and consistent progress toward that goal over the past several years through adequate funding for effective initiatives such as Supportive Services for Veterans Families, the Grant Per Diem Program, the Homeless Veterans Reintegration Program, and HUD-VASH vouchers.  The VFW feels that now is not the time to experiment with alternative funding sources for these critical services.  We must continue to pay for these programs with congressionally appropriated dollars in order to ensure that they receive consistent and reliable funding levels.

S.131, Women Veterans and Other Health Care Improvements Act of 2013

A decade of war has put service members at risk for experiencing reproductive and urinary tract issues due to the lack of pre-deployment health information, and the use of improvised explosive devices (IED) leaving many more susceptible to blast injuries including trauma to the reproductive areas.  DOD has reported that from 2003 to 2011at least 2,000 service members have suffered from reproductive and/or urinary tract trauma. 

Providing reproductive services that meet the complex needs of our severely wounded veterans is critical in helping many move forward with their lives and aspirations. Dreams of having a family often are at the top of the list. Currently, VA offers some fertility services, but they often do not meet the needs of those severely injured with more complex reproductive needs (In-vitro fertilization or IVF is excluded from VA medical benefits package under 38CFR 17.38 (c) (2)).

The VFW thanks Senator Murray for taking the lead on this issue and supports Sections 2 and 3 which will provide fertility counseling and treatment to include assisted reproductive technology, like IVF, to a spouse or surrogate of a severely wounded, ill or injured veteran who has an infertility condition which was incurred in the line of duty or while on active duty. The patient must be enrolled in VHA and, in the case of a spouse or surrogate of a veteran not enrolled, VA would coordinate fertility and counseling for them. VA is not required to find or certify a surrogate, or connect the veteran with a surrogate, or provide maternity care for the spouse or surrogate, which will negate any legal issue that may arise during the process.

The legislation also calls on VA to conduct collaborative research with DOD and Health and Human Services (National Institutes of Health) to address the long-term reproductive health care needs of veterans with service-connected reproductive injuries. We believe that this research is critical in addressing and treating the unique infertility issues of veterans with combat injuries now and in to the future.

The VFW also supports section 9 which improves access to services for women veterans through VA’s Women Veterans Call Center. With an increasing number of female veterans entering the health care arena, VA must take every opportunity to reach out and provide assistance and guidance, as well as referrals to community resources for services not offered within VA.

We are also pleased to see provisions in sections 10 and 11 of the bill that would expand the child care pilot program for veterans seeking readjustment counseling at Vet Centers, and also increase the number of counseling retreat locations which help to ease newly separated female veterans back into civilian life. The VFW supported the original language established in P.L. 111-163, and is happy to see these programs continue.

S. 229, Corporal Michael J. Crescenz Act of 2013

The National VFW does not take positions on the designation of federal property. We do encourage our state and local VFW members to be involved in these designations to ensure community buy-in.

S. 287, a bill to amend title 38, United States Code, to expand the definition of homeless veteran for purposes of benefits under the laws administered by the Secretary of Veterans Affairs, and for other purposes.

The VFW is pleased to support S.287, legislation that would clarify the definition of “homeless,” thereby aligning it with the McKinney-Vento Act to include those displaced by domestic violence.

No veteran should ever be homeless, and expanding the definition to include those veterans who are fleeing situations of domestic abuse is the right thing to do.  By making this change, we support this population of veterans and help them to have the courage and means to leave their abusive and sometimes life-threatening situation.   This bill will also ensure they receive access to the benefits VA already provides thousands of homeless veterans.

We believe this legislation will significantly improve the lives of those who become homeless   as a result of difficult circumstances outside of their control, and help them on their way to beginning a new chapter in their lives.  We urge the Committee to pass this bill quickly.

S. 325, a bill to amend title 38, United States Code, to increase the maximum age for children eligible for medical care under the CHAMPVA program, and for other purposes.

The VFW strongly supports this legislation to extend the age limit for coverage of veterans’ dependents through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) to the level set by the Patient Protection and Affordable Care Act. 

The health care reform legislation, passed in early 2010, allowed families with private health insurance coverage to keep their children on their plans until age 26.  Left out of that change was TRICARE and CHAMPVA recipients.  Thanks to responsible leaders in Congress, TRICARE coverage has been guaranteed to this age group.  Unfortunately, CHAMPVA beneficiaries have not been afforded the same privileges.  This program, which was established in 1973 and has more than 330,000 unique beneficiaries comprised of dependents and survivors of certain veterans, should in no instance ever receive less than the national standard.  This legislation would provide equity to CHAMPVA beneficiaries and rectify this outstanding issue.

S. 412, Keep Our Commitment to Veterans Act

The VFW supports S. 412. Congress must authorize the funding of the FY2013-FY2014 major medical leases. Without this funding, twelve VA facilities across the United States may not be able to properly serve their communities.  For example, the Errera Community Care Center (ECCC), a leading center of innovation providing psychological rehabilitation, homeless reintegration, substance abuse counseling, and employment services to over 4,700 veterans in the greater West Haven, Connecticut area must relocate to a larger facility in order to remain effective.  The facility that currently houses the ECCC is so insufficient to meet the demand for services that veterans’ group therapy sessions are conducted in hallways, and two to three staff members share a single desk.  In order to ensure that the momentum that has recently been achieved in solving the complex problems many veterans face is maintained, community centers like the ECCC must be provided with adequate facilities. 

However, the passage of this Act does not solve the long-term problem of funding VA major medical leases under the Congressional Budget Office’s new lease evaluation. While S. 412 is a good first step, Congress must take action to ensure that these annually appropriated leases are not continually delayed.

S. 422, Chiropractic Care Available to All Veterans Act of 2013

The VFW supports this legislation which would establish chiropractic care services at all VA medical centers by the end of 2016.  In accordance with P.L. 107-35, chiropractic care is currently offered at 47 of the 152 VA medical centers nationwide, with at least one facility being in each VISN.  This bill would initiate a gradual expansion of chiropractic care services, requiring that they be made available at no fewer than 75 medical centers by December 31, 2014, and all medical centers by December 31, 2016.

It is well known that service members who deploy to combat and participate in military training are subject to extraordinary physical demands, often resulting in the premature onset of painful spine and joint conditions.  The 2010 VA analysis of health care utilization among OIF and OEF veterans listed “diseases of musculoskeletal system/connective system” as the number one condition for which Iraq and Afghanistan veterans sought VA care.  Chiropractic care can often be a successful alternative to drugs or invasive procedures for treating musculoskeletal disorders, while also offering suggestions for lifestyle modifications which promote overall wellness.  The VFW believes that chiropractic care is a valuable option and should be made available to veterans at all VA medical centers.

S. 455, a bill to amend title 38, United States Code, to authorize the Secretary of Veterans Affairs to transport individuals to and from facilities of the Department of Veterans Affairs in connection with rehabilitation, counseling, examination, treatment, and care, and for other purposes.

The VFW supports this legislation to permanently authorize the Veterans Transportation Service (VTS).  This program, commissioned by the VHA Office of Rural Health in 2010, has greatly improved access to care for rural and seriously disabled veterans by allowing VA facilities to establish and coordinate networks of local transportation providers including VSOs, community and commercial transportation providers, and government transportation services.  The VTS serves an innovative supplement to the existing beneficiary travel programs of mileage reimbursement, which does nothing to assist in the coordination of transportation for those who need it, and special mode travel, for which few veterans medically qualify. 

The VTS program suffered a major setback in 2012 when it was temporarily suspended following a determination by the VA Office of General counsel that VA lacked the statutory authority to provide the new benefits.  Congress wisely passed a one-year authorization of the program in January 2013, but a long-term fix is still needed.

The VFW believes that unnecessary hardships associated with accessing VA health care should be eliminated at every opportunity.  This legislation would guarantee the continuation and future expansion of VTS, which plays a critical role in minimizing the challenges many veterans face in traveling to their appointments due to physical disabilities or great distances.

S. 522, Wounded Warrior Workforce Enhancement Act

The VFW does not support this legislation which would require the VA to award grants to eligible educational institutions that establish or expand existing master’s degree programs in orthotics and prosthetics.  The bill would also create a grant to be awarded to an institution that establishes a private Center of Excellence in Orthotic and Prosthetic Education.  Although the VFW recognizes the importance of promoting the development of high quality prosthetic staff and services, we feel that this bill takes the wrong approach.  Since it mandates no service requirement for the students who would benefit from the funding provided by the grants, VA does not stand to reap any direct benefit from their enhanced training.  Additionally, the VFW questions whether veterans would be better served by a Center of Excellence in this field within the VA, as opposed to one that is privately operated.

S. 529, a bill to amend title 38, United States Code, to modify the commencement date of the period of service at Camp Lejeune, North Carolina, for eligibility for hospital care and medical services with exposure to contaminated water, and for other purposes.

The VFW supports this legislation which would adjust the date for VA health care eligibility associated with exposure to contaminated water at Camp Lejeune, North Carolina from January 1, 1957 to August 1, 1953 or an earlier date specified by the Secretary in consultation with the Agency for Toxic Substances and Disease Registry, due to recent findings by the ATSDR that the drinking water at that installation was contaminated as early as 1953.

S. 543, VISN Reorganization Act of 2013

The VFW does not support the enactment of S. 543. The intent of this bill has merit. VA should assess the VISN structure for improved efficiency and possible VISN realignment. VA has taken steps to improve efficiency and is studying the impacts of VISN realignment. Congress should continue oversight of this process to ensure veterans are receiving the highest level of care in the most effective and efficient manner.

S. 633, a bill to amend title 38, United States Code, to provide for coverage under the beneficiary travel program of the Department of Veterans Affairs of certain disabled veterans for travel in connection with certain special disabilities rehabilitation, and for other purposes.

The VFW supports this legislation which would extend beneficiary travel benefits to veterans with certain severe non-service connected disabilities who travel to receive care provided through a VA special disabilities rehabilitation program.  Veterans who are catastrophically disabled due to spinal cord injuries, visual impairments, and multiple amputations often require in-patient care in order to achieve full rehabilitation.  Not all VA facilities, however, offer the specialized programs of care needed to properly treat these severe disabilities, and many veterans are forced to travel great distances to receive the care they need.  Those not eligible for travel reimbursement must do so at great personal cost and, as a result, may be forced to forego essential primary or preventative care for financial reasons.  This legislation would alleviate that hardship for this small but vulnerable population of veterans.

S. 800, Treto Garza Far South Texas Veterans Inpatient Care Act of 2013

The VFW does not hold an opinion regarding this legislation. The bill calls for the expansion of the Harlingen VA Outpatient Clinic to a full-service, inpatient care facility. The VFW would suggest that VA assess South Texas’ access and utilization gaps to ensure that veterans in that region are receiving a full continuum of care without the burden of excessive travel, and if there are gaps, prioritize the need and have it added to Strategic Capital Investment Plan.

S. 825, Homeless Veterans Prevention Act of 2013

The VFW supports most provisions of this legislation which expands and reauthorizes a number of programs aimed at addressing the unacceptable problem of homelessness among veterans.  It also keeps families together by allowing VA to house the children of veterans in transitional housing, while also improving the security of those facilities.  The VFW firmly believes that no veteran who has honorably served this nation should have to suffer the indignity of living on the streets. We praise the great progress that has been made in reducing veterans’ homelessness in recent years as a direct result of coordinated efforts across multiple government agencies to provide transitional housing, rapid re-housing, and employment programs for veterans in need.  The extension and adequate funding provided by this bill for these and other programs are vital to achieving the Secretary’s goal of eradicating homelessness among veterans by 2015.

The VFW generally supports Section 8 of the bill which would allow the Secretary to “enter into partnerships with public or private entities” to fund a portion of certain legal services for homeless veterans.  While we recognize that legal problems are often a significant barrier to homeless reintegration and must be addressed, we are concerned that there may be some for-profit legal entities that would view this program as an opportunity to exploit the availability of government resources in exchange for poor or inadequate services.  For this reason, we suggest that the language in this section be changed to allow VA to only enter into partnerships with public or non-profit private legal entities that provide services to homeless veterans.

S. 832, Improving the Lives of Children with Spina Bifida Act of 2013

Current law (Chapter 18, title 38, United States Code) defines the services provided to children of Vietnam veterans and certain Korea service veterans born with spina bifida to include comprehensive health care, but some veterans have reported that they have had difficulty accessing these benefits for their severely handicapped children.

This bill will help remedy some of these issues by requiring VA to carry out a pilot program in rural areas, and report to Congress on services they are providing to children under the law.  The legislation is of little or no cost to VA and will allow Congress an inside view of specifics within the program to include statistics on what types of services and how many are being provided.

The VFW believes that this is an appropriate use of Congressional oversight and the findings will provide insights into the program, specifically answering questions as to whether VA is doing everything within the law to provide care and services to this most vulnerable population. The VFW encourages Congress to enact this legislation so those in need of care and services can access what is rightfully and legally theirs - we owe them nothing less. 

S. 845, a bill to amend title 38, United States Code, to improve the Department of Veterans Affairs Health Professionals Assistance Program, and for other purposes.

The VFW supports this legislation which removes the $60,000 cap on the total amount payable under the Education Debt Reduction Program (EDRP) and extends the expiration date of the Health Professionals Education Assistance Program from December 31, 2014 to December 31, 2019.  VA must be given the tools to recruit and retain high quality medical professionals in order to guarantee the continued delivery of the highest level of care.  By providing targeted education debt repayment incentives to physicians in specific fields based on VA need in exchange for service obligations, these programs play a vital role in properly meeting VA staffing needs.

S. 851, Caregivers Expansion and Improvement Act of 2013

The VFW strongly supports this legislation which would extend current caregiver benefits to those who care for veterans who were severely injured prior to September 11, 2001.  We believe that severely wounded veterans of all conflicts have made incredible sacrifices, and that all family members who care for them are equally deserving of recognition and support. 

The VFW applauded the passage of the Caregivers and Veterans Omnibus Health Services Act of 2010 which provided a monthly stipend, respite care, mental and medical health care, and the necessary training and certifications required for caregivers of severely disabled Post 9/11 veterans, but have consistently maintained that eligibility should be expanded to include veterans of all eras.  By striking “on or after September 11, 2001” from 38 USC Section 1720G(a)(2)(B), this bill would accomplish that objective.

S. 852, Veterans’ Health Promotion Act of 2013

This legislation would create a new complementary and alternative medicine (CAM) program within VA in order to promote the overall health and well-being of veterans.  Although the VFW feels that CAM and wellness programs have the potential to play a significant role in VA health care, we would like to offer several suggestions which we feel would strengthen this bill.

S. 852 would establish at least one Center of Innovation for CAM in each of the 21 VISNs for health research, education, and clinical activities in each VISN, while simultaneously establishing a three year pilot program to assess the feasibility of CAM centers in VA medical facilities.  The VFW feels that it would be more appropriate to conduct the pilot program and analyze its results before mandating the establishment of CAM Centers of Innovation across VA.  Additionally, we are concerned that some VISNs may not currently have a medical center suitable to be designated a center of excellence.

The bill also establishes two pilot programs intended to address the issue of obesity.  The first would subsidize fitness center memberships for veterans who are determined to be overweight or obese by VA physicians.  The VFW suggests that veterans who participate in such programs should be required to report for regular examinations to ensure that fitness programs are being executed effectively and benefits are being achieved.  The second pilot program would establish fitness centers at VA facilities which would be made available to any veteran enrolled in the VA health care system.  Recognizing that space and resources are scarce, the VFW recommends that the use of such fitness centers be reserved for those veterans deemed overweight or obese by a VA physician.  With these changes, we believe that these programs would enhance the overall wellness of the veterans’ community, while allowing VA to most effectively experience the associated long-term cost savings.

Draft Bill, Veterans Affairs Research Transparency Act of 2013

The VFW has no position on this legislation which would establish a new website to make VA research data available to the public, and require the Veterans Affairs-Department of Defense Joint Executive Committee to submit recommendations on the establishment of a data –sharing program between VA and DOD in order to better facilitate research.  Although we see the value of the public dissemination of information and greater cooperation between VA and DOD with regards to data-sharing, we are unable to comment on whether the mandates of this bill would achieve those objectives most effectively.

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