[House Report 108-808]
[From the U.S. Government Publishing Office]
Union Calendar No. 493
108th Congress, 2d Session - - - - - - - - - - House Report
108-808
ACTIVITIES REPORT
of the
COMMITTEE ON VETERANS' AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTH CONGRESS
__________
first session
Convened January 7, 2003
Adjourned December 8, 2003
second session
Convened January 20, 2004
Adjourned December 7, 2004
January 3, 2005--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
?
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512�091800
Fax: (202) 512�092250 Mail: Stop SSOP, Washington, DC 20402�090001
COMMITTEE ON VETERANS' AFFAIRS
CHRISTOPHER H. SMITH, New Jersey, Chairman
MICHAEL BILIRAKIS, Florida LANE EVANS, Illinois
TERRY EVERETT, Alabama BOB FILNER, California
STEVE BUYER, Indiana LUIS V. GUTIERREZ, Illinois
JACK QUINN, New York CORRINE BROWN, Florida
CLIFF STEARNS, Florida VIC SNYDER, Arkansas
JERRY MORAN, Kansas CIRO D. RODRIGUEZ, Texas
RICHARD H. BAKER, Louisiana MICHAEL H. MICHAUD, Maine
ROB SIMMONS, Connecticut DARLENE HOOLEY, Oregon
HENRY E. BROWN, Jr., South Carolina TED STRICKLAND, Ohio
JEFF MILLER, Florida SHELLEY BERKLEY, Nevada
JOHN BOOZMAN, Arkansas TOM UDALL, New Mexico
JEB BRADLEY, New Hampshire SUSAN A. DAVIS, California
BOB BEAUPREZ, Colorado TIM RYAN, Ohio
GINNY BROWN-WAITE, Florida STEPHANIE HERSETH, South Dakota
RICK RENZI, Arizona
TIM MURPHY, Pennsylvania
Patrick E. Ryan, Chief Counsel and Staff Director
-------------
\1\ February 5, 2003--Rep. Michael H. Michaud was
appointed to the Committee.
\2\ February 12, 2003--Rep. Jim Gibbons resigned from
the Committee to serve on the Select Committee on Homeland Security.
\3\ February 13, 2003--Rep. Darlene Hooley, Rep.
Silvestre Reyes, Rep. Ted Strickland, Rep. Shelley Berkley, Rep. Tom
Udall, Rep. Susan A. Davis, and Rep. Tim Ryan were appointed to the
Committee.
\4\ February 25, 2003--Rep. Tim Murphy was appointed to
the Committee.
\5\ June 16, 2004--Rep. Silvestre Reyes resigned from
the Committee.
\6\ June 16, 2004--Rep. Stephanie Herseth was appointed
to the Committee.
(ii)
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__________
SUBCOMMITTEE ON HEALTH
ROB SIMMONS, Connecticut, Chairman
JERRY MORAN, Kansas CIRO D. RODRIGUEZ, Texas
RICHARD H. BAKER, Louisiana BOB FILNER, California
JEFF MILLER, Florida VIC SNYDER, Arkansas
JOHN BOOZMAN, Arkansas TED STRICKLAND, Ohio
JEB BRADLEY, New Hampshire SHELLEY BERKLEY, Nevada
BOB BEAUPREZ, Colorado TIM RYAN, Ohio
GINNY BROWN-WAITE, Florida LUIS V. GUTIERREZ, Illinois
RICK RENZI, Arizona CORRINE BROWN, Florida
CLIFF STEARNS, Florida DARLENE HOOLEY, Oregon
TIM MURPHY, Pennsylvania
__________
SUBCOMMITTEE ON BENEFITS
HENRY E. BROWN, Jr., South Carolina, Chairman
JACK QUINN, New York MICHAEL H. MICHAUD, Maine
JEFF MILLER, Florida SUSAN A. DAVIS, California
JEB BRADLEY, New Hampshire CORRINE BROWN, Florida
GINNY BROWN-WAITE, Florida STEPHANIE HERSETH, South Dakota
__________
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
STEVE BUYER, Indiana, Chairman
MICHAEL BILIRAKIS, Florida DARLENE HOOLEY, Oregon
TERRY EVERETT, Alabama LANE EVANS, Illinois
JOHN BOOZMAN, Arkansas BOB FILNER, California
Vacancy TOM UDALL, New Mexico
(iii)
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Committee Staff
Patrick E. Ryan, Chief Counsel and Staff Director
Charles M. Durishin, Democratic Staff Director (January 3, 2003-May 17,
2003)
James H. Holley, Democratic Staff Director (May 18, 2003)
Kingston E. Smith,* Deputy Chief Counsel
Arthur K. Wu, Deputy Staff Director/Staff Director, Subcommittee on
Oversight and Investigations
Leah M. Booth, Democratic Executive Assistant, Subcommittees on
Benefits and Health
John M. Bradley,* Staff Director, Subcommittee on Health
Geoffrey K. Collver, Democratic Counsel, Subcommittee on Benefits
Veronica Crowe, Professional Staff Member, Subcommittee on Oversight
and Investigations
Peter A. Dickinson, Communications Director
Bernadine N. Dotson, Office Manager
Dolores Dunn, Professional Staff Member, Subcommittee on Health
Susan C. Edgerton, Democratic Staff Director, Subcommittee on Health
Kevin J. Gash, Democratic Professional Staff Member
Kathleen S. Greve, Professional Staff Member, Subcommittee on Health
Darryl W. Kehrer, Staff Director, Subcommittee on Benefits
Sarah Keller-Likins, Democratic Executive Assistant, Subcommittee on
Health
Steven R. Kirkland, Director of Information Systems
Summer L. Larson, Staff Assistant, Legislative
Ruth J. Mahnken, Democratic Professional Staff Member, Subcommittee on
Oversight and Investigations
Mary Ellen Mc Carthy, Democratic Staff Director, Subcommittee on
Benefits
Mary Stevens McDermott, Administrative and Financial Assistant/Chief
Clerk
Jonathan M. McKay, Staff Assistant, Subcommittee on Oversight and
Investigations
Paige E. McManus, Professional Staff Member, Subcommittee on Benefits
Jeanne M. McNally, Legislative Coordinator
Holly M. Palmer, Staff Assistant, Legislative
Virginia E. Richardson, Democratic Executive Assistant, Subcommittee on
Oversight and Investigations
Devon E. Seibert, Staff Assistant, Subcommittee on Benefits
Leonard A. Sistek, Jr., Democratic Staff Director, Subcommittee on
Oversight and Investigations
Tanya J. Skypeck, Staff Assistant, Front Office
Deborah A. Smith, Democratic Administrative Assistant/Executive
Assistant, Subcommittee on Oversight and Investigations
Jeremiah B. Tan, Printing Clerk
Stacy H. Zelenski, Research Assistant, Subcommittee on Health
-------------
* On November 19, 2004, John M. Bradley was named Staff Director
and Kingston E. Smith was named Chief Counsel.
(v)
LETTER OF SUBMITTAL
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House of Representatives,
Committee on Veterans' Affairs,
Washington, DC, January 3, 2005
Hon. Jeff Trandahl,
Clerk, House of Representatives,
Washington, D.C.
Dear Mr. Trandahl:
In accordance with Clause 1(d) of Rule XI of the Rules of
the House of Representatives, I submit herewith the report of
the Committee on Veterans' Affairs setting forth its activities
in reviewing and studying the application, administration, and
execution of those laws, the subject matter of which is within
the jurisdiction of our committee.
Christopher H. Smith,
Chairman
FOREWORD
----------
The 108th Congress made substantial progress in
strengthening and reforming federal programs benefiting
veterans and their families. With the War on Terror being
fought every day in Iraq, Afghanistan and other locations
around the world, the 108th Congress continued to fulfill our
Nation's obligations to provide health care services,
compensation, and transition benefits to servicemembers,
veterans, and their families.
In the past two years, veterans health care services became
more comprehensive, accessible, and timely. Compensation
benefits for disabled veterans were expanded and increased.
Civil, legal and job protections for servicemembers and
veterans were strengthened. Education, training, employment,
and entrepreneurship programs for transitioning veterans were
improved. The national cemetery system honoring our veterans
was authorized to further expand to meet future needs.
Through steady oversight of the Department of Veterans
Affairs (VA), there have been measurable reductions in fraud,
waste, and mismanagement, as well as record increases in third
party collections that go directly back into VA to fund
veterans' health care.
Major Committee Legislation--The Veterans Benefits
Improvement Act of 2004 (Public Law 108-454) strengthens VA
education, training and employment programs; enhances VA
disability and compensation programs; expands VA's home loan
programs; and strengthens veterans' and servicemembers' legal
protections. Major provisions of Public Law 108-454, as
enacted:
LIncrease VA's monthly MGIB educational assistance
for apprenticeship and on-the-job training programs;
LAuthorize VA to pay benefits for competency-based
apprenticeships, which are predicated upon the mastery of job
skills rather than a set time period for training;
LProvide an additional $250 in dependency and
indemnity compensation (DIC) paid monthly to surviving spouses
with one or more children under age 18 for a two-year
transition period;
LIncrease the maximum VA home loan guaranty to 25
percent of the Freddie Mac conforming loan amount for a single-
family residence (currently from $240,000 to $333,700) and
annually index it to Freddie Mac.
The Veterans Health Programs Improvement Act of 2004
(Public Law 108-422) strengthens VA's homeless, long term care,
and nursing programs; authorizes new and expanded VA outpatient
clinics; and establishes new research and education centers for
veterans with multi-traumatic combat injuries. Major provisions
of Public Law 108-422, as enacted:
LAuthorize 16 leases totaling $24,420,000 for VA
community-based outpatient clinics;
LIncrease authorization for the Grant and Per Diem
homeless veterans assistance program from $75 million to $99
million in FY 2005;
LProvide payments to States to assist them in
hiring and retaining nurses to work in State veterans' homes;
LAuthorize a new pilot program to improve
recruitment of qualified nurses using outside agencies,
advertising, and interactive online technologies;
LAuthorize new research and education centers for
treating veterans with complex multi-trauma injuries associated
with combat.
The Department of Veterans Affairs Health Care Personnel
Enhancement Act of 2004 (Public Law 108-445) reforms VA's
physician pay and nurse employment systems to provide
additional flexibility to recruit and retain highly qualified
medical personnel. Under Public Law 108-445, a new physician
and dentist pay system will be established, to be comprised of
three elements: a 15-step Physician and Dentist Base and
Longevity Pay Schedule; a market pay band for clinical
specialties and subspecialties set by the Secretary; and
incentive bonuses up to $15,000 for physicians or dentists who
meet established performance goals set by the Department.
The Veterans Benefits Act of 2003 (Public Law 108-183)
expands and strengthens numerous compensation and transition
benefits for veterans. Major provisions of Public Law 108-183,
as enacted:
LExpand the Montgomery GI Bill program to cover
self-employment training programs and entrepreneurship courses
at approved institutions;
LAllow federal agencies to create sole-source
contracts for disabled veteran-owned small businesses and to
restrict certain contracts to disabled veteran-owned small
businesses;
LRestore dependency and indemnity compensation
(DIC), home loan, education, and burial benefit eligibility for
spouses remarried after age 57;
LIncrease the specially adapted automobile grant
from $9,000 to $11,000, and increase the specially adapted
housing grants from $48,000 to $50,000 for the most severely
disabled veterans and from $9,250 to $10,000 for less severely
disabled veterans;
LIncrease monthly educational benefits for spouses
and dependent children of disabled;
LEliminate the 30-day requirement for prisoners of
war (POWs) to qualify for presumptions of service-connection
for certain disabilities: psychosis, any of the anxiety states,
dysthymic disorder, organic residuals of frostbite, and post-
traumatic osteoarthritis;
LProvide full compensation and DIC to members of
the new Philippine Scouts if the individual resides in the
United States as a citizen or permanent resident, and also
extend eligibility for burial in a national cemetery.
The Servicemembers Civil Relief Act (Public Law 108-189),
rewrote the Soldiers' and Sailors' Civil Relief Act,
modernizing and expanding the law to meet today's civil, legal,
and financial arrangements. Important provisions of Public Law
108-189, as enacted:
LUpdate eviction protections for families of
servicemembers on active duty to reflect the increase in the
cost of rental housing;
LStrengthen protections for servicemembers from
losing life insurance coverage while on active duty;
LProvide coverage for all motor vehicles and other
personal property by the Act's installment contract
protections, so that the creditor must obtain a court order
before repossessing the motor vehicle;
LClarify that the Act's rights and protections
apply to civil administrative proceedings, such as license and
zoning matters, which are far more common today than they were
in 1940;
LImprove protection of servicemembers against
default judgments;
LExpand the professional liability protections to
include legal services.
The Veterans Health Care, Capital Asset, and Business
Improvement Act of 2003 (Public Law 108-170), authorized $276.6
million for major medical construction projects, and enhanced
and expanded numerous VA heath care benefits. Other major
provisions of Public Law 108-170, as enacted:
LEliminate the 90-day requirement for former POWs
to qualify for VA outpatient dental care and eliminate
prescription drug copayments for former POWs;
LAuthorize VA to provide health care services to
certain Filipino World War II veterans who permanently reside
in the United States;
LAuthorize VA to appoint chiropractors as clinical
practitioners;
LIncrease yearly earmarked funding for specialized
mental health care services to severely and chronically
disabled veterans from $15,000,000 to $25,000,000;
LExtend VA's authority to transfer housing
properties recovered through foreclosure of GI home loans to
community-based homeless veterans assistance providers;
LAuthorize premium pay for Saturday duty to
additional VA health care workers;
LAuthorize VA to carry out major construction
projects proposed by the Capitol Asset Realignment for Enhanced
Services (CARES) initiative only after submitting a report to
Congress listing each project in order of priority as
established in this legislation.
The National Cemetery Expansion Act of 2003 (Public Law
108-109) directed the Secretary of Veterans Affairs to
establish, not later than four years after the date of
enactment, six new national cemeteries in southeastern
Pennsylvania; Birmingham, Alabama; Jacksonville, Florida;
Bakersfield, California; Greenville/Columbia, South Carolina;
and Sarasota, Florida.
Oversight--The Committee continued aggressive oversight of
the federal veterans programs and laws. The tone was set early
in the 108th Congress when the Committee held a series of
hearings to investigate fraud, waste, abuse, and mismanagement
in the Department of Veterans Affairs. Detailed testimony from
both the Office of Inspector General and the Government
Accountability Office (GAO) documented progress made, as well
as areas where significant improvement was needed. Among the
major areas covered were mismanagement of part-time physicians,
erroneous benefits paid to fugitive felons, and ongoing efforts
to improve VA's third party insurance collections to the
Medical Care Collections Fund.
Other oversight topics examined in Committee hearings
included VA's CARES (Capital Asset Realignment for Enhanced
Services) process; VA-DOD sharing of medical resources; VA's
preparedness to meet national medical emergencies; and VA's
ability to provide a seamless delivery of benefits and services
to servicemembers as they transition from the military to
civilian life.
Budget and Appropriations--Funding for veterans programs
has increased significantly in each of the past four years.
Overall funding for the Department of Veterans Affairs has
risen $23 billion from approximately $48 billion in fiscal year
2001 to over $71 billion in the fiscal year 2005 budget, almost
a 50 percent increase in four years. Veterans medical care
funding has risen from $20.2 billion in the fiscal year 2001
budget to $27.8 billion in the fiscal year 2005 budget. The
fiscal year 2005 Consolidated Appropriations Act (Public Law
108-447) contained $1.2 billion more in veterans medical care
funding than had been requested by the Administration in the
budget submission.
As a result of these funding decisions made by Congress, as
well as aggressive oversight by the Committee, the number of
veterans who received VA medical care services in 2004 topped 5
million, over one million more than had received medical care
services four years prior. At the same time, using new
resources provided through the budget and appropriations
process, as well as increased focus upon management
initiatives, VA has been able to reduce the number of veterans
on long waiting lists by more than 98 percent in two years,
from over 300,000 in 2002 to less than 6,000 today.
Acknowledgements--The successes achieved for veterans in
the 108th Congress are the result of dedicated, bipartisan work
by the Members and staff of the Committee. I want to thank
Honorable Lane Evans of Illinois, the Ranking Minority Member
of the Committee, for his dedication and cooperation in
improving the lives of all veterans and their loved ones. I
want to thank the Chairmen and Ranking Minority Members of the
Subcommittees for all of their highly effective work: Honorable
Henry Brown and Honorable Michael Michaud of the Benefits
Subcommittee; Honorable Rob Simmons and Honorable Ciro
Rodriguez of the Health Subcommittee; and Honorable Steve Buyer
and Honorable Darlene Hooley of the Oversight and
Investigations Subcommittee. I also want to thank Honorable
Mike Bilirakis, the Vice Chairman of the Committee, for his
years of advocacy on behalf of veterans.
Our legislative success was only possible due to the
cooperation of our counterparts in the Senate, Honorable Arlen
Specter, Chairman, and Honorable Bob Graham, Ranking Member, of
the Senate Veterans' Affairs Committee. I want to thank them
and their expert professional staff for their work to better
the lives of veterans.
I especially want to thank the entire Majority and Minority
professional staffs of our Committee. The countless
contributions made by each of them throughout the 108th
Congress are responsible for truly historic progress made on
behalf of veterans and their families.
The Committee notes with sadness the June 20, 2003, death
of one of its most distinguished former members, Honorable Bob
Stump. Born and raised in Arizona, he served our country with
distinction, from his enlistment in the U.S. Navy during World
War II at the age of 16, to his extraordinary 26 years in the
United States Congress. From 1995-2000, he chaired the
Committee, and was its ranking minority member for the two
previous years. With an impressive record of legislative
accomplishments resulting in immeasurable good for veterans,
servicemembers, and their families, Bob Stump was a true
American hero.
The 108th Congress continued to build upon the legacy of
the 107th and prior Congresses. The course has been set, the
orders given, and there will be no retreat from the mission to
ensure that all of America's veterans are honored, cared for,
and given all of the benefits they earned through their
service.
Christopher H. Smith,
Chairman
C O N T E N T S
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Page
Jurisdiction of the House Committee on Veterans' Affairs......... 1
Veterans programs:
Department of Veterans Affairs............................... 2
Veterans Health Administration........................... 2
Medical care......................................... 3
Medical and prosthetic research...................... 4
Veterans Benefits Administration......................... 5
Compensation and pension............................. 5
Insurance............................................ 5
Education............................................ 6
Home loan assistance................................. 6
National Cemetery Administration......................... 6
Department of Labor.......................................... 7
American Battle Monuments Commission......................... 7
Arlington National Cemetery.................................. 8
Legislation enacted into law:
Public Law 108-109, National Cemetery Expansion Act of 2003,
11/11/2003................................................. 8
Public Law 108-147, Veterans' Compensation Cost-of-Living
Adjustment Act of 2003, 12/03/2003......................... 9
Public Law 108-170, Veterans Health Care, Capital Asset, and
Business Improvement Act of 2003, 12/06/2003............... 10
Public Law 108-183, Veterans Benefits Act of 2003, 12/16/2003 14
Public Law 108-189, Servicemembers Civil Relief Act, 12/19/
2003....................................................... 18
Public Law 108-363, Veterans' Compensation Cost-of-Living
Adjustment Act of 2004, 10/25/2004......................... 20
Public Law 108-422, Veterans Health Programs Improvement Act
of 2004, 11/30/2004........................................ 21
Public Law 108-445, Department of Veterans Affairs Health
Care Personnel Enhancement Act of 2004, 12/3/2004.......... 24
Public Law 108-454, Veterans Benefits Improvement Act of
2004, 12/10/2004........................................... 26
Activities of the Committee...................................... 32
Activities of the subcommittees:
Subcommittee on Health....................................... 47
Subcommittee on Benefits..................................... 64
Subcommittee on Oversight and Investigations................. 73
Summary of action by the Committee............................... 83
Hearings and Executive Sessions.................................. 84
Committee web site............................................... 89
Oversight Plan for 108th Congress................................ 91
Report on the budget proposed for fiscal year 2004............... 99
Report on the budget proposed for fiscal year 2005............... 120
Messages from the President and other Executive Branch
communications................................................. 140
Statistical data--war veterans and dependents.................... 152
Union Calendar No. 493
108th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 108-808
======================================================================
ACTIVITIES OF THE COMMITTEE ON VETERANS' AFFAIRS FOR THE 108TH CONGRESS
_______
January 3, 2005--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Smith of New Jersey, for the Committee on Veterans' Affairs,
pursuant to Clause 1(d) of Rule XI, submitted the following
R E P O R T
Jurisdiction
Rule X of the Rules of the House of Representatives
establishes the standing committees of the House and their
jurisdiction. Under that rule, all bills, resolutions, and
other matters relating to the subjects within the jurisdiction
of any standing committee shall be referred to such committee.
Clause 1(r) of Rule X establishes the jurisdiction of the
Committee on Veterans' Affairs as follows:
(1) Veterans' measures generally.
(2) Cemeteries of the United States in which veterans
of any war or conflict are or may be buried, whether in
the United States or abroad (except cemeteries
administered by the Secretary of the Interior).
(3) Compensation, vocational rehabilitation, and
education of veterans.
(4) Life insurance issued by the Government on
account of service in the Armed Forces.
(5) Pensions of all wars of the United States,
general and special.
(6) Readjustment of servicemen to civil life.
(7) Soldiers' and sailors' civil relief.
(8)Veterans' hospitals, medical care, and treatment
of veterans.
The Committee on Veterans' Affairs was established January
2, 1947, as a part of the Legislative Reorganization Act of
1946 (60 Stat. 812), and was vested with jurisdiction formerly
exercised by the Committee on World War Veterans' Legislation,
Invalid Pensions, and Pensions. Jurisdiction over veterans'
cemeteries administered by the Department of Defense was
transferred from the Committee on Interior and Insular Affairs
on October 20, 1967, by H. Res. 241, 90th Congress. The
Committee during the 108th Congress had 31 members, 17 in the
majority and 14 in the minority.
VETERANS PROGRAMS
Department of Veterans Affairs
President Herbert Hoover issued an executive order on July
21, 1930, creating the Veterans Administration. At that time,
the Veterans Administration had 54 hospitals and 31,600
employees to serve 4.7 million veterans. President Ronald
Reagan signed legislation on October 25, 1988, creating the
Department of Veterans Affairs (VA), which assumed
responsibility from the Veterans Administration for the mission
of providing Federal benefits to veterans and their families.
The veteran population was approximately 24.7 million on
September 30, 2004. Over 74 of every 100 veterans have served
during defined periods of armed hostilities. Altogether,
approximately 65 million veterans, dependents and survivors of
deceased veterans, over 20 percent of the Nation's population,
are potentially eligible for VA benefits and services.
To serve these veterans, their dependents and survivors, VA
carries out its veterans programs nationwide in three
administrations. The Veterans Health Administration (VHA) is
responsible for veterans' health care programs. The Veterans
Benefits Administration (VBA) is responsible for compensation,
pension, vocational rehabilitation, education assistance, home
loan guaranty and insurance programs. The National Cemetery
Administration (NCA) is responsible for the operation of 120
national cemeteries. The Board of Veterans' Appeals (BVA)
provides final decisions for the Secretary on appeals of
veterans benefits claims.
As of September 30, 2004, VA had 236,427 employees. Among
all the departments and agencies of the Federal government,
only the Department of Defense (DOD) has a larger work force.
Of the total number of VA employees, the Veterans Health
Administration has 214,580, the Veterans Benefits
Administration has 12,972, the National Cemetery Administration
has 1,542, and the Veterans' Canteen Service has 3,238. The
remaining 4,095 employees are in staff offices, including the
office of the Inspector General. VA is a leading employer of
veterans with about 25.2 percent of VA's employees being
veterans.
Since the formation of the Department, the Secretaries of
Veterans Affairs have been: Honorable Edward J. Derwinski,
1989-1992; Honorable Jesse Brown, 1993-1997; Honorable Togo D.
West, Jr., 1998-2000; and the current Secretary, Honorable
Anthony J. Principi.
VETERANS HEALTH ADMINISTRATION
VA's largest and most visible component is the Veterans
Health Administration (VHA). It has 157 hospitals, with at
least one in each of the 48 contiguous states, Puerto Rico, and
the District of Columbia, and with small VA inpatient bed
complements at military treatment facilities in Alaska and
Hawaii. VHA is divided into 21 Veterans Integrated Service
Networks (VISNs) that provide its basic management structure.
VHA is headed by the Under Secretary for Health, who is
appointed by the President for a four-year term.
In addition to its 157 hospitals, VA operates 696
community-based outpatient clinics, 134 nursing homes and 42
domiciliary care facilities.
Medical Care
In 2003, with about 19,000 average operating acute hospital
beds, VA treated 604,093 inpatients, 92,516 veterans in nursing
home care units or in community nursing facilities at VA
expense, and 24,413 veterans in home care and other community-
based health programs sponsored by VA. The Department's
outpatient clinics registered over 46 million visits by
veterans in 2003. Altogether, over 4.5 million veterans
received care under VA auspices in 2003.
Over the past decade, VA has transformed its health care
system through a structural and organizational change, with
improved resource allocation, better measurements of
accountability for quality and value, and development of an
information infrastructure to support the needs of patients,
clinicians, and administrators. VA has experienced
unprecedented growth in demand for medical care for the last
several years. Between 2000 and 2003, the number of veterans
treated through the VA health care system grew by 1.1 million,
or 31 percent. During the same period, the VA health care
budget increased by more than $6 billion (33 percent). This
growth resulted in long waiting lists. More than 175,000 new
enrollees waited six months or more for their first primary
care appointments in July 2002. Due to management initiatives,
VA was able to reduce the number of patients waiting for a
first appointment to less than 4,000 as of May 15, 2004.
Across the Nation, VA is currently affiliated with 107
medical schools, 54 dental schools, and over 1,000 other
schools offering students allied and associated education
degrees or certificates in 40 health profession disciplines.
More than one-half of all practicing physicians in the United
States received at least part of their clinical educational
experiences in the VA health care system. In 2003, over 83,000
health care professionals received training in VA medical
centers. The Department is also the largest employer of
registered nurses in the United States, with 34,464 nurses on
its rolls in 2003.
VA's efforts to provide clinical services for veterans
suffering from post-traumatic stress disorder (PTSD) were
inaugurated with the establishment of the Vet Center program in
1979.
VA's Vet Center program consists of 206 community-based Vet
Centers. The Vet Center program provides a mix of professional
readjustment counseling for war trauma, family-related services
and community-based service functions to include outreach,
education, case management and referral activities. The Vet
Centers make over 200,000 veteran referrals each year to VA
medical facilities and regional offices.
The Department conducts a variety of specialized programs,
including compensated work therapy to provide disabled veterans
with job skills, training, and rehabilitative residences.
Often, these programs assist homeless veterans. VA also
provides targeted services for homeless veterans, including
outreach, case management, clinical care, residential treatment
and rehabilitation, care for serious mental illnesses and
substance-use disorder, and supported housing.
In operating its health care facilities, the Department
benefits from the contributions of time and energy by more than
133,000 volunteers from all walks of life. Many veterans
themselves and family members of veterans volunteer through
VA's Voluntary Service. Volunteers donate nearly 13 million
hours of service each year to bring companionship, faith, hope
and comfort to hospitalized veterans and to the millions of
veterans who visit VA outpatient clinics.
Medical and Prosthetic Research
Some of the most recent advances from VA research include:
Establishment of a new center for limb loss care.
Researchers at the Providence VAMC have established a new
Center for Rebuilding, Regenerating and Restoring Function
After Limb Loss in collaboration with Brown Medical School and
the Massachusetts Institute of Technology. The Center will
provide state-of-the-art care for veteran amputees, foster the
development of new prosthetic devices, and advance research in
such areas as tissue engineering and robotics. VA expects the
Center to significantly improve outcomes for veterans with
recent combat injuries and other VA patients who have suffered
amputation.
Neuropsychological measures of military personnel. DOD has
permitted VA scientists access to military personnel prior to
deployment to establish baseline neuropsychological measures.
Once they return from Operation Iraqi Freedom, these soldiers
will be reassessed on the same neuropsychological measures,
allowing comparison of pre- and post-deployment health, and
providing valuable insight into the effects of traumatic
exposure.
Discovery that a harmless virus helps HIV infected
patients. A study at the Iowa City VAMC and University of Iowa
showed that a harmless virus, GBV-C, boosts immune proteins and
helps slow the progression of HIV to prolong survival for many
patients.
Studies related to multiple-sclerosis nerve damage.
Scientists with VA, Yale and University College, London, have
found alterations in the appearance of two sodium channel
molecules during nerve-fiber degeneration in multiple
sclerosis. This landmark finding provides, for the first time,
important clues about the molecular basis for the permanent and
irreversible damage caused by MS.
Clinical Trial using Deep Brain Stimulation to treat
refractory Parkinson's disease. VA, in collaboration with the
National Institute for Neurological Disorders and Stroke, is
conducting an investigational trail of two promising
neurosurgical techniques utilizing implantation of electrical
stimulation devices to assess the impact on symptoms and
functioning of Parkinson's patients, and to compare the effects
of the techniques.
Functional electrical stimulation (FES). VA researchers at
the Cleveland FES Center are focusing on the application of one
of the most advanced electrical currents technology to generate
and suppress activity in the nervous system. This application
can be used to control the movement of otherwise paralyzed
limbs to stand and hand grasp, activate bowel and bladder
function, create perceptions such as skin sensibility and
suppress pain and spasm. The original technology for the
diaphragm stimulator system, used by the late actor Christopher
Reeve to help him breathe for extended periods without a
ventilator, was developed at the Cleveland FES Center.
VETERANS BENEFITS ADMINISTRATION
The Veterans Benefits Administration (VBA) is responsible
for administering and delivering benefits and services to
eligible veterans, as well as certain survivors and dependents.
VBA operates 57 regional offices throughout the United States,
Puerto Rico and the Republic of the Philippines. In 2002, the
regional offices were realigned into four area offices which
set goals, monitor performance and share responsibility for
mission accomplishment within their geographic area. VBA
programs include disability compensation, pension, education,
vocational rehabilitation and employment, home loan guaranty,
life insurance, and burial. VBA is headed by the Under
Secretary for Benefits, who is appointed by the President for a
four-year term.
Compensation and Pension
More than 2.5 million veterans receive disability
compensation and another 342,000 receive pension payments from
VA. Additionally, over 340,000 individual widows, children and
parents of deceased veterans are paid survivor compensation or
death pension benefits. VA disability and death compensation
and pension payments amounted to more than $29.6 billion in
fiscal year 2004.
Insurance
VA operates the tenth largest insurance program in the
United States, based on total amount of coverage provided. VA-
administered and supervised insurance programs provide $750
billion of coverage to more than 7.5 million veterans,
servicemembers and their families. Six of the programs are
administered directly by VA. Two others, the Servicemembers'
Group Life Insurance (SGLI) and the Veterans' Group Life
Insurance (VGLI) programs, are supervised and overseen by VA
but are contracted to the Prudential Insurance Company of
America. SGLI and VGLI represent 97 percent of the coverage
amount and insure approximately 5.8 million lives for a total
of $729 billion, to include more than 2.8 million veterans,
active duty servicemembers, reservists and Guardsmen, plus 3.1
million spouses and children.
In 2003, the VA life insurance programs returned $569
million in dividends to 1.5 million veterans who hold some of
these VA life insurance policies, and paid an additional $2.42
billion in death claims and other disbursements. The
Philadelphia VA Insurance Center was selected from among 22
organizations as recipient of the 2004 Government Customer
Support Excellence Award, and was also named the recipient of
the 2004 Leo C. Wurschmidt, Jr. Customer Service Team Award,
VBA's highest award for customer service.
Education
Since 1944, when the first GI Bill became law, more than 21
million beneficiaries have participated in GI Bill education
and training programs. This includes 7.8 million World War II
veterans, 2.3 million Korean War veterans, and 8.2 million
post-Korean and Vietnam era veterans, and active duty
personnel. Proportionally, Vietnam era veterans were the
greatest participants in GI Bill training. Approximately 76
percent of those eligible took training, compared with 50.5
percent for World War II veterans and 48.4 percent for Korean
era veterans.
The All-Volunteer Force Educational Assistance Program
provides benefits for veterans, service personnel and members
of the Selected Reserve who train under the Montgomery GI Bill
(MGIB). Approximately 59 percent of veterans eligible for the
MGIB have used it through fiscal year 2004. Over 17,400 more
claimants received education benefits during fiscal year 2004
than during fiscal year 2003. Almost 68 percent of the 490,417
beneficiaries who used VA education benefits during fiscal year
2004 qualified under the provisions of the MGIB. Reservists
accounted for about 18 percent, and the Survivors' and
Dependents' Educational Assistance program for certain eligible
dependents of veterans accounted for almost 14 percent.
Home Loan Assistance
More than 16.8 million veterans and their dependents have
benefited from VA's loan guaranty program. From this program's
establishment as part of the original GI Bill in 1944 through
the end of fiscal year 2002, VA home loan guaranties totaled
more than $740 billion. In fiscal year 2002, VA guaranteed
317,000 loans valued at $40 billion. Since 1948, VA has
assisted 35,000 disabled veterans with grants totally more than
$537 million for specially adapted housing.
NATIONAL CEMETERY ADMINISTRATION
VA assumed responsibility for the National Cemetery
Administration (NCA) in 1973. As of March 2004, NCA maintains
almost 2.5 million gravesites at 120 national cemeteries in 39
states and Puerto Rico. NCA also oversees 33 soldiers' lots,
monument sites, and confederate cemeteries. Currently, 60 VA
cemeteries in 34 states are able to provide both casket and
cremation burials, and an additional 23 provide burial for
family members of those already buried and can also accommodate
cremated remains. Thirty-seven are closed to new interments but
can accommodate family members in already-occupied gravesites.
Total acreage in NCA has increased from 4,260 in 1973 to 14,200
in 2004. More than 3 million people, including veterans from
every war and conflict--from the Revolutionary War to Operation
Iraqi Freedom--are honored by burial in VA's national
cemeteries.
Since 1973, annual interments in VA national cemeteries
have increased from 36,400 to 89,750 in fiscal year 2003.
Interments are expected to increase annually until 2008. In
1999 and 2003, Congress directed VA to establish 12 new
national cemeteries. One of those, Fort Sill National Cemetery
in Oklahoma, opened in November 2001. The others, one in
Alabama, two in California, three in Florida, one in Georgia,
one in Michigan, two in Pennsylvania, and one in South
Carolina, will be located near large populations of veterans
who currently do not have access to burial in a veterans'
cemetery.
The Department of Veterans Affairs State Cemetery Grants
Program was established in 1978 to complement VA's National
Cemetery Administration. The program assists states with
building or improving state veterans cemeteries. VA will pay
for the construction costs in exchange for states providing the
land and operating the cemeteries. More than $175 million has
been awarded for 54 operational veterans cemeteries in 30
states and Guam. Five state cemeteries are under construction.
In 2003, state cemeteries that received VA grants buried 18,192
eligible veterans and family members. Owing to the success of
the State Cemetery Grants Program, Congress made the program,
set to expire in fiscal year 2004, permanent with Public Law
108-183.
Department of Labor
VETERANS' EMPLOYMENT AND TRAINING
The Veterans' Employment and Training Service (VETS) of the
Department of Labor provides employment and training services
to eligible veterans through a non-competitive Jobs for
Veterans State Grants Program. Under this grant program, funds
are allocated to State Workforce Agencies in direct proportion
to the number of veterans seeking employment within their
state. On December 14, 2004, the Department of Labor granted an
additional $3.78 million in grants above the annual
appropriations for Veterans' Employment and Training to be
divided among 17 communities in 15 states. Over 2,220 veterans
will benefit from these grants in the form of new job
placement, career counseling, classroom or on-the-job training,
and obtaining or retaining licenses and certifications.
American Battle Monuments Commission
The American Battle Monuments Commission (ABMC), created by
an Act of Congress in 1923, is a Federal agency responsible for
the construction and permanent maintenance of military
cemeteries and memorials on foreign soil, as well as certain
memorials in the United States. Its principal functions are to
commemorate, through the erection and maintenance of suitable
memorial shrines, the sacrifices and achievements of the
American armed forces where they have served since April 6,
1917; to design, construct, operate, and maintain permanent
American military burial grounds and memorials in foreign
countries; to control the design and construction on foreign
soil of U.S. military monuments and markers by other U.S.
citizens and organizations, both public and private; and to
encourage U.S. government agencies and private individuals and
organizations to maintain adequately the monuments and markers
erected by them on foreign soils. ABMC also provides
information and assistance, on request, to relatives and
friends of the war dead interred or commemorated at its
facilities.
In performance of its functions, ABMC administers, operates
and maintains 24 permanent American military cemetery memorials
and 22 monuments, memorials, markers and separate chapels in
fourteen foreign countries, the Commonwealth of the Northern
Mariana Islands, Gibraltar, and three memorials in the United
States. When directed by Congress, ABMC develops and erects
national military monuments in the United States, such as the
Korean War Veterans Memorial and most recently, the World War
II National Memorial. A decade in the making, the World War II
Memorial is located on the National Mall in Washington, DC and
was dedicated on May 29, 2004. It is the first national World
War II Memorial built to honor the 16 million servicemembers
who served in the Armed Forces of the United States, the more
than 400,000 who died, and the millions who supported the war
effort at home.
Arlington National Cemetery
Arlington Mansion and 200 acres of ground immediately
surrounding it were designated as a military cemetery on June
15, 1864, by Secretary of War Edwin M. Stanton. With more than
200,000 people buried, Arlington National Cemetery has the
second largest number of people buried of any national cemetery
in the United States. Arlington National Cemetery is
administered by the Department of the Army.
Veterans from all the Nation's wars and conflicts are
buried in the cemetery, from the American Revolution through
Operation Iraqi Freedom. Since the War on Terror began, 121
servicemembers have been interred at Arlington National
Cemetery; 15 from Operation Enduring Freedom in Afghanistan and
106 from Operation Iraqi Freedom. The cemetery conducts
approximately 6,452 burials each year. In addition to in-ground
burial, the cemetery has a large columbarium for cremated
remains. Seven courts are currently in use, each with 5,000
niches. Arlington is the site of many non-funeral ceremonies,
and approximately 3,700 such ceremonies are conducted each
year. Arlington is expected to continue to provide burials
through the year 2060 with its recently approved capital
investment plan.
More than 4 million people visit the cemetery annually,
many coming to pay final respects at graveside services, of
which nearly 125 are conducted each week. Also, more than 3,800
former slaves are buried there. The Tomb of the Unknowns and
the grave of President John F. Kennedy are among the most
visited sites at the cemetery.
LEGISLATION ENACTED INTO LAW
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Public Law 108-109
National Cemetery Expansion Act of 2003
(H.R. 1516, AS AMENDED)
Title: An Act to provide for the establishment by the
Secretary of Veterans Affairs of additional cemeteries in the
National Cemetery Administration.
H.R. 1516, as amended, will:
1. Direct the Secretary of Veterans Affairs to establish,
not later than four years after the date of enactment, six new
national cemeteries in the following areas: southeastern
Pennsylvania; Birmingham, Alabama; Jacksonville, Florida;
Bakersfield, California; Greenville/Columbia, South Carolina;
and Sarasota, Florida.
2. Direct the Secretary to use Advance Planning Funds for
the establishment of the new cemeteries.
3. Direct the Secretary, in determining the specific sites
for the new cemeteries, to solicit the advice of
representatives of State and local veterans' organizations and
other individuals as the Secretary considers appropriate.
4. Require the Secretary to submit a report to Congress
within 120 days of enactment setting forth the six areas where
those cemeteries will be established, a schedule for
establishment, the estimated cost associated with
establishment, and the amount of Advance Planning Funds
obligated for this purpose.
5. Require the Secretary to submit to Congress an annual
report that updates the information included in the initial
report until the six cemeteries are completed.
Effective Date: Date of enactment.
Cost: The Congressional Budget Office (CBO) estimates that
implementing the bill would cost $11 million in 2004 and $93
million over the 2004-2008 period, assuming appropriation of
the necessary amounts. The bill would not affect direct
spending or receipts.
Legislative History:
June 26, 2003: H.R. 1516 ordered reported amended favorably
by the Committee on Veterans' Affairs.
July 10, 2003: H.R. 1516 reported amended by the Committee
on Veterans' Affairs. H. Rept. 108-199.
July 21, 2003: Passed the House amended under suspension by
vote of 408-0 (Roll No. 399).
July 22, 2003: Referred to the Senate Committee on
Veterans' Affairs.
September 30, 2003: Senate Committee on Veterans' Affairs
ordered reported favorably with an amendment in the
nature of a substitute.
October 14, 2003: Senate Committee on Veterans' Affairs
reported with amendments and an amendment to the
title, with written report number 108-164.
October 17, 2003: Passed the Senate with amendments and an
amendment to the title by unanimous consent.
October 20, 2003: Message on Senate action sent to the
House.
October 29, 2003: House agreed to the Senate amendments
under suspension by vote of 412-0 (Roll No. 577).
November 11, 2003: Signed by the President, Public Law 108-
109.
------
Public Law 108-147
Veterans' Compensation Cost-of-Living Adjustment Act of 2003
(H.R. 1683)
Title: An Act to increase, effective as of December 1,
2003, the rates of disability compensation for veterans with
service-connected disabilities and the rates of dependency and
indemnity compensation for survivors of certain service-
connected disabled veterans, and for other purposes.
H.R. 1683 will:
Provide effective December 1, 2003, a cost-of-living
adjustment to the rates of disability compensation for veterans
with service-connected disabilities and to the rates of
dependency and indemnity compensation for survivors of certain
service-connected disabled veterans. The percentage amount
would be equal to the increase for benefits provided under the
Social Security Act, which is calculated based upon changes in
the Consumer Price Index.
Effective Date: December 1, 2003.
Cost: The COLA is assumed in the baseline, and would have
no budgetary effect relative to the baseline. Relative to
current law, the Congressional Budget Office estimates that
enacting this provision would increase spending for these
programs by about $420 million in 2004. (The annualized cost
would be about $560 million in subsequent years.) This estimate
assumes that the COLA effective on December 1, 2003, would be
2.2 percent.
Legislative History:
May 15, 2003: H.R. 1683 ordered reported favorably by the
Committee on Veterans' Affairs.
May 19, 2003: H.R. 1683 reported by the Committee on
Veterans' Affairs. H. Rept. 108-108.
May 20, 2003: Considered under suspension of the rules. At
the conclusion of debate, the Yeas and Nays were
demanded and ordered. Pursuant to the provisions of
clause 8, rule XX, the Chair announced that further
proceedings on the motion would be postponed.
May 22, 2003: Passed the House under suspension by vote of
426-0 (Roll No. 209).
May 22, 2003: Referred to the Senate Committee on Veterans'
Affairs.
November 21, 2003: Senate Committee on Veterans' Affairs
discharged by unanimous consent.
November 21, 2003: Passed the Senate by unanimous consent.
December 3, 2003: Signed by the President, Public Law 108-
147.
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Public Law 108-170
Veterans Health Care, Capital Asset, and Business Improvement Act of
2003
(S. 1156, AS AMENDED)
Title: An Act to amend title 38, United States Code, to
improve and enhance provision of health care for veterans, to
authorize major construction projects and other facilities
matters for the Department of Veterans Affairs, to enhance and
improve authorities relating to the administration of personnel
of the Department of Veterans Affairs, and for other purposes.
S. 1156, as amended, will:
TITLE I--HEALTH CARE AUTHORITIES AND RELATED MATTERS
1. Authorize former prisoners of war to receive
outpatient dental care from VA, irrespective of the number of
days detained in captivity.
2. Eliminate copayments for pharmaceuticals administered
to former prisoners of war.
3. Authorize VA to provide veterans who participated in
tests conducted by the Department of Defense (DOD) Deseret Test
Center from 1962 through 1973 higher priority for hospital
care, medical services and nursing home care without
requirement for proof of service-connection through December
31, 2005.
4. Authorize VA to provide hospital and nursing home care
and medical services to certain Filipino World War II veterans
of the Philippines Commonwealth Army and former Philippines
``New Scouts'' who permanently reside in the United States, in
the same manner as provided to U.S. veterans.
5. Expand VA authority to provide rehabilitative work
skills training and development services, employment support
services and job development and placement services.
6. Authorize VA to enter into ``provider agreements''
with non-VA entities to provide veterans with institutional
nursing care or non-institutional extended care in a manner
similar to such agreements permitted under the Social Security
Act.
7. Extend VA's authority to provide a range of non-
institutional extended care services as set forth in Public Law
106-117 through December 31, 2008.
8. Extend the mandate to provide medically necessary,
institutional nursing care services to severely service-
connected disabled veterans through December 31, 2008.
9. Expand and extend VA authority to conduct a pilot
program on assisted living for veterans.
10. Increase funding authorization for each of fiscal
years 2004 through 2006 from $15,000,000 to $25,000,000 for the
provision of specialized mental health services to veterans.
TITLE II--CONSTRUCTION AND FACILITIES MATTERS
1. Increase from $4,000,000 to $7,000,000 the threshold
that classifies a medical facility construction project as
``major construction.''
2. Streamline the process and notification requirements
in title 38, United States Code, when the Veterans Health
Administration (VHA) proposes an enhanced-use lease of VA
properties no longer needed for the delivery of care to
veterans
3. Authorize individual VHA facilities to be reimbursed
for expenses incurred in the development and execution of
enhanced-use leases.
4. Simplify the reporting of the Annual Report on Long-
Range Health Planning.
5. Authorize $14,500,000 for the construction of a long-
term care facility in Lebanon, Pennsylvania.
6. Authorize $20,000,000 for the construction of a long-
term care facility in Beckley, West Virginia.
7. Authorize $98,500,000 for the construction of a new
bed tower in Chicago, Illinois.
8. Authorize $48,600,000 for the correction of seismic
deficiencies in San Diego, California.
9. Authorize $50,000,000 for medical care and research
renovations in West Haven, Connecticut.
10. Authorize $45,000,000 for the construction of a VA-
Navy outpatient medical care facility in Pensacola, Florida.
11. Authorize a lease in the amount of $3,000,000 for an
outpatient clinic in Charlotte, North Carolina.
12. Authorize a lease in the amount of $2,879,000 for an
outpatient clinic extension in Boston, Massachusetts.
13. Authorize advance planning in the amount of
$26,000,000 for a major medical facility project in Denver,
Colorado.
14. Authorize advance planning in the amount of $9,000,000
for a major medical facility project in Pittsburgh,
Pennsylvania.
15. Authorize advance planning in the amount of
$25,000,000 for a major medical facility project in Las Vegas,
Nevada.
16. Authorize advance planning in the amount of $9,000,000
for a major medical facility project in Columbus, Ohio
17. Authorize advance planning in the amount of
$17,500,000 for a major medical facility project in East
Central, Florida.
18. Authorize a total of $276,600,000 for fiscal year 2004
for the construction of the projects designated in Section 211.
19. Authorize a total of $86,500,000 for the advance
planning authorized in Section 213.
20. Authorize VA to carry out major construction projects
in connection with the Capitol Asset Realignment for Enhanced
Services (CARES) initiative no sooner than 45 days or 30 days
of continuous session of Congress following the submission of a
one-time report to Congress by February 1, 2004, that lists
each proposed major construction project in order of priority,
with such priority established in Section 221(2).
21. Require VA to notify Congress in writing of actions
proposed under the CARES initiative that would result in
medical facility closures, significant staff realignments or
medical facility consolidations and prohibit such actions from
occurring until 60 days following the notification or 30 days
of continuous session of Congress.
22. Express the sense of Congress of the difficulties that
veterans residing in rural areas encounter in gaining access to
VA health care facilities and require VA to report actions to
be taken to improve rural access to care.
23. Require VA to develop a plan for meeting the future
inpatient hospital care needs of veterans who reside in
southern New Jersey.
24. Require VA to develop a plan for meeting the future
hospital care needs of veterans who reside in southern Texas.
25. Require VA to develop a plan for meeting the future
hospital care needs of veterans who reside in north central
Washington.
26. Require VA to develop a plan for meeting the future
hospital care needs of veterans who reside in the Panhandle
area of Florida.
27. Require VA to submit a report on each plan developed
under Section 231(a) to the Senate and House Committees on
Veterans' Affairs by April 15, 2004.
28. Require VA to conduct a feasibility study in
coordination with the Medical University of South Carolina and
in consultation with DOD to consider establishing a joint
health-care venture to deliver inpatient, outpatient and/or
long-term care to veterans, DOD, and other beneficiaries who
reside in Charleston, South Carolina, with a report to the
Committees by April 15, 2004.
29. Authorize VA to name the VA Medical Center in
Prescott, Arizona, the Bob Stump Department of Veterans Affairs
Medical Center.
30. Authorize VA to name the VA Medical Center (West Side
Division) in Chicago, Illinois, the Jesse Brown Department of
Veterans Affairs Medical Center.
31. Authorize VA to name the VA Medical Center in Houston
Texas, the Michael E. DeBakey Department of Veterans Affairs
Medical Center.
32. Authorize VA to name the VA Medical Center in Salt
Lake City, Utah, the George E. Wahlen Department of Veterans
Affairs Medical Center.
33. Authorize VA to name the outpatient clinic in New
London, Connecticut, the John J. McGuirk Department of Veterans
Affairs Outpatient Clinic.
34. Authorize VA to name the outpatient clinic in Horsham,
Pennsylvania, the Victor J. Saracini Department of Veterans
Affairs Outpatient Clinic.
TITLE III--PERSONNEL MATTERS
1. Modify the authorities on appointment and promotion of
certain personnel in the Veterans Health Administration.
2. Authorize VA to appoint chiropractors as clinical
practitioners in the Veterans Health Administration under title
38, United States Code, and set various conditions and
requirements associated with these appointments.
3. Authorize premium pay for Saturday duty to additional
Veterans Health Administration health care workers with direct
patient-care responsibilities.
4. Allow employees of the Veterans' Canteen Service to be
considered for appointment in VA positions in the competitive
service in the same manner as VA employees in the competitive
service are considered for transfer to a Canteen Service
position.
TITLE IV--OTHER MATTERS
1. Establish within the Veterans Health Administration
(VHA) an Office of Research Oversight to monitor, review and
investigate matters of medical research compliance and
assurance in the Department of Veterans Affairs (VA), including
matters relating to the protection and safety of human subjects
and VA employees participating in VA medical research programs.
Require various reports to the Congress concerned with this new
office.
2. Cover employees of Nonprofit Research Corporations
under the Federal Tort Claims Act.
3. Extend authority to establish Nonprofit Research
Corporations through December 31, 2008.
4. Authorize DOD to purchase medical equipment, services
and supplies through VA's revolving supply fund, and require
DOD to reimburse VA's supply revolving fund for any DOD
purchases using DOD appropriations.
5. Extend VA's authority to provide certain housing
assistance for homeless veterans through December 31, 2008.
6. Change the reporting date requirements on several
reports VA is required to make to Congress.
Effective Date: Date of enactment except the following
sections:
Sec. 301: Shall take effect 180 days after date of
enactment.
Sec. 303: Shall apply with respect to the first pay period
beginning on or after January 1, 2004.
Legislative History:
May 23, 2003: Referred to the Senate Committee on Veterans'
Affairs.
July 29, 2003: Hearing. Senate Committee on Veterans'
Affairs.
September 30, 2003: Senate Committee on Veterans' Affairs
ordered reported favorably with an amendment in the
nature of a substitute.
November 10, 2003: Senate Committee on Veterans' Affairs
reported with an amendment in the nature of a
substitute and an amendment to the title, with
written report number 108-193.
November 19, 2003: Passed the Senate with an amendment and
an amendment to the title by unanimous consent.
(Note: consists of certain provisions from S. 1815,
H.R. 1720, H.R. 2357, H.R. 2433, H.R. 3260, and
H.R. 3387.)
November 21, 2003: Passed the House under suspension by
vote of 423-2 (Roll No. 658).
December 6, 2003: Signed by the President, Public Law 108-
170.
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Public Law 108-183
Veterans Benefits Act of 2003
(H.R. 2297, AS AMENDED)
Title: An Act to amend title 38, United States Code, to
improve benefits under laws administered by the Secretary of
Veterans Affairs, and for other purposes.
H.R. 2297, as amended, will:
TITLE I--SURVIVOR BENEFITS
1. Provide that remarriage of the surviving spouse of a
veteran after attaining age 57 would not result in termination
of dependency and indemnity compensation (DIC), home loan, or
education benefits eligibility.
2. Expand benefits eligibility to those children with
spina bifida who were born to Vietnam-era veterans who served
in an area of Korea near the demilitarized zone between
September 1, 1967 and August 31, 1971.
3. Permit VA to make payment proceeds from National
Service Life Insurance and United States Government Life
Insurance policies to alternate beneficiaries should a primary
beneficiary not be located.
4. Repeal current law restricting a surviving spouse or
dependent children to receiving no more than two years of
accrued benefits if the veteran dies while a claim for VA
periodic monetary benefits is being processed.
TITLE II--BENEFITS FOR FORMER PRISONERS OF WAR AND FILIPINO VETERANS
1. Add cirrhosis of the liver to the list of presumed
service-connected disabilities for former prisoners of war, and
eliminate the requirement that a POW be held for 30 days or
more to qualify for presumptions of service-connection for
certain disabilities: psychosis, any of the anxiety states,
dysthymic disorder, organic residuals of frostbite, and post-
traumatic osteoarthritis.
2. Provide the full amount of compensation and DIC to
eligible members of the new Philippine Scouts, as well as the
full amount of DIC paid by reason of service in the organized
military forces of the Commonwealth of the Philippines,
including organized guerilla units, if the individual to whom
the benefit is payable resides in the United States and is
either a citizen of the U.S. or an alien lawfully admitted for
permanent residence.
3. Extend eligibility for burial in a national cemetery to
new Philippine Scouts, as well as eligibility for VA burial
benefits, to those who lawfully reside in the United States.
4. Extend the authority of the Secretary of Veterans
Affairs to maintain a regional office in Manila, Philippines,
through December 31, 2009.
TITLE III--EDUCATION BENEFITS, EMPLOYMENT PROVISIONS, AND RELATED
MATTERS
1. Expand the Montgomery GI Bill program by authorizing
educational assistance for on-job training in certain self-
employment training programs.
2. Increase monthly educational benefits for spouses and
dependent children of veterans who have permanent and total
disabilities or who have died as a result of service-related
causes to $788 for full-time study, $592 for three-quarter time
study, and $394 for half-time study.
3. Extend the delimiting date for survivors' and
dependents' education benefits when the eligible individual is
involuntarily ordered to full-time National Guard duty under
title 32, United States Code.
4. Round down to the nearest dollar the annual cost-of-
living adjustments to educational assistance benefits.
5. Authorize the use of VA education benefits to pay for
non-degree/non-credit entrepreneurship courses at approved
institutions.
6. Repeal VA's education loan program authorization.
7. Extend the Veterans' Advisory Committee on Education
through December 31, 2009.
8. Furnish federal agencies discretionary authority to
create ``sole-source'' contracts for disabled veteran-owned
small businesses--up to $5 million for manufacturing contract
awards and up to $3 million for non-manufacturing contract
awards.
9. Furnish federal agencies discretionary authority to
restrict certain contracts to disabled veteran-owned small
businesses if at least two such concerns are qualified to bid
on the contract.
10. Mandate that the Department of Labor place staff in
veterans' assistance offices at overseas military installations
90 days after date of enactment.
TITLE IV--HOUSING BENEFITS AND RELATED MATTERS
1. Extend VA's specially adapted housing grant to
severely disabled servicemembers prior to separation from
active duty service.
2. Increase the specially adapted automobile grant from
$9,000 to $11,000, and increase the specially adapted housing
grants from $48,000 to $50,000 for the most severely disabled
veterans and from $9,250 to $10,000 for less severely disabled
veterans.
3. Make permanent the VA home loan program for members of
the Selected Reserve.
4. Reinstate the Department of Veterans Affairs' vendee
loan program.
5. Adjust the funding fee charged to Selected Reserve
home loan applications and make certain increases in home loan
fees.
6. Extend for one year the procedures on liquidation
sales of defaulted home loans guaranteed by the Department of
Veterans Affairs.
TITLE V--BURIAL BENEFITS
1. Permit states to receive burial plot allowances for
burial of all eligible veterans.
2. Allow a remarried surviving spouse to retain
eligibility for burial in a national cemetery based on the
prior marriage to a deceased veteran.
3. Make permanent the State Cemetery Grants Program.
TITLE VI--EXPOSURE TO HAZARDOUS SUBSTANCES
1. Require independent oversight of the Department of
Defense radiation dose reconstruction program.
2. Require an independent study on the disposition of the
Air Force Health Study on ``Operation Ranch Hand'' veterans.
3. Authorize funding of medical follow-up agency of
Institute of Medicine of National Academy of Sciences for
epidemiological research on members of the Armed Forces and
veterans.
TITLE VII--OTHER MATTERS
1. Make clarifying amendments relating to the Veterans'
Claims Assistance Act.
2. Clarify the current prohibition on the assignment of
veterans' benefits.
3. Extend for six years the Advisory Committee on Minority
Veterans.
4. Authorize a nationwide, five-year contract medical
examination pilot program.
5. Expand the list of serious federal criminal offenses a
conviction of which would result in a bar to all VA benefits.
6. Extend for two years the requirement to round down to
the nearest dollar compensation cost-of-living adjustments.
Effective Date: Date of enactment except the following
sections:
Sec. 101: Subsections (a) and (b) shall take effect on
January 1, 2004; no benefit may be paid prior to
that date. Those surviving spouses who remarried
after attaining age 57 but prior to the date of
enactment have one year to apply for reinstatement.
Sec. 103: Subsections (a) and (b) shall take effect on
October 1, 2004.
Sec. 104: Shall apply with respect to deaths occurring on
or after date of enactment.
Sec. 211: Shall apply to benefits paid for months beginning
after date of enactment.
Sec. 212: Shall apply to deaths occurring on or after date
of enactment.
Sec. 301: Shall take effect on the date that is six months
after date of enactment and shall apply to self-
employment on-job training approved and pursued on
or after that date.
Sec. 302: Shall take effect on July 1, 2004, and shall
apply with respect to educational assistance
allowances payable under chapter 35 and section
3687(b)(2) of title 38, United States Code, for
months beginning on or after that date.
Sec. 303: September 11, 2001.
Sec. 305: Shall apply to courses approved by State
approving agencies after date of enactment.
Sec. 306: Subsection (d) shall take effect on date of
enactment. Subsections (e), (f), and (g) shall take
effect 90 days after date of enactment.
Sec. 309: Amendment made by paragraph (1) shall apply with
respect to offices established after date of
enactment. Section 309(b) shall take effect not
later than 90 days after date of enactment.
Sec. 402: Shall apply with respect to assistance furnished
on or after date of enactment.
Sec. 405: January 1, 2004.
Sec. 502: Shall apply with respect to deaths occurring on
or after January 1, 2000.
Sec. 701: Shall take effect as if enacted on November 9,
2000, immediately after the enactment of the
Veterans Claims Assistance Act of 2000 (P.L. 106-
475; 114 Stat. 2096).
Sec. 705: Shall apply to claims filed after date of
enactment.
Legislative History:
June 26, 2003: H.R. 2297 ordered reported amended favorably
by the Committee on Veterans' Affairs.
July 15, 2003: H.R. 2297 reported amended by the Committee
on Veteran's Affairs. H. Rept. 108-211.
October 8, 2003: Passed the House amended under suspension
by vote of 399-0 (Roll No. 536).
October 14, 2003: Referred to the Senate Committee on
Veterans' Affairs.
November 19, 2003: Passed the Senate with an amendment by
unanimous consent. (Note: consists of certain
provisions from H.R. 1257, H.R. 1460, and S. 1132.)
November 20, 2003: House agreed to the Senate amendment
under suspension by voice vote.
December 16, 2003: Signed by the President, Public Law 108-
183.
------
Public Law 108-189
Servicemembers Civil Relief Act
(H.R. 100, AS AMENDED)
H.R. 100, the Servicemembers Civil Relief Act, is a
comprehensive restatement of the Soldiers' and Sailors' Civil
Relief Act of 1940 that would clarify and strengthen the rights
and protections it provides to persons in military service.
The Act's coverage includes servicemembers' financial
obligations and liabilities, such as rent, mortgages,
installment contracts and leases; civil (but not criminal)
legal proceedings; life insurance; taxes; and rights in public
lands.
H.R. 100, as amended, includes:
Clear guidance that a tax jurisdiction may not
use the military compensation of a non-resident servicemember
to increase the tax liability imposed on other income earned by
the non-resident servicemember or spouse subject to tax by the
jurisdiction.
Clear guidance that the 6 percent interest rate
cap for obligations and liabilities of servicemembers incurred
before military service results in a reduction of monthly
payments and that any interest in excess of the cap is
forgiven, consistent with the Act's objective of reducing
monthly obligations for servicemembers, including mobilized
National Guard or Reserve members who may have a reduced
income.
A right for any active duty servicemember who has
permanent change of station orders or who is being deployed for
more than 90 days to terminate a housing lease. Currently, a
servicemember can be obligated to pay rent for housing he or
she is unable to occupy because of a government required move.
Updated eviction protection to reflect the
increase in the cost of rental housing. The current Act only
applies to leases of less than $1,200 per month; H.R. 100 would
increase that amount to $2,400, and the amount would increase
each year in accordance with a housing rental index. It would
also require the Secretary of Defense to publish the rental
amount annually in the Federal Register.
An increase in the coverage level for protection
against the lapse of life insurance policies when an individual
enters military service from $10,000 to $250,000 or the SGLI
maximum, whichever is greater.
Termination of a motor vehicle lease without
penalty when a servicemember is called up or deployed for not
less than 180 days, or ordered to make a permanent change of
station outside of the continental United States.
Coverage of all motor vehicles and other property
by the Act's installment contract protections, so that in the
case of a servicemember who, for example, has fallen behind on
motor vehicle lease payments, the lessor must obtain a court
order before repossessing the motor vehicle.
Clarification that the Act's rights and
protections apply to civil administrative proceedings, such as
license and zoning matters, which are far more common today
than they were in 1940.
Protection of assets of a servicemember from
attachment to satisfy business debts for which the
servicemember is personally liable, as long as the assets
sought to be attached are not held in connection with the
business.
Improved protection of servicemembers against
default judgments.
A minimum 90-day stay of proceedings at any stage
before final judgment in a civil action for a servicemember who
is serving on active duty or is within 90 days after
termination of active duty and who has received notice of such
proceedings, upon proper application.
An expansion of the professional liability
protections to include legal services.
Legislative History:
April 3, 2003: H.R. 100 ordered reported favorably with an
amendment in the nature of a substitute by the
Committee on Veterans' Affairs by voice vote.
April 30, 2003: H.R. 100 reported amended by the Committee
on Veterans' Affairs. H. Rept.108-81.
May 7, 2003: Passed the House amended under suspension by
vote of 425-0 (Roll No. 163).
May 8, 2003: Referred to the Senate Committee on Veterans'
Affairs.
November 21, 2003: Senate Committee on Veterans' Affairs
discharged by unanimous consent.
November 21, 2003: Senate struck all after the enacting
clause and substituted the language of S. 1136
amended.
November 21, 2003: Passed the Senate with an amendment by
unanimous consent.
December 8, 2003: House agreed to the Senate amendment by
unanimous consent.
December 19, 2003: Signed by the President, Public Law 108-
189.
------
Public Law 108-363
Veterans' Compensation Cost-of-Living Adjustment Act of 2004
(H.R. 4175, AS AMENDED)
Title: An Act to increase, effective as of December 1,
2004, the rates of disability compensation for veterans with
service-connected disabilities and the rates of dependency and
indemnity compensation for survivors of certain service-
connected disabled veterans, and for other purposes.
H.R. 4175, as amended, will:
1. Provide effective December 1, 2004, a cost-of-living
adjustment to the rates of disability compensation for veterans
with service-connected disabilities and to the rates of
dependency and indemnity compensation for survivors of certain
service-connected disabled veterans. The percentage amount
would be equal to the increase for benefits provided under the
Social Security Act, which is calculated based upon changes in
the Consumer Price Index.
Effective Date: Date of enactment
Legislative History:
May 19, 2004: H.R. 4175 ordered reported favorably amended by
the Committee on Veterans' Affairs.
June 3, 2004: H.R. 4175 reported amended by the Committee on
Veterans' Affairs. H. Rept. 108-524.
July 20, 2004: Considered under suspension of the rules. At the
conclusion of debate, the Yeas and Nays were
demanded and ordered. Pursuant to the provisions of
clause 8, rule XX, the Chair announced that further
proceedings on the motion would be postponed.
July 22, 2004: Considered as unfinished business. On motion to
suspend the rules and pass the bill, as amended,
agreed to by the Yeas and Nays: 421-0 (Roll No.
408).
September 7, 2004: Referred to the Senate Committee on
Veterans' Affairs.
October 5, 2004: Senate Committee on Veterans' Affairs
discharged by unanimous consent.
October 5, 2004: Senate struck all after the enacting clause
and substituted the language of S. 2483.
October 5, 2004: Passed the Senate in lieu of S. 2483 with an
amendment by unanimous consent. (Please note:
Sections 4 and 5 of H.R. 4175 were dropped when
passed by the Senate with an amendment.)
October 8, 2004: House agreed to the Senate amendment under
unanimous consent.
October 25, 2004: Signed by the President, Public Law 108-363.
------
Public Law 108-422
Veterans Health Programs Improvement Act of 2004
(H.R. 3936, AS AMENDED)
Title: An Act to amend title 38, United States Code, to
increase the authorization of appropriations for grants to
benefit homeless veterans, to improve programs for management
and administration of veterans' facilities and health care
programs, and for other purposes.
H.R. 3936, as amended, will:
TITLE I--ASSISTANCE TO HOMELESS VETERANS
1. Increase the authorization for the grant and per diem
program for homeless veterans from $75 million to $99 million
for fiscal year 2005.
TITLE II--VETERANS LONG-TERM CARE PROGRAMS
1. Direct the Secretary to make payments to States to
assist them in hiring and retaining nurses in State veterans'
homes; makes a State home eligible for such payments if it has
an employee incentive program and is receiving per diem
payments from VA; limit the amount of payment a State home may
receive each year; require a State home receiving such payment
to provide an annual report to VA; and require VA to implement
the assistance program so that eligible States would begin to
receive payments no later than June 1, 2005.
2. Clarify that per diem payments made by VA for the care
of veterans in State veterans homes shall not be used to offset
or reduce other payments made to assist veterans.
3. Extend until December 31, 2005, VA's authority to
provide care to veterans participating in certain long-term
care demonstration projects previously authorized in the
Veterans Millennium Health Care and Benefits Act.
4. Eliminate copayments for hospice care furnished by VA.
TITLE III--MEDICAL CARE
1. Make permanent the authority of the Secretary to
provide sexual trauma counseling to veterans.
2. Establish centers for research, education and clinical
activities that specialize in treating complex multi-trauma
associated with combat injuries.
3. Reduce the amount authorized to establish four
National Medical Emergency Preparedness Centers from $20
million to $10 million per year.
TITLE IV--MEDICAL FACILITIES MANAGEMENT AND ADMINISTRATION
Subtitle A--Major Medical Facility Leases
1. Authorize leases (all requested by the Department of
Veterans Affairs (VA)) to be paid from the medical care account
for outpatient clinics or other health care facilities which VA
currently operates or plans to operate in: Wilmington, North
Carolina, in the amount of $1,320,000; Greenville, North
Carolina, in the amount of $1,220,000; Norfolk, Virginia, in
the amount of $1,250,000; Summerfield, Florida, in the amount
of $1,230,000; Knoxville, Tennessee, in the amount of $850,000;
Toledo, Ohio, in the amount of $1,200,000; Crown Point,
Indiana, in the amount of $850,000; Fort Worth, Texas, in the
amount of $3,900,000; Plano, Texas, in the amount of
$3,300,000; San Antonio, Texas, in the amount of $1,400,000;
Corpus Christi, Texas, in the amount of $1,200,000; Harlingen,
Texas, in the amount of $650,000; Denver, Colorado, in the
amount of $1,950,000; Oakland, California, in the amount of
$1,700,000; San Diego, California (two sites), in the amounts
of $1,300,000 and $1,100,000, respectively.
2. Authorize appropriations of $24,420,000 for the leases
in the preceding paragraph.
3. Authorize VA to enter into a long-term lease of up to
75 years for land to construct a new medical facility on the
Fitzsimons Campus of the University of Colorado, in Aurora,
Colorado.
Subtitle B--Facilities Management
4. Provide the Secretary with additional authority to
transfer unneeded VA real property and retain the proceeds from
the transfer.
5. Require VA to receive fair market value for any
transfer of real property, except when transferred to providers
of homeless veterans' services receiving grants under section
2011 of title 38, United States Code.
6. Establish a new ``Capital Asset Fund'' for deposit of
proceeds from transfers of real property to be used to defray
VA's cost of such transfers, including demolition,
environmental remediation, maintenance, repair, establishment
of new and improved facilities, historic preservation and
administrative expenses.
7. Authorize an appropriation of $10,000,000 for the
Capital Asset Fund.
8. Terminate the Nursing Home Revolving Fund and transfer
unobligated balances from the fund to the Capital Asset Fund
subsequent to the Secretary's certification that VA facilities
maintain long-term care capacity as required by law.
9. Require an inventory and two subsequent annual reports
to Congress on the status of, and plans for, VA properties
listed on the National Register of Historic Properties.
10. Authorize VA to acquire and transfer certain real
property in the District of Columbia for use for homeless
veterans.
11. Require VA to notify Congress of the impact of actions
proposed for health facilities specified in this Act that may
result in a facility closure, consolidation, or administrative
reorganization, and prohibit such actions from occurring until
60 days following the notification or 30 days of continuous
session of Congress as specified.
12. Authorize the use of project funds to construct or
relocate surface parking incidental to an authorized major
medical facility construction project.
13. Provide the Secretary flexibility in using funds to
develop advance planning for major construction projects
previously authorized by law.
14. Exempt VA from state and local land use laws under the
enhanced-use lease authority.
15. Allow the Commonwealth of Kentucky the first option on
the further use of the VA Medical Center in Louisville,
Kentucky for a State veterans' home upon any proposed VA
disposal of the medical center.
16. Transfer to VA certain property in Boise, Idaho,
currently administered by the General Services Administration,
for the provision of veterans' benefits.
Subtitle C--Designation of Facilities
17. Authorize VA to name the VA Medical Center in
Amarillo, Texas, the Thomas E. Creek Department of Veterans
Affairs Medical Center.
18. Authorize VA to name the VA Medical Center in the
Bronx, New York, the James J. Peters Department of Veterans
Affairs Medical Center.
19. Authorize VA to name the outpatient clinic in Peoria,
Illinois, the Bob Michel Department of Veterans Affairs
Outpatient Clinic.
20. Authorize VA to name the outpatient clinic in Lufkin,
Texas, the Charles Wilson Department of Veterans Affairs
Outpatient Clinic.
21. Authorize VA to name the outpatient clinic in
Sunnyside, Queens, New York, the Thomas P. Noonan, Jr.
Department of Veterans Affairs Outpatient Clinic.
TITLE V--PERSONNEL ADMINISTRATION
1. Establish a pilot program within the Department of
Veterans Affairs (VA) to study the use of outside recruitment,
advertising and communications agencies and interactive and
online technologies, to improve VA's program for recruiting
nursing personnel.
2. Add blind rehabilitation personnel to the category of
positions VA is permitted to hire through use of a hybrid
appointment authority.
3. Repeal the requirement for VA's Under Secretary for
Health to be a medical doctor.
TITLE VI--OTHER MATTERS
1. Extend and codify VA's authority to recover
overpayments made for fee and contract health care services for
veterans.
2. Require VA to establish an inventory of medical waste
management activities at VA health care facilities and submit a
report to Congress by June 30, 2005, concerning such
activities.
3. Clarify that veterans enrolled in VA health care are
eligible to use the Veterans' Canteen Service (VCS).
4. Require VA to submit annual reports through 2007 to
Congress on veterans' waiting times for VA specialty care
appointments.
Effective Date: Date of enactment
Legislative History:
May 19, 2004: H.R. 3936 ordered reported favorably by the
Committee on Veterans' Affairs.
June 25, 2004: H.R. 3936 reported by the Committee on
Veterans' Affairs. H. Rept. 108-574, Part I.
June 25, 2004: Committee on Armed Services discharged.
July 20, 2004: Passed the House under suspension by voice
vote.
July 21, 2004: Received in the Senate.
September 7, 2004: Referred to the Senate Committee on
Veterans' Affairs
October 9, 2004: Senate Committee on Veterans' Affairs
discharged by unanimous consent.
October 9, 2004: Senate struck all after the enacting
clause and substituted the language of S. 2485, as
amended.
October 9, 2004: Passed the Senate in lieu of S. 2485 with
an amendment and an amendment to the title by
unanimous consent. (Note: consists of certain
provisions from H.R. 1318, H.R. 2786, H.R. 4231,
H.R. 4248, H.R. 4317, H.R. 4608, H.R. 4658, H.R.
4768, H.R. 4836, S. 2485 and S. 2596.)
November 17, 2004: House agreed to the Senate amendments
under suspension by voice vote.
November 30, 2004: Signed by the President, Public Law 108-
422.
------
Public Law 108-445
Department of Veterans Affairs Health Care Personnel Enhancement Act of
2004
(S. 2484, AS AMENDED)
Title: An Act to amend title 38, United States Code, to
simplify and improve pay provisions for physicians and dentists
and to authorize alternate work schedules and executive pay for
nurses, and for other purposes.
S. 2484, as amended, will:
1. Establish a reformed compensation system for physicians
and dentists appointed in the Veterans Health Administration
(VHA) of the Department of Veterans Affairs (VA). The
compensation system would require VA to determine the rate of
pay for a physician or dentist on the basis of three elements
as follows: (1) a 15-step Physician and Dentist Base and
Longevity Pay Schedule established in law; (2) a market pay
band for clinical specialties and subspecialties set by the
Secretary of Veterans Affairs; and (3) an incentive bonus not
to exceed the lower of $15,000 or 7.5 percent of the combined
base and market pay of a physician or dentist who meets
established performance goals set by the Department.
2. Require the Under Secretary for Health to be
compensated at the annual rate of base pay for positions at
Level III of the Executive Schedule, and permit the Under
Secretary who is also a physician or dentist to be paid the
market pay element of the reformed compensation system.
3. Require the Secretary to submit a series of reports to
Congress on the effectiveness of the reformed compensation
system and include an assessment of its impact on recruitment
and retention.
4. Establish the effective date of the reformed
compensation system to be the first day of the first pay period
that begins on or after January 1, 2006.
5. Provide a transition pay authority for physicians and
dentists appointed before the effective date of the revised
compensation system and guarantee that current physician pay
rates would be held harmless.
6. Authorize VA to offer two additional options for
alternative tours of duty for nurses working in VA health care
facilities as follows: (1) three 12-hour tours of duty in a
week would be paid as 40 hours; and (2) nine months of work
with three months off in a year that would be paid over a 12-
month period.
7. Authorize VA to provide nurse executives employed in VA
health care facilities and VA's Central Office special pay
allowances of not less than $10,000 or more than $25,000.
Effective Date: Date of enactment except the following
section:
Sec. 3: Shall apply on the first day of the first pay
period that begins on or after January 1, 2006.
Legislative History:
June 1, 2004: Referred to the Senate Committee on Veterans'
Affairs.
June 22, 2004: Hearing. Senate Committee on Veterans'
Affairs.
July 20, 2004: Senate Committee on Veterans' Affairs
ordered reported favorably with amendments.
September 23, 2004: Senate Committee on Veterans' Affairs
reported with an amendment in the nature of a
substitute and an amendment to the title, with
written report number 108-357.
October 5, 2004: Passed the Senate with an amendment and an
amendment to the Title by unanimous consent. (Note:
consists of similar provision from H.R. 4231.)
October 6, 2004: Received in the House.
October 6, 2004: Message on Senate action sent to the
House.
October 6, 2004: Held at the desk.
November 17, 2004: House agreed to the Senate amendments
under suspension by voice vote.
December 3, 2004: Signed by the President, Public Law 108-
445.
------
Public Law 108-454
Veterans Benefits Improvement Act of 2004
(S. 2486, AS AMENDED)
Title: An Act to amend title 38, United States Code, to
improve and enhance education, housing, employment, medical,
and other benefits for veterans and to improve and extend
certain authorities relating to the administration or benefits
for veterans, and for other purposes.
S. 2486, as amended, will:
TITLE I--VETERANS EARN AND LEARN ACT
1. Modify VA on-job training and apprenticeship benefit
entitlement rates under the Vietnam-era and survivors' and
dependents' programs to be consistent with the entitlement
rates for the Montgomery GI Bill-Active Duty and Selected
Reserve programs and the Post-Vietnam Era Veterans' Educational
Assistance Program. The modification would charge benefits
entitlement usage based on ``dollars used'' rather than ``time
spent'' in training, to help the trainee conserve entitlement.
This provision would take effect as of October 1, 2005.
2. Increase by 10 percent the percentage of the full-time
VA monthly educational assistance allowance payable to
individuals pursuing a full-time apprenticeship or on-job
training program. For the first six months of training, the
percentage of the monthly benefit would increase from 75
percent to 85 percent; for the second six months of training,
from 55 percent to 65 percent; and for subsequent months, from
35 percent to 45 percent. These percentage increases would
apply to the Montgomery GI Bill Active Duty and Selected
Reserve programs, the Post-Vietnam Era Veterans' Educational
Assistance program, and the Survivors' and Dependents'
Educational Assistance program. This provision would take
effect from October 1, 2005 through December 31, 2007.
3. Authorize VA to pay benefits for competency-based
apprenticeships, in addition to time-based apprenticeships, and
require State approving agencies to consider the recommendation
of the Secretary of Labor regarding the approximate term and
standards for such registered apprenticeship programs.
Competency-based apprenticeships are completed upon
demonstration of mastery of job skills rather than a set time
period.
4. Extend eligibility for Survivors' and Dependents'
Educational Assistance from 10 years to 20 years for a
surviving spouse of any person who died on active duty.
5. Authorize VA to provide educational assistance
benefits to reimburse eligible beneficiaries for the cost of
certain national tests required for admission to institutions
of higher learning or graduate schools, and for national tests
that can qualify veterans for receipt of college credit.
6. Require coordination of information among the
Departments of Veterans Affairs, Defense, and Labor with
respect to on-job training or registered apprenticeships
pursued by servicemembers while serving in the military and
their receipt of appropriate credit for such training in
civilian training programs.
7. Provide the Secretary of Veterans Affairs the
discretion to establish a pilot program that furnishes on-job
training benefits under VA educational assistance programs to
claims adjudicators training in its disability compensation,
dependency and indemnity compensation, and pension programs.
8. Permit the Secretary of Defense (or, in cases
involving the activation of Coast Guard personnel, the
Secretary of Homeland Security) to collect an activated
Selected Reserve member's $1,200 payment for use of Active Duty
Montgomery GI Bill educational assistance benefits under
Chapter 30 of title 38, United States Code, not later than 1
year after completion of 2 consecutive years of active duty.
TITLE II--EMPLOYMENT MATTERS
Subtitle A--Employment and Reemployment Rights
1. Increase from 18 months to 24 months the maximum
period of employer-sponsored health coverage that an employee
covered by USERRA may elect to continue, beginning with the
date the absence from the position of employment begins; and
providing that the effective date of the increased coverage
would be the date of enactment.
2. Reinstate the requirement for comprehensive annual
reports from the Secretary of Labor to Congress on the
disposition of cases filed under USERRA; such reports would
begin no later than February 1, 2005.
3. Require employers to provide notice to employees of
the rights, benefits and obligations of employers and employees
that apply under USERRA, and require the Department of Labor to
make available to employers the text of the notice to be
provided within 90 days after date of enactment.
4. Establish a demonstration project for the referral of
federal employee complaints under USERRA to the Office of
Special Counsel for investigation and resolution, and require
the Secretary of Labor and the Office of Special Counsel to
carry out the demonstration project. The Comptroller General is
required to evaluate and report on the project.
Subtitle B--Other Matters
5. Direct the Secretary of Veterans Affairs to contract
for a report on placement, retention, and advancement of
recently separated servicemembers in private sector employment
for the purpose of determining ways to improve their employment
opportunities.
TITLE III--BENEFITS MATTERS
1. Provide an additional $250 in dependency and indemnity
compensation (DIC) paid monthly to the surviving spouse with
one or more children below the age of 18. The additional
benefit would be paid for months occurring during the 2-year
period beginning on the date on which entitlement for DIC
commenced.
2. Permit a radiation-exposed veteran who received
payment under the Radiation Exposure Compensation Act (RECA),
administered by the Department of Justice, to be eligible for
VA compensation. A survivor who received a payment under RECA
would be entitled to dependency and indemnity compensation
(DIC). VA compensation and DIC would be reduced by any amounts
received under RECA.
3. Exclude life insurance proceeds paid upon the death of
a veteran from consideration as income for death pension
benefits.
4. Provide specially adapted automobile and adaptive
equipment benefits to veterans who are injured in a VA hospital
due to negligence, carelessness, or similar reasons, and to
veterans who are injured because of VA-sponsored rehabilitation
or training, and specify that such veterans are eligible for
specially adapted housing grants.
5. Make an award of death pension effective the first day
of the month in which the death occurred if the claim is
received within one year from the date of the veteran's death.
6. Codify VA regulations establishing cancer of the bone,
brain, colon, lung and ovary as diseases for which a
presumption of service connection is made for a veteran exposed
to ionizing radiation. In addition, specify that the definition
of ``radiation-risk activity'' includes service in a capacity
that, if performed as an employee of the Department of Energy,
would qualify the individual for the Energy Employees
Occupational Illness Compensation Program Act of 2000, as
amended (42 U.S.C. '7384 et. seq.).
7. Codify the current dollar amounts of disability
compensation and dependency and indemnity compensation provided
for in Public Law 108-147.
TITLE IV--HOUSING MATTERS
1. Extend eligibility for specially adapted housing
grants to veterans with permanent and total service-connected
disabilities due to the loss, or loss of use, of both arms at
or above the elbows.
2. Allow volunteers to provide services in connection
with the construction, alteration, or repair of multi-family
transitional housing. Permit commercial activities other than
neighborhood retail services and job training programs to be
performed by a multi-family transitional housing project.
3. Increase the maximum VA home loan guaranty to 25
percent of the Freddie Mac conforming loan amount for a single
family residence and annually index the maximum amount of VA's
home loan guaranty for construction or purchase of a home to
the Freddie Mac limit. In 2004, the increase is expected to
raise from $240,000 to $333,700 the maximum amount for a home
loan guaranteed by VA.
4. Reinstate the program of VA-guarantees for adjustable
rate mortgages (ARMs) through fiscal year 2008. The program
expired at the end of fiscal year 1995.
5. Extend the authority of VA to guaranty hybrid
adjustable rate mortgage loans through fiscal year 2008, and
make additional improvements to the program. This program is
set to expire at the end of fiscal year 2005. A hybrid ARM
offers lower interest rates (like most adjustable rate loans)
after a fixed payment for a longer period of time than most
traditional ARMs.
6. Terminate the collection of home loan fees from
veterans rated eligible for compensation at pre-discharge
rating examinations.
7. Extend the Native American Home Loan program through
December 31, 2008.
TITLE V--MATTERS RELATING TO FIDUCIARIES
1. Define a fiduciary as a guardian, curator,
conservator, committee or person legally vested with the
responsibility or care of a claimant (or the estate) or of a
beneficiary (or the beneficiary's estate), or any other person
appointed in a representative capacity to receive money paid by
VA.
2. Require VA to conduct an inquiry or investigation as
to the fitness of a fiduciary, prior to certification. Such
inquiry or investigation would include, to the extent
practicable, a face-to-face interview, a copy of a credit
report within one year of appointment, in addition to the
furnishing of any bond that may be required by the Secretary.
3. Require the Secretary, as a part of the inquiry or
investigation, to request information about whether the
potential fiduciary has been convicted of any offense under
Federal or State law.
4. Permit a less rigorous inquiry or investigation of the
parent of a minor beneficiary; spouse or parent of an
incompetent beneficiary; person appointed by a court of
competent jurisdiction; or appointed to manage an estate where
the annual amount of veterans' benefits to be managed does not
exceed $3,600.
5. Give the Secretary the authority to appoint a
temporary fiduciary for a period not to exceed 120 days, if
needed to protect the assets of the beneficiary when a
determination of incompetence is being made or appealed, or a
fiduciary is appealing a determination of misuse.
6. Prohibit the Secretary from continuing the temporary
fiduciary beyond 120 days if a final decision has not been made
on the competence of the beneficiary or fiduciary, unless the
Secretary has obtained a court order for a guardian,
conservator or similar legal fiduciary.
7. Prohibit a fiduciary from collecting a fee from the
beneficiary for any month when the Secretary or a court has
determined the fiduciary has misused some or all of the
veterans' benefits.
8. Require the Secretary to repay misused benefits if the
misuse is due to the Secretary's failure to investigate or
monitor a fiduciary; when the fiduciary is not an individual;
or is an individual who, for any month during a period when
misuse occurs, serves 10 or more individuals who are
beneficiaries.
9. Require the Secretary to conduct periodic on-site
reviews of any person or agency located in the United States
that serves as a fiduciary to more than 20 beneficiaries and
the total annual amount of benefits exceeds $50,000.
10. Authorize the Secretary to require a fiduciary to
personally appear at a VA regional office to receive payments.
11. Authorize federal courts to issue judicial orders of
restitution when sentencing a fiduciary who is a defendant in a
criminal matter arising from the misuse of benefits.
12. Require the Secretary to include in annual reports
information on the fiduciary program including the number of
beneficiaries, the types of benefits being paid, the number of
cases in which the fiduciary was changed by the Secretary
because of a finding that benefits had been misused, and other
information concerning actions taken in cases of misuse.
TITLE IV--MEMORIAL AFFAIRS MATTERS
1. Designate a memorial currently under construction at
the Riverside National Cemetery in Riverside, California, as:
Prisoner of War/Missing in Action National Memorial.
2. Authorize the Secretary of Veterans Affairs to lease
any undeveloped land and unused or underutilized buildings
belonging to the United States and part of the National
Cemetery Administration (NCA). The term of any lease would be
limited to 10 years. Proceeds from the lease of land or
buildings and proceeds from agricultural licenses of NCA lands
would be deposited in a National Cemetery Administration
Facilities Operation Fund. Fund proceeds would be available to
cover costs incurred by NCA in the operation and maintenance of
national cemeteries.
3. Expand the authority of the Secretary of Veterans
Affairs to acquire additional lands for national cemeteries by
exchanges of existing land.
TITLE VII--IMPROVEMENTS TO SERVICEMEMBERS CIVIL RELIEF ACT (SCRA)
1. Add to the definitions in the general provisions of
SCRA that the term ``judgment'' would mean ``any judgment,
decree, order or ruling, final or temporary.''
2. Clarify that waivers by servicemembers of rights and
protections under SCRA must be in writing and must be executed
in a separate instrument; and require that certain written
waivers must be in at least 12-point type.
3. Provide that plaintiffs as well as defendants may
under SCRA request stays of civil proceedings.
4. Clarify that dependents as well as servicemembers are
covered by SCRA's residential and motor vehicle lease
termination provisions on joint leases.
5. Provide that SCRA's lease termination provisions also
apply when the servicemember residing in a State outside the
continental United States receives permanent change of station
orders to any location outside that State, for example, from
Hawaii or Alaska to the 48 contiguous States or a foreign
country.
6. Define for the purposes of SCRA's lease termination
provisions that the term ``military orders'' would mean with
respect to a servicemember, ``official military orders, or any
notification, certification, or verification from the
servicemember's commanding officer, with respect to the
servicemember's current or future military duty status.''
7. Define for the purposes of SCRA's lease termination
provisions that the term ``continental United States'' would
mean ``the 48 contiguous States and the District of Columbia.''
8. Clarify that SCRA's lease termination provisions also
cover individual deployments, as well as military unit
deployments.
TITLE VIII--OTHER MATTERS
1. Authorize the principal office of the United States
Court of Appeals for Veterans Claims to be located at any
location in the Washington, D.C., metropolitan area, rather
than only in the District of Columbia.
2. Extend the requirement for the Advisory Committee on
Former Prisoners of War to report to the Secretary of Veterans
Affairs through 2009.
3. Provide a veteran separated from the Armed Forces
under honorable conditions after 3 years or more of active
service with administrative and judicial redress for alleged
violations of his or her rights under section 3304(f)(1) of
title 5, United States Code, which grants veterans preference
to compete for vacant positions in the Federal government.
4. Direct the Secretary of Veterans Affairs to submit a
report to Congress, not later than 1 year after date of
enactment of this Act, detailing the Department's outreach
efforts to make veterans and servicemembers aware of VA
benefits and services to which they may be entitled.
Effective Date: Date of enactment except the following
sections:
Sec. 102: Shall apply with respect to months beginning
after September 30, 2005.
Sec. 103: Shall apply with respect to months beginning on
or after October 1, 2005, and before January 1,
2008.
Sec. 202: The Secretary of Labor shall submit a report no
later than February 1, 2005, and annually
thereafter.
Sec. 203: Not later than the date that is 90 days after the
date of enactment, the Secretary of Labor shall
make available to employers the notice required
under section 4334 of title 38, United States Code.
Sec. 204: The demonstration project shall be carried out
during the period beginning on the date that is 60
days after the date of enactment and ending on
September 30, 2007.
Sec. 211: Not later than 180 days after the date of
enactment, the Secretary of Veterans Affairs shall
enter into a contract.
Sec. 301: Shall take effect with respect to payments for
the first month beginning after the date of the
enactment of this Act.
Sec. 302: Paragraph (4) of section 1112(c) of title 38,
United States Code, as added by subsection (a),
shall take effect with respect to compensation
payments for months beginning after March 26, 2002.
Subsection (c) of 1310 of such title, as added by
subsection (b), shall take effect with respect to
dependency and indemnity compensation payments for
months beginning after March 26, 2002.
Sec. 306: Shall take effect as of March 26, 2002.
Sec. 405: Shall not be construed to affect the force or
validity of any guarantee of hybrid adjustable rate
mortgages under section 3707A of title 38, USC, as
in effect on the day before the date of the
enactment of this Act.
Sec. 507(a): Except as otherwise provided, this title and
the amendments made by this title shall take effect
on the first day of the seventh month beginning
after the date of enactment.
Sec. 802: December 27, 2001.
Sec. 805: Not later than one year after the date of
enactment of this Act, the Secretary of Veterans
Affairs shall submit the report to Congress.
Legislative History
June 1, 2004: Referred to the Senate Committee on Veterans'
Affairs.
June 6, 2004: Senate Committee on Veterans' Affairs
hearing.
July 20, 2004: Senate Committee on Veterans' Affairs
ordered reported favorably with amendments.
September 20, 2004: Senate Committee on Veterans' Affairs
reported with an amendment in the nature of a
substitute and an amendment to the Title, with
written report number 108-352.
October 8, 2004: Passed the Senate with an amendment and an
amendment to the Title by unanimous consent. (Note:
consists of certain provisions from S. 1132, S.
2485, H.R. 1716, H.R. 3936, H.R. 4175, H.R. 4345
and H.R. 4658.)
October 9, 2004: Referred to the House Committee on
Veterans' Affairs.
November 17, 2004: House agreed to the Senate amendments
under suspension by voice vote.
December 10, 2004: Signed by the President, Public Law 108-
454.
ACTIVITIES OF THE COMMITTEE
LEGISLATIVE ACTIVITIES
First Session
Business Meeting to Approve the Committee's Views and Estimates
on the Administration's Proposed Budget for the Department of
Veterans Affairs for Fiscal Year 2004
On February 27, 2003, the Committee met to consider a
report to the Committee on the Budget from the Committee on
Veterans' Affairs on the Administration's proposed budget for
VA for fiscal year 2004.
The Committee voted 20-1 to send the report as proposed to
the Committee on the Budget. The Committee report recommended
$64 billion in budget authority for fiscal year 2004. The
Committee recommended $30.7 billion in discretionary
appropriations. (See Report on the Budget Proposal for Fiscal
Year 2004, p. 99)
Full Committee Markup of H.R. 100 and H.R. 1297
On April 3, 2003, the Committee met and marked up two
bills: H.R. 100 (see House Report 108-81), and H.R. 1297 (see
House Report 108-62). H.R. 100 was ordered reported, as
amended, favorably to the House. H.R. 1297 was also ordered
reported favorably to the House.
On May 7, 2003, the House passed H.R. 100 by a vote of 425-
0 (Roll No. 163).
On December 8, 2003, the House agreed to the Senate
amendment to H.R. 100 by unanimous consent.
On December 19, 2003, H.R. 100 was enacted as Public Law
108-189, the Servicemembers Civil Relief Act (see summary, p.
18).
H.R. 1297 was incorporated as Title III of S. 762, the
Fiscal Year 2003 Supplemental Appropriations Act, as passed by
the Senate on April 7, 2003.
On April 16, 2003, H.R. 1559 was enacted as Public Law 108-
11, the Emergency Wartime Supplemental Appropriations Act,
2003.
Markup of H.R. 1460, H.R. 1683, H.R. 1257, H.R. 1562, H.R. 1715
and H.R. 1911
On May 15, 2003, the Committee met and marked up six bills:
H.R. 1460, as amended, (see House Report 108-142); H.R. 1683
(see House Report 108-108); H.R. 1257, (see House Report 108-
107); H.R. 1562, as amended, that included H.R. 1832 and H.R.
1908 (see House Report 108-114); H.R. 1715; and H.R. 1911 (see
House Report 108-115, Part I). H.R. 1911 was also referred to
the House Committee on Armed Services. H.R. 1460, as amended,
H.R. 1683, H.R. 1257, H.R. 1562, as amended, H.R. 1715 and H.R.
1911 were ordered reported favorably to the House.
On May 21, 2003, the House passed H.R. 1911 by a vote of
426-0 (Roll No. 204).
On November 7, 2003, the House agreed to the Conference
Report to H.R. 1588, as amended, the National Defense
Authorization Act for fiscal year 2004, which included text
identical to H.R. 1911, by a vote of 362-40, 2 Present (Roll
No. 617); (see Conference Report 108-354).
On November 24, 2003, H.R. 1588, as amended, became Public
Law 108-136, the National Defense Authorization Act for Fiscal
Year 2004.
On December 16, 2003, H.R. 2297, as amended, became Public
Law 108-183, the Veterans Benefits Act of 2003 (see summary, p.
14).
Markup of H.R. 1516, H.R. 2297, H.R. 116, H.R. 1720, H.R. 2433,
H.R. 2595 and H. Con. Res. 159
On June 26, 2003, the Committee met and marked up seven
bills: H.R. 1516, as amended, (see House Report 108-199); H.R.
2297, (see House Report 108-210); H.R. 116, as amended, (see
House Report 108-200); H.R. 1720, as amended, (see House Report
108-210); H.R. 2357, as amended, (see House Report 108-198);
H.R. 2433, as amended, (see House Report 108-213); H.R. 2595,
(see House Report 108-197); and H. Con. Res. 159, (see House
Report 108-196). H.R. 1516, as amended, H.R. 2297, as amended,
H.R. 116, as amended, H.R. 1720, as amended, H.R. 2357, as
amended, H.R. 2433, as amended, H.R. 2595 and H. Con. Res. 159
were ordered reported favorably to the House.
On July 21, 2003, the House passed H.R. 2357, as amended,
by voice vote.
On September 10, 2003, the House passed H.R. 2433, as
amended, by voice vote.
On September 30, 2003, the House agreed to H. Con. Res. 159
by voice vote.
On October 29, 2003, the House passed H.R. 1720, as
amended, (included provisions of H.R. 116, as amended,) by a
vote of 417-0 (Roll No. 339).
On November 21, 2003, the House passed S. 1156 (included
provisions from H.R. 116, H.R. 1720, and H.R. 2433) by a vote
of 423-2 (Roll No. 658).
On December 6, 2003, S. 1156, as amended, became Public Law
108-170, the Veterans Health Care, Capital Asset, and Business
Improvement Act of 2003 (see summary p. 10).
Second Session
Markup of H.R. 4231, H.R. 4248, H.R. 3936, H.R. 4345, H.R. 1716
and H.R. 4175
On May 19, 2004, the Committee met and marked up six bills:
H.R. 4231, as amended, (see House Report 108-538); H.R. 4248,
as amended, (see House Report 108-534); H.R. 3936, (see House
Report 108-574); H.R. 4345; H.R. 1716, as amended, (see House
Report 108-572); and H.R. 4175, as amended, (see House Report
108-524). H.R. 4231, as amended, H.R. 4248, as amended, H.R.
3936, H.R. 4345, H.R. 1716, as amended and H.R. 4175, as
amended, were ordered reported favorably to the House.
On September 30, 2004, the House passed H.R. 4231, as
amended, by a vote of 411-1 (Roll No.483).
On October 7, 2004, the House passed H.R. 4248, as amended,
by voice vote.
On October 8, the House agreed to the Senate amendment to
H.R. 4175.
On October 25, 2004, H.R. 4175, as amended, was enacted as
Public Law 108-363, the Veterans' Compensation Cost-of-Living
Adjustment Act of 2004 (see summary, p. 20).
On November 17, 2004, the House agreed to the Senate
amendments to H.R. 3936 (included H.R. 4248 and provisions of
H.R. 4231), by voice vote.
On November 30, 2004, H.R. 3936, as amended, became Public
Law 108-422, Veterans Health Programs Improvement Act of 2004
(see summary p. 21).
Markup of H.R. 4768, H.R. 4658, H.R. 1318 and H.R. 4836
On July 21, 2004, the Committee met and marked up four
bills: H.R. 4768, as amended, (see House Report 108-663); H.R.
4658, as amended, (see House Report 108-683); H.R. 1318; and
H.R. 4836. H.R. 4768, as amended, H.R. 4658, as amended, H.R.
1318 and H.R. 4836 were ordered reported favorably to the
House.
On September 13, 2004, the House passed H.R. 1318 and H.R.
4836 by voice vote.
On September 29, 2004, the House passed H.R. 4768, as
amended, by voice vote.
On October 7, 2004, the House passed H.R. 4658, as amended,
by voice vote.
On November 17, 2004, the House agreed to the Senate
amendments to H.R. 3936 (included H.R. 4768) by voice vote.
On November 30, 2004, H.R. 3936, as amended, became Public
Law 108-422, the Veterans Health Programs Improvement Act of
2004 (see summary p. 21).
Hearing on Protecting the Rights of Those Who Protect Us:
Public Sector Compliance with the Uniformed Services Employment
and Reemployment Rights Act and Improvements to the
Servicemembers Civil Relief Act
On June 23, 2004, the Committee held a hearing on H.R.
4477, the Patriotic Employer Act of 2004, introduced by
Honorable James P. McGovern of Massachusetts, Honorable Jeb
Bradley of New Hampshire and Honorable Lane Evans of Illinois
on June 2, 2004; H.R. 3779, the Safeguarding Schoolchildren of
Deployed Soldiers Act of 2004, introduced by Honorable Louise
McIntosh Slaughter of New York and Honorable Ginny Brown-Waite
of Florida on February 4, 2004; a draft bill, the USERRA Health
Care Coverage Extension Act of 2004, subsequently introduced as
H.R. 4659 by Honorable Henry E. Brown Jr. of South Carolina,
Honorable Michael H. Michaud of Maine and Honorable Christopher
H. Smith of New Jersey on June 23, 2004; a draft bill, the
Servicemembers and Veterans Legal Protections Act of 2004,
subsequently introduced as H.R. 4658, by Honorable Christopher
H. Smith of New Jersey and Honorable Lane Evans of Illinois on
June 23, 2004. H.R. 4477, H.R. 4659, and H.R. 4658 were
subsequently incorporated into H.R. 1716 and S. 2486 (see
Summary, p. 26). The Committee also received testimony that
examined compliance with the Uniformed Services Employment and
Reemployment Rights Act (USERRA) and the Servicemembers Civil
Relief Act (SCRA).
Witnesses included: Honorable James P. McGovern of
Massachusetts, Honorable Jeb Bradley of New Hampshire,
Honorable Louise McIntosh Slaughter of New York, and Honorable
Ginny Brown-Waite of Florida who testified on behalf of their
legislation. Ms. Tammy Kimmel, Mr. Jason Burris, and Judithe
Hanover Kaplan, Ph.D., J.D., M.S.N., RN, also testified about
their experience with USERRA and SCRA protections.
Testifying for the Administration were: Honorable Scott J.
Bloch, Special Counsel for the U.S. Office of Special Counsel;
Honorable Dan G. Blair, Deputy Director for the Office of
Personnel Management; Honorable David C. Iglesias, United
States Attorney for the District of New Mexico, Department of
Justice; Mr. Charles S. Ciccolella, Deputy Assistant Secretary,
Veterans' Employment and Training Service, Department of Labor;
Mr. Craig W. Duehring, Principal Deputy Assistant Secretary of
Defense for Reserve Affairs, Department of Defense; and Colonel
Brarry Cox, Director, Military Member Support and Ombudsman
Services for the National Committee for Employer Support of the
Guard and Reserve.
Testifying on behalf of their respective organizations
were: Honorable Pat Quinn, Lieutenant Governor of Illinois, for
the Council of State Governments; Harry A. Van Sickle, Union
County Commissioner (PA), for the National Association of
Counties; Colonel Robert F. Norton, USA (Ret.), Deputy
Director, Government Relations, Military Officers Association
of America; Ms. Kathleen Moakler, Deputy Director, Government
Relations, National Military Family Association; and Margot
Saunders, Esq., Managing Attorney, National Consumer Law
Center.
Ms. Tammy Kimmel, an Army spouse, testified about the
difficulties she encountered when she and her husband attempted
to use their right under the SCRA to terminate their
obligations under a residential joint lease. He had permanent
change of station orders to go overseas.
The DOD representative, Mr. Craig Duehring, presented the
Department's views in support of the draft amendments to SCRA,
which were developed in cooperation with DOD. Mr. Duehring did
not offer DOD support for H.R. 3779.
The Committee's examination of USERRA compliance in the
public sector was a follow-up to the July 24, 2003, hearing on
private sector employees. The hearing also explored the merits
of expanding the jurisdiction of the Office of Special Counsel
(OSC) over USERRA enforcement cases for Federal employees.
Honorable Scott J. Bloch, Special Counsel, testified regarding
OSC's USERRA enforcement activities and also testified
favorably regarding expanded jurisdiction for OSC. Mr. Jason
Burris and Dr. Judith Kaplan, both former members of the
reserve components and former Federal employees, testified
about their USERRA cases and praised the work of the OSC in
resolving their cases.
The Committee also considered a draft bill, the USERRA
Health Care Coverage Extension Act of 2004, to extend from 18
months to 24 months the maximum period of employer-sponsored
health care coverage that a member of the reserve components
could elect to continue. The draft bill also contained a
provision to reinstate the reporting requirements for the
Department of Labor in consultation with the Department of
Justice and OSC on USERRA cases reviewed by or referred to
them. When USERRA was originally enacted, the reporting
requirements ended on February 1, 1996. The draft bill included
a requirement for a report on USERRA enforcement activities on
February 1, 2005 and annually thereafter. Witnesses testifying
on behalf of the Administration supported this proposed
legislation, and it was included in H.R. 4658.
OVERSIGHT ACTIVITIES
First Session
Hearing on VA Health Care System
On January 29, 2003, the Committee held an oversight
hearing on the current state of VA health care system, with a
focus on its capacity to meet the current demand for health
care and on the degree to which VA is fulfilling its statutory
mission to care for veterans.
The witnesses at this hearing were Honorable Robert H.
Roswell, Under Secretary for Health, VA; Mr. Dennis Cullinan,
Director, National Legislative Service, Veterans of Foreign
Wars; Mr. Peter S. Gaytan, Principal Deputy Director, Veterans
Affairs and Rehabilitation Commission, The American Legion; Mr.
Joseph Violante, National Legislative Director, Disabled
American Veterans; Mr. Richard Fuller, National Legislative
Director, Paralyzed Veterans of America; Mr. Richard Jones,
National Legislative Director, AMVETS; and Dr. Linda Spoonster
Schwartz, Chair, Health Committee, Vietnam Veterans of America.
Under Secretary Roswell testified that VA had made
adjustments, given its sustainable capacity to meet veterans'
health care needs, and shifted priorities to ensure that
service-disabled veterans have the first claim on VA health
care resources. He described a recent moratorium on
establishing any new clinics and discussed co-payments policy,
recruitment of new enrollees, a reorganized headquarters
leadership and further described the Capital Asset Realignment
for Enhanced Services (CARES) process to examine VA's capital
needs in the future.
Hearing on the State of Veterans' Employment
On February 5, 2003, the Committee held an oversight
hearing on veterans' employment issues. The hearing explored
the performance of government programs in three areas: the 3
percent contracting goal set forth in Public Law 106-50, the
Veterans Entrepreneurship and Small Business Act of 1999; the
implementation of Public Law 107-288, the Jobs for Veterans
Act; and the Transition Assistance Program (TAP) as
administered by the Department of Labor for servicemembers and
spouses transitioning to civilian life.
Witnesses included Mr. Richard Weidman, Vietnam Veterans of
America; Mr. John Lopez, Association for Service Disabled
Veterans; Mr. Blake Ortner, Paralyzed Veterans of America; Mr.
Joseph K. Forney, VetSource; Chief Master Sergeant Elizabeth S.
Schouten, Deputy Director of Operations for the United States
Air Force Band; Ms. Angela B. Styles, Administrator, Office of
Federal Procurement Policy in the Office of Management and
Budget, accompanied by Mr. Fred C. Armendariz, Associate Deputy
Administrator for Government Contracting and Business
Development for the Small Business Administration and Ms. Linda
G. Williams, Associate Administrator for Government Contracting
for the Small Business Administration; Mr. Kevin Boshears,
Director, Office of Small Business Development for Department
of Treasury; and Honorable Frederico Juarbe, Jr., Assistant
Secretary for Veterans' Employment and Training Service for the
Department of Labor, accompanied by Honorable Charles S.
Ciccolella, Deputy Assistant Secretary for Veterans' Employment
and Training Service and Mr. Ron Bachman, Regional
Administrator Chicago/Denver for the Veterans' Employment and
Training Service.
Mr. Weidman, Mr. Lopez, and Mr. Ortner thanked the
Committee for its work on Public Law 107-288 and testified that
it was a first step. Mr. Forney joined them by testifying that
the Federal government does not achieve the 3 percent
procurement goals of Public Law 106-50 for veteran-owned small
businesses.
Chief Master Sergeant Schouten, a transitioning
servicemember, testified about the excellent instruction she
received while attending her TAP classes.
Ms. Styles testified for the Administration on Public Law
106-50. She stated that she considered the procurement numbers
with regard to service-disabled veteran-owned small businesses
unacceptable. In her oral testimony, she stated, ``I can convey
to you a commitment from my office to do a better job, to pay
more attention to this program.''
Secretary Juarbe testified for the Administration on the
implementation of Public Law 107-288 and the TAP program as
administered by the Department of Labor. Mr. Juarbe
specifically addressed concerns regarding TAP sites at overseas
locations and how the Department provides informal services to
servicemembers at these locations through the service branches.
Mr. Juarbe also discussed the implementation plan for Public
Law 107-288.
Hearing on Proposed Fiscal Year 2004 Budget for Veterans
Programs
On February 11, 2003, the Committee held a hearing on the
fiscal year 2004 budget for veterans programs. The principal
witness for the Administration was Honorable Anthony J.
Principi, Secretary of Veterans Affairs. The Secretary was
accompanied by five Department officials including Honorable
Robert H. Roswell, M.D., Under Secretary for Health, and
Honorable Vice Admiral Daniel L. Cooper, Under Secretary for
Benefits.
The Administration requested $25.2 billion in discretionary
funding for veterans medical care, a $1.3 billion increase over
the Administration's fiscal year 2003 request.
Veterans service organization representatives presented
their Independent Budget proposal for fiscal year 2004.
Additionally, veterans service organizations representatives
advocated mandatory funding for veterans' health care.
The Committee expressed support for the President's
proposal to reduce the pharmacy co-payment burden for Priority
2-5 veterans by raising the income threshold at which such
payments would be required. However, the Committee questioned
the Administration's proposals to assess a $250 enrollment fee
for higher-income veterans; raise the prescription drug co-
payment from $7 to $15 for veterans making $24,000 or more a
year; and restrict institutional long-term care services to
those with service-connected disability rated 70 percent or
greater.
Hearing on Past and Present Efforts to Identify Fraud, Waste,
Abuse, and Mismanagement in Veterans Programs
On May 8, 2003, the Committee held the first in a series of
hearings on congressional efforts to eliminate waste, fraud,
abuse, and mismanagement within VA, and to improve the timely
delivery of quality health care and benefits for veterans and
their families.
Witnesses at the hearing included: Honorable. Richard
Griffin, Inspector General, Department of Veterans Affairs; and
Ms. Cynthia Bascetta, Director, Healthcare--Veterans' Health
and Benefits Issues, General Accounting Office.
The IG testified about ways to improve health care delivery
for veterans and summarized a recent audit of VA physician time
and attendance, which had been requested by the Secretary of
Veterans Affairs. He also stated that VA does not have
effective procedures to align staffing levels with workload
requirements, and that savings in excess of $209 million could
be realized as a direct result of the establishment of VA's
Fugitive Felon program, which stops improper payments of
veterans benefits to fugitive felons.
GAO testified about VA's health care and disability
benefits. Their witness also testified about excessive waiting
times for VA outpatient care, VA's large and aged
infrastructure, which is not well aligned to meet veterans'
needs, and about the need to consolidate duplicative care
provider locations serving the same populations. GAO concluded
that VA had made significant progress in the timeliness of its
claims processing, but VA's disability criteria are outmoded.
Hearings to Receive the Final Report of the President's Task
Force to Improve Health Care Delivery for Our Nation's Veterans
On June 3, 2003, the Committee held the first in a series
of two hearings on the final recommendations of the President's
Task Force to Improve Health Care Delivery for Our Nation's
Veterans, entitled President's Task Force to Improve Health
Care Delivery for Our Nation's Veterans, Final Report 2003. The
witness was Dr. Gail R. Wilensky, Co-Chair of the President's
Task Force.
The President's Task Force was established in May 2001 to
make recommendations on improving coordination between the
Departments of Defense and Veterans Affairs' health care
systems. The President's Task Force issued its Final Report on
May 26, 2003. Dr. Wilensky testified that the President's Task
Force recommended changing the veterans' health care funding
process through ``modifications to the current budget and
appropriations process, by using a mandatory funding mechanism,
or by some other changes in the process that achieve the
desired goal.'' She emphasized that the view of the President's
Task Force was that improved coordination between VA and DOD
could not be fully realized until the VA health care funding
problem is satisfactorily resolved.
Additionally, Dr. Wilensky stated that it was ``vital that
the field-level managers of the two Departments come to
understand the commitment of the top leadership to improved
collaborative efforts between VA and DOD.'' Further, Dr.
Wilensky discussed the President's Task Force recommendations
to achieve a seamless transition from active duty military to
veteran status. She said that the current transition process is
often cumbersome, slow, and overly bureaucratic and that ``the
development and use of electronic medical records that could
share data would not only foster collaboration in the delivery
of health care services but also reduce medical errors and
attendant costs.''
On June 17, 2003, the Committee held a follow-up hearing
concerning the President's Task Force. Witnesses included:
Honorable Leo S. Mackay Jr., Ph.D., Deputy Secretary, VA;
Honorable David S. C. Chu, Ph.D., Under Secretary of Defense
for Personnel and Readiness, DOD; and the following
Commissioners to the President's Task Force to Improve Health
Care Delivery for Our Nation's Veterans: Charles R. Anthony,
Ph.D.; Mr. Mack G. Fleming; Ms. Susan M. Schwartz; Mr. Robert
W. Spanogle; and Mr. Harry N. Walters. Testifying on behalf of
the veterans service organizations and military associations
were Mr. Dennis M. Cullinan, National Legislative Director,
Veterans of Foreign Wars; Mr. Richard Fuller, National
Legislative Director, Paralyzed Veterans of America; Mr.
Richard Jones, National Legislative Director, AMVETS; Colonel
Robert F. Norton, USA (Ret.), Deputy Director, Government
Relations, Military Officers Association of America; Mr. Steve
Robertson, Director, National Legislative Commission, The
American Legion; Mr. Joseph A. Violante, National Legislative
Director, Disabled American Veterans.
The testimony of the witnesses largely related to the
central recommendation of the President's Task Force that the
veterans' health care funding process be overhauled in order to
achieve the necessary funding to meet demand within established
access standards.
Second Hearing on Past and Present Efforts to Identify Fraud,
Waste, Abuse, and Mismanagement in Programs
On June 10, 2003, the Committee held a second hearing on
congressional efforts to eliminate waste, fraud, abuse, and
mismanagement within VA. The purpose of the second hearing was
to receive testimony from VA and to highlight the Committee's
oversight of VA's efforts to streamline and improve
efficiencies in its management of benefit delivery systems. The
hearing also examined what still needed to be accomplished to
further improve the timely delivery of all veterans benefits.
Witnesses included: Honorable Leo S. Mackay, Jr., Ph.D.,
Deputy Secretary, VA, who was accompanied by Honorable Robert
H. Roswell, MD, Under Secretary for Health, Honorable Vice
Admiral Daniel L. Cooper, Under Secretary for Benefits, and
Honorable William H. Campbell, Assistant Secretary for
Management.
Dr. Mackay testified about efforts underway at the
Department to prevent fraudulent behavior by employees within
the Veterans Benefits Administration and outlined safeguards
that had been established to prevent future problems. Dr.
Mackay also discussed recommendations made by the VA
Procurement Reform Task Force of 2001, and stated that 25 of
the 60 task force recommendations had already been implemented.
Legislation to change the result of the decision in Allen v.
Principi, 268 F. 3d 1340 (Fed. Cir. 2001), which allows
veterans to receive additional compensation for secondary
substance abuse caused by a veteran's disability, was cited by
VA as one of its major legislative proposals. This prompted
many questions by members of the Committee. Dr. Mackay also
noted problems with the computation and processes used to
report activities related to some competitive outsourcing
activities.
Hearing to Evaluate the Status of VA and DOD Efforts to Provide
Seamless Health Care Coverage to Transitioning Veterans
On October 16, 2003, the Committee held an oversight
hearing to evaluate availability of medical care for
servicemembers immediately following deployments, including
Guard and Reserve members, and the transition between DOD and
VA of servicemembers being discharged.
The following witnesses testified from VA: Honorable Robert
H. Roswell, MD, Under Secretary for Health, accompanied by
Michael J. Kussman, MD, Deputy Chief Patient Care Officer,
Veterans Health Administration, Mr. William D. Stinger, Deputy
Under Secretary for Benefits, Veterans Benefits Administration;
and Harold Kudler, MD, Chairman, Under Secretary for Health's
Special Committee on Post-Traumatic Stress Disorder (PTSD).
Mr. Edward Wyatt, Jr., Principal Deputy Assistant Secretary
of Defense for Health Affairs, accompanied by Lieutenant
General James B. Peake, MD, The Surgeon General, U.S. Army;
Vice Admiral Michael L. Cowan, MD, Surgeon General of the Navy;
Lieutenant General George Peach Taylor, Jr., MD, Surgeon
General of the U.S. Air Force; Mr. Tom Bush, Director, Program
Integration, Office of the Secretary Defense Reserve Affairs
Manpower and Personnel; and Chaplain Gary Mauck, Lieutenant
Colonel, U.S. Army Reserve, Fort Stewart, Georgia, accompanied
by Colonel John Kidd, Fort Stewart Garrison Commander;
presented statements for DOD.
Mr. Neal P. Curtin, Director, Defense Capabilities and
Management, accompanied by Mr. Clifton Spruill, Assistant
Director, Defense Capabilities and Management, provided
testimony for the General Accounting Office (GAO).
Colonel Robert T. Frame, DDS, U.S. Army Reserve; Senior
Master Sergeant Robbin Halcomb, Air National Guard; Mr. Nelson
Villegas, U.S. Army veteran; and Mrs. Arvilla Stiffler, mother
of Mr. Jason Stiffler, U.S. Army veteran testified about their
experiences with the transition between DOD and VA health care
systems.
This hearing included personal accounts and analysis of
individual experiences of separating servicemembers
transitioning from DOD to VA programs following a serious
illness or injury while on active duty. GAO reported its most
recent findings concerning DOD pre- and post-deployment health
screenings, health records maintenance and in-theater health
tracking of troops. The Committee heard testimony from health
care executives from both Departments, including the Surgeons
General of the U.S. Army, Navy and Air Force and a Reserve
Affairs official.
Additional witnesses provided a view of what occurs beyond
the metropolitan Washington, DC area, for both DOD and VA and
their patients. Chaplain Mauck, an Army Reserve Lieutenant
Colonel from Fort Stewart, Georgia, testified about the
pastoral programs the Army has established to assist returning
troops with post-traumatic stress disorder (PTSD) and about the
general stresses of returning from deployment. Dr. Kudler, the
Chairman of the VA Advisory Committee on PTSD, also testified
about VA's ``Iraq War Clinicians Guide'' and the sixteen
clinical practice guidelines developed jointly by VA and DOD
for the management of PTSD.
Second Session
Hearing on VA's Long-Term Care Policies
On January 28, 2004, the Committee held a hearing to
examine existing VA long-term care programs and VA's strategy
for addressing future long-term care needs of aging and
disabled veterans. GAO also presented testimony based on its
reported findings in VA Long-Term Care: Changes in Service
Delivery Raise Important Questions, GAO-04-425T, January 28,
2004.
Government witnesses included: Honorable Robert H. Roswell,
MD, Under Secretary for Health, VA, accompanied by James F.
Burris, M.D, Chief Consultant for Geriatrics and Extended Care
Strategic Healthcare Group; John D. Daigh, Jr., MD, Assistant
Inspector General for Health Care Inspections, Office of
Inspector General, VA, accompanied by Ms. Victoria Coates,
Director, VA Atlanta Regional Office of Healthcare Inspections,
Office of Inspector General; and Ms. Cynthia A. Bascetta,
Director, Veterans' Health and Benefits Issues, General
Accounting Office (GAO), accompanied by Mr. Jim Musselwhite,
Assistant Director, Health Care.
Other witnesses included: Joel Streim, MD, President,
American Association for Geriatric Psychiatry; Ms. Jade Gong,
RN, FAACN, Member of VA Geriatrics and Gerontology Advisory
Committee, Health Strategy Associates; Ms. Linda Sabo,
Executive Director, Alzheimer's Association Western New York
Chapter; Mr. Phillip Jean, President, National Association of
State Veterans Homes, and Administrator of the Maine Veterans
Home in Scarborough.
Statements for the record were submitted by Ms. Carol
Rutherford, Director, Veterans Affairs and Rehabilitation
Division, The American Legion; Mr. Richard Jones, National
Legislative Director, AMVETS; Mr. Adrian M. Atizado, Assistant
National Director, Disabled American Veterans; Mr. Fred Cowell,
Health Policy Analyst, Paralyzed Veterans of America; Mr. Paul
A. Hayden, Deputy Director, National Legislative Service,
Veterans of Foreign Wars; Mr. Richard Weidman, Director of
Government Relations, Vietnam Veterans of America; Charles H.
Roadman II, MD, CNA, President and Chief Executive Officer,
American Health Care Association.
The Committee learned that VA's long-term care services
have undergone some positive changes in recent years, but VA's
commitment to long-term care has not kept pace with veterans'
needs, and access to VA care and the basic availability of
these programs remain variable from network to network.
Many of the concerns expressed at the May 22, 2003,
Subcommittee hearing on long-term care remained unresolved.
Issues related to VA's role in meeting the long-term health
care needs of aging veterans, and the challenge to improve its
management and direction of long-term care policies will
require continued Committee oversight.
Hearing on the President's Proposed Fiscal Year 2005 Budget for
the Department of Veterans Affairs
On February 4, 2004, the Committee held a hearing on the VA
budget for fiscal year 2005. The Administration requested $64.9
billion in new appropriations in the VA budget. Of this total,
$35.2 billion was for entitlement programs such as disability
compensation and Montgomery GI Bill payments, and $29.7 billion
in discretionary funding was for health care, medical research
and administration of the benefits and cemetery systems.
VA witnesses testifying at the hearing included: Honorable
Anthony J. Principi, Secretary of Veterans Affairs, accompanied
by Honorable Robert H. Roswell, MD, Under Secretary for Health;
Honorable Daniel L. Cooper, Under Secretary for Benefits;
Honorable John W. Nicholson, Under Secretary for Memorial
Affairs; Honorable Tim S. McClain, General Counsel; and
Honorable William H. Campbell, Assistant Secretary for
Management.
Testifying on behalf of military and veterans service
organizations were the following witnesses: Mr. Dennis
Cullinan, Director, National Legislative Service, Veterans of
Foreign Wars; Mr. Richard Fuller, National Legislative
Director, Paralyzed Veterans of America; Mr. Richard Jones,
National Legislative Director, AMVETS; and Mr. Joseph A.
Violante, Disabled American Veterans; Mr. Peter S. Gaytan,
Principal Deputy Director of the Veterans Affairs and
Rehabilitation Division, The American Legion; Mr. Richard C.
Schneider, National Director, Veterans and State Affairs, Non
Commissioned Officers Association; Colonel Robert F. Norton,
USA (Ret.), Co-Chair, Veterans Committee, The Military
Coalition; Mr. Morgan Brown, Co-Chair, Veterans Committee, The
Military Coalition; and Mr. Richard Weidman, Director of
Government Relations, Vietnam Veterans of America.
Secretary Principi presented the Administration's fiscal
year 2005 budget requirements for veterans programs, and
representatives of the veterans service organizations presented
their Independent Budget proposal, with varying perspectives on
the levels of funding for VA programs.
Hearing on Employing Veterans of Our Armed Forces
On March 24, 2004, the Committee held an oversight hearing
on employing veterans of our armed forces. Witnesses included
Mr. Joseph J. Grano, Jr., Chairman, UBS Financial Services
Inc.; Mr. Steven A. Wohlwend, Senior Division Manager,
Industrial Relations, Deere & Company; Mr. Robert W. Smith III,
Global Controller, Service Engineering Operations, Ford Motor
Company; Mr. Joseph Keith Kellogg, Senior Vice President,
Homeland Security Solutions, Oracle Corporation; Mr. Wesley
Poriotis, Chief Executive Officer, The Center for Military and
Private Sector Initiative, Inc., Veterans Across America; Mr.
Harold A. Scott, Vice President, Human Resources, Harley-
Davidson Motor Company; Mr. Kevin M. Horigan, Group Vice
President, Public Services, PeopleSoft; Mr. Brad L. Champlin,
Executive Vice President, Union Planters Corporation; and Mr.
Robert C. Crawford, Vice President, Staffing, Prudential
Financial.
The witnesses from business and industry uniformly
testified that former servicemembers as a class of individuals
are valued business assets for several reasons, including their
loyalty, work habits, self-discipline, dependability, and
commitment. Witnesses generally expressed a lack of knowledge
as to how to have a job within their company approved for
veterans' training in the form of an on-job training or
apprenticeship program administered by VA. Mr. Poriotis
testified to a ``deselective bias'' that can exist in private-
sector hiring practices because relatively few chief human
resources officers have served in the military. Mr. Grano spoke
to language and other terminology barriers private companies
encounter in understanding how military occupational
specialties can translate to civilian jobs.
Hearing on Homeless Assistance Programs for Veterans
On May 18, 2004, the Committee held an oversight hearing on
Federal homeless assistance programs for veterans, and VA's
coordination with community-based providers and other Federal
agencies, principally the Departments of Health and Human
Services (HHS) and Housing and Urban Development (HUD). The
purpose of this hearing included a review of Public Law 107-95,
the Homeless Veterans Comprehensive Assistance Act of 2001, and
VA's progress in implementing this law and the transitional
housing authority of Public Law 105-368, the Veterans Programs
Enhancements Act of 1998.
Witnesses who testified at this hearing included: Honorable
Gordon H. Mansfield, Deputy Secretary of Veterans Affairs,
accompanied by Mr. Peter H. Dougherty, Director, Office of
Homeless Veterans Programs; Ms. M. Gay Koerber, Associate Chief
Consultant, Health Care for Homeless Veterans; Mr. Claude B.
Hutchison, Jr., Director, Office of Asset Enterprise
Management; Ms. Patricia Carlile, Deputy Assistant Secretary
for Special Needs Programs, HUD; Mr. Don Winstead, Deputy
Assistant Secretary for Planning and Evaluation, Office of
Human Services Policy, HHS; Mr. John Kuhn, LCSW, MPH, Homeless
Program Coordinator, VA New Jersey Health Care System,
accompanied by Mr. Robert Valentino, Mr. Ralph Owens, and Mr.
Thaddeus McNair; Richard McCormick, Ph.D., Hudson, Ohio; Ms.
Linda Boone, Executive Director, National Coalition for
Homeless Veterans, Washington, DC; Mr. William G. D'Arcy,
Catholic Charities of the Archdiocese of Chicago, Chicago,
Illinois; Mr. James W. Manning, Commissioner, Housing Authority
of the Township of Neptune, Neptune, New Jersey; Mr. Carlos
Martinez, President and CEO, American GI Forum, National
Veterans Outreach Program, Inc., San Antonio, Texas.
At this hearing, the Committee heard testimony about
successes of the program in Lyons, New Jersey. In rebuilding
their lives, three formerly homeless veterans are helping other
veterans by outreach, example, training and mentoring,
operating businesses, and developing a website.
Follow-up Hearing on Eliminating Waste, Fraud, and Abuse in
Veterans' Programs
On June 17, 2004, the Committee held its third hearing on
congressional efforts to eliminate waste, fraud, abuse, and
mismanagement within VA. The purpose of the hearing was to
review how VA has addressed ongoing problems that were reviewed
in previous hearings held on May 8, 2003 and June 10, 2003.
Witnesses included: Honorable Gordon H. Mansfield, Deputy
Secretary, VA; Mr. McCoy Williams, Director, Financial
Management and Assurance Team, General Accounting Office; and
Honorable Richard Griffin, Inspector General (IG), VA.
Deputy Secretary Mansfield focused the first part of his
testimony on the problems encountered with the implementation
of the Core Financial and Logistics System, which is an
integration of financial and management information systems, at
Bay Pines VA Medical Center, FL. He also testified that the IG,
the House Committee on Appropriations, and Carnegie Mellon
University were conducting investigations and would issue
reports later in the year on their findings. Deputy Secretary
Mansfield also provided an update on several areas discussed in
previous hearings and discussed how the Department intended to
address the problems outlined, including part-time physicians
and attendance, staffing levels, and improvements in the
collections process.
The IG indicated during the Committee's June 17, 2004,
hearing on VA's efforts to curtail waste, fraud, abuse, and
mismanagement that additional funding was critical to maintain
a current level of return of investment for the Fugitive Felon
Program. A hearing outcome was that on June 18, 2004, the
Committee requested that the Appropriations Committee provide
an additional $7.8 million to fully fund VA's Office of
Inspector General (OIG), in its efforts mandated by Public Law
107-103 to eliminate payments to fugitive felons.
Hearing on the Evolution of VA-DOD Collaboration in Research
and Amputee Care for Veterans of Current and Past Conflicts and
on Needed Reforms in VA Blind Rehabilitation Services
On July 22, 2004, the Committee held an oversight hearing
on the evolution of VA-DOD collaboration in research and
amputee care for veterans of current and past conflicts, and on
needed reforms in VA blind rehabilitation services.
Witnesses from VA included: Michael J. Kussman, MD, Acting
Deputy Under Secretary for Health; Mindy L. Aisen, MD, Deputy
Chief Research and Development Officer; Mr. Frederick Downs,
Jr., Chief Consultant, Prosthetic and Sensory Aids Service
Strategic Healthcare Group; Rory A, Cooper, Ph.D., Director,
Center of Excellence on Wheelchairs and Associated
Rehabilitation Science and Engineering, VA Healthcare System,
Pittsburgh, Pennsylvania; Ms. Penny L. Schuckers, MSW, Chief,
Eastern Blind Rehabilitation Center and Clinic, VA Medical
Center, West Haven, Connecticut; Mr. Bruce W. Davis, MSW,
Visual Impairment Services Team Coordinator, North Florida/
South Georgia VA Medical Center, Gainesville, Florida; and Ms.
Nancy J. Strohm, MSW, VISOR Coordinator, VA Medical Center,
Lebanon, Pennsylvania.
Testifying for DOD were the following witnesses: Brett P.
Giroir, MD, Deputy Director, Defense Sciences Office, Defense
Advanced Research Projects Agency; Paul F. Pasquina, MD, Chief,
Physical Medicine and Rehabilitation, Walter Reed Army Medical
Center; Mr. Chuck Scoville, Program Manager, U.S. Army Amputee
Patient Care, Walter Reed Army Medical Center; Sergeant David
Sterling, United States Army; and Staff Sergeant Ryan Kelly,
United States Army.
Testimony was provided by Ms. Cynthia A. Bascetta,
Director, Veterans' Health and Benefits Issues, Government
Accountability Office (GAO), and formerly known as the General
Accounting Office.
Mr. Thomas H. Miller, Executive Director, Blinded Veterans
Association; Mr. John Fales, President, Blinded American
Veterans Foundation; Ms. Joy J. Ilem, Assistant National
Legislative Director, Disabled American Veterans; Mr. Richard
B. Fuller, National Legislative Director, Paralyzed Veterans of
America presented testimony on behalf of veterans service
organizations.
Other witnesses included: Mr. Bert Harman, President and
CEO, Otto Bock Healthcare; and Mr. Robert Conetta, United
States Army veteran.
The Committee considered testimony affecting 157,000
legally blind veterans, 44,000 of whom are enrolled in VA
health care. According to the testimony, more than 2,000 of
these blinded veterans have received treatment in the VA's
Blind Rehabilitation Centers. One focus of the hearing was the
degree to which changes may be needed in VA's approach to
caring for blinded and visually-impaired veterans.
GAO found that, as a consequence of the growing number of
veterans in need of blind rehabilitation services and VA's
reliance on ten regional centers of excellence to provide that
care, the average waiting time is excessive for a veteran to be
admitted to a blind rehabilitation center. GAO reported to the
Committee, and VA agreed, that waiting time management for
blind rehabilitation needs to be improved. Also, GAO testified
on the need for VA to reform its program management. The
Committee expressed its view that VA should advance its
planning to make visual-impairment services more available to
veterans where they live, rather than requiring veterans to
report to specialized centers for these services.
A second focus of the hearing was to learn more about
recent efforts on the part of VA and DOD to improve care for
servicemembers and veterans suffering the effects of recent
traumatic amputations in the war on terrorism. The hearing
examined several aspects of the treatment being provided to
these survivors, and how this treatment improves the lives of
those who are wounded.
Three Years After 9/11: Is VA Prepared to Fulfill Its Roles in
Homeland Security?
On August 26, 2004, the Committee held a hearing to address
the findings of the National Commission on Terrorist Attacks
Upon the United States (also known as the 9/11 Commission) and
to examine VA's role in the National Response Plan and other
homeland security contingency plans; VA's preparations to
fulfill those obligations and duties; VA's coordination and
collaboration with other Federal agencies charged with homeland
security functions; and VA's integration into both national and
local emergency prevention and response plans.
Witnesses included: Honorable Gordon H. Mansfield, Deputy
Secretary, VA, accompanied by Honorable Robert N. McFarland,
Assistant Secretary for Information and Technology; Jonathan B.
Perlin, MD, Acting Under Secretary for Health, VA; Mr. Robert
J. Epley, Associate Deputy Under Secretary for Policy and
Program Management, VBA; Major General Lester Martinez-Lopez,
Commanding General, U.S. Army Medical Research and Materiel
Command and Fort Detrick, DOD; Honorable Stewart Simonson,
Assistant Secretary for Public Health Emergency Preparedness,
Department of Health and Human Services; Neil C. Livingstone,
Ph.D, Chief Executive Officer, Global Options, Inc.; Jerry L.
Mothershead, MD, Former Senior Medical Consultant, Navy
Medicine Office of Homeland Security, Physician Advisor,
Medical Readiness and Response Group, Batelle Memorial
Institute; and Karl Y. Hostetler, MD, VA San Diego Healthcare
System.
VA testified that funding for its initiative relating to
Homeland Security rose from $84.5 million in fiscal year 2002
to $271 million in fiscal year 2004, and its budget request for
fiscal year 2005 was $297 million. VA also described its
partnership in the National Disaster Medical System,
specifically its role in the aftermath of Hurricane Charley. VA
reiterated that one of its major roles in the National Disaster
Medical System is the management of four pharmaceutical and
medical supply caches for the Department of Homeland Security
and Federal Emergency Management Agency and two additional
special caches for other Federal agencies. Secretary Mansfield
restated his support for the Committee's efforts to secure
funding for VA emergency preparedness centers.
General Martinez-Lopez discussed the work carried out at
Fort Detrick, MD, in training first responders, and military
and civilian care providers to treat exposure to chemical and
biological agents. He also testified about VA's role in the
development of an oral smallpox vaccine. General Lopez
addressed the collaboration between VA, DOD and NIH on
neurodegenerative diseases research. Mr. Simonsen testified
about HHS' interagency working group and efforts to develop
recommendations to address availability of health care
providers to respond to a mass casualty event.
Dr. Mothershead stated that most medical facilities are
able to return to normal or near normal operation within 48
hours of an event. Dr. Mothershead further stated that while
500 hospitals or 10 percent of the total hospitals in the
country and 25 percent of the medical emergency departments
have closed, the demand has not declined. He expressed concern
that there are no national standards to effectively measure the
Nation's ability to handle a significant terrorist attack.
ACTIVITIES OF THE SUBCOMMITTEES
Subcommittee on Health
The Subcommittee on Health has legislative, oversight and
investigative jurisdiction over veterans' hospitals, medical
care, and treatment of veterans (see Oversight Plan for 108th
Congress, p. 91).
LEGISLATIVE ACTIVITIES
First Session
Subcommittee Markup of H.R. 1562, H.R. 1715, H.R. 1832, H.R.
1908, and H.R. 1911
On May 6, 2003, the Subcommittee on Health met and marked
up five bills: H.R. 1562, H.R. 1715, H.R. 1832, H.R. 1908, and
H.R. 1911. All five bills were reported favorably to the Full
Committee (see Full Committee Markup, p. 33).
Hearing on H.R. 1720, H.R. 116, H.R. 2307, and H.R. 2349
On June 11, 2003, the Subcommittee on Health held a
legislative hearing to consider the following four bills: H.R.
1720, the Veterans Health Care Facilities Capital Improvement
Act, introduced by Honorable Rob Simmons of Connecticut on
April 10, 2003; H.R. 116, Veterans' New Fitzsimons Health Care
Facilities Act of 2003, introduced by Honorable Joel Hefley of
Colorado on January 7, 2003; H.R. 2307, introduced by Honorable
David L. Hobson of Ohio on June 3, 2003, to establish new VA
medical facilities in the area of Columbus, Ohio and in south
Texas; and H.R. 2349, introduced by Honorable Lane Evans of
Illinois on June 5, 2003, to authorize construction of a new
bed tower at the VA West Side facility in Chicago and certain
other major medical facility projects.
Witnesses included: Honorable Robert H. Roswell, MD, Under
Secretary for Health, VA, who was accompanied by Mr. D. Mark
Catlett, Principal Deputy Assistant Secretary for Management
and Mr. Robert L. Neary, Jr., Associate Chief Facilities
Management Officer for Service Delivery; Ms. Cathleen C.
Wiblemo, Deputy Director, Health Care, Veterans Affairs and
Rehabilitation Division, The American Legion; Mr. Richard
Jones, National Legislative Director, AMVETS; Mr. Adrian M.
Atizado, Associate National Legislative Director, Disabled
American Veterans; Mr. Carl Blake, Associate Legislative
Director, Paralyzed Veterans of America; and Mr. Paul A.
Hayden, Deputy Director, National Legislative Service, Veterans
of Foreign Wars.
Statements for the Record were received from Honorable Joel
Hefley of Colorado; Honorable David L. Hobson of Ohio;
Honorable Solomon P. Ortiz of Texas; Honorable Deborah Pryce of
Ohio; and Honorable Lane Evans of Illinois.
VA supported H.R. 1720 and H.R. 116. VA also supported
Sections 1, 2, and 3 of H.R. 2349, but expressed opposition to
Section 4 of the bill, which would prohibit VA from spending
funds to dispose of VA's Lakeside property until a contract is
awarded to construct a new bed tower on VA's West Side campus.
Regarding H.R. 2307, VA agreed that the need for an expanded
replacement outpatient clinic in Columbus was appropriate, but
stated that it was premature to endorse a proposed new facility
in south Texas. VA also requested that the Subcommittee
consider additional project leases included in the President's
fiscal year 2004 budget for Boston, MA; Pensacola, FL; and for
a Health Administration Center in Denver, CO. Authorization for
VA seismic projects listed in the President's 2003 budget at
facilities in Palo Alto, San Francisco, and West Los Angeles
remained a high priority for the Department.
All of the veterans service organizations representatives
testified in support of the four bills and the Subcommittee's
efforts to improve the capital infrastructure of VA's health
care system, with one exception. The Disabled American Veterans
expressed some concern about H.R. 1720, asserting that whatever
option is approved for the Denver area, VA should maintain a
separate identity with direct line authority in all areas
involving care of veteran patients.
Subcommittee Markup of H.R. 116, H.R. 1720, H.R. 2357, and H.R.
2433
On June 24, 2003, the Subcommittee on Health met and marked
up four bills: H.R. 116, with an amendment; H.R. 1720, with an
amendment; H.R. 2357, with an amendment; and H.R. 2433, with an
amendment. All four bills were favorably reported to the Full
Committee (see Full Committee Markup, p. 33).
Hearing on H.R. 1585
On Tuesday, July 15, 2003, the Subcommittee on Health held
a legislative hearing to consider H.R. 1585, a bill to
establish an office to oversee research compliance and
assurance within VHA, and to provide for a Director of such
office, introduced by Honorable Steve Buyer of Indiana on April
3, 2003.
Witnesses included: Honorable Robert H. Roswell, MD, Under
Secretary for Health, VA, accompanied by Mindy L. Aisen, MD,
Deputy Chief Research and Development Officer, David A. Weber,
Ph.D., Acting Chief of the Office of Research Oversight, and
Lynn Cates, MD, Assistant Chief Research and Development
Officer; and John Clarkson, MD, Senior Vice President for
Medical Affairs and Dean of the University of Miami School of
Medicine, on behalf of the Association of American Medical
Colleges (AAMC).
Dr. Roswell testified that the legislation was unnecessary
because actions approved by the Secretary and undertaken by VA
to realign human research protection responsibilities and
activities within the Office of Research and Development
achieved the objectives of H.R. 1585. Additionally, he outlined
criticisms of certain other provisions of H.R. 1585. On behalf
of the AAMC, Dr. Clarkson supported the principle and intent of
the legislation.
Hearing on H.R. 2379 and H.R. 3094
On September 30, 2003, the Subcommittee on Health held a
hearing to consider two bills to improve veterans' access to
health care: H.R. 2379, the Rural Veterans Access to Care Act
of 2003, introduced by Honorable Tom Osborne of Nebraska on
June 5, 2003, and H.R. 3094, the Veterans Timely Access to
Health Care Act, introduced by Honorable Ginny Brown-Waite of
Florida on September 16, 2003.
Witnesses included: Honorable Tom Osborne of Nebraska;
Honorable Jon C. Porter of Nevada; Honorable Robert H. Roswell,
MD, Under Secretary for Health, VA; Mr. Arthur L. Johnsen,
Franklin County Veterans Service Officer, Nebraska; Mr. John J.
Kenney, Citrus County Veterans Service Officer, Florida; Ms.
Cathleen Wiblemo, Deputy Director for Health Care, Veterans
Affairs and Rehabilitation, The American Legion; Mr. Dennis
Cullinan, National Legislative Director, Veterans of Foreign
Wars; Mr. William Carl Blake, Associate Legislative Director,
Paralyzed Veterans of America; Mr. Adrian M. Atizado, Assistant
National Legislative Director, Disabled American Veterans; Mr.
Rick Weidman, Director, Government Relations, Vietnam Veterans
of America; and Mr. Richard Jones, National Legislative
Director, AMVETS.
Representative Osborne testified that H.R. 2379 would allow
enrolled veterans who live in highly rural areas to seek health
care and receive medical treatment closer to their homes.
Representative Brown-Waite stated that H.R. 3094 would ensure
that veterans have swift and speedy access to necessary health
care. Under Secretary Roswell presented the Administration's
view that both H.R. 2379 and H.R. 3094 would be harmful to VA's
existing efforts to improve overall access to VA health care.
Second Session
Hearing on H.R. 4020, H.R. 4231, H.R. 3849, and H.R. 4248
On May 6, 2004, the Subcommittee on Health held a hearing
to consider the following legislation: H.R. 4020, State
Veterans' Home Nurse Recruitment and Retention Act of 2004,
introduced by Honorable Christopher H. Smith of New Jersey on
March 23, 2004; H.R. 4231, Department of Veterans Affairs Nurse
Recruitment and Retention Act of 2004, introduced by Honorable
Rob Simmons of Connecticut on April 28, 2004; H.R. 3849,
Military Sexual Trauma Counseling Act of 2004, introduced by
Honorable Ciro Rodriguez of Texas on February 26, 2004; H.R.
4248, Homeless Veterans Assistance Reauthorization Act of 2004,
introduced by Honorable Christopher H. Smith of New Jersey on
April 29, 2004; and a draft bill to reform the qualifications
and selection requirements for the position of the Under
Secretary for Health.
VA witnesses included: Honorable Gordon H. Mansfield,
Deputy Secretary, who was accompanied by Honorable Tim S.
McClain, General Counsel, Jonathan B. Perlin, MD, Acting Under
Secretary for Health, VA, and Mr. Thomas J. Hogan, Deputy
Assistant Secretary for Human Resources Management.
Additional witnesses included: Linda S. Schwartz, RN,
Dr.PH, Commissioner of the Connecticut Department of Veterans
Affairs; Andrea Mengel, Ph.D., R.N., Head, Department of
Nursing, Community College of Philadelphia, representing the
American Association of Community Colleges; Ms. Marsha Four,
RN, Chair of VA Advisory Committee on Women Veterans; Mr.
Robert Van Keuren, Chair of VA Advisory Committee on Homeless
Veterans; Ms. Cathleen C. Wiblemo., Deputy Director, Health
Care, The American Legion; Mr. Rick Weidman, Director,
Government Relations, Vietnam Veterans of America; Mr. Richard
Jones, National Legislative Director, AMVETS; Mr. Richard
Fuller, National Legislative Director, Paralyzed Veterans of
America; Mr. Dennis Cullinan, National Legislative Director,
Veterans of Foreign Wars; and Mr. Adrian M. Atizado, Assistant
National Legislative Director, Disabled American Veterans.
VA testified in support of H.R. 4248, H.R. 3849 and the
intent of the draft bill to amend the procedures for
appointment and qualifications of the Under Secretary for
Health. VA opposed H.R. 4020, arguing that the Department
already contributes to the cost of nurse recruitment with the
per diem amount VA pays states for the care of veterans in
State homes, and that the legislation would reduce available
medical care funds for other programs. VA generally accepted
the provisions of H.R. 4231, but opposed Section 4 of the bill
to provide that a registered nurse applying for a VA
appointment may not be denied appointment solely because the
nurse applicant does not have a baccalaureate degree. Deputy
Secretary Mansfield expressed VA's belief that the provision
was unnecessary because it is not VA's policy to deny
appointment based on the lack of baccalaureate degree.
However, Dr. Andrea Mengel, representing community
colleges, testified in support of H.R. 4231, asking: ``With
hundreds of choices of workplace opportunities, why would new
RN graduates from associate degree programs choose to work at
the VHA where the hiring and promotion policy will hold them
back? Community colleges across the Nation report that their
graduates are not choosing the VHA.'' Also, Dr. Linda S.
Schwartz, Commissioner of the Connecticut Department of
Veterans Affairs, stated ``. . . I would just ask the
rhetorical question, which is better, no nurse or a nurse from
an associate degree program? And to me the answer is a nurse
from an associate degree program. . . .'' Ms. Marsha Four,
Chair of VA Advisory Committee on Women Veterans, testified in
strong support of H.R. 3849, and Mr. Robert Van Keuren, Chair
of the VA Advisory Committee on Homeless Veterans testified in
strong support of H.R. 4248.
All of the veterans service organizations testified in
support of H.R. 3849 and H.R. 4248 and generally supported H.R.
4020 and H.R. 4231. However, Ms. Wiblemo, on behalf of The
American Legion, expressed concern that Congress should
appropriate sufficient funding to allow VA to carry out the
intent of H.R. 4020 and did not take a position on Section 4 of
H.R. 4231. All of the veterans service organizations raised
questions about the draft bill to reform the qualifications and
selection requirements for the position of the Under Secretary
for Health.
Subcommittee Markup of H.R. 4231 and H.R. 4248
On May 13, 2004, the Subcommittee met and marked up two
bills: H.R. 4231, with an amendment; and H.R. 4248, with an
amendment. Both bills were reported favorably to the full
Committee (see Full Committee Markup, p. 34).
Hearing on Draft Legislation Pertaining to Major Medical
Facility Leases and Capital Asset Management within VA
On June 24, 2004, the Subcommittee on Health held a hearing
to consider a draft bill to authorize 17 VA major medical
facility leases, establish a new procedure for transferring
excess VA properties and a new fund into which proceeds from
such transfers would be deposited, and for other purposes.
Witnesses included Honorable Anthony J. Principi, Secretary
of Veterans Affairs, who was accompanied by Honorable Tim S.
McClain, General Counsel, Honorable William H. Campbell,
Assistant Secretary for Management, Mrs. Laura Miller, Deputy
Under Secretary for Health for Operations and Management, and
Mr. James M. Sullivan, Deputy Director, Office of Asset
Enterprise; Mr. Lawrence A. Biro, Network Director, VA Veterans
Integrated Service Network 19: Rocky Mountain Network;
Honorable Everett Alvarez, Jr., Former Chairman, Capital Asset
Realignment for Enhanced Services (CARES) Commission; Mr.
Dennis Brimhall, President and Chief Executive Officer,
University of Colorado Hospital; Mr. John L. Nau, III,
Chairman, Advisory Council on Historic Preservation; Mr. Dennis
Samic, Treasurer, American Veterans Heritage Center, Inc.; Mr.
Richard Jones, National Legislative Director, AMVETS; Mr. John
F. Sommer, Jr., Executive Director, The American Legion; Mr.
Robert Wallace, Executive Director, Veterans of Foreign Wars;
Mr. Thomas H. Corey, President, Vietnam Veterans of America;
Ms. Joy J. Ilem, Assistant National Legislative Director,
Disabled American Veterans; and Mr. Richard Fuller, National
Legislative Director, Paralyzed Veterans of America. Mr.
Richard Moe, President, National Trust for Historic
Preservation, submitted a statement for the record.
The draft bill was subsequently introduced as H.R. 4768,
the Veterans Medical Facilities Management Act of 2004, by
Honorable Rob Simmons of Connecticut on July 7, 2004.
Secretary Principi testified in support of the draft
legislation and discussed VA's CARES plan, to improve both
access and quality for veterans' medical care. Mr. Nau and Mr.
Samic testified in support of giving VA authorization to use
the proceeds from the transfer of real property for maintenance
and adaptive re-use of historic properties, but expressed
concern that the legislation lacked established priorities to
ensure that some of the funds would be used for historic
preservation. All of the veterans service organizations
endorsed the establishment of a Capital Asset Fund and the
CARES concept, but cautioned that the proper oversight would be
needed to make certain that VA would use the authority
appropriately.
Subcommittee Markup of H.R. 4768
On July 8, 2004, the Subcommittee on Health met and marked
up H.R. 4768, the Veterans Medical Facilities Management Act of
2004. The bill was reported favorably to the full Committee
(see Full Committee Markup, p. 34).
OVERSIGHT ACTIVITIES
First Session
Staff Site Visit to VA's Conference on Home as the Site of
Care, St. Petersburg, Florida
On February 5, 2003, a majority staff member of the
Subcommittee on Health attended VA's Conference on Home as the
Site of Care. The purpose of the conference was to advance the
use of telemedicine in the VA in the areas of long-term care;
chronic disease management; and mental health.
Under Secretary Robert Roswell stated VA's strategic plan
for long-term care was to triple the number of veterans
receiving home and community based care by 2006. Also, at the
Conference it was announced that a new Office of Care
Coordination would be established at VA's Central Office in
Washington, DC.
Hearing on the Availability and Eligibility for Pharmaceutical
Services Provided by VA
On March 19, 2003, the Subcommittee on Health held an
oversight hearing to examine new proposals for a veterans'
prescription drug benefit to improve access and shorten waiting
times for veterans enrolled in the VA health care system. The
following bills related to this subject were discussed during
the hearing: H.R. 709, the Veterans Prescription Access
Improvement Act, introduced by Honorable Roger F. Wicker of
Mississippi on February 11, 2003; H.R. 372, to authorize
pharmacies of the Department of Veterans Affairs to fill
prescriptions for drugs and medicines written by private
physicians, introduced by Honorable Stephen F. Lynch of
Massachusetts on January 27, 2003; H.R. 240, the Veterans
Prescription Drug Equity Act, introduced by Honorable John L.
Mica of Florida on January 8, 2003; and a draft bill, the
Veterans Prescription Drug Benefits Act of 2003.
Hearing witnesses included: Honorable Lane Evans of
Illinois and Ranking Democratic Member, Committee on Veterans
Affairs; Honorable Stephen F. Lynch of Massachusetts; Honorable
John L. Mica of Florida; Honorable Roger F. Wicker of
Mississippi; and Honorable Anthony J. Principi, Secretary of
Veterans Affairs. Honorable Nancy L. Johnson of Connecticut
submitted testimony for the record.
Under current law, VA does not offer prescription drugs as
a direct benefit, but rather as a part of its overall health
care benefits package to enrolled veterans. Current VA policy
requires veterans to be evaluated first by a VA health care
provider before a medication may be dispensed. According to VA,
these policies and practices for providing prescription drugs
to enrolled veterans are necessary for patient safety and
quality care. The VA Office of Inspector General questioned
these restrictions in a report, Audit of Veterans Health
Administration (VHA) Pharmacy Co-Payment Levels and
Restrictions on Filling Privately Written Prescriptions for
Priority Group 7 Veterans, OIG Report Number 99-00057-4,
December 20, 2000.
The Committee examined the decision issued by Secretary
Principi on January 17, 2003, ending enrollment of new Priority
8 veterans for the remainder of fiscal year 2003. The Secretary
explained his decision to restrict Priority 8 veterans from
enrolling as a consequence of a budget shortfall, the pressures
of greater demand for VA health care from higher-income
veterans and the lack of a meaningful drug benefit for many
senior citizens.
Secretary Principi testified that the Department would work
closely with the Committee to find a solution to the problem of
waiting lists and offered a limited program under which VA
would fill prescriptions written for veterans by non-VA
physicians. Under this limited program, enrollees could have
prescriptions filled if they were unable to obtain timely
services from VA. On July 24, 2003, subsequent to this hearing,
VA announced a short-term policy to allow certain veterans to
receive a transitional pharmacy benefit.
Hearing on the Status of the Implementation of Public Law 107-
287, the Department of Veterans Affairs Emergency Preparedness
Act of 2002; and Deployment Health Care for Veterans
On March 27, 2003, the Subcommittee on Health held a
hearing to review the status of VA and DOD readiness roles to
meet the challenges presented by bioterrorism, weapons of mass
destruction, combat injuries and combat-related illnesses. VA's
requirement to provide DOD with wartime casualty back-up and
post-deployment health care services was also a topic.
Witnesses who testified at this hearing included: Honorable
Robert H. Roswell, Under Secretary for Health, VA, accompanied
by Susan Mather MD, M.P.H., Chief Officer, Public Health and
Environmental Hazards; Honorable William Winkenwerder Jr. MD,
M.B.A., Assistant Secretary of Defense for Health Affairs, DOD,
accompanied by Michael E. Kilpatrick M.D., Deputy Director,
Deployment Health Support Directorate Office of the Deputy
Assistant Secretary of Defense for Force Health Protection and
Readiness; John D. Shanley, MD, Director Division of Infectious
Disease, University of Connecticut Health Center, Connecticut
State Chair in Infectious Disease; Laurence A. Feldman, Ph.D.,
Vice President, University of Medicine and Dentistry of New
Jersey; Harold J. Timboe, MD, M.P.H., Director, Center for
Public Health and Biomedical Research, University of Texas
Health Science Center at San Antonio; and Thomas E. Turndrup,
MD, F.A.C.E.P., Director, Center for Disease Preparedness,
Department of Emergency Medicine, University of Alabama at
Birmingham.
Also, the Subcommittee received testimony from Mr. Peter S.
Gaytan, Principal Deputy Director Veterans Affairs and
Rehabilitation Commission, The American Legion; Mr. Adrian M.
Atizado, Associate National Legislative Director, Disabled
American Veterans; Mr. Carl Blake, Associate Legislative
Director, Paralyzed Veterans of America; Mr. Richard Weidman,
Director of Government Relations, Vietnam Veterans of America;
and Mr. Dennis Cullinan, Director of National Legislative
Service, Veterans of Foreign Wars; and Mr. Richard Jones,
National Legislative Director, AMVETS, submitted a statement
for the record.
Dr. William Winkenwerder testified that military personnel
are trained and equipped to operate in a contaminated
environment and to deploy medical capabilities to evacuate and
treat casualties. The Subcommittee heard testimony about pre-
and post-deployment health screening, and the continuum of
medical services from active duty through transition to veteran
status.
Dr. Robert Roswell testified on matters relating to medical
recordkeeping and environmental surveillance. Both Dr.
Winkenwerder and Dr. Roswell testified that there is a need for
VA and DOD to work together to ensure proper health and troop-
movement records are kept and shared for departing service-
members. They both supported the establishment of the four
Medical Emergency Preparedness Centers authorized by Public Law
107-287, the Department of Veterans Affairs Emergency
Preparedness Act of 2002. This law established authority for
four geographically dispersed National Medical Emergency
Preparedness Centers under VA jurisdiction. The law was
intended to ensure that VA programs include expertise in the
care of injuries and illnesses from exposures to the hazards of
combat. The war on terrorism includes possible enemy uses of
biological, chemical, incendiary and nuclear weapons. The
enacted authority for these centers is consistent with VA's
``fourth mission,'' to provide health care and contingency
support to DOD in times of war and national emergencies.
Veterans' service organizations that testified unanimously
agreed on the need to fund and operate the centers. Witnesses
representing academic institutions from New Jersey, Alabama,
and Texas, specializing in biomedical research and medicine
each concurred that funding the Medical Emergency Preparedness
Centers was critical.
Hearing on Medical and Prosthetic Research Programs in VA
On Thursday, April 10, 2003, the Health Subcommittee held a
hearing to assess the status of medical and prosthetic research
programs in VA.
Witnesses appearing before the Subcommittee included
Honorable James R. Langevin of Rhode Island; Nelda P. Wray, MD,
MPH, Chief Research and Development Officer, Office of Research
and Development, Veterans Health Administration (VHA),
accompanied by Mindy Aisen, MD, Director, Rehabilitation
Research and Development; John G. Demakis, MD, Director, Health
Services Research and Development; and Fred S. Wright, MD,
Associate Chief of Staff for Research, VA Connecticut
Healthcare System; Eileen Lennon, Ph.D., Chairman, National
Association of Veterans' Research and Education Foundations
(NAVREF), accompanied by Ms. Barbara West, Executive Director;
Ira R. Katz, MD, Ph.D., Professor of Psychiatry, Director,
Section on Geriatric Psychiatry, University of Pennsylvania
Health System; and Kevin C. Dellsperger, MD, Ph.D., Chief of
Staff, Associate Dean for Veterans Affairs, Iowa City VA
Medical Center. Mr. Christopher Reeve, Christopher Reeve
Paralysis Foundation, submitted a letter of support for the
record.
According to VA witnesses, the Department conducts most of
its medical and prosthetic research programs as a complement to
affiliations with medical and health professions schools and
colleges nationwide. While VA research focuses primarily on the
special needs of veterans, it benefits all Americans. VA's
current areas of emphasis include research into aging, chronic
diseases, mental illnesses, substance-use disorders, sensory
losses, trauma-related illnesses, rehabilitation, and health
systems and services improvement.
Representative Langevin testified how VA research in the
area of spinal cord injuries is transferring to the larger
community in the area of cardiovascular technologies to help
improve muscle tone through electrode research. He also noted
VA's record in rehabilitation and employment services for
disabled veterans.
The Subcommittee received testimony from Dr. Katz on the
added value of the eight Mental Illness Research Education and
Clinical Centers (MIRECCs) to their host Networks and the VA
system as a whole. Also, the NAVREF witnesses presented
testimony about their ongoing programs and initiatives,
responded to oversight issues and provided legislative and
policy recommendations for consideration by the Subcommittee.
Staff Site Visit to VA Connecticut Health Care System
On April 14, 2003, majority staff members of the
Subcommittee on Health made a site visit to the VA Connecticut
Health Care System facilities at West Haven, New London, and
Newington. Additionally, staff attended and participated in a
fact-finding meeting at the VA Medical Center (VAMC) in West
Haven, organized by The American Legion for National Commander
Ron Conley. Attendance included representatives from all major
veterans service organizations in Connecticut, and senior staff
from the West Haven VAMC.
Staff Site Visit to VA New England Health Care System
On April 23, 2003, majority staff members of the
Subcommittee on Health made a site visit to the VA New England
Health Care System facilities in Jamaica Plain, West Roxbury,
and Bedford, MA; Portsmouth, NH; and Augusta, ME. The purpose
of the visit was to observe the status of the consolidation of
the West Roxbury and Jamaica Plain facilities, activities of
the Geriatric Research Education and Clinical Center in
Bedford; and the Portsmouth, New Hampshire community-based
outpatient clinic, which is situated at Pease Air Force Base.
This facility is unique in that the VA staff shares this space
with operations units of the New Hampshire National Guard.
The staff visited the Togus VAMC in Augusta, Maine, and
toured its National Cemetery. Two themes raised during visits
to all the major facilities were patient waiting times and
unmet construction needs.
Hearing on Long-Term Care Programs in VA
On Thursday, May 22, 2003, the Subcommittee on Health held
an oversight hearing to examine existing VHA long-term care
programs and expenditures and assess VHA's strategy for
addressing future long-term care needs of aging and disabled
veterans.
Testifying were: Honorable Robert H. Roswell, M.D., Under
Secretary for Health, VA, accompanied by James F. Burris, M.D.,
Chief Consultant for Geriatric and Extended Care; and Ms.
Cynthia A. Bascetta, Director, Veterans' Health and Benefits
Issues, U.S. General Accounting Office (GAO), accompanied by
Mr. Jim Musselwhite, Assistant Director, Health Care.
Testifying on behalf of the veterans service organizations
were Mr. Peter S. Gaytan, Principal Deputy Director, The
American Legion; Mr. Thomas H. Miller, Executive Director,
Blinded Veterans of America; Ms. Joy J. Ilem, Assistant
National Legislative Director, Disabled American Veterans; Mr.
Richard B. Fuller, National Legislative Director, Paralyzed
Veterans of America; and Mr. Paul A. Hayden, National
Legislative Service, Veterans of Foreign Wars.
The veterans service organizations representatives
submitted testimony for the record. Additionally, Mr. Stephen
McConnell, Vice President, Advocacy & Public Policy,
Alzheimer's Association; Mr. Richard Weidman, Director,
Government Relations, Vietnam Veterans of America; and Mr.
Jeremy Chwat, Director of Legislation, Eastern Paralyzed
Veterans Association, submitted statements for the record.
GAO presented testimony based on a report released at the
hearing entitled VA LONG-TERM CARE: Service Gaps and Facility
Restrictions Limit Veterans' Access to Noninstitutional Care,
GAO-03-815T, May 22, 2003. The GAO study revealed that VA's
lack of emphasis on increasing access to noninstitutional long-
term care services continues to contribute to service gaps, and
that individual facility restrictions and practices
inconsistent with Congressional intent serve to further limit
access to VA long-term care.
Staff Site Visit to University of Colorado Fitzsimons Campus
and Denver VA Medical Center
On May 28, 2003, Committee staff of the Subcommittees on
Health and Oversight and Investigations accompanied Honorable
Bob Beauprez of Colorado to meet with representatives of VA,
the United States Air Force, veterans organizations, the
University of Colorado Hospital and Health Sciences Center, and
the State of Colorado to explore the feasibility of sharing
facilities and resources between VA, DOD, and the University on
the Fitzsimons Campus.
The staff also visited the VA Health Administration Center
and met with Colorado State Representative John Witwer, and
Colorado State Senator Bill Owen, to discuss the status of
financing the University's plans at Fitzsimons. The staff also
reviewed the CHAMPVA operations at the VA Health Administration
Center. (CHAMPVA is a health care benefits program for the
spouse or survivor and for the children of a veteran who meets
specific eligibility criteria.)
Staff Oversight of Capital Asset Realignment for Enhanced
Services (CARES) Briefings and CARES Commission Hearings
Throughout the 108th Congress, Committee staff attended
briefings by various officials of VA and its Capital Asset
Realignment for Enhanced Services (CARES) Commission, as well
as public hearings of the CARES Commission, all of which
focused on progressing phases of the CARES process. CARES was a
VA-initiated review of plans to realign its infrastructure to
(a) enhance access to services over the next 20 years and (b)
redirect the cost of maintaining obsolete facilities to
providing additional care to veterans.
On August 11-12, 2003, Health Subcommittee staff attended
the CARES Commission hearing in Baltimore, MD. On August 18-19,
2003, Subcommittee staff reviewed the CARES National Draft Plan
for the consolidation of Wade Park and Brecksville campuses in
Cleveland, toured the facilities, met with key personnel and
attended the CARES Commission hearing in Columbus, OH. Other
staff visits and CARES Commission hearings included: Exton and
Pittsburgh, PA hearings on August 26-28, 2003, and an Orlando,
FL hearing on September 10-11, 2003; CARES Commission
discussions about the results of its site visits, hearings and
written comments received from stakeholders and the public in
Washington, DC, on October 14-16, 2003; and follow-up sessions
of the CARES Commission on November 19-21, 2003, in Washington,
DC.
Staff Site Visit to Salina and Clay Center, Kansas
On September 14, 2003, a majority staff member visited the
VA Outpatient Clinic in Salina, KS, and provided staff
assistance to Honorable Jerry Moran of Kansas at a veterans
health care forum in Clay Center, KS. Attendees included Mr.
Tom Sanders, Director of Wichita Veterans Affairs Medical and
Regional Office Center; Mr. Robert Malone, Director of
Leavenworth and Topeka Veterans Affairs Medical Center; The
American Legion and Post Commanders from ten Kansas counties;
and State officers of the major veterans service organizations.
Hearing on VA Physician and Dentist Compensation Issues
On October 21, 2003, the Subcommittee on Health held a
hearing on VA physician and dentist compensation issues,
including reforms being sought for the current pay system and
consideration of a draft bill proposed by the Secretary in a
letter to the Speaker of the House, dated July 18, 2003.
Witnesses testifying at the hearing were Honorable Robert
H. Roswell, MD, Under Secretary for Health, VA, accompanied by
Ms. Mari A. Horak, Associate Chief Patient Care Services
Officer, Veterans Health Administration; Thomas Joseph Lawley,
MD, Dean, Emory University School of Medicine, representing the
Association of American Medical Colleges; Lactancio D.
Fernandes, MD, F.C.C.P., President Local 1045, American
Federation of Government Employees; Stephen Rosenthal, MD,
President, National Association of VA Physicians and Dentists;
Jacqueline Parthemore, MD, F.A.C.P., Chief of Staff and Medical
Director, VA San Diego Health Care System; Richard Bauer, MD,
Chief of Staff, South Texas Veterans Health Care System; Ms.
Sheila M. Cullen, Medical Director, San Francisco VA Medical
Center; Michael H. Ebert, MD, Chief of Staff, VA Connecticut
Health Care System; Mr. Michael M. Lawson, Director, VA Boston
Health Care System; Michael S. Simberkoff, MD, Executive Chief
of Staff, VA New York Harbor Health Care System.
In addition, the following individuals submitted statements
for the record: Mr. James B. King, Executive Director, AMVETS;
Mr. Delatorro L. McNeal, Executive Director, Paralyzed Veterans
of America; Mr. Robert Wallace, Executive Director, Veterans of
Foreign Wars; and Mr. Thomas H. Corey, President, Vietnam
Veterans of America.
At the hearing, the Subcommittee learned of the problems VA
is facing with increased demand for VA health care, nearly
1,000 vacant physician and dentist positions and an outdated
pay system. The problems and the need for pay reform were
addressed at a national level by Under Secretary Roswell, and
anecdotally by the medical executives from various VA medical
centers and professional organizations.
Second Session
Staff Site Visit to East Orange Campus of the VA New Jersey
Health Care System
On January 15, 2004, majority staff members visited the
East Orange, NJ VA Medical Center. The purpose of the visit was
to discuss maintenance or improvement the medical center's
physical plant, which houses the only VA tertiary care health
care facility in New Jersey.
East Orange is a medical and surgical tertiary care
facility. While some areas of the hospital have been
modernized, the age and design of the facility would make
renovation expensive. However, a clinical addition could
address a number of the problems noted during this visit. VA
officials were encouraged to consider modernization of the East
Orange facility to make it comparable to other VA facilities
with similar missions.
Staff Site Visit to Explore the Feasibility of a Joint Venture
with the Ralph H. Johnson VA Medical Center (VAMC), the Medical
University of South Carolina and the Naval Hospital Charleston
On Monday, February 23, 2004, a majority staff member
accompanied Honorable Henry E. Brown, Jr., Chairman of the
Benefits Subcommittee to a meeting he requested in Charleston,
South Carolina, to explore the feasibility of the Charleston VA
Medical Center (VAMC) sharing facilities and resources with
Medical University of South Carolina, in consultation with the
Naval Hospital Charleston.
Attending the meeting were: Mr. William Mountcastle,
Director of the Charleston VAMC and Ms. Linda Watson; Medical
University of South Carolina representatives included: Dr. Jack
Feussner, Chairman of the Department of Medicine, Dr. John
Raymond, Vice President for Academic Affairs and Dr. Jerry
Reeves, Dean of the College of Medicine (Mr. Layton McCurdy, a
member of the CARES Commission); DOD: Captain Greg Hall, the
Executive Officer of the Naval Hospital Charleston. The
discussions revealed that the Medical University of South
Carolina is proceeding with plans for a major redevelopment of
the site for its own purposes, but it remained to be determined
if VA would have a role.
Hearing on the Status of VA Post-Traumatic Stress Disorder
(PTSD) Programs
On March 11, 2004, the Subcommittee on Health held a
hearing on the status of VA post-traumatic stress disorder
(PTSD) programs for veterans and on the role of chaplains in
providing pastoral care for veterans with mental health
problems.
The witnesses who testified at the hearing included:
Honorable Robert H. Roswell, MD, Under Secretary for Health,
VA, accompanied by Alfonso R. Batres, Ph.D., MSW, Chief
Officer, Readjustment Counseling Service, and Laurent S.
Lehmann, MD, Chief Consultant, Mental Health Strategic Health
Care Group; Thomas Horvath, MD, Chief of Staff, Michael E.
DeBakey Veterans Affairs Medical Center; Terence Keane, Ph.D.,
Director, Behavioral Science Division, National Center for
PTSD; Harold Kudler, MD, Co-Chair, Under Secretary for Health's
Special Committee on PTSD, Durham VA Medical Center; Chaplain
Robert W. Mikol, Clinical Chaplain, Lyons Campus of the VA New
Jersey Health Care System; and Father Philip G. Salois,
Veterans Integrated Service Network 1, Chaplain Program
Manager, VA Boston Health Care System; Lieutenant Colonel
Kenneth Brown, Chaplain, United States Army; Lieutenant Charles
E. Hodges, Chaplain Corps, United States Naval Reserve;
Commander Mark Andrew Jumper, Staff Chaplain, United States
Coast Guard Academy; and Sally Satel, MD, Resident Scholar, The
American Enterprise Institute.
Submitting statements for the record were: Matthew J.
Friedman, MD, Ph.D., Executive Director, National Center for
PTSD; Mr. Richard Jones, National Legislative Director, AMVETS;
Mr. David Gorman, Executive Director, Disabled American
Veterans; Mr. Delatorro L. McNeal, Executive Director,
Paralyzed Veterans of America; Mr. Robert Wallace, Executive
Director, Veterans of Foreign Wars; and Mr. Thomas H. Corey,
President, Vietnam Veterans of America.
VA witnesses testified that PTSD is a mental health
disorder that may occur from exposure to a traumatic event
involving the threat of imminent death or injury. In the
military, it is the most prevalent mental disorder arising from
combat, peacekeeping and humanitarian missions, and acts of
terrorism.
The witness panels indicated that the toll of PTSD on the
individual often results in many problems including
unemployment, family violence, broken marriages, substance
abuse, homelessness and incarceration. The Veterans Benefits
Administration reported 214,546 unique veterans with a PTSD
diagnostic code as of December 2003. Of that total, 200,146
were in receipt of VA compensation and 14,400 were in receipt
of pension.
One expert witness, Dr. Sally Satel, cautioned that as we
try to help the soldiers of Operation Iraqi Freedom meld back
into society, it would be a mistake to rely too heavily on the
conventional wisdom about Vietnam. Dr. Satel's testimony
acknowledged that some soldiers will return from Iraq and
Afghanistan with severe psychological problems and require
appropriate care. She also pointed out that receiving
disability payments can provide an economic incentive to
maintain dysfunction and could be the route to further
disability and isolation, when a return to work might offer the
best therapy.
The Subcommittee also heard personal accounts from a panel
of chaplains, who provide pastoral care to veterans and active
duty members, helping them to deal with the stress and
psychological trauma that may result from combat. Chaplains
serve as key members of treatment teams in VA health care
delivery programs. In the military services, chaplains serve on
the front lines and are often first responders in order to
provide pastoral care.
Hearing on VA Providing Certain Veterans with A Prescription-
Only Health Care Benefit
On March 30, 2004, the Subcommittee on Health held a
hearing on VA providing certain veterans with a prescription-
only health care benefit. The Subcommittee received testimony
on the results of VA's survey of veterans concerning a
potential prescription-only health benefit and a status report
on the implementation of VA's ``transitional pharmacy benefit''
announced on July 24, 2003.
Witnesses included: Jonathan Perlin, MD, Deputy Under
Secretary for Health, VA, accompanied by Mr. Michael A.
Valentino, Chief Consultant, Pharmacy Benefits Management, and
Ms. Barbara Manning, Veterans Health Administration Policy and
Forecasting Service; Cornelio R. Hong, MD, F.A.C.P., Norwich
Internal Medicine; Mr. Edward S. Banas, Sr., National
Commander, Veterans of Foreign Wars; Mr. Rick Weidman,
Director, Government Relations, Vietnam Veterans of America;
Mr. Carl Blake, Associate Legislative Director, Paralyzed
Veterans of America; Ms. Joy J. Ilem, Assistant National
Legislative Director, Disabled American Veterans; Mr. Peter S.
Gaytan, Principal Deputy Director Veterans Affairs and
Rehabilitation Division, The American Legion; Jr.; Mr. Richard
Jones, National Legislative Director, AMVETS. Submitting for
the Record: Mr. John Gage, National President, American
Federation of Government Employees.
Public Law 108-199, the Consolidated Appropriations Act,
2004, authorized VA to dispense prescription drugs to enrolled
veterans with privately written prescriptions based on
requirements established by the Secretary, provided the
implementation of the program incurs no additional cost to VA.
The Conference Report accompanying the law, House Report 108-
401, further directed the Secretary to collect and
independently verify data on the costs and benefits of this new
drug benefit and submit a report to the Committee on
Appropriations by March 2, 2004, detailing the number of
veterans who would utilize such benefit, as well as costs or
savings to the VA. As directed by Congress, VA conducted a
survey to assess the potential demand and cost of a
prescription-only health care benefit. The survey was completed
in February 2004. VA testified at this hearing on its results.
The Subcommittee received testimony about providing
veterans with a new cost-neutral prescription drug benefit that
would provide medications to veterans at cost with a marginal
administrative markup in price. The cost to the government
would be offset by veterans, who would benefit from VA's large
scale purchasing power by paying VA costs for medications
rather than drug store prices. The VFW Pharmacy Fairness Act, a
draft bill presented by the Commander in Chief of the Veterans
of Foreign Wars, Mr. Edward S. Banas, Sr., was another approach
discussed at the hearing. This bill proposed to ease waiting
times, reduce redundancy and improve access to veterans with a
change in VA's outpatient prescription benefit by requiring VA
to fill prescriptions written by licensed, non-VA physicians
for Medicare-eligible veterans.
Field Hearing on the Status of Military and VA Health Care
Coordination, including Post-Deployment Health Care of Recently
Discharged Veterans
On April 13, 2004, the Subcommittee on Health held a field
hearing in San Antonio, Texas. The hearing focused on the
status of coordinating efforts between the military and VA
health care, including the post-deployment health care of
recently discharged veterans.
Witnesses at the hearing included: Mr. Jose R. Coronado,
Director, VA South Texas Veterans Health Care System,
accompanied by Richard Bauer, MD, Chief of Staff of the VA
South Texas Veterans Health Care System; Ms. Janeth Del Toro,
NP, VA South Texas Veterans Health Care System; Raul Aguilar,
MD, Chief Medical Officer, McAllen Outpatient Clinic, VA South
Texas Veterans Health Care System; Brigadier General C. William
Fox, Jr., Commander, Brooke Army Medical Center, accompanied by
Colonel Bernard L. DeKoning, Commander, Darnall Army Community
Hospital, Fort Hood, TX; Lieutenant Colonel Lee Cancio, M.D.,
Chief, Burn Center, Brooke Army Medical Center; Brigadier
General Charles B. Green, Commander, 59th Medical Wing, Wilford
Hall Medical Center, Lackland AFB, TX, and Lead Agent, TRICARE
Region 6; Lieutenant Colonel Brian J. Masterson, MD, Chief
Information Officer, Wilford Hall Medical Center, Lackland AFB,
Texas; Stephen L. Holliday, Ph.D., ABPP, President, Association
of VA Psychologist Leaders; Mr. Ignacio Leija, American GI
Forum, National Veterans Outreach Program; Mr. Douglas Herrle,
Disabled American Veterans, accompanied by Mr. William Morin;
and Mr. Richard Holloway, The American Legion.
According to witnesses, the large concentration of military
and VA health resources in the area afford San Antonio a
promising setting for coordination between DOD and VA. The
delivery of post-deployment health care to veterans was
discussed at this hearing.
Among four medical facilities in the San Antonio area (the
Audie L. Murphy Memorial Veterans Hospital, the Kerrville VA
Medical Center, and their associated community clinics), almost
1,200 casualties of the global war on terrorism had been
treated as of the date of the hearing. One such casualty, Staff
Sergeant Canady, accompanied the Commander of Brooke Army
Medical Center, Brigadier General C. William Fox, Jr., to give
a first-hand account about the services that have been
coordinated and rendered between DOD and VA on his behalf.
Site Visit to Northern Arizona Health Care System
On April 16, 2004, majority staff members visited the
Prescott VA Medical Center and attended the ceremony to name
the facility in honor of the late Bob Stump, who served as
Chairman of the Veterans' Affairs Committee from 1995-2000. The
Secretary of Veterans Affairs, Honorable Anthony J. Principi,
spoke at the dedication ceremony, among other officials and
guests.
Staff Participation in a VA-DOD Conference on the Sharing of
Medical Resources: VA and DOD Explore New Partnerships, New
Orleans, LA
On April 21, 2004, Committee staff participated in a panel
discussion entitled ``Lessons Learned.'' Other conference
participants included VA, DOD, OMB and GAO staff. The purpose
of the conference was to provide a forum for discussion of the
status of VA-DOD health resources sharing under Public Law 97-
174, Veterans' Administration and Department of Defense Health
Resources Sharing and Emergency Operations Act. Staff members
offered their perspectives on changes made to that basic
mandate by Public Law 107-314, the Bob Stump National Defense
Authorization Act for Fiscal Year 2003, and discussed
Congressional expectations for further progress.
Staff Site Visit to the VA Outpatient Clinics in Twin Ports and
Chippewa Falls, Wisconsin and the Minneapolis VA Medical Center
On May 26, 2004, a majority staff member, along with staff
from Honorable Russell D. Feingold of Wisconsin's Wausau
district office and Honorable David R. Obey of Wisconsin's
Superior district office, participated with the Minneapolis VA
Medical Center director and several other staff in a site visit
to the Twin Ports, (Superior) WI outpatient clinic.
The itinerary also included a site visit to the Chippewa
Falls outpatient clinic and meetings with the Deputy Director
of Veterans Integrated Service Network 23, VA Midwest Health
Care Network; and Mr. Jimmie L. Coulthard, President of the
Veterans Outreach for the Minnesota Assistance Council for
Veterans, and the private sector initiator of several enhanced-
use leases with VA to build housing projects for homeless
veterans in Minneapolis and St. Cloud, Minnesota.
Field Hearing on Optimizing Facilities and Improving Health
Care and Benefit Services to Veterans in the State of
Connecticut
On June 7, 2004, the Subcommittee on Health conducted a
field hearing at the VA Connecticut Healthcare System,
Newington Campus, in Newington, CT. The purpose of the hearing
was to examine VA health care and other benefits provided to
Connecticut veterans.
The following witnesses testified before the hearing:
Jeannette Chirico-Post, MD, Network Director, VA New England
Healthcare System; Mr. Roger Johnson, Director, VA Connecticut
Veterans Healthcare System; Mr. Ricardo Randle, Director, VA
Regional Office, Hartford, CT; Fred Wright, MD, Associate Chief
of Staff for Research, VA Connecticut Veterans Healthcare
System; Karin T. Thompson, APRN, BC, President AFGE
Professional Nurses Union, Local 2138; Colonel William Sobota,
Director of Manpower and Personnel (JI), Connecticut Army
National Guard; Captain J. A. Bashford, Deputy Naval Health
Care New England, Naval Ambulatory Care Center; Mr. Rick Sapp,
VA Legal Instruments Examiner, Fort Drum, New York; Mrs.
Michelle Will, Enrollment Coordinator, VA Connecticut
Healthcare System; Mr. Edmund J. Burke, Secretary/Treasurer,
Connecticut Veterans Coalition Forum; Mr. Paul J. Pobuda,
Department Service Officer, The American Legion Department of
Connecticut, Mr. Donald Johnson, National Service Officer,
AMVETS Department of Connecticut; Mr. Allen Gumpenberger,
National Service Officer Disabled American Veterans Department
of Connecticut; Mr. Glen Tewksbury, Department Service Officer
Veterans of Foreign Wars Department of Connecticut. Dr. Linda
Spoonster Schwartz, R.N., Dr.PH, Commissioner, Connecticut
Department of Veterans Affairs also testified at the hearing.
Honorable Ciro Rodriguez, Ranking Member of the
Subcommittee, Honorable Christopher Shays of Connecticut and
Mr. Eliott Ginsberg, representing Honorable John Larson of
Connecticut, joined Honorable Rob Simmons, Chairman of the
Subcommittee, at this hearing.
The hearing focused on the ``Connecticut Model'' of
delivering VA health care and benefit services. Witnesses
testified about the developing relationships among VA, the
Connecticut Department of Veterans Affairs, local military
facilities and State veterans organizations, the importance of
working together, and sharing facilities and resources to
benefit Connecticut veterans. The collocation of the VA
Regional Office in Hartford to the Newington campus and the
collaboration between VA Connecticut and the Rocky Hill State
Veterans' Home were also discussed at the hearing.
Staff Site Visit to the Grand Opening of the Community Hope
Transitional Housing Program at the Lyons Campus of the VA New
Jersey Health Care System
On December 3, 2004, Community Hope, Inc., a private non-
profit organization celebrated the grand opening of its Hope
for Veterans, the largest and most comprehensive transitional
housing and recovery program for homeless veterans in New
Jersey. This 75-bed facility is located in a newly renovated,
once-vacant Building 53 on the Lyons campus of the VA New
Jersey Health Care System. A majority staff member participated
in the opening ceremonies, along with more than 100 attendees,
including Honorable Rodney P. Frelinghuysen of New Jersey;
Federal, state and county officials; financial supporters of
the project and various veterans' organizations.
Subcommittee on Benefits
The Subcommittee on Benefits has legislative, oversight and
investigative jurisdiction over compensation, general and
special pensions of all the wars of the United States, life
insurance issued by the Government on account of service in the
Armed Forces, cemeteries of the United States in which veterans
of any war or conflict are or may be buried, whether in the
United States or abroad, except cemeteries administered by the
Secretary of the Interior, burial benefits, education of
veterans, vocational rehabilitation, veterans' housing
programs, readjustment of servicemen to civilian life, and
soldiers' and sailors' civil relief (see Oversight Plan for
108th Congress, p. 91).
LEGISLATIVE ACTIVITIES
First Session
Hearing on H.R. 241, H.R. 533, H.R. 761, H.R. 850, H.R. 966,
and H.R. 1048
On April 10, 2003, the Subcommittee held a legislative
hearing on the following bills: H.R. 241, the Veterans
Beneficiary Fairness Act of 2003, introduced by Honorable
Christopher H. Smith of New Jersey on January 8, 2003; H.R.
533, the Agent Orange Veterans' Disabled Children's Benefits
Act of 2003, introduced by Honorable Lane Evans of Illinois on
February 5, 2003; H.R. 761, the Disabled Servicemembers Adapted
Housing Assistance Act of 2003, introduced by Honorable Lane
Evans of Illinois on February 13, 2003; H.R. 850, the Former
Prisoners of War Special Compensation Act of 2003, introduced
by Honorable Michael K. Simpson of Idaho on February 13, 2003;
H.R. 966, the Disabled Veterans Return-to-Work Act of 2003,
introduced by Honorable Henry E. Brown, Jr., of South Carolina
on February 27, 2003; and H.R. 1048, the Disabled Veterans
Adaptive Benefits Improvement Act of 2003, introduced by
Honorable Henry E. Brown, Jr., of South Carolina on March 4,
2003.
Witnesses included Honorable Michael K. Simpson; Honorable
Daniel L. Cooper, Under Secretary for Benefits, Veterans
Benefits Administration, accompanied by Mr. John Thompson,
Deputy General Counsel, Department of Veterans Affairs, and Mr.
Ron Henke, Director, Compensation and Pension Service, Veterans
Benefits Administration; Mr. Peter S. Gaytan of The American
Legion; Mr. Rick Surratt of the Disabled American Veterans; Mr.
Paul Hayden of the Veterans of Foreign Wars; Mr. Leslie Jackson
of the American Ex-Prisoners of War; and Mr. Carl Blake of the
Paralyzed Veterans of America.
Representative Simpson testified in support of his bill,
H.R. 850. The veterans service organization witnesses supported
the legislation before the Subcommittee, except section 3 of
H.R. 850, which would overturn the decision in Allen v.
Principi, 268 F. 3d 1340 (Fed. Cir. 2001) by prohibiting VA
from allowing secondary service-connected compensation for
disabilities associated with substance abuse caused by a
primary service-connected condition. This legislative proposal
was included in the President's 2004 budget submission. The
Administration supported H.R. 241 and H.R. 761, but opposed or
otherwise had reservations about the other bills on the agenda.
Hearing on H.R. 1460, H.R. 1712, and H.R. 1716
On April 30, 2003, the Subcommittee held a legislative
hearing on the following bills: H.R. 1460, the Veterans
Entrepreneurship Act of 2003, introduced by Honorable Rick
Renzi of Arizona on March 27, 2003; H.R. 1712, the Veterans
Federal Procurement Opportunity Act of 2003, introduced by
Honorable Lane Evans of Illinois on April 10, 2003; and H.R.
1716, the Veterans Earn and Learn Act, introduced by Honorable
Christopher H. Smith of New Jersey and Honorable Lane Evans of
Illinois on April 10, 2003.
Witnesses included Honorable Rick Renzi; Honorable Leo S.
Mackay, Jr., Ph.D., Deputy Secretary, VA, accompanied by
Honorable Tim S. McClain, VA General Counsel, Mr. Scott F.
Denniston, Director, Office of Small & Disadvantaged Business
Utilization, Honorable William Campbell, Assistant Secretary
for Management, and Mr. Robert Epley, Associate Deputy Under
Secretary for Policy and Program Management, Veterans Benefits
Administration; Mr. George H. Bliss, III, United Association of
Plumbers and Pipefitters; Mr. William D. Stephens, National
Association of State Approving Agencies; Mr. Chad Schatz,
National Association of State Approving Agencies; and Ms. Ann
Sullivan, Women Impacting Public Policy , Inc; Ms. Angela B.
Styles, Administrator, Office of Federal Procurement Policy,
Office of Management and Budget, accompanied by Mr. William D.
Elmore, Associate Administrator, Office of Veterans Business
Development, Small Business Administration, and Mr. Fred C.
Armendariz, Associate Deputy Administrator, Government
Contracting and Business Development, SBA; Major General
Charles R. Henry (USA, Retired), President and CEO, National
Veterans Business Development Corporation; Mr. John K. Lopez,
Association for Service Disabled Veterans; Mr. Donald T.
Wilson, Association of Small Business Development Centers; Mr.
James R. Krempasky, Western Fire, Inc.; Mr. Robert G. Hesser,
HI Tech Services, Inc; Mr. Blake Ortner, Paralyzed Veterans of
America; Mr. Brian E. Lawrence, Disabled American Veterans; Mr.
Peter S. Gaytan, The American Legion; and Mr. Richard Jones,
AMVETS.
Representative Renzi testified in support of his bill, H.R.
1460. The veterans service organizations supported all three
bills. The building and construction trades represented by Mr.
Bliss and the National Association of State Approving Agencies
testified on H.R. 1716, with general support for the bill. Mr.
Wilson, Mr. Krempasky, Mr. Hesser, and General Henry testified
in support of H.R. 1460 and H.R. 1712. The Administration
witnesses testified in support of H.R. 1460 and H.R. 1716 but
expressed concerns over cost implications, and opposed certain
provisions contained in H.R. 1712.
Subcommittee Markup of H.R. 241, H.R. 761, H.R. 1257, H.R.
1460, H.R. 1683, and H.R. 1949
On May 7, 2003, the Subcommittee met and marked up six
bills: H.R. 241; H.R. 761; H.R. 1257; H.R. 1460, with an
amendment; H.R. 1683; and H.R. 1949. All six bills were
reported favorably to the full Committee (see Full Committee
Markup, p. 33).
Hearing on H.R. 886, H.R. 1167, H.R. 1500, H.R. 1516, H.R.
2163, H.R. 2164, H.R. 2285, and H.R. 2297
On June 11, 2003, the Subcommittee held a legislative
hearing on the following bills: H.R. 886, to provide for the
payment of dependency and indemnity compensation to the
survivors of former prisoners of war who died on or before
September 30, 1999, introduced by Honorable Tim Holden of
Pennsylvania on February 23, 2003; H.R. 1167, to permit
remarried surviving spouses of veterans to be eligible for
burial in a national cemetery, introduced by Honorable Heather
Wilson of New Mexico on March 6, 2003; H.R. 1500, the Veterans'
Appraiser Choice Act, introduced by Honorable Adam Smith of
Washington on March 27, 2003; H.R. 1516, to direct the
Secretary of Veterans Affairs to establish a national cemetery
for veterans in southeastern Pennsylvania, introduced by
Honorable Jim Gerlach of Pennsylvania on March 31, 2003; H.R.
2163, to exclude the proceeds of life insurance from
consideration as income for purposes of determining veterans'
pension benefits, introduced by Honorable Jeb Bradley of New
Hampshire on May 20, 2003; H.R. 2164, to provide for an
extension in the period of eligibility for survivors' and
dependents' education benefits for members of the National
Guard who are involuntarily ordered to full-time National Guard
duty, introduced by Honorable Jeb Bradley of New Hampshire on
May 20, 2003; H.R. 2285, to require the Secretary of Labor to
provide staffing at military installations overseas under the
Transition Assistance Program, introduced by Honorable Michael
K. Simpson on June 2, 2003; and H.R. 2297, to modify and
improve certain benefits for veterans, introduced by Honorable
Christopher H. Smith of New Jersey and Honorable Lane Evans of
Illinois on June 2, 2003.
Witnesses included Honorable Michael K. Simpson; Honorable
Tim Holden; Honorable Jeb Bradley; Honorable Jim Gerlach;
Honorable Rick Larsen of Washington, on behalf of Honorable
Adam Smith; Honorable Heather Wilson; Honorable John Molino,
Deputy Assistant Secretary of Defense, Military, Community and
Family Policy; Honorable Frederico Juarbe, Jr., Assistant
Secretary for Veterans' Employment and Training Service,
Department of Labor, who was accompanied by Mr. Gordon Banks,
Director of Operations, Veterans' Employment and Training
Service; Mr. Robert Epley, Associate Deputy Under Secretary for
Policy and Program Management, Veterans Benefits
Administration, who was accompanied by Mr. John Thompson,
Deputy General Counsel, Department of Veterans Affairs, and Mr.
Dick Wannamacher, Senior Advisor, National Cemetery
Administration.
The Members of Congress testified in support of their
respective bills before the subcommittee. Mr. Juarbe of the
Veterans' Employment and Training Service opposed H.R. 2285 as
not necessary at this time; he stated that the Department of
Labor was in the process of establishing a presence at military
installations. Mr. Molino of the Department of Defense deferred
to the Department of Labor, but stated that a meeting was
scheduled to discuss establishing a Transition Assistance
presence overseas. Mr. Epley of the Veterans Benefits
Administration supported the bills under consideration, except
H.R. 1500 and H.R. 886. Mr. Epley testified that H.R. 1500
would inhibit the ability of the Department to maintain an
independent appraisal process, and under current law veterans
have the ability to select another appraiser if they are not
satisfied with the valuation performed by the VA-selected
appraisal; the Administration did not support H.R. 886 because
the proposal was not included in the President's 2004 budget.
Subcommittee Markup of H.R. 1516 and H.R. 2297
On June 25, 2003, the Subcommittee met and marked up two
bills: H.R. 1516, with amendments; and H.R. 2297, with
amendments. Each bill was reported favorably to the full
Committee (see Full Committee Markup, p. 33).
Second Session
Hearing on H.R. 348, H.R. 843, H.R. 1735, H.R. 2206, H.R. 2612,
H.R. 3936, H.R. 4065, H.R. 4172, H.R. 4173, and a Draft Bill
On April 29, 2004, the Subcommittee on Benefits held a
hearing on H.R. 348, the Prisoner of War Benefits Act of 2004,
introduced by Honorable Michael Bilirakis of Florida on January
27, 2003; H.R. 843, the Injured Veterans Benefits Eligibility
Act of 2003, introduced by Honorable Silvestre Reyes of Texas
on February 13, 2003; H.R. 1735, to increase the maximum VA
home loan guarantee introduced by Honorable Susan A. Davis of
California on April 10, 2003; H.R. 2206, the Prisoner of War/
Missing in Action National Memorial Act, introduced by
Honorable Ken Calvert of California on May 22, 2003; H.R. 2612,
the Veterans Adapted Housing Expansion Act of 2003, introduced
by Honorable Michael H. Michaud of Maine on June 26, 2003; H.R.
3936, to authorize the principal office of the United States
Court of Appeals for Veterans Claims to be at any location in
the Washington, DC, metropolitan area, introduced by Honorable
Christopher H. Smith of New Jersey and Honorable Lane Evans of
Illinois on March 11, 2004; H.R. 4065, the Veterans Housing
Affordability Act of 2003, introduced by Honorable Ginny Brown-
Waite of Florida on March 30, 2004; H.R. 4172, to codify
certain diseases as a presumption of service-connection for
veterans exposed to ionizing radiation introduced by Honorable
Lane Evans of Illinois on April 20, 2004; H.R. 4173, to direct
the Secretary of Veterans Affairs to contract for a report on
employment placement, retention, and advancement of recently
separated servicemembers, introduced by Honorable Michael H.
Michaud of Maine and Honorable Henry E. Brown, Jr., on April
20, 2004; and a draft bill to create an open period for active
duty servicemembers who declined to participate in the Post-
Vietnam Era Veterans' Educational Assistance Program to elect
to participate in the program of basic educational assistance
under the Montgomery GI Bill.
Witnesses included: Honorable Kenneth B. Kramer, Chief
Judge, United States Court of Appeals for Veterans Claims;
Honorable Michael Bilirakis; Honorable Ken Calvert; Honorable
Michael H. Michaud; Honorable Ginny Brown-Waite; Honorable
Susan A. Davis; Honorable Silvestre Reyes; Mr. Robert Epley,
Associate Deputy Under Secretary for Policy and Program
Management, Veterans Benefits Administration, accompanied by
Mr. John Thompson, Deputy General Counsel, VA; Mr. William
Carr, Acting Deputy Undersecretary of Defense for Military
Personnel Policy, DOD; Mr. F. Paul Dallas, American Ex-
Prisoners of War; Mr. Richard Jones, AMVETS; Mr. Carl Blake,
Paralyzed Veterans of America; Mr. John McNeill, Veterans of
Foreign Wars; Mr. Brian Lawrence, Disabled American Veterans;
and Ms. Cathleen Wiblemo, The American Legion.
The Members of Congress testified in support of their
respective bills. Chief Judge Kramer testified in support of
H.R. 3936. Mr. Epley testified in support of many of the bills
on the agenda, but opposed H.R. 843. Mr. Epley testified that
while the Department of Veterans Affairs supported the concepts
of H.R. 1735 and H.R. 4065, they were reserving opinion on
these two bills until VA could conclude a review of the results
of an independent evaluation of the VA Home Loan program. The
veterans service organization representatives either supported
or did not oppose the bills on the agenda.
Subcommittee Markup of H.R. 1716, H.R. 3936, H.R. 4175, and
H.R. 4345
On May 13, 2004, the Subcommittee met and marked up four
bills: H.R. 1716, with amendments; H.R. 3936; H.R. 4175, with
amendments; and H.R. 4345 (see Full Committee Markup, p. 34).
Hearing on H.R. 4032 and a Draft Bill
On June 16, 2004, the Subcommittee held a hearing on H.R.
4032, the Veterans Fiduciary Act of 2004, introduced by
Honorable Susan A. Davis of California on March 25, 2004; and a
draft bill, the Veterans Self-Employment Act of 2004.
Witnesses included Mr. Jack McCoy, Director, Education
Service, Veterans Benefits Administration, accompanied by Mr.
Robert Epley, Associate Deputy Under Secretary for Policy and
Program Management at the VA, and Mr. John Thompson, Deputy
General Counsel, Department of Veterans Affairs; Mr. John H.
Pickering, Former Chair, Commission on Law and Aging, American
Bar Association, accompanied by Ms. Nancy Coleman, Director,
Commission on Law and Aging, American Bar Association; Mr. John
Gay, Vice President, Government Relations, International
Franchise Association, accompanied by Mr. James Amos, Jr.,
Chairman Emeritus, Main Boxes Etc. and managing partner of
Eagle Alliance Partners; and Beth Buehlmann, Ph.D., Vice
President and Executive Director, Center for Workforce
Preparation, U.S. Chamber of Commerce.
Mr. McCoy testified that VA has not experienced any
significant problems carrying out the activities of the
Fiduciary Program, and viewed H.R. 4032 as imposing
restrictions and requirements on the program that might be too
broad to warrant VA's unqualified support. Mr. McCoy opposed
the draft bill because, among other things, in his view there
was no record to support expanding veterans' education benefits
for the cost of starting a business. Mr. Pickering supported
the concepts of H.R. 4032, and Mr. Gay and Dr. Buehlmann
supported the draft bill.
OVERSIGHT ACTIVITIES
First Session
Hearing on Troops-to-Teachers Program
On April 9, 2003, the Subcommittee held an oversight
hearing on the Troops-to-Teachers program as administered by
the Department of Defense (DOD) and funded by the Department of
Education (DOE). Troops to Teachers assists program
participants find employment in high-need local educational
agencies or public charter schools. These schools have a
poverty rate of at least 20 percent or serve at least 10,000
poor children and have a high percentage of teachers teaching
outside their specialty or with emergency credentials. A high
percentage of these school districts are found in inner cities.
The hearing highlighted the program's successes and challenges
since it began in 1994, as well as identified issues for future
actions.
Witnesses included Ms. Nina Rees, Deputy Under Secretary
for Innovation and Improvement, Department of Education,
accompanied by Dr. John Gantz, Director, Defense Activity for
Non-Traditional Educational Support, DOD; Dr. Deno Curris,
President, American Association of State Colleges and
Universities; Dr. Nancy Dunlap, Associate Director, School of
Education, Clemson University, accompanied by Dr. Kathy Brown,
Professor, The Citadel; Mr. Don Sweeney, National Association
of State Approving Agencies and Troops to Teachers New England;
Dr. William Harner, Superintendent, Greenville County Schools
(Troops-to-Teachers graduate); and Ms. Sandra Sessoms-Penny,
Assistant Principal, Yorktown, VA (Troops-to-Teachers
graduate).
Ms. Nina Reese testified for the Administration that the
Troops-to-Teachers program ``promotes high standards by
identifying and bringing these talented men and women, and
their top-notch skills and abilities, into our Nation's public
schools.'' However, Ms. Reese stated that many states have
barriers that keep talented individuals from the Troops-to-
Teachers program out of the classroom; DOE and DOD are working
together to try and break down these barriers.
Mr. Don Sweeney suggested, in his testimony, that the
program does not address the needs of the rural areas of
America. Mr. Sweeney offered a legislative proposal to address
this problem.
Hearing on Department of Veterans Affairs' Fiduciary and Field
Examination Activity
On July 16, 2003, the Subcommittee held an oversight
hearing on the Department of Veterans Affairs' Fiduciary
Program, and what improvements have been or need to be made to
protect the incomes and estates of beneficiaries from fraud and
abuse. When VA monetary benefits are payable to an individual
who is incapable of managing his or her own financial affairs,
a third party payee who acts as a fiduciary, is required.
Through the Fiduciary and Field Examination Activity, VA's
Compensation and Pension Service is responsible for protecting
the incomes and estates of these beneficiaries. This includes
monitoring the third party payee and scheduling periodic visits
to the beneficiary to ensure his or her needs are being met. As
of May 31, the Veterans Benefits Administration personnel
supervised the management of funds valued at over $2.7 billion
for 100,157 beneficiaries, to include veterans, widows, adult
helpless children, and minors.
Honorable Richard Griffin, the VA Inspector General,
testified on his office's past audits and reviews of the
Fiduciary and Field Examination Activity; Mr. Ronald Henke,
Director of the Compensation and Pension Service, testified on
the purpose of the program, how it is administered, and
improvements being made as a result of the Inspector General's
findings. Mr. John Pickering, a member of the American Bar
Association and former Chair of the Commission on Law and
Aging, explained the representative payee system at the Social
Security Administration and detailed many of the problems that
exist in both the Social Security Representative Payee program
and VA's Fiduciary Program.
Hearing on the Uniformed Services Employment and Reemployment
Rights Act
On July 24, 2003, the Subcommittee held an oversight
hearing on the Department of Labor's administration of the
Uniformed Services Employment and Reemployment Rights Act
(USERRA). The hearing examined the effect that the law has on
National Guard and Reserve members and their employers.
Witnesses included Second Lieutenant Taylor Adams, 315th
Airlift Wing, Maintenance Squadron, U.S. Air Force Reserve, a
recently returned reservist; Mrs. Michelle Comeau-Dumond, the
wife of a currently-mobilized National Guard member and a
disabled Gulf War veteran; Colonel Robert F. Norton, (USA,
Retired), Co-Chairman of the Veteran's Committee of The
Military Coalition; Mr. John Ryan, Senior Vice President for
Human Resources, Schering-Plough Corporation; Mr. Jim Rouse,
Vice President, Washington Office, ExxonMobil Corporation; Ms.
Susan LaChance, Manager of Selection, Evaluation, and
Recognition, United States Postal Service; Mr. Peter Perez,
Senior Vice President, Human Resources, W.W. Grainger, Inc.;
Lieutenant General Normand Lezy, (USAF-Ret), Vice President,
National Government Relations, Wal-Mart Stores, Inc.; and
Honorable Frederico Juarbe, Jr., Assistant Secretary for
Veterans' Employment and Training Service at the Department of
Labor, accompanied by Colonel Alan R. Smith, Director, Military
Member Support for the National Committee for the Employer
Support of the Guard and Reserve.
Lieutenant Adams testified that he was able to easily make
a smooth transition from active duty to civilian life with the
help of his employer. Mrs. Comeau-Dumond testified that her
family has faced many difficulties since her husband has been
mobilized to Kuwait. Colonel Norton made suggestions on how
USERRA could be improved. The witnesses representing employers
testified about how their corporations or services go beyond
the requirements of the law for their employees who are members
of the Guard and Reserve, including making up any pay
deferential and continuing benefits while the employees are
mobilized.
Secretary Juarbe testified for the Administration and
discussed how the Department of Labor and the National
Committee for the Employer Support of the Guard and Reserve, a
division of the Department of Defense, work closely together as
stewards of the program to assist National Guard and Reserve
Members and employers during times of mobilization.
Hearing on Department of Veterans Affairs' Life Insurance
Program
On September 25, 2003, the Subcommittee held an oversight
hearing on the administration of Department of Veterans Affairs
life insurance programs and operational or policy issues the
Department faces in administering the program.
Mr. Thomas Lastowka, Director, VA Regional Office and
Insurance Center, presented testimony on behalf of the
Department of Veterans Affairs. Mr. Lastowka was accompanied by
Mr. Stephen Wurtz, Deputy Assistant Director for Insurance, and
Mr. Mike Tarzian, Chief, Actuarial Staff. Colonel Virginia
Penrod (USAF), Director of Compensation, Military Personnel
Policy, testified on behalf of the Department of Defense. The
veterans service organizations were represented by Mr. Brian
Lawrence, Assistant National Legislative Director, Disabled
American Veterans; Mr. Donald Mooney, Assistant Director for
Resource Development, The American Legion; Mr. Richard Jones,
National Legislative Director, AMVETS; and Mr. Carl Blake,
Associate Legislative Director, Paralyzed Veterans of America.
The Administration witnesses explained the mechanisms in
administering the seventh largest insurance program in the
United States, and detailed their efforts to make the programs
even more successful. The Insurance Center received an
exemplary score of 90 on the American Customer Satisfaction
Index. The veterans service organization witnesses praised the
insurance programs, and offered legislative recommendations for
enhancing the Service-Disabled Veterans Insurance program and
the Veterans' Mortgage Life Insurance program.
Second Session
Hearing to Receive the Report of the VA Vocational
Rehabilitation and Employment Service Task Force
On April 1, 2004, the Subcommittee held an oversight
hearing to receive the report of the VA Vocational
Rehabilitation and Employment Service Task Force. Honorable
Dorcas R. Hardy, Chairman of the 12-member Task Force,
presented its findings and recommendations.
Chairman Hardy testified that the Task Force proposed more
than 100 recommendations in four board categories-program,
organization, work process, and integrating capacities. Some
program recommendations included: (1) development of new
policies and procedures to implement a new, five-track
employment-driven service delivery system with priority given
to Guard and Reservists in the tracks for reemployment and
rapid access to jobs; (2) acceleration of the delivery of
Chapter 31 rehabilitation services to those veterans in most
critical need; and (3) creation of new staff positions and
staff for an Employment Readiness Specialist and a Marketing
and Placement Specialist to facilitate implementation of a five
track employment-driven service delivery system, as designed by
the Task Force.
The Task Force recommended setting goals and measures of
success to improve the administration of VA's responsibilities
in the Transition Assistance Program and Disabled Transition
Assistance Program (DTAP). The Task Force also recommended VA
reorganize to include dedicated staff in planning and
implementation of VA's responsibilities in the DTAP, and in
executing a consistent, national DTAP program at all DOD
installations and Military Treatment Facilities.
Finally, the Task Force recommended initiating a study of
other Federal, state and private-sector vocational
rehabilitation service organizations to benchmark outcomes,
performance measures, and quality assurance practices.
Hearing on Federal Department and Agency Initiatives to use
Discretionary Set-Aside and Restricted Authorities in
Contracting with Service-Disabled Veteran-Owned Small
Businesses
On July 15, 2004, the Subcommittee held a joint hearing
with the Subcommittee on Workforce, Empowerment, and Government
Programs of the Committee on Small Business, on Federal
department and agency initiatives that would use discretionary
set-aside and restricted authorities established in Public Law
108-183 for contracting with service-disabled veteran-owned
businesses.
Witnesses included Ms. Allegra McCullough, Associate Deputy
Administrator for Government Contracting & Business
Development, U.S. Small Business Administration; Mr. Frank
Ramos, Director for the Office of Small and Disadvantaged
Business, Office of the Secretary of Defense, DOD; Mr. Brad
Scott, Regional Administrator for Region 6, Heartland Region,
General Services Administration; Mr. Scott Denniston, Director
for the Office of Small Business & Center for Veterans
Enterprise, VA; and Ms. Nina Rose Hatfield, Deputy Assistant
Secretary for the Business Management and Wildland Fire,
Department of the Interior, testified on behalf of the
Administration.
Mr. John Lopez, Co-Chairman for the Task Force for Veterans
Entrepreneurship; Mr. Rick Weidman, Chairman for the Task Force
for Veterans Entrepreneurship; Dr. Steven L. Schooner, Co-
Director for the Government Procurement Law Program at The
George Washington University Law School; Mr. Joseph Forney,
President, VetSource, Inc.; and Mr. James Hudson, Marketing
Director for Austad Enterprises, Inc., testified regarding
their experiences with contracting laws and regulations.
Federal departments and agencies now have additional tools
to contract with service-disabled veteran-owned small
businesses. The Subcommittees heard testimony by the agencies
and departments about the steps they are taking to aggressively
use these new contracting tools and their effect together to
develop and implement the regulations for Public Law 108-183 in
an expeditious manner.
Ms. McCullough reported to the Subcommittees that the
percentage of prime contracting dollars that goes to these
businesses is only 0.25 percent. She testified that only three
agencies met or exceeded the 3 percent goal: the National
Endowment for the Arts with 25.27 percent; the Consumer
Products Safety Commission with 4.35 percent; and the Railroad
Retirement Board with 3.44 percent.
The private-sector witnesses representing the veterans'
community testified on the effect of this new law on service-
disabled veteran-owned small businesses and the difficulties
they continue to face. Mr. Hudson, who operates the Veterans
Business Newswire, an e-newsletter sent to more than 25,000
veteran-small business owners, called for more outreach by the
Federal government toward service-disabled veteran-owned small
businesses to encourage more veterans to contract with the
Federal government.
Subcommittee on Oversight and Investigations
The Subcommittee on Oversight and Investigation has
authority over matters that are referred to the subcommittee by
the Chairman of the full Committee for investigation and
appropriate recommendations (see Oversight Plan for 108th
Congress, p. 91).
OVERSIGHT ACTIVITIES
First Session
Hearing on Weapons of Mass Destruction: Is Our Nation's Medical
Community Ready?
On April 10, 2003, the Subcommittee held a follow-up
hearing to assess VA's progress in the development of the
medical education program mandated by Section 3 of Public Law
107-287, the Department of Veterans Affairs Emergency
Preparedness Act of 2002. The hearing also reviewed what role
VA should play in the continuing medical education of current
and future health care professionals. This hearing was a
follow-up to a hearing on November 14, 2001, by the
Subcommittee on Oversight and Investigations to examine what
roles VA and DOD should play in providing our Nation's medical
students with the education and training programs necessary to
diagnose and treat casualties when exposure to biological,
chemical, or radiological agents is suspected.
Witnesses included: Robert H. Roswell, MD, VA Under
Secretary for Health; Mr. Jerome M. Hauer, Acting Assistant
Secretary for the Office of Public Health Emergency
Preparedness, HHS; Mr. Eric Tolbert, Director, Emergency
Preparedness and Response Directorate, Department of Homeland
Security (DHS); John Nelson, MD, Member of the Board of
Trustees, American Medical Association (AMA); and Colonel Maria
Morgan, Deputy Adjutant General, State of New Jersey.
Mr. Hauer stated VA's assistance has been invaluable to the
creation and ongoing maintenance of the Strategic National
Stockpile. The Centers for Disease Control has established
collaborative relationships with other specialty organizations
in an effort to disseminate constituent specific information on
bio-terrorism and other threats. The AMA discussed the idea of
a public-private entity to bridge the gap between medical
community and the public, which would be comprised of key
participants, including DVA and DOD. DHS explained VA's role in
National Disaster Medical System in maintaining the weapons of
mass destruction pharmaceutical caches. DHS also expressed
hopes of being an active partner in the development of
education and training programs in response to weapons of mass
destruction. The Subcommittee also received testimony from the
Deputy Adjutant General of the New Jersey National Guard on its
role in natural and man made disasters.
Hearing on VA's Progress on Third Party Collections
On May 7, 2003, the Subcommittee held its third oversight
hearing on the VA's third party collections process. The
purpose of the hearing was to examine a number of issues facing
VA as it seeks to improve its collections under the Medical
Care Collection Fund program, including the progress it has
made in implementing the Veterans Health Administration's 2001
Revenue Cycle Improvement Plan.
Witnesses included: Leo S. Mackay, Ph.D., Deputy Secretary,
VA; Mr. Robert A Perrault, Director, Veterans Health
Administration Business Office; Ms. Cynthia A. Bascetta,
Director, Veterans' Health and Benefits Issues, GAO,
accompanied by Mr. Michael T. Blair, Assistant Director of
Health Care, GAO; Mr. Joseph Glorioso, Director, Government
Subscriber Relations, Digital Healthcare Inc; Mr. Donald N.
Blanding, Healthcare Information Technology Consultant; and Ms.
Cathy C. Wiblemo, Deputy Director for Health Care, Veterans
Affairs and Rehabilitation Division, The American Legion.
GAO provided an update on VA's third-party collections
since September 2001. According to GAO, VA does not
consistently bill third parties for services it provides to
veterans. Further, GAO stated VA should ensure that veterans
file appropriate and accurate medical insurance claims, and
that all insurance claims are supported by medical record
documentation. The Subcommittee was also informed the VHA
should continue to reduce errors in coding, which lead to
delays or non-payment. VA stated it was implementing the
Patient Financial Services System project in Cleveland, which
would be a comprehensive integration of business processes and
information technology improvements. The Subcommittee should
continue its oversight of third party collections.
Human Subjects Protections in VA Research
On June 18, 2003, the Subcommittee held its fifth oversight
hearing on human subject protection in VA's medical research
programs. The purpose of the hearing was to review three
concerns: (1) the strength of the human subject protections at
VA; (2) the necessity of maintaining an independent oversight
entity that reports directly to the Under Secretary for Health;
and (3) the adequacy of H.R. 1585 in addressing these concerns.
Witnesses included: Ms. Cynthia Bascetta, Director,
Veterans' and Benefits Issues, GAO; Greg Koski, Ph.D., MD,
Senior Scientist, Institute for Health Policy; Robert H.
Roswell, M.C., VA Under Secretary for Health; accompanied by:
Nelda P. Wray, MD, Chief Research and Development Officer; John
H. Mather, MD, Special Assistant to the Under Secretary for
Health; and David A. Weber, Ph.D.
GAO testified that the VA had taken insufficient actions to
strengthen its human subjects protection systems since GAO
originally made recommendations in September of 2000. GAO was
critical of VA's reorganization of its headquarters research
offices which lacked adequate planning and notification. Dr.
Koski emphasized the need to create an autonomous oversight
office within VA as an important step toward ensuring the
integrity of its human research programs. Under Secretary
Roswell discussed actions taken since a VA research stand-down
ordered on March 6, 2003. As a result, the Program for Research
Integrity Development and Educations within the Office of
Research was established. Under Secretary Roswell also stated
that the newly established Office of Research Oversight would
be responsible for oversight of compliance with policy,
regulations, law, and ethics.
Hearing on Force Protection: Lesson Learned and Applied from
the First Gulf War.
On July 9, 2003, the Subcommittee on Oversight and
Investigations held a hearing on medical protections for
deployed DOD personnel. The purpose of the hearing was to
review the pre-and post-deployment medical protection of troops
deployed to Afghanistan and the Persian Gulf Region.
Specifically, the hearing provided an assessment of what health
protections were provided to troops deployed to the Gulf Region
and what measures the DOD took to protect service-members from
possible exposure to biological, chemical, and environmental
agents. The Subcommittee also was interested in learning what
medical data was collected by DOD because such information
assists VA in making its future determinations of eligibility
for benefits.
Witnesses included: Dr. William Winkenwerder, Assistant
Secretary of Defense for Health Affairs; Dr. Jonathan B.
Perlin, Deputy Under Secretary for Health, VA; and Dr. Marjorie
E. Kanof, Director, Health Care-Clinical and Military Health
Care Issues, GAO.
During the hearing, a lengthy discussion ensued regarding
the definition of medical examinations. DOD stated that its
interpretation of the law is that a medical screening fulfills
the requirements of Public Law 105-85, the National Defense
Authorization Act for Fiscal Year 1998. Public Law 105-85 also
requires pre- and post-deployment medical examinations. The
Subcommittee believes these health assessments should include:
reviews of required immunizations and other medications,
personnel protective and medical equipment, DNA and serum
samples, dental classification, and briefings on possible
health threats and countermeasures. The Subcommittee also
believes the intent of the requirement was for an actual
physical evaluation. GAO also testified that DOD's health care
examination requirements differ for active duty versus National
Guard and Reserve member.
Rx for VA's Nursing Shortage: Is There More Than One Antidote?
On October 2, 2003, the Subcommittee held a hearing to
review the impact of the nursing shortage on the Department of
Veterans Affairs. The purpose of the hearing was to examine
programs and initiatives that offer solutions for recruitment
and retention of VA's nursing work force.
Witnesses included: Cathy J. Rick, RN, CNAA, FACHE, Chief
Nursing Officer, VA; Sandra K. Janzen, MS, RN, CNAA, Associate
Chief of Staff/Nursing, James A. Haley Hospital, Tampa, FL;
Mary Raymer, RN, MA, CNAA, Nursing Education Program Manager,
Health Care Staff Development & Retention Office, VA, New
Orleans, LA. Barbara Blakeney, MS, APRN, BC, ANP, President,
American Nurses Association (ANA); Sarah Myers, Ph.D., RNC,
Nurses Organization of Veterans Affairs; Julie Cowan Novak,
DNSc, RN, MA, CPNP, Head, School of Nursing, Purdue University;
and Regina Foley, MBA, RN, CNAA, Vice President/Chief Nurse
Executive, Ocean Medical Center, NJ.
VA witnesses testified that the VA has experienced
difficulties in recruiting nursing staff, that one-third of the
VA's registered nurses, licensed practical nurses, and nursing
assistants are eligible to retire in 2005, and that different
strategies must be employed to attract nursing graduates to VA.
The Tampa VA Medical Center, FL, has had great success
recruiting and retaining health care professionals, especially
its nursing staff. The Subcommittee learned that 17 percent of
the eligible residency scholarship participants were hired by
VA facilities in 2002.
VA and the ANA cited a study conducted by Dr. Linda H.
Aiken (April 1998-November 1999), which concluded that in
hospitals with higher proportions of nurses educated at the
baccalaureate level or higher, surgical patients experienced
lower mortality rates. These assertions were disputed in
written testimony submitted by the American Association of
Community Colleges. VA and ANA also expressed their strong
enthusiasm and support for the Magnet Accreditation Program.
Magnet Status is the highest level of recognition that the
American Nurses Credentialing Center can extend to health care
organizations. The program has been beneficial to the hospital
in retaining and recruiting nursing staff. Private sector
witnesses also discussed the success rate in their hospitals
since receiving Magnet Status.
VA-DOD Shared Medical Records--20 Years and Waiting
On November 19, 2003, the Subcommittee held a hearing to
review the progress being made by the DOD and the VA in the
last 10 years with the sharing of medical information and
development of a seamless electronic medical record.
Witnesses included: Linda Koontz, Director, Information
Management Issues, GAO; Major General Kenneth L. Farmer, Jr.,
Deputy Surgeon General, U.S. Army, DOD, Ms. Jeanne B. Fites,
Deputy Under Secretary for Military Health System, DOD, Frances
M. Murphy, M.D., MPH, Deputy Under Secretary for Health Policy
Coordination, VA, Edward F. Meagher, Acting Chief Information
Officer, VA; and Kem Clawson, Director of Advanced Technology
Solutions, EMC Corporation, McLean, VA.
GAO testified that VA and DOD are making progress but full
implementation of a joint strategy is years away. GAO also
stated that VA and DOD have achieved a measure of success in
sharing data, as evidenced by VA clinicians now having access
to military health records for veterans through the Federal
Health Information Exchange. However, a virtual medical record
based on a two-way exchange of data between VA and DOD is far
from being achieved with DOD and VA presenting differing
perspectives of progress achieved.
The Subcommittee learned from Ms. Fites that it takes an
average of 60 days for the DD Form 214 to be available through
Defense Personnel Information Systems after a servicemember
separates from the military. VA stated that it needs such
information in order to process claims and determine what is
service connected. Questioning of VA and DOD witnesses revealed
that the two departments continue to purchase equipment that is
not compatible or interoperable, which defeats the goal of
achieving shared medical records.
Second Session
Staff Site Visit to Augusta, GA
On January 15-16, 2004, minority Staff traveled to both
campuses of the Augusta, GA VAMC, associated grounds, and two
contract nursing homes. A primary focus was on the function of
the textile care processing facility institutional laundry and
the need to seek alternative methods of accomplishing this
vital service due to the disrepair of the current laundry.
Tours of the medical centers were also accomplished.
Staff Site Visit to Bay Pines VAMC, FL
On February 22-23, 2004, minority staff traveled to Bay
Pines VAMC, FL to review the status of the Core Financial and
Logistics System (CoreFLS) information technology project and
to meet with principal parties to the project. A brief no-
notice tour of the VAMC and nursing home was also conducted.
Hearing VI on VA's Information Technology Programs
On March 17, 2004, the Subcommittee held its sixth
oversight hearing on VA's information technology programs. The
purpose of the hearing was to receive an update from the VA and
the DOD concerning their efforts to share medical information
and develop a seamless medical record. The Subcommittee
examined the advantages of electronic medical records,
including capturing insurance information for third party
collections and the reduction of medical errors.
Witnesses included: Dr. John Halamka, CIO of CareGroup
Healthcare System and Harvard Medical School; Dr. John R.
Clarke, Professor of Surgery, Drexel University, and Adjunct
Professor of Computer and Information Science, University of
Pennsylvania; Ms. Linda Koontz, Director, Information
Management Issues, GAO; Mr. James C. Reardon, CIO, Military
Health System, Office of the Assistant Secretary of Defense
(Health Affairs), DOD; Dr. Robert H. Roswell, MD, Under
Secretary for Health, VA; Robert M. Kollodner, Acting Chief
Information Officer for Health, Veterans Health Administration;
Mr. Robert N. McFarland, Assistant Secretary for Information
and Technology, Department of Veterans Affairs; and Mr. Edward
C. Davies, Managing Partner, Federal Civilian Agencies, Unisys
Corporation.
The Subcommittee received testimony from Dr. Halamka and
Dr. Clarke about the importance of moving away from paper
medical records towards electronic medical records. Dr. Halamka
stated that the medical group he manages has electronically
converted nine million records. Dr. Clarke provided valuable
information concerning the potential of electronic records to
offer improvement in the safety, quality, and efficiency of
health care in the United States, as called for in previous
Institute of Medicine reports. The Subcommittee also reviewed
the CoreFLS and the Patient Financial Services Systems. Both
had cost overruns and numerous delays.
Hearing on Department of Veterans Affairs Employment Screening
Practices and Procedure for Background Checks and Credentialing
On March 31, 2004, the Subcommittee held a hearing to
examine serious lapses and vulnerabilities in the Department of
Veterans Affairs screening process of applicants for positions
within the Veterans Health Administration. .
Witnesses included: Ms. Cynthia Grubbs, Director Office of
Policy and Planning, HHS; Ms. Cynthia Bascetta, Director,
Health Care--Veterans' Health and Benefits Issues, GAO; and Dr.
Frances M. Murphy, Deputy Under Secretary for Health Policy
Coordination, Veterans Health Administration, VA.
GAO testified that it had identified key VA screening
requirements that include verifying state licenses and national
certificates; completing background investigations, and
checking databases for practitioners who have been
professionally disciplined or excluded from Federal health care
programs. GAO stated that it found mixed compliance with the
key requirements in the four facilities they visited. GAO
recommended expansion of VA's verification process, its query
of national data banks and finger printing of all practitioners
who have direct patient care access.
The Subcommittee also learned that the Federal
Credentialing Program which was intended to develop electronic
credentialing for vetting of VA heath care professionals was
disbanded in 2003. Dr. Murphy stated that VA intended to create
systematic credentialing and oversight processes and would
verify all existing licenses and certificates with the issuing
organization for both applicants and employee renewals.
Site Visit to San Diego, CA
On April 19-22, 2004, majority staff from the Oversight and
Investigations and Benefits Subcommittees conducted a site
visit in the San Diego, CA area. Staff met with the VA Regional
Office and received an update on its efforts in hiring veterans
and disabled veterans. Staff also met with representatives
involved in Operation Transition from the TAP program,
organized labor, local businesses, SBA, One-Stop Career
Centers, non-profit organizations, and the San Diego Chamber of
Commerce to review efforts to assist veterans with employment,
and starting small businesses. Staff attended TAP classes and
DTAP at Point Loma Naval Base, Miramar Marine Base, and Camp
Pendleton Marine Base.
On April 22, 2004, majority staff met with Rear Admiral
John Mateczun, Commander, Naval Medical Center San Diego and
his staff to discuss VA-DOD sharing, separation physicals, VA-
DOD coordination on transition matters, physician
credentialing, and third party billing. Staff also learned that
the Naval Medical Center is continuing to fill its
prescriptions through Consolidated Mail Order Pharmacy, even
though the pilot has finished. The Center has also used VA as a
business partner to develop their East County Clinic Project
concept with VA Medical Center Outpatient Center in San Diego,
and has used VA's safety model as its prototype to develop
their own safety protocols. In the afternoon, staff met with VA
Medical Center Director Gary Rossio and his staff to discuss
part-time physicians time and attendance, the research program,
third party collections, and the pharmacy program.
Hearing on VA Research on Alzheimer's Disease, Parkinson's
Disease and Diabetes.
On April 28, 2004, the Subcommittee held a hearing to
review current research being conducted by VA and National
Institutes of Health (NIH) on Alzheimer's disease, diabetes and
Parkinson's disease. The hearing provided VA with an
opportunity to highlight the important biomedical research that
is being conducted by the VA in these areas.
Witnesses at the hearing included: Dr. Judith A. Salerno,
Deputy Director, National Institute on Aging, NIH; Dr. Michael
J. Kussman, Acting Deputy Under secretary for Health, Veterans
Health Administration; Dr. Franklin K. Zieve, Associate Chief
of Staff, Richmond VAMC; Dr. Robert Ferrante, Director,
Experimental Neuorpathology, Bedford VAMC; and Dr. Mary Sano,
Associate Chief of Staff, Bronx VAMC.
During the hearing, the Subcommittee received testimony
from NIH about its many collaborations with VA, and how NIH
conducted clinical trials in which veterans participate in
studies on diseases that afflict veterans such as diabetes,
Parkinson's and Alzheimer's. The Subcommittee also received an
update from VA on its ongoing research. VA provided the
Subcommittee with a video on deep brain stimulation which
showed how effective this treatment could be in alleviating
symptoms caused by Parkinson's disease. The Subcommittee also
heard from researchers in the field on projects currently
underway in their respective fields.
Hearing on the VA' Role in the Development of Interoperable
Electronic-Medical Records Systems in the Federal Government.
On May 19, 2004, the Subcommittee held a hearing to receive
an update from VA and DOD about their collaboration with HHS
over the past two years and how it was instrumental in laying
the groundwork for the Federal government's Health Information
Technology (IT) initiative.
Witness included: Dr. Jonathan J. Javitt, Potomac Institute
for Policy Studies, Member, Subcommittee on Health Care
Delivery and Information Technology, President's Information
Technology Advisory Committee; Ms. Linda Koontz, Director,
Information Management Issues, GAO; Jonathan B. Perlin, MD,
Acting Under Secretary for Health, VA; and Mr. James C.
Reardon, Chief Information Officer for Military Health System,
DOD.
The Subcommittee learned about the future role of VA and
DOD in developing and implementing the health IT initiative.
The hearing also examined the advantages of electronic medical
records, which include lower cost, fewer errors, and higher
quality. The Subcommittee received testimony from DOD and VA
about the progress they are making with the sharing of medical
information and development of a seamless electronic medical
record, which they have been working on since 1998.
GAO provided an update on the progress being made by VA and
DOD toward a two-way exchange of patient health care
information. Ms. Koontz stated that GAO found that the
departments have achieved a measure of success in sharing
through the one-way transfer of health information from DOD to
VA health care facilities but they have been severely
challenged in their pursuit of the longer term objective of a
two way transfer of health information between the two
departments. Dr. Javitt testified that when modern computer
technology is added to the practice of medicine, medical errors
are prevented and hospital costs are avoided and lives are
saved.
Staff Site Visit to James A. Haley Veterans Hospital, Tampa,
Florida
On July 1-2, 2004, majority staff members of the
Subcommittee on Oversight and Investigations made a site visit
to the Medical Center in Tampa, FL to review the facility's
third party collections and found that outpatient billing takes
longer because the facility is understaffed and does not have
enough medical coders. The biggest collection obstacles
appeared to be lack of integrated billing and current medical
data software systems. Staff also met with the facility's
research department to review its policy and implementation
concerning background checks, verification of degrees and
research misconduct.
On July 2, 2004, majority staff met with hospital and
nursing leadership to learn about its Magnet Recognition
Program. After the briefing on Tampa's Magnet Program, staff
toured the hospital and visited several units: spinal cord
injury, ambulatory care, and nursing home.
Oversight hearing on VA's Third Party Collections
On July 21, 2004, the Subcommittee held a hearing to
examine a number of issues facing VA as it seeks to improve its
third party collections, including implementation of its pilot
Patient Financial Services System. The pilot project is
currently underway at the Cleveland VA Medical Center. The
pilot project is designed to demonstrate how integrated,
commercial management and patient financial software will
improve VA's third party collections.
Witnesses included: Mr. Michael L. Staley, Assistant
Inspector General for Auditing, VA; Ms. Cynthia A. Bascetta,
Director, Health Care--Veterans' Health and Benefits Issues,
GAO; Mr. McCoy Williams, Director, Financial Management and
Assurance Team, GAO; Honorable Robert N. McFarland, Assistant
Secretary for the Office of Information and Technology, VA; Mr.
Kenneth Ruyle, Chief Business Officer, Veterans Health
Administration; Mr. Ken Ray, VISN 8 Chief Financial Officer;
and Mr. Edward C. Davies, Managing Partner, Unisys Corporation.
VA testified that collections had increased $129 million
above last fiscal year's collections. Considerable improvement
had been made toward automated billing and collections
activities. Improvements have been made to the VHA's Revenue
Action Plan, which includes targeted completion of the Medicare
Remittance Advice project, and its Consolidated Patient Account
Centers. VA also testified that it was using lessons learned
from a previous integration project and would utilize
independent consultants to perform a thorough risk analysis.
GAO's testimony focused on internal control activities over
third party billings and collections at three selected medical
centers. GAO found continuing weaknesses that affected billing
timeliness. These weaknesses included not billing insurance
companies in a timely manner, verifying and updating patients'
third-party insurance, and inadequate documentation to support
billings. GAO also found inconsistency in compliance with
follow-up procedures, especially for Medicare secondary
insurance companies. The IG provided a summary of Combined
Assessment Program reviews. Mr. Staley's testimony was similar
to GAO's regarding weaknesses in the collections process. The
IG also cited a 2002 audit showing that clearing the backlog of
unissued bills totaling over $1 billion would net $368.4
million in additional collections.
Staff Site Visit to Western VA Facilities
On August 9-14, 2004, Minority staff traveled to Dugway,
UT; Salt Lake City, UT; Sacramento, CA; Martinez, CA; Oakland,
CA; San Francisco, CA; Mare Island, CA; and Reno, NV. A general
review of management flexibility and standardization with VA
Central Office policies was the objective for this trip. The
visit included a number of both scheduled and no-notice visits.
At the medical centers, patient care was a principal focus of
the review, but issues including staffing, contracting, and
part-time physician attendance were also reviewed. At the
Regional Offices (VBA) and (NCA), staffing concerns and
performance were discussed. The VISN 21 Office visit focused on
contract nursing homes and nursing home quality. The trip
included a tour of the East Bay Stand-Down and also a day-long
visit to the classified technical library at the US Army's
Dugway Proving Ground in Utah to review chemical and biological
exposure reports involving US military and civilian personnel
circa 1948-1970s.
Site Visit to Nashville and Murfreesboro, TN
On August 27-18, 2004, Minority Staff conducted no-notice
visits of VA facilities at Nashville and Murfreesboro, TN,
which included a review of one medical center, a BVA Regional
Office and a national cemetery. The focus of the visit to the
Medical Center included general patient care, long-term
psychiatric care, and the laundry.
Hearing on Department of Veterans Affairs' Smart Card Projects
On October 6, 2004, the Subcommittee held a hearing to
receive an update from the VA concerning its Smart Card
projects.
Witnesses included: Honorable Benjamin H. Wu, Deputy Under
Secretary for Technology, Technology Administration, Department
of Commerce; Ms. Linda Koontz, Director, Information Management
Issues, GAO, accompanied by: Ms. Valerie C. Melvin, Assistant
Director, Information Management Issues, GAO Mr. Neville
Pattinson, Director of Business Development, Technology and
Government Affairs, Axalto; Honorable Robert N. McFarland,
Assistant Secretary for Information and Technology, VA; and Mr.
Robert J. Brandewie, Director, Defense Manpower Data Center,
Office of the Secretary of Defense for Personnel and Readiness,
DOD.
Under Secretary Wu addressed the development of the
Government's Smart-Card Interoperability Specification and the
efforts of the National Institute of Standards and Technology
standardize the specifications both nationally and
internationally. The Subcommittee also received testimony about
VA's efforts related to the development of its Smart Card and
biometric technologies, and its VA Authentication and
Authorization Infrastructure Project. Secretary McFarland
stated that its VA Smart Card project will be completed in 18
months.
During the hearing, the Subcommittee learned about the
benefits of using Smart Card technology to ensure VA
infrastructure security, cyber security, employee
accountability and fraud prevention in the compensation and
pension delivery system. DOD has issued approximately six
million cards to its employees without any major problems. GAO
testified that since VA is using the General Services
Administration's standard contracting vehicle to purchase
commercial Smart Card products from vendors and is
participating in government-wide initiatives, it should be in a
better position to be successful with its efforts.
SUMMARY OF VETERANS' AFFAIRS COMMITTEE ACTION
BILLS AND RESOLUTIONS REFERRED AND HEARINGS / EXECUTIVE SESSIONS CONDUCTED
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Congress
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90th 91st 92d 93d 94th 95th 96th 97th 98th 99th 100th 101st 102d 103d 104th 105th 106th 107th 108th
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Bills and resolutions referred.......... 685 740 693 839 719 709 339 273 229 198 147 194 215 174 128 134 146 194 253
Hearing sessions........................ 46 43 37 44 58 72 84 89 71 76 44 72 67 71 39 56 66 58 65
Meetings and mark-up sessions........... 13 27 21 16 30 26 19 18 16 20 16 26 20 23 19 18 13 14 16
Bills reported.......................... \3\ 19 34 26 \4\ 14 23 32 11 16 15 17 14 33 21 25 15 15 10 14 22
Bills in House.......................... 4 1 4 1 ...... 1 1 1 3 3 1 4 3 11 ...... ...... 1 ...... ......
Pending in Senate committees............ 3 9 7 2 \5\ 9 17 3 6 6 8 9 23 7 11 10 1 1 10 7
Bills on Senate Calendar or in Senate... ...... ...... ...... ...... ...... 1 1 1 ...... 1 3 1 3 3 ...... ...... 1 ...... 4
Recommitted............................. ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ......
Bills vetoed............................ ...... ...... 2 1 ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ......
Bills passed over veto.................. ...... ...... ...... 1 ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ......
Laws enacted............................ 15 24 15 15 15 13 6 8 8 6 4 8 24 15 6 6 11 13 9
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1 Including 4 bills enacted as amendment to other legislation; 1 left in House when similar Senate bill returned to Senate, and 1 similar to another bill enacted (Public Law 87-645).
2 Includes 2 bills enacted as amendments to other bills.
3 Includes 1 bill enacted as amendment to another bill.
4 Some laws include the substance of more than 1 bill reported separately. 39 separately reported bills were enacted, 7 as amendments to other legislation.
5 Provisions of 3 of these bills were passed by the House as separate bills, and the provisions of 1 bill were included as an amendment to another bill which became public law.
6 7 One bill in a Senate committee had purpose accomplished administratively, 5 other were enacted as sections of another bill; and portions of 1 bill left in the House were enacted as part
of another bill.
8 Includes S.J. Res. 197 making technical correction to law, which was brought to House floor for immediate consideration and passage by unanimous consent.
9 The difference in number of bills reported (14) and laws enacted (15) is due to the fact that S. 3705 did not go to the House Committee.
10 8 Includes S.J. Res. 197 making technical correction to law, which was brought to House floor for immediate consideration and passage by unanimous consent.
9 The difference in number of bills reported (14) and laws enacted (15) is due to the fact that S. 3705 did not go to the House Committee.
10 Includes H.R. 9576 subject matter of which was contained in S. 969, passed in lieu.
HEARINGS AND EXECUTIVE SESSIONS
(All hearings and executive sessions of the Committee are
held in the Committee hearing room. Room 334, Cannon House
Office Building unless otherwise designated.)
January 29, 2003. OPEN. 1:00 p.m. Full Committee. Meeting.
Organizational.
January 29, 2003. OPEN. 1:30 p.m. Full Committee. Hearing.
Department of Veterans Affairs Health Care System. (Serial No.
108-1)
February 5, 2003. OPEN. 2:00 p.m. Full Committee. Hearing.
The State of Veterans' Employment. (Serial No. 108-2)
February 11, 2003. OPEN. 10:00 a.m. Full Committee.
Meeting. Oversight Plan.
February, 11,2003. OPEN. 10:00 a.m. Full Committee.
Hearing. Department of Veterans Affairs Budget Request for
Fiscal Year 2004. (Serial No. 108-3)
February 25, 2003. OPEN. 2:00 p.m. House and Senate
Veterans Affairs Committees. Joint Hearing. Room 345 Cannon
HOB. The legislative priorities of the Disabled American
Veterans.
February 27, 2003. OPEN. 2:00 p.m. Full Committee. Meeting.
To approve Committee's views and estimates for the FY 2004
budget for submission to the Budget Committee.
March 6, 2003. OPEN. 10:00 a.m. House and Senate Veterans
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The
Legislative Priorities of the Military Order of the Purple
Heart, Paralyzed Veterans of America, Jewish War Veterans,
Blinded Veterans Association and Non Commissioned Officers
Association.
March 12, 2003. OPEN. 10:00 a.m. House and Senate Veterans
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The
Legislative Priorities of the Veterans of Foreign Wars.
March 13,2003. OPEN. 10:00 a.m. House and Senate Veterans
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The
Legislative Priorities of The Retired Enlisted Association,
Gold Star Wives, Fleet Reserve Association and Air Force
Sergeants Association.
March 19, 2003. OPEN. 10:00 a.m. Subcommittee on Health.
Hearing. Oversight Hearing on the Availability and Eligibility
for Pharmaceutical Services Provided by the Department of
Veterans Affairs. (Serial No. 108-4)
March 20, 2003. OPEN. 10:00 a.m. House and Senate Veterans
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The
Legislative Priorities of AMVETS, American ExPrisoners of War,
Vietnam Veterans of America, Military Officers Association of
America and the National Association of State Directors of
Veterans Affairs.
March 27, 2003. OPEN. 10:00 a.m. Subcommittee on Health.
Hearing. Bioterrorism Research and Post-Deployment Health Care
for Veterans. (Serial No. 108-5)
April 3, 2003. OPEN. 9:30 a.m. Full Committee. Markup. H.R.
100 and H.R. 1297.
April 9, 2003. OPEN. 2:00 p.m. Subcommittee on Benefits.
Hearing. Troops-to-Teachers. (Serial No. 108-6)
April 10, 2003. OPEN. 9:30 a.m. Subcommittee on Benefits.
Hearing. H.R. 241, H.R. 533, H.R. 761, H.R. 850, H.R. 966, and
H.R. 1048. (Serial No. 108-7)
April 10, 2003. OPEN. 10:00 a.m. Subcommittee on Oversight
and Investigations. Hearing. 340 Cannon HOB. Weapons of Mass
Destruction: Is Our Nation's Medical Community Ready? (Serial
No. 108-8)
April 10, 2003. OPEN. 1:00 p.m. Subcommittee on Health.
Hearing. Medical and Prosthetic Research in the Department of
Veterans Affairs. (Serial No. 108-9)
April 30, 2003. OPEN. 10:00 a.m. Subcommittee on Benefits.
Hearing. H.R. 1460, the Veterans Entrepreneurship Act of 2003;
H.R 1712, the Veterans Federal Procurement Opportunity Act of
2003; and H.R. 1716, the Veterans Earn and Learn Act. (Serial
No. 108-10)
May 6, 2003. OPEN. 1:00 p.m. Subcommittee on Health.
Markup. H.R. 1562, H.R. 1715, H.R. 1832, H.R. 1908 and
H.R.1911.
May 6, 2003. OPEN. 1:30 p.m. Subcommittee on Health.
Hearing. Homeless Assistance Programs in VA. (Serial No. 108-
11)
May 7, 2003. OPEN. 11:30 a.m. Subcommittee on Benefits.
Markup. H.R. 241, H.R. 761, H.R. 1257, H.R. 1460, H.R. 1683 and
H.R. 1949.
May 7, 2003. OPEN. 2:00 p.m. Subcommittee on Oversight and
Investigations. Hearing. To Review the Progress of the
Department of Veterans Affairs Regarding the Collection of its
Medical Care Collection Fund (MCCF). (Serial No. 108-12)
May 8 and June 10, 2003. OPEN. 10:00 a.m. Full Committee.
Hearings. Past and Present Efforts to Identify and Eliminate
Fraud, Waste, Abuse, and Mismanagement in Programs Administered
by the Department of Veterans Affairs. (Serial No. 108-13)
May 15, 2003. OPEN. 10:00 a.m. Full Committee. Markup. H.R.
]257, H.R. 1460, H.R. 1562, H.R. 1683, H.R. 1715 and H.R. 1911.
May 22, 2003. OPEN. 1:30 p.m. Subcommittee on Health.
Hearing. Oversight Hearing on Long-Term Care Programs in VA.
June 3 and June 17, 2003. OPEN. 10:00 a.m. Full Committee.
Hearing. Hearings on the Report of the President's Task Force
to Improve Health Care Delivery for our Nation's Veterans.
(Serial No. 108-15)
June 11, 2003. OPEN. 10:00 a.m. Subcommittee on Benefits.
Hearing. H.R. 886, H.R. 1167, H.R. 1500, H.R. 1516, H.R. 2163,
H.R. 2164, H.R. 2285, and H.R. 2297.
June 11, 2003. OPEN. 2:00 p.m. Subcommittee on Health.
Hearing. H.R. 116, H.R. 1720, H.R. 2307, and H.R. 2349. (Serial
No. 108-17)
June 18, 2003. OPEN. 10:00 a.m. Subcommittee on Oversight
and Investigations. Hearing. Human Subjects Protections in VA
Research.
June 24, 2003. OPEN. 11:00 a.m. Subcommittee on Health.
Markup. H.R. 116, H.R. 1720, H.R. 2357 and H.R. 2433.
June 25, 2003. OPEN. 10:00 a.m. Subcommittee on Benefits.
Markup. H.R. 1516 and H.R. 2297.
June 26, 2003. OPEN. 10:00 a.m. Full Committee. Markup.
H.R. 116, H.R.1516, H.R. 1720, H.R. 2357, H.R. 2433, H.R. 2595
and H. Con. Res. 159.
July 9, 2003. OPEN. 2:00 p.m. Subcommittee on Oversight and
Investigations. Hearing. Force Health Protection: Lessons
Learned and Applied From the First Gulf War. (Serial No. 108-
19)
July 15, 2003. OPEN. 10:00 a.m. Subcommittee on Health.
Hearing. H.R. 1585, a bill to establish an office to oversee
research compliance and assurance within the Veterans Health
Administration of the Department of Veterans Affairs.
July 16, 2003. OPEN. 10:30 a.m. Subcommittee on Benefits.
Hearing. Department of Veterans Affairs' Fiduciary Program.
(Serial No. 108-21)
July 24, 2003. OPEN. 9:30 a.m. Subcommittee on Benefits.
Hearing. Hearing on the Uniformed Services Employment and
Reemployment Rights Act.
September 16, 2003. OPEN. 10:00 a.m. House and Senate
Veterans' Affairs Committees. Joint Hearing. Room 216 Hart SOB.
The Legislative Priorities of The American Legion.
September 25, 2003. OPEN. 10:30 a.m. Subcommittee on
Benefits. Hearing. Oversight Hearing on the Department of
Veterans Affairs' Life Insurance Program. (Serial No. 108-23)
September 30, 2003. OPEN. 2:30 p.m. Room 340 Cannon HOB.
Subcommittee on Health. Hearing. H.R. 2379, the Rural Veterans
Access to Care Act of 2003; and H.R. 3094, the Veterans Timely
Access to Health Care Act. (Serial No. 108-24)
October 2, 2003. OPEN. 10:00 a.m. Subcommittee on Oversight
and Investigations. Hearing. Rx for VA's Nursing Shortage: Is
There More Than One Antidote?
October 8, 2003. OPEN. 1:30 p.m. Subcommittee on Health.
Markup. H.R. 1585.
October 16, 2003. OPEN. 10:00 a.m. Full Committee. Hearing.
Handoff or Fumble? Are DOD and VA Providing Seamless Health
Care Coverage to Transitioning Veterans? (Serial No. 108-26)
October 21, 2003. OPEN. 2:00 p.m. Subcommittee on Health.
Hearing. Hearing on Veterans Affairs Physician and Dentist
Compensation Issues. (Serial No. 108-27)
November 19, 2003. OPEN. 10:30 a.m. Subcommittee on
Oversight and Investigations. Hearing. Hearing on VA-DOD Shared
Medical Records--20 Years and Waiting.
January 28, 2004. OPEN. 10:00 a.m. Full Committee. Hearing.
Hearing on the Department of Veterans Affairs Policies
Affecting the Millions of Veterans Who Will Need Long-Term Care
in the Next Ten Years. (Serial No. 108-29)
February 4, 2004. OPEN. 10:00 a.m. Full Committee. Hearing
on the Department of Veterans Affairs Budget Request for Fiscal
Year 2005. (Serial No. 108-30)
February 24, 2004. OPEN. 2:00 p.m. House and Senate
Veterans' Affairs Committees. Joint Hearing. Room 216 Hart SOB.
The Legislative Priorities of the Disabled American Veterans.
March 4, 2004. OPEN. 10:00 a.m. House and Senate Veterans'
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The
Legislative Priorities of the Non Commissioned Officers
Association, Military Order of the Purple Heart, Paralyzed
Veterans of America, Jewish War Veterans and Blinded Veterans
Association.
March 10, 2004. OPEN. 10:00 a.m. House and Senate Veterans'
Affairs Committees. Joint Hearing. 216 Hart SOB. The
Legislative Priorities of of the Veterans of Foreign Wars.
March 11, 2004. OPEN. 9:30 a.m. Subcommittee on Health.
Hearing. Oversight Hearing on the Status of Department of
Veterans Affairs' Post-Traumatic Stress Disorder Programs.
March 17, 2004. OPEN. 10:00 a.m. Subcommittee on Oversight
and Investigations. Hearing. Hearing VI on the Department of
Veterans Affairs Information Technology Programs.
March 18, 2004. OPEN. 10:00 a.m. House and Senate Veterans'
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The
Legislative Priorities of the Air Force Sergeants Association,
The Retired Enlisted Association, Gold Star Wives and Fleet
Reserve Association.
March 24, 2004. OPEN. 11:00 a.m. Full Committee. Hearing.
Hearing on Employing Veterans of Our Armed Forces.
March 25, 2004. OPEN. 10:00 a.m. House and Senate Veterans'
Affairs Committees. Joint Hearing. Room 345 Cannon HOB. The
Legislative Priorities of the National Association of State
Directors of Veterans Affairs, AMVETS, American Ex-POWs,
Vietnam Veterans of America and the Military Officers
Association of America.
March 30, 2004. OPEN. 10:00 a.m. Subcommittee on Health.
Hearing. Hearing on the Department of Veterans Affairs
Providing Certain Veterans with a Prescription-Only Health Care
Benefit.
March 31, 2004. OPEN. 10:00 a.m. Subcommittee on Oversight
and Investigations. Hearing. Hearing on VA's Current Procedures
for Background Checks and Credentialing.
April 1, 2004. OPEN. 10:00 a.m. Subcommittee on Benefits.
Hearing. Hearing to Receive the Report of VA's Vocational
Rehabilitation and Employment Service Task Force.
April 13, 2004. OPEN. 8:30 a.m. Municipal Plaza Building,
City Hall Complex, City Council Chambers, San Antonio, Texas.
Subcommittee on Health. Hearing. Oversight Hearing on the
Status of Military and VA Health Care Coordination, Including
Post-Deployment Health Care of Recently Discharged Veterans.
April 28, 2004. OPEN. 10:00 a.m. Subcommittee on Oversight
and Investigations. Hearing. Hearing on VA Research on
Alzheimer's Disease, Parkinson's Disease, and Diabetes.
April 29, 2004. OPEN. 10:00 a.m. Subcommittee on Benefits.
Hearing. Hearing on H.R. 348, H.R. 843, H.R. 1735, H.R. 2206,
H.R. 2612, H.R. 3936, H.R. 4065, H.R. 4172, H.R. 4173 and a
draft bill.
May 6, 2004. OPEN. 9:30 a.m. Subcommittee on Health.
Hearing. Hearing on H.R. 4020, State Veterans' Homes Nurse
Recruitment and Retention Act of 2004; H.R. 4231, Department of
Veterans Affairs Nurse Recruitment and Retention Act of 2004;
H.R. 3849, Military Sexual Trauma Counseling Act of 2004; H.R.
4248, Homeless Veterans Assistance Reauthorization Act of 2004;
and a draft bill to reform the qualifications and selection
requirements for the position of the Under Secretary for
Health.
May 13, 2004. OPEN. 9:30 a.m. Subcommittee on Health.
Markup. H.R. 4231 and H.R. 4248.
May 13, 2004. OPEN. 11:00 a.m. Subcommittee on Benefits.
Markup. H.R. 1716, H.R. 3936, H.R. 4175 and H.R. 4345.
May 18, 2004. OPEN. 10:30 a.m. Full Committee. Hearing.
Oversight Hearing on Homeless Assistance Programs for
Veterans--Implementation of Public Law 107-95, the Homeless
Veterans Comprehensive Assistance Act of 2001, and Status of
the National Goal to End Chronic Homelessness by 2011.
May 19, 2004. OPEN. 10:00 a.m. Subcommittee on Oversight
and Investigations. Hearing. Department of Veterans Affairs
Role in the Future of Electronic Health Records.
May 19, 2004. OPEN. 2:30 p.m. Full Committee. Markup. H.R.
1716, H.R. 3936, H.R. 4175, H.R. 4231, H.R. 4248 and H.R. 4345.
June 7, 2004. OPEN. 9:30 a.m. Newington VAMC, Connecticut.
Subcommittee on Health. Hearing. Oversight Hearing on
Optimizing Facilities and Improving the Delivery of Health Care
and Services to Veterans in the State of Connecticut.
June 16, 2004. OPEN. 11:00 a.m. Subcommittee on Benefits.
Hearing. Room 340 Cannon HOB. Hearing on H.R. 4032, and draft
bill, the Veterans Self-Employment Act of 2004.
June 17, 2004. OPEN. 10:00 a.m. Full Committee. Follow-up
Hearing on Efforts to ldenti1)r and Eliminate Fraud, Waste,
Abuse, and Mismanagement in Programs Administered by the
Department of Veterans Affairs.
June 23, 2004. OPEN. 10:00 a.m. Full Committee. Hearing.
Hearing on Protecting the Rights of Those Who Protect Us:
Public Sector Compliance with the Uniformed Services Employment
and Reemployment Rights Act and Improvement of the
Servicemembers Civil Relief Act. Testimony also heard on H.R.
3779 and H.R. 4477; and two draft bills, the USERRA Health Care
Coverage Extension Act of 2004; and the Servicemembers Legal
Protection Act of 2004.
June 24, 2004. OPEN. 9:30 a.m. Subcommittee on Health.
Hearing. Hearing on a draft bill, the Department of Veterans
Affairs Real Property and Facilities Management Improvement Act
of 2004.
July 8, 2004. OPEN. 9:30 a.m. Subcommittee on Health.
Markup. H.R. 4768.
July 15, 2004. OPEN. 2:00 p.m. Subcommittee on Benefits and
Subcommittee on Workforce Empowerment, and Government Programs,
Committee on Small Business. Joint Hearing. Room 311 Cannon
HOB. Excellence in Action: Government Support of Disabled
Veteran-Owned Business.
July 21, 2004. OPEN. 10:00 a.m. Subcommittee on Oversight
and Investigations. Hearing. Fourth Hearing on the VA's
Progress in the Third Party Collections Program and
Implementation of the Patient Financial Services System.
July 21, 2004. OPEN. 1:15 p.m. Full Committee. Markup. H.R.
1318, H.R. 4658, H.R. 4768 and H.R. 4836.
July 22, 2004. OPEN. 9:30 a.m. Full Committee. Hearing.
Hearing on the Evolution of VA-DOD Collaboration in Research
and Amputee Care for Veterans of Current and Past Conflicts, as
well as Needed Reforms in VA Blind Rehabilitation Services.
August 26, 2004. OPEN. 10:00 a.m. Full Committee. Hearing.
Ten Years After 9/11: Is VA Prepared to Fulfill Its Roles in
Homeland Security?
September 21, 2004. OPEN. 10:00 a.m. House and Senate
Veterans' Affairs Committees. Joint Hearing. 345 Cannon HOB.
The legislative priorities of The American Legion.
October 6, 2004. OPEN. 9:30 a.m. Subcommittee on Oversight
and Investigations. Hearing. Hearing on the Department of
Veterans Affairs Smart Card Projects.
COMMITTEE WEB SITE
WWW.VETERANS.HOUSE.GOV
The Committee on Veterans' Affairs operates, maintains, and
updates a web site (veterans.house.gov) containing
comprehensive and timely information on Committee activities,
federal actions, and other news of interest to veterans. The
web site contains thousands of pages of information, organized
into nine sections: About the Committee; About the Chairman;
Committee News; Committee Hearings; Committee Documents;
Veterans' Legislation; VA Benefits; VA Health Care; and
Veterans Links.
The website was redesigned and re-launched in the 107th
Congress in order to make it more functional, informative, and
aesthetically pleasing. Subsequently, in March of 2003, the web
site was honored by the Congress Online Project as one of the
very best web sites among all 610 congressional web sites
reviewed. The Committee web site received a grade of ``A'',
making it one of only 26 web sites to receive a ``Silver Mouse
Award'' in 2003.
The transformation of the Committee's web site continued
during the 108th Congress with a redesigned section on
veterans' benefits, and a major new Committee Spotlight feature
on the 60th anniversary of the GI Bill. Both of these expanded
sections provide web site visitors with a wealth of
information, both historical and current. Throughout the 108th
Congress, the Committee continued to enhance the web site with
additional links and information of interest to our target
audiences: veterans, Congress, and other individuals and
organizations interested in public policy concerning veterans.
OVERSIGHT PLAN FOR 108th CONGRESS
In accordance with clause 2(d)(1) of Rule X of the House of
Representatives, the Committee on Veterans' Affairs on February
11, 2003, adopted its oversight plan for the 108th Congress.
This oversight plan is directed at those matters most in
need of oversight within the next two years. The Committee is
cognizant of the requirement that it conduct oversight on all
significant laws, programs, or agencies within its jurisdiction
at least every ten years. To ensure coordination and
cooperation with the other House committees having jurisdiction
over the same or related laws affecting veterans, the Committee
will consult as necessary with the Committee on Armed Services,
the Committee on Education and the Workforce, and the Committee
on Government Reform.
Oversight will be accomplished through committee and
subcommittee hearings, field and site visits by Members and
staff, and meetings and correspondence with interested parties.
Methods of oversight will include existing and requested
reports, studies, estimates, investigations and audits by the
Congressional Research Service, the Congressional Budget
Office, the General Accounting Office, and the Offices of the
Inspectors General of the Departments of Veterans Affairs and
Labor.
The Committee will seek the views of veterans' service
organizations, military associations, other interest groups and
private citizens. The Committee also welcomes communications
from any individuals and organizations desiring to bring
matters to its attention. A series of joint hearings is
scheduled with the Senate Committee on Veterans Affairs at
which veterans' service organizations and military associations
will present to the committees their national resolutions and
agendas for veterans.
While this oversight plan describes the foreseeable areas
in which the Committee expects to conduct oversight during the
108th Congress, the Committee and its subcommittees will
undertake additional oversight activities as the need arises.
1. VA-administered Insurance Program. The Department of
Veterans Affairs (VA) administers six life insurance programs
under which two million policies with a value of $20 billion
remained in force at the end of fiscal year 2002. The committee
will examine policy and operational issues VA faces in
operating the seventh largest insurance program in the United
States.
2. Non-Service-Connected Pension Program. The non-
service-connected disability pension program provides financial
assistance to more than 348,000 low-income veterans. Veterans
must have at least 90 days of military service, including at
least one day of wartime service, and be totally and
permanently disabled for employment purposes as a result of
disability not related to their military service, or over age
65. The committee will examine the administration of this
program.
3. Improvements in Timeliness of Claims Processing. VA
provides over $22 billion a year in disability compensation and
pension benefits to more than 2.4 million veterans. The
Veterans Benefits Administration (VBA) has made many
improvements to its operations, including realigning its field
offices to improve control of claims and shifting its focus
from resource management to workload management. The committee
will focus on the General Accounting Office's December 2002
report, Veterans Benefits: Claims Processing Timeliness
Performance Measure Could be Improved (GAO-03-282).
4. State of Veterans' Employment and Training. From May
1997 to June 2001, the General Accounting Office (GAO) issued
eight reports criticizing the Veterans' Employment and Training
Service, Department of Labor, for deficiencies in performance,
management, and strategic planning. Public Law 107-288, the
Jobs for Veterans Act, reformed the nationwide veterans'
employment and training delivery system, focusing on
accountability, flexibility, incentives, and results. Further,
Public Law 106-50, the Veterans Entrepreneurship and Small
Business Development Act of 1999, increased small business
opportunities for veterans and disabled veterans by improving
their access to capital, information, and markets. The
committee will examine implementation of these two laws.
5. Troops-To-Teachers. The Troops-To-Teachers program
services as an alternative route to teacher certification for
military servicemembers and retirees who seek a second career
as a public school teacher. The program is funded by the
Department of Education. The committee plans a joint hearing
with the Committee on Education and the Workforce. The
committees expect to examine the skills and experience that
veterans bring to teaching, as well as the administration of
the program.
6. Role of the Board of Veterans' Appeals in the 21st
Century. The Board of Veterans' Appeals (BVA) is the component
of the VA responsible for making the final Departmental
decision on behalf of the Secretary in appeals of veterans'
benefits claims. Since the advent of judicial review of appeals
of veterans' claims in 1988, the essential mission of BVA has
remained relatively unchanged. The committee will examine how
to most effectively use the Board's expertise and resources in
serving veterans.
7. Quality Assurance for Disability Claims at the Board
of Veterans' Appeals. Veterans who are dissatisfied with a
decision made by a VA regional office may appeal that decision
to BVA. During fiscal years 1999 and 2000, BVA decided an
average of 35,000 appeals per year. GAO reviewed the quality
assurance program at the Board and the Board's collection of
data to improve the quality and consistency of its decisions on
veterans' claims. The committee will focus on the GAO's August
2002 report, Veterans' Benefits: Quality Assurance for
Disability Claims and Appeals Processing Can Be Further
Improved. (GAO-02-806).
8. Vocational Rehabilitation and Employment. VA's
Vocational Rehabilitation and Employment (VR&E) program
provides services and assistance to enable veterans with
service-connected disabilities to obtain and maintain suitable
employment, and to enable certain other disabled veterans to
achieve independence in daily living. The committee will
examine VR&E's focus on suitable employment, assistance to the
most seriously disabled veterans, succession planning,
contracted services, claims processing, employer outreach and
quality assurance.
9. Office of Federal Contract Compliance Programs. The
Office of Federal Contract Compliance Programs (OFCCP) is an
enforcement agency within the Department of Labor. In addition
to other equal employment laws, OFCCP enforces the Vietnam Era
Veterans' Readjustment Assistance Act of 1974 (VEVRAA). The law
requires that employers with Federal contracts of $100,000 or
more provide equal opportunity and affirmative action for
certain veterans. The Federal government awards prime contracts
worth approximately $200 billion per year. The committee will
examine OFCCP's recent investigatory and enforcement actions
related to VEVRAA, staffing matters, and the general complaint
process.
10. Fiduciary Activities. When a probate court or VA
rating board determines an adult VA beneficiary is incompetent,
VBA personnel assess the need for a fiduciary, appoint an
appropriate person or entity to manage the beneficiary's funds,
and monitor the management of those funds. As of December 31,
2002, VBA personnel supervised the management of funds for more
than 100,000 incompetent beneficiaries. VA's Inspector General
has begun conducting Combined Assessment Program reviews at VBA
regional offices. The most recent summary report (Report No.
02-01811-38) indicates that improvement with regard to
Fiduciary and Field Examination activities is needed at more
than 50 percent of the regional offices reviewed between June
2000 and September 2002. The committee will determine the
extent of problems with VBA's fiduciary program and
recommendations for improvements.
11. Meeting the Health Care Needs of Veterans. Despite
record budget increases, the growing demand for health care is
outpacing the resources allotted to VA for veterans' health
care. The committee will evaluate factors that contribute to
the loss of current services, long waiting times and delayed or
denied care. The committee will also review the recommendations
of the President's Task Force to Improve Health Care Delivery
for Our Nation's Veterans and any plans to implement the Task
Force's recommendations.
12. Infrastructure Maintenance in VA Health Care and
CARES. The VA health care system capital asset planning
process, known as Capital Assets Realignment for Enhanced
Services (CARES) II, is underway, with a scheduled date of
completion during the 108th Congress. The committee is
concerned about the cumulative effects of years of insufficient
resources to adequately maintain VA's aging health care
facilities. Many need significant maintenance, repair and
modernization. The committee will review these needs and the
implementation of CARES and its next phases.
13. Veterans Equitable Resource Allocation System. The
Veterans Health Administration (VHA) adopted this system of
allocating funds to its field health activities in April 1997.
During the past year, the allocation model was revised. The
committee will review the implementation, operation and
effectiveness of the new Veterans Equitable Resource Allocation
(VERA) model and its impact on veterans.
14. Management Improvements. The VA's plans in fiscal year
2003 included saving $298 million by making management
improvements, with an additional $800 million in savings
proposed for fiscal year 2004. The committee will review the
business practices, scope and success of VA management
improvements.
15. VA and DOD Health Resources Sharing. Sections 721
through 726 of Public Law 107-314 provided the most significant
changes to VA-DOD sharing authority in its 20-year history.
With new opportunities and incentives in place to conserve
scarce federal health care resources and improve the delivery
of services to the military-veteran community, the committee
intends to continue its close oversight of VA-DOD resource
sharing, especially implementation of the new legislation.
16. Status of VA Medical, Biological, Chemical and
Radiological Research. VA medical research, in affiliation with
the nation's leading schools of medicine, has been remarkably
successful in curing human disease and advancing biomedicine.
The committee has monitored VA research for a number of years
and will continue to review it. Public Law 107-287 expanded the
VA's role in homeland security and created new research centers
to counter biological, chemical, and radiological terrorism and
threats against active duty service members, veterans and the
general public. Implementation of the new law will be carefully
monitored.
17. Mental Health and Substance-Use Disorder Programs.
Reported reductions in capacity of VA programs to care for the
most seriously mentally ill veterans, especially those with
psychoses and with substance-use disorders, continue to be a
matter of concern. The committee will explore the state of VA's
mental health programs and the effectiveness of chronic mental
illness treatment programs in VA's institutional, contract,
community-based, case-management and aftercare programs.
18. Follow-up on Millennium Act. Public Law 106-117, the
Veterans Millennium Health Care and Benefits Act, was the most
significant health care legislation Congress has enacted for
veterans in a number of years. Since the law was enacted, VA
has implemented many of its provisions. The committee will
continue to give attention to the remaining steps VA must take
to comply fully with its mandates and will provide oversight to
those programs already implemented, including the effectiveness
of pilot programs and the maintenance of capacity in VA's long-
term care programs.
19. Rural Health Care Matters. The committee is concerned
about the health of veterans who live in rural and remote
regions, particularly whether they have adequate access to VA
health care and services. The emergence of VA telemedicine
holds promise to extend VA services beyond major VA medical
centers. The committee will examine the role of telemedicine in
VA's efforts in rural care. Also, VA has promoted improved
access through its community-based clinics, primary care
outlets now numbering in the hundreds. The committee will
explore geographic distribution of these clinics to determine
if VA has adequately responded to rural veterans' needs,
including investigation of the availability of mental health
services in rural clinics.
20. Women Veterans' Programs. An Advisory Committee on
Women Veterans was established in 1983 under Public Law 98-160
to assess the health care, outreach, and benefits needs of
women veterans and make recommendations to the Secretary of
Veterans Affairs and Congress. VA medical centers have been
mandated to designate women veterans' coordinators, in addition
to providing specialized health services and outreach. The
committee will continue to review VA policies and programs for
women veterans.
21. Scarce Medical Specialty Contracting. The committee is
concerned about medical specialty services obtained through
government contracts. Some of these contracts are expensive
compared to average costs for government-employed physicians.
The committee will explore options for obtaining such physician
specialty services in a cost-effective manner.
22. Personnel Legislation. Congress made significant
changes in VA practitioner pay systems in Public Law 106-419,
the Veterans Health Care Personnel and Benefits Act of 2000.
The committee will examine VA's implementation of these changes
and consider the need for additional legislation.
23. Prescription Drugs. The committee will examine VA's
pharmaceutical program, including practices, costs and
copayments for veterans, in order to assess the pharmaceutical
services veterans receive.
24. Force Protection. The committee will continue to
actively monitor DOD force protection practices and policies
(especially those actions being taken by DOD in advance of
military deployments overseas), and review measures taken by
DOD to ensure VA will be able to appropriately identify and
care for service-connected conditions of returning veterans in
the event of war with Iraq. In addition, VA has announced it
will double its research investment for Persian Gulf War
Illnesses. The committee will continue to investigate issues
linked to war-related illnesses and injuries.
25. The Deseret Test Center Project 112 and Shipboard
Hazards and Defense Program. In the last session of the 107th
Congress, the committee held a hearing to investigate potential
health consequences to veterans involved in tests conducted
through DOD's Deseret Test Center, known as Project 112, and
Shipboard Hazards and Defense (SHAD). The committee will
continue to monitor information from DOD and review whether
active duty forces are being adequately protected and
appropriately informed regarding their potential exposures.
26. Hepatitis C Programs. The committee will examine VA's
response to the incidence of hepatitis C virus (HCV) infection
among its patient population and the methods by which VA
allocates and monitors funding for education, screening and
treatment of HCV.
27. Medical Care Collection Fund/Medicare Remittance
Advice. VA collects over $680 million per year from third party
insurers for medical care provided to veterans with health care
insurance. The committee will examine what progress has been
made by the VA since the September 20, 2001, hearing on this
issue. The committee will review improvements in collection
procedures, cost of collections, cost of care provided to
veterans, and outsourcing initiatives.
28. Fugitive Felon Program. Prior to 2002, veterans and
dependents wanted by United States law enforcement authorities
for committing felony criminal acts were eligible to receive VA
benefits while fleeing from justice. Based on a legislative
proposal presented by the VA Inspector General, the 107th
Congress enacted Public Law 107-103, prohibiting specified VA
benefits to be paid or provided to fugitive felons and
dependents. The committee will review the implementation of
this program.
29. Cemetery Standards of Appearance. The committee will
examine what steps the National Cemetery Administration should
take to ensure the appearance of the cemeteries it maintains
meets the standards defined in the Logistics Management
Institute's 2002 report, Cemetery Standards of Appearance.
30. National Personnel Records Center. The National
Personnel Records Center (NPRC) is responsible for maintaining
the official military personnel records of discharged members
of the Armed Forces. The committee will examine NPRC's external
role in VBA's processing of veterans claims and what
improvements are needed to ensure timely retrieval of records.
31. Hearing on VA's Biomedical Research Program. The
committee will review VA research developments, with a
particular focus on Parkinson's disease, Alzheimer's disease
and diabetes research.
32. VA Research. The committee will examine the
relationship between the Office of Research Compliance and
Assurance (ORCA) and the Office of Research and Development.
The committee will also conduct a follow-up review of ORCA's
report on the accreditation of human subject protections, and
related issues including the indirect costs associated with the
National Institute of Health (NIH) research at VA. The
committee will examine the impact of VA coverage of all
indirect costs associated with research on VA healthcare.
33. VA Information Technology Programs. The committee will
continue its oversight of VA's IT programs to review progress
being made with implementation of its integrated enterprise
architecture plan and efforts to improve its internal and
external cyber security.
34. Nursing Shortages. VA continues to have a difficult
time retaining and recruiting registered nurses. The committee
will examine short-term and long-term implications of this
nationwide problem and what actions VA should take to address
this nursing shortage.
35. VHA's 4th Mission, Preparedness and Capacity. The
events of September 11th, 2001, raised the national awareness
of the role of the Federal Government in times of emergency or
disaster. The committee will review VA's role and
responsibilities in emergency and disaster response.
36. VA Contract Nursing Home Safety. The various states
have differing standards for inspecting nursing homes. The
committee will review VA's role in oversight of nursing homes
with VA contracts.
37. Prioritization of Veterans Health Care. VA has
established a new "Category 8" classification for veterans who
have higher incomes and do not suffer from military service
related disabilities or health problems. In 2002, over half the
830,000 veterans who enrolled for VA health care were
classified as Category 8. The committee will examine the effect
that Category 8 veterans have on VA's budget and health care
delivery.
38. VA Physicians' Duty Assignments and Timekeeping. The
VA Inspector General's Combined Assessment Program Reviews have
cited the need for VA medical centers to do a better job of
monitoring their part-time physicians who hold a joint
appointment with the VA and an affiliated university. The
committee will examine VHA physician accountability.
39. VA Senior Executive Service Bonuses. The committee
will examine VA's bonus practices for its Senior Executive
Service employees. The committee will review GAO's September
2002 report, Results-Oriented Cultures, Using Balanced
Expectations to Manage Senior Executive Performance (GAO-02-
966), which used VBA as a case study. The examination will
focus on discrepancies between rewards and performance.
40. VA Sourcing Decisions. The President's Management
Agenda encourages government agencies to outsource work that
can be accomplished commercially. The committee will hold a
hearing to examine VA's efforts to comply with this goal.
41. Veterans Preference/VETS-100 Report. The Department of
Labor's Office of the Assistant Secretary for Policy (OASP) and
Veterans' Employment and Training Service (VETS) developed a
system designed to help veterans determine the type of Federal
employment preferences to which they are entitled, the benefits
associated with the preferences and the steps necessary to file
a complaint due to the failure of a Federal agency to provide
those benefits. The committee will review the enforcement of
the veterans' preference laws by the Department of Labor. The
committee will also review the VETS-100 Report, which companies
must file showing the number of targeted veterans in their work
force by job category, hiring location and number of new hires.
The committee will evaluate the VETS-100 report to determine
employer compliance with veterans preference laws.
42. The Civilian Health and Medical Program of the
Department of Veterans Affairs. There are approximately 160,000
Civilian Health and Medical Program of the Department of
Veterans Affairs (CHAMPVA) beneficiaries who generate over 1.7
million medical claims. Annual program expenditures are
approximately $160 million, with claims totaling around $145
million. The committee will review the effectiveness of program
management controls for duplicate claims payments, eligibility
verification, and recovery for fraudulent claims payments. The
committee will also review how the recently authorized CHAMPVA
for Life program is being implemented.
43. Controlled Substances Security. The VA IG's Combined
Assessment Program Reviews have consistently cited material
weaknesses in VA medical center security for controlled
substances. Weak security increases the potential for waste,
fraud, abuse, and drug diversion. The committee will examine VA
efforts to address this issue.
44. The Uniformed Services Employment and Reemployment
Rights Act. Under the Uniformed Services Employment and
Reemployment Rights Act (USERRA), reserve component service
members called up active duty have the right to return to their
employment upon leaving active duty. In light of the current
mobilizations of the reserve components, the committee will
examine the effectiveness of USERRA for returning service
members.
REPORT TO THE COMMITTEE ON THE BUDGET FROM THE COMMITTEE ON VETERANS'
AFFAIRS, SUBMITTED PURSUANT TO SECTION 301 OF THE CONGRESSIONAL BUDGET
ACT OF 1974, ON THE BUDGET PROPOSED FOR FISCAL YEAR 2004, MARCH 7, 2003
LETTER OF TRANSMITTAL
----------
House of Representatives,
Committee on Veterans' Affairs,
Washington, DC, February 28, 2003
Hon. Jim Nussle,
Chairman, Committee on the Budget
House of Representatives, Washington, DC
Dear Mr. Chairman: Enclosed with this letter is the report of the
Committee on Veterans' Affairs on the fiscal year 2004 budget for
veterans' benefits and services.
The Committee has carefully reviewed the Administration's budget
proposal for the Department of Veterans Affairs (VA). On February 11,
2003, the Committee held a hearing to receive the testimony of the
Secretary of Veterans Affairs and veterans service organizations on the
Administration's proposed budget, as well as views on the Independent
Budget proposed by four major veterans organizations. While the
Administration has again proposed a substantial increase in the budget
for veterans' affairs, there remains a gap between the level of
resources it would provide and that needed to meet unprecedented growth
in demand for VA health care. There is also a serious backlog of
maintenance and repair projects necessary to transform many of our
National Cemeteries from neglected graveyards to national shrines.
The Administration's proposed fiscal year 2004 budget requests
total resources for the medical care business line of $27.5 billion, a
net increase of $2 billion over the fiscal year 2003 level for
equivalent accounts; of this $2 billion, only $1.5 billion is
appropriated funds. Of the total increase requested in the 2004 budget,
about $525 million would come from increased collections. Payments by
veterans for VA health care are projected to increase by $187 million
due to several proposed policy changes; increased collections from
third parties account for $349 million of the $525 million projected
increase, with proposed legislative changes accounting for $69 million
of this amount. Adoption of these policies would result in a
significant reduction in demand for VA health care from veterans who do
not have a compensable service-connected disability and who are not
poor.
The VA's ability to provide long-term care would be severely
impaired by the Administration's proposal to close about 5,000 of its
12,000 nursing home beds. Given the expected number of elderly veterans
from World War II and the Korean War who are expected to seek nursing
home care over the next ten years, the Committee is strongly opposed to
any proposal that would result in the closure of even a single VA
nursing home bed.
The Administration's health care budget also is predicated on
achieving ``management efficiencies'' totaling $950 million. Previous
VA budgets contained similar proposals, and while the Committee does
not wish to discourage efforts to make VA health care more efficient,
there is little evidence that such savings have been or will be
achieved. Thus, the Committee is reluctant to rely on projections of
this magnitude as a substitute for funding veterans' health care.
The Committee observes that funding for veterans' health care has
become one of the most contentious topics year after year, and that it
is nearly impossible to manage veterans' health care on a rational,
business-like basis with the current unreliable funding situation. The
Committee is convinced that veterans' health care funding must be put
on a more firm foundation that matches funding with the actual number
of veterans who seek care from VA. Consequently, the Committee believes
that Congress should make a commitment to funding VA health care for
enrolled veterans on a fiscally responsible and guaranteed basis, and
the Committee recommends that the Budget Committee provide for this
funding change in the budget resolution.
For veterans' entitlement benefits, the Administration proposes
$33.4 billion in entitlement programs for compensation, pensions,
education, vocational rehabilitation and employment, housing, insurance
and burial. The Committee recommends legislation that would permit
surviving spouses of veterans killed on active duty to retain their VA
benefits if they remarry after age 55. Every other Federal survivor
benefit permits the continuation of benefits to spouses who remarry
after a certain age.
College Board data show the current $900 Montgomery GI Bill monthly
rate would need to be $1,496 for a veteran-student to attend a four-
year public college as a commuter student. The Committee recommends an
incremental increase in basic monthly benefits to $1,200, and
elimination of the initial $1,200 participation fee servicemembers must
pay. The total first-year cost of these and other benefit enhancements
is estimated by the Committee to be $701 million, and the Committee
strongly recommends that these benefit improvements be accommodated in
the 2004 budget resolution.
The Administration budget also requests $422 million to pay burial
benefits to veterans' families, operate 121 National Cemeteries,
develop new national cemeteries, expand existing cemeteries, and
establish or expand state veterans' cemeteries. The Committee welcomes
this initiative, but believes that an additional $65 million is needed
to address the $279 million in recently identified cemetery maintenance
and restoration projects.
Although the VA has made considerable progress in implementing a
number of recommendations made by a task force that studied the
benefits claim backlog, the Administration's budget inexplicably does
not provide any additional funding to continue implementation of a
number of recommendations. The Committee recommends a modest increase
of $12 million to implement these recommendations, as well as $17
million to retain existing staffing in VBA's various programs.
We believe the increases recommended by the Committee and more
fully justified in the accompanying views and estimates for fiscal year
2004 are necessary to adequately fund veterans programs. We
particularly wish to reiterate that Congress must find a better way to
fund veterans' health care in order to meet the obligation to care for
those who have answered the Nation's call to duty.
We thank the Committee on the Budget for considering our
recommendations and look forward to continued discussion on these
important issues.
Sincerely,
Christopher H. Smith, Lane Evans,
Chairman Ranking Democratic Member
______
BACKGROUND AND COMMITTEE RECOMMENDATIONS
Department of Veterans Affairs
VETERANS HEALTH ADMINISTRATION
The Status of VA Health Care.--Beginning in the mid-1990s,
the Department of Veterans Affairs accelerated internal reforms
of its health care delivery system for veterans, greatly
emphasizing primary and managed care, while expanding sites of
clinical service. Today, VA health care is widely available to
millions of veterans in 1,300 locations, ranging from major
urban academic medical centers to rural storefront clinics. VA
health care is recognized for its world-class patient safety
program and provides veterans a measurable advantage in quality
of care. As provided by law, VA manages veterans' access to
care through a formal enrollment system. Through outreach VA
has enrolled nearly seven million veterans, about five million
of whom are regular patients.
While the number of veterans enrolled in VA medical care
has increased dramatically, appropriated funding is not keeping
pace with the growth in enrollment or the increased needs of
elderly veterans. Further, much of VA's capital infrastructure
(hospitals and clinics) is outdated or not receiving adequate
maintenance. Many VA health care structures are subject to
severe seismic risk and some, in fact, have been damaged by
earthquakes in recent years. Some obsolescent facilities need
complete replacement.
In July 2002, VA reported to Congress that it estimated
that 310,000 veterans were waiting more than six months for
initial appointments. By December 2002, that number had been
reduced to 236,000, but two-thirds of these were new enrollees,
not respondents to the initial data review from July.
The Secretary of Veterans Affairs, the Honorable Anthony J.
Principi, on February 11, 2003, presented the VA's budget
request for fiscal year 2004 to the Committee. In his
testimony, the Secretary observed: ``[t]he demand for VA health
care has risen dramatically in recent years. From 1996 to 2002,
the number of patients to whom we provided health care grew by
54 percent. Among veterans in Priority Groups 7 and 8 alone,
the number treated in 2002 was about 11 times greater than it
was in 1996.''
The Department has confirmed to the Committee that in the
current fiscal year, it projects a shortfall in resources of
$1.9 billion to meet the anticipated needs for medical services
of those already enrolled. At the Committee's hearing on the
state of the VA health care system on January 29, 2003, the
Under Secretary for Health, the Honorable Robert H. Roswell,
testified that to adequately meet the needs of VA's core
constituency of service-disabled and poor veterans, the
Veterans Health Administration would require annual budgetary
increases of 13 to 14 percent. The Department received a record
health care funding increase of 11 percent from the omnibus
appropriations bill signed by the President on February 20,
2003, Public Law 108-7. This increase, however, did not address
the reported $1.9 billion shortfall.
The FY 2004 budget proposes closing 5,000 VA nursing home
beds at a time when older veterans' needs for nursing home care
are growing. VA would substitute non-institutional
alternatives, as well as state and community nursing home beds
for these VA nursing home beds, but does not request sufficient
resources to match the level of capability eliminated by
removing these beds from service. VA also proposes that
Congress double VA's prescription copayment for some veterans.
The Secretary of Veterans Affairs already has the authority to
increase copayments when necessary without intervening action
by Congress, provided the copayment does not exceed the actual
cost for these drugs. In February 2002, VA more than trebled
the prescription copayment amount. The Committee does not
recommend additional increases.
The Administration proposes that Congress impose an annual
enrollment fee of $250 on Category 7 and 8 veterans. The
Committee is concerned about ramifications of such a policy and
is opposed to its enactment as a solution to VA's recurring
financial problems. Other alternatives to resolving VA's
funding deficits should be exhausted before imposing this
additional cost on veterans. Proposals designed to discourage
veterans' use of services could prove unnecessary, for example,
with passage of a meaningful drug benefit. The Committee
recommends an additional $773 million to account for needs
associated with retention of nursing home beds, expansion of
alternative programs and maintaining veterans' access to care.
The Committee notes that the Secretary of Veterans Affairs
has announced an agreement in principle with the Secretary of
Health and Human Services to execute an agreement under the
Medicare Part C program so that VA facilities with available
capacities may participate in a ``VA+Choice'' managed care plan
for a small number of Priority 8 veterans now temporarily
excluded from direct enrollment in VA health care. Also, over a
quarter million veterans currently enrolled in VA care are
simultaneously enrolled participants in the military TRICARE
program; the VA should actively seek greater cooperation from
the Department of Defense in coordinating benefits for military
retirees who are enrolled as veterans in the VA health care
system.
If a private or other public health insurance plan covers a
veteran, whether through a private employer or the Federal
government, VA should have access to that information. The
Committee supports the Administration's proposal to make
accurate insurance disclosure a requirement and expects to
report legislation providing this authority along with other
measures, such as deeming VA a preferred provider for purposes
of receiving payment from managed care organizations. These new
authorities would aid VA's collections program.
Inflation.--The medical care component of the Consumer
Price Index (CPI) continues to escalate, outpacing all other
items in the CPI for the past seven years. The Bureau of Labor
Statistics (BLS) released inflation rate data in December 2002
that showed the overall health care inflation rate was 5
percent for calendar year 2002. Within that level, hospital
care inflation was the highest single component at 10.2
percent, followed by prescription drugs and medical supplies at
6 percent. An experimental price index Congress directed BLS to
develop also reveals that persons 65 years of age and over are
spending more than twice as much on health care as the total
population. During the Committee hearing on January 29, 2003,
Dr. Roswell testified as follows:
One of the things that we have determined is that in
a typical year, our expenses increase 6 to 7 percent by
new enrollment in Priorities 1 through 7. In addition
to that [enrollment growth], increased utilization,
because the veteran population ages, and health care
expenditures and health care utilization increase. With
every increasing year of age, particularly in an
elderly population, we have another 2 to 3 percent
incremental cost every year. So a 7 percent increase
associated with enrollment in our highest priority
groups, coupled with another 2 to 3 percent of
increased utilization costs, coupled with a
conservatively estimated health care inflation rate of
4.5 or 5 percent, yields a 13 or 14 percent per year
increase in the money available to take care of just
our core population of veterans.
Rising Pharmaceutical Costs.--VA expects to spend about
$4.4 billion this year on its pharmaceutical programs. VA's
budget for prescription drugs has nearly doubled over the past
three years and, at the current rate of growth, will exceed $7
billion by the end of fiscal year 2008. A budget growth of such
magnitude stems from both higher utilization of the program by
veterans and increased use of new drugs. From December 2000 to
December 2002, the Veterans Health Administration reported that
enrolled veterans increased from 4.7 million to 6.7 million,
with about 4.7 million expected to be active consumers of VA
health care services. VA should request adequate funding to
ensure that it remains capable of providing state of the art
pharmaceutical drug treatment.
Capacity and Demand for Long-term Care Services.--Public
Law 106-117, the Veterans Millennium Health Care and Benefits
Act of 1999, expanded VA's mission to provide and maintain
specialized capacities to care for aging veterans. The
Committee has been in regular communication with the Secretary
concerning a noted decline in VA nursing home beds
(approximately 2,000 beds). On May 8, 2002 the Secretary made a
commitment to restore these beds to their prior level, provided
that Congress appropriates an increase in VA's medical care
appropriation for fiscal year 2003. In the omnibus
appropriation approved by Congress on February 13, 2003, VA
received $1.1 billion more than what was requested by the
President for the period.
The Committee is disappointed by the Secretary's proposal
in this budget to close thousands of additional VA nursing home
beds. VA's own long-term care model, based on the medical needs
of its users, indicated a need for 17,000 new nursing home beds
by 2020. The Committee does not believe that VA can replace
5,000 nursing home beds with outpatient programs for elderly,
chronically ill veterans.
VA has never fulfilled the promise of its landmark mid-
1980's study, Caring for the Older Veteran. That study
recommended large increases in both inpatient and alternative
programs, such as respite, hospice, adult-day and home-based
care, so that VA could approach the needs of World War II
veterans with meaningful, health and end-of-life care programs,
on both institutional and non-institutional bases. This has not
been achieved.
In order to aid the Department in maintaining its current
nursing home bed level, the Committee recommends that VA's
budget request be augmented by an additional $297 million.
Furthermore, VA should fund effective alternatives to long-term
care and reopen long-term care nursing beds which have been
closed.
Health Care for World War II Filipino Veterans.--Last year,
the House approved legislation to authorize VA to provide
health care to certain Filipino World War II veterans now legal
residents or citizens of United States. The Administration
supported this provision and the Secretary stated that VA would
absorb the $12 million estimated cost of implementation in the
Departments budget. The Committee recommends an additional $12
million to support this proposal.
Mental Health Programs for Disabled Veterans.--Over the
past five years, the Department has shifted resources and
programs away from institutional mental health care. However,
as VA planned new community-based intensive case management
programs, it was understood that sufficient resources would be
preserved to provide an appropriate level of care for VA's
chronically mentally ill patients.
The VA Advisory Committee on Seriously Mentally Ill
Veterans estimates the shift in resources from mental health
programs may be as much as $600 million. VA has dramatically
expanded its primary care clinics. While the Committee
certainly supports the primary care clinics, VA should
partially restore lost support for mentally ill veterans. Again
this year the budget request does not address this need. The VA
Program Evaluation Resource Center maintains a registry of
veterans suffering with psychosis and bipolar disorder that
contains 200,000 individuals. These veterans cannot be
sustained medically without intensive efforts. Due to the
nature of their illnesses, most cannot speak for themselves.
Accordingly, the Committee recommends a number of funding
adjustments in the following areas:
1. Mental health intensive case management teams--The
Committee understands that VA presently operates about
50 intensive case management teams assigned to
aftercare of VA patients with serious and chronic
mental illness. Some of these teams that already had a
minimal staffing complement have recently suffered
reductions in staff. A fully functioning team's annual
average direct cost (primarily in staffing) is
approximately $400,000. The Committee recommends an
additional $40 million for fiscal year 2004 to fund 100
additional teams for a total of 150 Mental Health Care
Intensive Care Management teams to provide vulnerable
veterans better follow-up care and improved
coordination of community based services.
22. Mental health in community primary care--The
Department operates approximately 650 community based
outpatient clinics nationwide. When VA made the decision to
provide better access to community-based primary care, it did
not sufficiently provide for mental health needs in these
clinics. Approximately half of these facilities offer dedicated
mental health services, but the remaining sites do not. The
addition of qualified mental health staff to support effective
professional services in these settings is a way to ensure that
mental health care becomes more accessible and convenient.
Adding a small cadre of mental health professionals at
approximately 200 locations (according to their need) would
provide a more complete service in VA community-based clinics.
A $40 million enhancement to mental health capacity would also
give VA better options to care for not only the de-
institutionalized chronically mentally ill, but also to provide
new services to veterans with acute mental health needs who may
not otherwise receive adequate care.
3. Substance-abuse programs--VA Currently cares for
130,000 veterans with substance abuse problems. Over the past
decade, VA shifted its drug treatment programs from residential
care to ambulatory-based programs. VA has acknowledged in its
report under section 1706 of Title 38, United States Code, that
capacity in the substance-abuse disorder programs is declining.
The Committee believes these programs should be restored.
Opioid-substitution programs are insufficiently available in VA
facilities and some metropolitan areas do not provide enough
care to meet the needs of the veteran population. The Committee
recommends $20 million in additional funds to address these
shortcomings.
Medical Care Collections Fund.--VA is authorized to bill
health care insurers for covered non-service-connected care
provided to veterans. The Department projects medical care
collections for 2004 to be $2.1 billion. This would be the
largest one-year increase in collections in the program since
Congress authorized it in 1986--32 percent above the estimated
end-of-year collections for 2003. The Department is attempting
to achieve this remarkable goal by implementing a revenue cycle
improvement plan and collecting better, verifiable insurance
information sooner in the process of patient care. VA also is
pilot testing a business plan to reconfigure the revenue
collection program with contracted efforts and commercial
collections systems using standard practices.
The Committee supports the Department's efforts at
improving performance in first- and third-party collections,
but the Committee remains skeptical that VA can achieve all it
promises in fiscal year 2004. If VA fails to achieve its goal
of such a significant one-year increase, veterans will be
denied care to the extent of that failure. The Committee is
unwilling to assume VA will be successful in increasing
collections as promised. Assuming the Department can accomplish
a 10 percent increase in collections in fiscal year 2004 over
the current estimate for this year, the Committee recommends
that $363 million be restored to Medical Care to account for
the difference between VA's budget level and the practical
effect of its actions.
Management Improvements and Efficiencies.--The Department's
2004 budget proposes to achieve management savings of $950
million, three times the level of savings projected for fiscal
year 2003, from management efficiencies and improvements. VA's
plans include implementing a competitive out-sourcing plan,
reforming the health care procurement process, increasing
employee productivity, increasing health resources sharing with
the Department of Defense, and continuing the trend of shifting
patients from inpatient to outpatient levels of care.
The Committee concludes that VA will be able to achieve
only about a quarter of the management savings it has proposed
in this budget. Therefore, the Committee recommends an
additional $625 million for veterans' medical care.
Homelessness Among Veterans.--With the passage of the
Homeless Veterans Comprehensive Assistance Act of 2001, the
Committee enunciated a goal of ending chronic homelessness in
the veteran population within a decade. More than a year since
enactment of this law, the Committee is not satisfied with VA's
responsiveness to the mandates of this Act. Among some of the
most effective activities that need additional funding are VA
homeless domiciliaries; VA's grant and per diem program for
community providers; and the so-called ``Health Care for
Homeless Vets' initiative.'' VA also funds several programs in
mental health and coordinates with other Federal agencies
(principally the Departments of Housing and Urban Development,
and Labor) to address veterans' homelessness. VA has yet to
implement a prison and institutional outreach-transition
initiative and a special needs authority provided in the Act.
The Department has made a $5 million commitment to provide
health care services and case management in a VA-HUD-HHS joint
venture that would open 300-400 new beds in sites yet to be
announced. VA is prepared to commit $10 million to provide
dental services to homeless veterans as authorized in the Act.
The Department has not made a transitional housing loan as
authorized by 1998 legislation despite a commitment to do so.
The Committee rejects the VA proposal that Congress convert the
transitional housing loan program to a grant program.
The Act authorized funding of $75 million for the several
in-house homeless assistance programs for fiscal year 2003, but
VA is requesting no funding in its budget. Also, the Act
authorized $5 million for homeless domiciliaries in fiscal year
2003, and an additional $5 million in 2004. VA made no request
for these funds. The Committee recommends that $75 million be
added to the VA's budget to address the still unmet needs of
about one-quarter million homeless veterans.
Medical and Prosthetic Research.--The Department carries
out an extensive array of research and development as a
complement to its affiliations with medical and allied health
professional schools and colleges nationwide. While these
programs are specifically targeted to the needs of veterans, VA
research has defined new standards of care that benefit all
Americans. Among the major emphases of the program are aging,
chronic diseases, mental illnesses, substance-use disorders,
sensory losses, and trauma-related illnesses. VA's research
programs are internationally recognized and have made important
contributions in virtually every arena of medicine, health, and
health systems.
The Secretary has requested a 2004 budget for VA Medical
and Prosthetic Research of $408 million, an increase of $8
million or 2 percent over the fiscal year 2003 level. The
Committee strongly supports an increase in the research account
to $460 million (15 percent) in 2004, as recommended by both
the Independent Budget as well as the Friends of VA Research
coalitions. The Committee believes this additional funding is
needed in VA's research programs to keep pace with funding
developments in the Federal biomedical research community. A 16
percent funding increase was provided in the 2003 omnibus
appropriations bill for the National Institutes of Health.
Additional funding of $52 million in VA biomedical research in
fiscal year 2004 would provide coverage for inflation and
permit a small program expansion.
Emergency Preparedness in Bio-Terrorism.--The Department of
Veterans Affairs Emergency Preparedness Act of 2002 mandated VA
to establish four national emergency preparedness centers and
an educational curriculum for medical students and
professionals for response to weapons of mass destruction. The
Act authorized $20 million per year for the support of the
centers. Due to unavailability of funds, the Department has yet
to proceed with establishment of the centers. These centers are
critical to enable VA to aid the Department of Defense and
other Federal agencies to contend with the war on terrorism,
and even more importantly, to aid VA in preparing itself to
deal with the effects of the use of weapons of mass
destruction. The Committee urges the Committee on the Budget to
include $20 million to support the establishment of these new
bio-terrorism research centers. The Act also authorized the
establishment of an education program to be carried out through
VA. The education and training curriculum would include a
program to teach current and future health care professionals
how to diagnose and treat casualties who have been exposed to
chemical, biological, or radiological agents. The Committee
also urges the Committee on the Budget to include an additional
$5 million to support the requirement.
Medical Administration and Miscellaneous Operating
Expenses.--For national program administration, the Secretary
proposed an increase in the Medical Administration and
Miscellaneous Operating Expenses (MAMOE) account of $9.4
million in fiscal year 2004. The budget requests a total of
$87.5 million in MAMOE to provide improved corporate leadership
and support to VHA. Specifically, by providing VHA a basis to
increase staffing in national program administration from the
fiscal year 2003 estimated level of 545 to a planned 588, this
increase will have a beneficial effect on the development and
implementation of policies, plans, and broad program
activities. The increased funds are intended to help complete
the restructuring of the Office of the Under Secretary for
Health which began in 2002. Part of this restructuring is
focused on the Capital Assets Realignment for Enhanced Services
(CARES) process and the creation of a new Deputy Under
Secretary for Health Policy to better coordinate federal health
care benefits between various agencies, and to enhance the
prospects for VA-DOD sharing. The Committee supports $87.5
million as requested for MAMOE.
CARES and the Continuing Needs of Veterans.--VA is
continuing its initiative to identify the most effective and
efficient use of its infrastructure in health care delivery to
veterans. The Committee held a number of hearings during the
107th and earlier Congresses dealing with VA's capital assets.
VA hospitals were primarily built or converted after World War
II to rehabilitate and care for wounded, sick and traumatized
soldiers, sailors, airmen, and marines. For the past thirty
years VA has gradually changed its health care approach from an
institutional provider of physical medicine and rehabilitation,
long-term psychiatry, and restorative care to that of an
outpatient and acute primary care provider to serve an older
population with chronic illnesses. The capital infrastructure
built for its previous approach does not easily lend itself to
VA's new delivery model.
Even though VA's CARES process will take several years to
complete, the Committee strongly believes that VA's most
pressing capital infrastructure needs must be addressed. Due to
the CARES process, in recent years VA has proposed few
construction projects.
Outside consultants and VA's own reports show a growing
need and rising backlog of major and minor projects. For
example, a 1998 Price Waterhouse report suggested VA, in
proportion to the value of its $35 billion infrastructure,
should be investing in the range of $700 million to $1.4
billion annually on replacement and modernization projects. A
second consultant report disclosed dozens of VA patient care
buildings at the highest level of risk for earthquake damage or
even collapse. Another report revealed $57 million in needed
projects to protect women's privacy in VA health facilities.
Major Construction Projects.--In the 107th Congress, the
Committee authorized nearly $800 million in major medical
facility construction needs, but little of this funding was
appropriated. Last year, the Department advised Congress of its
major construction priorities, as follows:
1. Palo Alto, CA: This project would include seismic
corrections, correction of patient privacy
deficiencies, correction of fire safety deficiencies,
and functional improvements for the Mental Illness
Research, Education and Clinical Center.
2. Cleveland, OH: This project would include the
replacement of all mechanical, electrical, and
architectural systems installed in this facility built
in 1961.
3. San Francisco, CA: This project would seismically
upgrade the main inpatient building at the San
Francisco VA Medical Center.
4. Anchorage, AK: This project would consolidate the
Alaska Veterans Affairs Health Care System and Regional
Office at Elmendorf Air Force Base, Alaska.
5. West Los Angeles, CA: The upgrade of Building 500
would strengthen braced frames below the second floor,
strengthen collector plate connections to the braced
frames, and add new collector plates to transfer loads
in the central core area to the braced frames located
at the wings.
6. West Haven, CT: This project would renovate three
inpatient wards to correct for patient privacy
inadequacies as well as consolidate associated support
services.
7. Long Beach, CA: Building 7 of the VA Long Beach
Medical Center would be seismically upgraded and
retrofitted.
8. Palo Alto, CA: Renovations would include seismic
corrections, correction of fire safety deficiencies,
and functional laboratory improvements in areas
formerly occupied by inpatient psychiatric wards.
Building 205, Menlo Park campus, would be demolished.
Most research personnel would be relocated.
9. Tampa, FL: This project would relocate three
Spinal Cord Injury (SCI) inpatient wards and ancillary
support functions to a new SCI building.
10. VISN 4 (PA, WV, NJ, DE, OH): This multi-facility
project would renovate and expand outpatient clinics at
seven different medical centers. Six of the eight
projects would renovate and expand primary and
specialty care clinic areas. The other two projects
would expand outpatient ambulatory surgery and
outpatient day programs.
11. Beckley, WV: This project would consist of design
and construction of a nursing home care unit with 120
beds.
12. Lebanon, PA: This project would reconfigure two
floors at the VAMC which is currently unfit to house
inpatients. A new elevator shaft and entrance would be
built to meet the needs of the patients.
13. San Diego, CA: This project would seismically
strengthen the Medical Center by adding two new
exterior unbonded braced frames at the end of each
building wing, replacing the braces in all of the
existing braced frames with new unbonded braces, and
adding new collector elements.
14. Hines, IL: A blind rehabilitation center
(authorized and appropriated in fiscal year 2002) would
be relocated and modernized.
15. San Juan, PR: The air conditioning would be
repaired and overhauled in conjunction with asbestos
abatement and further seismic protections in three
areas in the existing basement, first, and second
floors.
16. VISN 6 (WV, VA, NC): This multi-facility project
would renovate five VAMCs' Mental Health and Spinal
Cord Injury/Dysfunction Units. The project includes
privacy improvements, hazardous materials abatement,
window replacement, and HVAC and utilities upgrading.
17. VISN 4 (PA, WV, NJ, DE, OH): This multi-facility,
VISN-wide project would renovate and upgrade seven
major VA medical centers for patient safety and
patient/employee welfare.
18. Atlanta, GA: The renovations would correct
patient privacy issues, improve staff efficiencies,
improve the functional layout, and meet ADA
requirements and female patient issues.
19. Tampa, FL: This project would provide
approximately 1,170 additional parking spaces for the
Tampa VA Medical Center.
20. Washington, DC: This project would allow for
three new clinics to improve patient flow between
primary care and specialty care clinics.
While the House passed an authorization measure supporting
the completion of many of these high-priority projects, only
the Hines, IL project on the above list received appropriations
in fiscal year 2002. No funds for any of the other projects
were appropriated in fiscal year 2003.
The Committee understands that the sale of the
underutilized VA Lakeside hospital in Chicago was expected to
be a direct source of funding to improve the West Side VA
facility as a key acute inpatient facility for the veterans of
Chicago. VA indicates in the budget that CARES will provide the
funding for the project which is now estimated at $98.5
million, considerably less than the previous estimate.
The Colorado University School of Medicine plans a major
relocation of all its facilities to the site of the closed
Fitzsimons Army Hospital. VA is considering whether to
recommend replacement of the Denver VA Medical Center, a 50-
year-old structure now co-located with the Colorado medical
school as a part of that relocation. These two meritorious
projects alone, the West Side tower and the new Denver VA
Medical Center, are estimated to cost nearly $500 million.
In addition, there are many other worthy projects high on
VA's established priority list that lack funds. Many are
medical centers that will not be affected significantly by
CARES and that are needed to continue providing good health
care to veterans. The Committee will further explore these
needs and will recommend projects to meet them. Consequently,
the Committee recommends an additional amount of $500 million
for the major medical facilities construction account in fiscal
year 2004.
State Home Grants Programs.--In 47 states, 114 homes for
veterans provide nursing, domiciliary care, and adult day care
to over 21,300 veterans whose care is coordinated with the
Department of Veterans Affairs. States commit to pay 35 percent
of the construction costs of projects for state home
facilities, and to bear most of the cost of facilities
operations and health care that exceeds amounts contributed by
VA. Fiscal year 2003 applications totaling $287 million for new
construction and renovation grants to state veterans homes are
pending in the Department. A new round of requests will be
solicited in April 2003 for fiscal year 2004 awards.
Congress revised the state home program in Public Law 106-
117 to provide a higher priority for critically needed
renovations in existing state homes, especially those projects
involving fire and life safety improvements. Prior to enactment
of P.L. 106-117, these long-delayed projects were given a lower
priority for funding than grants for constructing new state
home beds. Although VA has implemented the provisions of the
Act affecting the ranking criteria for funding projects,
renovation projects remain 63 percent of the overall backlog of
unfunded projects. The budget requests $102 million to support
the grant program, a two percent increase over the fiscal year
2003 appropriated level. The Committee recommends additional
funding of $30 million to support a more adequate VA response
to the growing demand for long-term care facilities and to
modernize and renovate existing facilities in the states'
inventories. Provision of these funds will support the
establishment of approximately 360 new nursing home and
domiciliary beds in state veterans' homes.
VETERANS BENEFITS ADMINISTRATION
Compensation and Pension Service.--The ability of VA to
provide accurate, timely and quality benefits delivery is
dependent on a number of factors, including an adequate number
of properly trained staff, effective business process and
computer modernization initiatives, accountability measures,
inter-departmental cooperation between the various VA
administrations and military service departments, including the
National Personnel Records Center and the Center for Unit
Records Research, and assistance from the veterans service
organizations. Entitlement benefits are provided to 2.5 million
veterans, more than 316,000 survivors, and 1,115 children.
The President is requesting $29.9 billion and 8,586 FTEE to
support the compensation and pension entitlement benefits
programs. This represents a $3.4 billion dollar increase over
the enacted fiscal year 2002 level, but a decrease of 190 FTEE
is also proposed. The Committee is concerned that a decrease in
FTEE could detract from continued improvements in claims
processing. The Committee notes that a number of VBA employees
have been called to active military service and that additional
activations may adversely impact claims processing.
Both the President and the Secretary have made timeliness
and quality in claims adjudication a top priority, and have set
a goal of adjudicating claims within 100 days by the summer of
2003. In December 2002, the average days pending for a rating-
related claim were 168, reduced from a high of 203 days in
January 2002. Additionally, the reported national accuracy rate
increased from 78 percent in 2001 to 80 percent in fiscal year
2002, with a target of 90 percent in 2004. VBA decreased its
claims workload from 344,183 rating-related claims at the end
of September 2002 to 328,566 as of December 2002.
In October 2001, the VA Claims Processing Task Force made
34 recommendations to improve claims processing. Of the 66
action items, 38 have been implemented--28 completely and 10
which are being monitored to ensure that the goals of the
recommendations are being met. The Committee recommends $12
million for VBA to implement the medium and long-term
recommendations, to include hiring nurses and other medically-
trained individuals, including veterans who have worked as
medical corpsmen or in similar military specialties, to work on
compensation and pension claims, to establish a more permanent
claims adjudication training cadre, and to out-base rating
specialists at 70 of the largest VA medical centers.
VBA Staffing for all Business Lines.--The Committee
commends VBA for its recent improvements in claims
adjudication; however, the Committee remains concerned that
FTEE levels across the board are actually below the fiscal year
2002 level. The Committee recommends an additional $17 million
to sustain employment and other critical operational process
improvements within VBA's major business lines: compensation,
pensions, education, housing, vocational rehabilitation and
employment, insurance and burial.
Regional Office Staffing.--The Committee is concerned about
the apparent lack of a long-term strategy for addressing the
claims needs of veterans served by poorly performing regional
offices. The Committee expects that VA will clearly articulate
a plan for addressing this critical problem and will
effectively use any funding for additional personnel to improve
performance. The Committee also expects that VA would closely
monitor the quality and productivity of any regional office
that receives additional funding or staff.
Homeless Veterans Coordinators.--Public Law 107-95 requires
the Secretary to ensure that there is at least one full-time
employee assigned to oversee and coordinate homeless veterans
programs at each of the 20 regional offices that the Secretary
determines have the largest homeless populations within the
regions of VBA. The Committee understands that, although the
offices have been designated and personnel nominally assigned
as coordinators, some of these employees have multiple
responsibilities and are not able to devote full-time efforts
to addressing the needs of homeless veterans. The Committee
expects that employees will be assigned to perform the
oversight and coordination activities mandated by Public Law
107-95 on a full-time basis and that general operating expense
funding for fiscal year 2004 will be used to support the
positions.
NATIONAL CEMETERY ADMINISTRATION
The President is requesting $156 million for (1) National
Cemetery Administration (NCA) operation and maintenance of 124
national cemeteries and 33 soldiers' and sailors' lots in
private or municipal cemeteries, monument sites and confederate
cemeteries, and (2) VBA adjudication of veterans' death
benefits. The President's budget request supports 1,588 FTEE in
NCA--an increase of 69 FTEE from the Fiscal Year 2003 request--
and 177 FTEE in VBA, an increase of two FTEE over last year's
request.
The President is requesting $108.9 million to develop new
national cemeteries, create additional gravesites at existing
national cemeteries, and establish/expand state veterans
cemeteries. The funds would be used to develop and/or expand
cemeteries in the following locations:
Detroit area, phase one development of a new
national cemetery;
Ft. Snelling, Minnesota, expansion of and
improvements to national cemetery; and
Barrancas National Cemetery, Florida, expansion
of and improvements to national cemetery.
The President's request does not provide funding for 928
full-scale cemetery restoration and repair projects, estimated
to cost $279 million, or funding for development of new
national cemeteries beyond those currently in development in
Pittsburgh, Sacramento, Southern Florida, and Atlanta. A study
mandated by Public Law 106-117 of future burial needs
determined that based upon 1990 census data, NCA would need to
develop 31 new cemeteries by 2020 to meet the burial needs of
veterans and their survivors. NCA is currently reevaluating
that recommendation with recently available data from the 2000
census.
The National Cemetery Administration (NCA) maintains almost
2.5 million gravesites at 124 national cemeteries in 39 states,
the District of Columbia and Puerto Rico. Of these, 61 have
available, unassigned gravesites for burial of both casketed
and cremated remains; 26 will only accept cremated remains and
the remains of family members for interment in the same
gravesite as a previously deceased family member; and 33 are
closed to new interments, but may accommodate family members in
the same gravesite as a previously deceased family member.
Occupied graves maintained by NCA are projected to increase
from 2,380,500 in fiscal year 2000 to over 2,998,100 in 2008.
VA is continuing to develop new cemeteries in areas not
presently served by NCA: Atlanta, Georgia; Detroit, Michigan;
Fort Sill, Oklahoma; Miami, Florida; Pittsburgh, Pennsylvania;
and Sacramento, California. However, an independent study--
mandated in Public Law 106-117--of veterans' burial needs based
on VA planning guidelines found that VA should establish 31
additional cemeteries through 2020 to provide service to 90
percent of veterans within 75 miles of their homes. This
assumed a veteran population threshold of 170,000. This study
was based upon data from the 1990 census. The Committee
understands that the report is being updated to reflect 2000
census data. Upon completion of that update, the Committee may
direct the Secretary to begin the planning phase for the
construction of seven new veterans' cemeteries in those areas,
with a veteran population threshold of 150,000, that are deemed
most in need between 2005 and 2020.
The Committee recommends a five-year, $300 million
restoration and improvements project at existing cemeteries.
The Committee recommends an initial, first-year appropriation
of $65 million for fiscal year 2004 to address this problem.
BOARD OF VETERANS' APPEALS
The President is requesting $50.4 million and 448 FTEE to
support its operations at the Board of Veterans' Appeals (the
Board). In fiscal year 2002, the Board received 28,158 appeals
and decided 17,231 appeals: 27.7 percent were granted in the
veterans' favor, 19.3 percent were remanded to a regional
office for further development, and 49.9 percent were denied.
The Committee recognizes that due to a number of factors,
including the large number of remands following enactment of
legislation mandating the VA's ``duty to assist'' claimants,
the number of appeals decided during fiscal year 2002 was
unusually low. Based upon new appeals filed during 2002, the
Committee expects that the number of decisions will return to
more historic levels (between 30,000 and 40,000), assuming
adequate staffing at the Board during future fiscal years.
During the past year, the Board has begun to assist in
developing some claims rather than remanding all of them to the
regional offices. The Board has converted 31 attorney positions
to support staff positions to staff the Evidence Development
Unit. It appears the loss of these attorneys has had a
significant impact on the Board's capacity to produce final
decisions in a timely manner. According to the Fiscal Year 2002
Report of the Board Chairman and the Administration's budget
request, without additional FTEE, the Board will not be able to
keep pace with the additional appeals it receives. With current
staffing and a 25 percent productivity increase projected in
the budget request, the Board is expected to develop a backlog
of 6,000 to 8,000 appeals per year. However, no additional
funding has been requested. The Committee expects that the
Board will manage its operations to fulfill its primary
function of deciding administrative appeals without developing
an unacceptable backlog.
Department of Labor
VETERANS' EMPLOYMENT AND TRAINING SERVICE
The Jobs for Veterans Act, Public Law 107-288, redesigned
the nationwide delivery system of veterans' employment and
training services based on themes of incentives, results,
accountability, and flexibility. In early December 2002, the
Department of Labor (DOL) established a comprehensive work
group of state and federal representatives to draft a broad
plan for implementing the new law. The Committee commends this
prompt action.
The states reported an average Entered Employment Rate
(percentage who register for work with the Job Service or a
One-Stop Career Center and gain employment) for veterans for
the first three quarters for fiscal year 2002 (October 1,
2001--June 30, 2002) of 41 percent. For fiscal years 1999,
2000, and 2001, the Entered Employment Rate for veterans
averaged about 30 percent. The Committee views the improvement
in Entered Employment Rate as a promising start.
The most recent DOL-published unemployment rate data are as
follows:
Average 2002 Unemployment Rates for Male and Female Veterans
----------------------------------------------------------------------------------------------------------------
Age Male Veterans Female Veterans
----------------------------------------------------------------------------------------------------------------
All Ages 4.7% 5.0%
20-24 10.8% 13.3%
25-34 5.7% 5.5%
35-44 5.3% 5.0%
45-54 4.6% 3.4%
55-64 4.2% 2.5%
----------------------------------------------------------------------------------------------------------------
Average 2002 Unemployment Rates for Black and Hispanic Veterans
--------------------------------------------------------------------------------------------------------------------------------------------------------
Male/Female Black/Hispanic
All Ages 20-24
--------------------------------------------------------------------------------------------------------------------------------------------------------
Black Male 7.0% 17%
Black Female 6.6% 23.9%
Hispanic Male 4.7% 8.7%
Hispanic Female 9.9% 21.6%
--------------------------------------------------------------------------------------------------------------------------------------------------------
Further, according to the Bureau of Labor Statistics, 50.7
percent of all disabled male veterans were in the labor force
in August 2001. The unemployment rate for disabled male
veterans was 4.4 percent. The unemployment rate for ``special''
disabled male veterans (rated at least 30 percent disabled by
VA) was 8.5 percent. The Committee notes Public Law 107-288
authorizes the Secretary of Labor to create a ``weighted''
placement system that provides greater job placement credit for
harder-to-place veterans, such as those who are disabled or
have other unique needs.
The Administration is requesting $219,993,000 for VETS for
fiscal year 2004: $162.415 million for state grants for
Disabled Veterans Outreach Program Specialists and Local
Veterans Employment Representatives, $29.028 million for
federal program administration, $2 million for the National
Veterans' Employment and Training Services Institute (NVESTI),
$19 million for the Homeless Veterans' Reintegration Program
(HVRP), and $7.55 million for the Veterans Workforce Investment
Program. The fiscal year 2003 appropriation for VETS is
$214,212,000. The Committee recommends an additional $1 million
for the NVESTI. Congress authorized funding of $50 million for
HVRP in Public Law 106-117.
The Committee believes that the HVRP is one of the most
cost effective job placement programs in the Federal
government. During fiscal year 2002, DOL competitively awarded
102 grants: 43 to non-profit organizations, 11 to faith-based
organizations, and the remainder to state and local agencies.
These grants resulted in the enrollment of 12,142 homeless
veterans in the program. Of those enrolled, 6,605 successfully
entered employment, despite in many cases having to overcome
major obstacles to being employable. The Committee accordingly
recommends an additional $31 million for HVRP.
LEGISLATION THE COMMITTEE MAY REPORT WITH DIRECT SPENDING IMPLICATIONS
Montgomery GI Bill.--The current Montgomery GI Bill (MGIB)-
Active Duty basic benefit is $900 per month, effective October
1, 2002. This benefit increases to $985 per month effective
October 1, 2003, per Public Law 107-103, enacted December 27,
2001. The Committee recommends an increase in the MGIB to
$1,200 per month effective October 1, 2004. Against the current
baseline, the Committee estimates this measure would cost about
$405 million in 2004, and $2.63 billion over five years. This
increase would represent an interim step toward implementing
the bipartisan Servicemembers and Veterans Transition
Assistance Commission recommendation for an MGIB that pays
tuition, fees, and a monthly subsistence allowance, thus
allowing veterans to pursue enrollment in any educational
institution in America limited only by their aspirations,
abilities, and initiative.
Based on data from the College Board's ``Trends in College
Pricing for the 2002-2003 Academic Year,'' the Committee
concludes that the current monthly basic MGIB benefit would
need to be $1,496 per month for a veteran-student to be able to
pay the average tuition and expenses as a commuter student at a
four-year public college for academic year 2002-2003. The
College Board's 2002-2003 academic year statistics reflect that
average annual tuition and fees, books and supplies, room and
board, transportation and other expenses for attending a four-
year public college amount to $13,463 for a commuter student
and $12,841 for a student who lives on campus. Four-year
private institutions cost $27,695 and $27,677, respectively.
With the current basic MGIB annual benefit of $8,100, however,
a veteran is expected to pay tuition, fees, room and board, and
other living expenses during the academic year. The disparity
between these ever increasing costs and a veteran's ability to
pay for them using the MGIB benefits seems clear.
The Committee also recommends repeal of the current $1,200
pay reduction under the MGIB-Active Duty program. The Committee
estimates the cost of the repeal would be $227 million in the
first year and $1.18 billion over five years. This repeal was a
recommendation of the Congressional Commission on
Servicemembers and Veterans Transition Assistance. The
Committee notes the MGIB is the only form of federal student
financial aid in which the student is required to furnish
$1,200 in cash ``up-front'' to establish eligibility for the
program.
Congress has not updated the on-the-job training and
apprenticeship programs under the MGIB and other VA educational
assistance programs essentially since World War II. The
Committee may report legislation to update this program to
reflect on-job training and apprenticeship in business and
industry today. Such legislation may incur limited costs
against the baseline of $3 million or less per year.
Option of $50 monthly MGIB pay reduction.--A
servicemember's pay is reduced $100 per month for the first 12
months of active-duty service to establish eligibility for the
MGIB. The Committee views the $1,200 as a burdensome fee that
discourages veteran participation in the program. No other
federal education program charges such a fee. The Committee
recommends legislation to give servicemembers the option of a
pay reduction of $100 per month for 12 months or $50 per month
for 24 months. The Committee estimates the cost to be $101
million in 2004 and $101 million over five years.
Access to Entrepreneurship.--The Committee recommends
legislation to help veterans start small businesses. The
legislation would: (1) allow veterans to use VA education
benefits to enroll in non-credit small business courses
sponsored by Small Business Development Centers and others, (2)
liberalize current law language to make it easier for graduates
of a VA vocational rehabilitation program to go directly into
business for themselves, and (3) make revisions to current law
to allow disabled veterans a greater opportunity to compete for
contracts with the Federal government. The Committee estimates
costs of $2 million or less per year.
Dependency and Indemnity Compensation for Surviving Spouses
Who Remarry after Age 55.--Dependency and Indemnity
Compensation (DIC) provides a partial substitute for the
economic loss suffered by the survivors upon the service-
connected death of a veteran. For a survivor to be eligible,
the veteran must have died during military service, from a
service-connected disability, or have had a service-connected
disability that was rated 100 percent for 10 years prior to
death from a non-service-connected condition. DIC terminates
upon the remarriage of a surviving spouse, although benefits
may be restored in the event that the subsequent remarriage
ends in death or divorce. DIC is the only federal annuity
program that does not allow a surviving spouse who is receiving
compensation to remarry at an older age and retain the annuity.
Public Law 107-330 provided that a surviving spouse, upon
remarriage after attaining age 55, would retain health
insurance under the Civilian Health and Medical Program of the
Department of Veterans Affairs (CHAMPVA). The Committee
recommends legislation to allow a surviving spouse who
remarries after age 55 to retain DIC, education, and home loan
benefits. In 2002, the Congressional Budget Office estimated
the cost of this eligibility change to be $38 million in 2003,
$368 million over five years, and $779 million over ten years.
Vocational Training for Non-Service-Connected Pension
Recipients under Age 50.--The non-service-connected disability
pension program provides financial help to more than 348,000
low-income veterans. To be eligible, veterans must have served
on active duty for at least 90 days including at least one day
of wartime service, and be totally and permanently disabled for
employment purposes as a result of disability not related to
their military service, or over age 65. To ensure the
availability of vocational training to newly eligible VA non-
service-connected pension recipients age 45 or younger, the
Committee recommends legislation to reinstate a pilot program
that expired in December 1995. The program would afford pension
recipients the opportunity to receive training, along with a
stipend, in order to return to the job market rather than
requiring these veterans to rely solely on the VA pension
program for their financial well being. The Committee estimates
the cost to be $1 million in the first year and $9 million over
5 years.
Accrued Benefits for Veterans' Survivors.--Current law
restricts a surviving spouse to receiving no more than two
years of accrued benefits if a veteran dies while a claim for
VA periodic monetary benefits (other than insurance and
servicemen's indemnity) is being processed. VA is making
efforts to lower claims processing times, but it can sometimes
take more than two years to correctly determine and adjudicate
a claim for disability compensation or non-service-connected
pension benefits. The Committee recommends legislation to
repeal the two-year limitation so that the veteran's survivor
may receive the full amount of the award and not be penalized
if VA does not process claims in a timely manner. The Committee
estimates the cost to be $1 million per year.
Special Compensation for Former Prisoners of War.--The
Committee recommends legislation to establish a three-tiered
special monthly pension to former prisoners of war, to be based
upon the length of captivity. Those who were detained 30-120
days would receive $150 per month, those detained 121-540 days
would receive $300 per month, and those detained 540 or more
days would receive $450 per month. In 2002, the Congressional
Budget Office estimated a direct spending increase of $24
million in 2003, $345 million over five years, and $634 million
over ten years for special compensation to former prisoners of
war. The Committee also recommends legislation to extend VA
dental benefits to all former prisoners of war, regardless of
their length of captivity. The Congressional Budget Office
estimates this program expansion would cost less than $500,000.
National Cemetery Administration.--As discussed above, the
Committee may direct the Secretary to begin the planning phase
for the construction of seven new veterans' cemeteries in those
areas, with a veteran population threshold of 150,000, that are
deemed most in need between 2005 and 2020. In addition, the
Committee recommends a five-year, $300 million restoration and
improvements project at existing cemeteries to ensure that
national cemeteries are dignified and respectful settings.
Increase Auto Allowance and Specially Adapted Housing
Allowance for Severely Disabled Veterans.--VA is authorized to
provide a one-time reimbursement to severely disabled veterans
of $9,000 for the cost of an automobile. According to the
American Association of Motor Vehicle Administrators, the
average cost of a new automobile was estimated to be $21,605 in
2001. The Committee recommends legislation to increase the auto
allowance to $11,000. VA also provides a grant to offset the
cost of modifying a home to accommodate a veteran's
disabilities. The Committee also recommends legislation to
increase the grant for specially adapted housing for severely
disabled veterans to $50,000 and for less severely disabled
veterans to $10,000. The Committee estimates combining these
two proposals to cost $6 million in 2004, $34 million over 5
years, and $74 million over 10 years.
Vendee Loans.--The Committee opposes VA's January 23, 2003,
decision to administratively terminate the vendee loan program.
When a purchaser agrees to buy a foreclosed VA home, VA often
offers to finance the sale by establishing a vendee loan to
encourage the prompt sale of the home. Vendee loans are made at
market interest rates and often require a down payment.
Borrowers are assessed a 2.25 percent funding fee that is paid
in cash.
The Committee views vendee loans as an important tool to
obtain a higher return on property sales, which reduces the
overall cost of program operations. VA makes, and subsequently
sells, $800 million to $1.2 billion in such loans each fiscal
year. There is an ample body of empirical data indicating that
offering vendee financing is cost effective. In March 2002,
Booz, Allen, and Hamilton, Inc., independently analyzed the
cost effectiveness of vendee loan financing. Their report
indicated a savings to the government of $16 million in fiscal
year 1999 due to vendee financing. The Committee believes the
vendee loan program is based on sound business principles and
recommends legislation to reinstate the program.
Guaranteed Health Funding.--Because VA health care
discretionary appropriations have not kept pace with the needs
of veterans enrolled in the VA health care system, H.R. 5250
was introduced in the 107th Congress to establish a funding
formula to guarantee sufficient annual funding to meet the
medical care needs of these veterans. The bill was intended to
stabilize VA's health care financing and promote more efficient
use of funds.
The Committee recommends to the Committee on the Budget
that it convert the veterans health care account from
discretionary to mandatory funding. The Committee believes the
conversion would be essentially budget neutral because the
increase in mandatory funding would be offset by a decrease in
current discretionary appropriations for veterans health care.
The continuing health care of veterans would be funded through
a new financing system similar to the financing systems used
for the military TRICARE for Life program, the Medicare program
and the Federal Employees Health Benefits Program. In none of
these programs has the funding formula itself been the source
of increased costs. Veterans deserve a health care program with
an equally reliable funding mechanism.
Comparison of President's Proposed Budget, Independent Budget and VA Committee Recommendations for the Department of Veterans Affairs FY 2004 Budget
(Budget Authority in millions)
--------------------------------------------------------------------------------------------------------------------------------------------------------
FY 2003 FY 2004 Admin. IB Compared VA Committee VA Committee
Approved Admin. Compared to Independent to Admin. Recommend Compared to
(Estimate) Request FY 2003 Budget (IB) FY04 Request Admin. FY 2004
--------------------------------------------------------------------------------------------------------------------------------------------------------
Medical Care............................................. $23,889 $25,218 $1,329 $27,201 $1,983 $27,488 $2,270
MCCF and HSIF Receipts................................... $1,617 $2,141 $524 No estimate ............ $1,778 ^\$363
provided
Medical and Prosthetic Research.......................... $400 $408 $8 $460 $52 $460 $52
Medical Administration & Misc. Operating Expenses........ $70 $79 $9 $84 $5 $79 $0
Construction, Major...................................... $137 $273 $136 $436 $163 $773 $500
Construction, Minor...................................... $164 $252 $88 $440 $188 $252 $0
State Home Grants........................................ $100 $102 $2 $150 $48 $132 $30
State Cemetery Grants.................................... $32 $32 $0 $37 $5 $32 $0
General Operating Expenses (VBA and General $1,256 $1,283 $27 $1,545 $262 $1,312 $29
Administration).........................................
National Cemetery Administration......................... $132 $144 $12 $162 $18 $209 $65
Inspector General........................................ $55 $62 $7 $61 ^\$1 $62 $0
Total VA Discretionary (Excluding MCCF and HSIF Receipts) $26,235 $27,853 $1,618 $30,455 $2,602 $30,688 $2,946
----------------------------------------------------------------------------------------------
VA Mandatory Spending.................................... $31,678 $32,710 $1,032 No estimate ............ $33,411 $701
provided
==============================================================================================
--------------------------------------------------------------------------------------------------------------------------------------------------------
REPORT TO THE COMMITTEE ON THE BUDGET FROM THE COMMITTEE ON VETERANS'
AFFAIRS SUBMITTED PURSUANT TO SECTION 301 OF THE CONGRESSIONAL BUDGET
ACT OF 1974, ON THE BUDGET PROPOSED FOR FISCAL YEAR 2005, MARCH 4, 2004
LETTER OF TRANSMITTAL
----------
House of Representatives,
Committee on Veterans' Affairs,
Washington, DC, February 26, 2004
Hon. Jim Nussle,
Chairman, Committee on the Budget
House of Representatives, Washington, DC
Dear Mr. Chairman: We are pleased to convey with this letter the
views and estimates of the Committee on Veterans' Affairs regarding the
fiscal year 2005 budget for veterans' health care and benefits.
On February 4, 2004, the Committee held a hearing to receive the
testimony of the Secretary of Veterans Affairs and veterans service
organizations on the proposed budget for veterans programs. The
Committee also heard testimony from the authors of the Independent
Budget proposed by the Veterans of Foreign Wars, Disabled American
Veterans, AMVETS, and Paralyzed Veterans of America. The Secretary
presented the Administration's fiscal year 2005 budget request for a
total of $67.324 billion, an increase of $5.27 billion in budget
authority. Entitlement programs would receive $35.3 billion and
discretionary programs would receive $32.1 billion. The overall
increase in discretionary funds would be $517 million.
Congress should provide VA with sufficient funding to maintain
current levels of service for veterans health and benefits programs.
After carefully considering the VA's budget submission, the Independent
Budget submission, and the testimony presented at the budget hearing,
we have concluded that an additional $2.524 billion in budget authority
for VA's discretionary programs would be needed to ensure a current
services budget. In the Committee's view, this increase would allow the
Department to continue during fiscal year 2005 to provide the level of
benefits and services veterans are now receiving.
The budget requested by the Administration for veterans medical
care is $29.1 billion in total resources. Of this amount, $26.646
billion would come from appropriated funds, an increase of $708 million
over the adjusted appropriated level for the current fiscal year. The
balance of the request for medical care consists of an estimated $2.4
billion in collections, an increase of $667 million over the fiscal
year 2004 projection.
The Administration also proposes a $250 annual enrollment fee for
priority 7 and 8 veterans seeking VA medical care, and an increase in
drug and primary care copayments. Similar user fees were rejected by
Congress last year, and the Committee again recommends against their
adoption. VA's ability to provide long-term care would be severely
impaired by another Administration proposal, also made last year, to
close about 5,000 of its estimated 12,000 nursing home beds. Given the
expected number of elderly veterans from World War II and the Korean
War who are expected to seek nursing home care over the next ten years,
these proposals are illogical and indefensible.
Last year, the Committee favorably considered an Administration
legislative proposal to provide VA with additional health care
resources. Acting on the proposal, the Committee reported H.R. 1562, a
measure that would increase VA medical care collections by holding
insurers responsible for the cost of covered care provided by VA. The
Congressional Budget Office estimated that this authority would boost
collections by almost $800 million over five years. However, our
efforts to have the House consider this measure have been rebuffed.
For entitlement benefits, the Administration proposes $35.3 billion
in funding to support programs for veterans compensation and survivors
benefits, pensions, education, vocational rehabilitation and
employment, housing, insurance and burial programs. However, the budget
request would decrease total Veterans Benefits Administration (VBA)
staffing by 540 FTEE. The Committee recommends an additional $32
million in budget authority to maintain current levels of such staffing
in order to continue needed performance improvements in disability
claims processing and other entitlement programs. The Committee also
recommends an additional $17.5 million to support initiatives to
improve claims processing.
The Administration also requests $161 million for fiscal year 2005
to operate 125 National Cemeteries, and $180.9 million in mandatory
spending for veterans burial benefits. The Administration requests $113
million to develop new national cemeteries, expand existing cemeteries
and provide grants for state cemeteries. The Committee believes these
requests are adequate. However, the Administration did not request
funding for 928 previously identified cemetery restoration and repair
projects that are badly needed to restore older cemeteries as national
shrines. Most of these cemeteries are closed to new interments and are
in a decrepit state. Therefore, we are recommending $50 million for
fiscal year 2005, for the first year of a five-year, $300 million
national cemetery restoration and improvement project.
The Committee's top legislative priority is a measure to create
jobs and economic opportunity for those who have performed military
service. Congress has not comprehensively updated the on-the-job
training and apprenticeship programs under the Montgomery GI Bill and
other VA educational assistance programs since World War II. ``Earning
and learning'' on the job in these programs is also an excellent
transition tool for returning servicemembers. A modernized statute
reflecting the nature of structured training in today's workplace would
improve access to these programs for recently-separated veterans by
giving employers greater incentives to participate. The Committee
recommends funding of $1.78 billion over 10 years to create new jobs
and economic opportunities for veterans.
The Committee believes that the increases it recommends in the
accompanying views and estimates for fiscal year 2005 are necessary to
maintain current services for veterans programs. Members of the
Committee may submit additional views under separate cover. We thank
the Committee on the Budget for its consideration of our
recommendations and look forward to continued discussion on these
important issues.
Sincerely,
Christopher H. Smith, Lane Evans,
Chairman Ranking Democratic Member
______
BACKGROUND AND COMMITTEE RECOMMENDATIONS
DEPARTMENT OF VETERANS AFFAIRS
Veterans Health Administration
The Status of VA Health Care.--Veterans have sought health
care from the Department of Veterans Affairs (VA) in
increasingly greater numbers over the past ten years as the VA
evolved from a system that primarily focused on inpatient care
to a primary care model. The increased capacity and
availability of VA health care resulted from the opening of
hundreds of new VA community-based outpatient clinics. VA's
accessible and affordable pharmacy benefit also encouraged
veterans to seek care.
The Department cared for 4.7 million unique veteran
patients in fiscal year 2002, 5 million in fiscal year 2003,
and expects to treat 5.2 million veterans in fiscal year 2004.
Approximately 2.4 million additional veterans will be enrolled
in VA health care in fiscal year 2005 but will not actually use
the health benefit. To respond to this growth, Congress has
increased VA medical care funding by 22 percent over the past
two years and 50 percent over the past five years, an average
of 10 percent per year. In the current fiscal year, the
Consolidated Appropriations Act of 2004, Public Law 108-199,
provides $25.9 billion in appropriations for veterans' medical
care (the funding level available for medical care assumes a
transfer of $400 million to medical construction). This
constitutes an increase of $2 billion or 9 percent over the
previous fiscal year. In fiscal year 2003, Congress provided an
increase of $2.6 billion or 12 percent for veterans' care.
For fiscal year 2005, the Administration requests $26.6
billion in appropriations for VA health care programs (not
including construction, national management, or grant programs)
an increase of $708 million or 2.7 percent over the fiscal 2004
appropriated level.
The Administration's budget proposes that Congress require
veterans with no service-connected disabilities (priority 7 and
priority 8 veterans) to pay a new annual enrollment fee of
$250, as well as higher pharmaceutical co-payments ($15 for
each 30-day prescription) and higher primary care appointment
co-payments (from $15 to $20 for each appointment). The
enrollment fee increase and the higher pharmaceutical co-
payments were proposed in previous budgets but were not
approved by Congress.
The Committee remains concerned about the growth in
enrollment and VA's inability to respond to the needs of some
patients once enrolled. Eighteen months ago, 310,000 enrolled
veterans had to wait six months or more to see a VA physician,
including some veterans who received no appointment at all.
Today, VA is reporting that number has been reduced to about
36,000. Following recommendations from the Members of this
Committee, VA implemented a temporary program in late 2003
designed to allow veterans who requested an initial appointment
with a physician and who were still waiting longer than 30 days
for that appointment to receive VA pharmacy services for
prescriptions written by private physicians. More recently, the
Secretary altered waiting policy by requiring facilities to
schedule service-connected veterans for appointments within 30
days. The Committee will continue to monitor the effect of this
change on waiting times and VA expenditures.
On January 17, 2003, the Secretary of Veterans Affairs
suspended further enrollment of Priority 8 veterans
(nonservice-connected veterans with incomes above a regionally
adjusted means test). The announced purpose for this action was
to ensure that VA was capable of caring for veterans with
military-related disabilities, lower incomes and those in need
of specialized care. The Secretary also announced a program in
partnership with the federal Centers for Medicare and Medicaid
Services (CMS) for VA to subcontract with Medicare+Choice
Organizations (M+CO) under the Medicare Part C program.
Projected to begin in late 2004, a small number of Medicare-
eligible Priority 8 veterans now excluded from direct
enrollment in VA health care would be offered the option of
receiving their Medicare benefits from VA facilities designated
as Medicare provider organizations.
Overall US Health Care Spending Growth.--Health care
spending slowed in 2003, but is still expected to rise at an
annual rate of 7.8 percent in 2004, about 3.5 percentage points
higher than general inflation, according to a report issued
February 11, 2004 by CMS. Prescription drugs continue to be the
fastest-growing segment of health spending. For the VA's health
care system, spending on prescription drugs was 13.4 percent of
VA health expenditures in 2003. In fiscal year 2004, VA expects
to spend about $3.7 billion on pharmaceutical products and
anticipates spending $3.9 billion in fiscal year 2005, a 5
percent increase. The projected increase stems from both higher
utilization of VA health care by veterans and increased use of
new drugs to deal with the chronic health problems of enrolled
veterans.
Health Care Inflation.--The Bureau of Labor Statistics
(BLS) has released inflation data for 2003 that shows that the
overall medical care inflation rate for calendar year 2003 was
4 percent, almost double the domestic ``All Items'' inflation
rate. Hospital care and related services grew faster than other
components of health inflation, at 7.3 percent.
Capacity and Demand for Long-Term Care Services.--The
veteran population most in need of nursing home care, veterans
85 years or older, grew from about 387,000 in fiscal year 1998
to about 640,000 in fiscal year 2002 and to about 870,000
during fiscal year 2003, amounting to more than a 100 percent
increase over the past seven years. Over the next decade, this
veteran population segment is expected to continue to rise to
about 1.3 million. In 1997, VA established a Long-Term Care
Federal Advisory Committee to recommend how VA should respond
to this growing demand. The Committee was chaired by Dr. John
Rowe, then President of Mount Sinai University and School of
Medicine and a former VA geriatrician. Dr. Rowe and the panel
of experts on the Advisory Committee issued a report in 1998
entitled VA Long-Term Care at the Crossroads. The Committee
offered 20 recommendations to guide the provision of VA long-
term care services through 2010.
In the Crossroads report, the Advisory Committee concluded
that ``[d]espite high quality and continued need, long-term
care is perceived to be an adjunct entity, unevenly funded and
undervalued. Continued neglect of the long-term care system
will lead to further marginalization and disintegration, and
have costly, unintended consequences throughout the VA health
care system.'' The Advisory Committee stressed the need for
nursing home capacity to remain at the 1998 bed level and for
VA to significantly expand home and community-based service
capacity to meet the anticipated growth in demand by a large
oncoming wave of aging veterans.
On November 30, 1999, Congress ratified many of the
recommendations of this Advisory Committee with enactment of
the Veterans' Millennium Health Care and Benefits Act (the
Millennium Act), Public Law 106-117. Under this Act, VA is
required to provide a comprehensive menu of extended care
programs, including geriatric evaluation, community nursing
home, domiciliary, adult day health, respite and other
alternatives to institutional care, including palliative and
hospice programs. VA is mandated to provide needed nursing home
care to veterans who are either 70 percent service-connected or
in need of such care for a service-connected condition, and is
required to provide such care to other veterans to the extent
VA has resources to do so. The Millennium Act also requires VA
to give priority to veterans with unique needs (such as
Alzheimer's) and for those without other placement options. It
also requires VA to maintain the level of ``in-house'' extended
care services and expand community-based long-term care
programs, supported in part by increased copayments for long-
term care services for nonservice-connected veterans.
In November 2002, the Committee Chairman requested the
General Accounting Office (GAO) to analyze current trends and
forecasts in veterans' nursing home utilization and VA's long-
term care expenditures. GAO testified before the Committee on
January 29, 2004, questioning whether any real growth had
occurred in VA's non-institutional care programs since
enactment of the Millennium Act. Also, the VA Inspector General
reported on December 13, 2003, on VA's homemaker and home
health aide program (Report No. 02-00124-48, Healthcare
Inspection: Evaluation of Veterans Health Administration
Homemaker and Home Health Aide Program). Both reviews showed
that VA's official policies had expired or that program
managers were not complying with Veterans Health Administration
(VHA) policies, and that there were no extant guidelines for
contracting for services or for rates to be paid for services.
Both reports observed significant differences between networks
in long-term care services provided and the types of patients
being served.
Although VHA's overall long-term care services have
expanded to some extent in recent years, VA's commitment to
long-term care has not kept pace with veterans' needs.
According to GAO, access to VA care remains markedly variable
from network to network. VA's average daily nursing home census
was 33,214 in fiscal year 2003, one percent below its fiscal
year 1998 workload. All of the program growth reported by GAO
was in the state home program and most of the shrinkage was in
VA's in-house capacity. Also, according to a November 11, 2003,
VA report, entitled VA Extended Care: Final Report to Congress
of VA's Experience Under the Millennium Act, VA itself reported
that it has not maintained the required level of in-house
nursing home care.
The Committee firmly rejects the Department's proposal to
close 5,000 additional VA nursing home beds. Congress rejected
a similar proposal last year. Outpatient programs cannot
replace the nursing home beds that chronically ill veterans
need. In order to maintain the required bed level, the
Committee recommends that VA's budget request be augmented by
$370 million. VA should also reopen the nursing home beds that
have been closed since passage of the Millennium Act.
Medical Care Collections Fund.--VA is authorized to bill
some veterans and most health care insurers for nonservice-
connected care provided to veterans enrolled in VA health care.
It retains this collection in the Medical Care Collections Fund
(MCCF) to defray costs of delivering VA medical services. The
Department projects that if its proposed fee increases are
adopted, medical care collections for fiscal year 2005 will be
$2.4 billion.
The Committee supports the Department's efforts to improve
performance in first and third party collections, but the
Committee remains skeptical that VA can achieve all of its
collections goals in fiscal year 2005. Much of the 38 percent
increase ($403 million) projected for fiscal year 2005 is
expected to come from new enrollment fees and increases in
copayments for pharmaceuticals and primary care for certain
veterans. Congress rejected these same proposals last year.
Another $300 million is projected to come from improving
collection methodologies. While VA might be successful in
increasing collections, past projections have proven to be
overly optimistic. The Committee believes a 10 percent increase
in collections, based on the fiscal year 2004 estimate of $1.75
billion in total collections, is a realistic goal. The
Committee estimates that this would reduce VA's need for new
appropriations in fiscal year 2005 by $175 million.
Management Improvements and Efficiencies.--The Department's
2005 budget proposes to achieve an additional $340 million from
``management savings.'' VA testified that it plans to achieve
these savings through improved standardization in the
procurement of supplies, pharmaceuticals and other capital
purchases, and by implementing a competitive out-sourcing plan,
increasing health resources sharing with the Department of
Defense (DOD), and continuing the trend of shifting patients
from inpatient to outpatient levels of care. The budget also
assumes that VA will continue to achieve the $950 million
``management efficiencies and improvements'' programmed into
the fiscal year 2004 budget. Management efficiencies,
improvements and savings are laudable goals and some have
indeed been achieved. However, based on prior experience, the
Committee is not confident that optimistic plans and goals
would produce the high-dollar reductions in costs the
Administration projects in its budget request.
On September 2, 2003, the Committee reported to the
Committee on the Budget (House Committee Print No. 4, 108th
Congress, 1st Session) on its review of efforts to eliminate
waste, fraud and abuse in veterans' programs. The Committee
invites close attention to this report as an indication of
efforts within VA, its Inspector General's Office (OIG) and at
GAO, to ferret out such conditions and improve VA programs,
within the health care system. As evidenced by hearings before
this Committee and other committees in the first session of the
108th Congress, Congress and the Administration together should
work aggressively to eliminate waste, fraud, abuse, and
mismanagement in VA programs. As this Committee continues to
examine VA funding needs, it will continue its efforts to
reduce waste and inefficiencies in these programs.
Enhanced Mental Health Services.--1. Peer Support Program
and Education: On April 29, 2002, President Bush established
the New Freedom Commission on Mental Health ``to conduct a
comprehensive study of the United States mental health service
delivery system, including public and private sector providers,
and to advise the President on methods of improving the
system.'' This Commission recently reported to the President.
VA, which participated in the Commission as an ex-officio
member, has established an action agenda to implement its
recommendations.
One recommendation of the Commission proposed ``peer
support networks'' to align relevant Federal programs and to
improve access and accountability for mental health services.
Peer support programs have proven to be cost-effective and
successful models for assisting veterans and others with mental
illnesses. The Committee believes that VA should hire peer
counselors to develop a training protocol and certification
program. The Committee recommends $5 million to initiate this
program.
2. Mental Health Intensive Case Management: Mental Health
Intensive Case Management (MHICM) programs are characterized as
an intensive, multidisciplinary team approach to managing
highly dysfunctional mentally ill veterans in the community. VA
has estimated as much as 20 percent of its seriously mentally
ill veteran population may be in need of such services. VA
issued an internal directive more than three years ago to
ensure that each of its networks establishes strategies to
provide severely mentally ill veterans with appropriate access
to mental health services. Recent reports from VA indicate that
some MHICM's were initiated in the last year, more than two
years after the directive was issued. Others have reduced or
held steady the number of veterans they treat. Medical
literature has shown the MHICM program to be a cost-effective
means of managing mentally ill people. The Committee recommends
VA continue to implement MHICM teams to treat veterans in the
target population. VA's Committee on Care of Veterans with
Serious Mental Illness has estimated that the cost to fully
implement this program would be an additional $32 million.
Enhancing VA Services along the VA Continuum of Care.--The
same VA advisory committee on mental illnesses has identified a
number of shortfalls in programs that aid veterans with mental
health disorders. The cost to meet the full demand by veterans
for mental health services in fiscal year 2004 would require
double the amount obligated in fiscal year 2002 for these
programs. However, in order to achieve realistic and feasible
program growth, the Committee recommends an increase in the
program funding by $55 million.
Readjustment Counseling Services to Address the Needs of
Veterans Returning from Iraq and Afghanistan.--Almost 287,000
American servicemen and women serve or have served in Operation
Enduring Freedom and Operation Iraqi Freedom. DOD reports that
it has cared for more than 9,000 casualties since these
deployments were authorized. Many of them have physical wounds;
others have mental health problems stemming from the stressful
conditions of combat. Patients with diagnoses of chronic Post
Traumatic Stress Disorder (PTSD) may require long-term courses
of treatment and often consume other types of health care
services at higher rates than average.
VA recently developed clinical guidelines in collaboration
with DOD to diagnose PTSD in its earliest stages to prevent
chronic and severe cases from developing. VA is now developing
plans to screen servicemembers who have returned from a recent
deployment. This outreach is intended to ensure that veterans
who are likely to have problems are identified and are offered
early intervention to address their problems.
Strong family support is integral to the recovery of
individuals with mental health disorders. Congress has
authorized VA to offer care to family members when it is
incidental to the treatment of the veteran or when a veteran
has died of service-connected conditions. The Committee
believes VA should take immediate steps to enhance the
resources available to its current readjustment counseling
centers (``Vet Centers'') to ensure that the program is
adequately prepared to address the needs of returning troops
and their immediate family members. To augment the existing
care sites and add family therapists at 50 of its sites that
may experience the greatest increase in demand due to
demobilization, would require an $8 million investment for
approximately 100 new full-time employees.
In sum, the Committee recommends augmentation of the
medical care budget by $100 million to account for these
heightened requirements from wartime deployments and for
programs that have not been adequately recognized as priorities
for veterans in need of mental health services.
Homelessness Among Veterans.--With the passage of the
Homeless Veterans Comprehensive Assistance Act of 2001, Public
Law 107-95, Congress established the goal of ending chronic
homelessness in the veteran population within a decade. VA is
not making sufficient progress in achieving this objective, as
evidenced by the slow pace of developing regulations and
policies to carry out several of these initiatives. In the case
of the authorization to expand VA domiciliaries, VA has
effectively prevented implementation of this authority, despite
its proven effectiveness. Other programs, including VA's grant
and per diem program for community providers, and the so-called
``Health Care for Homeless Vets'' initiative, should be funded
at higher levels if the goal is to be met. The Committee
recommends that, consistent with the recommendations of the
Administration, $15 million be added to the VA's budget to
address the still unmet needs of an estimated one-quarter
million homeless veterans. This will allow VA to increase
funding available to the homeless grant and per diem providers,
who, in turn, can assist thousands of veterans in returning to
productive activity.
Medical and Prosthetic Research.--The Department carries
out an extensive array of research and development as a
complement to its affiliations with medical and allied health
professional schools and colleges nationwide. While these
programs are specifically targeted to the needs of veterans, VA
research has defined new standards of care that benefit all
Americans. Among the major emphases of the program are aging,
chronic diseases, mental illnesses, substance-use disorders,
sensory losses, and trauma-related illnesses. VA's research
programs are internationally recognized and have made important
contributions in virtually every arena of medicine, health, and
health systems.
The Administration has requested a 2005 budget for VA
Medical and Prosthetic Research of $385 million, a decrease of
$21 million below the fiscal year 2004 appropriations level.
The Committee strongly supports an increase in the research
account to $415 million. The Committee believes this additional
funding is needed to keep pace with funding trends in the
Federal biomedical research community. The Committee places a
high premium on VA's research focus in chronic diseases
afflicting aging populations. The National Institutes of Health
received an increase of 3.7 percent in the 2004 omnibus
appropriations act. An equivalent increase in VA research for
2005 would be $427 million. Additional funding of $30 million
in VA biomedical research in fiscal year 2005, coupled with a
$30 million increase in medical care funds to support these
activities, would provide for inflation and permit a small
expansion in VA research programs.
Bio-Terrorism Research Centers.--The Department of Veterans
Affairs Emergency Preparedness Act of 2002, Public Law 107-287,
requires the Department to establish four national emergency
preparedness centers, and authorizes $20 million per year for
the support of those centers. A dispute over the funding for
these centers has prevented their establishment. These centers
are vital to VA's ability to care for veterans who may be
exposed to weapons of mass destruction on the battlefield, as
well as to provide assistance to the Departments of Homeland
Security, Defense and others in the federal and state
communities in contending with the health care challenges of
the war on terrorism. The Committee believes that the
Department should set aside $10 million from the amount the
Committee recommends for medical care to support the
establishment of four national medical preparedness research
centers within existing VA medical centers in fiscal year 2005.
The Act also authorizes the establishment of an education
program to be carried out through VA. The education and
training curriculum would include a program to teach current
and future health care professionals how to diagnose and treat
casualties who have been exposed to chemical, biological, or
radiological agents. The Committee believes that the Department
should set aside $5 million from the amount the Committee
recommends for medical care to support the requirement in
fiscal year 2005.
Major Medical Construction Projects and CARES.--The
physical infrastructure of the VA health care system is one of
the largest in the federal government, with over 4,700
buildings and thousands of acres valued at over $35 billion.
Much of this infrastructure was built over 50 years ago. These
aging facilities are in need of repair and restoration to
ensure that veterans are provided care in safe, reliable and
functional settings. In recent years, VA's investment in its
health care infrastructure has been minimal compared to
expected levels of investments in such capital facilities. At
the same time, GAO has reported to Congress that VA is
``wasting'' $1 million per day on unnecessary buildings and
empty spaces. As described above, VA has moved from a hospital-
based health care system to a primary care delivery model.
Accordingly, VA is completing its Capital Asset Realignment for
Enhanced Services (CARES) initiative. The independent CARES
Commission, chaired by Honorable Everett Alvarez, Jr., issued
its report to the Secretary of Veterans Affairs and Congress on
February 13, 2004. A major issue of concern to the Committee is
that the draft plan omits veterans' long-term care, domiciliary
care and outpatient mental health care, claiming that workload
forecasts in these programs were inaccurate or unrealistic.
This critical omission may call into question the validity of
many CARES recommendations.
The CARES Commission report confirms the need for at least
$4 billion in capital improvements over the next decade. The
CARES Commission agreed with VA's plan to build two new medical
centers, in Denver, CO, and Orlando, FL. It also recommended a
priority feasibility study for a new consolidated Medical
Center in Boston, MA, to replace four existing VA centers. The
Commission encouraged VA to continue its collaboration with the
Mike O'Callaghan Federal Hospital in Las Vegas, NV, and also
endorsed VA's proposals to further study the need for new
facilities in the Las Vegas area, as well as in Louisville, KY,
and in Charleston, SC. In testimony before the Committee on
February 4, 2004, Secretary Principi stated his intention to
proceed with CARES as a high priority. He identified $1.3
billion in funds available to begin major capital projects in
the next two fiscal years. Assuming that the Secretary does not
completely reject the recommendations of the Commission, the
Committee will carefully review the CARES report and VA's
prioritized list of capital improvement projects over the next
several months.
State Home Grants Program.--In 47 states and Puerto Rico,
there are 117 facilities for veterans that provide nursing
(21,000 beds), domiciliary (6,066 beds), and adult day care
(one small program) whose care is coordinated with VA. The
current VA reimbursements for each day of care a veteran
receives in a state home are: $57.78 for nursing home care,
$27.19 for domiciliary care, and $42.57 for adult day health
care.
States pay 35 percent of the construction costs of projects
for state home facilities, and bear most of the cost of the
facilities' operations and health care that exceed amounts
contributed by VA. Applications totaling $359.7 million for new
construction and renovation grants to state veterans' homes are
pending in the Department. A new round of requests will be
solicited in April 2004 for fiscal year 2005 awards.
In 1999, the Millennium Act reformed the state home
construction grant program. It provided a higher priority for
critically needed renovations in existing state homes,
especially those projects involving fire and life safety
improvements. Prior to enactment, these long-delayed projects
were given a lower priority for funding than grants for
constructing new state home beds. In fiscal year 2004, for the
first time since the implementation of these provisions
affecting the ranking criteria for funding, the backlogged
renovation projects with state matching grants are eligible for
funding.
The Administration budget proposal for fiscal year 2005
requests $105,163,000 to support the grant program, a 3.6
percent increase over the fiscal year 2004 appropriated level.
The Committee supports VA funding as many projects as possible
for which states have certified their matching funds to be
available. These projects will respond to the growing demand
for new long-term care facilities, and will aid states in
modernizing facilities in existing inventories.
Current Services for Veterans Health Care.--VA's estimate
of cost savings in this proposed budget does not consider the
increased costs that Medicare, TRICARE, and other federally-
subsidized health care programs would incur for veterans who
would be disenrolled from VA care as a result of proposals such
as a $250 health care copayment and an increased prescription
drug copayment. When the Congressional Budget Office and the
Office of Management and Budget estimated the cost of the
recently-enacted Medicare prescription drug benefit, they
reduced the projected costs of that benefit by the $3 billion
that VA spends annually to provide prescription drugs to
veterans using VA care. Similarly, the Administration and
Congress reduced the estimated cost of VA health care by $250
million annually following the enactment of TRICARE for Life in
2000. Veterans' use of VA care also reduces the cost of care in
the Indian Health Service and in Medicaid.
Rather than supporting Administration proposals that could
reduce demand for VA health care and shift costs to other parts
of the federal medical system, the Committee recommends
treating spending on veterans programs the same as spending on
Social Security and Medicare. To do so, a ``current services''
budget for VA medical care would require an increase of
approximately nine percent over the appropriated fiscal year
2004 level. A current services approach allows continued
enrollment for those veterans enrolled today in VA health care.
Veterans Benefits Administration
Veterans Benefits Administration.--The Administration
requests $35.2 billion to support the entitlement benefits
program, an increase of $2.5 billion over the appropriated
level for fiscal year 2004, as well as another $1.464 billion
for managing the programs for disability compensation, pension,
education, vocational rehabilitation and employment, housing,
life insurance, and burial. Over 3.3 million veterans,
survivors and dependents were receiving compensation or pension
benefits at the beginning of fiscal year 2003. An additional
681,000 beneficiaries received education or vocational
rehabilitation benefits.
The ability of VA to provide accurate, timely and quality
benefits delivery is dependent on a number of factors. These
include an adequate number of properly trained staff, effective
business process and information technology modernization
initiatives, accountability measures, inter-departmental
cooperation between the various VA administrations and military
service departments, including the National Personnel Records
Center and DOD's Center for Unit Records Research, and
assistance from the veterans service organizations. The
Administration requests $29.4 million to support new and on-
going initiatives designed to provide better customer service
through improved accuracy and access for benefits. The
Committee recommends an additional $17.5 million to support
added initiatives to include Virtual VA (paperless claims
processing), Data Quality Assurance, the One VA telephone
system, computer training programs, and contract medical
examinations.
Disability Compensation.--The Administration requests $29.3
billion to support compensation benefits to disabled veterans,
certain survivors, and eligible dependent children, and $657.6
million to fund the discretionary portion of the Disability
Compensation program, which will provide funding for the
administrative expenses of 7,057 FTEE, a decrease of 35 FTEE
from fiscal year 2004.
VBA is making every effort to increase quality and
productivity in the current adjudicative and appellate
processes for veterans. The Department has continued to make
reducing the pending workload of veterans' claims and attendant
quality in such claims top priorities. VBA decreased its
average days to process a rating claim from 223 days in 2002 to
182 days in 2003. By the end of 2004, VBA expects to be
processing these claims in 145 days, and by the end of 2005
expects them to be processed in 100 days. While significant
progress has been made, VBA did not meet the Secretary's goal
of processing claims within 100 days by the end of 2003.
``Reopened'' claims, those in which a request for
reconsideration of a previous denial is made, continue to
outnumber original claims by about three to one. The accuracy
rate for core rating work in claims decisions continued to
improve, increasing from 81 percent in 2002 to 86 percent in
2003.
The Committee notes VBA's efforts to meet its timeliness
goals through restructuring at its regional offices and
redesigning workflow, strengthening its partnership with DOD
and the U.S. Armed Services Center for Unit Records Research,
and developing a joint VBA/VHA/DOD examination protocol for
servicemembers leaving active duty. At the end of fiscal year
2003, VBA's pending claims inventory was 253,000, a 41.4
percent reduction in pending claims from a peak of more than
432,000 in January 2002. However, as of early February 2004,
336,721 claims were pending. This significant change in VBA's
inventory was the result of a September 22, 2003, decision by
the U.S. Court of Appeals for the Federal Circuit, Paralyzed
Veterans of Am. v. Sec'y of Veterans Affairs, 345 F.3d 1334
(Fed. Cir. 2003), which held that denial of a claim is
premature before the expiration of the one-year period
established by the Veterans Claims Assistance Act of 2000
(VCAA), Public Law 106-475, even if VA has reviewed all
available evidence. The VCAA requires VA to allow a claimant
one year to submit requested information or evidence to
substantiate a claim.
The Veterans Benefits Act of 2003, Public Law 108-183,
signed on December 16, 2003, changed the result of the Court's
decision. Veterans no longer have to wait until the expiration
of the one-year period to receive a decision on their claim.
VBA has begun the process of issuing decisions on the
approximately 60,000 cases deferred over the last three months
due to the Court's ruling.
Due to these workload considerations, the Committee rejects
the proposed decrease of 35 FTEE and recommends $2 million to
maintain current staffing levels.
Pension Program.--The Administration requests $3.2 billion
to support the pension program, and $139.4 million to fund the
discretionary portion of the pension program, which will
provide funding for the administrative expenses of 1,444 FTEE,
a decrease of 255 FTEE from fiscal year 2004, despite a
caseload increase of 8,024.
The average number of days to process pension claims has
decreased only slightly from 112 in 2000 to 98 in 2004, and the
overall customer satisfaction rate with the pension program has
remained static at 65 percent. The Committee rejects the
proposed decrease of 255 FTEE and recommends $15 million to
maintain current staffing levels.
Education Service.--The Administration requests 888 FTEE
for the Education Service, a decrease of 38 FTEE over fiscal
year 2004, although participation in VA's education programs is
projected to increase by about 29,000.
The Committee observes no significant improvement in the
quality of education claims processing from 2002 to 2003; some
indicators are better and some are worse than the previous
year. Moreover, from 2001 to 2003, overall payment accuracy
improved only slightly from 92.0 percent to 93.5 percent.
An additional priority for the Committee is the further
development of apprenticeship and other on-job training
programs for veterans. Sufficient resources and personnel must
be allotted to the processing, review and evaluation of federal
job training programs so that decisions are made accurately and
expeditiously. The Committee rejects the proposed decrease of
38 FTEE and recommends $2 million to maintain current staffing
levels.
Vocational Rehabilitation and Employment Service.--
Disability compensation can help offset a veteran's average
loss of earning power, but long-term sustained employment and
economic independence represent the aspirations of most
disabled veterans, according to VA's comprehensive 2001
National Survey of Veterans.
VA's Annual Accountability Report for FY 2000 showed the
rehabilitation rate of disabled veterans for the year was 65
percent, which appeared to exceed the goal of 60 percent.
However, VA's Inspector General concluded in its February 6,
2003, report titled Accuracy of VA Data Used to Compute the
Rehabilitation Rate for Fiscal Year 2000 (Report No. 01-01613-
52), the data VA used to compute the rehabilitation rate was
not accurate. In numerous cases, VA classified disabled
veterans as rehabilitated when they were not rehabilitated. The
Committee expects improvements in the integrity of these data.
The Administration requests 1,015 FTEE for the Vocational
Rehabilitation and Employment program in fiscal year 2005, a
decrease of 103 over the fiscal year 2004. The Committee
rejects the proposed decrease of 103 FTEE and recommends $7
million to maintain current staffing levels in order to allow
the program an opportunity to improve its performance.
Loan Guaranty Service.--In fiscal year 2003, this program
guaranteed 489,418 loans, the second highest amount since 1970.
The loans were valued at $63,254,794, with an average of
$129,245. In general, VA's home loan program is one of its most
popular with veterans and servicemembers. VA's 2001 National
Survey of Veterans notes that about 60 percent of the 20,000
veterans surveyed reported they had used VA's home loan program
to purchase, improve or refinance their home. On average, 93.2
percent of veterans have indicated satisfaction with VA's home
loan assistance over the past five fiscal years. The Committee
commends these results.
Average FTEE in this program has already been reduced
through careful administrative consolidation from 2,108 in
fiscal year 1999 to 1,390 in fiscal year 2004 without any
degradation in quality or cost-effectiveness. However, the
Administration requests a further reduction of 109 FTEE. The
Committee rejects the proposed decrease of 109 FTEE and
recommends $6 million to maintain current staffing levels in
order to maintain program performance.
The Committee is also concerned about a proposal contained
in the budget request to change the eligibility of the home
loan program to one-time use for veterans (active duty
servicemembers would continue to be able to use the benefits as
many times as needed). Such a change in program entitlement for
veterans is estimated by the Administration to cost $91
million. The Committee rejects this proposal and recommends no
change to current law in this regard.
VBA Staffing for all Business Lines.--VBA has an
administration-wide hiring freeze, effective May 8, 2003.
Additional hiring in early fiscal year 2003 of 150 new Rating
Veterans Service Representatives and 150 new Veterans Service
Representatives, along with Congressionally-mandated pay
increases, significantly increased the payroll base prior to
the hiring freeze. An exception to the hiring freeze was
granted to VBA's ``Tiger Team,'' located at the Cleveland
Regional Office. The Tiger Team concentrates on processing
older claims throughout the system, and top priority is given
to those claims from veterans over age 70 that have been
pending for a year or more.
The Administration requests a decrease of 540 FTEE in total
VBA staffing. The Committee is concerned that with decreased
staffing, VBA would not be able to continue its improvements in
disability claims processing, as well as improve its
performance in other entitlement programs.
The Committee rejects the total proposed decrease of 540
FTEE across all business lines and recommends a total of $32
million to maintain current full staffing for the disability
compensation, pension, education, vocational rehabilitation and
employment and housing business lines of VBA.
NATIONAL CEMETERY ADMINISTRATION
The Administration requests $274.4 million in discretionary
burial administration funding and $180.9 million in mandatory
spending to provide burial benefits. The burial account
includes operating and capital funding for the National
Cemetery Administration (NCA), the burial benefits program
administered by VBA, and the State Cemetery Grants Program.
Specifically, the budget requests $161.3 million for NCA
operation and maintenance of 125 national cemeteries and 33
soldiers' and sailors' lots, plots and monument sites in 2005
and $113 million for major construction, minor construction,
and funding for the State Cemetery Grants Program. The budget
requests $180.9 million in mandatory spending to provide burial
benefits on behalf of eligible deceased veterans and eligible
deceased dependents.
The budget request supports 1,611 FTEE in NCA, an increase
of 23 over the fiscal year 2004 request, and 168 FTEE in VBA, a
decrease of 6 FTEE over last year's request. The Committee
supports these requests.
The Administration requests $113 million to develop new
national cemeteries, expand and create additional gravesites at
existing national cemeteries, and provide grants for state
cemeteries. The funds would be used to develop and/or expand
cemeteries in the following locations:
* Sacramento, California, phase one development
of a new national cemetery;
* Florida National Cemetery at Bushnell,
gravesite expansion and cemetery improvements;
* Rock Island, Illinois, gravesite expansion
and cemetery improvements; and
* Ft. Snelling, Minnesota, gravesite expansion
and cemetery improvements
NCA maintains almost 2.6 million gravesites in 39 states,
the District of Columbia and Puerto Rico. Of the 125 national
cemeteries, 60 have available, unassigned gravesites for burial
of both casketed and cremated remains; 23 will only accept
cremated remains and the remains of family members for
interment in the same gravesite as a previously deceased family
member; and 37 are closed to new interments, but may
accommodate family members in the same gravesite as a
previously deceased family member.
Occupied graves maintained by NCA are projected to increase
from 2,574,489 in fiscal year 2003 to over 3,041,000 in 2009.
NCA continues to develop new cemeteries in areas not presently
served by NCA: Atlanta, Georgia; Detroit, Michigan; Miami,
Florida; Pittsburgh, Pennsylvania; and Sacramento, California.
Pursuant to section 613 of Public Law 106-117, the Veterans
Millennium Health Care and Benefits Act, VA awarded a contract
to Logistics Management Institute (LMI) to conduct an
assessment of the current and future burial needs of veterans.
Volume 1 of the study, entitled ``Future Burial Needs,''
identified areas of the country where new national cemeteries
might be constructed. The LMI study projected burial needs in
5-year increments to the year 2020 based on data derived from
the 1990 census. In June 2003, VA updated the burial needs
report to reflect the veterans' population from the 2000
census.
Based on the LMI rankings of the areas of the country most
in need of a national cemetery burial option, Congress passed
the National Cemetery Expansion Act of 2003, Public Law 108-
109, signed on November 11, 2003. It requires the Secretary to
establish six additional national cemeteries by 2008 in the
following areas: Southeastern Pennsylvania; Birmingham,
Alabama; Jacksonville, Florida; Bakersfield, California;
Greenville/Columbia, South Carolina; and Sarasota, Florida. The
budget requests $1 million in Advance Planning Funds and
includes funds for the site selection process for the six new
national cemeteries authorized by this law. The Committee
supports this request.
Volume 2 of the LMI study, entitled ``National Shrine
Commitment,'' was a report on capital improvements needed at
existing veterans' cemeteries. The budget request does not
provide funding for 928 full-scale cemetery restoration and
repair projects, estimated to cost $279 million, as determined
by the LMI study. Instead, the budget reflects a shift in
funding for projects to improve the appearance of cemetery
assets, and requests $15 million for funding gravesite
renovations and cemetery repair and infrastructure projects, to
be accomplished through the Minor Construction program.
The Committee recommends a five-year, $300 million
restoration and improvements project at existing cemeteries.
The Committee recommends an additional first-year appropriation
of $50 million for fiscal year 2005 to address this problem.
DEPARTMENT OF LABOR
Veterans' Employment and Training Service
The Veterans' Employment and Training Service (VETS) of the
U.S. Department of Labor furnishes employment and training
opportunities to veterans. The Assistant Secretary for VETS
serves as the principal advisor to the Secretary of Labor on
all policies and procedures affecting veterans. VETS also
administers grants to States, public entities and non-profits,
including faith-based organizations, to help veterans find
jobs.
The Administration requests $220.6 million for all VETS
programs, a $1.9 million increase over the appropriated level
for fiscal year 2004; $162.4 million for State grants (Disabled
Veterans' Outreach Program and the Local Veterans' Employment
Representative program); $29.7 million for program
administration activities; $2 million for the National
Veterans' Employment and Training Services Institute; $19
million for the Homeless Veterans' Reintegration Program; and
$7.5 million for the Veterans' Workforce Investment Program.
The Committee supports this request and expects states to
continue to use the flexibility furnished in the Jobs for
Veterans Act to determine the number and role of DVOPs and
LVERs in their state service plans. The Committee desires
states to use such flexibility to tailor services to meet
veterans' needs.
LEGISLATION THE COMMITTEE MAY REPORT WITH DIRECT SPENDING IMPLICATIONS
The Committee intends to continue its emphasis on economic
opportunity for those who have worn the military uniform.
Committee legislative accomplishments to date include: The
Veterans Entrepreneurship and Small Business Development Act of
1999 (Public Law 106-50), the Jobs for Veterans Act (Public Law
107-288), aspects of the Veterans Benefits Act of 2003 (Public
Law 108-183), and the Veterans Education and Benefits Expansion
Act of 2001 (Public Law 107-103), which provided a 46 percent
increase in the Montgomery GI Bill over three years.
On-Job Training and Apprenticeship.--Congress has not
comprehensively updated the on-job training (OJT) and
apprenticeship programs under the Montgomery GI Bill (MGIB) and
other VA educational assistance programs since World War II.
Some apprenticeships in today's workplace can last as long as
five years and most are competency-based. Title 38, United
States Code, limits itself to time-based learning on the job.
In addition, many technical and technology-based employers
require that workers meet occupational licensing,
certification, or other credentialing requirements that are an
``outgrowth'' of such training. Although different from
apprenticeships, on-job training is still time-based and lasts
up to two years.
About 65 percent of servicemembers are married and many
have children at the time they separate from active duty.
``Earning and learning'' on the job under a structured, VA-
approved OJT or apprenticeship program could serve as an
excellent transition tool. The Department of Labor reported in
2003 that the average unemployment rate for recently separated
male veterans ages 20 to 24 years was 11.5 percent, and 8.7
percent for similar female veterans. For 20-24 year old black
male and female veterans, the 2003 unemployment rate was 21.9
and 13.9 percent, respectively. For 20-24 year old male and
female Hispanic veterans, the 2003 unemployment rate was 8.7
percent and 21.4 percent, respectively.
The Subcommittee on Benefits held a public hearing on OJT
and apprenticeship programs on April 30, 2003. Business,
industry, and organized labor representatives testified that a
modernized statute reflecting the nature of structured training
in today's workplace would help improve participation of
recently-separated veterans in VA's OJT and apprenticeship
programs because employers likely would be more willing to
participate.
The Committee may report legislation to modernize this
program for business and industry. The Committee estimates the
cost to be $187 million for fiscal year 2005, with a five-year
cost of $769 million, and a 10-year cost of $1.782 billion.
ADDITIONAL VIEWS AND ESTIMATES
HONORABLE BOB FILNER
I am submitting the following additional views on the
budget for FY2005 to the Committee on Veterans' Affairs.
For years, I have relied on The Independent Budget, a
comprehensive budget and policy document created by veterans
for veterans. Developed by four veterans service organizations,
AMVETS, the Disabled American Veterans, the Paralyzed Veterans
of America, and the Veterans of Foreign Wars of the United
States, and endorsed by over thirty additional organizations,
this budget is a collaborative effort to present
recommendations on policy and the budget regarding veterans'
programs administered by the Department of Veterans Affairs
(VA).
For FY2005, the Independent Budget recommends $29.8
billion, an increase of $3.1 billion over the President's
Budget Request for medical care and $33.5 billion, an increase
of $3.9 billion over the President's Budget Request for VA
discretionary funding.
The recommendations of the Independent Budget meet the
needs of our veterans seeking health care and other services
from the VA. We must realize that the costs of war include
taking care of veterans returning with physical and mental
wounds. We must respond to the growing number of older veterans
who need long-term care. We must re-open enrollment for VA
health care to all veterans.
To address these and other veterans' needs, I recommend
that we follow the lead of the Independent Budget. I urge the
Committee on the Budget to consider an additional $3.9 billion
in budget authority for VA's discretionary programs.
HONORABLE CORRINE BROWN
Time and time again our veterans get the shaft. President
Bush came out with a budget that short changes the middle
class, children, seniors, and our veterans.
It is mind blowing to me that the Bush Administration is
going to make the trillion dollar deficit they created even
worse by keeping the tax cuts it gave to the wealthy. Americans
deserve to have a President who looks out for the interests of
the nation as a whole, not just for an elite few.
Adding to this deficit is the proposal to increase NASA's
budget by $1 billion dollars. Although I support NASA, this
funding will come at the expense of our Nation's veterans who
are waiting for a simple appointment with the doctor. HUD has
already been stripped to the bone and I am worried that VA is
next. America made a commitment to care for those who answered
our Nation's call to service, and we are not honoring that
commitment. If we can come up with an additional $1 billion for
NASA, then surely we can give VA the money that it needs to
provide for our veterans.
We have given approximately $150 billion to the ongoing war
in Iraq. We should be able to give VA enough money to take care
of our soldiers when they return. The Bush Administration
should be ashamed.
President Bush is cutting funding for veterans' medical
care in 2005. CBO has stated that the amount the President is
providing is $257 million below what is needed to MAINTAIN
purchasing power at 2004 levels. The Secretary of Veterans
Affairs has testified that he sought $1.2 billion more than
what the President provided. The fiscal year 2005 budget is a
perfect example of how the Bush Administration is failing to
treat our veterans with the respect that they have earned.
I am very concerned that enrollment in the VA healthcare
system continues to grow and of VA's inability to respond to
veterans' needs once enrolled. Although VA is reporting that
only 36,000 patients are waiting six months or more to see a VA
physician, 2.4 million additional veterans are expected to
enroll in VA healthcare for fiscal year 2005. Many of these
veterans are not expected to use healthcare services, but the
number is alarming.
VA is facing a decrease of $21 million below the fiscal
year 2004 appropriation for medical and prosthetic research. I
have been to Walter Reed and have seen the physical scars that
have been left on our soldiers returning home from Afghanistan
and Iraq. Many of the soldiers that I visited with are
amputees. How can the Bush Administration decrease prosthetic
research at a time when a new round of soldiers is returning
home and could benefit from new technology? I would like to see
VA receive additional funding for medical research coupled with
an increase in medical care funds to support these activities.
We show potential and current members of the Armed Forces
how America honors their sacrifice by how well we treat our
veterans. This budget is not adequate to meet the needs of 25
million of our Nation's finest individuals. President Bush
needs to start walking the walk if he is going to talk the
talk. Wearing a flightsuit and landing on a carrier does not
take care of the needs of former members of our Nation's
military.
Comparison of FY 2005 Budget Proposals: VA Department - VA Committee - Independent Budget
(Dollars in Millions)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Committee
Department VA FY 2005 on HCVA FY 2005 IB FY 2005
of Veterans VA's FY Request Veterans' Compared to Independent Compared to
Affairs 2005 Budget Compared to Affairs Admin. FY Budget (IB) Admin. FY
(VA) FY Request FY 2004 (HCVA) FY 2005 Request FY 2005 2005
2004 Final Final 2005 Recommend Request
Approp. Recommend
--------------------------------------------------------------------------------------------------------------------------------------------------------
Medical Care1 $25,938 $26,646 $708 $28,994 $2,348 $29,791 $3,145
MCCF and HSIF Receipts 1,752 2,419 667 1,927 ^\492 No estimate ...........
Medical and Prosthetic Research 406 385 ^\21 415 30 460 75
MAMOE 79 87 8 87 0 87 0
VA Medical Construction, Major 614 401 ^\213 401 0 571 170
VA Medical Construction, Minor 206 182 ^\24 182 0 545 363
VA State Home Grants 101 105 4 105 0 150 45
VA State Cemetery Grants 32 32 0 32 0 37 5
General Operating Expenses 1,276 1,325 49 1,375 50 1,618 293
National Cemetery Administration 143 149 6 199 50 175 26
Inspector General 62 65 3 65 0 62 ^\3
Other Discretionary 280 277 ^\3 323 46 100 ^\177
---------------------------------------------------------------------------------------------
VA Discretionary (Excluding MCCF and HSIF Receipts) 29,137 29,654 517 32,178 2,524 $33,596 $3,942
---------------------------------------------------------------------------------------------
Total VA Discretionary (INCLUDING Receipts) 30,889 32,073 1,184 34,105 2,032 ............ ...........
---------------------------------------------------------------------------------------------
VA Baseline Mandatory 31,166 35,252 4,086 35,252 0 No estimate ...........
---------------------------------------------------------------------------------------------
Committee Legislative Proposal 187 187 No estimate ...........
---------------------------------------------------------------------------------------------
Total VA Mandatory Spending 31,166 35,252 4,086 35,439 187 No estimate ...........
---------------------------------------------------------------------------------------------
TOTAL VA BUDGET (Mandatory and Discretionary) $62,055 $67,325 $5,270 $69,544 $2,219 ............ ...........
--------------------------------------------------------------------------------------------------------------------------------------------------------
1 FY 2004 Medical Care number assumes transfer of $400 million from Medical Care to Major Medical Construction per P.L. 108-199.
MESSAGES FROM THE PRESIDENT AND EXECUTIVE COMMUNICATIONS
------
Presidential Messages
Feb. 13, 2003:
Communication from the President of the United States,
transmitting the Administration's 2003 National Drug Control
Strategy, pursuant to 21 U.S.C. 1505.
June 16, 2003:
Communication from the President of the United States,
transmitting a report entitled, ``Demand Reduction Agenda:
Critical Programs''.
Mar. 2, 2004:
Communication from the President of the United States,
transmitting the Administration's 2004 National Drug Control
Strategy, pursuant to 21 U.S.C. 1705.
------
Executive Communications
Jan. 7, 2003:
Letter from the the Executive Secretary, the Disabled
American Veterans, transmitting the 2002 National Convention
Proceedings of the Disabled American Veterans, pursuant to 36
U.S.C. 90i and 44 U.S.C. 1332.
Jan. 27, 2003:
Letter from the Deputy General Counsel, Department of
Veterans Affairs, transmitting the Department's final rule--
Health Care for Certain Children of Vietnam Veterans--Covered
Birth Defects and Spina Bifida (RIN: 2900-AK88) Received
January 8, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Jan. 27, 2003:
Letter from the Acting Director, Office of Regulatory Law,
Department of Veterans Affairs, transmitting the Department's
final rule--Extension of the Presumptive Period for
Compensation for Gulf War Veteran's Undiagnosed Illnesses (RIN:
2900-AK98) Received January 8, 2002, pursuant to 5 U.S.C.
801(a)(1)(A).
Jan. 27, 2003:
Letter from the Acting Director, Office of Regulatory Law,
Department of Veterans Affairs, transmitting the Department's
final rule--Vocational Training for Certain Children of Vietnam
Veterans--Covered Birth Defects and Spina Bifida (RIN: 2900-
AK90) Received December 4, 2002, pursuant to 5 U.S.C.
801(a)(1)(A).
Jan. 27, 2003:
Letter from the The American Legion, transmitting the
financial statement and independent audit of The American
Legion proceedings of the 84th annual National Convention of
The American Legion, held in Charlotte, North Carolina from
August 27, 28, and 29, 2002 and a report on the Organization's
activities for the year preceding the Convention, pursuant to
36 U.S.C. 49.
Jan. 31, 2003:
Letter from the Deputy General Counsel, Department of
Veterans Affairs, transmitting the Department's final rule--
Enrollment--Provision of Hospital and Outpatient Care to
Veterans Subpriorities of Priority Categories 7 and 8 and
Annual Enrollment Level Decision (RIN: 2900-AL51) Received
January 22, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Feb. 5, 2003:
Letter from the Deputy General Counsel, Department of
Veterans Affairs, transmitting the Department's final rule--VA
Acquisition Regulation: Simplified Acquisition Procedures for
Health-Care Resources (RIN: 2900- AI71) Received January 22,
2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Mar. 18, 2003:
Letter from the Deputy General Counsel, Department of
Veteran Affairs, transmitting the Department's final rule--Loan
Guaranty: Implementation of Public Law 107-103 (RIN: 2900-AL23)
Received February 6, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
March 20, 2003:
Letter from the Deputy General Counsel, Board of Veterans'
Appeals, Department of Veterans Affairs, transmitting the
Department's final rule--Appeals Regulations: Title for Members
of the Board of Veterans' Appeals (RIN: 2900-AK62) Received
February 10, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
March 20, 2003:
Letter from the Deputy General Counsel, Department of
Veterans Affairs, transmitting the Department's final rule--
Provision of Drugs and Medicines to Certain Veterans in State
Homes (RIN: 2900-AJ34) Received March 12, 2003, pursuant to 5
U.S.C. 801(a)(1)(A).
Mar. 20, 2003:
Letter from the General Counsel, Department of Defense,
transmitting the Department's legislative proposal entitled,
``To authorize appropriations for fiscal year 2004 for military
activities of the Department of Defense, to prescribe military
personnel strengths for fiscal year 2004, and for other
purposes''.
Mar. 24, 2003:
Letter from the Deputy General Counsel, VHA, Department of
Veterans Affairs, transmitting the Department's final rule--VA
Homeless Providers Grant and Per Deim Program (RIN: 2900-AL30)
Received March 18, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Apr. 7, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Board of Veterans' Appeals: Rules of Practice-
Appeal Withdrawal (RIN: 2900-AK71) Received March 31, 2003,
pursuant to 5 U.S.C. 801(a)(1)(A).
Apr. 10, 2003:
Letter from the Under Secretary, Department of Defense,
transmitting the Department's plan to implement legislation
concerning the transfer of Montgomery GI Bill entitlements to
family members, pursuant to 38 U.S.C. 3020 Public Law 107-107,
Section 654.
Apr. 10, 2003:
Letter from the Assistant Secretary, Department of Defense,
transmitting a report on Outreach to Gulf War Veterans Calendar
Year 2002.
Apr. 10, 2003:
Letter from the Secretary, Department of Veterans Affairs,
transmitting the Department's seventh report describing the
administration of the Montgomery GI Bill educational assistance
program.
Apr. 10, 2003:
Letter from the Secretaries, Departments of Defense and
Veterans Affairs, transmitting a report on the implementation
of the health resources sharing portion of the Department of
Veterans Affairs and Department of Defense Health Resources
Sharing and Emergency Operations Act, pursuant to 38 U.S.C.
8111(f).
Apr. 12, 2003:
Letter from the Secretary, Department of Veterans Affairs
transmitting a report covering those cases in which equitable
relief was granted in calendar year 2002, pursuant to 38 U.S.C.
210(c)(3)(B).
Apr. 29, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Referrals of Information Regarding Criminal
Violations (RIN: 2900-AL31) Received April 12, 2003, pursuant
to 5 U.S.C., 801(a)(1)(A).
Apr. 29, 2003:
Letter from the Under Secretary, Department of Defense,
transmitting the biennial report on the Montgomery GI Bill
Education Benefits Program.
May 7, 2003:
Letter from the Chairman, Department of Veterans Affairs,
transmitting the Department's report of the chairman.
May 8, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Reasonable Charges for Medical Care or Services;
2003 Update (RIN: 2900-AL57) Received April 22, 2003, pursuant
to 5 U.S.C. 801(a)(1)(A).
May 8, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Eligibility for Burial of Adult Children;
Eligibility for Burial of Minor Children; Eligibility for
Burial of Certain Filipino Veterans (RIN: 2900-AI95) Received
March 31, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
June 2, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Schedule for Rating Disabilities: Evaluation of
Emeritus (RIN: 2900-AK86) Received May 14, 2003, pursuant to 5
U.S.C. 801(a)(1)(A).
June 11, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Compensation and Pension Provisions of the Veterans
Education and Benefits Expansion Act of 2001 (RIN: 2900-AL29)
June 6, 2002, pursuant to 5 U.S.C. 801(a)(1)(A).
June 16, 2003:
Letter from the Deputy General Counsel, Veterans Health
Administration, Department of Veterans Affairs, transmitting
the Department's final rule--Fisher Houses and Other Temporary
Lodging (RIN: 2900-AL13) Received February 21, 2003, pursuant
to 5 U.S.C. 801(a)(1)(A).
June 19, 2003:
Letter from the Under Secretary for Health and Assistant
Secretary of Defense, Health Affairs, Departments of Veterans
Affairs and Defense, transmitting a letter concerning a joint
review of the adequacy of processes and existing authorities
for the coordination and sharing of health care resources,
pursuant to Pubic Law 107-314, Section 723.
June 26, 2003:
Letter from the Associate Administrator, Office of Veterans
Business Development, Small Business Administration,
transmitting a letter regarding a report describing the
activities of the Committee and any recommendations developed
by the Committee for the promotion of small business concerns
owned and controlled by veterans.
July 7, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Increase in Rates Payable Under the Montgomery GI
Bill--Active Duty and Survivors' and Dependents' Educational
Assistance Program (RIN: 2900-AL17) Received June 9, 2003,
pursuant to 5 U.S.C. 801(a)(1)(A).
July 7, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Veterans Education: Additional Opportunity to
Participate in the Montgomery GI Bill and Other Miscellaneous
Issues (RIN: 2900-AK81) Received June 9, 2003, pursuant to 5
U.S.C. 801(a)(1)(A).
July 8, 2003:
Letter from the Secretary of Veterans Affairs, Department
of Veterans Affairs, transmitting a draft of proposed
legislation to amend title 38, United States Code, to improve
benefits for Filipino veterans of World War II and survivors of
such veterans and extend health care benefits to certain
Filipino veterans residing legally in the United States.
July 8, 2003:
Letter from the Under Secretary, Department of Defense,
transmitting the biennial report on the Montgomery GI Bill for
Members of the Selected Reserve.
July 15, 2003:
Letter from the Deputy General Counsel, Department of
Veterans Affairs, transmitting the Department's final rule--
Recognition of Organizations and Accreditation of
Representatives, Attorneys, and Agents (RIN: 2900-AI93)
Received July 7, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
July 24, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Presumption of Service Connection for Cirrhosis of
the Liver in Former Prisoners of War (RIN: 2900-AL36) Received
July 21, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
July 24, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Increase in Rates Payable Under the Montgomery GI
Bill--Selected Reserve (RIN:2900-AL41) Received July 21, 2003,
pursuant to 5 U.S.C. 801(a)(1)(A).
July 24, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Medication Prescribed by Non-VA Physicians (RIN:
2900-AL68) Received July 23, 2003, pursuant to 5 U.S.C.
801(a)(1)(A).
July 25, 2003:
Letter from the Secretary, Department of Veterans Affairs,
transmitting a draft of proposed legislation relating to
amending title 38 of the United States Code to modify and
improve authorities relating to former prisoners of war.
July 25, 2003:
Letter from the Secretary, Department of Veterans Affairs,
transmitting a draft bill ``To amend title 38, United States
Code, to simplify and improve pay provisions for physicians and
dentists, to authorize alternate work schedules and executive
pay for nurses''.
Sept. 9, 2003:
Letter from the Director, Regulations Management,
Department of Veteran's Affairs, transmitting the Department's
final rule--Effective Dates of Benefits for Disability or Death
Caused By Herbicide Exposure; Disposition of Unpaid Benefits
After Death of Beneficiary (RIN: 2900-AL37) Received August 26,
2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Sept. 9, 2003:
Letter from the Secretary, Department of Veterans Affairs,
transmitting a draft bill, ``To amend title 38, United States
Code, to enhance the ability of the Department of Veterans
Affairs to care for veterans, and for other purposes''.
Sept. 10, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Schedule for Rating Disabilities; The Spine (RIN:
2900-AJ60) Received September 2, 2003, pursuant to 5 U.S.C.
801(a)(1)(A).
Sept. 15, 2003:
Letter from the Secretaries, Departments of Health and
Human Services, Defense and Veterans Affairs, transmitting a
report entitled ``Report to Congress on Accounting for VA and
DoD Expenditures for Medicare Beneficiaries''.
Sept. 25, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Board of Veterans' Appeals: Rules of Practice--
Motions for Revision of Decisions on Grounds of Dear and
Unmistakable Error: Advancement on the Docket (RIN: 2900-AJ85)
Received September 23, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Sept. 25, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Board of Veterans' Appeals: Speeding Appellate
Review for Aging Veterans (RIN: 2900-AL08) Received September
23, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Sept. 25, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--VA Homeless Providers Grant and Per Diem Program
(RIN: 2900-AL30) Received September 24, 2003, pursuant to 5
U.S.C. 801(a)(1)(A).
Sept. 25, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Eligibility for an Appropriate Government Marker
for a Grave Already Marked at Private Expense (RIN: 2900-AL40)
Received September 24, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Sept. 25, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Compensation and Pension Provisions of the Veterans
Benefits Act of 2002 (RIN: 2900-AL62) Received September 24,
2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Oct. 24, 2003:
Letter from the Secretary, Department of Veterans Affairs,
transmitting a draft bill, ``To amend title 38, United States
Code, to strengthen the ability of the Secretary of Veterans
Affairs to manage Veterans Health Administration medical
personnel effectively, and for other purposes''.
Oct. 29, 2003:
Letter from the Director, Regulations Management, Office of
Regulation Policy and Management, Department of Veterans
Affairs, transmitting the Department's final rule--Exclusions
from Income and Net Worth Computations (RIN: 2900-AJ52)
Received October 27, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Oct. 29, 2003:
Letter from the Director, Regulations Management, Office of
Regulation Policy and Management, Department of Veterans
Affairs, transmitting the Department's final rule--Co-payments
for Inpatient Hospital Care Provided to Veterans Enrolled in
Priority Category 7 (RIN: 2900-AL35) Received October 27, 2003,
pursuant to 5 U.S.C. 801(a)(1)(A).
Oct. 29, 2003:
Letter from the Director, Regulations Management, Office of
Regulation Policy and Management, Department of Veterans
Affairs, transmitting the Department's final rule--Veterans
Education: Independent Study Approved for Certificate Programs
and Other Miscellaneous Issues (RIN: 2900-AL34) Received
October 16, 2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Oct. 29, 2003:
Letter from the Director, Regulations Management, Office of
Regulation Policy and Management, Department of Veterans
Affairs, transmitting the Department's final rule--Disease
Associated with Exposure to Certain Herbicide Agents: Chronic
Lymphocytic Leukemia (RIN: 2900-AL55) Received October 16,
2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Nov. 21, 2003:
Letter from the Secretary, Department of Veterans Affairs,
transmitting a draft bill, ``To amend title 38, United States
Code, to improve veterans' benefits programs, and for other
purposes''.
Nov. 25, 2003:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Accelerated Payments Under the Montgomery GI Bill--
Active Duty Program (RIN: 2900-AL22) Received June 12, 2003,
pursuant to 5 U.S.C. 801(a)(1)(A).
Nov. 25, 2003:
Letter from the Director, Office of Regulation Policy and
Management, Veterans Benefits Administration, Department of
Veterans Affairs, transmitting the Department's final rule--
Veterans Education: Increases Allowances for the Educational
Assistance Test Program (RIN: 2900-AL52) Received November 19,
2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Dec. 8, 2003:
Letter from the the National Adjutant, the Disabled
American Veterans, transmitting 2003 National Convention
Proceedings of The Disabled American Veterans, pursuant to 36
U.S.C. 90i and 44 U.S.C. 1332.
Dec. 8, 2003:
Letter from the Director, Regulations Management, Office of
Regulation Policy and Management, Department of Veterans
Affairs, transmitting the Department's final rule--Board of
Veterans' Appeals: Rules of Practice; Use of Supplemental
Statement of the Case (RIN: 2900-AL42) Received November 13,
2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Jan. 23, 2004:
Letter from the Director, Office of Personnel Management,
transmitting the Office's Fiscal Year 2002 annual report on
Veteran's Employment in the Federal Government, pursuant to 38
U.S.C. 4214(e)(1).
Jan. 27, 2004:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Reasonable Charges for Medical Care or Services;
2003 Methodology Changes (RIN: 2900-AL06) Received December 15,
2003, pursuant to 5 U.S.C. 801(a)(1)(A).
Jan. 30, 2004:
Letter from the Secretary, Department of Veterans Affairs,
transmitting the Special Medical Advisory Group's Annual Report
to Congress for FY 2003, pursuant to 38 U.S.C. 4112(a).
Feb. 4, 2004:
Letter from the The American Legion, transmitting the
financial statement and independent audit of The American
Legion proceedings of the 85th annual National Convention of
The American Legion, held in St. Louis, Missouri from August
26, 27, and 28, 2003 and a report on the Organization's
activities for the year preceding the Convention, pursuant to
36 U.S.C. 49.
Feb. 10, 2004:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Charges Used for Recovery from Tortuously Liable
Third Parties for Medical Care or Services Provided by the
Department of Veterans Affairs (RIN: 2900-AL48) Received
January 8, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).
Mar. 12, 2004:
Letter from the Director, Regulations Management, Office of
Regulation, Policy, and Management, Department of Veterans
Affairs, transmitting the Department's final rule--Delegation
of Authority--Property Management Contractor (RIN: 2900-AL85)
Received March 4, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).
Mar. 16, 2004:
Letter from the Director, Regulations Management, National
Cemetery Administration, Department of Veterans Affairs,
transmitting the Department's final rule--Eligibility for an
Appropriate Government Marker for a Grave Already Marked at
Private Expense (RIN: 2900-AL40) Received March 8, 2004,
pursuant to 5 U.S.C. 801(a)(1)(A).
Mar. 25, 2004:
Letter from the Assistant Secretary for Health Affairs,
Department of Defense, transmitting notice of a delayed
delivery date for the final VA/DoD Joint Assessment Study, as
required by Section 8147 of the Department of Defense
Appropriations Act for FY 2002.
Mar. 30, 2004:
Letter from the General Counsel, Department of Defense,
transmitting the Department's legislative initiatives for
inclusion in the National Defense Authorization Act for FY
2005.
Apr. 21, 2004:
Letter from the Secretary, Department of Veterans Affairs,
transmitting a report covering those cases in which equitable
relief was granted in calendar year 2003, pursuant to 38 U.S.C.
503(c).
Apr. 22, 2004:
Letter from the Secretary, Department of Labor,
transmitting the first report of the President's National Hire
Veterans Committee, pursuant to 38 U.S.C. 4100 Note.
Apr. 26, 2004:
Letter from the Director, Regulations Management, Office of
Regulation, Policy and Management, Department of Veterans
Affairs, transmitting the Department's final rule--Board of
Veterans' Appeals: Rules of Practice--Notice Procedures
Relating to Withdrawal of Services by a Representative (RIN:
2900-AL45) Received April 19, 2004, pursuant to 5 U.S.C.
801(a)(1)(A).
May 5, 2004:
Letter from the Director, Regulations Management, National
Cemetery Administration, Department of Veterans Affairs,
transmitting the Department's final rule--State Cemetery Grants
(RIN: 2900-AH46) Received April 9, 2004, pursuant to 5 U.S.C.
801(a)(1)(A).
May 5, 2004:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Board of Veterans' Appeals: Rules of Practice--
Medical Opinions From the Veterans Health Administration (RIN:
2900-A K52) Received April 15, 2004, pursuant to 5 U.S.C.
801(a)(1)(A).
May 20, 2004:
Letter from the Secretary, Department of Veterans Affairs,
transmitting the Department's Capital Asset Realignment for
Enhanced Services (CARES) Decision, pursuant to Public Law 108-
170, Section 222.
June 9, 2004:
Letter from the Chairman, Board of Veterans' Appeals,
Department of Veterans Affairs, transmitting a copy of the
Report of the Chairman for FY 2003.
June 17, 2004;
Letter from the Secretaries, Departments of Defense and
Veterans Affairs, transmitting a report for FY 2003 regarding
the implementation of the health coordination and sharing
activities portion of the National Defense Authorization Act of
2003 (Pub. L. 107-314) and an estimate of the cost to prepare
this report, as required by Title 38, Chapter 1, Section 116,
pursuant to 38 U.S.C. 8111(f).
July 7, 2004:
Letter from the Director, Regulations Management, Veterans
Health Administration, Department of Veterans Affairs,
transmitting the Department's final rule--VA Homeless Providers
Grant and Per Diem Program; Religious Organizations (RIN: 2900-
AL63) Received June 7, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).
July 7, 2004:
Letter from the Director, Regulations Management,
Department of Veterans Affairs, transmitting the Department's
final rule--Board of Veterans' Appeals: Rules of Practice--
Motions for Revision of Decision on Grounds of Clear and
Unmistakable Error: Advancement on the Docket (RIN: 2900-AJ85)
Received May 27, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).
July 7, 2004:
Letter from the Director, Regulations Management, Veterans
Health Administration, Department of Veterans Affairs,
transmitting the Department's final rule--Sensori-Neural Aids
(RIN: 2900-AL60) Received June 16, 2004, pursuant to 5 U.S.C.
801(a)(1)(A).
July 7, 2004:
Letter from the Director, Regulations Management, Veterans
Health Administration, Department of Veterans Affairs,
transmitting the Department's final rule--Priorities for
Outpatient Medical Services and Inpatient Hospital Care (RIN:
2900-AL39). Received June 17, 2004, pursuant to 5 U.S.C.
801(a)(1)(A).
July 7, 2004:
Letter from the Director, Regulations Management, Veterans
Health Administration, Department of Veterans Affairs,
transmitting the Department's final rule--Change of Effective
Date of Rule Adding a Disease Associated With Exposure to
Certain Herbicide Agents: Type 2 Diabetes (RIN: 2900-AL93)
Received June 7, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).
July 9, 2004:
Letter from the Secretary, Department of Veterans Affairs,
transmitting a draft bill "To amend title 38, United States
Code, to improve the authorities of the Department of Veterans
Affairs relating to compensation, dependency and indemnity
compensation, life insurance benefits, memorial benefits, and
education benefits, and for other purposes''.
Sept. 13, 2004:
Letter from the Director, Regulations Management, Office of
Regulation Policy and Management, Veterans Benefits
Administration, Department of Veterans Affairs, transmitting
the Department's final rule--Additional Disability or Death Due
to Hospital Care, Medical or Surgical Treatment, Examination,
Training and Rehabilitation Services, or Compensated Work
Therapy Program (RIN: 2900-AK77) Received July 30, 2004,
pursuant to 5 U.S.C. 801(a)(1)(A).
Sept. 13, 2004:
Letter from the Director, Regulations Management, Office of
Regulation Policy and Management. Veterans Health
Administration, Department of Veterans Affairs, transmitting
the Department's final rule--Copayments for Extended Care
Services (RIN: 2900-AL49) Received June 28, 2004, pursuant to 5
U.S.C. 801(a)(1)(A).
Sept. 13, 2004
Letter from the Director, Regulations Management, Office of
Regulation Policy and Management, National Cemetery
Administration, Department of Veterans Affairs, transmitting
the Department's final rule--Eligibility for Burial in a
National Cemetery for Surviving Spouses Who Remarry and New
Philippine Scouts (RIN: 2900-AM00) Received June 28, 2004,
pursuant to 5 U.S.C. 801(a)(1)(A).
Sept. 29, 2004:
Letter from the Director, Regulations Management, Office of
Regulation Policy and Management, Department of Veterans
Affairs, transmitting the Department's final rule--Compensation
for Certain Cases of Bilateral Deafness (RIN: 2900-AL59)
Received August 6, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).
Oct. 5, 2004:
Letter from the Assistant Secretary of Defense for Health
Affairs and the Acting Under Secretary for Health, Departments
of Defense and Veterans Affairs, transmitting as required by
Section 8147 of the Department of Defense Appropriations Act
for FY 2002, the Findings and Recommendations from the
Department of Defense (DoD)/Department of Veterans Affairs (VA)
Joint Assessment Study.
Oct. 7, 2004:
Letter from the Director, Regulations Management, Office of
Regulation Policy and Management, Department of Veterans
Affairs, transmitting the Department's final rule--Board of
Veterans' Appeals: Obtaining Evidence and Curing Procedural
Defects (RIN: 2900-AL77) Received August 30, 2004, pursuant to
5 U.S.C. 801(a)(1)(A).
Oct. 8, 2004:
Letter from the Chief, Reg. Development Ofc. of Regulations
Policy & Mgt. VA, Department of Veterans Affairs, transmitting
the Department's final rule--Presumptions of Service Connection
for Diseases Associated with Service Involving Detention or
Internment as a Prisoner of War (RIN: 2900-AM09) Received
October 6, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).
Nov. 16, 2004:
Letter from the the National Adjutant, the Disabled
American Veterans, transmitting 2004 National Convention
Proceedings of The Disabled American Veterans, pursuant to 36
U.S.C. 90i and 44 U.S.C. 1332.
Nov. 19, 2004:
Letter from the Office of Regulation Policy & Mgt., VA,
Department of Veterans Affairs, transmitting the Department's
final rule--Increase in Rates Payable Under the Survivors' and
Dependents' Education Assistance Program (RIN: 2900-AL64)
Received October 22, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).
Nov. 19, 2004:
Letter from the Office of Regulation Policy & Mgt., VA,
Department of Veterans Affairs, transmitting the Department's
final rule--Veterans Education: Increased Allowances for the
Educational Assistance Test Program (RIN: 2900-AL81) Received
October 22, 2004, pursuant to 5 U.S.C. 801(a)(1)(A).
Nov. 19, 2004:
Letter from the Office of Regulation Policy & Mgt., VA,
Department of Veterans Affairs, transmitting the Department's
final rule--Increase in Rates Payable Under the Montgomery GI
Bill--Selected Reserve (RIN: 2900-AL80) Received October 22,
2004, pursuant to 5 U.S.C. 801(a)(1)(A).
Nov. 19, 2004:
Letter from the Office of Regulation Policy & Mgt., VA,
Department of Veterans Affairs, transmitting the Department's
final rule--Standards for Collection, Compromise, Suspension,
or Termination of Collection Effort, and Referral of Civil
Claims for Money or Property; Regional Office Committees on
Waivers and Compromises; Salary Offset Provisions; Delegations
of Authority (RIN: 2900-AK10) Received October 22, 2004,
pursuant to 5 U.S.C. 801(a)(A).
Nov. 19, 2004:
Letter from the Office of Regulation Policy & Mgt., VA,
Department of Veterans Affairs, transmitting the Department's
final rule--Waivers (RIN: 2900-AK29) Received October 22, 2004,
pursuant to 5 U.S.C. 801(a)(1)(A).
STATISTICAL DATA--WAR VETERANS AND DEPENDENTS
(As of September 2004)
American Revolution (1775-1783)
Total Servicemembers.............................................217,000
Battle Deaths......................................................4,435
Non-mortal Woundings...............................................6,188
Last Veteran, Daniel F. Bakeman, died April 5, 1869,.............age 109
Last Widow, Catherine S. Damon, died November, 11, 1906,..........age 92
Last Dependent, Phoebe M. Palmeter, died April 25, 1911,..........age 90
War of 1812 (1812-1815)
Total Servicemembers.............................................286,730
Battle Deaths......................................................2,260
Non-mortal Woundings...............................................4,505
Last Veteran, Hiram Cronk, died May 13, 1905,....................age 105
Last Widow, Carolina King, died June 28, 1936,...............age unknown
Last Dependent, Esther A.H. Morgan, died March 12, 1946,..........age 89
Indian Wars (approx. 1817-1898)
Total Servicemembers......................................\1\
106,000
Battle Deaths
...............................................\1\
1,000
Last Veteran, Fredrak Fraske, died June 18, 1973,................age 101
Mexican War (1846-1848)
Total Servicemembers..............................................78,718
Battle Deaths......................................................1,733
Other Deaths in Service...........................................11,550
Non-mortal Woundings...............................................4,152
Last Veteran, Owen Thomas Edgar, died September 3, 1929,..........age 98
Last Widow, Lena James Theobald, died June 20 1963,...............age 89
Last Dependent, Jesse G. Bivens, died November 1, 1962,...........age 94
Civil War (1861-1865)
Total Servicemembers (Union)...................................2,213,363
Battle Deaths (Union)............................................140,414
Other Deaths in Service (Union)..................................224,097
Non-mortal Woundings (Union).....................................281,881
Total Servicemembers (Confederate).............................1,050,000
Battle Deaths (Confederate).......................................74,524
Other Deaths in Service (Confederate)
......................\2\ 59,297
Non-mortal Woundings (Confederate)...............................Unknown
Last Union Veteran, Albert Woolson, died August 2, 1956,.........age 109
Last Confederate Veteran, John Salling, died March 16, 1958,.....age 112
Last Union Widow, Gertrude Janeway, died January 17, 2003,........age 93
Spanish-American War (1898-1902)
Total Servicemembers (Worldwide).................................306,760
Battle Deaths........................................................385
Other Deaths in Service............................................2,061
Non-mortal Woundings...............................................1,662
Last Veteran, Nathan E. Cook, died September 10, 1992,...........age 106
World War I (1917-1918)
Total Servicemembers (Worldwide)...............................4,734,991
Battle Deaths.....................................................53,402
Other Deaths in Service...........................................63,114
Non-mortal Woundings.............................................204,002
Living Veterans.................................\1\
Approximately 100
World War II (1940-1945)
Total Servicemembers (Worldwide)..............................16,112,566
Battle Deaths....................................................291,557
Other Deaths in Service..........................................113,842
Non-mortal Woundings.............................................671,846
Living Veterans.........................................\1\
3,984,200
Korean Conflict (1950-1953)
Total Servicemembers (worldwide)...............................5,720,000
Battle Deaths.....................................................33,741
Other Deaths (In theater)..........................................2,835
Other Deaths in Service...........................................17,670
Non-mortal Woundings.............................................103,284
Living veterans.........................................\1\
3,423,300
Vietnam Era (1964-1975)
Total Servicemembers (Worldwide)...............................9,200,000
Deployed to Southeast Asia.....................................3,403,000
Battle Deaths.....................................................47,415
Other Deaths (In Theater).........................................10,785
Other Deaths in Service......................................est. 32,000
Non-mortal Woundings.............................................153,303
Living Veterans.........................................\1\
8,122,000
Desert Shield/Desert Storm (1990-1991)
Total Servicemembers (Worldwide)...............................2,322,332
Deployed to Gulf.................................................694,550
Battle Deaths........................................................147
Other Deaths (In Theater)............................................235
Other Deaths in Service..............................................914
Non-mortal Woundings.................................................467
Living Veterans................................................1,900,000
War on Terrorism (2001-Present)
Total U.S. Servicemembers (Worldwide)..........................1,428,383
Deployed to Iraq & Afghanistan...................................185,329
Battle Deaths........................................................848
Other Deaths (In Theater)............................................341
Non-mortal Woundings...............................................5,828
Living Veterans...........................................\3\
194,700
America's Wars Total
Military Service During War...................................42,353,843
Battle Deaths....................................................651,254
Other Deaths (In Theater).........................................13,919
Other Deaths in Service (Non-Theater)............................524,545
Non-mortal Woundings...........................................1,434,076
Living War Veterans....................................\4\
16,522,400
Living Veterans...............................................24,737,500
------
Veterans and Dependents on the Compensation and Pension Rolls
(As of September 2004)
----------------------------------------------------------------------------------------------------------------
SURVIVING
VETERANS CHILDREN PARENTS SPOUSES
----------------------------------------------------------------------------------------------------------------
Civil War................................................... ........... 5 ........... ...........
Indian Wars................................................. ........... ........... ........... ...........
Spanish-American War........................................ ........... 150 ........... 192
Mexican Border.............................................. 5 23 ........... 101
World War I................................................. 26 4,486 1 11,773
World War II................................................ 506,399 16,818 429 247,296
Korean Conflict............................................. 236,628 3,646 674 62,292
Vietnam Era................................................. 1,028,022 11,133 4,358 138,204
Gulf War.................................................... 540,193 10,997 560 10,061
TOTAL WARTIME............................................... 2,898,599 51,757 7,681 503,760
Nonservice-connected........................................ 342,903 22,852 ........... 199,614
Service-connected........................................... 2,555,696 28,905 7,681 304,146
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Source: Department of Defense (DOD), except living veterans, which are VA estimates.
Periods of service used in Census data may differ slightly from those of DOD. For compensation and pension
purposes, the Gulf War period has not yet been terminated and includes those discharged from 1991 to date. The
living Gulf War veterans estimate is for the peak 1990-1991 period only.
``Other Deaths in Service'' is the number of servicemembers who died while on active duty, other than those
attributable to combat, regardless of the location or cause of death.
\1\ VA estimate as of September 30, 2004.
\2\ Does not include 26,000 to 31,000 who died in Union prisons.
\3\ VA estimate may include veterans who both served in Iraq and Afghanistan.
\4\ Unless otherwise indicated, estimates for living U.S. veterans are based on the 2000 Census, except for WWI,
which is based on the 1990 Census, the last census to include WWII figures. Dates for periods of service used
in census data may differ slightly from those of VA and DOD. The total Living War Veterans estimate is not a
cumulative of the individual war periods shown, as many veterans served in more than one war.